Kivimäki M, Vahtera J, Pentti J, Ferrie J E
Department of Psychology, Division of Applied Psychology, University of Helsinki, PO Box 13, FIN-00014 University of Helsinki, Finland.
BMJ. 2000 Apr 8;320(7240):971-5. doi: 10.1136/bmj.320.7240.971.
To explore the underlying mechanisms between organisational downsizing and deterioration of health of employees.
Longitudinal cohort study. Data were assembled from before downsizing (time 1); during major downsizing affecting some job categories (time 2); and after downsizing (time 3). Contributions of changes in work, support, and health related behaviours between time 1 and time 2 to the relation between downsizing and sickness absence at time 3 were assessed by multilevel modelling. Mean length of follow up was 4.9 years.
Raisio, a town in Finland.
764 municipal employees who remained in employment after downsizing.
Records of absences from work from all causes with medical certificate.
Downsizing was associated with negative changes in work, impaired support from spouse, and increased prevalence of smoking. Sickness absence rate from all causes was 2.17 (95% confidence interval 1.54 to 3.07) times higher after major downsizing than after minor downsizing. Adjustment for changes in work (for instance, physical demands, job control, and job insecurity) diminished the relation between downsizing and sickness absence by 49%. Adjustments for impaired social support or increased smoking did not alter the relation between downsizing and sickness absence. The findings were unaffected by sex and income.
The exploration of potential mediating factors provides new information about the possible causal pathways linking organisational downsizing and health. Downsizing results in changes in work, social relationships, and health related behaviours. The observed increase in certificated sickness absence was partially explained by concomitant increases in physical demands and job insecurity and a reduction in job control. A considerable proportion of the increase, however, remained unexplained by the factors measured.
探讨机构精简与员工健康恶化之间的潜在机制。
纵向队列研究。数据收集于精简前（时间1）、影响部分工作类别的大规模精简期间（时间2）以及精简后（时间3）。通过多水平模型评估了时间1和时间2之间工作、支持及健康相关行为的变化对时间3时精简与病假之间关系的影响。平均随访时间为4.9年。
芬兰的拉伊西奥镇。
764名在精简后仍在职的市政雇员。
所有有医疗证明的因病缺勤记录。
精简与工作方面的负面变化、配偶支持受损以及吸烟率上升有关。大规模精简后所有原因导致的病假率比小规模精简后高2.17倍（95%置信区间1.54至3.07）。对工作变化（如体力要求、工作控制和工作不安全感）进行调整后，精简与病假之间的关系减弱了49%。对社会支持受损或吸烟增加进行调整并未改变精简与病假之间的关系。研究结果不受性别和收入的影响。
对潜在中介因素的探索为机构精简与健康之间可能的因果途径提供了新信息。精简会导致工作、社会关系和健康相关行为的变化。观察到的有证明的病假增加部分可由体力要求和工作不安全感的增加以及工作控制的减少来解释。然而，相当一部分增加无法由所测量的因素来解释。
