Aims: Exposure to workplace bullying is associated with an increased risk of mental health conditions, yet it is debated whether the association is causal. This study aims to address this by examining whether onset of workplace bullying is associated with initiating treatment with psychotropic medication, here used as a proxy measure for onset of common mental disorders.

Methods: We used two longitudinal datasets from Sweden and Denmark (mean age: 47.4, women: 52.8%), combined with national registry data on psychotropic medication purchases. Using a target trial approach, the study population (N = 25 309) consisted of employees free of workplace bullying and psychotropic medication use at baseline. We used Cox proportional hazards regression (adjusted for sociodemographic variables, depressive symptoms and psychosocial work characteristics) to assess the association between onset of exposure to workplace bullying and incident treatment with psychotropic medication during 2 years.

Results: In total, 1490 individuals (5.9%) experienced onset of workplace bullying. Bullying onset was associated with incident treatment with any psychotropic medication (HR: 1.42, 95% CI 1.15–1.77, model adjusted for sociodemographic variables). This association was attenuated in the fully adjusted model (HR: 1.24, 95% CI 0.99–1.53). In analyses focusing on antidepressant treatment, the estimates were stronger (HR: 1.55, 95% CI: 1.15–2.09, fully adjusted model). The results further demonstrated an exposure–response relationship, such that higher frequency of bullying exposure was associated with an increased risk of initiating any psychotropic treatment and antidepressants.

Conclusions: Individuals experiencing onset of workplace bullying were at higher risk of starting antidepressant treatment within 2 years. This is the first study showing that onset of workplace bullying can contribute to the development of mental health conditions requiring medical treatment. These results underline the importance of preventive interventions that reduce workplace bullying.

Mental health conditions, including both mental disorders and mental distress, are common among adults, including among the working population. Although work generally promotes health, previous research indicates that several factors in the work environment may contribute to poor mental health. This thesis aims to examine whether workplace bullying, defined as repeated exposure to negative acts at work over a prolonged period, contributes to the occurrence of depression and anxiety among individuals of working age. To address this aim, longitudinal survey and register data from Sweden and Denmark are used.

The first paper of the thesis, Paper I, aimed to assess the theoretical and psychometric properties of a measure of workplace bullying used in Papers II-IV. The results showed that the measure captured theoretically grounded experiences of workplace bullying and that it overlapped satisfactorily with established measures of workplace bullying, thereby supporting its validity and justifying its use in the subsequent papers of the thesis.

Paper II examined the association between workplace bullying and anxiety symptoms, as well as whether good leadership quality could mitigate anxiety following exposure to bullying. When exposed individuals were compared with non-exposed individuals, the results indicated a bidirectional association. Exposure to workplace bullying was prospectively associated with an increased risk of higher anxiety, while higher initial anxiety increased the risk of subsequent exposure to workplace bullying. However, in analyses accounting for within-individual changes in bullying status, only immediate, but not long-term, changes in anxiety were observed, and no reverse association was found. Furthermore, no evidence was found of leadership quality moderating these associations.

Paper III examined the association between workplace bullying and sickness absence due to depressive and anxiety disorders, also considering bidirectional associations. The results indicated that individuals exposed to workplace bullying had an increased risk of sickness absence during the subsequent two years compared with non-exposed individuals. However, no clear evidence was found that such sickness absence increased the risk of later exposure to workplace bullying.

The fourth paper of the thesis, Paper IV, examined whether workplace bullying was associated with an increased risk of treatment with psychotropic medication. The analysis was restricted to individuals without prior exposure to workplace bullying and without a recent history of psychotropic medication use. The results suggested an increased risk of initiating psychotropic treatment during the subsequent two years among exposed individuals, with the risk of initiating treatment with antidepressants being particularly pronounced.

In conclusion, the findings of the studies included in this thesis indicate that workplace bullying constitutes a risk factor for depression and anxiety. The consistency of the observed associations, even after adjustment for sociodemographic factors, prior mental health conditions, and other work environment factors, strengthens the credibility of the results. These findings underscore the importance of preventive efforts against workplace bullying and of ensuring that exposed individuals receive adequate and timely support to reduce the risk of subsequent mental health conditions.

Background: Prior research on health and work-related consequences of workforce restructuring have shown mixed findings. This study seeks to examine if organizational upsizing and downsizing is prospectively associated with sickness absence due to common mental disorders (SA-CMD) and/or with exposure to workplace offensive behaviors (i.e. workplace bullying and workplace violence/threats of violence), and assess if workplace offensive behaviors mediate any association between organizational upsizing/downsizing and SA-CMD.

Methods: This study used a prospective design, combining self-reported survey data from the Swedish Longitudinal Occupational Survey of Health and national register data covering the period 2010–2018 on 10 358 employed individuals. Logistic regression with generalized estimating equations was used to examine the associations between organizational upsizing/downsizing, offensive behaviors, and sickness absence due to common mental disorders. To examine the role of offensive behaviors in the association between exposure to upsizing/downsizing and sickness absence due to common mental disorders, mediation analysis was performed.

Results: We found that upsizing, but not downsizing, was significantly associated with a higher risk of workplace violence/threats of violence (ORadj: 1.2, 95% CI 1.0-1.3). However, neither upsizing nor downsizing was significantly associated with workplace bullying or with subsequent SA-CMD and the mediation analysis indicated no mediation.

Conclusions: Although this study did not find a link between organizational upsizing/downsizing and later sickness absence due to SA-CMD, it suggests that upsizing may be associated with certain types of workplace offensive behaviors. Further research is needed to explore the mechanisms associated with these dynamics.

Background The link between workplace bullying and poor mental health is well-known. However, little is known about the prospective and potentially reciprocal association between workplace bullying and mental health-related sickness absence. This 2-year prospective study examined bidirectional associations between exposure to workplace bullying and sickness absence due to common mental disorders (SA-CMD) while controlling for confounding factors from both work and private life.

Methods The study was based on propensity score-matched samples (N = 3216 and N = 552) from the Swedish Longitudinal Occupational Survey of Health, using surveys from years 2012, 2014 and 2016. Self-reported exposure to workplace bullying was linked to registry-based information regarding medically certified SA-CMD (≥ 14 consecutive days). The associations were examined by means of Cox proportional hazards regression and via conditional logistic regression analysis. Hazard ratios and odds ratios with 95% confidence intervals were estimated.

Results Exposure to workplace bullying was associated with an increased risk of incident SA-CMD (HR: 1.3, 95% CI: 1.0–1.8), after accounting for the influence of job demands, decision authority, previous SA-CMD, as well as other sociodemographic covariates. However, we found no statistically significant association between SA-CMD and subsequent workplace bullying (OR 1.2, 95% CI 0.7–1.9).

Conclusions The results support an association between self-reported workplace bullying and SA-CMD, independent of other sociodemographic factors and workplace stressors. Preventing workplace bullying could alleviate a share of the individual and societal burden caused by SA globally.

Objective: Associations between debt and suicidal behaviour have been identified, but the research is sparse. Thus, more research is needed to understand the association between economic vulnerability and suicide. The study aimed to generate further knowledge about over-indebted individuals who have attempted suicide at least once. Method: Participants were a Swedish sample comprising 641 over-indebted individuals. The inclusion criteria were that the participants should be indebted and have been subjected to debt collection measures and/or seizure orders by the Swedish Enforcement Authority. Participants answered questionnaires regarding socio-demographic variables, debt size, history of suicide attempt, critical life events, and social contacts, and filled the Hospital Anxiety and Depression Scale (HADS). In the statistical analyses, Chi(2) test for independence and t-test was used, and binary logistic regression to adjust for the confounding effects of the variables on each other. Results: The analysis revealed that nearly one in five (19.3%, N = 123) had attempted suicide at least once. A larger part of the respondents who had a history of suicide attempts reported that they were living alone (OR 2.30 (95% CI 1.34-3.89, p = .002). Many of those living alone were women (chi(2) (1, n = 121) = 4.88, p = 0.03, phi = 0.22). Conclusions: The results of the current study point to the fact that economic vulnerability is an important psychosocial aspect to take into serious consideration concerning mental health and suicide prevention. Longitudinal research is needed to explain, predict and prevent suicide due to over-indebtedness.

Objectives: Workplace bullying has been suggested to increase symptoms of anxiety. A reverse relationship has also been proposed. However, so far only few earlier studies have investigated this topic and the reported associations might partly be explained by unmeasured individual characteristics. In this study, we aim to examine the temporality and directionality between workplace bullying and anxiety symptoms, taking time-invariant characteristics into account. Furthermore, we aim to examine whether leadership quality modifies these associations.

Methods: We included 13 491 individuals from two nationwide cohort studies in Sweden and Denmark. Using cross-lagged structural equation models (SEM) and dynamic panel models with fixed effects, we examined contemporaneous and lagged associations between self-reported workplace bullying and anxiety. Cohort-specific results were estimated and combined using fixed-effect meta-analysis.

Results: The cross-lagged SEM models supported contemporaneous and lagged relationships in both directions (from workplace bullying to symptoms of anxiety and vice versa). In contrast, only contemporaneous relationships remained statistically significant and of considerable magnitude in the dynamic panel models with fixed effects. Specifically, exposure to workplace bullying was related to a concurrent increase in anxiety symptoms (b=0.61, 95% confidence interval 0.32–0.90). No support of interaction with leadership quality was found.

Conclusions: The results indicate that onset of workplace bullying is associated with an immediate or short-term increase in anxiety symptoms. This study provides novel insights regarding temporal aspects and causal inference of the bullying-anxiety relationship useful for managing psychological hazards and preventing mental illness at work.