Do positive psychosocial work factors protect against two-year incidence of long-term sickness absence among employees with and those without depressive symptoms? A prospective study

Objective: This study sought to examine the influence of protective work factors on long-term sickness absence among employees reporting different levels of depressive symptoms in a representative sample of the Danish workforce. Methods: Questionnaire data were collected from a random sample of members of the Danish workforce aged between 18 and 64 years using information from two surveys with baselines in 2000 and 2005. From the year 2000 baseline, questionnaires from 5510 employees (2790 males and 2720 females) were included; from the 2005 baseline, questionnaires from 8393 employees (3931 males and 4462 females) were included. Baseline data were collected on depressive symptoms, leadership, colleague support, and decision latitude. Information on 2-year incidence of sickness absence was derived from an official register. Results: Stratified analyses on depressive symptom scores (none, moderate, and severe) indicate that quality of leadership was associated with reduced sickness absence to a somewhat stronger degree for those with moderate depressive symptoms (adjusted hazard ratio=0.88, 95% confidence interval=0.78-0.98) than for those without depressive symptoms and that high decision latitude was associated with reduced sickness absence to a somewhat larger degree for those without depressive symptoms (adjusted hazard ratio=0.91, 95% CI=0.85-0.97) than for those with depressive symptoms. However, quality of leadership and decision latitude did not interact significantly with depressive symptom status. Conclusions: Quality of leadership may protect against long-term sick leave to a certain degree in those with moderate depressive symptoms. Possible interactions between psychosocial working conditions and depression status should be investigated in larger populations

Overweight, obesity and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120,813 adults from 16 cohort studies from the USA and Europe

Background Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight. Methods We pooled individual-participant data for BMI and incident cardiometabolic multimorbidity from 16 prospective cohort studies from the USA and Europe. Participants included in the analyses were 35 years or older and had data available for BMI at baseline and for type 2 diabetes, coronary heart disease, and stroke at baseline and follow-up. We excluded participants with a diagnosis of diabetes, coronary heart disease, or stroke at or before study baseline. According to WHO recommendations, we classified BMI into categories of healthy (20·0–24·9 kg/m²), overweight (25·0–29·9 kg/m²), class I (mild) obesity (30·0–34·9 kg/m²), and class II and III (severe) obesity (≥35·0 kg/m²). We used an inclusive definition of underweight (<20 kg/m²) to achieve sufficient case numbers for analysis. The main outcome was cardiometabolic multimorbidity (ie, developing at least two from: type 2 diabetes, coronary heart disease, and stroke). Incident cardiometabolic multimorbidity was ascertained via resurvey or linkage to electronic medical records (including hospital admissions and death). We analysed data from each cohort separately using logistic regression and then pooled cohort-specific estimates using random-effects meta-analysis. Findings Participants were 120 813 adults (mean age 51·4 years, range 35–103; 71445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973–2012). During a mean follow-up of 10·7 years (1995–2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2·0, 95% CI 1·7–2·4; p<0·0001), almost five times higher for individuals with class I obesity (4·5, 3·5–5·8; p<0·0001), and almost 15 times higher for individuals with classes II and III obesity combined (14·5, 10·1–21·0; p<0·0001). This association was noted in men and women, young and old, and white and non-white participants, and was not dependent on the method of exposure assessment or outcome ascertainment. In analyses of different combinations of cardiometabolic conditions, odds ratios associated with classes II and III obesity were 2·2 (95% CI 1·9–2·6) for vascular disease only (coronary heart disease or stroke), 12·0 (8·1–17·9) for vascular disease followed by diabetes, 18·6 (16·6–20·9) for diabetes only, and 29·8 (21·7–40·8) for diabetes followed by vascular disease. Interpretation The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes

Long working hours as a risk factor for atrial fibrillation: A multi-cohort study

Aims Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (>55 per week) and those working standard 35-40 hours per week. Methods In this prospective multi-cohort study from the Individual-Participant-Data Meta-analysis in and results Working Populations (IPD-Work) Consortium, the study population was 85,494 working men and women (mean age 43.4 years) with no recorded atrial fibrillation. Working hours were assessed at study baseline (1991-2004). Mean follow-up for incident atrial fibrillation was 10 years and cases were defined using data on electrocardiograms, hospital records, drug reimbursement registers, and death certificates. We identified 1061 new cases of atrial fibrillation (10-year cumulative incidence 12.4 per 1000). After adjustment for age, sex and socioeconomic status, individuals working long hours had a 1.4-fold increased risk of atrial fibrillation compared to those working standard hours (hazard ratio=1.42, 95%CI=1.13-1.80, P=0.003). There was no significant heterogeneity between the cohortspecific effect estimates (I2=0%, P=0.66) and the finding remained after excluding participants with coronary heart disease or stroke at baseline or during the follow-up (N=2006, hazard ratio=1.36, 95%CI=1.05-1.76, P=0. 0180). Adjustment for potential confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association. Conclusion Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours

Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data

Background Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression. Methods We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individuallevel data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) consortium. Summary estimates of the association were obtained using random effects models. Individual-level data analyses were based on a pre-published study protocol (F1000Res 2013;2:233). Results We included 6 published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published (Relative Risk [RR]= 1.77, 95% confidence interval [CI] 1.47-2.13) and unpublished datasets (RR=1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR=1.25, 95% CI: 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR=1.03, 95% CI: 0.81- 1.32). Conclusion Job strain may precipitate clinical depression among employees. Future intervention studies

STUDY PROTOCOL: Examining the short term risk of sickness absence following shift work in a cohort study with register-based payroll data.

<p>Working in shifts or having irregular working hours is frequent. Shift work and in particular night shifts may increase the risk of disease. Further, studies suggest that shift workers have a higher level of sickness absence than day workers. However, research on the impact of shift work on the risk of sickness absence is sparse, and there is a need for high-quality research including detailed and precise information on shift work. The present study protocol describes the methods of two studies with the aims to study: a) if exposure to night shift prospectively predicts sickness absence of different durations and b) if working hour characteristics e.g. time of day and time between shifts predict sickness absence. </p><p>The study population is a subpopulation of the Danish Working Hour Database (DWHD); which is created from administrative payroll data of employees from the public sector within the five Danish administrative regions from the period 2007-2013. </p

Results of the effectiveness of mental health promotion interventions: Secondary outcomes.

Results of the effectiveness of mental health promotion interventions: Secondary outcomes.</p

Study protocol: effort-reward imbalance at work and risk of type 2 diabetes - a prospective study linking survey and register data

<div><b>Abstract</b><br></div><div><br></div><div><b>Background:</b> Diabetes is a growing public health concern. Psychosocial factors at work might be associated with an increased risk of developing type 2 diabetes. One hypothesised mechanism is stress stimulated cortisol release via the HPA-axis, where cortisol is involved in blood glucose regulation. High levels of blood glucose lead to secretion of insulin to the blood and if this continues, insulin resistance might develop, which is associated with the development of type 2 diabetes. Other possible pathways might be via associations of psychosocial work factors with 1) adverse health-related behaviour such as physical inactivity, and 2) psycho-physiological disturbances associated with overweight and metabolic changes. However, the current research on the relationship between psychosocial work factors and type 2 diabetes is inconclusive. <br></div><div><br></div><div><b>Objective:</b> This protocol describes the planned analyses for a study aiming to investigate the prospective association of effort-reward imbalance at work and its sub-dimensions with the risk of developing type 2 diabetes. <br></div><div><br></div><div><b>Methods:</b> The population under study is a sample of workers in Denmark from the biennial survey “Work Environment and Health in Denmark 2012-2020”. We include approximately 50,000 participants aged 30-64 years. The participants are linked to and followed in national registers. We will apply Cox proportional hazards models to study the prospective association of effort-reward imbalance with risk of type 2 diabetes with adjustment for a range of demographic and social determinants. <br></div><div><br></div><div><b>Discussion:</b> We expect that this study will expand the current knowledge about the potential impact of psychosocial work factors on the risk of developing type 2 diabetes. </div

Summary of quality appraisal results.

Summary of quality appraisal results.</p

Sample search strategy.

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Intervention characteristics of the included studies.

Intervention characteristics of the included studies.</p