Copyright © 2016 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited Association of Psychosocial Work Hazards With Depression and Suboptimal Health in Executive Employees Sandy Huey-Jen Hsu, PhD, Duan-Rung Chen, PhD, Yawen Cheng, PhD, and Ta-Chen Su, MD, PhD Objectives: This study aims to investigate whether psychosocial work- related hazards, measured by workplace justice and employment insecurity, are associated with depression and suboptimal health status in Taiwan’s executive-level employees. Methods: There were 365 executives who have received a series of cardiovascular health examinations, blood sampling, and self-reported questionnaires, which included the psychosocial work-related hazards and the CES-D scale. Suboptimal health status was defined as the presence of dyslipidemia or prediabetes. Results: Executive-level employ- ees perceived lower workplace justice and higher employment insecurity and had a significantly higher risk of depression (CES-D scores 16 or 23). However, workplace justice was identified as a significant determinant factor that was negative for dyslipidemia but protective for prediabetes. Conclusion: This study supports the fact that psychosocial work-related hazards can independently contribute to the risk of developing depression, prediabetes, and dyslipemia in executives. A s a result of globalization, several companies have been forced to undertake mergers and downsizing in addition to introduc- ing temporary or contract-based project employees. 1,2 Like all social transformations, these changes may potentially affect the health of individuals and general population. 2 Therefore, psycho- social work hazards have been the focus of a large number of studies during the past few decades. Recent epidemiological studies have shown that both employment insecurity and workplace injustice are important psychosocial hazards of stress-related illness in the work- place. 3,4 Job insecurity has been defined as an employee’s perception of a potential threat to the continuity of his or her current position and the everyday experience involving prolonged uncertainty about the future. 5 Hence, employment insecurity can be considered as a work stressor, which has been found to be associated with poor health and could increase the risks of psychological problems. 3,6 Workplace justice is generally defined as workers being fairly treated in the workplace. 7 On the basis of previous research, workplace justice comprises the following components: resources and benefits distribution (distributive justice), processes and pro- cedures condition distribution (procedural justice), and interperso- nal relationships (interactional justice). Prior reports have demonstrated that a lower level of workplace justice is associated with various health problems as well as mental disorders. 7,8 The most common model used in prior studies to evaluate the associations between workplace justice and employee’s health is the Demand-Control-Support (DCS) model. 7 The DCS model has three major components to describe the workplace qualities: demands (psychological), control (or decision latitude), and support (social). Workplace stress is thought to be the result of a mixture of high demands, low control, and low social support. Moreover, several studies have suggested that long work hours, interpersonal conflicts, under- utilization of skills, inadequate rewards, and organizational problems are considered to be some of the major sources of job stress. 9,10 Despite the fact that a great deal of previous evidence has shown that justice perception is associated with a higher risk of mental distress as well as poor self-rating health status, 11,12 only a few studies have examined the relation between psychosocial work hazards and suboptimal health status, such as elevated serum lipids, 13 prediabetes, 14 and immune system diseases. 6 Furthermore, most researchers who have investigated the effects of job insecurity on health have focused on psychological morbidity as an outcome, often deduced as the only outcome. Few studies have looked at the effect of job insecurity and workplace justice on physiological measures. Moreover, there are only a few empirical findings that simultaneously associate health with both employment insecurity and workplace justice, primarily in Chinese-speaking working populations. 15–18 In this study, we extended this line of research to explore the influences of psychosocial work hazards on both psychological assessments and suboptimal health status. Taiwan is a newly industrialized country that has experienced dramatic industrial transformation and changes over the past dec- ades. Psychosocial work hazards are a widespread public problem in most industrialized countries. However, there are few reports of such studies conducted on working populations in Asia. 19 In Taiwan, psychosocial work hazards have recently received public health attention, with one previous study investigating the associ- ation between psychosocial work hazards and health impacts among the general population. 19 To our knowledge, socioeconomic dis- advantaged groups may suffer more from workplace injustice and uncertainty. 19 Generally speaking, executives tend to have access to more resources, 20 and perceived more workplace justice and employment security. 20 However, executives are responsible for upholding stakeholders’ or owners’ expectations and taking care of employees, which may increase their work-related stress. Not much is known regarding the actual health impacts of psychosocial work hazards on this group. This study aims to investigate whether psychosocial work hazards, including employment insecurity and workplace justice, are associated with depression and physical suboptimal health in Taiwan’s executive employees. The research modeling outline is shown in Fig. 1. MATERIALS AND METHODS Study Subjects Between 2009 and 2011, 689 adults in the age group of 35 to 65 years were recruited by a bulletin announcement to participate in a case–control study of work- and environment-related cardiovas- cular diseases as the control subjects of acute coronary heart diseases (CHD) in National Taiwan University Hospital (NTUH). 21,22 Participants reported they were free from phys- ician-diagnosed CHD, cerebrovascular disease, and heart failure. Three hundred sixty-five participants were employed as deputy From the Department of Laboratory Medicine, National Taiwan University Hos- pital, National Taiwan University College of Medicine (Dr Hsu); Institute of Health Policy and Management, National Taiwan University College of Public Health (Drs Hsu, Chen, Cheng); Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine (Dr Su); and Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei (Dr Su). The authors report no conflicts of interest. Address correspondence to: Ta-Chen Su, MD, PhD, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei 10002, Taiwan (tachensu@ntu.edu.tw). Copyright ß 2016 American College of Occupational and Environmental Medicine DOI: 10.1097/JOM.0000000000000760 728 JOEM  Volume 58, Number 7, July 2016 ORIGINAL ARTICLE