The Impact of Managerial Leadership on Stress and Health among Employees

The overall aim of this thesis was to explore the relationship between managerial leadership on the one hand and stress, health, and other health related outcomes among employees on the other. This was done in five studies, three using a cross-sectional and two a prospective design. In all studies the employees rated their managers with a selfadministered questionnaire. The health outcomes were in four of the studies selfreported, but in the last study register-based diagnoses were used to determine incidence of ischemic heart disease. Logistic and Cox regression analyses were used to estimate the associations. In three of the five studies, the association between managerial leadership and the outcomes were adjusted for the dimensions in the Demand-control-support model. Other adjustments included staff category, labour market sector, job insecurity, marital status, satisfaction with life in general, and biological risk factors for cardiovascular disease. In the first study (I) Attentive managerial leadership was found to be significantly related to the employees’ perceived stress, age-adjusted self-rated health and sickness absence due to overstrain or fatigue in a multi-national company. The association remained significant after adjustment for the dimensions of the Demand-control-support model. In the second study (II) focussing hotel employees in Sweden, Poland, and Italy the factors Autocratic and Malevolent leadership (less common in Sweden than in the other two countries) aggregated to the organisational level were found to be related to poorer individual ratings of vitality. The relationships were significant also after adjustments for the dimensions of the Demand-control-support model aggregated to the organisational level. Self-centred leadership (which was as common in Sweden as in the other two countries) was related to poor employee mental health, vitality, and behavioural stress after these adjustments. The third study (III) showed significant associations in the expected directions between Inspirational leadership, Autocratic leadership, Integrity, and Team-integrating leadership on the one hand and self-reported sickness absence among employees on the other in SLOSH, a nationally representative sample of the Swedish working population. These associations were adjusted for the Demandcontrol-support model and self-reported general health (SRH). In the fourth (IV) prospective study significant associations were found between Dictatorial leadership and lack of Positive leadership on the one hand, and long-lasting stress, emotional exhaustion, deteriorated SRH, and the risk of leaving the workplace due to poor health or for unemployment on the other hand. In the fifth study (V) a dose-response relationship between positive aspects of managerial leadership and a lower incidence of hard end-point ischemic heart disease among employees was observed. This relationship was very little affected by adjustments for conventional risk factors for cardiovascular disease. Leadership associated with good employee health included to provide employees with the means to carry out their work in an independent manner (provide information, power, and clarity), encourage employees to partake in the development of the workplace, provide support, inspire employees, show integrity (justice), and to integrate team members to work well together. Leadership associated with poor employee health was found to encompass both actively destructive (e.g. acting dictatorial, forcing own opinions on others, being insincere and actively unfriendly) and passively destructive behaviours (withdrawing from employees).