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Background The number of hours people are required to work has a pervasive influence on both physical and
mental health. Excessive working hours can also negatively affect sleep quality. The impact at work of
mental health problems can have serious consequences for individuals’ as well as for organizations’
productivity.
Aims To evaluate differences in sleep quality and anxiety and depression symptoms between longer work-
ing hours group (LWHG) and regular working hours group (RWHG). To examine factors influenc-
ing weekly working hours, sleep quality and anxiety and depressive symptoms.
Methods Participants were divided into two groups, RWHG and LWHG, based on working hours, with a cut-
off of 48 h per week. We used the Hospital Anxiety and Depression Scale (HADS) to assess anxiety
and depression symptoms and the Pittsburgh Sleep Quality Index (PSQI) to measure the quality
and patterns of sleep.
Results The response rate was 23%. Among the 429 study participants, those in the LWHG group (n = 256,
53%) had significantly more depressive and anxiety symptoms and worse sleep quality than those in
RWHG (n = 223, 47%). Working time was significantly positively correlated with higher corporate
position and HADS scores. Moreover, HADS scores were positively correlated with PSQI scores
and negatively correlated with age.
Conclusions This study suggests that longer working hours are associated with poorer mental health status and
increasing levels of anxiety and depression symptoms. There was a positive correlation between these
symptoms and sleep disturbances.
Key words Anxiety; depression; long working hours; sleep quality.
© The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
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378 OCCUPATIONAL MEDICINE
In Japan, such deaths are called karoshi, meaning ‘death latency, duration, usual efficiency, sleep disturbances,
from overwork’ [7]. In Japan, the number of workers medication use and daytime dysfunction. A score >5 is
suffering from cardiovascular disease, cerebrovascular suggestive of a sleep disorder.
disease and mental disorders due to work has increased Standard descriptive summary statistics were used
3-fold in the last decade [3]. to characterize the full sample and the two groups.
Mental health problems in the workplace have seri- Associations between variables were evaluated using
ous consequences not only for the individual, but also the χ2 test (categorical variables) and the independent
for the productivity of the organization. In Organisation t-test with unequal variances and estimated degrees of
for Economic Co-operation and Development countries, freedom (continuous variables). Regression analysis was
mental ill-health is responsible for between one-third performed on average work hours per week, PQSI and
and half of all long-term sickness and disability in the HADS scores, social and demographic variables, work-
Table 1. Characteristics of the study participants by groups with long and regular working hours
NS, non-significant.
a
Student t-test.
χ test.
b 2
Table 2. PSQI and HADS in groups with long and regular working hours#8232;
NS, non-significant.
a
Student t-test.
(54%). In addition, there were significantly higher total those in RWHG. Although HADS scores do not provide
HADS scores and HADS subscale scores for anxiety definitive diagnoses of anxiety and depressive disor-
and depression in LWHG members compared with ders, these results show that LWHG members reported
380 OCCUPATIONAL MEDICINE
significantly more anxiety and depression symptoms working hours compared with those reporting regular
than those in RWHG. hours. These findings are similar to those of several previ-
Results of the regression analysis are shown in Tables 3–5. ous studies [7,15–17]. Moreover, there was a significant
As shown in Table 3, a significant positive relationship negative correlation between total HADS score and age.
was found between working hours per week and work in This relationship can probably be explained by burnout,
some professional areas, having a higher level of corpor since age has been found to be related to burnout. For
ate responsibility, taking work home and the number of instance, in younger employees, the level of burnout is
working days per week. Additionally, a negative correla- higher than in those over 30 or 40 years old [18], sug-
tion was found between working hours per week and the gesting that burnout appears early in a person’s career
number of vacation days annually. and may be a risk factor for developing depression [19].
The results from the regression analysis for PSQI However, the apparent relationship between burnout
Table 3. Regression analysis of factors associated with working hours per week
The factors ‘Corporate position’ and ‘Education level’ were reparametrized so that their coefficients have a null mean. This allows the coefficients to be interpreted as
positive or negative deviations from a nominal level. Multiple R2 = 0.323. NS, non-significant.
P. AFONSO ET AL.: IMPACT OF WORKING HOURS ON SLEEP AND MENTAL HEALTH 381
associated with sleep disturbance [1,21,25], which may workers and with a higher level of education than the
bias the results. However, there were only seven shift general population.
workers in the RWHG (3%) and 12 in the LWHG (5%), Almost a century has passed since the 1919 adop-
a non-significant difference unlikely to have biased the tion of the first international labour standard on work-
results. Sleep problems may be associated with psychiat- ing hours, which established the principle of the 8-h
ric conditions. Thus, there is growing experimental evi- working day and 48-h working week. Despite progress in
dence that the relationship between psychiatric disorders legislation, ~22% of workers worldwide still work >48 h
and sleep is complex and includes bi-directional causa- per week [2]. Surprisingly, 53% of workers in our study
tion [26]. The positive correlation between PSQI scores reported working >48 h per week, suggesting that the
and HADS-anxiety and HADS-depression scores seem European Working Time Directive has been ineffective,
to support this relationship. In other words, our results at least at higher corporate levels.
showed an association between poor sleep quality and Work is important for economic self-sufficiency and
anxiety and depression symptoms. a meaningful way of living. However, as demonstrated
A sex-specific difference was also found between in this study, long working hours can also be associ-
the two groups, with more men in the LWHG (73%) ated with problems such as an increased risk of sleep
than the RWHG (62%). Similar results were obtained disturbance and symptoms of anxiety and depression.
in a large survey regarding working conditions in the Our findings suggest that we still need to advocate
European Union [27]. Women tend to work shorter shorter working hours in order to preserve health and
hours than men, presumably because they still retain pri- well-being.
mary responsibility for the majority of housework and
childcare. Not surprisingly, LWHG members had sig- Key points
nificantly less vacation time, worked more days per week
and took more work home than RWHG members. •• In this study of Portuguese business school alumni
Our study has several limitations. Firstly, it was a cross- long weekly working hours were associated with
sectional study, whereas longitudinal research would be poorer mental health status, as evidenced by
necessary to clarify the long-term effects of long working higher levels of anxiety and depression symptoms.
hours on mental health and sleep quality. Secondly, long •• Long weekly working hours were also associ-
working hours may in part affect mental health through ated with reduced sleep time and increased sleep
factors not measured in our study, such as work–fam- disturbance.
ily conflicts [28], burnout [18], a prolonged increase in •• These results confirm the importance of main-
cortisol levels [28,29] and alcohol abuse [30]. Finally, taining regular weekly working hours and avoid-
the participants in the study were alumni from a busi- ing excessive overtime work in reducing the risk of
ness school, so the results may not be applicable to other anxiety, depression and sleep disorders.
workers. In particular, the participants were white-collar
382 OCCUPATIONAL MEDICINE
Conflicts of interest 14. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR,
Kupfer DJ. The Pittsburgh Sleep Quality Index: a new
None declared. instrument for psychiatric practice and research. Psychiatry
Res 1989;28:193–213.
15. Virtanen M, Stansfeld SA, Fuhrer R, Ferrie JE, Kivimäki
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