Kaisa Reuna

Background: Psychosocial job stressor studies usually examine one exposure at a time and focus on individual workers. In this study we examined the accumulation of work stressors in work units and its association with psychological distress (PD) on work-unit level. We also investigated whether high workplace social capital modifies the effect. Methods: We examined survey responses from 813 Finnish health and social services (HSS) work units, comprising 9 502 employees, in a cross-sectional study design. The survey was conducted in 2021. We calculated odds ratios for the association between accumulating job stressors and PD. We also analyzed the interaction between work stressors and the effect modification of high workplace social capital. Results: We found that HSS work units with high percentage of employees having high job demands and low rewards (OR 7.2, 95% CI 3.7, 13.8) have an increased risk of higher PD in the work unit. We also found indication of high social capital possibly modifying the effect of job stressors on PD. The results suggest that accumulated job stressors are associated with PD on work unit level, with excess risk for PD compared to the stressors acting separately. Conclusions: The results indicate that the effect of accumulating job stressors should be further studied on work-unit level. Participatory organizational-level and work-unit level interventions to tackle job stressors and to improve workplace social capital are warranted.

Psychosocial job stressors increase the risk of mental health problems for the workers in health and social services (HSS). Although previous studies suggest that the accumulation of two or more stressors is detrimental to mental health, few studies have examined the synergistic interaction of accumulating job stressors. We examined survey responses from 9855 Finnish HSS workers in a cross-sectional study design from 2021. We conducted an interaction analysis of high job demands, low rewards and low workplace social capital on psychological distress, focusing on the relative excess risk due to interaction (RERI). Additionally, we analysed the interaction of job demands, low rewards and COVID-19 burden (extra workload and emotional load). Our analysis showed that the total RERI for the job stressors on psychological distress was considerable (6.27, 95% CI 3.14, 9.39). The total excess risk was caused by two-way interactions, especially between high demands and low rewards and by the three-way interaction of all stressors. The total RERI for job demands, low reward and COVID-19 burden (3.93, 95% CI 1.15, 6.72), however, was caused entirely by two-way interaction between high demands and low rewards. Mental health interventions tackling high demands, low rewards and low social capital are jointly needed.