INSERM, U558, Toulouse F-31300, France.
Laboratoire PACTE (Politiques Publiques, Action Publique, Territoires), UMR 5194 CNRS, Université Pierre Mendès France, Grenoble, France.
Soc Sci Med. 2010 Aug;71(3):534-540. doi: 10.1016/j.socscimed.2010.04.003. Epub 2010 Apr 24.
Few studies have analysed the association between the organisational work environment and depression in hospital workers and we still have little understanding of how processes in the practice environment are related to depressive disorders. However, individual perception of an imbalance between efforts made and expected rewards has been associated with incident depression. The main goal of this study was to test the hypothesis that some organisational constraints at the work-unit level may be related to depressive symptoms in hospital workers, either directly or through individual perceptions of effort-reward imbalance (ERI). In 2006, 3316 female registered nurses and nursing aids working in 190 work units in seven French university hospitals, recruited from the baseline screening of an epidemiological cohort study (the ORSOSA study), responded in 2006 to valid self-report questionnaires (CES-D, ERI). The organisational work environment was assessed with the self-rated Nursing Work Index - Extended Organisation (NWI-EO) aggregated at the work unit level. Multilevel models were used. We found that poor relations between workers within work units were associated with higher CES-D score, independently of perceived ERI. Low level of communication between workers in the unit was associated with individual perceptions of ERI and indirectly associated with depressive symptoms. Understaffing and non-respect of planned days off and vacations were associated with perceived ERI but these organisational constraints were not associated with depressive symptoms. Our study allowed us to identify and quantify organisational factors that have a direct effect on hospital workers' depressive symptoms, or an indirect effect through perceived ERI. Better understanding of the effect of organisational factors on health through perceived ERI would provide targets for successful interventions. Organisational approaches may be more effective in improving mental health at work and may also have a longer-lasting impact than individual approaches.
很少有研究分析医院工作人员的组织工作环境与抑郁之间的关系，我们对实践环境中的过程如何与抑郁障碍相关仍知之甚少。然而，个体对努力与预期回报之间失衡的感知与抑郁事件有关。本研究的主要目的是检验以下假设，即工作单位层面的某些组织限制可能与医院工作人员的抑郁症状有关，这种关系可能是直接的，也可能是通过个体对努力-回报失衡（ERI）的感知。2006 年，在法国 7 所大学医院的 190 个工作单位中，有 3316 名注册护士和护理助理参加了一项流行病学队列研究（ORSOSA 研究）的基线筛查，他们在 2006 年对有效自报问卷（CES-D、ERI）作出了回应。组织工作环境是用自我评估的护士工作指数-扩展组织（NWI-EO）在工作单位层面进行评估的。使用了多层次模型。我们发现，工作单位内部工作人员之间的关系不佳与 CES-D 评分较高有关，而与感知 ERI 无关。单位内工作人员之间沟通不畅与个体对 ERI 的感知有关，并间接与抑郁症状有关。人手不足、不遵守计划的休息日和假期与感知 ERI 有关，但这些组织限制与抑郁症状无关。我们的研究使我们能够识别和量化对医院工作人员的抑郁症状有直接影响的组织因素，或通过感知 ERI 产生间接影响的组织因素。通过感知 ERI 更好地理解组织因素对健康的影响，可以为成功的干预措施提供目标。组织方法可能在改善工作中的心理健康方面更有效，并且可能比个体方法具有更长的影响。
