Exploring expected and perceived facilitators and barriers of an indicated prevention strategy to prevent future long-term sickness absence; a qualitative study among employers and employees.

BACKGROUND: An indicated prevention strategy (IPS), consisting of a screening questionnaire and early treatment, was found to be effective for the prevention of future long-term sickness absence (LTSA) in two large Dutch RCT's. This IPS aims to detect employees who have a high risk to become absent, and subsequently offer them early treatment. Despite the overall effectiveness, only a few companies have implemented this strategy so far. This suggests that companies may not be convinced of the (cost) effectiveness of this strategy yet. In companies where IPS has been implemented, screenings uptake and adherence to early treatment appeared to be moderate, indicating that both employees and employers might perceive barriers. METHODS: The aim of this qualitative study was to explore the expected and perceived facilitators and barriers for the implementation of the IPS. Semi-structured interviews were conducted with 9 employers and 11 employees (acquainted and unacquainted with IPS) from large companies. Purposive sampling was used to recruit participants. All interviews were transcribed and analyzed thematically. RESULTS: The employers believed they were primarily responsible for psychological and work-related health complaints and SA, while the employees felt responsible for health complaints related to their lifestyle. According to the employees, the responsibility of the employer was solely related to work-related health. This finding exposed a relation with the health culture, which was solely based on creating a safe work environment, omitting psychological health issues. The efficacy of this IPS regarding reducing SA was estimated positive, however, the efficacy regarding LTSA was questioned. Fear of a privacy breach was often mentioned by the respondents as an important barrier. CONCLUSIONS: This study showed that the health culture within a company may be important for the perceived responsibility towards SA and health. A health culture which primarily focuses on physical complaints may raise barriers for the adoption and implementation of this preventive strategy. Participant' perceptions of the nature of LTSA and the fact that not all participants were familiar with the exact content and phasing of IPS may have doubted the efficacy regarding LTSA. This study provides important clues for future and improved implementation of IPS.

Improving measurement models in clinical epidemiology: time to move beyond the inherent assumption of an underlying reflective measurement model.

OBJECTIVES: The nature of a construct's measurement model, most decisively being predominantly reflective or formative, is essential for its development, validation, and use. Differentiating between these types of measurement models cannot be done based on statistics alone, but has to rely on expert judgment, preferably guided by checklists and theoretical assumptions. However, consideration and substantiation of the choices of the measurement models is lacking in most studies describing the validation of measurement instruments in the field of clinical epidemiology. STUDY DESIGN AND SETTING: A convenience sample of 96 clinimetric studies, published from 2017 up until May 17th, 2018 was scored on model use and (mis)specification. RESULTS: In over 50% of the identified studies in this sample, formative measurement models are considered and/or analyzed as reflective. CONCLUSION: Misspecification of formative measurement models as reflective was found to be more rule than exception. It is therefore recommended that model selection and considerations on the theoretical nature of the measurement model should be classified, motivated, and discussed, for example, by using available checklists. Hereby, it can be ensured that the appropriate measurement models and corresponding statistics are used.

Handling the reflective-formative measurement conundrum: a practical illustration based on sustainable employability.

OBJECTIVES: Constructs capturing health or functioning can have reflective and/or formative measurement models. Although a construct's measurement model has extensive implications on the construction, validation, and use of a measurement instrument, measurement models are frequently wrongly or not explicitly specified. As this is likely due to a lack of guidelines, this study uses sustainable employability as an example to demonstrate a) the applicability of an adapted checklist for establishing a construct's measurement model; and b) the use of structural equation modeling to handle formative constructs. STUDY DESIGN AND SETTING: First, the checklist is applied to sustainable employability to establish its measurement model. Second, using observational self-report data from 2,544 employees, structural equation models are estimated to evaluate the structural and criterion validity of sustainable employability as a formative construct. RESULTS: The checklist demonstrates strong applicability, identifying sustainable employability as a formative construct. Model fit indices (Comparative fit indices ≥ 0.932, Tucker-Lewis indices ≥ 0.925, root mean square errors of approximation ≤ 0.034) suggest the formative measurement model for sustainable employability is valid. CONCLUSION: The checklist and structural equation modeling facilitate handling formative constructs. By establishing sustainable employability as a formative construct, individuals' long term ability to function at work can be more adequately studied and intervened upon.

Time takes us all? A two-wave observational study of age and time effects on sustainable employability.

Objectives Various cognitive and physical abilities decline with age. Consequently, sustainable employability research has focused on the labor market participation of older employees. However, it remains unclear whether age actually affects employees' work and labor-market functioning. A major complicating factor is that age effects can be distorted by time effects. That is, changes over time may not be due to aging but to some structural difference between the times of measurement. The present article aims to provide clarity by estimating age effects on sustainable employability while controlling for potential time effects. Methods Based on two-wave survey data from a sample of 2672 employees (ages 35‒65 years) multilevel regressions are estimated to analyze the effects of age and time on sustainable employability. Here, sustainable employability is operationalized as a formative construct consisting of nine dimensions, each capturing a different facet of an individual's ability to function at work and in the labor market. Results The analyses reveal that age has small effects on only two dimensions (employability and perceived health) while time affects three dimensions (fatigue, job performance, and skill gap) of sustainable employability. Moreover, for all dimensions of sustainable employability most variance exists between (61.43-84.96%) rather than within (15.04-38.57%) subjects. Conclusions These findings suggest that the process of aging has a limited effect on working individuals' capacities to function in their job and the labor market. Consequently, the focus on age in the context of sustainable employability policies and research may require reconsideration.

Fostering functioning of workers: A new challenge for prevention in occupational health.

Given large changes in working conditions and society, occupational health care has to prioritize its efforts towards fostering health and functioning of workers and as such promote work participation. This requires that more emphasis is given on the application of biopsychological models in the care of workers. Although a biopsychological approach is often mentioned as essential part of occupational health care, it's application is often hampered in practice, by practical barriers and lack of practical knowledge. This is illustrated by a study that uncovered facilitating and hindering factors in the implementation process of a preventive strategy, proven effective in reducing the risk of long term sickness absence. To facilitate the use of biopsychological models in occupational health care, it is shown that setting up a training curriculum is possible, based on the International Classification of Functioning, Disability and Health (ICF) grafted on available training in evidence based practice skills is possible. Furthermore, there is a need for elaboration of the personal factors relevant for workers and the relevant work-related environmental factors to support practical application of ICF in occupational health care. A paradigm shift in occupational health care can facilitate widespread implementation of the biopsychosocial approach in occupational health and may stimulate occupational health professionals to further integrate this approach in their daily practice.

Experiences of occupational physicians with the implementation of indicated prevention for long term sickness absence.

BACKGROUND: Functioning including work participation, is an emerging challenge in occupational health. The prevention of long term sickness absence (LTSA) through a strategy involving screening and structured early consultation (preventive strategy) was proven effective and can address participation issues. Implementation of this strategy has proven difficult. OBJECTIVE: The aim of this study is to investigate the experiences of occupational physicians (OPs) delivering a structured early consultation to office workers, in order to enhance implementation of the strategy. METHODS: In this case study, a mixed method design was used. Interviews and surveys were conducted to obtain an in-depth picture of OPs experiences. RESULTS: Factors hindering implementation in relation to the OPs were difficulties in communicating the risk of future sick leave, prioritization of other tasks, maintaining a reactive approach due to work pressure, preference for prevention on the level of the work environment, privacy issues related to labeling workers to have mental or psychosocial issues, and the biomedical model being the mental model in use. CONCLUSIONS: Implementation of the preventive strategy seems to require a more profound focus on the biopsychosocial approach. Training of relevant skills is important to achieve a focus on prevention and fostering health over the lifespan.

Implementing the ICF in Occupational Health; building a curriculum as an exemplary case.

BACKGROUND: This paper addresses the need for a paradigm shift from post-diagnosis tertiary care towards maintenance and promotion of health across the lifespan, for healthcare in general and in occupational healthcare specifically. It is based on the assumption that the realization of this paradigm shift may be facilitated by teaching (future) occupational health professionals to use the International Classification of Functioning, Disability and Health (ICF). OBJECTIVE: Describing the development of a an ICF based occupational health curriculum. METHODS: Grafting a training trajectory in the ICF for educating the biopsychosocial health paradigm, onto a training trajectory in the Critical Appraisal of a Topic (CAT), a method for teaching evidence based practice skills. RESULTS: The development process of the training trajectories in the master program Work, Health, and Career at Maastricht University is described as an example of an intervention for shifting the paradigm in healthcare curricula. The expected results are a shift from the biomedical towards the biopsychosocial paradigm, a reductionist approach towards a more holistic view on cases, a reactive way of working towards a more proactive work style, and from using a merely quantifiable evidence base towards using a broad evidence base. CONCLUSIONS: Incorporating the biopsychosocial paradigm into the assessment and scientific reasoning skills of students is not only valuable in occupational healthcare but might be a valuable approach for all disciplines in healthcare for which contextual factors are important e.g. rehabilitation, psychiatry and nutritional science.

Cardiovascular Morbidity and Mortality Among Working Individuals With Rheumatic Disease: Results From a Large Prospective Cohort Study.

BACKGROUND: Cardiovascular comorbidities are common in rheumatic diseases and are associated with an increased mortality risk but have not been studied in a working population, with less severe disease. Also, the impact of premature cardiovascular mortality on work participation has been neglected until now. OBJECTIVES: The objectives of this study were to evaluate the cardiovascular risk in working individuals with inflammatory rheumatic diseases and to explore whether cardiovascular morbidity and mortality are associated with decreased work participation in this population. METHODS: Employees from 45 companies in The Netherlands (n = 12,140) were prospectively followed up from 1998 onward by annual questionnaires. Data covering 10 years of follow-up was available (1998-2008) for rheumatic and cardiovascular morbidities. Self-reported rheumatic and cardiovascular diseases were verified by clinical review in hospital records in a subsample living in 1 specific region of The Netherlands. Information on the vital status was obtained by linking our records to national registries. Cox proportional hazards models were used to determine the contribution of cardiovascular comorbidity on mortality, with adjustment for confounders. RESULTS: In the sample verified by clinical review, the 10-year risk of developing cardiovascular diseases tended to be increased in workers with inflammatory rheumatic diseases (n = 17) at baseline (relative risk, 2.30; 95% confidence interval [CI], 0.91-5.81) and was significantly increased in those with gout (n = 18) at baseline (relative risk, 3.64; 95% CI, 1.64-8.09) as compared with those without inflammatory rheumatic diseases or gout, respectively. Gout (n = 31; hazard ratio, 4.19; 95% CI, 1.33-13.25) and cardiovascular diseases (n = 206; hazard ratio, 2.19; 95% CI, 1.24-3.84) were significantly related to 10-year mortality. No deaths had occurred in individuals with inflammatory rheumatic diseases during follow-up. CONCLUSIONS: In this study, gout was significantly associated with cardiovascular comorbidity and mortality, but inflammatory rheumatic diseases were not. Decreased work participation in workers with gout and potentially inflammatory rheumatic diseases can be expected because of an increased morbidity but not mortality risk.

Approaches for predicting long-term sickness absence. Re: Schouten et al. "Screening manual and office workers for risk of long-term sickness absence: cut-off points for the Work Ability Index".

We read with much interest the article of Schouten et al (1) on identifying workers with a high risk for future long-term sickness absence using the Work Ability Index (WAI). The ability to identify high-risk workers might facilitate targeted interventions for such workers and, consequently, can reduce sickness absence levels and improve workers' health. Earlier studies by both Tamela et al (2), Kant et al (3), and Lexis et al (4) have demonstrated that such an approach, based on the identification of high-risk workers and a subsequent intervention, can be effectively applied in practice to reduce sickness absence significantly. The reason for our letter on Schouten et al's article is twofold. First, by including workers already on sick leave in a study predicting long-term sick leave will result in an overestimation of the predictive properties of the instrument and biased predictors, especially when also the outcome of interest is included as a factor in the prediction model. Second, we object to the use of the term "screening" when subjects with the condition screened for are included in the study. Reinforced by the inclusion of sickness absence in the prediction model, including workers already on sick leave will shift the focus of the study findings towards the prediction of (re)current sickness absence and workers with a below-average return-to-work rate, rather than the identification of workers at high risk for the onset of future long-term sickness absence. The possibilities for prevention will shift from pure secondary prevention to a mix of secondary and tertiary prevention. As a consequence, the predictors of the model presented in the Schouten et al article can be used as a basis for tailoring neither preventive measures nor interventions. Moreover, including the outcome (sickness absence) as a predictor in the model, especially in a mixed population including workers with and without the condition (on sick leave), will result in biased predictors and an overestimation of the predictive value. A methodological approach of related issues is provided in the works of Glymour et al (5) and Hamilton et al (6). This phenomenon is even more clearly illustrated by the predictive properties of the workability index, as described by Alavinia et al (7, page 328), which reported that "when adjusted for individual characteristics, lifestyle factors, and work characteristics, two dimensions of the WAI were significant predictors for both moderate and long durations of sickness absence: (i) the presence of sickness absence in the past 12 months prior to the medical examination and (ii) experienced limitations due to health problems." So, when applied to the study by Schouten et al (1), this means that most of the predictive value would be related to the factors "sickness absence in the past 12 months". In addition, we object to the use of the term "screening" in the Schouten et al study as it includes workers with the intended outcome (long-term sickness absence). One can identify three separate aims to study the longitudinal association between risk factors and subsequent long-term sickness absence: (i) to establish causal risk factors for long-term sickness absence, often to find clues for primary preventive strategies (beyond the scope here); (ii) to identify high-risk workers who are still at work and might benefit from an intervention before sickness absence occurs (secondary prevention); and (iii) to identify workers on sick leave who might suffer a below-average return-to-work rate or have a high risk for the recurrence of (long-term) sickness absence and might benefit from intensification or optimization of the return-to-work process (tertiary prevention). In this light, one needs to separate screening instruments from predictive instruments and reserve the term "screening" for the situation as defined by Wilson and Junger (8, page 7): "The object of screening for disease is to discover those among the apparently well who are in fact suffering from disease" (ie, situations of secondary prevention). This means that, when applying this definition on long-term sickness absence under the precondition that the individuals are still at work, screening enables the identification of high-risk individuals in the early "stages" of a "disease" that can progress into long-term sickness absence. In the case of the Schouten et al study, the population at risk, as derived from their predictive instrument, consists of workers with and without sickness absence, and as such excludes the use of the term "screening" in this case. To conclude, we have substantiated that, in addition to correct usage of the term "screening", careful selection of the study population, predictors and most importantly the aim of the predictive model are essential in the process of developing predictive instruments aimed at identifying workers at high risk of long-term sickness absence. Two fundamentally different approaches are possible. One approach aims at identifying workers on sick leave with either a below-average chance to return to work an/or a high risk for a successive episode of long-term sickness absence. From a methodological and practical point of view, such an instrument should be developed and validated among workers already on sick leave. A second approach aims at identifying workers who are still at work but at high risk for future long-term sickness absence. To develop and validate such an instrument, a study sample where workers already on sick leave are excluded is a prerequisite. Such instruments fit in a pro-active approach of preventing future sickness absence, where an early intervention can be offered to those workers with an increased risk for future sickness absence.

Effects of cardiovascular comorbidities on work participation in rheumatic diseases: a prospective cohort study among working individuals.

OBJECTIVE: To determine the risk of sick leave and work disability in relation to rheumatic diseases and cardiovascular comorbidities among working individuals. METHODS: Employees (n = 12,140) from 45 companies in The Netherlands were prospectively followed up from 1998-2008. Questionnaires were used to assess self-reported diseases and employment status. Company records provided individual sick leave data for the first 2.5 years of followup. For a selected sample of the cohort (50%), verification of self-reported diseases was sought through hospital record linkage. Poisson regressions and Cox proportional hazards models were applied to determine the impact of both self-reported and verified diseases on sick leave and work disability, respectively. RESULTS: The number of days and frequency of sick leave were increased in working individuals with self-reported rheumatic and cardiovascular disease (P < 0.001), but self-reported cardiovascular comorbidity did not result in more sick leave in those who also self-reported rheumatic disease. Work disability was also increased for both self-reported rheumatic disease and cardiovascular disease (P < 0.001), but again, no additive effects were found. In the sample verified by clinical review, the frequency or number of days of sick leave was significantly higher in employees with cardiovascular disease (P < 0.001), inflammatory rheumatic disease (P < 0.05), and osteoarthritis (P < 0.05) compared to employees without these diseases. Work disability in the verified sample occurred especially in patients with osteoarthritis (hazard ratio [HR] 12.36 [95% confidence interval (95% CI) 1.59-13.66]), fibromyalgia (HR 14.24 [95% CI 2.02-16.54]), and cardiovascular disease (HR 4.88 [95% CI 1.70-14.01]). CONCLUSION: Rheumatic and cardiovascular diseases increased the risk of sick leave and work disability in a working population, but there was no indication that these effects convey an additive risk.

Cancer risk among tetrafluoroethylene synthesis and polymerization workers.

Tetrafluoroethylene (TFE), a compound used for the production of fluorinated polymers including polytetrafluoroethylene, increases the incidence of liver and kidney cancers and leukemia in rats and mice. This is the first time the cancer risk in humans has been explored comprehensively in a cohort mortality study (1950-2008) that included all polytetrafluoroethylene production sites in Europe and North America at the time it was initiated. A job-exposure matrix (1950-2002) was developed for TFE and ammonium perfluoro-octanoate, a chemical used in the polymerization process. National reference rates were used to calculate standardized mortality ratios (SMRs) and 95% confidence intervals. Among 4,773 workers ever exposed to TFE, we found a lower rate of death from most causes, as well as increased risks for cancer of the liver (SMR = 1.27; 95% confidence interval: 0.55, 2.51; 8 deaths) and kidney (SMR = 1.44; 95% confidence interval: 0.69, 2.65; 10 deaths) and for leukemia (SMR = 1.48; 95% confidence interval: 0.77, 2.59; 12 deaths). A nonsignificant upward trend (P = 0.24) by cumulative exposure to TFE was observed for liver cancer. TFE and ammonium perfluoro-octanoate exposures were highly correlated, and therefore their separate effects could not be disentangled. This pattern of findings narrows the range of uncertainty on potential TFE carcinogenicity but cannot conclusively confirm or refute the hypothesis that TFE is carcinogenic to humans.

The association between study characteristics and outcome in the relation between job stress and cardiovascular disease - a multilevel meta-regression analysis.

OBJECTIVES: Studies about job strain and cardiovascular disease (CVD) have yielded inconsistent results, which hinders making a firm conclusion about the association. Inconsistent findings may be the result of methodological differences. If the relative CVD risk is influenced by methodological differences, these differences should be explored in more detail in future research to clarify which methodological characteristics are inherent to obtain the most accurate estimate between job strain and CVD risk. By assessing how study characteristics are associated with the outcome, we take the first step in unraveling this association. In this review, we explore the following research question: are study characteristics associated with the size of the reported relative CVD risk? METHODS: A systematic literature search yielded 71 studies about job stress, assessed with the demand-control model, and CVD. Traditional meta-regression was extended enabling the use of correlated data to quantify heterogeneity within and between studies. RESULTS: Compared to studies that use the original Job Content Questionnaire (JCQ), studies in which a more deviant form of the JCQ was used yielded, on average, 43% higher estimates. Studies conducted in the USA yielded about 26% lower estimates compared to studies conducted in Scandinavian countries. CONCLUSIONS: Several study characteristics are associated with the size of the reported relative CVD risk. Many of these study features are related to the validity of the exposure and outcome assessment and are inherent to obtain an accurate estimate between work stress and CVD risk. More research is needed to clarify why these study features impact the average relative CVD risk.

The mutual relationship between shift work and depressive complaints--a prospective cohort study.

OBJECTIVE: The aim of this study was to examine longitudinally the mutual relationship between shift work and depressive complaints. METHODS: Data from the ongoing Maastricht cohort study (1998-2008) were used. Firstly, the impact of shift work on the development of depressive complaints, defined as depressed mood, was studied. Both prospective and retrospective approaches were used, conducting, respectively, survival and logistic regression analyses, correcting for possible confounding factors. Secondly, the impact of depressed mood on changes in shift work at one-year follow-up was studied. All analyses were stratified for men and women and, where possible, for age (<45 versus ≥45 years). RESULTS: Overall, the impact of shift work on the development of depressed mood over a ten-year period was rather small, although, male shift workers ≥45 years did contribute to a higher risk of developing depressed mood [hazard risk (HR) 1.37, 95% confidence interval (95% CI) 1.01-1.86]. Retrospective analyses found higher odds of depressed mood and depressive disorder among former or current male shift workers than "never shift workers" [odds ratio (OR) 1.39, 95% CI 1.09-1.79 and OR 1.79, 95% CI 1.32-2.42, respectively]. Results lacked significance when correcting for demographic and work-related factors. Analyses studying the impact of depressed mood on changes in work schedules showed that the risk to change from shift to day work or from shift work to sick leave was higher when depressed mood was reported at baseline [relative risk (RR) shift to day work 1.98, 95% CI 1.13-3.47; RR shift work to sick leave 2.96, 95% CI 2.00-4.29]. CONCLUSIONS: Although shift work did not have a large impact on the development of depressed mood, results might be underestimated due to selection processes and possibly overcorrection.

Prevention of long-term sickness absence and major depression in high-risk employees: a randomised controlled trial.

OBJECTIVES: To examine the efficacy of early intervention on the prevention of long-term sickness absence and major depression among employees at high risk of future sickness absence and with mild to severe depressive complaints. METHODS: Randomised controlled trial conducted among employees working in an office environment. 139 employees were identified both at high risk of future sickness absence and with mild to severe depressive complaints through screening. Subsequently, they were randomly assigned to the intervention group (n = 69) or the control group (n = 70). Objective sickness absence was analysed at 12 and 18 months of follow-up. Depressive complaints were assessed by the Beck Depression Inventory (BDI-II) at baseline, and at 6 and 12 months of follow-up. RESULTS: Intention-to-treat analyses showed a significant difference in total sickness absence duration between the intervention (27.5 calendar days (SD 44.7)) and control group (50.8 days (SD 75.8)) over 12 months of follow-up, a reduction of 46% (p = 0.017). The intervention group showed a non-significantly lower proportion of long-term sickness absence spells compared with the control group (p = 0.127). Statistically significant and clinically relevant differences in depressive complaints were found after both 6 months (p = 0.001) and 12 months (p = 0.005) of follow-up, in favour of the intervention group. Relative risk reductions (RRR) were 19.2% and 19.8% respectively. Sickness absence data were available for all participants over 18 months of follow-up. Questionnaire data were available for 99 (at 6 months) and 90 participants (at 12 months). No adverse events or side effects occurred. CONCLUSIONS: Early intervention in employees with mild to severe depressive complaints and high risk of future long-term sickness absence proved to be effective in preventing/reducing both sickness absence and depressive complaints.

Changes in working time arrangements over time as a consequence of work-family conflict.

Existing longitudinal studies on the relationship between working time arrangements (WTA) and work-family conflict have mainly focused on the normal causal relationship, that is, the impact of WTA on work-family conflict over time. So far, however, the reversed relationship, that is, the effect of work-family conflict on adjustments in WTA over time, has hardly been studied. Because work-family conflict is highly prevalent in the working population, further insight in this reverse relationship is invaluable to gain insight into secondary selection processes. The aim of this study is to investigate whether work-family conflict is prospectively related to adjustments in work schedules, working hours, and overtime work, and to explore sex differences and different time lags in this relation. Data of the prospective Maastricht Cohort Study were used. To study the effect of work-family conflict on a change from shift- to day work over 32 months of follow-up, male three-shift (n = 727), five-shift (n = 932), and irregular-shift (n = 451) workers were selected. To study effects of work-family conflict on reduction of working hours over 12 and 24 months of follow-up, respectively, only day workers (males and females) were selected, capturing 5809 full-time workers (> or =36 h/wk) and 1387 part-time workers (<36 h/wk) at baseline. To examine effects of work-family conflict on refraining from overtime work over 12 months of follow-up, only day workers reporting frequent overtime work at baseline were selected (3145 full-time and 492 part-time workers). Cox regression analyses were performed with adjustments for age, educational level, and presence of a long-term illness. Work-family conflict was associated with a significantly increased risk of changing from shift- to day work over 32 months of follow-up in three-shift workers (relative risk [RR] = 1.77, 95% confidence interval [CI] 1.19-2.63) but not in five-shift workers (RR = 1.32, 95% CI 0.78-2.24) and irregular-shift workers (RR = 0.81, 95% CI 0.50-1.31). Within day workers, work-family conflict among full-time workers was associated with a significantly increased risk of reducing working hours during 1 yr of follow-up in women (RR = 2.80, 95% CI 1.42-5.54) but not men (RR = 1.34, 95% CI 0.81-2.22). In part-time workers, work-family conflict was associated with a significantly increased risk of reducing working hours during 1 yr of follow-up both in women (RR = 1.99, 95% CI 1.04-3.82) and men (RR = 4.03, 95% CI 1.28-12.68). Whereas the effects of work-family conflict on a reduction of working hours somewhat decreased among female full-time workers after 2 yr of follow-up (RR = 2.13, 95% CI 1.24-3.66), among male full-time workers the effects increased and reached statistical significance (RR = 1.53, 95% CI 1.05-2.21). Work-family conflict was not significantly associated with refraining from overtime work over 1 yr of follow-up. This study shows that work-family conflict has important consequences in terms of adjustments in work schedules and working hours over time, with considerable sex differences. The study thereby clearly illustrates secondary selection processes both in shift- and day workers, with significant implications for labor force participation, emphasizing the need for prevention of work-family conflict.

Depressed mood in the working population: associations with work schedules and working hours.

The impact of working time arrangements (WTA) on health has been studied extensively. Still, little is known about the interrelation between work schedules, working hours, and depressed mood. For work schedules, the underlying assumptions regarding depressed mood refer to a disturbance of social and biological rhythms, whereas for working hours, the assumptions relate to workload and work capacity. Conversely, depressed mood may urge an employee to adjust his/her work schedule and/or number of working hours/week (h/wk). The aim of this study was to assess the association between work schedule and working hours with depressed mood. Using baseline data from the Maastricht Cohort Study, depressed mood in day work was compared with depressed mood in different shiftwork schedules (n = 8843). Within day work, several categories of working h/wk were studied in association with depressed mood (n = 7217). The association between depressed mood and several aspects of overtime was assessed separately. Depressed mood was measured with a dichotomous item: "Did you feel down every day over the last two weeks?" Separate logistic regression analyses were conducted for men and women, with adjustments for potential confounders. The odds ratio (OR) for depressed mood was greater for men involved in shiftwork than for men only involved in day work (three-shift OR = 2.05 [95% confidence interval, CI 1.52-2.77]; five-shift OR = 1.34 [95% CI 1.00-1.80]; irregular-shift OR = 1.79 [95% CI 1.27-2.53]). In female employees, five-shift work was associated with a higher prevalence of depressed mood (OR = 5.96 [95% CI 2.83-12.56]). Regarding the number of working h/wk, men working <26 h/wk had a higher prevalence of depressed mood than men working 36-40 h/wk (OR = 2.73 [95% CI 1.35-5.52]). After conducting trend analyses, a significant decreasing trend was found in men, whereas an increasing trend was found in women working a high number of hours. Furthermore, a dose-response relationship was present in men regarding the number of overtime h/wk. This study showed that different work schedules and working hours are associated with depressed mood. Shiftwork was related to a higher prevalence of depressed mood than day work. The association was more pronounced for male employees. Regarding the number of working h/wk, male and female employees showed an opposite trend in depressed mood. Because of the possibility of a healthy worker effect and the possibility of a reciprocal relationship between WTA and depressed mood, the reported relation might be underestimated. This study has illustrated that occupational physicians, who deal with depressed mood among workers, should carefully consider the impact of WTA.

Depressive complaints as a predictor of sickness absence among the working population.

OBJECTIVE: To study the relationship between depressive complaints and sickness absence in the working population. METHODS: Data from a prospective epidemiological cohort (n = 3339) were used. Depressive complaints were measured with the Hospital Anxiety and Depression (HAD-D) Scale. Sickness absence was assessed objectively through individual record linkage with the company registers. RESULTS: Higher levels of depressive complaints were associated with a shorter time to first sickness absence spell and a longer duration of sickness absence. In women with mild depressive complaints, the average number of sickness absence days over 10 months follow-up was 27.37 (SD = 64.73) days versus 11.01 (SD = 30.03) days (P < 0.001) in employees scoring within the reference range. In men this was 14.48 (SD = 38.73) days versus 7.67 (SD = 25.80) days (P < 0.001). CONCLUSIONS: Prevention of mild depressive complaints might be beneficial in preventing future sickness absence.