title: The indirect association of job strain with long-term sickness absence through bullying: a mediation analysis using structural equation modeling.
abstract: In this longitudinal study the complex interplay between both job strain and bullying in relation to sickness absence was investigated. Following the "work environment hypothesis", which establishes several work characteristics as antecedents of bullying, we assumed that job strain, conceptualized by the Job-Demand-Control model, has an indirect relation with long-term sickness absence through bullying.
  
  
  
  The sample consisted of 2983 Belgian workers, aged 30 to 55 years, who participated in the Belstress III study. They completed a survey, including the Job Content Questionnaire and a bullying inventory, at baseline. Their sickness absence figures were registered during 1 year follow-up. Long-term sickness absence was defined as at least 15 consecutive days. A mediation analysis, using structural equation modeling, was performed to examine the indirect association of job strain through bullying with long-term sickness absence. The full structural model was adjusted for several possible confounders: age, gender, occupational group, educational level, company, smoking habits, alcohol use, body mass index, self-rated health, baseline long-term sickness absence and neuroticism.
  
  
  
  The results support the hypothesis: a significant indirect association of job strain with long-term sickness absence through bullying was observed, suggesting that bullying is an intermediate variable between job strain and long-term sickness absence. No evidence for the reversed pathway of an indirect association of bullying through job strain was found.
  
  
  
  Bullying was observed as a mediating variable in the relation between job strain and sickness absence. The results suggest that exposure to job strain may create circumstances in which a worker risks to become a target of bullying. Our findings are generally in line with the work environment hypothesis, which emphasizes the importance of organizational work factors in the origin of bullying. This study highlights that remodeling jobs to reduce job strain may be important in the prevention of bullying and subsequent sickness absence.
authors.affiliation: Department of Public Health, Ghent University, University Hospital, block 4k3, De Pintelaan 185, B 9000, Ghent, Belgium. heidi.janssens@ugent.be.
authors.forename: Heidi
authors.initials: H
authors.lastname: Janssens
authors.affiliation: Department of Public Health, Ghent University, University Hospital, block 4k3, De Pintelaan 185, B 9000, Ghent, Belgium.
authors.forename: Lutgart
authors.initials: L
authors.lastname: Braeckman
authors.affiliation: Department of Public Health, Ghent University, University Hospital, block 4k3, De Pintelaan 185, B 9000, Ghent, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: De Clercq
authors.affiliation: Research Centre Social approaches of Health, School of Public Health, Université libre de Bruxelles, B-1070, Bruxelles, Belgium.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Casini
authors.affiliation: Department of Public Health, Ghent University, University Hospital, block 4k3, De Pintelaan 185, B 9000, Ghent, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: De Bacquer
authors.affiliation: Research Centre Social approaches of Health, School of Public Health, Université libre de Bruxelles, B-1070, Bruxelles, Belgium.
authors.forename: France
authors.initials: F
authors.lastname: Kittel
authors.affiliation: Department of Public Health, Ghent University, University Hospital, block 4k3, De Pintelaan 185, B 9000, Ghent, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: Clays
mesh_terms: D000041:Absenteeism; D000328:Adult; D001530:Belgium; D058445:Bullying; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology / Q000523:psychology*; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D017132:Workplace / Q000523:psychology
keywords: Absenteeism; Bullying; Structural equation modeling