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Objective The aim of this review was to determine whether employees exposed to effort-reward imbalance (ERI) at work have a higher risk of depressive disorders than non-exposed employees. Methods We conducted a systematic review and meta-analysis of published prospective cohort studies examining the association of ERI at baseline with onset of depressive disorders at follow-up. The work was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and a detailed study protocol was registered before literature search commenced (Registration number: CRD42016047581). We obtained a summary estimate for the association of ERI with risk of depressive disorders by pooling the study-specific estimates in a meta-analysis. We further conducted pre-defined sensitivity analyses. Results We identified eight eligible cohort studies, encompassing 84 963 employees and 2897 (3.4%) new cases of depressive disorders. Seven of the eight studies suggested an increased risk of depressive disorders among employees exposed to ERI. The pooled random-effects estimate was 1.49 [95% confidence interval (95% CI) 1.23-1.80, P＜0.001], indicating that ERI predicts risk of depressive disorders. The estimate was robust in sensitivity analyses stratified by study quality, type of ERI ascertainment and type depressive disorder ascertainment, respectively. Conclusions Employees exposed to ERI were at increased risk of depressive disorder. Future studies on ERI and depressive disorders should examine if this association is stronger or weaker when ERI is measured repeatedly during follow-up and with other methods than self-report or when depressive disorders are ascertained with clinical diagnostic interviews.

Objectives The aim of this study was to describe the development and the content of the Danish Psychosocial Work Environment Questionnaire (DPQ) and to test its reliability and validity. Methods We describe the identification of dimensions, the development of items, and the qualitative and quantitative tests of the reliability and validity of the DPQ. Reliability and validity of a 150 item version of the DPQ was evaluated in a stratified sample of 8958 employees in 14 job groups of which 4340 responded. Reliability was investigated using internal consistency and test-retest reliability. The factorial validity was investigated using confirmatory factor analysis (CFA). For each multi-item scale, we undertook CFA within each job group and multi-group CFA to investigate factorial invariance across job groups. Finally, using multi-group multi-factor CFA, we investigated whether scales were empirically distinct. Results Internal consistency reliabilities and test-retest reliabilities were satisfactory. Factorial validity of the multi-item scales was satisfactory within each of the 14 job groups. Factorial invariance was demonstrated for 10 of the 28 multi-item scales. The hypothesis that the scales of the DPQ were empirically distinct was supported. The final DPQ version consisted of 119 items covering 38 different psychosocial work environment dimensions. Conclusions Overall, the DPQ is a reliable and valid instrument for assessing psychosocial working conditions in a variety of job groups. The results indicate, however, that questions about psychosocial working conditions may be understood differently across job groups, which may have implications for the comparability of questionnaire-based measures of psychosocial working conditions across job groups.

OBJECTIVE: This paper presents an overview of 50 years of research on psychosocial working conditions and health with regards to conceptualization, interventions and policy. We reflect on the promise of past and current research on psychosocial working conditions and, in addition, discuss current progress in translating this research into workplace practice and improvements in people’s working lives. METHODS: We conducted a narrative review of meta-reviews and key publications on psychosocial working conditions and health. The review covers a historical overview of theories of the past 50 years, measurement of psychosocial working conditions, health effects, intervention research, and policy development on psychosocial working conditions. RESULTS: Psychosocial working conditions are conceptualized in different ways, with increasing complexity in the understanding developing over time. Exposures related to psychosocial working conditions are associated with a wide range of health outcomes, in particular cardiovascular disease and mental health conditions. In response to growing evidence on associations between psychosocial working conditions and health outcomes, intervention research has expanded rapidly, but for various reasons the evidence base is stronger and more extensive for individual- than organizational-level interventions. This individual/organizational imbalance is reflected in practice, and may partly explain why policy interventions have yet to show reductions in exposures to psychosocial work factors and associated adverse outcomes. CONCLUSIONS: Pressing needs for advancing the field include improvements in capturing exposure dynamics, developing objective measures of exposure, methodologic advancements to optimize causal inference in etiologic studies, and alternatives to randomized controlled trials for intervention evaluation.

The topic of work-related sexual harassment has gained renewed attention in recent years following the public accounts of sexually harassing experiences – many of which were work-related – that emerged during the #MeToo movement beginning in October 2017 (1). The many testimonials from the movement illustrated the magnitude of the problem and put faces to the numbers of statistics on the topic. However, work-related sexual harassment is not a new phenomenon. In fact there are accounts of experiences that could be classified as sexual harassment in legal procedures dating back to at least the early 1900s (2). In labelling these experiences, feminist legal scholars MacKinnon (3) and Farley (4) introduced the term `sexual harassment` in the late 1970s in the United States. The behaviors were considered unlawful when occurring in a work-setting and conducted or condoned by the employer. Since they negatively affected employment conditions of women, they were considered a violation of laws regarding equal rights between women and men (5). From the outset, sexual harassment was considered a legal rather than a working-conditions problem. Over time, it has become acknowledged also in the literature on working conditions, and recent studies have illustrated the salience of this exposure, showing increased risk of severe outcomes such as long-term sickness absence (6), depression (7), psychotropic treatment (8), alcohol-related morbidity and mortality (9), suicide and suicide attempt (10). Definitions and concepts But how should we define this exposure, which appears to be associated with such severe negative consequences? This question has been a topic of long-standing academic debate (11, 12). Legally, sexual harassment definitions differ between countries. In the European Union legal framework, sexual harassment is when “Any form of unwanted verbal, non-verbal or physical conduct of a sexual nature occurs, with the purpose or effect of violating the dignity of a person, in particular when creating an intimidating, hostile, degrading, humiliating or offensive environment.” (13) . From an academic perspective, leading scholars have argued that research should not be confined to those behaviors that are illegal but should have a broader focus and definition of the concept (14). An early definition from pioneering researcher Fitzgerald and colleagues (15) was that sexual harassment is “Unwanted sex-related behavior at work that is appraised by the recipient as offensive, exceeding her resources, or threatening her wellbeing”. Another more recent perspective focuses on sex-based rather than sexual harassment, suggesting that “sexual harassment should be viewed as harassment that is based on sex – as behavior that derogates, demeans, or humiliates an individual based on that individual’s sex” (16, p644). A key notion to this research is that sexual harassment is rooted in power and gender dynamics rather than sexual attraction. A leading conceptual framework has been the tripartite model, introduced in the mid 1990s (17), stating that sexual harassment consists of three interrelated but distinct phenomena: gender harassment, unwanted sexual attention, and sexual coercion (5, 15). Gender harassment denotes behaviors that convey insulting, hostile or degrading attitudes about another person’s gender (often, but not always, towards women). The behaviors do not necessarily involve any explicit sexual content, and they are not aimed at sexual encounters. Unwanted sexual attention comprises sexual behaviors and advances – verbal or nonverbal – that are unwelcome, offensive, and unreciprocated. According to the tripartite model, this category also encompasses sexual assault, such as rape. Sexual coercion relates to quid pro quo scenarios, such as being promised a reward in exchange for sex or threatened with sanctions if one does not comply. The tripartite model has been foundational to much research in the area, and proponents of the model argue that gender harassment is the most common but often overlooked form of sexual harassment (5). As an illustration, an iceberg model has been developed, proposing that the behaviors most commonly associated with sexual harassment – unwanted sexual advances – are merely the visible tip of a much larger structure, with the hidden base of the iceberg consisting of a wide array of derogatory treatment of women (5). Most of the empirical work supporting the model, however, has been conducted in the US, and often analyzes data collected a couple of decades ago. Consequently, it is unclear how accurately the model describes the phenomenon of sexual harassment in a contemporary context outside of the US. More recently, a number of studies concerning the potential serious consequences of sexual harassment have emerged, mainly from a Scandinavian context (6–10). Notably, most of these studies are based on questionnaires measuring sexual harassment using a single item – a method referred to as the self-labelling approach (18). This measurement identifies only those cases of sexual harassment that are defined by the respondent as such. Research suggests that the estimates for prevalence are much higher when measuring situations that could be classified as sexual harassment – but may not be labelled as such by the respondent – using specific questions concerning experiences related to unwanted sexual attention, gender harassment, or sexual coercion (19). Theoretical perspectives on the causes of sexual harassment Similar to debates concerning the definition and measurement of sexual harassment, there is no single unifying theory to explain why sexual harassment occurs. According to Pina et al (11), the most widely recognized theories include: (i) sociocultural theories; (ii) organizational theories; and (iii) natural-biological theories. In brief, the sociocultural theories, largely feminist [eg, (20)], view gender inequality and sexism as the root of sexual harassment. Similarly, organizational theories [eg, (21)] acknowledge that power differentials play a central role in sexual harassment. However, organizational theories do not focus on gender-specific differentials, but on status inequalities within the organization. These theories also consider other organizational factors, such as tolerance of sexual harassment, gender norms, and organizational policies. These theories are often supported by empirical studies showing that especially women, young individuals, and individuals in precarious work arrangement are more often exposed to sexual harassment (22). In contrast, the natural-biological theories [eg, (23)] view sexual harassment as an expression of a natural sexual attraction between people. According to this understanding, the reason that men are more inclined to sexually harass than women is because they have a higher sex drive than women. Considering that each of these perspectives may be too simplistic to understand the phenomenon of sexual harassment, the four-factor model (24) has been developed. This model can be characterized as multifactorial, seeking to incorporate many of the elements from the preceding theories. According to this model, sexual harassment depends on (i) a motivation to harass (eg, any combination of power, control, or sexual attraction), (ii) overcoming internal inhibitions (eg, moral restraints), (iii) overcoming external inhibitions (eg, specific organizational workplace barriers), and (iv) target resistance (eg, assertiveness or the targets’ relative status within the workplace). Workplace prevention The prevention of work-related sexual harassment is a topic of high importance and – perhaps unsurprisingly – high complexity. To our knowledge, no interventions exist that have strongly documented effects on reducing the risk of sexually harassing behaviors at work. Researchers often highlight sexual harassment policies and training as essential prevention efforts, but the evidence of their effect remains limited (25–28). The aim of preventive workplace efforts is typically to change employee’s knowledge, skills, and attitudes, for instance to increase self-protection skills, alter gender beliefs and reduce tolerance of sexual harassment in order to change the organizational culture. However, despite more than a decade of research, rigorous evaluations remain scarce and most existing studies are from the US, possibly with limited generalizability (22, 25, 27, 28). Training interventions are diverse, ranging from brief online programs to intensive face-to-face programs that include group discussions and roleplay (27, 28). Training may include all employees or target specific groups with a special responsibility to manage sexual harassment, eg, managers and human resource personnel. Given the diversity of the interventions, it is difficult to assess how the duration, content, and mode of delivery affects the intervention`s effectiveness. Similarly, considerable controversy exists regarding zero-tolerance policies – a widely applied instrument (25, 29). Proponents argue that zero-tolerance policies send a strong signal that reduces employee’s proclivity to sexually harass others and encourages targets and witnesses to come forward. However, critics argue that strict zero-tolerance policies that are followed by severe punishment may make targets and witnesses more hesitant to come forward and result in pushback from employees if sanctions and procedures are deemed unfair (29). Future directions in research and practice To advance our state of knowledge in this complex area of sexual harassment, we suggest two important tasks. First, there is a need for conceptual clarity. Given that even the definition of the concept of sexual harassment has been a topic of debate for decades (11, 12), this is no small task. Nonetheless, it is pivotal to advancing the state of knowledge that we strive towards conceptual clarity so that it is clear what phenomenon we are actually resea

Objectives This systematic review and meta-analysis combined published study-level data and unpublished individual-participant data with the aim of quantifying the relation between long working hours and the onset of depressive symptoms. Methods We searched PubMed and Embase for published prospective cohort studies and included available cohorts with unpublished individual-participant data. We used a random-effects meta-analysis to calculate summary estimates across studies. Results We identified ten published cohort studies and included unpublished individual-participant data from 18 studies. In the majority of cohorts, long working hours was defined as working ≥55 hours per week. In multivariable-adjusted meta-analyses of 189 729 participants from 35 countries [96 275 men, 93 454 women, follow-up ranging from 1-5 years, 21 747 new-onset cases), there was an overall association of 1.14 (95% confidence interval (CI) 1.03-1.25] between long working hours and the onset of depressive symptoms, with significant evidence of heterogeneity (I^2=45.1%, P=0.004). A strong association between working hours and depressive symptoms was found in Asian countries (1.50, 95% CI 1.13-2.01), a weaker association in Europe (1.11, 95% CI 1.00-1.22), and no association in North America (0.97, 95% CI 0.70-1.34) or Australia (0.95, 95% CI 0.70-1.29). Differences by other characteristics were small. Conclusions This observational evidence suggests a moderate association between long working hours and onset of depressive symptoms in Asia and a small association in Europe.

OBJECTIVES: This population-based cohort study examined the association between psychosocial work environment exposures and autoimmune rheumatic diseases, including rheumatoid arthritis (RA), systemic sclerosis (SS), and systemic lupus erythematosus (SLE). METHODS: The total Danish working population, 19–58 years of age (N=2 319 337) was followed from 1997–2018 (37 529 977 person years). Quantitative demands, decision authority, emotional demands, job insecurity, physical violence, role conflicts and possibilities for development at work, as well as a combined psychosocial index were assessed by job-exposure matrices (JEM) and linked with diagnoses of autoimmune rheumatic diseases, ie, RA, SS, and SLE identified in The Danish National Patient Registry. For each psychosocial work environment exposure, recent exposure, accumulated exposure, and number of years with high exposure level were calculated for every employee. Associations with autoimmune rheumatic diseases were assessed by Poisson regression analyses. RESULTS: The results show that employees in occupations with higher decision authority and, to some degree, possibilities for development at work, have lower risks of autoimmune rheumatic diseases, while employment in occupations with high risk of physical violence involves a higher risk of rheumatoid arthritis. No association was observed for job insecurity or role conflicts at work. The results on quantitative demands, emotional demands and the psychosocial index were less conclusive. CONCLUSION: These findings generally do not support that psychosocial work environment exposures are major risk factors for autoimmune rheumatic diseases, but low decision authority, possibilities for development at work, physical violence and possibly the sum of recent adverse psychosocial exposure may be of importance.

Curiously, though, this observation did not inspire research on occupational stressors but rather led to the development of the concept of \"type A behavior\", a behavioral pattern characterized by feelings of time urgency, competitiveness and hostility that became the dominant psychosocial explanation for risk of coronary heart disease in the late 1970s and early 1980s (4). In Belgium, Kornitzer and colleagues published a paper in 1975 on the risk of coronary heart disease in employees at two banks, and discussed whether the higher occurrence in one of the banks could be related to work organization (6), a hypothesis which they later examined and corroborated (7). A major advance was made in 2012, when the \"Individual-Participant Data Meta-Analysis in Working Populations (IPD-Work) Consortium published pooled estimates from 13 European cohort studies with almost 200 000 participants, showing a prospective association between exposure to job strain and risk of coronary heart disease (16). [...]these studies should also be seen as only small pieces of the bigger puzzle.

Objectives The aim of this study was to investigate the individual, joint and interactive effects of job strain and informal caregiving on long-term sickness absence with special attention to gender differences. Methods The study comprised a prospective cohort study of 6798 working adults from France, 14 727 from Finland, and 5275 from the UK. A total of 26 800 participants, age 52 (interquartile range 47-56) years participated in the study. Job strain was assessed using the demand-control model. Informal caregiving was defined as care for a sick, disabled, or elderly person. Long-term sickness absence spells defined as absence ＞14 consecutive days were registered during two years follow-up. We used recurrent-events Cox regression in random-effects meta-analyses. Results A total of 12% men and 21% women had ≥1 long-term sickness absence spell. Among women, both high job strain [hazard ratio (HR) 1.08, 95% confidence interval (95% CI) 1.00-1.17] and informal caregiving (HR 1.13, 95% CI 1.04-1.23) were associated with a modestly higher risk of sickness absence. Women doubly exposed to high job strain and informal caregiving also showed a moderately higher risk of sickness absence (HR 1.20, 95% CI 1.03-1.41), but the excess risk was not more than expected from joint exposure to caregiving and job strain. Neither job strain nor informal caregiving predicted sickness absence for men. Conclusions High job strain and informal caregiving predicted long-term sickness absence among women. However there was no noticeable interaction in the presence of both exposures.

Objectives This study aimed to examine the association between job strain and incident coronary heart disease (CHD) in Denmark, while accounting for changes of job strain. Methods We included all employees residing in Denmark in 2000, aged 30-59 years with no prevalent CHD (N=1 660 150). We determined exposure to job strain from 1996-2009 using a job exposure matrix (JEM) with annual updates. Follow-up for incident CHD was from 2001-2010 via linkage to health records. We used Cox regression to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and incident CHD. Results During 16.1 million person-years, we identified 24 159 incident CHD cases (15.0 per 10 000 person-years). After adjustment for covariates, job strain in 2000 predicted onset of CHD during a mean follow-up of 9.71 years (HR 1.10, 95% CI 1.07-1.13). When analyzing changes in job strain from one year to the next and CHD in the subsequent year, persistent job strain (HR 1.07, 95% CI 1.03-1.10), onset of job strain (HR 1.20, 95% CI 1.12-1.29) and removal of strain (HR 1.20, 95% CI 1.12-1.28) were associated with higher CHD incidence compared to persistent no job strain. Associations were similar among men and women. Conclusions Job strain is associated with a higher risk of incident CHD in Denmark. As we used a JEM, we can rule out reporting bias. However, under- or overestimation of associations is possible due to non-differential misclassification of job strain and residual confounding by socioeconomic position.

Objectives: Psychosocial working conditions are suggested risk factors for low-back pain, but it is unclear whether these associations are causal. The present study examined whether there are lagged and bidirectional associations between job strain and low-back pain and further controlled for unmeasured time-invariant confounding. Methods: The study was based on four biennial waves of data from the Swedish Longitudinal Occupational Survey of Health (SLOSH), including 3084 men and women. Cross-lagged analyses using structural equation modeling (SEM) were conducted on job strain, a combination of high job demands and low control, and any as well as low-back pain severity (how much any problems affected the respondents life). Analogous SEM (dynamic panel) models with fixed effects were also fitted to remove confounding from time-invariant factors (such as non-observed individual and environmental factors, eg, genetics, childhood conditions, personality). Results: The SEM models indicated bidirectional associations between job strain and any back pain over a 2-year time lag (β=0.21 and 0.19, P＜0.05), when adjusting for a range of covariates. Job strain was also associated with an increase in low-back pain severity and vice versa. However, the SEM models with fixed-effects showed no statistically significant lagged relationships between job strain and any or low-back pain severity (β=-0.05 and β=0.00, respectively). Conclusions: This study suggests that associations between job strain and low-back pain with a lag of years may be due to residual confounding by time invariant characteristics. Further studies are, however, needed to elucidate short-term relationships.