Unpaid overtime and mental health in the Canadian working population.

BACKGROUND: Unpaid overtime-describing a situation where extra hours are worked but not paid for-is a common feature of the labor market that, together with other forms of wage theft, costs workers billions of dollars annually. In this study, we examine the association between unpaid overtime and mental health in the Canadian working population. We also assess the relative strength of that association by comparing it against those of other broadly recognized work stressors. METHODS: Data were drawn from a survey administered to a heterogeneous sample of workers in Canada (n = 3691). Generalized linear models quantified associations between unpaid overtime, stress, and burnout, distinguishing between moderate (1-5) and excessive (6 or more) hours of unpaid overtime. RESULTS: Unpaid overtime was associated with higher levels of stress and burnout. Relative to those working no unpaid overtime, men working excessive unpaid overtime were 85% more likely to report stress (prevalence ratios [PR]: 1.85, 95% confidence interval [CI]: 1.26-2.72) and 84% more likely to report burnout (PR: 1.84, 95% CI: 1.34-2.54), while women working excessive unpaid overtime were 90% more likely to report stress (PR: 1.90, 95% CI: 1.32-2.75) and 52% more likely to report burnout (PR: 1.52; 95% CI: 1.12-2.06). The association of excessive unpaid overtime with mental health was comparable in magnitude to that of shift work and low job control. CONCLUSIONS: Unpaid overtime may present a significant challenge to the mental health of working people, highlighting the potential role of wage theft as a neglected occupational health hazard.

Perceived Adequacy of Infection Control Practices and Symptoms of Anxiety Among In-Person Elementary School Educators in Ontario.

OBJECTIVE: The aim of this study was to examine the association between the perceived adequacy of infection control practices (ICPs) and symptoms of anxiety among educators in Ontario, Canada. METHODS: Data from 4947 educators were collected in December 2020. Modified Poisson models assessed the association between adequacy of ICPs and moderate or severe anxiety symptoms, adjusting for a range of covariates. RESULTS: Approximately 60% of respondents reported moderate or severe anxiety symptoms. Two-thirds (66.5%) of the sample had less than half of their ICP needs met. Respondents with less than half their ICP needs met were more than three times more likely to have moderate or severe anxiety, compared with respondents with their ICP needs met. CONCLUSION: Findings highlight the importance of adequate administrative and engineering controls in schools, not only to minimize risk of infection, but also for educator's mental health.

Longitudinal Reciprocal Relationships Between the Psychosocial Work Environment and Burnout.

OBJECTIVE: To examine longitudinal reciprocal relationships between the psychosocial work environment and burnout. METHODS: We used two-wave cross-lagged panel models to estimate associations between a wide range of psychosocial work factors (ie, job demands, job control, job insecurity, coworker support, supervisor support, and organizational justice) and burnout in a broadly representative sample of the general working population in Canada (n = 453). RESULTS: Bidirectional associations between the psychosocial work environment and burnout were observed. Results supported the causal predominance of psychosocial work factors over burnout. Higher job demands, lower job control, higher job insecurity, and lower organizational justice predicted burnout over time. Burnout only predicted lower supervisor support over time. CONCLUSIONS: Our findings suggest that stress at work is better understood as a cause rather than a consequence of burnout in the general working population.

Assessing the psychometric properties of the Guarding Minds @ Work questionnaire recommended in the Canadian Standard for Psychological Health and Safety in the Workplace.

This study examines the item and dimension distribution and factorial reliability and validity of the GM@W questionnaire for assessing the 13 dimensions of the work environment outlined in The Canadian National Standard for Psychological Health and Safety in the Workplace (The Standard). Methods An internet survey of 1,006 Ontario workers was conducted between February 10th and March 5th, 2020. Respondents had to be employed in a workplace with five or more employees. The survey included the 65 items from the GM@W questionnaire, and questions to assess sociodemographic characteristics and employment arrangements. Analyses examined the distribution of scores for items and for overall dimensions. A confirmatory factor analysis (CFA) examined the relationship between the 13 proposed dimensions and each of the 65 questions, using only respondents with complete information (N = 900). Results Low levels of missing responses were observed, although 14 of the 65 items had potential ceiling effects. CFA analyses demonstrated poor fit for the conceptual model linking the 13 dimensions of The Standard to the 65-items. High correlations between dimensions were also noted. The GM@W questionnaire displayed poor discriminant in measuring the specific dimensions proposed in The Standard. Conclusions Our results suggest the GM@W survey is unable to isolate the proposed dimensions of the psychosocial work environment as outlined in The Standard. These limitations are important, as workplaces using the GM@W survey will not be able to identify dimensions of the work environment which require attention or assess changes in particular dimensions over time.

The impact of the COVID-19 pandemic on mental health of nurses in British Columbia, Canada using trends analysis across three time points.

PURPOSE: This study examined trends over time in the prevalence of anxiety and depression among Canadian nurses: 6 months before, 1-month after, and 3 months after COVID-19 was declared a pandemic. METHODS: This study adopted a repeated cross-sectional design and surveyed unionized nurses in British Columbia (BC), Canada on three occasions: September 2019 (Time 1, prepandemic), April 2020 (Time 2, early-pandemic) and June 2020 (Time 3). RESULTS: A total of 10,117 responses were collected across three timepoints. This study found a significant increase of 10% to 15% in anxiety and depression between Time 1 and 2, and relative stability between Time 2 and 3, with Time 3 levels still higher than Time 1 levels. Cross-sector analyses showed similar patterns of findings for acute care and community nurses. Long-term care nurses showed a two-fold increase in the prevalence of anxiety early pandemic, followed by a sharper decline mid pandemic. CONCLUSIONS: COVID-19 has had short- and mid-term mental health implications for BC nurses particularly among those in the long-term care sector. Future research should evaluate the impact of COVID-19 on the mental health of health workers in different contexts, such as jurisdictional analyses, and better understand the long-term health and labor market consequences of elevated mental health symptoms over an extended time period.

Assessing the Psychosocial Work Environment in Relation to Mental Health: A Comprehensive Approach.

OBJECTIVES: Prevailing job stress models encourage a multidimensional view of the psychosocial work environment and highlight the role that multiple co-occurring stressors play in the aetiology of mental health problems. In this study, we develop a latent typology of psychosocial work environment profiles to describe how a comprehensive array of job stressors are clustered in the Canadian labour market. We also examine the association between these latent psychosocial work environment profiles and several indicators of mental health. METHODS: Data were collected from 6408 workers who completed the Canadian National Psychosocial Work Environment Survey. Psychosocial work exposures were measured using standard items from the Copenhagen Psychosocial Questionnaire. We employed latent profile analyses to identify groups of individuals with similar psychosocial work environment profiles. We used log-linear regression models to examine the association between latent psychosocial work environment profiles and burnout, stress, and cognitive strain. RESULTS: Four distinct groups with highly divergent psychosocial work environment profiles were identified. Adjusting for a range of demographic and socioeconomic factors, latent psychosocial work environment profiles were strongly related to mental health. Individuals who reported exposure to a comprehensive array of psychosocial job stressors (11% prevalence) reported the highest probability of burnout (PR: 7.51, 95% confidence interval [CI]: 5.56-10.15), stress (PR: 8.98, 95% CI: 6.20-13.0), and cognitive strain (PR: 7.29, 95% CI: 5.02-10.60). CONCLUSIONS: Findings suggest that psychosocial work stressors are tightly clustered in the Canadian labour market, and that the clustering of work stressors is strongly associated with adverse mental health outcomes. Future scholarship may benefit from adopting a more comprehensive approach to the assessment of psychosocial job quality as a determinant of health and well-being.

Labour Market Attachment, Workplace Infection Control Procedures and Mental Health: A Cross-Sectional Survey of Canadian Non-healthcare Workers during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has led to large proportions of the labour market moving to remote work, while others have become unemployed. Those still at their physical workplace likely face increased risk of infection, compared to other workers. The objective of this paper is to understand the relationship between working arrangements, infection control programs (ICP), and symptoms of anxiety and depression among Canadian workers, not specifically working in healthcare. METHODS: A convenience-based internet survey of Canadian non-healthcare workers was facilitated through various labour organizations between April 26 and June 6, 2020. A total of 5180 respondents started the survey, of which 3779 were assessed as employed in a full-time or part-time capacity on 2 March 2020 (prior to large-scale COVID-19 pandemic responses in Canada). Of this sample, 3305 (87.5%) had complete information on main exposures and outcomes. Anxiety symptoms were measured using the Generalised Anxiety Disorder screener (GAD-2), and depressive symptoms using the Patient Health Questionnaire screener (PHQ-2). For workers at their physical workplace (site-based workers) we asked questions about the adequacy and implementation of 11 different types of ICP, and the adequacy and supply of eight different types of personal protective equipment (PPE). Respondents were classified as either: working remotely; site-based workers with 100% of their ICP/PPE needs met; site-based workers with 50-99% of ICP/PPE needs met; site-based workers with 1-49% of ICP/PPE needs met; site-based workers with none of ICP/PPE needs met; or no longer employed. Regression analyses examined the association between working arrangements and ICP/PPE adequacy and having GAD-2 and PHQ-2 scores of three and higher (a common screening point in both scales). Models were adjusted for a range of demographic, occupation, workplace, and COVID-19-specific factors. RESULTS: A total of 42.3% (95% CI: 40.6-44.0%) of the sample had GAD-2 scores of 3 and higher, and 34.6% (95% CI: 32.-36.2%) had PHQ-2 scores of 3 and higher. In initial analyses, symptoms of anxiety and depression were lowest among those working remotely (35.4 and 27.5%), compared to site-based workers (43.5 and 34.7%) and those who had lost their jobs (44.1 and 35.9%). When adequacy of ICP and PPE was taken into account, the lowest prevalence of anxiety and depressive symptoms was observed among site-based workers with all of their ICP needs being met (29.8% prevalence for GAD-2 scores of 3 and higher, and 23.0% prevalence for PHQ-2 scores of 3 and higher), while the highest prevalence was observed among site-based workers with none of their ICP needs being met (52.3% for GAD-2 scores of 3 and higher, and 45.8% for PHQ-2 scores of 3 and higher). CONCLUSION: Our results suggest that the adequate design and implementation of employer-based ICP have implications for the mental health of site-based workers. As economies re-open the ongoing assessment of ICP and associated mental health outcomes among the workforce is warranted.

A Quantitative Retrospective Exposure Assessment for Former Chrysotile Asbestos Miners and Millers from Baie Verte, NL, Canada.

Despite numerous studies of asbestos workers in the epidemiologic literature, there are very few cohort studies of chrysotile asbestos miners/millers that include high-quality retrospective exposure assessments. As part of the creation of the Baie Verte Miners' Registry in 2008, a two-dimensional job exposure matrix (JEM) was developed for estimating asbestos exposures for former chrysotile asbestos miners/millers. Industrial hygiene data collected between 1963 and 1994 were analysed to assess validity for use in a retrospective exposure assessment and epidemiologic study. Registered former employees were divided into 52 exposure groups (EGs) based on job title and department and mean asbestos concentrations were calculated for each EG. The resulting exposure estimates were linked to individual registrants' work histories allowing for the calculation of cumulative asbestos exposure for each registrant. The distribution of exposure for most EGs (82.6%) could be described as fitting a log-normal distribution, although variability within some EGs (55%) exceeded a geometric standard deviation (GSD) of 2.5. Overall, the data used to create EGs in the development of the JEM were deemed to be of adequate quality for estimating cumulative asbestos exposures for the former employees of the Baie Verte asbestos mine/mill. The variability between workers in the same job was often high and is an important factor to be considered when using estimates of cumulative asbestos exposure to adjudicate compensation claims. The exposures experienced in this cohort were comparable to those of other chrysotile asbestos miners/millers cohorts, specifically Italian and Québec cohorts.

The Association between the Perceived Adequacy of Workplace Infection Control Procedures and Personal Protective Equipment with Mental Health Symptoms: A Cross-sectional Survey of Canadian Health-care Workers during the COVID-19 Pandemic: L'association entre le caractère adéquat perçu des procédures de contrôle des infections au travail et de l'équipement de protection personnel pour les symptômes de santé mentale. Un sondage transversal des travailleurs de la santé canadiens durant la pandémie COVID-19.

OBJECTIVES: To examine the relationship between perceived adequacy of personal protective equipment (PPE) and workplace-based infection control procedures (ICP) and mental health symptoms among a sample of health-care workers in Canada within the context of the current COVID-19 pandemic. METHODS: A convenience-based internet survey of health-care workers in Canada was facilitated through various labor organizations between April 7 and May 13, 2020. A total of 7,298 respondents started the survey, of which 5,988 reported information on the main exposures and outcomes. Anxiety symptoms were assessed using the Generalized Anxiety Disorder (GAD-2) screener, and depression symptoms using the Patient Health Questionnaire (PHQ-2) screener. We assessed the perceived need and adequacy of 8 types of PPE and 10 different ICP. Regression analyses examined the proportion of GAD-2 and PHQ-2 scores of 3 and higher across levels of PPE and ICP, adjusted for a range of demographic, occupation, workplace, and COVID-19-specific measures. RESULTS: A total of 54.8% (95% confidence interval [CI], 53.5% to 56.1%) of the sample had GAD-2 scores of 3 and higher, and 42.3% (95% CI, 41.0% to 43.6%) of the sample had PHQ-2 scores of 3 and higher. Absolute differences of 18% (95% CI, 12% to 23%) and 17% (95% CI, 12% to 22%) were observed in the prevalence of GAD-2 scores of 3 and higher between workers whose perceived PPE needs and ICP needs were met compared to those who needs were not met. Differences of between 11% (95% CI, 6% to 17%) and 19% (95% CI, 14% to 24%) were observed in PHQ-2 scores of 3 and higher across these same PPE and ICP categories. CONCLUSIONS: Our results suggest strengthening employer-based infection control strategies likely has important implications for the mental health symptoms among health-care workers in Canada.

Dissecting the effect of workplace exposures on workers' rating of psychological health and safety.

OBJECTIVES: To validate the factor structure of the Copenhagen Psychosocial Questionnaire (COPSOQ) in a North American population and dissect the associations between psychosocial factors and workplace psychological health and safety. METHODS: Confirmatory factor analysis and multivariate linear regression were used to determine the associations between COPSOQ dimensions and a global rating of workplace psychological health and safety. Models were stratified by sex, gender roles, and age. RESULTS: The COPSOQ factor structure was verified among Canadian workers. Three factors were found to significantly contribute to the global rating of the psychological health and safety for all workers. Few differences were observed across sex, gender roles, and age. CONCLUSIONS: This study identified dimensions of the psychosocial work environment that are strongly associated with the global rating of workplace psychological health and safety. Using a standardized questionnaire like the COPSOQ allows for comparisons over time, between different industries, and worker populations.

The Third Version of the Copenhagen Psychosocial Questionnaire.

INTRODUCTION: A new third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) has been developed in response to trends in working life, theoretical concepts, and international experience. A key component of the COPSOQ III is a defined set of mandatory core items to be included in national short, middle, and long versions of the questionnaire. The aim of the present article is to present and test the reliability of the new international middle version of the COPSOQ III. METHODS: The questionnaire was tested among 23,361 employees during 2016-2017 in Canada, Spain, France, Germany, Sweden, and Turkey. A total of 26 dimensions (measured through scales or single items) of the middle version and two from the long version were tested. Psychometric properties of the dimensions were assessed regarding reliability (Cronbach α), ceiling and floor effects (fractions with extreme answers), and distinctiveness (correlations with other dimensions). RESULTS: Most international middle dimensions had satisfactory reliability in most countries, though some ceiling and floor effects were present. Dimensions with missing values were rare. Most dimensions had low to medium intercorrelations. CONCLUSIONS: The COPSOQ III offers reliable and distinct measures of a wide range of psychosocial dimensions of modern working life in different countries; although a few measures could be improved. Future testing should focus on validation of the COPSOQ items and dimensions using both qualitative and quantitative approaches. Such investigations would enhance the basis for recommendations using the COPSOQ III.

Identifying knowledge activism in worker health and safety representation: A cluster analysis.

BACKGROUND: Although worker representation in OHS has been widely recognized as contributing to health and safety improvements at work, few studies have examined the role that worker representatives play in this process. Using a large quantitative sample, this paper seeks to confirm findings from an earlier exploratory qualitative study that worker representatives can be differentiated by the knowledge intensive tactics and strategies that they use to achieve changes in their workplace. METHODS: Just under 900 worker health and safety representatives in Ontario completed surveys which asked them to report on the amount of time they devoted to different types of representation activities (i.e., technical activities such as inspections and report writing vs. political activities such as mobilizing workers to build support), the kinds of conditions or hazards they tried to address through their representation (e.g., housekeeping vs. modifications in ventilation systems), and their reported success in making positive improvements. A cluster analysis was used to determine whether the worker representatives could be distinguished in terms of the relative time devoted to different activities and the clusters were then compared with reference to types of intervention efforts and outcomes. RESULTS: The cluster analysis identified three distinct groupings of representatives with significant differences in reported types of interventions and in their level of reported impact. Two of the clusters were consistent with the findings in the exploratory study, identified as knowledge activism for greater emphasis on knowledge based political activity and technical-legal representation for greater emphasis on formalized technical oriented procedures and legal regulations. Knowledge activists were more likely to take on challenging interventions and they reported more impact across the full range of interventions. CONCLUSIONS: This paper provides further support for the concepts of knowledge activism and technical-legal representation when differentiating the strategic orientations and impact of worker health and safety representatives, with important implications for education, political support and recruitment.

Bone manganese as a biomarker of manganese exposure: a feasibility study.

BACKGROUND: There is a need for a diagnostic tool with the ability to measure cumulative exposure to manganese (Mn) in the workplace. Measuring bone Mn levels with in vivo neutron activation analysis (IVNAA) could serve as a biomarker of past exposure. Bone Mn levels of welders were measured and compared to the levels found in subjects without exposure to the element. METHOD: Forty subjects (30 welders and 10 controls) were recruited. An occupational history was obtained and subjects underwent IVNAA bone Mn measurements. RESULTS: The mean bone Mn levels were (2.9 +/- 0.4) and (0.1 +/- 0.7) microg Mn/g Ca for welders and controls, respectively (P < 0.05). CONCLUSIONS: This project, the first of its kind, reports differences in bone Mn between Mn-exposed welders and non-occupationally exposed subjects. It appears that bone Mn levels do reflect differences in the occupational exposure of welders.

Noisiness in operating theatres: nurses' perceptions and potential difficulty communicating.

Elevated operating theatre noise can be hazardous to patient safety and may cause occupational stress. In a nine-hospital study, background noise and average noise were measured, during operations in different subspecialties, and found to be higher than noise levels recommended by the World Health Organization (WHO) for hospital areas in which patient care takes place. In operations in which nurses had also answered a question about hearing 'quiet', 'normal', and 'loud' talking, speech interference levels were estimated and indicated that nurses and other personnel had to substantially raise their voices to be well understood.

Investigating respiratory responses to metalworking fluid exposure.

In response to worker and union representative concerns, the association between metalworking fluid exposure and respiratory symptoms was investigated in a cross-sectional survey, in a large automotive machining location. A self-administered respiratory symptom-screening questionnaire was sent to 2935 current employees. MWF exposure levels were assigned to respondents on a departmental basis based on average and "peak" area aerosol measurements. MWF exposure, years in the plant, and smoking status were regressed on presence or absence of daily or weekly respiratory symptoms, as well as upper and lower respiratory symptom groupings derived from principal components factor analysis. The response rate was 81 percent. Symptom prevalence was high: 29 percent of subjects reported weekly or daily phlegm; 23 percent, dry cough; 42 percent, runny or plugged nose. Average aerosol concentration in departments with exposure ranged from 0.02 to 0.84 mg/m(3), and peak levels from 0.02 to 2.85 mg/m(3). Average exposures ranging from 0.25 to 0.84 mg/m(3), as compared to exposures in the range of 0.02 to 0.09 mg/m(3), were statistically significantly associated with wheezing, chest tightness, sore throat, and hoarse throat, as well as with the upper respiratory symptom grouping. When peak exposure was included in the regression, it exerted a stronger effect than average exposure level on dry cough, phlegm, wheezing, fever/chills, and hoarse throat, as well as on upper and lower respiratory symptom groupings. These effects were independent of smoking status. Exposure-symptom trends for the average and peak departmental area concentration categories were statistically significant for the upper and lower respiratory symptom groupings and for most individual symptoms. We have observed an association of increasing upper and lower respiratory symptoms with estimated MWF exposure, measured independently, at average departmental aerosol concentrations well below the NIOSH recommended personal exposure level of 0.5 mg/m(3). The results have been used to prioritize exposure reduction efforts in the workplace.