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The aim of this study was to determine the association between intergenerational workplace climate (attitudes, feelings, and perceptions about workers of different ages in the workplace) and self-perceived aging, work engagement, and turnover intention. A cross-sectional study was conducted via an online survey including answers from a representative sample of 1571 individuals aged 18–74 years, living and working in Denmark. In line with our hypotheses, we found that a more positive intergenerational workplace climate was related to a better self-perceived aging as well as to more work engagement and less turnover intention. In addition, we found that these associations were similar in all age groups. The findings point to the potential benefits of initiatives aimed at strengthening the intergenerational climate in workplaces.

PurposeWork-related violence is a major occupational safety and health (OSH) issue. According to the concept of violence prevention climate, managers play a pivotal role in preventing the risk of violence at work. However, research on this is scarce. The objective of this study was, therefore, to examine line managers' use of violence preventive practices in high-risk sectors.Design/methodology/approach The authors employed three different sources of data (semi-structured interviews and field notes from both leadership seminars and coaching sessions) that were collected in the context of an intervention study in Denmark aimed at improving violence prevention. The authors conducted a thematic analysis of violence prevention experiences among 16 line managers – eight from the prison and probation services and eight from psychiatric hospitals.FindingsUsing an existing prevention framework, the authors categorized the descriptions into three types of violence preventive practices used by the line managers across the two sectors: “preventing violence”, “managing episodes of violence” and “promoting the positive”. Especially the category “promoting the positive” is often neglected in the intervention literature.Originality/value The study identified new aspects of managers' violence preventive practices than those included in the violence prevention climate concept. Such knowledge may help organizations devise improved systems for violence prevention in high-risk sectors.

BACKGROUND: Work-related violence and threats are frequent in human service sectors. Although previous studies have identified several psycho-social work environmental risk factors for work-related violence and threats, the research domain still remains mainly descriptive and non-theoretical in nature.OBJECTIVE: Using the Job-Demands-Control model we analysed the relationship between the psycho-social work environment and work-related threats and violence.METHOD: Using a two-wave (2011 and 2015) longitudinal study of 2678 participants, we analysed the main and interactive effects of quantitative demands and job control on exposure to work-related violence and threats.RESULTS: High work demands and low job-control were associated with elevated risk of work-related threats in 2011 and in 2015. The associations of work demands and job control and work-related violence were mixed. There were not statistically significant interaction effects between high demands and low job control on neither work-related violence nor threats.CONCLUSION: In sectors where work-related threats and violence are likely to occur, risk prevention may also require improving the work conditions for employees, more specifically by reducing work-demands and increasing job control for instance by differentiating between important and less important work demands and by implementing self-autonomous work-teams may be a way to increase job control.

BACKGROUND: Work-related violence and threats are major problems in many occupations, especially within the human service sector, with consequences at multiple levels, including reduced physical and mental health, increased absenteeism, and reduced organizational commitment. It is, therefore, crucial to identify risk factors for work-related violence and threats. However, only a few studies have examined whether negative acts at work increase the risk of work-related violence and threats from clients toward employees.OBJECTIVE: To examine the associations between exposure to negative acts towards employees from colleagues, clients, or a combination of both, and the risk of work-related violence and threats perpetrated by clients towards employees in a longitudinal study.METHODS: Questionnaire data were collected in 2010, 2011, and 2015. In total, 5333 employees from special schools, psychiatric wards, eldercare, and the Prison and Probation Services participated in the first round of data collection in 2010. Negative acts were measured in 2010 using the Short Negative Acts Questionnaire, while work-related threats and violence were measured at all three-time points. The analyses were performed using multilevel logistic regression.RESULTS: Negative acts from clients and the combination of negative acts from both clients and colleagues were associated with later exposure to work-related violence and threats. The associations were observed after one year, and work-related threats were still present after four years.CONCLUSION AND IMPLICATIONS: Negative acts are associated with an increased risk of work-related violence and threats perpetrated by clients toward employees. Organizations may reduce the risk of work-related violence and threats by preventing negative acts.

Objectives: The aim of the present study was to examine the long-term association of job demands and job resources with self-reported exposure to workplace bullying in a representative sample of employees in Germany. Methods: We analysed a nation-wide representative cohort of employees working in the same workplace with a 5-year follow-up (S-MGA, N = 1637). The study contained self-reported measures of psychosocial working conditions, including work pace, amount of work, influence at work, role clarity and quality of leadership, and workplace bullying, and of organisational factors, including organisational restructuring and layoffs. Results: After controlling for bullying and occupational level at baseline, higher baseline levels of organisational restructuring (OR 1.73, 95% CI 1.10–2.70), work pace (1.30, 95% CI 1.01–1.66), and amount of work (1.55, 95% CI 1.21–1.99), and lower baseline levels of influence at work (0.70, 95% CI 0.55–0.90) and quality of leadership (1.99, 0.64, 95% CI 0.50–0.82), were associated with an elevated risk of workplace bullying at follow-up. In all, 90% of cases of self-reported workplace bullying could be attributed to these factors. Conclusions: The study suggests that employees reporting higher demands and lower resources, as well as organisational factors such as restructuring, are at a higher long-term risk of being targets of workplace bullying. Interventions aimed at preventing workplace bullying could benefit from a focus on psychosocial working conditions and organisational factors.

OBJECTIVES: The aim was to investigate workplace bullying as a risk factor for five-year occurrence of long-term sickness absence (LTSA) in a representative cohort of employees in Germany.METHODS: In the German Study on Mental Health at Work (S-MGA) ( n = 2476), episodes of long-term sickness absence (LTSA) between baseline and follow-up were assessed in the follow-up interview. Workplace bullying was measured in the baseline interview using a hybrid approach, which combines the behavioural experience and self-labelling methods. Through binomial regressions, the association of baseline level of workplace bullying with first-episode LTSA during follow-up was estimated, adjusting for baseline age, gender, occupational level, smoking status and physical demands at work. RESULTS: Severe bullying heightened the risk for LTSA by approximately 50% (Rate ratio-RR: 1.48, 95% Confidence interval-CI: 1.05; 2.19), while occasional bullying heightened the risk by 15% (RR: 1.15, CI: 0.85; 1.55). When excluding LTSA events occurring in the first 2 years, the associations between bullying and LTSA increased by approximately one third.CONCLUSIONS: Workplace bullying seems to be a risk factor for LTSA even when controlling for occupational level, smoking and physical demands at work and when taking possible reverse causality into account. We suggest to investigate effects of LTSA in more settings, to distinguish between occasional and severe bullying and employ longer follow-up intervals.

Background: Workplace bullying may severely affect mental health, but its association with suicidal behaviour is unknown. We analysed whether individuals reporting exposure to workplace bullying had higher risk of suicidal behaviour than those not reporting such exposure. Methods: Using a prospective cohort study design, we linked data from nine Danish questionnaire-based surveys (2004-2014) to national register data until December 31st, 2016. Exposure to workplace bullying was measured by a single item. Suicide attempts were identified in hospital registers and death by suicide in the Cause of Death Register. Among participants with no previous suicide attempts, we estimated Hazard Ratios (HR) and 95% Confidence Intervals (CI), adjusting for sex, age, marital status, socio-economic status, and history of psychiatric morbidity. Outcomes: The sample consisted of 98 330 participants (713 809 person-years); 63·6% women, mean age 44·5 years. Workplace bullying was reported by 10 259 participants (10·4%). During a mean follow-up of 7·3 years, we observed 186 cases of suicidal behaviour, including 145 suicide attempts, 36 deaths by suicide and 5 cases that died by suicide after surviving a suicide attempt. The fully-adjusted HR for the association between workplace bullying and suicidal behaviour was 1·70 (95% CI 1·10–2·61). The HRs for suicide attempts and death by suicide were 1·72 (1·14–2·58) and 2·29 (1·00–5·53), respectively. A multiplicative interaction with sex (2·78, CI 1·59–4·88) indicated that workplace bullying was associated with suicidal behaviour among men. Interpretation: The results suggested an elevated risk of suicidal behaviour among men reporting workplace bullying. Funding Information: Region of Southern Denmark (grant number A1763); Danish Working Environment Research Fund (grant number 20130023294); Danish Working Environment Research Fund (grant number 10-2019-03). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The project has been approved by the Danish Data Protection Agency (Capital Region of Denmark; j.nr.: 2012-58-0004).

Objective To examine 5-year prospective associations between working conditions and work ability among employees in Germany. Methods A cohort study (2011/2012–2017), based on a random sample of employees in employments subject to payment of social contributions aged 31–60 years (Study on Mental Health at Work; S-MGA; N = 2,078), included data on physical and quantitative demands, control (influence, possibilities for development, control over working time), relations (role clarity and leadership quality) and work ability (Work Ability Index, WAI; subscale ‘subjective work ability and resources’). Data were analysed using linear regression. Results Physical demands and control were associated with small 5-year changes in work ability (ΔR2 = 1%). Among the subgroup of employees with ≥ 25 sickness days, possibilities for development, control and quality of leadership were associated with changes in work ability (ΔR2 = 8%). Conclusions The impact of working conditions on long term changes in work ability seems to be negligible. However, in vulnerable subpopulations experiencing poor health, working conditions may be associated to a larger extent to work ability over this time span.

Objectives: The aim was to investigate the longitudinal relationship between precarious work and depressive symptoms in a representative cohort of employees in Germany. Methods: In the German Study on Mental Health at Work (S-MGA) (n = 2009), depressive symptoms were assessed by the Patient Health Questionnaire (PHQ−9). Precarious work was measured through baseline (2012) self-reported job insecurity, marginal part-time, fixed-term contract, hourly wage and—during follow-ups 2012–2017—unemployment. Among employees without depressive symptoms at baseline (2012), we ran logistic regression analyses stratified by gender with depressive symptoms at follow-up in 2017 as the dependent variable, adjusting for baseline (2012) age, gender, socioeconomic position and partner status. Results: Among men, job insecurity (OR: 2.47; 95% 95% CI: 1.37–4.48) and low wage (3.79; 1.64–8.72) at baseline were significantly associated with depressive symptoms at follow-up. Among women, indicators of precarious work were not associated with depressive symptoms at follow-up. Among men, a cumulative exposure index of precarious work was significantly associated with the development of depressive symptoms (one indicator: 1.84; 0.94–3.60, ≥two indicators: 7.65; 3.30–17.73). This index was not associated with depressive symptoms among women. The population attributable fraction of precarious work due to depressive symptoms among men was approximately 30%. Conclusions: Among employees in Germany, precarious work seems to be a risk factor for the subsequent development of depressive symptoms among men, but not among women. Research on precarious employment in different countries is needed.

OBJECTIVES: The aim of this study was to examine the prevalence of workplace bullying in Germany while also taking the perpetrator and severity level (measured by frequency) into account and considering the role of gender, age and socio-economic status.METHODS: We used data from a large representative sample (N = 4143) of employees in Germany subject to social security contributions. Self-reported bullying was assessed for different combinations of perpetrators (co-workers, superiors) and according to severity, i.e., being exposed at all and to severe bullying (at least weekly).RESULTS: Prevalence estimates varied from 2.9% for severe bullying by co-workers to 17.1% for overall bullying (i.e., without distinguishing by perpetrator, less severe bullying also included). Unskilled workers reported more bullying by both perpetrators than academics/managers. We also observed an age trend for severe bullying by superiors (i.e., bossing), with younger employees being more affected from bossing than elder. No gender differences were detected.CONCLUSIONS: The findings indicate that it is crucial to consider type of perpetrator and severity of the behaviors when examining the prevalence of workplace bullying. The way bullying is defined and operationalized strongly contributes to the prevalence estimates. Differences between subgroups and associations or cause-effect relationships should be analyzed with these variations in mind.

Aim: To examine if non-bullied employees at work units (WUs) with workplace bullying have more long-term sickness absence (LTSA) than employees in non-bullying WUs. Methods: We included 7229 public health employees from 302 WUs and 3158 responders to a questionnaire on working conditions and health in 2007. WUs were classified into three categories of WUs; (1) no bullying (0% bullied); (2) moderate prevalence of bullying (less than 10% bullied); and (3) high prevalence of bullying (more than or equal to 10% bullied). LTSA (more than or equal to 30 consecutive days of sickness absence) during the following 2 years was obtained by linkage to the Danish register of sickness absence compensation benefits and social transfer payments. Results: Non-bullied coworkers in WUs, where bullying was reported had 15% to 22% more LTSA compared with non-bullying WUs. Conclusion: Workplace bullying may be associated with LTSA in the entire WU.

OBJECTIVES: To investigate the association between workplace bullying and change of job/unemployment, and to investigate whether psychological stress reactions constitute a potential pathway linking workplace bullying and change of job/unemployment.METHODS: We used questionnaire data on workplace bullying and psychological stress reactions and register data on change of job/unemployment. We applied a multiple pathway approach to estimate the proportion of the association between workplace bullying and subsequent change of job/unemployment that was potentially mediated by psychological stress reactions.RESULTS: Workplace bullying was associated with risk of change of job (odds ratio [OR] = 1.35; 95% confidence interval [CI]: 1.06-1.72; 24% potentially mediated by psychological stress reactions) and unemployment (OR = 4.90; 95% CI: 3.18-7.55; 19% potentially mediated by psychological stress reactions).CONCLUSION: Workplace bullying has important consequences for labor market outcomes. Psychological stress reactions may play a vital role in this process.

Using the Columbia-Suicide Severity Rating Scale (C-SSRS), we examined the predictive and incremental predictive validity of past-month suicidal behavior and ideation for short-term suicidal behavior among adolescents at high risk of suicide. The study was conducted in 2014 on a sample of 85 adolescents (90.6% females) who participated at follow-up (85.9%) out of the 99 (49.7%) baseline respondents. All adolescents were recruited from a specialized suicide-prevention clinic in Denmark. Through multivariate logistic regression analyses, we examined whether baseline suicidal behavior predicted subsequent suicidal behavior (actual attempts and suicidal behavior of any type, including preparatory acts, aborted, interrupted and actual attempts; mean follow-up of 80.8 days, SD = 52.4). Furthermore, we examined whether suicidal ideation severity and intensity incrementally predicted suicidal behavior at follow-up over and above suicidal behavior at baseline. Actual suicide attempts at baseline strongly predicted suicide attempts at follow-up. Baseline suicidal ideation severity and intensity did not significantly predict future actual attempts over and above baseline attempts. The suicidal ideation intensity items deterrents and duration were significant predictors of subsequent actual attempts after adjustment for baseline suicide attempts and suicidal behavior of any type, respectively. Suicidal ideation severity and intensity, and the intensity items frequency, duration and deterrents, all significantly predicted any type of suicidal behavior at follow-up, also after adjusting for baseline suicidal behavior. The present study points to an incremental predictive validity of the C-SSRS suicidal ideation scales for short-term suicidal behavior of any type among high-risk adolescents.

Objective: To examine if perceived stress mediated the association between workplace bullying and subsequent long-term sickness absence. Methods: The PRISME cohort was established in 2007 and re-examined in 2009. Questionnaire data about workplace bullying and perceived stress were obtained from 4114 individuals. Participants were followed in registers on long-term sickness absence (≥30 consecutive days of sickness absence). Results: Workplace bullying was associated with subsequent sickness absence (odds ratio [OR]=2.05; 95% confidence interval [CI]: 1.57 to 2.65) and concurrent high perceived stress levels (OR=2.34; 95% CI: 1.86 to 2.96). A high perceived stress level was also associated with subsequent sickness absence (OR=1.33; 95% CI: 1.13 to 1.56). Perceived stress explained 13% (95% CI: 6 to 23%) of the total association between bullying and sickness absence. Conclusions: The association between workplace bullying and subsequent long-term sickness absence may be partially mediated by perceived stress. © Copyright 2016 American College of Occupational and Environmental Medicine.

OBJECTIVE: This study investigates the 2-year prospective association between exposure to negative acts at work and depression.METHODS: A questionnaire study was carried out among 3363 employees and followed up 2 years later. Negative acts as potential bullying behavior were assessed by the Revised Negative Acts Questionnaire and depression by The Major Depression Inventory or Schedule for Clinical Assessment in Neuropsychiatry interviews. Logistic regression analyses tested potential associations between depression and negative acts.RESULTS: Exposure to negative acts was associated with depression 2 years later; however, when adjusting for Sense of Coherence and depressive symptoms at baseline the association was no longer significant. Conversely, depression at baseline predicted self-reported exposure to negative acts at follow-up.CONCLUSIONS: Depression predicts exposure to negative acts at a 2-year follow-up, whereas negative acts do not predict depression after adjustment for Sense of Coherence and baseline depressive symptoms.

Aim: The aim of the present study was to examine the bidirectional associations between subjective role ambiguity and role conflicts at work, respectively, and self-reported sleep 2 years later. In addition, we also examine whether sense of coherence (SOC) moderate or mediate the association between role stressors and poor sleep and between poor sleep and role stressors. Methods: We used questionnaire data collected in 2006 and 2008 from the Workplace Bullying and Harassment cohort. In 2006, 3363 responded to the questionnaire and in 2008 1671 responded. In total, 1569 participants responded in both 2006 and 2008 to the questions on role stressors (in terms of role ambiguity and role conflicts at work) and sleep problems in both 2006 and 2008. Sleep problems were assessed with the awakening index (AWI) and the disturbed sleep index (DSI). Moderation and mediation analyses of the association were estimated using structural equation modelling. Results: We found a prospective association between role stressors and sleep problems [beta values were 0.07 (95% CI 0.03–0.11) and 0.05 (CI 0.01–0.10) for DSI and AWI, respectively] when adjusting for sleep problems at baseline, age, sex, and life style factors (i.e. alcohol, smoking, and leisure time physical activity). SOC moderated the association showing that participants with lower SOC scores who reported higher role ambiguity reported sleep problems to a higher extent than participants with high SOC scores. SOC also mediated the association between role stressors and sleep problems. We also found support for sleep problems at baseline and role stressors 2 years later [DSI 0.04 (CI 0.00–0.08) and 0.15 (CI 0.09–0.21)] for role ambiguity and role conflicts, respectively. Similar results were observed for AWI. Conclusion: Subjective role stressors were prospectively associated with sleep problems. Yet, sleep problems could also prospectively predict subjective role stressors (i.e. reverse causation). The analyses also showed that SOC may be regarded as both a mediating and a moderating factor of the association between subjective role conflicts and poor sleep. We found that SOC moderated the prospective association so participants with low SOC report more sleep problems with subjective role conflicts compared to participants with high SOC. Finally, we also found SOC mediated the prospective association between subjective role stressors and sleep problems and the reverse association.

Objectives: The behavioural experience method has been extensively used in the literature for the measurement of potential bullying behaviours at work. However, this approach presents limitations when used to classify respondents as targets or non-targets of workplace bullying. Therefore, the present study aimed to: (i) identify optimal cut-off points, reflecting a possible subjectively experienced exposure to occasional and frequent workplace bullying, for the 9-item Short Negative Act Questionnaire (S-NAQ), and (ii) examine the criterion validity of these cut-off points in relation to depressive symptoms and diagnosis of depression. Methods: The study was based on a sample of 4882 participants from the Danish MODENA cohort study (year 2011), which included both the S-NAQ (score range 9-45) and a one-item measure applying the self-labelling method with a definition to assess occasional and frequent workplace bullying. We employed receiver operating characteristic (ROC) curve analyses to derive the cut-off points for the S-NAQ. Based on these cut-off points, we created a new S-NAQ variable with three levels of exposure (i.e. 'not exposed', 'first threshold', and 'second threshold') and tested its criterion validity in relation to depressive symptoms (N = 4071) and diagnosis of depression (N = 4844). Results: The S-NAQ cut-off points obtained were =12 and =16 when using occasional and frequent bullying as reference standards, respectively. Both cut-off points showed high classification accuracy (area under the curve = 0.89 and 0.93) as well as good sensitivity (84.8% and 88.0%) and specificity (77.4% and 94.7%). In the adjusted linear regression analyses, both the first (B = 0.78, 95% confidence interval [CI] = 0.66-0.90) and the second threshold of exposure (B = 1.65, 95% CI = 1.44-1.86) were significantly associated with depressive symptoms. In the adjusted logistic regression analyses, both the first (odds ratio [OR] = 3.55, 95% CI = 1.98-6.38) and the second threshold of exposure (OR = 5.90, 95% CI = 2.93-11.88) were significantly associated with diagnosis of depression. Conclusions: The two cut-off points for the S-NAQ identified in this study showed a significant association with both depressive symptoms and diagnosis of depression. However, future prospective studies are needed to establish the predictive validity of the proposed cut-off points.

The theoretical and empirical link between leadership and workplace bullying needs further elaboration. The aim of the study is to examine the relationship between quality of leadership and the occurrence of workplace bullying 2 years later. Furthermore, we aim to examine a possible mechanism from leadership to bullying using social community at work as mediator. Using survey data that were collected at two different points in time (2006–2008) among 1664 workers from 60 Danish workplaces, we examined the total, direct and indirect effects between quality of leadership and workplace bullying. Our results indicate that quality of leadership plays a role in establishing working conditions that lead to workplace bullying. Furthermore, social community at work fully mediates the effect of poor quality of leadership on workplace bullying. This longitudinal study adds to previous cross-sectional studies on the substantial role played by leaders in the bullying process. Within the leadership–bullying relationship, social community at work acts as a full mediator, adding a significant contribution to the discussion of mechanisms involved in the bullying process. Plausible explanations of this mechanism and practical implications are discussed.

There is scarce research on the interaction between psychosocial working conditions and being a target of workplace bullying with individual characteristics as a moderator. We therefore examined 3,363 employees from 60 Danish workplaces to test whether sense of coherence moderates the relationship between the job demand-control model and bullying. This work is exploratory in nature, as no previous study to assess this moderation was found. Hierarchical linear regressions showed that demand-control model was significantly associated with bullying. Sense of coherence displayed a significant though practically negligible moderating effect. This suggests that negative psychosocial working conditions are associated with bullying independently of personal characteristics, at least in terms of sense of coherence.

The aim of this study was to investigate exposure to workplace bullying as a potential risk factor for sickness presenteeism (SP), i.e. working while ill. This study is based on data collected through self-reported questionnaires in a 2-year prospective study on employees in Denmark. At baseline, 3363 employees (45.7 % response rate) answered to a questionnaire on their psychosocial work environment and health status. After 2 years, 1664 of the respondents also completed a follow-up questionnaire (49.5 % of the total baseline respondents). After excluding participants with missing values, the final samples were composed of 2865 and 1331 participants in the cross-sectional and prospective analyses, respectively. Modified poisson regression analyses showed that frequent (i.e. daily or weekly) exposure to workplace bullying was associated with reporting 8 or more days of SP in the preceding year in both the cross-sectional and the prospective analysis, also when controlling for several confounders including health-related variables. However, the prospective relationship became non-significant after adjustment for baseline SP. This study provides indications of a significant relationship between exposure to frequent workplace bullying and SP, although causal connections could not be established. Methodological and theoretical considerations about study findings are provided, which could be of benefit to future studies examining the impact of being a target of workplace bullying on SP.

To investigate whether self-reported exposure to workplace bullying predicts the risk of disability pensioning among employees in two occupational groups—(1) employees working with clients or customers and (2) office workers and manual workers—and whether leadership support and occupational group moderates that association. Survey data from 24,538 employees (112,889 person years) were fitted to a national register containing information on disability-pension payments. Using multi-adjusted Cox-regression analysis, observations were followed in the register to assess the risk of disability pensioning. The average follow-up time was 4.6 years (standard deviation [SD] = 1.5). Self-reported exposure to workplace bullying predicted an increased risk of disability pensioning (hazard ratio [HR] = 1.46; 95% confidence interval [CI]: 1.15–1.86). This association was moderated by leadership support: the association between workplace bullying and disability pensioning was significantly different for respondents who reported low leadership support (HR = 1.97; 95% CI: 1.38–2.80) compared to respondents who reported medium (HR = 1.03; 95% CI: 0.60–1.76) or high leadership support (HR = 1.08; 95% CI: 0.60–1.95). Further analyses showed similar associations between workplace bullying and the risk of disability pensioning among the two occupational groups. Self-reported workplace bullying increases the risk of disability pensioning, and this association is buffered by leadership support. Workplace bullying should be considered an important workplace stressor. This study indicates that workplaces may enhance worker retention by actively promoting measures to eliminate the occurrence of workplace bullying and to enhance leadership support.

Purpose: The aim of this study is to investigate whether organizational justice climate at the workplace level is associated with individual staff members’ perceptions of care quality and affective commitment to the workplace. Methods: The study adopts a cross-sectional multi-level design. Data were collected using an electronic survey and a response rate of 75% was obtained. Organizational justice climate and affective commitment to the workplace were measured by items from Copenhagen Psychosocial Questionnaire and quality of care by three self-developed items. Non-managerial staff working at dental clinics with at least five respondents (n = 900 from 68 units) was included in analyses. A set of Level-2 random intercept models were built to predict individual-level organizational affective commitment and perceived quality of care from unit-level organizational justice climate, controlling for potential confounding by group size, gender, age, and occupation. Results: The results of the empty model showed substantial between-unit variation for both affective commitment (ICC-1 = 0.17) and quality of care (ICC-1 = 0.12). The overall results showed that the shared perception of organizational justice climate at the clinical unit level was significantly associated with perceived quality of care and affective commitment to the organization (p

This chapter reviews the available international literature on the organizational antecedents of bullying and harassment by adopting the perspective of the work environment hypothesis as the main underlying theoretical explanation. According to this hypothesis, in a poorly organized work environment, employees experience high levels of stress and frustration, which may lead them to be involved in interpersonal conflicts, with some of these conflicts spiralling and evolving into bullying situations. Thus, the work environment hypothesis conceptualizes bullying as a behavioural strain outcome triggered by negative working conditions. Research adopting this explanation has grown considerably in the last decade or so, using progressively more convincing research designs. The chapter first presents a detailed description of the work environment hypothesis. It then reviews the main results of the first exploratory surveys on the role of working conditions in bullying that have consolidated such a hypothesis and have opened the way to more systematic and robust investigations. Next, it reports the evidence linking the following specific working conditions to bullying: job demands and job resources as conceptualized and measured according to two well-known job stress models (i.e. the demand–control–support model and the job demands–resources model); leadership characteristics; organizational change and job insecurity; organizational culture and climate; reward systems; and physical working conditions. In the concluding section, the main limitations of the available research will be highlighted and, based on these, directions for future research will be proposed.

To examine the prospective association between sickness presenteeism (SP), that is, working while ill, and the onset of depression.We carried out a two-wave (2006 to 2008) questionnaire-based study among 1271 employees from 60 Danish workplaces. Sickness presenteeism was assessed by asking participants to report the number of days that they went to work despite illness in the preceding year.Multivariate logistic regression revealed that, after controlling for several health-related variables and other relevant confounders, reporting 8 or more days of SP was associated with an increased risk of depression among initially nondepressed participants (odds ratio, 2.45; 95% confidence interval, 1.06 to 5.64). No significant sex-related differences were observed in this relationship.Adding to previous evidence on the health effects of SP, this study suggests that working while ill may also be a significant risk factor for the development of depression.

Background Workplace bullying is a severe stressor that is related to numerous adverse outcomes, such as poor health and low quality of life. Previous studies have shown that bullying is a strong predictor of long-term sickness absence that can have substantial costs for both society and the individual. A commonly used definition of bullying is when an individual, over a prolonged period of time, such as six months, perceives him/herself as being exposed to negative acts from superiors or co-workers that it is difficult to defend one-self against. The causes of long-term sickness absence are multifactorial. One possible pathway linking workplace bullying and sickness absence is through chronically increased levels of perceived stress. Objective To examine if perceived stress mediated the association between workplace bullying and subsequent long-term sickness absence. Methods The PRISME cohort was established in 2007 and re-examined in 2009. Questionnaire data about workplace bullying (self-labelling question) and perceived stress (Cohen’s perceived stress scale) were obtained from 4114 individuals. Participants were followed in registers on long-term sickness absence (≥30 consecutive days of sickness absence). Results We had 4,114 participants with no history of long-term sickness absence in the previous two years contributing 6,331 observations in 2007 and/or 2009, giving a total of 6331 observations of which 430 were among workplace bullied. Workplace bullying was associated with subsequent sickness absence (OR = 2.05; 95% CI: 1.57–2.65) and concurrent high perceived stress levels (OR = 2.34; 95% CI: 1.86–2.96). A high perceived stress level was also associated with subsequent sickness absence (OR = 1.33; 95% CI: 1.13–1.56). Perceived stress explained 13% (95% CI: 6–23%) of the total association between bullying and sickness absence. Conclusions The association between workplace bullying and subsequent long-term sickness absence may be partially mediated by perceived stress.

Shiftwork may be a demanding situation because it raises problems for reconciling work and nonwork activities; as such, this conflict may be mitigated by designing and implementing effective preventative actions at the workplace. There is a paucity of research directly examining the impact of work schedules and preventative measures at work on work-family conflict. Hence, the authors posed the following questions in their study: What is the impact of different work schedules on work-family conflict? Is a preventative culture associated with less work-family conflict? Is work-family conflict associated with specific health and well-being indicators and if so, how does work-family conflict affect well-being as compared with other potential determinants? A subset of 750 nurses ( approximately 10% of total workforce) were randomly selected from a larger sample. Nurses completed the Italian version of the NEXT questionnaire plus newly developed items to create an index on occupational safety and health prevention at work. Data were explored using two data mining techniques, Random Forests and Bayesian Networks, and modeled using hierarchical linear regression models. In all, 664 (88.5% of sample) nurses answered the questionnaire. The authors found that different work schedules had a differential impact on work-family conflict. In addition, effective risk communication between workers and people in charge of safety and health, and participation in preventative activities, quantitative workload, performing tasks not belonging to the nursing profession, and the number of weekends/month spent at work were all strongly associated with work-family conflict. The variable "time schedules" also acted as an effect modifier in the relationship between effective communication and participation in preventative activities and work-family conflict. In addition, quantitative demands played a role as a mediator (30% of total effect) in the relationship between effective communication and participation in preventative activities and work-family conflict. Work-family conflict was significantly associated with burnout, sleep, and presenteeism; its association with burnout was higher than other precursors. Shift schedules that involved night work implied different workload demands, less effective communication, and participation in preventative activities than the other work schedules considered. The presence of a preventative culture directly reduced work-family conflict and indirectly via reduction of work demands. The authors conclude that the development of a preventative culture among irregular and night shiftworkers can be effective in reducing work-family conflict, while positively increasing well-being and job performance.

Background: Qualified nurses commonly report several work-related problems, which may threat their health and work ability, and may have an impact upon retention. - Objective: The aim of the present study was to investigate whether perceived work ability is a predictor for different types of thinking of quitting and for actual exit from the workplace. - Design: A prospective study has been performed based on 3329 Italian registered nurses which responded to both measurements of the Nurses’ Early Exit Study. Institutions were selected by means of a stratified sampling procedure. All the 7447 nurses working in that healthcare organizations were recruited for the study. Baseline questionnaire was collected from 5504 nurses. Response rate at follow-up was 63.4%. Two hundred and fifty-five nurses left the job in the course of the investigation. - Methods: Several multiple logistic regression analyses were performed controlling for indicators of work-related well-being, socio-demographic, and labour-market characteristics. - Results: As a whole, our results show that among nurses younger than 45 years work ability is a significant predictor of different types of thinking of quitting, but not of actual exit from the workplace: a lower perceived work ability was associated with a higher desire to undertake further education (OR: 3.05; 95% CI: 1.30–7.18) and/or to change workplace (OR: 4.03; 95% CI: 1.84–8.83) or profession (OR: 6.67; 95% CI: 2.78–15.99). In contrast, among the older nurses (>45), only actual exit was predicted by lower work ability scores (OR: 7.14; 95% CI: 1.15–44.13), along with the perception of a larger availability of free nursing posts in the region (OR: 2.70; 95% CI: 1.13–6.43). - Conclusion: Therefore, we conclude that in the relationship between low perceived work ability and intended or actual exit, a significant part is explained by age itself, but also by the age-related differences in occupational and life opportunities. This contribution concludes with some age-related policies aimed at boosting nurses’ retention.

Among healthcare workers, shiftwork (mostly if nightwork is also included), ageing and work-related stress may be factors leading to impaired health. Such risk factors may also operate in interaction, resulting in an even increased harm for health. The present study aims at evaluating these relationships in a sample of 1842 hospital workers in Northern Italy. Subjects were mainly women, 33.1% were aged > or = 45 yr, and they were almost evenly distributed between dayworkers and rotating shiftworkers (nights included). Shiftwork was associated with poor sleep, while it was protective against gastrointestinal disorders, poor work ability and job dissatisfaction. Work stress was the risk factor with the highest relevance for poor health. Ageing was associated with lower physical health. Few significant interactions were observed. Shiftwork with nights and high work stress significantly interacted in increasing the risk for poor sleep. The "healthy worker effect" may have played a strong role in study findings.

Neurological patients can be entirely unaware of their disease; this phenomenon is called anosognosia and it has been shown in different sensory-motor and cognitive domains. Lack of awareness has been investigated in Alzheimer's disease (AD) and within different domains of it. In the present article we review the literature on anosognosia for AD that had been indexed on the Medline database until the end of 2004. Historical introduction to the subject is followed by a brief description of the anatomy and clinical characteristics of AD. An analysis of a number of studies that focus on the relationship between anosognosia and AD then follows. This review shows that anosognosia is typical in AD, compared with other types of dementia, and it is a distinctive feature in the most severe cases and particularly in the beginning phases of illness. From an anatomical point of view, anosognosia seems to be strictly connected to frontal lobe areas; in fact, patients with anosognosia and AD show a reduction of cerebral haematic flow in the frontal regions, as well as deficits of executive functions and extrapyramidal signs. Interestingly, co-occurring depression could be interpreted as an adaptive behavior to counter the effects of perceived loss of cognitive abilities. Finally, self-awareness in AD could have some common mechanisms with auto-monitoring in schizophrenia.

Satisfactory work ability is sustained and promoted by good physical and mental health and by favorable working conditions. This study examined whether favorable and rewarding work-related factors increased the work ability among European nurses. The study sample was drawn from the Nurses' Early Exit Study and consisted of 7,516 nursing staff from seven European countries working in state-owned and private hospitals. In all, 10.8% were day, 4.2% were permanent night, 20.9% were shift without night shift, and 64.1% were shift workers with night shifts. Participants were administered a composite questionnaire at baseline (Time 0) and 1 yr later (Time 1). The Work Ability Index (WAI) at Time 1 was used as the outcome measure, while work schedule, sleep, rewards (esteem and career), satisfaction with pay, work involvement and motivation, and satisfaction with working hours at Time 0 were included as potential determinants of work ability. Univariate and multivariate analyses were conducted after adjusting for a number of confounders (i.e., country, age, sex, type of employment, family status, and other job opportunities in the same area). Work schedule was not related to Time 1 changes in WAI. Higher sleep quality and quantity and more favorable psychosocial factors significantly increased work ability levels. Higher sleep quality and quantity did not mediate the effect of work schedule on work ability. No relevant interaction effects on work ability were observed between work schedule and the other factors considered at Time 0. As a whole, sleep and satisfaction with working time were gradually reduced from day work to permanent night work. However, scores on work involvement, motivation, and satisfaction with pay and rewards were the highest in permanent night workers and the lowest in rotating shift workers that included night shifts.

To investigate whether self-reported exposure to negative acts in the workplace (bullying and threats of violence) predicted turnover in three occupational groups (human service and sales workers, office workers and manual workers). Survey data on 2766 respondents were combined with data from a national labour force register to assess turnover. Mixed effects logistic regression analysis was used to examine the association between self-reported exposure to negative acts at baseline and risk of turnover after a 1-year follow-up. We found no significant associations between exposure to negative acts (bullying and threats of violence) and risk of turnover. When participants were stratified by occupational group and analyses were adjusted for age, gender, tenure and psychosocial working conditions, we found that exposure to bullying predicted risk of turnover in office workers (OR 2.03, 95 % CI 1.05–3.90), but neither in human service and sales workers, nor in manual workers. The association in office workers lost statistical significance when additionally adjusted for depressive symptoms (OR 1.77, 95 % CI 0.90–3.49). However, in a sensitivity analysis in which we used a 2-year (instead of a 1-year) follow-up period the association between bullying and turnover remained statistically significant in office workers even after adjusting for depressive symptoms (OR 2.10, 95 % CI 1.17–3.76). We found no statistically significant associations between threats of violence and risk of turnover in the stratified analyses. Exposure to bullying predicted risk of turnover among office workers but not among human service and sales workers and among manual workers. Threats of violence were not associated with turnover in any occupational group.

Introduction: The respective roles of medical specialties and work organization on violent events against healthcare workers (HCW) in different countries was examined. Methods: Using the results of the Presst-Next study, we analyzed data from 27 134 HCW in 7 European countries. Multivariate logistic analyses were conducted with SPSS 12 software. Results: After adjustment for age, gender and other occupational risk factors, the factors indicating insufficient team work were highly associated with an increased risk of violent events. Dissatisfaction with shift change (OR=1.35; 95%CI 1.23-1.47), uncertainty about treatment (OR=1.57; 95%CI 1 .44-1.71), and frequent interruptions (OR=2.04; 95%CI 1.81-2.31) were linked to violent events, up to twice the number among HCW reporting better team work. Contradictory orders, dissatisfaction with psychological support, and harassment by superiors were all significantly associated with increased reporting of frequent violent events. We observed a positive gradient between violent events and job demand (time pressure) (OR=1.25 for an intermediate score and OR=1.55 for a high score, compared with a low score). Loneliness at work, certain work schedules, and physical load increased the risk. Nurses' aides were exposed to violent events more often (OR=1.57; 95%CI 1.38-1.79) than head nurses. Older HCW and those with more experience were less exposed. The highest risks were associated with working in psychiatric (OR=4.89; 95%CI 3.82-6.25) and emergency (OR=2.68; 95%CI 2.10-3.44) departments, compared with home care and day care. The excess risk was an additional 30% in geriatrics and long-stay departments. Significantly less risk was observed in pediatrics, obstetrics and gynecology departments (OR=0.70; 95%CI 0.56-0.88). Conclusion: Team building requires time, and shift change is a key period. This time is far from nonproductive. Rather, its effective use reduces treatment errors, enhances quality of care, and reduces the frequency of violent events. It is crucial in every department.

The main purpose of this study is to illustrate how, within the nursing profession, work ability can be deteriorated by a job alienation mechanism which acts differently according to age. From the total number of nurses participating in the NEXT Study, a sample of 27,146 nurses was selected. In addition to age, “Job demands”, “Job control” and “Harassment at work” were considered as determinants of job alienation. “Overcommitment”, “Uncertainty about patients' treatment” and “Work meaning” were used as symptoms of job alienation. Finally, “Work Ability Index” (WAI) was employed as the outcome variable. A structural equation model was used to test the job alienation hypothesis. The model demonstrated a good fit with the data. Overcommitment, uncertainty about patients' treatment and work meaning had a direct effect on WAI. High job demands, high harassment at work, low job control and age had both direct and indirect effects (via overcommitment, uncertainty about patients' treatment and work meaning) on WAI. Low work ability in older nurses is due to ageing and to an increase in overcommitment yielded by perceived high demands, low job control and high harassment at work. On the contrary, among the nurses under 50 years old, decrease of WAI turned out to be more associated with higher uncertainty about patients' treatment and lower work meaning, which both affect the possibility to reach more professional competence and develop occupational expertise.

To assess the relationship between workplace bullying and sickness absenteeism in a large sample of Italian workers.A cross-sectional study conducted by means of questionnaires.In all, 8,992 subjects filled in a questionnaire to detect workplace bullying, the presence of work stress factors and days of sickness absence in the last year.Workplace bullying and psychosocial stressor were measured by the means of the CDL 2.0 questionnaire.Days of sickness absence reported by the subjects.On average, days of sickness absence were 7.4, and 7.2% of the respondents were defined as bullied. Results from logistic regression analyses showed that a workplace bullying was associated with more days of sickness absence after controlling for gender, age, professional qualification, company sector and juridical nature and other psychosocial factors (men: OR =1.62; women: OR =2.15).The present study confirms that workers exposed to a workplace bullying reported higher sickness absenteeism as compared with non-exposed subjects, also when a potentially highly stressful work environment is considered. The results of the present study support that workplace bullying may be viewed as an extreme stressful condition. Interventions to avoid workplace bullying not only favoure workers' health, but also avoid the company costs associated with workers' sickness absenteeism.

To test three hypotheses in an Italian sample of call center workers: higher levels of perceived work stress are associated with more frequent common mental disorders (GHQ-12) and a lower Work Ability Index; combining the Job Strain (JS) and Effort/Reward Imbalance (ERI) models increases explained variance in health over and above either model when applied separately; compared with outbound operators, inbound call handlers are expected to report a lower health status,which is due to a more intense exposure to task-related work stress factors in the latter.A multi-center cross-sectional study, conducted by means of interviews and self-administered questionnaires.Call handlers working in the Italian branch of a telecommunication multinational company. In all, 1,106 permanent workers were examined (35.9%of the total target population, 98.9% response rate). The majority were women (76.5%);mean age was 33.3 (SD: 3.9) and company seniority 8.0 (SD: 2.1). Nearly 60% worked as inbound call handlers, about one third as outbound operators.Work stress was measured with the well-known JS and ERI models. Three exposure levels (based on tertiles) were identified for each scale.Common mental disorders were measured with the GHQ-12 questionnaire. Subjects with a GHQ-12 score 4 were classified as "cases". The Work Ability Index (WAI) was used to evaluate work ability. Being in the "poor" or "moderate" categories of the WAI indicated a low work ability status. Cronbach's alphas were 0.70 for all scales.Multivariate Poisson regressions showed that both models were linked to more frequent common mental disorders and a lower WAI. Moreover, combined models demonstrated an advantage in terms of explained variance in health. Finally, performing inbound call handling was associated with a lower WAI in comparison with engaging in outbound activities. Mediation analyses showed that such association is explained by the higher levels of psychological job demands and Job Strain experienced by inbound operators.Our results highlight the relevance of work stress as a risk factor for lower psychological health, and especially for a poorer WAI among call center workers. The combined use of the two models increases completeness of work stress assessment in this sector.The higher levels of work stress and the lower WAI observed among inbound operators are due to objectively less favourable task-related characteristics.

The Italian Advisory Committee on work-related stress has outlined a step-by-step approach which considerably limits workers' participation in the first phases of the assessment procedure. Albeit cost-effective, such approach neglects the relevance of employees' perception in correctly identifying likely risk factors for job stress. Results of the present study, considering call center workers, points to the need of adopting subjective instruments for job stress assessment that are context-specific, whereas using generic job stress models only (such as Job Demand-Control and Effort Reward/Imbalance) may not permit the identfication of risk factors that are peculiar to the work settings under investigation.

BACKGROUND: Recent research suggests that violence in health care is increasing and that it strongly influences the recruitment and retention of nurses as well as sick leave and burnout levels. AIMS: To identify the prevalence of violence in nursing and to provide a basis for appropriate interventions. METHODS: Nurses from 10 European countries answered to a questionnaire and to a follow-up assessment. Stepwise adjusted multiple logistic regression was used to assess the association between frequency of violence, factors related to teamwork and other work-related factors and outcomes, such as burnout, intention to leave nursing and intention to change institution. RESULTS: A total of 39 894 nurses responded to the baseline questionnaire (51% response rate). After adjustment for age, gender and other risk factors, quality of teamwork appeared to be a major factor with odds ratio (OR) 1.35 (1.24-1.48) for medium quality and 1.52 (1.33-1.74) for low quality. Uncertainty regarding patients' treatments was linked with violence, with a clear gradient (OR 1.59, 1.47-1.72 for medium uncertainty and 2.13, 1.88-2.41 for high uncertainty). Working only night shift was at high risk (OR 2.17, 1.76-2.67). High levels of time pressure and physical load were associated with violence OR 1.45 (1.24-1.69) and 1.84 (1.66-2.04), respectively. High and medium frequency of violence was associated with higher levels of burnout, intent to leave nursing and intent to change institution. A 1-year follow-up assessment indicated stability in the relationships between outcomes. CONCLUSION: This study supports efforts aimed at improving teamwork-related factors as they are associated with a decrease in violence against nurses. Language: en

Background: The occurrence of workplace violence is rather frequent within the nursing profession, with well-known consequences on the psychological health of victims. - Objectives: This study is aimed at assessing the relationships between relevant individual, organizational, and psychosocial factors, and the frequency of several types of workplace violence; the direct as well as the interactive impact of violence and psychosocial factors on organizational commitment and perceived health. - Design: Questionnaire-based cross-sectional and longitudinal survey designs were employed for the two study objectives, respectively. - Setting: Five hundred and sixty-five healthcare institutions from eight European countries participated in the Nurses’ Early Exit Study. - Participants: The 34,107 participants were nursing staff holding different qualifications. The response rate was 55.1% in the cross-sectional part and 40.5% in the follow-up phase. At baseline, the respondents were mostly female (89.3%), in the age group 30–44 years (52.9%), registered or specialized nurses (67.0%), working mainly in medico-surgical wards (36.3%), and employed full-time (72.8%). - Methods: In the cross-sectional analysis, the relationship between the predictor variables and frequency of violence was assessed by means of a hierarchical multiple linear regression. In the longitudinal analysis, main direct and interactive effects of violence and psychosocial factors on perceived health and organizational commitment were assessed by means of hierarchical multiple linear regression analyses with interaction terms. - Results: Higher levels of adverse work-related factors were significantly associated with higher frequency of the distinguished types of violence. Significant interactions were found between psychosocial factors and violence only in predicting organizational commitment, even if effect sizes were very low. No interactions were observed for perceived health. The prevalence of the distinguished types of violence varied across the participating countries according to the presence of adverse work- and non-work-related factors. - Conclusions: These findings suggest the necessity of interventions both over working conditions conducive to violence and violent behaviours themselves.