Objectives Systematic research on employment/working conditions as risk or protective factors for suicidal behaviors is limited. In this study, we systematically reviewed the literature on a range of employment or working conditions and the risk of suicidal behaviors (suicide and suicide attempt), focusing on longitudinal studies.

Methods We searched Web of Science, Scopus, PsycInfo, and Embase during 1995–2024 for cohort and case-control studies and performed meta-analysis to pool data if there were ≥2 studies on the same type of conditions and outcome.

Results A total of 27 studies met the eligibility criteria, of which 14 studies were used in meta-analyses. Meta-analyses showed statistically significant associations between part-time work [relative risk (RR) 1.21, 95% confidence interval (CI) 1.12–1.30], job loss (RR 2.27, 95% CI 1.12–4.61), job insecurity (RR 1.64, 95% CI 1.36–1.96), high job demands (RR 1.14, 95% CI 1.08–1.20), low job control (RR 1.11, 95% CI 1.05–1.17), job strain (RR 1.32, 95% CI 1.29–1.36), workplace bullying (RR 1.78, 95% CI 1.16–2.73), and suicide. In terms of the evidence, we found moderate and low certainty for job loss and job insecurity, respectively. For other working conditions, certainty of evidence was considered very low or could not be assessed because of too few studies. Studies investigating suicide attempts were limited, and we only found very low evidence for workplace bullying and suicide attempt (RR 1.33, 95% CI 1.09–1.62, in a previously published meta-analysis). For all other conditions, we could not assess certainty of evidence of associations with suicide attempt.

Conclusions Although some working conditions may be risk factors for suicide, the number of studies is still too limited to allow for certainty of evidence on associations between specific working conditions and suicide.

Background: Sickness absence (SA) due to mental disorders is a public health concern in many western countries, including Sweden. Employment uncertainty is also common today, but the link between the two is still unexplored. The aim of this study was to investigate the association between employment uncertainty and SA due to mood, anxiety, and stress-related disorders, also assessing the importance of familial factors (genetics and shared early environment), personality and workplace social support.

Method: This study, where we used a combination of survey- and register-based data, was performed as a prospective twin study applying a co-twin control design. The study sample (n=9326) was derived from the Swedish Twin project of Disability pension and Sickness absence (STODS). Odds of medically certified SA due to mood, anxiety, and stress-related disorders following employment uncertainty, were estimated through logistic regression analysis. The impact of personality and social support was assessed by multiplicative and additive interaction analyses and the influence of familial factors by conditional logistic regression analysis.

Results: An association between employment uncertainty and SA due to mood, anxiety, and stress-related disorders was found, even after adjustment for several potential confounding factors (adjOR 1.46, (95% CI 1.30-1.65). The interaction analyses assessing interaction between the personality trait extraversion and employment uncertainty and the interaction between workplace social support and employment uncertainty did not indicate any multiplicative or additive interaction. Regarding the personality trait neuroticism, the results did not indicate any multiplicative interaction with employment uncertainty but the results of the analysis assessing additive interaction between neuroticism and employment uncertainty were less clear, indicating that the association may to some degree depend on the level of neuroticism. The conditional logistic regression analysis resulted in lowered estimates (OR 1.09, CI 0.75-1.58), indicating that the association between employment uncertainty and SA due to mood, anxiety and stress-related disorders might be explained by familial factors such as genetics and shared early environment.

Conclusion: The findings of the present study indicate that employment uncertainty is associated with SA due to mood, anxiety, and stress-related disorders. However, familial factors, such as genetics and shared early environment, may explain the association. Hence, further studies assessing the effects of exposure to work-related stressors such as employment uncertainty should, if possible, take such factors into account. The association between employment uncertainty and SA due to mood, anxiety and stress-related disorders does not seem to be influenced by personality or social support to any large degree, however the results regarding the impact of neuroticism were less clear and more studies are needed to explore this topic further.

Perceived job insecurity is associated with poor mental health, but whether it affects sickness absence is not well understood. The present study examines the association between perceived job insecurity and sickness absence due to common mental disorders and whether changes in perceived job insecurity affects the risk of sickness absence due to common mental disorders. Data are from the Swedish Longitudinal Occupational Survey of Health and include those who participated at least once between 2010 and 2020 (n = 24 049). Two different types of analyses were conducted: (1) logistic regression with adjustments for baseline covariates and (2) pooled logistic regression with inverse probability weights, across 5 emulated target trials assessing onsets and/or offsets of job insecurity versus stable security or stable insecurity, on the risk of sickness absence for common mental disorders. Perceived job insecurity was associated with increased odds of sickness absence for common mental disorders over a 2-year period (odds ratio = 1.38, 95% confidence intervals (CI) 1.13-1.68). We found no statistically significant associations for an onset of job insecurity versus being stably secure (risk ratio (RR) 1.484, 95% CI 0.913-2.055) nor for offset versus stable insecurity (RR 0.855, 95% CI 0.308-1.402). The findings from our emulated target trials were, however, uncertain. Findings suggest that perceived job insecurity increases the risk of sickness absence for common mental disorders. The study implies that efforts to increase employee's sense of security may help reduce rates of sickness absence for common mental disorders if job insecurity is reduced long-term.

Background: Suicidal ideation may be a warning sign for suicide and previous work has indicated a higher prevalence of suicidal ideation during the COVID-19 pandemic. Job loss and job insecurity are potential risk factors for suicidal ideation, but their importance during the pandemic, and the role of organizational changes for suicidal ideation, is unclear. This study examined the association between various experiences associated with job loss and job insecurity during the pandemic and thoughts of suicide/self-harm in Sweden.

Methods: The study sample was drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH). Auxiliary data collections in February 2021 and 2022 assessed exposure to job loss/unemployment, furlough, workplace downsizing, or increased job insecurity versus stable employment and thoughts of suicide or self-harm (PHQ-9) during the pandemic. The analyses were based on 1558 individuals (2 349 observations) participating in either or both waves and who had been working before the pandemic. Logistic regression models with cluster-robust standard errors were fitted, including sociodemographic factors and prior mental health problems to control for potential confounding. Measures of personality based on a brief version of the Big-Five personality inventory were also added.

Results: The results indicated an association between all experiences, except furlough, and thoughts of suicide/self-harm, when adjusting for sex, age, civil status, socioeconomic status and prior mental health (job loss odds ratio (OR) = 3.70, 95% confidence interval (CI) 1.79–7.63, downsizing OR = 2.41, CI 1.24–4.70, job insecurity OR = 2.77, CI 1.15–6.67). The associations for job loss and insecurity were attenuated by adjustment for personality, although it remained statistically significant for downsizing.

Conclusions: The results suggested a higher risk of suicidal ideation connected with loss of employment and survival of a downsizing, but not a forced reduction in working times/pay during the COVID-19 pandemic. The association for subjective job insecurity was less robust and may be partly explained by personality.

Previously published analyses of suicide case investigations suggest that work or working conditions contribute to 10%–13% of suicide deaths. Yet, the way in which work may increase suicide risk is an underdeveloped area of epidemiologic research. In this Commentary, we propose a definition of work-related suicide from an occupational health and safety perspective, and review the case investigation-based and epidemiologic evidence on work-related causes of suicide. We identified six broad categories of potential work-related causes of suicide, which are: (1) workplace chemical, physical, and psychosocial exposures; (2) exposure to trauma on the job; (3) access to means of suicide through work; (4) exposure to high-stigma work environments; (5) exposure to normative environments promoting extreme orientation to work; and (6) adverse experiences arising from work-related injury or illness. We summarise current evidence in a schema of potential work-related causes that can also be applied in workplace risk assessment and suicide case investigations. There are numerous implications of these findings for policy and practice. Various principle- and evidence-based workplace intervention strategies for suicide prevention exist, some of which have been shown to improve suicide-prevention literacy, reduce stigma, enhance helping behaviours, and in some instances maybe even reduce suicide rates. Prevailing practice in workplace suicide prevention, however, overly emphasises individual- and illness-directed interventions, with little attention directed to addressing the working conditions that may increase suicide risk. We conclude that a stronger emphasis on improving working conditions will be required for workplace suicide prevention to reach its full preventive potential.

Background: Individuals' lives have been substantially affected by the COVID-19 pandemic. We aimed to describe changes in psychosocial work environment and mental health and to investigate associations between job insecurity and mental ill-health in relation to changes in other psychosocial work factors, loneliness and financial worries.

Methods: A sub-sample of individuals from the eighth Swedish Longitudinal Occupational Survey of Health answered a web-based survey in early 2021 about current and pandemic-related changes in health, health behaviours, work and private life. We investigated participants working before the pandemic (N=1231) in relation to standardised measures on depression, anxiety and loneliness, together with psychosocial work factors, in descriptive and logistic regression analyses.

Results: While 9% reached the clinical threshold for depression and 6% for anxiety, more than a third felt more worried, lonelier or in a low mood since the start of the pandemic. Two per cent had been dismissed from their jobs, but 16% experienced workplace downsizings. Conditioning on socio-demographic factors and prior mental-health problems, the 8% experiencing reduced job security during the pandemic had a higher risk of anxiety, but not of depression, compared to employees with unaltered or increased job security. Loneliness and other psychosocial work factors explained more of the association than objective measures of job insecurity and financial worries.

Conclusions: Reduced job security during the COVID-19 pandemic seems to have increased the risk of anxiety among individuals with a strong labour market attachment, primarily via loneliness and other psychosocial work factors. This illustrates the potentially far-reaching effects of the pandemic on mental health in the working population.

Background: The evidence is insufficient regarding the association between organizational downsizing and employee mental health. Our aim was to analyze trajectories of prescribed sedatives and anxiolytics with a sufficiently long follow-up time to capture anticipation, implementation and adaption to a downsizing event among stayers, changers and those who become unemployed compared to unexposed employees.

Method: Residents in Sweden aged 20-54 years in 2007, with stable employment between 2004 and 2007, were followed between 2005 and 2013 (n = 2,305,795). Employment at a workplace with staff reductions >= 18% between two subsequent years in 2007-2011 (n = 915,461) indicated exposure to, and timing of, downsizing. The unexposed (n = 1,390,334) were randomized into four corresponding sub-cohorts. With generalized estimating equations, we calculated the odds ratios (OR) of purchasing prescribed anxiolytics or sedatives within nine 12-month periods, from four years before to four years after downsizing. In order to investigate whether the groups changed their probability of purchases over time, odds ratios (OR) and their 95% confidence intervals (95% CI) were calculated contrasting the prevalence of purchases during the first and the last 12-month period within four time periods for each exposure group.

Results: The odds of purchasing psychotropic drugs increased more for changers (sedatives OR 1.08, 95% CI 1.05-1.11) and unemployed (anxiolytics OR 1.08, 95% CI 1.03-1.14), compared to unexposed before downsizing, while for stayers purchases increased more than for unexposed during and after downsizing. Among those without previous sickness absence, stayers increased their purchases of psychotropic drugs from the year before the event up to four years after the event.ConclusionThis study indicates that being exposed to downsizing is associated with increased use of sedatives and anxiolytics, before the event among those who leave, but especially thereafter for employees who stay in the organization.

The COVID-19 pandemic led to permanent and temporary job losses but the mental health consequences of different types of employment transitions are not well-understood. In particular, knowledge is scarce concerning furloughs, which was a common job protection strategy in many high-and upper middle-income countries during this crisis. This study focuses on how different types of job instability and job loss during the pandemic influences depression and anxiety in the context of Sweden.A subset of participants from the Swedish Longitudinal Occupational Survey of Health were contacted in February 2021 and again in February 2022. A total of 1558 individuals participated in either or both waves and worked before the pandemic. We examined whether i) workplace downsizing, ii) furlough, or iii) unemploy-ment/job loss were associated with depression and anxiety over this one-year period during the pandemic. Logistic regression models with cluster-robust standard errors were estimated, adjusting for sociodemographic factors and prior mental health problems. Effect modification by sex and prior mental health problems was also examined.In comparison to stable employment, being furloughed was unrelated to mental health, while experiencing workplace downsizing during the pandemic was associated with an increased risk of anxiety (adjusted Odds Ratio (OR) = 2.09, 95% Confidence interval (CI) = 1.08-4.05). Job loss/unemployment increased the risk of depression (OR = 1.91, 95% CI = 1.02-3.57) compared to being stably employed, but the risk estimate crossed unity when considering prior mental health status. No effect modification by sex or by prior mental health problems was found.This study found that while job loss and downsizing during the COVID-19 pandemic were associated with depression and anxiety, respectively, being furloughed was not. These findings thus suggest that job retention schemes in the form of short-time work allowances, as implemented in Sweden during the COVID-19 pandemic, may prevent mental health problems among employees during economic crises.

Introduktion och syfte med rapporten

Coronapandemin (Covid-19 pandemin) innebar en rad restriktioner och en påföljande ekonomisk kris, som påverkade mångas arbetsliv och privatliv. Det finns emellertid fortfarande få svenska och internationella populationsbaserade studier om arbetsmiljöförändringarna i samband med coronapandemin, som fokuserar på olika sektorer utöver vård-/omsorgssektorn, och som är representativa för den arbetande befolkningen.

Syftet med denna rapport är att undersöka hur upplevelsen bland den arbetande befolkningen i Sverige har förändrats i samband med coronapandemin, vad gäller den organisatoriska och psykosociala arbetsmiljön samt balans mellan arbetet och privatlivet. Syftet är även att undersöka om de eventuella förändringarna inom dessa arbetsmiljöområden skiljer sig åt beroende av bakgrundsfaktorer såsom kön, ålder, utbildningsnivå, socioekonomisk status, yrkesgrupp, samt distansarbete under coronapandemin.

Metod

Urvalet till analyserna i denna rapport är hämtat från den Svenska Longitudinella studien Om Sociala förhållanden, arbetsliv och Hälsa (SLOSH). Denna studie följer ett stort urval av initialt arbetande män och kvinnor ur Sveriges arbetande befolkning vartannat år med frågeformulär. Det genomfördes även en kompletterande webbundersökning i ett urval från SLOSH kallad ”SLOSH-corona” under 2021 (under ”mitten av coronapandemin”) och under 2022 (under ”slutet av coronapandemin”). Den fokuserade på arbetsmiljön, den sociala situationen, samt hälsan och hälsobeteenden i samband med coronapandemin.

Denna rapport använder uppgifter från SLOSH-datainsamlingarna under våren 2018 (före coronapandemin), under våren 2020 (”i början av corona­ pandemin”), samt från SLOSH-corona 2021 och 2022. Det gäller uppgifter från totalt 1 345 individer som har deltagit i både SLOSH 2018 och 2020, samt som har arbetat både före coronapandemin och vid något av insamlingstillfällena under coronapandemin. De svarande i urvalet är representativa för hela Sverige och den svenska arbetsmarknaden. Men de bestod bland annat av en något större andel kvinnor än män, samt av en övervägande andel medelålders eller äldre personer i arbetslivet, gifta eller sammanboende personer, personer med en universitetsutbildning, samt tjänstemän. Frågeformulären innehöll uppgifter om en rad arbetsmiljöfaktorer som indelats i kategorierna; den organisatoriska arbetsmiljön, krav och resurser, den sociala arbetsmiljön, samt balans mellan arbete och privatliv.

Eventuella förändringar över tid undersöktes i huvudsak genom regressionsanalyser. Dessa jämförde svaren på frågorna från någon av de insamlingar som gjordes under coronapandemin, med svaren på samma frågor från insamlingarna före coronapandemin. De svarande rapporterade själva för några faktorer, om de upplevde en förändring jämfört med före coronapandemin. Resultaten består därmed av både beskrivande och analytisk statistik samt tester av om de eventuella arbetsmiljöförändringarna över tid skilde sig åt beroende av ett antal bakgrundsfaktorer, samt på grund av om arbete skett från en ordinarie arbetsplats eller på distans/hemifrån.

Resultat

Organisatorisk arbetsmiljö

Jämfört med före coronapandemin, så visade de övergripande analyserna i hela urvalet främst på:

• en betydligt högre andel som arbetade på distans/hemifrån under coronapandemin.
• en lägre andel som jobbade långa arbetstider (mer än 40 timmar per vecka) under coronapandemin.
• att en relativt stor andel upplevde att arbetsuppgifterna ökade, och framför allt från början till mitten av coronapandemin.

Förändringar i den organisatoriska arbetsmiljön skilde sig främst åt beroende på aspekter som utbildning och socioekonomi. Exempelvis så ökade förekomsten av distansarbete tydligare bland högutbildade personer och tjänstemän. Förekomsten av långa arbetstider minskade samtidigt mer markant i dessa grupper. Förekomsten av långa arbetstider ökade däremot i stället bland personer med yrken som fokuserar på vården/omsorgen och andra kontaktyrken.

Krav och resurser

Jämfört med före coronapandemin, visade de övergripande analyserna främst på:

• något lägre nivåer av psykologiska krav i arbetet under coronapandemin.
• något högre nivåer av kontroll/beslutsutrymme i arbetet under coronapandemin.
• en lägre andel med spänt arbete (höga psykologiska krav och en låg kontroll/ett lågt beslutsutrymme) under coronapandemin.
• att en relativt stor andel upplevde en ökad arbetsmängd och en psykisk arbetsbelastning (vilket skulle kunna handla om en anpassning och en hantering av sina känslor i olika arbetssituationer) under coronapandemin.
• marginellt högre nivåer av anställningsotrygghet, men endast under början av coronapandemin.

En ökning av anställningsotryggheten var tydligare bland personer med yrken som fokuserar på materiell tillverkning i början av pandemin (såsom yrken inom byggverksamhet och tillverkning, maskinell tillverkning och transport, lantbruk, trädgård, skogsbruk, samt fiske). En ökad arbetsmängd och en psykisk arbetsbelastning var tydligast bland kvinnor och personer som arbetar inom yrken med fokus på vården/omsorgen och grundskolan/barnomsorgen. De med yrken inom vården/omsorgen, upplevde emellertid även att beslutsutrymmet ökat i en större utsträckning. Det var även de personer som hade arbetet på sin ordinarie arbetsplats under coronapandemin som i en högre grad upplevde att arbetsmängden och den psykiska arbetsbelastningen hade ökat. De personer som delvis eller mestadels arbetade på distans/hemifrån upplevde en ökad kontroll/ett ökat beslutsutrymme i en högre grad, samt ett ökat inflytande.

Social arbetsmiljö

Jämfört med före coronapandemin, visade de övergripande analyserna främst på:

• en lägre nivå av ett socialt stöd i arbetet under slutet av coronapandemin.
• att en relativt hög andel deltagare upplevde ökade konflikter med andra (t.ex. patienter, kunder, elever, passagerare) under coronapandemin.
• att en relativt hög andel deltagare upplevde en försämrad stämning och ett försämrat samarbete på arbetsplatsen under coronapandemin.

Socialt stöd hade minskat speciellt för vården och omsorgspersonalen, samt bland de personer som hade jobbat på sin ordinarie arbetsplats under coronapandemin. Ökade konflikter med andra var även tydligast bland de som jobbat på sin ordinarie arbetsplats under coronapandemin. En försämrad stämning på arbetsplatsen var tydligast bland de personer som jobbade inom yrken med ett fokus på grundskolan och barnomsorgen, samt inom andra kontaktyrken och bland högutbildade. Det var tydligare med en försämrad sammanhållning och ett försämrat samarbete på arbetsplatsen bland högutbildade personer och tjänstemän, samt bland de som arbetat på distans/hemifrån.

Balans mellan arbete och privatliv

Att arbetssituationen under coronapandemin påverkade privatlivet på ett positivt sätt var en vanligare upplevelse än att det hade en negativ påverkan. Det var även vanligare med en upplevelse av att privatlivet påverkade arbetssituationen på ett positivt sätt, än på ett negativt.

Det var vanligare bland de som arbetat på distans under coronapandemin, att arbetssituationen påverkade privatlivet på ett positivt sätt, eller att privatlivet påverkade arbetssituationen på ett positivt sätt. För de personer som hade yrken fokuserade inom vården/omsorgen och inom grundskolan/barnomsorgen var det vanligare med en upplevelse av att arbetssituationen påverkade privatlivet på ett negativt sätt.

Slutsatser

Resultaten från dessa analyser tyder på flera förändringar inom den organisatoriska arbetsmiljön, i samband med coronapandemin. Det gäller främsten generell ökning av distansarbete, och en generell minskning av arbetstider. Resultaten var mindre tydliga vad gäller krav och resurser i arbetet. De psykologiska kraven minskade något, medan kontroll/beslutsutrymme ökade något. Det innebar en lägre andel deltagare med spänt arbete under pandemin, vilket kan tyda på en generell förbättring av balans mellan denna typ av krav och resurser. Det fanns samtidigt indikationer på en ökning av vissa typer av krav åtminstone för vissa grupper på arbetsmarknaden, till exempel vad gäller arbetsmängden och den psykiska arbetsbelastningen. Resultaten tyder vidare på en generell försämring i den sociala arbetsmiljön, och en relativt god balans mellan arbetet och privatlivet. Det finns emellertid betydande skillnader framför allt beroende av yrkesgrupper och distansarbete. Resultaten tyder exempelvis på en ökning av vissa typer av krav, och en försämring av vissa typer av sociala arbetsmiljöfaktorer bland de som arbetat inom hälso-/ sjukvårds- och utbildningssektorn, samt bland de som arbetat på sin ordinarie arbetsplats. Vidare så tyder resultaten på en relativt god balans mellan arbetet och privatlivet, men på en försämring av andra sociala arbetsmiljöfaktorer bland högutbildade personer och tjänstemän, samt bland de som arbetat på distans/hemifrån.

Research suggests that work-related factors like job insecurity increases the risk of major depression (MD), although it is unclear whether the association is causal. Research further suggests that job insecurity increases sleep disturbances, which is also a risk factor for MD. Based on current knowledge, it is possible that job insecurity operates through sleep disturbances to affect MD, but this pathway has not been examined in the literature. The current study extends the literature by using two complementary, counterfactual approaches (i.e., random- and fixed-effects regression and a mediational g-formula) to examine whether job insecurity causes MD and whether sleep disturbances mediate the relationship. A methodological triangulation approach allowed us to adjust for unobserved and intermediate confounding, which has not been addressed in prior research. Findings suggest that the relationship between job insecurity and MD is primarily direct, that hypothetically intervening on job insecurity (in our g-formula) would reduce MD by approximately 10% at the population level, and this relationship operates via sleep disturbances to some degree. However, the indirect pathway had a high degree of uncertainty.