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REPORT 2020:2
Psychosocial Work
Environment:
Health and Well-being
– two systematic reviews
PSYCHOSOCIAL WORK ENVIRONMENT: HEALTH AND WELL-BEING
– TWO SYSTEMATIC REVIEWS
Government commission to compile knowledge about factors that
engender healthy and well-functioning workplaces A2018/01349/ARM
REPORT 2020:2
ISBN 978-91-986142-1-3
Swedish Agency for Work Environment Expertise
Box 6051, SE-800 06 Gävle
Telephone: 00 46 2614 84 00, Email: info@mynak.se
www.sawee.se
REPORT 2020:2
Psychosocial Work
Environment:
Health and Well-being
– two systematic reviews
This report is written by:
Per Lytsy
Emilie Friberg
Foreword
In June 2018, the Swedish government commissioned the Swedish Agency for Work Environment
Expertise to compile knowledge about factors that engender healthy and well-functioning work-
places (A2018/01349/ARM). According to the commission, a special focus was to be placed
on the organizational and social work environment. To carry out the commission, the Agency
assigned a number of researchers from different universities and research institutions to prepare
literature reviews in four areas: the physical work environment, focusing particularly on workload
ergonomics; leadership; work organization; and the psychosocial work environment.
In the present report we present the compilation of knowledge about the psychosocial work
environment. The compilation was prepared by Dr Per Lytsy, MD, PhD and Dr Emilie Friberg,
PhD, at Karolinska Institutet. At the Agency’s behest, Prof. Gunnar Bergström at Gävle Universi-
ty and Karolinska Institutet carried out quality assurance of the literature review, and Malin Alm-
stedt Jansson, librarian at Gävle University, assisted our external experts in dening and gathering
scientic supporting documentation for the literature review.
The authors of the literature review entitled the Psychosocial Work Environment: Health and
Well-being conducted two systematic literature reviews of systematic reviews that, on an overall
level, present results from association or intervention studies on psychosocial work environment
factors and health. The results show not only that there are many systematic reviews in this area,
but also that few systematic literature reviews include questions and conclusions that describe
the psychosocial work environment in terms of healthy or protective factors. The authors also
observe that one and the same association can be described as either a risk factor or a protective
factor; consequently, the results reect the questions and perspectives that have predominated in
the research to date.
The authors of the literature review chose their own theoretical and methodological
points of departure and are responsible for the results and the conclusions presented in
the literature review.
I would like to express my deep gratitude to our external researchers, our quality assurance
reviewer and our colleagues at the Agency who contributed to the preparation of this valuable
literature review.
The literature review is published on the Agency’s website and in the printed Literature
reviews series.
Nader Ahmadi
Director-General
Our process model for systematic reviews
To support the researchers in their preparation of this literature review,
the Swedish Agency for Work Environment Expertise developed a
system for the systematic creation of literature compilations in its area
of responsibility. It contains systems of preparation, literature search, re-
levance assessment, quality assurance and the presentation of studies and
results. It also includes the Agency’s process management and university
library support, as well as external quality assurance.
At the Swedish Agency for Work Environment Expertise, Nadja
Grees and, subsequently, Annette Nylund supervised the preparation
of the literature review. Susanne Lind administrated the process,
while a communications team consisting of Pernilla Bjärne, Sverre
Lundqvist, Liv Nilsson, Joakim Silfverberg and Camilla Wengelin
managed the text preparation, layout, accessibility considerations and
planning of webinars and podcasts.
Summary
This report contains two systematic literature
reviews that bring together existing know-
ledge in the form of previously published
systematic reviews. The report is intended to
provide knowledge in relation to the question
of what creates healthy, vital workplaces. The
two systematic reviews compile the exis-
ting research on the factors in psychosocial
work-environment contexts. The rst con-
tains compiled knowledge from association
studies, that is, research about associations
between psychosocial work environment
factors and health outcomes for individuals
and for organizations. The second review
contains compiled knowledge about the ef-
fects of psychosocial workplace interventions,
typically based on experimental research.
The results show that there is a signicant
amount of compiled research on associations
between psychosocial work-environment
factors in the form of work-related stress
and mental or physical health issues. There
is also compiled knowledge about associa-
tions between work conicts or bullying and
the development of mental health issues in
particular. Only a few systematic literatu-
re reviews have expressly investigated and
described ndings assuming that psychosocial
work-environment factors can be protective,
or health-promoting, factors.
Regarding compiled research on interven-
tions designed to inuence the psychosocial
work environment and create well-functioning
workplaces, there is a great deal of compiled
knowledge showing the effects of vario-
us stress reduction and stress management
programmes. Most interventions are desig-
ned either to improve the participants’ health
by inuencing their work situation and thus
reducing their stress, or to increase the parti-
cipants’ ability to cope with their stress. There
is also compiled knowledge about other types
of generally health-promoting interventions
designed to increase well-being, reduce or ma-
nage mental health issues, or improve sleep.
Much of the existing compiled knowledge
indicates that the psychosocial work environ-
ment is important for the individual and that
it is possible, through active workplace inter-
ventions, to promote employee health.
Aim
In the report, the signicance of the psycho-
social work environment is investigated with
two questions: The rst question considers
what existing knowledge is available in the
form of relevant, well-conducted systematic
reviews concerning the associations between
psychosocial work-environment factors and
various health-related outcomes for indivi-
dual employees and for the organization.
The second question considers what existing
knowledge is available in the form of relevant,
well-conducted systematic reviews that have
investigated the effects of workplace inter-
ventions designed to inuence the psycho-
social work environment and health-related
outcomes for the employees and for the orga-
nization. The inclusion of systematic reviews
that have looked at actual workplace situations
(that is, associations between psychosocial
work-environment factors and health) and
active interventions carried out at workplaces
(effects of workplace interventions) provide a
more comprehensive view of the total know-
ledge base as regards what has been studied
in relation to the question of what creates
healthy, well-functioning workplaces.
Method
Both questions have been answered through
searching and compiling existing knowledge
in the form of systematic literature reviews.
The search for systematic reviews was carried
out in three electronic databases. Systematic
reviews that were deemed relevant and of
good or moderate quality were included, while
those deemed of low quality were excluded.
The results of the systematic reviews included
are also presented descriptively and organised
by theme, creating an overview of the resear-
ch that has been carried out and compiled on
psychosocial work-environment factors and
related interventions.
Question 1. Results from
association studies
A total of 42 relevant, well-conducted sys-
tematic literature reviews were included for
the question concerning associations between
psychosocial work-environment factors and
different health-related outcomes for the
employees and for the organization. Only a
few systematic reviews had formulated their
question or presented parts of their results
in a way that psychosocial work-environment
factors were expressed as healthy or protective
factors. The absolute majority of the systema-
tic reviews included had studied associations
between psychosocial work-environment
factors and the risk of developing health
issues or consequences of health issues, such
as long-term sick leave. The types of psycho-
social work environment factors studied were
primarily different types of strain resulting
from stress (high demands, low control, low
support, low compensation, injustice, social
climate, etc.), and conict and bullying. About
half of the systematic reviews included had
studied associations between various aspects
of the psychosocial work environment and
mental health issues (primarily stress-related
conditions, depression, anxiety and sleep pro-
blems), and the other half had studied asso-
ciations between physical health issues (pri-
marily cardiovascular disease, musculoskeletal
complaints, and pain). Most of the systematic
reviews based their results and conclusions on
studies of employees in general; however, ve
systematic reviews focused on healthcare and
veterinary care personnel, while one or two
focused on workers in industry, police and
correctional care, and occupational groups
involved in disaster relief and rescue opera-
tions. Only one systematic review investiga-
ted associations between the psychosocial
work environment and outcomes on the
organizational level.
Question 2. Results from
intervention studies
Altogether, 44 relevant, well-conducted
systematic literature reviews were included
for the question concerning the effects of
workplace interventions, that is, interventions
intended to inuence the psychosocial work
environment and health-related outcome
for employees and for the organization. The
types of interventions conducted involved
mainly different forms of stress-reduction or
stress-management programmes, or different
forms of health-promoting programmes,
either targeting certain health issues speci-
cally or more general in nature. There were
Number of systematic literature reviews of association studies, by type of psychosocial exposure and
outcome
Type of psychosocial exposure Type of outcome
Mental health,
sleep, cognition
Physical health Work-related out-
come (individual)
Work-related out-
come (organization)
Stress 19 19 5 1
Bullying 6 1
also accounts of interventions to counter
bullying, or to promote social support, work
efciency enhancement and the psychosocial
climate at the workplace. A very large quantity
of outcome measures were identied, and
several of the authors of the included syste-
matic reviews described having had difculty
nding comparable outcome measures in the
primary studies. The large majority of out-
come measures concerned mental or general
health; however, stress- and work-related
measures (on the individual or organizational
level) also occurred frequently. The majority
of the included systematic literature reviews
reported several outcomes.
While a large proportion of the systema-
tic literature reviews included interventions
aimed at a general group of working people,
many were carried out on healthcare workers
specically. Other occupational groups in-
volved in the systematic reviews were police
and correctional ofcers, and teachers. In
the systematic reviews, effects were found
from different types of stress-reducing
interventions for stress, well-being and sleep.
Reviews that analysed the effect of interven-
tions designed to inuence the dimensions
of demand and control found favourable
health effects. Several of the systematic re-
views presented greater intervention effects
if the intervention had been implemented
on multiple levels in the workplace − such
as both the individual and the organizational
levels − simultaneously.
Conclusions
There was a fair amount of compiled rese-
arch on both psychosocial work-environ-
ment factors and their links to well-being
and to mental and physical health issues, as
well as on workplace interventions that exa-
mined the effects of psychosocial workpla-
ce interventions. Particularly prominent was
the compiled research on stress and bully-
ing, and on stress-reduction and stress-ma-
nagement interventions. Few of the associ-
ation studies looked at the significance of
psychosocial workplace factors expressed
as health-promoting or protective factors.
Interventions, on the other hand, are “by
Number of systematic literature reviews on effects of psychosocial workplace interventions, by type of
intervention and outcome
Type of intervention Type of
outcome
Mental health General health,
physical health
Stress and
mindful-
ness
Work-re-
lated
outcome
(individual)
Work-related
outcome
(organization)
Stress manage-
ment/ reduction
13 6 9 4 5
Bullying
1 1
Social support
1 3 3
Work efciency enhance-
ment, adaptations 2 4 2 2
Health, mental health,
well-being, and return to work
(RTW)
11 6 1 4 4
Psychosocial climate
3 1 1 2
nature” to a larger extent studying “positive”
outcomes, such as improvements in various
health outcomes. Much of the knowledge
that exists indicates that the psychosocial
work environment is signicant for individu-
als and that through active workplace inter-
ventions it is possible to promote the health
of individuals and of organizations.
Table of contents
1. Introduction and aim 1
Aim 1
Reading instructions 2
Background 2
2. Method 9
Questions 9
Literature search 9
Inclusion and exclusion criteria 11
Method of selection and relevance assessment 12
Method of quality assessment 12
Method of compilation of results 13
3. Results 15
Results of Question 1: Associations between psychosocial work-environment factors and health/
well-being 15
Results of Question 2:
Effects of psychosocial workplace interventions t 21
4. Discussion 29
Discussion of results 29
Discussion of method 30
5. Conclusions 33
Conclusions based on the analysis of systematic literature reviews that investigated associations
between psychosocial work-environment factors and health/well-being 33
Conclusions based on the analysis of systematic literature reviews that investigated the effects of
psychosocial workplace interventions 33
6. General recommendations 35
Employers 35
Decision-makers, public authorities and researchers 35
7. References 37
8. Appendices 41
Appendix 1 Included studies for research question 1 - associations 42
Appendix 2 Included studies for research question 2 - interventions 56
Appendix 3 Excluded studies based on relevance, research question 1– associations 69
Appendix 4. Excluded studies based on high risk of bias (assessed using AMSTAR) – research
question 1: associations 71
Appendix 5 Excluded studies based on relevance, research question 2 – interventions 75
Appendix 6 – Excluded studies based on high risk of bias (assessed using AMSTAR) – research
question 2: interventions 78
Appendix 7 – Literature searches 81
References 87
1. Introduction and aim
This report was prepared within the fra-
mework of a government commission to
the Swedish Agency for Work Environment
Expertise to compile knowledge about factors
that engender healthy, well-functioning work-
places (Ref. No. A2018/01349/ARM).
The report’s aim is to provide a general
overview of existing knowledge on associa-
tions between psychosocial workplace factors
and the health and well-being of individuals
and organizations, and to compile existing
knowledge on the effects of psychosocial
workplace interventions.
The report contains the results of two
separately conducted systematic literatu-
re reviews investigating two closely related
issues. One of these sought to establish what
knowledge exists on associations between
the psychosocial work environment and the
health and well-being of individuals and of
organizations. The other sought to establish
what knowledge exists about the effects of
psychosocial workplace interventions desig-
ned to improve some aspect of individual or
organizational health.
Investigating two closely related issues –
actual workplace circumstances (i.e., associa-
tions between psychosocial work-environment
factors and health), and the effects of active
interventions (effects of workplace interven-
tions) − yields a more comprehensive view
of the total knowledge base of what has been
studied in relation to the question of what
creates workplaces that foster healthy, conten-
ted employees.
In this context, “knowledge” refers to
published systematic literature reviews de-
emed to be of sufcient quality that investi-
gated a specic issue by compiling the results
of several primary studies. The authors of a
systematic review may draw different conclu-
sions. These might be that there is knowledge
on a particular issue and that is presented as
a conclusion. This conclusion could be, for
example, that there is an association between
a certain workplace factor and a particular
health outcome, or that there is a particular
effect of a psychosocial workplace interven-
tion. It is also possible to reach the conclusion
that one can, with some certainty, establish
that there is no association or effect.
Sometimes, the underlying scientic data
of a systematic review is insufcient for
drawing any conclusion in relation to the
question posed. This could be because the
number of primary studies is too small, or the
quality of such primary studies is considered
inadequate. In such cases there is a scientic
knowledge gap. Since new primary studies are
emerging all the time, conclusions from syste-
matic reviews need to be updated, particularly
if formulated knowledge gaps are based on
older systematic reviews.
The present report does not present a
conclusive synthesis of the current resear-
ch situation. That was not the aim of these
systematic literature reviews nor would it have
been possible to do in a comprehensive way,
as the various included reviews investigated
a range of different research questions. The
systematic reviews that we found and that
we included are considered to have been well
conducted and relevant to the topic of the
systematic reviews. We have not evidence-gra-
ded the results of the included systematic
reviews or assessed how transferable their
conclusions are to a Swedish context.
Aim
The aim of the project involves two questions:
1. What systematic literature reviews exist
that have investigated associations between
psychosocial work-environment factors
and health/well-being?
1Report 2020:2
1. What systematic literature reviews ex-
ist that have investigated the effects of
psychosocial workplace interventions?
The report was prepared in accordance with
an established transparent scientic method.
In addition, the aim was to ensure that the
description given by the report of methods
and results would be accessible not only for
researchers but also for others, such as deci-
sion-makers and employers.
Reading instructions
The structure and presentation of the present
report conforms to an established structure
consisting of a background, method des-
cription, results presentation and discussion,
conclusions, and recommendations. The back-
ground and method sections present the rea-
soning behind the questions posed, the details
of how the questions have been delimited
and what requirements have been imposed to
assess whether an article should be included
or excluded.
The results section presents the identied
articles. The included systematic reviews are
summarized in result tables and in text. The
results for the rst question are presented
rst, followed by the results for the second
question. The discussion section is divided
rst into a discussion of results, followed by
a discussion of method, the latter containing
a discussion of methodological problems
and how they have been handled. Following
conclusions and general recommendations
are appendices, for those readers who wish to
know more. These contain tables with infor-
mation extracted from the individual systema-
tic reviews included in the two compilations,
as well as lists of the articles that were read in
full but excluded.
Readers who are primarily interested in the
results of the systematic reviews are advised
to go directly to the results section (Section
3) and the conclusions (Section 5). Wherever
possible, we have endeavoured to ensure that
the texts can be read independently.
Background
Concerning health-promoting and
protective factors, and risk factors:
the salutogenic and the pathogenic
perspectives
It is well known that the work environment is
signicant for both the health and well-being
of the employees and the health and pro-
ductivity of the company or organization.
The commission that the Swedish Agency
for Work Environment Expertise received
from the Swedish government was to com-
pile knowledge about factors that engender
healthy, vital workplaces; that is, knowledge
of what promotes healthy, satised person-
nel and sustainable and well-functioning
organizations. Accordingly, the description
of the assignment stressed the “salutogenic
perspective”; that is, an approach that focu-
ses on factors that lead to and sustain health,
rather than precipitate illness. Based on this
perspective, different aspects and factors in
the work environment can be protective or
health-promoting factors – promoting both
the individual’s health and the organization’s
well-being and goals. The traditional per-
spective, however, has long been that of the
pathogenic (illness-precipitating) perspective;
that is, an approach that investigates different
factors’ associations to and signicance for
the development of health issues and illness
in the individual. This approach investiga-
tes work-environment factors that are to be
considered risk factors contributing to the
development or maintaining of health issues.
Research on workplace interventions − that
is, interventions designed to inuence the work
environment or work content − have, on the
other hand, in the absolute majority of cases,
the explicit aim of improving something, which
is closer to the salutogenic perspective. Effects
of intervention studies are also measured to
a considerably greater extent in the form of
factors or outcomes that pertain to health and
well-being − such as job satisfaction, improved
health or lower sickness absence.
2Report 2020:2
Scientically there is no sharp distinction
between the salutogenic and the pathogenic
perspectives. Associations between work-en-
vironment factors and health and illness can
be described as both health-promoting and
risk factors. The presence of certain factors
promotes health, while the absence of said
factors promotes the development of health
issues and sickness. How associations between
work-environment factors or effects of
workplace interventions are described is also
a consequence of the question that a research
intends to investigate and how the informa-
tion that is analysed is dened and measured.
In other words, it is possible to describe one
and the same association as a risk factor if we
have shown that high psychosocial work-en-
vironment stress co-varies with some adverse
health outcome, and as a health-promoting
factor if we have shown that low psychosocial
work-environment stress co-varies with some
favourable health outcome, such as the ab-
sence of illness or sick leave. The concept of
“risk factor” is well established in medical re-
search. A risk factor predicts, that is, provides
information about, future health conditions,
such as health issues or sickness. There are
causal risk factors, which cause or contribute
to future health issues, and non-causal risk
factors, which provide information about fu-
ture health issues but are not part of the cau-
sative chain. For the concept of “health-pro-
moting factor”, no analogous terminology has
been established. We have chosen to consider
a health-promoting factor as corresponding to
a risk factor; that is, a health-promoting factor
is a factor that predicts a favourable health
outcome without further specifying whether
or not the health-promoting factor is a part
of the causative chain.
In this report we have included research
regardless of whether it takes a salutogenic or
a pathogenic approach. The results, therefore,
will reect the manner in which researchers
approached the question and presented the
results in already published research.
The concept of “psychosocial”:
established scientic models
Common to the two questions investigated
in the present report is the psychosocial work
environment. The concept of “psychoso-
cial” refers to an approach whereby indivi-
duals are considered simultaneously from a
psychological and a social perspective. People
have different experiences and psychological
backgrounds, and in a social context, such as
at a workplace, individuals will react and have
various attitudes to things and events happe-
ning around them. The interaction between a
workplace and the tasks performed there, and
individuals’ own personalities and those of
their colleagues, creates a psychosocial work
environment. It is common to distinguish
between the psychosocial work environme-
nt and the physical work environment. The
Swedish Work Environment Authority’s Regu-
lations on promoting a healthy work environ-
ment talk about the organizational and social
aspects of the work environment, rather than
the psychosocial work environment (20). The
Regulations state that managers and supervi-
sors should know how to prevent unhealthy
workloads and victimization. The distinction
between organizational factors and psychoso-
cial aspects is not self-evident.
In this report we have taken a highly inclu-
sive approach to what psychosocial work-en-
vironment factors or psychosocial workplace
interventions are. It has to be something that
could affect the individual psychologically or
socially and it has to be workplace-related.
The psychosocial work environment is the
environment in which the individual is active
and expected to perform his or her employ-
ment duties. However, we have not included
studies investigating the effects of different
forms of workplace organization or different
leadership styles, even if such aspects could
conceivably inuence the psychosocial work
environment. The exception is systematic
reviews that, within the framework of their
question, included studies investigating speci-
c leadership or support interventions within
the framework of a limited intervention.
3Report 2020:2
In studies investigating the work environ-
ment and its effects on health and well-being,
researchers typically employ scientic models.
Such models usually describe a theoretical
framework based on notions of how a certain
environmental aspect or other exposure could
inuence work and health-related outcomes.
A number of scientic models considering
different aspects of the psychosocial work
environment were developed several decades
ago and have been investigated in hundreds
of studies. One of these is the demand–con-
trol model (Demand–Control Model, Kara-
sek & Theorell) (21, 22). The model is based
on the premise that the emotional demands
placed on an employee are balanced by the
decision latitude – that is the control and
ability to make decisions that the employee also
has. High levels of demands in combination
with little decision latitude results in a tense work
situation with higher risk of health issues. The
model has subsequently been supplemented with
a further dimension, namely, social support (23,
24), considered as being able to buffer the effects
of high levels of demands in a workplace.
Another well-established model is the ef-
fort–reward imbalance model (Effort–Reward
Imbalance Model, Siegrist) (25, 26). This
model is based on the idea that there has to
be balance in the work situation, such that a
person’s effort is counterbalanced by salary
and by individual and social recognition.
Common to these models is the idea that
high levels of demands are not necessarily
negative for the individual and for employee
health, if the demands are counterbalanced by
other factors, such as the ability to make deci-
sions, support, recognition and compensation.
Yet another proposed model is the job
demands–resources model (Job Demands–
Resources Model, Bakker) (27), which is an
attempt to combine aspects of the above-na-
med models into a more exible model.
Other known psychosocial stresses include
victimization, sexual harassment and bullying,
which can affect individuals or several persons
in a social group. Harassment and bullying
can be subtle – or more obvious, through so-
cial exclusion, insulting comments, pestering,
and in extreme cases, violence or threats of
violence. The psychosocial work environment
can be affected by harassment by individuals
in management or leadership positions or by
colleagues. Harassment and other psychoso-
cial stresses can also come from the target
group or the customers or clientele with
which the organizations are involved.
Another relevant model is the organiza-
tional justice model (Organizational Justice,
Greenberg) concerns individuals in a work
environment who perceive the company or
the organization as fair in various respects. It
can inuence both job satisfaction and job
performance (28, 29).
In this report we have chosen to include re-
search on known and named scientic models
of stress and other psychosocial difculties in
working life. We have also chosen to include
research that investigates psychosocial expo-
sures that are measured as individual factors –
that is, that are outside the framework of esta-
blished models. As mentioned above, however,
we have imposed certain delimitations. Even
if the organization and leadership styles of a
particular operation can directly and indirectly
affect the psychosocial work environment to
a great extent, studies of associations/effects
between organization and leadership and dif-
ferent outcomes have not been included. Nor
have we included articles that have studied
associations between the physical work en-
vironment, such as working position, workload
or ergonomics and health, even though it is
possible that the psychosocial work environ-
ment can be considered a partial component
of or mechanism in these relationships. These
delimitations were imposed partly for reasons
of time and resources and partly because the
importance of leadership, work organization
and the physical work environment are studied
in separate projects within the framework of
the larger government commission on Healthy
and Well-Functioning Workplaces that is being
carried out by the Swedish Agency for Work
Environment Expertise.
4Report 2020:2
The psychosocial work environment as
exposure and as outcome
In scientic studies of associations between
factors, such as scientic studies of effects of
interventions, the concepts of “factors”, “in-
terventions” and “outcomes” are dened in
advance. It is important to do this in systema-
tic reviews as well – such as the two that are
part of the present report – partly because it
determines how the database searches will be
done and partly because it guides the assess-
ment of whether the references and articles
found are relevant to the question. How the
search and the inclusion were carried out is
described in detail in the method section.
This report presents the results of two
systematic literature reviews, both of which
analyse and compile earlier research that has
been compiled in published systematic litera-
ture reviews. One of the reviews focuses on
the associations between psychosocial work
environment factors and the health of the
individual or the organization. The second
systematic review in this report focuses on the
effects of psychosocial workplace interven-
tions. Since the concept of “psychosocial” has
no single unambiguous denition or content,
the search strategy was designed, in collabora-
tion with a search specialist, on the basis of a
number of terms that relate to some psycho-
social component or that describe some
form of intervention that could conceivably
impact individuals and groups. The terms we
have used are named in the method section
and in the appendix giving search strategy
details (Appendix 7).
As regards outcomes, we have included
research that studied associations or effects
on both individual work and health-related
outcomes, as well as outcomes on the orga-
nizational level. Just which outcomes were
studied was determined partly by the rese-
archers who carried out the primary studies
and partly by the researchers who compiled
the results of the primary studies on the
basis of a given question.
There is no single way to measure the
psychosocial work environment; rather a
multitude of questions and instruments that
measure aspects of it. Such an aspect could
be, for example, job satisfaction. It would be
reasonable to assume that individuals who are
satised with their jobs have a better psycho-
social work environment than individuals
who are not satised with their jobs. Similarly,
there are several estimates of employees’ sa-
tisfaction, attitudes and behaviour that could
be interpreted as proxy or surrogate vari-
ables representing different aspects of the
psychosocial work environment. It is worth
noting that surrogate variables of this type
could be both exposures and outcomes in a
studied model.
Common outcomes have to do with pe-
ople’s health. Health can be estimated using
different types of self-assessment instruments
such as quality of life, or specic aspects of
physical or mental health. Other ways of mea-
suring health are based on clinical assessments
by physicians, psychologists or other experts
– through diagnoses given, for example. It is
also possible to investigate the consequences
or effects of health and health issues, for ex-
ample, as healthy presence or sick leave, early
retirement or death.
Most of the outcomes mentioned are
measured on the individual level, but it is also
possible to measure outcomes on the organi-
zational level — for example, in the form of
productivity, staff turnover, protability, etc.
In the two systematic reviews that are
examined in this report we have chosen to in-
clude, very broadly, different types of conce-
ivable psychosocial exposures and outcomes.
When examining the results, it is important to
consider what model the researchers have in-
vestigated. Using a particular stress model, for
example, it is possible to investigate whether
the stress in a workplace is related to the
employees’ job satisfaction. In this case, the
stress is to be considered as the exposure, and
the outcome as the employees’ job satisfac-
tion. Another researcher might be interested
in investigating possible connections between
job satisfaction as a surrogate measure of
the psychosocial work environment and the
5Report 2020:2
employee’s mental well-being. In such a mo-
del, job satisfaction would be considered to be
the exposure.
The outcomes deemed relevant are those
that relate to the health of the individual. On
the other hand, we did not include studies
that considered different types of behaviour
or lifestyles as outcomes (physical activity, diet
and drinking habits, tobacco use). Nor did we
consider studies in which only the outcomes
of work-related injuries or violence and crime
were included.
In the case of the assessment of systema-
tic literature reviews that compiled research
investigating the effect of interventions, the
intervention must have occurred either at or
in close proximity to the workplace. One im-
portant criterion is that the intervention must
have been initiated by or have involved the
employer. Studies of care interventions that
are implemented within the framework of the
regular healthcare system were not conside-
red, unless they were part of a more extensi-
ve workplace intervention. This means that
compiled research on interventions delivered
through workplace healthcare providers was
included if such interventions were conside-
red as corresponding to intervention projects.
One challenge has been, just as with the
systematic review of association studies, to
dene what we mean by a psychosocial work-
place intervention. Ultimately it was necessary
to instead consider what it is not. Such deli-
mitations are, of course, open to question.
For example, we have chosen not to include
systematic reviews that only include primary
studies of yoga interventions or physical acti-
vity, but have included studies about mindful-
ness interventions and other stress-reducing
programmes if such programmes occurred at
or in close proximity to the workplace.
A detailed review of the inclusion and ex-
clusion criteria of the two systematic reviews
can be found in the method section.
Methods to investigate associations
and effects
When we compile existing knowledge about
psychosocial factors that create workplaces
for healthy and satised employees and for
less well-functioning workplaces, we need to
consider many factors – such as the question
and model that the researchers investigated
and how they chose to measure the outcomes.
It is also important to assess what type of
research has been compiled and how it affects
the reliability of the results. In work environ-
ment research it is rarely possible to conduct
strictly experimental investigations – that is,
implement research in which the employees
are randomly assigned to different work-en-
vironment aspects. Randomized, double-blin-
ded, placebo-controlled studies are common
in medicine, and it is that type of study that
provides best condence when research
wishes to make conclusions about cause and
effect – that is, draw the conclusion that a
certain exposure will give rise to a certain
outcome.
This report presents the results of two
systematic literature reviews of systematic
reviews. One includes systematic literature
reviews that investigated associations between
psychosocial work-environment factors and
different aspects of the health and well-be-
ing of the individual and the organization.
Questions that relate to associations are
usually investigated in observational studies
in which exposed individuals are compared
with non-exposed individuals – for example,
those with a stress-lled job have a high risk
of developing poor health, compared with
those who do not have stress-lled jobs. In
observational studies, the participants are
not randomly assigned to a certain exposure;
instead, they themselves, or other factors,
“determine” this. Thus, there is always a risk
that the groups that are compared through
selection mechanisms differ in more respects
than the exposure being investigated – in this
case, exposure to stress. A researcher can try
to consider such group differences – so-called
confounders – when carrying out the study
6Report 2020:2
and the data analysis, but even when that is
done, many are hesitant to draw conclusions
about causal effects on the basis of obser-
vational studies. Therefore, when the results
of association studies are presented, resear-
chers rarely talk about the effect, but rather
about associations that can be described as
health-promoting or protective factors and
as risk factors, respectively, depending on the
nature of the association and the outcome.
There are also other aspects that should be
taken into account when assessing research
that has investigated associations between
exposures, and one of these is time. Usual-
ly, it is reasonable to assume that the longer
a person is exposed to a risk factor (or to a
protective factor), the greater signicance it
has for the outcome. This applies particularly
to situations in which the outcome is serious
consequences such as illness, long-term sick
leave, or death. Studies that measure exposure
in terms of time before measuring outcomes
can provide information about the temporal
association between exposure and outcome.
If the exposure occurs before the outcome,
this strengthens condence that the associa-
tion may be causal; that is, that the exposure
wholly or partly causes the outcome. Studies
that investigate associations and outcomes
over a longer period, however, are often ex-
pensive and time-consuming. In research on
associations we often also nd cross-sectional
studies. In this type of study, data is gathered
about exposure and outcomes at one and the
same time, which means that it can be dif-
cult to establish an association that exists over
time. Therefore, cross-sectional studies are
not usually considered reliable for establishing
causal relationships.
Regarding the compilation of research
on effects of interventions, such effects are
generally investigated in experimental studies,
in which a group of participants receive an
intervention and another receives a control
intervention. In work-environment contexts
it is rarely or never possible to give the con-
trol group a placebo– that is, a condition that
actually has no active effect. Instead, compa-
risons are often made with the situation prior
to the intervention – that is, before compared
with after. Other conceivable control condi-
tions for the group that does not receive any
intervention are a wait list, other interventions
or no intervention at all. The results must be
interpreted with respect to the control con-
dition used. When compiling research that
was carried out using an experimental design,
researchers often express their conclusions in
terms of effects; that is, that an intervention
causes a certain outcome – that the interven-
tion had a certain effect.
This report presents the results of published
systematic literature reviews and includes both
observational studies and controlled studies.
When assessing the conclusions of the syste-
matic literature reviews presented, we should
consider the type of primary studies that are
included and analysed in each particular case.
7Report 2020:2
8Report 2020:2
2. Method
1 PEO is an acronym for Population, Exposure and Outcome, while PICO stands for Population, Intervention, Control (comparative intervention) and Outco-
me. PEO and PICO are established methods of structuring both the research question, to facilitate the planning of the search strategy, and the relevance
assessment.
This report is based on two systematic litera-
ture reviews of systematic reviews. A systema-
tic literature review is a compilation of resear-
ch results from primary studies, and these two
systematic reviews are, thus, a compilation of
existing compiled knowledge. The results in
this type of systematic review of other syste-
matic reviews are not combined into a single
result or conclusion, since the identied and
included systematic reviews may have fully
or partially investigated different questions,
in different populations, and combined their
results in different ways.
The result instead constitutes an overview
– a general map – of the areas researchers
have investigated and for which they have
compiled knowledge. Each systematic litera-
ture review included could, depending on its
particular question, have reached a conclu-
sion that knowledge either exists or that the
knowledge situation is inadequate. There may
be several reasons why the knowledge situa-
tion regarding a particular question is deemed
inadequate – for example, there were too few
relevant primary studies of sufcient quality;
the results of the primary studies included are
contradictory; or the reliability of the conclu-
sions is deemed low owing to methodological
shortcomings in the underlying study data.
Since new research is being initiated conti-
nuously, conclusions from older systematic
literature reviews have to be re-examined in
the light of new research results. This applies
particularly if an older systematic literature
review assessed the knowledge situation as
inadequate because of a dearth of primary
studies – a state of affairs that can change
within just a few years.
The results in this report have not been evi-
dence-graded; in other words, the reliability of
the included systematic literature reviews has
not been assessed. Nor has it been assessed
whether results and conclusions are relevant
to or transferable to Swedish circumstances.
Such analyses and assessments are possible,
but did not fall within the projects’ time and
resource constraints.
Questions
The report has two questions:
1. What systematic literature reviews exist
that have investigated associations between
psychosocial work-environment factors
and health/well-being on the individual
and the organizational levels?
1. What systematic literature reviews ex-
ist that have investigated the effects of
psychosocial workplace interventions?
Literature search
Prior to the literature search the questions
were rened in accordance with the so-called
PEO and PICO structure.1 Special empha-
sis has been given to designing the search
strategies to ensure they would be broad and
inclusive. The search strategies were designed
in consultation with an information specialist.
Population (P)
The population in both of the questions
consists of individuals of active working age
(18–64) who have a job/a place of work. The
population may also include individuals who
have a health issue but can work; however, the
population may also consist to a certain extent
of individuals who are on sick leave.
9Report 2020:2
Exposure (E, in PEO)
In Question 1, the psychosocial work-en-
vironment factors constitute “exposures”.
While these may be of widely varying charac-
ter, they are all aspects that are of relevance
in how individuals and groups perceive the
psychosocial work climate and the work
environment. The search strategy is based on
several known terms and theories of psycho-
social work-environment exposure, as both
established index concepts and key concepts
in the area.
Intervention (I, in PICO)
In Question 2, the effects of psychosocial
workplace interventions are investigated. The-
se interventions may be aimed at individuals,
groups, managers or the entire organization.
The search strategy employed is based
on several known psychological, social and
psychosocial interventions as well as on esta-
blished key concepts and search terms.
Control (C, in PICO)
In Question 2, the purpose is to investigate
the effects, which usually requires comparison
of an intervention group with a control group
that does not receive any intervention. Since
the search is limited to systematic reviews that
themselves included primary studies based
on their own search strategies, no require-
ments are imposed as to a control group. The
control conditions in the included systematic
reviews have been imposed by the authors of
these articles.
Outcome (O)
No requirements have been imposed as to
specic outcomes for Question 1 and 2 other
than that they should be relevant for the indi-
vidual from a health perspective (for example,
well-being, quality of life, job satisfaction,
self-rated health, morbidity, etc.) or for the
organization from a health/sustainability per-
spective (staff turnover, sick leave).
Based on PICO a search strategy was de-
signed. Table 1 shows examples of the central
search terms for each question.
The literature search was conducted in the
databases Pubmed, PsycINFO and Cinahl on
11 June 2019 and it generated 2,777 referen-
ces for Question 1 and 3,056 references for
Question 2. No time limitations were used.
Over and above the literature searchers in
databases, systematic reviews that the authors
searched for manually or had knowledge of
were added subsequently. This group also
includes studies that were obtained via the
search strategy for one of the questions, but
that upon examination and assessment were
included in the second.
Table 1: Examples of search concepts/terms for Exposure and for Intervention in PEO and PICO, respectively.
For the full search strategy, see Appendix 7.
Question 1
Psychosocial work-environment exposures
Question 2
Psychosocial workplace interventions
job strain, work demand, lack of control, work control, job
control, decision latitude, work inuence, demand resource,
effort reward, time pressure, work overload, coping, social
support, support system, social network, emotional support,
interpersonal relation, interaction, work justice, injustice, sa-
tisfaction, boredom, discrimination, harassment, workplace
conict, workplace violence, bullying, homophobia, racism,
sexism, role ambiguity, role conict, work role, working hour,
working time, organizational change
psychosocial support systems, health promotion, counsel-
ling, mentoring, psychotherapy, social work, social support,
mentoring/organization and administration, education,
psychological adaptation, prevention of bullying
10 Report 2020:2
Inclusion and exclusion criteria
To further rene the selection after the scre-
ening and relevance assessment of the publi-
cations, , delimiting, inclusion and exclusion
criteria were established.
Common delimitations for Questions 1
and 2
• Delimitation to the study type systematic
literature reviews or HTA reports.
• Delimitation to the study type systematic
reviews in English, Swedish, Norwegian
or Danish.
• Delimitation to systematic reviews that
analysed quantitative data.
Common exclusionary criteria for
Questions 1 and 2
• The following reviews were excluded:
• Systematic reviews that have not studied
a working population (for example, those
on disability pension or unemployed). If
the study population is mixed, with some
individuals working, the review is included
if the result for the working subpopulation
has been presented separately.
• Systematic reviews in which the popu-
lation consists only of individuals with
a specic serious health condition – for
example, cancer, HIV, brain injury or de-
velopment disorder.
• Systematic reviews of work environments
or interventions that were not found to
exist in or were not at all relevant for the
Swedish context.
• Systematic reviews in which the majority
of the studies/populations come from
non-Western countries, which would
signicantly affect the relevance and va-
lidity of the conclusions for Swedish and
Western societies.
• Systematic reviews that themselves limited
their searching to studies from only one
country or one region.
• Studies of relatives.
Inclusionary and exclusionary criteria in
Question 1
Inclusion
• Studies that investigated associations
between some form of psychosocial
work-environment exposure and an out-
come on the individual or organizational
level.
Exclusion
• Systematic reviews, the purpose of which
was to investigate the prevalence of some
psychosocial aspect and/or a health con-
dition, without investigating any potential
associations between them.
• Systematic reviews of associations
between some psychosocial aspect and
shift work, night work or work time.
• Systematic reviews of associations
between some psychosocial aspect and
leadership or organizational changes.
• Systematic reviews that investigated
psychosocial work-environment
factors and their associations with the
following outcomes:
• surrogate measures, such as hormonal
or immunological markers
• the use of pharmaceuticals
• physical activity
• dietary habits
• drinking habits
• drug use
• occupational injuries
• violence and crime
• security or the equivalent.
Inclusionary and exclusionary criteria in
Question 2
Inclusion
• The delimitation to systematic literature
reviews in which the intervention was
carried out at or in close proximity to the
workplace.
11Report 2020:2
Exclusion
• Systematic reviews that only investigated
the effect of rehabilitation – that is, where
the primary purpose was to try to improve
health/stimulate the return to work of
employees currently on sick leave.
• Systematic reviews that investigated the
effects of workplace healthcare (unless
this was provided within the framework of
an otherwise dened psychosocial inter-
vention).
• Systematic reviews of interventions
initiated by individuals or external actors,
such as workplace healthcare providers
or insurance companies – that is, inter-
ventions that were not actual workplace
interventions.
• Systematic reviews of the effects of le-
adership and organizational changes.
• Systematic reviews that investigated the
effect of interventions on the following
outcomes:
• surrogate measures, such as biological
or immunological markers
• the use of pharmaceuticals
• physical activity (including yoga)
• dietary habits
• drinking habits
• drug use
• occupational injuries
• violence and crime
• security or the equivalent.
• Systematic reviews in which the
question concerned only implementation
or feasibility.
Method of selection and
relevance assessment
The titles and abstracts of the references
identied in the literature search were read
independently by both authors. If both consi-
dered that an article should be read in full, the
full text of the article was obtained. Refe-
rences/abstracts of which the authors made
different assessments were read in detail and
consensus decisions were made as to whether
the article was adequate for the set questions
and delimitations. In the case of doubt, the
article was acquired so the full text of the
article could be read.
The authors then assessed, independently
of each other, the relevance of the full-text
articles on the basis of the project questions,
delimitations, and inclusionary and exclusio-
nary criteria.
Differences of opinion were resolved
through discussion of the imposed criteria.
The studies that did not meet the imposed
relevance criteria were excluded. Studies that
were read in full text and excluded, and the
primary reason for their exclusion, are found
in Appendices 3 and 5.
Method of quality assessment
In this report, the search has been delimi-
ted to systematic reviews. When conducting
a systematic review there is a risk that the
result will be skewed because of shortco-
mings in the delimitation, literature review
and handling of the results. It is therefore
important to examine the method used in a
systematic review.
The authors of this report have assessed,
independently of each other, the risk of
systematic errors in each systematic review
assessed as relevant with the support of the
questions that are described in the AMSTAR
review template (30, 31), based on the adapted
version that the Swedish Agency for Health
Technology Assessment and Assessment of
Social Services (SBU) use (32). When carrying
out the quality assessments, we gave particular
weight to the following aspects:
The systematic review should have a clearly
dened question that was relevant to the pro-
ject question. The systematic review should
have a predetermined declared method: a
literature search was deemed adequate (sear-
ching in at least two databases, several rele-
vant search terms and concepts, documented
search strategy). The systematic review should
declare that screening of titles and abstracts
12 Report 2020:2
was done by at least two individuals inde-
pendently of one another, and that relevan-
ce, quality assessment and data extraction
were done by at least two independent
individuals.
It was further required that the authors
of the systematic review have in some way
evaluated, documented, and assessed the
scientific quality of the studies they inclu-
ded and that they took this information
into consideration when formulating their
conclusions.
If the above requirements had been met,
the systematic literature review would have
been considered to have been of at least
moderate quality. Other aspects taken into
consideration were whether the review
described the characteristics and results of
the included studies, whether it used app-
ropriate methods for weighing the results,
whether it assessed the risk of publication
bias, and whether it took potential con-
flicts of interest into consideration. If such
had been the case, the method used in the
systematic review would have been consi-
dered of high quality, entailing low risk of
skewing of the results.
Systematic reviews found to be of high
or moderate quality have been included
and constitute the basic data of the pre-
sent report. No special distinction has been
made in the report between systematic
reviews of moderate quality and systematic
reviews of high quality. The reviews judged
to be of low quality were excluded owing
to a heightened risk that they might present
misleading results and conclusions. Initially,
differing assessments of study quality by
the authors were resolved by a reading the
study again together and discussing it after.
Excluded studies can be found, for Ques-
tion 1, in Appendix 4, and for Question 2, in
Appendix 6.
Method of compilation of
results
This report compiles the knowledge that
exists based on published systematic reviews.
No summarized synthesis has been made of
the results, which are instead given in a des-
criptive, theme-based presentation. Based on
the identication by each included systematic
review of the population, exposures/inter-
ventions and outcomes studied, the systema-
tic review has been categorized to provide a
general description of the research efforts
included. For the question concerning asso-
ciations between psychosocial work-environ-
ment factors and health and well-being, it
is a matter of generally describing different
types of psychosocial exposures and models
that were investigated in relation to various
types of health outcomes in different popu-
lations/work environments. As regards the
question of the effects of interventions, we
describe the types of interventions assessed,
the contexts in which they were conducted,
the populations on which they were carried
out and what measures of effect were used.
It is not possible, nor is it an aim of this
report, to weigh the resulting outcome or
effect measures of identied systematic
reviews into a single conclusion. We do,
however, provide a general summary of the
overall conclusions presented in the included
systematic reviews.
13Report 2020:2
14 Report 2020:2
3. Results
The results of the compilations of identied
articles are presented here. The results are
presented both generally, in result tables, and
in text. The results for the rst question are
presented rst, followed by the results for the
second question.
Results of Question 1:
Associations between
psychosocial work-environment
factors and health/ well-being
The search for systematic literature reviews
concerning associations between psychosocial
work-environment factors and well-being and
health for the individual or the organization
generated slightly less than 2,800 references.
A small number of potentially interesting stu-
dies were found in the search for intervention
studies or through the authors’ own aware-
ness of them. The majority of the studies
could be excluded after examination on the
title and abstract level. The remaining articles
were obtained, and of the articles we exami-
ned in full text, many were excluded either
because they did not meet the established
relevance criteria or because they fell short of
the quality requirements. After weeding the
selection and examining the reviews for rele-
vance and quality, 42 systematic reviews were
included that were assessed to be relevant and
that met the requirements of being of at least
moderate quality. Figure 1 shows a ow chart
illustrating publication screening, exclusion
and inclusion.
Figure 1: Flow chart showing included studies, Question 1
References from database searches
(n = 2777)
Reviewed abstracts
(n = 2,800)
Reviewed full-text articles
(n = 134)
Quality-reviewed full-text articles
(n = 117)
Included systematic reviews
(n = 42)
References from manual searches
(n = 23)
Excluded abstracts
(n = 2,666)
Full-text articles excluded on basis of
insufcient relevance (n = 17)
Full-text articles excluded on basis of
inadequate quality (n = 75)
15Report 2020:2
The included systematic reviews are shown
in a table in Appendix 1. The table shows, for
each study, what research question the authors
had, how many and what type of association
studies they included, what exposures and
outcomes they studied and what their prima-
ry results and conclusions are. Two of the
included systematic reviews were systematic
reviews of systematic reviews – that is, they
included only systematic reviews themselves
(9, 33). To reduce the risk of translation er-
rors, the extracted information in the tables is
shown in the original language of the study.
The number of systematic reviews
In total, 42 systematic reviews, published
between 2001 and 2019, have been included.
The majority of the systematic reviews were
published in the past ve years. Figure 2 is
a diagram showing the number of included
studies by publication year.
Systematic reviews focusing on health-
promoting factors: the salutogenic
perspective
The concept of “health and well-being” is a
commonly studied outcome and it is possible
to describe associations between these out-
comes and psychosocial work-environment
factors as both risk factors and health-pro-
moting factors, depending on the researcher’s
question, how data are measured and how
results are compiled and presented in the
primary studies.
None of the systematic literature reviews
included in Question 1 in this report, based
on its question or presentation of results and
conclusions present a one-sided focus on
health-promoting or protective factors. Most
of the included systematic reviews have des-
cribed the occurrence of associations between
psychosocial work-environment factors as risk
factors for undesired outcomes. In ve syste-
matic reviews, parts of the results have been
presented in a salutogenic perspective; that is,
when psychosocial work-environment factors
are described as health-promoting, protective
or buffering/balancing factors for adverse
outcomes (6, 8, 11, 12, 15). For example,
Aronsson et al. expressed their ndings in a
systematic review on associations between
work environment and burn-out, concluding
Figure 2: Number of systematic literature reviews concerning associations by publication
10
9
8
7
6
5
4
3
2
1
0
2001 2003 2005 2007 2009 2011 2013 2015 2017 2019
16 Report 2020:2
that certain factors protected, whereas others
increased the risk of health issues: “While
high levels of job support and workplace jus-
tice were protective for emotional exhaustion,
high demands, low job control, high worklo-
ad, low reward and job insecurity increased
the risk for developing exhaustion” (8). In this
case, support at work and organizational justi-
ce are examples of health-promoting factors.
Another example is the review by Sch-
neider et al., which investigated associations
between psychosocial work-environment
factors and mental health among staff in
emergency medical care units, with the con-
clusions: “Conclusive results reveal that peer
support, well-designed organizational structu-
res, and employee reward systems balance the
negative impact of adverse work factors on
ED providers’ well-being” (15).
Systematic literature reviews focusing
on individual outcomes and on
organizational outcomes
In this report no specic requirements on
the outcomes were imposed, other than that
they be relevant for the individual or for the
organization. Measures that are relevant for
the individual concern, in some way, indivi-
dual health, quality of life, job satisfaction
and, to a certain extent, sickness-related or
other workplace absence. Common for these
measures is that they are applied on the
individual level. It is also possible to measure
associations between psychosocial work-en-
vironment factors and aggregated data on the
organizational level. Such data can relate to
parameters such as the unit’s, the company’s
or the organization’s productivity, protabi-
lity, staff turnover, presenteeism and healthy
presence, etc.
Only one study included, in its question,
outcomes on the organizational level as well
as outcomes on the individual level. This
study investigated the signicance of bullying
in the workplace for younger physicians and
according to the authors of the systematic
review, bullying, for this group, was found to
lead not only to health problems for the indi-
viduals but also to more errors and incorrect
decisions in the work situation (34).
The number of systematic reviews
based on the outcomes studied
Table 2 presents an overview of the types of
outcomes that the included systematic reviews
studied. The primary outcomes concern indi-
viduals’ health, which can be roughly classied
as studies that investigated the associations
of work-environment factors with mental or
somatic health issues.
A systematic review may include, in its
question, several types of outcomes, which is
why the total number of studies in the table is
greater than 42.
Based on the systematic reviews’ ques-
tions, approaches to measuring exposures and
outcomes, descriptions of results and con-
clusions, the exposure was classied as either
stress or bullying.
Based on these classications, 24 syste-
matic reviews investigated the results of
psychosocial exposures, in the form of
stress or in the form of bullying, on mental
health. The corresponding gures for soma-
tic health comprised a total of 20 systematic
reviews, of which 19 investigated associa-
tions with stress exposure and 1 investigated
associations with bullying. A total of six sys-
tematic reviews had work-related outcomes,
ve of them on the individual level and one
on the organizational level.
These tables are presented below:
• Table 2: Number of studies by type of
psychosocial work-environment factor
studied in relation to different types of
outcomes (individual or organization)
• Table 3: Number of studies by type of
psychosocial work-environment factor and
types of mental-health issue
• Table 4: Number of studies by type of
psychosocial work-environment factor and
types of somatic health issue
• Table 5: Number of studies by type of
psychosocial work-environment factor and
studied populations (work-environment
situations).
17Report 2020:2
Number of systematic reviews by type
of outcome relating to mental health
It is possible to further specify the included
systematic reviews based on the type of
outcome relating to mental health that was
studied. Four systematic reviews investigated
what can be considered general mental health
issues (2, 14, 15, 17), whereas other systematic
reviews focused – in their question, outcomes
or manner of describing results – on a spe-
cic mental health issue. The most frequent
type was studies rating workplace-related
stress and the association of these ratings
with the risk or occurrence of stress-related
conditions (1, 3, 6, 8, 13, 18) and with the risk
of or occurrence of depression or anxiety
symptoms in employees (5–7, 9, 10). The-
re were a couple of systematic reviews that
presented associations between stress-related
work environment and other outcomes, such
as sleep (2, 11), suicidal ideation and beha-
viour (19), and associations between different
aspects of the psychosocial work environme-
nt on cognition and dementia (12).
A compilation of the number of systematic
reviews based on the type of mental health is-
sue used in outcomes is presented in Table 3.
Number of systematic reviews by type
of outcome relating to somatic health
Similarly, it is possible to further specify the
picture of the type of illnesses and somatic
complaints used as outcomes in the syste-
matic reviews included. Several studies that
investigated associations between stress in
working life and the risk and occurrence of
cardiovascular diseases such as high blood
pressure, myocardial infarction and car-
diovascular disease, metabolic syndrome,
stroke and cardiovascular-related death (2,
33, 37–43, 51). A majority of systematic
reviews had also investigated associations
between stress-related aspects of the work
environment and the risk of or occurrence
of musculoskeletal problems and pain in
the neck, shoulders and upper extremities
(36, 44–47, 49, 50). Two systematic reviews
investigated associations between bully-
ing and the occurrence of general somatic
health issues (34, 54).
A compilation of the number of syste-
matic reviews based on the type of somatic
health issue used as outcomes is presented
in Table 4.
Table 2: Number of systematic literature reviews of association studies, by studied psychosocial exposure and
outcomes on the individual and organizational levels, respectively (categorization based on question, results
and conclusions).
Type of psychosocial exposure Type of outcome
Mental health,
sleep, cognition
Physical health Work-related
utcome,
individual-related
(long-term sick
leave disability
pension)
Work-related out-
come,
organization-
related
(production,
collaboration,
communication)
Stress
(according to different stress mo-
dels, such as high level of mand/low
control, balance between effort/
compensation, organizational
injustice, low social support, etc.)
19
(1-19)
19
(2, 33, 35-51)
5
(2, 3, 14, 52, 53)
1
(16)
Bullying 6
(5, 6, 9, 11, 34,
54, 55)
1
(54)
18 Report 2020:2
Number of systematic reviews by type
of outcome and occupational group or
population studied
A further way of categorizing the systematic
reviews that investigated associations between
psychosocial work-environment factors and
outcomes is based on the population studied
– that is, the type of workplace/work en-
vironment in which the primary study parti-
cipants worked. The majority of the included
systematic reviews had as their only criterion
the restriction that the population had to be
employed. Five systematic reviews focused on
employees working in healthcare or related
occupations (emergency medical services, nur-
sing, veterinary care), particularly as regards
the risk of and occurrence of mental health
and stress-related issues (14, 15, 18, 19, 53).
Individual systematic reviews restricted them-
selves to other occupations and groups, such
as labourers with neck pain (36), individuals
working in the police force or the correctional
system (13, 51), industrial workers (47) and in-
dividuals who in their jobs come into contact
with disaster victims (17).
A compilation of the number of systema-
tic reviews based on the type of population
studied is presented in Table 5.
What aspects of the psychosocial
work environment have been
investigated?
In the tables, the psychosocial exposure has
been roughly categorized as stress or bullying.
It is possible to further specify these expo-
sures. Certain systematic reviews restricted
their question and their inclusion criteria to
a specic psychosocial exposure or model,
whereas others did not, with the result that
they included primary studies that investigated
different models.
A large number of the systematic reviews
have investigated the psychosocial work en-
vironment based on workplace demands alo-
ne or based on the demand–control–support
model (1–9, 11, 12, 14, 15, 33, 35, 37–44, 46,
47, 49, 50, 52, 53) or effort/reward model (2-
6, 9-12, 14, 33, 40, 43, 45). The authors of the
majority of these studies conclude that there
is an association between the named way of
handling stress, workplace stress and different
types of mental and somatic health issues. Se-
veral systematic reviews had also considered
other psychosocial work-environment aspects,
such as the signicance of justice (3, 5, 6, 9)
and the social climate (5, 6).
Table 3: Number of systematic literature reviews that studied associations between psychosocial exposure by
outcome and type of mental health issue
Type of psycho-
social exposure
Type of outcome
Mental
health issues
generally
Stress-related
conditions
Depression
and anxiety
Sleep Suicidal
ideation and
behaviour
Cognitive
effects/
dementia
Stress
(according to diffe-
rent stress models,
such as high level
of demand/low
control, imbalance
between effort/
reward,
organizational
injustice, low social
support, etc.)
4
(2, 14, 15, 17)
6
(1, 3, 6, 13, 18)
5
(5-10)
2
(2, 11)
1
(19)
1
(12)
Bullying 2
(34, 54)
2
(6, 34)
2
(5, 6)
1
(55)
Footnote: The articles with the reference numbers (8) and (5) are English reports which are part of the results of reference number (6) (in Swedish).
19Report 2020:2
Table 4: Number of systematic literature reviews that studied associations between psychosocial exposure by
outcome and type of somatic health issue
Type of psychosocial exposure Type of outcome
Somatic
health issues ge-
nerally
Cardiovascular
illnesses (cardiovas-
cular death, hyperten-
sion, metabolic
syndrome, stroke
Type 2 diabetes Musculoskeletal
problems and pain
Stress
(according to different stress
models, such as high level of
demand/low control, balance
between effort/reward, orga-
nizational injustice, low social
support, etc.)
1
(2)
10
(2, 33, 37-43, 51)
1
(35)
7
(36, 44-47,
49, 50)
Bullying 2
(34, 54)
Table 5: Number of systematic literature reviews that studied associations between psychosocial exposure by
mental and somatic health issues and populations studied
Associations between psychosocial exposure and mental health issues, by populations studied
Type of psychosocial
exposure
Type of outcome
Working
population,
generally
Employees
with neck pain
Healthcare/
eterinary care
Police and
correctional
care
Occupational
groups that deal
with disasters and
disaster victims
Stress
(according to different
stress models, such as high
level of demand/low control,
imbalance between effort/
reward, organizational injus-
tice, low social support, etc)
13
(1-12, 52)
1
(36)
5
(14, 15, 18,
19, 53)
1
(13)
1
(17)
Mobbning 1
(55)
2
(34, 54)
Associations between psychosocial exposure and somatic health issues, by populations studied
Type of psychosocial
exposure
Type of outcomel
Working population,
generally
Industrial
workers
Police and
rectional care
Healthcare -
Stress
(according to different stress
models, such as high level of
demand/low control, imbalance
between effort/reward, orga-
nizational injustice, low social
support, etc.)
17
(2, 33, 35-46, 48,
49, 52)
1
(47)
1
(51)
1
(50)
Bullying
Footnote: The articles with the reference numbers (8) and (5) are English reports which are part of the results of reference number (6) (in Swedish).
20 Report 2020:2
A compilation of what included
systematic literature reviews found
support for
Here is a summary of the primary ndings
from the included systematic reviews based
on their own conclusions. The authors of
several systematic reviews conclude that there
is an association between high-stress work
environments and the risk or occurrence of
stress-related health-issues (1, 3, 6, 8, 13, 18),
depression and anxiety (5–7, 9, 10) and sleep
problems (2, 11).
The authors of several systematic reviews
also conclude that there is an association
between perceived bullying and various
outcomes such as stress-related health issues,
depression and suicidal ideation (5, 6, 34, 54,
55), and the occurrence of sleep problems
and headaches, respectively (54).
Regarding somatic health issues the au-
thors report that in several systematic reviews
there is an association between psychosocial
work-environment factors and the risk or
occurrence of cardiovascular disease (2, 33,
37, 42, 43), hypertension (40, 41, 43, 51) and
stroke (38), work-related stress and the risk of
developing type 2 diabetes (35).
There are also systematic reviews that
present some support, or strong support, for
the association of psychosocial work-related
stress with the risk of or occurrence of back,
neck, shoulder, arm and wrist pain (36, 44, 46,
47, 49), as well as general musculoskeletal pain
(47, 50).
Altogether there is a great deal of compiled
research on associations between aspects of
the psychosocial environment and the occur-
rence or risk of health issues.
There is no compiled research that has
specically investigated associations between
psychosocial health-promoting factors and
outcomes on the individual or organizational
level. The salutogenic perspective – that is, the
description of psychosocial work environment
as something that can promote health – is ta-
ken in only a few of the results and conclusions
of the included systematic literature reviews.
The pathological perspective – that is,
when the psychosocial work environment is
described as a risk factor for health issues –
predominates in the included research.
The primary areas of knowledge are
psychosocial stress, based on models of stress
(demand/control, support, and effort/reward,
respectively), and bullying.
Results of Question 2:
Effects of psychosocial
workplace interventions t
The search for systematic literature reviews
about psychosocial workplace interventions
produced slightly more than 3,000 records. A
few potentially interesting studies were found
among the results for the search for associa-
tion studies or by other routes. Most of the
studies were excluded at the title and abstract
level. Of the articles we reviewed in full text,
several were eliminated, more on the basis of
quality shortcomings than relevance. After the
screening of publications in accordance with
Figure 3, 44 systematic literature reviews that
were relevant to the question, and of at least
moderate quality, were included.
The number of included systematic
reviews
The included systematic reviews are shown in
a table in Appendix 2. The table shows, for
each study, what question the authors had,
how many primary intervention studies were
included, what interventions and what types
of outcomes they recognized, and what their
primary results and conclusions were. To
reduce the risk of translation errors, the infor-
mation was extracted in the original language.
In total, 44 systematic literature studies,
published between 2007 and 2019, have been
included. The majority of the studies were
published in the past ve years. Figure 4
shows a diagram of the number of included
studies by publication year.
21Report 2020:2
Systematic reviews focusing on
individual outcomes and organizational
outcomes, respectively.
This report did not impose specic require-
ments on the outcomes, but rather presents
the types of outcomes that were included
in the systematic literature reviews. A large
proportion of the measurements relate to
outcomes on the individual level, but there
are also measurements on the organizational
level, particularly when it concerns the organi-
zation’s productivity or staff turnover. Unlike
the reviews on association studies, interven-
tions by their nature focus more on studying
favourable outcomes, such as improvements
in various health outcomes, reduced depres-
sion and long-term sick leave, etc. In other
words, intervention research is more often
studies of “health-promoting factors”, as it is
undesirable or not ethically defensible to
expose study participants to anything that
leads to health problems.
Number of included systematic reviews
based on the type of intervention and
type(s) of outcome studied
These tables are presented below:
Table 6: Contains the number of systema-
tic reviews categorized by type of exposure
factor studied in the various interventions.
This is then shown divided by what relevant
outcome the various studies chose to measure
and include.
Table 7: Contains the number of systematic
reviews divided by either type of exposure
factor or measured included relevant outcome
and by occupational group or population on
which the intervention was conducted.
Table 6 presents a compilation of the types
of outcomes that the included systematic
literature reviews studied. A systematic review
may include, in its question, several types of
outcomes, which is why the total number of
studies in the table is greater than 44. The
delimitations in the individual studies were
usually imposed in respect of what types of
Figure 3: Flow chart showing included studies, Question 2: Systematic literature reviews that included
psychosocial workplace interventions
References from database searches
(n = 3,056)
Reviewed abstracts
(n = 2,800)
Reviewed abstracts
(n = 2,800)
Quality-reviewed full-text articles
(n = 100)
Included systematic reviews
(n = 44)
References from manual searches and the
second search (n = 34)
Full-text articles excluded on basis of
insufcient relevance (n = 47)
Full-text articles excluded on basis of
inadequate quality (n = 56)
Excluded abstracts
(n = 2943)
22 Report 2020:2
interventions were included and in a majority
of the cases all types of outcomes in the indi-
vidual primary studies were included.
We have opted to divide the intervention
types into the following six overall cate-
gories: stress management, bullying, social
support, work efficiency enhancement,
health and the psychosocial climate. Most
of the interventions described focused on
health or stress management.
The systematic reviews of interven-
tions that in some way concerned different
methods of handling or reducing stress total-
led 19 (56–74). The majority of them con-
tained intervention studies involving various
coping and behavioural strategies for reducing
stress in the individual (56-58, 60, 62,
64–66, 69, 70, 72, 74). Six systematic
literature reviews focused on stress-related
interventions that employed mindfulness
techniques as a base (59, 61, 63, 67, 71, 73).
It is worth noting that mindfulness techni-
ques were not only employed as techniques
expressly for reducing stress. Murray and
colleagues (75) include studies of interven-
tions in which some mindfulness technique
was used for a more general purpose, to
enhance employees’ well-being. Three syste-
matic literature reviews evaluate interventions
that employed stress-reducing programmes,
focusing on the organizational level (62, 65,
66). One systematic literature review focused
on the use of digital media to implement
stress-reducing interventions (68).
Unlike the reviews about association stu-
dies, we identied only one systematic review
that evaluated interventions to prevent or
reduce bullying (76).
Three systematic reviews summarized
literature about different forms of social
support (77–79). The interventions consisted
either of mentor programmes (77, 79) or
other forms of social support, and quality in
work supervision (78).
We identied seven systematic reviews
that concern interventions that were in some
way designed to inuence the work, such as
through work efciency enhancement, adap-
tation or changing how work was performed
(62, 72, 80–84).
Carolan and colleagues evaluated interven-
tion studies that investigated work efciency
enhancement by means of a digitally distribu-
ted intervention – interventions also designed
to improve mental health (80). Other indivi-
dual systematic reviews focused on a special
Figure 4: Number of systematic literature reviews about interventions by publication year
10
9
8
7
6
5
4
3
2
1
0
2007 2008 2009 2010 2011 2012 2013 2014 2015 20192016 2017 2018
23Report 2020:2
work method (81), adaptations (83), or chang-
es in working conditions (84). Three systema-
tic reviews evaluated interventions in which
they investigated the effects of changing how
the work was done (62, 72, 82).
A large number of interventions are desig-
ned to promote health in some way (60, 66,
69, 70, 72, 75, 80, 84–92). Under the primary
question of this literature review, concerning
the psychosocial work environment, we have
identied 13 systematic reviews that focused
mainly on interventions designed to promote
mental health, prevent depression and burn-
out, or ease depressive symptoms (56, 60,
66, 70, 75, 80, 85–91). Four studies involved
interventions with a more general purpose,
such as increasing general health or well-being
among employees on the individual level (69,
72, 75, 92) or on the organizational level (84).
Three reviews concerned interventions de-
signed to change the psychosocial climate in
the workplace (93–95). Two of these focused
more expressly on the climate itself (93, 95)
and one review focused on eliminating stress
factors in teachers’ work situation (94).
We have chosen to group the outcomes
presented in the included literature reviews in
the following ve categories: mental health,
general health, stress, work-related individu-
al-related outcomes, and work-related out-
comes that are organization-related. Mental
health and general health were the most
frequently occurring outcomes. The ma-
jority of the included systematic literature
reviews reported several different outco-
mes. Most of the reviews reported having
difficulty finding comparable outcome
measures in the primary studies.
A majority – 23 – of the included literature
reviews described some mental health measu-
re (56-68, 75, 82, 84–91). This involved a large
number of different measures, everything
from changes in depression scales to the oc-
currence of different diagnoses. Many studies
– 14 – included more general health measures
(67, 69–73, 80–82, 84, 92–95); studies focu-
sing on well-being or health have been grou-
ped among these.
While distinguishing between the outcomes
of mental health and stress is not entirely
simple, and several studies describe both out-
comes, we have nevertheless chosen to have
one outcome category specically for stress
as that is mentioned expressly as an outcome
in 11 reviews (58, 59, 61–65, 68, 69, 79, 94).
Finally, we have two outcome categories that
concern work-related outcomes. The rst is
the work-related outcomes measured on the
individual level (60, 64, 68, 74, 76-79, 82–86,
94). This category concerns particularly
reviews that included measures of long-term
sick leave and the like (60, 64, 68, 74, 76, 78,
83–86, 94), and/or job satisfaction (60, 64,
77, 79, 85). The second work-related outcome
category concerns the outcomes that are more
“organization-related” (61, 64, 67, 71, 74,
76-80, 82, 84, 92–94, 96). Here, it is primarily
outcomes such as staff turnover (74, 77, 79,
94), different productivity and efficiency
measures (64, 71, 74, 78–80, 93, 96) and
measures of collaboration and communi-
cation in the workforce (61, 67, 76, 77, 92)
that are described.
The largest category contained studies
that included interventions involving some
form of stress management programme and
measured outcomes such as mental health,
depression, burn-out, and so on (56–68).
A large number of these studies also mea-
sured stress as an outcome. The next-largest
category included interventions that more
generally focused on improving health or
preventing mental health issues or depres-
sion, studies in which the outcome was
mental health issues, depression or burn-out,
and so on (60, 66, 75, 84–91).
Number of included systematic reviews
by different occupational groups or
populations
Many interventions focused on a general
group of individuals in employment (59, 60,
68, 71, 74, 76, 78, 80, 82–85, 87–89, 93, 95,
96); however, interventions targeting particu-
lar occupational groups were also common.
A majority of the included reviews were con-
24 Report 2020:2
ducted on healthcare workers (56–58, 61, 62,
64–67, 69, 70, 72, 73, 75, 77, 79, 81, 90, 92),
particularly physicians or nurses. Other occu-
pational groups targeted in the reviews were
police and correctional ofcers (91), as well as
teachers (94). We identied two reviews that
limited themselves to populations that had
already reported mental health issues (60, 63),
and one review that was limited to male-do-
minated industries (86).
The most common interventions for
healthcare workers involved different types
of stress-management programmes (56–58,
61, 62, 64–67, 69, 70, 72, 73) while those for a
more general working population involved, to
a greater extent, more broadly focused inter-
ventions to prevent mental health issues and
increase well-being and general health (60, 80,
84, 85, 87–89, 96).
A large proportion of the studies that
focused on the healthcare system had different
forms of mental health issues as their outcome
(56–58, 61, 62, 64–67, 75, 90) while a signi-
cantly larger proportion of the studies of a
general working population focused on more
work-related measures on both the individual
(60, 68, 74, 76, 78, 82–85) and the organizatio-
nal level (71, 74, 76, 78, 80, 82, 84, 93, 96).
A compilation of the number of systematic
reviews by the type of occupational group or
population studied is presented in Table 7.
Table 6: Number of systematic literature reviews that study different psychosocial workplace interventions on
the individual or the organizational level, by type of included outcome
Type of psychosocial
exposure
Type of outcome
Mental health
issues, depres-
sion, depressive
symptoms, burn-
out, cognition
Mental health,
sleep, cognition
Physical
health
Work-related
utcome,
individual-
related (long-
term sick
leave disability
pension)
Work-related
outcome,
organization-
related
(production,
collaboration,
communication)
Stress management/
reduction, resilience,
mindfulness
13
(56-68)
6
(67, 69-73)
9
(58, 59, 61-65,
68, 69)
4
(60, 64, 68, 74)
5
(61, 64, 67, 71, 74)
Bullying 1
(76)
1
(76)
Social support,
mentoring
1
(79)
3
(77-79)
3
(77-79)
Work efciency
enhancement,
adaptations, assistive
devices, methods
2
(62, 82, 84)
4
(72, 80-82, 84)
1
(62)
2
(82-84)
2
(80, 82, 84)
Health, mental health,
well-being and
return to work
11
(60, 66, 75,
84-91)
6
(69, 70, 72, 80,
84, 92)
1
(69)
4
(60, 84-86)
4
(80, 84, 92, 96)
Psychosocial climate/
Workplace stressors
3
(93-95)
1
(94)
1
(94)
2
(93, 94)
25Report 2020:2
Compilation of what the included
systematic literature reviews found
support for
Here is a summary of the conclusions
reached by the individual included
literature reviews from the results of the
primary interventions for which they
compiled findings.
Different types of stress-reducing inter-
ventions in the workplace have been shown
to be able to reduce stress levels among
employees in a favourable manner in se-
veral reviews (60, 62, 63, 65, 69, 97), and
also have an effect on well-being and sleep
(97). One review found some evidence for
social support having an effect on absen-
ce from work (78). The two reviews that
categorized their included interventions in a
demand/control perspective (60, 82) found
connections between increased control
and favourable health outcomes. Different
forms of interventions designed to promo-
te employee health have been shown capa-
ble of favourably influencing stress levels
(57, 98) and mental health (57, 87, 88, 98).
Preventative measures relating to men-
tal health were found to be cost-effective
(96). Daniels and colleagues (93) found, in
their review, that interventions to improve
the psychosocial climate had an effect on
employees’ well-being.
Several reviews also focused on the
method of the intervention and found that
digital interventions to influence mental
health worked (80) and that interventions
that targeted multiple levels simultaneously,
such as individual, group and organization
levels, (66, 84, 85, 90) had greater effect.
26 Report 2020:2
Table 7: Types of interventions and outcomes studied, by studied occupational groups or populations
Types of interventions by studied occupational groups or populations
Type of intervention Type of population
Working
population,
generally
Workers with
mental
health issues
Healthcare Police and
correctional
care
School Part of
the labour
marke
Stress management/
reduction, resilience
5
(59, 60, 68,
71, 74)
2
(60, 63)
13
(56-58, 61,
62, 64-67, 69,
70, 72, 73)
Bullying 1
(76)
Social support, mentoring
programmes, management
1
(78)
2
(77, 79)
Work efciency enhance-
ment, adaptations, assistive
devices, methods
3
(80, 82-84)
2
(62, 72, 81)
Health, mental health,
well-being and return
to work
8
(60, 80, 84,
85, 87-89, 96)
1
(60)
7
(66, 69, 70,
72, 75, 90, 92)
1
(91)
1
(86)
Psychosocial climate/
workplace stressors
2
(93, 95)
1
(94)
Types of studied outcomes based on studied occupational groups or populations
Type of outcome Typ av population
Working
population,
generally
Workers with
mental
health issues
Healthcare Police and
correctional
care
School Part of
the labour
marke
Mental health, depression,
depressive symptoms,
burn-out, sleep,
cognition, etc.
8
(59, 60, 68,
82, 84, 87-89)
2
(60, 63)
11
(56-58, 61,
62, 64-67, 75,
90)
1
(91)
1
(86)
General health, somatic
health, well-being
7
(71, 80, 82,
84, 85, 93, 95)
7
(67, 69, 70,
72, 73, 81, 92)
1
(94)
Stress and mindfulness 2
(59, 68)
1
(63)
7
(58, 61, 62,
64, 65, 69, 79)
1
(94)
Work-related outcome,
individual-related (long-
term sick leave, disability
pension, job satisfaction)
9
(60, 68, 74,
76, 78, 82-85)
1
(60)
3
(64, 77, 79)
1
(94)
1
(86)
Work-related outcome,
organization-related
(production, efciency,
cooperation, communica-
tion, staff turnover,
cost-effectiveness)
9
(71, 74, 76,
78, 80, 82, 84,
93, 96)
6
(61, 64, 67,
77, 79, 92)
1
(94)
27Report 2020:2
28 Report 2020:2
4. Discussion
Discussion of results
We have produced two systematic literature
reviews in which we have analysed and compi-
led existing knowledge in the form of previo-
usly published systematic reviews. Since the
two questions together include studies that
looked at actual circumstances at workplaces
(that is, associations between psychosocial
work-environment factors and health) and
active interventions carried out at workpla-
ces (effects of interventions conducted at
or in close proximity to workplaces), a more
comprehensive picture of the total know-
ledge base regarding what has been studied
in relation to the question of what creates
workplaces that promote healthy and satised
employees is given.
We have found that there is a great deal of
compiled research on association studies of
psychosocial work-environment factors and
some type of health outcome, particularly on
the individual level. There is also a great deal
of compiled research relating to the effects
of psychosocial workplace interventions. As
regards both of these questions, the number
of systematic literature reviews has grown in
the past ve years.
Discussion of results of Question 1:
Associations
Particular attention has been paid to psycho-
social work-environment exposures, based
on models of stress (demand/control, sup-
port, and effort/reward) and bullying and the
associations of these factors with individuals’
well-being and health. There are approxima-
tely equally many systematic literature reviews
that have investigated associations between
the psychosocial work environment and out-
comes of mental-health and somatic health
issues. The most common type of mental
health issues for which associations have been
studied for psychosocial work-environment
factors were stress-related health issues, anx-
iety and depression. The most common type
of somatic health issue for which associations
have been studied for psychosocial workpla-
ce-factors were cardiovascular and muscu-
loskeletal disease, and pain. The compiled
research has usually been based in a general
work environment (not further specied);
however, several systematic literature reviews
investigated specic work environments or
populations – primarily healthcare or other
care organizations.
What has not been studied/ compiled?
Strikingly, very few systematic reviews have
investigated and described different types of
psychosocial work-environment factors as
health-promoting or protective factors. The
absolute majority of the included reviews
present results and conclusions in which
work-environment aspects are identied as
risk factors for health issues and illness. The
results presumably reect the questions,
perspectives, results and conclusions that are
found in the primary research. A possible
explanation for why the knowledge situation
looks the way it does is that there are often
denitions of health issues and illness and
there are established and validated methods
of identifying, diagnosing and assessing
health issues and illness, which makes these
outcomes appropriate as outcome measures
in research studies. Corresponding methods
for assessing when an individual feels good
or has optimal working ability have not been
developed and established to the same extent.
The absence of health issues does not mean
that physical, mental and social functioning
in a workplace is optimal or good. There is
29Report 2020:2
an opportunity here to develop methods for
measuring and classifying working ability
and to determine the factors that support
working ability from a salutogenic perspec-
tive. The development and establishment of
health-promoting factors that reect a good
psychosocial function could be used in both
work-environment research and practical
work to promote a healthy work environme-
nt and to prevent the risk of health issues
due to organizational and social circumstan-
ces in a workplace.
Another remarkable result was that the
outcomes that the included systematic reviews
presented were primarily on the individual
level and less frequently on the organizational
level. Many outcomes on the individual level
are easy to study and relevant to both the
individual and organization. Outcomes on
the organizational level are often aggregated,
which can make it more difcult to draw con-
clusions regarding causes than if the exposure
is assessed on the individual level. Aggre-
gated outcomes on the organizational level,
however, have the advantage of being able to
directly identify aspects that may be relevant
for organizations and employers – in terms
of productivity, long-term sick leave and staff
turnover, for example.
Discussion of results for Question 2:
Interventions
What has been studied above all is interven-
tions designed to reduce stress or improve
employees’ ability to handle stress. The most
common outcomes studied are the effects
of different interventions on well-being and
mental health. Many of the interventions
compiled in systematic literature reviews in-
vestigated interventions conducted in health-
care settings.
What has not been studied/compiled?
Given the number of association studies
identied about bullying, it is remarkable that
more compilations of intervention studies on
that theme have not been conducted. Only
one such review was identied (76), and it in
turn included only ve primary studies of low
quality. Long-term effects of workplace-focu-
sed psychosocial interventions have not been
investigated either to any great extent.
The dominance of association studies that
investigated the demand/control model is
not present to the same extent among the
intervention studies. We identied only two
systematic literature reviews that compiled
interventions that in some way focused on
greater control or studied work task changes
that led to less control (60, 82).
Occupational groups other than those in
healthcare are present to a very limited extent
among the interventions included in the re-
views we found. However, a large proportion
of the reviews were not restricted other than
to a generally employed population.
In the analysis of reviews of interven-
tions, it is apparent that the most common
effect measures concern different types of
health-related outcomes or outcomes that
measure symptom reduction. It is less com-
mon to nd the work-related outcomes have
been measured as well, which implies that
from an employer perspective it is difcult
to know whether the intervention would
be cost-effective or not. The great diversity
of outcomes also makes it more difcult
to make a comparison of the effects of
different studies and thus the possibility of
drawing general conclusions.
We have not conducted an analysis of
whether the association studies or the in-
terventions conducted might be valid in a
Swedish context. However, we limited the
inclusion of reviews to those that were rele-
vant to “Western” contexts and did not set a
restriction to any particular geographic area –
for example, studied only nurses in Australia.
Discussion of method
This report is based on two systematic litera-
ture reviews. The method of implementation
of these essentially follows the international
standard used by Cochrane, among others.
This method involves a rigorous process for
30 Report 2020:2
dening and delimiting the question, sear-
ching systematically for references in several
electronic databases, screening references and
examining full-text articles that could be of
value for the question for relevance and qua-
lity. The process has to be transparent so that
the reader can interpret the results based on
the question, the inclusionary and exclusiona-
ry criteria and other restrictions imposed. The
selection process and data extraction must
also, as far as possible, be implemented by
at least two independent reviewers and thus
reduce the risk of results that skew the total
knowledge base being included. This structu-
red method is a strength.
This report restricted its search to stu-
dies that themselves are systematic reviews.
One shortcoming of this type of review is
that its results consist of questions to which
other researchers have limited themselves. It
is possible that knowledge may exist in the
form of primary studies that have, however,
not been compiled within the framework of
a systematic literature review. Accordingly, it
is not certain that the absence of systematic
reviews in an area, based on one question
and/or specic population, can be interpreted
as indicating that knowledge does not exist in
that area. To be able to state that knowledge
does or does not exist requires a well-condu-
cted systematic review that is not too old and
that has found the knowledge situation to be
insufcient. This in turn may be because there
is too little primary research, or the primary
research that exists is poorly executed, or
shows contradictory results.
The compilation of systematic literature
reviews of associations between psychoso-
cial work-environment factors and health
outcomes included two reports that themsel-
ves involved only systematic reviews (9, 33).
The one by Harvey et al., published in 2016
(9), was designed to investigate how diffe-
rent psychosocial work-environment factors
co-vary with mental health issues. This review
included seven systematic reviews, which
have also been included separately in this
report. The authors of the review propose
a meta-theory of how three broad work-en-
vironment categories (imbalance in the work
setup, absence of foundational values and
respect, work-related uncertainty) can be seen
as interacting risk factors for the development
of mental health issues.
The second systematic review, which only
involved systematic reviews, was authored
by Fishta and Backe and published in 2015
(33), and was designed to investigate whether
there is a connection between psychosocial
work-environment factors and the risk of car-
diovascular disease and death. Six systematic
reviews were included, of which one is also
among the reviews included in the present
report. The authors did not perform any me-
ta-analysis of their own, but rather present the
results of two included studies that indicate
that there is a moderately strong connection
between the psychosocial work environment
and cardiovascular events.
The compilation of systematic reviews of
associations between psychosocial work-en-
vironment factors and health outcomes
also included a Swedish Health Technology
Assessment (HTA) report (6), from which
specic results for different questions were
also published as systematic reviews in inter-
national journals (5, 8). This means that the
same results were included in two instances
for the different questions, which should be
taken into consideration.
The compilation of systematic literature
reviews on psychosocial workplace interven-
tions includes two reviews that in themselves
include systematic literature reviews, by Joyce
et al. (60) and Wagner (78). Both include
individual reviews that we also include in the
present analysis; however, since the questions
are different, the overlap is minimal. It could
also be the case that individual primary inter-
vention studies were included in more than
one systematic literature review. We have not
had the opportunity to consider what primary
studies were included in the systematic re-
views. Since this systematic literature review is
intended to describe the areas that have been
researched and does not provide any summa-
31Report 2020:2
rized synthesis of the results; this fact could
be viewed as a minor problem.
The quality of the systematic reviews in-
cluded in this report has been assessed using
AMSTAR. On the other hand, we have not
conducted quality assessment of the prima-
ry studies that the authors of each included
study included in turn. One of the criteria for
a systematic review being considered at least
moderately well conducted is that the authors
have assessed the quality of the primary stu-
dies it included. We, however, have not made
any assessment
of whether the authors’ assessments are
correct or not. Nor have we assessed the
reliability of (that is, assessed in terms of evi-
dence) the authors’ conclusions, or assessed
whether they are relevant and transferrable to
a Swedish context.
One of the challenges when compiling
the existing knowledge about psychosocial
work-environment factors and their associ-
ations with and signicance for workplaces
that promote healthy and satised employ-
ees is the need to dene concepts and deli-
mit the question. One overall challenge has
been dening what we mean by the concept
“psychosocial”, partly in a work-environment
perspective and partly as a factor that can be
inuenced by some intervention. Different
specialist and subject areas and research dis-
ciplines can be based on different theoretical
schools and use different terminology. We
have chosen denitions that to our own eyes
are broad, denitions designed to capture the
psychological perspective for individuals and
groups as well as social interaction that goes
on between individuals. This understanding
of the concept of “psychosocial” and the
delimitation it implies is of course open to
question, and it is possible that researchers
with a different subject background would
have chosen to dene concepts, search stra-
tegy and restrictions in another way, which
would then affect the results. For example, we
have chosen not to include systematic reviews
of interventions that only included studies
of yoga interventions or physical activity;
however, on the other hand, we have included
studies about mindfulness interventions and
other stress-reducing programmes, if they
were conducted at or in close proximity to the
workplace. A wider denition of the type of
intervention that could conceivably inuence
the psychosocial work environment would,
in other words, probably have led to more
included studies.
A specic restriction in the form of an
exclusionary criterion concerned associations
between leadership and psychosocial work
environment and effects of leadership and
organizational changes (provided they were
not conducted within the framework of some
dened intervention). These restrictions were
done for reasons of resources – partly since
the signicance of the management and orga-
nizational structure is examined in other lite-
rature reviews in the Healthy and Well-Func-
tioning Workplaces project. However, we do
nd that we have excluded very few systema-
tic reviews that compiled knowledge based on
these questions.
The search strategy in the two conducted
systematic reviews that provide the founda-
tion of the present report was implemented
in three digital databases: PubMed (Medline),
Cinahl and Psycinfo. That is a relatively small
number of databases. However, many syste-
matic reviews are found in more than one da-
tabase; for example, Pubmed also covers tho-
se published by Cochrane. Further, it has been
previously observed that a search in Pubmed
(Medline) concerning intervention studies in
research on working life captures about 90 per
cent of high-quality research. (99)
32 Report 2020:2
5. Conclusions
We have carried out two systematic litera-
ture reviews in which we have analysed and
compiled existing knowledge in the form of
published systematic reviews. We have not
carried out any summarized synthesis of the
results, and our conclusions are therefore ge-
neral and descriptive in nature. However, we
can state the following based on the project
aims and questions:
• There is extensive compiled research
on both associations and interventions.
Knowledge production in the form of
systematic literature reviews has increased
in the past few years.
• For the question concerning the effects of
interventions, there are more outcomes on
the organizational level compared with the
question concerning associations between
psychosocial work-environment factors
and health/well-being.
Conclusions based on the
analysis of systematic literature
reviews that investigated
associations between
psychosocial work-environment
factors and health/well-being
• There is no compiled research specically
investigating associations between psycho-
social health-promoting factors and outco-
mes on the individual or the organizational
level. The salutogenic perspective – the
description of the psychosocial work en-
vironment as something that can promote
health – is evident in only a few of the
results and conclusions of the included
systematic literature reviews. The patholo-
gical perspective – when the psychosocial
work environment is described as a risk
factor for health issues – predominates in
the included research.
• Regarding the question on associations
between psychosocial work-environment
factors and health/well-being, the research
has focused primarily on psychosocial stress
based on stress models (demand–control–
support, and effort/reward) and bullying.
• Regarding the question concerning
psychosocial work-environment factors
there are systematic reviews that focused
on associations with both mental-health
and somatic outcomes, particularly on the
individual level.
• Most of the systematic reviews that con-
cern these associations examined the work
environment in general. A specic work en-
vironment investigated in several studies is the
healthcare system and other care operations.
Conclusions based on the
analysis of systematic literature
reviews that investigated
the effects of psychosocial
workplace interventions
• For the question on the effects of inter-
ventions, what has been studied above all
is interventions designed to reduce stress
or improve employees’ ability to cope
with stress. There are also several syste-
matic reviews that investigated the effects
of general or specically health-promo-
ting interventions.
• For the question on the effects of inter-
ventions, what has been studied above all
is the effects of interventions on well-be-
ing and mental health, on both the indivi-
dual and the organizational levels.
• For the question on the effects of psycho-
social workplace interventions, the ma-
jority of the systematic literature reviews
investigated interventions conducted in
the healthcare system.
33Report 2020:2
• For the question concerning the effects of
interventions, there are very few systema-
tic reviews that describe long-term effects.
• There are many different ways of asses-
sing the effects of interventions. The
diversity of outcomes makes it more dif-
cult to compare the effects and opportuni-
ties in order to draw general conclusions.
34 Report 2020:2
6. General recommendations
These recommendations are based on the au-
thors’ interpretation of the conclusions found
in the studies that were included. We have
chosen to formulate our recommendations in
such a way that they address employers, deci-
sion-makers, public agencies or researchers.
Employers
• The psychosocial work environment is
of great importance for employees, and
it can be inuenced through active work-
place interventions. That is one of the
overall conclusions of this report. There
is relatively extensive research indicating
the signicance of the psychosocial work
environment. Much research also indicates
considerable adverse consequences for
employees when the psychosocial work
environment is perceived as challenging.
• Interventions can be conducted on dif-
ferent levels: they may target the indi-
vidual, or they may be more extensive
interventions that involve the employer
organization. Several of the identified
literature reviews indicate greater effects
from interventions that involve several
levels simultaneously.
Decision-makers, public
authorities and researchers
• There is a need to develop concepts,
methods and relevant outcomes so that
we may systematically study the saluto-
genic perspective; that is, the significan-
ce of the psychosocial work environme-
nt in creating workplaces that promote
healthy, satisfied employees.
• There is a need for further compiled
knowledge concerning the signicance of
psychosocial factors in many commonly
occurring workplace environments, such
as among private-sector employees, inde-
pendent entrepreneurs, and in non-tradi-
tional occupations.
• There is a need for compiled knowledge
concerning the signicance of psycho-
social factors for specic groups, such as
women, men, and those born abroad.
• There is a need to investigate the extent
to which existing knowledge concerning
workplace interventions is transferrable
and feasible in a Swedish context.
• It would be useful to have more long-term
follow-ups of effects of workplace inter-
ventions, to investigate whether changes in
the psychosocial workplace environment
and the employees’ ability to cope with the
work environment persist over time.
• It would be useful to have more studies
that investigate outcomes on the organi-
zational level.
• There is a need to develop standardized/
recommended outcome measures for work-
place interventions, to enable comparison.
35Report 2020:2
36 Report 2020:2
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2018;13(1):e0191332.
61. Joyce S, Modini M, Christensen H, Mykletun
A, Bryant R, Mitchell PB, et al. Workplace
interventions for common mental disorders:
a systematic meta-review. Psychol Med.
2016;46(4):683-97.
62. Lamothe M, Rondeau E, Malboeuf-Hurtubise C,
Duval M, Sultan S. Outcomes of MBSR or MBSR-
based interventions in health care providers: A
systematic review with a focus on empathy and
emotional competencies. Complement Ther
Med. 2016;24:19-28.
63. Marine A, Ruotsalainen J, Serra C, Verbeek J.
Preventing occupational stress in healthcare
workers. Cochrane Database Syst Rev.
2006(4):Cd002892.
64. Luken M, Sammons A. Systematic Review of
Mindfulness Practice for Reducing Job Burnout.
Am J Occup Ther. 2016;70(2):7002250020 1-10.
65. van Wyk BE, Pillay-Van Wyk V. Preventive
staff-support interventions for health workers.
Cochrane Database Syst Rev. 2010(3):Cd003541.
66. Ruotsalainen J, Serra C, Marine A, Verbeek J.
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67. Panagioti M, Panagopoulou E, Bower P, Lewith
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Meta-analysis. JAMA Intern Med. 2017;177(2):
195-205.
40 Report 2020:2
8. Appendices
41Report 2020:2
Appendix 1 Included studies for research question 1 - associations
Table of included studies that investigated associations between psychosocial work-environment factors and health/well-being on an individual or organizational level. Data is
extracted in the study’s original language.
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Rosario et al. 2016.
(2)
Population: adult workers
(variety of settings)
Aim: to review the existing
high-quality evidence for the
inuence of work-related
psychosocial factors on
workers’ health.
10 included studies, 7
prospective cohorts and 3
cross-sectional.
Exposure: psychosocial work charac-
teristics measured with psychosocial
validated instrument, typically within
theoretical model (demand-con-
trol-support model, effort-reward
imbalance model).
Outcome: physical and mental health
outcomes as reected through
psychosocial validated instruments,
medical evaluation, health-related
work outcomes, data on sickness
absence.
Most studies (7/10) observed an adverse
effect of poor psychosocial work factors on
workers’ health: 3 on sickness absence, 4 on
cardiovascular diseases. The other 3 studies
reported detrimental effects on sleep and
on disease-associated biomarkers. A more
consistent effect was observed in studies
of higher methodological quality that used
a prospective design jointly with the use of
validated instruments for the assessment
of the psychosocial (work) environment and
clinical evaluation.
Sui et al. 2016
(35)
Population: persons with
work related stress.
Systematic review of cohort
studies.
Aim: explore association
between work-related stress
and risk of type 2 diabetes.
7 cohort studies involving
214,986 participants.
Exposure: work related stress (inclu-
ding job demands, decision latitude/
job control, job strain.
Outcome: incidence of type 2 diabe-
tes.
No signicant association was found between
work-related stress and risk for type 2
diabetes based on meta-analysis of seven
prospective cohort studies involving 214,086
participants and 5,511 cases.
Nieuwenhuijsen et al.
2010.
(3)
Population: adult workers
Aim: to assess which
work-related psychosocial
risk factors may contribute
to the occurrence of stress
related disorders.
7 prospective cohort studies
were included. Follow-up
times 12–48 months.
Exposure: The psychosocial work
factors that were measured in the
original studies were grouped in 10
categories, derived from the three
models on work-related psychosocial
risk factors.
Strong evidence was found that high job
demands, low job control, low co-worker
support, low supervisor support, low pro-
cedural justice, low relational justice and a
high effort–reward imbalance predicted the
incidence of SRDs.
42 Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Stansfeld et al 2006.
(4)
Population: working age
adults.
Aim: to clarify the associa-
tions between psychosocial
work stressors and mental ill
health.
38 papers were identied
that explored psychosocial
work characteristics and
subsequent common mental
disorders. The numbers of
papers eligible for the me-
ta-analysis were reduced to
11 which reported results in a
form that could be submitted
to a meta-analysis.
Exposure: the psychosocial work
characteristics that were included
in the meta-analysis were Karasek’s
job-strain indices: decision latitude,
decision authority, psychological
demands, job strain, work social sup-
port, the combination of high efforts
and low rewards, and job insecurity.
Outcomes: new onset of a common
mental disorder: neurotic disorders
(WHO, ICD-10 codes F40–F42), de-
pressive disorders (codes F32–39),
and suicide.
This meta-analysis provides robust consis-
tent evidence that (combinations of) high
demands and low decision latitude and (com-
binations of) high efforts and low rewards are
prospective risk factors for common mental
disorders and suggests that the psychosocial
work environment is important for mental
health. The associations are not merely
explained by response bias. The impact of
work stressors on common mental disorders
differs for women and men.
Theorell et al. 2015.
(5)
Population: people at work,
with working conditions
relevant to Sweden.
Aim: to provide systematical-
ly graded evidence for pos-
sible associations between
work environment factors
and near-future development
of depressive symptoms.
59 studies included, 19 of
high quality and 40 of mode-
rate quality.
Exposure: was not conned to any
specic kind of work environment
factors. Physical/chemical/ergono-
mic exposures as well as psychosoci-
al factors were screened.
Outcomes: symptoms of depression.
These should have been certied
through diagnostic investigation or
with established scales.
Moderately strong evidence (grade three out
of four) was found for job strain (high psycho-
logical demands and low decision latitude),
low decision latitude and bullying having
signicant impact on development of depres-
sive symptoms. Limited evidence (grade two)
was shown for psychological demands, effort
reward imbalance, low support, unfavorable
social climate, lack of work justice, conicts,
limited skill discretion, job insecurity and
long working hours. There was no differential
gender effect of adverse job conditions on
depressive symptoms
There is substantial empirical evidence
that employees, both men and women, who
report lack of decision latitude, job strain and
bullying, will experience increasing depressive
symptoms over time.
Seidler et al. 2014
(1)
Population: working age po-
pulation, aged 17 or older.
Aim: to provide a compre-
hensive overview about
the effects of psychosocial
working conditions on the
development of burnout and
its core symptom, emotional
exhaustion.
6 moderate level quality
prospective cohort studies,
follow-up times 8 months to
3 years.
Exposure: psychosocial working
conditions.
Outcome: burnout and emotional ex-
haustion (measured by burnout-sub-
scales or by multi-item measures).
The results of our systematic review point to
a relationship between psychosocial working
conditions and the development of emotional
exhaustion/burnout. Particularly high job de-
mands seem to play a role in the development
of emotional exhaustion. However, strong
intercorrelations between workplace factors,
as a matter of principle, make the identica-
tion of a single psychosocial workplace factor
(being associated with an especially high or
low risk of burnout) difcult.
43Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
SBU, Statens bered-
ning för medicinsk
och social utvärde-
ring, 2014.
(6)
Population: arbetare
Frågeställningar: Vilken
betydelse har olika faktorer
i arbetsmiljön för uppkomst
och vidmakthållande av de-
pressionssymtom respektive
symtom på utmattningssyn-
drom?
59 artiklar om depressions-
symptom och 25 över utmatt-
ningssyndrom. Delmängder
av studier användes för
samband mellan specika ex-
poneringar och utfall, ibland i
metaanalys, ibland narrativt.
Exponering: psykosociala arbetsmil-
jöfaktorer, däribland krav/kontroll/
stöd, passivt arbete, pressande
arbete, obalans i ansträngning/be-
löning, lågt stöd från arbetsledning,
lågt stöd på arbetsplatsen, lågt stöd
från medarbetare, ogynnsamt socialt
klimat, ogynnsamt socialt kapital, låg
förekomst av rättvis miljö, konikter,
mobbning, liten möjlighet till utveck-
ling, osäkerhet i anställning.
Utfall: Depression/depressionssym-
tom (skalor, register, diagnos m.m.)
Utmattningssyndrom/symtom på
utmattning (skattningsskalor)
Personer som upplever en arbetssituation
med små möjligheter att påverka, i kombi-
nation med alltför höga krav, utvecklar mer
depressionssymtom.
Personer som upplever bristande medmänsk-
ligt stöd i arbetsmiljön utvecklar mer symtom
på depression och utmattningssyndrom än
andra. De som upplever mobbning eller kon-
ikter i sitt arbete utvecklar mer depressions-
symtom än andra, men det går inte att avgöra
om det nns något motsvarande samband för
symtom på utmattningssyndrom.
Personer som upplever att de har pressande
arbete eller en arbetssituation där belöningen
upplevs som liten i förhållande till ansträng-
ningen utvecklar mer symtom på depression
och utmattningssyndrom än andra. Detta
gäller även för dem som upplever osäkerhet i
anställningen, t ex en oro för att arbetsplatsen
ska läggas ner.
I vissa arbetsmiljöer har människor mindre
besvär.
Personer som upplever goda möjligheter till
kontroll i det egna arbetet och de som upple-
ver att de behandlas rättvist utvecklar mindre
symtom på depression och utmattningssyn-
drom än andra.
Den systematiska
översikten har en bre-
dare frågeställning än
enbart psykosociala
exponeringar.
Madsen et al. 2017.
(7)
Populations: workers
Aim: investigating the associ-
ation between job strain and
clinically diagnosed depres-
sion in a systematic review
and meta-analysis using
individual patient data.
6 published studies and
unpublished data from 14
cohort studies were used for
separate individual-partici-
pant-data meta-analysis.
Exposure: job strain
Outcomes: clinically diagnosed
depression (assessed by diagnostic
interview or hospital records).
Job strain was associated with an increased
risk of clinical depression in both published
[relative risk (RR) = 1.77, 95% condence inter-
val (CI) 1.47–2.13] and unpublished datasets
(RR = 1.27, 95% CI 1.04–1.55).
…
Job strain may precipitate clinical depression
among employees.
44 Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Ariens et al. 2001
(36)
Population: persons with
neck pain.
Systematic review of cohort
and cross-sectional studies.
Aim: to identify psychosocial
work risk factors for neck
pain.
In total 29 studies, one
prospective cohort and 28
cross-sectional.
Exposure: quantitative job demands,
social support, conicts, job control,
job strain, job satisfaction, job securi-
ty, rest break opportunities.
Outcome: neck pain
Some evidence was found for a positive
relationship between neck pain and high qu-
antitative job demands, low social (coworker)
support, low job control, high and low skill dis-
cretion and low job satisfaction. Inconclusive
evidence was found for high job strain, low
supervisor support, conicts at work, low job
security, and limited rest break opportunities.
Quality issues noted.
Aronsson et al 2017
(8)
Populations: employees
Systematic review
Aim: to provide systematical-
ly graded evidence in longitu-
dinal studies for possible as-
sociations between working
conditions and near-future
burnout, emotional exhaus-
tion, cynicism and reduced
personal accomplishment
among the employees.
25 included studies (case
control, cohort or randomised
controlled studies).
Exposures: job control, demands
(different types), support (different ty-
pes), workload, reward, job insecurity,
workplace justice, conicts, threats,
lack of feedback, occupational role.
Outcome: burnout (and like)
While high levels of job support and work-
place justice were protective for emotional
exhaustion, high demands, low job control,
high workload, low reward and job insecurity
increased the risk for developing exhaustion.
Our approach with a wide range of work
exposure factors analysed in relation to the
separate dimensions of burnout expanded the
knowledge of associations, evidence as well
as research needs. The potential of organi-
zational interventions is illustrated by the
ndings that burnout symptoms are strongly
inuenced by structural factors such as job
demands, support and the possibility to exert
control.
Results structured as
ndings associated
with more or less
burnout.
The article is a
shorter, peer reviewed
version of a Swedish
SBU-report: Arbets-
miljöns betydelse för
symptom på depres-
sion och utmattnings-
syndrom. (6)
Harvey et al. 2017.
(9)
Systematic review of reviews
(meta review)
Population: workers
Aim: investigate how work
factors may contribute to the
development of depression
and anxiety disorders and
symptoms.
37 studies included, 7 of at
least moderate quality.
Exposures: Twelve work-related risk
factors were identied among the in-
cluded reviews; high job demand, low
job control, low workplace social sup-
port, effort–reward. imbalance (ERI),
low organisational procedural justice,
low organisational relational justice,
organisational change, job insecu-
rity, temporary employment status,
atypical working hours, workplace
conict/bullying and role stress.
Outcomes: common mental health
problems, specically depression,
anxiety and/or work-related stress.
Within these broad categories, there was
moderate level evidence from multiple pro-
spective studies that high job demands, low
job control, high effort–reward imbalance,
low relational justice, low procedural justice,
role stress, bullying and low social support in
the workplace are associated with a greater
risk of developing common mental health
problems.
45Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Rugulies et al 2017.
(10)
Population: workers (econo-
mically active individuals.)
Aim: The primary objective
of this article is to determine
whether employees who are
exposed to effort-reward-im-
balance at work have a higher
risk of depressive disorders
compared to employees who
are not exposed.
8 studies from 6 articles were
included, all being prospec-
tive cohorts encompassing
84,963 employees and 2,897
(3.4%) new cases of depres-
sive disorders.
Exposure: quantitative baseline
assessment of exposure to ef-
fort-reward-imbalance model.
Outcome: depressive disorder (as-
sessed by a psychiatric diagnostic
interview, a diagnosis by a physician,
register data, administrative data with
diagnosis of depression) or a valida-
ted self-administered rating scale.
Seven of the eight studies suggested an
increased risk of depressive disorders among
employees exposed to ERI. The pooled
random-effects estimate was 1.49 [95% con-
dence interval (95% CI) 1.23–1.80, P<0.001],
indicating that ERI predicts risk of depressive
disorders. The estimate was robust in sensi-
tivity analyses stratied by study quality, type
of ERI ascertainment and type depressive
disorder ascertainment, respectively.
Lever et al. 2019
(54)
Population: health care
workers.
Aim: to provide a synthesis
of studies examining both
mental and physical health
consequences for staff who
report being bullied in health
care settings.
45 studies of primarily nurses
(66.7%), doctors (22.2%) and
midwives (8.9%).
Exposure: perceived workplace
bulling
Outcome: physical and mental health,
sick leave.
Perceived bullying was associated with men-
tal health problems including psychological
distress, depression and burnout, as well as
physical health problems including insomnia
and headache. Bullied staff took more sick
leave.
Unclear if screening
was performed by two
independent resear-
chers.
Leach et al. 2017.
(55)
Population: workers
Aim: investigate the relations-
hip of workplace bullying
with suicidal ideation and
behaviour.
12 included studies, 8 on
suicide ideation and 1 on
suicidal behaviour (other on
prevalence and more).
Exposure: work place bullying/mob-
bing
Outcome: prevalence of suicidal
ideation and behaviour.
The results show an absence of high-quality
epidemiological studies (eg. prospective
cohort studies, which controlled for workplace
characteristics and baseline psychiatric mor-
bidity). While the available literature (predo-
minantly cross-sectional) suggests that there
is a positive association between workplace
bullying and suicidal ideation, the low quality
of studies prevents ruling out alternative
explanations.
Supercial quality
evaluation.
Linton et al. 2015.
(11)
Population: workers
Aim: to review systematically
the literature on the effects
of work (physical, organi-
zational, and psychosocial
factors) on sleep.
24 studies included, 3 of high
and 21 of moderate quality)
Exposure: a broad range of known
work environment variables, one
being psychosocial factors.
Outcome: any measure of sleep
disturbance including all ICD-10 sleep
diagnoses.
Results showed that the psychosocial work
variables of social support at work, control,
and organizational justice were related to
fewer sleep disturbances, while high work de-
mands, job strain, bullying, and effort-reward
imbalance were related to more future sleep
disturbances.
Aim broader than
just psychosocial
exposure.
Partly salutogenic
presentation of work
factors as protective
factors.
46 Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Then et al. 2014.
(12)
Population: Working popula-
tion, age ≥ 17year
Aim: investigate the evidence
on the effects of psycho-
social work conditions on
cognition and dementia
We identied 17 articles of
adequate quality; 9 studies
examined the impact of
psychosocial work conditions
on clinical dementia, 5 stu-
dies reported on global cogni-
tive functioning and 3 studies
focused on performance in
specic cognitive abilities.
Exposure: Psycho-social work
environment characteristics: stress,
mental load, work load, effort,
reward, shift work, time pressure, job
insecurity, institutional changes like
downsizing or merger, social support/
mobbning, bullying, leadership style,
climate and work-related justice
Outcome: Long-term cognitive (dis)
abilities: measured in terms of errors,
injuries, processing speed, alert-
ness, distraction, memory, testing of
intellectual skills (eg. intelligence);
dementia and Alzheimer’s disease.
We found evidence for a protective effect of
high job control and high work complexity
with people and data on the risk of cognitive
decline and dementia. Moreover, cognitive-
ly demanding work conditions seem to be
associated with a decreased risk of cognitive
deterioration in old age. Psychosocial work
conditions can have an impact on cognitive
functioning and even on the risk of dementia.
Work factors as pro-
tective factors.
Knardahl et al. 2017
(52)
Population: workers
Aim: Which psychological
task-level work factors
contribute to retirement due
to disability? Which social
interaction factors at work
contribute to retirement
due to disability? Which
organizational work factors
contribute to retirement due
to disability?
39 studies of acceptable
quality, 37 of them from the
Nordic countries.
Exposure: organizational, psycholo-
gical, and social exposure pertaining
to work.
Outcome: registry-based disability
pension awards or self-reported
retirement from work due to ill health
or disease.
There was moderate evidence for the role of
low control (supported by weighted average
RR = 1.40; 95% CI = 1.21-1.61) and mode-
rate evidence for the combination of high
demands and low control (although weighted
average was RR = 1.45; 95% CI = 0.96-2.19) as
predictors of disability retirement.
Watanabe et al 2018.
(37)
Population: workers
Aim: to evaluate published
prospective studies to
investigate whether adverse
work-related psychosocial
factors were associated with
an elevated risk of metabolic
syndrome.
8 prospective studies inclu-
ded in metanalysis.
Exposure: adverse work related
psychosocial factors.
Outcome: metabolic syndrome onset.
The pooled risk of adverse work-related stress
on metabolic syndrome onset was signicant
and positive (RR = 1.47; 95% CI, 1.22–1.78).
Sensitivity analyses limiting only the effects
of job strain and shift work also indicated a
signicant positive relationship (RR = 1.75;
95% CI, 1.09–2.79; and RR = 1.59; 95% CI,
1.00–2.54, P = 0.049 respectively).
This study reveals a strong positive asso-
ciation between work related psychosocial
factors and an elevated risk of metabolic
syndrome onset.
47Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Huang et al. 2015
(38)
Population: workers
Aim: In this study, we aimed
to assess the association
between job strain and the
risk of incident stroke.
6 prospective cohorts com-
prising 138,782 participants.
Exposure: job strain
Outcome: incident stroke
Exposure to high strain jobs was associated
with an increased risk of stroke, especially in
women. Further studies are needed to conrm
whether interventions to reduce work stress
decrease the risk of stroke.
Unclear if screening
was performed by two
independent resear-
chers.
Babu et al. 2014
(39)
Population: adults in occupa-
tional setting.
Systematic review and me-
ta-analysis
Aim: to determine whether
job strain is associa-
ted with hypertension.
Nine observational studies (3
case control, 6 cohort), about
25,000 participants.
Exposures: job strain as dened as
the combination of high job demands
and low job decision latitude.
Outcome: hypertension The pooled OR
of the nine studies was 1.3 (95% CI 1.14 to
1.48; p<0.001), of case–control studies 3.17
(95% CI 1.79 to 5.60; p<0.001) and of cohort
studies 1.24 (95% CI 1.09 to 1.41)
…
We conclude that despite methodological dif-
ferences, case–control and cohort studies of
good methodological quality showed positive
associations between hypertension and job
strain.
Gilbert-Ouimet et al.
2014
(40)
Population: workers
Aim: do workers exposed to
psychosocial work factors of
the demand control support
and effort reward imbalance
models have higher blood
pressure than unexposed
workers? (There were additio-
nal specic objectives).
74 included studies (57 cross
sectional, 15 prospective
cohorts and 2 case-control
studies).
Exposure: psychosocial work factors
of the demand-control-support model
and/or the effort -reward-imbalance
model.
Outcome: blood pressure or hyperten-
sion incidence/prevalence.
Approximately half of the studies observed
a signicant adverse effect of psychosocial
work factors on BP. A more consistent effect
was observed, however, among men than wo-
men. For job strain, a more consistent effect
was also observed in studies of higher metho-
dological quality, i.e. studies using a prospec-
tive design and ambulatory BP measures.
Landsbergis et al.
2013
(41)
Population: workers
Aim: to review evidence of
the relationship between job
strain and ambulatory blood
pressure.
29 studies included.
Meta-analysis on 22
cross-sectional studies of a
single exposure to job strain.
Review of 1 case–control
study, 3 studies of cumulative
exposure to job strain, and 3
longitudinal studies.
Exposure: exposure to job strain via
its 2 major dimensions, job psycho-
logical demands and job decision
latitude, an operationalization of the
concept of job control.
Outcome: ambulatory blood pressure
(during work hours, leisure time
or evening, sleep, or 24 hours) or
hypertension status (if measured by
ambulatory blood pressure).
Single exposure to job strain in cross-sectio-
nal studies was associated with higher work
systolic and diastolic ABP. Associations were
stronger in men than women and in studies
of broad-based populations than those with
limited occupational variance.
Quality issue unclear
if study selection was
performed by at least
two authors.
Measures of blood
pressure and hy-
pertension used as
outcomes.
48 Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Xu et al. 2015
(42)
Population: workers
Aim: the objectives of the
present study include: 1)
investigating the association
between coronary heart
disease risk and categories
of job strain accessed by
demand control model; and
2) evaluating whether this
relationship is caused by job
control or job demands as
observed separately.
14 prospective cohort
studies (including 232,767
participants) were included.
Several meta analyses were
performed.
Exposure: job strain and job demands
with the demand control model.
Outcomes: risk/onset of coronary
heart disease.
Fourteen prospective cohort studies compri-
sing 232,767 participants were included. The
risk of coronary heart disease was increased
in high strain (RR 1.26; 95% CI 1.12–1.41) and
passive jobs (RR 1.14; 95% CI 1.02–1.29) but
not in active jobs (RR 1.09; 95% CI 0.97–1.22),
when compared with low-strain group.
…
Individuals with high-strain and passive jobs
were more likely to experience a coronary
heart event.
Fishta et al 2015
(33)
Systematic review of syste-
matic reviews
Population: working popu-
lation.
Aim: to nd out whether
psychosocial stress at work
leads to cardiovascular mor-
bidity and mortality.
6 systematic reviews inclu-
ded, based on 81 studies.
Exposure: various psychosocial
stress models, such as demand-con-
trol model, effort-reward imbalance,
organizational justice imbalance.
Outcomes: cardiovascular morbidity
and mortality.
The two enrolled meta-analysis conrmed a
modest (1.32, 95 % CI 1.09–1.59) to moderate
evidence (1.45, 95 % CI 1.15–1.84), predo-
minantly among men, for the association
between psychosocial stress at work and CV
outcomes.
Systematic review of
systematic reviews,
no meta-synthesis.
Backe et al. 2012
(43)
Population: Working popu-
lation.
Aim: to to conduct an up-to
date systematic review based
on longitudinal data on the
association of psychosocial
stress at work with cardio-
vascular diseases.
26 cohort studies of un-
selected general working
population.
Exposures: perceived at work
(psychosocial stress at work, work
stress, occupational stress, mental
stress, job strain, effort, reward,
demand, control).
Outcomes: cardiovascular disease,
coronary heart disease, myocardial
infarction, heart failure, angina pecto-
ris, stroke and hypertension.
No meta-analysis, descriptive results: In
summary, statistically signicant associations
between psychosocial stress and cardiovas-
cular disease were described in 14 out of 26
publications (11 out of 20 cohorts, respecti-
vely).
Conclusions: In accordance with other
systematic reviews, this review stresses the
importance of psychosocial factors at work in
the aetiology of cardiovascular diseases.
Bongers et al. 2002
(44)
Population: working popu-
lation.
Aim: investigate relations-
hip between psychosocial
factors and upper limb
problems, i.e., symptoms and
disorders of the hand/wrist,
elbow/forearm, and shoulder.
28 included studies, of which
26 were cross sectional.
Exposures: various models of job de-
mands (quantitative and qualitative),
job stimulus, job control, job support,
job satisfaction and more.
Outcome. Upper extremity problems
(UEP)
The large majority of the identied studies
reported an association between at least one
work-related psychosocial factor and adverse
upper extremity symptoms or signs. High
perceived job stress was consistently associ-
ated with all assessed UEP in high and lower
quality studies.
49Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Koch et al. 2014
(45)
Population: working popu-
lation.
Aim: investigate whether
there is an association
between the psychosocial
factors ascertained using the
ERI (effort-reward-imbalance)
model and job-related muscu-
loskeletal pain.
In total 19 studies were
included (15 cross sectional,
3 prospective cohorts and 1
case control.)
Exposure: measure of ef-
fort-reward-imbalance.
Outcome: reporting of having muscu-
loskeletal disorders.
The association between the psychosocial
factors ascertained using the ERI model and
the frequency of musculoskeletal.
Aim was broader than
just psychosocial
exposure.
Results and con-
clusion somewhat
conicting.
Kraatz et al. 2013
(46)
Population: workers
Aim: to investigate whether
psychosocial workplace
factors have an independent,
incremental effect on the
development of neck and/
or shoulder complaints, as
described in studies of a
longitudinal design.
In total 18 studies of which
16 were deemed high quality.
Exposure: psychosocial factors at
work (job-demand-control model, job
satisfaction, mental stress, organisa-
tional factors).
Outcomes: the development and re-
porting of neck/shoulder complaints.
Study results were too heterogeneous to de-
duce pooled risk estimates. But the weight of
evidence was strong for an incremental effect
of job demands, job control, social support,
and job strain, on the development of neck
and/or shoulder disorders.
Lang et al 2012.
(47)
Population: workers in indu-
strialized work settings.
Aim: to conduct a systematic
review and meta-analysis
regarding the inuence of oc-
cupational psychosocial risk
factors on the development
of musculoskeletal problems
musculoskeletal disorders.
In total 50 included studies
with various measures of
psychosocial work factors
and musculoskeletal.pro-
blems used for 23 analyses.
Exposures: various psychosocial
factors such as demands, control,
job strain, social support, supervisor
support, co-worker support, security
etc.).
Outcome: symptoms from low back,
neck/shoulder, upper and lower
extremity.
In total, 50 primary studies fullled inclusion
criteria. Within these studies at least ve
effect sizes were available for 23 of the 45
possible psychosocial work stress muscu-
loskeletal problems relationships, leaving 9
psychosocial variables and four musculos-
keletal problem areas for analyses. Of these
23 relationships, pooled OR estimates were
positive and signicant ranging from 1.15 to
1.66 with the largest pooled OR estimating the
relationship between highly monotonous work
and lower back pain.
50 Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Manseld et al.
2018.
(48)
Population: adults with carpal
tunnel syndrome
Aim: to investigate the
incidence of carpal tunnel
syndrome in association to
psychosocial factors and
whether psychosocial factors
may predict the development
of carpal tunnel syndrome.
6 moderate- to high-quality
studies were included in the
nal review.
Exposure: psychosocial factors –
cognitive (eg. neuropsychological
functioning), affective (eg. distress,
mood), behavioral (eg. coping stra-
tegies), vocational (eg. employment
status, job satisfaction, self-perceived
work ability), or interpersonal proces-
ses (eg. social support).
Outcome: carpal tunnels syndrome
(clinically diagnosed, self reported,
electrophysiological testing).
Five studies reported a positive association
between psychosocial factors and carpal
tunnel syndrome, where psychosocial factors
were more in those who reported carpal tun-
nel syndrome. One study reported no positive
or negative association with carpal tunnel
syndrome development. Four studies reported
a negative association between psychosocial
factors and carpal tunnel syndrome, where
psychosocial factors were less in those who
reported carpal tunnel syndrome.
…
There is limited evidence for a positive as-
sociation between psychosocial factors and
carpal tunnel syndrome.
Aim broader than just
work related psycho-
social exposures.
McLean et al. 2010
(49)
Population: Workers without
neck pain at baseline.
Aim: to summarise current
good-quality literature in
order to identify factors that
have been linked to the onset
of a new episode of non-spe-
cic neck pain.
15 studies of which 14 were
independent cohorts.
Exposures: risk factors (physical,
psychological, sociodemographic
and clinical.
Outcome: onset of neck pain.
Female gender, older age, high job demands,
low social/work support, being an ex-smoker,
a history of low back disorders and a history
of neck disorders were linked to the develop-
ment of non-specic neck pain.
Broader aim than
just psychosocial
exposures.
Unclear if screen were
performed by two
independent resear-
chers.
Finney et al. 2013
(13)
Population: employed in adult
correctional facilities.
Aim: examine organizational
stressors that are related to
job stress and burnout.
8 studies included Exposures: categorized as: the
organizational structure, climate,
stressors intrinsic to the job, role
within the organization, rewards at
work and supervisory support.
Outcome: job stress and burnout.
The results of this review indicate that
organizational stressors are associated with
job stress and burnout in COs within adult cor-
rectional facilities. Specically, the organiza-
tional structure and climate was signicantly
associated with CO job stress and burnout.
51Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Basu et al 2017
(14)
Population: clinical staff
working in emergency de-
partments (medical, nursing,
support workers).
Aim: examining sources of
organisational stress leading
to psychological illness, bur-
nout and adverse occupatio-
nal outcomes.
25 studies included, several
cross sectional.
The heterogeneity of data
precluded a meta-analysis,
thus narrative review of
contextual factors.
Exposure: Occupational stress,
dened as when the resources of the
individual are not sufcient to cope
with the demands of a situation.
Outcome: adverse health outcomes.
Results: Whilst high demand and low job
control were commonly featured; other
studies demonstrated the role of insufcient
support at work, effort-reward imbalance and
organisational injustice in the development of
adverse health and occupational outcomes.
Bernal et al. 2015.
(50)
Population: nurses and aides
(health care).
Aim: To estimate the associ-
ation between psychosocial
risk factors in the workplace
and musculoskeletal disor-
ders.
24 studies included in syste-
matic review, 17 in meta-ana-
lysis.
Exposure: psychosocial stress (high
demand/low control).
Outcomes (different models using
subsets of studies) for back pain, low
back pain, shoulder pain, neck pain.
This meta-analysis suggests that psychosoci-
al risk factors at the workplace are associated
with MSD in hospital nurses and nursing
aides. Although most preventive strategies
at the workplace are focused on ergonomic
risk factors, improving the psychosocial
work environment might have an impact on
reducing MSD.
Quality issue: unclear
if there were two inde-
pendent screeners.
Brborovic et al 2017.
(53)
Population: nurses
Aim: to investigate
elements associated with
nursing sickness presen-
teeism (SP) and sickness
absenteeism (SA).
12 cohort studies (11 on
sickness absenteeism and 1
on presentism).
Exposure: any exposure in primary
studies.
Outcome: sickness absenteeism (SA)
and sickness presentism (SP).
Twentythree antecedents were associated
with SA and grouped as work and organizatio-
nal, mental and physical health, and demo-
graphic; 3 antecedents were associated with
SP (job demands, burnout, and exhaustion).
Exhaustion (fatigue) and job demands were
associated with SA and SP.
Aim broader than just
investigating psycho-
social antecedents
and associations with
the outcomes.
Samsudin et al 2018.
(34)
Population: junior doctors
Aim: What impact has work-
place bullying had on victims
of workplace bullying as well
as on organizations?
18 studies with 9,597 junior
doctor participants included
in narrative synthesis.
Exposure: bullying dened as being
exposed to “situations where an
employee is persistently exposed to
negative and aggressive behaviours
at work from superiors, colleagues
and subordinates that are primarily of
a psychological nature with the effect
of humiliating, intimidating, frighte-
ning or punishing the target”.
Outcomes: health outcomes.
… signicant associations between bullying
and mental strain, job dissatisfaction, bur-
nout, and increased accidents at work were
observed. Concurrently, heterogeneity in the
terms and methodologies used to examine
workplace bullying as well as denitional iss-
ues in relation to the persistency of negative
interactions were noted. Evidence suggests
that workplace bullying is a serious occupatio-
nal hazard for junior doctors.
Aim broader, had
three aims in total.
52 Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Schneider et al.
2018.
(15)
Population: workers at emer-
gency departments (ED).
Aims: (1) to identify and
categorize psychosocial
ED work factors associated
with the mental well-being of
ED providers, (2) to systema-
tically categorize these rela-
tionships according to their
quantity as well as strength,
and (3) to derive recommen-
dations for future research
and prevention practice.
In total 39 studies included,
37 cross-sectional and 2
prospective cohorts.
18 of the included studies
focused on nurses and 12 on
physicians, 4 studies involved
nonclinical ED professions
including administrative and
support staff.
Exposure: psychosocial work factors
assigned to a multi-level taxonomy
drawing on the work system model:
(a) patients and task-related work
factors, e.g. job control, work over-
load; (b) organizational factors, e.g.
personnel resources, rewards; (c)
social factors, e.g. support from su-
pervisors or colleagues, interpersonal
conict; and (d) other factors which
could not be assigned to (a)–(c),
such as general job demands.
Outcomes: mental well-being out-
comes were classied into positive
well-being outcomes, (job satisfac-
tion, work engagement), affective
symptoms and negative psychologi-
cal functioning (emotional exhaus-
tion, post-traumatic stress reactions),
cognitive-behavioural outcomes,
(turnover intention, commitment and
role behaviours), health complaints,
(somatic symptoms, physical com-
plaint).
To the best of our knowledge, this review is
the rst to provide a quantitative summary
of the research base on associations of
psychosocial ED work factors and provider
well-being. Conclusive results reveal that peer
support, well-designed organizational structu-
res, and employee reward systems balance
the negative impact of adverse work factors
on ED providers’ well-being.
Magnavita et al.
2018
(51)
Population: police workers.
Aim: investigate the associ-
ations between life stress,
work stress, and the risk of
metabolic syndrome and
cardiovascular disease in
police.
16 studies with total 17,698
participants. Average low
quality of studies.
Exposure: occupational stress
Outcome: incidence and prevalence
of cardiac and vascular diseases,
including risk factors for CVD, such
as hypertension, hypercholesterole-
mia, hypertriglyceridemia, obesity,
and diabetes.
Exposure to stress in cross-sectional studies
was inconstantly associated with hyperten-
sion, obesity, dyslipidaemia, and impaired
glucose metabolism.
Results were, however, often conicting and
inconsistent with regard to denitions and
measurement of stress, features of individual
study design, study conduct, and conclusions
drawn.
Aim broader than just
investigating psycho-
social risk.
53Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Zangaro et al. 2007
(16)
Population: registered nurses
working in staff positions.
Aim: to examine the strength
of the relationships between
job satisfaction and auto-
nomy, job stress, and nurse–
physician collaboration
among registered nurses.
31 studies with 14,567 parti-
cipants included in meta-ana-
lysis.
Exposure: job satisfaction
Outcome: measures of autonomy,
job stress, and workplace communi-
cation.
Job satisfaction was most strongly corre-
lated with job stress (ES¼.43), followed by
nurse–physician collaboration (ES¼.37), and
autonomy (ES¼.30).
Authors had job
satisfaction as expo-
sure and job stress as
outcome, results are
however reported as
correlations.
Unclear screening
was performed by two
independent resear-
chers.
Brooks et al. 2016
(17)
Population: occupational
groups affected by disasters
Aim: identify social and oc-
cupational factors affecting
the psychological impact of
disasters on responders.
111 studies, most of
cross-sectional design. Most
common disaster: terrorism
followed by natural disasters.
Exposures: occupational factors in
pre, peri and post phase of disaster.
Outcome: wellbeing
The psychological impact of disasters on res-
ponders appeared associated with pre-disas-
ter factors (occupational factors; specialised
training and preparedness; life events and
health), during-disaster factors (exposure;
duration on site and arrival time; emotional
involvement; peri-traumatic distress/dissoci-
ation; role-related stressors; perceptions of
safety, threat and risk; harm to self or close
others; social support; professional support)
and post-disaster factors (professional sup-
port; impact on life; life events; media; coping
strategies).
Aim broader than
just psychosocial
exposure.
Authors developed
their own quality
assessment.
O’Connor et al. 2018
(18)
Population: mental health
professionals
Aim: The aim of this review
is [1] to quantify the level of
burnout in
Mental health professionals
and [2] to identify specic
determinants of burnout in
mental health professionals.
33 studies used in quantita-
tive synthesis of prevalence
data and 60 studies used in
qualitative narrative synthesis
of determinants of burnout.
Exposure: determinants were cate-
gorised as ‘individual’ factors and
‘work-related’ factor.
Outcome: measures of burnout, typi-
cally validated questionnaires
Work-related factors such as workload and
relationships at work, are key determinants
for burnout, while role clarity, a sense of
professional autonomy, a sense of being
fairly treated, and access to regular clinical
supervision appear to be protective. Staff
working in community mental health teams
may be more vulnerable to burnout than those
working in some specialist community teams,
e.g. assertive outreach, crisis teams.
Aim broader than just
investigating psycho-
social determinants of
burnout.
54 Report 2020:2
Author, Year
[Ref]
Population/context
Aim
Number of studies/
participants
Exposure
Outcome
Method of synthesis
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Platt et al. 2012
(19)
Population: veterinary sur-
geons.
Aim: to conduct a systematic
review of studies investiga-
ting suicidal behaviour and
psychosocial problems in
veterinary surgeons.
52 studies in total are inclu-
ded in this review, 11 were
of relatively high quality as
dened by scores 9–12 on
the quality rating scale.
Exposure: non-fatal suicidal beha-
viour.
Outcomes: psychosocial problems.
The majority of studies were of stress and
occupational difculties experienced by
veterinary surgeons. Occupational stressors
included managerial aspects of the job, long
working hours, heavy workload, poor work-life
balance, difcult client relations, and perfor-
ming euthanasia. Few studies investigated
suicidal behaviour or mental health difculties
in the profession. Some studies suggested
that young and female veterinarians are at
greatest risk of negative outcomes such as
suicidal thoughts, mental health difculties,
and job dissatisfaction.
Unclear which was
considered exposu-
re, and which was
outcome.
55Report 2020:2
Appendix 2 Included studies for research question 2 - interventions
Table of included studies that investigated effects of psychosocial workplace interventions.
Data is extracted in the study’s original language.
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Bartlett, L. et al.
2019
(97)
Employees/Work
To assess the effectiveness
of mindfulness training
delivered in the work context
for employee mindfulness,
stress, mental health, well-be-
ing, and work performance
and second to explore the
moderating role of workplace
characteristics and of inter-
vention dose, content, and
delivery mode.
25 primary studies (27
articles)
Intervention: Mindfulness training
Outcomes: A range of outcomes in-
cluding: mindfulness, stress, mental
health, well-being etc.
Training increased mindfulness and had sig-
nicant positive effects for perceived stress,
psychological distress, anxiety, wellbeing
and sleep, but evidence for improvements in
work performance, depression and burnout
was ambivalent. No signicant results were
observed in analyses of the inuence of inter-
vention or workplace characteristics.
Test of mediators
Bellon, J.A. et al.
2018
(100)
Working/Workplace
To evaluate the effective-
ness of psychological and
educational interventions in
preventing depression in the
workplace.
3 primary studies/1,246 in in-
tervention and 614 in control
group.
Intervention: Universal prevention
programs with non-depressed
workers with any level of risk of
depression.
Outcomes: Depression
Psychological or educational interventions
in the workplace may prevent depression,
although the quality of evidence was low.
Buchberger, B.et al
2011
(98)
Health care personnel/work-
place health promotion.
What kind of interventions in
workplace health promotion
help maintain the working
capacity of health care
personnel?
6 Intervention: Psychological health
interventions
Outcomes: A range of outcomes in-
cluding: stress management, coping
with workload, communication skills,
burnout etc.
Study personnel actively taking part in
psychological health interventions beneted
from a signicantly decreased intake of anal-
gesics, better stress management and better
coping with workload; they also displayed
improved communication skills and gained
additional vocational training.
Also economic evalu-
ations and physical
health interventions
HTA-report
56 Report 2020:2
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Carolan, S.et al 2017
(80)
Employees/Workplace
To evaluate the overall
effectiveness of occupa-
tional digital mental health
interventions for employee
psychological well-being and
work effectiveness and to
identify, through the partial
implementation of positive
deviance methodology,
which intervention features
inuence engagement and
adherence.
21 primary studies/5,260
(2711 intervention and 2,549
control group).
Intervention: Psychological interven-
tions aimed at increasing
psychological well-being or work ef-
fectiveness delivered via the Internet,
mobile technology, or a computer
program.
Outcome: Well-being or work effecti-
veness.
Occupational digital mental health interven-
tions can improve workers’ psychological
well-being and increase work effectiveness.
Chen, C. M. and Lou,
M.F. 2014
(77)
Nurses/Health care
To examine the effective-
ness and application of
mentorship programmes for
recently registered nurses.
5 primary studies Intervention: Mentorship programs
Outcome: Turnover rate, turnover
costs, medical negligence rate, nur-
sing competencies, job satisfaction,
communication skills, and develop-
ment of interpersonal relationships.
The results of this systematic review suggest
that mentorship
programmes are a benecial process for
mentors and recently registered nurses.
Clough, B. A. et al
2017
(57)
Medical doctors/Health care
To review and evaluate
evidence on psychosoci-
al interventions aimed at
reducing occupational stress
and burnout among medical
doctors.
23 primary studies Intervention: Psychosocial interven-
tion targeting individual level stress
or burnout.
Outcome: Directly assessed occu-
pational stress or burnout among
doctors (e.g. depression, anxiety, or
substance use).
This review found that the quality of research
examining the benets of psychosocial/beha-
vioural interventions for occupational stress
and burnout in medical doctors remains low.
Despite this, interventions focused on cog-
nitive and behavioural principles appear to
show promise in reducing doctor stress and
burnout.
Unclear if initiated by
workplace
Corbiere, M. et al
2009
(85)
Employees/Worksites
To review the literature from
2001 to 2006 using Cottrell’s
conceptualization to assess
preventive psychological
interventions for workers.
24 primary studies Intervention: Preventive (primary or
secondary) psychological interven-
tions for workers.
Outcome: A range of work and
health-related outcomes.
There was a predominance of studies
utilizing skills training. One-third of studies
used a combination of individual, group and
organization level interventions, most often
supported by psychosocial intervention or
participatory research. These components
brought positive and signicant results with
regard to work and mental health outcomes
to workers.
57Report 2020:2
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Daniels, K. et al 2017
(93)
Workers/Organisations
To assess if interventions
that seek to improve social
environments in organiza-
tions promote well-being?
Further if interventions that
seek to improve social en-
vironments in organizations
improve performance?
8 primary studies Intervention: Changes in the social
environment in work organizations.
Outcome: Well-being, performance.
There is promising evidence that workers’
well-being may be improved through a com-
bination of initiatives based on shared social
activities. There is insufcient evidence to
make any conclusions about the effects on
well-being of organizational interventions to
improve perceptions of fair treatment at work.
Fox, S.et al 2018
(58)
Physicians/Health care
To synthesise the literature
describing interventions to
improve resilience among
physicians, to evaluate the
quality of the extant research
and to outline the type and
efcacy of interventions
implemented.
22 primary studies Intervention: Interventions promoting
resilience
Outcome: Perceived stress, perceived
resilience.
Methodological quality was low to moderate.
The most frequently employed interventional
strategies were psychosocial skills training
and mindfulness training. Effect sizes were
heterogeneous.
Unclear if two individu-
als did the screening
for inclusion
Furlan, A. et al 2012
(74)
Workers/Work or facilitated
by work
To identify evidence-based
programs, or intervention
approaches that could be
implemented or facilitated
by employers to manage
workers’ depression and
reduce associated productivi-
ty losses.
12 primary studies (from 14
publications)
Intervention: Interventions to manage
workers’ depression and reduce
associated productivity losses.
Outcome: A range of outcomes inclu-
ding: sickness absence, absenteeism,
worker turnover, long- term disability,
on-the-job health-related performan-
ce, work-functioning.
There is no one intervention found that can
be recommended as effective for the four
main outcomes suggested by the stakehol-
ders (prevention and management of work
disability/sickness absence, work functioning
and recurrences of work disability/sickness
absence).
Gillen, P. A. et al
2017
(76)
Workers/Workplace
To evaluate the effectiveness
of workplace interventions
to prevent bullying in the
workplace.
5 primary studies Intervention: Prevention of bullying in
the workplace.
Outcome: Bullying victimization,
civility, bullying perpetration, absen-
teeism.
This review shows that organisational and
individual interventions may prevent bullying
in the workplace. However, the evidence is of
very low quality.
58 Report 2020:2
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Haggman-Laitila, A.
et al 2018
(69)
Nurse leaders, nursing staff/
Health care
To gather, assess and
synthesize current research
knowledge on interventions
that aimed to improve nurse
leaders’ well-being at work.
5 primary studies Intervention: Interventions on well-be-
ing at work, where the target group
consisted of nurse leaders or nurse
leaders and nursing staff.
Outcome: Wellbeing at work.
Stress management with mental exercises
was the most examined and most successful
interventions, as these primarily reduced the
participants’ stress levels.
Hamberg-van Re-
enen, H. H.et al 2012
(96)
Workers/Workplace and
elsewhere
To give an overview of the
evidence on the cost-effec-
tiveness and nancial return
of interventions aimed at
preventing or treating mental
health problems, or to impro-
ve RTW of workers sicklisted
from mental health problems.
10 primary studies Intervention: Interventions aimed at
preventing or treating mental health
problems, or to improve RTW of wor-
kers sicklisted from mental health
problems.
Outcome: Effectiveness or costs.
Worksite interventions to prevent or treat
mental health problems might be cost-ef-
fective, while RTW interventions aimed at
depressed employees do not seem to be cost
benecial on the basis of those studies that
included a full economic evaluation.
Not all workplace-ba-
sed
Hill, R. C. et al 2016
(70)
Palliative care staff/Palliative
care
To investigate quantitative
studies exploring the effec-
tiveness of psychosocial
interventions that attempt to
improve psychological well-
being of palliative care staff.
9 primary studies Intervention: Psychosocial interven-
tions
Outcome: A range of psychological
outcomes
Interventions comprised a mixture of
relaxation, education, support and cogni-
tive training and targeted: stress, fatigue,
burnout, depression and satisfaction. The
RCT evaluations didn’t improve psychological
wellbeing of palliative care staff. Only two of
the quasi-experimental studies appeared to
show improved staff wellbeing though these
studies were methodologically weak.
Note denition of
psychosocial:
“An important aspect
of our denition of
psychosocial interven-
tions is that there had
to be an experiential
and reective compo-
nent.”
Janssen, M.et al
2018
(59)
Workers/Digital means rela-
ted to workplace
To gain deeper insight into
the effects of two mind-
fulness interventions on
employees' mental health
across different occupational
sectors.
23 primary studies (from 24
publications)
Intervention: Interventions with Mind-
fulness-Based Stress Reduction or
Mindfulness-Based Cognitive The-
rap y.
Outcome: A range of mental and
psychological outcomes.
The results of this systematic review suggest
that mindfulness based stress reduction may
help to improve psychological functioning in
employees.
Unclear if two individu-
als did the screening
for inclusion.
59Report 2020:2
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Joyce, S. et al 2016
(60)
Workers, workers with a
depression or anxiety diagno-
sis/Workplace.
To examine the effectiveness
of workplace mental health
interventions, dened as any
intervention that a workplace
may either initiate or facilitate
that aims to prevent, treat
or rehabilitate a worker with
a diagnosis of depression,
anxiety or both.
140 systematic reviews inclu-
ding 481 primary studies.
Intervention: Primary, secondary and
tertiary workplace mental health
interventions for anxiety and depres-
sion disorders.
Outcome: Symptom reduction and
occupational outcomes
Moderate evidence was identied for two
primary prevention interventions; enhancing
employee control and promoting physical
activity. Stronger evidence was found for
CBT-based stress management although
less evidence was found for other secondary
prevention interventions, such as counselling.
Strong evidence was also found against the
routine use of debrieng following trauma.
Tertiary interventions with a specic focus on
work, such as exposure therapy and CBT-ba-
sed and problem-focused return-to-work
programmes, had a strong evidence base for
improving symptomology and a moderate
evidence base for improving occupational
outcomes.
Lamothe, M.et al
2016
(61)
Healthcare personnel/Healt-
hcare
To identify outcomes in stu-
dies on the effect of Mindful-
ness-Based Stress Reduction
in healthcare personnel. The
second objective is to evalu-
ate the impact of Mindful-
ness-Based Stress Reduction
on these outcomes. The
third objective is to assess
if some of these outcomes
reect empathy and three key
emotional competencies: (a)
identication of one’s own
emotions, (b) identication
of other’s emotions, and (c)
emotional acceptance, as
these are deemed essential
to professional healthcare.
39 primary studies Intervention: Mindfulness-Based
Stress Reduction -based intervention.
Outcome: A range of mental health,
physical health, mindfulness and
relational outcomes.
Evidence regarding the effects of Mindful-
ness-Based Stress Reduction in professionals
suggests this intervention is associated with
improvements in burnout, stress, anxiety and
depression. Improvements in empathy are
also suggested but no clear evidence is cur-
rently available on emotional competencies.
60 Report 2020:2
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Lee, N. K. et al 2014
(86)
Workers/Male dominated
industries
To examine the current
evidence base for workplace
interventions addressing
mental health problems in
male-dominated industries.
5 primary studies Intervention: Mental health workplace
interventions
Outcome: Work and health related
outcomes
Overall, the body of evidence supporting
effective interventions for mental health pro-
blems among workers in male-dominated in-
dustries is limited. Nonetheless, the evidence
does suggest that mental health interventions
in male-dominated industries are logistically
feasible and can have some positive impact
on the mental health of workers, particularly
for high prevalence low severity disorders
such as anxiety and depression.
Marine, A. et al
20016
(62)
Healthcare workers/Health
care
To evaluate the effectiveness
of work- and person-directed
interventions compared to
no intervention or alternative
interventions in preventing
stress at work in healthcare
workers.
19 primary studies Intervention: Interventions aimed at
preventing or reducing stress arising
from work.
Outcome: Occupational stress or
burnout.
We conclude that cognitive-behavioral trai-
ning as well as mental and physical relaxation
all reduce stress moderately. Changing work
schedules can also reduce stress, but other
organizational interventions have no clear
effects.
Montano, D.et al
2014
(84)
Employees/Workplace
Evaluate all organisational-le-
vel intervention studies iden-
tied by our search strategy
on the basis of
a systematic classication.
This classication aims
to synthesise the major
modications of the working
conditions implemented by
the interventions. We dis-
tinguish work organisation-di-
rected changes from work
time-directed changes and
from changes of the material
substrate of work.
39 primary studies Intervention: Organisational-level
workplace interventions aiming at
improving employees’ health
Outcome: Effect of intervention,
which is a wide range of different
outcomes including different health
outcomes, sleep, injury rates and sick
leave.
Success rates were higher among more com-
prehensive interventions tackling material, or-
ganisational and work-time related conditions
simultaneously.
61Report 2020:2
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Murray, M. et al 2016
(75)
General Practitioners/Health
care
To evaluate the effectiveness
of interventions designed to
improve General Practitio-
ner well-being across two
continua; psychopathology
(mental ill-health focus) and
‘languishing to ourishing’
(positive mental health
focus).
4 primary studies/997 gene-
ral practitioners
Intervention: Well-being interventions
Outcome: Mental illness or positive
mental health
The studies reported statistically signicant
improvement in self-reported mental ill-
health. Two interventions used cognitive-be-
havioral techniques, one was mindfulness-ba-
sed and one fed-back scores and self-help
information.
Naghieh, A. et al
2015
(94)
Teachers/School
To evaluate the effectiveness
of organisational interven-
tions for improving wellbeing
and reducing work-related
stress in teachers.
4 primary studies Intervention: Organisational inter-
ventions for employee wellbeing
targeting the stressors in the work
environment, rather than the stress
response of the individual employee.
Outcome: work stress, wellbeing,
teacher turnover (retention rates),
and sickness absence.
Changing the way teachers’ work is organised
at schools may improve the teachers’ wellbe-
ing and may reduce teacher resignations.
Nigatu, Y. T.et al
2019
(87)
Workers/Workplace
To evaluate the effectiveness
of indicated interventions for
reducing depressive sympt-
oms in the workplace.
15 primary studies Intervention: Indicated interventions
for reducing depressive symptoms.
Outcome: Depressive disorder or
depressive symptomatology.
This review demonstrates that indicated inter-
ventions can signicantly reduce the level of
depressive symptoms among workers.
Wagner et al. 2015
(78)
Adults (15+ years) working or
attempting to work/Work or
work related.
To investigate what level of
evidence is available that
social support and/or super-
visory quality interventions
impact work outcomes.
10 systematic literature
reviews
Intervention: workplace interventions
specically targeting social support
or supervisory quality.
Outcome: Absenteeism, nancial
outcomes, and/or productivity
There is moderate evidence that social
support and limited evidence that supervisory
quality interventions have a positive effect on
work outcomes.
Best-Evidence Synt-
hesis of Systematic
Reviews
62 Report 2020:2
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Ravalier et al. 2016
(71)
Adult employees without cli-
nical levels of psychological
illness/Work
To explore whether the imple-
mentation of complementary
therapies in the workplace
can aid in improvement of
employee health and perfor-
mance at work.
10 primary studies Intervention: Workplace-based com-
plementary therapies
Outcome: Health and performance.
Mindfulness and meditation-based interven-
tions were most effective in improving work-
place health and work performance; the latter
demonstrating some evidence of maintaining
gains up to 3 months later. The evidence for
relaxation interventions was inconclusive.
Aim broader than just
psychosocial interven-
tions.
Luken et al. 2016
(63)
Individuals with workpla-
ce burnout but otherwise
healthy (mainly health care
providers and teachers)/Work
To investigate the evidence
for the efcacy of practicing
mindfulness to treat job
burnout.
8 primary studies Intervention: Mindfulness training
Outcome: A range of outcomes inclu-
ding mindfulness stress reductions.
6 of the 8 studies demonstrated statistically
signicant decreases in job burnout after
mindfulness training.
There is strong evidence for the use of mind-
fulness practice to reduce job burnout among
health care professionals and teachers.
Unclear if all inter-
ventions were work
related.
Brand et al. 2017
(92)
Healthcare personnel/Health
care
To identify whole-system
healthy workplace interven-
tions in healthcare settings
that incorporate (combina-
tions of) these recommenda-
tions and determine whether
they improve staff health and
wellbeing.
11 primary studies Intervention: interventions which
were targeted at all staff within a
healthcare setting, categorized as
pre-determined, pre-determined and
some choice of activities including a
wide choice of a range of activities
and adaptation.
Outcome: Individual health behavio-
urs, health outcomes, and psychoso-
cial workplace environment.
Only ve of the interventions included
substantial involvement and engagement of
leadership and efforts aimed at up-skilling
the leadership of staff to support staff health
and wellbeing. All studies were deemed by
their authors to be at least partly effective.
Two studies reported statistically signi-
cant improvement in objectively measured
physical health (BMI) and eight in subjective
mental health. Six studies reported statistical-
ly signicant positive changes in subjectively
assessed health behaviours.
Whole system app-
roaches are broader
concepts than psycho-
social interventions.
63Report 2020:2
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Tan et al 2014.
(88)
Workers/Workplace
To assess evidence for
work-based universal preven-
tion of depressive illness.
9 primary studies Intervention: preventive workplace
interventions
Outcomes: depressive symptoms
The majority of the included studies utilized
cognitive behavioral therapy (CBT) tech-
niques. The overall standardized mean
difference (SMD) between the intervention
and control groups was 0.16 (95% condence
interval (CI): 0.07, 0.24, P = 0.0002), indicating
a small positive effect.
There is good quality evidence that univer-
sally delivered workplace mental health inter-
ventions can reduce the level of depression
symptoms among workers.
Stock et al. 2018
(95)
Non-sick-listed workers/
Workplace
To answer the following
research question: compared
to usual work activity (ie, no
intervention), are workplace
interventions that target work
organization or the psychoso-
cial work environment effec-
tive in preventing the onset
of or reducing the incidence,
prevalence or intensity of
work-related musculoskeletal
pain or of musculoskeletal
disorders).
28 primary studies Intervention: any intervention (orga-
nizational component or targeted
organizational or psychosocial) in the
workplaces.
Outcome: musculoskeletal health
outcome (incidence, prevalence or
intensity of such pain, specic disor-
ders, or work absence/work disability
due to such pain or disorders).
One before–after uncontrolled study provided
very low-quality evidence that a participatory
organizational intervention targeting psycho-
social work exposures was more effective
than work as usual in reducing the six-month
prevalence of neck/shoulder and lower back
pain with functional limitations.
Aim broader than just
psychosocial work
interventions.
Van Wyk et al. 2010
(64)
Professional health workers
and health teams/Primary,
secondary, tertiary, commu-
nity, residential, and referral
care settings.
To determine the effects of
preventive staff-support inter-
ventions for health workers.
10 primary studies/716
participants
Interventions: Interventions intended
to improve health-workers’ ability to
cope or manage job stress.
Outcomes: absenteeism; turnover;
burnout; productivity; job stress; job
satisfaction, staff morale or work
motivation.
Three studies demonstrated a beneci-
al effect of stress management training
intervention on job stress. Only one of these
showed that this effect is sustainable over
the medium-term. One study demonstrated
the benecial effect of a high intensity, stress
management training intervention on burnout.
Low and moderate intensity stress manage-
ment training interventions failed to demon-
strate benet on burnout or staff satisfaction.
Management interventions demonstrated
increases in job satisfaction but failed to
show effect on absenteeism.
64 Report 2020:2
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Palmer et al. 2012
(83)
Workers/Workplace or com-
munity
To assess the effectiveness
of interventions in commu-
nity and workplace settings
to reduce sickness absence
and job loss in workers with
musculoskeletal disorders.
42 primary studies Intervention: Workplace adaptations
and provision of additional services.
Outcome: Sickness absence, muscu-
loskeletal disorder related job loss,
RTW during follow-up or prevalence
of work attendance at follow-up.
Most interventions appeared benecial …
however, effects were smaller in larger and
better-quality studies, suggesting publication
bias.
Broader aim than just
psychosocial interven-
tions and workplace
settings. The effects of
psychosocial interven-
tions available in table
4 of the publication.
Wan Mohd Yunus et
al. 2018
(89)
Employees/Workplace based
or related to application of
skills in workplace.
To evaluate the effectiveness
of workplace interventions
for depression in RCTs
investigating the efcacy
of different therapeutic
approaches involving both
universal and targeted inter-
ventions.
22 primary studies Intervention: studies investigating the
efcacy of prevention interventions,
treatments, workshops, seminars or
any interventions that were workpla-
ce-based or related to the application
of skills in the workplace.
Outcome: depression, and levels of
depressive symptoms.
The cognitive behavioural therapy (CBT)
approach is the most frequently used in the
workplace, while interventions that combine
different therapeutic approaches showed the
most promising results. A universal interven-
tion in the workplace that combines CBT and
coping exibility recorded the highest effect
size (d=1.45 at 4 months’ follow-up). Most
interventions were delivered in group format
and showed low attrition rates compared with
other delivery formats.
Unclear if two individu-
als did the screening
for inclusion.
Ruotsalainen et al.
2008
(65)
Health-care workers who had
not actively sought help for
stress, burnout, depression,
or anxiety disorder/Work-
place
To ascertain the effecti-
veness of interventions in
reducing stress in health care
workers.
14 primary studies/2,812
participants
Intervention: Any stress intervention,
characterized as person directed, per-
son-work interface or organisational.
Outcome: stress or burnout and all
measures of the detrimental effects
of stress or burnout.
Limited evidence is available for a small, but
probably relevant reduction in stress levels
from person-directed, person–work interfa-
ce, and organizational interventions among
health-care workers.
Zhang et al. 2016
(79)
Newly graduated nurses/
Health care
To evaluate the effectiveness
of a mentoring program on
the mentor, mentee, and
organization.
9 primary studies Intervention: mentoring programs.
Outcome: Various outcomes inclu-
ding: turnover, job satisfaction, costs,
occupational stress etc.
These studies revealed that the turnover
rate can be decreased through a mentoring
program. Additionally, mentoring can enhance
nursing competency and establish a sup-
portive workforce environment, resulting in
positive outcome.
65Report 2020:2
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Panagioti et al. 2017
(66)
Physicians/Health care and
other
Firstly, to assess the effec-
tiveness of interventions in
reducing burnout. Secondly,
what types of interventions
are the most effective.
Thirdly, are any differences in
the effect of interventions in
different health care settings
(primary care, secondary or
intensive care) and in physi-
cians with different levels of
working experience.
19 primary studies Intervention: Interventions designed
to relieve stress and/or improve
performance of physicians and
reported burnout outcomes including
physician-directed interventions and
organization-directed interventions.
Outcome: Burnout
Interventions were associated with small
signicant reductions in burnout.
Evidence from this meta-analysis suggests
that recent intervention programs for burnout
in physicians were associated with small
benets that may be boosted by adoption
of organization-directed approaches. This
nding provides support for the view that
burnout is a problem of the whole health care
organization, rather than individuals.
Potential quality issue
on study selection (not
clear that two indepen-
dent persons did the
screening).
Aim broader than just
workplace settings.
West et al. 2016
(90)
Physicians/Health care
To examine the literature
to date on interventions to
prevent and reduce physician
burnout.
52 primary studies/3,630
physicians
Intervention: interventions to prevent
and reduce physician burnout.
Outcome: Burnout, emotional exhaus-
tion score, and depersonalisation
score.
The literature indicates that both individu-
al-focused and structural or organisational
strategies can result in clinically meaningful
reductions in burnout among physicians.
Many various types of
interventions. Summed
effects reported on
different outcomes.
Penalba et al. 2008
(91)
Police ofcers/Police
To assess the effectiveness
of psychosocial interven-
tions for the prevention of
psychological disorders in
law enforcement ofcers.
This included primary preven-
tion to reduce its incidence,
secondary prevention and
tertiary prevention.
10 primary studies Intervention: Psychosocial interven-
tions, as long as they were manuali-
sed or described by study’s authors,
allowing replication.
Outcomes: Psychological disorders
and/or psychological symptoms.
There is evidence only from individual small
and low-quality trials with minimal data
suggesting that police ofcers benet from
psychosocial interventions, in terms of physi-
cal symptoms and psychological symptoms
such as anxiety, depression, sleep problems,
cynicism, anger, PTSD, marital problems and
distress. No data on adverse effects were
available.
10 studies were inclu-
ded in the review but
only 5 reported data
that could be used.
No meta-analyses
were possible due to di-
versity of participants,
interventions and
outcomes.
66 Report 2020:2
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Taylor et al. 2018
(81)
Health-care staff workers/
Health care
To synthesise the eviden-
ce-base for Schwartz Center
Rounds to assess any impact
on healthcare staff and
identify key features. Second
aim to scope evidence for in-
terventions with similar aims,
and compare effectiveness
and key features to Rounds.
10 primary studies (from 12
publications)
Intervention: Schwartz Rounds
(where staff could openly share and
reect on the emotional, social and
ethical challenges faced at work).
Scoping review also collected studies
with comparative interventions.
Outcome: Wellbeing (qualitative or
quantitative assessment).
Findings showed the value of Rounds to
attenders, with a self-reported positive
impact on individuals, their relationships with
colleagues and patients and wider cultural
changes. The evidence for the comparative
interventions was scant and also low/mode-
rate quality.
…
Evidence of effectiveness for all interventions
considered here remains limited.
Unclear if two individu-
als did the screening
for inclusion.
Williams et al. 2018
(72)
Employees within health care
organizations/Health care
To systematically review the
literature regarding health
and well-being interventions
for health care employees to
assess whether we are able
to draw any conclusions as to
which interventions are most
effective in a health care
setting.
44 primary studies Intervention: Interventions intended
to improve employee health and well-
being within the context of a health
care organization, conceptualized as
changing ways of working, physical
health promotion, complementary
and alternative medicine, stress ma-
nagement interventions, and those
employing multimodal interventions.
Outcome: A range of different measu-
res of health and wellbeing.
The majority of interventions reviewed here
led to measurable
improvements in health and well-being, but
methodological shortcomings and a lack of
standardization cloud our ability at this point
to directly compare specic interventions
with any clarity.
Some interventions not
within our denition of
psychosocial.
Bambra, C. et al.
2007
(82)
Workers/Workplace
To systematically review
the health and psychosocial
effects (with reference to the
demand–control–support
model) of changes to the
work environment brought
about by task structure work
reorganisation, and to deter-
mine whether those effects
differ for different socioeco-
nomic groups.
19 primary studies Intervention: experimental and
quasi-experimental studies that
examined the effects on health of
interventions which reorganised work
task structures. The review included
all task structure interventions that
fell into one of Karasek’s three clus-
ters: task variety, teamworking and
autonomous groups.
Outcome: measures of the psychoso-
cial work environment (demand, con-
trol or support) and health outcomes
including specic diseases as well as
more general measures of physical
health and psychological well-being.
This systematic review suggests that
task-restructuring interventions that increase
demand or decrease control adversely affect
the health of employees.
67Report 2020:2
Author, year
[Ref]
Population/kontext
Syfte
Number of studies/
participants
Intervention
Outcome
Results and/or conclusions as presented by
the authors of the systematic review
Comments
Gilmartin, H. et al
2017
(73)
Health-care providers/Hospi-
tal setting
To examine the effective-
ness of brief mindfulness
programs on health care pro-
viders in the hospital setting.
14 primary studies Intervention: Studies that evaluated
brief mindfulness-based interven-
tions using dedicated content (eg.
mindfulness-based stress reduc-
tion-based programs ≤ 4 hours).
Outcome: Well-being, behavior etc.
Nine of 14 studies reported positive chang-
es in levels of stress, anxiety, mindfulness,
resiliency, and burnout symptoms. No studies
found an effect on provider behavior. Brief
mindfulness interventions may be effective in
improving provider well-being.
Guillaumie, L. et al
2017
(67)
Registered nurses and nur-
sing students/Health care
To review the effects of mind-
fulness-based interventions
on Registered Nurses and
nursing students.
32 primary studies Intervention: Mindfulness-based
interventions.
Outcome: Range of physical and
psychological outcomes both quanti-
tative and qualitative.
Mindfulness appeared to improve nurses’
mental health signicantly. It could be used in
worksite health promotion programmes. Only
a few studies have explored the impact of
mindfulness on nurses’ professional behavio-
urs and their relationships with patients and
colleagues.
All kinds of mindful-
ness, meditation and
relaxation techniques
were included in this
study.
Unclear if all interven-
tions were workplace
initiated.
Kuster, A.T. et al
2017
(68)
Employees/Work
To compare the effects of
computer-based interven-
tions to in-person interven-
tions for preventing and
reducing stress in employees.
2 primary studies/159 par-
ticpants
Intervention: Worker-focused web-ba-
sed stress management intervention,
aimed at preventing or reducing
work-related stress. Delivered via
email, a website, or a stand-alone
computer programme, and compared
to a face-to-face stress management
intervention with the same content.
Outcome: Stress, burnout, sick leave,
absenteeism, return to work.
We found very low-quality evidence with con-
icting results, when comparing the effective-
ness of computer-based stress management
interventions with in-person stress manage-
ment interventions in employees. We could
include only two studies with small sample
sizes. We have very little condence in the
effect estimates. It is very likely that future
studies will change these conclusions.
Lee, H. F. et al 2016
(56)
Nurses/Health care
To integrate the effects of
coping strategies designed
to decrease burnout and the
time they were incorporated
(that is the time frame).
7 primary studies Intervention: Interventions on coping
strategies to reduce nurse burnout.
Outcome: Burnout scores
The primary ndings of the present study
reveal that coping strategies can decrease
nurses' work-related burnout. The emotional
exhaustion, depersonalization, and perso-
nal accomplishment were reduced in the
intervention group but increased or remai-
ned unchanged in the control group. In the
emotional exhaustion and depersonalization
dimensions, the effects could be maintained
for 1 year, and personal accomplishment was
only effective for 6 months.
68 Report 2020:2
Appendix 3 Excluded studies based on relevance, research question
1– associations
Studies that were included in screening procedure but excluded after full text reading because
deemed not being relevant to the research question as it was formulated according to PICO/PEO and
inclusion and exclusion criteria.
Reference Reason for
exclusion
1Crawford JO, MacCalman L, Jackson CA. The health and well-being of remote and mobile wor-
kers. Occupational Medicine 2011; 61:385–394.
Wrong exposure
2Eijckelhof BH, Huysmans MA, Bruno Garza JL, Blatter BM, van Dieen JH, Dennerlein JT, et
al. The effects of workplace stressors on muscle activity in the neck-shoulder and forearm
muscles during computer work: a systematic review and meta-analysis. Eur J Appl Physiol 2013;
113:2897-2912.
Wrong outcome
3Gershon RR, Stone PW, Zeltser M, Faucett J, MacDavitt K, Chou SS. Organizational climate and
nurse health outcomes in the United States: a systematic review. Ind Health 2007; 45:622–636.
Wrong context
4Salvagioni DAJ, Melanda FN, Mesas AE, Gonzalez AD, Gabani FL, Andrade SM. Physical, psycho-
logical and occupational consequences of job burnout: A systematic review of prospective
studies. PLoS One 2017; 12:e0185781.
Wrong exposure
5Trudel X, Brisson C, Gilbert-Ouimet M, Milot A. Psychosocial Stressors at Work and Ambulatory
Blood Pressure. Curr Cardiol Rep 2018; 20:127.
Not a systematic
review
6Wilson G, Larkin V, Redfern N, Stewart J, Steven A. Exploring the relationship between mentoring
and doctors' health and wellbeing: a narrative review. J R Soc Med 2017; 110:188–197.
Wrong study
question
7Weberg D. Transformational leadership and staff retention: an evidence review with implications
for healthcare systems. Nursing Administration Quarterly 2010; 34:246–258.
Wrong exposure
8Donnelly E, Siebert D. Occupational risk factors in the emergency medical services. Prehosp
Disaster Med 2009; 24:422–429.
Wrong study
question
9Hillier D, Fewell F, Cann W, Shephard V. Wellness at work: enhancing the quality of our working
lives. Int Rev Psychiatry 2005; 17:419-431.
Wrong study
question
10 Kivimaki M, Nyberg ST, Batty GD, Fransson EI, Heikkila K, Alfredsson L, et al. Job strain as a risk
factor for coronary heart disease: a collaborative meta-analysis of individual participant data.
Lancet 2012; 380:1491–1497.
Not a systematic
review
11 Labrague LJ, McEnroe-Petitte DM, Leocadio MC, Van Bogaert P, Cummings GG. Stress and ways
of coping among nurse managers: An integrative review. J Clin Nurs 2018; 27:1346–1359.
Wrong study
question
12 Lamiani G, Borghi L, Argentero P. When healthcare professionals cannot do the right thing: A
systematic review of moral distress and its correlates. J Health Psychol 2017; 22:51–67.
Wrong study
question
13 Lim J, Bogossian F, Ahern K. Stress and coping in Australian nurses: a systematic review. Int
Nurs Rev 2010; 57:22–31.
Wrong population
and context
14 Sakuraya A, Watanabe K, Kawakami N, Imamura K, Ando E, Asai Y, et al. Work-related psychosoci-
al factors and onset of metabolic syndrome among workers: a systematic review and meta-ana-
lysis protocol. BMJ Open 2017; 7:e016716.
Not a systematic
review
15 Siegrist J, Li J. Work Stress and Altered Biomarkers: A Synthesis of Findings Based on the Ef-
fort-Reward Imbalance Model. Int J Environ Res Public Health 2017; 14.
Not a systematic
review
69Report 2020:2
Reference Reason for
exclusion
16 Szerencsi K, van Amelsvoort LG, Viechtbauer W, Mohren DC, Prins MH, Kant I. The association
between study characteristics and outcome in the relation between job stress and cardiovascular
disease – a multilevel meta-regression analysis. Scand J Work Environ Health 2012; 38:489–502.
Wrong study
question
17 Tang K. A reciprocal interplay between psychosocial job stressors and worker well-being? A sys-
tematic review of the “reversed” effect. Scand J Work Environ Health 2014; 40:441–456
Wrong study
question
70 Report 2020:2
Appendix 4. Excluded studies based on high risk of bias (assessed
using AMSTAR) – research question 1: associations
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74 Report 2020:2
Appendix 5 Excluded studies based on relevance, research question
2 – interventions
Studies that were included in the screening procedure but excluded after full text reading because deemed
not being relevant to the research question as it was formulated according to PICO/PEO and inclusion and
exclusion criteria.
Reference Reason for
exclusion