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J Occup Health
J Occup Health
joh
Journal of Occupational Health
1341-9145
1348-9585
Oxford University Press

39129668
10.1093/joccuh/uiae043
uiae043
Original Article
AcademicSubjects/MED00010
AcademicSubjects/MED00640
Trends in negative interpersonal relationships at work and awareness of occupational safety and health services: a 2014-2019 trend analysis
https://orcid.org/0000-0002-5638-9057
Backhaus Insa Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Tondheim, Norway

https://orcid.org/0000-0002-0378-0757
Dragano Nico Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany

Di Tecco Cristina Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority (INAIL), Rome, Italy

https://orcid.org/0000-0002-5956-9723
Iavicoli Sergio Directorate for Communication and International Affairs, Ministry of Health, Rome, Italy

https://orcid.org/0000-0002-5416-0179
Hoven Hanno Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Tondheim, Norway
Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany

Corresponding author: Insa Backhaus, (insa.backhaus@ntnu.no).
Jan-Dec 2024
12 8 2024
12 8 2024
66 1 uiae04317 11 2023
29 5 2024
12 7 2024
03 9 2024
© The Author(s) [2024]. Published by Oxford University Press on behalf of Journal of Occupational Health
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Abstract

Objective: A good psychosocial climate at work, including positive interpersonal relationships, is a protective factor for health, whereas social conflict imposes a considerable health risk. Occupational safety and health (OSH) services can help create a positive working environment. In the present study, we analyzed trends in the awareness of OSH services and interpersonal relationships and whether these are linked.

Methods: We used time series data from the Italian Survey on Health and Safety at Work (INSuLa) from 2014 and 2019 (n = 16 000 employees). Negative interpersonal relationships included workplace bullying and lack of workplace support. The availability of OSH services was measured through items inquiring about the awareness of OSH representatives and OSH training. We used Poisson regression in reporting prevalence ratios and provided predicted probabilities and average marginal effects to show trends and differences in interpersonal relationships and OSH availability.

Results: Our findings suggest that negative interpersonal relationships at work increased, whereas awareness about OSH services declined between 2014 and 2019. These trends were particularly strong for young workers, for whom workplace bullying increased by 6.3% and awareness of OSH training declined by 11.7%. We also found that unawareness about OSH services is associated with negative interpersonal relationships at work.

Conclusion: The results suggest that low OSH awareness may be an increasing problem, whereas exposure to an adverse social climate at work became more frequent at the same time. Given the role of OSH services in ensuring a positive working climate, it is important to increase workers’ awareness about OSH services.

interpersonal relationships
bullying
support
occupational safety and health
young workers
Italian National Institute for Insurance against Accidents at Work INAIL BRIC 2019 ID: N:20/2019
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pmcKey points

What is already known on this topic: A negative psychosocial work climate, including negative interpersonal relationships at work, has been linked to work-related stress and poorer health outcomes among affected workers. Occupational safety and health (OSH) services can be an important measure to prevent the adverse consequences of a negative psychosocial work climate, but awareness of such services is often lacking, especially among younger workers. Furthermore, as the organization of work changes, concerns about deteriorating working conditions and organizational structures affecting access to and awareness of OSH have been expressed.

What this study adds: This is the first study in Italy to investigate trends in the awareness of OSH services and their link to an adverse psychosocial work climate. The study shows that negative interpersonal relationships are increasing whereas awareness of OSH services is declining, particularly among younger employees.

How this study might affect research, practice, or policy: The study highlights the importance of promoting employee awareness of OSH services, particularly because prevention services such as OSH can significantly reduce work-related stress and promote health. Moreover, the results of this study imply that interventions to prevent and manage the emergence of negative interpersonal relationships in the workplace must take age differences into account.

1. Introduction

According to data of the sixth wave of the European Working Conditions Survey, in 2015 approximately 5% of workers experienced bullying and 30% received little to no support from colleagues.1 A good psychosocial climate at work and positive interpersonal relationships (eg, social support), however, have been widely recognized as drivers for employee well-being, whereas a poor psychosocial work climate and negative interpersonal relationships (eg, conflicts, lack of support, and bullying) vigorously contribute to the burden of a stressful work environment and have been identified as major stress factors.2‑7

Despite the known implications of a poor psychosocial work climate on employee well-being and increasing political awareness, a poor work climate continues to be a prevalent problem in Europe.1 With the right approach, however, the negative impact of a poor psychosocial work environment may be addressed. In Europe, employers are legally responsible for ensuring that occupational safety and health (OSH) measures are in place. The European Directive 89/391—also called the OSH “Framework Directive”—for example, highlights the importance of basic safety and health regulations and lays down general principles concerning the prevention and protection of workers against occupational hazards, such as the assessment and management of risks as well as the information, consultation, participation, and training of workers and their representatives.8 Generally, the focus of OSH services is (1) to maintain and promote workers’ health and work capacity, (2) to improve the work environment, and (3) to develop work organizations and working cultures that support health and safety at work, thereby promoting a positive social climate. OSH measures, therefore, offer an important opportunity to improve the psychosocial climate at work. However, over the past years, OSH services have faced a variety of challenges including changing work environments, emerging technologies, evolving workforce demographics, and economic crises possibly limiting equitable access to OSH services.9‑12

Generally, in Europe, the availability of and access to OSH services vary significantly across countries due to differences in economic structures and regulatory frameworks.13 Whereas northern European countries (eg, Sweden) often have more stringent regulations that promote a good work-life balance and ensure a high level of worker participation in health and safety practices, in southern European countries (eg, Greece), OSH regulations exist, but their implementation is often less stringent due to economic challenges that potentially impact the allocation of resources toward OSH initiatives. The Italian context presents a particularly interesting context, because Italy was historically among the first countries in Europe to implement specific legislation for the protection of workers’ safety.14,15 Nowadays, Italy organizes, assesses, and manages occupational health and safety, using the Italian Legislative Decree 81/08, which was enacted in 2008 and unifies many previous adopted regulations on workers’ safety and health.16 Still, despite Italy’s comprehensive OSH regulations and established structures, differences in access and utilization exist across different age groups.17 Furthermore, the Italian labor market is marked by a high prevalence of temporary and part-time contracts with significant differences across age groups. Regarding work climate, younger and middle-aged employees seem to be more frequently affected by workplace bullying than older workers.18,19

To the best of our knowledge, research exploring trends in negative interpersonal relationships at work, awareness about OSH services, and the link between a negative psychosocial work climate and OSH services, is limited.20 We aimed to fill this gap by analyzing trends of a negative psychosocial work climate and awareness of OSH services in Italy. The aims of our study were twofold: first, we aimed to investigate the association between a negative psychosocial work climate, characterized by negative interpersonal relationships at work, and OSH services; and second, we aimed to explore trends in negative interpersonal relationships at work and awareness of OSH services separately for different age groups of workers.

2. Methods

We use time-series data from the Italian Survey on Health and Safety at Work (INSuLa). INSuLa data were collected by the Italian Workers Compensation Authority (INAIL) in collaboration with TNS Italia, who carried out computer-assisted telephone interviews. INSuLa comprises cross-sectional time-series data from 2014 and 2019 with 8000 employed men and women in each wave, aged 16-64 years and whose employment is regulated by the national legal framework for health and safety (Legislative Decree 81/08; excluding all occupations with specific regulations, such as the armed forces or civil protection volunteers). A quota sampling strategy based on the National Workforce Survey of Istituto nazionale di statistica (ISTAT) is applied for regional distribution, gender, age, type of contract, occupational level, and economic sector. INSuLa focuses on workers’ perceptions of health and safety at work. INSuLa was approved by bodies regulating ethical data collection in Italy, and all participants signed an informed consent sheet.

2.1 Measures

2.1.1. Psychosocial climate

In the present study, we used indicators of negative interpersonal relationships at work as part of the psychosocial climate, which include workplace bullying and a lack of workplace support. In both 2014 and 2019, workplace support was assessed by asking respondents if they could obtain help and support from colleagues if needed. Answering options ranged from “completely disagree” to “completely agree” scored with values of 1 to 5. For the analyses, the response options were dichotomized to “No lack of support” (completely agree and slightly agree) (0) and “Lack of workplace support” (completely disagree and mostly disagree) (1). For workplace bullying, the items were not identical in the 2 waves. Whereas in 2014 bullying was assessed by asking respondents if they were subject to bullying at work, in 2019 respondents were asked if they were bullied by colleagues or supervisors (item 1) or clients and customers (item 2). In both 2014 and 2019, items were rated on a 5-point Likert scale with 1 being “completely disagree” to 5 being “completely agree.” This allowed us to construct a composite score of the bullying items in 2019 and 2014 from which we then created a binary variable with “agree” (completely disagree and mostly disagree = 0) and “disagree” (completely agree and slightly agree = 1).

2.1.2. Awareness of OSH services

Awareness about OSH services was investigated through two yes/no questions inquiring about (1) the availability of an OSH worker representative, and (2) any OSH-related training programs provided by the company in the past 5 years. Workers who reported that such services were unavailable to them or that they did not know about them were defined as being unaware of OSH services. It is important to note that in 2014, all survey participants were asked about OSH services, whereas in 2019, only half of the workers (n = 4002) were asked.

2.1.3. Age

Age was measured initially on a continuous scale and was regrouped for the analysis into three categories: 16-29 (young workers), 30-49 (midlife workers), and 50-64 (older workers).

2.1.4. Covariates

We additionally include sex (ie, male, female) and region (regrouped into five categories, ie, Centre, North East, North West, Island, and South) as potential confounders in the analyses. We also considered educational level (low, medium, high), which was assessed according to the International Standard Classification of Educational Degrees.21

Table 1 Sample characteristics (n = 16 000 workers).

	Total (n = 16 000)	2014 (n = 8000)	2019  a  (n = 8000)	
	n (%)	n (%)	n (%)	
Gender				
 Female	7250 (45.3)	3686 (46.1)	3564 (45.6)	
 Male	8750 (54.7)	4314 (53.9)	4436 (55.4)	
Age categories				
 Young workers (16-29 y)	1827 (11.4)	670 (8.4)	1157 (14.5)	
 Midlife worker (30-49 y)	9024 (56.4)	5037 (63.0)	3987 (49.8)	
 Older workers (50-64 y)	5149 (32.2)	2293 (28.7)	2856 (35.7)	
Education a				
 Low	3771 (23.7)	1741 (21.9)	2030 (25.5)	
 Medium	8938 (56.3)	4388 (55.3)	4550 (57.2)	
 High	3176 (20.0)	1801 (22.7)	1375 (17.3)	
Experience of workplace bullying				
 Yes, experienced bullying	1003 (6.3)	364 (4.5)	639 (8.0)	
 No, has not experienced bullying	14 997 (93.7)	7636 (95.5)	7631 (92.0)	
Lack of workplace support				
 Low support	2067 (12.9)	913 (11.4)	1154 (14.4)	
 High support	13 933 (87.1)	7087 (88.6)	6846 (85.6)	
Unawareness about an OSH workers’ representative b				
 No	8151 (80.1)	6001 (83.9)	2150 (71.1)	
 Yes	2028 (19.9)	1153 (16.1)	875 (28.9)	
Unawareness about OSH-related training c				
 No	8756 (74.2)	6132 (76.6)	2624 (68.9)	
 Yes	3052 (25.8)	1868 (23.4)	1184 (31.1)	
Abbreviation: OSH, occupational safety and health.

a In 2019 only 4002 workers were asked about OSH services.

b In 2014 n = 846 (10.4%) cases were missing; in 2019 n = 977 cases (24.4%) were missing.

c In 2019 n = 194 cases (4.8%) were missing.

2.2 Statistical analyses

To analyze trends in negative interpersonal relationships at work, we first compared changes in bullying and social support at work across the different survey years using descriptive statistics. Next, we investigated the association between negative interpersonal relationships and OSH services by applying Poisson regression analysis. We applied binary Poisson regression analysis for comparative longitudinal data to estimate prevalence ratios (PRs) for each measure of negative interpersonal relationships separately. We obtained age-specific trends using interaction terms between the age categories and wave, and we computed average marginal effects (AMEs) by age categories. These values present the predicted probability of experiencing negative interpersonal relationships at work, which can be compared between age groups 2014 versus 2019. AMEs can be interpreted as the percentage point increase or decrease in the probability of experiencing negative interpersonal relationships at work in 2019 compared with 2014. All calculations were carried out using Stata version 16.1 (StataCorp LLC, College Station, TX, USA).

Table 2 Prevalence ratios (PRs) for the association between unawareness of OSH services and workplace bullying and low workplace support stratified by survey year.

	Wave 1: 2014	Wave 2: 2019	
	Workplace bullying	Lack of workplace support	Workplace bullying	Lack of workplace support	
	PR	95% CI	PR	95% CI	PR	95% CI	PR	95% CI	
Unawareness about an OSH representative									
 No	ref		ref		ref		ref		
 Yes	1.22	(0.93-1.62)	1.41	(1.19-1.67)	1.43	(1.10-1.85)	1.73	(1.42-2.10)	
Unawareness about OSH training									
 No	ref		ref		ref		ref		
 Yes	1.42	(1.13-1.79)	1.61	(1.40-1.85)	1.03	(0.81-1.32)	1.63	(1.37-1.95)	
Abbreviation: OSH, occupational safety and health.

Table 3 Predicted probabilities for negative interpersonal relationships at work and availability of OSH measures in 2014 and 2019 by age, percentages, and 95% CIs.a

	2014 predicted probability (95% CI)	2019 predicted probability (95% CI)	AME 2019 vs 2014 in % (P value)	
Experience of workplace bullying	
 Young workers	2.4 (1.2-3.6)	8.7 (7.0-10.4)	6.3 (<.001)	
 Midlife workers	4.3 (3.7-4.9)	8.2 (7.4-9.2)	3.9 (<.001)	
 Older workers	5.7 (4.7-6.6)	7.0 (6.1-8.0)	1.3 (.059)	
 AME young workers vs older workers (P value)	−3.3 (<.001)	1.7 (.088)	5.0 (<.001)	
 AME young workers vs midlife workers (P value)	−1.9 (.005)	0.5 (.631)	2.4 (.047)	
Lack of workplace support	
 Young workers	9.8 (7.4-12.3)	15.7 (13.25-18.0)	5.9 (.001)	
 Midlife workers	11.1 (10.2-12.0)	14.0 (12.8 –15.2)	2.9 (<.001)	
 Older workers	12.8 (11.3-14.2)	14.2 (12.8-15.6)	1.4 (.169)	
 AME young workers vs older workers (P value)	−3.0 (.043)	1.5 (.252)	4.5 (.024)	
 AME young workers vs midlife workers (P value)	1.3 (.350)	1.7 (.183)	3.0 (.109)	
Unawareness about an OSH representative				
 Young workers	27.7 (23.2-32.1)	37.1 (30.7-43.5)	9.4 (.018)	
 Midlife workers	16.1 (14.9-17.3)	27.0 (24.4-29.7)	10.9 (<.001)	
 Older workers	12.9 (11.3-14.5)	28.6 (25.5-31.7)	15.7 (<.001)	
 AME young workers vs older workers (P value)	14.8 (<.001)	8.4 (.020)	−6.3 (.146)	
 AME young workers vs midlife workers (P value)	11.6 (<.001)	10.1 (.004)	1.5 (.715)	
Unawareness about OSH training				
 Young workers	31.4 (27.0-36.0)	43.1 (37.4-48.9)	11.7 (.001)	
 Midlife workers	23.2 (21.9-24.6)	29.1 (26.7-31.5)	5.9 (<.001)	
 Older workers	21.5 (19.6-23.4)	28.9 (26.0-31.8)	7.4 (<.001)	
 AME young workers vs older workers (P value)	9.9 (<.001)	14.2 (<.001)	4.3 (.280)	
 AME young workers vs midlife workers (P value)	8.2 (<.001)	14.0 (<.001)	5.8 (.129)	
Abbreviations: AME, average marginal effect; OSH, occupational safety and health.

a Estimates are based on Poisson regressions on the association between covariates and negative interpersonal relationships at work and the unawareness of OSH measures. The estimates are adjusted for gender and education.

3. Results

3.1. Sample characteristics

Table 1 presents the sample characteristics and the prevalence of negative interpersonal relationships at work as well as the availability of OSH measures in 2014 and 2019. In both survey years, slightly more men than women participated (2014: 53.9% were men; 2019: 55.4% were men). Most respondents were between 30 and 49 years old and had a medium degree of education (Table 1). The proportion of workers experiencing bullying rose from 4.5% in 2014 to 8.0% in 2019, and the proportion of workers lacking workplace support increased from 11.4% in 2014 to 14.4% in 2019.

3.2. Association between negative interpersonal relationships and OSH services

The association between unawareness of OSH services and workplace bullying and low workplace support stratified by survey year is presented in Table 2. Unawareness of OSH services was associated with a lack of workplace support in both 2014 and 2019. As such, the PR of lack of workplace support for workers unaware of an OSH representative was 1.61 (95% CI, 1.40-1.85) in 2014 and 1.63 (95% CI, 1.37-1.95) in 2019. The results are slightly less consistent in the case of workplace bullying and OSH unawareness. Whereas unawareness about OSH training, specifically, was linked to workplace bullying in both 2014 and 2019, unawareness about an OSH representative seemed to be associated with workplace bullying only in 2019 (PR: 1.43; 95% CI, 1.10-1.85).

3.3 Trends in social climate and OSH awareness

Table 3 shows the predicted probabilities for 2014 and 2019 as well as the corresponding AMEs for workplace bullying, lack of workplace support, and the availability of OSH services. The last column of Table 3 presents the AMEs for the change between waves (ie, changes from 2014 to 2019). The last row of each subsection (ie, bullying, lack of workplace support, OSH services) shows the AMEs for the different age groups, indicating the percentage differences in negative interpersonal relationships at work and the availability of OSH services between younger and older workers. To facilitate interpretation, we provide a visual illustration of the analyses in Figure. 1.

Figure 1 Predicted probabilities of negative interpersonal relationships and availability of occupational safety and health (OSH) services for 2014 and 2019 by workers’ age. Percentages and 95% CIs.

Starting with interpersonal relationships at work, we found higher predicted probabilities for bullying and lack of workplace support across all age groups in 2019 than in 2014. For young, middle-aged, and older workers, the probability of workplace bullying increased from 2.4% to 8.7%, from 4.3% to 8.2%, and from 5.7% to 7.0% between 2014 and 2019, equaling differences of 6.3%, 3.9%, and 1.3%, respectively. However, the results indicate an age gradient, and the increase in negative relationships at work is not equally distributed among the age groups. Whereas in 2014 older workers appeared to have higher predicted probabilities for workplace bullying and low workplace support, in 2019 younger workers had higher predicted probabilities for workplace bullying and a lack of workplace support. Nevertheless, the results suggest that the increase in workplace bullying, and lack of workplace support, are more significant among younger workers. We present the difference from 2014 to 2019 between younger and older workers and the corresponding P value in the bottom right corner of the last column in Table 3. For example, the AME (younger workers vs older workers) for workplace bullying was 5% at a P value of <.001.

Turning to the results relating to unawareness of an OSH representative and OSH training, we found higher predicted probabilities for both unawareness of an OSH representative and unawareness of OSH training across all age groups in 2019 compared with 2014. However, when we looked closer at each year and the AMEs (younger workers vs older workers), we noticed that the predicted probabilities were greater for younger workers. Taking unawareness of OSH training as an example, we found that the predicted probability of unawareness of OSH training increased from 31.4% to 43.3%, from 23.2% to 29.1%, and from 21.5% to 28.9% between 2014 and 2019, equaling a difference of 11.7%, 5.9%, and 7.4% for young, midlife, and older workers, respectively. Furthermore, the results suggest a within-wave age gradient. Again, taking unawareness of an OSH representative as an example, in 2019 unawareness of an OSH representative was predicted to be 43.1% for young workers and 28.9% for older workers. This is a difference of 14.2% (P < .001). Furthermore, the values also indicate a widening gap over time, as presented in the 2 last rows of Table 3 (AME young workers vs midlife workers, young workers vs older workers). However, when comparing the AMEs (younger vs older workers), the values suggest that the gap between younger and older workers widened for unawareness about OSH training but decreased for unawareness about an OSH representative. However, it must be noted that the corresponding P values are not significant. This suggests that the increase across waves/times significantly differed between young and old individuals.

Focusing on the trend analysis of OSH services by age group, both unawareness about an OSH representative and unawareness about OSH training significantly increased within each age group from 2014 to 2019. However, the increase in unawareness about an OSH representative and unawareness about OSH training seems not to be significantly larger in magnitude between younger and older workers. Moreover, we present the difference from 2014 to 2019 between younger and older workers and the corresponding P value in the bottom right corner of the last column in Table 2. Unlike negative interpersonal relationships at work, we could find neither a significant improvement nor a worsening of unawareness about OSH services by age.

4. Discussion

The findings of our study suggest that negative interpersonal relationships at work have increased between 2014 and 2019 and that awareness about OSH services has declined across all age groups, but especially for younger workers. This is important because the findings also suggest that unawareness about OSH services is associated with negative interpersonal relationships at work.

Both the results regarding a possible worsening in psychosocial work climate and the results regarding age differences in awareness of OSH services align with previous evidence. Rigó et al,22 for instance, found that job strain increased by 10% from 1995 to 2015 in countries with low investment in labor market policy, such as Greece, Spain, and Italy. With regard to age differences in the awareness of OSH services, Dragano et al17 found that young workers were 2 times more likely to be unaware of legal OSH frameworks than older workers. The authors17 argued that younger workers generally manifest better health than older individuals, which may blur their need to inform themselves about OSH services. The present study adds to existing research by pointing to important trend differences between 2014 and 2019. Our findings suggest that younger workers are particularly exposed to negative interpersonal relationships at work and, at the same time, do not receive adequate support from their employers in the form of targeted OSH measures.

The reasons behind the increase in workplace bullying and the decline in awareness about OSH services remain speculative. Over the past years, Italy has faced economic challenges, especially in the aftermath of the global economic crisis of 2008, resulting in a high unemployment rate, an increasing number of precarious employment contracts, and high job insecurity, possibly creating a work environment that fosters bullying behavior.23 Additionally, economic difficulties may lead to budgets cuts for health and safety initiatives, such as OSH measures, as companies may prioritize immediate financial survival over investments in employee health (eg, training of OSH representatives). Furthermore, over the past decades many workplaces have undergone fundamental technological and organizational changes (eg, remote working).24 Thus, the adoption of updated OSH protocol and services may lag behind.

Considering the demonstrated impact of workplace bullying on health, it is important to investigate trends in workplace bullying as well as to develop interventions aimed at preventing and reducing workplace bullying. Future research may investigate the effectiveness of interventions focused on workplace bullying in terms of availability, and awareness of availability by employees as well as their effectiveness.2 This is in line with the 2019 International Labour Organization’s Convention No. 190 concerning the elimination of violence and harassment in the world of work.25 Convention 190 recalled members’ responsibility in promoting a zero-tolerance environment for violence and harassment, and it asked all actors in the workplace to actively avoid, prevent, and address such behavior. Italy ratified the convention in 2021 and is expected to promote awareness and understanding of the importance of eradicating workplace violence and harassment including bullying behaviors.26 This should involve training and educational initiatives as well as interventions that can help foster a culture of respect and support. Thus, developing interventions for managing emerging risks such as workplace bullying and lack of support is not only a moral imperative but also a strategic decision for organizations. As noted by Nielsen and Einarsen,2 interventions may be examined at the primary level (ie, intervention to prevent workplace bullying), the secondary level (ie, intervention to reduce the impact of bullying when it has already occurred), and the tertiary level (ie, interventions to reduce the long-term impact of bullying). Moreover, interventions to prevent and manage the emergence of negative interpersonal relationships in the workplace must take into account age differences, as revealed in our study. Understanding the within-wave age gradient is crucial for implementing effective strategies that address negative relationships at work and foster a supportive and respectful work environment for employees of all age groups. By tailoring interventions to accommodate these age-related variations, organizations can proactively promote mental well-being from an aging perspective. Moreover, the age-related disparity in the knowledge and awareness concerning OSH services may lie in the difference in the health and safety culture among younger employees. Thus, organizations should implement tailored communication and participation strategies and interventions targeting young workers to promote a strong health and safety culture among all employees. However, it should also be noted that despite the positive impact of OSH services, it is imperative that other organizational roles are also called upon to prevent bullying and improve the social climate. First and foremost it is the responsibility of management, whose contribution unfortunately could not be examined in this analysis.

4.1. Strengths and limitations

There are limitations to the study that must be considered when interpreting the results. First, we included data from cross-sectional waves only. For a comprehensive trend analysis, data from several time points would have been preferable.27 Second, in INSuLa, workplace bullying was assessed with a single-item questionnaire to ensure the criterion of brevity in a survey aimed at investigating various aspects related to working conditions and perceptions of health and safety at work. A more comprehensive assessment of workplace bullying covering several domains of bullying, such as the “Negative Acts Questionnaire,”28 would have been desirable. Third, in 2019 only a subset of respondents (4000 out of 8000 respondents) were asked about the availability of OSH services. This may limit the generalizability of the findings and might not accurately represent the views of all workers. Last, workplace bullying was measured differently in the 2 waves. Whereas in 2014 a general question about workplace bullying was asked, in 2019 two items with a specific focus on bullying by clients or customers were used. The use of different items makes a direct comparison challenging and we have to take into account potential bias when interpreting our findings on changes in workplace bullying between 2014 and 2019. At least 3 important strengths balance these limitations. First, to the best of our knowledge, this is the first study to comprehensively analyze trends of interpersonal relationships at work and the availability of OSH services. Second, by using data from INSuLa, we are able to study relationships in Italy, a country with a labor market that is challenged by demographic aging, high youth unemployment rates, and age discrimination of younger workers.29 Available trend studies on bullying in Italy have primarily focused on school-aged children and adolescents30 but have neglected working-aged adults. Third, the analyses are based on a large, repeated cross-sectional time-series dataset representative of the Italian working population.

5. Conclusion

Our results suggest that negative interpersonal relationships at work may have worsened and awareness about OSH services has declined in Italy from 2014 to 2019, particularly among younger workers. One way in which a negative social work environment, including negative interpersonal relationships, may be addressed is by ensuring that OSH services are available and accessible. Addressing workplace bullying and improving support is crucial, considering their impact on health, and our results suggest that OSH services may play a role in doing so. Awareness of OSH services must therefore be improved. Moreover, consideration of age differences could be instrumental in designing effective preventive strategies. Tailored communication and participation strategies can promote a strong health and safety culture, especially among younger workers.

Acknowledgments

The survey was commissioned and approved by the Ministry of Health’s Scientific Committee and ratified by INAIL’s Scientific Committee, which approved the study and procedures of data collection. All procedures in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Declaration of Helsinki and its amendments or comparable ethical standards. We used secondary data, and no consent for the publication of this study was needed.

Author contributions

I.B., N.D., and H.H. conceived the ideas; I.B. analyzed the data; I.B. and H.H. led the writing of the manuscript; N.D., C.T., and S.I. provided critical feedback throughout the data analysis process and on the draft of the manuscript. All authors approved the final version of this manuscript.

Funding

This work was supported by funding from the Italian National Institute for Insurance against Accidents at Work, grant number: INAIL BRIC 2019 ID: N:20/2019.

Conflicts of interest

The authors have no conflict of interest to declare.

Data availability

The data that support the findings of this study are not publicly available but can be made available from the Italian Workers Compensation Authority at https://www.inail.it/cs/internet/home.html upon reasonable request.
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