Make a SLR paper from the below search terms Analyzing visualizing data social in google scholar use the below link to view the results. https://scholar.google.com/scholar?hl=en&as_sdt=0,48&q="Analyzi

Information extraction Information from papers was extracted and coded within the following categories: study aim, study design, type of study population (for example, occupational group), sampling strat- egy, sample size and response rate, demographic characteris- tics, type of intervention, type of study measure, main outcomes, and summary of results.

Further selection criteria Coded papers excluded from the review were studies with:

volunteer or inadequately described sample; response rate of less than 60%; no standardised measures of psychological outcome.

RESULTS Of the studies identi®ed as part of the larger study, 140 were selected for this study (34 associations and six interventions).

A further nine studies meeting the above selection criteria were identi®ed in the period 1998±99, all of associations. No studies were found in the Cochrane Controlled Trials Register.

The results are summarised in tables 1±4. Because these studies were diverse in terms of outcomes and measures used to assess these outcomes, a meta-analysis was not appropriate.

Associations with work The results are presented in three groups: health care workers in the UK, health care workers in other developed countries, and non-health care workers. This enabled an assessment of whether associations between work factors and psychological ill health are similar across sector and country. Health care In the UK, factors associated with psychological ill health in doctors, from junior to senior grades, are long hours worked, 9 high workload and pressure of work, 71611 and lack of role clarity 12(table 1). Pressure of work has also been found to be associated with poor mental health in dentists. 10In family doctors, the issues were interruptions during and outside sur- gery hours and patient demands. 16 Among UK nurses, the most frequently reported source of psychological ill health was workload pressures. 17Distress in student nurses has been caused by low involvement in decision making and use of skills, and low social support at work. 13In a study of health care workers across job type, bul- lying was found to be prevalent, carried out mainly by manag- ers and associated with both anxiety and depression. 14Of the two studies addressing sickness absence, one found a negative association with job demands, 13while the other found no association with control over work.15 Similar factors are associated with psychological ill health in health care workers in the rest of Europe, the USA, and Australia (table 2). The one study of doctors found an associ- ation between work control and social support and psycho- logical distress. 22 Among nurses, lack of co-worker support, 24 27 job in¯uence, 26and organisational climate and role ambiguity 28were associated with psychological distress.

Among other hospital workers, work overload and pressure, role ambiguity, lack of control over work, and lack of participation in decision making were all found to be associated with distress. 18 20 25 Sickness absence was associated with work pressures and lack of training, 23unsupportive management style, 21role ambiguity, tolerance of absenteeism, and low pay. 19 Beyond health care The picture among non-health care workers in Europe and the USA was similar to that of health care workers (table 3). The Table 1 Summary of observational studies of associations between work factors and ill health: health care workers in UK Study Design Participants Response rate Work factors Outcomes Results Agius et al , 1996 7 Cross sectional 375 consultant doctors 75% Work demands Emotional exhaustion (MBI)High academic work demands associated with low emotional exhaustion ( r= -0.14, p<0.05) Baglioni et al , 1990 8 Cross sectional 475 senior nurses 80% Workload Mental health (CCEI) No association Baldwin et al , 1997 9 Longitudinal 142 junior doctors 95% Long hours Psychological distress (GHQ-28)No association overall; association with somatic symptoms, r=0.24 Cooper et al , 1988 10 Cross sectional 484 dentists 85% Time pressures, pay stressors and technical problemsMental health (CCEI) Time pressures, pay stressors and technical problems associated with poor mental health (respective Bs=0.24, 0.20, 0.12; F=20.54, p<0.001) Deary et al , 1996 11 Cross sectional 333 consultant doctors 67% Clinical workload Psychological distress (GHQ-28), emotional exhaustion (MBI)High clinical workload associated with emotional exhaustion ( c 2for model=30.31, p=0.11, satisfactory fit) Heyworth et al , 1993 12 Cross sectional 201 trainee and consultant doctors 72% Task clarity, supportive communication Depression (CES-D) Task clarity and supportive communication associated with lower depression ( r=-0.51 and -0.36 respectively, p=0.0001) Parkes, 1982 13 Experimental 164 student nurses 97% Job demand, discretion, social supportAnxiety (GHQ), depression (CCEI), sickness absence Anxiety and depression associated with low job discretion and job support ( r=-0.30 and -0.35 for anxiety and -0.26 and - 0.36 for depression) and job demand was negatively associated with sickness absence ( r=-0.24) Quine, 1999 14 Cross sectional 1100 health care workers 70% Bullying Anxiety, depression (HADS)Bullying associated with higher anxiety (30% v 9%, p<0.001) and depression (8% v 1%, p<0.001) Rees and Cooper, 1992 15 Cross sectional 1176 health care workers 67% Control over work (OSI) Sickness absence No association Sutherland and Cooper, 1993 16 Cross sectional 917 family doctors 61% Job demands Anxiety, depression and somatic anxiety (CCEI)Associations with anxiety (beta=0.17) depression (beta=0.28) and somatic anxiety (beta=0.23) Tyler and Cushway, 1992 17Cross sectional 72 nurses 60% Workload, conflict, social supportPsychological distress (GHQ 28) GHQ predicted by managing the workload (beta=0.32) 4 Michie, Williams www.occenvmed.com on July 5, 2020 by guest. Protected by copyright.

http://oem.bmj.com/ Occup Environ Med: first published as 10.1136/oem.60.1.3 on 1 January 20\ 03. Downloaded from key work factors associated with psychological ill health were:

work overload and pressure 31 34 36 39±40 41 47 48 ; con¯icting de- mands 47; lack of control over work and lack of participation in decision making 34 36 37 39 40 46±48 ; poor social support at work 31 33 35 38 39 41 47 48 ; unclear management and work role 29 30 41 34 38 ; interpersonal con¯ict 42 46 ; and con¯ict between work and family demands. 46Long hours were found to be associated with depression in women, but not in men. 44 Sickness absence was negatively associated with high job demand, 45and positively associated with monotonous work, not learning new skills and low control over work, 36 37 45 and non-participation at work. 43 Evaluated interventions Six intervention studies met our methodological criteria (table 4). Three were randomised controlled trials, 49 50 52 three were conducted in the USA, 50 51 54 one in the UK, 53and two in Scandinavia. 49 52 Three were of health care workers. 50 52 54 Five were training programmes offered as part of the working day and one was an organisational intervention. 53 Skills to mobilise support at work and to participate in problem solving and decision making were taught to care staff of people with mental ill health or mental disability in a ran- domised controlled trial. 50Groups of 20 had six sessions of 4±5 hours training over two months, and were trained to train those in their workplace. Compared to those in the control group, the intervention group reported more supportive feed- back, more ability to cope, and better work team functioning and climate. Among those most at risk of leaving, those undergoing the training reported reduced depression. The second randomised controlled trial compared receiving support, advice, and feedback from a psychologist with having the passive presence of the same psychologist at staff meetings in a geriatric hospital facing organisational change. 52Staff were taught skills of stress management, and how to partici- pate in, and control, their work. The intervention was an hour a fortnight during the 10 weeks before, and the 10 weeks after, the organisational change. There was a signi®cant difference between groups, with a decrease of stress hormone levels in the intervention group. Staff of a psychiatric hospital were taught verbal and non- verbal communication and empathy skills. 54Groups of 6±8 had eight hour weekly sessions for four weeks involving infor- mation, videos, modelling, and role playing. Compared to a matched control group, the intervention group showed reduced staff resignations and sick leave, although no statisti- cal tests are reported. Among physically inactive employees of an insurance com- pany, a randomised controlled trial found stress management training and aerobic exercise interventions had mixed Table 2 Summary of observational studies of associations between work factors and ill health: health care workers in developed countries beyond the UK Study Country Design Participants Response rate Work factors Outcomes Results Arsenault et al , 1991 18 Canada Cross sectional 760 hospital workersNot reportedProfessional latitude, clinical demands, workload problems, role difficulties Mental strain including depression (Cobb) and anxiety (STAI)Low professional latitude (F=12.7, p<0.001) and high workload problems (F=4.5, p<0.04) and role difficulties (F=31.6, p<0.01) associated with mental strain Brooke and Price, 1989 19 USA Cross sectional 425 hospital workers74% Routinisation, centralisation, pay, reward policy, role ambiguity, conflict, overload, organisational tolerance of absenteeism Absenteeism High role ambiguity and tolerance of absenteeism, low pay and low centralisation predicted absenteeism (structural coefficients 0.21, p<0.001; 0.27, p<0.001; -0.11, p<0.05; -0.19, p<0.02, respectively) Estryn-Behar et al , 1990 20 France Cross sectional 1505 female hospital workers90% Mental load, insufficient training, time pressure Psychological distress (GHQ-12)Mental load and time pressure associated with psychological distress (ORs 2.9 and 2.2) Gray-Toft and Anderson, 1985 21 USA Experimental 159 nurses Not reportedOpen, supportive supervisory style Absenteeism Open supportive supervisory style associated with lower absenteeism (relevant statistics not presented) Johnson et al , 1995 22 USA Longitudinal 581 doctors 86% Job demands, work control, social supportPsychological distress (GHQ-20)Work control and social support negatively associated with psychological distress (B= -0.44, p=0.05 and B= -0.46, p=0.05) Landeweerd and Boumans, 1994 23 Netherlands Cross sectional 561 nurses 96% Work pressure, job complexity, feedback, autonomy, promotion/trainingAbsence frequency Work pressures associated with absence frequency (B=0.12) and promotion/training negatively associated (B=-0.12) Marshall & Barnett, 1992 24 USA Cross sectional 362 female nurses and social workersNot reported Work related support, job overload Psychological distress (SCL-90-R) and emotional well-being (Rand Corporation)Co-worker support associated with emotional wellbeing (B= -0.20, p<0.01) Martin, 1984 25 USA Cross sectional 95 and 140 hospital workers63% and 70% Work overload and ambiguity, participation in decision making Psychological distress (GHQ-12) Work factors associated with distress (canonical correlations=0.53 and 0.41, p<0.001) Petterson et al , 1995 26 Sweden Cross sectional 2568 nurses 76% Job influence Emotional exhaustion (MBI) Job influence negatively associated with emotional exhaustion (p<0.001) Pisarski et al , 1998 27 Australia Cross sectional 172 nurses, aged 21±40 yearsNot reported Social support Psychological distress (GHQ-12)Co-worker social support directly associated with distress and mediates association with supervisor social support (path coefficients <0.001) Revicki and May, 1989 28 USA Cross sectional 232 nurses 77% Organisational climate, supervisor behaviour, role ambiguity, social supportDepression (Rand corporation) The association of organisational climate and role ambiguity with depression is mediated by stress Reducing work related psychological ill health and sickness absence 5 www.occenvmed.com on July 5, 2020 by guest. Protected by copyright.

http://oem.bmj.com/ Occup Environ Med: first published as 10.1136/oem.60.1.3 on 1 January 20\ 03. Downloaded from Table 3Summary of observational studies of associations between work factors and ill health: non-health care workers Study Country Design Participants Response rate Work factors OutcomesResults Bacharach et al , 1991 29USA Cross sectional 430 public sector engineers79% Role conflict, time pressure Emotional exhaustion (MBI) High role conflict (B=0.24) associated with emotional exhaustion Carayon et al , 1995 30 USA Prospective 148 public sector office workers71% Job demands, content and control, social support, task clarity and job future ambiguity Worker strain, including anxiety and depression (McNair)Predictors of worker strain at one and two years were task clarity and job future ambiguity Driscoll et al , 1995 31 USA Cross sectional 4900 public sector workers70% Job demands, control and social support Anxiety and depression (NIOSH Generic Job Stress Questionnaire)High demand and low support associated with anxiety (ORs 1.46 and 2.01) and depression (ORs 2.02 and 1.69) Ferrie et al , 1998 32 UK Prospective 10308 public sector workers80% Job insecurity Psychological distress (GHQ-30) Non-significant association Frese, 1999 33 Germany Longitudinal 90 male blue collar workers35±66% Work intensity, uncertainty, organisational problems, environmental problems, social pressure, social support Anxiety, depression Social pressure and support associated with anxiety/depression ( r=0.21/0.20 and-0.21/-0.27) Frone et al , 1995 34 USA Longitudinal 795 employed adults67% Work pressure, lack of autonomy, role ambiguity Depression (CES-D) Work pressure, lack of autonomy, role ambiguity all associated with depression (Bs=0.10, p<0.01; 0.19, p<0.001; 0.18, p<0.001, respectively) Fusilier et al , 1987 35 USA Cross sectional 312 police officers and fire fighters65% Role conflict and ambiguity, social support Depression (Caplan) Low social support associated with depression (B= -0.24, p<0.01) Karasek, 1979: Study 1 36 Sweden Longitudinal 1896 working males 92% and 85% Decision latitude and job demands Depression (amended from American Health Survey), absenteeismDecision latitude negatively associated with depression and absenteeism (OR= -1.29, p<0.05 and -1.44, p<0.01). Job demands associated with depression (OR=1.45, p<0.001) Study 2 USACross sectional 911 working males 76% As aboveAs aboveDecision latitude negatively associated with depression and absenteeism (OR= -1.41, p<0.01 and ±2.04, p<0.01); job demands associated with depression (OR=1.20, p<0.05) Karasek, 1990 37 Sweden Cross sectional 8504 white collar workers87% Changes in control over work Depression and absenteeism Decreased control associated with depression (p<0.01) and with absenteeism in men (p<0.01) but not women LaRocco et al , 1980 38 USA Cross sectional 636 male workers Not reported Supervisor support, participation, future ambiguity, under-utilisation, workload, role conflictAnxiety and depression (Cobb and Kasl) Supervisor support buffers the adverse effect of low participation on depression (p<0.1, significant ) and of future ambiguity on anxiety (p<0.01) Niedhammer et al , 1998 39 France Prospective 11552 92%Psychological demands, decision latitude and social support Depression (CES-D) High psychological demand, low decision latitude and social support associated with subsequent depression. For men, OR of 1.8, 1.4 and 1.6 respectively and for women, OR of 1.4, 1.4 and 1.3 respectively.

Payne and Fletcher, 1983 40 UK Cross sectional 148 teachers 74% Workload demands, discretionAnxiety and depression (CCEI) Association with workload demands (betas=0.117 for anxiety and 0.176 for depression) and negative association with discretion (betas=-0.222 for anxiety and ±0.121 for depression) Reifman et al , 1991 41 USA Cross sectional and longitudinal 200 married, professional women>90% Social support at work , control over work, role ambiguity, workload Depression (SCL-90) Cross sectionally, association with social support at work ( r=0.37), role ambiguity ( r=0.35) and workload ( r=0.29). No associations one year later Romanov et al , 1996 42 Finland Prospective 15530 employees Not reported Conflict at work Psychiatric morbidity (hospital discharge registry) Positive association (RR 2.18, CI 951.34, 3.54) Rubenowitz et al , 1983 43 Sweden Cross sectional 25 departments of 5 companies.

Numbers not reported85±90% Perceived participation (individual, group, representative) Absenteeism Negative association for individual participation ( r=-0.53) Shields, 1999 44 Canada Prospective 3830 working population80% Long working hours Depression (Composite International Diagnostic Interview)>35 hours per week associated with depression in women (OR=2.2) but not men Smulders and Nijuis, 1999 45 The Netherlands Cross sectional and prospective 1755 male public sector workers70% Job control and job demands Absence rate and absence frequencyCross sectionally, job control associated with low absence frequency (beta=0.10, p<0.01) and job demand associated with low absence rate (beta= -0.08, p<0.05) Sparks and Cooper, 1999 46 UK Cross sectional 7099 from 13 occupationsNot reported Work control, career achievement, organisational climate, job factors, home/work interface, work relationships Mental health (OSI) All associated ( r=0.22 to -0.28, p<0.001) Stansfeld et al , 1995 47 UK Cross sectional 10314 public sector employees73% Job variety and skill use, control, social support, work pace, conflicting demands Psychological distress (GHQ-30)All significantly associated (intertile trend p values < 0.001) Stansfeld et al , 1998 48 UK Prospective 7372 public sector workers72% Job demands, decision latitude, social support and effort-reward imbalance Psychological functioning (SF-36)Low support and effort-reward imbalance associated with poor psychological functioning (OR=1.2 for men and 1.4 for women; 1.8 for men and 2.3 for women respectively). In men, low decision latitude (OR=1.2) and in women, high job demand (OR=2.0) were associated with poor psychological functioning 6 Michie, Williams www.occenvmed.com on July 5, 2020 by guest. Protected by copyright.

http://oem.bmj.com/ Occup Environ Med: first published as 10.1136/oem.60.1.3 on 1 January 20\ 03. Downloaded from effects. 49After three sessions a week for 10 weeks, stress man- agement training resulted in improved perceived coping abil- ity but no change in physical or psychological health. Aerobic exercise resulted in improved feelings of wellbeing and decreased complaints of muscle pain. Employees of a ®re department underwent one of seven training programmes emphasising one or more aspect of stress management: physiological processes, coping with people, or interpersonal awareness processes. 51Weekly ses- sions for 8±10 people were run over 42 weeks. There was no control group. Compared to baseline, there were reductions in depression, anxiety, psychological strain, and emotional exhaustion immediately after the programme. There was a further reduction in psychological strain and emotional exhaustion at 9±16 months follow up. A structural intervention for local authority staff on long term sickness absence was effective in reducing sickness absence. Referral to occupationalhealthservices was triggered after two or three months absence, rather than at six months which was the practice before the intervention. The average duration of sickness absence reduced from 40 to 25 weeks before resumption of work and from 72 to 53 weeks for those staff who left employment for medical reasons. The authors describe large ®nancial savings but no statistical tests are reported. 53 DISCUSSION This systematic review of a large number of studies covers a wide range of employment sectors in the developed world and summarises those studies that use rigorous methods. The studies show that, while levels of psychological ill health are higher in health care than in non-health care workers, 5the associations between work factors and psychological ill health are similar. They are also similar across continents. This suggests that a generic approach to reducing work related psychological ill health may be appropriate. The most common work factors associated with psychologi- cal ill health were work demand (long hours, workload,and pressure), lack of control over work, and poor support from managers. These were also associated with sickness absence.

The ®ndings of this review, summarised in tables 1±4, are consistent with the demand-control model of job strain. 36 Interventions aimed at changing these workplace factors reduced psychological ill health.

This review highlights limitations in the research identi®ed.

The studies that have been carried out are limited in the ques- tions addressed and in the study designs used. Since most studies are cross sectional, causal relations cannot be shown.

It may be that the associations found re¯ect a tendency for more vulnerable people to choose work in caring roles or other types of job which are well represented in published research studies. The question of what aspects of work lead to ill health and sickness absence can only be addressed by longitudinal studies that are able to investigate the causal relations between work factors and health outcomes and by ran- domised controlled trials of interventions. A longitudinal study that directly addressed the nature of the relation found a causal relation between psychological stress and psychoso- matic complaints. 55 There are several practical implications suggested by the studies of association in this review, for both employment Table 4 Summary of studies of interventions Study Participants Design Response rate Intervention Outcomes Results Gronningsaeter et al , 1992 49 76 physically inactive Norwegian insurance workers Stratified RCT 72% 6 sessions aerobic exercise per week for 10 weeks or 3 sessions stress management training per week for 10 weeks Anxiety (STAI) and health complaints No association of either intervention with anxiety. Aerobic exercise associated with reduced health complaints (F=3.4, p=0.07 compared to controls, and F=4.8, p<0.05 compared to stress management intervention) Heaney et al , 1995 50 1375 US residential care workers Cluster RCT 62% 6 ´4 hour sessions over 9 weeks to teach skills to enhance social support and problem solving Depression (SCL-90R) For those most at risk of leaving their jobs, R 2=0.41, p<0.01 Kagan et al , 1995 51 373 US fire department workers Randomised, uncontrolledNot reported42 weeks of 7 psycho-educational programmes, 6 weeks each Anxiety, depression, psychological strain, emotional burnoutCompared to baseline, F=52.3, 42.2, 29.1, 10.6 respectively; p<0.001 for all.

At 9±16 month follow up, F=4.8 (p<0.05), 8.7 (p<0.01), 21.4 (p<0.001), 45.2 (p<0.001) respectively Lokk and Arnetz, 1997 52 26 Swedish hospital ward workers RCT 93% 20 weekly 1 hour stress management sessions Stress hormone (prolactin) levelChange scores:

Intervention group -0.58 Control group +1.85 F=7.3, p<0.01 Malcolm et al , 1993 53 604 UK long term sick local government workers Observational 100% Early referral to Occupational Health Duration of sickness absence (weeks)25 weeks in intervention period compared to 40 in control period Smoot and Gonzales, 1995 54 65 US hospital workers Matched controlled90% 4 weekly 8 hour sessions of communication training Sick leave (hours) in 6 months after compared to 6 months before% change:

-28.2 in experimental group, -6.4 in control group Main messages · Key work factors associated with psychological ill health and sickness absence in staff are long hours worked, work overload and pressure, and the effects of these on personal lives; lack of control over work; lack of participation in decision making; poor social support; and unclear management and work role.

· There is some evidence that sickness absence is associated with poor management style.

· Successful interventions that improve psychological health and levels of sickness absence use training and organisa- tional approaches to increase participation in decision making and problem solving, increase support and feedback, and improve communication. Reducing work related psychological ill health and sickness absence 7 www.occenvmed.com on July 5, 2020 by guest. Protected by copyright.

http://oem.bmj.com/ Occup Environ Med: first published as 10.1136/oem.60.1.3 on 1 January 20\ 03. Downloaded from practices and management style. Intervention studies, how- ever, have focused mainly on staff training. There is a need for future studies to evaluate interventions based on employment practices and management style. This would represent primary prevention, reducing sources of psychological ill health, rather than secondary prevention, training individuals who are already experiencing work related stress, to be more robust in the face of such pressures. Only one of the interven- tion studies included an economic evaluation: such evalua- tions are important in facilitating employers to make decisions about whether or not to implement interventions.Future research should adhere to minimum scienti®c standards absent in many of the studies reviewed, such as adequate design, suf®ciently large samples, and valid outcome measures. Lessons that are learnt from rigorously evaluated interventions can then be applied more generally.

ACKNOWLEDGEMENTSWe are grateful to Shriti Pattani for help with literature searching and to Fr×d×rique Cooper for help with preparing this manuscript.

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Authors' affiliationsS Michie, Reader in Clinical Health Psychology, Centre for Outcomes Research and Effectiveness, Department of Psychology, University College London, Gower Street, London WC1E 6BT, UK S Williams, Consultant in Occupational Medicine, Royal Free Hampstead NHS Trust, London NW3 2QG, UK REFERENCES1 Williams S , Michie S, Pattani S. Improving the health of the NHS workforce. London: The Nuffield Trust, 1998.

2 Confederation of British Industry . Managing absence: in sickness and in health . London: CBI, 1997.

3 Whitley TW , Allison Jr EJ, Gallery ME, et al . Work related stress and depression among practicing emergency physicians: an international study. Ann Emerg Med 1994; 23:1068±71.

4 Cox T , Griffiths A. The nature and measurement of work stress: theory and practice. In: Wilson, JR, Corlett E, Nigel E, et al ,eds. Evaluation of human work: a practical ergonomics methodology , 2nd edn. London:

Taylor & Francis, 1995:783±803.

5 Wall TD , Bolden RI, Borrill CS, et al . Minor psychiatric disorder in NHS trust staff: occupational and gender differences. Br J Psychiatry 1997; 171:519±23.

6 University of York . Understanding systematic reviews of research on effectiveness . CDR report 4. York: NHS Centre for Reviews and Dissemination, 1996.

7 Agius RM , Blenkin H, Deary IJ, et al . Survey of perceived stress and work demands of consultant doctors.Occup Environ Med 1996; 53:217±24.

8 Baglioni Jr AJ , Cooper CL, Hingley P. Job stress, mental health and job satisfaction among UK senior nurses. Stress Medicine 1990; 6:9±20.

9 Baldwin PJ , Dodd M, Wrate RM. Young doctors' healthÐI. How do working conditions affect attitudes, health and performance. Soc Sci Med 1997; 45:35±40.

10 Cooper CL , Watts J, Baglioni Jr AJ, et al . Occupational stress amongst general practice dentists. J Occup Psychol 1988; 61:163±74.

11 Deary IJ , Blenkin H, Agius RM, et al . Models of job-related stress and personal achievement among consultant doctors. Br J Psychol 1996; 87:3±29.

12 Heyworth J , Whitley, TS, Allison Jr EJ, et al . Correlates of work-related stress amongst consultants and senior registrars in accident and emergency medicine. Arch Emerg Med 1993; 10:279±88.

13 Parkes KR . Occupational stress among student nurses: a natural experiment. J Appl Psychol 1982; 67:784±96.

14 Quine L . Workplace bullying in NHS community trust: staff questionnaire study. BMJ 1999; 318:228±32. 15 Rees D , Cooper CL. Occupational stress in health service workers in the UK. Stress Medicine 1992; 8:79±90.

16 Sutherland VJ , Cooper CL. Identifying distress among general practitioners: predictors of psychological ill health and job dissatisfaction. Soc Sci Med 1993; 37:575±81.

17 Tyler P , Cushway D. Stress, coping and mental well-being in hospital nurses. Stress Medicine 1992; 8:91±8.

18 Arsenault A , Dolan SL, Van Ameringen MR. Stress and mental strain in hospital work: exploring the relationship beyond personality. Journal of Organisational Behaviour 1991; 12:483±93.

19 Brooke PP , Price JL. The determinants of employees absenteeism: an empirical test of a causal model. J Occup Psychol 1989; 62:1±19.

20 Estryn-Behar M , Kaminski J, Peigne E, et al . Stress at work and mental health status among female hospital workers.Br J Ind Med 1990; 47:20±8.

21 Gray-Toft PA , Anderson JG. Organisational stress in the hospital:

development of a model for diagnosis and prediction. Health Serv Res 1985; 19:753±74.

22 Johnson JV , Stewart W, Hall EM, et al . The psychosocial work environment of physicians. J Occup Environ Med 1995; 37:1151±9.

23 Landeweerd JA , Boumans NPG. The effect of work dimensions and need for autonomy on nurses' work satisfaction and health. J Occup Organ Psychol 1994; 67:207±17.

24 Marshall NL , Barnett RC. Work-related support among women in caregiving occupations. J Community Psychol 1992; 20:6±42.

25 Martin TN . Role stress and inability to leave as predictors of mental health. Human Relations 1984; 37:969±83.

26 Petterson IL , Arnetz BB, Arnetz JE. Predictors of job satisfaction and job influence: results from a national sample of Swedish nurses. Psychother Psychosom 1995; 64:9±19.

27 Pisarski A , Bohle P, Callan VJ. Effects of coping strategies, social support and work-nonwork conflict on shift worker's health. Scand J Work Environ Health 1998; 241:41±145.

28 Revicki DA , May HJ. Organisational characteristics, occupational stress, and mental health in nurses. Behav Med 1989; 15:30±6.

29 Bacharach SB , Bamberger P, Conley S. Work-home conflict among nurses and engineers: mediating the impact of role stress on burnout and satisfaction at work. Journal of Organisational Behaviour 1991; 12:39±53.

30 Carayon P , Yang C, Lim S. Examining the relationship between job design and worker strain over time in a sample of office workers.

Ergonomics 1995; 38:1199±211.

31 Driscoll RJ , Worthington KA, Hurrell Jr JJ. Workplace assault: an emerging job stressor. Consulting Psychology Journal: Practice and Research 1995; 47:205±12.

32 Ferrie JE , Shipley MJ, Marmot MG, et al . An uncertain future: the health effects of threats to employment security in white-collar men and women. Am J Public Health 1998; 88:1030±6.

33 Frese M . Social support as a moderator of the relationship between work stressors and psychological dysfunctioning: a longitudinal study with objective measures.

J Occup Health Psychol 1999; 3:179±92.

34 Frone MR , Russell M, Cooper ML. Job stressors, job involvement and employee health: a test of identity theory.

J Occup Psychol 1995; 68:1±11.

35 Fusilier MR , Ganster DC, Mayes BT. Effects of social support, role stress, and locus of control on health. Journal of Management 1987; 13:517±28.

36 Karasek Jr RA . Job demands, job decision latitude, and mental strain:

implications for job redesign. Adm Sci Q 1979; 24:285±311.

37 Karasek R . Lower health risk with increased job control among white collar workers. Journal of Organisational Behaviour 1990; 11:171±85.

38 LaRocco JM , House JS, French Jr JRP. Social support, occupational stress, and health. J Health Soc Behav 1980; 21:202±18.

39 Niedhammer I , Goldberg M, Leclerc A,et al . Psychosocial factors at work and subsequent depressive symptoms in the Gazel cohort. Scand J Work Environ Health 1998; 24:197±205.

40 Payne R , Fletcher BC. Job demands, supports, and constraints as predictors of psychological strain among schoolteachers. Journal of Vocational Behaviour 1983; 22:136±47.

41 Reifman A , Biernat M, Lang EL. Stress, social support, and health in married professional women with small children. Psychology of Women Quarterly 1991; 15:431±45.

42 Romanov K , Appelberg K, Honkasalo M, et al . Recent interpersonal conflict at work and psychiatric morbidity: a prospective study of 15,530 employees aged 24±64. J Psychosom Res 1996; 40:169±76.

43 Rubenowitz S , Norrgren F, Tannenbaum AS. Some social psychological effects of direct and indirect participation in ten Swedish companies. Organisation Studies 1983; 4:243±59.

44 Shields M . Long working hours and health. Health Reports 1999;11:33±48.

45 Smulders PGW , Nijhuis, FJN. The job demands-job control model and absence behaviour: results of a 3-year longitudinal study. Work and Stress 1999; 13:115±31.

46 Sparks K , Cooper CL. Occupational differences in the work-strain relationship: towards the use of situation-specific models. Journal of Occupational Organizational Psychology 1999; 72:219±29.

47 Stansfeld SA , North FM, White I, et al . Work characteristics and psychiatric disorder in civil servants in London. J Epidemiol Community Health 1995; 49:48±53.

48 Stansfeld SA , Bosma H, Hemingway H, et al . Psychosocial work characteristics and social support as predictors of SF-36 health functioning: the Whitehall II study. Psychosom Med 1998; 60:247±55. Policy implications · Many of the work related variables associated with high levels of psychological ill health are potentially amenable to change.

· More evaluations of interventions are required, based on randomised or longitudinal research designs.

· Interventions for which evidence of effectiveness exists should be piloted and evaluated across different work settings.

8 Michie, Williams www.occenvmed.com on July 5, 2020 by guest. Protected by copyright.

http://oem.bmj.com/ Occup Environ Med: first published as 10.1136/oem.60.1.3 on 1 January 20\ 03. Downloaded from 49Gronningsaeter H , Hytten K, Skauli G, et al . Improved health and coping by physical exercise or cognitive behavioural stress management training in a work environment . Psychology and Health 1992; 7:147±63.

50 Heany CA , Price RH, Refferty J. Increasing coping resources at work: a field experiment to increase social support, improve work team functioning, and enhance employee mental health. Journal of Organisational Behaviour 1995; 16:335±52.

51 Kagan NI , Kagan H, Watson MG. Stress reduction in the workplace: the effectiveness of psychoeducational programs. Journal of Counselling Psychology 1995; 42:71±8. 52 Lokk J , Arnetz B. Psychophysiological concomitants of organisational change in health care personnel: effects of a controlled intervention study. Psychother Psychosom 1997; 66:74±7.

53 Malcolm RM , Harrison J, Forster H. Effects of changing the pattern of referrals in a local authority.

Occup Med 1993; 43:211±15.

54 Smoot SL Gonzales JL . Cost-effective communication skills training for state hospital employees. Psychiatr Serv 1995; 46:819±22.

55 Frese M . Stress at work and psychosomatic complaints: a causal interpretation. J Appl Psychol 1985; 70:314±28. ECHO .......................\ ......... Air pollution study confirms concerns over childhood rickets A study in India has shown that young children living in areas of high air pollution are in danger of developing rickets.

Two groups of age matched infants and toddlers were compared for serum vitamin D metabolites, cal- cium, alkaline phosphatase (AP), and parathormone (PTH) concentrations. One group lived in a central location in Delhi and the other on the outskirts of the city, where air pollution is much lower. Children from the city centre had signi®cantly lower mean serum total 25-hydroxyvitamin D (25(OH)D)Ðan indictor of vitamin D statusÐthan children from the outskirts (12.4 ng/ml v27.1 ng/ml).

Their mean serum AP and PTH concentrations were signi®cantly higher, and the inverse relations between 25(OH)D and AP, PTH were also signi®cant. Three children had serum total 25(OH)D low enough to indicate rickets, and nine more below adequate amounts. All children from the outskirts had adequate 25(OH)D. Mean haze score was signi®cantly less at the city centre (2.1 against 2.7). Each group included 34 children aged 9±24 months with similar home conditions, diet, family income, and time spent outside. Blood was taken from 26 children from the city centre and 31 from the outskirts.

Haze scores measured at ground level three times daily (0900, 1200, 1600) during February 2000 were taken as a marker for UVB radiation. Concerns are growing that increasing air pollution from industry and motor vehicles blocks out UVB radiation and children's ability to make vitamin D naturally, leading to rickets. mArchives of Disease in Childhood 2002; 87:111±113. Please visit the Occupational and Environmental Medicine website [www.

occenvmed.com] for link to this full article. Reducing work related psychological ill health and sickness absence 9 www.occenvmed.com on July 5, 2020 by guest. Protected by copyright.

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