2. Identification of modern working life stressors

There are a number of relatively recent appearances of stressors that were absent in the early days of work stress research. Here we try to identify these stressors, define their role and investigate their linkages to health. A general remark is that factors resulting from managerial use of numerical, functional and temporal flexibility in the staffing of organizations appear to be highly relevant stressors characteristic of modern working life. Not only have major organizational change and restructuring per se been found to have adverse effects on employees; a substantial portion of employees also worry about losing their jobs, have difficulty finding alternative employment and experience that work and non-work activities are becoming more intertwined, and such stressors are of central importance.

Subpackages

2.1 Labor market mobility, career development and return to work

Given the limited knowledge regarding how individuals’ mobility, career development and labor market status may affect well-being, adjustment and work motivation, we have carried out several projects to investigate further these issues. Pioneering research findings from a longitudinal life-span project show that entrepreneurship in middle age can be predicted from childhood social and antisocial factors. Earlier research from the group has focused on involuntary lack of mobility and shown that about 20 percent of individuals with permanent employment are not in their preferred occupation or in their preferred work-place (double locked in), and, moreover, that these employees suffer from more health-related problems than do other groups. Research from the group also shows that volition plays an important role in translating temporary employment into consequences. Within a research collaboration including researchers in Portugal unemployed older workers engaged in training were found to experience more meaningfulness and better well-being as compared to those not engaged in training. However, a number of conference presentations show that organizations have difficulties making good use of knowledge from individuals transferring between jobs.

2.3 Organizational change

Over the past years, we have conducted a set of pioneering studies of organizational change by following employees in organizations undergoing various change processes, such as downsizing, privatization, restructuring, and even plant closures. These findings clearly show the existence of short-term negative effects of major organizational changes. Downsizing of companies and re-organization have been suggested as potential health risks, and a qualitative study identified structure and involvement of employees as crucial during organizational restructuring. In a IPD-work study, perceived job insecurity was moderately associated with risk of incident coronary heart disease, an association partly attributable to differences in socioeconomic circumstances and risk factor profiles. Another study indicated that although organizational change affects employees’ health negatively in the short term it is common to recover from such negative effects. Organizational changes were furthermore identified as a potential risk factor for bullying at work. Researchers in the center have since long studied the effect of ownership changes in the health care sector. In more recent years, health care privatization has been found to have more negative effects on midlevel employees as compared to other groups. Psychosocial demands and resources differ between employees at for-profit and non-profit companies and publicly administered organizations. However, the findings also suggest that empowerment can homogenize after privatization, although certain groups are at risk of experiencing reduced empowerment.

Importantly, albeit paradoxical, one of our unique findings showed that plant closure sometimes may lead to increased motivation during the closedown process. Findings from international collaborations however underscore the fact that commitment to change is important for employee behaviors and may lead to more active support for organizational change processes. Organizational justice and other aspects of organizations have also been related to lower levels of sickness absence and more positive work attitudes and well-being.

2.4 Employment uncertainty

Our frontline research has made substantial contributions to the literature on various aspects of uncertain employment relations, by providing narrative and meta-analytic reviews of job insecurity and publishing numerous books, special issues, and articles. Several collaborative studies have linked the perception of job insecurity to various indicators of health and well-being  (and also shown that it is partly related to objective health indicators) as well as work-related attitudes and behavior including higher sickness presenteeism. Studies have also validated measures of job insecurity using both national and international data, and investigated the role of dispositions and coping styles for the experience of job insecurity. More recent research has identified factors that can moderate (e.g., personality, social support, coping, employability, and financial as well as psychological job dependence) or mediate (e.g., control, workload, work–family conflict) the relation between job insecurity and outcomes, using both cross-sectional and longitudinal data. This important research has been summarized in a recent special issue, following up on our previous books, reviews and meta-analyses. Ongoing research has made substantial contributions to the area in furthering the understanding of job insecurity not only at the individual level but also as a shared phenomenon. This involves us having developed and tested a new measure of job insecurity climate in Sweden and other cultural settings.

2.5 Working conditions and healthy work

Another set of studies have identified and explored further working conditions that may hinder or facilitate the development of healthy work practices. Our findings show that job demands/resources predict well-being and motivation. Importantly, focusing on the changing working life of different professionals, we have identified and isolated illegitimate tasks as a central hinder for healthy and sustainable work, and our unique findings have clearly shown that illegitimate tasks are related to poorer well-being. Some of our research has involved intensive studies of specific groups of workers. These studies have for instance provided important findings show- ing that welfare workers experience a tough work climate. An additional line of research has focused on safety climates within organizations; our findings within this area have shown that bonus systems in nuclear plants seem not to violate the safety climate. Other studies have examined the interaction between job characteristics and organizational justice in predicting work-related attitudes and health. Yet other studies focusing on bus drivers have shown that work stress is linked to high BP and musculoskeletal problems in this group. Investigating potential pathways, we have focused specifically on delineating the linkages between psychosocial work stressors and salivary cortisol as a marker of chronic activation. However, the systematic review produced inconsistent results underscoring the need of further studies investigating the linkages between various psychosocial factors at work and biomarkers. However, other reviews have also underscored the need for investigating further the biological correlates of health and well-being along with identifying positive psychological functioning in occupational settings and healthy work. Yet, our findings have also shown that health appraisals mediate the effects of working conditions on outcomes. Most notably, our research clearly suggests that unions play an important role in keeping up healthy work practices. A study of the working conditions associated with the accumulation of stress and lack of recovery (pre-school, home care and social work, n=193). As many as 43% of the social workers belonged to the not-recovered group.

2.6 Work-family conflict

Work-Family Conflict (WFC) was found to be associated with an increased risk of emotional exhaustion among both men and women, poor self-rated health among women and problem drinking among men and high work-home interference (WHI) prospectively predicted major depression and/or antidepressant treatment. In a study of Swedish hospitals it was found that 6% of the variability in WFC experienced by registered nurses was at the department level, suggesting an impact of organizational factors on WFC, and that WFC in turn increased the risk of emotional exhaustion. Adequate staffing and support was in the same study found to decrease the risk of emotional exhaustion and depersonalization. Another study found reciprocal relationships between WFC and performance-based self-esteem (PBS), with PBS but not WFC predicting also emotional exhaustion.

2.8 Psychosocial factors and breast cancer

With a somewhat different approach we studied a cohort of women who had undergone breast cancer surgery, and showed that most of them valued paid work very high and consider work as one of the most important things in life. They also regarded work as a health promoting factor and a way to reduce stress and ‘take care of themselves’. Nevertheless, few had been encouraged to return to work and several stated that they had been advised, from healthcare and social insurance, to take sick leave in order ‘to take care of themselves’. Their ways of handling stress over the future two years are now investigated, using repeated survey and register data.

2.9 Open plan office

Open plan office environments are becoming increasingly common, but relatively few scientific studies have addressed the stress/health consequences of such work environments. SSC is pioneering an approach where health and wellbeing in open office environments are studies taking the specific architectural qualities of different modern office solutions into account. Most of these studies are collabora- tive (E+W). One study found an excess risk of short sick leave spells in open-plan offices. Another study found that the perception of leadership varied between office types, with the most negative rating of the supervisor among employees working in shared room offices. A third study found an interaction between office type and the need for concentration in the job; employees with a large need for concentration reported more distraction than those with less need for concentration in all office types except in cell offices, and also more cognitive stress in all office types except cell offices and flex (activity based) offices. In a review, two different concepts of ‘lean’ office were discussed combining architectural, organizational and employee points of view.

2.10 Work environment and antidepressants

The prevalence of antidepressant use was found to be higher in the Swedish than in the Danish working population, but the association with psychosocial work characteristics was similar in the two countries. Job strain was as strongly related to depressive symptoms among men as among women, but more common in women.

2.11 Boundaryless work

Several projects and studies within the center have established that working conditions tend to change as the boundaries between work and life outside of work become more blurred. For instance, flexible working and boundarylessness appear to affect the work strategies and be associated with a stronger regulation of work. This line of research has also been summarized in a book.

2.12 Leadership and management

Managerial leadership is increasingly studied in relation to employee outcomes, and was found to predict stress, self-rated health and sickness absence over and above measures of job strain. Non-listening leadership was associated with low income and low education as well as with emotional exhaustion and depressive symptoms. In a study of Italian, Polish and Swedish hotels, destructive lead- ership was found to be related to poor psychological well-being, as well as to be less common in Sweden than in the other two countries. Covert coping among employees, i.e. not indicating when one feels unfairly treated, was associated with an increased risk of myocardial infarction and cardiac death. However, high emotional demands at work were associated with increased risk of antide- pressant treatment, with no substantial modification by leadership quality. In a collaborative qualitative case study, we described the implementation of lean management in a Swedish hospital. Prospectively following the implementation indicated that the success of lean implementation may partly be due to the stage of group development at the ward. In studies based on SLOSH, the work environment was furthermore found to influence the risk of workplace conflicts, bullying, and future cognitive complaints.

2.14 Sickness certification

Among physicians a different type of work environment stressor is work tasks like sickness certification of patients. In a study of the 37,000 physicians working in Sweden, half of those with such work tasks experienced this as a work environment problem They found it particularly problematic to assess patient’s level of work incapacity and to manage the two roles as the patient’s treating physician and as a medical expert. Many did not have organizational support in those tasks and health care managers described it as problematic to manage the work with sickness certification of patients.

2.15 The temporal framework for work and stress – work scheduling

Work hours / work schedules constitute the framework for much of adult life and sets limits for activities and exert demands on the individual. This problem has been approached in several ways. Among studies of shift work we have shown that changes into and out of shift work leads to subsequent changes in sleep and sleepiness. These results are the first of their kind in their focus on changes in work schedules. Among the long-term outcomes of shift work we have found that it is connected to new cases of multiple sclerosis, and breast cancer. We have also attempted to understand what characteristics of work hours are most important to the individual. In a representative Swedish sample we found that short notice of a new work schedule, short recovery time (<11h) between shifts and split duty work (morning + evening work the same day) and >5 work days in succession constitute the main problems. Night work, often thought to be the main problem, seemed well tolerated, but was heavily linked to health problems. The amount of work hours is another issue and it is often argued that reduced hours of work will reduce stress. In one unique work hour study we have shown that a reduction of work hours from 8 to 6h (800 individuals) during two years (full pay) did not lead to any effects on clinical health parameters (including blood pressure and cortisol). In contrast, subjective fatigue and stress were reduced, while sleep was improved. Influence over working hours was associated with lower sickness absence.

 

Planned research

We will extend the existing work on identifying and analyzing the consequences of modern working life stressors. SSC funding will be used for facilitating collaborations, mainly W+E+I+S

2.1 Organizational change

One important line of planned collaborative (W+E+I+S) and SSC funded research on organizational change is to investigate effects of upsizing, downsizing, privatization and closure at the individual and organizational levels using register data (All Sweden database – 10m people), which allows for studying consequences such as sick-leave, medical treatment and indicators of health care and ill-health. To accomplish these goals we have recently added one register to the All-Sweden database, namely that of the Register on Changes in Companies and Workplaces (Företagens och Arbetsställenas Dynamic, the FAD database), which includes comprehensive information on the workplaces, each of the ten million people in the data base worked at over a 20 year period. Data management and -analyses are now ongoing, the first study is about stress related to downsizing of companies. Other studies will use self-reports from employees within the Swedish public sector from a nationally representative sample (W+E) using SLOSH, as well as data from specific organizations. Within this area there will also be continued international collaboration (W+E) with the Whitehall project (UK). Additionally, research will include methodological development by validating measures intended to assess employee commitment to and engagement in change processes.

2.2 Labor market mobility, career development and return to work

The planned research in this area is partly collaborative (W+E). We will continue our studies focusing on labor market and career development. A recently started project, involving collaboration between W and E, will target employees who, for various reasons, have difficulty changing jobs and/or organizations (the so-called locked-in position) as well as individuals on temporary employment contracts to contribute to the understanding of the consequences of such situations. The ambition is also to use longitudinal survey data (such as SLOSH) to investigate how changes in employment contract and labor market status are accompanied by changes in employability, career agency as well as work attitudes and health (W+E). Other plans concern flexible work and blurred lines between work and life outside work. This research includes a combined methodological approach covering biomarkers, activity and sleeping patterns, diary data along with self-reports in questionnaires and organizational record data on sickness absence. This project makes use of the infrastructure and interdisciplinary knowledge within the center (W+E+P+I) but also includes international collaboration.

2.3 Employment uncertainty

The group has published extensively on employment uncertainty. Planned research involves a meta-analysis on the consequences of job insecurity as well as a state-of-the-art literature review. Another important line of research with strong collaborative parts (W+E) concerns efforts that explain mechanisms linking job insecurity to outcomes, through the continued identification of mediators and moderators, using nationally representative data, data from specific organizations and intercultural comparisons. The focus will be on career-related (e.g., employability), dispositional (e.g., self-efficacy, personality characteristics), financial (economic uncertainty, bread- winner status), and organizational (e.g., organizational justice, communication) factors. This area also involves comparisons between individual and collective perceptions of job insecurity as well as the development and validation of a measure of collective job insecurity.

2.4 Work hours

Work hours will be a continued focus of interest. One area is flexible working time arrangements, which are becoming increasingly common as organizations seek to satisfy employees’ desires to combine work and private life, while maintaining high productivity and optimum-staffing levels. One way to increase flexibility is to increase work time control (WTC). While there is moderately strong evi- dence that WTC promotes better work-life balance, the aim of the proposed collaborative (E+S+W+I) project is to analyze the impact of WTC on health (e.g. sickness absence based on registry data) and job related outcomes over time. The main strengths of this project (financed largely by Forte) include its longitudinal design, the use of a well-established measure of WTC and the availability of a wide range of outcomes that includes objective measures of health. An additional strength is that the results will be based on data from a large representative sample of the Swedish working population (SLOSH), as well data from a large multinational survey conducted in the health sector (RN4CAST) including more than 33 000 nurses. Another series of planned studies concern long term effects of shift work on dementia and mortality using the twin registry and the All Sweden cohort (S+I), and probably also a follow-up on multiple sclerosis and exposure to night work.

2.5 Working conditions

The planned research will continue to investigate and compare different work climate models, along with focusing on specific psycho- social working conditions and their linkages to health, well-being and work motivation. It will be largely collaborative (W+E+I). Some studies will aim at describing the situation for certain occupational groups where the prevalence of ill- health and long-term sick-leave is high (e.g., welfare workers, school teachers, health care employees). Other studies will focus on specific stressors (e.g., illegitimate tasks, emotional demands, the need for continuous competence development) or investigate how organizational factors and management practices (e.g., pay-for-performance, recruitment practices, safety culture, organizational justice, and opportunities for participation in decision-making) relate to health- and work-related outcomes.

2.6 Justice at work and health – the impact of job-related uncertainty

Financed by Riksbankens jubileumsfond (The Swedish Foundation for Humanities and Social Sciences we (E+W) are starting a project to investigate the impact of justice at work on health over time under conditions of uncertainty, i.e. job insecurity and different degrees of employability. This will be done with advanced longitudinal modelling techniques in SLOSH).

2.7 Women’s managerial careers and health

We (E+W) are currently initializing a Forte-financed project (#2013-1253) to investigate how factors at the workplace and in private life influence women’s managerial careers, both in terms of being promoted to a managerial position, as well as to sustain and develop, a managerial career. In addition, possible health consequences of a managerial career will be explored. This will be done in SLOSH and the Finnish Public Sector Study, complemented by qualitative interviews.

2.8 Physicians and sickness certification

We will continue to study how the physicians’ experiences of sickness certification tasks as a work environment problem have devel- oped since 2008, based on large surveys to the 33,000 physicians of Sweden. It is of special interest to study if the same trend regarding experiences in physicians in different clinical settings remains, and how these experiences relate to organizational factors.