Context-free wellbeing and health outcomes

Psychological wellbeing. According to DIENER et al. (1999) wellbeing is a broad construct consisting of four distinct components. These are pleasant affect or positive wellbeing, unpleasant affect or psychological distress, life satisfaction and domain specific satisfaction (i.e. job satisfaction). The World Health Organization regards im-paired wellbeing as a determinant of reduced job involvement and absenteeism (HARNOIS et al., 2002).

A recent meta-analysis by KUOPPALA et al. (2008) examined the relationship be-tween leadership and job-related wellbeing and health. The authors found that good leadership (i.e. considerative, supportive and transformational leadership) is in fact associated with better wellbeing, lower sick leave and a decreased risk of early re-tirement. ARNOLD and colleagues (2007) investigated the relation between trans-formational leadership and employee affective wellbeing. Their study of 319 employ-ees of a long-term care facility revealed a correlation of .57 between transformational leadership and affective wellbeing. SKAKON and colleagues (2010) reviewed the literature on the relation between leadership variables on the one hand and employ-ees’ stress and affective wellbeing on the other. They found that positive leader be-haviour, leader support and transformational leadership were associated with high levels of employee affective wellbeing and low employee stress levels. Moreover, the study indicated that leaders’ stress level and affective wellbeing might be associated with employees’ stress and wellbeing. This association could be explained by the hypothesis that stressed leaders may increase the stress level of their subordinates (SKAKON et al., 2010).

LYONS and SCHNEIDER (2009) conducted an experimental study comparing the effect of transformational versus transactional leadership (contingent reward and management by exception) on stress outcomes. The authors manipulated leadership style on a stressful task by video instruction and found that transformational leader-ship was associated with lower degrees of negative affect and lower threat appraisal.

It can be concluded that there is considerable support for an association between leadership and a positive definition of psychological wellbeing (including low stress levels) as proposed by the World Health Organization (WHO).

General mental health. This section summarizes empirical work on relatively broad conceptualizations of mental health assessing symptoms of different psychiatric dis-eases except for depression which is discussed in a separate chapter. Investigations of the specific psychiatric diseases burnout and depression are reported in sections 3.2.5 and 3.2.6. In the studies summarized in the present section general mental health is defined as the absence of symptoms of mental disorders.

A three-wave longitudinal study by MOYLE (1998) assessed low work demands and high managerial support as predictors of good general mental health while controlling for neuroticism. The general mental health score consisted of four scales measuring symptoms of anxiety, depression, somatic symptoms and social dysfunction. Struc-tural equation modelling suggests that work demands predict both current and future mental health. Results for managerial support were ambiguous as either current or future mental health was predicted by managerial support but not both.

ARNOLD and colleagues (2007) also investigated the relation between transforma-tional leadership and employee mental health. Participants were asked to indicate how often they had experienced various minor symptoms of psychiatric disorders.

Participants’ mental health correlated to (r = .29) with their ratings of supervisory transformational leadership suggesting that transformational leadership has a health promoting effect.

GILBREATH and BENSON (2004) assessed the incremental contribution of supervi-sor behaviour on employee mental health that goes beyond other important work-place factors. After controlling for age, health practices, support from other people at work and at home, and stressful life and work events a broad measure of leadership behaviour was associated with general health measured by a version of the General Health Questionnaire (GOLDBERG et al., 1988). The General Health Questionnaire includes subscales measuring somatic symptoms, insomnia and anxiety, social dys-function and severe depression. Supervisor behaviour (R² = .41) made a significant incremental contribution (R² = .05) to the prediction of employee wellbeing beyond the total of the workplace factors (R² = .35) listed above. The authors thus consider that supervisor behaviour potentially influences mental health.

A recent review of the relation between leadership variables and different outcomes by CUMMINGS and colleagues (2010) concludes that transformational and support-ive leadership are associated with better staff health and lower levels of anxiety, emotional exhaustion and stress. Thus, it can be concluded that empirical evidence suggests a relation between leadership and psychological health outcomes.

Depression. Several studies have supported an association of work characteristics and employee depression, but very few studies can be found specifically on leader-ship and employee depression or depressive symptoms. According to a recent re-view by SKAKON et al. (2010), transformational leadership style has been found to be strongly associated with positive employee outcomes. This finding seems to apply to depressive symptoms as well. In a recent study transformational leadership was associated with reduced depressive symptoms both cross-sectionally and prospec-tively (MUNIR et al., 2010).

Support by the supervisor may have an important function buffering stress and pre-venting depression in the workplace. DORMANN and ZAPF (1999) investigated the moderating role of supervisory social support on the relation between social stressors in the work context and depressive symptoms in a longitudinal study. Moderating ef-fects could only be confirmed for a time lag of eight months. Results indicate that so-cial stressors increased depressive symptoms when support was low, while soso-cial stressors reduced depressive symptoms in case of high social support. The interac-tion effect size for the 8-month time lag was -.15 on average.

Leaders usually – depending on their position – have the possibility to influence so-cial and organizational issues. Work unit soso-cial factors were a major predictor of sub-sequent doctor-diagnosed depression, the best predictor being poor team climate (YLIPAAVALNIEMI et al., 2005). Findings from this study emphasized the relational components of organizational justice (unfair and inconsiderate behaviours of lead-ers). In another Finnish prospective study, organizational equity and especially lack of procedural justice predicted clinical depression or other doctor-diagnosed psychi-atric disorders in a sample of female employees (KIVIMÄKI et al., 2003). On the whole, procedural justice has been more consistently related to health effects than relational justice (ELOVAINIO et al., 2001). As KIVIMÄKI and his colleagues (2003) mention, severe relational injustice like workplace bullying has however severe ef-fects. The aforementioned study by TEPPER (2000) also assessed depression as an outcome of abusive supervision and showed that depression was associated with abusive supervision (r = .18) indicating the substantial impact of abusive leadership behaviour.

In a Japanese intervention study depression scores decreased in the groups which participated in a 1-year stress reduction program (KAWAKAMI et al., 1997). Supervi-sors had a prominent role in this intervention which was oriented towards work envi-ronment and targeted at blue-collar work sites showing high depression scores initial-ly. Occupational health and perceptions of supervisors have also been studied in a military setting (PFLANZ et al., 2006). Work stress and depression was significantly related to negative perceptions about the abilities of supervisors and commanders.

This study was cross-sectional and did not use any well-known scale to measure stress and depression.

As work characteristics especially can be affected by leaders, these take a prominent part as a mediator between leadership variables and depression in the work context.

A recent study by RAU, MORLING and RÖSLER (2010) investigated the association between depression and objectively measured work characteristics (job demand and job control). The idea is that depression may bias self-report measures of work char-acteristics resulting for example in the reporting of higher job demands by depressed persons in spite of objectively identical conditions. Results indicate that employees suffering from depression in fact had higher objective work demands than those in a mentally healthy control group. In contrast, objective job control was not associated with depression though perceived job control was lower for the clinical sample. This interesting study was thus able to demonstrate that increased work demands are as-sociated with depression.

Generally high job demands have been consistently reported to be related to depres-sion or depressive symptoms. In a review of 16 follow-up studies on work site psy-chosocial stressors and depression the associations were strongest and most con-sistent for job strain defined as high demand and low decision latitude among men (BONDE, 2008). However, the conclusion of this critical review was that methodolog-ical limitations preclude causal inference. In a study by PATERNITI et al. (2002) high job demands and low social support were independent predictors of increased de-pressive symptoms for both genders. In men, high decision latitude was predictive of a decrease in depressive symptoms. This study included personality factors, as well:

hostility and low self-esteem were independent predictors of an increase in depres-sive symptoms. In a study based on a diagnostic interview, high job strain (defined by

high demand and low decision authority) was related to all three kinds of depression examined (major depressive episode, depressive syndrome and dysphoria) (MAUSNER-DORSCH et al., 2000). These results were stronger for women.

Altogether, not much research has thus far been reported on the relation between leadership and depression. Transformational leadership predicted reduced depres-sive symptoms in the study by MUNIR et al. (2010), and supervisory support had a buffering effect on depression in the study by DORMANN and ZAPF (1999). Besides, workplace social factors predicted clinical depression (YLIPAAVALNIEMI et al., 2005), and high job demands were related to employee depression even when objec-tively assessed (RAU et al., 2010). In particular, longitudinal research is needed to investigate the possible causal effects of leadership factors on employee depressive symptoms. The possible mediating mechanisms linking leader behaviour and em-ployee depressive symptoms are also largely unknown. However, the shortcomings mentioned by BONDE (2008) in the research on work characteristics and depression – such as lack of studies with objective measures (RAU et al., 2010) and independ-ent outcome assessmindepend-ent (MAUSNER-DORSCH et al., 2000) – can be considered to be partly improved.

Physical wellbeing. Measures of physical wellbeing may be of subjective or objective nature. Subjective measures of physical health include indicators that often cannot be observed or diagnosed by others but must be gathered by self-report like head-aches or backhead-aches. On the other hand, objective measures include indicators such as blood pressure, salivary cortisol (or other indicators of immune status) or relations to certain physical illnesses.

A prospective study by NYBERG et al. (2009) investigated the association between managerial leadership and ischemic heart disease (IHD). A sample of Swedish male employees rated the leadership behaviour of their supervisors with respect to individ-ual consideration, goal clarity and clarity of role expectations, supply of information and feedback, ability to carry out changes successfully, promotion of employee par-ticipation and control. These managerial behaviours are regarded as promoting a favourable work environment. The study found that these positive leadership behav-iours significantly reduced the risk of ischemic heart disease approximately ten years later, even when controlling for factors like for example BMI, smoking, education, blood pressure, diabetes and perceived physical work load. These impressive find-ings underline the powerful impact of health-promoting leadership behaviour on is-chemic heart disease, as an important cause of human disability and death.