Negative Acts in the Courtroom: Characteristics, Distribution, and Frequency among a National Cohort of Danish Prosecutors.

Danish prosecutors report exposure to negative acts from professional counterparts in courtrooms, which is associated with an increased risk of burnout. However, knowledge of the characteristics of these acts is limited. Based on existing theoretical frameworks, this study aims to characterize these negative acts. A nation-wide survey of Danish prosecutors (response rate: 81%) yielded 687 descriptions of experiences with negative acts from professional counterparts from a career perspective. These were analyzed using theory-directed content analysis based on the Stress-as-Offense-to-Self (SOS) theory by Semmer and colleagues and Cortina and colleagues' characterization of incivility in American courtrooms. We identified a total of 15 types of behavior within the three main themes: illegitimate tasks (n = 22), illegitimate stressors (n = 68), and illegitimate behavior (n = 612). Tentative differences in the distribution of experienced negative acts from a career perspective were found for gender and seniority. Women reported negative acts more frequently than men, and assistant prosecutors reported verbal abuse more frequently than senior prosecutors, who, conversely, more often reported a perceived lack of court management. More prospective research is needed on negative acts experienced by prosecutors to assess the scope of these in Danish courtrooms and how they impact the risk of burnout.

Acts of offensive behaviour and risk of disability pension in Danish female eldercare workers: prospective cohort with 11-year register follow-up.

OBJECTIVES: To investigate whether acts of offensive behaviour (threats, violence, workplace bullying and sexual harassment) in the workplace and type of perpetrator (internal or external to the workplace) of the offensive behaviours predicted risk of disability pension in Danish eldercare workers. METHODS: We merged survey responses from 8731 female eldercare workers with a national register on social transfer payments (Danish Register for Evaluation of Marginalisation (DREAM)), including all types of disability benefits. Using Cox proportional hazards models, we investigated the prospective association between self-reported exposures at baseline and the risk of receiving disability pension (any type of disability benefit payment) during 11 years of follow-up, while adjusting for potential confounders. RESULTS: Self-reported exposure to threats (hazard ratio (HR) 1.14; 95% confidence interval (CI) 1.00-1.32), violence (HR 1.16; 95% CI 1.00-1.35) and bullying (HR 1.44; 95% CI 1.22-1.71) predicted increased risk of disability pension during follow-up, when adjusted for age and educational attainment. When further adjusted for psychosocial working conditions only bullying remained a statistically significant (HR 1.39; 95% CI 1.16-1.67) predictor of disability pension. The results indicated no elevated risk for participants reporting sexual harassment. Moreover, we observed stronger associations between self-reported exposure to threats, violence and workplace bullying and risk of disability pension when the perpetrator was internal to the workplace (i.e. colleagues, managers and/or subordinates), than when the perpetrator was reported to be external to the workplace (i.e. service users, and/or relatives of service users). CONCLUSIONS: Results indicate that prevention of work-related exposure to threats, violence and workplace bullying may contribute to reduce involuntary early retirement in female eldercare workers.

Crisis social support after work-related violence and threats and risk for depressive symptoms: a 3-months follow-up study.

INTRODUCTION: Employees working at psychiatric wards are at risk for work-related threats and violence that may impact their physical and mental health. Studies have found that crisis social support may mitigate these adverse health effects. PURPOSE: To examine the effects crisis social support on depressive symptoms 3 months after a violent or threating work incident and furthermore, to examine the effect of variations in prolonged social support on depressive symptoms during 3 months after a violent or threating incident. METHODOLOGY: After exposure to work-related violence and threats at work, the employees received a questionnaire within the first month and after 3 months. Right after the incident, 374 employees answered both the depression and crisis support items and were included in the analyses. 3 months later 276 employees answered both the depression and social support items. Prospective associations between crisis social support and depression were calculated using stepwise regressions and linear mixed models. RESULTS: Crisis social support at T1 was significantly and inversely associated with a lower level of depressive symptoms at T2, Std. Beta = - 012, t (3) = - 2.1, p = .040. Employees experiencing either a stable or increasing level of support from T1 to T2 had significantly lower levels of depressive symptoms compared to employees who experienced a decrease in support in the same period, mean differenceStable-Decreasing = 4.0 t (190) = 5.2, p = 0.006 and mean differenceIncreasing-Decreasing = 7.6, t (189) = 5.3, p < .001. CONCLUSION: The study results indicate that depressive symptoms following work-related violence or threats can be mitigated by prolonged social support. We recommend that organizations continue to offer crisis social support in the subsequent months, and not just immediately after a violent or threating incident.

Critical Incidents Scale for Ambulance Work - Denmark (CISAW-D): the development of a screening tool for work exposure to critical events in operative ambulance personnel.

Introduction: Critical incidents in ambulance work are not easily compared to other risk occupations. Understanding types of incidents that can be considered critical in operational ambulance work is important to prevent work-related post-traumatic stress (PTS). Aim: This study aimed to develop a scale of critical incidents in ambulance work and assess its predictive validity in relation to the severity of PTS symptoms. Methods: A total of 1092 open-ended descriptions from Danish ambulance personnel were content analysed to develop a categorical scale that identifies types of events perceived as critical to operative ambulance personnel. Multiple regression was used to assess whether the scale predicted PTS symptoms and to assess the cumulative effect of exposure to these events. Results: The study found that the 1092 descriptions of critical events could be condensed into 28 categories of critical events. These ranged from life-threatening situations and deaths, to more daily events such as handling strong emotional reactions from patients' relatives and working with terminally ill children. The frequency of events significantly predicted the severity of PTS symptoms with low to moderate effect (std beta = 0.2, t(375) = 3.7, p < .001), even when adjusting for known risk factors for post-traumatic stress disorder. Conclusion: This study showed that critical events in ambulance work included events that are not normally considered traumatic, and indicated that understanding the cumulative effect of these events is important when trying to prevent traumatic sequalae in ambulance personnel. The study highlighted the importance of increased focus on non-traumatic incidents that have an ongoing impact on paramedics' mental health and well-being. The Critical Incidents Scale for Ambulance Work - Denmark (CISAW-D) is a promising tool for systematic screening for exposure to critical events in ambulance work.

Workplace Social Capital as Buffer for Emotional Demands and Perceived Stress in Symphony Orchestras: A Danish Cross-Sectional Survey.

INTRODUCTION: High workplace social capital (WSC) is associated with improved occupational health in the common occupational areas. However, little is known on WSC and its effect on the emotional demands and stress seen in the work of classical symphonic musicians. AIM: To investigate whether WSC moderates the associations between emotional demands and stress in the professional musicians working in Danish symphony orchestras. METHODS: This cross-sectional study builds on existing data collected on a sample of 341 Danish classical symphonic musicians. An interaction model based on multiple regression with bias corrected boot-strapping was used to assess the moderating effect of low, medium and high levels of WSC on the association between emotional demands and perceived stress. RESULTS: WSC had a significant moderating effect on the association between emotional demands and perceived stress: b = -0.01, t(212) = -2.40, p = 0.018. At low levels of WSC the effect of emotional demands on stress was strongest, declining at higher levels of WSC in a dose response pattern: low-WSC, b = 0.23, t(212) 3.20, p = 0.002, medium-WSC, b = 0.11, t(212) = 2.40, p = 0.017, and high-WSC, b = 0.04, t(212) = 0.75, p = 0.455. CONCLUSION: The study indicates a buffering effect of WSC on the association between emotional demands and stress in the work of orchestra musicians. Thus, enhancement of WSC could be a potential stress-preventing strategy in symphony orchestras and should be investigated in future studies on musicians' mental health.

Identifying child protection workers at risk for secondary traumatization: A latent class analysis of the Professional Quality of Life Scale-5.

Secondary traumatization (ST) is a topical area among trauma-exposed employees, where many are at risk of occupational mental health problems due to their work with trauma survivors. Challenges related to the accurate operationalization of ST symptoms persist, and there is no valid method for identifying employees at risk of clinically significant symptom levels. This study aimed to test the applicability of latent class analysis (LCA) to identify employees at risk for clinically relevant ST symptoms. LCA was used to identify patterns of ST symptom endorsement using the Professional Quality of Life Scale-5 (ProQoL) in a national sample of Danish child protection workers (CPW; N = 545). Predictors and associated levels of distress and functional impairment across the symptom presentations were tested using regression analysis, and three classes were identified. A total of 3.8% (n = 21) of participants were at high risk of endorsing symptoms of ST that were associated with significant levels of distress and increased functional impairment. The LCA approach outperformed existing scoring procedures in differentiating between employees with varying levels of distress, impairment, and well-being. A minority of Danish CPWs are at risk for levels of ST that may be considered clinically significant for their associations with anxiety and social and cognitive impairment. Although the ProQoL is not a diagnostic tool, per se, a revised scoring procedure may render the measure useful when screening for employees who are at risk for levels of distress and impairment that require intervention.

Are You All right (AYA)? Association of cumulative traumatic events among Danish police officers with mental health, work environment and sickness absenteeism: protocol of a 3-year prospective cohort study.

INTRODUCTION: Police officers are frequently exposed to potentially traumatic events at work that increases risk of developing mental health problems, in particular post-traumatic stress disorder (PTSD). Individual and organisational factors may influence the detrimental effects of cumulative exposure to traumatic events. Occupational stress and lack of organisational support are associated with increased risk of PTSD among police officers. The Are You All right? (AYA) project is a prospective cohort study investigating the cumulative effect of traumatic events at work on mental health problems and absenteeism among police officers. The study also investigates whether potential risk and protective factors modify the association of traumatic events at work with mental health problems and absenteeism. METHOD AND ANALYSIS: The AYA-study includes the entire Danish police force. Prospective survey data are collected over a 3-year period beginning in the spring of 2021. Electronic surveys are sent out at baseline with 1-year, 2-year and 3-year follow-up. Further, short surveys are sent out every third month, covering exposure to traumatic events and current mental health status. The survey data are paired with workplace register data on sickness absence. Register data on sickness absence cover the period from 2020 to 2025. ETHICS AND DISSEMINATION: This study was presented for evaluation at the National Ethics Committee in Denmark (reference number: 20202000-216), but according to Danish legislation, survey studies do not require approval by official Danish scientific or ethical committees. Participation in the project is based on informed consent, and data are handled in accordance with the Danish data legislation (journal number: 20/41457). Results are published in scientific journals and disseminated at international conferences.

The influence of coping and cognitive appraisal in predicting Posttraumatic Stress Disorder: A prospective study on workplace violence in psychiatric staff in Denmark.

BACKGROUND: Since psychiatric staff experience a high occurrence of workplace violence and subsequent Posttraumatic Stress Disorder (PTSD), it is important to assess the behavioral and cognitive risk factors of PTSD in this population. OBJECTIVE: The current study assesses the incidence of PTSD 12 months after the occurrence of WV. Furthermore, it examines possible prospective associations between coping strategies and cognitive appraisals, respectively, and PTSD. METHODS: This prospective cohort study was conducted with staff from 18 psychiatric wards in Denmark (n = 183) who had reported an incidence of workplace violence. Most subjects were women (83.3%). RESULTS: The incidence of PTSD was 9.8%. The main analysis showed a significant relationship between negative cognitive appraisals about the self and PTSD (OR = 2.87, p < .05), and a coping strategy of self-blame and PTSD (OR = 2.21, p < .05). CONCLUSIONS: Certain dysfunctional coping strategies and negative cognitive appraisals seems to predict posttraumatic stress in an occupational context. Information about these processes could be important for preventive strategies in the workplace.

Work-related violence and organizational commitment among health care workers: does supervisor's support make a difference?

INTRODUCTION: Work-related threats and violence are major occupational hazards, with potentially serious consequences for both victims and the organization that employs them. Only a few studies have prospectively examined the mitigating effect of social support from supervisors on organizational commitment following exposure to work-related violence and threats. OBJECTIVE: This study aimed at examining the effect of immediate supervisor's support on affective commitment within 1, 3, 6 and 12 months after exposure to violence and threats. METHODS: After exposure to work-related violence and threats, the employees received a questionnaire within the first month and after 3, 6 and 12 months. Right after the incident, 398 employees filled out the questionnaire, and 138 employees answered the questionnaire at all four time points. Prospective associations and mean differences between groups were calculated using linear mixed models. RESULTS: Employees receiving very high levels of social support from supervisors immediately after being exposed to work-related violence or threats had a significantly higher level of organizational commitment across all four time points when compared to the group experiencing middle/low levels of support. Furthermore, at 1- and 3-month follow-up employees receiving very high levels of social support from supervisors following work-related violence and threats reported significantly higher levels of commitment than did the group with high levels of social support from supervisors. CONCLUSION: Organizations should enhance the availability of social support from supervisors for employees experiencing work-related violence and threats. Training of supervisors to be very much concerned about employees exposed to work-related violence may be of critical importance to both the health and work outcomes of employees.

Can high workplace social capital buffer the negative effect of high workload on patient-initiated violence? Prospective cohort study.

BACKGROUND: High workload seems to increase the risk of patient-initiated workplace violence (patient-initiated violence). However, the temporal association between workload and violence remains uncertain. Understanding the interplay of factors in the psychosocial working environment and patient-initiated violence is important to future preventive initiatives. AIM: To assess whether a high workload increases the risk of patient-initiated violence, and whether intraorganizational relationships based on trust, reciprocity, justice and collaboration, known as workplace social capital, moderate this risk. METHOD: Baseline survey data on 1823 social educators was collected followed by 12 monthly surveys on patient-initiated violence exposure. Poisson regressions, in mixed models, were conducted to assess the risk of violence at four levels of workload. Further, moderation analyses were conducted to assess the moderating effects of three sub-types of workplace social capital. RESULTS: High and very high workload increased the risk of patient-initiated violence: RR = 1.5 [1.4-1.6], p < .001 and RR = 1.4 [1.3-1.4], p < .001. All three levels of workplace social capital had a moderating effect on the workload-violence association: Workload*Workplace social capital(co-worker): F (3, 16,712) = 3.4, p = .017, Workload*Workplace social capital(local management): F (3, 16,748) = 11.9, p < .001, Workload*Workplace social capital(general management): F (3, 16,556) = 5.5, p < .001. Only high Workplace social capital (co-workers) reduced the risk of violence at all levels of workload. Workplace social capital (general management) reduced the risk of violence at high, medium and low workload, and Workplace social capital (local management) reduced the risk of violence at medium and low workload. CONCLUSION: High workload clearly increases the risk of patient-initiated violence. A high workplace social capital appears to be a viable protective factor and should be investigated further in studies of patient-initiated violence prevention.

Associations of emotional burden and coping strategies with sick leave among healthcare professionals: A longitudinal observational study.

OBJECTIVES: To investigate 1) whether care-related regrets (regret intensity, number of recent regrets) are associated with sick leave, independently of personality traits, perceived safety climate, and physical activity; and 2) whether these associations were mediated or moderated by coping strategies. METHODS: Using a longitudinal international observational study (ICARUS), data were collected by the means of a weekly web survey. Descriptive and generalized estimation equations were performed. RESULTS: A total of 276 newly practicing healthcare professionals (nurses, physicians, others) from 11 countries were included in this study. The average proportion of weeks with at least one day of sick leave was 3.2%. Nurses' sick leave increased with number of care-related regrets (Relative Risk [RR]=1.52; 95% Confidence Interval [CI]=[1.18; 1.95], p=.001), while physicians' sick leave increased with intensity of care-related regret (RR=1.21; 95%CI=[1.00; 1.21], p=.049). Coping was associated with lower risk of sick leave for nurses (RR problem-focused strategies = 0.53; 95%CI=[0.37; 0.74], p=.001, and RRphysical activity=0.68; 95%CI:[0.54; 0.85], p<.001), but not for physicians. Nevertheless, the association of regret with sick leave remained significant even when adjusting for coping. Finally, this study did not find evidence of moderation by the coping strategies. CONCLUSION: Regrets are associated with increased risks of sick leave, even in young healthcare professionals. Use of coping strategies partially mediated these associations in nurses. The results of this study should be used to inform interventions to reduce emotional burdens and enhance protective coping strategies.

Does acute stress disorder predict posttraumatic stress disorder following workplace violence? A prospective study of psychiatric staff.

OBJECTIVES: Psychiatric staff is at risk of workplace violence (WV) and subsequent posttraumatic symptomatology. The current study assesses the prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in psychiatric staff following WV. This also examines the prospective association between ASD and PTSD. METHODS: This is a prospective cohort study of staff from 18 psychiatric wards in Denmark (n = 250), that reported an incident of workplace violence. RESULTS: The prevalence of ASD was 10.8%, while 8% had PTSD 3 months post-assault. Generalized linear mixed models showed a significant predictive power of ASD on PTSD (OR 8.45, p < 0.001) in the fully adjusted model. CONCLUSIONS: ASD seems to be a predictor of future PTSD in an occupational context and should be considered a possible instrument in enactment of preventive strategies.

Back pain occurrence and treatment-seeking behavior among nurses: the role of work-related emotional burden.

PURPOSE: To assess the association of back pain and treatment-seeking behavior for such pain with work-related emotional burden (regret about care), regret coping strategies, and physical burden among newly practicing nurses. METHODS: We used data from the Impact of Care-related Regret Upon Sleep (ICARUS) cohort collected between 05.2017 and 07.2018 using web-based surveys (weekly for measures of emotional burden, physical burden and coping strategies, and monthly for back pain and seeking care). We investigated immediate associations and temporal influences between burdens and back pain with linear mixed models and cross-lagged Bayesian models, respectively. Coefficients were standardized to allow comparison between burdens. Logistic regression was used to examine the association of burdens with seeking care. RESULTS: Among 105 nurses with an average follow-up of 3 months, 80 reported at least one episode of back pain. Neither physical nor emotional burdens had an immediate association with back pain. However, number of days with back pain in a given month was associated with an increase in both burdens during the previous month, with similar degrees of association (emotional: b = 0.24, physical: b = 0.21). Decision to seek treatment was associated with an increase in back pain frequency (OR 1.12, p = 0.04) and intensity (OR 1.80, p = 0.002) and a decrease in emotional burden (OR 0.95, p = 0.03). Coping strategies were associated neither with the occurrence of back pain nor with care-seeking. CONCLUSION: While both emotional and physical burdens were associated with increased frequency of back pain the following month, emotional burden additionally showed a negative association with the decision to seek care.

Are frequency and severity of workplace violence etiologic factors of posttraumatic stress disorder? A 1-year prospective study of 1,763 social educators.

Although cross-sectional studies have associated workplace violence (WPV) with posttraumatic stress disorder (PTSD), prospective studies are needed to ascertain the exposure leading to the development of PTSD. Using a 1-year prospective survey design, with monthly measures of violence, and 1,763 participants, we investigated whether frequency and/or severity of WPV could be considered etiological factors for PTSD. Binary logistic regression models were used, with subclinical and clinical PTSD as outcomes. The models were adjusted for demographic, lifestyle, and trauma-related factors, as well as strain in the work environment. Compared with the nonexposed group, frequency of WPV increased the risk of PTSD in an exposure-response pattern: low frequencyOR = 4.0, 95% confidence intervals [CI] [1.0, 16.3], medium frequency OR = 5.9, 95% CI [1.4, 24.3], and high frequency OR = 6.5, 95% CI [1.6, 25.6]. We also found that when threat was the most severe incident of WPV, the risk of PTSD increased, OR = 5.4, 95% CI [1.2, 24.2]. In addition, severe incidents of WPV increased the risk of PTSD, OR = 6.5, 95% CI [1.6, 26.0]. This prospective study consolidates existing cross-sectional studies, which have indicated that frequency of WPV is an etiological factor for PTSD. The study underlines the need for integrating an understanding of the pattern and characteristics of WPV in future research. Specifically, we propose the use of frequency of WPV as an additional factor in targeting employees at risk of developing PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Occupational Violence and PTSD-Symptoms: A Prospective Study on the Indirect Effects of Violence Through Time Pressure and Nontraumatic Strains in the Occupational Context.

OBJECTIVE: The aim of this study was to assess whether frequency of occupational violence (OV) affects posttraumatic stress disorder (PTSD) symptoms through nontraumatic strains in the occupational context. METHODS: Twelve-month prospective survey data on 1763 Social educators were used. Path-analysis measured direct and indirect pathways of frequency of OV on PTSD through change in time pressure, change in burnout, change in sense of safety at work, and change in coping with regret in patient work. RESULTS: Forty-two pct. of the variance in PTSD symptoms was predicted; F (20, 1541) = 36.8, P < 0.001, R = 0.42. Frequency of OV indirectly affected level of PTSD through all the mediators; estimated indirect effects = 0.14, 95% confidence interval 0.07 to 0.22. CONCLUSION: PTSD resulting from OV is not only a result of the violent acts themselves but is also caused by nontraumatic strains. It is essential to include the broader context of work environment factors in prevention of work-related PTSD.

Associations of regrets and coping strategies with job satisfaction and turnover intention: international prospective cohort study of novice healthcare professionals.

AIMS OF THE STUDY: (1) To assess the associations of care-related regrets with job satisfaction and turnover intention; and (2) to examine whether these associations are partially mediated by coping strategies. METHODS: Data came from ICARUS, a prospective international cohort study of novice healthcare professionals working in acute care hospitals and clinics from various countries (e.g., Australia, Austria, Botswana, Canada, Denmark, France, Haiti, Ireland, Kenya, the United Kingdom and United States). Care-related regrets (number of regrets and regret intensity), coping strategies, job satisfaction and turnover intention were assessed weekly for 1 year. RESULTS: 229 young healthcare professionals (2387 observations) were included in the analysis. For a given week, experiencing a larger number of care-related regrets was associated with decreased job satisfaction, and experiencing more intense care-related regrets was associated with increased turnover intention. These associations were partially mediated by coping strategies. Maladaptive emotion-focused strategies were associated with decreased job satisfaction and increased turnover intention, whereas adaptive problem-focused strategies showed the opposite pattern. CONCLUSIONS: Our results revealed that care-related regrets and maladaptive coping strategies are associated with job dissatisfaction and the intention to quit patient care. Helping healthcare professionals to cope with these emotional experiences seems essential to prevent early job quitting.  .

Comparison of exhaustion symptoms in patients with stress-related and other psychiatric and somatic diagnoses.

BACKGROUND: Several rating scales assessing stress-related symptoms of exhaustion have emerged in recent years. However, more knowledge is needed about the performance of these rating scales in patients with stress-related disorders as well as in other patient groups. With the recently developed Karolinska Exhaustion Disorder Scale (KEDS), we compared symptoms of exhaustion in different patient groups that were sorted according to diagnosis. METHODS: Patients were sampled consecutively from departments of occupational medicine (DOM) at three Danish hospitals. The total study group comprised 698 care-seeking patients (487 women). Patients with stress-related diagnoses (n = 217; the International Classification of Diseases [ICD]-10 code F43: reaction to severe stress and adjustment disorder) were compared to a diverse group of patients with a range of somatic diagnoses (n = 338) and to patients with other psychiatric diagnoses (n = 143), including subgroups with major depression disorder (n = 34; F32 and F33) and problems related to employment and unemployment (n = 99; Z56). The data were analysed using linear mixed models with the SPSS statistical program. RESULTS: The mean KEDS sum score in patients with stress-related diagnoses (29.3; SD = 8.0) was significantly higher than in patients with other psychiatric diagnoses (25.9; SD = 9.5) and in patients with somatic diagnoses (17.6; SD = 10.8). The subgroup with a major depression disorder had high mean KEDS sum scores (31.4, SD = 8.1), similar to patients with stress-related diagnoses, while the mean KEDS sum score in patients with problems related to employment and unemployment (Z56) was 23.5 (SD = 9.0). Young and old patients scored similarly on KEDS, but in patients with somatic diagnoses, female patients scored significantly higher than male patients. CONCLUSION: The symptoms of exhaustion measured with KEDS were higher in patients with stress-related diagnoses and major depression disorder than in patients with somatic diagnoses. The intermediate level of the symptoms of exhaustion that were associated with problems related to employment and unemployment, (Z56) compared to the lower level of the symptoms with somatic diagnoses, suggests that KEDS might be useful in detecting mild, prodromal states of exhaustion. This needs further investigation.

Workplace violence and development of burnout symptoms: a prospective cohort study on 1823 social educators.

PURPOSE: Burnout and workplace violence (WPV) have been associated in cross-sectional studies, but longitudinal studies with solid methods and adequate sample sizes are lacking. This study investigates whether WPV increases burnout symptoms during a 12-month period. METHODS: Questionnaire data were collected on 1823 social educators at baseline and 12-month follow-up, coupled with additionally 12 monthly text-message surveys on exposure to WPV. Using general linear modelling for repeated measures, we estimated change over time in burnout symptoms in three WPV exposure groups (none, low, high). RESULTS: A time by exposure to WPV interaction existed for development of burnout; F(2) = 7.2, p = 0.001 η2 = 0.011. Burnout increased significantly within the group of low exposure; F(1) = 6.8, p = 0.01 and high exposure; F(1) = 6.7 p = 0.001, but not within the non-exposed F(1) = 2.1 p = 0.15. At follow-up, both the low exposed and high exposed had significantly higher levels of burnout compared to the non-exposed. CONCLUSION: Exposure to WPV increases level of burnout within a 12-month period. We propose that assessment of burnout in future studies should utilize instruments capable of detecting small changes. We further propose that prevention against employee burnout could be improved using monitoring targeted at employees exposed to WPV.

Neurobiological effects of work-related stress: protocol for a case-control neuroimaging study.

INTRODUCTION: Stress is one of the greatest burdens of our society and often implies impairments in cognitive and emotional functions. Here, we hypothesise that changes in the brain's dopamine (DA)-based mesocorticolimbic projec-tions in patients with work-related stress (adjustment disorder) will manifest themselves as altered glucose metabolism in relation to neural activity, and as altered DA radiotracer binding potentials at the relevant receptors. METHODS: Subjects and healthy controls undergo neuropsychiatric tests and PET/MRI with three tracers: 18F-fluorodeoxyglucose to measure glucose metabolism as a marker of neural activity, 11C-raclopride to explore binding potentials in the striatum, and 11C-FLB 457 to study possibly impaired mesocortical dopaminergic transmission in the cortex. To demonstrate differences of glucose metabolism, more than 2 × 41 patients/controls are needed. We expect to find that symptoms of cognitive and motivational reward deficits are attributable to changes in the frontal lobe and striatal glucose metabolism in the majority of patients, and that changes of D2-receptor availability and impaired dopaminergic transmission in the striatum and prefrontal cortex are contributing factors. CONCLUSIONS: This project is designed to generate entirely new and objective evidence of stress-induced cerebral illness, and to provide a basis for in-depth research and for a more rational management of this strenuous disorder. FUNDING: Private, industrial and public funds. TRIAL REGISTRATION: Clinicaltrails.gov/NCT03334045.

The Regret Coping Scale for Health-Care Professionals (RCS-HCP): A validation study with Danish social educators.

BACKGROUND: Coping with regret has a substantial impact on wellbeing and mental health, but has rarely been investigated in an occupational setting. OBJECTIVE: To translate the Regret Coping Scale for Health-Care Professionals (RCS-HCP) and explore internal consistency, construct-, criterion- and predictive validity. METHODS: The instrument was translated using forward- back method. The qualities were evaluated with a sample of 2758 social educators using exploratory and confirmatory factor analysis as well as Cronbach's alpha, Pearson correlation, and multivariable regression. RESULTS: The translated instrument showed a trend similar to the original instrument. A 10-item version resulted from the research being reported. The reduced RCS-HCP showed improved fit (Full model, 15 items); CFI = 0.91, TLI = 0.89, RMSEA = 0.66, PClose = 0.000 and BIC = 1392 vs. (Reduced instrument, 10 items); CFI = 0.97, TLI = 0.96, RMSEA = 0.05, PClose = 0.499 and BIC 307. This instrument had acceptable internal consistency for short scales (Cronbach's alpha = 0.65, 0.69 and 0.84 respectively). The subscales correlated as expected with measures of health and occupational factors, coefficient ranging from 0.182 to 0.399. Also, the RCS-HCP predicted stress three month later ΔF[3,2747] = 15.1, p < 0.001, but with very small effect ΔR2 = 0.01, p≤0.001. CONCLUSIONS: The 10-item Danish version of the RCS-HCP is a valid instrument for measuring coping with regret in health related work.