Cited by 219Workplace Health and Well-beingSleep and Work-Related FatigueWorkaholism, burnout, and well-being

The DOI matches its Crossref record; 94 of the 95 references it cites were found in a registry or an index; 18 of the 51 sources its claims cite were checked for support.

Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data

Open access

Abstract

Objectives This systematic review and meta-analysis combined published study-level data and unpublished individual-participant data with the aim of quantifying the relation between long working hours and the onset of depressive symptoms. Methods We searched PubMed and Embase for published prospective cohort studies and included available cohorts with unpublished individual-participant data. We used a random-effects meta-analysis to calculate summary estimates across studies. Results We identified ten published cohort studies and included unpublished individual-participant data from 18 studies. In the majority of cohorts, long working hours was defined as working ≥55 hours per week. In multivariable-adjusted meta-analyses of 189 729 participants from 35 countries [96 275 men, 93 454 women, follow-up ranging from 1–5 years, 21 747 new-onset cases), there was an overall association of 1.14 (95% confidence interval (CI) 1.03–1.25] between long working hours and the onset of depressive symptoms, with significant evidence of heterogeneity (I 2 =45.1%, P=0.004). A moderate association between working hours and depressive symptoms was found in Asian countries (1.50, 95% CI 1.13–2.01), a weaker association in Europe (1.11, 95% CI 1.00–1.22), and no association in North America (0.97, 95% CI 0.70–1.34) or Australia (0.95, 95% CI 0.70–1.29). Differences by other characteristics were small. Conclusions This observational evidence suggests a moderate association between long working hours and onset of depressive symptoms in Asia and a small association in Europe.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis combined published and unpublished individual-participant data from 28 prospective cohort studies (189,729 participants, 35 countries) to quantify the association between long working hours and onset of depressive symptoms. It found an overall modest increased risk (OR 1.14, 95% CI 1.03–1.25), with a stronger association in Asia (OR 1.50) and a small association in Europe (OR 1.11), but no association in North America or Australia.

Key findings

  • Overall multivariable-adjusted OR for long working hours and new-onset depressive symptoms was 1.14 (95% CI 1.03–1.25), with significant heterogeneity (I²=45.1%, P=0.004).
  • By region: Asia OR 1.50 (95% CI 1.13–2.01); Europe OR 1.11 (95% CI 1.00–1.22); North America OR 0.97 (95% CI 0.70–1.34); Australia OR 0.95 (95% CI 0.70–1.29). Asia differed significantly from other regions (P=0.034 heterogeneity test; P=0.041 meta-regression).
  • Published studies showed OR 1.35 (95% CI 1.07–1.71) versus unpublished data OR 1.08 (95% CI 1.00–1.16); occupational cohorts showed OR 1.34 (95% CI 1.10–1.62) versus population-based studies OR 1.07 (95% CI 0.96–1.20).
  • Other subgroup differences were small; no significant differences were found by sex, age group, socioeconomic status, study baseline year, study quality, follow-up length, response rate, loss to follow-up, outcome type, or population prevalence/onset of symptoms.

Methods

  • Systematic review and random-effects meta-analysis following PRISMA; searched PubMed and Embase to January 2017, plus reference lists and cited-reference searches, identifying 10 published prospective cohort studies and including unpublished individual-participant data from 18 studies (28 total).
  • Included 189,729 participants (96,275 men, 93,454 women) from 35 countries, follow-up 1–5 years, with 21,747 new-onset cases; long working hours was most often defined as ≥55 hours/week versus 35–40 hours/week as reference.
  • In individual-participant data studies, ORs were adjusted for age, sex, socioeconomic status, and marital status; published studies used the closest available adjustment. Analyses used random-effects meta-analysis, I², meta-regression, and Egger’s test.

Limitations

  • Paper-stated: exposure was self-reported and measured only once, risking recall bias and misclassification; exposure definitions varied across published studies; outcome assessment varied (psychological distress, depressive symptoms, or clinical depression), though associations were similar across outcome types; only three studies used structured DSM-III/DSM-IV interviews.
  • Paper-stated: observational design cannot establish causality; unmeasured confounding (e.g., work-related factors, alcohol use) cannot be ruled out; most studies were from high-income countries, so findings are not generalizable to low- or middle-income countries.
  • Evident from the text: subgroup differences by publication status and cohort type were based on limited numbers, including only one Asian study in the unpublished group and one in the population-based group, so those subgroup findings may be unstable; mediation by effort–reward or effort–recovery imbalance was not tested.

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Integrity signals

Registry

Crossref · 10.5271/sjweh.3712

Cites

94 of 94 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

18 of 51 cited sources checked · 12 supported · 0 flagged · accuracy not yet measured

Show all 44 claims

  • Probably not a substantial claim. 21
  • It may state two separate claims as one. 21
  • The quote only partly states this claim. 1
35 of 35
  • The paper relies on this without support.

    Long working hours are more common in Asia and North America than in Europe.

    “Furthermore, long working hours are more common in Asia and North America than in Europe”
  • The paper relies on this without support.

    The risk of mental health problems is higher among women and individuals with low socioeconomic position than among men and those with high socioeconomic status.

    “and the risk of mental health problems is higher among women and individuals with low socioeconomic position than men and those with high socioeconomic status.”
2 of 2

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Each contradiction between two passages listed here was confirmed by an independent check.

  • Working-hour categories were not used in all unpublished datasets

    Minor

    The paper says the same working-hour categories, including a 35-40-hour reference group and a ≥55-hour highest group, were used in all unpublished datasets. It then says the Helsinki Health Study, one of those datasets, used a 30-40-hour reference group and a >50-hour highest group.

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Metadata

Authors
Virtanen, M., Jokela, M., Madsen, I. E., Magnusson Hanson, L. L., Lallukka, T., Nyberg, S. T., Alfredsson, L., Batty, G. D., Bjorner, J. B., Borritz, M., Burr, H., Dragano, N., Erbel, R., Ferrie, J. E., Heikkilä, K., Knutsson, A., Koskenvuo, M., Lahelma, E., Nielsen, M. L., Oksanen, T., Pejtersen, J. H., Pentti, J., Rahkonen, O., Rugulies, R., Salo, P., Schupp, J., Shipley, M. J., Siegrist, J., Singh-Manoux, A., Suominen, S. B., Theorell, T., Vahtera, J., Wagner, G. G., Wang, J. L., Yiengprugsawan, V., Westerlund, H., & Kivimäki, M.
Affiliations
  • Uppsala University (SE)
  • University of Helsinki (FI)
  • Finnish Institute of Occupational Health (FI)
  • Region Stockholm (SE)
  • University College London (GB)
  • National Research Centre for the Working Environment (DK)
  • Federal Institute for Occupational Safety and Health (DE)
  • Heinrich Heine University Düsseldorf (DE)
  • West German Heart and Vascular Center Essen (DE)
  • London School of Hygiene & Tropical Medicine (GB)
  • Mid Sweden University (SE)
  • University of Copenhagen (DK)
  • University of Turku (FI)
  • German Institute for Economic Research (DE)
  • Stockholm University (SE)
Corresponding author
Virtanen, Marianna
Venue
Scandinavian Journal of Work, Environment & Health
Published
2018-02-08
Volume
44
Issue
3
Pages
239-250
ISSN
  • 0355-3140 (ISSN-L)
  • 1795-990X
OpenAlex
W2785409727
Cited by
219
References
95
Citations by year
2026: 18 · 2025: 22 · 2024: 37 · 2023: 32 · 2022: 30 · 2021: 35 · 2020: 20 · 2019: 18 · 2018: 6
FWCI
4.29
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Scandinavian Journal of Work Environment & Health (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
  • UTUPub (University of Turku) (submittedVersion, other-oa)
  • University Library of Skövde (University of Skövde) (submittedVersion, other-oa)
  • KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Econstor (Econstor) (submittedVersion, cc-by)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • ANU Open Research (Australian National University) (submittedVersion, cc-by)
Funders
  • Työsuojelurahasto
  • NordForsk (75021, K013351, 311492)
  • Medical Research Council (MR/K013351/1, K013351, 311492, 258598)
  • Economic and Social Research Council (ES/J023299/1)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Workplace Health and Well-being
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
  • Social Sciences › Psychology › Social Psychology › Workaholism, burnout, and well-being
Keywords
long working hours, depressive symptoms, depression onset, occupational stress, workplace mental health, individual patient data, cross-national comparison
MeSH terms
Asia, Depression, Europe, Female, Humans, Male, North America, Prospective Studies, Work Schedule Tolerance, Risk Assessment, Observational Studies as Topic

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