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Reply to Letter to the Editor regarding the article ‘Exposure to workplace sexual harassment and risk of cardiometabolic disease: a prospective cohort study of 88 904 Swedish men and women’

Year: 2024

Type: letter

Abstract: We appreciate Dr de Beus and others for their insightful comments1 on our paper2 which are highly relevant to clinical practice. When treating a patient, it is crucial to consider their specific conditions and circumstances, as these can significantly influence treatment outcomes, prognosis, and adherence. Among these factors are the unique stressors each patient may face. Our study, however, adopted a public health approach, aiming to determine whether exposure to work-related sexual harassment could increase the risk of cardiometabolic disease at a population level. The goal was to assess whether this specific stressor poses a risk to cardiometabolic health. Population-based studies such as ours can provide insights that are generalizable to the broader working population, and help evaluate whether primary prevention strategies at the organizational/employer level might effectively reduce the burden of diseases. The definition of workplace sexual harassment has long been debated, and there is no universal definition and operationalization for the term.3,4 Most definitions, however, highlight the importance of the individuals’ subjective perception of the behaviour. Many also emphasize that the behaviours are unwanted, unwelcome, and sexual in nature.5,6 Future research would benefit from greater clarification of the phenomena and operationalizations.7 All self-report studies are subject to limitations such as problems with recall, and potential social desirability bias. Additionally, individuals may have different interpretations of workplace sexual harassment. In our study, the questions on workplace sexual harassment were accompanied by a definition, which may have helped the respondents better recognize whether their experiences constituted sexual harassment, thereby reducing variability in reporting of exposures. Moreover, any potential misclassification of exposure is unlikely to be influenced by the presence of cardiometabolic disease during follow-up. Such non-differential misclassification, if anything, would likely dilute the risk estimates, meaning that our results may underestimate, rather than overestimate, the true associations. Therefore, this type of bias is unlikely to compromise our conclusions about associations. All observational studies are also subject to confounding, where factors affect both the likelihood of workplace harassment and the risk of cardiovascular disease. However, many of the factors listed by de Beus et al. are unlikely to be the causes of harassment and therefore not major sources of confounding. It is more plausible that factors such as smoking and physical activity are part of the pathway from work stressors to cardiovascular disease or diabetes. It is thereby doubtful that adjustment for such factors would have improved accuracy, as it could have attenuated or even eliminated the true risk estimate of the association between work-related sexual harassment and cardiometabolic disease outcomes. Although we agree that future research should assess the accumulation and interactions with other stressors such as non-work stressors, we believe the findings in our paper contribute to the growing evidence that workplace harassment is harmful to health, underscoring the need for actions to minimize and eliminate it. This work was supported by the Swedish Research Council for Health, Working Life and Welfare (grant number #2019-01318). The funders had no role in the study design and conduction of the study; data collection, management, analysis, and interpretation; and drafting, review, or approval of the manuscript. No new data were generated or analysed in support of this research.

Source: European Journal of Preventive Cardiology

DOI: 10.1093/eurjpc/zwae300

Authors: K C Prakash, Ida E H Madsen, Reiner Rugulies, Tianwei Xu, Mika Kivimaki, Linda L Magnusson Hanson