Implemented disability-related policies and practices and sustained employment of partially disabled employees: evidence from linked survey and register data.

OBJECTIVES: This study examined the associations between implemented disability-related policies and practices (DPP) and sustained employment among partially disabled employees in The Netherlands. METHODS: Employer survey data on implemented DPP were linked to register data on employment outcomes of partially disabled employees (N=6103 employees from N=366 employers). DPP included six domains based on 48 elements: sick leave policy, occupational health and safety services (OHS), prevention policy, reintegration policy, reintegration practices within the current employer and reintegration practices towards another employer. DPP domains were standardized on a 0-1 scale. Separate logistic regression models were estimated for DDP domains on one-year sustained employment adjusted for employee characteristics, firm size, and sector. RESULTS: Almost all organizations implemented at least one element of DPP on prevention policy, OHS, sick leave policy, and reintegration practices within the current employer, and two-thirds on reintegration policy and reintegration practices towards another employer. Implemented DPP on prevention policy [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.3-4.0], OHS (OR 1.9, 95% CI 1.1-3.2), and sick leave policy (OR 1.8, 95% CI 1.0-3.3) were positively associated with sustained employment. No significant results were found for reintegration policy and both reintegration practices domains. Stratified analysis showed that DDP domains were particularly associated with sustained employment in larger organizations and in the private sector. CONCLUSIONS: Implemented DPP related to sick leave policy, OHS and prevention policy are associated with sustained employment among partially disabled employees, in particular in larger organizations and in the private sector.

Experiences of workers with long-term disabilities on employer support throughout the RTW process in The Netherlands: a qualitative study.

PURPOSE: The aim of this qualitative study was to explore ways that employer support influenced successful return to work (RTW) in workers with disabilities. METHODS: We conducted a semi-structured interview study among 27 workers with disabilities in the Netherlands who received a partial disability benefit two years after sick leave and who continued working in paid (part-time) employment after a period of long-term sickness absence (> 2 years). We analyzed data by means of thematic analysis. RESULTS: We identified four types of employer support that were experienced as factors of successful RTW: 1. Supervisor accessibility; 2. Supervisor engagement; 3. Supervisor strategies; and 4. Supervisor-initiated work accommodations. More specifically, during the preparations for RTW phase, the supervisor's active role involved having a positive and open attitude toward facilitating RTW; during the initial RTW phase, the supervisor's role involved being creative in finding solutions for work accommodations; and during the sustained RTW phase, the supervisor's role included helping workers who still needed changes in their work situations. CONCLUSION: The elements of successful employer support reveals that the pressure on the shoulders of the supervisor is high. Future research should further investigate whether supervisors need more phase-specific training from their organization.

The support of the employer is found to be crucial to help workers on long-term sick leave to return- to and remain at work.Supervisors may need more training in skills relevant for RTW, not often having faced cases of long-term sick leave.An important precondition for supervisors to apply these skills is the provision of resources for work accommodations, which should be provided by the employer.

Sustainable employability of long-term care staff in self-managing teams: A qualitative study.

AIM: To discover what long-term care (LTC) staff working in self-managing teams consider necessary to remain sustainably employable. DESIGN: Qualitative study with semi-structured interviews. METHODS: In 2020, semi-structured interviews were conducted one-on-one with 25 LTC workers from a medium-large Dutch organization providing long-term care. All interviews were audio-recorded, anonymously transcribed verbatim and analysed with thematic content analysis in the software program Atlas.ti. RESULTS: LTC workers indicated a need for autonomy. They wanted their control and involvement in decisions to be strengthened. Furthermore, LTC workers indicated a need for relatedness, by experiencing support, a feeling of togetherness and more time to have attention for the residents. Lastly, LTC workers expressed a need for (assistance in) further developing their competence. CONCLUSION: In order to remain willing and able to work, LTC workers in self-managing teams want their needs for autonomy, relatedness and competence to be addressed. Working conditions are important to these LTC workers' sustainable employability since they can hinder or promote the satisfaction of their needs. IMPLICATIONS: It is important that management in LTC is aware of the importance of LTC workers' needs for sustainable employability. We recommend that management critically reflect on and invest in addressing these needs by enhancing indicators and limiting inhibitors of the needs. IMPACT: A robust LTC workforce is necessary to provide care to the aging population. In the context of the increasing implementation of self-managing teams in LTC organizations, understanding what workers in self-managing teams need in order to remain sustainably employable is crucial. For sustainable employability (i.e. to remain willing and able to work), interviewees indicated a need for autonomy, relatedness, and competence. Nearly all participants stressed the importance of belonging and feeling connected. Working conditions seemed to relate not only directly to the sustainable employability of LTC staff but also indirectly through their lack of contribution to the satisfaction of workers' psychological needs. The outcomes of this study primarily impact workers and management within LTC organizations with self-managing teams. They benefit from recognizing the significance of addressing workers' needs to ensure their essential and sustainable employability in the sector. REPORTING METHOD: The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative (COREQ) research were used. PATIENT OR PUBLIC CONTRIBUTION: Two LTC workers provided advice and feedback regarding the materials and set up of the interviews. These two ambassadors additionally helped in reaching our population, by disseminating information about the study.

Effects of a participatory work stress prevention approach for employees in primary education: results of a quasi-experimental study.

OBJECTIVE: Work stress is a serious problem for employees in primary education. This study evaluates the effects of a work stress prevention approach on emotional exhaustion and work stress determinants (job crafting behavior, quantitative and emotional demands, leadership, support, autonomy, team culture and feelings of competence), and the impact of implementation success (management commitment, employee involvement, communication during implementation) on these outcomes. METHODS: A quasi-experimental study was conducted with an intervention group (4 schools, N=102 employees) and a control group (26 schools, N=656 employees) using questionnaires at baseline (T0), one-year (T1) and two-year (T2) follow-up. Multilevel mixed model analyses were performed to test effects of condition and implementation success on changes in emotional exhaustion and work stress determinants between T0 and T2 in the intervention and control group. RESULTS: No effect were found for emotional exhaustion. Improvement of quality of leadership between T0 and T2 was significantly larger in the intervention compared to the control group. Additionally, implementation success was associated with a decrease in unnecessary demands and an increase in quality of leadership, team culture and job crafting behavior. CONCLUSIONS: This study shows no direct effect of the approach on emotional exhaustion, but it does show beneficial effects on quality of leadership. Additionally, results suggest that, when successfully implemented, the approach also has beneficial effects on other work stress determinants (ie, job crafting behavior, unnecessary demands and team culture). Results indicate that - if implemented successfully - the organizational-level intervention has the potential to improve the psychosocial work context.

Transformational leadership and employability among support staff workers with long tenure.

BACKGROUND: In the changing world of work, there is an urgency to gain insight into determinants of the employability among support staff workers with long tenure whose functions may become outdated as their competencies may no longer match the requirements of future jobs. OBJECTIVE: The specific aim of this study was to investigate the relationship between transformational leadership and employability. METHODS: Support staff (n = 236) from a university participated in an online questionnaire focusing on five dimensions of employability (occupational expertise, anticipation and optimization, personal flexibility, corporate sense, and balance) and transformational leadership (identifying and articulating a vision, providing an appropriate model, fostering the acceptance of group goals, providing individual support, and intellectual stimulation. RESULTS: Identifying and articulating a vision (ß= 0.247, p < 0.001), providing an appropriate model (ß= 0.196, p = 0.002), fostering the acceptance of group goals (ß= 0.298, p < 0.001) and providing individual support (ß= 0.258, p < 0.001) were associated with higher balance scores. No significant associations were found between the transformational leadership subscales and the other dimensions of employability. CONCLUSION: The current study found that just one specific dimension of transformational leadership was associated with only one aspect of employability for our target group of long-term employed support staff workers with a high level of job security.

Barriers and Facilitators to Participation and Key Components of Sleep Health Programs: Perspectives for the Corporate Work Environment.

OBJECTIVE: The aim of the study is to explore the barriers and facilitators of participation and key components for sleep health programs designed for corporate work environments. METHODS: Semistructured interviews with corporate executives and occupational medicine specialists in the decision making and management of workplace health promotion programs (WHPP) within their companies were held before and during COVID-19. Interviews were transcribed verbatim and analyzed using thematic content analysis to identify themes. RESULTS: Barrier and facilitator themes emerging from the data include sleep health awareness, work culture, work-family balance, and confidentiality. Key components for sleep health programs included the following: identifying the need for a program, incorporating sleep health risk screening to WHPP, and promoting sleep health by raising awareness thereof. CONCLUSIONS: The identified barriers and facilitators to employee participation and key components of an ideal sleep health program provide guidance for further WHPP.

Mental health of healthcare workers during the first year of the COVID-19 pandemic in the Netherlands: a longitudinal study.

Purpose: In March 2020, the WHO declared COVID-19 a pandemic. Previous virus outbreaks, such as the SARS outbreak in 2003, appeared to have a great impact on the mental health of healthcare workers. The aim of this study is to examine to what extent mental health of healthcare workers differed from non-healthcare workers during the first year of the COVID-19 pandemic. Methods: We used data from a large-scale longitudinal online survey conducted by the Corona Behavioral Unit in the Netherlands. Eleven measurement rounds were analyzed, from April 2020 to March 2021 (N = 16,615; number of observations = 64,206). Mental health, as measured by the 5-item Mental Health Inventory, was compared between healthcare workers and non-healthcare workers over time, by performing linear GEE-analyses. Results: Mental health scores were higher among healthcare workers compared to non-healthcare workers during the first year of the pandemic (1.29 on a 0-100 scale, 95%-CI = 0.75-1.84). During peak periods of the pandemic, with over 100 hospital admissions or over 25 ICU admissions per day and subsequently more restrictive measures, mental health scores were observed to be lower in both healthcare workers and non-healthcare workers. Conclusion: During the first year of the COVID-19 pandemic, we observed no relevant difference in mental health between healthcare workers and non-healthcare workers in the Netherlands. To be better prepared for another pandemic, future research should investigate which factors hinder and which factors support healthcare workers to maintain a good mental health.

Work characteristics and emotional exhaustion among young workers: a latent class analysis.

OBJECTIVES: This study aims to assess the heterogeneity of psychosocial working conditions of young workers by identifying subgroups of work characteristic configurations within young workers and to assess these subgroups' associations with emotional exhaustion. DESIGN: Latent class analysis. Groups were formed based on 12 work characteristics (8 job demands and 4 job resources), educational level and sex. Differences in emotional exhaustion between subgroups were analysed using analysis of variance and post hoc comparisons. SETTING: Data from the 2019 wave of the Netherlands Working Conditions Survey. PARTICIPANTS: 7301 individuals between the age of 18 and 30 years, who worked more than 16 hours per week. MAIN OUTCOME MEASURE: Emotional exhaustion. RESULTS: Five subgroups of work characteristics could be identified and were labelled as: (1) 'low-complexity work' (24.4%), (2) 'office work' (32.3%), (3) 'manual and non-interpersonal work' (12.4%), (4) 'non-manual and interpersonal work' (21.0%), and (5) 'manual and interpersonal work' (9.9%). Mean scores for emotional exhaustion in the two interpersonal work groups (M=3.11, SD=1.4; M=3.45, SD=1.6) were significantly higher than in the first three groups (M=2.05, SD=1.1; M=1.98, SD=1.0; M=2.05, SD=1.1) (all 95% CIs excluding 0). Further, mean scores for emotional exhaustion were significantly higher in the 'manual and interpersonal work' group than in the 'non-manual and interpersonal work' group (95% CI 0.24, 0.45). All results could be replicated in the 2017 and 2021 waves of the Netherlands Working Conditions Survey. CONCLUSIONS: Young workers reported heterogeneous work characteristic configurations with substantial differences in degrees of emotional exhaustion between the identified subgroups. Preventing emotional exhaustion should focus on the two interpersonal work subgroups, which showed a high degree of emotional exhaustion. In prevention efforts, these groups' configurations of work characteristics should be taken into account.

Longitudinal associations between self-reported sleep duration and cardiometabolic disease risk in corporate executives.

OBJECTIVE: This study aimed to determine the longitudinal associations between self-reported sleep duration and cardiometabolic disease (CMD) risk in corporate executives. METHODS: Self-reported sleep duration and lifestyle, occupational, psychological, and anthropometrical, blood pressure and blood marker variables were obtained from 1512 employees at annual health risk assessments in South Africa between 2016 and 2019. Gender-stratified linear mixed models, adjusting for age, lifestyle, occupational and psychological covariates were used to explore these longitudinal associations. RESULTS: Among women, shorter sleep duration was associated with higher body mass index (BMI) covarying for age only (ß with 95% confidence intervals: -0.19 [-0.36, -0.03]), age and occupational factors (-0.20 [-0.36, -0.03]) and age and psychological factors (-0.20 [-0.37, -0.03]). Among men, shorter sleep was associated with both BMI and waist circumference (WC) covarying for age only (BMI: -0.15 [-0.22; -0.08]; WC: -0.62 [-0.88; -0.37]); age and lifestyle factors (BMI: -0.12 [-0.21; -0.04]); WC: -0.016 [-0.92; -0.29], age and occupational factors (BMI: -0.20 [-0.22; 0.08]; WC: -0.62 [-0.88; -0.36]), and age and psychological factors (BMI: -0.15 [-0.22; -0.07]; WC: -0.59 [-0.86; -0.33]). Among men, shorter sleep was also longitudinally associated with higher CMD risk scores in models adjusted for age and lifestyle factors (CMD: -0.12 [-0.20; -0.04]) and age and psychological factors (CMD: -0.08 [-0.15; -0.01]). CONCLUSION: Corporate executives who report shorter sleep durations may present with poorer CMD risk profiles, independent of age, lifestyle, occupational and psychological factors. Addressing sleep health in workplace health programmes may help mitigate the development of CMD in such employees.

Process evaluation of workplace health promotion in a sheltered workplace: a care ethics perspective.

Despite the potential health benefits of workplace health promotion for employees in sheltered workplaces, participation is often limited. The aim of this study was (i) to understand this limited participation, and (ii) to find opportunities for adapting workplace health promotion, such that it better meets the needs of the target population. A responsive process evaluation of an extensive multi-component workplace health promotion program targeting lifestyle behaviors, financial behaviors, literacy and citizenship, was performed in a large, sheltered workplace in the Netherlands (>3500 employees). To understand the limited participation, interviews with employees (n = 8), supervisors (n = 7) and managers (n = 2), and 10 participant observations were performed. To find opportunities for improving workplace health promotion in the sheltered workplace, 7 dialogs with employees were performed (n = 30). The interview data on the barriers for participation were evaluated through the lens of care ethics, as this allowed to understand the role of various stakeholders in the limited participation, as well as the indirect role of the institutional context. Findings showed that participation in workplace health promotion could increase if it is organized in a way that it encourages employees to work on health together, allow to tailor activities to different needs and capabilities of employees, and connects activities to employees' daily lives. A strength of this study is that the responsive process evaluation focused both on barriers for participation, as well as on opportunities to increase participation.

People who cannot participate in work without adaptations, for example, due to disability, can work in sheltered workplaces. These employees face various health risks, which are prompted by, for example, low income or low (health) literacy. More and more sheltered workplaces provide health promotion programs to improve health of their employees, such as educational workshops about physical exercise and healthy nutrition. However, participation of employees in such programs is limited. In this study, we investigated why participation is limited, and what are possible ways to make workplace health promotion programs that aim to improve health more attractive to employees in a sheltered workplace. We used different methods, such as interviews, group dialogs and participant observations. We concluded that workplace health promotion programs seem to rely too much on the individual employee, who prefers to work on health together with peers. Employees also value that activities in the health program are useful for their daily lives. This increases the relevance of the program for them and makes employees more inclined to participate.

Discrepancies between workers with disabilities and their supervisors in reported work accommodations and associations with return to work.

BACKGROUND: The aims of this study were: (1) to explore the frequency of discrepancies in work accommodations reported by workers and their supervisors, and (2) to investigate whether these discrepancies are associated with full return to work (RTW). METHODS: We used data from a longitudinal survey study of long-term sick-listed workers and their supervisors (n = 406). Discrepancies in reports on implementing eight types of work accommodations were explored. Logistic regression analyses were conducted to test associations between discrepancies in reported work accommodations and odds of full RTW 27 months after the sick-leave onset. RESULTS: Discrepancies were the lowest for the work accommodation therapeutic RTW (53%) and the highest (85%) for job training or education and reimbursement of therapy or treatment. Four out of eight types of work accommodations were more often reported by workers than by their supervisors. Only a discrepancy on a job reassignment within the organization was associated with lower odds of full RTW (OR 0.56, 95%-CI 0.36-0.88). CONCLUSION: We found substantial discrepancies in the reported implementation of work accommodations between workers and their supervisors. Future research should focus on disentangling mechanisms that lead to discrepancies to avoid inefficiencies in the RTW process.

The Grip on Health Intervention to Prevent Health Problems Among Workers With a Lower Socioeconomic Position: A Pilot Implementation Study.

OBJECTIVE: Workers with a lower socioeconomic position (SEP) often face problems on multiple life domains. This study evaluated an intervention to identify and solve problems on multiple life domains, called "Grip on Health." METHODS: A mixed-methods process evaluation was performed among occupational health professionals (OHPs) and lower SEP workers with problems on multiple life domains. RESULTS: Thirteen OHPs delivered the intervention to 27 workers. For seven workers, the supervisor was involved, and for two, stakeholders from outside the workplace were involved. Agreements between OHPs with employers often affected implementation. OHPs were essential to help workers identify and solve problems. The intervention increased workers' health awareness and self-control, and led to small and practical solutions. CONCLUSIONS: Grip on Health can support lower SEP workers with solving problems on multiple life domains. However, contextual factors make implementation difficult.

Effectiveness of Team and Organisational Level Workplace Interventions Aimed at Improving Sustainable Employability of Aged Care Staff: A Systematic Review.

Purpose The sustainable employability of healthcare professionals in aged care is under pressure, but research into the effectiveness of interventions aimed at improving employees' sustainable employability is scarce. This review therefore aimed to investigate the effectiveness of workplace interventions on sustainable employability of healthcare professionals in aged care. Methods A systematic literature search was performed. Studies were included when reporting about the effect of an intervention at work in an aged care setting on outcomes related to one of the three components of sustainable employability (i.e. workability, vitality, employability). The methodological quality of each study was assessed and a rating system was used to determine the level of evidence. Additionally, a sensitivity analysis was performed, accounting for the match between the intervention's focus and the targeted component of sustainable employability. Results Current review includes 32 interventions published between 1996 and 2019. Interventions covered learning and improving skills, changing the workplace, and exercising or resting. The initial analysis showed a strong level of evidence for employability and insufficient evidence for workability and vitality. The sensitivity analysis revealed strong evidence for the effectiveness of interventions addressing either employability or workability, and insufficient evidence for vitality. Conclusions Evidence for workplace interventions on sustainable employability of healthcare professionals in aged care differed. We found strong evidence for effects of workplace interventions on employability and for those directly targeting workability. Evidence for effects of interventions on vitality was insufficient. The alignment of the interventions to the targeted component of sustainable employability is important for effectiveness.

Psychosocial work factors affecting mental health of young workers: a systematic review.

OBJECTIVE: For the general working population, robust evidence exists for associations between psychosocial work exposures and mental health. As this relationship is less clear for young workers, this systematic review aims at providing an overview of the evidence concerning psychosocial work factors affecting mental health of young workers. METHODS: The electronic databases used were PubMed, Web of Science, and PsycINFO and were last searched in October 2021. The eligible outcomes included depression-, stress-, burnout- and anxiety-related complaints, and fatigue, excluding clinical diagnoses and suicide-related outcomes. Only studies with workers aged 35 years or younger were included, which reported at least one association between a psychosocial work factor as exposure and a mental health complaint as outcome. Studies had to be in English, German or Dutch. Risk of bias was assessed using an instrument from the National Heart, Lung, and Blood Institute. Data synthesis was conducted using GRADE. RESULTS: In total 17 studies were included in this systematic review, including data from 35,600 young workers in total. Across these studies 86 exposure-outcome associations were reported. Nine exposure-outcome associations could be synthesised. The application of the GRADE framework led to one "low" assessment for the association between psychosocial job quality and mental health. The certainty of evidence for the other eight associations in the synthesis was very low. CONCLUSIONS: The current systematic review disclosed a high degree of uncertainty of the evidence due to conceptually fuzzy outcomes and exposures as well as large heterogeneity between studies.

Responsive evaluation: an innovative evaluation methodology for workplace health promotion interventions.

Background: Workplace health promotion (WHP) interventions have limited effects on the health of employees with low socioeconomic position (SEP). This paper argues that this limited effectiveness can be partly explained by the methodology applied to evaluate the intervention, often a randomised controlled trial (RCT). Frequently, the desired outcomes of traditional evaluations may not match employees'-and in particular employees with low SEP-needs and lifeworld. Furthermore, traditional evaluation methodologies do not function well in work settings characterised by change resulting from internal and external developments. Objective: In this communication, responsive evaluation is proposed as an alternative approach to evaluating WHP interventions. Responsive evaluation's potential added value for WHP interventions for employees with low SEP in particular is described, as well as how the methodology differs from RCTs. The paper also elaborates on the different scientific philosophies underpinning the two methodologies as this allows researchers to judge the suitability and quality of responsive evaluation in light of the corresponding criteria for good science.

Caregiver's burden at the end of life of their loved one: insights from a longitudinal qualitative study among working family caregivers.

BACKGROUND: Growing numbers of people with advanced illnesses who wish to die at home, a concurrent decline in the accessibility of professional home care, and policies aiming at prolonging work participation are increasing the reliance on family caregivers. This study aimed to describe trajectories in burden of working family caregivers who care for patients with a life-threatening illness, and identify factors in work and care that are related to changes in burden over time. METHODS: Semi-structured interviews were held in one to four rounds between July 2018 and November 2020 with 17 working family caregivers of patients with a life-threatening illness living at home. Transcripts were analysed as a single unit to create timelines per participant. Next, individual burden trajectories were created and grouped based on the course of burden over time. Factors related to changes in burden were analysed, as well as similarities and differences between the groups. RESULTS: It was common for family caregivers who combine work and end-of-life care to experience a burden. Two trajectories of caregiver burden were identified; caregivers with a persistent level of burden and caregivers with an increasing burden over time. Family caregivers with a persistent level of burden seemed to be at risk for burnout throughout the illness trajectory, but were often able to cope with the situation by making arrangements in care or work. Caregivers with an increasing burden were unable to make sufficient adjustments, which often resulted in burnout symptoms and sick leave. In both groups, burden was mostly related to aspects of the care situation. The emotional burden, a decreasing burden after death and a different view on the trajectory in hindsight proved to be important overarching themes. CONCLUSIONS: Providing care to a loved one nearing the end of life is often emotionally burdensome and intensive. To facilitate the combination of paid work and family care, and reduce the risk of burnout, more support is needed from employers and healthcare professionals during the illness trajectory and after death. Bereaved family caregivers also warrant more attention from their supervisors and occupational physicians in order to facilitate their return to work.

Participatory Approach to Create a Supportive Work Environment for Employees With Chronic Conditions: A Pilot Implementation Study.

OBJECTIVE: To evaluate a pilot implementation of an organizational-level intervention. The participatory approach (PA) was used to create a supportive work environment for employees with chronic conditions, with a key role for occupational physicians (OPs). METHODS: Twenty-eight semi-structured interviews were conducted with OPs and stakeholders within their organizations. Furthermore, observational data and research notes were gathered. Data analysis occurred through content analysis. RESULTS: Recruitment of organizations was challenging, with a reach of 25%. Dose delivered, dose received, and fidelity differed across the three organizations. Organizations were positive about the PA as a method to improve support for employees with chronic conditions. CONCLUSIONS: The PA could be of added value for creating a supportive work environment. However, research is needed on activating organizations to improve support for employees with chronic conditions.

A team level participatory approach aimed at improving sustainable employability of long-term care workers: a study protocol of a randomised controlled trial.

BACKGROUND: Staff currently working in long-term care experience several difficulties. Shortage of staff and poor working conditions are amongst the most prominent, which pose a threat to staff's sustainable employability. To improve their sustainable employability it is important to create working conditions that fulfil workers' basic psychological need for autonomy, relatedness and competence in line with Self-Determination Theory. Since many long-term care organisations work with self-managing teams, challenges exist at team level. Therefore, there is a need to implement an intervention aimed at maintaining and improving the sustainable employability of staff on team level. METHODS: We developed a participatory workplace intervention, the Healthy Working Approach. In this intervention teams will uncover what problems they face related to autonomy, relatedness and competence in their team, come up with solutions for those problems and evaluate the effects of these solutions. We will evaluate this intervention by means of a two-arm randomized controlled trial with a follow-up of one year. One arm includes the intervention group and one includes the waitlist control group, each consisting of about 100 participants. The primary outcome is need for recovery as proxy for sustainable employability. Intervention effects will be analysed by linear mixed model analyses. A process evaluation with key figures will provide insight into barriers and facilitators of the intervention implementation. The Ethical Committee Social Sciences of the Radboud University approved the study. DISCUSSION: This study will provide insight in both the effectiveness, and the barriers/facilitators of the implementation process of the Healthy Working Approach. The approach is co-created with long-term care workers, focuses on team-specific challenges, and is rooted in the evidence-based participatory workplace approach and Self-Determination Theory. First results are expected in 2022. TRIAL REGISTRATION: Netherlands Trial Register, NL9627 . Registered 29 July 2021 - Retrospectively registered.

Sex and gender differences in depressive symptoms in older workers: the role of working conditions.

BACKGROUND: Female older workers generally leave the work force earlier than men. Depressive symptoms are a risk factor of early work exit and are more common in women. To extend working lives, pathways leading to these sex inequalities need to be identified. The aim of this study was to investigate the association of sex and gender with depressive symptoms in older workers, and the role of working conditions in this association. METHODS: We used data from the Longitudinal Aging Study Amsterdam (2012-2013/2015-2016, n = 313). Our outcome was depressive symptoms, measured by the Center for Epidemiologic Studies Depression Scale. We included biological sex, a gender index ranging from masculine to feminine (consisting of six items measuring gender roles: working hours, income, occupation segregation, education, informal caregiving, time spent on household chores), and working conditions (physical demands, psychosocial demands, cognitive demands, autonomy, task variation, social support) in our models. We examined the differential vulnerability hypothesis, i.e., sex/gender moderates the association between working conditions and depressive symptoms, and the differential exposure hypothesis, i.e., working conditions mediate the association between sex/gender and depressive symptoms. RESULTS: Female sex and feminine gender were both associated with more depressive symptoms. The differential vulnerability hypothesis was not supported by our results. We did find that femininity was negatively associated with autonomy and task variation. In turn, these working conditions were associated with fewer depressive symptoms. Thus, autonomy and task variation partially mediated the association between gender and depressive symptoms, supporting the differential exposure hypothesis. Mediation effects for sex inequalities were not significant. CONCLUSIONS: Older female workers and older feminine workers have more depressive symptoms than their male/masculine counterparts. Autonomy and task variation appeared to be important in - partially - explaining gender differences in depressive symptoms rather than sex differences. By improving these conditions, gender inequality in mental health among older workers can be reduced, so that both genders have similar chances to reach the retirement age in good mental health.