Background

High emotional demands at work can affect employees’ health and there is a need to understand whether such an association might be modified by other working conditions. We aimed to examine emotional demands at work as a risk factor for long-term sickness absence and analyse whether influence, possibilities for development, role conflicts, and physical demands at work might modify this risk.

Methods

We did a nationwide, population-based, prospective cohort study in Denmark and included employed individuals who were residing in Denmark in 2000, aged 30–59 years, who had complete data on age, sex, and migration background, with information on emotional demands and possible effect modifiers from job exposure matrices, and covariates and outcome (sickness absence) from population registers. Individuals with long-term sickness absence (≥6 weeks of consecutive sickness absence) between Jan 1, 1998, and Dec 31, 2000, and self-employed individuals were excluded. We assessed long-term sickness absence during a 10-year period from Jan 1, 2001, to Dec 31, 2010. Using Cox regression, we estimated hazard ratios (HRs) and 95% CIs and tested interaction as departure from additivity, estimating relative excess risk due to interaction (RERI). Multivariable adjusted models included sex, age, cohabitation, migration background, and income.

Findings

1 521 352 employed individuals were included and contributed data between Jan 1, 2000, and Dec 31, 2010. During 11 919 021 person-years (mean follow-up 7·8 years), we identified 480 685 new cases of long-term sickness absence. High emotional demands were associated with increased risk of long-term sickness absence compared with low emotional demands, after adjusting for age, sex, cohabitation, migration background, income, and the four possible effect modifiers (adjusted HR 1·55 [95% CI 1·53–1·56]). The association between high emotional demands and risk of long-term sickness absence was stronger in a synergistic way when individuals were also exposed to low possibilities for development (RERI 0·35 [95% CI 0·22–0·47]; 28·9 additional cases per 1000 person-years) and high role conflicts (0·13 [0·11–0·15]; 22·0 additional cases per 1000 person-years). No synergy was observed for influence and physical demands at work.

Interpretation

People in occupations with high emotional demands were at increased risk of long-term sickness absence. Our findings on synergistic interactions suggest that, in emotionally demanding occupations, increasing possibilities for development and reducing work-related role conflicts might reduce long-term sickness absence. Further interventional studies are needed to confirm or refute this hypothesis.

Funding

Danish Work Environment Research Fund, NordForsk.

中文翻译：

---

丹麦 1·500 万员工的工作情绪需求和长期病假风险：一项关于效果修正的前瞻性队列研究

背景

工作中的高情绪需求会影响员工的健康，因此有必要了解这种关联是否会因其他工作条件而改变。我们旨在将工作中的情绪需求作为长期病假的风险因素进行检查，并分析影响、发展的可能性、角色冲突和工作中的身体需求是否会改变这种风险。

方法

我们在丹麦进行了一项全国性的、基于人群的前瞻性队列研究，纳入了 2000 年居住在丹麦、年龄在 30-59 岁之间、拥有完整的年龄、性别和移民背景数据以及情感需求信息的就业人员和来自工作暴露矩阵的可能的影响修饰符，以及来自人口登记的协变量和结果（疾病缺席）。1998 年 1 月 1 日至 2000 年 12 月 31 日期间长期病假（连续病假 6 周以上）的个人和个体经营者被排除在外。我们评估了从 2001 年 1 月 1 日到 2010 年 12 月 31 日的 10 年期间的长期缺勤情况。使用 Cox 回归，我们估计了风险比 (HR) 和 95% CI，并测试了交互作用偏离加性，估计相对互动导致的额外风险（RERI）。

发现

在 2000 年 1 月 1 日至 2010 年 12 月 31 日期间，共有 1 521 352 名在职人员被纳入并提供了数据。在 11 919 021 人年（平均随访 7·8 年）期间，我们确定了 480 685 例新的长期病假。在调整了年龄、性别、同居、迁移背景、收入和四种可能的影响因素（调整后的 HR 1·55 [95% CI 1·53–1·56]）。当个体也暴露于低发展可能性时，高情绪需求与长期病假风险之间的关联以协同方式更强（RERI 0·35 [95% CI 0·22–0·47]；28·每 1000 人年新增 9 例）和高度角色冲突（0·13 [0·11–0·15]；每 1000 人年增加 22·0 例）。在工作中没有观察到影响力和体力需求的协同作用。

解释

从事情感需求高的职业的人长期病假的风险增加。我们关于协同互动的研究结果表明，在情感要求高的职业中，增加发展的可能性和减少与工作相关的角色冲突可能会减少长期病假。需要进一步的干预研究来证实或反驳这一假设。

资金

丹麦工作环境研究基金，NordForsk。