Enhancing Workers’ Well-Being. Scientific and social relevance of managing stress in the workplace

Purpose. Despite work-related stress is one of the most studied topic in organizational psychology, many aspects as for example the use of different measures (e.g. subjective and objective, qualitative and quantitative) are still under debate. According to this, in order to enhance knowledge concerning which factors and processes contribute to create healthy workplaces, this thesis is composed by four different studies aiming to understand: a) the role of relevant antecedents (e.g. leadership, job demands, work-family conflict, social support etc.) and outcomes (e.g. workplace phobia, absenteeism etc.) of work-related stress; and b) how to manage psychosocial risk factors in the workplace. The studies. The first study focused on how disagreement between supervisors and their employees on leadership style (transformational and transactional) could affect workers well-being and work team variables. The second and third study used both subjective and objective data in order to increase the quality of the reliability of the results gained. Particularly, the second study focused on job demand and its relationship with objective sickness leave. Findings showed that despite there is no direct relationship between these two variables, job demand affects work-family conflict, which in turn affect exhaustion, which leads to absenteeism. The third study analysed the role of a new concept never studied before in organizational settings (workplace phobia), as a health outcome in the JD-R model, demonstrating also its relationship with absenteeism. The last study highlighted the added value of using the mixed methods research approach in order to detect and analyse context-specific job demands which could affects workers’ health. Conclusion. The findings of this thesis answered both to open questions in the scientific literature and to the social request of managing psychosocial risk factors in the workplace in order to enhance workers well-being.

Well-being, distress and health status in a population of adolescent students

The present work explores the psychosocial issues emerging from a large cross-sectional study aimed to assess the prevalence, clinical manifestations, and psychosocial correlates of hyperandrogenism in a population of Italian high school students. Participants were 1804 adolescents, aged between 15 and 19 years, who volunteered to fill in a package of self-report questionnaires (including the Psychosocial Index, the Symptom Questionnaire and Ryff’s Psychological Well-Being scales for the assessment of psychological aspects) and undergo a comprehensive physical examination. Significant gender differences were found with regard to psychological distress, with females reporting higher scores compared with males, but not on well-being dimensions. The relationships of well-being to distress were found to be complex. Although inversely associated, well-being and ill-being appeared to be distinct domains of mental functioning. The evaluation of the moderating effects of well-being in the association between stress and psychological distress indicated that well-being may act as a protective factor, contributing to less pronounced psychological distress as stress levels increased. Higher rates of somatic complaints were found among current smokers. However, substance use (i.e., smoking and drug use) was also found to be positively associated with some well-being dimensions. A considerable number of participants were found to present with disordered eating symptoms, particularly females, and associated higher stress levels and lower quality of life. Sport activities were found to favourably affect psychological health. As to clinical signs of hyperandrogenism, a significant impairment in psychosocial functioning was found among females, whereas no effects on psychological measures could be detected among males. Subgroups of adolescents with distinct clinical and psychological characteristics could be identified by means of cluster analysis. The present study provides new insights into better understanding of the complex relationships between well-being, distress and health status in the adolescent population, with important clinical implications.

The application of a new psychotherapeutic strategy for enhancing eudaimonic well-being in children with mood and anxiety disorders

The aim of the dissertation was to test the feasibility of a new psychotherapeutic protocol for treating children and adolescents with mood and anxiety disorders: Child-Well-Being Therapy (CWBT). It originates from adult Well-Being Therapy protocol (WBT) and represents a conceptual innovation for treating affective disorders. WBT is based on the multidimensional model of well-being postulated by Ryff (eudaimonic perspective), in sequential combination with cognitive-behavioral therapy (CBT). Results showed that eudaimonic well-being was impaired in children with affective disorders in comparison with matched healthy students. A first open investigation aimed at exploring the feasibility of a 8-session CWBT protocol in a group of children with emotional and behavioural disorders has been implemented. Data showed how CWBT resulted associated to symptoms reduction, together with the decrease of externalizing problems, maintained at 1-year follow-up. CWBT triggered also an improvement in psychological well-being as well as an increasing flourishing trajectory over time. Subsequently, a modified and extended version of CWBT (12-sessions) has been developed and then tested in a controlled study with 34 patients (8 to 16 years) affected by mood and anxiety disorders. They were consecutively randomized into 3 different groups: CWBT, CBT, 6-month waiting list (WL). Both treatments resulted effective in decreasing distress and in improving well-being. Moreover, CWBT was associated with higher improvement in anxiety and showed a greater recovery rate (83%) than CBT (54%). Both groups maintained beneficial effects and CWBT group displayed a lower level of distress as well as a higher positive trend in well-being scores over time. Findings need to be interpret with caution, because of study limitations, however important clinical implications emerged. Further investigations should determine whether the sequential integration of well-being and symptom-oriented strategies could play an important role in children and adolescents’ psychotherapeutic options, fostering a successful adaptation to adversities during the growth process.

The role of proactive coping strategies and perceived health status for Social well-being and life-project in old age.

The latter part of the 20th century was a period characterized by a fundamental demographic transition of western society. This substantial and structural demographic change proposes several challenges to contemporary society and fosters the emergence of new issues and challenges. Among these, none is more crucial than the comprehension of the mechanisms and the processes that lead people to positive aging. Rowe and Kahn’s model of successful aging highlights the interplay between social engagement with life, health, and functioning for a positive aging experience. Other systemic models of successful aging (Kahana et al., 1996; 2003; Stevernik et al., 2006) emphasize the role of internal and external resources for attaining positive aging. Among these, the proactive coping strategies are indicated as important active strategies for avoiding the depletion of resources, counterbalancing the declines and maintaining social and civic involvement. The study has analyzed the role of proactive coping strategies for two facets of positive aging, the experience of a high social well-being and the presence of personal projects in fundamental life domains. As expected, the proactive coping strategies, referred to as the active management of the environment, the accumulation of resources and the actualization of human potentials are confirmed as positive predictors of high level of social well-being and of many personal projects focused on family, culture, leisure time, civic and social participation. Perceived health status give a significant contribution only to the possession of many personal projects. Gender and level of school education give also a significant contribution to these two dimensions of positive aging, highlighting how positive aging is rooted not only in the possession of personal resources, but also in historical models of education and in positive longitudinal chains related to early development.

Prevention of binge drinking in young adolescents through the promotion of a balanced level of psychological well-being: be-dry

This doctoral thesis presents a project carried out in secondary schools located in the city of Ferrara with the primary objective of demonstrating the effectiveness of an intervention based on Well-Being Therapy (Fava, 2016) in reducing alcohol use and improving lifestyles. In the first part (chapters 1-3), an introduction on risky behaviors and unhealthy lifestyle in adolescence is presented, followed by an examination of the phenomenon of binge drinking and of the concept of psychological well-being. In the second part (chapters 4-6), the experimental study is presented. A three-arm cluster randomized controlled trial including three test periods was implemented. The study involved eleven classes that were randomly assigned to receive well-being intervention (WBI), lifestyle intervention (LI) or not receive intervention (NI). Results were analyzed by linear mixed model and mixed-effects logistic regression with the aim to test the efficacy of WBI in comparison with LI and NI. AUDIT-C total score increased more in NI in comparison with WBI (p=0.008) and LI (p=0.003) at 6-month. The odds to be classified as at-risk drinker was lower in WBI (OR 0.01; 95%CI 0.01–0.14) and LI (OR 0.01; 95%CI 0.01–0.03) than NI at 6-month. The odds to use e-cigarettes at 6-month (OR 0.01; 95%CI 0.01–0.35) and cannabis at post-test (OR 0.01; 95%CI 0.01–0.18) were less in WBI than NI. Sleep hours at night decreased more in NI than in WBI (p = 0.029) and LI (p = 0.006) at 6-month. Internet addiction scores decreased more in WBI (p = 0.003) and LI (p = 0.004) at post-test in comparison with NI. Conclusions about the obtained results, limitations of the study, and future implications are discussed. In the seventh chapter, the data of the project collected during the pandemic are presented and compared with those from recent literature.

Precarious employment and social reproduction: the impact on health and well-being

This dissertation aims to make a theoretical and empirical contribution to the debate on precarious employment, social reproduction and the impact on health and well-being. In recent years, numerous studies have examined the effect of precarious employment as a social determinant on health and well-being, focusing on gender differences in this phenomenon. Within this framework, the research design is to investigate this topic quantitatively in the United Kingdom using longitudinal data to assess the long-term effects of precarious employment and informal care work on health. More specifically, the aim of this thesis is to investigate the impact of precarious employment on health and to analyze gender differences within this phenomenon, particularly in relation to the role of informal care work. The analysis shows that precarious employment is indeed associated to a detrimental effect on health and that this effect is stronger for women’s mental health. Additionally, the analysis shows that time spent on informal care work explains part of the gender gap in mental health, and that informal care and the number of hours spent on it are associated with worse mental health for women. Finally, during the first few months of Covid-19, for both men and women, performing more hours of care work on average is associated with worse mental health, showing that it is not so much the change from fewer to more hours that affects health, but rather those who do more hours on average, hence the long-term effect of being an intensive informal carer.

The Integrated European Project "GEHA - GEnetics of Healthy Aging": recruitment, health status assessment and survival of the Italian 90+ sibpairs

The present study is part of the EU Integrated Project “GEHA – Genetics of Healthy Aging” (Franceschi C et al., Ann N Y Acad Sci. 1100: 21-45, 2007), whose aim is to identify genes involved in healthy aging and longevity, which allow individuals to survive to advanced age in good cognitive and physical function and in the absence of major age-related diseases. Aims The major aims of this thesis were the following: 1. to outline the recruitment procedure of 90+ Italian siblings performed by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The procedures related to the following items necessary to perform the study were described and commented: identification of the eligible area for recruitment, demographic aspects related to the need of getting census lists of 90+siblings, mail and phone contact with 90+ subjects and their families, bioethics aspects of the whole procedure, standardization of the recruitment methodology and set-up of a detailed flow chart to be followed by the European recruitment centres (obtainment of the informed consent form, anonimization of data by using a special code, how to perform the interview, how to collect the blood, how to enter data in the GEHA Phenotypic Data Base hosted at Odense). 2. to provide an overview of the phenotypic characteristics of 90+ Italian siblings recruited by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The following items were addressed: socio-demographic characteristics, health status, cognitive assessment, physical conditions (handgrip strength test, chair-stand test, physical ability including ADL, vision and hearing ability, movement ability and doing light housework), life-style information (smoking and drinking habits) and subjective well-being (attitude towards life). Moreover, haematological parameters collected in the 90+ sibpairs as optional parameters by the Bologna and Rome recruiting units were used for a more comprehensive evaluation of the results obtained using the above mentioned phenotypic characteristics reported in the GEHA questionnaire. 3. to assess 90+ Italian siblings as far as their health/functional status is concerned on the basis of three classification methods proposed in previous studies on centenarians, which are based on: • actual functional capabilities (ADL, SMMSE, visual and hearing abilities) (Gondo et al., J Gerontol. 61A (3): 305-310, 2006); • actual functional capabilities and morbidity (ADL, ability to walk, SMMSE, presence of cancer, ictus, renal failure, anaemia, and liver diseases) (Franceschi et al., Aging Clin Exp Res, 12:77-84, 2000); • retrospectively collected data about past history of morbidity and age of disease onset (hypertension, heart disease, diabetes, stroke, cancer, osteopororis, neurological diseases, chronic obstructive pulmonary disease and ocular diseases) (Evert et al., J Gerontol A Biol Sci Med Sci. 58A (3): 232-237, 2003). Firstly these available models to define the health status of long-living subjects were applied to the sample and, since the classifications by Gondo and Franceschi are both based on the present functional status, they were compared in order to better recognize the healthy aging phenotype and to identify the best group of 90+ subjects out of the entire studied population. 4. to investigate the concordance of health and functional status among 90+ siblings in order to divide sibpairs in three categories: the best (both sibs are in good shape), the worst (both sibs are in bad shape) and an intermediate group (one sib is in good shape and the other is in bad shape). Moreover, the evaluation wanted to discover which variables are concordant among siblings; thus, concordant variables could be considered as familiar variables (determined by the environment or by genetics). 5. to perform a survival analysis by using mortality data at 1st January 2009 from the follow-up as the main outcome and selected functional and clinical parameters as explanatory variables. Methods A total of 765 90+ Italian subjects recruited by UNIBO (549 90+ siblings, belonging to 258 families) and ISS (216 90+ siblings, belonging to 106 families) recruiting units are included in the analysis. Each subject was interviewed according to a standardized questionnaire, comprising extensively utilized questions that have been validated in previous European studies on elderly subjects and covering demographic information, life style, living conditions, cognitive status (SMMSE), mood, health status and anthropometric measurements. Moreover, subjects were asked to perform some physical tests (Hand Grip Strength test and Chair Standing test) and a sample of about 24 mL of blood was collected and then processed according to a common protocol for the preparation and storage of DNA aliquots. Results From the analysis the main findings are the following: - a standardized protocol to assess cognitive status, physical performances and health status of European nonagenarian subjects was set up, in respect to ethical requirements, and it is available as a reference for other studies in this field; - GEHA families are enriched in long-living members and extreme survival, and represent an appropriate model for the identification of genes involved in healthy aging and longevity; - two simplified sets of criteria to classify 90+ sibling according to their health status were proposed, as operational tools for distinguishing healthy from non healthy subjects; - cognitive and functional parameters have a major role in categorizing 90+ siblings for the health status; - parameters such as education and good physical abilities (500 metres walking ability, going up and down the stairs ability, high scores at hand grip and chair stand tests) are associated with a good health status (defined as “cognitive unimpairment and absence of disability”); - male nonagenarians show a more homogeneous phenotype than females, and, though far fewer in number, tend to be healthier than females; - in males the good health status is not protective for survival, confirming the male-female health survival paradox; - survival after age 90 was dependent mainly on intact cognitive status and absence of functional disabilities; - haemoglobin and creatinine levels are both associated with longevity; - the most concordant items among 90+ siblings are related to the functional status, indicating that they contain a familiar component. It is still to be investigated at what level this familiar component is determined by genetics or by environment or by the interaction between genetics, environment and chance (and at what level). Conclusions In conclusion, we could state that this study, in accordance with the main objectives of the whole GEHA project, represents one of the first attempt to identify the biological and non biological determinants of successful/unsuccessful aging and longevity. Here, the analysis was performed on 90+ siblings recruited in Northern and Central Italy and it could be used as a reference for others studies in this field on Italian population. Moreover, it contributed to the definition of “successful” and “unsuccessful” aging and categorising a very large cohort of our most elderly subjects into “successful” and “unsuccessful” groups provided an unrivalled opportunity to detect some of the basic genetic/molecular mechanisms which underpin good health as opposed to chronic disability. Discoveries in the topic of the biological determinants of healthy aging represent a real possibility to identify new markers to be utilized for the identification of subgroups of old European citizens having a higher risk to develop age-related diseases and disabilities and to direct major preventive medicine strategies for the new epidemic of chronic disease in the 21st century.

Envy: A Psychometric Refinement of the Construct

The noticeable differences in the theoretical and operative definitions of envy across studies and approaches have produced a fragmentary representation and understanding of the envious emotion. The present dissertation aimed to clarify the inherent nature of the construct of envy through the integration of findings from three independent studies. We focused on malicious envy, and investigated it from both a dispositional and an episodic perspective. Studies 1 and 2 investigated the dimensionality of envy as a stable individual characteristic and an episodic emotional state, respectively. In order to elicit episodic envy, a scenario-based experiment was conducted. Results indicated that, in both its dispositional and episodic facets, envy is a bidimensional construct composed by an inner-directed dimension of inferiority and helplessness, and an outer-directed dimension of feelings of anger and ill will. Moreover, findings from Study 1 allowed to establish boundaries between envy and competing constructs that have often been included in conceptualizations of envy. The psychometrically validated definition of envy provided by Studies 1 and 2 represents a valuable contribution to empirical research. Implications for envy research concern the promotion of a shared operationalization of envy in future studies, which will arguably facilitate the comparison of findings between studies and between approaches. Study 3 examined the mechanisms through which dispositional envy affects individuals’ social adjustment and psychological wellbeing. Findings revealed that the detrimental effects of envy on perceived social support and subjective well-being are mostly mediated by other personal characteristics, such as neuroticism and self-esteem. By reducing global self-esteem, the envious disposition may damage supportive social networks via antisocial direct and indirect behaviors that may arise from envy and that are likely to drive others away. On the other hand, by damaging both emotional stability and self-worth, dispositional envy leads to reduced subjective well-being. Implications for clinical practice are discussed.

Pedagogy of healthcare interactions. A study on pediatric well-child visits as culture-oriented and culture-making sites

This study investigates interactions between parents and pediatricians during pediatric well-child visits. Despite constituting a pivotal moment for monitoring and evaluating children’s development during the critical ‘first thousand days of life’ and for family support, no study has so far empirically investigated the in vivo realization of pediatrician-parent interactions in the Italian context, especially not from a pedagogical perspective. Filling this gap, the present study draws on a corpus of 23 videorecorded well-child visits involving two pediatricians and twenty-two families with children aged between 0 and 18 months. Combining an ethnographic perspective and conversation analysis theoretical-analytical constructs, the micro-analysis of interactions reveals how well-child visits unfold as culture-oriented and culture-making sites. By zooming into what actually happens during these visits, the analysis shows that there is much more than the “mere” accomplishment of institutionally relevant activities like assessing children’s health or giving parents advice on baby care. Rather, through the interactional ways these institutional tasks are carried out, parents and pediatricians presuppose, ratify, and transmit culturally-informed models of “normal” growth, “healthy” development, “good” caring practices, and “competent” parenting, thereby enacting a pervasive yet unnoticed educational and moral work. Inaugurating a new promising line of inquiry within Italian pedagogical research, this study illuminates how a) pediatricians work as a “social antenna”, bridging families’ private “small cultures” and broader socio-cultural models of children’s well-being and caregiving practices, and b) parents act as agentive, knowledgeable, (communicatively) competent, and caring parents, while also sensitive to the pediatrician’s ultimate epistemic and deontic authority. I argue that a video-based, micro-analysis of interactions represents a heuristically powerful instrument for raising pediatricians’ and parents’ awareness of the educational and moral density of well-child visits. Insights from this study can constitute a valuable empirical resource for underpinning medical and parental training programs aimed at fostering pediatricians’ and parents’ reflexivity.