Job demands, health perception and sickness absence

BACKGROUND: Investigation of the relations between job demands, health and sickness absence is required to design a strategy for the prevention of absence and disability. AIM: To study the relationships between (physical and psychological) job demands, health perception and sickness absence. METHODS: Prospective study of 414 male employees working in two organizations with low company absence levels. Job demands and health were examined using the Basic Occupational Health Questionnaire. Sickness absence was followed for 1 year thereafter. The number of days and episodes of absence were counted. RESULTS: The questionnaires of 247 workers (60%) were suitable for statistical analysis. Physical job demands (r = 0.41; P <0.01) and, to a lesser extent, psychological job demands (r = 0.16; P = 0.01) were related to the number of health complaints. Short (1-7 days) duration absence was neither related to job demands nor to the number of health complaints. Longer (>7 days) duration absence was positively related to psychological job demands and to the number of health complaints. CONCLUSIONS: Job demands, particularly physical demands, correlated with perceived health. Poor health predicted long-term sickness absence. Early recognition of poor health should be the basis of a strategy that prevents long-term sickness absence.     

Occupational and social variation in subjective health complaints

OBJECTIVES: Occupational and social factors are thought to be important determinants of health inequality. The aim of this study was to examine the relationships between occupation, lifestyle and subjective health complaints (SHC). METHODS: SHC and self-reported sickness absence were recorded in a cross-sectional study of 662 individuals aged between 16 and 67 from five occupational groups: blue-collar, school/education, health service, white-collar and service. Differences in SHC and sickness absence were investigated. A model of sociodemographic, lifestyle and work-related factors was tested to examine associations with SHC. RESULTS: Few differences in SHC and sickness absence were found when educational level, age and gender were controlled for. Female health service workers did, however, show significantly higher prevalence of pseudoneurological complaints compared with white-collar workers. Male blue-collar workers had significantly higher frequency of sickness absence than white-collar workers; otherwise, there were no significant differences in frequency and duration of sickness absence. The model explained very little of the variance of SHC (R(2)(adj) = 0.15) and occupational group was not significantly associated with health. Physical workload and sleep quality showed significant relationships with SHC for both genders. Education, however, was a significant factor for women only. CONCLUSIONS: The differences in health found between major occupational groups in this sample were mainly explained by gender differences. Sociodemographic, lifestyle and work-related factors explained little of the variance in SHC, suggesting that factors such as psychological demands, perceived job stress, coping and other psychological factors might be of stronger importance for SHC.     

Variations in self-reported health by occupational grade in the British Post Office: the Q-health project

Between 1995 and 1998 a national sample of 58,501 (42,885 males, 15,616 females) Post Office employees (29%) completed and returned a postal questionnaire survey providing information on demographic characteristics, physical and psychological health, health and lifestyles and health screening behaviour. Response rates by occupational grade were as follows: manual (male 69.3%, females 43.6%); clerical (male = 11.8%, female, 42.3%); middle management (males 15.5%, females 10.7%) and senior management (males 3.4%, females 3.3%). A number of differences in health status occurred with occupational grade. Angina, high blood pressure, obesity, smoking, arthritis, disability, GP consultations and abnormal smears were all more prevalent in lower occupational grades. Height, job satisfaction, seat belt use and breast self-examination were also lower in lower status jobs. Some findings were unexpected: GHQ scores indicated better mental health in lower grades, whilst knowledge and frequency of testicular self-examination and attendance for mammograms were higher in lower grades. Self-reports for asthma, diabetes and family history of bowel cancer were also greater in higher grades. These findings are considered in terms of response bias, health selection, the psychosocial work environment, occupational health interventions and the nature, meaning and organization of social position within the Post Office.     

The relations between work demands and health complaints in lorry drivers

In this study, data of a questionnaire study among 439 lorry drivers were fitted to a model in which work demands and the worker's decision latitude are related to musculoskeletal complaints and general psychosomatic complaints. Structural analysis with LISREL was used to investigate the hypothesized relations. Two modifications resulted in a ² of overall fit equal to 77.35 with 47 degrees of freedom. The quality of model fit was considered to be satisfactory when the sample size was taken into account. The values of the Adjusted Goodness of Fit Index (0.948) and the Root Mean Square Residuals (0.029) indicated the same. The standardized solution of LISREL showed that work demands with respect to task contents were significantly related to musculoskeletal complaints as well as to general psychosomatic complaints (0.75 and 0.34 respectively, both P < 0.001). This conceptual variable was indicated by physical activities that the drivers had to perform. The relations between work-related psychosocial factors and musculoskeletal complaints were weak. Another significant effect on general psychosomatic complaints was found for work demands with respect to terms of employment (0.30, P < 0.001). This conceptual variable was indicated by variables concerning working hours and pressure of the work. It is recommended that in future occupational epidemiology, both physical and psychosocial aspects of the working situation be related to health effects, rather than solely a single exposure variable.     

Health complaints and sickness absence in Norway, 1996-2003

BACKGROUND: From 1996 to 2003, the total number of sickness absence days increased by 65% in Norway. AIM: To investigate if this could be explained by a corresponding increase in the prevalence of self-reported health complaints in the same period. METHODS: Representative samples of the Norwegian working population in 1996 (n = 838) and 2003 (n = 637) answered the subjective health complaints (SHC) questionnaire. The single items of the SHC questionnaire were matched with the corresponding sickness absence statistics from the National Insurance Administration in 1996 and 2003. RESULTS: The main finding was a poor concordance between the change in prevalence of health complaints and the change in the prevalence of sickness absence for diagnoses corresponding to these complaints. The prevalence of health complaints in Norway was high and relatively stable from 1996 to 2003. The only complaints that increased in prevalence during the period were allergy and severe asthma. Sickness absence for health complaints, however, showed a general increase. The diagnoses with the largest percentage increase in sickness absence were sleep problems, tiredness, anxiety and palpitation, although the absolute number of individuals with sickness absence for these complaints was small. CONCLUSIONS: The increased sickness absence in Norway from 1996 to 2003 cannot be explained by an increase in health complaints in the general population in the same period. The increase in sickness absence is most likely to be explained by multifactorial causes, such as changes in working life and health expectations.     

Relationship between job, lifestyle, age and occupational injuries

Background Physical job demands (PJD), age, disability and lifestylemay influence the risk of occupational injury. Aim To assess the relationships between PJD, lifestyle and injuryin workers of various ages. Methods A total of 2888 randomly selected workers from northeasternFrance, aged 15, completed a postal questionnaire. The PJD scorewas defined as the total number of the following reported jobdemands: using pneumatic tools, other vibrating hand tools,hammers, machine tools or vibrating platforms and exposure tomanual handling tasks, awkward postures, high pace of work,high physical workload, work at heights, work in adverse climatesor exposure to noise, cold or heat. Data were analysed usinglogistic regression. Results Nine per cent of subjects reported an injury duringthe previous 2 years. The PJD score was related to the injuryrate for workers aged 45: crude odds ratio (OR) 3.5 (95% confidenceinterval = 1.5–8.0) for PJD = 1, 5.0 (2.2–11.3)for PJD = 2–3 and 14.5 (6.5–32.2) for PJD 4, versusPJD = 0. Lower ORs were found for those aged <30 (1.4, 4.2and 9.9, respectively) and 30–44 (1.5, 4.4 and 6.5, respectively).The differences between age groups remained when controllingfor all factors studied. Obesity, smoking and musculoskeletaldisorders were associated with injury risk in workers aged 45(adjusted ORs 1.7–2.6). Smoking was also an injury riskfactor for workers aged <30. Conclusions PJD and lifestyle have a higher impact on injuryrates among older workers than among younger ones. Injury preventionshould address reducing PJD and improving relevant lifestylefactors, especially for older workers.     

Attitudes to job turnover among Finnish anaesthetists

Background Structural changes have led to higher workload andmore frequent conflicts among hospital staff, which in turnhas been shown to be associated with increased employee turnover. Aims To study the willingness of anaesthetists to change theiremployment and factors associated with it. Work-related, individualand family-related factors were investigated as potential influenceson such willingness. Method A postal questionnaire was sent to all working Finnishanaesthetists (N = 550). Results The response rate was 60%; 175 (53% of responders) weremen. Of the respondents, 31% were willing to consider changingto another physician's job and 43% to a profession other thanmedicine. The most important correlates for these views wereconflicts with superiors (odds ratio 6.1; 95% confidence interval2.1–17.7) and co-workers (4.2; 1.4–12.2), low jobcontrol (2.6; 1.4–4.9), a sense of organizational injustice(2.4; 1.3–4.6), stress (6.5; 2.6–16.3) and job dissatisfaction(4.6; 2.4–8.8). Conclusions The establishment of respect, trust and genuinedialogue between co-workers and superiors is needed to minimizethe risk of loss of members of this occupational group.     

The mental health of farmers

Farmers are subject to a number of unique occupational stressors, many of which have been aggravated in recent years by changes in farming practice and by economic factors. These are probably part of the explanation for the high rates of suicide in farmers and farm workers, which in the UK account for the largest number of suicides in any occupational group. Suicide is usually associated with mental illness, which, in farming communities, appears to be particularly stigmatized and poorly understood. This affects health-seeking behaviour, which is compounded by the geographical isolation and inaccessibility of many services in rural areas. Our current understanding of these issues suggests a number of potentially valuable interventions.     

A cross-sectional study of self-reported work conditions and psychiatric health in native Swedes and immigrants

Several studies have demonstrated that immigrants in Scandinaviancountries are more affected by psychosocial disabilities thanthe native-born population. The aim of the study was to evaluatethe possible impact of work-related stressors on psychiatrichealth in immigrants compared to native Swedes. The study includeda cluster selected cohort of 1,040 men born in 1944 (participationratio=79.9%), living in Gothenburg, Sweden. Of these, 182 (18.0%)were immigrants, defined as being born outside Sweden. Informationon work conditions and psychiatric health were obtained by self-administeredquestionnaires. Employment in native Swedes showed inverse associationsto frequent use of anxiolytics [relative risk (RR)=0.2; 95%confidence interval (Cl)=0.067ndash;0.4], frequent use of hypnotics(RR=0.1; Cl=0.02–0.2) and use of antidepressants (RR=0.3;Cl=0.2–0.5). None of the employed immigrants used anxiolyticsor hypnotics frequently. Swedes seemed to display a number ofpsychiatric ill-health factors related to working conditions.These factors included frequent use of hypnotics, frequent insomnia,use of antidepressants, a high degree of melancholy, and wererelated to shift work, dissatisfaction with current work andmanagement and a low degree of influence on work situation,often related to a high degree of stress at work and a frequentdesire to change type of work. These associations were not seenin immigrants, apart from the risk of frequent insomnia (RR=4.7;Cl=1.2–18.3) and dissatisfaction with colleagues (RR=10.4;Cl=2.27ndash;48.8) when working in shift. With a few exceptions,non-optimal working environment was associated with a low degreeof life satisfaction in both groups. It was hypothesized thatoptimal working conditions are important for maintaining psychiatrichealth, and that immigrants, when employed, seem less affectedby impaired working conditions than native Swedes.     

Medical aspects of expatriate health: health threats

The globalisation of business activity can lead to the movement of key employees and their dependants from country to country. In their host country these expatriates often face health hazards not experienced at home. This paper describes the range of health issues of relevance to expatriates.     

Different response alternatives in the assessment of job demands

Objectives The assessment of job demands, a pivotal concept in the study of work stress, is often problematic. Part of the problem is that people differ in their perception of whether a given task is overly demanding, or merely a welcome challenge. This study address this problem by examining alternative response formats for job demands that include the respondents’ appreciation of this aspect. Another job stress dimension known to be important for health, leadership, was used for comparison and the association with health measures were examined. Methods A professionally homogenous group of 105-white collar workers participated in the study. A questionnaire assessing two job characteristics, demand and leadership, was used with four alternative response formats. The selected items were taken from the General Nordic Questionnaire for Psychological and Social Factors at Work (the QPS_Nordic). Five indices from the SF-36 were used to reflect physical and mental health. Part correlations, taken from a multiple regression procedure were used to elucidate the unique contribution of response format in the association with health variables. Result For the assessment of Demand, response formats that tapped the employee’s experience of the demands performed best. This was in contrast to Leadership scales, where an alternative response format did not contribute any unique information. Conclusion Insofar as interventions are aimed at improving worker’s health, it seems reasonable to recommend that the workers should also be asked if the job demands are actually experienced as overly demanding.     

The intention to utilize occupational health services

Workers' intention to utilize the Occupational Health Service(OHS), conceived as a cost-benefit assessment of an action,is described for a series of conceivable situations. Data wereacquired during interviews with a sample of 313 employees withan over-representation of workers with work-related health problemsin three different companies. Only for problems that are perceivedas medical, individual and work-related, do a substantial numberof workers intend to utilize the occupational physician. Forhealth and work-related problems of a collective character,the line of supervision is mostly preferred for use as an adviser.Workers' intention to utilize OHS is positively correlated withtheir attitude towards the occupational physician. No associationswere found with self-reported health status, working environmentor actual utilization of the OHS. It is concluded that the intentionto utilize the OHS is an independent factor affecting the actualutilization and it should be seriously taken into considerationwhen evaluating or implementing the coverage by the OHS.     

Job satisfaction of health care staff employed at health centres in Turkey

The objective of the study was to identify job satisfaction levels and their causes among health care workers employed at public health centres. A survey was therefore carried out of health care workers in 21 health centres in Konya, Turkey. The Minnesota Satisfaction Questionnaire was used to investigate job satisfaction. The satisfaction score and proportion of those satisfied were determined according to demographic features. The percentage of satisfied health care workers was 60% and the satisfaction score was 3.8 +/- 0.5. Midwives had the lowest satisfaction scores. Working environment and income were the most important factors for dissatisfaction. There was no correlation between global satisfaction and other demographic variables. These results showed that the health care workers at public health centres in the province have low satisfaction scores. Improving working conditions and income may improve the overall quality of health care provision.     

Risk of health complaints and disabilities among Dutch firefighters

Objectives: The purpose of the present study was threefold: (1) to compare the work demands on firefighters (FFs) and office workers (OWs), (2) to compare the prevalence of health complaints and disabilities in the work situation in these two groups, and (3) to explore the effect of work demands on the risk of health complaints. Methods: Self-reported information was gathered from 1,624 FFs (55% response) and 630 OWs (80% response), at the same fire departments in different regions of the Netherlands, on work demands (sitting, and biomechanically and energetically demanding activities and 24-h shifts), health complaints and disabilities. First, we compared the work demands and prevalence rates of health complaints and related disabilities in the two groups, then we explored the risk of health complaints in workers with high and low exposure to work demands. Results: Compared with office workers, FFs reported: (1) less exposure to sitting and more to biomechanically and energetically demanding activities, (2) more knee (OWs 14% vs FFs 20%) and ankle (3% vs 10%) complaints and disabilities resulting from back complaints (30% vs 47%), and (3) less hypertension (7% vs 5%), stomach (13% vs 7%), heart (6% vs 2%), neck (26% vs 16%), shoulder (16% vs 14%) and arm (14% vs 6%) complaints. A higher risk of subjective fatigue was found in workers highly exposed to energetically demanding activities, and of neck, shoulder and arm complaints in workers highly exposed to sitting. Conclusions: Firefighters reported higher physical demands (with the exception of sitting) than office workers did. The prevalence rate of certain complaints or disabilities among FFs was higher (knee and ankle complaints and disabilities related to back complaints) or lower (hypertension, stomach, heart, neck, shoulder and arm complaints) than among OWs. The results suggest that exposure to highly biomechanically demanding activities might cause an increased risk of knee and ankle complaints and that exposure to highly energetically demanding activities might increase the risk of subjective fatigue.     

Doctors, their mental health and capacity for work

Background Information about doctors’ mental ill-healthis limited. This study looks at doctors’ careers followingmental illness and the strategies that helped them return towork. Aim To examine the effect of mental ill-health on doctors’careers. Methods Questionnaire survey of members of the Doctors SupportNetwork (DSN). The DSN is a peer support group for doctors whohave experienced, or are experiencing, mental ill-health. Results One hundred and sixteen doctors (35% response rate)returned completed questionnaires (n = 116, 63% female, 37%male). Prior to their ill-health, 80% worked full time, 15%part-time, 2% were not working and 3% were medical students.Following illness, 33% worked full time (P < 0.05), 36% part-time(P < 0.05) and 29% were not working (P < 0.01). Flexibleworking practices were the most helpful reported strategy forenabling a doctor to return to work. Conclusions Following mental ill-health, a doctor’s capacityto work full time is reduced. Most doctors return to full-timeor part-time work. With improved support, more doctors may beable to return to work.     

Psychosocial factors and psychosomatic complaints among postal workers

The aim with this cross-sectional study of postal workers in7 different occupations was to evaluate the correlations betweensome psychosocial factors and psychosomatic complaints. A sampleof 105 men and 38 women were given self-administered questionnaires.The questionnaires inquired about gastrointestinal complaints,sleep quality, psychological work demands, decision latitude,and social support at the workplace. The data were analysedby variance analysis (Anova), ²-test and stepwise multiple regression.In the group with the lowest psychological work demands, thehighest decision latitude, and the best social support, therewere few symptoms in comparison with the other groups. The findingsare consistent with the hypothesis that a poor psychosocialwork situation results in a higher report of psychosomatic complaints.Therefore, it is important to elucidate the causes of high frequencyof certain symptoms. This would be an important task for theoccupational health service, since psychosomatic symptoms mightbe an early indicator of work related problems.     

Psychosocial job adversity and health in Australia: analysis of data from the HILDA Survey

Objective: This study examines measures of psychosocial job quality developed from the Household Income and Labour Dynamics in Australia (HILDA) Survey, and reports on associations with physical and mental health. Methods: The study used seven waves of data from the HILDA Survey with 5,548 employed respondents. Longitudinal random‐intercept regression models assessed the association of time‐varying and between‐person measures of psychosocial job quality job adversity with physical and mental health. Results: Respondents’ specific experience of psychosocial job adversity, except marketability, was associated with increased risk of mental health problems, whereas the association between psychosocial job adversity and physical health was largely driven by differences between people. Conclusions and Implications: Moving into jobs with different psychosocial quality is associated with changes in mental health. In contrast, individuals with poor physical health show an increased propensity to work in poor‐quality jobs but it seems that changes in physical health are not as strongly tied to changes in job quality. Differences in the relationship between physical and mental health and psychosocial job quality have implications for the design of employment, health and social policy. The HILDA Survey is an important resource for policy development in Australia, and the availability of valid measures of psychosocial of job quality will enhance its use to better understand this important determinant and correlate of health.     

Adherence to mental health guidelines by Dutch occupational physicians

BACKGROUND: In 2000, the Dutch Association of Occupational Physicians published a national guideline for the management of employees with mental health problems. OBJECTIVES: To examine predictors of adherence to this guideline by Dutch occupational physicians (OPs). METHODS: Using the Theory of Planned Behaviour, a questionnaire was developed about self-reported guideline adherence of OPs and possible predictors of this behaviour. A total of 165 OPs were approached to complete the questionnaire and registration forms of first consultations of workers with mental health problems. Performance indicators based on the guideline were developed to calculate performance rates of guideline adherence by OPs. RESULTS: Eighty of 165 (48%) OPs approached completed the questionnaire. Fifty-six OPs returned one or more registration forms, totalling 344 consultations. On a five-point Likert scale, ranging from never (1) to always (5), the mean score on self-reported guideline adherence was 2.35, compared to a mean score of 4.06 on the intention to comply with the guideline. The mean performance rate of OPs ranging from 0 to 2 was 1.27 on diagnosis and 0.60 on guidance. No relation was found between self-reported guideline adherence and performance rates. Self-reported guideline adherence correlated significantly with perceived behaviour control (r = 0.48, P < 0.05), subjective norms (r = 0.33, P < 0.05) and positive job stress (r = 0.35, P < 0.05). CONCLUSIONS: Guideline adherence by Dutch OPs lags behind its acceptance. Further implementation efforts need to focus on diminishing barriers and enhancing social norms of OPs to work according to the guideline.     

Fitness for work: the need for conducting a job analysis

Ensuring that employees are both physically fit for work by matching their capabilities with the physical requirements of their job, and physically fit for life by promoting health-related physical activities, are important and under-utilized tools in a company's arsenal for reducing absence and ill-health retirement (IHR). Both the Health and Safety at Work Act (1974) and the Disability Discrimination Act (1995) require evidence-based approaches to setting physical and medical employment standards. Proven fitness-related strategies include redesigning the most demanding tasks, selecting and training personnel who possess the necessary physical attributes, and assessing and redeploying personnel to jobs within their capability. An essential precursor to pursuing these strategies is to conduct a job analysis to quantify the physical demands of the job.