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The Association between Long Working Hours and Health: A Systematic Review of Epidemiological Evidence
Objectives Many studies have investigated the association between long working hours and health. By focusing on differences in the definition of long working hours and the influence of shift work, we attempt to explain why the results of these studies remain inconclusive. Methods We defined long working hours as working time greater than around 40 hours per week or 8 hours per day. Since previous studies have indicated that shift work is detrimental to health, we minimized the influence of shift work in the studies. We also placed importance on the existence of reference groups since this made the results clearer. Based on these points, we analyzed previous studies to clarify the epidemiological evidence regarding the association between long working hours and health. We established inclusion criteria and carried out a systematic search for articles published in the Mediine and PsycINFO databases between 1995-2012. Results We identified a total of 17 articles and 19 studies (12 prospective cohort and 7 cross-sectional studies). The outcomes were all-cause mortality, circulatory disease, diabetes mellitus, metabolic syndrome, depressive state, anxiety, other psychological disorders, sleep condition, cognitive function, and health-related behavior. Long working hours had significant adverse effects on most health outcomes. Conclusions We concluded that working long hours is associated with depressive state, anxiety, sleep condition, and coronary heart disease. However, further studies that appropriately deal with the definition of long working hours and shift work are needed.
Journal Article
Working hours and health – key research topics in the past and future
OBJECTIVE: This paper discusses the past and present highlights of working hours and health research and identifies key research needs for the future. METHOD: We analyzed over 220 original articles and reviews on working hours and health in the Scandinavian Journal of Work, Environment & Health published during the last 50 years. Key publications from other journals were also included. RESULTS: The majority of identified articles focussed on the effects of shift and night work, with fewer studying long and reduced working hours and work time control. We observed a transition from small-scale experimental and intensive field studies to large-scale epidemiological studies utilizing precise exposure assessment, reflecting the recent emergence of register-based datasets and the development of analytic methods and alternative study designs for randomized controlled designs. The cumulative findings provide convincing evidence that shift work and long working hours, which are often associated with night work and insufficient recovery, increase the risk of poor sleep and fatigue, sickness absence, occupational injuries, and several chronic health conditions such as cardiovascular diseases and cancer. The observed risks are strongly modified by individual and work-related factors. CONCLUSIONS: Although the observed health risks of shift work and long working hours are mostly low or moderate, the widespread prevalence of exposure and the hazardousness of the many associated potential outcomes makes such working time arrangements major occupational health risks. Further research is needed to identify exposure–response associations, especially in relation to the chronic health effects, and to elucidate underlying pathways and effective personalized intervention strategies.
Journal Article
Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data
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.
Journal Article
Impact of Shift Work and Long Working Hours on Worker Cognitive Functions: Current Evidence and Future Research Needs
Particular working conditions and/or organization of working time may cause important sleep disturbances that have been proposed to be predictive of cognitive decline. In this regard, circadian rhythm misalignment induced by exposure to night work or long working hours would be responsible for cognitive impairment. Nevertheless, evidence supporting this correlation is limited and several issues still need to be elucidated. In this regard, we conducted a systematic review to evaluate the association between shift/night work and cognitive impairment and address its main determinants. Information provided by the reviewed studies suggested that night work might have serious immediate negative effects especially on cognitive domains related to attention, memory and response inhibition. Furthermore, cognitive performance would progressively worsen over consecutive night shifts or following exposure to very long work shifts. Otherwise, conflicting results emerged regarding the possible etiological role that night work chronic exposure would have on cognitive impairment. Therefore, circadian rhythm desynchronization, lack of sleep and fatigue resulting from night work may negatively impact worker’s cognitive efficiency. However, in light of the considerable methodological variability of the reviewed studies, we proposed to develop a standardized research and evaluation strategy in order to obtain a better and comprehensive understanding of this topic.
Journal Article
Impact of Long Working Hours on Mental Health: Evidence from China
Although previous studies have examined the impact of long working hours on mental health in China, they have not addressed the initial value and reverse causality issues. To bridge this gap in the literature, I conducted a dynamic longitudinal analysis to investigate the association between long working hours and the risk of mental illness nationwide. Using three-wave longitudinal data from the China Family Panel Studies conducted in 2014, 2016, and 2018, I adopted dynamic regression models with lagged long working hours variables to examine their association with the risk of mental illness. The results indicate that long working hours have positive and significant (p < 0.01 or p < 0.05) associations with the risk of mental illness (OR: 1.12~1.22). The effect is more significant for women, white-collar workers, and employees in micro-firms, compared with their counterparts (i.e., men, pink- and blue-collar workers, employees of large firms, and self-employed individuals). The results provide empirical evidence of the effects of long working hours on mental health in China, confirming the need to enforce the regulations regarding standard working hours and monitor regulatory compliance by companies, as these factors are expected to improve mental health.
Journal Article
Trajectories of marginal part-time work and risk of depression. Does job or income insecurity mediate the relation?
OBJECTIVES: Working few hours a week, known as marginal part-time work, may increase both job and income insecurity, which have been linked to the risk of depression. This study examines the association between marginal part-time work and depression and the mediating role of job and income insecurity. METHODS: We included 30 523 respondents of the Danish Labor Force Survey (DLFS) between 2010 and 2017 and linked them to register-based information on weekly working hours, which was used to identify full-time workers and model group-based trajectories of marginal part-time. These data were linked with survey information on job and income insecurity, and register-based information on hospital-diagnosed depression or redeemed anti-depressant drugs in the following two years. We estimated hazard ratios (HR) by Cox proportional hazards models and conducted mediation analyses to estimate the natural direct and indirect effects using job and income insecurity as mediators. RESULTS: We identified three distinct trajectories of marginal part-time work: constant marginal part-time work, mobile towards marginal part-time work, and fluctuating in and out of marginal part-time work. Compared with full-time workers, the constant [HR 2.42, 95% confidence interval (CI) 1.83–3.20], mobile (HR 2.84, 95% CI 2.16–3.75), and fluctuating (HR 3.51, 95% CI 2.07–5.97) trajectories all had higher risks of depression. There was no evidence of mediation by either job (HR 1.02, 95% CI 0.92–1.12) or income (HR 0.98, 95% CI 0.89–1.08) insecurity. CONCLUSIONS: We found a higher risk of depression following marginal part-time work. The higher risk was not mediated by job or income insecurity.
Journal Article
Atypical working hours are associated with tobacco, cannabis and alcohol use: longitudinal analyses from the CONSTANCES cohort
Background
This study examined prospective associations between atypical working hours with subsequent tobacco, cannabis and alcohol use as well as sugar and fat consumption.
Methods
In the French population-based CONSTANCES cohort, 47,288 men and 53,324 women currently employed included between 2012 and 2017 were annually followed for tobacco and cannabis use. Among them, 35,647 men and 39,767 women included between 2012 and 2016 were also followed for alcohol and sugar and fat consumption. Three indicators of atypical working hours were self-reported at baseline: working at night, weekend work and non-fixed working hours. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to atypical working hours at baseline while adjusting for sociodemographic factors, depression and baseline substance use when appropriate.
Results
Working at night was associated with decreased smoking cessation and increased relapse in women [odds ratios (ORs) of 0.81 and 1.25], increased cannabis use in men [ORs from 1.46 to 1.54] and increased alcohol use [ORs from 1.12 to 1.14] in both men and women. Weekend work was associated with decreased smoking cessation in women [ORs from 0.89 to 0.90] and increased alcohol use in both men and women [ORs from 1.09 to 1.14]. Non-fixed hours were associated with decreased smoking cessation in women and increased relapse in men [ORs of 0.89 and 1.13] and increased alcohol use in both men and women [ORs from 1.12 to 1.19]. Overall, atypical working hours were associated with decreased sugar and fat consumption.
Conclusions
The potential role of atypical working hours on substance use should be considered by public health policy makers and clinicians in information and prevention strategies.
Journal Article
Long working hours are inversely related to sick leave in the following 3 months: a 4-year registry study
PurposeThe aim of this study was to investigate the effects of long working hours (≥ 12 h shifts) on sick leave using objective records of shift work exposure and of sick leave.MethodsA total of 1538 nurses (mean age 42.5, SD 12.0; response rate 42%) participated. Payroll and archival sick leave data over a 4-year period were retrieved from employers’ records and aggregated over every third calendar month. A multilevel negative binomial model was used to investigate the effects of exposure to long working hours, on subsequent sick leave rates the following 3 months. Covariates included prior sick leave, number of shifts worked, night and evening shifts, personality, and demographic characteristics.ResultsExposure to long working hours was associated with fewer sick leave days in the subsequent 3 months [adjusted model, incidence rate ratio (IRR) = 0.946, 95% CI 0.919–0.973, p < 0.001]. The interaction long working hours by a number of work days showed that sick leave days the subsequent 3 months was higher by long shifts when number of shifts was high compared to when number of shifts was low [adjusted model, IRR 1.002, 95% CI 1.000–1.004, p < 0.05].DiscussionLong working hours was associated with fewer sick leave days. The restorative effects of extra days off with long working hours are discussed as possible explanations to this relationship.
Journal Article
Shift and Night Work and Long Working hours-a Systematic Review of Safety Implications
Objective In order to devise effective preventive strategies, it is important to study workplace stressors that might increase the risk of workplace accidents -both affecting workers themselves as well as causing harm to third-parties. The aim of this report is to provide a systematic, updated overview and scientific review of empirical research regarding accidents in relation to long work hours and shift work, primarily based on epidemiological studies. Methods The search for articles was part of a large review study on the effects of work hours on various health outcomes, safety, and performance. The search strategy included 5 international scientific databases, and nearly 7000 articles were initially identified using our search string. Following the application of inclusion and exclusion criteria, 443 publications were found and evaluated using a pre-defined scoring system. Of these, 43 concerned safety and accidents but only 14 were considered to be of high quality (total score 2 or 3 on a scale from 0-3) and therefore used for this study. Results Both shift work and long working hours present a substantial and well-documented detrimental effect on safety -all the studies that are included in this review have one or more significant findings in this respect. The trends are quite coherent although the increases in accident rates are mostly from 50% to 100%. In epidemiological terms, these may be considered rather small differences. The use of such data is therefore only of importance if the accident incidence is high or if accidents may have large effects. Conclusions The findings are most relevant to safety-critical activities such as the transport and health sectors. Work periods > 8 hours carry an increased risk of accidents that cumulates, so that the increased risk of accidents at around 12 hours is twice the risk at 8 hours. Shift work including nights carries a substantial increased risk of accidents, whereas \"pure\" night work may bring some protection against this effect due to resynchronization. The evaluated studies give no clear indications of any age or gender being specifically susceptible to or protected against the effects of work times scheduling on accident risk.
Journal Article