title: Does good leadership buffer effects of high emotional demands at work on risk of antidepressant treatment? A prospective study from two Nordic countries.
abstract: OBJECTIVE
  Emotionally demanding work has been associated with increased risk of common mental disorders. Because emotional demands may not be preventable in certain occupations, the identification of workplace factors that can modify this association is vital. This article examines whether effects of emotional demands on antidepressant treatment, as an indicator of common mental disorders, are buffered by good leadership.
  
  
  METHODS
  We used data from two nationally representative work environment studies, the Danish Work Environment Cohort Study (n = 6,096) and the Swedish Longitudinal Occupational Survey of Health (n = 3,411), which were merged with national registers on antidepressant purchases. All individuals with poor self-reported baseline mental health or antidepressant purchases within 8.7 months before baseline were excluded, and data analysed prospectively. Using Cox regression, we examined hazard ratios (HRs) for antidepressants in relation to the joint effects of emotional demands and leadership quality. Buffering was assessed with Rothman's synergy index. Cohort-specific risk estimates were pooled by random effects meta-analysis.
  
  
  RESULTS
  High emotional demands at work were associated with antidepressant treatment whether quality of leadership was poor (HR = 1.84, 95 % CI 1.32-2.57) or good (HR = 1.70, 95 % CI 1.25-2.31). The synergy index was 0.66 (95 % CI 0.34-1.28).
  
  
  CONCLUSIONS
  Our findings suggest that good leadership does not substantially ameliorate any effects of emotional demands at work on employee mental health. Further research is needed to identify possible preventive measures for this work environment exposure.
authors.affiliation: The National Research Centre for the Working Environment, Lerso Park Allé 105, 2100, Copenhagen, Denmark, ihm@nrcwe.dk.
authors.forename: Ida E H
authors.initials: IE
authors.lastname: Madsen
authors.forename: Linda L Magnusson
authors.initials: LL
authors.lastname: Hanson
authors.forename: Reiner
authors.initials: R
authors.lastname: Rugulies
authors.forename: Töres
authors.initials: T
authors.lastname: Theorell
authors.forename: Hermann
authors.initials: H
authors.lastname: Burr
authors.forename: Finn
authors.initials: F
authors.lastname: Diderichsen
authors.forename: Hugo
authors.initials: H
authors.lastname: Westerlund
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003718:Denmark / Q000453:epidemiology; D004644:Emotions; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007857:Leadership; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology; D008603:Mental Health; D008875:Middle Aged; D009790:Occupations; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D013548:Sweden / Q000453:epidemiology; D017132:Workplace / Q000523:psychology*
chemical_list: D000928:Antidepressive Agents