Assédio moral no trabalho e seu papel nos transtornos mentais comuns e dor lombar: um estudo com trabalhadores do judiciário federal

Abstract

Introduction: The new models of work management have impacted occupational risks and workers health. In the Brazilian public service, this phenomenon is consolidated with state reform, which started in the 1990s. In this context, psychosocial risk at work, such as stress and bullying, increase, and negatively affect mental and physical health. It may lead to an increase in the occurrence of common mental disorders and musculoskeletal problems such as low back pain. Most studies which evaluate workplace bullying as a determinant of health are from high-income countries, being scarce in low- and middle-income countries. Besides, the mechanisms, confounders and mediators of the association between bullying, mental disorders and musculoskeletal complaints still need further clarification. Objectives: The first paper, a systematic review, aimed to analyse epidemiological studies that have addressed risk factors for workplace bullying, seeking to understand its mechanisms and determination; the other two articles evaluated the prevalence of common mental disorders and low back pain in civil servants of the Federal Judiciary in Porto Alegre, analysing the association between bullying and the health outcomes. Methods: The first paper of the thesis is a systematic review of risk factors for workplace bullying, with focus on epidemiological studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) and MOOSE (Meta-Analyzes of Observational Studies in Epidemiology) guidelines were used to describe the selected articles, and the quality was evaluated by the Downs and Black checklist. The second part of the thesis consists of two papers related to a cross-sectional study, with data collected by a web survey between June and October 2018. The online questionnaire addressed demographic, socioeconomic, behavioural, and occupational factors, focusing on work organization, psychosocial factors at work and workplace bullying, as well as the health outcomes. The revised Negative Acts Questionnaire (NAQ-r) was used to assess workplace bullying, the Self- Report Questionnaire (SRQ-20) to measure common mental disorders, and the Nordic Questionnaire to evaluate low back pain. The association between workplace bullying and outcomes was analysed using logistic regression, controlling for confounders, according to a conceptual model. Odds ratios and their confidence intervals were estimated. The heterogeneity test, for categorical variables, and the linear trend test, for continuous or variables with a linear relationship, were used. Results: The Systematic Review comprised 51 papers that evaluated risk factors for bullying, identifying a strong association of occupational and psychosocial factors at work with bullying. Females were at higher risk of bullying in most studies, as well as several occupational factors. Leadership styles, work stress, and other psychosocial factors related to the work organization were strongly associated with bullying. The other two papers analysed 907 civil servants from the federal judiciary of the municipality of Porto Alegre, identifying a prevalence of 32.8% of Common Mental Disorder, 50.1% of lastweek Low Back Pain and 19.3% of Chronic Low Back Pain. The prevalence of bullying was 18.3%, which was strongly associated with goal-based management, occupational stress, and low psychosocial safety in the institution. Psychosocial factors at work were positively associated with common mental disorders and low back pain. Multivariate models showed a strong association of bullying at work with CMD and low back pain, even after adjustment for several confounders and covariates, including some mediators. Discussion: The systematic review showed that epidemiological studies on risk factors for workplace bullying support Leymann's theoretical model, emphasizing the role of work organization and management in determining harassment in workplaces, in contrast to individual factors such as personality. The results of the study with judiciary civil servants corroborated findings of research from high-income countries, showing a positive association of workplace bullying with mental health problems and musculoskeletal pain, and highlighting the role of bullying in both outcomes. The different ways used to categorize bullying, as well as the statistical models we used, with adjustment for several sociodemographic, behavioural and occupational confounders, should guide future analyses of these associations and may help to understand mechanisms that lead workers to health outcomes. The prevention of bullying and health problems such as mental disorders and low back pain demands changes in contextual factors of work organization and organizational culture.