| Study | Design and methods appraisal* | Setting and participants | Intervention | Implementation | Psychosocial outcomes (p<0.05)†,‡ | Health outcomes (p<0.05)‡ |
| Mikkelsen and Saksvik (1999)44 | Prospective cohort study with two intervention groups and two comparison groups. 1-week and 12-month follow-up Final sample: n = 125 Methods appraisal: 1, 2, 3, 4, 5, 7, 8, 10 | Post office depot, Norway Manual and clerical workers | Conference on working conditions followed by supervisor and employee workgroups meeting for 2 hours each week (nine times in total). intervention was moderated by consultants. Intervention took place during period of company downsizing | Authors report that union and management helped design intervention. In one department, the intervention was not successfully implemented because steering group members lost interest and personnel were relocated or made redundant | Job demands (D) ↔ Skill discretion (C) ↔ Decision authority (C) ↔ Laissez-faire (C) ↓§ Social support (S) ↔ Individual consideration (S) ↑§ Job satisfaction (O) ↔ Management style (O) ↔ Opportunity to develop (O) ↔ Contentedness (O) ↔ Learning climate (O) ↔ Intellectual stimulation (O) ↑§ | Self-reported job stress ↔ Self-reported health complaints ↔ Self-reported trait anxiety ↔ |
| Woodward et al. (1999)45 | Prospective, cohort study 1-year and 2-year follow-up Final sample: n = 346 Methods appraisal 1, 2, 4, 6, 7, 8, 9, 10 | Two teaching hospitals, Canada Managers, doctors, nurses, clerical and technical staff | Management–employee design teams set up to implement “re-engineering” of hospital services, including a merger and (mostly management) redundancies. Staff required to reapply for posts | Few reported details on effectiveness of implementation or commitment of employers or employees to employee participation | Demands (D) ↓ Role clarity (D) ↓ Decision latitude (C) ↔ Job influence (C) ↔ Co-worker support (S) ↓ Supervisor support (S) ↓ Teamwork (S) ↓ Job insecurity (O) ↓ | Mean emotional exhaustion (Maslach Burnout Inventory) ↓ Mean anxiety (10-item State Anxiety Scale) ↓ Mean depression (10-item scale) ↓ |
| Parker et al. (1997)46 | Prospective, cohort study 4-year follow-up Final sample: 139 Methods appraisal: 1, 2, 4, 6, 7, 8, 9, 10 | Factory. UK Managerial, clerical, manual employees | “Empowerment initiative”: multiskilling, management restructuring, work teams and greater emphasis on employee development. Company downsizing at all levels, but particularly for clerical and manual workers | Few reported details on implementation although an independent body (Investors in People) judged the empowerment initiative to have been a success | Demands all (D) ↓ Demands manual¶ (D) ↓ Role clarity all (D) ↔ Role clarity manual (D) ↔ Control all (C) ↑ Control manual (C) ↔ Participation all (C) ↑ Participation manual (C) ↑ Satisfaction all (O) ↔ Satisfaction manual (O) ↑ | Combined mean score: anxiety–contentment, depression–enthusiasm (all)§ ↔ Combined mean score: anxiety–contentment, depression–enthusiasm (management)§ ↑ |
| Heaney et al. (1993)47 | Retrospective, cohort study 6-year follow-up Final sample: n = 277 Methods appraisal: 2, 4, 6, 7, 9, 10 | Factory, USA Manual employees and supervisors | Participatory action research committee (representing management, union and researchers) helped establish a stress and wellness committee (made up of employee representatives). Downsizing and creation of hierarchical management structure in one department (site 1), whilst another (site 2) maintained a more “co-operative”, less hierarchical structure | Authors report a lack of support from higher management and union representatives, especially in site 1 | Participative climate (C) ↔ Participation (C) ↔ Co-worker instrumental support (S) ↔ Co-worker emotional support (S) ↔ Supervisor instrumental support (S) ↔ Supervisor emotional support (S) ↓ | Mean scores for depressive symptoms (Centre for Epidemiological Studies Depression (11-item scale, 1–3 points) ↔ |
| Herting et al. (2003)48 | Qualitative, retrospective panel study based on a series of in-depth interviews. A randomly selected panel of six secretaries received three interviews each over time. T1 = 3 months after restructuring, T2 = 15 months after, T3 = 27 months after Final sample: n = 6 | Hospital, Sweden Clerical staff | (a) “Collaboration meetings” between clerical and professional employees (b) Labour-saving ergonomic changes (c) Downsizing linked with restructuring | Restructuring prompted by government cost-cutting. Degree to which managers supported the participatory intervention is not clear. Mixed response from clerical workers to the intervention | Respondents report that they have too much work (D) ↓ Respondents report that they feel a loss of control (C) ↓ Respondents report communication problems and feelings of inferiority when dealing with senior staff (S) ↓ | Mental health: respondents report feeling “close to tears”; lacking “joy” and “motivation”; becoming “irritable” and “snappy”; poor sleep; lack of energy; feelings of shame and frustration ↓ |
*Methods appraisal: 1 = prospective; 2 = representative sample; 3 = appropriate comparison group; 4 = baseline response >60%; 5 = follow-up >80% in cohort, >60% in cross-section; 6 = adjustment for non-response and drop-out; 7 = conclusions substantiated by data; 8 = adjustment for confounders; 9 = all intervention group exposed, non-contaminated comparison group; 10 = appropriate statistical tests. †D, demand; C, control; S, social support; O, other psychosocial outcome measures. ‡↑ = improvement; ↓ = worsening; ↔ = little change/inconclusive (with reference to the DCS hypothesis that reduced demands and increased control and support are ‘improvements’). §Short-term effects. ¶All = manual, clerical and managerial staff; Manual = Manual staff (for whom separate figures are given because their mental health appeared to improve following the intervention).