title: Adverse conditions at the workplace are associated with increased suicide risk.
abstract: OBJECTIVE
  The present study addressed potential harms of a negative working environment for employed subjects. The main aim was to evaluate if adverse working conditions and job strain are related to an increase in suicide mortality.
  
  
  METHODS
  The study population consisted of 6817 participants drawn from the MONICA/KORA Augsburg, Germany, surveys conducted in 1984-1995, being employed at baseline examination and followed up on average for 12.6 years. Adverse working conditions were assessed by an instrument of 16 items about chronobiological, physical and psychosocial conditions at the workplace, job strain was assessed as defined by Karasek. Suicide risks were estimated by Cox regression adjusted for suicide-related risk factors.
  
  
  RESULTS
  A number of 28 suicide cases were observed within follow-up. High levels of adversity in chronobiological/physical working conditions significantly increased the risk for suicide mortality (HR 3.28, 95% CI 1.43-7.54) compared to low/intermediate levels in a model adjusted for age, sex and survey (p value 0.005). Additional adjustment for living alone, low educational level, smoking, high alcohol consumption, obesity and depressed mood attenuated this effect (HR 2.73) but significance remained (p value 0.022). Adverse psychosocial working conditions and job strain, in contrast, had no impact on subsequent suicide mortality risk (p values > 0.200).
  
  
  CONCLUSIONS
  A negative working environment concerning chronobiological or physical conditions at the workplace had an unfavourable impact on suicide mortality risk, even after controlling for relevant suicide-related risk factors. Employer interventions aimed to improve workplace conditions might be considered as a suitable means to prevent suicides among employees.
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Baumert
authors.affiliation: LVR-Klinik Köln, Cologne, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Schneider
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: Karoline
authors.initials: K
authors.lastname: Lukaschek
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Emeny
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Natalia
authors.initials: N
authors.lastname: Erazo
authors.affiliation: Institute for Medical Sociology, Medical Faculty, University of Dusseldorf, Dusseldorf, Germany.
authors.forename: Nico
authors.initials: N
authors.lastname: Dragano
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Electronic address: ladwig@helmholtz-muenchen.de.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Ladwig
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D000428:Alcohol Drinking / Q000523:psychology; D003863:Depression / Q000523:psychology; D004651:Employment / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology; D012307:Risk Factors; D012907:Smoking / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications*; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*; D017132:Workplace / Q000523:psychology*
keywords: Cohort study; General population; Job strain; Suicide; Working conditions