Association between long working hours of doctors and the seriousness of adverse events: a cross-sectional study using national adverse event reporting system data in Japan.

The association between doctors' long working hours and the seriousness of adverse events with high patient impact has not been fully confirmed. Most previous studies were based on work hour regulations using more than 80 hours per week as an indicator of long working hours. We aimed to assess the association using a shorter indicator as the cut-off for long working hours among hospital doctors including senior doctors. This cross-sectional study used 12,245 adverse event reports from the Japan Council for Quality Health Care. We defined long working hours as 55 hours or more in the week before the adverse event and assessed the association with the seriousness of adverse events with high patient impact. The results showed that doctors working 55 or more hours in the preceding week were more likely to be involved in serious adverse events than those working fewer hours (odds ratio (OR) 1.22, 95% confidence interval (CI): 1.12-1.32). This association remained significant after adjusting for all covariates (OR 1.18, 95% CI: 1.08-1.28). Senior doctors were more likely to be involved in serious adverse events. Long working hours among doctors were associated with the seriousness of adverse events.

Effect of working hours on prognosis of acute ischemic stroke patients following alteplase intravenous thrombolysis.

OBJECTIVE: To investigate the effect of hospital working hours on outcomes of patients with acute ischemic stroke 3 months after receiving alteplase intravenous thrombolysis. METHODS: A retrospective analysis was performed on 254 individuals with acute ischemic stroke who received alteplase intravenous thrombolysis between January 2018 and December 2020 either during peak hospital working hours (08:00-17:59; Group A) or off-peak hours (18:00-07:59 the following day; Group B). Patients were also categorized according to which of four peak/off-peak-hour periods they received treatment in: Group 1 (08:00-11:59), Group 2 (12:00-17:59), Group 3 (18:00-21:59), Group 4 (22:00-07:59 the following day). Baseline data and 3-month prognosis were compared across groups. Logistic regression analysis was used to investigate the correlation between hospital working hours and 3-month prognosis. RESULTS: There were no significant differences in door-to-needle time, onset-to-needle time, 24-hour National Institutes of Health Stroke Scale (NIHSS) score, 7-day NIHSS score or Modified Rankin Score between Groups 1 to 4 or between Groups A and B. Whether treatment was administered during peak or off-peak hours did not significantly affect 3-month prognosis. CONCLUSION: At this hospital, differences in the time at which stroke patients were treated were not associated with outcomes.

Impact of Long Working Hours on Mental Health Status in Japan: Evidence from a National Representative Survey.

Using the 2010-2019 Comprehensive Survey of Living Conditions (CSLC) conducted in Japan, we examined the impact of long working hours on mental health in Japan while addressing the endogeneity issue arising from non-random selection bias. We assessed the variations in the effects of long working hours on mental health across different groups. The results show that first, individuals working longer hours (55 h or more per week) exhibited a higher likelihood of developing mental illness than those working regular hours or fewer hours. Second, the negative effect of long working hours on mental health is more pronounced among non-regular workers than among regular workers. Third, the effect of long working hours on mental health varies among different demographic groups, with a greater impact observed among women, managers, non-regular workers, employees in small- or large-sized firms, and those in smaller cities compared to their counterparts. Thus, to enhance worker productivity, the Japanese government should address the issue of long working hours to improve employees' mental well-being. Initiatives aimed at promoting work-life balance, family-friendly policies, and measures to ameliorate working conditions are expected to help mitigate the challenges associated with long working hours and mental health issues, especially among non-regular workers.

Joint association of daily rest periods and sleep duration with sick leave: a one-year prospective cohort study of daytime employees in Japan.

Daily rest period (DRP) refers to the interval between the end of one workday and the start of the next. This study examined the joint association of DRP and sleep duration with subsequent sick leave among Japanese daytime employees. Participants (n=5,593) were measured for DRP and sleep duration at baseline and for sick leave at 1-year follow-up. They were categorized into 10 groups based on their DRP and daily sleep duration. Logistic regression analyses for individuals experiencing sick leave for longer than a month showed that the combination of short DRP (<11 h) and sleep duration (<6 h) had a higher odds ratio (4.981, 95% confidence interval [CI] = 1.126-22.046) than the reference group. Furthermore, the combination of short DRP and normal sleep duration had a higher odds ratio (8.152, 95% CI = 1.801-36.902) than the reference group. Short DRP was associated with subsequent long sick leave.

The Effect of 24 h Shift Work on the Nutritional Status of Healthcare Workers: An Observational Follow-Up Study from Türkiye.

This study aimed to determine changes in energy and nutrient intakes over three consecutive days, including the day of the shift, and the days before and after the shift, in healthcare workers working in a 24 h shift system. This study is an observational follow-up study conducted with a total of 500 volunteer healthcare professionals. Food consumption records were taken over 3 consecutive days: pre-shift (off day), shift day (24 h shift), and post-shift (off day). Mean daily intakes of energy, carbohydrate, protein, fat, saturated fat, caffeine, vitamins B1, B2, niacin, B6, folate, and B12, potassium, magnesium, phosphorus, iron, and zinc are listed from highest to lowest as shift day > pre-shift > post-shift (p < 0.05 for all pairwise comparisons). While fiber, vitamin C, and calcium intakes were similar on the shift day and pre-shift day, they were significantly lower on the post-shift day (p < 0.05). The lowest dietary reference intake percentages on the post-shift day were calcium, fiber, and folate, respectively. In the present study, significant differences were detected in the energy, micronutrient-intake, and macronutrient-intake levels between the pre-shift day, shift day, and post-shift day of healthcare workers. Awareness should be increased regarding the decreased nutrient intake seen especially on the first day after a 24 h shift, and appropriate precautions should be taken to increase calcium, fiber, and folate intake levels.

Commuting time, working time, and their link to insomnia symptoms among Korean employees: A cross-sectional study.

OBJECTIVE: Although commuting time is an extension of working hours, few studies have examined the relationship between commuting time and insomnia symptoms in relation to working time. Thus, this study investigated the relationship between commuting time and working time and their link to sleep disturbance. METHODS: This study included employees with ≥35 weekly working hours (n = 30,458) using data from the Sixth Korean Working Conditions Survey conducted in Korea between October 2020 and April 2021. The association between commuting time (≤60, 61-120, and >120 minutes) and insomnia symptoms based on working hours (35-40, 41-52, and >52 h/wk) or shift work was investigated using survey-weighted logistic regression analysis. RESULTS: Long commuting time (>120 min/d) combined with >52 working hours/week (OR: 7.88, 95% CI: 2.51-24.71) or combined with 41-52 h/wk (OR: 3.64, 95% CI: 2.15-6.14) was associated with a higher risk of insomnia symptoms compared with the reference group (working hours: 35-40 h/wk; daily commuting time: ≤60 minutes), after controlling for sex, age, socioeconomic factors, and work-related factors. Among shift workers, those with daily commuting time ≤60 minutes (OR: 1.71, 95% CI: 1.39-2.09), 61-120 minutes (OR: 2.63, 95% CI: 1.21-5.74), and >120 minutes (OR: 5.16, 95% CI: 2.14-12.44) had higher odds of insomnia symptoms than nonshift workers with ≤60 minutes daily commuting time. CONCLUSION: Long working hours and shift work are associated with greater risk of insomnia symptoms.

Sleep duration and quality in permanent night work: an observational field study.

PURPOSE: Permanent night workers conceivably show better adaptation of circadian rhythms to night work than shift workers and therefore better possibilities of obtaining sufficient sleep of good quality after night shifts. We investigated the effect of night shifts including number of consecutive shifts on sleep among self-selected permanent night workers, and studied if the effect of night shifts differed between morning and evening types and compared with 3-shift workers. METHODS: The study population included 90 permanent night workers followed for 14 days (warehouse workers, 1228 observation days, 80% males). For comparison, we included 70 3-shift workers followed for 26 days (police officers, 1774 observation days, 100% men). Total sleep time (TST), primary sleep duration (PSD), and sleep efficiency were assessed by actigraphy. Measures of sleep quality and diurnal type were self-reported. RESULTS: Among permanent night workers, TST, PSD, difficulties falling asleep, disturbed sleep, and the number of awakenings decreased after night shifts compared with days without night work. Sleep efficiency, difficulties awakening, and non-refreshing sleep increased. More consecutive night shifts were associated with shorter TST and PSD. Sleep outcomes did not differ by diurnal type. Permanent night workers had fewer awakenings after night shifts than 3-shift workers, but no other differences were observed. CONCLUSION: This study does not provide evidence that supports recommendation of permanent night work to reduce adverse effects of night shifts on sleep. A limited number of consecutive night shifts is recommended to reduce accumulation of sleep debt.

Could working less promote environmental concern? A cross-national intercohort analysis.

Working time and the environment are two important issues of our time and have attracted wide attention from both academia and the public. An emerging body of literature connects these two fields and discusses the environmental impacts of long working hours, yet little is known about how working time is related to the underlying pro-environmental attitude change. Drawing upon literature in worktime studies and environmental sociology, this study examines the extent to which working hours are associated with environmental concern, and how this relationship is contingent on the level of national economic development and cohort replacement. Cross-national intercohort analyses of four waves of ISSP data show that consistent with the political economic theories and degrowth perspective, working hours are negatively related to environmental concern. Furthermore, this association is more salient in high-income countries and intensifies among younger cohorts. This study highlights the importance of examining environmental concern in a dynamic social structure as well as the possibility of constructing a socio-ecological sustainable society.

An organizational working time reduction and its impact on three domains of mental well-being of employees: a panel study.

BACKGROUND: Work hours are an important aspect of one's job and these in turn have the potential to impact people's well-being. Much research investigating the link between working hours and well-being uses cross-sectional data. Longitudinal studies, especially those studying the same subjects changing their working time, can study the impact of work time more clearly. Using panel data, this study aims to explore the impact of a reduction in working time on three domains of well-being: general well-being, job-related well-being (positive work experience) and work-family well-being (work-family conflict). In addition, our study offers insights into the role of concomitant changes in work and private circumstances of employees as we investigate whether the impact of shorter working hours for well-being is mediated by changes in the participants' and circumstances related to paid and unpaid work resources. METHOD: An organization of about 60 (female) employees trialed a shorter workweek for one calendar year in 2019. All full-time employees reduced their hours. The part-time working employees can be used as a control group. Panel data (survey and time-use diary data) of a 30-h workweek trial in Belgium was collected in four waves over two years in a pre- and post-intervention design. Change over time (waves) was analyzed through multilevel growth models. RESULT: A decrease in work-family conflict was observed during the shorter workweek. Part of this decrease is explained by concomitant changes in work and private circumstances, such as sufficiency in free time, schedule control, and satisfaction with work pressure. Positive work experience and general well-being tend to have decreased during the shorter workweek, although this could partly be explained by other organizational changes and not by the reduction in working hours per se. Schedule control helped suppress these somewhat negative effects of organizational changes on positive work experience. CONCLUSION: Reduced working hours have the largest and most positive impact on work-family conflict. The feeling of having enough leisure time contributes to this increased well-being. Especially for women, who were the majority in this study, a reduction in working time might be beneficial as they often bear more responsibility for household work and care tasks. Next to the duration of working time, schedule control/autonomy has an important impact on well-being.

Unpaid overtime and mental health in the Canadian working population.

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

The prevalence of post-traumatic stress disorder among emergency medical services personnel in Saudi Red Crescent Authority, Riyadh, Saudi Arabia.

Background: Determining the prevalence of PTSD and contributing variables among (EMS) specialists was the goal of the current investigation. Furthermore, limited evidence exists regarding the application of PCL-5 for EMT practitioners, and the incidence of PTSD among different age groups and genders in Saudi Arabia. Methods: This cross-sectional descriptive study includes 211 prehospital care providers of the Saudi Red Crescent Authority stations in Riyadh. The randomization was done using Google Forms into subgroups according to participants' gender, years of experience, occupations, and average working hours. The presence and severity of PTSD symptoms were evaluated using the 20-item PTSD Checklist for DSM-5 (PCL-5) self-report questionnaire. Data were analyzed using Pearson Chi-Square, Mann-Whitney and Kruskal-Wallis tests. The reliability statistics were calculated using Cronbach's Alpha for the 20-survey questionnaire. Results: The comparison of PCL-5 total scores indicated more PTSD symptomatology among females (1.61 + 0.799) as compared to male workers (1.13 + 0.642). The total score of PTSD demonstrated no statistically significant (P=0.79) differences between our age group classifications. In terms of the participants' city (Riyadh), the total PTSD score was less than the cutoff point which is 31. PTSD total score may not be affected by working experience as indicated by the non-significant difference in prevalence among EMT practitioners having <5 years, 5-10 years and above 10 years of working experience (P=0.215 with X2 = 3.076). PTSD incidence is affected by the type of occupation as statistically significant differences between groups (P=0.001) were recorded depending on the position and responsibilities of EMS practitioners. PTSD is also affected by average working hours per week, and there were statistically significant differences between groups (P=0.001). Conclusion: The total score of PTSD in the case of emergency service practitioners was found to be 33.7% among all the research participants, which may be regarded as a high prevalence when compared to the general population. Our investigations would contribute to a better understanding of the underlying factors of mental stress in EMS specialists in Saudi Arabia and to the development of adequate mental health practices.

Reliability and validity of the Japanese version of the Overwork Climate Scale.

This study aimed to investigate the validity and reliability of the Japanese version of the Overwork Climate Scale. Japanese workers were invited to participate in online surveys at baseline and 1-month follow-up. The Overwork Climate Scale was translated into Japanese, according to international guidelines. Reliability was assessed using Cronbach's alpha and the intra-class correlation coefficient (ICC), while structural validity was evaluated through confirmatory factor analysis (CFA). Psychological job demands, work engagement, psychological safety, and workaholism were assessed for convergent validity. The number of respondents was 302 at baseline and 169 at follow-up. Results indicated robust Cronbach's alpha values of 0.86 (for overwork endorsement) and 0.80 (for lacking overwork reward) at baseline, complemented by ICC of 0.89 and 0.82, respectively. CFA confirmed the suitability of the two-factor model. Moreover, the Japanese Overwork Climate Scale exhibited significant correlations with anticipated constructs. Structural equation modeling revealed a consistent association between overwork climate and both workaholism and work engagement, similar to the original version. In conclusion, the Japanese version of the Overwork Climate Scale demonstrates acceptable levels of reliability and validity, warranting its potential adoption among Japanese workers.

The association of long working hours and short sleep duration on mental health among Japanese physicians.

This cross-sectional study investigate the association between long working hours, short sleep duration, and mental health among Japanese physicians. We enrolled 232 Japanese physicians. We used the Brief Job Stress Questionnaire to assess high-stress status, and the Japanese version of the Center for Epidemiologic Studies Depression scale to assess depressive status. Daily sleep duration (DSD) and weekly working hours (WWHs) were collected using a self-administered questionnaire. Multivariable-adjusted logistic regression analysis was performed to examine the association of the combined categories of DSD and WWHs with high-stress and depressive status. Compared to physicians with WWHs <80 h and DSD ≥6 h, the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of high-stress status for those with WWHs ≥80 and DSD ≥6, WWHs <80 and DSD <6, and WWHs ≥80 and DSD <6 were 2.76 (0.97-7.87), 3.36 (1.53-7.40), and 3.92 (1.52-10.14), respectively. The respective ORs (CIs) of depressive status were 1.82 (0.42-7.81), 4.03 (1.41-11.53), and 4.69 (1.33-16.62). The results showed that regardless of working long hours or not, physicians with DSD <6 h had significantly higher stress and depressive status, suggesting that not only regulating long working hours but also ensuring adequate sleep duration is important for preventing physicians' mental health.

Impacts of Working Hours, Wages, and Regular Employment Opportunity on Suicide Mortalities of Employed and Unemployed Individuals before and during the COVID-19 Pandemic in Japan.

Standardized suicide mortality rates per 100,000 population (SMRs) in Japan consistently decreased from 2009-2019, but these decreasing trends were reversed to increase in 2020. To clarify the mechanisms of recent increasing suicide in Japan, temporal fluctuations of SMRs disaggregated by sex and employment status (employed and unemployed individuals) and labor indices such as working hours, wages, and regular employment opportunity index (REO) from January 2012 to June 2023 were analyzed using interrupted time-series analysis. Additionally, temporal causalities from labor indices to SMRs were analyzed using vector autoregressive and non-linear auto-regressive distributed lag analyses. Decreasing trends among employed SMRs of both sexes were attenuated after the enactment of the "Work Style Reform Program" in 2018, but male SMRs were unaffected by the COVID-19 pandemic. However, female employed SMRs sharply increased, synchronized with the "Work Style Reform Act" and the COVID-19 pandemic outbreak (the COVID-19 impact was greater than the "Work Style Reform Act"). Additionally, unemployed SMRs of both sexes sharply increased with the revision and scale-down of countermeasures against economic deterioration caused by COVID-19 ("revision of economic supportive countermeasures against economic deterioration caused by COVID-19"). Unexpectedly, after enacting the "Work Style Reform Act", wages decreased due to possibly decreasing working hours. Increasing REO, which consistently increased, was a protective factor for male suicides, but unemployed SMRs were not affected by any labor indices. It has been established that controlling a heavy workload plays an important role in suppressing the deterioration of physical and mental conditions, including suicide; however, this study suggested that, at least within appropriate ranges of working hours, decreasing working hours due to excessive management probably contributes to increasing suicides of some vulnerable individuals via de-creasing their wages. Although governmental welfare and economic support measures had to be revised according to rapidly changing situations during the COVID-19 pandemic, this study also suggested that temporal gaps among a part of revisions of several welfare and economic support measures were unexpectedly involved in drastically/sharply increasing suicides of unemployed individuals in 2022.

Self-reported diabetes mellitus among seafarers: occupational and sociodemographic predictors.

BACKGROUND: Seafarers are at increased risk of diabetes due to their lifestyle and working conditions on board ships. There is, however, limited evidence regarding the magnitude of diabetes and its risk factors. In this study, we aimed to assess the prevalence of self-reported diabetes among seafarers on board ships and identify risk factors associated with it. MATERIALS AND METHODS: A cross-sectional epidemiological survey was conducted among seafarers aboard ships between November and December 2022. The study enrolled a total of 4,500 seafarers aged 18 and older. Data were collected using anonymous, standardized questionnaires. The association between the outcome variable and the independent variables was assessed using binary logistic regression models. RESULTS: In total, 2,986 participants were included in the study. The prevalence of self-reported diabetes among seafarers was found to be 8.2% (95% CI: 7.2-9.2). Self-reported diabetes prevalence among officers and non-officers was 7% and 9%, respectively. The mean age of study participants was 37.96 ± 10.22, while the mean age of participants with diabetes was 47.5 ± 9.46. Independent predictors of self-reported diabetes mellitus were age (51+ years) [adjusted odds ratio (AOR): 3.52, 95% confidence interval (CI): 1.46-8.95], rank (non-officer) [AOR: 1.65; 95% CI: 1.14-2.40], worksites (engine) (AOR: 2.08, 95% CI: 1.19-3.77), work experience (10-20 years) (AOR: 4.66, 95% CI: 2.33-10.05), work experience (21+ years) (AOR: 5.01, 95% CI: 2.32-11.55), working hours per week (57-70 hours) (AOR: 1.57, 95% CI: 1.08-2.31), working hours per week (71+ hours) (AOR: 1.80, 95% CI: 1.17-2.80), self-reported hypertension (AOR: 1.44, 95% CI: 1.03-1.99), overweight (AOR: 1.74; 95% CI: 1.24-2.47), and obesity (AOR: 2.93; 95% CI: 1.84-4.65). CONCLUSIONS: This study revealed that one in twelve seafarers between the ages of 19 and 70 have self-reported diabetes. The present study identified significant risk factors associated with diabetes. Risk factor mitigation strategies aimed at high-risk groups should be implemented on board ships.

Adoption and Use of Telemedicine and Digital Health Services Among Older Adults in Light of the COVID-19 Pandemic: Repeated Cross-Sectional Analysis.

BACKGROUND: As the population ages and the prevalence of long-term diseases rises, the use of telecare is becoming increasingly frequent to aid older people. OBJECTIVE: This study aims to explore the use and adoption of 3 types of telehealth services among the older population in Israel before, during, and after the COVID-19 pandemic. METHODS: We explored the use characteristics of older adults (aged ≥65 years) belonging to Clalit Health Services in several aspects in the use of 3 types of telehealth services: the use of digital services for administrative tasks; the use of synchronous working-hours telehealth visits with the patient's personal physician during clinic business hours; and the use of after-hours consultations during evenings, nights, and weekends when the clinics are closed. The data were collected and analyzed throughout 3 distinct periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic, and following the COVID-19 peak. RESULTS: Data of 618,850 patients who met the inclusion criteria were extracted. Telehealth services used for administrative purposes were the most popular. The most intriguing finding was that the older population significantly increased their use of all types of telehealth services during the COVID-19 pandemic, and in most types, this use decreased after the COVID-19 peak, but to a level that was higher than the baseline level before the COVID-19 pandemic. Before the COVID-19 pandemic, 23.1% (142,936/618,850) of the study population used working-hours telehealth visits, and 2.2% (13,837/618,850) used after-hours consultations at least once. The percentage of use for these services increased during the COVID-19 pandemic to 59.2% (366,566/618,850) and 5% (30,777/618,850) and then decreased during the third period to 39.5% (244,572/618,850) and 2.4% (14,584/618,850), respectively (P<.001). Multiple patient variables have been found to be associated with the use of the different telehealth services in each period. CONCLUSIONS: Despite the limitations and obstacles, the older population uses telehealth services and can increase their use when they are needed. These people can learn how to use digital health services effectively, and they should be given the opportunity to do so by creating suitable and straightforward telehealth solutions tailored to this population and enhancing their usability.

[Position paper of the Berlin-Brandenburg Surgical Society-On the future of surgical further training]. / Positionspapier der Berlin-Brandenburgischen Chirurgischen Gesellschaft ­ zur Zukunft der chirurgischen Weiterbildung.

BACKGROUND: Surgical further training faces the challenging task of reconciling technological advancements and patient safety, particularly in the context of the planned hospital reform. Additionally, the generation shift and evolving expectations of Generations Y and Z in the workplace present further challenges. In response to these demands, the Berlin-Brandenburg Surgical Society (Berlin-Brandenburgische Chirurgische Gesellschaft, BCG) initiated a structured discussion and developed a position paper during the Neuhardenberg talks (Neuhardenberger Gespräche). METHODOLOGY: Within the framework of the Neuhardenberg talks, four sessions with keynote presentations and discussions took place. Based on the main discussion points, theses and positions were subsequently formulated and digitally voted on. RESULTS: The results reveal a clear consensus favoring flexible working hours models, earlier specialization options and the integration of external rotations in surgical further training. Regarding talent acquisition and early recruitment of residents, there was a clear consensus supporting the promotion of employee engagement and structured early recruitment of students. There was unanimous agreement on the introduction of training associations as an effective means to ensure high-quality surgical further training. DISCUSSION: One of the central points in the discussions was that high-quality surgical further training will only be achievable within training associations, especially given the impending hospital reform. The BCG plans to develop a modular further training association to make surgical further training in Berlin/Brandenburg fit for the future.

The overall fractions of coronary heart diseases and depression attributable to multiple dependent psychosocial work factors in Europe.

OBJECTIVES: The literature is nonexistent on the assessment of overall fractions of diseases attributable to multiple dependent psychosocial work factors. The objectives of the study were to calculate the overall fractions of coronary heart diseases (CHD) and depression attributable to multiple dependent psychosocial work factors in 35 European countries. METHODS: We used already published fractions of CHD and depression attributable to each of the following psychosocial work factors: job strain, effort-reward imbalance, job insecurity, long working hours, and workplace bullying. We took all exposures and their correlations into account to calculate overall attributable fractions. Wald tests were performed to test differences in these overall attributable fractions between genders and between countries. RESULTS: The overall fractions of CHD and depression attributable to all studied psychosocial work factors together were found to be 8.1% [95% CI: 2.0-13.9] and 26.3% [95% CI: 16.2-35.5] respectively in the 35 European countries. There was no difference between genders and between countries. CONCLUSION: Our study showed that the overall fractions attributable to all studied psychosocial work factors were substantial especially for depression. These overall attributable fractions may be particularly useful to evaluate the burden and costs attributable to psychosocial work factors, and also to inform policies makers at European level.