Increased Job Demands Research Articles

Is being a leader a mixed blessing? A dual‐pathway model linking leadership role occupancy to well‐being

SummaryRecent leadership research has drawn greater attention to how the well‐being of leaders influences leadership behaviors, follower performance and well‐being, and overall leadership effectiveness. Yet little attention has been paid to the relationship between occupying leadership positions and job incumbents' well‐being. This research addresses this question by developing and testing a dual‐pathway model. Our model proposes that incumbency in leadership positions is positively related to high levels of both job demands and job control, whereas job demands and job control have offsetting effects on well‐being. Results based on a longitudinal sample revealed that employees who transitioned from nonleadership positions to leadership roles showed trajectories of increasing job demands and job control, whereas such trends were weaker among those who remained in nonleadership positions. Findings from three additional samples generally demonstrated that leadership role occupancy was indirectly related to various indices of psychological and physiological well‐being through job demands and job control. Because the signs of the indirect effects through job demands and job control differed in expected ways, the overall relationship between leadership role occupancy and the well‐being outcomes was generally small and nonsignificant. We discuss research and practical implications of our framework and findings for organizations, employees, and leaders.

Nurse Manager Perceptions of Work Overload and Strategies to Address It

The role of the nurse in the hospital setting has evolved to meet the ever-increasing acuity and complexity of patients. Likewise, the role of the nurse manager has expanded to meet the needs of the staff and patients on the nursing units, and is considered by some to be the most demanding role in health care. 1 Johansson G Sandahl C Hasson D Role stress among first-line nurse managers and registered nurses: a comparative study. J Nurs Manag. 2011; 21: 449-458 Crossref PubMed Scopus (36) Google Scholar In addition to responsibility for the financial outcomes of the unit, nurse managers are also accountable for the experience of the patient, which includes both clinical and satisfaction outcomes, as well as for providing a safe, engaging, positive work environment for the staff in the area. Nurse managers are also expected to foster relationships with leaders of the various interdisciplinary teams throughout the hospital, as well as to promote physician engagement and partnership with nursing. Expanded role responsibilities along with broader spans of control contribute to increased job demands as well as work stress. 2 Wong CA Spence Laschinger HK The influence of frontline manager job strain on burnout, commitment and turnover intention: a cross-sectional study. Int J Nurs Stud. 2015; 52: 1824-1833 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar Additionally, nurse managers often do not have adequate authority to make decisions affecting the operations in their areas, which can undermine their authority, leading to dissatisfaction with the work. 2 Wong CA Spence Laschinger HK The influence of frontline manager job strain on burnout, commitment and turnover intention: a cross-sectional study. Int J Nurs Stud. 2015; 52: 1824-1833 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar The increased stress and workload can lead to disengagement, burnout, and ultimately, to nurse manager turnover. The role of the nurse in the hospital setting has evolved to meet the ever-increasing acuity and complexity of patients. Likewise, the role of the nurse manager has expanded to meet the needs of the staff and patients on the nursing units, and is considered by some to be the most demanding role in health care. 1 Johansson G Sandahl C Hasson D Role stress among first-line nurse managers and registered nurses: a comparative study. J Nurs Manag. 2011; 21: 449-458 Crossref PubMed Scopus (36) Google Scholar In addition to responsibility for the financial outcomes of the unit, nurse managers are also accountable for the experience of the patient, which includes both clinical and satisfaction outcomes, as well as for providing a safe, engaging, positive work environment for the staff in the area. Nurse managers are also expected to foster relationships with leaders of the various interdisciplinary teams throughout the hospital, as well as to promote physician engagement and partnership with nursing. Expanded role responsibilities along with broader spans of control contribute to increased job demands as well as work stress. 2 Wong CA Spence Laschinger HK The influence of frontline manager job strain on burnout, commitment and turnover intention: a cross-sectional study. Int J Nurs Stud. 2015; 52: 1824-1833 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar Additionally, nurse managers often do not have adequate authority to make decisions affecting the operations in their areas, which can undermine their authority, leading to dissatisfaction with the work. 2 Wong CA Spence Laschinger HK The influence of frontline manager job strain on burnout, commitment and turnover intention: a cross-sectional study. Int J Nurs Stud. 2015; 52: 1824-1833 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar The increased stress and workload can lead to disengagement, burnout, and ultimately, to nurse manager turnover.

Care living labs at work

Introduction: Flanders (Belgium) is searching for innovative solutions to tackle the challenges in elderly care. A care living labs program was launched in 2013 as a testing and experimentation space. The objective was to create new care concepts, services, processes and products together with the end users, and to test them in practice in 23 care innovation projects. These projects are very diverse, with topics including technology, housing, informal care networks, mobility, care management and care and cure integration. From a prior plan evaluation study it became apparent that direct references to the organization of care and the quality of working life of the care professionals could seldom be found in the project plans. These issues could however be crucially important for the projects to be successful. Moreover, we did not find any previous study of care living labs which specifically focused on these issues. The main research question here is: what is the impact of the 23 care innovation projects on the organization of care and the quality of working life? Theory: Drawing on Sociotechnical Systems theory, we used an organizational model (Van Hootegem, 2000) to conceptualize the possible impact on the organization of care. The impact on the quality of working life was conceptualized by using the Job Demand / Control model of Karasek (1979). Methods: A mixed method approach was applied. A document analysis was made of the initial project proposals. Subsequently, near the end of each care innovation project, an in-depth interview was conducted with the project coordinator, using a semi-structured questionnaire. Results: All 23 care innovation projects resulted in minor or major changes in the organization of care (such as changes in task division). Each project did impact the quality of working life of at least one type of care professionals (e.g. nurses), and in many cases multiple types of care professionals were affected. During the projects, many care professionals experienced an increase in job demands and steady or slightly increased job controls. According to the project coordinators the increase in job demands was expected to be temporary, with a decrease following once the innovation would be fully established. We also noticed a different impact on the quality of working life between various types of care professionals. Conclusions: Although the 23 care innovation projects in general did not explicitly aimed at changing the organization of care or affecting the quality of working life of the care professionals involved, our study shows a clear impact on both dimensions. Lessons learned: Implementing care innovations is likely to have implications for the organization of care and the quality of working of life. In order to avoid unintended implications, future care innovation projects are advised to take this explicitly into consideration. Limitations and future research directions: Further research is needed to differentiate between possible impacts, depending on the type of care innovation involved.

Changes in working conditions and major weight gain among normal- and overweight midlife employees.

Objectives We aimed to examine the association between changes in psychosocial working conditions and major weight gain among midlife women and men. Furthermore, we examined the associations separately among normal- and overweight participants. Methods We used survey data among employees of the City of Helsinki, Finland, from 2000-2002 (phase 1, N=8960), 2007 (phase 2, N=7332), and 2012 (phase 3, N=6814), with a final study sample of 4369 participants. We examined changes in job strain, job demands, and job control from phase 1 to 2. We defined major weight gain as ≥10% weight gain between phases 1 and 3 based on self-reported weight (kg). We performed logistic regression analysis adjusting for baseline age, marital status, and occupational class, stratifying by gender and by baseline body mass index. Results Job demands among both genders and job strain among women was associated with major weight gain. Furthermore, increased job demands [odds ratio (OR) 1.52, 95% CI 1.05-2.20] or increased job strain (OR 1.53, 95% CI 1.11-2.11) was associated with major weight gain among overweight women. Normal-weight men reporting decreased job demands (OR 4.11, 95% CI 1.48-11.40) and overweight men reporting increasing job demands (OR 2.93, 95% CI 1.26-6.82) exhibited higher odds of major weight gain. Conclusions Associations between working conditions and weight gain appeared primarily weak. Our study suggests that overweight individuals might be at a higher risk of weight gain when facing psychosocial strain in the workplace.

Restructuring seriously damages well-being of workers: The case of the restructuring programme in local administration in Greece

Organisational restructuring has become an important characteristic of the modern working environment, both for private and public organisations. This study examines the impact of “Kallikratis”, a major restructuring programme of local administration in Greece, on employee well-being. Using an adapted version of the “PSYRES” questionnaire in a representative sample of 1600 employees in 13 municipalities, the study investigated the effect of restructuring, job insecurity and psychosocial factors on wellbeing. The main issues identified were the “rushed” and “abrupt” implementation of the restructuring process, as well as lack of sufficient information and training.Moreover restructuring resulted in higher levels of (reported) work intensification and stress. Increased work-related stress was found to be related to increased emotional and quantitative job demands, as well as to job insecurity. Moreover, higher levels of emotional exhaustion were found to be related to increased job demands, job insecurity and unfair treatment during change.Employees in certain departments and under permanent contract were found to be more negatively affected by restructuring. Permanent employees reported higher levels of work-related stress and emotional exhaustion. Employees working in urban planning services and waste collection services reported increased workload and significantly higher levels of stress.Restructuring has been expanding both in the private and public sector in Greece and further studies should be carried out to investigate its effects on the well-being of workers.

Working overtime in community mental health: Associations with clinician burnout and perceived quality of care.

Funding cuts have increased job demands and threatened clinicians' ability to provide high-quality, person-centered care. One response to increased job demands is for clinicians to work more than their official scheduled work hours (i.e., overtime). We sought to examine the frequency of working overtime and its relationships with job characteristics, work-related outcomes, and quality of care in community health clinicians. One hundred eighty-two clinicians completed demographic and job characteristics questions and measures of burnout, job satisfaction, turnover intention, work-life conflict, and perceived quality of care. Clinicians also reported the importance of reducing stress and their confidence in reducing their stress. Clinicians who reported working overtime were compared to clinicians that did not on demographic and job characteristics and work-related outcomes. Ninety-four clinicians (52%) reported working overtime in a typical week. Controlling for exempt status and group differences in time spent supervising others, those working overtime reported significantly increased burnout and work-life conflict and significantly lower job satisfaction and quality of care than those not working overtime. Clinicians working overtime also reported significantly greater importance in reducing stress but less confidence in their ability to reduce stress than those not working overtime. There were no significant group differences for turnover intention. Working overtime is associated with negative consequences for clinician-related work outcomes and perceived quality of care. Policies and interventions aimed at reducing overtime and work-related stress and burnout may be warranted in order to improve quality of care. (PsycINFO Database Record

Portuguese Mothers and Fathers Share Similar Levels of Work-Family Guilt According to a Newly Validated Measure

Transformations in family and work life have led to profound changes in the articulation of both spheres. The massive entry of women into the labor market, the decline of a family model based on the male provider, increasing job demands, and persistent gender inequality are factors that can generate work-family conflict and lead to feelings of guilt. Work-family guilt is a topic still rarely studied, particularly in Portugal. Given the importance of understanding the complexity of the relationships underlying the work-family interface and the lack of instruments in Portuguese to assess the feeling of guilt as it pertains to the work-family interface, our goal was to adapt the Work-Family Guilt Scale (WFGS) to the Portuguese population. Our results confirmed the two-dimensional structure of the scale with good reliability and validity. The WFGS was invariant between genders, with no significant mean differences between men and women. Convergent validity with the variables of work-to-family and family-to-work conflict and discriminant validity between the two dimensions of the WFGS was demonstrated. Use of this scale will allow the identification of feelings of guilt, which pose risks to the physical, emotional and psychological well-being of workers. Guilt feelings should, like conflict, be considered as a psychosocial risk that must be mitigated through policies and practices aimed at promoting a balance between family and working life.

Associations between job demands, work-related strain and perceived quality of care: a longitudinal study among hospital physicians.

Drawing on a sample of hospital physicians, we attempted to determine prospective associations between three job demands, work-related strain and perceived quality of care. Longitudinal follow-up study with with a 1-year time lag. Physicians of two acute-care hospitals in Germany (one general urban and one children's hospital). Ninety-five physicians filled out a standardized questionnaire. Physicians' evaluations of quality of care at both waves. Our results support the hypothesis that job demands directly influence quality of care irrespective of strain. Specifically, high social stressors (β=-0.15, P=0.036) and time pressure (β=-0.19, P=0.031) were associated with decreased quality of care over time. We additionally observed reversed effects from quality of care at baseline to time pressure at follow-up (β=-0.35, P=0.006). Contrary to expectations, physicians' work-related strain did not mediate the job demands-quality of care-relationship, nor were strain-to-stressor effects observed. Our results corroborate that hospital work environments with high demands have a direct impact on physician-perceived quality of care. In turn, poor care practices contribute to increased job demands. Our findings also emphasize that further understanding is required of how physicians' workplace conditions affect job demands, well-being, and quality of care, respectively.

The effects of temporary agency work contract transitions on well-being.

Theoretical and empirical research has provided mixed arguments and evidence for the effects of temporary agency work on workers' well-being. This study aims to go one critical step further by comparing the workplace and general well-being of workers who continue to have this employment status with others who obtain a direct contract and others who remain unemployed. Temporary agency workers longitudinal data (n=289) was used, and three groups were compared: (1) maintaining a temporary agency contract (n=187), (2) obtaining a direct contract (n=57), and (3) remaining unemployed (n=45). Covariance analyses adjusted for background variables showed that those who obtained a direct contract experienced a decrease in job insecurity but experienced an increase in job demands, while those who continued to have a temporary agency contract maintained these job conditions. However, in terms of workplace well-being, the temporary agency contract was not found to be more detrimental than a direct contract, but in terms of life satisfaction, unemployment was found to be more detrimental than other transitions. A temporary agency contract does not have an inevitable negative effect on workers' well-being.

Twenty-four-hour work shifts, increased job demands, and elevated blood pressure in professional firefighters.

To investigate whether working conditions (number of 24-h shifts, number of calls, sedentary work, job strain, effort-reward imbalance, and physical demands) are associated with elevated blood pressure and hypertension among professional firefighters. A total of 330 (321 males and 9 females) firefighters were chosen for this study among the Southern California firefighters who participated in a work and obesity project. Working conditions were measured with a firefighter-specific occupational health questionnaire. Blood pressure was clinically assessed, and hypertension was defined according to the contemporary standard classification. About 11% of the firefighters had hypertension. Fifty percent of the hypertensive firefighters (mostly mild hypertensive) had uncontrolled high blood pressure. Hypertension was more prevalent in male, older, and high-rank firefighters and firefighter who reported low numbers of daily calls. In male firefighters who were normotensive or hypertensive without taking anti-hypertensive medication, additional 24-h shifts in the past month increased the risk of elevated diastolic blood pressure (DBP) than those who reported a standard work schedule (eight to eleven 24-h shifts). Particularly, firefighters who reported sixteen 24-h shifts had 5.0mmHg higher DBP (p<0.01). Body mass index attenuated the association between number of shifts and blood pressure to some extent. Firefighters who reported "increased job demands over the past years" had 3.0mmHg (p=0.06) higher systolic blood pressure. Other working conditions were not associated with elevated blood pressure and hypertension. Many additional 24-h shifts and increased job demands were risk factors for elevated blood pressure in male firefighters. Optimal collective and individual workload and improved hypertension management are warranted for enhancing the cardiovascular health of firefighters.

Workers' intrinsic work motivation when job demands are high: The role of need for autonomy and perceived opportunity for blended working

Work overload or work pressure may undermine workers' intrinsic motivation. In the present research, we tested the conditions under which this may (not) occur, including the perceived opportunity to blend on-site and off-site working through the effective use of computers and modern information and communication technology. Our sample consisted of 657 workers (51% female) representing a variety of industries. As hypothesized, it is not high job demands per se, but high demands in combination with a high need for autonomy and a lack of perceived opportunities for blended working that undermines intrinsic work motivation. When workers high in need for autonomy perceived opportunities for blended working, their intrinsic work motivation was not negatively affected by increasing job demands. This main finding suggests that, particularly for workers high in need for autonomy, the perceived opportunity for blended working is an effective, contemporary resource to cope with the increasing job demands typically observed in today's workplace. Theoretically, these findings contribute to the refinement and extension of influential demands-resource models and Person-Job Fit theory. Practically, our findings may show managers how to effectively keep workers intrinsically motivated and productive in their jobs when job demands are high.

Modification Effects of Changes in Job Demands on Associations Between Changes in Testosterone Levels and Andropause Symptoms: 2-Year Follow-up Study in Male Middle-Aged Japanese Workers.

The purpose of this longitudinal study was to ascertain if changes in job demands modify associations between changes in testosterone levels and andropause symptoms in male Japanese workers. A baseline survey including job demands and the Aging Males' Symptoms scale, lifestyle factors, and blood levels of testosterone was conducted in 2007. Among 192 men (mean age ± SD 52.2 ± 7.6years) who completed all relevant questionnaires and provided blood at baseline, 104 men (50.9 ± 7.2years) were followed up in 2009. Changes of variables in 2years were calculated (data of follow-up minus those of baseline). Testosterone levels were increased significantly, whereas job demands and somatic symptoms were reduced significantly, at follow-up. Changes in testosterone levels were negatively associated with changes in total andropause symptoms, psychological symptoms, and sexual symptoms (standardized β = -0.27, -0.24, and, -0.29, p < 0.05, respectively), after adjustment for confounders. Changes in job demands were positively associated with changes in somatic symptoms (standardized β = 0.21, p < 0.05). Significant interactions of changes in testosterone levels and job demands were noted for changes in psychological symptoms (standardized β = 0.26, p < 0.05). For men with a 1-SD reduction in job demands, negative associations between changes in testosterone levels and psychological symptoms were intensified, but not for men with a 1-SD increase in job demands. Andropause symptoms may be affected by changes in testosterone levels and job demands. Change in job demands may modify associations between changes in testosterone levels and andropause symptoms.

Work-nonwork interference: Can ministers currently cope with increasing job demands against limited resources within South Africa?

Ministers of religion have a unique occupation with designated job demands and incongruous resources at their disposal. Literature indicates that stressors within the work environment are significant predictors of work-nonwork interference. Ministers play a key role within society and provide support for individuals on multiple levels. However, limited studies are found in South Africa focussing on ministers’ job characteristics related to work-nonwork interference, and how ministers cope. The main objective of this study was to investigate job demands and job resources as significant predictors of work-nonwork interference amongst ministers of religion, and to identify which coping strategies are most significant for ministers in dealing with work-nonwork interference. A cross-sectional survey design was used amongst ministers working in the three sister churches (N = 199). Various instruments were administered to measure job characteristics, work-nonwork interference and coping strategies empirically. Statistical analyses included descriptive statistics, product-moment correlations and multiple regression analyses. Results indicated that for ministers different job demands (i.e. cognitive demands and pace and amount of work) and job resources (i.e. financial support and job significance) significantly predicted work-parent, work-home and work-religion/spirituality interference. Results indicated turning to religion as the only significant coping strategy used by ministers to deal with work-parent interference and work-religion interference. Ministers of religion are continually exposed to increasing job demands and a lack of job resources, and therefore experience work-nonwork interference. Nevertheless, the ministers apparently cope by using the strategy best related to their profession, turning to religion/spirituality. Turning to religion/spirituality seems to be the most effective in dealing with work-nonwork interference.

Understanding the Impact of School Factors on School Counselor Burnout: A Mixed-Methods Study

This mixed-methods study investigated the relationship between burnout and performing noncounseling duties among a national sample of professional school counselors, while identifying school factors that could attenuate this relationship. Results of regression analyses indicate that performing noncounseling duties significantly predicted burnout (e.g., exhaustion, negative work environment and deterioration in personal life), and that school factors such as caseload, Adequate Yearly Progress status and level of principal support significantly added to the prediction of burnout over and above noncounseling duties. Moderation tests revealed that Adequate Yearly Progress and caseload moderated the effect of noncounseling duties as related to several burnout dimensions. Participants related their burnout experience to emotional exhaustion, reduced effectiveness, performing noncounseling duties, job dissatisfaction and other school factors. Participants conceptualized noncounseling duties in terms of adverse effects and as a reality of the job, while also reframing them within the context of being a school counselor.Keywords: burnout, noncounseling duties, professional school counselors, mixed methods, job dissatisfactionAlthough the term burnout was first coined by Freudenberger (1974) to describe a clinical syndrome encompassing symptoms of job-related stress, it is generally accepted that the work of Maslach and colleagues has served as the foundation of the empirical study of burnout as a psychological phenomenon. Maslach, Schaufeli, and Leiter (2001) defined burnout as a prolonged exposure to chronic emotional and interpersonal stressors on the job. The primary focus of burnout studies remains within the occupational sector of human services and education, where empathy demands are high and the emotional challenges of working intensively with other people in either a caregiving or teaching role are considerable (Maslach et al., 2001). Burnout is defined by three core dimensions: emotional exhaustion, depersonalization and reduced personal accomplishment (Maslach & Jackson, 1981).Emotional exhaustion is a key aspect of the burnout syndrome. It is the most obvious manifestation of the syndrome (Maslach et al., 2001) and a reaction to increasing job demands that produce a sense of overload and exhaust one's capacity to maintain involvement with clients (Lee & Ashforth, 1996). Feeling unable to respond to the needs of the client, one experiences purposeful emotional and cognitive distancing from one's work. This effort to establish distance between oneself and the client is defined as depersonalization. Reduced personal accomplishment describes the eroded sense of effectiveness that burned-out individuals experience (Maslach et al., 2001).According to the job demands-resources model, one of the most cited models in burnout literature, burnout occurs in two phases: first, extreme job demands lead to sustained effort and eventually exhaustion; second, a lack of resources to deal with those demands further leads to withdrawal and eventual disengagement from work (Demerouti, Nachreiner, Bakker, & Schaufeli, 2001). Professional school counseling is a profession in which emotional empathy is a requirement, and the qualitative and quantitative job demands are high. Stressors linked to burnout (e.g., high workload, negative work environment) have effects that may persist even after exposure to the stressor has ended, leading to negative impact on daily well-being (Repetti, 1993). In those jobs in which high demands exist simultaneously with limited job resources, both exhaustion and disengagement are evident (Bakker, Demerouti, & Euwema, 2005; Demerouti et al., 2001). With organizational factors accounting for the greatest degree of variance in burnout studies (Lee & Ashforth, 1996), robustly exploring factors unique to the profession of school counseling is a key to understanding the phenomenon of burnout in school counselors. …

Coming to grips with challenging behaviour: A cluster randomised controlled trial on the effects of a new care programme for challenging behaviour on burnout, job satisfaction and job demands of care staff on dementia special care units

BackgroundCaring for people with dementia in dementia special care units is a demanding job. Challenging behaviour is one of the factors influencing the job satisfaction and burnout of care staff. A care programme for the challenging behaviour of nursing home residents with dementia might, next to diminishing the challenging behaviour of residents, improve job satisfaction and reduce the care staff's feelings of burnout. ObjectivesTo determine the effects of a care programme for the challenging behaviour of nursing home residents with dementia on the burnout, job satisfaction and job demands of care staff. DesignThe care programme was implemented according to a stepped wedge design in which care units were randomly divided over five groups with different time points of starting with implementation. Setting17 Dutch dementia special care units. ParticipantsCare staff members of the 17 units. InterventionThe care programme consists of an education package and of various structured assessment tools that guide professionals through the multidisciplinary detection, analysis, treatment and evaluation of treatment of challenging behaviour. MethodsBurnout, job satisfaction and job demands were measured before implementation, halfway through the implementation process and after all the care units had implemented the care programme. Burnout was measured with the Dutch version of the Maslach burnout inventory (UBOS-C, three subscales); job satisfaction and job demands were measured with subscales of the Leiden Quality of Work Questionnaire. Mixed model analyses were used to determine effects. Care staff could not be blinded for the intervention. ResultsOf the 1441 questionnaires, 645 were returned (response 45%, 318 control measurements, 327 intervention measurements) by 380 unique care staff members. Significant effects were found on job satisfaction (0.93, 95% CI 0.48–1.38). On the other outcomes, no significant changes in the scores were found. ConclusionPositive effects of using the Grip on Challenging behaviour care programme were found on job satisfaction, without an increase in job demands.

HIM and Employee Psychological Strain

Both positive and negative employee consequences have been found to result from high performance work system (HPWS) use, and we expect that these differing employee-level effects depend on which practices are included in the HPWS bundled. The current study explores increased job demands and subsequent psychological strain as potential outcomes of high involvement practices. The relationship was supported in a sample of 21,312 employees across 1,913 workplaces, and the use of additional practices (personality-based selection, competency-based selection, and communication practices) were shown to moderate the effect. Limitations, implications, and directions for future research are discussed.

Is UK general practice education and training now fit for purpose?

Recent major structural and policy developments in the UK health services have significantly impacted on the primary role of the GP as a generalist clinician; there is increasing emphasis on their capabilities as team leaders, care coordinators, educators, and commissioners.1 Sir Bruce Keogh, the NHS Medical Director in England, is exploring issues of demand for services and the need to ensure people with long-term conditions are better looked after outside the hospital system, thus reducing their need for emergency care services. The Health Secretary for England, Jeremy Hunt, is calling for better integration between the health and social care systems, which implies a significantly revised model for the delivery of primary care. NHS England launched ‘Call to Action’2 to stimulate debate in communities and enable GPs to play a stronger role in delivery of out-of-hospital integrated services for an improved patient experience, personalised care, with more effective and efficient use of the resources. In the devolved administrations there are similar policy directives reflecting the wish to increase care in the community in the future.3–5 Consequently, there are significantly increasing job demands, not least from patients, for GPs to be better prepared to manage increasingly complex long-term conditions. To what extent do the current curriculum, the training provision, and the licensure assessments accommodate these changes? New evidence from a multi-source, multi-method job analysis study6 (involving interviews, focus groups, observations of GPs at work, a …

Interpersonelle Psychotherapie bei arbeitsstressbedingten depressiven Erkrankungen

In general work involves health promoting functions but can also have hazardous impacts on well-being. Due to a massive change in working conditions it has become increasingly more recognized that depressive disorders are highly prevalent at the workplace and that work stress belongs to the most common triggers of depressive disorders, particularly in men. It is relevant to differentiate between subjectively experienced burnout and clinical depression. The best investigated psychosocial work stressors include increased job demands in connection with low control possibilities and lack of gratification, interpersonal conflicts, role stress and social isolation. For the treatment of work-related clinical depression, an additional focus of interpersonal psychotherapy (IPT) of depression, namely "work-related stress and burnout experience" was conceptualized based on a vulnerability-stress model and the fact that work usually takes place in an interpersonal context. This new problem area focuses on role stress and conflicts at work and the reduction of stressful working conditions. Interpersonal psychotherapy has so far been useful for the treatment of depression due to problems at work; however, further studies are needed to evaluate the efficacy of this newly designed problem area.

Psychosocial factors and well-being among Finnish GPs and specialists: a 10-year follow-up

BackgroundIdentifying factors that determine well-being among physicians may help to improve the functioning of hospitals and healthcare centres. We examined associations of psychosocial factors with psychological distress and sleep problems...

Psychosocial working conditions, occupational groups, and risk of disability pension due to mental diagnoses: a cohort study of 43 000 Swedish twins

The aim of this study was to investigate associations between psychosocial working conditions, occupational groups defined by sector, and disability pension (DP) with mental diagnoses while accounting for familial confounding. A prospective population-based cohort study was conducted, including all Swedish twins who, in January 1993, were living and working in Sweden and not on old-age pension or DP (N=42 715). The twins were followed from 1993-2008 regarding DP. Data on DP, exposures, and covariates were obtained from national registries. Cox proportional hazards regression models with hazard ratios (HR) and 95% confidence intervals (95% CI) were constructed for the whole cohort, and for discordant twin pairs. The associations for the whole cohort between DP with mental diagnoses and (i) job demands (HR 1.23, 95% CI 1.06-1.43), (ii) job control (HR 0.91, 95% CI 0.83-0.99), (iii) healthcare and social work (HR 1.41, 95% CI 1.04-1.92), and (iv) service and military work (HR 2.07, 95% CI 1.37-3.14) remained after accounting for possible confounders, including familial factors, while the associations between DP and (i) social support, (ii) type of jobs, and (iii) some of the occupational groups were attenuated, becoming non-significant. In the discordant twin pair analyses, commercial work was significantly associated with lower risk of DP (HR 0.55, 95% CI 0.32-0.95). One unit increase in job demands and working in the occupational groups healthcare and social work or service and military work seem to be risk factors of DP with mental diagnoses, independent from various background factors including familial ones. However, one unit increase in job control or working in commercial work seem to be protective factors of such DP, accounting for confounding factors of this study.