Occupational Determinants of Affective Disorders

  • Reiner RuguliesEmail author
  • Birgit Aust
  • Ida E. H. Madsen
Living reference work entry
Part of the Handbook Series in Occupational Health Sciences book series (HDBSOHS, volume 1)


Affective disorders encompass mental disorders related to excessively elated and depressed mood, referred in clinical diagnostic terms as manic episode, bipolar disorders, and depressive disorders. The etiology of affective disorders is complex and only partly understood. Regarding the role of working conditions in the etiology of affective disorders, research evidence is currently limited to depressive disorders. We present results from recent reviews and meta-analyses of prospective cohort studies showing that the combination of high job demands and low job control (denoted as job strain), low job control in itself, the imbalance between high efforts and low rewards at work, and high job insecurity are associated with a moderately increased risk of depressive disorders. Long working hours are associated with a weak, albeit statistically significantly increased risk; however the associations vary across different world regions. Exposure to workplace bullying is strongly associated with risk of depressive disorders; however, this result is based on only a few studies. We critically discuss the epidemiological evidence while considering various potential biases leading to both over- and underestimation of the reported associations. We conclude with pointing to future research needs for a better understanding of the role of working conditions in the etiology of depressive disorders, including strategies to address biases; a stronger focus on a work-life course perspective; the analyses of possible effect modification by other variables, including contextual factors; approaches for advancing theory and understanding mechanisms; and the development, implementation, and comprehensive evaluation of workplace intervention studies.


Occupational health Psychosocial work environment Stress Depression Anxiety Social psychiatry Psychosocial epidemiology Meta-analysis 


  1. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Health Disorders, fifth edition (DSM-5). American Psychiatric Association, Arlington.
  2. Beck AT (1967) Depression: clinical, experimental and theoretical aspects. Harper and Row, New YorkGoogle Scholar
  3. Blazer DG (2005) The age of melancholy. “Major depression” and its social origins. Routledge, New YorkGoogle Scholar
  4. Bolwig TG, Shorter E (eds) (2007) Melancholia: beyond DSM, beyond neurotransmitters. Proceedings of a conference, May 2006, Copenhagen, Denmark. Acta Psychiatr Scand 115:4–183. CrossRefGoogle Scholar
  5. Brown GW, Harris T (1978) Social origins of depression. A study of psychiatric disorder in women. Tavistock, LondonGoogle Scholar
  6. Caspi A et al (2003) Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science 301:386–389. CrossRefGoogle Scholar
  7. Clausen T et al (2019) The Danish Psychosocial Work Environment Questionnaire (DPQ): development, content, reliability and validity. Scand J Work Environ Health 45:356-369. CrossRefGoogle Scholar
  8. Cuijpers P, Smit F (2004) Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatr Scand 109:325–331. CrossRefPubMedGoogle Scholar
  9. Culverhouse RC et al (2018) Collaborative meta-analysis finds no evidence of a strong interaction between stress and 5-HTTLPR genotype contributing to the development of depression. Mol Psychiatry 23:133–142. CrossRefPubMedGoogle Scholar
  10. Davison GC, Neale JM (1990) Abnormal psychology, 6th edn. Wiley, New YorkGoogle Scholar
  11. Dragano N, Siegrist J, Wahrendorf M (2011) Welfare regimes, labour policies and unhealthy psychosocial working conditions: a comparative study with 9917 older employees from 12 European countries. J Epidemiol Community Health 65:793–799. CrossRefPubMedGoogle Scholar
  12. Drill R, Nakash O, DeFife JA, Westen D (2015) Assessment of clinical information: comparison of the validity of a Structured Clinical Interview (the SCID) and the Clinical Diagnostic Interview. J Nerv Ment Dis 203:459–462. CrossRefPubMedPubMedCentralGoogle Scholar
  13. Ehrenberg A (1998) La fatigue d’être soi – dépression et société. Odile Jacob, ParisGoogle Scholar
  14. Ekmekci PE (2017) An increasing problem in publication ethics: publication bias and editors’ role in avoiding it. Med Health Care Philos 20:171–178. CrossRefPubMedGoogle Scholar
  15. Flint J, Kendler KS (2014) The genetics of major depression. Neuron 81:484–503. CrossRefPubMedPubMedCentralGoogle Scholar
  16. France CM, Lysaker PH, Robinson RP (2007) The “chemical imbalance” explanation for depression: origins, lay endorsement, and clinical implications. Prof Psychol Res Pract 38:411–420. CrossRefGoogle Scholar
  17. GRADE Working Group (2018) GRADE. Accessed 20 Aug 2018
  18. Grawitch MJ, Ballard DW, Erb KR (2015) To be or not to be (stressed): the critical role of a psychologically healthy workplace in effective stress management. Stress Health 31:264–273. CrossRefPubMedGoogle Scholar
  19. Hämäläinen J, Isometsä E, Sihvo S, Kiviruusu O, Pirkola S, Lönnqvist J (2009) Treatment of major depressive disorder in the Finnish general population. Depress Anxiety 26:1049–1059. CrossRefPubMedGoogle Scholar
  20. Harmer CJ et al (2009) Effect of acute antidepressant administration on negative affective bias in depressed patients. Am J Psychiatry 166:1178–1184. CrossRefPubMedGoogle Scholar
  21. Harris T (2001) Recent developments in understanding the psychosocial aspects of depression. Br Med Bull 57:17–32CrossRefGoogle Scholar
  22. Horowitz MA, Zunszain PA (2015) Neuroimmune and neuroendocrine abnormalities in depression: two sides of the same coin. Ann N Y Acad Sci 1351:68–79. CrossRefPubMedGoogle Scholar
  23. Hoven H, Siegrist J (2013) Work characteristics, socioeconomic position and health: a systematic review of mediation and moderation effects in prospective studies. Occup Environ Med 70:663–669. CrossRefPubMedPubMedCentralGoogle Scholar
  24. Jakobsen LM, Jorgensen AFB, Thomsen BL, Greiner BA, Rugulies R (2015) A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark. BMJ Open 5:e008713. CrossRefPubMedPubMedCentralGoogle Scholar
  25. Joyce S, Modini M, Christensen H, Mykletun A, Bryant R, Mitchell PB, Harvey SB (2016) Workplace interventions for common mental disorders: a systematic meta-review. Psychol Med 46:683–697. CrossRefPubMedGoogle Scholar
  26. Karasek R, Theorell T (1990) Healthy work: stress, productivity, and the reconstruction of working life. Basic Books, New YorkGoogle Scholar
  27. Kendler KS (1986) Kraepelin and the differential diagnosis of dementia praecox and manic-depressive insanity. Compr Psychiatry 27:549–558CrossRefGoogle Scholar
  28. Kendler KS, Gardner CO, Prescott CA (2002) Toward a comprehensive developmental model for major depression in women. Am J Psychiatry 159:1133–1145. CrossRefPubMedGoogle Scholar
  29. Kendler KS, Hettema JM, Butera F, Gardner CO, Prescott CA (2003) Life event dimensions of loss, humiliation, entrapment, and danger in the prediction of onsets of major depression and generalized anxiety. Arch Gen Psychiatry 60:789–796. CrossRefPubMedGoogle Scholar
  30. Kendler KS, Gardner CO, Prescott CA (2006) Toward a comprehensive developmental model for major depression in men. Am J Psychiatry 163:115–124. CrossRefGoogle Scholar
  31. Kim TJ, Knesebeck O (2016) Perceived job insecurity, unemployment and depressive symptoms: a systematic review and meta-analysis of prospective observational studies. Int Arch Occup Environ Health 89:561–573. CrossRefPubMedGoogle Scholar
  32. Kivimäki M, Steptoe A (2018) Effects of stress on the development and progression of cardiovascular disease. Nat Rev Cardiol 15:215–229. CrossRefPubMedGoogle Scholar
  33. Kompier M, Aust B (2016) Organizational stress management interventions: is it the singer not the song? Scand J Work Environ Health 42:355–358. CrossRefPubMedGoogle Scholar
  34. Krueger RF et al (2018) Progress in achieving quantitative classification of psychopathology. World Psychiatry 17:282–293. (commentaries 241–242 and 294–305). CrossRefPubMedPubMedCentralGoogle Scholar
  35. LaMontagne AD et al (2014) Workplace mental health: developing an integrated intervention approach. BMC Psychiatry 14:131. CrossRefPubMedPubMedCentralGoogle Scholar
  36. Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M (2003) Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol 157:98–112CrossRefGoogle Scholar
  37. Madsen IEH, Tripathi M, Borritz M, Rugulies R (2014) Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers. Scand J Work Environ Health 40:631–638. CrossRefPubMedGoogle Scholar
  38. Madsen IEH et al (2017) Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data. Psychol Med 47:1342–1356. CrossRefPubMedPubMedCentralGoogle Scholar
  39. Marangoni C, Hernandez M, Faedda GL (2016) The role of environmental exposures as risk factors for bipolar disorder: a systematic review of longitudinal studies. J Affect Disord 193:165–174. CrossRefPubMedGoogle Scholar
  40. Mayes R, Horwitz AV (2005) DSM-III and the revolution in the classification of mental illness. J Hist Behav Sci 41:249–267. CrossRefPubMedGoogle Scholar
  41. Moffitt TE, Caspi A, Taylor A, Kokaua J, Milne BJ, Polanczyk G, Poulton R (2010) How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychol Med 40:899–909. CrossRefPubMedGoogle Scholar
  42. Montano D, Hoven H, Siegrist J (2014) Effects of organisational-level interventions at work on employees’ health: a systematic review. BMC Public Health 14:Art 135. CrossRefGoogle Scholar
  43. Rugulies R (2019) What is a psychosocial work environment? Scand J Work Environ Health 45:1–6. CrossRefPubMedGoogle Scholar
  44. Rugulies R, Aust B, Madsen IEH (2016) Effort-reward imbalance and affective disorders. In: Siegrist J, Wahrendorf M (eds) Work stress and health in a globalized economy – the model of effort-reward imbalance. Springer International Publishing, Cham, pp 103–143. CrossRefGoogle Scholar
  45. Rugulies R, Aust B, Madsen IEH (2017) Effort-reward imbalance at work and risk of depressive disorders. A systematic review and meta-analysis of prospective cohort studies. Scand J Work Environ Health 43:294–306. CrossRefPubMedGoogle Scholar
  46. Rugulies R, Jakobsen LM, Madsen IEH, Borg V, Carneiro IG, Aust B (2018) Managerial quality and risk of depressive disorders among Danish eldercare workers: a multilevel cohort study. J Occup Environ Med 60:120–125. CrossRefPubMedGoogle Scholar
  47. Sacco WP (1999) A social-cognitive model of interpersonal processes in depression. In: Joiner T, Coyne JC (eds) Advances in interpersonal approaches: the interactional nature of depression. American Psychological Association, Washington, DC, pp 329–362CrossRefGoogle Scholar
  48. Seligman M (1975) Helplessness: on depression, development, and death. Freeman, San FranciscoGoogle Scholar
  49. Semmer NK, Jacobshagen N, Meier LL, Elfering A, Beehr TA, Kalin W, Tschan F (2015) Illegitimate tasks as a source of work stress. Work Stress 29:32–56. CrossRefPubMedPubMedCentralGoogle Scholar
  50. Siegrist J (2016) A theoretical model in the context of economic globalization. In: Siegrist J, Wahrendorf M (eds) Work stress and health in a globalized economy – the model of effort-reward imbalance. Springer International Publishing, Cham, pp 3–19. CrossRefGoogle Scholar
  51. Stansfeld SA, Fuhrer R, Shipley MJ, Marmot MG (1999) Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study. Occup Environ Med 56:302–307CrossRefGoogle Scholar
  52. Stansfeld SA, Clark C, Caldwell T, Rodgers B, Power C (2008) Psychosocial work characteristics and anxiety and depressive disorders in midlife: the effects of prior psychological distress. Occup Environ Med 65:634–642. CrossRefPubMedGoogle Scholar
  53. Theorell T et al (2015) A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public Health 15:738. CrossRefPubMedPubMedCentralGoogle Scholar
  54. Virtanen M et al (2008) Overcrowding in hospital wards as a predictor of antidepressant treatment among hospital staff. Am J Psychiatry 165:1482–1486. CrossRefPubMedGoogle Scholar
  55. Virtanen M et al (2018) Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data. Scand J Work Environ Health 44:239–250. CrossRefPubMedGoogle Scholar
  56. Wakefield JC (2015) DSM-5, psychiatric epidemiology and the false positives problem. Epidemiol Psychiatr Sci 24:188–196. CrossRefPubMedGoogle Scholar
  57. Wieclaw J, Agerbo E, Mortensen PB, Burr H, Tüchsen F, Bonde JP (2008) Psychosocial working conditions and the risk of depression and anxiety disorders in the Danish workforce. BMC Public Health 8:280. CrossRefPubMedPubMedCentralGoogle Scholar
  58. Wittchen HU, Kessler RC, Pfister H, Lieb M (2000) Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatr Scand 102:14–23CrossRefGoogle Scholar
  59. Wittchen HU et al (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21:655–679. CrossRefPubMedGoogle Scholar
  60. World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization, GenevaGoogle Scholar
  61. World Health Organization (2015) International classification of diseases (ICD). Accessed 19 Nov 2018

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Reiner Rugulies
    • 1
    • 2
    • 3
    Email author
  • Birgit Aust
    • 1
  • Ida E. H. Madsen
    • 1
  1. 1.National Research Centre for the Working EnvironmentCopenhagenDenmark
  2. 2.Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of PsychologyUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations