Have a personal or library account? Click to login
Working hours indirectly affect anxiety symptoms through sleep and stress in dentists, physicians, and psychotherapists Cover

Working hours indirectly affect anxiety symptoms through sleep and stress in dentists, physicians, and psychotherapists

Open Access
|Jun 2025

References

  1. Messenger JC, Lee S, McCann D. Working Time Around the World: Trends in Working Hours, Laws, and Policies in a Global Comparative Perspective. London: Routledge; 2007.
  2. International Labour Organization (ILO). World Employment and Social Outlook: Trends 2018. Geneva: ILO; 2018.
  3. International Labour Organization (ILO). World Employment and Social Outlook: Trends 2024. Geneva: ILO; 2024.
  4. Bannai A, Tamakoshi A. The association between long working hours and health: a systematic review of epidemiological evidence. Scand J Work Environ Health 2014;40:5–18. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5271/sjweh.3388" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5271/sjweh.3388</a></pub-id>
  5. Huang Y, Xiang Y, Zhou W, Li G, Zhao C, Zhang D, Shenying F. Long working hours and all-cause mortality in China: A 26-year follow-up study. Scand J Work Environ Health 2023;49:539–48. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5271/sjweh.4115" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5271/sjweh.4115</a></pub-id>
  6. Wong K, Chan AHS, Ngan SC. The effect of long working hours and overtime on occupational health: a meta-analysis of evidence from 1998 to 2018. Int J Environ Res Public Health 2019;16(12):2102. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.3390/ijerph1612210" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.3390/ijerph1612210</a></pub-id>
  7. Portuné R. Psychosocial risks in the workplace: an increasing challenge for German and international health protection. Arh Hig Rada Toksikol 2012;63:123–31. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.2478/10004-1254-63-2012-2212" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.2478/10004-1254-63-2012-2212</a></pub-id>
  8. Duchaine CS, Aubé K, Gilbert-Ouimet M, Vézina M, Ndjaboué R, Massamba V, Talbot D, Lavigne-Robichaud M, Trudel X, Pena-Gralle AB, Lesage A, Moore L, Milot A, Laurin D, Brisson C. Psychosocial stressors at work and the risk of sickness absence due to a diagnosed mental disorder. JAMA Psychiatry 2020;77:842–51. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1001/jamapsychiatry.2020.0322" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1001/jamapsychiatry.2020.0322</a></pub-id>
  9. Afonso P, Fonseca M, Pires JF. Impact of working hours on sleep and mental health. Occup Med 2017;67:377–82. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1093/occmed/kqx054" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1093/occmed/kqx054</a></pub-id>
  10. Kleppa E, Sanne B, Tell GS. Working overtime is associated with anxiety and depression: the Hordaland Health Study. J Occup Environ Med 2008;50:658–66. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1097/JOM.0b013e3181734330" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1097/JOM.0b013e3181734330</a></pub-id>
  11. Blomgren J, Perhoniemi R. Increase in sickness absence due to mental disorders in Finland: trends by gender, age and diagnostic group in 2005–2019. Scand J Public Health 2022;50:318–22. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1177/1403494821993705" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1177/1403494821993705</a></pub-id>
  12. Kausto J, Pentti J, Oksanen T, Virta LJ, Virtanen M, Kivimäki M, Jussi V. Length of sickness absence and sustained return-to-work in mental disorders and musculoskeletal diseases: a cohort study of public sector employees. Scand J Work Environ Health 2017;43:358–66. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5271/sjweh.3643" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5271/sjweh.3643</a></pub-id>
  13. Zechinatti AC, Belloti JC, de Moraes VY, Albertoni WM. Occupational musculoskeletal and mental disorders as the most frequent associations to worker’s sickness absence: A 10-year cohort study. BMC Res Notes 2012;5:229. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1186/1756-0500-5-229" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1186/1756-0500-5-229</a></pub-id>
  14. Dahlgren A, Kecklund G, Akerstedt T. Overtime work and its effects on sleep, sleepiness, cortisol and blood pressure in an experimental field study. Scand J Work Environ Health 2006;32:318–27. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5271/sjweh.1016" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5271/sjweh.1016</a></pub-id>
  15. Wirtz A, Nachreiner F. The effects of extended working hours on health and social well-being–a comparative analysis of four independent samples. Chronobiol Int 2010;27:1124–34. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.3109/07420528.2010.490099" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.3109/07420528.2010.490099</a></pub-id>
  16. Schiller H, Lekander M, Rajaleid K, Hellgren C, Åkerstedt T, Barck-Holst P, Kecklund G. The impact of reduced worktime on sleep and perceived stress – a group randomized intervention study using diary data. Scand J Work Environ Health 2017;43:109–16. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5271/sjweh.3610" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5271/sjweh.3610</a></pub-id>
  17. Härmä M, Kecklund G, Tucker P. Working hours and health – key research topics in the past and future. Scand J Work Environ Health 2024;50:233–43. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5271/sjweh.4157" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5271/sjweh.4157</a></pub-id>
  18. Krystal AD. Psychiatric disorders and sleep. Neurol Clin 2012;30:1389–413. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1016/j.ncl.2012.08.018" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1016/j.ncl.2012.08.018</a></pub-id>
  19. Luyster FS, Strollo PJ, Zee PC, Walsh JK. Sleep: a health imperative. Sleep 2012;35:727–34. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5665/sleep.1846" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5665/sleep.1846</a></pub-id>
  20. Nakashima M, Morikawa Y, Sakurai M, Nakamura K, Miura K, Ishizaki M, Kido T, Naruse Y, Suwazono Y, Nakagawa H. Association between long working hours and sleep problems in white-collar workers. J Sleep Res 2011;20:110–6. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1111/j.1365-2869.2010.00852.x" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1111/j.1365-2869.2010.00852.x</a></pub-id>
  21. Kalmbach DA, Abelson JL, Arnedt JT, Zhao Z, Schubert JR, Sen S. Insomnia symptoms and short sleep predict anxiety and worry in response to stress exposure: a prospective cohort study of medical interns. Sleep Med 2019;55:40–7. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1016/j.sleep.2018.12.001" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1016/j.sleep.2018.12.001</a></pub-id>
  22. Cox RC, Olatunji BO. A systematic review of sleep disturbance in anxiety and related disorders. J Anxiety Disord 2016;37:104–29. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1016/j.janxdis.2015.12.001" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1016/j.janxdis.2015.12.001</a></pub-id>
  23. Han KS, Kim L, Shim I. Stress and sleep disorder. Exp Neurobiol 2012;21:141–50. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5607/en.2012.21.4.141" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5607/en.2012.21.4.141</a></pub-id>
  24. Kalmbach D, Cuamatzi-Castelan A, Tonnu C, Tran KM, Anderson J, Roth T, Drake CL. Hyperarousal and sleep reactivity in insomnia: current insights. Nat Sci Sleep 2018;10:193–201. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.2147/NSS.S138823" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.2147/NSS.S138823</a></pub-id>
  25. McEwen BS. Sleep deprivation as a neurobiologic and physiologic stressor: allostasis and allostatic load. Metabolism 2006;55(10 Suppl 2):S20–3. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1016/j.metabol.2006.07.008" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1016/j.metabol.2006.07.008</a></pub-id>
  26. Meerlo P, Sgoifo A, Suchecki D. Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev 2008;12:197–210. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1016/j.smrv.2007.07.007" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1016/j.smrv.2007.07.007</a></pub-id>
  27. Åkerstedt T. Psychosocial stress and impaired sleep. Scand J Work Environ Health 2006;32:493–501. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5271/sjweh.1054" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5271/sjweh.1054</a></pub-id>
  28. Sanford LD, Suchecki D, Meerlo P. Stress, arousal, and sleep. Curr Top Behav Neurosci 2015;25:379–410. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1007/7854_2014_314" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1007/7854_2014_314</a></pub-id>
  29. Benham G. Sleep: an important factor in stress-health models. Stress Health 2010;26:204–14. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1002/smi.1304" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1002/smi.1304</a></pub-id>
  30. Benham G, Charak R. Stress and sleep remain significant predictors of health after controlling for negative affect. Stress Health 2019;35:59–68. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1002/smi.2840" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1002/smi.2840</a></pub-id>
  31. Japundžić I, Lugović-Mihić L, Košćec Bjelajac A, Macan J, Novak-Hlebar I, Buljan M, Zovak M, Vidović D, Trkanjec Z, Kuna M. Psychological stress and hand eczema in physicians and dentists: a comparison based on surgical work. Behav Sci (Basel) 2023;13(5):379. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.3390/bs13050379" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.3390/bs13050379</a></pub-id>
  32. Babić Ž, Japundžić-Rapić I, Lugović Mihić L, Macan J. Evaluation of skin barrier condition among physicians and dentists. Dermatitis 2024;35:70–6. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1089/derm.2023.0266" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1089/derm.2023.0266</a></pub-id>
  33. Japundžić-Rapić I, Macan J, Babić Ž, Vodanović M, Salarić I, Prpić-Mehičić G, Gabrić D, Pondeljak N, Lugović-Mihić L. Work-related and personal predictors of hand eczema in physicians and dentists: results from a field study. Dermatitis 2024;35:101–5. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1089/derm.2022.0071" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1089/derm.2022.0071</a></pub-id>
  34. Roenneberg T, Pilz LK, Zerbini G, Winnebeck EC. Chronotype and social jetlag: a (self-) critical review. Biology (Basel) 2019;8(3):54. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.3390/biology8030054" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.3390/biology8030054</a></pub-id>
  35. Roenneberg T, Wirz-Justice A, Merrow M. Life between clocks: daily temporal patterns of human chronotypes. J Biol Rhythms 2003;18:80–90. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1177/0748730402239679" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1177/0748730402239679</a></pub-id>
  36. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385–96. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.2307/2136404" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.2307/2136404</a></pub-id>
  37. Zung WW. A rating instrument for anxiety disorders. Psychosom J Consult Liaison Psychiatry 1971;12:371–9. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1016/S0033-3182(71)71479-0" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1016/S0033-3182(71)71479-0</a></pub-id>
  38. Muthén LK, Muthén BO. Mplus User’s Guide. 9<sup>th</sup> ed. Los Angeles (CA): Muthén &amp; Muthén; 1998.
  39. Kline RB. Principles and Practice of Structural Equation Modeling. 4<sup>th</sup> ed. New York (NY): The Guilford Press; 2016.
  40. Browne MW, Cudeck R. Alternative ways of assessing model fit. Sociol Methods Res 1992;21:230–58. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1177/0049124192021002005" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1177/0049124192021002005</a></pub-id>
  41. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling 1999;6:1–55. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1080/10705519909540118" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1080/10705519909540118</a></pub-id>
  42. Burnham KP, Anderson DR. Model Selection and Multimodel Inference: A Practical Information-Theoretic Approach. 2<sup>nd</sup> ed. New York (NY): Springer; 2002.
  43. Green T. A methodological review of structural equation modelling in higher education research. Stud High Educ 2016;41:2125–55. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1080/03075079.2015.1021670" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1080/03075079.2015.1021670</a></pub-id>
  44. Schermelleh-Engel K, Moosbrugger H, Müller H. Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods Psychol Res 2003;8:23–74. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.23668/psycharchives.12784" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.23668/psycharchives.12784</a></pub-id>
  45. McNeish D, Matta TH. SRMR for models with covariates. Psychometrika 2025;90:24–46. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1017/psy.2024.10" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1017/psy.2024.10</a></pub-id>
  46. Kenny DA, Kaniskan B, McCoach DB. The performance of RMSEA in models with small degrees of freedom. Sociol Methods Res 2015;44:486–507. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1177/0049124114543236" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1177/0049124114543236</a></pub-id>
  47. Hricova M, Nezkusilova J, Raczova B. Perceived stress and burnout: the mediating role of self-care and job satisfaction as preventive factors in helping professions. Eur J Ment Health 2020;15:3–22. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5708/EJMH.15.2020.1.1" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5708/EJMH.15.2020.1.1</a></pub-id>
  48. Matre D, Skogstad M, Sterud T, Nordby KC, Knardahl S, Christensen JO, Lie JS. Safety incidents associated with extended working hours. A systematic review and meta-analysis. Scand J Work Environ Health 2021;47:415–24. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5271/sjweh.3958." target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5271/sjweh.3958.</a></pub-id>
  49. Virtanen M, Ferrie JE, Gimeno D, Vahtera J, Elovainio M, Singh-Manoux A, Marmot MG, Kivimäki M. Long working hours and sleep disturbances: the Whitehall II prospective cohort study. Sleep 2009;32:737–45. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1093/sleep/32.6.737" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1093/sleep/32.6.737</a></pub-id>
  50. Virtanen M, Ferrie JE, Singh-Manoux A, Shipley MJ, Stansfeld SA, Marmot MG, Ahola K, Vahtera J, Kivimäki M. Long working hours and symptoms of anxiety and depression: a 5-year follow-up of the Whitehall II study. Psychol Med 2011;41:2485–94. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1017/S0033291711000171" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1017/S0033291711000171</a></pub-id>
  51. Drake CL, Pillai V, Roth T. Stress and sleep reactivity: a prospective investigation of the stress-diathesis model of insomnia. Sleep 2014;37:1295–304. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5665/sleep.3916" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5665/sleep.3916</a></pub-id>
  52. Taylor DJ, Lichstein KL, Durrence HH, Reidel BW, Bush AJ. Epidemiology of insomnia, depression, and anxiety. Sleep 2005;28:1457–64. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1093/sleep/28.11.1457" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1093/sleep/28.11.1457</a></pub-id>
  53. Kim S, Shin Y, Oh K, Shin D, Lim W, Kim E, Cho SJ, Jeon SW. The association of occupational stress and sleep duration with anxiety symptoms among healthy employees: A cohort study. Stress Health 2020;36:675–85. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1002/smi.2948" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1002/smi.2948</a></pub-id>
  54. Åkerstedt T, Knutsson A, Westerholm P, Theorell T, Alfredsson L, Kecklund G. Sleep disturbances, work stress and work hours: A cross-sectional study. J Psychosom Res 2002;53:741–8. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.1016/s0022-3999(02)00333-1" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.1016/s0022-3999(02)00333-1</a></pub-id>
  55. Van Laethem M, Beckers DG, Kompier MA, Dijksterhuis A, Geurts SA. Psychosocial work characteristics and sleep quality: a systematic review of longitudinal and intervention research. Scand J Work Environ Health 2013;39:535–49. doi: <pub-id pub-id-type="doi"><a href="https://doi.org/10.5271/sjweh.3376" target="_blank" rel="noopener noreferrer" class="text-signal-blue hover:underline">10.5271/sjweh.3376</a></pub-id>
DOI: https://doi.org/10.2478/aiht-2025-76-3954 | Journal eISSN: 1848-6312 | Journal ISSN: 0004-1254
Language: English, Croatian, Slovenian
Page range: 102 - 112
Submitted on: Feb 1, 2025
Accepted on: May 1, 2025
Published on: Jun 30, 2025
Published by: Institute for Medical Research and Occupational Health
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year

© 2025 Patricia Tomac, Iva Japundžić Rapić, Liborija Lugović-Mihić, Jelena Macan, Adrijana Košćec Bjelajac, published by Institute for Medical Research and Occupational Health
This work is licensed under the Creative Commons Attribution 4.0 License.