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Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data

  • I. E. H. Madsen (a1), S. T. Nyberg (a2), L. L. Magnusson Hanson (a3), J. E. Ferrie (a4) (a5), K. Ahola (a2), L. Alfredsson (a6) (a7), G. D. Batty (a4) (a8) (a9), J. B. Bjorner (a1), M. Borritz (a10), H. Burr (a11), J.-F. Chastang (a12) (a13), R. de Graaf (a14), N. Dragano (a15), M. Hamer (a4) (a16), M. Jokela (a17), A. Knutsson (a18), M. Koskenvuo (a19), A. Koskinen (a2), C. Leineweber (a3), I. Niedhammer (a12) (a13), M. L. Nielsen (a20), M. Nordin (a3) (a21), T. Oksanen (a2), J. H. Pejtersen (a22), J. Pentti (a2), I. Plaisier (a23), P. Salo (a2) (a24), A. Singh-Manoux (a4) (a25), S. Suominen (a26) (a27) (a28), M. ten Have (a14), T. Theorell (a3), S. Toppinen-Tanner (a2), J. Vahtera (a2) (a28) (a29), A. Väänänen (a2), P. J. M. Westerholm (a30), H. Westerlund (a3), E. I. Fransson (a3) (a6) (a31), K. Heikkilä (a2) (a32) (a33), M. Virtanen (a2), R. Rugulies (a1) (a34), M. Kivimäki (a2) (a4) (a35) and for the IPD-Work Consortium (a1)...
Abstract
Background

Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression.

Method

We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol.

Results

We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47–2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04–1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94–1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81–1.32).

Conclusions

Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
*Address for correspondence: I. E. H. Madsen, National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen Ø, Denmark. (Email: ihm@nrcwe.dk)
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Equal contribution as senior authors.

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References
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