The associations of psychosocial work exposures with suicidal ideation in the national French SUMER study.

BACKGROUND: The literature remains scarce on the work-related risk factors for suicide and suicidal ideation. The objectives were to explore the associations of psychosocial work exposures with suicidal ideation in a nationally representative sample of the working population. METHODS: The study was based on the sample of 25,977 employees (14,682 men and 11,295 women) of the national French 2016-17 SUMER survey. The outcome was suicidal ideation assessed using the PHQ-9 instrument. Psychosocial work exposures included various factors from the job strain and effort-reward imbalance models, and other concepts. Statistical analyses were performed using weighted methods, including weighted logistic regression models. Other occupational exposures and covariates were considered. Gender differences were tested. RESULTS: The prevalence of suicidal ideation was 3.5 % without any difference between genders. Psychosocial work exposures were found to be associated with suicidal ideation. The strongest association was observed between workplace bullying and suicidal ideation. Associations were also found between job strain model factors, job insecurity, low esteem, work-family conflict, ethical conflict, teleworking, and low meaning, and suicidal ideation. The associations were in general similar for men and women. LIMITATIONS: The study had a cross-sectional design and no causal interpretation could be done. A reporting bias and a healthy worker effect may be suspected. CONCLUSION: Psychosocial work exposures played a major role in suicidal ideation. More research may be needed to confirm our results, as suicidal ideation is an important warning signal for suicide prevention. More primary prevention towards the psychosocial work environment may be useful to reduce suicidal ideation at the workplace.

The overall fractions of coronary heart diseases and depression attributable to multiple dependent psychosocial work factors in Europe.

OBJECTIVES: The literature is nonexistent on the assessment of overall fractions of diseases attributable to multiple dependent psychosocial work factors. The objectives of the study were to calculate the overall fractions of coronary heart diseases (CHD) and depression attributable to multiple dependent psychosocial work factors in 35 European countries. METHODS: We used already published fractions of CHD and depression attributable to each of the following psychosocial work factors: job strain, effort-reward imbalance, job insecurity, long working hours, and workplace bullying. We took all exposures and their correlations into account to calculate overall attributable fractions. Wald tests were performed to test differences in these overall attributable fractions between genders and between countries. RESULTS: The overall fractions of CHD and depression attributable to all studied psychosocial work factors together were found to be 8.1% [95% CI: 2.0-13.9] and 26.3% [95% CI: 16.2-35.5] respectively in the 35 European countries. There was no difference between genders and between countries. CONCLUSION: Our study showed that the overall fractions attributable to all studied psychosocial work factors were substantial especially for depression. These overall attributable fractions may be particularly useful to evaluate the burden and costs attributable to psychosocial work factors, and also to inform policies makers at European level.

Prospective associations of psychosocial work factors with sickness absence spells and duration: Results from the French national working conditions survey.

BACKGROUND: Some psychosocial work factors are associated with sickness absence, however little information is available on the associations of various psychosocial work factors and multiple exposures with sickness absence spells and duration, and gender differences. METHODS: Data were from the French working conditions survey conducted on a nationally representative sample of the working population. The study sample included 17,437 employees (7292 men, 10,145 women) followed from 2013 to 2016 and/or from 2016 to 2019. Occupational exposures (20 psychosocial work factors, 4 working time/hours factors, 4 physical work exposures) were measured at the beginning of each follow-up period. Hurdle and multinomial models were used to study the associations with the number of days and spells of sickness absence. RESULTS: Most of the psychosocial work factors predicted the risk of at least 1 day of sickness absence. Stronger associations were found among women than men for some factors. Psychosocial work factors were more likely to predict the number of spells than the number of days of sickness absence. Some physical work exposures predicted sickness absence spells and days, whereas shift work in women predicted the risk of at least 1 day of sickness absence. Dose-response associations were found between multiple psychosocial work exposures and sickness absence spells, and between multiple physical exposures and sickness absence spells and days. CONCLUSION: Comprehensive prevention policies oriented toward the whole psychosocial and physical work environment should be useful to reduce sickness absence among men and women.

Exploring the employment determinants of job insecurity in the French working population: Evidence from national survey data.

Studies are lacking on the employment determinants of job insecurity, that may be helpful to determine highly exposed groups and to assess the feasibility of constructing job-exposure matrices (JEMs) for this occupational exposure. The objectives were to explore the employment determinants of job insecurity in a nationally representative sample of the French working population. The study was based on the cross-sectional data of the 2013 national French working conditions survey including a sample of 28,293 employees, 12,283 men and 16,010 women. Job insecurity was assessed using one single item related to the fear of job loss in the next 12 months. Gender, age, and educational level were studied as well as the following employment variables: temporary/permanent work contract, full/part time work, job seniority, occupation, economic activity of the company, public/private sector, and company size. The associations with job insecurity were studied using bivariate and multivariate analyses. One quarter of the study sample was exposed to job insecurity, without any difference between genders. Lower age and lower educational levels were associated with job insecurity. Employees who had a temporary work contract, lower job seniority, who were working in low-skilled occupational groups, in manufacturing (for both genders) and construction (among men), and in the private sector had a higher prevalence of exposure to job insecurity. The two major employment variables associated with job insecurity were temporary work contract (prevalence ratios>2) and private sector (prevalence ratios>1.4) for the whole sample and for both men and women. Our findings suggested that intervention/prevention measures could be oriented towards specific highly exposed groups of the working population, especially those exposed to temporary work contract and/or working in the private sector. Our study also underlined that constructing JEMs for job insecurity may be possible and could be a useful tool for large-scale occupational health studies.

Study of the variation of the 12-month prevalence of exposure to workplace bullying across national French working population subgroups.

OBJECTIVES: The studies are lacking on the variation of the prevalence of exposure to workplace bullying according to subgroups of national working populations. The objectives were to assess the 12-month prevalence of bullying in the national French working population, to describe the reported reasons for bullying, and to study its variation according to various employment variables. METHODS: The study was based on the data of the 2013 national French working conditions survey. The study sample included 25,769 employees aged 15-65 working in the same job within the last 12 months. The 12-month prevalence of bullying was assessed using a 9-item questionnaire. Employment variables included: occupation, economic activity of the company, public/private sector, company size, permanent/temporary work contract, and full/part-time work. The analyses were performed using statistical methods for weighted survey data. RESULTS: The 12-month prevalence of bullying was 26.7% and 28.7% for men and women, respectively. The most prevalent forms of bullying were criticisms, exclusion, and deprivation of right of expression. The leading reasons for being bullied were related to occupation, age, and gender. The prevalence of bullying was higher among the younger employees, the employees working in medium/large companies (including the public sector), and among employees working full time. Though significant, the variations according to occupations and economic activities of the company were small. CONCLUSION: Workplace bullying appeared as a widespread phenomenon in France. More attention should be given to young employees and the employees working in medium/large companies. Preventive measures should also target the whole working population comprehensively.

Employment Factors Associated With Long Working Hours in France.

The objectives of the study were to explore the employment factors associated with long working hours, known as a risk factor for various health outcomes. The study relied on the national representative data of the 2013 French working conditions survey and a study sample of 23,378 full-time employees. Long working hours were defined by the threshold of 48 hours a week following the European Working Time Directive. The prevalence of long working hours was higher among men (13.5%) than among women (8.5%). Employees of the private sector, with permanent work contract, in small companies, and men in the services had a higher prevalence of exposure. This prevalence increased with educational and occupational levels. Our findings may help decision-makers to define preventive strategies. More research is needed to improve our knowledge of the employment factors associated with long working hours, as there may be strong differences between countries.

Prospective associations between psychosocial work factors and self-reported health: study of effect modification by gender, age, and occupation using the national French working conditions survey data.

BACKGROUND: Prospective studies exploring the effects of psychosocial work factors on self-reported health (SRH) are lacking, especially those studying effect modifications. The objectives were to examine the prospective associations of these factors, and multiple exposures to these factors, with SRH in a national representative sample, and effect modifications by gender, age, and occupation. METHODS: The prospective study relied on the three data collection waves (2013, 2016, and 2019) of the national French Working Conditions survey and was based on a sample of 15,971 employees, in good SRH at the beginning of the follow-up period. The occupational exposures were time-varying variables measured in 2013 and 2016, and included: 20 psychosocial work factors grouped into 5 broad domains, 4 exposures related to working time/hours and 4 physical-biomechanical-chemical exposures. The incidence of poor SRH three years later was the outcome. Discrete time Poisson regression models were performed using weighted data and with adjustment for gender, age, marital status, life events, and occupation. RESULTS: Almost all the studied psychosocial work factors were predictive of poor SRH. Some physical-biomechanical-chemical exposures were found to predict poor SRH. Only rare effect modifications were observed according to gender, age, and occupation. Dose-response associations between multiple exposures and the incidence of poor SRH were observed for 4 among 5 domains of psychosocial work factors. CONCLUSIONS: Our study underlined the effects of psychosocial work factors, as well as multiple exposure effects, on the incidence of poor SRH. However, most of these effects were the same across population groups related to gender, age, and occupation.

Burden of cardiovascular diseases and depression attributable to psychosocial work exposures in 28 European countries.

BACKGROUND: This study aimed to estimate the annual burden of cardiovascular diseases and depression attributable to five psychosocial work exposures in 28 European Union countries (EU28) in 2015. METHODS: Based on available attributable fraction estimates, the study covered five exposures, job strain, effort-reward imbalance, job insecurity, long working hours and workplace bullying; and five outcomes, coronary/ischemic heart diseases (CHD), stroke, atrial fibrillation, peripheral artery disease and depression. We estimated the burden attributable to each exposure separately and all exposures together. We calculated Disability-Adjusted Life Years (DALY) rate per 100 000 workers in each country for each outcome attributable to each exposure and tested the differences between countries and between genders using the Wald test. RESULTS: The overall burden of CHD attributable to the five studied psychosocial work exposures together was estimated at 173 629 DALYs for men and 39 238 for women, 5092 deaths for men and 1098 for women in EU28 in 2015. The overall burden of depression was estimated at 528 549 DALYs for men and 344 151 for women (respectively 7862 and 1823 deaths). The three highest burdens in DALYs in EU28 in 2015 were found for depression attributable to job strain (546 502 DALYs), job insecurity (294 680 DALYs) and workplace bullying (276 337 DALYs). Significant differences between countries were observed for DALY rates per 100 000 workers. CONCLUSIONS: Such results are necessary as decision tools for decision-makers (governments, employers and trade unions) when defining public health priorities and work stress preventive strategies in Europe.

Shift and Night Work and All-Cause and Cause-Specific Mortality: Prospective Results From the STRESSJEM Study.

The literature remains sparse and inconclusive about the impact of shift and night work on mortality, and still more on specific causes of death. The objectives were to explore the prospective associations between exposure to shift and night work and all-cause and cause-specific mortality. The study was based on a large national representative French prospective cohort of 1,511,456 employees followed up from 1976 to 2002. Exposure to shift and night work relied on a job-exposure matrix, and 3 time-varying measures (current, cumulative, and recency-weighted cumulative exposure) were constructed. Mortality and causes of death were provided by the national registry, and all-cause, cardiovascular, cancer and preventable mortality, and suicide were studied. Cox proportional hazards models were performed to study the associations between shift and night work and mortality. During follow-up, 22,105 deaths occurred for all-cause mortality. In the study of mortality until the end of last job during follow-up, shift and/or night work were associated with all-cause, cardiovascular, cancer and preventable mortality, and suicide (except night without shift work with cancer mortality and suicide) among men. Shift work (especially shift without night work) was associated with all-cause, cancer and preventable mortality among women. The results were similar for current, cumulative, and recency-weighted cumulative exposure. Associations were found for more detailed causes of death: cerebrovascular diseases for both genders, ischemic heart diseases, respiratory cancers, smoking-related mortality, and external causes of death among men, and breast cancer among women. In the study of mortality until the end of follow-up, some additional associations were found among women between night work and all-cause and preventable mortality, and suicide, suggesting long-term or delayed exposure effects. The study may, however, be underpowered to detect all the exposure-outcome associations, especially among women. More research and prevention are needed to reduce mortality among shift and night workers.

Update of the fractions of cardiovascular diseases and mental disorders attributable to psychosocial work factors in Europe.

OBJECTIVES: The objectives of this study were to provide the fractions of cardiovascular diseases and mental disorders attributable to five psychosocial work exposures, i.e. job strain, effort-reward imbalance, job insecurity, long working hours, and bullying in Europe (35 countries, including 28 European Union countries), for each one and all countries together, in 2015. METHODS: The prevalences of exposure were estimated using the sample of 35,571 employees from the 2015 European Working Conditions Survey (EWCS) for all countries together and each country separately. Relative risks (RR) were obtained via literature reviews and meta-analyses already published. The studied outcomes were: coronary/ischemic heart diseases (CHD), stroke, atrial fibrillation, peripheral artery disease, venous thromboembolism, and depression. Attributable fractions (AF) for each exposure and overall AFs for all exposures together were calculated. RESULTS: The AFs of depression were all significant: job strain (17%), job insecurity (9%), bullying (7%), and effort-reward imbalance (6%). Most of the AFs of cardiovascular diseases were significant and lower than 11%. Differences in AFs were observed between countries for depression and for long working hours. Differences between genders were found for long working hours, with higher AFs observed among men than among women for all outcomes. Overall AFs taking all exposures into account ranged between 17 and 35% for depression and between 5 and 11% for CHD. CONCLUSION: The overall burden of depression and cardiovascular diseases attributable to psychosocial work exposures was noticeable. As these exposures are modifiable, preventive policies may be useful to reduce the burden of disease associated with the psychosocial work environment.

Multiple psychosocial work exposures and well-being among employees: prospective associations from the French national Working Conditions Survey.

Aims: Working conditions, especially psychosocial work factors (PWFs), are thought to influence mental health outcomes among working populations, but there have been few studies on well-being per se. We assessed the prospective associations between a wide variety of occupational factors, including PWFs, multiple exposure to these factors, and well-being among employees in France. Methods: This study was based on a nationally representative sample of 15,776 employees, including 6595 men and 9181 women, followed up from 2013 to 2016. Psychological well-being was assessed using the WHO-5 Well-Being Index. Occupational factors included 20 PWFs, 4 factors related to working time/hours, and 4 physical work exposures. The associations of occupational exposures with poor well-being were estimated using weighted robust Poisson regression models in men and women separately. Results: Among the employees who rated their well-being as good in 2013, 10.3% of men and 16.8% of women had a poor well-being 3 years later. Most PWFs in 2013 were associated with poor well-being in 2016 among women, and half of them among men. An increase in the risk of poor well-being with the number of PWFs was found. Noise exposure was associated with poor well-being in women. Conclusions: The occupational factors associated with psychological well-being were mainly those related to the psychosocial work environment. A linear association was observed between the number of exposures to PWFs and well-being. Preventive policies focused on PWFs may be beneficial for well-being. More attention should be given to multiple exposures to these factors.

Psychosocial work exposures and health outcomes: a meta-review of 72 literature reviews with meta-analysis.

OBJECTIVE: This meta-review aimed to present all available quantitative pooled estimates for the associations between psychosocial work exposures and health outcomes using a systematic literature review of literature reviews with meta-analysis. METHODS: A systematic review of the literature from 2000 to 2020 was conducted using PubMed, Web of Science, Scopus, and PsycINFO databases following the PRISMA guidelines. All literature reviews and Individual-Participant Data (IPD)-Work consortium studies exploring an association between psychosocial work exposures and health outcomes and providing pooled estimates using meta-analysis were included. All types of psychosocial work exposures and health outcomes were studied. The quality of each included review was assessed. RESULTS: A total of 72 reviews and IPD-Work consortium studies were included. These mainly focused on job strain as exposure and cardiovascular diseases and mental disorders as outcomes. The associations between psychosocial work factors and cardiovascular diseases and mental disorders were in general significant, and the magnitude of these associations was stronger for mental disorders than for cardiovascular diseases. Based on high-quality reviews, significant associations were found between job/high strain and long working hours as exposures and coronary heart diseases, (ischemic) stroke, and depression as outcomes. A few additional significant associations involved other exposures and health outcomes. CONCLUSIONS: The included reviews brought convincing findings on the associations of some psychosocial work factors with mental disorders and cardiovascular diseases. More research may be needed to explain these associations, explore other exposures and outcomes, and make progress towards determining the causality of the associations.

Associations between multiple occupational exposures and sleep problems: Results from the national French Working Conditions survey.

Studies evaluating the effects of multiple occupational exposures on sleep are very rare. We assessed the associations between a wide range of occupational exposures and sleep problems and investigated the cumulative effects of these exposures on this outcome. We used data from the French 2016 Working Conditions survey conducted on a nationally representative sample of workers, including 20,430 employees aged 15-65 yr (8,579 men, 11,851 women). Sleep problems were defined by either sleep disturbances or sleep medication, almost daily or several times a week. Occupational exposures included 21 psychosocial work factors grouped into five dimensions, four factors related to working time/hours and four factors related to the physical work environment. Unadjusted and adjusted weighted robust Poisson regression analyses were performed. Almost all psychosocial work exposures were associated with sleep problems, whereas the only significant working time/hours factor associated with sleep problems was night work among women. Some gender differences in the exposure-outcome associations were found. The prevalence ratio of sleep problems increased with the number of exposures for most dimensions of psychosocial work factors. Physical work exposures were associated with sleep problems, and there was a linear association between the number of these occupational exposures and sleep problems in both genders, although the trend did not reach statistical significance among women. Workplace preventive strategies targeting the work environment comprehensively may be effective in improving sleep among working populations. More attention should be given to multiple exposures in the workplace.

Psychosocial factors at work from the job strain model and preventable mortality in France: The STRESSJEM prospective study.

The study aimed to explore the prospective associations between psychosocial factors at work from the job strain model and preventable mortality, including smoking- and alcohol-related mortality as well as external causes of death. The study was based on prospective data and relied on a sample of 1,511,456 individuals for which data on job history, mortality and causes of death were linked over the 1976-2002 period. Exposures were the factors from the job strain model imputed through a job-exposure matrix. Various time-varying measures of exposure were used including current exposure and two measures of cumulative exposure. Preventable mortality was defined using the OECD/Eurostat list of preventable causes of death. The associations between exposures and outcomes were studied using Cox proportional hazards models. Effect modification by gender was also assessed. Over the study period, 57,264 preventable deaths occurred before the age of 75 years. Low decision latitude, low social support, job strain, iso-strain, passive job, and high strain were associated with preventable mortality, and associations of stronger magnitude were found for job strain and isostrain among men. Stronger associations were observed for alcohol-related mortality than for smoking-related mortality and external causes of death. The fractions of preventable mortality attributable to current exposure to job strain and isostrain were significant among men only (5.1% and 3.3%). Psychosocial factors at work from the job strain model may play a role on preventable mortality. Intensifying research and prevention towards the psychosocial work environment may be helpful to reduce risky health-related behaviours and related mortality.

Psychosocial Work Factors of the Job Strain Model and All-Cause Mortality: The STRESSJEM Prospective Cohort Study.

OBJECTIVE: The objectives were to examine the prospective associations between psychosocial work factors of the job strain model and all-cause mortality in a national representative cohort of French employees using various measures of time-varying exposure. METHODS: The study was based on a sample of 798,547 men and 697,785 women for which data on job history from 1976 to 2002 were linked to mortality data from the national death registry. Psychosocial work factors from the validated job strain model questionnaire were imputed using a job-exposure matrix. Three time-varying measures of exposure were explored: current, cumulative, and recency-weighted cumulative exposure. Cox proportional hazards models were performed to study the associations between psychosocial work factors and mortality. RESULTS: Within the 1976-2002 period, 88,521 deaths occurred among men and 28,921 among women. Low decision latitude, low social support, job strain, isostrain, high strain, and passive job were found to be risk factors for mortality. The model using current exposure was the best relative-quality model. The associations of current exposure to job strain and mortality were found to have hazard ratios of 1.30 (95% confidence interval [CI] = 1.24-1.36) among men and 1.15 (95% CI = 1.06-1.25) among women. The population fractions of mortality attributable to job strain were 5.64% (95% CI = 4.56%-6.71%) among men and 4.13% (95% CI = 1.69%-6.71%) among women. CONCLUSIONS: This study supports the role of the psychosocial work factors of the job strain model on all-cause mortality. Preventive intervention to improve the psychosocial work environment may help to prevent mortality in working populations.

Associations of multiple occupational exposures with major depressive and generalized anxiety disorders: Findings from the French National Working Conditions Survey.

BACKGROUND: There have been numerous studies on the associations between psychosocial work factors and mental health, but very few of them explored the cumulative effects of these factors. The objectives were to study the associations between multiple occupational exposures and two common mental disorders, major depressive episode (MDE) and generalized anxiety disorder (GAD), among employees in France. METHODS: The data came from the 2016 French National Working Conditions Survey based on a representative sample of 20,430 employees (8579 men and 11,851 women) aged 15-65 years. MDE and GAD were assessed using the MINI (Mini International Neuropsychiatric Interview) standardized diagnostic interview. Occupational exposures included 21 psychosocial work factors grouped into five dimensions, four factors related to working time/hours, and four physical work exposures. Logistic regression modeling for weighted data was performed to evaluate the associations of occupational exposures with MDE and GAD in men and women separately. RESULTS: The prevalence of MDE and GAD was higher among women (8.6% and 8.7%, respectively) than among men (4.3% and 4.6%). Most psychosocial work factors were associated with MDE and/or GAD. A linear increase in the risk of MDE/GAD with the number of psychosocial work factors was found for each dimension, except workplace violence. The risk of MDE also increased linearly with multiple physical work exposures. CONCLUSIONS: Our results showed that a wide variety of occupational exposures were associated with clinical depression and anxiety, and that the risk of disease increased with multiple exposures to psychosocial and physical factors at work.

Correction to: Fractions of cardiovascular diseases and mental disorders attributable to psychosocial work factors in 31 countries in Europe.

Whilst working on an update of our study published in 2014 (orginal article), we have discovered an error in the measure of effort-reward imbalance (ERI) in this study, leading to errors in Table 3 for (1) the prevalence of exposure to ERI, and (2) the fractions of cardiovascular diseases and mental disorders attributable to ERI, attributable fractions (AF) being calculated from exposure prevalence and relative risk.

Psychosocial work exposures and suicide ideation: a study of multiple exposures using the French national working conditions survey.

BACKGROUND: Our study aimed to explore the associations between psychosocial work exposures, as well as other occupational exposures, and suicide ideation in the French national working population. An additional objective was to study the cumulative role of occupational exposures in this outcome. METHODS: The study was based on a nationally representative sample of the French working population of 20,430 employees, 8579 men and 11,851 women (2016 French national Working Conditions survey). Occupational exposures included 21 psychosocial work factors, 4 factors related to working time/hours and 4 factors related to the physical work environment. Suicide ideation within the last 12 months was the outcome. The associations between exposures and outcome were studied using weighted logistic regression models adjusted for covariates. RESULTS: The 12-month prevalence of suicide ideation was 5.2% among men and 5.7% among women. Among the occupational exposures, psychosocial work factors were found to be associated with suicide ideation: quantitative and cognitive demands, low influence and possibilities for development, low meaning at work, low sense of community, role conflict, job insecurity, temporary employment, changes at work, and internal violence. Some rare differences in these associations were observed between genders. Linear associations were observed between the number of psychosocial work exposures and suicide ideation. CONCLUSIONS: Psychosocial work factors were found to play a major role in suicide ideation, and their effects were cumulative on this outcome. More research on multiple and cumulative exposures and suicide ideation and more prevention towards the psychosocial work environment are needed.