Psychosocial Workplace Factors and Healthcare Utilization: A Study of Two Employers

Document Type : Original Article

Authors

1 Harvard Center for Population & Development Studies, Cambridge, MA, USA

2 The University of Kansas Medical Center, Department of Health Policy and Management, Kansas City, KS, USA

3 Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA

4 Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA

5 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA

6 Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

7 RTI International, Research Triangle Park, NC, USA

8 Department of Economics, University of North Carolina Greensboro, Greensboro, NC, USA

9 Harvard Center for Population and Development Studies, T.H. Chan Harvard School of Public Health, Cambridge, MA, USA

Abstract

Background
While a large literature links psychosocial workplace factors with health and health behaviors, there is very little work connecting psychosocial workplace factors to healthcare utilization.

 
Methods
Survey data were collected from two different employers using computer-assisted telephone interviewing as a part of the Work-Family Health Network (2008-2013): one in the information technology (IT) service industry and one that is responsible for a network of long-term care (LTC) facilities. Participants were surveyed four times at six month intervals. Responses in each wave were used to predict utilization in the following wave. Four utilization measures were outcomes: having at least one emergency room (ER)/Urgent care, having at least one other healthcare visit, number of ER/urgent care visits, and number of other healthcare visits. Population-averaged models using all four waves controlled for health and other factors associated with utilization.

 
Results
Having above median job demands was positively related to the odds of at least one healthcare visit, odds ratio [OR] 1.37 (P < .01), and the number of healthcare visits, incidence rate ratio (IRR) 1.36 (P < .05), in the LTC sample. Work-to-family conflict was positively associated with the odds of at least one ER/urgent care visit in the LTC sample, OR 1.15 (P < .05), at least one healthcare visit in the IT sample, OR 1.35 (P < .01), and with more visits in the IT sample, IRR 1.35 (P < .01). Greater schedule control was associated with reductions in the number of ER/urgent care visits, IRR 0.71 (P < .05), in the IT sample.

 
Conclusion
Controlling for other factors, some psychosocial workplace factors were associated with future healthcare utilization. Additional research is needed.

Highlights

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Keywords

Main Subjects


  1. Joint ILO/WHO Committee on Occupational Health. Psychosocial Factors at Work: Recognition and Control. Occupational Safety and Health Series. 1984.
  2. Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. J Occup Environ Med. 2004;46(4):398-412.
  3. Cohidon C, Santin G, Chastang JF, Imbernon E, Niedhammer I. Psychosocial exposures at work and mental health: potential utility of a job-exposure matrix. J Occup Environ Med. 2012;54(2):184-191. doi:10.1097/JOM.0b013e31823fdf3b
  4. Wang HX, Leineweber C, Kirkeeide R, et al. Psychosocial stress and atherosclerosis: family and work stress accelerate progression of coronary disease in women. The Stockholm Female Coronary Angiography Study. J Intern Med. 2007;261(3):245-254. doi:10.1111/j.1365-2796.2006.01759.x
  5. Kasl SV. The influence of the work environment on cardiovascular health: a historical, conceptual, and methodological perspective. J Occup Health Psychol. 1996;1(1):42-56.
  6. Ishizaki M, Nakagawa H, Morikawa Y, Honda R, Yamada Y, Kawakami N. Influence of job strain on changes in body mass index and waist circumference--6-year longitudinal study. Scand J Work Environ Health. 2008;34(4):288-296.
  7. Nyberg ST, Heikkila K, Fransson EI, et al. Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies. J Intern Med. 2012;272(1):65-73. doi:10.1111/j.1365-2796.2011.02482.x
  8. Schnall PL, Dobson M, Rosskam E. Unhealthy Work: Causes, Consequences, Cures. 1st ed. Amityville, New York: Baywood Publishing; 2009.
  9. Lee S, Colditz G, Berkman L, Kawachi I. A prospective study of job strain and coronary heart disease in US women. Int J Epidemiol. 2002;31(6):1147-1153.
  10. Aboa-Eboule C, Brisson C, Maunsell E, et al. Job strain and risk of acute recurrent coronary heart disease events. JAMA. 2007;298(14):1652-1660. doi:10.1001/jama.298.14.1652
  11. Hwang WJ, Hong O. Work-related cardiovascular disease risk factors using a socioecological approach: implications for practice and research. Eur J Cardiovasc Nurs. 2012;11(1):114-126. doi:10.1177/1474515111430890
  12. Glozier N, Tofler GH, Colquhoun DM, et al. Psychosocial risk factors for coronary heart disease. Med J Aust. 2013;199(3):179-180.
  13. Boschman JS, van der Molen HF, Sluiter JK, Frings-Dresen MH. Psychosocial work environment and mental health among construction workers. Appl Ergon. 2013;44(5):748-755. doi:10.1016/j.apergo.2013.01.004
  14. Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol. 1998;3(4):322-355.
  15. da Costa BR, Vieira ER. Risk factors for work-related musculoskeletal disorders: A systematic review of recent longitudinal studies. Am J Ind Med. 2010;53(3):285-323. doi:10.1002/ajim.20750
  16. Stansfeld SA, Shipley MJ, Head J, Fuhrer R. Repeated job strain and the risk of depression: longitudinal analyses from the Whitehall II study. Am J Public Health. 2012;102(12):2360-2366. doi:10.2105/ajph.2011.300589
  17. Lang J, Ochsmann E, Kraus T, Lang JW. Psychosocial work stressors as antecedents of musculoskeletal problems: a systematic review and meta-analysis of stability-adjusted longitudinal studies. Soc Sci Med. 2012;75(7):1163-1174. doi:10.1016/j.socscimed.2012.04.015
  18. Bambra C, Egan M, Thomas S, Petticrew M, Whitehead M. The psychosocial and health effects of workplace reorganisation. 2. A systematic review of task restructuring interventions. J Epidemiol Community Health. 2007;61(12):1028-1037. doi:10.1136/jech.2006.054999
  19. Greenhaus JH, Allen T. Work-family balance: A review and extension of the literature. In: Quick JC, Tetrick LE, American Psychological A. Handbook of occupational health psychology. 2nd ed. Washington, DC: American Psychological Association; 2011:165-183.
  20. Hammer LB, Zimmerman KL. Quality of work life. APA handbook of industrial and organizational psychology, Vol 3: Maintaining, expanding, and contracting the organization. Washington, DC, US: American Psychological Association; 2011:399-431.
  21. Hammer LB, Cullen JC, Neal MB, Sinclair RR, Shafiro MV. The longitudinal effects of work-family conflict and positive spillover on depressive symptoms among dual-earner couples. J Occup Health Psychol. 2005;10(2):138-154. doi:10.1037/1076-8998.10.2.138
  22. Berkman LF, Buxton O, Ertel K, Okechukwu C. Managers' practices related to work-family balance predict employee cardiovascular risk and sleep duration in extended care settings. J Occup Health Psychol. 2010;15(3):316-329. doi:10.1037/a0019721
  23. Crain TL, Hammer LB, Bodner T, et al. Work-family conflict, family-supportive supervisor behaviors (FSSB), and sleep outcomes. J Occup Health Psychol. 2014;19(2):155-167. doi:10.1037/a0036010
  24. Moen P, Kelly EL, Tranby E, Huang Q. Changing work, changing health: can real work-time flexibility promote health behaviors and well-being? J Health Soc Behav. 2011;52(4):404-429. doi:10.1177/0022146511418979
  25. Stansfeld S, Candy B. Psychosocial work environment and mental health--a meta-analytic review. Scand J Work Environ Health. 2006;32(6):443-462.
  26. Solovieva S, Lallukka T, Virtanen M, Viikari-Juntura E. Psychosocial factors at work, long work hours, and obesity: a systematic review. Scand J Work Environ Health. 2013;39(3):241-258. doi:10.5271/sjweh.3364
  27. Bambra C, Gibson M, Sowden AJ, Wright K, Whitehead M, Petticrew M. Working for health? Evidence from systematic reviews on the effects on health and health inequalities of organisational changes to the psychosocial work environment. Prev Med. 2009;48(5):454-461. doi:10.1016/j.ypmed.2008.12.018
  28. Nieuwenhuijsen K, Bruinvels D, Frings-Dresen M. Psychosocial work environment and stress-related disorders, a systematic review. Occup Med (Lond). 2010;60(4):277-286. doi:10.1093/occmed/kqq081
  29. Aldana SG, Anderson DR, Adams TB, et al. A review of the knowledge base on healthy worksite culture. J Occup Environ Med. 2012;54(4):414-419. doi:10.1097/JOM.0b013e31824be25f
  30. Williams JA. Health-related employer support, recurring pain, and direct insurance costs for a self-insured employer. BMC Public Health. 2015;15:449. doi:10.1186/s12889-015-1784-4
  31. Tamers SL, Beresford SA, Thompson B, Zheng Y, Cheadle AD. Exploring the role of co-worker social support on health care utilization and sickness absence. J Occup Environ Med. 2011;53(7):751-757. doi:10.1097/JOM.0b013e318223d42f
  32. Ganster DC, Fox ML, Dwyer DJ. Explaining employees' health care costs: a prospective examination of stressful job demands, personal control, and physiological reactivity. J Appl Psychol. 2001;86(5):954-964.
  33. Modrek S, Hamad R, Cullen MR. Psychological well-being during the great recession: changes in mental health care utilization in an occupational cohort. Am J Public Health. 2015;105(2):304-310. doi:10.2105/ajph.2014.302219
  34. Hamad R, Modrek S, Cullen MR. The Effects of Job Insecurity on Health Care Utilization: Findings from a Panel of U.S. Workers. Health Serv Res. 2016;51(3):1052-1073. doi:10.1111/1475-6773.12393
  35. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973;51(1):95-124.
  36. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1-10. doi:10.2307/2137284
  37. Leibowitz AA. The demand for health and health concerns after 30 years. J Health Econ. 2004;23(4):663-671. doi:10.1016/j.jhealeco.2004.04.005
  38. Bray JW, Kelly EL, Hammer LB, et al. An Integrative, Multilevel, and Transdisciplinary Research Approach to Challenges of Work, Family, and Health. Methods Rep RTI Press. 2013. doi:10.3768/rtipress.2013.mr.0024.1303
  39. Kossek EE, Hammer LB, Kelly EL, Moen P. Designing Work, Family & Health Organizational Change Initiatives. Organ Dyn. 2014;43(1):53-63. doi:10.1016/j.orgdyn.2013.10.007
  40. Kossek EE, Moen P, Wipfli B, et al. The Work, Family & Health Network Intervention: Core Elements and Customization for Diverse Occupational Health Contexts. In: Leong F, Eggerth D, Chang D, Flynn M, Ford K, Martinez R, eds. Occupational Health Disparities among Racial and Ethnic Minorities: Formulating Research Needs and Directions. Washington DC: APA; 2017.
  41. Berkman LF, Liu SY, Hammer L, et al. Work-family conflict, cardiometabolic risk, and sleep duration in nursing employees. J Occup Health Psychol. 2015;20(4):420-433. doi:10.1037/a0039143
  42. Documentation of the Work, Family, & Health Network (WFH) Field Operations. http://projects.iq.harvard.edu/files/wfhn/files/mop_2015_10_30.pdf?m=1446830151.   Accessed December 1, 2015. Published 2015.
  43. Bray JW, Zarkin GA, Miller WR, et al. Measuring economic outcomes of alcohol treatment using the Economic Form 90. J Stud Alcohol Drugs. 2007;68(2):248-255.
  44. Thomas LT, Ganster DC. Impact of family-supportive work variables on work-family conflict and strain: A control perspective. J Appl Psychol. 1995;80(1):6-15. doi:10.1037/0021-9010.80.1.6
  45. Belkic KL, Landsbergis PA, Schnall PL, Baker D. Is job strain a major source of cardiovascular disease risk? Scand J Work Environ Health. 2004;30(2):85-128. doi:10.5271/sjweh.769
  46. Karasek RA. Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Q. 1979;24(2):285-308. doi:10.2307/2392498
  47. Theorell T, Karasek RA. Current issues relating to psychosocial job strain and cardiovascular disease research. J Occup Health Psychol. 1996;1(1):9-26.
  48. Netemeyer RG, Boles JS, McMurrian R. Development and validation of work–family conflict and family–work conflict scales. J Appl Psychol. 1996;81(4):400-410.
  49. The General Social Survey, 1972–2002: Cumulative Codebook and Data File. National Opinion Research Center and University of Chicago; 2003.
  50. Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184-189.
  51. Division of Nutrition PA, and Obesity, National Center for Chronic Disease Prevention and Health Promotion,. About BMI for Adults. 2015; http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html. Accessed 3/25/2015.
  52. Lee S, Almeida DM, Berkman L, Olson R, Moen P, Buxton OM. Age differences in workplace intervention effects on employees' nighttime and daytime sleep. Sleep Health. 2016;2(4):289-296. doi:10.1016/j.sleh.2016.08.004
  53. Moen P, Kelly EL, Lee SR, et al. Can a flexibility/support initiative reduce turnover intentions and exits? Results from the work, family, and health network. Soc Probl. 2017;64(1):53-85. doi:10.1093/socpro/spw033
  54. Marino M, Killerby M, Lee S, et al. The effects of a cluster randomized controlled workplace intervention on sleep and work-family conflict outcomes in an extended care setting. Sleep Health. 2016;2(4):297-308. doi:10.1016/j.sleh.2016.09.002
  55. Kelly EL, Moen P, Oakes JM, et al. Changing work and work-family conflict: evidence from the work, family, and health network. Am Sociol Rev. 2014;79(3):485-516. doi:10.1177/0003122414531435
  56. Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 national and state costs of excessive alcohol consumption. Am J Prev Med. 2015;49(5):e73-e79. doi:10.1016/j.amepre.2015.05.031
  57. StataCorp. Statistical Software: Release 14. College Station, TX: StataCorp LP; 2015.
  58. Berkman LF, Liu SY, Hammer L, et al. Work-family conflict, cardiometabolic risk, and sleep duration in nursing employees. J Occup Health Psychol. 2015;20(4):420-433. doi:10.1037/a0039143
  59. Dembe AE, Yao X, Wickizer TM, Shoben AB, Dong XS. Using O*NET to estimate the association between work exposures and chronic diseases. Am J Ind Med. 2014;57(9):1022-1031. doi:10.1002/ajim.22342
  60. Meyer JD, Cifuentes M, Warren N. Association of self-rated physical health and incident hypertension with O*NET factors: validation using a representative national survey. J Occup Environ Med. 2011;53(2):139-145. doi:10.1097/JOM.0b013e318203f220
  61. Petrou S, Murray L, Cooper P, Davidson LL. The accuracy of self-reported healthcare resource utilization in health economic studies. Int J Technol Assess Health Care. 2002;18(3):705-710.
  62. Roberts RO, Bergstralh EJ, Schmidt L, Jacobsen SJ. Comparison of self-reported and medical record health care utilization measures. J Clin Epidemiol. 1996;49(9):989-995.
  63. Bhandari A, Wagner T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev. 2006;63(2):217-235. doi:10.1177/1077558705285298
  • Receive Date: 19 April 2017
  • Revise Date: 22 September 2017
  • Accept Date: 05 November 2017
  • First Publish Date: 01 July 2018