Workplace Bullying and Suicidal Ideation: A 3-Wave Longitudinal Norwegian Study

Objectives. We examined whether victimization from bullying is related to an increased risk of suicidal ideation over time and whether suicidal ideation is related to subsequent bullying.Methods. In a longitudinal study (2005–2010), we used well-established single-item measures to assess victimization from bullying and suicidal ideation. We used latent Markov models to determine forward and reverse relationships between variables at 3 time points with 2 or 3 years between the measurement points among a randomized nationwide sample of 1846 employees in Norway.Results. Victimization from bullying was associated with subsequent suicidal ideation (odds ratio = 2.05; 95% confidence interval = 1.08, 3.89). Suicidal ideation at baseline was not related to subsequent victimization from workplace bullying.Conclusions. Workplace bullying may be a precursor to suicidal ideation, whereas suicidal ideation seems to have no impact on subsequent risk of being bullied. Regulations against bullying should be integrated into work-related legislation and public health policies.Suicide is a leading cause of death around the globe. Estimates show that more than 800 000 people take their own lives every year.1 In Norway (with a population of 5 165 802) there are about 530 reported suicides every year.2 In the United States, 12 suicide deaths per 100 000 people were reported in 2010, making suicide the 10th leading cause of death among Americans.3 Altogether, 1719 employees committed suicide in US workplaces between 2003 and 2010.4Although psychiatric disorders are involved in the majority of suicide attempts,5 most psychiatric patients do not commit suicide. A psychiatric disorder alone is, therefore, an insufficient condition for suicide.6 To identify other risk factors, we must look beyond the presence of a psychiatric syndrome and understand the underlying factors of suicide and suicidal ideation. Among many potential causes, exposure to workplace bullying has been proposed to be an important predictor of both suicidal ideation and actual suicide.7,8To date, bullying as an antecedent to suicide has been examined only with anecdotal evidence9,10 and cross-sectional research designs.11,12 Einarsen et al.13 established that severely bullied workers were 6 times more likely than nonbullied workers to report suicidal ideations. Sterud et al.8 found that workplace bullying was positively associated with suicidal ideation in a nationwide sample of 1022 Norwegian ambulance personnel. Bullying was more strongly associated with suicidal ideation than were gender, neuroticism, anxiety, somatic complaints, depersonalization, and job dissatisfaction.Cross-sectional research cannot provide adequate evidence for anything more than that suicidal ideation is a correlate of bullying. To understand the directional nature of the association, longitudinal research is needed. In this representative, longitudinal study, we contribute to the literature by examining whether victimization from bullying is related to increased risk of suicidal ideation over time and whether suicidal ideation is related to subsequent bullying.Workplace bullying refers to a situation in which 1 or several individuals persistently perceive themselves to be on the receiving end of negative actions from superiors or co-workers and in which the targets find it difficult to defend themselves against these actions.14,15 Following this definition, there are 3 main characteristics of workplace bullying: (1) an employee becomes the target of systematic negative and unwanted social behavior in the workplace; (2) the exposure occurs over a prolonged period, often with ever more escalating intensity and frequency in the attacks; and (3) targets feel they cannot easily escape the situation or stop the unwanted treatment. This third characteristic, the feeling of being victimized by the harassment, distinguishes bullying from other forms of mistreatment in the workplace.15 Globally, about 11% of workers perceive themselves as victims of bullying,16 and 5% of the Norwegian working population is victimized by bullying at any time.17The interpersonal theory of suicide (ITS)5 provides a theoretical foundation for how exposure to such bullying may be related to suicide. The theory posits that fundamental to suicidal ideation and behavior is that an individual has both the desire and the ability to die by suicide.18 With regard to the desire to die, displayed through suicidal ideation, the ITS asserts that when people over a prolonged period perceive themselves to be socially alienated from others and simultaneously feel that they are a burden on others, they develop a desire for death.19 As for the ability to commit suicide, displayed through suicidal behavior, the ITS proposes that people who are repeatedly exposed to painful and provocative events will lose any fear of pain, injury, and death and thereby be able to overcome the instinct of self-preservation.Because of its focus on persistent exposure to painful events and social alienation, the ITS strongly suggests that repeated and long-term exposure to negative treatment and social exclusion from one’s peers or supervisors at work constitutes a risk factor for suicidal ideation and behavior.Although previous research has assumed bullying to be an antecedent to suicidal ideation, it is possible that the established cross-sectional association reflects a relationship in which suicidal ideation is a precursor to bullying. Two different mechanisms can explain such a reverse association. First, employees with suicidal ideation may report less favorable work characteristics because their distress makes them evaluate their work environment increasingly more negatively.20 Second, employees with suicidal ideations may elicit aggressive behavior in others because their psychological state creates aversive feelings among co-workers and supervisors.21,22To provide better indications of how workplace bullying is related to suicidal ideation, we investigated direct forward and reverse associations with longitudinal data. We tested the following hypotheses:

• Hypothesis 1: Victimization from bullying is associated with an increased risk of later suicidal ideation.
• Hypothesis 2: Suicidal ideation is associated with an increased risk of later victimization from bullying.

     

Relationship between blood pressure and in vivo action of insulin in type II (non-insulin-dependent) diabetic subjects.

In nondiabetic hypertensive subjects, a relationship has been found between insulin resistance and level of blood pressure. Since type II (non-insulin-dependent) diabetic subjects are often both insulin-resistant and hypertensive, we studied the relationship between insulin resistance and blood pressure level in a group of patients with type II diabetes. Fourteen women and 19 men with diabetes for 2 to 14 (mean, 7.4) years, treated with diet alone (five subjects) or combined with hypoglycemic agents, were studied. Their average hemoglobin A1c (HbA1c) levels during the study period were 6.6% to 11.7% (mean, 8.6%), and their body mass indexes (BMI) were 20.8 to 33.1 (mean, 26.3) kg/m2. Insulin sensitivity was measured using the hyperinsulinemic, euglycemic glucose clamp technique, and an insulin-sensitivity index was calculated as the ratio of the glucose disposal rate (GDR) to the insulin concentration during clamp (GDR/I). The average of three to eight measurements of diastolic blood pressure (DBP) during the study period (9 to 24 months) in each subject was 79 to 111 (mean, 95.1) mm Hg, and DBP also showed significant correlations to BMI (r = .54) and fasting C-peptide level (r = .38). In a multiple regression model, GDR/I, antihypertensive treatment, and known duration of diabetes were significant and independent predictors of variations in blood pressure, and GDR/I could account for 35% of the observed variations in DBP. We conclude that, in accordance with what has been found in nondiabetic hypertensives, DBP correlates significantly to insulin resistance in type II diabetic subjects.     

NIDDM: a rapid progressive disease Results from a long-term,randomised, comparative study of insulin or sulphonylurea treatment

Summary The objective of the present study was to assess the relative efficacy of insulin or glibenclamide treatment for non-insulin-dependent diabetes mellitus (NIDDM) over 42 months. We performed a randomised, controlled trial allocating patients treated with diet and oral antihyperglycaemic agents to treatment with glibenclamide or insulin to achieve HbA_1c levels under 7.5 %. We included 36 subjects with established NIDDM of more than 2 years' duration. Mean HbA_1c levels were significantly reduced in patients allocated to insulin treatment from 9.1 ± 1.4 % before the start to 7.8 ± 1.3 % (p< 0.05) after 1 year, and did not change significantly thereafter throughout the study period. Mean HbA_1c levels increased during the study in the patients allocated to glibenclamide treatment, and 11 of 18 patients had to be switched to insulin treatment due to increasing hyperglycaemia (HbA_1c > 10 %). Mean body weight increased in the subjects allocated to insulin by 7.2 ± 4.1 kg during the study period. In conclusion, insulin was more effective than glibenclamide treatment in obtaining control over hyperglycaemia in these patients, and once improved, glycaemic control did not deteriorate over 42 months in the insulin-treated group. Two thirds of the patients allocated to glibenclamide treatment had to be given insulin due to inadequate glycaemic control. [Diabetologia (1996) 39: 1629–1633]     

Cardiovascular and Renal Disease Burden in Type 1 Compared With Type 2 Diabetes: A Two-Country Nationwide Observational Study

OBJECTIVEType 1 diabetes (T1D) and type 2 diabetes (T2D) increase risks of cardiovascular (CV) and renal disease (CVRD) compared with diabetes-free populations. Direct comparisons between T1D and T2D are scarce. We examined this by pooling full-population cohorts in Sweden and Norway.RESEARCH DESIGN AND METHODSA total of 59,331 patients with T1D and 484,241 patients with T2D, aged 18–84 years, were followed over a mean period of 2.6 years from 31 December 2013. Patients were identified in nationwide prescribed drug and hospital registries in Norway and Sweden. Prevalence and event rates of myocardial infarction (MI), heart failure (HF), stroke, chronic kidney disease (CKD), all-cause death, and CV death were assessed following age stratification in 5-year intervals. Cox regression analyses were used to estimate risk.RESULTSThe prevalence of CV disease was similar in T1D and T2D across age strata, whereas CKD was more common in T1D. Age-adjusted event rates comparing T1D versus T2D showed that HF risk was increased between ages 65 and 79 years, MI between 55 and 79 years, and stroke between 40 and 54 years (1.3–1.4-fold, 1.3–1.8-fold, and 1.4–1.7-fold, respectively). CKD risk was 1.4–3.0-fold higher in T1D at all ages. The all-cause death risk was 1.2–1.5-fold higher in T1D at age >50 years, with a similar trend for CV death.CONCLUSIONSAdult patients with T1D compared with those with T2D had an overall greater risk of cardiorenal disease (HF and CKD) across ages, MI and all-cause death at middle-older ages, and stroke at younger ages. The total age-adjusted CVRD burden and risks were greater among patients with T1D compared with those with T2D, highlighting their need for improved prevention strategies.     

Parental origin of mutation and the risk of breast cancer in a prospective study of women with a BRCA1 or BRCA2 mutation

The objective is to estimate the risk of breast cancer in women who carry a deleterious BRCA1 or BRCA2 mutation, according to parental origin of mutation. We conducted a cohort study of women with a BRCA1 mutation (n = 1523) or BRCA2 mutation (n = 369) who had not been diagnosed with breast or ovarian cancer. For each woman, the pedigree was reviewed and the origin of the mutation was assigned as probable paternal or maternal. The hazard ratio (HR) for developing breast cancer in the follow‐up period was estimated for women with a paternal mutation compared to a maternal mutation. The risk of breast cancer was modestly higher in women with a paternal BRCA1 mutation compared to women with a maternal BRCA1 mutation (HR = 1.46; 95% CI = 0.99–2.16) but the difference was not significant (p = 0.06). The parental mutation origin did not affect the risk in women with a BRCA2 mutation. Our results are consistent with the hypothesis that there is an increased risk of breast cancer among women with a paternally inherited BRCA1 mutation compared to a maternally inherited mutation. However, the data are not sufficiently compelling to justify different screening recommendations for the two subgroups.     

To tell or not to tell – what to do about p.C282Y heterozygotes identified by HFE screening

Hereditary hemochromatosis (HH) is a common preventable disorder of iron overload that can result in liver cirrhosis and reduced lifespan. Most HH is due to homozygosity for the HFE p.C282Y substitution. We conducted a study of screening for p.C282Y in high schools where p.C282Y heterozygotes (CY) individuals were informed of their genotype by letter. We studied whether these individuals understood the implications of their genotype, whether this resulted in anxiety or reduced health perception and whether cascade testing was higher in families of CY than wild‐type homozygous (CC) individuals. We found 586 of 5757 (1 in 10) screened individuals were CY. One month after receiving their result, 83% correctly answered that they have one copy of p.C282Y. There was no adverse change in anxiety or health perception from prior to screening to 1 month after receiving results. Significantly more family members of CY individuals than CC individuals were informed about HH and had testing for HH. In conclusion, we found that informing CY individuals of their genotype does not increase anxiety and the implications are generally well understood. This leads to cascade testing in a minority of families. CY individuals should be informed of their genetic status when identified by population screening.     

Molecular heterogeneity in acute leukemia lineage switch

Six cases of acute leukemia that underwent lineage switch from acute lymphocytic leukemia to acute myelogenous leukemia are reported. The mean age of the patients was 24 years, time to conversion was 36 months, and survival after conversion was only 3 months. Of the three cases which showed abnormal metaphases at both diagnosis and conversion, two (cases 2, 5) showed related cytogenetic abnormalities, and the third showed (case 3) independent chromosomal changes. Molecular analysis for immunoglobulin heavy chain and T-cell receptor beta chain genes showed that five of the six cases had rearrangement of at least one of these lymphoid associated genes at conversion to acute myelogenous leukemia. The single case (case 3) in which there were no lymphoid gene rearrangements at conversion was also the only case in which independent karyotypic abnormalities at diagnosis and conversion were demonstrated. Our findings suggest that lineage switch can represent either relapse of the original clone with heterogeneity at the molecular level or the emergence of a second new leukemic clone without molecular heterogeneity.     

宫内炎症暴露对早产儿固有免疫应答的影响

目的探讨宫内炎症暴露对早产儿固有免疫应答的影响。方法 2013年6月至2014年6月出生、胎龄35周的早产儿47例纳入本研究。依据胎盘病理检查结果,将早产儿分为宫内炎症阳性组和阴性组。采用Ficoll密度梯度离心法和贴壁黏附法分别获得脐血单个核细胞以及单核细胞。用内毒素(LPS,100 ng/ml)刺激单个核细胞12 h后,流式细胞术(PCR)检测CD14+单核细胞HLA-DR的表达量以及CD3+CD4+/CD3+CD8+的比例。用LPS(100 ng/ml)刺激单核细胞6 h后,Real-Time PCR检测单核细胞IL-1β、IL-6、IL-10、TNF-αm RNA表达量的变化。ELISA检测脐血以及单核细胞培养上清液中IL-1β、IL-6、IL-10和TNF-α水平。结果宫内炎症阳性组脐血血浆IL-6水平高于宫内炎症阴性组,差异有统计学意义(P=0.001)。LPS刺激后,两组单核细胞IL-1β、IL-6、IL-10、TNF-αm RNA表达量及培养上清液中蛋白水平均显著升高,与刺激前比较差异均有统计学意义(P0.05);但两组间比较差异均无统计学意义(P0.05)。LPS刺激后,宫内炎症阳性组CD14+单核细胞HLA-DR表达量显著降低,而宫内炎症阴性组则显著升高,与刺激前比较差异均有统计学意义(P0.05);且阳性组HLA-DR表达量显著低于阴性组(P=0.002)。结论宫内炎症暴露并不影响早产儿脐血单核细胞对LPS的应答反应水平,但可抑制单核细胞激活后主要抗原递呈受体的表达。     

Search for intrafamilial transmission of hepatitis C virus in hemophilia patients

This study was performed to determine the risk of family members of anti-hepatitis C virus (HCV)-positive hemophilia patients (index patients) for infection with HCV compared with the risk of acquiring hepatitis B virus (HBV), human immunodeficiency virus (HIV), and hepatitis A virus (HAV) infection. All index patients (n = 141) were found to be positive by first and second generation anti-HCV enzyme immunoassays (EIAs). Among their household contacts (n = 228), 224 were negative and 1 positive by both assays. Three contacts gave positive results in first generation anti-HCV EIA and negative results in second generation assay. This latter result was confirmed by further tests (neutralization test, synthetic peptides, and supplemental assay). Percent positivity for anti-HBc was about the same in non-sexual household contacts and sexual partners (13 of 109 [12%] and 7 of 54 [13%], respectively). Percent prevalence of anti-HBc was higher in contacts of index patients with chronic hepatitis B than in those of index patients who had recovered from that disease (6 of 20 [30%] and 14 of 133 [10%], respectively; P < .05). The HBV infection rate of contacts participating in controlled self-treatment was not higher than that of controls (3 of 57 [5%] and 10 of 98 [10%], respectively). Of 44 sexual partners, 5 (11%) were found to be positive for anti-HIV. Prevalence of anti-HAV matched with the age-related distribution in the German population. These findings suggest that intrafamilial transmission of HCV to family members of hemophilia patients is uncommon. In contacts of hemophilia patients, the risk of acquiring HBV infection seems to be as high in household contacts as in sexual contacts. Participation in controlled self-treatment does not appear to be an additional risk for HCV and HBV infection. There is no doubt that sexual transmission of HCV is less common than that of HBV and HIV.