OBJECTIVE:The aim of this cross-sectional study was to assess the association between burnout and pain among vascular surgeons (VS) and vascular surgical trainees (VST) in Denmark. METHODS:In 2023, all clinically active VS/VST in Denmark were invited to participate in an anonymous survey consisting of validated questionnaires assessing burnout, perceived physical job demands, and pain. RESULTS:Of 111 VS/VST in Denmark, a response rate of 72% was obtained (n = 80). The majority were men (54%, n = 43) and VS (75%, n = 60). Associations between burnout and pain in the nine body regions assessed were statistically significant (p = .035 to < .001). Surgeons reporting frequent pain (weekly or more often) had statistically significantly higher burnout scores compared with surgeons reporting pain less often (monthly or never) (p = .029 to < .001). Pain was primarily reported in the neck/shoulders, back, and head, with different main pain areas depending on type of surgical procedure primarily performed (open, endovascular, endovenous). Pain during or after surgery was reported by 65% (n = 51), with frequency ranging from always (8%, n = 6), to often (24%, n = 19) and sometimes (33%, n = 26). The overall burnout prevalence (ranging from mild to severe) was 72% (n = 58), of whom 32% (n = 26) reported moderate to severe burnout symptoms. On a scale from 0 - 100, the mean burnout score was 37.7 (95% confidence interval [CI] 32.9 - 42.4) and varied between departments (p = .096) and job positions, with junior attendings reporting the highest levels of burnout (47.4, 95% CI 36.8 - 57.9) (attending vs. junior attending, p = .066; chief resident vs. resident, p = .58). Higher levels of perceived physical job demands were associated with higher levels of burnout (Pearson's r = 0.49). CONCLUSION:This national study showed that pain during or after surgery is frequent among VS/VST and that it is significantly associated with burnout. Creating work conditions that mitigate pain and burnout is essential to support occupational health and to maintain a robust vascular surgical service.

This systematic review evaluates the effectiveness of organisational-level mental health promotion interventions in healthcare, construction, and Telework and ICT-based Mobile (TICTM) work, focusing on burnout, depression, anxiety, stress, and overall mental well-being. Following PRISMA 2020 guidelines and registered with PROSPERO (CRD42024541652), we searched PubMed Medline, Scopus, Web of Science, and EBSCOHost Medline. Studies were included if they assessed organisational-level interventions targeting mental health outcomes, used quantitative methods with control groups, and applied validated measurement tools. Eligible publications were those appearing between 10 July 2021 and 30 June 2024 for healthcare and 17 May 2022 and 30 June 2024 for construction, reflecting the cut-off dates of our previous reviews, and between 1 January 2014 and 30 June 2024 for TICTM. Included studies were appraised for quality using the Quality Assessment Tool for Quantitative Studies (QATQS), and findings were synthesised using a narrative synthesis approach. Six controlled trials (four randomised, two non-randomised) met the inclusion criteria. The four healthcare-sector studies each reported significant improvements in at least one primary mental health outcome-burnout, depression, or stress. The construction-sector study found a short-term reduction in stress at 12 months, but this was not sustained at 24 months. The single TICTM study reported improvements in positive affect, a component of psychological well-being. This update confirmed our previous findings, showing that evidence on organisational-level interventions remains strongest in healthcare, where most studies reported improvements in at least one mental health outcome, while studies in construction and TICTM settings remain scarce. Only one study each was found for the construction sector and the TICTM setting, confirming the lack of organisational-level interventions for better mental health in sectors and settings other than healthcare. Due to this limited evidence base, no general trends can be identified. Nevertheless, the few studies suggest that organisational-level mental health promotion interventions have the potential to improve mental health outcomes in diverse settings when appropriately adapted to sector-specific conditions.

BackgroundThe Danish return-to-work (RTW) program was a coordinated, tailored and multidisciplinary intervention aimed at improving sickness benefit management at municipal jobs and benefits offices in Denmark.ObjectiveTo estimate long-term effects of the Danish RTW program for participants with mental ill health.MethodsThe study population consisted of 8655 20-54 year-old citizens in 21 Danish municipalities who were sick-listed due to self-reported mental health problems (anxiety (4%), depression (47%), stress/ burnout (37%), or other (12%)) in 2010-2012. Of these, 5252 received the intervention while 3403 (the control group) received ordinary case management. Multinomial logistic regression was used to estimate odds ratios (intervention vs. control) for health and non-health related welfare dependency at a 1, 3 and 5-year follow-up in national registers.ResultsWe did not find effects on the odds of receiving health related welfare benefits at 1 (OR = 0.90, 99% CI: 0.78-1.05), 3 (1.00, 0.85-1.17) and 5 years (0.98, 0.85-1.14). We did also not find effects on the odds of receiving non-health related welfare benefits at 1 (1.11, 0.95-1.29) and 3 years (0.94, 0.81-1.09), but found an effect at the 5-year follow-up OR = 0.81 (0.69-0.96).ConclusionFor persons with mental ill health at baseline, a structured RTW program reduced the risk of unemployment at 5-year follow-up, suggesting an impact on a process that can only be measured after several years. The intervention did not have long-term effects on the odds of receiving health related welfare benefits.

BackgroundOrganizational multilevel interventions have been called for as a means to improve psychosocial working conditions, reduce stress, and enhance wellbeing in organizations. However, these types of interventions are highly complex to implement and evaluate, and they remain scarce in the literature. In this study, we present the evaluation of a multilevel intervention conducted in a municipality setting.MethodsThe intervention was based on a train-the-trainer principle and participatory risk assessment workshops on all organizational levels. Action plans were subsequently developed at the team level, and identified risks, which could not be addressed at the team level, were reported to the management for further action planning or escalation to the next management level. Using a pre-post study design, we evaluated changes in proximal outcomes related to the psychosocial working environment, and distal outcomes related to stress and job satisfaction. Changes over time in outcome measures were analyzed using linear mixed models. A quantitative process evaluation was used to examine the degree of implementation of the intervention.ResultsSmall improvements over time were observed with regard to quantitative demands, overall perception of the psychosocial work environment, job satisfaction, and the psychosocial safety climate. We also observed an increase in empowering leadership. Positive tendencies were also found for predicatability at work, possibilities for solving work tasks and support from closest manager. The effect sizes were small in all cases. No improvements in perceived stress or stress symptoms were found. The study revealed several practical and methodological challenges in conducting and implementing this type of multilevel intervention in a municipal setting.ConclusionsOverall, our study suggests that the intervention was associated with small positive changes in certain aspects of the working environment but no improvements were observed in stress outcomes. The study highlights a number of challenges in relation to implementing this type of multilevel intervention in a municipal setting.Trial RegistrationThe study was prospectively registered at ISRCTN84940247 on April 23, 2019.

Childcare workers are faced with high job demands. The use of selection, optimization, and compensation strategies (SOC) may help reach a better balance between job demands and resources. We aimed to develop and evaluate the feasibility of a participatory intervention to increase the collective use of SOC strategies among childcare workers. Five childcare institutions participated in the development and evaluation of the intervention. Feasibility of the intervention was evaluated through interviews, observations, and a questionnaire survey. We transformed the SOC terminology into the more practical applicable terminology ‘PEX’: Prioritize tasks, Explore resources, and use of eXternal resources, and developed a dialogue tool. The PEX approach seems feasible to use in childcare institutions, and to have the potential to increase the collective use of SOC strategies and thereby improve employee well-being. Also, the study illustrates how important it is that feasibility studies allow for adjustments based on the active participation of employees.

BACKGROUND:The digital transition in the workplace has increased trends such as permanent connectivity, an increased sedentary lifestyle, and reduced social interaction, leading to additional psychosocial and ergonomic risks for workers. Musculoskeletal disorders (MSDs) and mental health problems are particularly prevalent, posing a significant burden. To address these challenges, organisations can implement digital or blended interventions targeting MSDs and mental health problems. However, there is still limited evidence on combined workplace interventions targeting both MSDs and mental health problems and respective facilitators and barriers for their successful implementation and sustainability. The objective of this scoping review is to identify barriers and facilitators to the implementation of blended and digital interventions targeted at combined mental health and MSDs in the workplace. METHODS:Bibliographic databases will be searched for studies published since 2014 and reported on the implementation of interventions with a digital component targeted at mental health and MSDs in the workplace. Studies will be included if the intervention was delivered within, or access provided through, the workplace. The title and abstract screen and the full-text screening will be completed independently by two reviewers, with a third reviewer resolving any arising conflicts in the process. RESULTS:Descriptive characteristics of the study design, workplace sector, mode of working, intervention details, mode of intervention delivery, outcomes, and barriers and facilitators will be extracted. Results will be reported in accordance with the PRISMA for Scoping Reviews checklist and a narrative synthesis used to summarise characteristics of included studies, as well as barriers and facilitators to the implementation of interventions. DISCUSSION:The findings from this review will provide practical recommendations relevant to researchers and practitioners developing or implementing digital interventions in the workplace targeting mental health conditions and MSDs. SYSTEMATIC REVIEW REGISTRATION:Research Registry, reviewregistry1847, https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/66671b683a0f410028a230bd/ .

BACKGROUND:Teacher's exposure to pupils' aggressive behaviour is an international phenomenon that requires more attention. This study examined if organizational prevention measures are associated with decreased risk of pupils' aggressive behaviour. METHOD:94 public schools in Denmark participated. Questionnaire data about preventive measures at school level were collected in 2018 and outcome data about pupils' aggressive behaviour in form of harassment, threats and violence towards teachers were collected in 2019. In total, 1198 teachers participated in both rounds. The analyses were performed using multivariate logistic regressions with cluster adjusted standard errors to account for cluster effects. RESULTS:The results were mixed. Violence prevention climate perceptions at the management level decreased the risk of pupils' aggressive behaviour, however when adjusting for baseline harassment, threats, and violence the associations became statistically insignificant. Violence prevention climate perceptions at co-worker level statistically significant decreased the risk of pupils' aggressive behaviour in form of violence even when adjusted for baseline violence. Practice and procedures statistically significantly decreased the risk of harassment. The results for conflict management training were mixed, while supervision in case of challenging pupils decreased the risk of harassment, threats, and violence, but none of the associations were statistically significant. Finally, the registration of threats and violence statistically significantly increased the risk of threats and violence at follow-up. CONCLUSION:This study shows that implementing organizational prevention measures in public schools may reduce the risk of pupils' aggressive behaviour towards teachers. It is, therefore, recommended to implement organizational prevention measures in public schools to reduce the risk of pupils' aggressive behaviour towards teachers.

Workplace violence is associated with negative consequences for workers, organizations, and society. Experiencing violence at work has consistently been associated with an increased risk of symptoms of depression and anxiety, diagnosis of post-traumatic stress disorder (PTSD), and suicide (1–3). Further, workplace violence has been found to increase the risk of physical health outcomes such as type 2 diabetes and cardiovascular diseases (4, 5). Workplace violence can also lead to higher rates of turnover and sick leave (1, 6), translating into a societal economic burden (7). Longitudinal studies indicate that repeated exposure to workplace violence, compared with single episodes of violence, increases the risk of PTSD and sick leave further (8–10). Moreover, a recent study shows synergistic interaction effects for simultaneous exposure to workplace violence and other psychosocial working conditions, such as high emotional demands and high quantitative demands—conditions that are typically present in the same sectors (such as healthcare and education) where violence is frequently reported (11). Prevalence of workplace violence – the problem persists In a 2022 global survey, the International Labor Organization (ILO) found that more than one-fifth of the workforce experienced violence and harassment at work during their working life (12). While this gives an idea of the magnitude of the problem, it covers large differences between countries and sectors, as well as among types of violence and harassment. Effective prevention requires a more precise understanding of all these aspects, but in many countries, comprehensive data to identify the most exposed groups are not available. For Europe, however, it is possible to describe the main characteristics of workplace violence – which may be quite different from other parts of the world (12). Estimates from Europe indicate that 2–5% of the general workforce is affected by work-related violence, with substantially higher rates—ranging from 5–30%—reported in high-risk sectors (13–16). Despite these overall trends, comparing the prevalence of workplace violence remains challenging due to variations in definitions and measurements; in addition, widespread underreporting makes it difficult to obtain accurate figures (17). In this issue of the Scandinavian Journal of Work, Environment and Health, a longitudinal study by Gash & Blom (15) addresses some of these issues. Using nationally representative data from the UK, the authors show that workplace violence is prevalent in a wide variety of sectors, but with elevated numbers in public administration (eg, benefits administration), followed by health- and residential care and social work. Because the study by Gash & Blom uses the same set of questions to assess violence across sectors, patterns can be identified, making it possible to compare them with results from similar studies. Two relevant cohorts to compare their results with are the Work Environment and Health in Denmark study (WEHD) (18) and the European Survey of Enterprises on New and Emerging Risks (ESENER) conducted by Eurofound (13, 14). The WEHD study comprises identical measures of violence at work in four surveys of national samples of the Danish working population conducted between 2012 and 2018. The three sectors persistently reporting the highest levels of violence are healthcare, social work, and education (16, 19). The same trend is seen in the ESENER survey, where health and social work, education, and public administration were the top three most exposed sectors in both 2015 and 2021 (13, 14). Together, data reveal a persistent and concerning pattern for European countries, showing that workplace violence remains particularly high in specific sectors. As evidence of both the prevalence and consequences of the problem continues to grow, the need for decisive action becomes increasingly urgent. From problem to strategy: making the case for systemic solutions Workplace violence can be categorized into three types, each guiding tailored prevention efforts (20). Type I involves perpetrators with no legitimate connection to the workplace—typically criminal acts such as robberies. Type II arises from interactions with clients, patients, or service users, where violence occurs without criminal intent. Type III refers to violence from current or former colleagues, supervisors, or acquaintances within the organization (20). Cross-national patterns in the sectors most affected by workplace violence (healthcare, social work, and education) suggest that violent incidents are associated with a high degree of contact with clients, patients, or service users, characteristic of Type II violence. Type II violence typically arises in situations where the “perpetrator” experiences emotional stress caused by pain or frustration due to, eg, rejection of requests perceived as legitimate (21, 22). While the term violence is meaningful from an occupational safety and health (OSH) perspective, it connotes an overly intentional act from the perpetrator that is often not the case. For example, a care worker in a residential facility may frequently encounter violent episodes involving elderly residents with severe behavioral symptoms of dementia. Preventive measures in these sectors must therefore include a deeper understanding of how to improve the well-being of the affected individual—both to protect the care worker and to enhance the quality of life for the resident (23). Consequently, it is important to recognize that the prevention of Type II violence should be approached from a dual perspective—one that reflects a shared interest between the worker and the potential “perpetrator” in preventing conflict situations that normally precede the violent incident. This applies whether the source of the violent incident is a patient, a child in kindergarten, or a citizen who needs support from social services (23–25). As such, the prevention of violence is closely linked to professional practices within a given sector that aim to strengthen relational work with patients, clients, or service users. As mentioned above, the patterns and characteristics of workplace violence may be different in other parts of the world, where Type I and Type III violence are more prevalent, and investigating these patterns would be important for tailored prevention. Policy measures and workplace interventions While national and transnational legislation in the area has evolved with violence as a highly regulated psychosocial hazard (19, 26), that in itself does not seem to be enough to solve the problem (27, 28). Recent research indicates that both external pressure from legislation and internal pressure on actors within organizations through OSH systems and procedures are needed to change practices to prevent psychosocial risks (29). Therefore, local intervention still carries significant importance. Despite a rise in the number of intervention studies on workplace violence, only a few have succeeded in reducing workplace violence. Numerous reviews show that the majority of studies focus on de-escalation training, which seems to improve workers’ knowledge and self-efficacy, but has only limited or no impact on reducing violent incidents at work (17, 30–32). The lack of effective preventive interventions might be explained by the multicausal nature of violent episodes, where risk factors on different levels interact to create the specific risk (33–35). Some studies have examined comprehensive multi-stranded interventions addressing this complexity, and the limited evidence available suggests these interventions can be effective (36–40). However, these complex interventions can be especially challenging to conduct in workplaces that need them most. The high prevalence of workplace violence can considerably strain organizational resources, as such incidents are closely linked to increased rates of sickness absence and staff turnover (1, 6, 21, 41–43). The most vulnerable workplaces are therefore often caught in a downward spiral of resource depletion. A complex challenge demanding a systemic response This situation calls for addressing broader systemic factors that support workplaces and sectors with the highest risks and the fewest resources—factors that currently hinder their ability to comply with regulatory requirements or successfully conduct workplace interventions. Inspired by systems thinking (44), we propose a systemic approach to workplace violence prevention, as represented in figure 1. Such a systemic approach enables the identification of gaps across organizational preventive practices and research knowledge and supports the recognition of key leverage points within the system that influence multiple interrelated challenges (44). The approach aligns with system-oriented approaches such as AcciMap analysis (45), which emphasize the importance of identifying the broader organizational and systemic factors that contribute to incidents of workplace violence. Rather than focusing solely on the safety behavior of frontline staff, such approaches highlight how decisions and interactions across multiple system levels—from policy to management to task execution—shape the conditions in which violence occurs. The application of a systemic approach to workplace violence prevention is informed by studies from Australia in two high-risk sectors: healthcare and social work (32, 35), and violence-prevention research from Denmark in the high-risk sectors of eldercare, psychiatry, prison and probation services, and the education sector (23, 38, 46). The figure illustrates how violent episodes arise in the inner circle at the task execution level. However, task execution is nested within a broader context, affecting the situational risk. On the task execution level, the figure highlights the importance of adopting a dual perspective on conflict reduction—addressing both the employees’ work environment and the well-being of individuals who may pose a risk of violent situations. In healthcare, social work, and educational settings, violent episodes can create emotional and cognitive dilemmas—especially when acts are unintentional or where incrimination, eg, of an adolescent, may hinder the pedagogical relationship. Therefore, a dual perspective is needed, integrating conflict prevention and client well-being into occupational safety and health efforts (23, 34, 37). At the department level, preventive work should focus on strong collaboration between employees and managers to foster a safe and supportive psychosocial work environment (38). Psychosocial factors such as trust are essential for encouraging reporting and facilitating crucial knowledge sharing (24). At the organizational level, the focus should be on systematic, data-driven OSH efforts and policies, as typically advocated in the safety climate literature (36, 38). The two outer circles emphasize the significance of sector-specific resources and regulations, as well as (trans-)national legislation, in providing a solid framework for violence prevention (35, 47). The systemic approach to violence prevention provides a valuable framework for organizing and critically assessing existing knowledge in the field. Applying this perspective reveals a notable gap in the literature: few studies address sector-level dynamics, despite their potential as key leverage points for systemic change. Decisions related to well-known implementation barriers—such as staffing and resource allocation—can be influenced at this level. A recent study from the Australian social work sector demonstrated how systemic risk factors can be mapped effectively through active engagement of stakeholders across all levels, bridging silos of OSH, visitation processes, and quality improvement (47). This type of sector-level intervention that engages stakeholders beyond the OSH domain holds promise as an impactful strategy, given that decision-making authority over systemic factors often resides at this level. Such interventions offer a strategic opportunity to support the workplaces most in need. Adopting a systems perspective on workplace violence, therefore, requires coordinated action from multiple actors such as sector-specific interest organizations, employer organizations, and politicians. References 1. Nyberg A, Kecklund G, Hanson LM, Rajaleid K. Workplace violence and health in human service industries: a systematic review of prospective and longitudinal studies. Occup Environ Med. 2020;78(2):69-81. https://doi.org/10.1136/oemed-2020-106450 2. Rudkjoebing LA, Bungum AB, Flachs EM, Eller NH, Borritz M, Aust B, et al. Work-related exposure to violence or threats and risk of mental disorders and symptoms: a systematic review and meta-analysis. Scand J Work Environ Health. 2020;46(4):339-49. https://doi.org/10.5271/sjweh.3877 3. Magnusson Hanson LL, Pentti J, Nordentoft M, Xu T, Rugulies R, Madsen IEH, et al. Association of workplace violence and bullying with later suicide risk: a multicohort study and meta-analysis of published data. Lancet Publ Health. 2023;8(7):e494-e503.https://doi.org/10.1016/S2468-2667(23)00096-8 4. Xu T, Magnusson Hanson LL, Lange T, Starkopf L, Westerlund H, Madsen IEH, et al. Workplace bullying and violence as risk factors for type 2 diabetes: a multicohort study and meta-analysis. Diabetologia. 2018;61(1):75-83. https://doi.org/10.1007/s00125-017-4480-3 5. Xu T, Magnusson Hanson LL, Lange T, Starkopf L, Westerlund H, Madsen IEH, et al. Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study. Eur Heart J. 2019;40(14):1124-34. https://doi.org/10.1093/eurheartj/ehy683 6. Clausen T, Hogh A, Borg V. Acts of offensive behaviour and risk of long-term sickness absence in the Danish elder-care services: a prospective analysis of register-based outcomes. Int Arch Occ Env Hea. 2012;85(4):381-7. https://doi.org/10.1007/s00420-011-0680-1 7. Hassard J, Teoh KRH, Cox T. Estimating the economic burden posed by work-related violence to society: A systematic review of cost-of-illness studies. Safety Sci. 2019;116:208-21. https://doi.org/10.1016/j.ssci.2019.03.013 8. Pihl-Thingvad J, Andersen LL, Brandt LPA, Elklit A. Are frequency and severity of workplace violence etiologic factors of posttraumatic stress disorder? A 1-year prospective study of 1,763 social educators. J Occup Health Psych. 2019;24(5):543-55. https://doi.org/10.1037/ocp0000148 9. Biering K, Andersen LPS, Hogh A, Andersen JH. Do frequent exposures to threats and violence at work affect later workforce participation? Int Arch Occ Env Hea. 2018;91(4):457-65. https://doi.org/10.1007/s00420-018-1295-6 10. Hansen NB, Louis AL, Rosenbeck MS, Ask E, and Pihl-Thingvad J. Exposure to critical incidents at work and development of posttraumatic stress among police officers: a 2-year prospective cohort study. Eur J Work Organ Psy. 2023:1-23. 11. Clausen T, Sørensen JK, Dalsager L, Karlsen IL, Kristiansen J. Do different job demands interact as predictors of long-term sickness absence? A register-based follow-up on 55 467 Danish workers. Occup Environ Med. 2023;80(1):7-13. https://doi.org/10.1136/oemed-2022-108444 12. ILO. Experiences of violence and harassment at work: a global first survey. Geneva: International Labour Organization, 2022. 13. Eurofound. Sixth European Working Conditions Survey - Overview report (2017 update). Luxemboug: Publications Office of the European Union, 2017. 14. Eurofound. Psychosocial risks to workers’ well-being: Lessons from the COVID-19 pandemic, European Working Conditions Telephone Survey 2021 series. Luxembourg: Publications Office of the European Union, 2023. 15. Gash V, Blom N. Workplace violence and fear of violence: an assessment of prevalence across industrial sectors and its mental health effects. Scand J Work Environ Health. 2025;51(5):370-379. https://doi.org/10.5271/sjweh.4230 16. Danish Ministry of Labour. Regeringen og arbejdsmarkedets parter er enige om nye mål for arbejdsmiljøet [The government and the social partners have reached an agreement on new goals for the working envionment] [Internet]. 2020. Available from: https://bm.dk/nyheder/pressemeddelelser/2020/12/regeringen-og-arbejdsmarkedets-parter-er-enige-om-nye-maal-for-arbejdsmiljoeet 17. Geoffrion S, Hills DJ, Ross HM, Pich J, Hill AT, Dalsbø TK, et al. Education and training for preventing and minimizing workplace aggression directed toward healthcare workers. Cochrane Db Syst Rev. 2020(9). https://doi.org/10.1002/14651858.CD011860.pub2 18. Sørensen JK, Dalsager L, Andersen LL, Bay H, Garde AH, Johnsen NF, et al. Cohort Profile: the Work Environment and Health in Denmark study. Int J Epidemiol. 2025;54(3):dyaf085. https://doi.org/10.1093/ije/dyaf085 19. ILO. Preventing and addressing violence and harassment in the world of work through occupational safety and health measures. Geneva: International Labour Organization, 2024. 20. Milczarek M. Workplace Violence and Harassment: a European Picture. Luxembourg, Publications Office of the European Union: European Agency for Safety and Health at Work, EU-OSHA, 2010. 21. Nowrouzi-Kia B, Chai E, Usuba K, Nowrouzi-Kia B, Casole J. Prevalence of Type II and Type III Workplace Violence against Physicians: A Systematic Review and Meta-analysis. Int J Occup Environ Med. 2019;10(3):99-110. https://doi.org/10.15171/ijoem.2019.1573 22. Pejtersen JH, Holt H. En undersøgelse af omfanget af krænkende handlinger og konflikter på det danske arbejdsmarked (A study of the extent of abusive behaviour and conflicts in the Danish labour market). Copenhagen: The Danish Center for Social Science Research (VIVE), 2021. 23. Karlsen IL, Kristiansen J, Jaspers SØ, Rasmussen L, Laursen LL, Bengtsen E, et al. Reduction of aggressive behavior and effects on improved wellbeing of health care workers and people with dementia: A review of reviews. Aggress Violent Beh. 2023;71:101843. https://doi.org/10.1016/j.avb.2023.101843 24. Andersen DR, Karlsen IL, Jaspers S, Pedersen AHM, Andersen LPS, Aust B. Experiences of preventing violence in two high-risk sectors: A qualitative study of front-line workers. Work. 2023; 75(3):987-99. https://doi.org/10.3233/WOR-220151 25. Andersen LPS, Winding TN, Grytnes R. Pupils’ challenging behaviour towards their teachers: The role of teacher team collaboration in prevention. A qualitative study. TeachTeach Educ. 2025;155:104883. https://doi.org/10.1016/j.tate.2024.104883 26. C190 - Violence and Harassment Convention, 2019 (No. 190). ILO. 2019. 27. Boot CR, LaMontagne AD, Madsen IE, Health. Fifty years of research on psychosocial working conditions and health: From promise to practice. Scand J Work Environ Health. 2024(6):395-405. https://doi.org/10.5271/sjweh.4180 28. Potter R, Jamieson S, Jain A, Leka S, Dollard M, O’Keeffe V. Evaluation of national work-related psychosocial risk management policies: An international review of the literature. Safety Sci. 2022;154:105854. https://doi.org/10.1016/j.ssci.2022.105854 29. Ståhl C, Lundqvist D, Reineholm C. When rules become practice. The importance of work environment regulation, inspection and organisational conditions. The Swedish Agency for Work Environment Expertise, 2025. 30. Aust B, Møller JL, Nordentoft M, Frydendall KB, Bengtsen E, Jensen AB, et al. How effective are organizational-level interventions in improving the psychosocial work environment, health, and retention of workers? A systematic overview of systematic reviews. Scand J Work Environ Health. 2023;49(5):315 https://doi.org/10.5271/sjweh.4097 31. Somani R, Muntaner C, Hillan E, Velonis AJ, Smith P. A Systematic Review: Effectiveness of Interventions to De-escalate Workplace Violence against Nurses in Healthcare Settings. Safety Health Work. 2021;12(3):289-95. https://doi.org/10.1016/j.shaw.2021.04.004 32. Miller O, Dobson O, Casey T, Newnam S. Work-related violence interventions in the disability sector: A systematic review and systems mapping exercise. Safety Sci. 2025;184:106765. https://doi.org/10.1016/j.ssci.2024.106765 33. Sheppard DM, Newnam S, Louis RMS, Perrett MS. Factors contributing to work-related violence: A systematic review and systems perspective. Safety Sci. 2022;154:105859. https://doi.org/10.1016/j.ssci.2022.105859 34. Tamatea AJ, Day AJ, Cooke DJ. Preventing prison violence: An ecological perspective: Taylor & Francis; 2023. https://doi.org/10.4324/9781003272458 35. Salmon PM, Coventon L, Read GJ. A systems analysis of work-related violence in hospitals: stakeholders, contributory factors, and leverage points. Safety Sci. 2022;156:105899. https://doi.org/10.1016/j.ssci.2022.105899 36. Arnetz JE, Hamblin L, Russell J, Upfal MJ, Luborsky M, Janisse J, et al. Preventing patient-to-worker violence in hospitals: outcome of a randomized controlled intervention. J Occ Env Med. 2017;59(1):18-27. https://doi.org/10.1097/JOM.0000000000000909 37. Bowers L, James K, Quirk A, Simpson A, SUGAR, Stewart D, et al. Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial. Int J Nurs Stud. 2015;52:1412-22. https://doi.org/10.1016/j.ijnurstu.2015.05.001 38. Andersen LP, Jaspers S, Andersen D, Karlsen I, Aust B. A participatory and comprehensive intervention to improve violence prevention in two high-risk occupations: effect and process evaluation of a stepped wedge cluster randomised trial. BMC Public Health. 2024;24(1):1043. https://doi.org/10.1186/s12889-024-18527-5 39. Elvegård K, Antonsen S. The aftermath of fatal violence incidents: Why organisational measures were successful and why they their effects diminished. Safety Sci. 2024;179:106630. https://doi.org/10.1016/j.ssci.2024.106630 40. Spelten E, Thomas B, O’Meara PF, Maguire BJ, FitzGerald D, Begg SJ. Organisational interventions for preventing and minimising aggression directed towards healthcare workers by patients and patient advocates. Cochrane Db of Syst Rev. 2020;4(4):CD012662 https://doi.org/10.1002/14651858.CD012662.pub2 41. Andersen LPS, Hogh A, Biering K, Gadegaard CA. Work-related threats and violence in human service sectors: The importance of the psycho-social work environment examined in a multilevel prospective study. Work. 2018;59(1):141-54. https://doi.org/10.3233/WOR-172654 42. McKeown M, Thomson G, Scholes A, Jones F, Baker J, Downe S, et al. “Catching your tail and firefighting”: The impact of staffing levels on restraint minimization efforts. J Psych Ment Heal Nurs. 2019;26(5-6):131-41. https://doi.org/10.1111/jpm.12532 43. Jaspers SØ, Andersen DR, Karlsen IL, Pedersen AHM, Andersen LPS, Conway PM, et al. Contextualizing Violence Prevention-How Contextual Aspects Influence the Implementation of a Violence Prevention Initiative in Prisons and Psychiatry. Scand J Work Org Psych. 2022;7(1):4. https://doi.org/10.16993/sjwop.141 44. Wright D, Meadows DH. Thinking in systems: a primer: Taylor and Francis; 2012. https://doi.org/10.4324/9781849773386 45. Rasmussen J. Risk management in a dynamic society: a modelling problem. Safety Sci. 1997;27(2):183-213. https://doi.org/10.1016/S0925-7535(97)00052-0 46. Andersen LPS, Aust B, Winding TN. Pupils’ aggressive behaviour towards teachers: identifying protective factors at organizational level examined in a follow-up study. BMC Psych. 2025;13(1):247. https://doi.org/10.1186/s40359-025-02564-9 47. Miller O, Dobson O, Goode N, Newnam S. Actors, contributory factors, and preventative strategies for work-related violence in the Australian residential disability sector: A systems analysis. Safety Sci. 2025;191:106934. https://doi.org/10.1016/j.ssci.2025.106934

Worker psychological health is a significant global imperative that requires national policy action and stakeholder engagement. While national policy is a critical lever for improving worker psychological health, some countries are more progressive than others in relation to policy development and/or implementation. At the Joint Congress of the International Commission on Occupational Health, Scientific Committee on Work Organization and Psychosocial Factors and the Asia Pacific Academy for Psychosocial Factors at Work in Tokyo (September 2023), a Global Roundtable was held that to initiate international dialogue and knowledge exchange about national policy approaches for work-related psychological health. The Global Roundtable involved experts from diverse regions alongside an engaged audience of congress attendees and facilitators. Qualitative data were analysed against the five components of the National Policy Index tool comprising, policy priority, specific laws, nation-wide initiatives, sector-oriented initiatives, national survey and/ or studies. Analysis revealed that while work-related psychological health is a policy priority across many countries, at the same time, there are global gaps in both legislation specificity and active regulation across different countries. For future policy development across countries, it will be beneficial to continue and deepen international discourse and for countries to share their approaches with others.

BACKGROUND:Mental health in the workplace is a growing concern for enterprises and policy makers. MENTUPP is a multi-level mental health intervention implemented in small and medium size enterprises from three work sectors in nine countries. This pilot study aimed to evaluate the feasibility, delivery, and instruments for the MENTUPP intervention to inform the planning of a clustered randomized controlled trial. METHODS:We administered items from the Copenhagen Psychosocial Questionnaire and the Danish Work Environment Cohort Study measuring psychosocial workplace factors. The questionnaire was answered by 382 participants at baseline, of which 98 participants also answered after six months at follow-up. We calculated mean scores of 19 psychosocial factors at baseline and conducted repeated measures ANOVAs to assess differences in eight psychosocial factors at follow-up. We also examined whether outcomes differed between work sectors and job positions at follow-up. RESULTS:The construction sector and workers with no or a lower leadership role reported more negative working environment factors at baseline. We observed a statistically significant decline in social support from colleagues and social community at work, and a marginally significant decline in justice at work. For the rest of the constructs, we did not observe statistically significant changes. CONCLUSIONS:We found significant differences in psychosocial work environment factors among work sectors and job positions at baseline. Contrary to our hypotheses, three psychosocial work environment factors decreased at follow-up. Possible explanations are the utilization of specific psychosocial factors as resources to cope with psychosocial stressors, high participant expectations that were not met by the intervention, insufficient time for structural changes, or the intervention prompting critical evaluations of the work environment. These findings will inform the design and implementation of the forthcoming clustered randomized controlled trial, where they will also be further investigated to validate their significance.

In this paper, line managers' experiences of, and discursive subject positioning in, a participatory work environment initiative in four nursing homes called 'The Health Circle Project' is examined. We focus on line managers' change related subject positioning by interviewing the managers of the four workplaces before and after the initiative and conduct a comparative case study from a discursive psychology frame. The aim of this paper is to focus on change reactions from managers and move beyond a reductionistic dichotomy of change resistance/readiness. Instead, we focus our analysis on the change related subject positioning the managers engage in, and how they position both themselves and their subordinates. Hence, we examine how the line managers experienced the participatory Health Circle intervention, and how they reacted to potential loss of power to discursively construct and define work environment problems caused by the initiative. The study exemplifies how the line managers experienced the Health Circle intervention as both confirming and challenging their subject positions as capable managerial subjects. Finally, in the light of the analysis, the potential unintended consequences of engaging in participatory work environment intiatives and similar activities are discussed.MAD statementResistance to change is one of the most frequently used explanations for why change processes fail. The current study presents a more nuanced theoretical concept, change-related subject positioning and explores how increasing employee participation, can elicit unintended reactions from managers.This study hence contributes to our understanding of how a, in principle, positive change process of empowering employees to improve working conditions leads to a multitude of change related subject positioning from managers. Some managers embrace the change and position themselves in line with the employee participants. Others feel threatened which in extreme cases leads to negative positioning of their subordinates.

Introduction Interventions trying to prevent violence from clients towards employees tend to show limited effect on the risk or the frequencies of violent episodes, possibly due to a too-narrow focus on only one or a few preventive strategies. This study aimed to show what employees and line managers identify as key intervention areas for preventing violence and threats. Methods The study is based on data collected during a participatory intervention study aiming to improve violence prevention in Danish psychiatric units and prison and detention centers. In the intervention study, employees and line managers from 13 work units developed 293 suggestions and 92 action plans to prevent workplace violence. Through qualitative thematic analysis of the suggestions and action plans, we identified the main categories that work units viewed as important and realistic to work with to improve violence prevention. Results We identified 12 topics of violence prevention that work units considered relevant. Action plan topics used by more than half of the work units included: specific approaches to violence prevention (e.g., de-escalating techniques), communication between employees to transfer knowledge between shifts, and introduction to new employees and temporary workers. Topics used by three to five work units were: interdisciplinary corporation, communication and relational work, uniform approaches, organization of work, and staffing. Topics used rarely were: definition of violence and threats, policy and guidelines, support from colleagues and management, and engagement in violence prevention. For nine of the 12 topics, action plans were developed in both high-risk sectors. Conclusions The violence prevention action plans developed by work units from two high-risk sectors indicate that workplaces estimate the prevention of client-induced workplace violence to require activities on many levels and cannot be solved by a single focused approach. This variety of preventive activities needs to be considered when designing violence prevention interventions.

Violence and aggressive behavior are part of behavioral and psychological symptoms of dementia (BPSD). Therefore, reducing BPSD might have positive effects on the wellbeing of older adults and direct care workers (DCW). This scoping review of reviews investigates to what extent interventions targeting BPSD integrate the 'work environment perspective' and the 'care perspective'. PubMed, Web of Science, and PsycINFO were searched for studies published from 2008 to 2019. Reviews were included if they assessed non-pharmacological interventions to reduce BPSD and included outcome measures on BPSD of the older adults and/or on the health/wellbeing of DCW. We identified eighteen reviews 1) eleven reviews focused on changes in the care approach 2) six reviews covered interventions offering a specific activity/therapy and 3) two reviews looked at mixed approaches. Only six reviews had outcome measures on DCW. The six reviews found mixed results regarding the effect on DCW. More research combining the focus on work environment and eldercare treatment is needed to clarify if, and to what extent, the two aims of better care of older adults and a better work environment for DCW can influence each other positively. Based on the results, we present suggestions for how to advance this area of research.

Mental health problems and disorders are common among working people and are costly for the affected individuals, employers, and whole of society. This discussion paper provides an overview of the current state of knowledge on the relationship between work and mental health to inform research, policy, and practice. We synthesise available evidence, examining both the role of working conditions in the development of mental disorders, and what can be done to protect and promote mental health in the workplace. We show that exposure to some working conditions is associated with an increased risk of the onset of depressive disorders, the most studied mental disorders. The causality of the association, however, is still debated. Causal inference should be supported by more research with stronger linkage to theory, better exposure assessment, better understanding of biopsychosocial mechanisms, use of innovative analytical methods, a life-course perspective, and better understanding of the role of context, including the role of societal structures in the development of mental disorders. There is growing evidence for the effectiveness of interventions to protect and promote mental health and wellbeing in the workplace; however, there is a disproportionate focus on interventions directed towards individual workers and illnesses, compared with interventions for improving working conditions and enhancing mental health. Moreover, research on work and mental health is mainly done in high-income countries, and often does not address workers in lower socioeconomic positions. Flexible and innovative approaches tailored to local conditions are needed in implementation research on workplace mental health to complement experimental studies. Improvements in translating workplace mental health research to policy and practice, such as through workplace-oriented concrete guidance for interventions, and by national policies and programmes focusing on the people most in need, could capitalise on the growing interest in workplace mental health, possibly yielding important mental health gains in working populations.

Objectives Increasing access to mental health support is a key factor for treating mental disorders, however, important barriers complicate help-seeking, among them, mental health related stigma being most prominent. We aimed to systematically review the current evidence for interventions focusing on reducing stigma related to mental health problems in small and medium enterprises (SMEs). Design Systematic review with a focus on interventions targeting mental health related stigma in the workplace in accordance with PRISMA guidelines. The methodological quality of included articles was assessed using the Quality Assessment Tool for Quantitative Studies Scale. Data sources PubMed, Ovid Medline, PsycINFO, Scopus, and Cochrane databases and Google Scholar were searched from January 2010 until November 2022. Eligibility criteria for selecting studies We included experimental or quasi-experimental studies about workplace interventions aiming to reduce stigma, where the outcomes were measured in terms of stigmatisation against depression, anxiety and/or other mental health problems. Data extraction and synthesis Records were screened by two independent reviewers after inspecting titles and abstracts and a full-text read of the articles to assess whether they meet inclusion criteria. The results were synthesised narratively. Results We identified 22 intervention studies, 3 with high quality, 13 with moderate quality and 6 with weak quality. Only 2 studies included SMEs, but no study focused on SMEs exclusively . The mode of delivery of the intervention was face to face in 15 studies, online in 4 studies and mixed in 3 studies. We found a significant reduction in stigmatising attitudes in almost all studies (20/22), using 10 different instruments/scales. Effects seemed to be independent of company size. Online interventions were found to be shorter, but seemed to be as effective as face-to-face interventions. Conclusions Although we did not find interventions focusing exclusively on SMEs, it is likely that antistigma interventions also will work in smaller workplaces. Trial registration PROSPERO: ID: CRD42020191307

BackgroundThere is a gap between the necessity of effective mental health interventions in the workplace and the availability of evidence-based information on how to evaluate them. The available evidence outlines that mental health interventions should follow integrated approaches combining multiple components related to different levels of change. However, there is a lack of robust studies on how to evaluate multicomponent workplace interventions which target a variety of outcomes at different levels taking into account the influence of different implementation contexts.MethodWe use the MENTUPP project as a research context to develop a theory-driven approach to facilitate the evaluation of complex mental health interventions in occupational settings and to provide a comprehensive rationale of how these types of interventions are expected to achieve change. We used a participatory approach to develop a ToC involving a large number of the project team representing multiple academic backgrounds exploiting in tandem the knowledge from six systematic reviews and results from a survey among practitioners and academic experts in the field of mental health in SMEs.ResultsThe ToC revealed four long-term outcomes that we assume MENTUPP can achieve in the workplace: 1) improved mental wellbeing and reduced burnout, 2) reduced mental illness, 3) reduced mental illness-related stigma, and 4) reduced productivity losses. They are assumed to be reached through six proximate and four intermediate outcomes according to a specific chronological order. The intervention consists of 23 components that were chosen based on specific rationales to achieve change on four levels (employee, team, leader, and organization).ConclusionsThe ToC map provides a theory of how MENTUPP is expected to achieve its anticipated long-term outcomes through intermediate and proximate outcomes assessing alongside contextual factors which will facilitate the testing of hypotheses. Moreover, it allows for a structured approach to informing the future selection of outcomes and related evaluation measures in either subsequent iterations of complex interventions or other similarly structured programs. Hence, the resulting ToC can be employed by future research as an example for the development of a theoretical framework to evaluate complex mental health interventions in the workplace.

BACKGROUND:Exposure to workplace violence is associated with physical and/or psychological trauma. Despite its significant impact, little is known about front-line workers' experiences of preventing workplace violence.OBJECTIVE:This study aimed to identify what workers identify as important to preventing workplace conflicts from escalating into violence.METHODS:We conducted seventeen qualitative focus-group interviews with fifty-eight workers at the Danish Prison and Probation Service and psychiatric hospitals. We applied thematic analysis to identify types of violence-prevention practices, and prerequisites for successfully preventing workplace violence.RESULTS:We identified two main categories of violence-prevention practices, and one main category of prerequisites for violence-prevention practices. Main category A), "the individual worker's violence-prevention practices" included the sub-categories, 1) identify the causes of workplace violence and potentially violent situations, 2) establish relationships, state rules, and set clear boundaries and 3) display empathy and communicate respectfully. Main category B), "collaborative practices for preventing workplace violence" included 4) communicate with co-workers, and share information and observations, 5) coordinate work, avoid being played off against colleagues, and support colleagues. Main category C), "prerequisites for violence-prevention practices" included 6) managing one's emotions, and 7) having sufficient time to do the job, and being a part of a stable team, whose members know each other and the inmates/patients".CONCLUSION:This study contributes to a better understanding of the interplay among individual, collaborative, and contextual aspects of preventing workplace violence. We believe that an increased understanding of the complexity of preventing workplace violence in high-risk sectors is useful when designing comprehensive violence-prevention strategies.

BACKGROUND:Burnout among physicians has widespread negative consequences. Little is known about burnout among European vascular surgeons (VS). A previously published study found that 82% of VS and vascular surgical trainees (VST) in Denmark experience burnout symptoms. The present study aimed to investigate work- and health-related consequences of burnout.STUDY DESIGN:An electronic survey was distributed to all VS/VST in Denmark in January 2020. Validated assessment tools were used to measure burnout, mental health, and psychosocial work environment aspects.RESULTS:Of 104 invited VS/VST, 82% (n = 85) completed the survey. VS accounted for 72% (n = 61) of the respondents, and 40% (n = 33) were female. Statistically significant associations were found between higher levels of burnout and a range of work- and health-related outcomes, including a sense of meaning at work, workplace commitment, conflicts between work and private life, work stress, sick leave, and depressive symptoms. VS/VST using pain medication daily or weekly had significantly higher burnout scores than respondents who rarely or never use pain medication. A significant association between burnout and job satisfaction and retention was found, with respondents indicating an intention to stay within the specialty having significantly lower burnout scores than those who considered leaving within 5 years. Among those who indicated leaving the specialty, 35% (n = 13) attributed this to their current working conditions.CONCLUSIONS:Burnout among VS/VST in Denmark is negatively associated with various work- and health-related outcomes. The work environment seems to play an essential role in these associations, and alterations in workplace organization may remedy this situation.