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Emotional demands at work and risk of long-term sickness Continuation........
The RERI was less than 0 for influence (–0·25 [–0·28 to –0·23) and physical demands (–0·41 [–0·45 to –0·36]), indicating less than additive interaction (ie, antagonism) in the double-exposed groups (table 3). When estimates were stratified by high and low values of the other four work environment factors, high emotional demands were associated with a higher risk of long-term sickness absence in all strata (appendix p 9). In sensitivity analyses, the synergistic interaction between high emotional demands and low possibilities for development remained robust when follow-up was for 1 year instead of 10 years (appendix p 11) and when the estimates were not adjusted for other working conditions (appendix p 12). When working conditions were dichotomized by a median split, the synergistic interaction between high emotional demands and low possibilities for development disappeared (appendix p 13). The synergistic interaction between high emotional demands and high role conflicts remained robust when working conditions were dichotomized by median split (appendix p 13), but not when follow-up was limited to 1 year (appendix p 11) and when estimates were not adjusted for other working conditions (appendix p 12). Discussion In this study based on a cohort of 1521 352 employed individuals in Denmark, men, and women working in emotionally demanding occupations was found to be at increased risk of long-term sickness absence compared with those in occupations with low emotional demands.
Additive interaction analyses indicated synergism (ie, a higher than additive risk), for double exposure to high emotional demands and low possibilities for development (that remained robust in two of three sensitivity analyses) and double exposure to high emotional demands and high role conflicts (that remained robust in one of three sensitivity analyses). With regard to high emotional demands and low influence and high emotional demands and high physical demands, we identified antagonism (ie, a lower than additive risk associated with double exposure). These findings support smaller-scale studies that have reported that high emotional demands at work are a risk factor for long-term sickness absence.4 As we used a job-exposure matrix-based approach, our findings are unlikely to be affected by reporting bias. To our knowledge, with 1·5 million participants and more than 11·9 million person-years of follow-up, this study is by far the largest study so far on emotional demands and work absence. The next largest study was based on 26 410 participants, with 1002 incident long-term sickness absence cases during 22466 person-years of follow-up.4 To our knowledge, this study is the first to examine whether influence, possibilities for development, role conflicts, and physical demands at work modify the higher risk of long-term sickness absence in relation to high emotional demands at work.
Previous observational studies have shown that leadership quality did not substantially buffer the adverse effect of high emotional demands on levels of antidepressant treatment27 and sickness absence.8 However, work-related goal attainment seemed to moderate the negative effect of high emotional demands on employee wellbeing,28 and finding work emotionally enriching and meaningful seemed to buffer the adverse effect of high emotional demands on exhaustion.29 Our results indicate that high emotional demands at work might be particularly hazardous in the presence of low possibilities for development and high role conflicts. Low possibilities for development might inhibit employees from learning and acquiring and using new skills that could help with their handling of high emotional demands. Acquiring and using new skills might also increase job satisfaction and partly compensate for the strain of high emotional demands. Role conflicts might elicit negative emotions and add another type of emotional strain to a work situation already characterized by high emotional demands.
Furthermore, role conflicts might arise from having too little time or resources to do the job properly, which might add further strain and exacerbate the negative effects of high emotional demands High emotional demands are part of the job in several occupations, such as teaching and health care, and reducing emotional demands might be difficult. Our findings suggest that workplace interventions in emotionally demanding occupations that aim to increase possibilities for the development of the employees and to prevent or reduce role conflicts might be a successful approach for reducing long-term sickness absence. For the combinations of high emotional demands and low influence, and high emotional demands and high physical demands, the RERI was less than 0, indicating antagonism instead of synergism. However, it is important to note that both low influence (model two; table 2) and high physical demands (models two and three; table 2) were associated with an increased risk of long-term sickness absence compared with high influence and low physical demands, respectively.
Thus, our analyses do not indicate that low influence and high physical demands are not of importance in risk of long-term sickness absence, but instead indicate that low...
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