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.
Observational studies suggest that high job strain is a risk factor for retirement on health grounds, but few studies have analysed specific diagnoses. We examined job strain's association with all-cause and cause-specific disability pensions.
Survey responses to questions about job strain from 48,598 (response rate, 68%) public sector employees in Finland from 2000 to 2002 were used to determine work unit- and occupation-based scores. These job strain scores were assigned to all the 69,842 employees in the same work units or occupations. All participants were linked to the disability pension register of the Finnish Centre of Pensions with no loss to follow-up. Cox proportional hazard models were used to calculate HRs and their 95% CIs for disability pensions adjusted by demographic, work unit characteristics and baseline health in analyses stratified by sex and socioeconomic position.
During a mean follow-up of 4.6 years, 2572 participants (4%) were granted a disability pension. A one-unit increase in job strain was associated with a 1.3- to 2.4-fold risk of requiring a disability pension due to musculoskeletal diseases in men, women and manual workers, depending on the measure of job strain (work unit or occupation based). The risk of disability pension due to cardiovascular diseases was increased in men with high job strain but not in women nor in any socioeconomic group. No consistent pattern was found for disability pension due to depression.
High job strain is a risk factor for disability pension due to musculoskeletal diseases.
Occupational stress is assumed to arise from social arrangements that are partially determined by the modes of organization of work. However, there is little systematic research on the extent to which modes of organizing nursing work are related to stressful characteristics of work.
This study explored the relationship between modes of organizing nursing and stress.
Survey responses on modes of organization of nursing were collected from 27 ward sisters and those on stressful work characteristics from 568 nurses working in 27 wards with different nursing modes.
Four different nursing modes (primary, modular, team and functional nursing) were not consistently associated with stress. Statistically significant associations involved only certain features of these modes and specific components of stress. After the effects of demographic and ward characteristics were controlled for, hierarchical regression analyses showed that opportunity to write nursing notes decreased the likelihood of nurses' stress because of problems in interpersonal relationships. Writing nursing notes is common in patient-focused nursing modes (primary and modular nursing). Other features of nursing modes were not associated with stress.
In general, nursing mode is not associated with stressful job characteristics. However, certain aspects of patient-focused nursing reduce the likelihood of interpersonal problems among staff.
Identifying factors that determine well-being among physicians may help to improve the functioning of hospitals and healthcare centres. We examined associations of psychosocial factors with psychological distress and sleep problems in Finnish general practitioners (GPs) and specialists.
In this prospective cohort study, data from repeated measures over 10 years, related to 886 physicians followed-up from 2000 to 2010 (the Finnish Public Sector Cohort Study). Psychological distress was assessed repeatedly using the 12-item General Health Questionnaire, and sleeping problems using the Jenkins scale in three or in four surveys. Psychosocial factors and potential confounders were measured in four surveys over the same period.
High job demands were associated with psychological distress in GPs but not in specialists (p for interaction 0.005). This association was slightly stronger in the within-individual analysis than in the ordinary (total effects) regression, suggesting that the association was not confounded by stable differences between individuals. There was suggestive evidence for a stronger association between effort/reward imbalance and psychological distress in GPs compared with specialists (p for interaction 0.06). High demands and effort-reward-imbalance were associated with elevated sleeping problems in both groups, whereas high job control was associated with lower psychological distress but not sleeping problems.
These findings suggest that work-related psychosocial factors are partly responsible for the rise of health problems in physicians, such as psychological distress and sleeping problems. Increasing job demands may be a health risk, especially in GPs.
The association between the psychosocial work environment, including job demands, job control, and organizational justice, and employee wellbeing has been well established. However, the exposure to adverse work environments is typically measured only using self-reported measures that are vulnerable to reporting bias, and thus any associations found may be explained by reverse causality. Using linear regression models and cross-lagged structural equation modeling (SEM), we tested the direction of the association between established job stress models (job demand control and organizational justice models) and 3 wellbeing indicators (psychological distress, sleeping problems, and job satisfaction) among 1524 physicians in a 4-year follow-up. Results from the longitudinal cross-lagged analyses showed that the direction of the association was from low justice to decreasing wellbeing rather than the reverse. Although the pattern was similar in job demands and job control, a reciprocal association was found between job control and psychological distress.