Beskæftigelsesudvalget 2022-23 (2. samling)
BEU Alm.del Bilag 251
Offentligt
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Supplementary appendix
This appendix formed part of the original submission and has been peer reviewed.
We post it as supplied by the authors.
Supplement to: Magnusson Hanson LL, Pentti J, Nordentoft M, et al. Association of
workplace violence and bullying with later suicide risk: a multicohort study and meta-
analysis of published data.
Lancet Public Health
2023;
8:
e494–503.
 BEU, Alm.del - 2022-23 (2. samling) - Bilag 251: Orientering om nye forskningsresultater på arbejdsmiljøområdet om konsekvenser ved vold og mobning i arbejdet
Appendix
Individual participant data
The Finnish Public Sector Study (FPS) was established in 1997/1998, has data from national
health registers covering the years 1987/1994 to 2011 of all 151,618 employees with
≥6-
month job contract in any year from 1991/1996 to 2005 in 10 towns and 5 hospital districts in
Finland. Additional repeated survey data with 2-4 years intervals of a nested cohort of over
100000 individuals has been collected.
S1
For
participants who responded to multiple surveys,
only the first response to bullying and violence was used in present analysis.
The Swedish Work Environment Survey (SWES) is a largely representative biennial cross-
sectional survey of the Swedish workforce (individuals 16-64 year of age), performed every
second year since 1989. Data for the analyses were derived from self-completion
questionnaires 1995-2013 for which updated register data until 2016 (3-25 years of follow-up)
was available at the time of study completion. Of the 154677 originally selected individuals,
130944 responded to telephone interviews, and 98164 to self-report surveys in the respective
years. In total, there were 85462 unique respondents 1995-2013, after exclusion of individuals
with reused personal identification numbers.
The ‘Work Environment and Health in Denmark’ (WEHD) study target the national work
force in Denmark and consists of a random selection of individuals 18-64 years of age with
records of an address in Denmark, a minimum of 35 monthly working hours and a minimum
of 3000 Danish kroner ($530/€400) in monthly income subject to taxation.
S2
Starting in 2012,
a series of biennial data collections have been performed via postal or web-based
questionnaires. For this study data from the 2012, 2014 and 2016 wave were used, with a
response rate of approximately 50% across waves (62289 respondents in total).
References
S1.
Joensuu M, Kivimaki M, Pentti J, et al. Components of job control and mortality: the
Finnish Public Sector Study.
Occup Environ Med
2014;71(8):536-42.
S2.
Johnsen NF, Thomsen BL, Hansen JV, et al. Job type and other socio-demographic factors
associated with participation in a national, cross-sectional study of Danish employees.
BMJ
Open 2019;9(8):e027056.
The IPD-Work consortium
The IPD-Work consortium (individual participant data meta-analysis in working populations)
is a large ongoing multicohort study of work and health. IPD-Work investigations have
focussed on a number of work stressors, including job strain, long working hours, and effort-
reward imbalance, and several health outcomes with public health significance (e.g.
cardiovascular diseases, diabetes, cancer, depression, dementia and total mortality).
w1-w9
The
composition of cohorts included in each analysis has depended on the availability of relevant
 
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 BEU, Alm.del - 2022-23 (2. samling) - Bilag 251: Orientering om nye forskningsresultater på arbejdsmiljøområdet om konsekvenser ved vold og mobning i arbejdet
data. Of the three cohorts of the present study, FPS and SWES belong to the IPD-Work
consortium.
References
w1
Dragano N, Siegrist J, Nyberg ST, Lunau T, Fransson EI, Alfredsson L, et al. Effort-reward
imbalance at work and incident coronary heart disease: A multicohort study of 90,164
individuals. Epidemiol 2017;28(4):619-626.
Ervasti J, Pentti J, Nyberg ST, Shipley MJ, Leineweber C, Sørensen JK, et al. Long
working hours and risk of 50 health conditions and mortality outcomes: a multicohort study in
four European countries.Lancet Reg Health Eur. 2021 Sep 6;11:100212.
w3
w2
Virtanen M, Nyberg ST, Batty GD, Jokela M, Heikkilä K, Fransson EI, et al. Perceived job
insecurity as a risk factor for incident coronary heart disease: systematic review and meta-
analysis.BMJ. 2013 Aug 8;347:f4746.
w4
Kivimäki M, Walker KA, Pentti J, Nyberg ST, Mars N, Vahtera J, et al. Cognitive
stimulation in the workplace, plasma proteins, and risk of dementia: three analyses of
population cohort studies. BMJ. 2021 Aug 18;374:n1804.
Kivimäki M, Pentti J, Ferrie JE, Batty GD, Nyberg ST, Jokela M, et al. Work stress and risk
of death in men and women with and without cardiometabolic disease: a multicohort study.
Lancet Diabetes Endocrinol. 2018 Sep;6(9):705-713.
Kivimäki M, Nyberg ST, Batty GD, Fransson EI, Heikkilä K, Alfredsson L, et al. Job strain
as a risk factor for coronary heart disease: a collaborative meta-analysis of individual
participant data. Lancet. 2012 Oct 27;380(9852):1491-7.
w7
w6
w5
Kivimäki M, Jokela M, Nyberg ST, Singh-Manoux A, Fransson EI, Alfredsson L, et al.
Long working hours and risk of coronary heart disease and stroke: a systematic review and
meta-analysis of published and unpublished data for 603,838 individuals.Lancet. 2015 Oct
31;386(10005):1739-46.
Madsen IEH, Nyberg ST, Magnusson Hanson LL, Ferrie JE, Ahola K, Alfredsson L, et al.
Job strain as a risk factor for clinical depression: systematic review and meta-analysis with
additional individual participant data. Psychol Med. 2017 Jun;47(8):1342-1356.
w9
w8
Nyberg ST, Fransson EI, Heikkilä K, Ahola K, Alfredsson L, Bjorner JB, et al. Job strain as
a risk factor for type 2 diabetes: a pooled analysis of 124,808 men and women. Diabetes Care.
2014 Aug;37(8):2268-75.
 
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Table S1. Measures of workplace violence and bullying by cohort
Workplace
violence
FPS
WEHD
SWES
Workplace
bullying
Conway et al. “Have you been subjected
2022
*
to bullying at work within the past 12 months?”
FPS
“Psychological violence or bullying at work refers to a constant, repeated
isolation of a member of the work community, belittling one’s work effort,
threats, talking behind one’s back or other forms of pressure – Have you
suffered from such bullying in the past 12 months?”
SWES
“Are you subjected to personal persecution in the form of unkind words or
behavior from you supervisors or fellow workers?”
* Conway PM, Erlangsen A, Grynderup MB, et al. Workplace bullying and risk of suicide and suicide attempts:
A register-based prospective cohort study of 98 330 participants in Denmark.
Scand J Work Environ Health
2022;48(6):425-34.
“Have any if the following violent or threatening confrontations happened
to you this year? …
1) Throwing or breaking things?
2) Psychological violence (e.g. verbal threats)?
3) Physical violence (e.g. hitting, kicking)?
4) Threatening with a weapon (firearm, edged weapon, striking
weapon)?”
“In the last 12 months, have you been subjected to physical violence at
your work place?”
“In the last 12 months, have you been subjected to threats of violence at
your work place?”
“Are you exposed to violence or the threat of violence in your work?”
 
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Table S2. Measurement of work characteristics
Job
demands
FPS
WEHD
SWES
Scale consisting of 3 items based on the Job Content Questionnaire (JCQ)
q1
about working very hard/intensively, excessive amount of work/too much
effort and having enough time.
Scale consisting of 4 items with different wordings, but resembling those in the
standardized and widely used Job Content Questionnaire (JCQ)
q1
or the
Demand Control Questionnaire (DCQ)
q2
.
Example item: “How often do you find that you do not have enough time for
all your work tasks?”
q3
Scale consisting of 4 items with different wordings, but resembling those in the
standardized and widely used Job Content Questionnaire (JCQ) or the Demand
Control Questionnaire (DCQ). Example item: “Is your work sometimes so
stressful that you do not have time to talk or even think of anything other than
work?”
q4
Job
control
FPS
WEHD
SWES
Scale consisting of 6 items based on the Job Content Questionnaire (JCQ)
q1
about learning new things, high level of skill, creativity/initiative, repetitive
work, a lot of say/what to do, and little freedom/how to do.
Scale consisting of 2 items with different wordings, but resembling those in the
standardized and widely used Job Content Questionnaire (JCQ) or the Demand
Control Questionnaire (DCQ). Example item: “Can you influence how you
solve your work tasks?”
q3
Scale consisting of 4 items with different wordings, but resembling those in the
standardized and widely used Job Content Questionnaire (JCQ) or the Demand
Control Questionnaire (DCQ). Example item: “Are you involved in planning
your work (for example, what is to be done, how it is to be done, or who is to
work with you)?”
q4
Note. All scales were divided by the median to form groups with high job demands versus low job
demands and groups for low job control versus high job control.
References
Job Content Questionnaire, Recommended format.[http://www.jcqcenter. org/]. Theorell T:
The demand-control-support model for studying health in relation to the work environment-an
interactive model. In Behavioral medicine approaches to cardiovascular disease prevention.
Edited by: OrthGomér K, Schneiderman N. Mahwah, NJ: Lawrence Erlbaum Associates;
1996:69-85.
q1
 
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 BEU, Alm.del - 2022-23 (2. samling) - Bilag 251: Orientering om nye forskningsresultater på arbejdsmiljøområdet om konsekvenser ved vold og mobning i arbejdet
Fransson EI, Nyberg ST, Heikkilä K, Alfredsson L, Bacquer de D, Batty GD, Bonenfant S,
Casini A, Clays E, Goldberg M, Kittel F, Koskenvuo M, Knutsson A, Leineweber C,
Magnusson Hanson LL, Nordin M, Singh-Manoux A, Suominen S, Vahtera J, Westerholm P,
Westerlund H, Zins M, Theorell T, Kivimäki M. Comparison of alternative versions of the job
demand-control scales in 17 European cohort studies: the IPD-Work consortium. BMC Public
Health. 2012 Jan 20;12:62.
Theorell T, Perski A, Akerstedt T, Sigala F, Ahlberg-Hulten G, Svensson J, Eneroth
P:Changes in job strain in relation to changes in physiological state. A longitudinal study.
ScandJWorkEnvironHealth1988,14(3):189-196.
Fransson EI, Nyberg ST, Heikkilä K, Alfredsson L, Bacquer de D, Batty GD, Bonenfant S,
Casini A, Clays E, Goldberg M, Kittel F, Koskenvuo M, Knutsson A, Leineweber C,
Magnusson Hanson LL, Nordin M, Singh-Manoux A, Suominen S, Vahtera J, Westerholm P,
Westerlund H, Zins M, Theorell T, Kivimäki M. Comparison of alternative versions of the job
demand-control scales in 17 European cohort studies: the IPD-Work consortium. BMC Public
Health. 2012 Jan 20;12:62.
q3
q2
Nielsen HB, Gregersen LS, Bach ES, Dyreborg J, Ilsøe A, Larsen TP, Pape K, Pedersen J,
Garde AH. A comparison of work environment, job insecurity, and health between marginal
part-time workers and full-time workers in Denmark using pooled register data. J Occup
Health. 2021 Jan;63(1):e12251.
q4
Magnusson Hanson LL, Theorell T, Bech P, et al. Psychosocial working conditions and
depressive symptoms among Swedish employees. Int Arch Occup Environ Health
2009;82(8):951-60
SCB & Arbetsmiljöverket. Negativ stress och ohälsa Inverkan av höga krav, låg egenkontroll
och bristande socialt stöd i arbetet, Information om utbildning och arbetsmarknad, SCB &
Arbetsmiljöverket, 2001:2
 
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Registers used to define suicide death or attempts
The Finnish Hospital Discharge Register and Cause of Death Register
https://www.stat.fi/hae_en
The National Patient Register and the Cause of Death Register
https://www.socialstyrelsen.se/en/
The Danish Psychiatric Central Research Register
www.dst.dk
https://www.esundhed.dk/
 
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 BEU, Alm.del - 2022-23 (2. samling) - Bilag 251: Orientering om nye forskningsresultater på arbejdsmiljøområdet om konsekvenser ved vold og mobning i arbejdet
Risk of bias assessment of included studies
The risk of
bias was assessed using the ROBINS-E*
by one of the authors (TX).
To assess risk of bias, we evaluated bias in the following domains:
1.
2.
3.
4.
5.
6.
7.
Risk of bias due to confounding
Risk of bias arising from measurement of the exposure
Risk of bias in selection of participants into the study (or into the analysis)
Risk of bias due to post-exposure interventions
Risk of bias due to missing data
Risk of bias arising from measurement of the outcome
Risk of bias in selection of the reported results
The risk of bias was assessed using the signalling questions and algorithms for each domain,
resulting in the following judgements for each domain:
Low risk of bias –“There is little or no concern about bias with regard to this domain”
Some concerns –“There is some concerns about bias with regard to this domain, although it is
not clear that there is an important risk of bias”
High risk of bias – “The study has some important problems in this domain: characteristics of
the study give rise to a high risk of bias”
Very high risk of bias – “The study is very problematic in this domain: characteristics of the
study give rise to a very high risk of bias”
For Domain 1 (“Risk of bias due to confounding), risk of bias is judged as low if confounding
is very well addressed acknowledging that confounding cannot be eliminated in observational
studies.
The overall judgement of risk of bias was regarded as:
Low -if found low in domain 1 and low in all other domains
Some concerns -if at least one domain is at some concerns, but no domains are at high risk of
very high risk
High – if at least one domain is at high risk of bias, but no domain are at very high risk of bias
or several domains are at some concerns leading to an additive judgement of high risk of bias
Very high -if at least one domain is at very high risk of bias or several domains are at high
risk of bias leading to an additive judgement of very high risk of bias
 
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Table S3. Assessment of 7 domains of risk of bias and the overall assessment of risk of
bias.
Study
1 Risk
of bias
due to
confoun
ding
High
3 Bias
in
measure
ment of
exposur
e
Low
3 Bias in
selection
of
participa
nts in the
study
Low
4 Risk of
bias due
to post-
exposure
intervent
ions
Low
5 Risk of
bias due
to
missing
data
Low
6 Risk
of bias
in
measure
ment of
outcome
Low
7 Bias in
selection
of
reported
results
Low
Overall
risk of
bias
High
Conway et al
2022
Magnusson
Hanson et al.
High
Low
Low
Low
Low
Low
Low
High
*ROBINS-E Development Group (Higgins J, Morgan R, Rooney A, Taylor K, Thayer K,
Silva R, Lemeris C, Akl A, Arroyave W, Bateson T, Berkman N, Demers P, Forastiere F,
Glenn B, Hróbjartsson A, Kirrane E, LaKind J, Luben T, Lunn R, McAleenan A, McGuinness
L, Meerpohl J, Mehta S, Nachman R, Obbagy J, O'Connor A, Radke E, Savović J, Schubauer-
Berigan M, Schwingl P, Schunemann H, Shea B, Steenland K, Stewart T, Straif K, Tilling K,
Verbeek V, Vermeulen R, Viswanathan M, Zahm S, Sterne J). Risk Of Bias In Non-
randomized Studies - of Exposure (ROBINS-E). Launch version, 1 June 2022. Available
from:
https://www.riskofbias.info/welcome/robins-e-tool.
 
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Fig S1. Association between workplace violence, workplace bullying and suicide attempt
and/or suicide death in individual participant data. Hazard ratios adjusted for age, sex,
education and family situation.
 
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Fig S2. Association between workplace violence and suicide attempt and/or suicide
death in individual participant data, according to subgroups and after serial
adjustments. Hazard ratios adjusted for age, sex, education and family situation unless
otherwise stated.
 
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Fig S3. Association between workplace violence and suicide attempt and/or suicide
death according to frequency of exposure in the SWES study. Hazard ratios adjusted
for age, sex, education and family situation.
* P values for trend: <0.001 for suicide attempt of death and suicide death, <0.01 for suicide
attempts
Fig S4. Association between workplace violence, workplace bullying and
tumors/neoplasms in individual participant data. Hazard ratios adjusted for age, sex,
education and family situation.
 
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Fig S5. Association between workplace violence, workplace bullying and
tumors/neoplasms in individual participant data, according to subgroups and after
serial adjustments. Hazard ratios adjusted for age, sex, education and family situation
unless otherwise stated.
 
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Figure S6. Association between workplace bullying and suicide attempt and/or suicide
death in both published (Conway et al. 2022) and individual participant data and
previously published data (Conway et al. 2022). Hazard ratios adjusted for age, sex,
education or socioeconomic status and family situation. Confidence intervals for the
study by Conway et al. 2022 differ slightly from the published paper since the meta-
analyses were based on natural log transformed hazard ratios with estimated standard
errors.
 
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