Associations Of Organizational Justice With Tinnitus And .
Int.J. Behav. Med.DOI 10.1007/s12529-015-9505-zAssociations of Organizational Justice with Tinnitusand the Mediating Role of Depressive Symptomsand Burnout—Findings from a Cross-Sectional StudyRaphael M. Herr 1,2 & Adrian Loerbroks 3 & Jos A. Bosch 1,2 & Max Seegel 1 &Michael Schneider 1 & Burkhard Schmidt 1# International Society of Behavioral Medicine 2015AbstractBackground Tinnitus refers to the perception of a sound whilean external source is absent. Research has identified workrelated stress and its potential mental health-related sequelaes,i.e., depression and burnout, as risk factors for tinnitus.Perceived unfairness at work (organizational injustice), whichis considered a psychosocial occupational stressor, has beenshown to predict depression and burnout but its potentialassociations with tinnitus remains unaddressed.Purpose The aim was to determine the relationship of organizational injustice with tinnitus, and to examine depressionand burnout as potential mediators.Method Cross-sectional data from a sample of 1632 employeeswere used. Tinnitus was assessed by self-report (n 207;13.9 %). Organizational justice and its subcomponents (interactional and procedural justice), burnout, and depressive symptoms were measured by validated questionnaires. Associationswere assessed by logistic regressions, and mediation wasassessed by maximum likelihood logistic regression estimations.Results Overall organizational justice, interactional and procedural justice were inversely related to tinnitus (z-score foroverall justice: OR 0.754; 95 % CI 0.649 to 0.876). Theseassociations were independent of demographics,* Raphael M. Herrraphael.herr@medma.uni-heidelberg.de1Mannheim Institute of Public Health, Social and PreventiveMedicine, Medical Faculty Mannheim, Heidelberg University,Ludolf-Krehl-Straße 7-11, 68167 Mannheim, Germany2Department of Clinical Psychology, University of Amsterdam,Weesperplein 4, 1018 XA Amsterdam, The Netherlands3Institute of Occupational and Social Medicine, Centre for Health andSociety, Faculty of Medicine, University of Düsseldorf,Universitätsstrasse 1, 40225 Düsseldorf, Germanysocioeconomic status, job characteristics (including potentialnoise exposure), and health behaviors. Mediation analysessuggested a potential mediation by burnout (95 % CI indirecteffect 0.188 to 0.066) and depressive symptoms (95 % CIindirect effect 0.160 to 0.043). Parallel multiple mediationanalysis revealed that mediation through burnout was significantly larger than through depressive symptoms.Conclusion Organizational justice appeared inversely relatedto tinnitus and this association was explained by individualdifferences in burnout symptoms, suggesting mediation. Longitudinal studies may further help to strengthen the evidencebase for prevention of tinnitus through promotion of organizational justice and prevention of burnout.Keywords Tinnitus . Organizational justice . Work stress .Depressive symptoms . Burnout . MediationIntroductionTinnitus is defined as the conscious perception of an auditorysensation in absence of an external stimulus. Tinnitus represents an increasing concern in public health due to its considerable prevalence (i.e., 10 to 15 % among the adult population) and due to its property of increasing the risk of sleepingproblems, cognitive complaints, anxiety, depression, restrictedparticipation in social life, inability to work, and reduced efficiency [1, 2].Studies have demonstrated associations between psychological distress and tinnitus [3–5]. To the best of our knowledge, the current evidence on the role of work stress is restricted to only two studies [4, 6]. One study found that stress due toperceived job insecurity showed a significantly elevated prevalence of hearing problems (i.e., tinnitus and/or hearing loss)[4]. The other study used a single-item overall rating of work
Int.J. Behav. Med.stress (BHow frequently do you feel stressed at work? ). Theresults show that employees reporting frequent or constantstress at work were twice as likely to report tinnitus comparedto people reporting lower stress levels [6]. These preliminaryfindings warrant a more detailed examination of the role ofwork stress. A specific limitation of earlier work is that ratherrough indicators of work stress were used, e.g., a single itemrating the threat of getting fired [4] or the unspecific frequencyof feeling stressed out [6]. However, the utilization of moredetailed and more established work stress measures—like organizational justice—which have been shown to predict multiple health outcomes in occupational cohorts [7] could expand current evidence and would be more informative forthe identification of targets and strategies for effectiveintervention.The concept of organizational justice represents one of thekey work stress models. Organizational justice conceptualizesperceived fairness at the workplace by three dimensions: distributive, interactional, and procedural justice, with the lattertwo having been identified as most relevant to health [8, 9].Distributive justice refers to the fair allocation of outcomes,while procedural justice characterizes the fairness of thedecision-making process [10, 11], and interactional justicedescribes the fairness of interpersonal interactions with superiors [12]. Prospective studies documented that organizationaljustice predicts depression [13–18] and emotional exhaustion/burnout [13, 19–21], which have all been associated withtinnitus [4, 22–25]. However, the association of organizationaljustice with tinnitus has hitherto not been tested.In view of organizational justice as key determinant ofwork stress, the first aim of the present study was to determinewhether organizational justice is associated with tinnitus. Asecond aim was to examine whether depressive symptomsand/or burnout mediate this association.MethodsStudy PopulationA cross-sectional online survey covering psychosocial workfactors and health was conducted among employees of a largepharmaceutical company in Germany in October 2013. A random sample of 4027 individuals was drawn from the wholeworking population (n 7235). Members of the sample wereinvited by e-mail to participate in an online survey coveringdemographics, psychosocial work conditions, health-relatedlifestyles, and health. The e-mail comprised information onthe study background, its content and data protection. Ananonymous link referred participants to the online survey ofa trustee company. A total of 1632 employees (response rate40.5 %) completed the questionnaire and provided writteninformed consent. The ethical committee of the MedicalFaculty Mannheim of the University of Heidelberg approvedthe study.MeasurementsOrganizational Justice A previously validated scale assessedorganizational justice, consisting of seven items for interactional justice and four items for procedural justice [9]. Participants rated on a five-point Likert scale to what extent eachstatement applied to their work situation (ranging from 1 does not apply at all to 5 applies completely). A total organizational justice score (Cronbach’s α 0.92), as well as aninteractional (Cronbach’s α 0.89) and procedural(Cronbach’s α 0.89) subscore were calculated by averagingcorresponding items. Higher values indicate more perceivedjustice. Additionally, scores were categorized into tertiles.Proposed Mediators: Burnout and Depressive SymptomsThe Copenhagen Burnout Inventory (CBI) assessed personalburnout [26]. The six items of the CBI (Cronbach’s α 0.90)inquire how often the respondent feels tired, physicallyexhausted, emotionally exhausted, worn out, weak and susceptible to illness, and how often that respondent thinks: BIcan’t take it anymore. Answers were rated on a five-pointLikert scale (ranging from 1 never to 5 always). Highervalues on the average score indicated higher levels of burnoutsymptoms. Depressive symptoms were assessed by the corresponding subscale of the German version of the Hospital Anxiety and Depression Scale (HADS) [27], which has shown itsvalidity in general population samples [28]. The depressionscale consist of seven items (Cronbach’s α was 0.88), whichare to be answered on a four-point Likert scale ranging from0 mostly to 3 not at all. A sum depression score was computed (ranging from 0 to 21) and higher values indicate moredepressive symptoms.Tinnitus Tinnitus was assessed by a single item included in ageneral symptom checklist (BPlease mark in the following listyour current diseases. Please also indicate if a physician hasdiagnosed or treated these diseases ). The response categorieswere Bno, Byes, physician-diagnosed or treated, and Byes,self-assessed. Participants indicated whether Btinnitus (persistent sound in the ears) was present. The response optionsByes, physician-diagnosed or treated or Byes, self-assessed accordingly defined presence of tinnitus, and the responseoption Bno absence of tinnitus.Confounder Confounders measured in the study includedsociodemographic factors, job characteristics, and lifestylefactors. Marital status was categorized by two (married vssingle, divorced or widowed) and education by three categories (low, intermediate, high). Concerning job characteristics,job position (head of department, team leader, employee),
Int.J. Behav. Med.symptoms. In the second step, a parallel multiple mediation was estimated by including burnout and depressivesymptoms simultaneously to statistically compare theirpotential indirect effects.employment status (part-time employee yes vs no), shift-work(yes vs no), and place of work (office, laboratory, productionplant) were assessed. Lifestyle factors included smoking status (never smoker, ex smoker, current smoker), alcohol consumption (no, occasional, regular alcohol consumption), andphysical exercise (no exercise, less 1 h/week, 1–2 h/week,more than 2 h/week). Body mass index (BMI) was calculatedbased on participant reports of their height and weight.ResultsData AnalysisCharacteristics of ParticipantsThe analytical strategy comprised two steps. In the first step,hierarchical logistic regression analyses were computed to estimate the association of organizational justice with tinnitus.In the second step, the mediating role of depressive symptomsand burnout was examined.Hierarchical logistic regression models quantified associations of organizational justice, as well as its interactional and procedural subcomponent, with tinnitus. Four statistical models were estimated with tinnitus on the onehand as categorical (i.e., tertiles) and on the other handas continuous (i.e., z-score) independent variable. Splittingvariables into three or more categories provides better illustration of potential dose-response relationships than continuous exposures, which represent a criterion possiblysupporting causal interpretation of observed associations[29]. The first model was adjusted for age and gender.The second model additionally controlled forsociodemographic factors (i.e., marital status and educational level). In the third model, job characteristics (occupation, job position, shift work, employment status) wereadded. The final model (model four) additionally comprised lifestyle factors (i.e., smoking, alcohol consumption,physical exercise, BMI). These analyses were run usingSPSS, version 21 (SPSS Inc., Chicago, IL, USA).To test the hypothesis that the association betweenorganizational justice and tinnitus is mediated by burnout and/or depressive symptoms, mediation models werespecified using the PROCESS macro for SPSS (release2.041) by Hayes [30, 31]. This procedure employs maximum likelihood logistic regression estimations to compute direct and indirect effects with bias-corrected bootstrap 95 % confidence intervals (BCb 95 % CI) using5000 bootstrap samples. This nonparametric test doesnot violate the assumption of normal distribution, allowsmediation analyses using dichotomous outcome variables, and has advantageous compared traditional approaches (e.g., more statistical power and quantificationof intervening effects) [32, 33]. The organizational justice, burnout, and depressive symptom variables werecentered by z-transformation for statistical analyses. Ina first step, two simple mediation models were estimated, specified separately for burnout and depressiveRoughly half of the study population was male and theaverage age equaled 41 years (Table 1). Most participants were married (60 %) and had attained higher educational school degrees (59 %). The majority ofTable 1Participants characteristicsMean or %SD or nOrganizational justice3.530.72Tinnitus (yes)MaleAge (years)MarriedEducation13.9 %51.6 %41.3560.2 %2078379.4197211.1 %29.5 %59.4 atoryProductionJob positionHead of departmentTeam leaderEmployeePart-timeShift-workBody mass indexPhysical activity: nonePhysical activity: less 1 h/weekPhysical activity: 1-2 h/weekPhysical activity: more than 2 h/weekNonsmokerEx-smokerSmokerNo alcohol consumptionOccasional alcohol consumptionRegular alcohol consumptionPersonal burnoutDepressive symptoms68.6 %111019.6 %11.9 %3171929.5 %11.0 %79.5 %153177128016.6 %7.5 %25.412.4 %21.3 %36.6 %29.7 %57.7 %26.8 %15.5 %14.3 %74.5 %11.2 0.84.08
Int.J. Behav. Med.Table 2Logistic regression models (odds ratios and 95 % confidence intervals) of organizational justice and its dimensions on tinnitusModel 1Model 295 % CIORLowerModel 395 % CIUpperORLowerModel 495 % CIUpperORLower95 % CIUpperORLowerUpperOrganizational justiceLowest 23.08Middle tertileHighest 10.932.09Test for 10.750.650.870.0010.750.650.88Lowest tertileMiddle .27Highest tertileTest for 0.910.790.680.92Interactional JusticeLowest tertile1.86Middle tertile1.38Highest .660.860.650.860.640.860.650.87Procedural JusticeTest for 410.0070.0090.75Model 1: adjustment for age and gender; model 2: model 1 additional adjustment for sociodemographic factors (marital status and educational level);model 3: model 2 additional adjustment for job characteristics (occupation, job position, shift work, employment status); model 4: model 3 additionaladjustment for lifestyle factors (smoking, alcohol consumption, physical exercise, BMI)participants were regular employees rather than teamleaders or department heads (80 %), were full-timeemployed (83 %), did not do shift work (93 %), andmostly worked in offices (69 %). With regard to healthylifestyles, most participants had never smoked (58 %),engaged into at least 1-h physical activity per week(66 %), and consumed alcohol occasionally (75 %).The average BMI was 25 kg/m2. The mean values were3.5 for organizational justice, 2.7 for personal burnout,and 5.2 for depressive symptoms. Overall, 13.9 % (n 207) reported the presence of tinnitus.Table 3 Bivariate (under thediagonal) and partial (above thediagonal) correlations for tinnitus,organizational justice, depressivesymptoms, and burnoutTinnitusTinnitusOrganizational justiceDepressives symptomsBurnout 0.1000.1360.129Association of Organizational Justice with TinnitusLogistic regressions suggested that organizational justiceis inversely related to tinnitus (z-score: OR 0.754;95 % CI 0.649 to 0.876). Individuals with scores inthe lowest organizational justice tertile were twice aslikely to perceive tinnitus than those in the highesttertile (Table 2). The subdimensions of organizationaljustice showed similar association with tinnitus: personsin the lowest procedural and interactional tertile hadincreased odds of reporting tinnitus ( 1.7-fold andOrganizational justiceDepressives symptomsBurnout 0.0970.123 0.3570.146 0.3200.672 0.373 0.3250.666n 1430. All correlations p 0.001 (two-tailed). Partial correlations were adjusted for health behaviors, jobcharacteristics, and sociodemographic variables. Organizational justice, depressive symptoms, and burnout werez-scores
Int.J. Behav. b1*Indirect effect: -.12***bTotal effect (C1): -.28***Direct effect ivesymptoms.29*:a1Indirect effect: -.10***.05*-.1Depressivesymptoms:b1**c8Total effect (C1): -.28***Direct effect 5**:a2The current study documents an inverse association of organizational justice with tinnitus. Mediation analyses demonstrated that this association was partly accounted for by individual differences in depressive symptoms and, in particular,burnout. Except for representing the first study on organizational justice and tinnitus, a specific contribution of our studyis that we utilized an established theory-based work stressTotal effect (C1): -.28***Direct effect (C1.3Discussiona:a1As shown in Table 3, tinnitus was negatively correlated withorganizational justice and showed positive associations withburnout and depressive symptoms. Organizational justice wasinversely associated with burnout and depressive symptoms(r 0.32, p 0.001). Burnout was strongly correlated withdepressive symptoms (r 0.67, p .001). All associations wereindependent of sociodemographic variables, health behaviors,and job characteristics.Figure 1 shows the results of the adjusted simple mediationmodels for burnout (Fig. 1a), and depressive symptoms(Fig. 1b), as well as the multiple mediation of burnout anddepressive symptoms (Fig. 1c) of the association betweenorganizational justice and tinnitus. Organizational justicewas inversely related to burnout (Fig. 1a, a 1 0.31,p 0.0001), which, in turn, was positively associated with tinnitus (b1 0.40, p 0.0001). The direct effect of organizationaljustice on tinnitus was not significant (p 0.058); however, theindirect effect was (effect 0.12, BCb 95 % CI 0.188 to 0.066, Sobel test: p 0.0001). There was also a negativeassociation of organizational justice with depressive symptoms (Fig. 1b, a1 0.35, p 0.0001). Depressive symptomswas positively related to tinnitus (b1 0.29, p 0.0004). Thedirect effect of organizational justice on tinnitus was 0.17(p 0.038) and the indirect was 0.10 (BCb 95 % CI 0.160to 0.043, Sobel test: p 0.0006). The parallel multiple mediation analysis (Fig. 1c) indicated that the direct effect of organizational justice on tinnitus was not significant ( 0.14, p 0.101) but the total mediation effect was ( 0.14, BCb 95 % CI 0.207 to 0.070). Indirect effects revealed that only burnoutwas a mediator between organizational justice and tinnitus( 0.11, BCb 95 % CI 0.188 to 0.038). The specific indirecteffect through burnout was significant larger than the specificindirect effect through depressive symptoms (contrast: BCb95 % CI 0.201 to 0.003). Stratified analyses for the organizational justice subdimension revealed similar patterns.1:Mediation of the Association of Organizational Justicewith Tinnitus by Burnout and Depressive Symptomsmodel. According to organizational justice work stress occuron multi dimensions due to the (in-)appropriateness of interpersonal treatment and procedure-related unfair allocation ofoutcomes. Both the perceived fairness of procedures (i.e., procedural justice) as well as the fairness related to personal interactions (i.e., interactional justice) were associated witha 1.9-fold, respectively). A positive linear trend acrossthe tertiles of organizational justice and tinnitus wasfound.Indirect effects:Total: -.14***BurnoutTinnitus: -.11**OJOJBurnoutDepressiveTinnitus: -.02symptomsOJDepressive symptomsTinnitus: -.01Fig. 1 Simple mediation analyses of burnout (a) and de
mediation analyses using dichotomous outcome vari- ables, and has advantageous compared traditional ap- proaches (e.g., more statistical power and quantification
Mr.Justice Sh.Riaz Ahmed, HCJ Mr.Justice Munir A.Sheikh Mr.Justice Iftikhar Muhammad Chaudhry Mr.Justice Qazi Muhammad Farooq Mr.Justice Mian Muhammad Ajmal Mr.Justice Syed Deedar Hussain Shah Mr.Justice Hamid Ali Mirza Mr.Justice Abdul Hameed Dogar Mr.Justice Muhammad Nawaz Abbasi CONSTITUTION PETITION NO.15 OF 2002
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and Job Satisfaction on Organizational Commitment, and its implementation on Organizational Citizenship Behavior (OCB)". The purpose of this study is to find out and explain: (1) the effect of organizational culture on organizational commitment, (2) the effect of job satisfaction on organizational commitment,
several authors that organizational values influence organizational structure (Walsh et al. 1981, Kabanoff et al. 1995), organizational culture (Pettigrew, 1979), organizational identity (Ashforth & Mael, 1989), organizational strategy (Ban
culture, organizational commitment, and employee performance can satisfy customers. Leadership is associated with organizational outcomes such as team effectiveness and organizational performance (Chen, Kirkman, Kanfer, Allen and Rosen, 2007; Lin, 2009). Servant leadership in organizational culture and organizational commitment
The role of organizational resources and environment in Organizational performance and customer loyalty; service climate as mediator: A Study of Telecommunication . The organizational climate is based on beliefs among the employees according to organizational policies, procedures, and practice that are supported and rewarded (Randhawa and .
