The New World of Work

A project at the Unit of Occupational Medicine at IMM.

The ever-changing economic environment, technological advancements, general weakening of trade unions and changes in labor laws have led to the emergence of a variety of non-standard work arrangements. Repeated economic cuts and changed management in the human service industries has furthermore led to increased psychosocial hazards for a large part of the workforce, particularly the female one. An important psychosocial stressor in the workplace raised in recent years is that of gender-based and sexual harassment, and the research field of antecedents and consequences of this kind of workplace violence is currently underdeveloped. In our group we aim to deepen the understanding of how non-standard work arrangements and various psychosocial stressors in the workplace, not least workplace violence, affect individuals, families and communities and how these contribute to inequalities in work environment, health and well-being. We use multiple methods including quantitative, qualitative, review and participatory research. The group also has extensive international collaboration and performs international comparative studies with researchers from Belgium, Spain, Chile, USA and Canada.


Project members

Theo Bodin

Assistant professor

Cecilia Orellana

Assistant professor

Emma Hagqvist

Assistant professor

Anna Nyberg

Researcher

Carin Håkansta

Affiliated to research

Gun Johansson

Affiliated to research

Signild Kvart

PhD student

Daniele De Leone

Research assistant

Ongoing 

Non-standard work arrangements - effects on health, work and families

The overall purpose of this research program is to

  1. Deepen the understanding of how non-standard work arrangements affect individuals, families and communities and how these contribute to inequalities in work environment, health and well-being.
  2. Identify initiatives that counteract the negative effects of non-standard work arrangements and increase the ability of workers to participate, exercise empowerment, and live healthy lives.

WP1 consists of a total population cohort in Sweden 2003-2020 which will study effects of non-standard work arrangements on health and well-being of individual workers, their coworkers and families. WP2 is a multi-country qualitative study exploring the complex inter-relations between non-standard work arrangements, health and well-being to gain a better understanding of how work be proactively shaped to support the needs of workers. In WP3, which has three parts, we will 1) review case-studies from different countries of local policy initiatives which have aimed to stop or counteract the negative effects of non-standard work arrangements 2) follow and evaluate a government-sponsored program in Sweden involving unions and employers, aimed to counteract crimes and rules violations among companies as a means of gaining a competitive advantage 3) translate the results of this programme into practical tools for practitioners for assessing risks of non-standard work arrangements.

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Key Business Indicators As Risk Factors For Occupational Accidents In Sweden  (KIROS)

This project hypothesizes that occupational injuries increase in companies which are under economical strain. We aim to investigate changes in key economic indicators of business performance as risk factors for occupational accidents over short-term (1 year) and long-term (5-years) periods. Examples of key business indicators are size, profits, leverage, debt, liquidity and efficiency. This project is a cohort study where every Swedish organization with more than 10 employees are followed prospectively from 2003 to 2016. The time frame includes a full economic cycle including the financial downturn 2007-2009 with two periods of economic growth on both sides. The project involves researchers from University Massachusetts, the Occupational Health Surveillance Program of Massachusetts and the Department of Public Helath at KI.

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Risk factors for occupational accidents - effects of under-reporting and precarious employment (CURSOR)

The aim is to examine the magnitude of under-reporting of occupational injuries in Swedish registers and the factors that can be linked to these differences. The second objective is to make better estimates of the most important risk factors for occupational accidents in Sweden. The expected results may have implications for future inspections and preventive measures. The project involves researchers from University Massachusetts, the Occupational Health Surveillance Program of Massachusetts and the Department of Public Health at KI.

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Precrious Employment and Health in Stockholm (PREMIS)

Precarious employment is a comprehensive term that captures several aspects of work including insufficient wages, vulnerability, lack of rights and temporary contracts. The increase in precarious work is a challenge that may seriously affect work environment and workers' health in many parts of the world. Limited information is available on the health effects associated with these type of working conditions and research data is scarce, which requires us to develop new methods and sampling strategies. PREMIS includes methodological development and implications for labor force surveys and register-based research The project is a collaboration with researchers from Lund University, Universitat Pampeu Fabra in Barcelona and the department of public health at KI.

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Mental ill-health and sickness absence in the human service sector

Sickness absence due to mental ill-health is high in the female-dominated industries health and social care and education. More knowledge about why is needed. The aim of the present project is to investigate if the increase in mental ill-health and sickness absence can be explained by that the development of organisational and psychosocial factors have been less favourable in female-dominated industries compared with others. Data are drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH), a cohort representing the Swedish working population with data collected every second year from 2006. Data from various registers are connected to SLOSH. These data make it possible to study associations between gender composition, organisational and psychosocial work factors, mental ill health, and self-reported and register based sickness absence over a longer time period. Adjustable determinants for mental ill-health and sickness absence in working life can be identified in the present project.

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Gender-based harassment harassment in the Swedish workplace

The silence around sexual and gender-based harassment was broken in large parts of the world with the #MeToo campaign in autumn 2017. However, more research is needed on causes, associations with other types of vulnerability in the workplace, and health consequences over time. The aim of the project is to, in representative samples of the Swedish working population, use an intersectional perspective to generate new knowledge about the importance of the individual’s relative vulnerability in the workplace for risks of being exposed to gender-based harassment. The aim is furthermore to study the long-term consequences of gender-based harassment on mental ill-health, sickness absence, sickness presenteeism, and prescription of antidepressant medication, tranquilizers and sleeping pills. Reciprocal associations between direct as well as indirect exposure (to have seen, heard, or be aware of others being exposed) to gender-based harassment and mental ill-health will be investigated in a longitudinal design. Additionally, reciprocal associations between organizational factors, leadership and the cohesiveness of the workgroup on the one hand and gender-based harassment on the other will be studied. The present project will generate unique knowledge about vulnerability in the workplace and risk of exposure to gender-based harassment as well as about consequences for the individual and workplace over time.

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Evaluation of primary workplace interventions organizational and social to improve the psychosocial work conditions

In most developed countries poor mental health is one of the leading causes of sickness absence and long-term work incapacity.  In Sweden stress related diagnoses are increasing the most. It poses a threat to workers’ wellbeing by increasing mental and physical health risks.  Research suggests that the psychosocial work environment is a contributing factor to stress or burnout, for example having an imbalance between job demands and control, experiencing role stress, bullying or low social support. The knowledge on how to change these adverse psychosocial working conditions preventing work-related stress is however somewhat limited. Most research conducted in the field is still on secondary or tertiary interventions. Hence, more research is needed evaluating organizational interventions with the aim to improve psychosocial working conditions and decrease stress. Studies which nevertheless have evaluated organizational interventions conclude that both the content of the intervention and the implementation process are crucial to reach successful outcomes. By being able to disentangle these factors, relating them to the outcomes, we will learn more about the mechanisms of change within each intervention project. 

This project  evaluate the effectiveness of two interventions aiming at improving health by changing psychosocial work conditions. One intervention is performed in middle-sized municipality and one in a construction company.

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To what extent are work disability and exit from work preventable? Completing the Nordic Work Disability Database and utilizing it to look at occupation-specific prevention potential and working life expectancy.

In a joint Nordic project, directed from Finland, we are responsible for the Swedish study. The overall objective of the project is to synthesize knowledge from published studies with new results on the effect of the working environment on transitions between work, sickness absence (SA), temporary and permanent exit from the workforce, as well as on healthy working life expectancy, utilizing nationwide register and survey data from four Nordic countries. The information generated during the project will form the Nordic Work Disability Database (NWDD). We aim 1) to identify occupations and occupational groups in Denmark, Finland, Norway, and Sweden with excessive SA, temporary and permanent exit from paid employment, and substantially reduced healthy working life expectancy; 2) to synthesize international, evidence-based knowledge on work-related factors associated with work participation and exit from paid employment with the information from the NWDD and 3) to identify working conditions that need to be prioritized in workplace interventions to enhance work participation and prolong working life. We foresee the NWDD as a knowledge resource for policy makers as well as professionals and experts working in occupational health services. The NWDD can also be seen as a surveillance tool for monitoring secular trends in occupational exposures, work participation and healthy working life expectancy. The database allows evaluation of the preventive potential of workplace interventions and setting up national priorities for them. Furthermore the info- sheets  generated from NWDD can be used as educational material.

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A study of physician work environment and health in Sweden.

The overall purpose of this project (Forte: 2019-00311) is to 1) identify the prevalence and experience of CMD among Swedish physicians, 2) explore factors contributing to CMD, 3) the short- and long-term effect and consequences of the Covid-19 pandemic, and 4) study the societal consequences related to physicians’ CMD.

Three work packages are planned:

  1. A questionnaire will be distributed to a representative sample physicians (7200) in Sweden during the beginning of 2021. The questionnaire includes validated instrument focusing on work environment, leadership, moral stress and health and some additional question focusing on work during the covid-19 pandemic. The questionnaire will be distributed yearly. Data will be connected to register data bases.
  2. Qualitative interviews with physicians was conducted during 2020. Physicians described their experiences of working during the first wave of the pandemic. All 51 have agreed to be interviewed again in 2021.
  3. A health economic calculation will be conducted including the direct and indirect costs of physicians ill health.

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Healthy physicians: Prevalence of common mental disorders among Swedish physicians, its antecedents and consequences. 

International research is consistent: work related common mental disorders (CMD) among practicing physicians is high. In fact, prevalence of CMD and suicide are higher among physicians than in the general population. Although a bulk of international research have been found to study the prevalence of CMD among physicians, its antecedents and consequences, the knowledge gap in Sweden remains; for example, no Swedish articles were found in several recent literature reviews in the field. This despite the fact that statistics show increasing levels of sickness absenteeism. Physicians CMD has bearing on patients’ health and safety and access to health care and result in high costs for society. Sweden is in immediate need to fill this knowledge gap. Thus, the overall purpose of the project is to 1) identify the prevalence and experience of CMD among Swedish physicians, 2) explore factors contributing to CMD, 3) the short- and long-term effect and consequences of the Covid-19 pandemic, and 4) study the societal consequences related to physicians’ CMD.  

Area 1: Prevalence of CMD among physicians 
In area 1, the prevalence of CMD will be investigated. It will be measured as self-rated CMD and will take note of sick leave due to CMD among Swedish physicians. Furthermore, we will investigate differences in these outcomes across gender, ethnicity, specialty, level of specialisation and region, type and size of hospital. In addition, interviews with physicians will be carried out to better understand how physicians view themselves as doctors as well as their experience of CMD.  

Area 2: Contributors to physicians CMD 
In area 2, we seek to identify work related risk factors which probably contribute to CMD among physicians. Based on previous studies we will focus on four areas: working conditions, stress of conscience and ethics, harassment and discriminations and work-life conflict. Gender is of high relevance in all three areas and will have a prominent place in the analysis. 

Area 3: Work during Covid-19 
As physicians are at the front-line of covid-19 pandemic, we will investigate physicians’ experiences of working through the pandemic. Furthermore, we will identify an eventual occupational risks and hazards, as well as the long-term effects on the health of physicians of working through the pandemic.  

Area 4: Consequences of physicians CMD 
International studies have identified consequences related to physicians with CMD for the physicians themselves, their patients, the health care system and society, which tend to amount to large costs.  

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Publications and abstracts

  1. Cedstrand, E., Nyberg, A., Bodin, T., Augustsson, H., & Johansson, G. (2020). Study protocol of a co-created primary organizational-level intervention with the aim to improve organizational and social working conditions and decrease stress within the construction industry–a controlled trial. BMC public health, 20(1), 1-8. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-08542-7
  2. Kreshpaj, B., Orellana, C., Burström, B., Davis, L., Hemmingsson, T., Johansson, G., ... & Bodin, T. (2020). What is precarious employment? A systematic review of definitions and operationalizations from quantitative and qualitative studies. Scandinavian Journal of Work, Environment & Health. https://www.sjweh.fi/download.php?abstract_id=3875&file_nro=1
  3. Bodin, T., Çağlayan, Ç., Garde, A. H., Gnesi, M., Jonsson, J., Kiran, S., ... & Julia M. (2019). Precarious employment in occupational health–an OMEGA-NET working group position paper. Scandinavian journal of work, environment & health. https://www.sjweh.fi/download.php?abstract_id=3860&file_nro=1
  4. Jonsson J, Vives A, Johansson G, Benach J, Kjellberg K, Selander J, Bodin T. Measuring precarious employment in Sweden: Translation, adaptation and psychometric properties of the Employment Precariousness Scale (EPRES) BMJ Open 2019;0:e029577. https://www.ncbi.nlm.nih.gov/pubmed/31551377
  5. Cerdas S, Härenstam A, Johansson G, Nyberg A. Development of job demands, and social support in industries with different gender composition – Sweden, 1991-2013. BMC Public Health 2019; 19:758. doi.org/10.1186/s12889-019-6917-8
  6. Jonsson, J., Stein, M., Johansson, G., Bodin, T., & Strömdahl, S. (2019). A performance assessment of web-based respondent driven sampling among workers with precarious employment in Sweden. PloS one, 14(1), e0210183.
    https://www.ncbi.nlm.nih.gov/pubmed/30629661
  7. Rönnblad T, Grönholm E, Jonsson J, Koranyi I, Orellana C, Kreshpaj B, Lingjing C, Stockfelt L, Bodin T. (2019). Precarious employment and mental health: a systematic review and meta-analysis of longitudinal studies. Scandinavian Journal of Work, Environment & Health. https://www.ncbi.nlm.nih.gov/pubmed/31165899
  8. Koranyi I, Jonsson J, Ronnblad T, Stockfelt L, Bodin T. Precarious employment and occupational accidents and injuries - a systematic review. Scand J Work Environ Health. 2018 Feb 14. https://www.ncbi.nlm.nih.gov/pubmed/29443355
  9. Hjartstrom C, Lindahl Norberg A, Johansson G, Bodin T. To work despite chronic health conditions: a qualitative study of workers at the Swedish Public Employment Service. BMJ open. 2018 Apr 20;8(4):e019747. https://www.ncbi.nlm.nih.gov/pubmed/29678972
  10. Nyberg A, Magnusson Hanson LL, Leineweber C, Hammarstrom A, Theorell T. Occupational gender composition and mild to severe depression in a Swedish cohort - the impact of psychosocial work factors. Scandinavian Journal of Public Health, 2018: 46(3):425-432.