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Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data.

ABSTRACT: 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published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium.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 From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression.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risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47-2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04-1.55).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.

SUBMITTER: Madsen IEH

PROVIDER: S-EPMC5471831 | biostudies-other | 2017 Jun

REPOSITORIES: biostudies-other

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Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data.

Madsen I E H IEH Nyberg S T ST Magnusson Hanson L L LL Ferrie J E JE Ahola K K Alfredsson L L Batty G D GD Bjorner J B JB Borritz M M Burr H H Chastang J-F JF de Graaf R R Dragano N N Hamer M M Jokela M M Knutsson A A Koskenvuo M M Koskinen A A Leineweber C C Niedhammer I I Nielsen M L ML Nordin M M Oksanen T T Pejtersen J H JH Pentti J J Plaisier I I Salo P P Singh-Manoux A A Suominen S S Ten Have M M Theorell T T Toppinen-Tanner S S Vahtera J J Väänänen A A Westerholm P J M PJM Westerlund H H Fransson E I EI Heikkilä K K Virtanen M M Rugulies R R Kivimäki M M

Psychological medicine 20170126 8

<h4>Background</h4>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.<h4>Method</h4>We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpu ...[more]

PMID: 28122650

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Project description:BACKGROUND:Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies. METHODS:We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death. FINDINGS:30,214 (15%) of 197,473 participants reported job strain. In 1·49 million person-years at risk (mean follow-up 7·5 years [SD 1·7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1·23 (95% CI 1·10-1·37). This effect estimate was higher in published (1·43, 1·15-1·77) than unpublished (1·16, 1·02-1·32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1·31, 1·15-1·48) and 5 years (1·30, 1·13-1·50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3·4%. INTERPRETATION:Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking. FUNDING:Finnish Work Environment Fund, the Academy of Finland, the Swedish Research Council for Working Life and Social Research, the German Social Accident Insurance, the Danish National Research Centre for the Working Environment, the BUPA Foundation, the Ministry of Social Affairs and Employment, the Medical Research Council, the Wellcome Trust, and the US National Institutes of Health.

Dataset Information

Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data.

Publications

Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data.

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