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Introduction
The last decade has brought increased attention to the possible detrimental effects of work on mental health. Existing research has focused on work strain and occupational health and found consistent evidence for associations. 1 Organisational change is often cited as a harmful exposure but few studies have been published to support this assumption. 2-6 One of the first studies on health risks was a study from Finland 7 where they found that the risk of health problems was at least two times greater after major downsizing than after no downsizing. A longitudinal study published few years later found a significantly faster decline in self-rated health even 4 years after downsizing among employees who had experienced major downsizing. 8 The increase in health problems was partially explained by concomitant increases in physical demands and job insecurity and a reduction in job control. 8 9 Besides, downsizing and repeated exposure to rapid personnel expansion may predict long-term sickness absence and hospital admissions. 10 Although these studies did not specifically address mental health problems, they should be interpreted within the framework of work stress.
Employees are increasingly confronted with frequent minor daily stressors related to changes in technology and workplace practices as well as the major upheavals of mergers, downsizing and restructuring. 11 12 The imminence, duration and temporal uncertainty surrounding events of change can have a negative impact on employees. 13 Indeed, the increased uncertainty regarding job future or the direction of organisational change has been suggested to be a principal cause of stress. 14 15 Others propose that organisational change acts as a stressor through the individual's negative appraisal of the changes. 16
The well-documented risks that might follow organisational changes are: intensification of job strain, time pressure, reduction of social support, lack of control and role ambiguity, which all have been associated with mental health problems. 17-19 Two systematic reviews of psychosocial factors at work and depression found evidence of a relation between perceived psychosocial job strains and an elevated risk of depressive symptoms or major depressive episode. 20 21 Job insecurity has also been consistently linked with detrimental mental health effects in both meta-analysis and reviews. 22 23 Another potential factor affected by organisational change: job dissatisfaction has shown strong associations with depression...