Hege R Eriksen
Uni Research

MS, PhD
37.42

Publications

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    ABSTRACT: Purpose The purpose of this study is to test if there is correspondence in stakeholders' assessments of health, work capacity and sickness certification in four workers with comorbid subjective health complaints based on video vignettes. Methods A cross sectional survey among stakeholders (N = 514) in Norway in 2009/2010. Logistic regression and multinomial logistic regression was used to obtain the estimated probability of stakeholders choosing 100 % sick leave, partial sick leave or work and the estimation of odds ratio of stakeholder assessment compared to the other stakeholders for the individual worker. Results The supervisors were less likely to assess poor health and reduced work capacity, and more likely to suggest partial sick leave and full time work compared to the GPs for worker 1. The public was less likely to assess comorbidity and reduced work capacity, and 6 and 12 times more likely to suggest partial sick leave and full time work compared to the GPs for worker 1. Stakeholders generally agreed in their assessments of workers 2 and 3. The public was more likely to assess poor health, comorbidity and reduced work capacity, and the supervisors more likely to assess comorbidity and reduced work capacity, compared to the GPs for worker 4. Compared to the GPs, all other stakeholders were less likely to suggest full time work for this worker. Conclusions Our results seem to suggest that stakeholders have divergent assessments of complaints, health, work capacity, and sickness certification in workers with comorbid subjective health complaints.
    Full-text · Article · Nov 2015 · Journal of Occupational Rehabilitation
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    ABSTRACT: Subjective health complaints (SHC), including nonspecific low back pain (LBP) as the most common single complaint, are the main reasons for long-term sick leave in many western countries. These complaints are often attributed to "stress". Cortisol has frequently been considered a biomarker reflecting sustained physiological HPA-axis activity, and is characterized by a high cortisol awakening response (CAR) and low evening values. The aim of the study was to investigate whether LBP patients had a normal characteristic cortisol profile, and whether possible deviations were related to coping and health. 305 patients on long-term sick leave for LBP participated in the study, and saliva cortisol profiles were compared to a reference population consisting of Danish workers. Cortisol was measured upon awakening, after 30 min, and in the evening. Additionally, patients answered questionnaires about SHC, fatigue, pain, coping, and social support. The patients showed a seemingly normal cortisol profile. However, CAR was larger among patients compared to the reference population. Patients with low cortisol reactivity had more SHC, pain, and fatigue, and those with higher evening cortisol reported higher scores on coping. The results are discussed in terms of theory, practical considerations, and possible mechanisms for the association between cortisol, health, and coping.
    Full-text · Article · Aug 2015 · Applied Psychophysiology and Biofeedback
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    Full-text · Dataset · Aug 2015
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    ABSTRACT: Musculoskeletal pain is associated with comorbidity, extensive use of health services, long-term disability and reduced quality of life. The scientific literature on effects of treatment for musculoskeletal pain is inconclusive. The purpose of this study is to compare a multidisciplinary intervention (MI), including use of the novel Interdisciplinary Structured Interview with a Visual Educational Tool (ISIVET), with a brief intervention (BI), on effects on mental and physical symptoms, functioning ability, use of health services and coping in patients sick-listed due to musculoskeletal pain. Two hundred eighty-four adults aged 18-60, referred to a specialist clinic in physical rehabilitation, were randomized to MI or BI. Patients received a medical examination at baseline and completed a comprehensive questionnaire at baseline, 3 months and 12 months. Both groups reported improvements in mental and physical symptoms, including pain, and improved functioning ability at 3 and 12 months, but the MI group improved faster than the BI group except from reports of pain, which had a similar course. Significant interactions between group and time were found on mental symptoms (anxiety (p < 0.05), depression (p < 0.01), somatization (p < 0.01)) and functioning ability (p < 0.01) due to stronger effects in the MI group at 3 months. At 3 and 12 months, the MI group reported significantly less use of health services (general practitioner (p < 0.05)). At 12 months, the MI group reported better self-evaluated capability of coping with complaints (p < 0.001) and they took better care of their own health (p < 0.001), compared to the BI group. The results indicate that the MI may represent an important supplement in the treatment of musculoskeletal pain.
    Full-text · Article · Apr 2015 · International Journal of Behavioral Medicine
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    ABSTRACT: Dysregulation of hypothalamus-pituitary-adrenal-activity has been associated with low back pain (LBP). The underlying mechanisms are not fully explained, but psychological mechanisms are considered important. In this study we examine the association between psychiatric disorders/symptoms measured with different instruments, and cortisol in a population with LBP. Participants (n=305) sick-listed 2-10 months due to non-specific LBP were included in the study. The screening instruments were the MINI-interview, HADS and HSCL-25. Saliva cortisol were measured on 2 consecutive days; at awakening, 30min later, at 15:00h and 22:00h. Results showed no associations between any of the main diagnostic categories from the MINI-interview, or anxiety/depression measured with HADS or HSCL-25 and cortisol. However, significant associations were found between low cortisol awakening response, low cortisol slope during the day and the somatization scale from HSCL-25 (dizziness or lack of energy, lack of sexual interest, the feeling that everything requires substantial efforts, difficulties to fall asleep, headache). The results indicate that cortisol, may not be directly associated with psychopathology, such as anxiety and depression, but instead are associated with one dimension of the psychopathology, namely lack of energy. This could help explain the inconsistency in the literature, and it should be explored further. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Apr 2015 · Psychiatry Research
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    Full-text · Dataset · May 2014
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    ABSTRACT: The aim of this study was to explore how functional ability, coping and health were related to work and benefit status three years after participating in a four-week inpatient interdisciplinary occupational rehabilitation program. The cohort consisted of 338 individuals (75% females, mean age 51 years (SD=8.6)) who three years earlier had participated in a comprehensive inpatient interdisciplinary occupational rehabilitation program, due to long-term sick leave. The participants answered standardised questionnaires about subjective health complaints, functional ability, coping, and current work and benefit status. The relationships between these variables were analysed using logistic regression analyses. At the time of the survey, 59% of the participants worked at least 50% of a full working day. Twenty-five percent received at least 50% disability pension and 16% received other benefits. Poor functional ability (OR 4.8; CI 3.0-7.6), poor general health (OR 3.8; CI 2.3-6.1), high level of subjective health complaints (OR 3.3; CI 2.1-5.2), low coping (OR 2.8; CI 1.7-4.4), poor physical fitness (OR 2.8; CI 1.7-4.6) and poor sleep quality (OR 2.4; CI 1.5-3.7) were associated with receiving allowances. In a fully adjusted model, only poor functional ability and low coping were associated with receiving allowances three years after occupational rehabilitation. Functional ability and coping were the variables most strongly associated with not having returned to work. More attention should therefore be paid to enhance these factors in occupational rehabilitation programs. Part-time work may be a feasible way to integrate individuals with reduced workability in working life, if the alternative is complete absence from work.
    Full-text · Article · Apr 2014 · Scandinavian Journal of Public Health
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    ABSTRACT: Objective The relationship between fatigue and pain has been investigated previously, but little is known about the prevalence of substantial fatigue in patients sick-listed for chronic low back pain (CLBP) and about how fatigue is associated with depression, pain, and long-term disability. The aims of the study were to examine the prevalence of substantial fatigue; associations between fatigue, depression, and pain; and whether fatigue predicted long-term disability.Methods Five hundred sixty-nine patients participating in a randomized controlled trial and sick-listed 2–10 months for LBP were included in the study. Cross-sectional analyses were conducted to investigate the prevalence and independent associations between fatigue, depression, pain, and disability, while longitudinal analyses were done to investigate the association between fatigue and long-term disability.ResultsThe prevalence of substantial fatigue was 69.7%. Women reported significantly more fatigue than men (t = −3.6, df = 551; P < .001). Those with substantial fatigue had higher pain intensity (t = −3.3, df = 534; P = 0.01), more depressive symptoms (t = −10.9, df = 454; P < 0.001), and more disability (t = −7.6, df = 539; P < 0.001) than those without substantial fatigue. Musculoskeletal pain and depression were independently associated with substantial fatigue. In the longitudinal analyses, fatigue predicted long-term disability at 3, 6, and 12 months' follow-up. After pain and depression were controlled for, fatigue remained a significant predictor of disability at 6 months' follow-up.Conclusions The vast majority of the sick-listed CLBP patients reported substantial fatigue. Those with substantial fatigue had more pain and depressive symptoms and a significant risk of reporting more disability at 3, 6, and 12 months. Substantial fatigue is disabling in itself but also involves a risk of developing chronic fatigue syndrome and long-term disability.
    Full-text · Article · Apr 2014 · Pain Medicine
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    Full-text · Dataset · Mar 2014
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    Silje Endresen Reme · Stein Atle Lie · Hege R Eriksen
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    ABSTRACT: Study Design. Cross-sectional study.Objective. To examine the sensitivity of two single-item questions compared to two longer questionnaires in screening for depression and anxiety in chronic low back pain (CLBP).Summary of Background Data. Psychosocial factors are frequently identified as risk factors for developing CLBP and as predictors for treatment, and questionnaires are often used to screen for this. Shorter instruments may be easier to use in clinical practice settings.Methods. 564 patients with 2-10 months of at least 50% sickness absence due to non-specific LBP were assessed for depression and anxiety with the Mini-International Neuropsychiatric Interview (MINI). Single questions for depression and anxiety from the Subjective Health Complaint Inventory, and two longer questionnaires, the Hospital Anxiety and Depression scale (HADS) and Hopkins Symptom Checklist (HSCL) were compared to MINI results, considered the gold standard in this study. Sensitivity and specificity of single item and longer questionnaires and ROC curves were compared.Results. According to MINI, the prevalence of anxiety disorders was 12%, while the prevalence of depressive disorders was 4%. The screening questions showed 95% sensitivity and 56% specificity for depressive disorders, and 68% sensitivity and 85% specificity for anxiety disorders. The longer questionnaire, HADS, showed 91% sensitivity and 85% specificity for depressive disorders, and 58% sensitivity and 83% specificity for anxiety disorders. HSCL showed 86% sensitivity and 74% specificity for depressive disorders, and 67% sensitivity and 87% specificity for anxiety disorders. For three of the anxiety disorders and two of the depressive disorders, a perfect sensitivity was found between the screening questions and the MINI interview.Conclusions. A single-item screening question was sensitive for depression, but less sensitive for anxiety. The screening questions further performed equal to two widely used questionnaires. Validation of these results in other populations and compared to other short-item screeners is needed.
    Full-text · Article · Jan 2014 · Spine
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    ABSTRACT: Objectives. The primary objective of this study was to explore whether general practitioners (GPs) in Norway, Sweden, and Denmark make similar or different decisions regarding sick leave for patients with severe subjective health complaints (SHC). The secondary objective was to investigate if patient diagnoses, the reasons attributed for patient complaints, and GP demographics could explain variations in sick leave decisions. Design. A cross-sectional study. Method. Video vignettes of GP consultations with nine different patients. Subjects. 126 GPs in Norway, Sweden, and Denmark. Setting. Primary care in Norway, Sweden, and Denmark. Main outcome measure. Sick leave decisions made by GPs. Results. "Psychological" diagnoses in Sweden were related to lower odds ratio (OR) of granting sick leave than in Norway (OR = 0.07; 95% CI = 0.01-0.83) Assessments of patient health, the risk of deterioration, and their ability to work predicted sick leave decisions. Specialists in general medicine grant significantly fewer sick leaves than non-specialists. Conclusion. Sick-leave decisions made by GPs in the three countries were relatively similar. However, Swedish GPs were more reluctant to grant sick leave for patients with "psychological" diagnoses. Assessments regarding health-related factors were more important than diagnoses in sick-leave decisions. Specialist training may be of importance for sick-leave decisions.
    Full-text · Article · Oct 2013 · Scandinavian journal of primary health care
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    ABSTRACT: Purpose: The aim of this study was to examine if age, gender, medical diagnosis, occupation, and previous sick leave predicted different probabilities for being at work and for registered sickness benefits, and differences in the transitions between any of these states, for individuals that had participated in an interdisciplinary work-related rehabilitation program. Methods: 584 individuals on long-term sickness benefits (mean 9.3 months, SD = 3.4) were followed with official register data over a 4-year period after a rehabilitation program. 66 % were female, and mean age was 44 years (SD = 9.3). The majority had a mental (47 %) or a musculoskeletal (46 %) diagnosis. 7 % had other diagnoses. Proportional hazards regression models were used to analyze prognostic factors for the probability of being on, and the intensity of transitions between, any of the following seven states during follow-up; working, partial sick leave, full sick leave, medical rehabilitation, vocational rehabilitation, partial disability pension (DP), and full DP. Results: In a fully adjusted model; women, those with diagnoses other than mental and musculoskeletal, blue-collar workers, and those with previous long-term sick leave, had a lower probability for being at work and a higher probability for full DP during follow-up. DP was also associated with high age. Mental diagnoses gave higher probability for being on full sick leave, but not for transitions to full sick leave. Regression models based on transition intensities showed that risk factors for entering a given state (work or receiving sickness benefits) were slightly different from risk factors for leaving the same state. Conclusions: The probabilities for working and for receiving sickness benefits and DP were dependent on gender, diagnoses, type of work and previous history of sick leave, as expected. The use of novel statistical methods to analyze factors predicting transition intensities have improved our understanding of how the processes to and from work, and to and from sickness benefits may differ between groups. Further research is required to understand more about differences in prognosis for return to work after intensive work-related rehabilitation efforts.
    Full-text · Article · Aug 2013 · Journal of Occupational Rehabilitation
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    ABSTRACT: The associations between socioeconomic status (SES), physical and psychosocial workload and health are well documented. According to The Cognitive Activation Theory of Stress (CATS), learned response outcome expectancies (coping, helplessness, and hopelessness) are also important contributors to health. This is in part as independent factors for health, but coping may also function as a buffer against the impact different demands have on health. The purpose of this study was to investigate the relative effect of SES (as measured by level of education), physical workload, and response outcome expectancies on subjective health complaints (SHC) and self-rated health, and if response outcome expectancies mediate the effects of education and physical workload on SHC and self-rated health. A survey was carried out among 1,746 Norwegian municipal employees (mean age 44.2, 81 % females). Structural Equation Models with SHC and self-rated health as outcomes were conducted. Education, physical workload, and response outcome expectancies, were the independent 28 variables in the model. Helplessness/hopelessness had a stronger direct effect on self-rated health and SHC than education and physical workload, for both men and women. Helplessness/hopelessness fully mediated the effect of physical workload on SHC for men (0.121), and mediated 30 % of a total effect of 0.247 for women. For women, education had a small but significant indirect effect through helplessness/hopelessness on self-rated health (0.040) and SHC (-0.040), but no direct effects were found. For men, there was no effect of education on SHC, and only a direct effect on self-rated health (0.134). The results indicated that helplessness/hopelessness is more important for SHC and health than well-established measures on SES such as years of education and perceived physical workload in this sample. Helplessness/hopelessness seems to function as a mechanism between physical workload and health.
    Full-text · Article · Jul 2013 · International Journal of Behavioral Medicine
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    ABSTRACT: Purpose: To evaluate whether information and reassurance about low back pain (LBP) given to employees at the workplace could reduce sick leave. Methods: A Cluster randomized controlled trial with 135 work units of about 3,500 public sector employees in two Norwegian municipalities, randomized into two intervention groups; Education and peer support (EPS) (n = 45 units), education and "peer support and access to an outpatient clinic" (EPSOC) (n = 48 units), and a control group (n = 42 units). Both interventions consisted of educational meetings based on a "non-injury model" and a "peer adviser" appointed by colleagues. Employees in the EPSOC group had access to an outpatient clinic for medical examination and further education. The control group received no intervention. The main outcome was sick leave based on municipal records. Secondary outcomes were self-reported pain, pain related fear of movement, coping, and beliefs about LBP from survey data of 1,746 employees (response rate about 50 %). Results: EPS reduced sick leave by 7 % and EPSOC reduced sick leave by 4 % during the intervention year, while sick leave in the control group was increased by 7 % during the same period. Overall, Rate Ratios (RR) were statistically significant for EPSOC (RR = .84 (C.I = 0.71-.99) but not EPS (RR = .92 (C.I = 0.78-1.09)) in a mixed Poisson regression analysis. Faulty beliefs about LBP were reduced in both intervention groups. Conclusions: Educational meetings, combined with peer support and access to an outpatient clinic, were effective in reducing sick leave in public sector employees.
    Full-text · Article · May 2013 · Journal of Occupational Rehabilitation

  • No preview · Article · Dec 2012
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    M Odeen · L H Magnussen · S Maeland · L Larun · H R Eriksen · T H Tveito
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    ABSTRACT: Background The workplace is used as a setting for interventions to prevent and reduce sickness absence, regardless of the specific medical conditions and diagnoses.AimsTo give an overview of the general effectiveness of active workplace interventions aimed at preventing and reducing sickness absence.Methods We systematically searched PubMed, Embase, Psych-info, and ISI web of knowledge on 27 December 2011. Inclusion criteria were (i) participants over 18 years old with an active role in the intervention, (ii) intervention done partly or fully at the workplace or at the initiative of the workplace and (iii) sickness absence reported. Two reviewers independently screened articles, extracted data and assessed risk of bias. A narrative synthesis was used.ResultsWe identified 2036 articles of which, 93 were assessed in full text. Seventeen articles were included (2 with low and 15 with medium risk of bias), with a total of 24 comparisons. Five interventions from four articles significantly reduced sickness absence. We found moderate evidence that graded activity reduced sickness absence and limited evidence that the Sheerbrooke model (a comprehensive multidisciplinary intervention) and cognitive behavioural therapy (CBT) reduced sickness absence. There was moderate evidence that workplace education and physical exercise did not reduce sickness absence. For other interventions, the evidence was insufficient to draw conclusions.Conclusions The review found limited evidence that active workplace interventions were not generally effective in reducing sickness absence, but there was moderate evidence of effect for graded activity and limited evidence for the effectiveness of the Sheerbrooke model and CBT.
    Full-text · Article · Dec 2012 · Occupational Medicine
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    ABSTRACT: Background. A diagnosis is the basis of medical action, the key to various social privileges and national sick leave statistics. The objectives of this study were to investigate which diagnoses general practitioners in Scandinavia give patients with severe subjective health complaints, and what kind of treatments they suggested. Methods. One hundred and twenty-six self-selected general practitioners in Scandinavia diagnosed nine patients, presented as video vignettes, in a cross-sectional study. The main outcome measures were primary, secondary, and tertiary diagnoses. Results. The nine patients got between 13 and 31 different primary diagnoses and a large variety of secondary and tertiary diagnoses. Fifty-eight percent of the general practitioners chose different primary and secondary diagnoses, indicating that they judged the patients to have multimorbid complaints. The most commonly recommended treatment was referral to a psychologist, a mix of psychological and physical treatments, or treatment by the general practitioner. Conclusion. Scandinavian general practitioners give a large variety of symptom diagnoses, mainly psychological and general and unspecified, to patients with severe subjective health complaints. Referral to a psychologist or a mix of psychological or physical treatments was most commonly suggested to treat the patients.
    Full-text · Article · Nov 2012
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    ABSTRACT: The aim of this study is to provide a narrative review of the current state of knowledge of the role of cognitive behavioral therapy (CBT) in the management of chronic nonspecific back pain. A literature search on all studies published up until July 2012 (PubMed and PsycINFO) was performed. The search string consisted of 4 steps: cognitive behavioral therapy/treatment/management/modification/intervention, chronic, back pain (MeSH term) or low back pain (MeSH term), and randomized controlled trial (MeSH term). The conclusions are based on the results from randomized controlled trials (RCTs) and reviews of RCTs. Interventions were not required to be pure CBT interventions, but were required to include both cognitive and behavioral components. The search yielded 108 studies, with 46 included in the analysis. Eligible intervention studies were categorized as CBT compared to wait-list controls/treatment as usual, physical treatments/exercise, information/education, biofeedback, operant behavioral treatment, lumbar spinal fusion surgery, and relaxation training. The results showed that CBT is a beneficial treatment for chronic back pain on a wide range of relevant variables, especially when compared to wait-list controls/treatment as usual. With regards to the other comparison treatments, results were mixed and inconclusive. The results of this review suggest that CBT is a beneficial treatment for chronic nonspecific back pain, leading to improvements in a wide range of relevant cognitive, behavioral and physical variables. This is especially evident when CBT is compared to treatment as usual or wait-list controls, but mixed and inconclusive when compared with various other treatments. Multidisciplinary and transdisciplinary interventions that integrate CBT with other approaches may represent the future direction of management of chronic back pain, with treatments modified for specific circumstances and stakeholders. There is a need for future intervention studies to be specific in their use of cognitive behavioral elements, in order for results to be comparable.
    Full-text · Article · Oct 2012 · Journal of Pain Research
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    ABSTRACT: Background Return to work (RTW) after long-term sick leave can be a long-lasting process where the individual may shift between work and receiving different social security benefits, as well as between part-time and full-time work. This is a challenge in the assessment of RTW outcomes after rehabilitation interventions. The aim of this study was to analyse the probability for RTW, and the probabilities of transitions between different benefits during a 4-year follow-up, after participating in a work-related rehabilitation program. Methods The sample consisted of 584 patients (66% females), mean age 44 years (sd = 9.3). Mean duration on various types of sick leave benefits at entry to the rehabilitation program was 9.3 months (sd = 3.4)]. The patients had mental (47%), musculoskeletal (46%), or other diagnoses (7%). Official national register data over a 4-year follow-up period was analysed. Extended statistical tools for multistate models were used to calculate transition probabilities between the following eight states; working, partial sick leave, full-time sick leave, medical rehabilitation, vocational rehabilitation, and disability pension; (partial, permanent and time-limited). Results During the follow-up there was an increased probability for working, a decreased probability for being on sick leave, and an increased probability for being on disability pension. The probability of RTW was not related to the work and benefit status at departure from the rehabilitation clinic. The patients had an average of 3.7 (range 0–18) transitions between work and the different benefits. Conclusions The process of RTW or of receiving disability pension was complex, and may take several years, with multiple transitions between work and different benefits. Access to reliable register data and the use of a multistate RTW model, makes it possible to describe the developmental nature and the different levels of the recovery and disability process.
    Full-text · Article · Sep 2012 · BMC Public Health
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    ABSTRACT: We examined scores on the Narcissistic Personality Inventory (NPI; Raskin & Terry, 1988) in relation to drive to work, enjoyment of and engagement in work, and professional position. A sample of 235 Norwegian bank employees completed a cross-sectional survey. We found that managers scored higher than subordinates on all measures. NPI scores correlated significantly and positively with drive, enjoyment of and engagement in work. Multiple regression analyses controlling for demographic and work variables showed that narcissism was significantly related to enjoyment of work and work engagement but unrelated to drive. Although the associations were rather weak, our findings support previous clinical observations of narcissistic traits in workaholics as well as findings in empirical research on narcissistic traits in managers.
    Full-text · Article · Jul 2012 · Social Behavior and Personality An International Journal

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