IMPORTANCE Mental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a systematic review and meta-analysis. OBJECTIVETo synthesize the evidence of the association of psychosocial stressors at work with sickness absence due to a diagnosed mental disorder among adult workers.DATA SOURCES Seven electronic databases (MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, Sociological Abstracts, and International Bibliography of the Social Sciences), 3 gray literature databases (Grey Literature Report, WHO-IRIS and Open Grey), and the reference lists of all eligible studies and reviews were searched in January 2017 and updated in February 2019.STUDY SELECTION Only original prospective studies evaluating the association of at least 1 psychosocial stressor at work from the 3 most recognized theoretical models were eligible: the job demand-control-support model, including exposure to job strain (high psychological demands with low job control); effort-reward imbalance model; and organizational justice model. Study selection was performed in duplicate by blinded independent reviewers. Among the 28 467 citations screened, 23 studies were eligible for systematic review.DATA EXTRACTION AND SYNTHESIS This meta-analysis followed the PRISMA and MOOSE guidelines. Data extraction and risk of bias evaluation, using the Risk of Bias in Nonrandomized Studies-Interventions tool, were performed in duplicate by blinded independent reviewers. Data were pooled using random-effect models. MAIN OUTCOMES AND MEASURES Sickness absence due to a mental disorder with a diagnosis obtained objectively.RESULTS A total of 13 studies representing 130 056 participants were included in the 6 meta-analyses. Workers exposed to low reward were associated with a higher risk of sickness absence due to a diagnosed mental disorder compared with nonexposed workers (pooled risk ratio [RR], 1.76 [95% CI, 1.49-2.08]), as were those exposed to effort-reward imbalance (pooled RR, 1.66 [95% CI, 1.37-2.00]), job strain (pooled RR, 1.47 [95% CI, 1.24-1.74]), low job control (pooled RR, 1.25 [95% CI, 1.02-1.53]), and high psychological demands (pooled RR, 1.23 [95% CI, 1.04-1.45]).CONCLUSIONS AND RELEVANCE This meta-analysis found that workers exposed to psychosocial stressors at work were associated with a higher risk of sickness absence due to a mental disorder. A better understanding of the importance of these stressors could help physicians when evaluating their patients' mental health and work capacity.

Background: A review of epidemiological papers conducted in 2009 concluded that several studies employed variable selection methods susceptible to introduce bias and yield inadequate inferences. Many new confounder selection methods have been developed since then. Methods:The goal of the study was to provide an updated descriptive portrait of which variable selection methods are used by epidemiologists for analyzing observational data. Studies published in four major epidemiological journals in 2015 were reviewed. Only articles concerned with a predictive or explicative objective and reporting on the analysis of individual data were included. Method(s) employed for selecting variables were extracted from retained articles.Results: A total of 975 articles were retrieved and 299 met eligibility criteria, 292 of which pursued an explicative objective. Among those, 146 studies (50%) reported using prior knowledge or causal graphs for selecting variables, 34 (12%) used change in effect estimate methods, 26 (9%) used stepwise approaches, 16 (5%) employed univariate analyses, 5 (2%) used various other methods and 107 (37%) did not provide sufficient details to allow classification (more than one method could be employed in a single article).Conclusions: Despite being less frequent than in the previous review, stepwise and univariable analyses, which are susceptible to introduce bias and produce inadequate inferences, were still prevalent. Moreover, 37% studies did not provide sufficient details to assess how variables were selected. We thus believe there is still room for improvement in variable selection methods used by epidemiologists and in their reporting.

ObjectivesThe healthy worker survivor effect (HWSE) usually leads to underestimation of the effects of harmful occupational exposures. HWSE is characterised by the concomitance of three associations: (1) job status–subsequent exposure, (2) job status–disease and (3) previous exposure–job status. No study has reported the coexistence of these associations in the relationship between psychosocial work-related factors and health. We assessed if HWSE is present when measuring the effects of cumulative exposure to psychosocial work-related factors on the prevalence of hypertension in white-collar workers.MethodsData were obtained from two timepoints (1991–1993 at baseline and 1999–2001 at follow-up) of a prospective cohort study. At baseline, the population was composed of 9188 white-collar employees (women: 49.9%) in Quebec City. Job strain as psychosocial work-related factor and blood pressure were measured using validated methods. Job status (retirees vs employees) at follow-up was self-reported. Multiple multilevel robust Poisson regressions were used to estimate prevalence ratios of hypertension and risk ratios of retirement separately by gender. We performed multiple imputations to control selection bias due to missing values.ResultsRetirement eliminated the subsequent exposure to job strain de facto and was associated with the reduction in the prevalence of hypertension in younger (−33%) and older (−11%) men and in older women (−39%). Job strain was associated with job status in younger men and in women of any age.ConclusionData showed the presence of HWSE in younger men and older women given the coexistence of the three structural associations.

The World Health Organization has highlighted the emergence of non-communicable chronic diseases, including stroke, in developing countries. As a cause of death, stroke ranks first in Africa. Stroke is the foremost cause of neuropsychiatric disease, including post-stroke depression (PSD) which is a very common disease. Surveys of this condition in Congolese patients are virtually non-existent. The objectives of this study were to assess the prevalence of PSD in Congolese patients and identify associated sociodemographic factors. Age, sex, address, province of origin, social and professional status, education, religion and consumption habits were chosen as indicators or parameters of interest to be examined in this study. The results of descriptive analyses are presented as frequencies for categorical variables and as mean ± standard deviation for quantitative variables. The association between different variables was assessed using tables of comparisons of proportions and the Chi-square test. Logistic regression was performed to predict the occurrence of PSD. There were more male than female patients. The mean age was 54.67 ± 12.51 years. Nearly 3 fourths of the patients were aged less than 65. The family was the primary source of social support. The majority was satisfied by the social support received from the family. Just over half the study patients (53.6%) had mild to severe depression as assessed by the PHQ9. Univariate analysis and logistic regression indicated a statistically significant association between low educational level and the occurrence of PSD. However, there was no relationship between age, sex or drinking habits and the onset of PSD. The majority of the subjects were satisfied by the social support from their families. Depression was common after stroke with the occurrence of 53.6%. These results highlight the need to investigate, diagnose and treat PSD, which is a risk factor for morbidity and mortality after stroke.