Objectives This systematic review and meta-analysis combined published study-level data and unpublished individual-participant data with the aim of quantifying the relation between long working hours and the onset of depressive symptoms. MethodsWe searched PubMed and Embase for published prospective cohort studies and included available cohorts with unpublished individual-participant data. We used a random-effects meta-analysis to calculate summary estimates across studies.Results We identified ten published cohort studies and included unpublished individual-participant data from 18 studies. In the majority of cohorts, long working hours was defined as working ≥55 hours per week. In multivariable-adjusted meta-analyses of 189 729 participants from 35 countries [96 275 men, 93 454 women, follow-up ranging from 1-5 years, 21 747 new-onset cases), there was an overall association of 1.14 (95% confidence interval (CI) 1.03-1.25] between long working hours and the onset of depressive symptoms, with significant evidence of heterogeneity (I 2 =45.1%, P=0.004). A strong association between working hours and depressive symptoms was found in Asian countries (1.50, 95% CI 1.13-2.01), a weaker association in Europe (1.11, 95% CI 1.00-1.22), and no association in North America (0.97, 95% CI 0.70-1.34) or Australia (0.95,. Differences by other characteristics were small. ConclusionsThis observational evidence suggests a moderate association between long working hours and onset of depressive symptoms in Asia and a small association in Europe.Key terms depression; mental health; overtime; psychological distress; working life; working time. Long working hours and depressive symptomsDepression is a leading cause of years lived with disability, contributing to a significant proportion of disease burden worldwide (1). Given that the burden of mental disorders peaks at working age (1), workingage populatio ns are an important target for prevention. There is growing evidence to suggest a link between work characteristics and the onset of depression, with perceived psychosocial work stress being the most often investigated work exposure (2-7).Recently, studies have also focused on long working hours as a potential risk factor for mental disorders (8). However, although several reviews of this field exist (5, 9-24), the few systematic quantifications of the evidence have been based on published cross-sectional (18,19,25) or published longitudinal studies (26). Given the potential publication bias in studies based on published data (27), an individual-participant metaanalysis of unpublished data would provide important complementary evidence to evaluate the effect of long working hours on mental health. Furthermore, long working hours are more common in Asia and North America than in Europe and the risk of mental health problems is higher among women and individuals with low socioeconomic position than men and those with high socioeconomic status. As determinants and mechanisms that harm and protect mental health may also vary by regio...

Background: In recent years, interest in the study of inequalities in health has not stopped at quantifying their magnitude; explaining the sources of inequalities has also become of great importance. This paper measures socioeconomic inequalities in self-reported morbidity and self-assessed health in Thailand, and the contributions of different population subgroups to those inequalities.

Global warming will increase heat stress at home and at work. Few studies have addressed the health consequences in tropical low and middle income settings such as Thailand. We report on the association between heat stress and workplace injury among workers enrolled in the large national Thai Cohort Study in 2005 (N=58,495). We used logistic regression to relate heat stress and occupational injury separately for males and females, adjusting for covariate effects of age, income, education, alcohol, smoking, Body Mass Index, job location, job type, sleeping hours, existing illness, and having to work very fast. Nearly 20% of workers experienced occupational heat stress which strongly and significantly associated with occupational injury (adjusted OR 2.12, 95%CI 1.87-2.42 for males and 1.89, 95%CI 1.64-2.18 for females). This study provides evidence connecting heat stress and occupational injury in tropical Thailand and also identifies several factors that increase heat exposure. The findings will be useful for policy makers to consider workrelated heat stress problems in tropical Thailand and to develop an occupational health and safety program which is urgently needed given the looming threat of global warming.

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BackgroundDecomposition of concentration indices yields useful information regarding the relative importance of various determinants of inequitable health outcomes. But the two estimation approaches to decomposition in current use are not suitable for binary outcomes.FindingsThe paper compares three estimation approaches for decomposition of inequality concentration indices: Ordinary Least Squares (OLS), probit, and the Generalized Linear Model (GLM) binomial distribution and identity link. Data are from the Thai Health and Welfare Survey 2003. The OLS estimates do not take into account the binary nature of the outcome and the probit estimates depend on the choice of reference groups, whereas the GLM binomial identity approach has neither of these problems.ConclusionsThe GLM with binomial distribution and identity link allows the inequality decomposition model to hold, and produces valid estimates of determinants that do not vary according to choice of reference groups. This GLM approach is readily available in standard statistical packages.