Reiner Rugulies1, Kathrine Sørensen2, Cristina Di Tecco3, Michela Bonafede4, Bruna M Rondinone5, Seoyeon Ahn6, Emiko Ando7, Jose Luis Ayuso-Mateos8, Maria Cabello9, Alexis Descatha10, Nico Dragano11, Quentin Durand-Moreau12, Hisashi Eguchi13, Junling Gao14, Lode Godderis15, Jaeyoung Kim16, Jian Li17, Ida E H Madsen18, Daniela V Pachito19, Grace Sembajwe20, Johannes Siegrist21, Kanami Tsuno22, Yuka Ujita23, JianLi Wang24, Amy Zadow25, Sergio Iavicoli26, Frank Pega27. 1. National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark. Electronic address: rer@nfa.dk. 2. National Research Centre for the Working Environment, Copenhagen, Denmark. Electronic address: ksn@nfa.dk. 3. Inail, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone (Rome), Italy. Electronic address: c.ditecco@inail.it. 4. Inail, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone (Rome), Italy. Electronic address: m.bonafede@inail.it. 5. Inail, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone (Rome), Italy. Electronic address: b.rondinone@inail.it. 6. National Pension Research Institute, Jeonju-si, Republic of Korea. Electronic address: ahnseoyeon@nps.or.kr. 7. National Cancer Center, Tokyo, Japan. Electronic address: andoemiko-tky@umin.ac.jp. 8. Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain. Electronic address: joseluis.ayuso@uam.es. 9. Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain. Electronic address: maria.cabello@uam.es. 10. Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000 Angers, France; AP-HP (Paris Hospital), Occupational Health Unit, Poincaré University Hospital, Garches, France; Inserm Versailles St-Quentin Univ - Paris Saclay Univ (UVSQ), UMS 011, UMR-S 1168, Villejuif, France. Electronic address: alexis.descatha@inserm.fr. 11. Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany. Electronic address: Dragano@med.uni-duesseldorf.de. 12. Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Canada. Electronic address: durandmo@ualberta.ca. 13. Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan; Department of Public Health, Kitasato University School of Medicine, Sagamihara, Knagawa, Japan. Electronic address: eguchi@med.uoeh-u.ac.jp. 14. School of Public Health, Fudan University, Shanghai, People's Republic of China. Electronic address: jlgao@fudan.edu.cn. 15. Centre for Environment and Health, KU Leuven, Leuven, Belgium; KIR Department (Knowledge, Information & Research), IDEWE, External Service for Prevention and Protection at Work, Leuven, Belgium. Electronic address: lode.godderis@kuleuven.be. 16. Department of Preventive Medicine, College of Medicine, Keimyung University, Daegu, Republic of Korea. Electronic address: jaeykim@dsmc.or.kr. 17. Department of Environmental Health Sciences, Fielding School of Public Health, School of Nursing, University of California, Los Angeles, United States. Electronic address: jianli2019@ucla.edu. 18. National Research Centre for the Working Environment, Copenhagen, Denmark. Electronic address: ihm@nfa.dk. 19. Hospital Sírio-Libanês, Sao Paulo, Brazil. Electronic address: pachito@uol.com.br. 20. Department of Occupational Medicine Epidemiology and Prevention, Zucker School of Medicine at Hofstra University, Feinstein Institutes for Medical Research, Northwell Health, New York, United States; Department of Environmental Occupational and Geospatial Sciences, CUNY Institute for Implementation Science in Public Health, CUNY Graduate School of Public Health and Health Policy, New York, United States. Electronic address: Grace.Sembajwe@sph.cuny.edu. 21. Life Science Centre, University of Düsseldorf, Düsseldorf, Germany. Electronic address: johannes.siegrist@med.uni-duesseldorf.de. 22. School of Health Innovation, Kanagawa University of Human Services, Japan. Electronic address: ktsuno-tky@umin.ac.jp. 23. Labour Administration, Labour Inspection and Occupational Safety and Health Branch, International Labour Organization, Geneva, Switzerland. Electronic address: ujita@ilo.org. 24. Institute of Mental Health Research, University of Ottawa, Canada. Electronic address: JianLi.Wang@theroyal.ca. 25. University of South Australia, Adelaide, Australia. Electronic address: Amy.zadow@unisa.edu.au. 26. Inail, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone (Rome), Italy. Electronic address: s.iavicoli@inail.it. 27. Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland. Electronic address: pega@who.int.
Abstract
BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), supported by a large number of individual experts. Evidence from previous reviews suggests that exposure to long working hours may cause depression. In this article, we present a systematic review and meta-analysis of parameters for estimating (if feasible) the number of deaths and disability-adjusted life years from depression that are attributable to exposure to long working hours, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the effect of exposure to long working hours (three categories: 41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on depression (three outcomes: prevalence, incidence and mortality). DATA SOURCES: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies, including the WHO International Clinical Trial Registers Platform, Medline, PubMed, EMBASE, Web of Science, CISDOC and PsycInfo. We also searched grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (aged <15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of exposure to long working hours (41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on depression (prevalence, incidence and/or mortality). STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined odds ratios using random-effects meta-analysis. Two or more review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide and GRADE tools and approaches adapted to this project. RESULTS: Twenty-two studies (all cohort studies) met the inclusion criteria, comprising a total of 109,906 participants (51,324 females) in 32 countries (as one study included multiple countries) in three WHO regions (Americas, Europe and Western Pacific). The exposure was measured using self-reports in all studies, and the outcome was assessed with a clinical diagnostic interview (four studies), interview questions about diagnosis and treatment of depression (three studies) or a validated self-administered rating scale (15 studies). The outcome was defined as incident depression in all 22 studies, with first time incident depression in 21 studies and recurrence of depression in one study. We did not identify any study on prevalence of depression or on mortality from depression. For the body of evidence for the outcome incident depression, we had serious concerns for risk of bias due to selection because of incomplete outcome data (most studies assessed depression only twice, at baseline and at a later follow-up measurement, and likely have missed cases of depression that occurred after baseline but were in remission at the time of the follow-up measurement) and due to missing information on life-time prevalence of depression before baseline measurement. Compared with working 35-40 h/week, we are uncertain about the effect on acquiring (or incidence of) depression of working 41-48 h/week (pooled odds ratio (OR) 1.05, 95% confidence interval (CI) 0.86 to 1.29, 8 studies, 49,392 participants, I2 46%, low quality of evidence); 49-54 h/week (OR 1.06, 95% CI 0.93 to 1.21, 8 studies, 49,392 participants, I2 40%, low quality of evidence); and ≥ 55 h/week (OR 1.08, 95% CI 0.94 to 1.24, 17 studies, 91,142 participants, I2 46%, low quality of evidence). Subgroup analyses found no evidence for statistically significant (P < 0.05) differences by WHO region, sex, age group and socioeconomic status. Sensitivity analyses found no statistically significant differences by outcome measurement (clinical diagnostic interview [gold standard] versus other measures) and risk of bias ("high"/"probably high" ratings in any domain versus "low"/"probably low" in all domains). CONCLUSIONS: We judged the existing bodies of evidence from human data as "inadequate evidence for harmfulness" for all three exposure categories, 41-48, 48-54 and ≥55 h/week, for depression prevalence, incidence and mortality; the available evidence is insufficient to assess effects of the exposure. Producing estimates of the burden of depression attributable to exposure to long working appears not evidence-based at this point. Instead, studies examining the association between long working hours and risk of depression are needed that address the limitations of the current evidence.
BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), supported by a large number of individual experts. Evidence from previous reviews suggests that exposure to long working hours may cause depression. In this article, we present a systematic review and meta-analysis of parameters for estimating (if feasible) the number of deaths and disability-adjusted life years from depression that are attributable to exposure to long working hours, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the effect of exposure to long working hours (three categories: 41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on depression (three outcomes: prevalence, incidence and mortality). DATA SOURCES: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies, including the WHO International Clinical Trial Registers Platform, Medline, PubMed, EMBASE, Web of Science, CISDOC and PsycInfo. We also searched grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (aged <15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of exposure to long working hours (41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on depression (prevalence, incidence and/or mortality). STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined odds ratios using random-effects meta-analysis. Two or more review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide and GRADE tools and approaches adapted to this project. RESULTS: Twenty-two studies (all cohort studies) met the inclusion criteria, comprising a total of 109,906 participants (51,324 females) in 32 countries (as one study included multiple countries) in three WHO regions (Americas, Europe and Western Pacific). The exposure was measured using self-reports in all studies, and the outcome was assessed with a clinical diagnostic interview (four studies), interview questions about diagnosis and treatment of depression (three studies) or a validated self-administered rating scale (15 studies). The outcome was defined as incident depression in all 22 studies, with first time incident depression in 21 studies and recurrence of depression in one study. We did not identify any study on prevalence of depression or on mortality from depression. For the body of evidence for the outcome incident depression, we had serious concerns for risk of bias due to selection because of incomplete outcome data (most studies assessed depression only twice, at baseline and at a later follow-up measurement, and likely have missed cases of depression that occurred after baseline but were in remission at the time of the follow-up measurement) and due to missing information on life-time prevalence of depression before baseline measurement. Compared with working 35-40 h/week, we are uncertain about the effect on acquiring (or incidence of) depression of working 41-48 h/week (pooled odds ratio (OR) 1.05, 95% confidence interval (CI) 0.86 to 1.29, 8 studies, 49,392 participants, I2 46%, low quality of evidence); 49-54 h/week (OR 1.06, 95% CI 0.93 to 1.21, 8 studies, 49,392 participants, I2 40%, low quality of evidence); and ≥ 55 h/week (OR 1.08, 95% CI 0.94 to 1.24, 17 studies, 91,142 participants, I2 46%, low quality of evidence). Subgroup analyses found no evidence for statistically significant (P < 0.05) differences by WHO region, sex, age group and socioeconomic status. Sensitivity analyses found no statistically significant differences by outcome measurement (clinical diagnostic interview [gold standard] versus other measures) and risk of bias ("high"/"probably high" ratings in any domain versus "low"/"probably low" in all domains). CONCLUSIONS: We judged the existing bodies of evidence from human data as "inadequate evidence for harmfulness" for all three exposure categories, 41-48, 48-54 and ≥55 h/week, for depression prevalence, incidence and mortality; the available evidence is insufficient to assess effects of the exposure. Producing estimates of the burden of depression attributable to exposure to long working appears not evidence-based at this point. Instead, studies examining the association between long working hours and risk of depression are needed that address the limitations of the current evidence.
Authors: Nico Dragano; Marvin Reuter; Annette Peters; Miriam Engels; Börge Schmidt; Karin H Greiser; Barbara Bohn; Steffi Riedel-Heller; André Karch; Rafael Mikolajczyk; Gérard Krause; Olga Lang; Leo Panreck; Marcella Rietschel; Hermann Brenner; Beate Fischer; Claus-Werner Franzke; Sylvia Gastell; Bernd Holleczek; Karl-Heinz Jöckel; Rudolf Kaaks; Thomas Keil; Alexander Kluttig; Oliver Kuss; Nicole Legath; Michael Leitzmann; Wolfgang Lieb; Claudia Meinke-Franze; Karin B Michels; Nadia Obi; Tobias Pischon; Insa Feinkohl; Susanne Rospleszcz; Tamara Schikowski; Matthias B Schulze; Andreas Stang; Henry Völzke; Stefan N Willich; Kerstin Wirkner; Hajo Zeeb; Wolfgang Ahrens; Klaus Berger Journal: Dtsch Arztebl Int Date: 2022-03-18 Impact factor: 8.251
Authors: Jenni Ervasti; Jaana Pentti; Solja T Nyberg; Martin J Shipley; Constanze Leineweber; Jeppe K Sørensen; Lars Alfredsson; Jakob B Bjorner; Marianne Borritz; Hermann Burr; Anders Knutsson; Ida E H Madsen; Linda L Magnusson Hanson; Tuula Oksanen; Jan H Pejtersen; Reiner Rugulies; Sakari Suominen; Töres Theorell; Hugo Westerlund; Jussi Vahtera; Marianna Virtanen; G David Batty; Mika Kivimäki Journal: Lancet Reg Health Eur Date: 2021-09-06
Authors: Frank Pega; Natalie C Momen; Diana Gagliardi; Lisa A Bero; Fabio Boccuni; Nicholas Chartres; Alexis Descatha; Angel M Dzhambov; Lode Godderis; Tom Loney; Daniele Mandrioli; Alberto Modenese; Henk F van der Molen; Rebecca L Morgan; Subas Neupane; Daniela Pachito; Marilia S Paulo; K C Prakash; Paul T J Scheepers; Liliane Teixeira; Thomas Tenkate; Tracey J Woodruff; Susan L Norris Journal: Environ Int Date: 2022-02-16 Impact factor: 9.621
Authors: Natalie C Momen; Kai N Streicher; Denise T C da Silva; Alexis Descatha; Monique H W Frings-Dresen; Diana Gagliardi; Lode Godderis; Tom Loney; Daniele Mandrioli; Alberto Modenese; Rebecca L Morgan; Daniela Pachito; Paul T J Scheepers; Daria Sgargi; Marília Silva Paulo; Vivi Schlünssen; Grace Sembajwe; Kathrine Sørensen; Liliane R Teixeira; Thomas Tenkate; Frank Pega Journal: Environ Int Date: 2021-11-30 Impact factor: 9.621
Authors: Rosane Harter Griep; Maria da Conceição C Almeida; Sandhi Maria Barreto; André R Brunoni; Bruce B Duncan; Luana Giatti; José Geraldo Mill; Maria Del Carmen B Molina; Arlinda B Moreno; Ana Luisa Patrão; Maria Inês Schmidt; Maria de Jesus Mendes da Fonseca Journal: Front Psychol Date: 2022-10-03