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Objective: The objectives were to examine the prospective associations between psychosocial work factors of the job strain model and all-cause mortality in a national representative cohort of French employees using various measures of time-varying exposure., Methods: The study was based on a sample of 798,547 men and 697,785 women for which data on job history from 1976 to 2002 were linked to mortality data from the national death registry. Psychosocial work factors from the validated job strain model questionnaire were imputed using a job-exposure matrix. Three time-varying measures of exposure were explored: current, cumulative, and recency-weighted cumulative exposure. Cox proportional hazards models were performed to study the associations between psychosocial work factors and mortality., Results: Within the 1976-2002 period, 88,521 deaths occurred among men and 28,921 among women. Low decision latitude, low social support, job strain, isostrain, high strain, and passive job were found to be risk factors for mortality. The model using current exposure was the best relative-quality model. The associations of current exposure to job strain and mortality were found to have hazard ratios of 1.30 (95% confidence interval [CI] = 1.24-1.36) among men and 1.15 (95% CI = 1.06-1.25) among women. The population fractions of mortality attributable to job strain were 5.64% (95% CI = 4.56%-6.71%) among men and 4.13% (95% CI = 1.69%-6.71%) among women., Conclusions: This study supports the role of the psychosocial work factors of the job strain model on all-cause mortality. Preventive intervention to improve the psychosocial work environment may help to prevent mortality in working populations., (Copyright © 2020 by the American Psychosomatic Society.)

Objective: Previous research suggests that psychosocial job stressors may be plausible risk factors for suicide. This study assessed the relationship between psychosocial job stressors and suicide mortality across the Australian population., Methods: We developed a job exposure matrix to objectively measure job stressors across the working population. Suicide data came from a nationwide coronial register. Living controls were selected from a nationally representative cohort study. Incidence density sampling was used to ensure that controls were sampled at the time of death of each case. The period of observation for both cases and controls was 2001 to 2012. We used multilevel logistic regression to assess the odds of suicide in relation to 2 psychosocial job stressors (job control and job demands), after matching for age, sex, and year of death/survey and adjusting for socioeconomic status., Results: Across 9,010 cases and 14,007 matched controls, our results suggest that low job control (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.26-1.44; p < .001) and high job demands (OR, 1.36; 95% CI, 1.26-1.46; p < .001) were associated with increased odds of male suicide after adjusting for socioeconomic status. High demands were associated with lower odds of female suicide (OR, 0.81; 95% CI, 0.72-0.92; p = .002)., Conclusions: It seems that adverse experiences at work are a risk factor for male suicide while not being associated with an elevated risk among females. Future studies on job stressors and suicide are needed, both to further understand the biobehavioral mechanisms explaining the link between job stress and suicide, and to inform targeted prevention initiatives.

Introduction: A Job Exposure Matrix (JEM) for psychosocial job stressors allows assessment of these exposures at a population level. JEMs are particularly useful in situations when information on psychosocial job stressors were not collected individually and can help eliminate the biases that may be present in individual self-report accounts. This research paper describes the development of a JEM in the Australian context., Methods: The Household Income Labour Dynamics in Australia (HILDA) survey was used to construct a JEM for job control, job demands and complexity, job insecurity, and fairness of pay. Population median values of these variables for all employed people (n = 20,428) were used to define individual exposures across the period 2001 to 2012. The JEM was calculated for the Australian and New Zealand Standard Classification of Occupations (ANZSCO) at the four-digit level, which represents 358 occupations. Both continuous and binary exposures to job stressors were calculated at the 4-digit level. We assessed concordance between the JEM-assigned and individually-reported exposures using the Kappa statistic, sensitivity and specificity assessments. We conducted regression analysis using mental health as an outcome measure., Results: Kappa statistics indicate good agreement between individually-reported and JEM-assigned dichotomous measures for job demands and control, and moderate agreement for job insecurity and fairness of pay. Job control, job demands and security had the highest sensitivity, while specificity was relatively high for the four exposures. Regression analysis shows that most individually reported and JEM measures were significantly associated with mental health, and individually-reported exposures produced much stronger effects on mental health than the JEM-assigned exposures., Discussion: These JEM-based estimates of stressors exposure provide a conservative proxy for individual-level data, and can be applied to a range of health and organisational outcomes.

Objectives: This study aimed at exploring the cross-sectional and prospective associations between psychosocial work factors and sleep problems., Methods: The study population consisted of a national representative sample of the French working population (SIP survey). The sample sizes were 7506 and 3555 for the cross-sectional and prospective analyses. Sleep problems were defined by either sleep disturbances or insufficient sleep duration at least several times a week. Psychosocial work factors included classical (job strain model factors) and emergent factors (recognition, insecurity, role/ethical conflict, emotional demands, work-life imbalance, etc.). Occupational factors related to working time/hours and physical work environment were also included as well as covariates related to factors outside work. Statistical analyses were performed using weighted Poisson regression analysis., Results: In the cross-sectional analyses, psychological demands, low social support, low recognition, emotional demands, perception of danger, work-life imbalance and night work were found to be associated with sleep problems. In the prospective analyses, psychological demands and night work were predictive of sleep problems. Using a less conservative method, more factors were found to be associated with sleep problems. Dose-response associations were observed, showing that the more frequent the exposure to these factors, the higher the risk of sleep problems. No effect of repeated exposure was found on sleep problems., Conclusion: Classical and emergent psychosocial work factors were associated with sleep problems. More prospective studies and prevention policies may be needed.

Prospective studies exploring the associations between a large range of occupational factors and psychotropic drug use among national samples of workers are seldom. This study investigates the cross-sectional and prospective associations between occupational factors, including a large set of psychosocial work factors, and psychotropic drug use in the national French working population. The study sample comprised 7542 workers for the cross-sectional analysis and 4213 workers followed up for a 4-year period for the prospective analysis. Psychotropic drug use was measured within the last 12 months and defined by the use of antidepressants, anxiolytics or hypnotics. Three groups of occupational factors were explored: classical and emergent psychosocial work factors, working time/hours and physical work exposures. Weighted Poisson regression analyses were performed to adjust for covariates. In the cross-sectional analysis, psychological demands, low social support and hiding emotions were associated with psychotropic drug use. Job insecurity for men and night work for women were associated with psychotropic drug use. In the prospective analysis, hiding emotions and physical exposure were predictive of psychotropic drug use. Dose-response associations were observed for the frequency/intensity of exposure and repeated exposure to occupational factors. This study underlines the role of psychosocial work factors, including emergent factors, in psychotropic drug use. Prevention policies oriented toward psychosocial work factors comprehensively may be useful to reduce this use., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: This study aims at exploring the associations between psychosocial work factors and occupational injury., Methods: The study was based on 46,962 employees of the French national representative survey SUMER 2010. The associations between psychosocial work factors and occupational injury/absence duration for injury within the last year were studied using weighted logistic and negative binomial regression models adjusted for covariates., Results: Verbal abuse and low predictability for both sexes, psychological demands for women and low reward, physical violence, and bullying for men were associated with occupational injury. Low decision latitude and psychological demands for women were associated with absence duration for injury., Conclusions: Some psychosocial work factors may play a role in occurrences of occupational injury, but the role is unclear in relation to absence duration for injury.

Introduction: This study was designed to investigate the associations between psychosocial work factors, using well-known theoretical models and emerging concepts, and self-reported health in the national population of French employees., Methods: This study was based on the data of the French national representative SUMER 2010 survey. The sample included 46,962 employees, 26,883 men and 20,079 women, with an 87% participation rate. Self-reported health was measured by means of a single question and was analysed as a binary variable. Psychosocial work factors included factors related to job strain and effort-reward imbalance models, workplace violence and working hours. Associations between psychosocial work factors and self-reported health were studied using weighted logistic regression models adjusted for covariates (age, occupation, economic activity, and other types of occupational exposure)., Results: Low decision latitude (skill discretion and decision authority), high psychological demands, low social support (from supervisors for men), low reward (low esteem and low job promotion for both genders and job insecurity for men), bullying and verbal abuse for both genders were associated with self-reported health., Conclusions: This study emphasizes the role of psychosocial work factors as risk factors for poor self-reported health and suggests that the implementation of preventive measures to reduce exposure to psychosocial work factors should be an objective for the improvement of health at work.

Background: Little is known about associations between emergent psychosocial work factors and mental health., Aims: To explore associations between classical and emergent psychosocial work factors and depression and anxiety symptoms in employees in France., Methods: A national cross-sectional study (the SUrveillance Médicale des Expositions aux Risques professionnels (SUMER) survey) assessed psychosocial work factors including psychological demands, decision latitude, social support, reward and its sub-dimensions (esteem, job security and job promotion), bullying, verbal abuse, physical violence and sexual assault, long working hours, shift and night work, unsociable work days, predictability and demands for responsibility. We also measured depression and anxiety symptoms using the Hospital Anxiety and Depression scale. We used gender-stratified generalized linear models to adjust for age, occupation and economic activity., Results: A total of 26883 men and 20079 women participated (response rate 87%). Low decision latitude, high psychological demands, low social support, low reward, bullying and verbal abuse were associated with depression and anxiety in both genders (β coefficients from 0.14 to 1.40). In men, low predictability was associated with both depression and anxiety (β = 0.12 [95% confidence interval (CI) 0.01, 0.24] and 0.19 [95% CI 0.06, 0.32]) and long working hours were associated with anxiety (β = 0.48 [95% CI 0.27, 0.69]). The strongest associations were observed for bullying, reward (especially esteem) and psychological demands. Using a less conservative approach, we found more factors to be significantly associated with mental health symptoms., Conclusions: Most psychosocial work factors studied are associated with depression and/or anxiety symptoms. Comprehensive prevention policies may help to reduce exposure to psychosocial work factors, including emergent ones, and improve mental health at work., (© The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Purpose: The aim of the study was to assess the changes in psychosocial work factors in the French working population between 2006 and 2010 and to examine potential differential changes according to age, occupation, public/private sector, work contract and self-employed/employee status., Methods: The study sample included 5,600 workers followed up from 2006 to 2010 from the national representative Santé et Itinéraire Professionnel (SIP) survey. Psychosocial work factors included decision latitude, psychological demands, social support, reward, overcommitment, long working hours, predictability, night- and shift work, emotional demands, role conflict, ethical conflict, tensions with the public, job insecurity and work-life imbalance, and were measured using scores. Linear regressions were used to analyse the change in the scores of these factors adjusted for age and initial score. All analyses were stratified by gender., Results: Psychosocial work factors worsened between 2006 and 2010: decision latitude, social support, reward, role conflict and work-life imbalance for both genders, and psychological demands, emotional demands, ethical conflict and tensions with the public for women. Differential changes according to age, occupation, public/private sector, work contract and self-employed/employee status were observed suggesting that some groups may be more likely to be exposed to negative changes especially the younger, low- and high-skilled and public sector workers., Conclusion: Monitoring exposure to psychosocial work factors over time may be crucial, and prevention policies should take into account that deterioration of psychosocial work factors may be sharper among subgroups such as younger, low- and high-skilled and public sector workers.

Objective: This study aims at exploring the associations between psychosocial work factors and sickness absence., Methods: The sample from the French National Survey SUMER 2010 included 46,962 employees. Sickness absence spells and days within the last year were studied as two outcomes. Psychosocial work factors included psychological demands, decision latitude, social support, reward, working time, and workplace violence variables. Covariates were age, occupation, economic activity, and other occupational exposures., Results: For both genders, low latitude, low reward, shift work, bullying, and verbal abuse were risk factors of absence spells while long working hours were a protective factor. High demands, low support, and physical violence were risk factors for women. Low support and bullying for both genders, high demands for women, and low reward, long working hours, and physical violence for men increased absence duration., Conclusions: This study highlights the importance of psychosocial work factors as risk factors of sickness absence., (© 2014 Wiley Periodicals, Inc.)

Objectives: The aim of this study was to evaluate the fractions of cardiovascular diseases and mental disorders attributable to three psychosocial work factors, job strain, effort-reward imbalance (ERI) and job insecurity, in 31 countries in Europe., Methods: The prevalence of exposure (Pe) to job strain, ERI and job insecurity was calculated using the sample of 29,680 workers from 31 countries of the 2005 European Working Conditions Survey. Relative risks (RR) were obtained from three published meta-analyses. Pe and RR estimates were used to calculate attributable fractions (AF)., Results: Pe estimates were 26.90, 20.44 and 14.11% for job strain, ERI and job insecurity in Europe, and significant differences were observed between countries. The job strain and ERI AFs for cardiovascular diseases were, respectively, 4.46% (significantly different from zero for Europe and all countries, but without any differences between countries) and 18.21% (not significantly different from zero for Europe and without differences between countries). The significant job strain and job insecurity AFs for mental disorders were 18.16 and 4.53% in Europe, without any significant difference between countries. The significant ERI AF for mental disorders was 14.81%, and significant differences were found between countries; the 3 highest AFs were observed in Greece, Slovenia and Turkey, and the 3 lowest in Bulgaria, Ireland and Latvia., Conclusion: This study is the first one to provide fractions of cardiovascular diseases and mental disorders attributable to three psychosocial work factors for the whole Europe and to explore the differences between 31 countries. These results may be useful to guide European and national prevention policies as well as to evaluate the economic costs of diseases attributable to these exposures.

Background: Studies exploring a wide range of psychosocial work factors separately and together in association with long sickness absence are still lacking., Objectives: The objective of this study was to explore the associations between psychosocial work factors measured following a comprehensive instrument (Copenhagen psychosocial questionnaire, COPSOQ) and long sickness absence (> 7 days/year) in European employees of 34 countries. An additional objective was to study the differences in these associations according to gender and countries., Methods: The study population consisted of 16 120 male and 16 588 female employees from the 2010 European working conditions survey. Twenty-five psychosocial work factors were explored. Statistical analysis was performed using multilevel logistic regression models and interaction testing., Results: When studied together in the same model, factors related to job demands (quantitative demands and demands for hiding emotions), possibilities for development, social relationships (role conflicts, quality of leadership, social support, and sense of community), workplace violence (physical violence, bullying, and discrimination), shift work, and job promotion were associated with long sickness absence. Almost no difference was observed according to gender and country., Conclusions: Comprehensive prevention policies oriented to psychosocial work factors may be useful to prevent long sickness absence at European level.

Objective: The aim was to assess the changes in psychosocial work factors among European employees between 2005 and 2010., Methods: The study samples came from the European Working Conditions Survey, involving 23,580 and 32,516 employees in 2005 and 2010, respectively, from 30 European countries. The psychosocial work factors studied were based on job strain and effort-reward imbalance models, and more recent factors. Multilevel linear and logistic regression models were used. Differences according to occupations and countries were tested., Results: Results were mixed with improvement for some factors and decline for other factors. Some countries and occupations were more likely to be affected by negative changes, especially low-skilled employees., Conclusion: Prevention policies at the workplace should take into account that the degradation of some psychosocial work factors may be sharper for some countries and occupations.

Background: Work stress has become a major occupational risk factor in industrialized countries and an important economic issue. The objective was to estimate the annual costs of coronary heart diseases (CHD) and mental disorders (MD) attributable to job strain exposure according to Karasek's model in France for the year 2003 from a societal perspective., Methods: We produced attributable fraction estimates which were applied to the number of cases (morbidity and mortality) and the costs of CHD and MD. Relative risk estimates came from a systematic literature review of prospective studies. We conducted meta-analyses based on this selection of studies. Prevalence of exposure to job strain came from the national SUMER survey conducted in France in 2003. Costs included direct medical costs and indirect costs: production losses due to sick leaves and premature deaths., Results: Between 8.8 and 10.2% of CHD morbidity was attributable to job strain, and between 9.4 and 11.2% of CHD mortality was attributable to this exposure for men. Between 15.2 and 19.8% of MD was attributable to job strain for men, and between 14.3 and 27.1% for women. As a whole, between 450 000 and 590 000 cases of diseases and 910-1130 deaths were attributable to job strain for men. From 730 000 to 1 380 000 cases of diseases and from 150 to 280 deaths were attributable to job strain for women. The total number of sick leave days amounted from 5 to 6.6 million days for men, and from 8.5 to 16 million days for women. The total costs of CHD and MD attributable to job strain exposure ranged from 1.8 to 3 billion euros for the year 2003 (0.12-0.19% GDP). Medical costs accounted for 11% of the total costs, value of life costs accounted for 13-15% and sick leave costs for 74-77%. The cost of CHD was estimated at 113-133 million euros and the cost of MD was between 1.7 - 2.8 billion euros in 2003., Conclusion: This study on the economic burden of diseases attributable to job strain in France provides relevant insights for policy-makers when defining public health priorities for prevention policies.

Background: Anxiety and depression are prevalent mental disorders in working populations. The risk factors of these disorders are not completely well known. Developing knowledge on occupational risk factors for mental disorders appears crucial. This study investigates the association between various classical and emergent psychosocial work factors and major depressive and generalised anxiety disorders in the French working population., Methods: The study was based on a national random sample of 3765 men and 3944 women of the French working population (SIP 2006 survey). Major Depressive Disorder (MDD) and Generalised Anxiety Disorder (GAD) were measured using a standardised diagnostic interview (MINI). Occupational factors included psychosocial work factors as well as biomechanical, physical, and chemical exposures. Adjustment variables included age, occupation, marital status, social support, and life events. Multivariate analysis was performed using logistic regression analysis., Results: Low decision latitude, overcommitment, and emotional demands were found to be risk factors for both MDD-GAD among both genders. Other risk factors were observed: high psychological demands, low reward, ethical conflict, and job insecurity, but differences were found according to gender and outcome. Significant interaction terms were observed suggesting that low decision latitude, high psychological demands, and job insecurity had stronger effects on mental disorders for men than for women., Limitations: Given the cross-sectional study design, no causal conclusion could be drawn., Conclusions: This study showed significant associations between classical and emergent psychosocial work factors and MDD-GAD. Preventive actions targeting various psychosocial work factors, including emergent factors, may help to reduce mental disorders at the workplace., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: Although psychosocial work factors are recognized as major occupational risk factors, little information is available regarding the prevalence of exposure to these factors and the differences in exposure between countries., Aims: To explore the differences in various psychosocial work exposures between 31 European countries., Methods: The study was based on a sample of 14,881 male and 14,799 female workers from the 2005 European Working Conditions Survey. Eighteen psychosocial work factors were studied: low decision latitude (skill discretion and decision authority), high psychological demands, job strain, low social support, iso-strain, physical violence, sexual harassment, bullying, discrimination, work-family imbalance, long working hours, high effort, job insecurity, low job promotion, low reward and effort-reward imbalance. Covariates were age, number of workers in household, occupation, economic activity, self-employed/employee, public/private sector and part/full time work. Statistical analysis was performed using multilevel logistic regression analysis., Results: Significant differences in all psychosocial work factors were observed between countries. The rank of the countries varied according to the exposure considered. However, some countries, especially Denmark, Netherlands and Norway, displayed a significantly lower prevalence of exposure to four factors or more, while some Southern and Eastern countries, especially Czech Republic, Greece, Lithuania and Turkey, had a higher prevalence., Conclusions: Differences in psychosocial work exposures were found between countries. This study is the first to compare a large set of psychosocial work exposures between 31 European countries. These findings may be useful to guide prevention policies at European level.

Aim: To examine the associations between psychosocial work factors and general health outcomes, taking into account other occupational risk factors, within the national French working population., Methods: The study was based on a large national sample of 24 486 women and men of the French working population who filled in a self-administered questionnaire in 2003 (response rate: 96.5%). Psychosocial work exposures included psychological demands, decision latitude, social support, workplace bullying and violence from the public. The three health indicators studied were self-reported health, long sickness absence (>8 days of absence) and work injury. Adjustment was made for covariates: age, occupation, work status, working hours, time schedules, physical, ergonomic, biological and chemical exposures. Men and women were studied separately., Results: Low levels of decision latitude, and of social support, and high psychological demands were found to be risk factors for poor self-reported health and long sickness absence. High demands were also found to be associated with work injury. Workplace bullying and/or violence from the public also increased the risk of poor health, long sickness absence and work injury., Conclusion: Psychosocial work factors were found to be strong risk factors for health outcomes; the results were unchanged after adjustment for other occupational risk factors. Preventive efforts should be intensified towards reducing these psychosocial work exposures.

This study explored the association between the two job-stress models, job-strain and effort-reward imbalance, and mental health outcomes in a working population exposed to major organizational changes. The cross-sectional study was based on 680 subjects, 504 men and 176 women. Psychosocial factors at work included: psychological demands, decision latitude, social support, effort, reward, and overcommitment. Mental health outcomes were depressive symptoms (CES-D) and psychiatric disorders (GHQ-12). Job strain, low decision latitude, effort-reward imbalance, and low reward (especially job instability) were found to be associated with depressive symptoms and/or psychiatric disorders among men. Overcommitment at work was a risk factor for both men and women. Social support at work played a role to reduce depressive symptoms for women. These findings emphasize the deleterious effects of psychosocial work environment on mental health during major organizational changes.

Background: Personal responses to stressful life events are suspected of increasing the risk of serious traffic accidents., Methods: We analyzed data from a French cohort study (the GAZEL cohort), including a retrospective driving behavior questionnaire, from 13,915 participants (10,542 men age 52-62 years and 3373 women age 47-62 years in 2001). Follow-up data covered 1993-2000. Hazard ratios for serious accidents (n = 713) were computed by Cox's proportional hazard regression with time-dependent covariates. Separate analyses were also performed to consider only at-fault accidents., Results: Marital separation or divorce was associated with an increased risk of a serious accident (all serious accidents: hazard ratio 2.9, 95% confidence interval = 1.7-5.0; at-fault accidents: 4.4, 2.3-8.3). The impact of separation and divorce did not differ according to alcohol consumption levels. Other life events associated with increased risk of serious accident were a child leaving home (all accidents: 1.2, 0.97-1.6; at-fault accidents: 1.5, 1.1-2.1), an important purchase (all accidents: 1.4, 1.1-1.7; at-fault accidents: 1.6, 1.2-2.1), and hospitalization of the partner (all accidents: 1.4, 1.1-2.0)., Conclusion: This study suggests that recent separation and divorce are associated with an increase in serious traffic accidents.

To assess stress and satisfaction related to HIV medical work and its impact on psychological wellbeing, a cross-sectional study was undertaken among the population of doctors caring for HIV/AIDS patients in French hospitals. They were sent a questionnaire on demographic and professional characteristics along with three additional scales: the Consultants Mental Health Questionnaire with three components - stress, satisfaction and responses to job stress; the Maslach Burnout Inventory; and the GHQ-12 (General Health Questionnaire). A total of 670 physicians responded anonymously (65.4% participation). For 45% of respondents, HIV/AIDS represented less than 25% of their activity. Three dimensions were extracted by multivariate analysis from the stress scale (overload, social relationships at work, patients/family distress) and four dimensions from the satisfaction scale (work content, patients/family, peer recognition, work environment). Length of time working in HIV/AIDS, and proportion of clinical work in HIV/AIDS were not related to either stress or satisfaction. Only participation in NGOs increased the level of stress. Stress was not related to time spent in clinical work, neither to HIV work. Satisfaction derived from work decreases with time in direct contact with patients and is mainly related to the position in hospital. Eleven per cent sought help from professionals for psychological problems. Stress derived from patients suffering was not related to any psychological outcomes. Work overload and stress derived from social relationships at work are the main predictors of psychological distress, emotional exhaustion and depersonalization, while the moderator effect of satisfaction is weak. In the late nineties, the amount of HIV work did not appear as a specific feature of hospital medical work.