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Impact of organisational change on mental health:
a systematic review
Simon Grandjean Bamberger,
1
Anker Lund Vinding,
2
Anelia Larsen,
3
Peter Nielsen,
4
Kirsten Fonager,
5
Rene
´Nesgaard Nielsen,
6
Pia Ryom,
1
Øyvind Omland
1
ABSTRACT
Although limited evidence is available, organisational
change is often cited as the cause of mental health
problems. This paper provides an overview of the
current literature regarding the impact of organisational
change on mental health. A systematic search in
PUBMED, PsychInfo and Web of Knowledge combining
MeSH search terms for exposure and outcome. The
criterion for inclusion was original data on exposure to
organisational change with mental health problems as
outcome. Both cross-sectional and longitudinal studies
were included. We found in 11 out of 17 studies, an
association between organisational change and
elevated risk of mental health problems was observed,
with a less provident association in the longitudinal
studies. Based on the current research, this review
cannot provide sufficient evidence of an association
between organisational change and elevated risk of
mental health problems. More studies of long-term
effects are required including relevant analyses of
confounders.
INTRODUCTION
The last decade has brought increased attention to
the possible detrimental effects of work on mental
health. Existing research has focused on work strain
and occupational health and found consistent
evidence for associations.
1
Organisational change is
often cited as a harmful exposure but few studies
have been published to support this assumption.
2e6
One of the first studies on health risks was a study
from Finland
7
where they found that the risk of
health problems was at least two times greater
after major downsizing than after no downsizing.
A longitudinal study published few years later
found a significantly faster decline in self-rated
health even 4 years after downsizing among
employees who had experienced major down-
sizing.
8
The increase in health problems was
partially explained by concomitant increases in
physical demands and job insecurity and a reduc-
tion in job control.
89
Besides, downsizing and
repeated exposure to rapid personnel expansion
may predict long-term sickness absence and
hospital admissions.
10
Although these studies did
not specifically address mental health problems,
they should be interpreted within the framework of
work stress.
Employees are increasingly confronted with
frequent minor daily stressors related to changes in
technology and workplace practices as well as the
major upheavals of mergers, downsizing and
restructuring.
11 12
The imminence, duration and
temporal uncertainty surrounding events of change
can have a negative impact on employees.
13
Indeed,
the increased uncertainty regarding job future or
the direction of organisational change has been
suggested to be a principal cause of stress.
14 15
Others propose that organisational change acts as
a stressor through the individual’s negative
appraisal of the changes.
16
The well-documented risks that might follow
organisational changes are: intensification of job
strain, time pressure, reduction of social support,
lack of control and role ambiguity, which all have
been associated with mental health problems.
17e19
Two systematic reviews of psychosocial factors at
work and depression found evidence of a relation
between perceived psychosocial job strains and an
elevated risk of depressive symptoms or major
depressive episode.
20 21
Job insecurity has also been
consistently linked with detrimental mental health
effects in both meta-analysis and reviews.
22 23
Another potential factor affected by organisational
change: job dissatisfaction has shown strong asso-
ciations with depression and anxiety according to
meta-analysis.
24
Examining organisational change
as a potential work stressor yields a certain benefit
because organisational change is more tangible in
nature than for instance change in meaningfulness
of work is to the individual. Empirically it is
possible to determine whether or not a change has
happened and whether or not the employees are
feeling worse (or better) hereafter.
The health effects of workplace reorganisation in
intervention studies have previously been reviewed
by Egan et al
25
and Bambra et al
26
who found small
evidence for beneficial effects of increased employee
participation and control. However, the reorgan-
isation that occurs in intervention studies is typi-
cally aimed at addressing unhealthy environments,
which is different from the economic motives of,
for example, company downsizing.
Therefore, the objective of this paper is to
provide a systematic review of observational
studies on associations between organisational
change and employee mental health problems.
METHODS
The review was conducted in accordance with the
PRISMA statement.
27
Eligibility criteria
Participants
The study population of interest was individuals
employed in companies undergoing some sort of
organisational change. Relevant comparators were
1
Department of Occupational
Medicine, Aalborg Hospital,
Aarhus University Hospital,
Danish Ramazzini Center,
Aalborg, Denmark
2
Department of Quality, North
Denmark Region, Aalborg,
Denmark
3
Outpatient Department,
Aalborg Psychiatric Hospital,
Aalborg, Denmark
4
Department of Political
Science, Aalborg University,
Aalborg, Denmark
5
Department of Social Medicine,
Aalborg Hospital, Aalborg,
Denmark
6
Department of Business and
Management, Aalborg
University, Aalborg, Denmark
Correspondence to
Simon Grandjean Bamberger,
Department of Occupational
Medicine, Aalborg Hospital,
Aarhus University Hospital,
Havrevangen 1, Aalborg
DK-9000, Denmark; sigb@rn.dk
Accepted 4 March 2012
Published Online First
27 April 2012
592 Occup Environ Med 2012;69:592e598. doi:10.1136/oemed-2011-100381
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either employees not exposed to change or employees exposed to
different levels or types of changes.
Exposure
Our definition of organisational change was inspired by Raff-
erty’sdefinition of transformational change and refers to modifi-
cations made to the core systems of an organisation including
traditional ways of working, values, structure and strategy.
Transformational changes can either be changes to the normal
operational procedures (tasks, working hours) or changes in the
system itself (eg, downsizing, changing the organisation’s hier-
archy or incorporating a new organisational system).
28
Only
studies with organisational change explicitly listed as the
primary exposure were considered.
Outcome
This review was limited to studies examining mental health
problems, specifically with a focus on depression, anxiety and
stress. All health variables had to be measured by validated scale
or based on diagnosis made by a mental health professional.
Conversely studies where the outcome measured was readiness
for change, commitment to change, coping with change or job
satisfaction after change were not included.
Study design
We focused on observational studies and in the case of duplicate
publications of data from the same study, the paper with the
most relevant analysis and risk estimate was chosen.
Information sources
A series of computerised librarian-assisted systematic searches
were undertaken in PubMed, PsycInfo, Excerpta Medica Data-
base (EMBASE), EBSCO Business Source Complete and Web of
Knowledge using a broad search strategy to find peer-reviewed
articles of relevance. The searches were carried out using MeSH
terms (medical subject headings) or free text when no MeSH
term was available, and limited to English journal articles with
abstracts. To find the most recent articles not yet indexed by
MeSH terms, free text words were included for the period 2010-
search date. The searches were performed in October 2011.
Organisational change was operationalised in the search strategy
as ‘organizational change’,‘organizational innovation’,‘organi-
zational restructuring’,‘organizational transition’,‘work
change’,‘downsizing’and ‘reorganization’. The search terms for
mental health problems were ‘anxiety’,‘depression’,‘mental
disorders’,‘mental health’,‘stress’,‘occupational stress’and
‘psychological stress’. Search terms were derived from keywords
and titles of known core papers.
Study selection
Initial eligibility assessment of titles was performed by the first
author (SGB) under careful supervision of senior researcher ØO.
Both ØO and SGB screened articles by abstract. Difficult
judgements on relevance among reviewers were resolved by
consensus.
Data collection process
Data were extracted systematically from each study following
a standardised format. Data were extracted by SGB under
supervision of ØO. Information was extracted on: (1) Partici-
pants: (including nationality, sample size, type of organisations,
work type, controls); (2) Exposure (type of organisational
change); (3) Type of outcome measure (mental health problems
using validated scale or other type of diagnostic tool); and (4)
Study aim and design, follow-up time, statistical analysis used,
adjustments, bias and conclusion/results.
RESULTS
The search strategy yielded 5443 records, which were screened
for relevance based on title by one of the authors (SGB) and 5146
records were excluded. A duplicate search was performed and
further 88 articles were removed. At step two the remaining 209
records were screened by abstract by SGB and ØO, and 156
records were removed. The reasons for exclusion was missing or
ill-defined mental health outcome (57 studies), theoretical
articles (22 studies), lack of organisational change as exposure
(20 studies), intervention studies (17 studies), coping studies
(17 studies), duplicate publications of data from same study (five
studies), managers as study population (four studies) and
otherwise irrelevant study design (14 studies).
At step three 53 full text articles were assessed for eligibility
and 17 articles were included in the final synthesis. The reasons
for exclusions were missing or ill-defined mental health outcome
(22 studies), missing or ill-defined organisational change as
exposure (12 studies), and duplicate publications of data from
same study (two studies). The selection process is depicted in
figure 1.
Descriptive statistics of the 17 eligible studies included in the
review are listed in table 1. Six studies used a cross-sectional
design
29e34
and 11 were longitudinal.
2335e43
All but three
studies
23243
were published within the last 10 years. The
included studies involved 40 993 participants, excluding the
population and registry studies
30 35 37
which accounted for
a total of 142 110 individuals. Besides the three large studies of
the general working population, hospital staff and civil servants
were the most frequent study subjects (table 1).
Data were primarily collected by questionnaire, though two
studies were strictly registry based,
35 37
three studies used
structured interviews
29 30 41
and finally one study
36
collected
blood samples. The studies had a mean baseline response rate of
64%, with three studies below 50%
33943
and one longitudinal
study
3
was even below 20%; however, this was partly redeemed
by a high retention rate. The median follow-up time of the
longitudinal studies was approximately 2 years (ranging from 1
to 7). Four studies assessed participants twice
36 39e41
and four
studies
233843
assessed them thrice, while one study assessed
Figure 1 Flowchart of the number of articles in different stages of the
selection strategy.
Occup Environ Med 2012;69:592e598. doi:10.1136/oemed-2011-100381 593
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Table 1 Studies of organisational change and mental health problems
Cross-sectional studies
Author, year Sampling frame Participation Statistical analysis Adjusted/controlled for Exposure Outcome (p<0.05%)
Bourbonnais, 2005
29
Nurses (n¼2002) 77.1% (76% and 84%) Binominal regression Coping strategies, social support,
domestic load, type A behaviour,
personal and socio-occupational
characteristics (age, familial status,
seniority in the institution,
job status, work shift)
Restructuring Exposed PR 1.84 (1.56e2.16) of
psychological distress vs controls
Dragano, 2005
30
Population (n¼22 559) 61% Bivariate analyses Age, east/west residency, education,
occupational status, physical demands
and occupational hazards, weekly
working hours and job insecurity
Downsizing OR 1.53 (1.30e1.79) for exposed
men of increased symptom load.
OR 1.71 (1.43e2.06) for
exposed women
Greubel, 2011
31
Police employees (n¼1523) 76% ANOVA Age, gender and shift work Relocation, extensive changes:
downsizing and job changes
Anxiety [depression [
Karasek, 1990
32
White collar (n¼8504) 87% Mantel-Haenszel Age, sex Company initiated job changes Depression [
Pepper, 2003
33
State employees (n¼5889) 55% Hierarchical linear modelling Nothing Downsizing rate Mental health component 4
Perceived Stress 4
Verhaeghe, 2006
34
Hospitals (n¼2094) 51% Logistic regression Age, sex Situational changes in working
environment
Distress [
Longitudinal studies
Author, year Sampling frame Participation (follow-up time) Statistical analysis Adjusted/controlled for Exposure Outcome (p<0.05%)
Dahl, 2011
35
Population (n¼92 869) Registry based study (6 years) Multivariate analysis with
logit models
Age, gender, children (3 age
groups), marital status, stress
of parents and spouse, firm
tenure, wage, occupation
level, firm size, firm age and
industry classification
Organisational change Stress [
Ferrie, 1998
2
White collar (n¼7419) 73% (w3 years) ANOVA and logistic regression Age and employment grade Change in job description,
increase in workload and
pace of work
OR 1.56 (1.30e1.86) of minor
psychiatric morbidity for
exposed men. For women 4
Hansson, 2008
36
Hospital (n¼226) 74% (1 year) One-way and two-way ANOVA Nothing Reorganisation of work
systems
Biological stress markers 4
Kivimaki, 2007
37
Municipal employees (n¼26 682) Registry based study (7 years) Negative binominal regression Sex, age, education,
occupational status and
local government
Downsizing RR 1.49 (1.10e2.02) of psychotropic
drug use for exposed men. RR 1.12
(1.00e1.27) for exposed women
Loretto, 2010
3
Hospital (n¼5385) Baseline 18.4%, 84.3% retention
rate of 1st cohort, 76.7 of
2nd cohort, (w1 year)
Logistic regression Past GHQ casesness, personal
and biographic factors, objective
workplace and job characteristics
Perceived amount of
overall change
OR 1.21 (1.06e1.38) of GHQ caseness
when exposed to change
Moore, 2006
38
Manufacturing company (n¼460) 62%e74% (w2.5 years) ANCOVA Age, gender, education and
marital status
Downsizing Depression 4
Netterstrom, 2010
39
Civil servants (n¼685) 44% (2 years) Logistic regression Age, leadership, department
and occupation
Merger Depression 4
Probst 2003
40
State agency employees (n¼313) 63% (6 months) Multivariate ANOVA Nothing Restructuring Mental health index 4
Rohall, 2001
41
Military officers (n¼1536) 85% (w2 years) ANOVA Nothing Downsizing Anxiety [depression [
Vaananen 2011
42
Forest industry corporation
(n¼6511/4096)
82.3% (w4 years) Cox proportional hazard models Sex, age, marital status, occupational
status, sense of coherence and
job characteristics
Merger Increased risk of postmerger
psychiatric event HR 1.60 (1.19e2.14)
Woodward 1999
43
Hospital employees (n¼346) 47% (w2 year) ANOVA Nothing Re-engineering Anxiety [depression [
Where applicable ratios (HR, OR, RR and PR) and 95% CIs were available in the studies, these are listed.
Otherwise relevant significant results are reported using errors: Y¼decrease in symptoms; [¼increase in symptoms; 4no significant change in symptoms.
ANOVA, analysis of covariance; GHQ, General Health Questionnaire; PR, prevalence ratio.
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participants a total of four times.
42
The two remaining
longitudinal studies were registry based and contained annual
information from a 6-year
35
and 7-year period.
37
Various types of organisational change were assessed in the 17
studies ranging from major changes like downsizing, mergers
and reorganisations to lesser (though perhaps not less intrusive)
job content changes. Downsizing as the best described exposure
was analysed in two cross-sectional studies
30 33
and three
longitudinal studies.
37 38 41
The three longitudinal studies
37 38 41
examined different degrees of contact with downsizing over
time, that is, exposureeresponse relationships. One of the cross-
sectional studies
33
used downsizing ratio as the exposure that is
also a type of exposureeresponse study. The last downsizing
study
30
simply examined the exposureeeffect relationship of
downsizing on mental health. Two longitudinal studies examine
the effect of company mergers
39 42
while two other longitudinal
studies
335
examined the effect of multiple types of organisa-
tional changes both quantitatively and qualitatively. Restruc-
turing was assessed in one cross-sectional study
29
and three
longitudinal studies.
36 40 43
Finally, job changes were examined
by one longitudinal study
2
and three cross-sectional.
31 32 34
Only one study
42
used clinical psychiatric criteria (Interna-
tional Classification of Disease) to define the mental health
outcome. The remaining studies primarily relied on self-rated
questionnaires or registry information to determine the mental
health effects. Depression
31 32 38 39 41 43
and anxiety
31 41 43
were
the most specific mental health problems reported; however, all
the studies utilised different measurement scales. One study
37
used the ambiguous ‘psychotropic drug use’as mental health
indicator. Finally, a large part of the studies relied on the vague
term ‘distress’
29 33e36
or general measures of self-rated mental
health
23303340
as indicators of mental unbalance. Due to the
disparity of the outcome data extracted from the studies and
the heterogeneity of the outcome we chose not to perform
a meta-analysis or any other type of data synthesis.
Most of the studies
2329e32 34 35 37e39 42
adjusted results for
socio-demographic factors such as age, gender, marital status
and education. Work-related factors such as employment status
and different job characteristics were less commonly adjusted
for.
2329e31 35 37 39 42
Only three studies adjusted for personality
traits like type A behaviour,
29
neuroticism
3
or sense of
coherence.
42
Though there is evidence of exacerbated risk of
reoccurrence of mental health problems like depression,
44
only
three studies
34042
analysed for effects of previous mental health
status. Five studies
33 36 40 41 43
did not adjust results for any
possible confounders. Almost all of the studies lacked a non-
respondents analysis and for the longitudinal studies analysis of
attrition.
Associations between organisational change and mental
health problems were found in five
29e32 34
of the six cross-
sectional studies. The remaining study
33
found no association
between downsizing rate and mental health effects, but did
report lower mental health scores than national norm for all
participating study sites. The longitudinal studies presented
mixed results as only six out the 11 studies
3353741e43
found
associations between exposure to organisational change and
subsequent mental health problems, and one study
2
only found
significant effects for men.
Three
30 37 41
out of five of the studies on downsizing found an
association between mental health problems and exposure, and
of these two
37 41
studies were longitudinal. In two
29 43
out of
four studies on restructuring an effect on mental health was
observed, and of these studies one was longitudinal.
43
The two
negative studies
36 40
were both longitudinal. The effects of
mergers on mental health have been analysed in two studies.
39 42
Netterstrøm et al
39
did not find an association between mergers
and depression while Väänänen et al
42
found an association
between the exposure and postmerger psychiatric events.
Concerning the studies on exposure to multiple types of
organisational changes both studies
335
found an association
with negative health effects. All four studies on job
changes
2313234
found an association between the exposure and
mental health problems; however, in one study this association
was only evident for men.
DISCUSSION
Despite the broad search profile we found few studies which
analysed the association between organisational change and
mental health. A total of 17 studies were found eligible for this
review, surprisingly few considering the high number of records
initially evaluated by title, a finding experienced by others.
2 3
An
association between exposure to organisational change and
decreased mental health was found in 11 out of the 17 studies
with a less provident association in the longitudinal studies.
This might be explained by an observed acute short-term effect
on mental health during the actual change process that later
disappears or normalises over time such as the results by Dahl
suggest.
35
Another reason for the discrepancy could be that the
mental health impaired has already left work, or have not the
energy to participate in such a study. None of the longitudinal
studies provide drop-out analyses to counter this argument;
however, three studies
34042
at least take previous mental health
status into account. The prospective cohort study by Kivimäki
et al
37
included all employees who were at work before down-
sizing. The use of psychotropic drugs was examined in
employees who kept their jobs after major downsizing and
among those who lost their jobs during the downsizing,
compared with the employees who did not experience down-
sizing. This strategy specifically allowed examination of the role
of drop-out in the results.
An important aspect all but three of the studies
33 34 42
omit is
the employees’individual perception of change. The individual
categorisation of a specific organisational change as threatening
or not is connected to the psychological reaction. This process
can be influenced by several factors like coping strategies,
45
negative affectivity,
46
stress prior to change,
47
perceived social
support
48
or length of employment.
49
Personal characteristics
such as personality type, temperament, intelligence and genetic
constitution may all affect the way in which an individual
understands and reacts to life experiences. Mental health prob-
lems can take years to develop but the studies explore a snapshot
of a particular time period.
50
The effect of these confounding
factors may influence the estimate. Kivimäki et al
37
also notes
that survival bias may prevent detection of the adverse effects of
work, as major psychiatric disorders are commonly related to
work disability and, furthermore, a potential selective factor for
unemployment.
Recall bias may influence the results as employees who
experienced organisational change as traumatic might be more
inclined to remember the experience than employees who were
less affected. In relation to this, utilising self-reported data like
Verhaeghe et al
34
introduces the risk of circular reasoning;
51
those who rate the organisational change as stressful are the
stressed employees. In a broader perspective this approach
addresses the issue whether organisational change really is
harmful in itself, or if merely the employees’individual percep-
tion of the change makes it harmful. This type of bias is avoided
in population studies where the exposure (typically downsizing)
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is determined by registry data. These types of studies, however,
provide little information on the actual process of implementing
the organisational change. Research into change processes
suggests that the readiness for organisational change and the
subsequent healthiness of the change process may reduce the
experience of stress and increase the employees’abilities to cope
with the changes,
45 52 53
that is, mediate or even moderate the
change effect. Due to the number of different workplaces
included in the population studies no specific information on the
change process is reported. Furthermore, there is a risk of
misclassification when organisational change is assessed at
workplace level, as the particular change may have affected only
parts of the organisation. Therefore, it would be preferable to
use an independent measure of exposure in these studies.
Additional risk of misclassification is related to the possible
effect of preceding organisational changes. This could skew the
results in either way making the employees more vulnerable or
resilient to mental health problems.
38
Pepper et al
33
noted that
downsizing (as well as merger) is usually a change existing in
a complex network of events. This would add to the likelihood
of concomitant organisational changes such as restructuring or
contract changes making it harder to measure the effect of
downsizing as an independent exposure and increasing the risk of
misclassification. Another important aspect emphasised by Dahl
35
is the rationale behind companies’change in the first place. He
hypothesises that employees might be experiencing increased
stress because their firms are poor performers trying to regain
momentum by implementing organisational change. Thus, the
mental health problems are related to the companies’poor
performance and not the organisational change itself. If job inse-
curity is a central component in the pathway between organisa-
tional change and mental health problems as suggested,
14 15 23
then organisational changes in branches or industries with high
competition might be at further risk. Indeed, the results of Dahl
35
suggest that performance variables influence the effect of change
on stress; however, this needs to be further examined.
Limitations
The epidemiologic evidence this review provides is limited mainly
due to the low number of published relevant studies. Second, the
definition of organisational change is at best vague including both
major and minor changes to the organisation and work envi-
ronment. To some extent, we compare the effect of major
downsizing
30 33 37 38 41
and work schedule rearrangement
23234
as
being equal.
Subsequently, the definition of mental health as outcome is
also marred by confinements. Limiting mental health to minor
psychiatric disorders and not just mental discomfort narrows
the available material considerably. Numerous studies otherwise
relevant use job security, job satisfaction and morale as
psychological outcome which can be relevant in other contexts
but hardly describe mental health on a psychiatric level.
54e61
The most optimal mental health outcome would be diagnosis by
psychiatrist; however, we had to settle for registry data, self-
reported data or proxies like psychotropic drug use and stress
hormone levels.
Several of the studies were cross-sectional leaving out any
causality from the conclusions. However, it could be argued that
it is probable that poor psychosocial work environment could be
a reason to implement job changes and doubtful that the
employee’s mental health status is the cause of the major
changes like downsizing and mergers.
31
In three
3 36 38
of the included studies there is a high risk of
confounding. The study by Hansson et al
36
identifies hormone
markers of mental distress, but fails to define valid baseline
hormone levels. The analysis does not control for individual
differences in cortisol awakening response, seasonal and diurnal
variation, and lifestyle factors such as intake of coffee and
alcohol, smoking and physical exercise.
62
Moore et al
38
comment
in their discussion that due to small cell sizes, the results should
only be regarded as exploratory, which is a conclusion we
support. The study by Loretto et al,
3
otherwise solid, has a low
response rate (18.4%) and no analysis of non-responders. The
results might, therefore, be heavily biased. However, for the
majority of the studies
229313235373941e43
we have no reason
to believe that the results were confounded in such a degree that
the associations would be altered significantly. Taken this into
account and restricting the analyses to 14 studies with no major
confounding errors, 10 studies
29e32 34 35 37 41e43
report a positive
association between organisational changes and mental health,
one study
2
reported an association for men but not women and
finally three studies reported no association.
33 39 40
However,
this restriction would alter the effect on the estimate increasing
the positive association from w65% including all 17 studies to
w71% when limited to the 14 studies. Both numbers are
significantly lower than the ratio of 85% positive studies that
Quinlan and Bohle
23
reported in their 2009 review on health and
safety effects of downsizing and job insecurity. However,
Quinlan and Bohle
23
included a wider array of (softer) outcomes
and considered job insecurity an exposure in itself, and conse-
quently their ratio is not directly comparable with the ratio
found in this study.
CONCLUSION
The exposure variables are multi-dimensional, and have been
described, evaluated or measured differently. Multiple study
designs have been used and the size of the population analysed
has varied substantially. The outcomes in the analyses are
inconsistent and similar outcomes have been defined differently
among the studies. In 11 out of 17 studies an association
between organisational change and elevated risk of mental
health problems was observed, with a less provident association
in the longitudinal studies. Given the heterogeneity of the
studies, and the large number of cross-sectional studies this
What is already known on this subject
<The psychosocial work environment affects the mental health
of employees.
<Perceived psychosocial job strains elevate the risk of
depressive symptoms, anxiety and work stress.
<Organisational change is related to temporal increase of job
insecurity.
What this paper adds
<The first systematic review of the association between
organisational change and employee mental health problems.
<No convincing evidence of an association between these was
found; however, studies are scarce and results should be
considered with care.
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review cannot provide convincing evidence of an association
between organisational change and elevated risk of mental
health problems. The studies are scarce and the findings should
be considered with great care. Further analysing is needed to
determine if the observed effect is of temporary or of more
persistent nature. More studies with relevant analyses of
confounders are recommended.
Acknowledgements We wish to thank Hjørdis Rasmussen who helped with the
literature search.
Contributors SGB and ØO were responsible for the conduction of the study,
interpretation of the data, study analysis including figures and tables and writing the
report. Literature search was performed by SGB, ØO and Hjørdis Rasmussen. SGB is
the guarantor. All members of the GOPA group (Globalisation, organisational change
and psychosocial environment) participated in revising of the draft and all approved
the final version for publication. All the authors are members of the GOPA group and
ALV is the project leader.
Funding This research was financed by grant: 20080053113/12-2008-09 from the
Foundation for Research of Work Environment (Denmark). The funders played no part
in the conduct or reporting of the research.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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27, 2012 2012 69: 592-598 originally published online AprilOccup Environ Med
Simon Grandjean Bamberger, Anker Lund Vinding, Anelia Larsen, et al.
health: a systematic review
Impact of organisational change on mental
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