Psychosocial work environment and hospital admissions due to mental disorders: a 15-year prospective study of industrial employees.
BACKGROUND
Low levels of job control and social support may increase the risk of mental disorders, particularly depression, but the evidence is mostly based on self-reports. We examined whether components of job control and work-related social support predict medically-certified mental disorders.


METHODS
13868 forest company employees with no previous hospital admissions for mental disorders responded to questionnaires on decision authority, skill discretion, co-worker and supervisor support. They were followed-up for hospital admissions due to mental disorders (ICD-9 codes 290 to 319), using national hospital discharge records (577 hospitalized, mean follow-up 15.1 years).


RESULTS
In analyses adjusted for confounders, high skill discretion was associated with a reduced risk of hospital admission for mental disorders (HR 0.74, 95% CI 0.58-0.95). High decision authority was associated with an elevated risk (HR 1.48, 95% CI 1.17-1.87). Diagnosis-specific analyses showed high skill discretion to associate with a reduced risk of both depressive and non-depressive non-alcohol-related mental disorders. High decision authority was a risk factor for alcohol-related and depressive disorders. Good co-worker support was associated with a reduced risk of non-depressive non-alcohol-related mental disorders. Supervisor support was not associated with any mental disorders.


CONCLUSIONS
We used a single time point estimate in an industrial sample comprising largely of men.


CONCLUSIONS
Contrary to previous research on job control, high decision authority increased the risk of depressive and alcohol-related disorders, which suggest a need to reconsider the strategies for prevention and clinical practise in regard to psychosocial work environment and mental health.
Joensuu
Matti
M
Finnish Institute of Occupational Health, Work Organizations, Helsinki, Finland. matti.joensuu@ttl.fi
Väänänen
Ari
A
Koskinen
Aki
A
Kivimäki
Mika
M
Virtanen
Marianna
M
Vahtera
Jussi
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D003657:Decision Making; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005387:Finland; D016468:Forestry; D006608:Hierarchy, Social; D006801:Humans; D007221:Industry; D007389:Internal-External Control; D007588:Job Satisfaction; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012931:Social Environment; D012944:Social Support; D055815:Young Adult