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Original Research

Patient Overcrowding in Hospital Wards as a Predictor of Diagnosis-Specific Mental Disorders Among Staff: A 2-Year Prospective Cohort Study

Marianna Virtanen, PhD; G. David Batty, PhD; Jaana Pentti, BS; Jussi Vahtera, MD, PhD; Tuula Oksanen, MD; Katinka Tuisku, MD, PhD; Paula Salo, PhD; Kirsi Terho, RN, MNSc; Kirsi Ahola, PhD; Marko Elovainio, PhD; and Mika Kivimäki, PhD

Published: May 4, 2010

Article Abstract

Objective: Hospital ward patient overcrowding has been hypothesized to increase psychiatric morbidity among staff, but it is unknown whether the association is specific to depressive disorders. This study examined whether patient overcrowding in hospital wards predicts diagnosis-specific mental disorders among staff.

Method: A 2-year prospective cohort study was conducted, in which the extent of hospital ward overcrowding was determined using routinely recorded patient bed occupancy rates between 2003 and 2004 and linked to sickness absence for 5,166 nurses and physicians in 203 somatic illness wards in 16 Finnish acute-care hospitals. Medically certified long-term (>’ ‰9 days) sickness absence spells in 2004 and 2005 with physician-determined diagnosis (based on ICD-10 criteria) were obtained from the register of the Social Insurance Institution of Finland.

Results: Cox proportional hazard models for recurrent events adjusted for sex, age, occupation, type and length of employment contract, hospital district, and specialty showed that health professionals working in wards with a patient occupancy level 10 percentage units above the optimal during a 1-year period experienced twice the risk of sickness absence due to depressive disorders (HR’ ‰=’ ‰1.95; 95% CI, 1.18−3.24) relative to colleagues working in wards with optimal or below-occupancy levels. No significant association was found for diagnoses of severe stress and adjustment disorders or other psychiatric disorders.

Conclusions: Chronic workload, as expressed by patient overcrowding in hospital wards, is associated with the onset of depressive disorders among staff.

J Clin Psychiatry

Submitted: March 24, 2009; accepted June 9, 2009.

Online ahead of print: May 4, 2010 (doi:10.4088/JCP.09m05238blu).

Corresponding author: Marianna Virtanen, PhD, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, 00250 Helsinki, Finland (

Volume: 71

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