Review. Scand J Work Environ Health online first. doi: /sjweh.3712

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1 Review. Scand J Work Environ Health online first. doi:1.5271/sjweh.3712 Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data 1 by Marianna Virtanen, PhD, 2 Markus Jokela, PhD, Ida EH Madsen, PhD, Linda L Magnusson Hanson, PhD, Tea Lallukka, PhD, Solja T Nyberg, PhD, Lars Alfredsson, PhD, G David Batty, DSc, Jakob B Bjorner, MD, PhD, Marianne Borritz, PhD, Hermann Burr, PhD, Nico Dragano, PhD, Raimund Erbel, MD, PhD, Jane E Ferrie, PhD, Katriina Heikkilä, PhD, Anders Knutsson, PhD, Markku Koskenvuo, MD, PhD, Eero Lahelma, PhD, Martin L Nielsen, PhD, Tuula Oksanen, PhD, Jan H Pejtersen, PhD, Jaana Pentti, PhD, Ossi Rahkonen, PhD, Reiner Rugulies, PhD, Paula Salo, PhD, Jürgen Schupp, PhD, Martin J Shipley, PhD, Johannes Siegrist, PhD, Archana Singh-Manoux, PhD, Sakari B Suominen, PhD, Töres Theorell, MD, PhD, Jussi Vahtera, MD, PhD, Gert G Wagner, PhD, Jian Li Wang, PhD, Vasoontara Yiengprugsawan, PhD, Hugo Westerlund, PhD, Mika Kivimäki, PhD 1 Supplementary materials 2 Correspondence to: Marianna Virtanen, Finnish Institute of Occupational Health, PO Box 4, 32 Työterveyslaitos, Finland. [ marianna.virtanen@ttl.fi]

2 Supplementary figure A. Selection of studies in the meta-analysis Embase n=3295 January 217 Articles screened in detail n=17 PubMed n=174 January 217 ISI Web of Science referred publication database, hand search and published reviews January 217 Unpublished data from the IPD- Work Consortium and open access databases Excluded n= wrong topic 3 review 23 crosssectional 18 no data / estimates 1 editorial 8 overlapping data 5 commentary 4 letter 4 general outcome 2 continuous outcome 1 no baseline data 1 metaanalysis 1 interview 1 study protocol 1 student sample Studies included in the meta-analysis n=4 Studies included in the metaanalysis n=18 Studies included in the metaanalysis n=6

3 Supplementary table A. Assessment of seven domains of study quality and the overall quality score. Symbols ++ = definitely yes; + = probably/mostly yes; - = probably/mostly no; - - = definitely no Study Confidence in exposure (predictor) assessment a Exposed and unexposed from the same Confidence in exclusion of prevalent cases Comprehensive adjustments Confidence in confounders assessment b Confidence in outcome assessment c Adequate Overall score HIGH follow-up d /ACCEPTABLE QUALITY Suwazono no Bildt no Shields yes Virtanen yes Tokuyama no Amagasa yes Niedhammer yes Wang yes Kato yes Kim yes ACL yes BHPS yes NLSY yes HRS yes HESSUP yes BCS yes PUMA yes FPS yes

4 DWECS yes ELSA yes SHARE yes HILDA yes SOEP yes HHS yes SLOSH yes PAIRFAM yes TCS yes UKHLS yes a Recorded working hours (++); self-reported working hours (+). b Confounders data from several sources (++); data mainly self-reported (+). c Structured interview data of clinically significant depressive disorder (++); self-reported data on depressive symptoms or psychological distress (+). d Follow-up of 2 to 4 years (++); 1 or 5 years (+).

5 Supplementary table B. Overview of prospective studies excluded from the meta-analysis, investigating the association between long working hours and depressive symptoms First author Year of study entry Study site Population No of participants Proportion (%) of women Mean age / age range at entry Mean followup time Assessment of depressive symptoms Findings Summary of findings Sugisawa (52) <1994 Japan Various occupations and firms Medical treatment for mental disorders Marchand (47) 1994 Canada General Within-subject repeated assessments of psychological distress Tarumi (53) 1997 Japan White-collar employees Steptoe (49) <1998 UK Department store employees D Errico (5) 1999 Italy Members of a workers union Medical records of incident mental disorder (F-F99) /36,5 Within-subject analysis of workinghours change and psychological distress % aged Antidepressant prescriptions Allen (46) 21 USA Manual workers Self-reported mental health, continuous outcome Ogasawara (48) 26 Japan Office workers DSM-IV-TR major depressive disorder RR=1.45 ( ) for 8 hours; RR=1.38 ( ) for 71-8 hours versus 5-6 Linear regression coefficient b=.1 (n.s.) RR=1.36 ( ) for 5 hours versus 44 hours Variation in working hours was not associated with change in psychological distress RR=1. ( ) for >4h/week overtime versus none b=.12 (n.s.) for 6 hours/ week versus RR=1.3 ( ) for a

6 continuous working hours measure Varma (51) 28 Denmark Senior medical consultants Antidepressant prescriptions HR=.67 ( ) for hours; HR.48 ( ) for 6 hours versus 37-4

7 Supplementary table C. Overview of prospective studies investigating the association between long working hours and depression First author / Study (acronym) Year of study entry Study site Population No of participants Proportion (%) of women Mean age / age range at entry Mean followup time Assessment of depression Covariates in the multivariable adjusted model Published data Suwazono (54) 1992 Japan Workers of a telecommuni cation enterprise Bildt (55) 1993 Sweden General (younger) from Stockholm county Shields (56) 1994 Canada General Virtanen (57) 1997 UK Londonbased civil service employees Tokuyama (58) 1997 Japan White-collar employees of an insurance company Amagasa (59) 1999 Japan Clerical workers Psychological distress Sex-stratified, adjusted for time period Subclinical depression (Nottingham Life Quality Questionnaire) DSM-III major depressive episode (MDE) Psychological distress (General Health Questionnaire, GHQ- 3) Zung self-rating depression scale (SDS) Depression subscale of the General Wellbeing scale Sex-stratified Sex-stratified; adjusted for age, SES, work characteristics and family situation, employment at follow-up None. job control

8 Niedhammer (6) 26 France General Wang (61) 28 Canada General Kato (62) 28 Japan Employees of a manufacturin g company Kim (63) 21 South Korea General Unpublished data Major depressive disorder interview (MINI) DSM-IV Major depressive disorder (MDD) Depressive symptoms (CES-D) 685 observati ons from 2733 participan ts Depressive symptoms (CES-D) occupation, family situation, social support, stressful life events marital, education Age, tenure, job grade, shift work, site of work education, income, marital Americans' Changing Lives (ACL) (64) British Household Panel Survey (BHPS) (65) National Longitudinal Survey of Youth (NLSY) (66) Health and Retirement Study (HRS) (67) 1986 USA General 1991 UK General 1992 USA General 1992 USA General (older) Depressive symptoms (CES-D) Psychological distress (General Health Questionnaire, GHQ- 12) Depressive symptoms (CES-D) Depressive symptoms

9 Health and Social Support (HeSSup) (68) 1998 Finland General, age-stratified Depressive symptoms (Beck Depression Inventory, BDI) British Birth Cohort 197 (BCS) (69) 1999 UK National birth cohort Psychological distress (General Health Questionnaire, GHQ- 12) Burnout, Motivation and Job Satisfaction (PUMA) (7) 1999 Denmark Employees in the human service sector Depressive symptoms (Mental Health Inventory, MHI-5); Finnish Public Sector Study (FPS) (71) 2 Finland Public sector employees (1 towns, 21 hospitals) Psychological distress (General Health Questionnaire, GHQ- 12) Danish Work Environment Cohort (DWECS 2) (72) 2 Denmark General Depressive symptoms (Mental Health Inventory, MHI-5) English Longitudinal Study of Aging (ELSA) (73) 22 UK General (older) Depressive symptoms (CES-D) Helsinki Health Study (HHS) (74) 22 Finland Public sector employees (City of Helsinki) Psychological distress (General Health Questionnaire, GHQ- 12) Survey of Health, Ageing and Retirement in Europe (SHARE) (75) 24 Europe General (older) Depressive symptoms (EURO-D) Household, Income, and Labour Dynamics in Australia (HILDA) (76) 25 Australia General Depressive symptoms (Mental Health Inventory, MHI)

10 German Socioeconomic Panel Survey (SOEP) (77) Swedish Longitudinal Occupational Survey of Health (SLOSH) (78) Panel Analysis of Intimate Relationships and Family Dynamics (PAIRFAM) (79) Thai Cohort Study (TCS) (8) UK Household Longitudinal Study (UKHLS) (81) 26 Germany General 28 Sweden General 28 Germany General (younger) 29 Thailand Employed enrolled in open university 29 UK General Depressive symptoms (Mental Component Summary Scale MCS) Depressive symptoms (Symptom Check List, SCL) Depressive symptoms (State-Trait Depression Scale) % (men) 58% (women) <4 years 4 K6 psychological distress marital, income Psychological distress

11 Supplementary table D. Response rate, loss to follow-up, and prevalence and onset of depressive symptoms in study cohorts Study Response rate (%) at baseline Loss to follow-up (%) Prevalence (%) of depressive symptoms at baseline Onset (%) of depressive symptoms at follow-up Suwazono 1 n.a. 16/2 Bildt n.a. 15 1/12 1/9 Shields 96 6 n.a. 3/5 Virtanen Tokuyama Amagasa 97 9 n.a. n.a. Niedhammer n.a. 4 Wang Kato Kim n.a ACL BHPS NLSY HRS HESSUP BCS PUMA FPS DWECS ELSA SHARE HILDA SOEP HHS SLOSH PAIRFAM TCS UKHLS