An urgent call to address work-related psychosocial hazards and improve worker well-being.

Work-related psychosocial hazards are on the verge of surpassing many other occupational hazards in their contribution to ill-health, injury, disability, direct and indirect costs, and impact on business and national productivity. The risks associated with exposure to psychosocial hazards at work are compounded by the increasing background prevalence of mental health disorders in the working-age population. The extensive and cumulative impacts of these exposures represent an alarming public health problem that merits immediate, increased attention. In this paper, we review the linkage between work-related psychosocial hazards and adverse effects, their economic burden, and interventions to prevent and control these hazards. We identify six crucial societal actions: (1) increase awareness of this critical issue through a comprehensive public campaign; (2) increase etiologic, intervention, and implementation research; (3) initiate or augment surveillance efforts; (4) increase translation of research findings into guidance for employers and workers; (5) increase the number and diversity of professionals skilled in preventing and addressing psychosocial hazards; and (6) develop a national regulatory or consensus standard to prevent and control work-related psychosocial hazards.

Vital Signs: Health Worker-Perceived Working Conditions and Symptoms of Poor Mental Health - Quality of Worklife Survey, United States, 2018-2022.

Introduction: Health workers faced overwhelming demands and experienced crisis levels of burnout before the COVID-19 pandemic; the pandemic presented unique challenges that further impaired their mental health. Methods: Data from the General Social Survey Quality of Worklife Module were analyzed to compare self-reported mental health symptoms among U.S. adult workers from 2018 (1,443 respondents, including 226 health workers) and 2022 (1,952, including 325 health workers). Logistic regression was used to examine associations between health workers' reported perceptions of working conditions and anxiety, depression, and burnout. Results: From 2018 to 2022, health workers reported an increase of 1.2 days of poor mental health during the previous 30 days (from 3.3 days to 4.5 days); the percentage who reported feeling burnout very often (11.6% to 19.0%) increased. In 2022, health workers experienced a decrease in odds of burnout if they trusted management (odds ratio [OR] = 0.40), had supervisor help (OR = 0.26), had enough time to complete work (OR = 0.33), and felt that their workplace supported productivity (OR = 0.38), compared with those who did not. Harassment at work was associated with increased odds of anxiety (OR = 5.01), depression (OR = 3.38), and burnout (OR = 5.83). Conclusions and implications for public health practice: Health workers continued to face a mental health crisis in 2022. Positive working conditions were associated with less burnout and better mental health. CDC's National Institute for Occupational Safety and Health has developed a national campaign, Impact Wellbeing, to provide employers of health workers with resources to improve the mental health of these workers.

Risking one's life to save one's livelihood: Precarious work, presenteeism, and worry about disease exposure during the COVID-19 pandemic.

The present study advances research on the negative consequences of precarious work experiences (PWE), which include perceptions of threats to one's job and financial security as well as a sense of powerlessness and inability to exercise rights in the workplace. Using the COVID-19 pandemic as a backdrop, we examine how PWE relate to sickness presenteeism and worry about work-related COVID-19 exposure. In a 12-week, four-wave study of workers working fully in-person, perceptions of powerlessness and job insecurity were associated with presenteeism (e.g., general presenteeism as well as attending work with known or possible COVID-19 infection) and concerns about disease exposure at work. Whereas powerlessness primarily operated at the between-person level of analysis, job insecurity's effects emerged at both levels of analysis. A sense of powerlessness at work also predicted sending children to school/daycare sick. In sum, the findings suggest that precarity related to being able to keep one's job and a sense of powerlessness at work contribute to concerns about the risk of COVID-19 exposure at work and, simultaneously, behaviors that may contribute to the health risks faced by others. This research provides added support to the argument that precarious work should be addressed in order to improve both worker well-being and public health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychosocial risk factors for low back pain in US workers: Data from the 2002-2018 quality of work life survey.

BACKGROUND: Examining workplace psychosocial risk factors for back pain becomes increasingly important because of the changing nature of work and rising healthcare costs. Some psychosocial risk factors for back pain, such as work and family imbalance, exposure to a hostile work environment, and job insecurity, are understudied for the working population in the United States. METHODS: Data used in this study came from the Quality of Work Life Survey (QWL), a supplementary module of the General Social Survey conducted in the United States. Data from the 2002, 2006, 2010, 2014, and 2018 QWL surveys were used in these analyses, giving a total sample size of 6661. Five domains of workplace psychosocial risk factors for back pain were examined, including job strain, low social support, work-family imbalance, exposure to a hostile work environment (harassment and discrimination), and job insecurity. The adjusted odds ratio (aOR) of each psychosocial risk factor for back pain with 95% confidence intervals (CI) was estimated using a multivariable logistic regression model after controlling for job physical factors, occupation, and demographic and socioeconomic characteristics. RESULTS: Significant associations were found between back pain and several psychosocial factors including job strain (aOR 1.19; CI 1.00,1.41), work-family imbalance (aOR,1.42; CI 1.22,1.64), harassment (aOR 1.40; CI 1.15,1.71), and discrimination (aOR 1.20 CI 1.00,1.44). CONCLUSION: This study contributes to the understanding of the relationship between a variety of workplace psychosocial factors and back pain. Our findings suggest directions in future longitudinal research to examine emerging workplace psychosocial factors for back pain.

Expanding the Focus of Occupational Safety and Health: Lessons from a Series of Linked Scientific Meetings.

There is widespread recognition that the world of work is changing, and agreement is growing that the occupational safety and health (OSH) field must change to contribute to the protection of workers now and in the future. Discourse on the evolution of OSH has been active for many decades, but formalized support of an expanded focus for OSH has greatly increased over the past 20 years. Development of approaches such as the National Institute for Occupational Safety and Health (NIOSH)'s Total Worker Health® concept and the World Health Organization (WHO)'s Healthy Workplace Framework are concrete examples of how OSH can incorporate a new focus with a wider view. In 2019, NIOSH initiated a multi-year effort to explore an expanded focus for OSH. This paper is a report on the outputs of a three-year cooperative agreement between NIOSH and The University of Texas School of Public Health, which led to subject matter expert workshops in 2020 and an international conference of global interest groups in 2021. This article traces the background of these meetings and identifies and assesses the lessons learned. It also reviews ten thematic topics that emerged from the meetings: worker health inequalities; training new OSH professionals; future OSH research and practice; tools to measure well-being of workers; psychosocial hazards and adverse mental health effects; skilling, upskilling and improving job quality; socioeconomic influences; climate change; COVID-19 pandemic influences; and strategic foresight. Cross-cutting these themes is the need for systems and transdisciplinary thinking and operationalization of the concept of well-being to prepare the OSH field for the work of the future.

Approaches to managing work-related fatigue to meet the needs of American workers and employers.

On September 13-14, 2019, the National Institute for Occupational Safety and Health (NIOSH) hosted a national forum entitled "Working hours, sleep and fatigue: Meeting the needs of American workers and employers." The purpose of this inaugural meeting was to discuss current evidence about the broad-based risks and effective countermeasures related to working hours, sleep, and fatigue, with further considerations to tailor solutions for specific industries and worker populations. We aimed to identify the knowledge gaps and needs in this area and future directions for research. We also sought to identify similarities across industries with the goal of sharing lessons learned and successful mitigation strategies across sectors. Participants included an international representation of academics, scientists, government representatives, policymakers, industry leaders, occupational health and safety professionals, and labor representatives. A total of eight manuscripts were developed following stakeholder comments and forum discussions. Six focused on sector-specific approaches (i.e., Agriculture, Forestry & Fishing; Healthcare & Social Assistance; Mining; Oil and Gas Extraction; Public Safety; Transportation, Warehousing & Utilities) to identify unique factors for fatigue-risk and effective countermeasures. Two additional manuscripts addressed topic areas that cut across all industries (disproportionate risks, and economic evaluation). Findings from the Forum highlight that the identification of common risk factors across sectors allows for transfer of information, such as evidence for effective mitigation strategies, from sectors where fatigue risk has been more widely studied to those sectors where it has been less so. Further considerations should be made to improve knowledge translation activities by incorporating different languages and modes of dissemination such that information is accessible for all workers. Additionally, while economic evaluation can be an important decision-making tool for organizational- and policy-level activities, multi-disciplinary approaches combining epidemiology and economics are needed to provide a more balanced approach to economic evaluation with considerations for societal impacts. Although fatigue risk management must be tailored to fit industries, organizations, and individuals, knowledge gained in this forum can be leveraged, modified, and adapted to address these variabilities. Our hope is to continue sharing lessons learned to encourage future innovative, multi-disciplinary, cross-industry collaborations that will meet the needs of workers and employers to mitigate the risks and losses related to workplace fatigue.

Association of Parent Workplace Injury With Emotional and Behavioral Problems in Children.

OBJECTIVE: Investigate associations between occupational injury to parents and the psychological well-being of their children. METHODS: We used multiple logistic regression to examine effects of occupational injury to parents on measures of psychological well-being among their children using National Health Interview Survey data from 2012 through 2016. RESULTS: Children of injured workers exhibited greater impairment than children of workers who had not sustained injuries for four of five measures of emotional and behavioral functioning that were hypothesized to differentiate these two child groups. A significant group difference was not observed for a sixth behavioral measure that was expected to be insensitive to parent occupational injury. CONCLUSION: Study findings heighten concern over downstream effects of occupational injury and signal need for more expansive investigation of these effects and mitigation strategies among children of injured workers.

Adverse Childhood Experiences Among Gynecology Patients With Chronic Pelvic Pain.

OBJECTIVE: To compare adverse childhood experiences (ACEs) in women with chronic pelvic pain with a control group, and describe occurrence of specific ACEs in women with chronic pelvic pain. METHODS: This case-control study examined the relationship between history of ACEs, traumatic events occurring during childhood as defined by the Centers for Disease Control and Prevention (CDC), and chronic pelvic pain. Patients diagnosed with chronic pelvic pain (n=60) were age-matched to a control group of women without chronic pelvic pain (n=60). All participants completed validated measures to detect for presence of any of the 11 ACEs as identified by the CDC's Behavioral Risk Factor Surveillance System ACE Module. RESULTS: Mean participant age was 40 (±11 years). Total numbers of ACEs were elevated in chronic pelvic pain participants compared with a control group (median 4 [interquartile range 2-6] vs median 1 [interquartile range 0-4], P<.001) and 53% of chronic pelvic pain participants had four or more ACEs, compared with 27% of the control group (odds ratio [OR] 3.14; 95% CI 1.46-6.75). All categories of abuse were more prevalent in chronic pelvic pain compared with the control group: physical (43% vs 15%, OR 4.3; 95% CI 1.8-10.4; P=.001), sexual (55% vs 23%, OR 4.0; 95% CI 1.8-8.8; P<.001) and verbal or emotional (62% vs 33%, OR 3.2; 95% CI 1.5-6.8; P=.003). Regarding household challenges, the subcategory most prevalent in chronic pelvic pain participants compared with the control group was that of witnessed domestic violence (35% vs 8%, OR 5.9; 95% CI 2.1-17.1, P<.001). CONCLUSION: Chronic pelvic pain participants had a greater than threefold odds of having a history of childhood abuse and having witnessed domestic violence during childhood compared with the control group. Women with chronic pelvic pain had increased numbers of ACEs and 53% had four or more ACEs, crossing a threshold that others have found to predict poor overall health outcomes.

Workplace psychosocial and organizational factors for neck pain in workers in the United States.

BACKGROUND: Neck pain is a prevalent musculoskeletal condition among workers in the United States. This study explores a set of workplace psychosocial and organization-related factors for neck pain. METHODS: Data used for this study come from the 2010 National Health Interview Survey which provides a representative sample of the US population. To account for the complex sampling design, the Taylor linearized variance estimation method was used. Logistic regression models were constructed to measure the associations. RESULTS: This study demonstrated significant associations between neck pain and a set of workplace risk factors, including work-family imbalance, exposure to a hostile work environment and job insecurity, non-standard work arrangements, multiple jobs, and long work hours. CONCLUSION: Workers with neck pain may benefit from intervention programs that address issues related to these workplace risk factors. Future studies exploring both psychosocial risk factors and physical risk factors with a longitudinal design will be important. Am. J. Ind. Med. 59:549-560, 2016. © 2016 Wiley Periodicals, Inc.

Unstable sitting in the workplace--are there physical activity benefits?

The increasingly popular practice of using a stability ball (exercise/fitness ball) as a sitting surface runs counter to conventional human factors/ergonomics guidelines for seated workspace design. Employees sitting on stability balls in an office environment present safety risks that might be justifiable if the practice has a definitive benefit to the promotion of health. However, the published studies and best evidence to date call into question even the theoretical basis for this practice and do not suggest significant health benefits. First, biomechanical studies do not confirm the intended trunk muscle activation. Second, energy expenditure studies show a small (if any) increase in metabolic demand that is unlikely to be effective in combating sedentary work risk factors. Until studies demonstrate more conclusive benefits, the practice of stability ball sitting should be viewed skeptically as a general workplace recommendation in the interest of health or wellness.

Workplace psychosocial factors associated with work-related injury absence: a study from a nationally representative sample of Korean workers.

BACKGROUND: Little is known about the association between psychosocial factors and injury absence in the workplace. PURPOSE: This study aims to assess the association of comprehensive workplace psychosocial factors with work-related injury absence among Korean workers. METHODS: The data (n = 7,856) were derived from the First Korean Working Conditions Survey conducted in 2006 with a representative sample (n = 10,043) of the Korean working population. The survey instrument contained questions about hours of work, physical risk factors, work organization, and the effect of work on health/injury. Work-related injury absence was indicated by a dichotomous variable with at least 1 day absence during the preceding 12 months. Logistic regression models were used to calculate odds ratio and confidence interval (CI). Incremental adjustments for sociodemographic, health behavior, and occupational confounding variables were employed in the models. RESULTS: The overall 1-year prevalence of work-related injury absence in this study was 1.37 % (95 % CI, 1.11-1.63 %). Those who experienced violence at work (adjusted odds ratio (aOR), 7.05 (95 % CI, 2.69-18.5)), threat of violence at work (aOR, 4.25 (95 % CI, 1.32-13.64)), low job autonomy (aOR, 1.79 (95 % CI, 1.17-2.74)), and high job strain (aOR, 2.38 (95 % CI, 1.29-4.42) had an increased risk of injury absence, compared with their respective counterparts (p < 0.05). Among all job types, skilled workers in Korea were at a near fourfold risk of work absence due to occupational injuries, compared with managers in low-risk jobs. CONCLUSION: Workplace violence and increased job strain were two key workplace psychosocial factors associated with work-related injury absence.

Job strain, effort-reward imbalance and neck, shoulder and wrist symptoms among Chinese workers.

The purpose of this study was to examine the association between psychosocial job stress (by the Job Control-Demand (JCD) model and Effort-Reward imbalance (ERI) model) and musculoskeletal (MS) symptoms among workers in China. Overall, 3,632 male and 1,706 female workers from 13 factories/companies participated in this study. Perceived job stress was evaluated by the Chinese version of the Job Content Questionnaire (JCQ) and ERI Questionnaire. Neck, shoulder and wrist symptoms were assessed by self-report during the past year. Workers reporting high job demands and low job control or high effort and low rewards had moderately increased risk for all MS symptoms. Odds ratios (ORs) were higher in workers reporting both high effort and low rewards. The combination of high physical job demands with low job control showed significant associations with MS symptoms. The effects of psychological demands on symptoms in women, effort and effort-reward imbalance on symptoms among both genders were increased as the number of regions with symptoms increased. These results suggest that high job strain and ERI are associated with neck, shoulder and wrist symptoms in Chinese factory workers independent of individual factors, physical factors, and other psychological variables.

Organizational factors associated with work-related sleep problems in a nationally representative sample of Korean workers.

PURPOSE: The purpose of this study was to assess the association of organizational factors with work-related sleep problems (WRSP) among Korean workers. METHODS: The data were derived from the First Korean Working Conditions Survey conducted in 2006 with a representative sample of the Korean working population (n = 10,039). RESULTS: The overall prevalence of WRSP was 5.1% (95% confidence interval (CI) 4.7-5.5). Those who experienced sexual harassment at work (adjusted odds ratio (aOR) 3.47: 95% CI 1.77-6.81), discrimination due to sex (aOR 2.44: 95% CI 1.36-4.36) or age (aOR 2.22: 95% CI 1.52-3.23), violence at work (aOR 1.98: 95% CI 1.06-3.68), threat of violence (aOR 1.96: 95% CI 1.05-3.66), poor work-life balance (aOR 1.78: 95% CI 1.44-2.20), low job satisfaction (aOR 1.69: 95% CI 1.37-2.09), high cognitive (OR 1.64: 95% CI 1.32-2.03) and emotional (aOR 1.53: 95% CI 1.22-1.91) demands, job insecurity (aOR 1.32: 95% CI 1.07-1.63), and high work intensity (aOR 1.55: 95% CI: 95% CI 1.25-1.92) had an increased risk of WRSP compared to their respective counterparts (p < 0.01). Low social support was not significantly associated with WRSP (aOR 0.88: 95% CI 0.67-1.15). CONCLUSION: The results revealed that poor psychosocial working conditions may be related to a high prevalence of WRSP among representative Korean workers.

Co-effect of Demand-control-support model and effort-reward imbalance model on depression risk estimation in humans: findings from Henan Province of China.

OBJECTIVE: To investigate the co-effect of Demand-control-support (DCS) model and Effort-reward Imbalance (ERI) model on the risk estimation of depression in humans in comparison with the effects when they are used respectively. METHODS: A total of 3 632 males and 1 706 females from 13 factories and companies in Henan province were recruited in this cross-sectional study. Perceived job stress was evaluated with the Job Content Questionnaire and Effort-Reward Imbalance Questionnaire (Chinese version). Depressive symptoms were assessed by using the Center for Epidemiological Studies Depression Scale (CES-D). RESULTS: DC (demands/job control ratio) and ERI were shown to be independently associated with depressive symptoms. The outcome of low social support and overcommitment were similar. High DC and low social support (SS), high ERI and high overcommitment, and high DC and high ERI posed greater risks of depressive symptoms than each of them did alone. ERI model and SS model seem to be effective in estimating the risk of depressive symptoms if they are used respectively. CONCLUSION: The DC had better performance when it was used in combination with low SS. The effect on physical demands was better than on psychological demands. The combination of DCS and ERI models could improve the risk estimate of depressive symptoms in humans.

Job satisfaction, common cold, and sickness absence among white-collar employees: a cross-sectional survey.

The purpose of this study is to examine the independent association of job satisfaction with common cold and sickness absence among Japanese workers. A total of 307 apparently healthy white-collar employees (165 men and 142 women), aged 22-69 (mean 36) yr, completed a questionnaire survey during April to June, 2002. Global job satisfaction was measured by a 4-item scale from the Japanese version of a generic job stress questionnaire with higher scores indicating greater satisfaction. Information about whether the employees had a common cold (within the past 6 months) and sickness absence (within the past 12 months) was self-reported. Hierarchical log-linear Poisson regression analysis controlling for confounders revealed that greater job satisfaction was inversely correlated with days (B = -0.116; p<0.001) and times (B = -0.058; p = 0.067) of common cold and days (B = -0.160; p<0.001) and times (B = -0.141; p<0.001) of sickness absence. Our findings suggested that poor job satisfaction is associated with both common cold and sickness absence.

Evaluating the association of workplace psychosocial stressors with occupational injury, illness, and assault.

This research project characterizes occupational injuries, illnesses, and assaults (OIIAs) as a negative outcome associated with worker exposure to generalized workplace abuse/harassment, sexual harassment, and job threat and pressure. Data were collected in a nationwide random-digit-dial telephone survey conducted during 2003-2004. There were 2151 study interviews conducted in English and Spanish. Analyses included cross tabulation with Pearson's Chi-Square and logistic regression analyses. Three hundred and fifty-one study participants reported having an OIIA during the 12 months preceding the study. Occurrences of generalized workplace harassment (OR = 1.53; CI = 1.33-1.75, p ≤ 0.05); sexual harassment (OR = 1. 18; CI = 1.04-.34, p ≤ 0.05); and job pressure and threat (OR = 1.26; CI = 1.10-1.45, p ≤ 0.05) were significantly associated with reporting an OIIA. The psychosocial environment is significantly associated with an increased risk of OIIA. Further research is needed to understand causal pathways and to explore potential interventions.

Nurses, smoking, and immunity: a review.

Nurses regularly are exposed to a variety of occupational hazards. In addition to documented occupational hazards, exposure to smoking remains a major concern. This article reviews the prevalence of smoking among nurses working in the United States and discusses their reasons for smoking. Researchers conducted a state-of-the-art review on the effects of cigarette smoking and exposure to secondhand smoke (SHS) on the immune system. Smoking prevalence among nurses working in the United States ranged from 796-12%, and high work stress, poor work environment, shift work, and peer influence were suspected major risk factors influencing smoking behavior. A review of the effects of smoking on immunity revealed that both active smoking and exposure to SHS negatively affects immune function. When rehabilitation nurses stop smoking their health improves and nonsmokers are exposed to less SHS. Rehabilitation nurses are encouraged to share knowledge of the immunological benefits of smoking cessation with patients to facilitate nurse-led rehabilitation programs.

Is self-rated health associated with blood immune markers in healthy individuals?

BACKGROUND: Although self-rated health (SRH) has been established as a robust predictor of morbidity and mortality, the immunological mechanisms underpinning this relationship are poorly understood. PURPOSE: This study examined the association of SRH with humoral and cellular immune markers in healthy individuals who reported no physical illnesses. METHOD: A total of 116 healthy Japanese white-collar employees (79 women and 37 men) at a pharmaceutical company, aged 23-62 (mean 32) years, underwent a blood draw for the measurement of circulating immune (T, B, and natural killer) cells, inflammatory cytokines (interleukin-6 and tumor necrosis factor-alpha), and plasma immunoglobulin G (IgG) and completed a health survey including SRH. The question regarding SRH ranged from "very good" (coded 1) to "very poor" (coded 5). Hierarchical multiple regression analysis was carried out to calculate the relationship between SRH and immune markers. RESULTS: In this sample, poor SRH was positively correlated with B (CD19(+)) cell numbers (beta = 0.260, p < 0.05) and IgG levels (beta = 0.335, p < 0.01) even after adjusting for depressive symptoms, age, education, marital status, smoking, alcohol consumption, physical activity, body mass index, sex, and sex x SRH interaction. The interaction between SRH and sex on the immune markers was not significant. CONCLUSION: Although the connection between SRH and immune markers was not strong in this context, the results suggest that poor SRH may be associated with reduced humoral immune system capacity to respond to new/latent challenges. The results provide some support for the immunological basis of SRH in healthier individuals.

Job satisfaction is associated with elevated natural killer cell immunity among healthy white-collar employees.

Although the association of job satisfaction with health has been well documented, little is known about the biological mechanisms underlying this relationship. This study investigates the association of job satisfaction with cell-mediated immunity among Japanese white-collar daytime workers. A total of 306 healthy full-time employees (141 women and 165 men), aged 22-69 (mean 36) years, provided a blood sample for the measurement of circulating immune (natural killer (NK), B, and total T) cells and NK cell cytotoxicity (NKCC) and completed a questionnaire survey during April to June 2002. Job satisfaction was measured by a 4-item scale from the Japanese version of the generic job stress questionnaire with higher scores indicating greater satisfaction. Analyses were done separately for women and men using a hierarchical multiple linear regression model controlling for multiple confounders. The results revealed that greater job satisfaction was positively correlated with NKCC (ß = .207; p = .029) and the number of NK (CD3(-)CD56(+)) cells (ß = .261; p = .008) in women. In men, job satisfaction was marginally correlated with NKCC (ß = .165; p = .050) but was not correlated with the number of NK (CD3(-)CD56(+)) cells (ß = .142; p = .107). Job satisfaction did not correlate with numbers of T (CD3(+)CD56(-)) and B (CD19(+)) cells in both women and men. Our findings suggest an independent association between job satisfaction and NK cells but the association seems to be stronger in women than in men. Although the results provide a support for the biological plausibility of the job satisfaction-health relationship, additional research is required to determine whether greater job satisfaction contributes to recovery/maintenance of NK cell immunity and host defense over time.

Active and passive smoking and depression among Japanese workers.

OBJECTIVE: To assess the relation of passive and active smoking to depressive symptoms in 1839 men and 931 women working in a suburb of Tokyo in 2002. METHOD: Self-reported smoking history and exposure to passive smoking (no, occasional, or regular) at work and at home. Depressive symptoms according to the Center for Epidemiologic Studies Depression Scale, with a cut-off point of 16. RESULTS: Compared to never smokers unexposed to passive smoking, never smokers reporting regular and occasional exposure to passive smoking at work had increased depressive symptoms. The adjusted odds ratios (aORs) were 1.92 (95% confidence interval (CI) 1.14, 3.23) for regular exposure and 1.63 (95% CI 1.08, 2.47) for occasional exposure. Current smokers had significantly increased depressive symptoms (aOR ranging from 2.25 to 2.38) but former smokers had only marginal increases of depressive symptoms (aOR ranging from 1.43 to 1.55). Gender did not modify the effects of active/passive smoking on depressive symptoms. CONCLUSION: Passive smoking at work and current smoking appear associated with higher levels of depressive symptoms.