Respiratory sinus arrhythmia (RSA) is a marker of parasympathetic activity hypothesized to index a neurophysiological system supporting social engagement behaviors. Following migration, people must navigate and adapt to a new sociocultural environment. Whether RSA affects this psychological acculturation process is unknown. This longitudinal study investigated whether resting RSA on arrival in the receiving country was related to changes in cultural orientations toward both mainstream and heritage cultural groups during the first 5 months following migration. Sixty new international students provided information on their cultural orientations toward the mainstream and heritage cultural groups shortly after arrival in the new country and 2 and 5 months after the first assessment. Results indicated that both heritage and mainstream orientations increased linearly over time. Furthermore, greater resting RSA at baseline was prospectively associated with larger increases in positive orientation toward the mainstream culture but not the heritage culture, over and above individual differences in extraversion, depression, and anxiety. These data provide longitudinal evidence that higher RSA promotes an approach-oriented stance toward a novel cultural environment.
Marginal structural models (MSMs) allow estimating the causal effect of a time‐varying exposure on an outcome in the presence of time‐dependent confounding. The parameters of MSMs can be estimated utilizing an inverse probability of treatment weight estimator under certain assumptions. One of these assumptions is that the proposed causal model relating the outcome to exposure history is correctly specified. However, in practice, the true model is unknown. We propose a test that employs the observed data to attempt validating the assumption that the model is correctly specified. The performance of the proposed test is investigated with a simulation study. We illustrate our approach by estimating the effect of repeated exposure to psychosocial stressors at work on ambulatory blood pressure in a large cohort of white‐collar workers in Québec City, Canada. Code examples in SAS and R are provided to facilitate the implementation of the test.
The Healthy Enterprise Standard (HES) is related to a certification program in Québec (Canada) and targets four areas: Lifestyle, Work-life balance, Workplace environment and Management practices. The aim of this study was to open the black box of intervention and analyse the implementation process in order to interpret effects of HES on health and workplace risk factors, and cost-benefit results from the employer's perspective.
Methods
We used a before-after design for a two-case analysis with a mixed-method approach. In two organisations from different sectors, quantitative data were collected with a questionnaire among all active workers before the standard's implementation (T1 organisation A=186, organisation B=1081) and 25–31 months after (T2 A=190, B=975). Psychosocial work factors (demand-control-support and effort-reward imbalance validated scales), psychological distress (validated Kessler-6), and work-related musculoskeletal problems (WMSP, 4 items from the Nordic Questionnaire) were measured as well as intervention exposure. Intervention costs data, presenteeism and absences data were collected. Qualitative data through interviews and focus groups in both organisations were recorded, transcribed and coded in order to perform thematic analysis a posteriori.
Results
The prevalence of psychosocial work factors (low social support, low reward) at T2 was lower amongst participants exposed to intervention in the Management practices area in both organisations. WMSP was lower for those exposed to the Workplace environment area in B. The average cost per worker per year was very similar for A and B whereas distribution of cost categories differed. The net benefit was highly positive in B and negative in A. Implementation analysis showed that each area of HES was associated to different types of facilitators and obstacles. Cyclical factors, communication and management involvement differed between A and B.
Discussion
These results show that the implementation process analysis provides interesting insights into understanding effect and cost-benefit results and improving OSH interventions.
Mental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a systematic review and meta-analysis.To synthesize the evidence of the association of psychosocial stressors at work with sickness absence due to a diagnosed mental disorder among adult workers.Seven electronic databases (MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, Sociological Abstracts, and International Bibliography of the Social Sciences), 3 gray literature databases (Grey Literature Report, WHO-IRIS and Open Grey), and the reference lists of all eligible studies and reviews were searched in January 2017 and updated in February 2019.Only original prospective studies evaluating the association of at least 1 psychosocial stressor at work from the 3 most recognized theoretical models were eligible: the job demand-control-support model, including exposure to job strain (high psychological demands with low job control); effort-reward imbalance model; and organizational justice model. Study selection was performed in duplicate by blinded independent reviewers. Among the 28 467 citations screened, 23 studies were eligible for systematic review.This meta-analysis followed the PRISMA and MOOSE guidelines. Data extraction and risk of bias evaluation, using the Risk of Bias in Nonrandomized Studies-Interventions tool, were performed in duplicate by blinded independent reviewers. Data were pooled using random-effect models.Sickness absence due to a mental disorder with a diagnosis obtained objectively.A total of 13 studies representing 130 056 participants were included in the 6 meta-analyses. Workers exposed to low reward were associated with a higher risk of sickness absence due to a diagnosed mental disorder compared with nonexposed workers (pooled risk ratio [RR], 1.76 [95% CI, 1.49-2.08]), as were those exposed to effort-reward imbalance (pooled RR, 1.66 [95% CI, 1.37-2.00]), job strain (pooled RR, 1.47 [95% CI, 1.24-1.74]), low job control (pooled RR, 1.25 [95% CI, 1.02-1.53]), and high psychological demands (pooled RR, 1.23 [95% CI, 1.04-1.45]).This meta-analysis found that workers exposed to psychosocial stressors at work were associated with a higher risk of sickness absence due to a mental disorder. A better understanding of the importance of these stressors could help physicians when evaluating their patients' mental health and work capacity.
Objectives Women have a higher incidence of mental health problems compared with men. Psychosocial stressors at work are associated with mental health problems. However, few prospective studies have examined the association between these stressors and objectively measured outcomes of mental health. Moreover, evidence regarding potential differences between women and men in this association is scarce and inconsistent. This study investigates whether psychosocial stressors at work are associated with the 7.5-year incidence of medically certified work absence due to a mental health problem, separately for women and men. Methods Data from a prospective cohort of white-collar workers in Canada (n=7138; 47.3% women) were used. We performed Cox regression models to examine the prospective association between self-reported psychosocial stressors at work (job strain model) at baseline and the 7.5-year HR of medically certified work absence of ≥5 days due to a mental health problem. Results During follow-up, 11.9% of participants had a certified work absence, with a twofold higher incidence among women. Women (HR 1.40, 95% CI 1.01 to 1.93) and men (HR 1.41, 95% CI 0.97 to 2.05) exposed to high strain (high demands and low control) had a higher incidence of work absence compared with those unexposed. Among women only, those exposed to an active job situation (high demands and high control) also had a higher risk (HR 1.82, 95% CI 1.29 to 2.56). Conclusions Prevention efforts aimed at reducing psychosocial stressors at work could help lower the risk of work absence for both women and men. However, important differences between women and men need to be further studied in order to orient these efforts.
Adverse psychosocial work factors are recognized as a significant source of psychological distress, resulting in a considerable socioeconomic burden. The impact of occupational health standards that aim to reduce these adverse work factors, such as the Quebec Healthy Enterprise Standard (QHES), is of great interest for public health. The aim of this study was to evaluate, for the first time, the effect of QHES interventions targeting adverse psychosocial work factors on the prevalence of these factors and of psychological distress among ten Quebec organizations. These outcomes were assessed by questionnaire using validated instruments before (T1, n = 2849) and 2–3 years following (T2, n = 2560) QHES implementation. Beneficial effects of interventions were observed for two adverse psychosocial work factors: low rewards (ratio of prevalence ratios (PRs) = 0.77, 95% CI = 0.66–0.91) and low social support at work (ratio of PRs = 0.89, 95% CI = 0.77–1.03). Moreover, beneficial effects of interventions were also observed on the prevalence of high psychological distress (ratio of PRs = 0.86, 95% CI = 0.75–0.998). Psychosocial interventions implemented in the context of this standard improved the psychosocial work environment and had beneficial effects on workers’ mental health.
Objectives This study assesses the validity of a self-reported mental health problem (MHP) diagnosis as the reason for a work absence of 5 days or more compared with a physician-certified MHP diagnosis related to the same work absence. The potential modifying effect of absence duration on validity is also examined. Methods A total of 709 participants (1031 sickness absence episodes) were selected and interviewed. Total per cent agreement, Cohen’s kappa, sensitivity and specificity values were calculated using the physician-certified MHP diagnosis related to a given work absence as the reference standard. Stratified analyses of total agreement, sensitivity and specificity values were also examined by duration of work absence (5–20 workdays,>20 workdays). Results Total agreement value for self-reported MHP was 90%. Cohen’s kappa value was substantial (0.74). Sensitivity was 77% and specificity was 95%. Absences of more than 20 workdays had a better sensitivity than absences of shorter duration. A high specificity was observed for both short and longer absence episodes. Conclusion This study showed high specificity and good sensitivity of self-reported MHP diagnosis compared with physician-certified MHP diagnosis for the same work absence. Absences of longer durations had a better sensitivity.
Objectives This systematic review and meta-analysis aimed to synthesize the available data on prospective associations between work-related stressors and the risk of type 2 diabetes mellitus (T2DM) among adult workers, according to the demand–control–support (DCS) and the effort–reward imbalance (ERI) models. Method We searched for prospective studies in PubMed, EMBASE, Web of Science, Scopus, CINHAL and PsychInfo. After screening and extraction, quality of evidence was assessed using the ROBINS-I tool adapted for observational studies. The effect estimates extracted for each cohort were synthesized using random effect models. Results We included 18 studies (reporting data on 25 cohorts) in meta-analyses for job strain, job demands, job control, social support at work and ERI. Workers exposed to job strain had a higher risk of developing T2DM when compared to unexposed workers [pooled rate ratio (RR) 1.16, 95% confidence interval (CI) 1.07–1.26]. This association was robust in several supplementary analyses. For exposed women relative to unexposed women, the RR was 1.35 (95% CI 1.12–1.64). The RR of workers exposed to ERI was 1.24 (95% CI 1.08–1.42) compared to unexposed workers. Conclusions This is the first meta-analysis to find an effect of ERI on the onset of T2DM incidence. It also confirms that job strain increases the incidence of T2DM, especially among women.
