Norway: Mental distress causes found

Symptoms of mental distress were reported by 1 in 10 Norwegian employees in a recent survey. It found the greatest risk factor at work for anxiety and depression was ‘role conflict’ (receiving incompatible requests from two or more people). A good social climate and empowering leadership helped reduce the risk of mental distress.

New risk factors for workplace mental distress

In a recent study on Norwegian employees, more than 1 in 10 reported having symptoms of anxiety and depression severe enough to hamper their work and to need treatment. This study investigated the relation between a broad set of specific psychological and social work factors and potentially clinically relevant mental distress. The most important risk factor was role conflict. The most significant protective factors were support from immediate superiors, fair leadership, and a factor the study authors called 'positive challenge'.

Mental health problems represent an increasingly important public health challenge, especially in middle- and high-income countries, according to the World Health Organization. Although employment is commonly assumed to promote health, the psychosocial quality of work can badly affect mental health.

Long-term studies have shown that anxiety and depression can be caused by:

  • high demands on workers;
  • low control;
  • low social support;
  • an imbalance in effort/reward;
  • organisational injustice;
  • job insecurity;
  • undesirable work events;
  • bullying.

However, although these studies have contributed much to current knowledge, it has meant that other work factors have not been fully explored.

About the study

The present study looked at 19 specific factors, many more than previous studies and including some that had not previously been investigated. It found that four were statistically significant predictors of anxiety and depression, or of their absence. Role conflict was associated with increased odds of mental distress. Support from an immediate superior, fair leadership, and positive challenge lowered the likelihood of such problems.

Overall, role conflict, rumours of change, procedural injustice, observed bullying and experienced bullying increased the likelihood of mental distress. Decision control, role clarity, support from immediate superior, empowering leadership, fair leadership, predictability during the next month, commitment to organisation, positive challenge, human resource primacy, and social climate were associated with decreased likelihood.


Participants in the study were followed for a two-year period. In all, 9,304 employees were invited to take part in the survey at two points in time. Of these, 3,644 (39.2%) responded to both requests. The data were collected by survey.

Respondents were recruited from 48 Norwegian organisations (31 private and 17 public). Baseline data were collected between November 2004 and June 2009, and follow-up data between September 2006 and June 2011. The organisations included municipalities, an insurance company, public organisations, health institutions, and educational institutions, representing a wide variety of job types.

Employees and management were informed of the project at the organisational level. The organisations supplied lists of names, addresses, gender, age, personal identification numbers, departmental affiliation, and classification of the occupations of all their employees. Subsequently, all employees were mailed letters about the purpose of the study and given either a personal access code to the web-based questionnaire or a paper version of the questionnaire.


The prevalence of potentially clinically relevant mental distress was 11.9% (N = 432). This is similar to the prevalence observed in a representative sample of the Norwegian population. The incidence of mental distress during the follow-up period was 6.8% (N = 219).


To the authors’ knowledge, this is the first long-term study that has investigated such a broad set of specific psychological and social work factors as predictors of potentially clinically relevant mental distress (anxiety and depression).

The results show that it is important for future studies to broaden their scope and provide knowledge for designing workplace interventions that could reduce employees’ mental distress.

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