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Workplace
Original article
Work-unit organisational changes and subsequent prescriptions for psychotropic medication: a longitudinal study among public healthcare employees
  1. Johan Høy Jensen1,2,
  2. Jens Peter Bonde1,
  3. Esben Meulengracht Flachs1,
  4. Janne Skakon3,
  5. Naja Hulvej Rod4,
  6. Ichiro Kawachi2
  1. 1 Department of Occupational and Environmental Medicine, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
  2. 2 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  3. 3 Department of Psychology, University of Copenhagen, Copenhagen, Denmark
  4. 4 Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Johan Høy Jensen, Department of Occupational and Environmental Medicine, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen 2400, Denmark; johan.hoey.jensen{at}regionh.dk

Abstract

Objectives We examined exposure to different types of organisational changes at work as risk factors for subsequent prescription for psychotropic medication among employees.

Methods The study population included 15 038 public healthcare employees nested within 1284 work units in the Capital Region of Denmark. Multilevel mixed-effects parametric survival models were developed to examine time to prescription for psychotropic medications (anxiolytics/hypnotics/sedatives/antidepressants) during the 12-month interval following exposure to organisational changes relative to no change from January to December 2013. Data on work-unit level organisational changes (including mergers, split-ups, relocation, change in management, employee lay-offs and budget cuts) were collected from work-unit managers (59% response).

Results Any organisational change versus no change was associated with a higher risk of psychotropic prescription (HR: 1.14, 95% CI: 1.02 to 1.26), especially change in management (HR: 1.23, 95% CI: 1.07 to 1.41). Splitting the 12-month follow-up period into two halves yielded particularly high rates of psychotropic prescription in the latter half of the follow-up, for example, any change (HR: 1.25, 95% CI: 1.11 to 1.41), change in management (HR: 1.42, 95% CI: 1.22 to 1.65), mergers (HR: 1.26, 95% CI: 1.06 to 1.50), employee lay-off (HR: 1.23, 95% CI: 1.03 to 1.46) and budget cuts (HR: 1.13, 95% CI: 1.00 to 1.41). The associations did not vary by sex.

Conclusions Organisational changes in the workplace, especially change in management, may be associated with increased risk of psychotropic prescription among employees regardless of sex.

  • mental health
  • organisation of work
  • health care workers
  • public health
  • psychology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/oemed-2018-105442

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    Footnotes

    • Patient consent for publication Not required.

    • Contributors JHJ had full access to all data provided in the present study, and JHJ takes responsibility for the integrity and the accuracy of the data analyses. All authors were responsible for the current study design. JHJ wrote the initial draft of the manuscript. All authors contributed to the present study and approved the final draft of the manuscript.

    • Funding This work was funded by the Danish Working Environment Research Fund (13-2015-03).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.