The associations between workplace bullying, salivary cortisol, and long-term sickness absence: a longitudinal study.

BACKGROUND: Workplace stressors, such as bullying, are strongly related to subsequent long-term sickness absence, but little is known of the possible physiological mechanisms linking workplace stressors and sickness absence. The primary aim of this study was to investigate to what extent cortisol levels were associated with subsequent sickness absence and if cortisol mediated the association between workplace bullying and sickness absence. We additionally investigated possible bidirectional associations between bullying, cortisol, and long-term sickness absence. METHODS: Participants came from two Danish cohort studies, the "Psychosocial RIsk factors for Stress and MEntal disease" (PRISME) cohort and the "Workplace Bullying and Harassment" (WBH) cohort (n = 5418). Information about exposure to workplace bullying and morning and evening salivary cortisol was collected at three time points with approximately two years in between. After each data collection, all participants were followed for two years in registers, and cases with long-term sickness absence lasting 30 or more consecutive days were identified. The association between cortisol levels and subsequent sickness absence was assessed by logistic regression, while the extent to which the association between bullying and sickness absence was mediated by cortisol was quantified through natural direct and indirect effects. RESULTS: High evening cortisol was associated with a decreased risk of sickness absence (OR = 0.82, 95% CI = 0.68-0.99), but we did not find that high morning cortisol levels (OR = 0.98, 95% CI = 0.81-1.18) or high morning-to-evening slope (OR = 0.99, 95% CI = 0.82-1.18) were associated with subsequent sickness absence. We also tested for reverse causation and found that long-term sickness absence, but not salivary cortisol, was a strong risk factor for subsequent workplace bullying. There was no indication that cortisol mediated the association between workplace bullying and sickness absence. CONCLUSION: We found no straightforward and simple association between cortisol and long-term sickness absence. Furthermore, the association between workplace bullying and long-term sickness absence was not mediated by cortisol.

Relationship Between Changes in Workplace Bullying Status and the Reporting of Personality Characteristics.

OBJECTIVE: To examine whether a shift in work-related bullying status, from being non-bullied to being bullied or vice versa, was associated with changes in reporting of personality characteristics. METHODS: Data on bullying and personality (neuroticism, extraversion, and sense of coherence) were collected in three waves approximately 2 years apart (N = 4947). Using a within-subjects design, personality change scores that followed altered bullying status were evaluated with one-sample t tests. Sensitivity analyses targeted depressive symptoms. RESULTS: Shifts from non-bullied to frequently bullied were associated with increased neuroticism or decreased sense of coherence manageability scores. Shifts from bullied to non-bullied were associated with decreasing neuroticism and increasing extraversion scores, or increasing sense of coherence meaningfulness and comprehensibility scores. Excluding depressive cases had minor effects. CONCLUSIONS: Bullying seems to some extent to affect personality scale scores, which thus seem sensitive to environmental and social circumstances.

Negative Acts at Work as Potential Bullying Behavior and Depression: Examining the Direction of the Association in a 2-Year Follow-Up Study.

OBJECTIVE: This study investigates the 2-year prospective association between exposure to negative acts at work and depression. METHODS: A questionnaire study was carried out among 3363 employees and followed up 2 years later. Negative acts as potential bullying behavior were assessed by the Revised Negative Acts Questionnaire and depression by The Major Depression Inventory or Schedule for Clinical Assessment in Neuropsychiatry interviews. Logistic regression analyses tested potential associations between depression and negative acts. RESULTS: Exposure to negative acts was associated with depression 2 years later; however, when adjusting for Sense of Coherence and depressive symptoms at baseline the association was no longer significant. Conversely, depression at baseline predicted self-reported exposure to negative acts at follow-up. CONCLUSIONS: Depression predicts exposure to negative acts at a 2-year follow-up, whereas negative acts do not predict depression after adjustment for Sense of Coherence and baseline depressive symptoms.

Workplace bullying, sleep problems and leisure-time physical activity: a prospective cohort study.

OBJECTIVES: Workplace bullying is a potent stressor that may increase sleep problems. Since physical fitness improves resilience to stress, it seems plausible that recreational physical activities may moderate the association between bullying and sleep. The study aimed to examine prospectively whether (i) bullying increases the risk of sleep problems, and (ii) the association between bullying and sleep problems is moderated by leisure-time physical activity (LTPA). METHODS: The study sample comprised a cohort of public and private sector employees, who were enrolled into the Work Bullying and Harassment (WBH) cohort (N=3278) or the Psychosocial Risk Factors for Stress and Mental Disease (PRISME) cohort (N=4455). We measured workplace bullying using one question that was preceded by a definition of bullying. We used the Karolinska sleep questionnaire to assess sleep problems. The number of hours per week spent on LTPA estimated the degree of physical activity. RESULTS: Workplace bullying at baseline (T1) was associated with awakening problems and lack of restful sleep at follow-up (T2) but not with overall sleep problems and disturbed sleep. T1-LTPA did not moderate the association between T1-workplace bullying and T2-sleep problems. CONCLUSION: We found support that workplace bullying is related to development of T2-sleep problems, but this association seems not to be modified by LTPA.

Health correlates of workplace bullying: a 3-wave prospective follow-up study.

OBJECTIVE: This study aimed to examine the course of workplace bullying and health correlates among Danish employees across a four-year period. METHODS: In total, 7502 public service and private sector employees participated in a 3-wave study from 2006 through 2011. Workplace bullying over the past 6-12 months and data on health characteristics were obtained by self-reports. We identified major depression using Schedules for Clinical Assessment in Neuropsychiatry interviews and the Major Depression Inventory. We performed cross-sectional and longitudinal analyses of outcomes according to self-labelled bullying at baseline using logistic regression. RESULTS: Reports of bullying were persistent across four years in 22.2% (57/257) of employees who initially reported bullying. Baseline associations between self-labelled bullying and sick-listing, poor self-rated health, poor sleep, and depressive symptoms were significant with adjusted odds ratios (OR) ranging from 1.8 [95% confidence interval (95% CI) 1.5-2.4] for poor sleep quality among those bullied "now and then" to 6.9 (95% CI 3.9-12.3) for depression among those reporting being bullied on a daily to monthly basis. In longitudinal analyses adjusting for bullying during follow-up, all health correlates except poor sleep quality persisted up to four years. CONCLUSION: Self-reported health correlates of workplace bullying including sick-listing, poor self-rated health, depressive symptoms, and a diagnosis of depression tend to persist for several years regardless of whether bullying is discontinued or not. Independent measures of bullying and outcomes are needed to learn whether these findings reflect long lasting health consequences of workplace bullying or whether self-labelled workplace bullying and health complaints are correlated because of common underlying factors.

Are changes in workplace bullying status related to changes in salivary cortisol? A longitudinal study among Danish employees.

OBJECTIVES: This study aims to investigate whether incident workplace bullying and its dicontinuance is related to subsequent change in morning and evening saliva cortisol concentrations. METHODS: Participants came from two Danish cohort studies, the PRISME cohort (n=4489) and the Workplace Bullying and Harassment Cohort (n=3707). At baseline and follow-up exposure to bullying was measured by a single question on bullying (preceded by a definition). Two saliva samples to measure cortisol were collected during a work-day (30 min after awakening and at 8 p.m.). All participants responding to the item on workplace bullying, giving saliva samples and participated at both baseline and follow-up were included. The reference group consisted of non-bullied respondents at both baseline and follow-up. Multilevel mixed-effects linear regressions were used to test for changes in salivary cortisol after newly onset of and discontinuance of workplace bullying. All analyses were adjusted for the potentially confounding effect of differences from baseline to follow-up in education, smoking, alcohol consumption, body mass index, cohort, sampling waves, time of awakening, and time of sampling. RESULTS: We found no indication of statistically significant difference in saliva cortisol, neither when participants changed their self-labelling from not bullied at baseline to being bullied at follow-up, nor when they at follow-up two years later reported discontinuance of bullying. CONCLUSION: This longitudinal study on the impact of changes in bullying status on change in cortisol levels showed consistent lack of associations with onset and discontinuance of workplace bullying.

Exposure to workplace bullying and risk of depression.

OBJECTIVE: We examined the prospective association between self-labeled and witness-reported bullying and the risk of newly onset of depression. METHODS: Employees were recruited from two cohorts of 3196 and 2002 employees, respectively. Participants received a questionnaire at baseline in 2006 to 2007 with follow-up in 2008 to 2009 and 2011. New cases of depression were diagnosed in the follow-up using Schedules for Clinical Assessment in Neuropsychiatry interviews and the Major Depression Inventory questionnaire. RESULTS: We identified 147 new cases of depression. The odds ratio for newly onset depression among participants reporting bullying occasionally was 2.17 (95% confidence interval [CI]: 1.11 to 4.23) and among frequently bullied 9.63 (95% CI: 3.42 to 27.1). There was no association between percentage witnessing bullying and newly onset depression. CONCLUSIONS: Frequent self-labeled bullying predicts development of depression but a work environment with high proportion of employees witnessing bullying does not.

Painful heat attenuates electrically induced muscle pain in men and women.

Aabstract Background and purpose Women exhibit higher prevalence of most painful disorders. Several explanations have been proposed for this discrepancy, one being that endogenous pain modulatory pathways, which affect incoming nociceptive signals, act differently in men and women. A less efficient pain inhibitory system has been proposed as a contributing factor to explain why women exhibit higher prevalence of most painful disorders. The present study determined whether muscle pain, induced experimentally by electrical stimulation, is inhibited by a painful heat stimulus. This conditioned pain modulation (CPM) paradigm was used to determine whether women show signs of reduced inhibition compared to men. Methods Forty self-reported healthy individuals (20 female, 20 male) participated in a cross-over design with painful and non-painful heat as a conditioning stimulus. Test stimuli were painful intramuscular electrical stimulation of the tibialis anterior muscle at two intensities; low (1.1 × pain threshold) and high (1.6 × pain threshold). Painful conditioning was contact heat (45-49 ° C) to the contralateral forearm. Nonpainful conditioning was contact heat at 35 °C. Ten test stimuli were delivered in three blocks (before, during and after conditioning) in two sessions (painful and non-painful conditioning). The women were tested during days 12-14 of the menstrual cycle. This interval corresponds to the ovulatory phase of the menstrual cycle, the interval during which women are reported to show the largest inhibitory effects. Results Test stimuli were rated significantly lower during painful conditioning, compared with before conditioning. This was found for both low and high test stimulus intensities. Anonspecific attenuation was seen during non-painful conditioning for the low test stimulus intensity. Test stimuli were rated significantly lower also 3 min after conditioning, compared with before conditioning. The inhibitory effects were not different between men and women. Similar findings were obtained also if six non-CPM-responders (subjects rating test stimuli higher during conditioning than before conditioning) were excluded. Conclusions and implications The present findings indicate that painful contact heat inhibits electrically induced muscle pain and that inhibition was not different between men and women, when women were tested in the interval 12-14 days after their last menstruation. Some inhibition of muscle pain was seen during non-painful conditioning, indicating that nonspecific inhibitory effects were triggered. Also the nonspecific inhibitory effects were similar in men and women.