Workplace Harassment, Macro-Level Stressors, Substance Use and Health Outcomes: A Long-Term Follow Up

点击翻译按钮获取中文摘要

Workplace harassment (WH) is a traumatic stressor that is consistently linked to substance use and abuse, poor mental health, and health symptoms. However, long-term risk for serious psychopathology, morbidity, and mortality remains unstudied. Building on our prior work on WH and substance use, we focus on four aims: 1) delineate long-term consequences of WH on morbidity and mortality over a 25 year period; 2) using three approaches, test the role of substance abuse, psychological and cognitive mediators (distress, alienation, and rumination), and stress sensitization, and the possible integration of these factors, to explain the long-term effects of WH on psychopathology and adverse health outcomes, including mortality, in the context of other stressors and key work-related structural and contextual factors; 3) examine risk and protective factors (services use, coping and coping effectiveness, gender and race/ethnicity) modifying the relationships between prior and current stressors and substance abuse, psychopathology, and adverse health outcomes, and 4) examine the reliability of long-term recall of prior WH experiences and substance use by comparing current recall to prior reports. A central innovation of the proposed study is delineating how WH, a micro-level stressor, may sensitize reactions to later micro- and macro-level stressors, increasing long-term risk for substance abuse, psychopathology, and adverse health outcomes. Capitalizing on an existing 8-wave dataset spanning 10 years, this follow-up study will a) re-survey at 3 one-year intervals a cohort of adults first surveyed while employed in 1996 (N=2478); b) supplement the survey with structured interviews to assess presence and timing of current and past psychopathology and substance abuse as per DSM-5 criteria, long-term recall of WH and substance abuse, and work-related structural and contextual factors that contribute to WH; and c) use the National Death Index to ascertain mortality, including date and cause of death, on mortality occurring since the end of the prior study. This design will allow us to test longitudinal models of the effects of WH on morbidity and mortality, incorporating both proximal and distal mechanisms, and incorporating intrapsychic factors, behavioral factors, and work-related structural/contextual factors in models to explain long-term effects of WH on outcomes. This will be the first study of long-term risk for mortality associated with WH. Given the wealth of previous data characterizing the sample, this study presents a unique opportunity to inform viable strategies to prevent and address WH-related substance abuse, psychopathology, chronic health issues, and mortality, and to inform targeted, timely treatment and prevention strategies to ameliorate negative health-related effects of WH at individual, workplace, and policy levels.