Recent studies based on self-reported data suggest that retirement may have beneficial effects on mental health, but studies using objective endpoints remain scarce. This study examines longitudinally the changes in antidepressant medication use across the 9 years spanning the transition to retirement.
Participants were Finnish public-sector employees: 7138 retired at statutory retirement age (76% women; mean age, 61.2 years), 1238 retired early due to mental health issues (78% women; mean age, 52.0 years), and 2643 retired due to physical health issues (72% women; mean age, 55.4 years). Information on purchase of antidepressant medication 4 years before and 4 years after retirement year was based on comprehensive national pharmacy records in 1994-2005.
One year before retirement, the use of antidepressants was 4% among those who would retire at statutory age, 61% among those who would retire due to mental health issues, and 14% among those who would retire due to physical health issues. Retirement-related changes in antidepressant use depended on the reason for retirement. Among old-age retirees, antidepressant medication use decreased during the transition period (age- and calendar-year-adjusted prevalence ratio for antidepressant use 1 year after versus 1 year before retirement = 0.77 [95% confidence interval = 0.68 to 0.88]). Among those whose main reason for disability pension was mental health issues or physical health issues, there was an increasing trend in antidepressant use prior to retirement and, for mental health retirements, a decrease after retirement.
Trajectories of recorded purchases of antidepressant medication are consistent with the hypothesis that retirement is beneficial for mental health.
Mental ill-health, particularly depression and anxiety, is a leading and increasing cause of disability worldwide, especially for women.
We examined the prospective association between physical activity and symptoms of mental ill-health in younger, mid-life and older working women. Participants were 26 913 women from the ongoing cohort Finnish Public Sector Study with complete data at two phases, excluding those who screened positive for mental ill-health at baseline. Mental health was assessed using the 12-item General Health Questionnaire. Self-reported physical activity was expressed in metabolic equivalent task (MET) hours per week. Logistic regression models were used to analyse associations between physical activity levels and subsequent mental health.
There was an inverse dose-response relationship between physical activity and future symptoms of mental ill-health. This association is consistent with a protective effect of physical activity and remained after adjustments for socio-demographic, work-related and lifestyle factors, health and body mass index. Furthermore, those mid-life and older women who reported increased physical activity by more than 2 MET hours per week demonstrated a reduced risk of later mental ill-health in comparison with those who did not increase physical activity. This protective effect of increased physical activity did not hold for younger women.
This study adds to the evidence for the protective effect of physical activity for later mental health in women. It also suggests that increasing physical activity levels may be beneficial in terms of mental health among mid-life and older women. The alleviation of menopausal symptoms may partly explain age effects but further research is required.
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The purpose of our two-year follow-up study was to examine the effect of the social components of the work group, such as group absence norms and cohesion, on sickness absence behavior among individuals with varying attitudes toward work attendance. The social components were measured using a questionnaire survey and data on sickness absence behavior were collected from the employers' records. The study population consisted of 19,306 Finnish municipal employees working in 1,847 groups (78% women). Multilevel Poisson regression modeling was applied. The direct effects of work group characteristics on sickness absence were mostly insignificant. In contrast, both of the social components of a work group had an indirect impact: The more tolerant the group absence norms (at both individual- and cross-level) and the lower the group cohesion (at the individual level), the more the absence behavior of an individual was influenced by his or her attitude toward work attendance. We conclude that work group moderates the extent to which individuals with a liberal attitude toward work attendance actually engage in sickness absence behavior.
The objective of the study was to determine whether the double burden of and negative spillover between domestic and full-time paid work are associated with an increase in health problems. Survey responses were linked with sickness absence records in a cross-sectional study of 6442 full-time municipal employees. Women and men experiencing severe work-family spillover had a 1.5-1.6 (95% confidence intervals 1.1 to 2.0) times higher rate of sickness absence than those with no such experience. The corresponding odds ratios for psychological distress and suboptimal self-assessed health varied between 3.6 and 6.5 (2.3 to 11.0). Among the women, severe family-work spillover increased the risk of psychological distress and suboptimal health [odds ratios 2.0 (1.4 to 2.9) and 1.6 (1.1 to 2.3), respectively], and accumulated sole responsibilities were associated with a 1.5 (1.1 to 2.1) times higher odds ratio for psychological distress. Long domestic work hours (>50/week) were associated with a 1.5 (1.1 to 2.0) times higher rate of sickness absence among the men, but there was no such increase among the women. We conclude that negative work-family spillover especially is associated with health problems among both women and men, and negative family-work spillover is related to a poorer health status among women.
To examine the combined effects of childhood adversities and low adult socioeconomic status (SES) on the risk of future work disability.
Included were 34 384 employed Finnish Public Sector study participants who responded to questions about childhood adversities (none vs any adversity, eg, parental divorce or financial difficulties) in 2008, and whose adult SES in 2008 was available. We categorised exposure into four groups: neither (reference), childhood adversity only, low SES only or both. Participants were followed from 2009 until the first period of register-based work disability (sickness absence >9 days or disability pension) due to any cause, musculoskeletal or mental disorders; retirement; death or end of follow-up (December 2011). We ran Cox proportional hazard models adjusted for behavioural, health-related and work-related covariates, and calculated synergy indices for the combined effects.
When compared with those with neither exposure, HR for work disability from any cause was increased among participants with childhood adversity, with low SES, and those with both exposures. The highest hazard was observed in those with both exposures: HR 2.53, 95% CI 2.29?to 2.79 for musculoskeletal disability, 1.55, 95% CI 1.36?to 1.78 for disability due to mental disorders and 1.29, 95% CI 1.20?to 1.39 for disability due to other reasons. The synergy indices did not indicate synergistic effects.
These findings indicate that childhood psychosocial adversity and low adult SES are additive risk factors for work disability.
To investigate the associations of workplace neighbourhood socioeconomic status with health behaviours, health and working conditions among school teachers.
The survey responses and employer records of 1862 teachers were linked to census data on school neighbourhood socioeconomic status. In the multilevel analysis, adjustments were made for demographics, work factors and the socioeconomic status of the teacher's own residential area.
226 public schools in Finland.
Teachers working in schools from neighbourhoods with the lowest socioeconomic status reported heavy alcohol consumption (OR 2.25; 95% CI 1.32 to 3.83) and higher probability of doctor-diagnosed mental disorders (OR 1.47; 95% CI 1.02 to 2.12) more often than teachers working in schools located in the wealthiest neighbourhoods. After controlling for the socioeconomic status of the teacher's own residential area, only heavy alcohol consumption remained statistically significant. Teachers working in schools with lower socioeconomic status also reported lower frequency of workplace meetings, lower participation in occupational training, lower teaching efficacy and higher mental workload.
School neighbourhood socioeconomic status is associated with working conditions and health of school teachers. The association with health is partially explained by the socioeconomic status of the teachers' own residential neighbourhoods. An independent association was found between low socioeconomic status of school neighbourhoods and heavy alcohol use among teachers.
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Objectives The aim of this study was to investigate the association between the length of sickness absence and sustained return to work (SRTW) and the predictors of SRTW in depression, anxiety disorders, intervertebral disc disorders, and back pain in a population-based cohort of employees in the Finnish public sector. Methods We linked data from employers' registers and four national population registers. Cox proportional hazards regression analysis with a cluster option was applied. SRTW was defined as the end of the sickness benefit period not followed by a recurrent sickness benefit period in 30 days. Results For depression, the median time to SRTW was 46 and 38 days among men and women, respectively. For anxiety disorders, the figures were 24 and 22 days, for intervertebral disc disorders, 42 and 41 days, and, for back pain, 21 and 22 days among men and women respectively. Higher age and the persistence of the health problem predicted longer time to SRTW throughout the diagnostic categories. Comorbid conditions predicted longer time to SRTW in depression and back pain among women. Conclusions This large cohort study adds scientific evidence on the length of sickness absence and SRTW in four important diagnostic categories among public sector employees in Finland. Further research taking into account, eg, features of the work environment is suggested. Recommendations on the length of sickness absence at this point should be based on expert opinion and supplemented with research findings.
Objectives The aim of this study was to examine the status of night work as a risk factor for common mental disorders (CMD). Methods A cohort study with three data waves was conducted on populations of social and healthcare employees for a duration of eight years (total N=46 010). Data were analyzed as a non-randomized pseudo trial to examine (i) whether moving from non-night work to night work is associated with the development of CMD, (ii) the extent to which moving back to non-night work biases this association and (iii) whether moving from night to non-night work is associated with the recovery from CMD. Results According to logistic regression with generalized estimating equation and without bias-correction, changing to night work was not associated with the odds of acquiring CMD [odds ratio (OR) 1.03, 95% confidence interval (CI) 0.82-1.30]. However, night workers with CMD had higher odds of recovery from CMD when changing to non-night work compared to continuing night work (1.99, 95% CI 1.20-3.28). When night workers developed CMD, the odds of moving back to non-night work increased by 68%. In analyses corrected for this bias, changing from non-night to night work was associated with a 1.25-fold (95% CI 1.03-1.52) increased odds of acquiring CMD. Conclusions A change from non-night to night work may increase the risk of CMD, while moving back from night to non-night work increased recovery from CMD.
Organizational justice perceptions have been suggested to be associated with symptoms of mental health but the nature of the association is unknown due to reporting bias (measurement error related to response style and reversed causality). In this study, we used prospective design and long-term (>9 days) sickness absence with psychiatric diagnosis as the outcome measure. Participants were 21,221 Finnish public sector employees (the participation rate at baseline in 2000-2002 68%), who responded to repeated surveys of procedural and interactional justice in 2000-2004 along with register data on sickness absence with a diagnosis of depression or anxiety disorders (822 cases). Results from logistic regression analyses showed that a one-unit increase in self-reported and work-unit level co-worker assessed interactional justice was associated with a 25-32% lower odds of sickness absence due to anxiety disorders. These associations were robust to adjustments for a variety of potential individual-level confounders including chronic disease (adjusted OR for self-reported interactional justice 0.77, 95% CI 0.65-0.91) and were replicated using co-worker assessed justice. Only weak evidence of reversed causality was found. The results suggest that low organizational justice is a risk factor for sickness absence due to anxiety disorders.
The extent to which predictors of return to work (RTW) and recurrence of work disability episodes vary by age group is not well understood.
We examined the associations of sociodemographic and clinical factors with RTW and recurrence after mental-disorder-related work disability episodes in a cohort of 10,496 Finnish public sector employees. Disability records were derived from national disability registers between 2005 and 2011. Effect modification by age was examined in age groups of 21-34, 35-50 and >50 years.
A total of 16,551 disability episodes from mental disorders were recorded. The likelihood of RTW was elevated in age group 21-34 (hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.28-1.46) and 35-50 years (HR = 1.22, 95% CI = 1.18-1.26) compared to age group >50 years. The risk of a recurrent episode of work disability was higher in age groups >50 (HR = 1.29, 95% CI = 1.09-1.52) and 35-50 years (HR = 1.20, 95% CI = 1.03-1.41) compared to the youngest age group. Employees with depressive disorders were less likely to RTW than employees with neurotic, stress-related and somatoform disorders, and this difference increased with age. Low education was associated with increased risk of recurrent work disability episode in age groups of 50 years or younger, while no such association was observed in age group >50 years.
The importance of depressive symptoms over neurotic, stress-related and somatoform disorders as predictors of delayed RTW increases with age, whereas educational differences in the recurrence of an episode diminish by age.
To examine the associations between socio-economic position (SEP) and the onset of psychiatric work disability, return to work and recurrence of disability.
Prospective observational cohort study (1997-2005) including register data on 141 917 public-sector employees in Finland. Information on International Classification of Diseases, 10th Revision diagnosis-specific psychiatric work disability (=90 days) was obtained from national registers.
During a mean follow-up of 6.3 years, 3938 (2.8%) participants experienced long-term psychiatric work disability. Of these, 2418 (61%) returned to work, and a further 743 (31%) experienced a recurrent episode. SEP was inversely associated with onset of disability owing to depressive disorders, anxiety disorders, personality disorders, schizophrenia and substance-use disorders. No association was found between SEP and disability owing to bipolar disorders or reaction to severe stress and adjustment disorders. High SEP was associated with a greater likelihood of a return to work following depressive disorders, personality disorders, schizophrenia and substance-use disorders, but not bipolar disorders, anxiety disorders or reaction to severe stress and adjustment disorders. Low SEP predicted recurrent episodes of work disability.
High SEP is associated with lower onset of work disability owing to mental disorders, as well as return to work and lower rates of recurrence. However, the socio-economic advantage is diagnosis-specific. SEP predicted neither the onset and recovery from disability owing to bipolar disorders and reaction to severe stress and adjustment disorders, nor recovery from disability owing to anxiety disorders. SEP should be taken into account in the attempts to reduce long-term work disability owing to mental disorders.
Comment In: Occup Environ Med. 2011 Nov;68(11):789-9021849348
Studies have reported higher levels of absenteeism due to illness among special education teachers compared to other teachers, but it is not known which factors might contribute to this difference. We examined whether health, health behaviors, and exposure to violence at work differed between special education and general education teachers in Finnish basic education.
Survey data from 5760 general and special education teachers were analyzed with multilevel logistic models adjusted for individual- and school-level confounding factors.
No difference was found between the health behaviors of general and special education teachers. The differences in physical and mental health between the two groups were also relatively small. With regard to work-related violence, however, male special education teachers were 3 times more likely to be exposed to mental abuse, and 5 times more likely to be exposed to physical violence when compared to their male colleagues in general education. Although female special educators were also at an increased risk of mental abuse and physical violence compared to their female general teacher colleagues, their odds ratios for such an encounter were smaller (2- and 3-fold, respectively) than those of male special education teachers. The school-level variance of physical violence toward teachers was large, which indicates that while most schools have little physical violence toward teachers, schools do exist in which teachers' exposure to violence is common.
These findings suggest that special education teachers may benefit from training for handling violent situations and interventions to prevent violence at schools.
This ongoing prospective study examined characteristics of school neighborhood and neighborhood of residence as predictors of sick leave among school teachers. School neighborhood income data for 226 lower-level comprehensive schools in 10 towns in Finland were derived from Statistics Finland and were linked to register-based data on 3,063 teachers with no long-term sick leave at study entry. Outcome was medically certified (>9 days) sick leave spells during a mean follow-up of 4.3 years from data collection in 2000-2001. A multilevel, cross-classified Poisson regression model, adjusted for age, type of teaching job, length and type of job contract, school size, baseline health status, and income level of the teacher's residential area, showed a rate ratio of 1.30 (95% confidence interval: 1.03, 1.63) for sick leave among female teachers working in schools located in low-income neighborhoods compared with those working in high-income neighborhoods. A low income level of the teacher's residential area was also independently associated with sick leave among female teachers (rate ratio = 1.50, 95% confidence interval: 1.18, 1.91). Exposure to both low-income school neighborhoods and low-income residential neighborhoods was associated with the greatest risk of sick leave (rate ratio = 1.71, 95% confidence interval: 1.27, 2.30). This study indicates that working and living in a socioeconomically disadvantaged neighborhood is associated with increased risk of sick leave among female teachers.
To examine the association between worktime control and subsequent disability pension among employees.
Two scores of worktime control (self-assessed and co-worker assessed) were obtained from a survey in 2000-2001 (score range 1-5) among 30 700 public sector employees (78% women) aged 18-64 years. Information on cause-specific disability pension during follow-up was collected from national registers.
During a mean follow-up of 4.4 years, 1178 employees were granted disability pensions (incidence per 1000 person-years: 9.2 in women and 8.7 in men). The most common causes of a disability pension were musculoskeletal disorders (43% of all pensions), mental disorders (25%), tumours (8%) and diseases of the circulatory system (6%) and nervous system (6%). A one unit increase in self-assessed and co-worker assessed worktime control score was associated with a 41-48% decrease in risk of disabling musculoskeletal disorders in men and a 33-35% decrease in women. This association was robust to adjustment for 17 baseline covariates (in men and women combined, adjusted HR 0.76, 95% CI 0.67 to 0.87 and 0.64, 95% CI 0.51 to 0.79 per one unit increase in self-assessed and co-worker assessed worktime control, respectively). Self-assessed, but not co-worker assessed, worktime control was also associated with risk of disability retirement due to mental disorders in women. Disability pensions from other disease categories were not related to worktime control.
In these public sector employees, high worktime control was associated with reduced risk of early retirement caused by musculoskeletal disorders independent of baseline characteristics.
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The proportion of aging employees with cardiometabolic diseases, such as heart or cerebrovascular disease, diabetes and chronic hypertension is on the rise. We explored the extent to which health- and work-related factors were associated with the risk of disability pension among individuals with such cardiometabolic disease.
A cohort of 4798 employees with and 9716 employees without a cardiometabolic disease were followed up for 7years (2005-2011) for disability pension. For these participants, register and survey data (from 2004) were linked to records on disability pensions. Cox proportional hazards modeling was used for estimating the hazard ratios (HR) with 95% confidence intervals (CI).
Individuals with heart or cerebrovascular disease had 2.88-fold (95% CI=2.50-3.31) higher risk of all-cause disability pension compared to employees with no cardiometabolic disease. Diabetes was associated with a 1.84-fold (95% CI=1.52-2.23) and hypertension a 1.50-fold (95% CI=1.31-1.72) increased risk of disability pension. Obesity in cases of diabetes and hypertension (15%) and psychological distress in cases of heart or cerebrovascular disease (9%) were the strongest contributing factors. All 12 health- and work-related risk factors investigated accounted for 24% of the excess work disability in hypertension, 28% in diabetes, and 11% in heart or cerebrovascular disease. Cause-specific analyses (disability pension due to mental, musculoskeletal and circulatory system diseases) yielded similar results.
In this study, modifiable risk factors, such as obesity and mental comorbidity, predicted permanent exit from the labor market due to disability in individuals with cardiometabolic disease.
To examine sleep disturbances as a predictor of cause-specific work disability and delayed return to work.
Prospective observational cohort study linking survey data on sleep disturbances with records of work disability (> or = 90 days sickness absence, disability pension, or death) obtained from national registers.
Public sector employees in finland.
56,732 participants (mean age 44.4 years, 80% female), who were at work and free of work disability at the study inception.
During a mean follow-up of 3.3 years, incident diagnosis-specific work disability was observed in 4,028 (7%) employees. Of those, 2,347 (60%) returned to work. Sleep disturbances 5-7 nights per week predicted work disability due to mental disorders (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.3-1.9) and diseases of the circulatory system (HR = 1.6, 95% CI 1.2-2.1), musculoskeletal system (HR = 1.6, 95% CI 1.4-1.8) and nervous system (HR = 1.5, 95% CI 1.0-2.2), and injuries and poisonings (HR = 1.6, 95% CI 1.2-2.1) after controlling for baseline age, sex, socioeconomic status, night/shift work, health behaviors (e.g., smoking, exercise), diagnosed somatic diseases, use of pain killers, depression, and anxiety. In addition, sleep disturbances prior to disability were associated with higher likelihood of not returning to work after work disability from musculoskeletal diseases (HR = 1.2, 95% CI 1.1-1.7) and, in men, after work disability due to mental disorders (HR = 4.4, 95% CI 1.7-11.1).
Sleep disturbances are associated with increased risk for subsequent disabling mental disorders and various physical illnesses. They also predict the outcome of work disability due to musculoskeletal disorders.
Among employees with depression, diagnoses of other psychiatric and somatic conditions are common. However, few studies have examined whether the combined presence of depression and other psychiatric or somatic disorders adversely affects return to work after depression-related absence from work.
We examined the association of present and recent psychiatric and somatic conditions and return to work after depression-related absence in a cohort of 9908 Finnish public sector employees with at least one such episode. The data included a total of 14,101 episodes during the period January 2005 to December 2011.
A total of 89% (n = 12,486) of depression-related absence episodes ended in return to work during the follow-up. For those episodes, the median length of absence was 34 days (interquartile range, 20-69 days). After adjustment for sex, age, socioeconomic status, and type of employment contract, present or recent psychiatric disorders other than depression (hazard ratio [HR] = 0.78, 95% confidence interval [CI] = 0.74-0.83), cancer (HR = 0.66, 95% CI = 0.47-0.92), diabetes (HR = 0.73, 95% CI = 0.62-0.86), cardiovascular disease (HR = 0.78, 95% CI = 0.62-0.99), hypertension (HR = 0.76, 95% CI = 0.67-0.85), musculoskeletal disorders (HR = 0.82, 95% CI = 0.77-0.87), and asthma (HR = 0.84, 95% CI = 0.75-0.94) were all associated with a lower likelihood of returning to work compared with depression episodes without other conditions.
Among employees with depression-related absence, return to work is delayed in the presence of other psychiatric and somatic conditions. These findings suggest that other diseases should be taken into account when evaluating the outcome of depression-related absence. Randomized controlled trials are needed to examine whether integrated treatment of mental and physical disorders improves successful return to work after depression.
This study examined whether indicators of poor health and health risk behaviors among hospital staff differ between the ward specialties.
Across 21 hospitals in Finland, 8003 employees (mean age 42 years, 87% women, 86% nurses) working in internal medicine, surgery, obstetrics and gynecology, pediatrics, intensive care, and psychiatry responded to a baseline survey on health and health risk behaviors (response rate 70%). Responses were linked to records of sickness absence and medication over the following 12 months.
Psychiatric staff had higher odds of smoking [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 2.14-3.12], high alcohol use (OR 1.55, 95% CI 1.21-1.99), physical inactivity (OR 1.30, 95% CI 1.11-1.53), chronic physical disease (OR 1.19, 95% CI 1.04-1.36), current or past mental disorders (OR 1.81, 95% CI 1.50-2.17), and co-occurring poor health indicators (OR 2.65, 95% CI 2.08-3.37) as compared to those working in other specialties. They also had higher odds of sickness absence due to mental disorders (OR 1.40, 95% CI 1.02-1.92) and depression (OR 1.61, 95% CI 1.02-2.55) at follow-up after adjustment for baseline health and covariates. Personnel in surgery had the lowest probability of morbidity. No major differences between specialties were found in the use of psychotropic medication.
The prevalence of hospital employees with an adverse health risk profile is higher in psychiatric wards than other specialties.
Comorbid psychiatric disorders, cardiovascular disease, chronic hypertension, diabetes, and musculoskeletal disorders are highly prevalent in depression. However, the extent to which these conditions affect the recurrence of depression-related work disability is unknown. The specific aims of the study were to investigate the extent to which comorbid other psychiatric disorders, cardiometabolic, and musculoskeletal conditions were associated with the recurrence of depression-related work disability among employees who had returned to work after a depression-related disability episode.
A cohort study of Finnish public sector employees with at least one depression-related disability episode during 2005-2011 after which the employee had returned to work (14,172 depression-related work disability episodes derived from national health and disability registers for 9,946 individuals). We used Cox proportional hazard models for recurrent events.
Depression-related work disability recurred in 35% of the episodes that had ended in return to work from a previous episode, totaling 4,927 recurrent episodes among 3,095 (31%) employees. After adjustment for sex, age, socioeconomic status, and type of employment contract, comorbid psychiatric disorder (hazard ratio = 1.82, 95% CI 1.68-1.97), cardiovascular disease (1.39, 95% CI 1.04-1.87), diabetes (1.43, 95% CI 1.11-1.85), chronic hypertension (1.33, 95% CI 1.11-1.58), and musculoskeletal disorder (1.17, 95% CI 1.06-1.28) were associated with an increased risk of a recurrent episode compared to those without these comorbid conditions.
Recurrence of depression-related work disability is common. Employees with comorbid psychiatric, cardiometabolic, or musculoskeletal conditions are at an increased risk of recurrent depression-related work disability episodes.
Patient overcrowding and violent assaults by patients are two major problems in psychiatric healthcare. However, evidence of an association between overcrowding and aggressive behaviour among patients is mixed and limited to small-scale studies.
This study examined the association between ward overcrowding and violent physical assaults in acute-care psychiatric in-patient hospital wards.
Longitudinal study using ward-level monthly records of bed occupancy and staff reports of the timing of violent acts during a 5-month period in 90 in-patient wards in 13 acute psychiatric hospitals in Finland. In total 1098 employees (physicians, ward head nurses, registered nurses, licensed practical nurses) participated in the study. The outcome measure was staff reports of the timing of physical assaults on both themselves and ward property.
We found that 46% of hospital staff were working in overcrowded wards, as indicated by >10 percentage units of excess bed occupancy, whereas only 30% of hospital personnel were working in a ward with no excess occupancy. An excess bed occupancy rate of >10 percentage units at the time of an event was associated with violent assaults towards employees (odds ratio (OR) = 1.72, 95% CI 1.05-2.80; OR = 3.04, 95% CI 1.51-6.13 in adult wards) after adjustment for confounding factors. No association was found with assaults on ward property (OR = 1.06, 95% CI 0.75-1.50).
These findings suggest that patient overcrowding is highly prevalent in psychiatric hospitals and, importantly, may increase the risk of violence directed at staff.