Today’s working life has led to new requirements and conditions at the workplace, and additional factors may be of importance for employees’ health. Most earlier research has taken place in stable organizations, and has not taken changes in organizations into account. The way in which psychosocial work conditions affect employees’ health and well-being has been the topic of several studies but mental ill health is still one of the most common causes of sick leave in Sweden. Little attention is given to the importance of the workplace and organizational context for employees’ health. The overall aim of this thesis is to investigate how different aspects of health are associated with psychosocial work conditions in today’s working life.

This thesis comprises two empirical studies. The first study is a longitudinal study, based on questionnaire data from 1010 employees at the Swedish Labour Market Administration. The second study is designed as a prospective cohort study, based on questionnaire data from 8430 employees in ten organizations, participating in the LOHP project. Linear and logistic regressions were performed to investigate associations between psychosocial work conditions and different aspects of health. Multilevel analysis was performed in one paper.

The main findings in Paper I are that traditional job stress models are better for predicting ill health than good health. Different psychosocial work conditions may however, be useful for measuring different aspects of health, depending on whether the purpose is to prevent ill health or to promote health. In Paper II, psychosocial work conditions and symptoms of burnout were found to differ between different hierarchical levels, and different psychosocial work conditions were associated with symptoms of burnout at different hieratical levels. Paper III showed that psychosocial work conditions predict voluntary job mobility, and this may be due to two forces for job mobility: job dissatisfaction and career development. In Paper IV, a strong association between high work ability and better performance was found. Clear goals and expectations may result in improved psychosocial work conditions and work ability, which in turn affects employees’ performance.

This thesis has provided knowledge regarding different aspects of health and psychosocial work conditions. Conditions at the organizational and workplace level set the prerequisites for if and how employees use their resources and their ability to act. Access to resources and the capacity to use them may vary depending on the employees’ hierarchal position. Occupational health research needs to focus on differences in psychosocial work conditions at different hierarchical levels. Organizations with clear goals and expectations may create more favourable conditions at work, supporting employees’ room for manoeuver, social capital and their ability to cope with working life, hence promoting health. Health promotion has a holistic approach and considers the work environment, the individual and the interplay between them. However, most health interventions at workplaces are directed to employees’ health behaviour rather than improvements in organizational and work conditions. To develop a good work environment it is necessary to identify conditions at work that promote different aspects of health. These conditions need to be tackled at the organizational, workplace and individual level, as good health is shaped by the interplay between the employee and the conditions for work.

Although psychosocial work conditions, health and leadership are concepts that have been studied for a long time, more knowledge is needed on how they are related in managers. Existing research suggests that managers are very influential in their workplaces, but the way in which their workplaces influence them is often overlooked. As a result, the potential reciprocity between managers’ psychosocial work conditions, health and leadership is not in focus. Furthermore, managers have often been studied as a uniform group and little consideration has been given to potential differences between managers at different managerial levels.

The overall aim of this thesis is to increase knowledge about the relationships between managers’ psychosocial work conditions, their health, and their leadership; and to elucidate differences between managers at different managerial levels in these relationships. The thesis consists of four separate papers with specific aims. In Paper I, the aim was to compare the differences in work conditions and burnout at three hierarchical levels: subordinates, first-line managers, and middle managers; and to investigate if the association between work conditions and burnout differs for subordinates, first-line managers, and middle managers. In Paper II, the aim was to advance knowledge of workplace antecedents of transformational leadership, by investigating what psychosocial work conditions of first-line managers are associated with their display of transformational leadership; and whether superiors’ leadership is associated with first-line managers’ display of transformational leadership. In Paper III, the aim was to deepen the understanding of how managers’ health and leadership is related by combining two perspectives in previous research. The two specific research questions were: What psychosocial conditions at work affect managers’ health? How does managers’ health influence their leadership? In Paper IV, the aim was to further the understanding of managers’ perceptions of social support, and to increase our understanding of how managers perceive that receiving social support affects their managerial legitimacy.

The empirical material is based on three research projects with quantitative and qualitative designs. Papers I and II are based on cross-sectional data from 4096 employees in nine Swedish organizations. Paper III is based on 42 interviews with managers in a Swedish industrial production company, and Paper IV is based on 62 interviews with managers in a Swedish industrial production company and a Swedish municipality. The interviews were analysed using inductive content analysis.

The results showed that psychosocial work conditions and symptoms of burnout generally differed between subordinates and managers, and few differences were found between the managerial levels (Paper I). However, in the associations between psychosocial work conditions and symptoms of burnout, similarities were found between subordinates and first-line managers, while middle managers differed. First-line managers’ psychosocial work conditions were also found to be associated with their display of transformational leadership (Paper II). Psychosocial work conditions were perceived to influence managers’ performance and health, and particularly first-line managers described being dependent on favourable work conditions (Paper III). Furthermore, managers’ health was perceived to influence their leadership, and affect both the quality of their work and the quality of their relationships with subordinates. Managers’ social support came from different people within and outside their workplace (Paper IV). Support that concerned their work came from people within the workplace and was perceived to increase their managerial legitimacy, whereas support that concerned personal and sensitive matters was sought from those outside the workplace so that their managerial legitimacy would not be questioned.

The results suggest that managers’ psychosocial work conditions, health and leadership are closely related and can be conceptualized as reciprocal spirals. Some resources in the psychosocial work environment, such as social support, may be hard to take advantage of, even if they are available. The psychosocial work conditions of managers at different managerial levels differ to some extent, which has consequences for how the relationship between psychosocial work conditions, health and leadership is expressed. Especially first-line managers seem to be in a vulnerable position because their influence  s more restricted, and they are more dependent on favourable psychosocial work conditions.