title: Job demands and job strain as risk factors for employee wellbeing in elderly care: an instrumental-variables analysis.
abstract: BACKGROUND
  The association between psychosocial work environment and employee wellbeing has repeatedly been shown. However, as environmental evaluations have typically been self-reported, the observed associations may be attributable to reporting bias.
  
  
  METHODS
  Applying instrumental-variable regression, we used staffing level (the ratio of staff to residents) as an unconfounded instrument for self-reported job demands and job strain to predict various indicators of wellbeing (perceived stress, psychological distress and sleeping problems) among 1525 registered nurses, practical nurses and nursing assistants working in elderly care wards.
  
  
  RESULTS
  In ordinary regression, higher self-reported job demands and job strain were associated with increased risk of perceived stress, psychological distress and sleeping problems. The effect estimates for the associations of these psychosocial factors with perceived stress and psychological distress were greater, but less precisely estimated, in an instrumental-variables analysis which took into account only the variation in self-reported job demands and job strain that was explained by staffing level. No association between psychosocial factors and sleeping problems was observed with the instrumental-variable analysis.
  
  
  CONCLUSIONS
  These results support a causal interpretation of high self-reported job demands and job strain being risk factors for employee wellbeing.
authors.affiliation: 1 National Institute for Health and Welfare, Helsinki, Finland 2 Department of Behavioural Sciences, University of Helsinki, Finland marko.elovainio@thl.fi.
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
authors.affiliation: 1 National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Heponiemi
authors.affiliation: 1 National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Hannamaria
authors.initials: H
authors.lastname: Kuusio
authors.affiliation: 3 Department of Epidemiology and Public Health, University College London, UK.
authors.forename: Markus
authors.initials: M
authors.lastname: Jokela
authors.affiliation: 1 National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Anna-Mari
authors.initials: AM
authors.lastname: Aalto
authors.affiliation: 1 National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Laura
authors.initials: L
authors.lastname: Pekkarinen
authors.affiliation: 1 National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Anja
authors.initials: A
authors.lastname: Noro
authors.affiliation: 1 National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Harriet
authors.initials: H
authors.lastname: Finne-Soveri
authors.affiliation: 2 Department of Behavioural Sciences, University of Helsinki, Finland 3 Department of Epidemiology and Public Health, University College London, UK 4 Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.affiliation: 1 National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Sinervo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000488:Allied Health Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D005851:Geriatric Nursing / Q000706:statistics & numerical data*; D006801:Humans; D065102:Licensed Practical Nurses / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D009728:Nursing Assistants / Q000523:psychology / Q000706:statistics & numerical data; D016272:Occupational Health / Q000706:statistics & numerical data; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*; D016526:Workload / Q000523:psychology* / Q000706:statistics & numerical data; D017132:Workplace / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult