Adverse conditions at the workplace are associated with increased suicide risk

doi:10.1016/j.jpsychires.2014.06.007

Journal of Psychiatric Research

Volume 57, October 2014, Pages 90-95

https://doi.org/10.1016/j.jpsychires.2014.06.007 Get rights and content

Highlights

•
We examined the impact of adverse working conditions on suicide mortality.
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Analyses were done in a population-based cohort followed up for an average of 13 years.
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Adverse chronobiological and physical conditions led to a higher suicide mortality.
•
Adverse psychosocial conditions showed a suggestive increase in suicide risk.
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Job strain defined by Karasek had no significant impact on suicide mortality.

Abstract

Objective

The present study addressed potential harms of a negative working environment for employed subjects. The main aim was to evaluate if adverse working conditions and job strain are related to an increase in suicide mortality.

Methods

The study population consisted of 6817 participants drawn from the MONICA/KORA Augsburg, Germany, surveys conducted in 1984–1995, being employed at baseline examination and followed up on average for 12.6 years. Adverse working conditions were assessed by an instrument of 16 items about chronobiological, physical and psychosocial conditions at the workplace, job strain was assessed as defined by Karasek. Suicide risks were estimated by Cox regression adjusted for suicide-related risk factors.

Results

A number of 28 suicide cases were observed within follow-up. High levels of adversity in chronobiological/physical working conditions significantly increased the risk for suicide mortality (HR 3.28, 95% CI 1.43–7.54) compared to low/intermediate levels in a model adjusted for age, sex and survey (p value 0.005). Additional adjustment for living alone, low educational level, smoking, high alcohol consumption, obesity and depressed mood attenuated this effect (HR 2.73) but significance remained (p value 0.022). Adverse psychosocial working conditions and job strain, in contrast, had no impact on subsequent suicide mortality risk (p values > 0.200).

Conclusions

A negative working environment concerning chronobiological or physical conditions at the workplace had an unfavourable impact on suicide mortality risk, even after controlling for relevant suicide-related risk factors. Employer interventions aimed to improve workplace conditions might be considered as a suitable means to prevent suicides among employees.

Section snippets

Study design

The data of the present study was drawn from three population-based MONICA/KORA Augsburg surveys (S1, S2, S3) conducted between 1984 and 1995 in the region of Augsburg, southern Germany, and followed-up within the KORA research platform (Holle et al., 2005). The MONICA Augsburg project was part of the multinational WHO MONICA project aimed to estimate the prevalence and distribution of cardiovascular risk factors among men and women aged 25–64 (S1) or 25–74 years (S2, S3) (WHO MONICA Project

Descriptive analyses

The associations of suicide-related risk factors with adverse chronobiological/physical and psychosocial working conditions as well as with job strain are shown in Table 1. Participants with high adverse working conditions, both chronobiological/physical and psychosocial, were significantly younger and more often male than participants in the low or intermediate group; the opposite was observed for job strain with a higher mean age and a lower percentage of men in the high compared to the

Overall

Being employed is an important resource and could improve mental well-being (Woo and Postolache, 2008). However, on the other hand, being employed can also be a source of dissatisfaction and sustained stress. A number of studies have shown associations of elevated work-related psychosocial stress with increased risk for cardiovascular diseases (Kivimaki et al., 2012, Emeny et al., 2013). In the worst case, it can act as a life-threatening source of stress and lead to suicide mortality (Woo and

Conclusions

A negative working environment concerning chronobiological or physical conditions at the workplace had an unfavourable impact on suicide mortality risk, even after controlling for relevant suicide-related risk factors. These findings should be considered in measurements aimed to prevent suicidal events in the working population.

Employed subjects often spend more time at work than at home during the daytime which reinforces the need to tackle health problems at the workplace, regardless of

Role of the funding sources

The KORA research platform is financed by the Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. Barbara Schneider is investigator of a clinical trial of Norgine-ETOH, a multi-centre open short term follow-up Phase II study to evaluate the clearance of ETOH, funded by Pierrel Research GmbH.

Contributors

JB had the idea of the study, performed the statistical analyses and took the lead in writing the manuscript. BS, KL and RTE made substantial contribution to the interpretation of the analyses and revised the manuscript critically for important intellectual content. CM made substantial contributions to the acquisition of data and revised the manuscript critically for important intellectual content. NE revised the manuscript critically for important intellectual content. ND made substantial

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgement

We thank all members of the Helmholtz Zentrum München and the KORA study center who were involved in the planning and conduct of the MONICA/KORA Augsburg studies. Finally, we are indebted to all study participants.

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Job strain and mortality ratio: a systematic review and meta-analysis of cohort studies
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Citation Excerpt :
At that stage, 12 review articles and one article that shared the database with another article were dropped. After the aforementioned steps, seventeen articles7,22,35–49 were reviewed, the specifications of which are given in Table 1. The meta-analysis included studies from the three continents Europe, Asia, and Americas, and more studies were available from Sweden and the USA.
Research has explored the relationship between job strain and adverse effects on physical and psychological health. Accordingly, the effects of job strain on mortality risk were pooled based on longitudinal studies.
Systematic review and meta-analysis.
Both researchers searched for published articles in scientific databases until May 2019. Then, the articles were screened based on the inclusion and exclusion criteria. The results were combined, and analyses of subgroups and reviewing the bias of the publication were performed as well.
Seventeen longitudinal studies included in the meta-analysis were from three continents: Europe, Asia, and America. The risk ratio (RR) of mortality based on job strain was equal to 1.20, with a confidence interval (CI) of 1.04–1.37 (P = 0.00.10). In men, the RR is 1.21, and the CI is 1.02–1.44 (P = 0.032), and in women, the RR is 0.97 and CI is 0.84–1.12 (P = 0.686). Evaluation of publication bias indicated nothing significant.
Based on the findings, it was found that job strain was a risk factor for mortality, and this finding was more appropriate for men. Hence, reducing job strain can be a deterrent against the dangers that threaten health.
Impact of meteorological parameters on suicide mortality rates: A case-crossover analysis in Southern Germany (1990–2006)
2020, Science of the Total Environment
There is evidence for a seasonal pattern of suicides with peaks in spring and early summer; however, only a limited number of studies has investigated whether daily changes in meteorological variables may trigger suicides.
Daily fatal suicide (N = 10,595) and meteorological data were available for four Bavarian cities and ten counties (Germany) for 1990–2006. City/county-specific immediate, delayed and cumulative effects of air temperature, sunshine duration, and cloud cover on suicides were analyzed using a time-stratified case-crossover approach; city/county-specific effects were then combined using random effects meta-analysis. Potential effect modifiers were specific weather conditions, personal or regional characteristics, and season.
A 5 °C increase in air temperature on the day before a suicide compared to the control days was associated with a 5.7% (95% confidence interval (CI): 0.6; 11.0) higher suicide risk. Further, the suicide risk was 6.5% (95% CI: 0.2; 13.3) higher on days with low/medium cloud cover (0–6 oktas) compared to days with high cloud cover (7–8 oktas). While daily changes in temperature were not associated with suicides in spring, we found a higher suicide risk in summer, autumn, and winter in association with temperature increases. The effects of cloud cover were strongest in summer and autumn and on days with temperature above the median (>8.8 °C). Sunshine duration was not associated with suicides.
We found a higher risk for suicides in association with short-term increases in air temperature on the day before the event compared to the control days and on days with low to medium cloud cover. This may highlight times when people are more likely to commit suicide.
Work intensity in men and work-related emotional demands in women are associated with increased suicidality among persons attending primary care
2018, Journal of Affective Disorders
Citation Excerpt :
In the general population, we founded 6 studies examining adverse workplace conditions and the risk of suicide, 2 studying suicide attempts and 7 studying suicidal ideation. Regarding suicide, a report based on 28 cases in Germany reported an increased risk among persons with high levels of adversity in terms of chronobiological/physical work conditions, but no effect of job strain as evaluated by Karasek's questionnaire (Baumert et al., 2014). To the contrary, job strain was related to suicide risk in two series of suicide cases in Japan: high psychological demands (long working hours, heavy workloads), low control, low social support and concern over work prospects (Amagasa et al., 2005; Tsutsumi et al., 2007).
A large proportion of persons died by suicide are employed at the time of death and work-related factors partly contribute to suicide risk. Our aim was to examine the association between multiple aspects of work organization and suicidal ideation in a study conducted in primary care.
Data came from a study of 2027 working patients attending a GP representative of patients in the Nord Pas-de-Calais region in France (April-August 2014). Suicidality was assessed using the MINI (Mini International Neuropsychiatric Interview). Six emergent worked-related factors were explored (work intensity, emotional demands, autonomy, social relationships at work, conflict of values, insecurity of work). Several covariates were considered: patient's and GP's characteristics, and area-level data (material and social deprivation, psychiatrist and GPs’ density, suicide attempts and suicide rates).
8.0% of participants reported suicidal ideation in the preceding month (7.5% of men and 8.6% of women, p = .03). In multivariate analyses adjusted for covariates, suicidality was significantly associated with work intensity (OR = 1.65; 95%CI [1.18–2.31]) in men and with work-related emotional demands (OR = 1.35; 95%CI [1.01–1.80]) in women. Area-level data were not associated.
Our cross-sectional study cannot assess the direction of the relationships under study.
Our results emphasise a central role for GPs in suicide prevention among workers and highlight the importance of work-related factors with regard to suicidality in primary care.
The impact of changes in work stressors and coping resources on the risk of new-onset suicide ideation among Chinese petroleum industry workers
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In contrast, Tsutsumi et al., (2007) estimated higher suicide risks for subjects with high job control but not for those with low job demands. Recently, two longitudinal studies also reported inconsistent findings: Baumert et al., (2014) found that adverse psychosocial working conditions (disturbances and interruptions, urge for fast decisions, high responsibility for people, high responsibility for machines, strong competition) and job strain had no impact on subsequent suicide mortality risk. Nielsen et al. (2015) revealed an increased later suicidal ideation risk for subjects experiencing workplace bullying.
Little is known about the relationship between changing psychosocial work conditions and suicidality. We examined whether or not changed work stressors and coping resources increase the risk of new-onset suicidal ideation.
A total of 1384 workers from the Occupational Health Study of Petroleum Industry Workers were included in this study. A baseline evaluation of work-related stress and coping resources was followed by a final evaluation after 2 years. The changes in task stressors and coping resources were measured using the Occupation Stress Inventory-Revised Edition, and changes in job control and organizational stressors were evaluated using the Instrument for Stress-Related Job Analysis (v. 6.0).
Increased task stressors (RR = 2.87, 95% CI = 1.48, 6.15) and decreased coping resources (RR = 2.53, 95% CI = 1.31, 5.34) were associated with an elevated risk of new-onset suicidal ideation incidence. Effect magnitudes were higher than known suicidal risk factors. The main risk factors were increased role overload, increased role insufficiency, increased accident risk, and decreased recreation. Decreased coping resources also increased the negative effect of task stressors on new-onset suicidal ideation. However, increased coping resources did not decrease the effect.
These findings demonstrate that changes in work stressors and coping resources have a strong influence on new-onset suicidal ideation, highlighting the importance of preventive measures against adverse psychosocial work conditions and reduced coping resources for workplace suicide behavior prevention.
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View full text

Adverse conditions at the workplace are associated with increased suicide risk

Highlights

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Study design

Descriptive analyses

Overall

Conclusions

Role of the funding sources

Contributors

Conflict of interest

Acknowledgement

Lancet

Lancet

Ann Epidemiol

J Psychiatr Res

J Affect Disord

Lancet

J Clin Epidemiol

Karojisatsu in Japan: characteristics of 22 cases of work-related suicide

J Occup Health

Psychiatric diagnoses in 3275 suicides: a meta-analysis

BMC Psychiatry

Suicides associated with the 2008-10 economic recession in England: time trend analysis

BMJ

Psychosocial factors at work and risk of depression: a systematic review of the epidemiological evidence

Occup Environ Med

Impact of 2008 global economic crisis on suicide: time trend study in 54 countries

BMJ

Job strain-associated inflammatory burden and long-term risk of coronary events: findings from the MONICA/KORA Augsburg case-cohort study

Psychosom Med

Stress and suicide in the Nurses' health study

J Epidemiol Community Health

Suicide as an outcome for mental disorders. A meta-analysis

Br J Psychiatry

KORA–a research platform for population based health research

Gesundheitswesen