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The consequences of work-related violence and threats for clinically significant mental health problems are unclear: One study showed associations with hospitalisation for depressive and stress-related disorders, but a different study found no association with use of antidepressants. This null-finding, however, could be due to lack of statistical power.
Re-examining the relation between exposure to work-related threats and violence in a large sample of Danish employees (n = 15527).
Assessing whether employees reporting exposure to work-related threats or violence are more likely to start treatment with psychotropics.
We synthesized three Danish studies with self-reported data on exposure to work-related threats or violence within the past 12 months and linked it with purchases of psychotropic medications through registry-data. After excluding 1750 respondents who had used psychotropic medication previous to 12 months before questionnaire-response, the final study population was 15527 employees. We examined four mutually exclusive outcomes:
1) antidepressants (N06a),
2) anxiolytics (N05b),
3) antidepressants and anxiolytics,
4) hypnotics only (N05c).
Using four separate logistic regressions we adjusted risk estimates for confounding by gender, age, cohabitation, education, and income.
Preliminary analyses show increased risk for treatment with antidepressants (OR = 1.46; 95%CI: 1.15–1.86) and antidepressants combined with anxiolytics (OR = 1.79; 95%CI:1.16–2.76), but not anxiolytics (OR = 1.04; 95%CI: 0.74-1.45) or hypnotics only (OR = 1.08; 95%CI: 0.77–1.50). Final results will be available for the conference.
In this large sample of Danish employees, exposure to threats or violence in the workplace is associated with treatment with antidepressants, and antidepressants combined with anxiolytics, but not anxiolytics or hypnotics only.
Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression.
We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol.
We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47–2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04–1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94–1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81–1.32).
Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.
Numerous studies describe the occurrence of post-traumatic stress disorder following disasters, but less is known about the risk of major depression.
To review the risk of depressive disorder in people surviving disasters and in soldiers returning from military deployment.
A systematic literature search combined with reference screening identified 23 controlled epidemiological studies. We used random effects models to compute pooled odds ratios (ORs).
The average OR was significantly elevated following all types of exposures: natural disaster OR = 2.28 (95% CI 1.30–3.98), technological disaster OR = 1.44 (95% CI 1.21–1.70), terrorist acts OR = 1.80 (95% CI 1.38–2.34) and military combat OR = 1.60 (95% CI 1.09–2.35). In a subset of ten high-quality studies OR was 1.41 (95% CI 1.06–1.87).
Disasters and combat experience substantially increase the risk of depression. Whether psychological trauma per se or bereavement is on the causal path is unresolved.
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