Schedule control and mental health: the relevance of coworkers’ reports

Abstract

Although some studies suggest that schedule control might promote mental health, research has over-relied on self-reports, which might explain why the evidence is inconclusive and mixed. In this study, we introduce an analytical approach based on coworkers’ reports (in lieu of self-reports) in order to better characterize the organizational nature of schedule control, and to address biases of self-reports (e.g. reverse causation or confounding). Following job demand-control theoretical principles, in this cross-sectional study of 1229 nurses nested in 104 hospital units, we tested the hypothesis that psychological distress (a risk factor for mental illness) would be lower for nurses where coworkers reported higher levels of schedule control at their units. Results showed that increments in coworkers’ reports of schedule control at their units were associated with lower risk of psychological distress, even after accounting for self-reports of schedule control, which were not associated with this outcome. In conclusion, relying only on self-reports might conceal mental health effects of schedule control, so future research ought to include organizational and individual measures and perspectives of schedule control. Using coworkers’ reports is a pertinent strategy to better signal the potential health effect of schedule control, especially when biased self-reporting is suspected.

Aunque algunos estudios sugieren que el control horario promueve la salud mental, las investigaciones se han enfocado demasiado en los auto-reportes, lo cual puede explicar por qué la evidencia es mixta e inconclusa. En este estudio se presenta un abordaje analítico basado en los reportes de los colegas (en lugar de auto-reportes de cada trabajador) con el objetivo de caracterizar mejor la naturaleza contextual del control horario, y también para lidiar con sesgos potenciales de los auto-reportes (e.g. causalidad inversa o variables de confusión). Siguiendo principios de la teoría de demanda-control, este estudio transversal de 1229 enfermeras agrupadas en 104 unidades hospitalarias, probó la hipótesis de que el riesgo de malestar psicológico (un factor de riesgo para enfermedades mentales) sería más bajo en enfermeras que trabajaran en unidades donde sus colegas reportaran mayores niveles de control horario. Se encontró que mayores niveles de control horario, reportado por los colegas, estaban asociados con menor riesgo de malestar psicológico, inclusive después de considerar los auto-reportes, los cuales no estuvieron relacionados con malestar psicológico. En conclusión, basarse solamente en los auto-reportes puede ocultar efectos del control horario sobre la salud mental, y por tanto, investigaciones futuras sobre control horario deberían incluir medidas y perspectivas tanto contextuales como individuales. Usar los reportes de los colegas es una estrategia pertinente para señalar mejor los efectos potenciales del control horario, especialmente cuando se sospecha de auto-reportes sesgados.

Keywords:

• schedule control
• psychological distress
• coworkers
• work-teams

Palabras claves:

• control horario
• malestar psicológico
• colegas de trabajo
• grupos de trabajo

Acknowledgements

This study would not have been accomplished without the participation of Partners HealthCare System and leadership from Dennis Colling, Sree Chaguturu, and Kurt Westerman. The authors would like to thank Partners Occupational Health Services including Marlene Freeley for her guidance, as well as Karen Hopcia, Elizabeth Taylor, Elizabeth Tucker O'Day, and Terry Orechia. We also thank individuals at each of the hospitals including Jeanette Ives Erickson and Jacqueline Somerville in Patient Care Services leadership, and Jeff Davis and Julie Celano in Human Resources. Additionally, we wish to thank Charlene Feilteau, Mimi O'Connor, Margaret Shaw, Eddie Tan and Shari Weingarten for assistance with supporting databases. We also thank Chris Kenwood of NERI for his statistical and programming support, Julie Theron, Project Director, and Linnea Benson-Whelan for her assistance with the production of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

David A. Hurtado, ScD, MS, was at the time of the study the Yerby Postdoctoral Research Fellow at the Harvard Center for Work, Health and Well-being. His primary research interests are evaluating the health effect of time arrangements at work. Currently he is assistant scientist at the Oregon Institute of Occupational Health Sciences in Oregon Health & Science University.

M. Maria Glymour is an Associate Professor at the Department of Epidemiology and Biostatistics at the University of California, San Francisco School of Medicine. She is a social epidemiologists interested in overcoming methodological problems encountered in analyses of social determinants of health over the life course.

Lisa F. Berkman is the Thomas D. Cabot Professor of Public Policy and of Epidemiology and Director of the Harvard Center for Population and Development Studies. She is an internationally recognized social epidemiologist whose work focuses extensively on social and policy influences on health outcomes.

Dean Hashimoto is the Chief of Occupational and Environmental Medicine, Occupational Health Services, Partners HealthCare System. His research focuses on the impact of regulatory and business systems on the health-care delivery.

Silje E. Reme is a Senior Rsearcher at Uni Research Bergen, Norway. She is a clinical psychologist interested in the psychological dimensions of pain management, disability and workplace factors.

Glorian Sorensen is Professor of Social and Behavioral Sciences at the Harvard School of Public Health, and Director of the Dana-Farber Cancer Institute Center for Community-Based Research. She is the Principal Investigator for the Harvard School of Public Health Center for Work, Health and Well-being, funded by the National Institute of Occupational Safety and Health. The core of her cancer prevention research is randomized worksite- and community-based studies that test the effectiveness of theory-driven interventions targeting individual and organizational change.

ORCID

David A. Hurtado http://orcid.org/0000-0002-5769-6083

Additional information

Funding

This work was supported by a grant from the National Institute for Occupational Safety and Health [grant number U19 OH008861] for the Harvard School of Public Health Center for Work, Health and Well-being.