Psychosocial work characteristics, recovery, and health-related outcomes in teaching

Occupational stress in teaching concerns not only teachers; it also impacts on wider social contexts. It may negatively affect teachers’ health, but also indirectly influence students’ health and their academic achievements. Yet, despite the challenges teacher stress and health problems pose for society, little research has examined and compared the relevance of different psychosocial work characteristics in predicting poor teacher health, or explored mechanisms that explain or moderate these associations in the teaching profession. This thesis examined the associations between different psychosocial work characteristics and health-related outcomes among Finnish teachers, as well as the potential explanatory (i.e., mediating) and moderating mechanisms for these associations. The data were gathered via self-report questionnaires and included a cross-sectional sample of primary school teachers from the Helsinki metropolitan area of Finland and a longitudinal sample of teachers in primary or secondary education from the prospective Finnish Public Sector study. Psychosocial work characteristics involved job strain, effort-reward imbalance, organizational injustice, and teacher-targeted violence. The health-related outcomes potentially associated with psychosocial work characteristics included depressive symptoms, burnout, and sleep problems. In addition, the extent to which different aspects of recovery explained the associations and the moderating role of organizational justice were examined. Psychosocial work characteristics in terms of effort-reward imbalance and, to a lesser extent, with regard to job strain, were found to be relevant predictors of poor health in teaching. Effort-reward imbalance was associated with higher levels of burnout and, compared with job strain and organizational injustice, this was the most important predictor of depressive symptoms. Job strain was associated particularly with impaired sleep. Although organizational injustice did not seem to be a major predictor of poor health, high organizational justice represented a valuable resource in the teachers’ psychosocial work environment. Encountering violence at work had the most pronounced effect on sleep among teachers working in relatively unjust conditions, whereas the sleep of those perceiving high organizational justice was not affected by violence. Some of the effects of psychosocial work characteristics on health were mediated through aspects of recovery; namely, through sleep and recovery experiences during leisure time. Non-restorative sleep partially explained both the association of job strain with depressive symptoms and the association of effort-reward imbalance with depressive symptoms and overall burnout score. Furthermore, the association between effort-reward imbalance and burnout was partially mediated through poor relaxation during leisure time. The indirect effects were relatively weak, suggesting that although poor recovery may partly mediate the association between psychosocial work characteristics and health-related outcomes in teaching, it does not play a major role in the process. For teachers in basic education, reducing the demanding aspects of the psychosocial work environment and increasing the rewarding elements, such as the respect and support they receive, may be important in occupational stress prevention. Furthermore, although preventive measures against teacher-targeted violence should be prioritized, resources aimed at promoting organizational justice in schools may also mitigate the adverse consequences of teacher victimization. Although improving teachers’ psychosocial work environment is probably the most important means of supporting their health, interventions that help teachers unwind after working hours and reduce sleep problems may further complement workplace development programs.Työstressin vaikutukset opetusalalla eivät rajoitu yksinomaan opettajiin vaan ne ulottuvat koskettamaan myös laajempaa ympäristöä. Opettajien työstressin ja terveysongelmien asettamista yhteiskunnallisista haasteista huolimatta verrattain vähän on toistaiseksi tutkittu sitä, mitkä opettajan työn psykososiaaliset tekijät ovat merkittävimmin yhteydessä heikentyneeseen terveyteen ja millaiset tekijät voivat selittää tai muovata tätä yhteyttä opettajan ammatissa. Tämä väitöskirja tarkastelee työssä psykososiaalista kuormitusta aiheuttavia tekijöitä (epätasapaino työn vaatimuksissa ja hallinnassa, ponnisteluiden ja palkkioiden epäsuhta, organisatorinen epäoikeudenmukaisuus ja opettajiin kohdistettu väkivalta) ja niiden yhteyksiä heikentyneeseen terveyteen (masennusoireet, työuupumus ja uniongelmat) suomalaisten opettajien keskuudessa. Lisäksi väitöskirja tarkastelee näitä yhteyksiä selittäviä ja muovaavia tekijöitä, kuten unta ja palautumista. Väitöskirjan aineisto koostuu pääkaupunkiseudun luokanopettajien työhyvinvointitutkimuksen yhteydessä kerätystä poikittaisaineistosta ja valtakunnallisen Kunta10 -tutkimuksen pitkittäisaineistosta. Tutkimukseen osallistuneet opettajat työskentelivät perusopetuksen piirissä. Koettu ponnisteluiden ja palkkioiden epäsuhta oli yhteydessä työuupumukseen ja verrattuna muihin tarkasteltuihin tekijöihin se ennusti merkittävimmin opettajien masennusoireita. Epätasapaino työn vaatimuksissa ja hallinnassa oli yhteydessä erityisesti opettajien uniongelmiin. Organisatorinen epäoikeudenmukaisuus ei tutkimuksen tulosten mukaan ollut merkittävä heikentyneen terveyden riskitekijä opetusalalla, mutta korkea oikeudenmukaisuus osoittautui tärkeäksi resurssiksi opettajien työympäristössä. Epäoikeudenmukaisessa työympäristössä väkivallan kohteeksi joutuminen kasvatti uniongelmien riskiä, kun taas oikeudenmukaisessa työympäristössä vastaavaa kohonnutta uniongelmien riskiä ei esiintynyt. Puutteet unen virkistävyydessä ja vapaa-ajan rentoutumisessa selittivät osittain joitain havaittuja yhteyksiä työn psykososiaalisten kuormitustekijöiden ja terveyden välillä. Nämä epäsuorat yhteydet olivat kuitenkin kohtalaisen heikkoja. Tämä viittaa siihen, että vaikka puutteellinen palautuminen voi osittain selittää työn psykososiaalisten kuormitustekijöiden ja heikentyneen terveyden välistä yhteyttä opettajien ammatissa, sillä ei ole merkittävää roolia tässä prosessissa. Perusopetuksessa työskentelevien opettajien työstressin ennaltaehkäisyssä olennaista vaikuttaisi olevan työn vaatimusten vähentäminen ja toisaalta työn palkitsevuuden kasvattaminen esimerkiksi lisäämällä opettajien saamaa tukea ja arvostusta. Vaikka opettajiin kohdistuvan väkivallan torjuminen tulee asettaa etusijalle, organisatorisen oikeudenmukaisuuden varmistaminen kouluissa voi osaltaan lieventää väkivallan haitallisia seurauksia opettajien keskuudessa. Opettajien työympäristön kehittämisen ohella interventiot, jotka edistävät vapaa-ajalla tapahtuvaa rentoutumista ja parantavat unen laatua, voivat olla hyödyksi opettajien terveyden tukemisessa

Organisatorinen epäoikeudenmukaisuus psykososiaalisena kuormitustekijänä

Tämän tutkimuksen avulla pyritään lisäämään tietoa siitä, kuinka oikeudenmukaisella johtamisella ja esimiestyöllä voidaan vaikuttaa työhyvinvointiin organisaatioissa. Tutkimuksen lähtökohtana on näkemys organisatorisesta epäoikeudenmukaisuudesta psykososiaalisena kuormitustekijänä, joka altistaa henkilön stressille ja työuupumuksen kehittymiselle. Tutkimuksessa analysoidaan tilastollisin menetelmin Työterveyslaitoksen ja Helsingin kauppakorkeakoulun alun perin vuonna 2007 toteuttaman "Henkilöstön työkyky ja yrityksen menestyminen" -kyselytutkimuksen aineistoa. Tutkimuksessa tarkastellaan sitä, ovatko kokemukset organisatorisesta oikeudenmukaisuudesta yhteydessä henkilöstön työhyvinvointia ja stressiä heijastavaan ilmiöön, työuupumukseen. Lisäksi tässä tutkimuksessa tarkastellaan sitä, toimiiko kokemus esimiehen tarjoamasta sosiaalisesta tuesta muovaavana eli moderoivana tekijänä koetun oikeudenmukaisuuden ja työuupumuksen välisessä suhteessa. Kokemus oikeudenmukaisuudesta osoittautui tutkimuksessa merkitseväksi työuupumuksen selittäjäksi siten, että epäoikeudenmukaisuutta kokevat henkilöt kokivat eniten työuupumusta. Hierarkkisen regressioanalyysin tuloksissa oikeudenmukaisuus selitti työuupumuksen vaihtelusta 17 %, kun demografiset taustamuuttujat oli kontrolloitu. Esimiehen tarjoamalla sosiaalisella tuella oli kuitenkin muovaava vaikutus oikeudenmukaisuuden ja työuupumuksen suhteeseen siten, että niiden henkilöiden joukossa, jotka kokivat saavansa esimieheltään paljon tukea, koettu oikeudenmukaisuus selitti enää ainoastaan 10 % työuupumuksen vaihtelusta. Epäoikeudenmukaisuus on tutkimuksen tulosten mukaan psykososiaalinen kuormitustekijä, joka altistaa epäoikeudenmukaisuutta kokevan henkilön työuupumukselle. Tämän lisäksi esimiehen tuen puute ei tutkimuksen tulosten mukaan vahvista epäoikeudenmukaisuuden kuormittavaa vaikutusta, mutta vahva esimiehen tuki sen sijaan toimii osittain suojaavana tekijänä epäoikeudenmukaisuuden negatiivisia seurauksia vastaan. Tutkimuksen tulokset viittaavat organisatorisen oikeudenmukaisuuden merkittävään asemaan organisaation jäsenten työhyvinvoinnin tukemisessa. Oikeudenmukainen johtaminen edistää henkilöstön hyvinvointia, kun taas epäoikeudenmukaiseksi koettu johtaminen altistaa henkilöstön stressille ja työpahoinvoinnille. Toimimalla alaisiaan tukevasti esimiehet voivat kuitenkin osittain ehkäistä tai ainakin vaimentaa epäoikeudenmukaisuuden haitallisia seurauksia organisaatiossa

General psychopathology factor and borderline personality disorder : Evidence for substantial overlap from two nationally representative surveys of U.S. adults

A general psychopathology factor reflects an underlying liability for a wide range of mental disorders. There is suggestive evidence that borderline personality disorder (BPD) may be strongly associated with the general psychopathology factor, but there are no detailed data on the degree of overlap between the general psychopathology factor and BPD or its individual symptoms. This study examined the overlap between the general psychopathology factor and BPD using cross-sectional survey data from two nationally representative samples of U.S. adults, the National Comorbidity Survey Replication (N = 5,692) and the National Comorbidity Survey follow-up (N = 5,001). Structural equation modeling was used to fit a bifactor general psychopathology model and to examine the general psychopathology factor's associations with (a) a series of Clusters A, B, and C personality disorder symptoms including BPD symptoms and (b) a latent BPD. Results showed that the shared variance between the general psychopathology factor and a latent BPD was 56% in the National Comorbidity Survey Replication and 71% in the National Comorbidity Survey follow-up. The correlation between the general factor and BPD could be set to unity without worsening model fit, suggesting that BPD closely reflects a general liability to psychopathology. The affective features of BPD were particularly strongly associated with the general psychopathology factor. Findings are discussed with respect to the nosology of BPD and the treatment of mental disorders.Peer reviewe

The Associations Between Mental Health Problems and Attitudes Toward Web-Based Health and Social Care Services : Evidence From a Finnish Population-Based Study

Background: The significance of web-based health and social care services has been highlighted in recent years. There is a risk that the digitalization of public services will reinforce the digital and social exclusion of vulnerable groups, such as individuals with mental health problems. Objective: This study aims to examine the associations between mental health problems and attitudes toward web-based health and social care services in the general population. The attitudes measured include lack of interest, perceived need for face-to-face encounters, and concern for safety. The study also evaluates whether sociodemographic characteristics (age, gender, education level, and poverty) modify these associations. Methods: Cross-sectional population-based data were collected from 4495 Finnish adults in 2017. Linear regression was used to examine the main effects and interactions of poor mental health and sociodemographic characteristics on attitudes toward web-based health and social care services. Results: The results show that mental health was associated with attitudes toward web-based health and social care services. Individuals with mental health problems were especially concerned about the safety of web-based services. Poor mental health was independently associated with negative attitudes toward web-based services over the effects of sociodemographic factors. Some of the associations between poor mental health and negative attitudes toward web-based services were stronger among older people and men. With regard to sociodemographic characteristics, particularly higher age, low education, and poverty were associated with negative attitudes toward web-based health and social care services. Conclusions: Poor mental health is associated with negative attitudes toward web-based health and social care services and thus indirectly with exclusion. It seems that being older and being male both reinforce the link between poor mental health and exclusion. In supporting the digital inclusion of people with mental health problems, attention should be paid to guidance and counseling, reliability, and the user-friendliness of web-based services as well as to the prevention of poverty. In addition, it is essential to see web-based services as complementary to, and not a substitute for, face-to-face services.Peer reviewe

The General Psychopathology Factor: Structural Stability and Generalizability to Within-Individual Changes

Objectives: Although cross-sectional investigations have found a bifactor structure of psychiatric comorbidity that includes a general psychopathology factor plus more specific factors, prospective evidence supporting the bifactor structure is still limited. We evaluated the structural stability (i.e., longitudinal invariance) of the bifactor model in comparison to an alternative structure, a correlated factors model without a general psychopathology factor. We also investigated the models’ generalizability to change processes in psychopathology. Methods: The analyses were conducted on 10-year follow-up data from 5,001 respondents in the US National Comorbidity Survey. Invariance was evaluated through a series of nested invariance tests using confirmatory factor analysis, and the models’ generalizability to change processes was investigated using change scores of disorder status. Results: The bifactor model and the correlated factors model exhibited an equal degree of strong structural stability over time. Only the bifactor model satisfactorily characterized the structure of temporal changes in psychopathology. Conclusions: The bifactor structure with a general psychopathology factor is stable over time and describes temporal changes in psychopathology. The findings support the notion that the general psychopathology factor describes a transdiagnostic etiology and may therefore provide a useful target for intervention and treatment.Peer reviewe

Health behaviors and psychological distress : changing associations between 1997 and 2016 in the United States

Objectives Smoking rates have declined with a slower pace among those with psychological distress compared to those without. We examined whether other health behaviors (heavy alcohol consumption, physical inactivity, short sleep duration) showed similar trends associated with sychological distress. We also examined differences by age and birth cohort. Methods Data were from the annually repeated cross-sectional U.S. National Health Interview Surveys (NHIS) of 1997-2016 (total n = 603,518). Psychological distress was assessed with the 6-item Kessler Psychological Distress Scale (K6). Results Psychological distress became more strongly associated with smoking (OR 1.09 per 10 years; 95% CI 1.07, 1.12), physical inactivity (OR 1.08; 1.05, 1.11), and short sleep (OR 1.12; 1.06, 1.18), but less strongly associated with heavy alcohol consumption (OR 0.93; 0.89, 0.98). The associations of smoking and alcohol consumption attenuated with age, whereas the association with physical inactivity strengthened with age. Compared to older birth cohorts, smoking became more strongly associated with psychological distress among younger birth cohorts up to those born in the 1980s. Conclusions The strength of associations between psychological distress and health behaviors may vary by time period, age, and birth cohort.Peer reviewe

Behavior change techniques to promote healthcare professionals' eHealth competency : A systematic review of interventions

Introduction: The use of eHealth is rapidly ->increasing; however, many healthcare professionals have insufficient eHealth competency. Consequently, interventions addressing eHealth competency might be useful in fostering the effective use of eHealth. Objective: Our systematic review aimed to identify and evaluate the behavior change techniques applied in interventions to promote healthcare professionals' eHealth competency. Methods: We conducted a systematic literature review following the Joanna Briggs Institute's Manual for Evidence Synthesis. Published quantitative studies were identified through screening PubMed, Embase, and CINAHL. Two reviewers independently performed full-text and quality assessment. Eligible interventions were targeted to any healthcare professional and aimed at promoting eHealth capability or motivation. We synthesized the interventions narratively using the Behavior Change Technique Taxonomy v1 and the COM-B model. Results: This review included 32 studies reporting 34 heterogeneous interventions that incorporated 29 different behavior change techniques. The interventions were most likely to improve the capability to use eHealth and less likely to enhance motivation toward using eHealth. The promising techniques to promote both capability and motivation were action planning and participatory approach. Information about colleagues' approval, emotional social support, monitoring emotions, restructuring or adding objects to the environment, and credible source are techniques worth further investigation. Conclusions: We found that interventions tended to focus on promoting capability, although motivation would be as crucial for competent eHealth performance. Our findings indicated that empathy, encouragement, and usercentered changes in the work environment could improve eHealth competency as a whole. Evidence-based techniques should be favored in the development of interventions, and further intervention research should focus on nurses and multifaceted competency required for using different eHealth systems and devices.Peer reviewe

The association between stress attributed to information systems and the experience of workplace aggression : a cross-sectional survey study among Finnish physicians

Publisher Copyright: © 2022, The Author(s).Background: Physicians commonly suffer from workplace aggression and its negative consequences. Previous studies have shown that stressors such as job demands increase the risk of inappropriate treatment at workplace. Poorly functioning, and constantly changing information systems form a major work stressor for physicians. The current study examined the association between physicians’ stress attributed to information systems (SAIS) and their experiences of workplace aggression. Workplace aggression covered physical and non-physical aggression, perpetrated by coworkers, patients, patient’s relatives, or supervisors. Methods: A cross-sectional survey study was conducted. The participants included 2786 physicians (67.4% women) who were sampled randomly from the registry of Finnish Medical Association, which covers almost all of the Finnish physician population. First, bivariate associations were studied among participant characteristics, SAIS and workplace aggression. Logistic regression analysis was then used to further determine how SAIS was associated with the likelihood of experiencing different types of aggression. Results: Higher levels of SAIS were associated with higher likelihood of aggression with regard to all types of aggression, except non-physical aggression perpetrated by patients or relatives. The demographic factors (work-sector, gender, age) did not have a noticeable influence on the association between SAIS and aggression. Conclusions: The present results build on previous evidence on the prevalence of SAIS and its negative effects on healthcare workers. Since SAIS may increase the risk of experiencing aggression, it is possible that SAIS also endangers the wellbeing of physicians and thereby the quality of patient care. Resourcing time and training during introduction of a new IS could alleviate time pressure and thus stress attributed to managing new information systems. The role of organizational climate and general workload in arousing SAIS and aggression should be examined in future studies.Peer reviewe

Psychotherapy and change in mental health-related work disability : a prospective Finnish population-level register-based study with a quasi-experimental design

Background Mental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based on small-scale randomised trials with relatively short follow-ups. We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety-related work disability. Methods We drew a nationally representative sample of the working-age population (aged 18-55 in 2010). The study group comprised all those who started rehabilitative psychotherapy in 2011-2014. A total of 10 436 participants who were followed from 3 years prior to 4 years after the onset of rehabilitative psychotherapy. This resulted in 83 488 observations. The annual total number of mental health-related work disability months (0 to 12) was calculated from the total number of annual compensated sickness absence and disability pension days. A quasi-experimental interrupted time series analysis was applied. Results The onset of rehabilitative psychotherapy marked a decline in work disability in comparison to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76 to 0.85) and a 48% decrease in the slope (IRR 0.52; 95% CI 0.50 to 0.54) of work disability were detected in comparison to the counterfactual scenario. No significant gender differences were observed. The decline in work disability was the steepest in the oldest age group. Conclusions This study suggests that statutory psychotherapy may decrease work disability at the population level. However, further evidence of causal inference and the potential heterogeneity of the association is required.Peer reviewe

Leaders' support for using online symptom checkers in Finnish primary care : Survey study

Online symptom checkers (SCs) are eHealth solutions that offer healthcare organizations the possibility to empower their patients to independently assess their symptoms. The successful implementation of eHealth solutions, such as SCs, requires a supportive organizational culture and leadership. However, there is limited knowledge about the factors associated with leaders' support for the use of SCs. The aim of the study was to identify the factors associated to primary care leaders' support for SCs in triage and their experiences of the benefits and challenges related to the use of SCs. An online survey was used to collect data from 84 Finnish primary care leaders. The data were analyzed using statistical analysis methods and content analysis. Vision clarity, perceiving efficiency improvements, and considering the service to be beneficial for patients were associated with leaders' support for the service (beta ranging from 0.41 to 0.44, p < 0.001). Leaders' support for the service was also associated with how well the leaders provided information about the service to their subordinates (beta =0.22, p < 0.048). SCs present slightly more challenges than benefits regarding health professionals' work. The developers of SCs should focus more on features that decrease health professionals' workload as well as how the solution can benefit patients.Peer reviewe