Appendix 1: Coding Manual for the AWaC Category System
Categories from the preliminary analysis are work, stress, heredity, personal relationships, bullying, childhood, negative life events, somatic diagnoses, somatic complaints, injuries and accidents, pregnancy and childbirth, economy, death of significant other, lack of social support, life situation, unpredictability, sexual orientation, maltreatment, other external factors, personal expectations, self-regulation, self-image, psychiatric diagnoses, psychological complaints, emotional reactions, lack of coping, personal vulnerability, behavior and lifestyle, responsibility and do not know.
All items are to be given at least one code, referred to as the primary code. When a response item fits several categories, it is given additional codes corresponding to all relevant categories. The primary code is based on the first-mentioned category in the response item, or the code considered to be best-fitting. To exemplify, the item “work and family” is primarily coded in the Work category, and given an additional code for the Personal relationships category. Descriptions with inclusion and exclusion criteria for the categories are as follow:
Work
This category includes all items that are work-related in some way, like workload, work stress, work satisfaction, psychosocial work environment, work hours, work conflicts and unemployment. Items that mention bullying at work are excluded, and placed in the Bullying category.
Stress
This Category contains items that mention stress/strain/external pressure without any specific stressor (for example “stress”), or several stressors that interact to cause stress (e.g. “stress – work and domestic”). The key is that the person pictures stress as the causal factor. Items are also included if they contain words that describe a load that is too much to handle, for instance “too much to do at work and at home”. Items are not included if they
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Contain words that refer to psychological processes that cause stress, or lack of psychological capacity to cope with stress. These factors are regarded as internally controllable, and the items are to be placed in one of the internal categories.
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Contain several specific factors without relating them to stress (to exemplify, “work and family”. These items are to be coded like double-barreled items mentioned above).
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Attribute stress to one of the other more specific categories, for instance “marital stress” and “work stress”. These are placed in the category that match the stressor (in these cases, Personal Relationships or Work).
Heredity
This category includes all items related to genetic dispositions, such as “heredity”, “heritability”, “it runs in the family”, “genes”. Items are excluded if they refer to
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Passing on in the family of factors that are not genetic, for instance “social heritage”.
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Disorders/diseases that are thought to be hereditary, but heredity is not mentioned specifically (such as “bipolar disorder”).
Personal Relationships
This category contains responses that refer to significant others and close relationships; family relations and family roles, love and friendships, significant others failing to meet expectations in such relationships (for instance “betrayal”), and domestic factors, for example “domestic situation”. The person may or may not contribute to the problem. Items are excluded when they refer to
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Death of significant others, these are placed in the death of significant other category.
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Lack of social support in a wider sense, such as “lack of respect”, without mention of significant other. These are placed in the lack of social support category.
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Psychological reactions to such relationships, these are placed in one of the internal categories.
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Actions of significant others that are not relational (to illustrate, “my sons drug abuse”, “my father’s illness”). These are placed in the negative life events category.
Bullying
Items are put here that mention bullying specifically, for example “bullying” or “harassment”. Items are also placed here even if
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The bullying is time-limited, and therefore could have been placed in the negative life events category (such as “was bullied in first grade”).
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The bullying happened in childhood, and therefore could have been placed in the childhood category.
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The bullying takes place at work, and could be placed in the work category.
Childhood
This category pertains to items referring to childhood and experiences in childhood. If other categories also are mentioned, for instance “emotional abuse in childhood”, the item belongs to this category. The key is that the respondent traces the factor back to childhood. Items are also placed here if they not mention childhood specifically, but are clearly related to childhood, such as “absent father”. Items are excluded if they mention bullying.
Negative Life Events
Items are placed here when they refer to traumatic experiences or negative events that are relatively limited in time, for example “rape”. Items are excluded if they refer to
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Relational difficulties or processes where the person also may contribute to the problem, for instance “marriage problems” or “conflict with boyfriend”, these are placed in the personal relationships category.
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Factors that are relatively situational, general or chronic, such as “unpredictable situation”. These items are placed in the other external factors category.
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Death of a significant other, these are placed in the death of significant other category.
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Bullying, these are placed in the bullying category.
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Accidents, these are placed in the injuries and accidents category.
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Divorce/break up, these are placed in the personal relationships category.
Somatic Diagnoses
This category contains responses that refer to clinical somatic diagnoses, for example “cancer” and “migraine”. It also includes responses that refer to surgical treatment of such diseases. Items are excluded if they refer to
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Somatic symptoms or health complaints, for instance “headache” or “back pain”.
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Psychological reactions to such diseases, these are placed in one of the internal categories.
Somatic Complaints
This category includes responses that refer to somatic symptoms and subjective health complaints that do not constitute a diagnosis, such as “back pain” and “head ache”. This includes complaints after surgical treatment, exemplified by “pain after cancer surgery”. Items are excluded if they refer to psychological diagnoses, complaints or symptoms, for example “fatigue”, “worrying” or “sleep difficulties”. These are placed in one of the internal categories.
Injuries and Accidents
This contains responses that refer to somatic injuries or accidents, such as “car accident” or “arm fracture”, or surgical treatment that are unrelated to somatic diagnosis, e.g. “amputation”. Items are excluded if they refer to somatic diagnoses or psychological complaints or symptoms following such incidents, such as “back pain after car accident”. These are placed in one of the internal categories.
Pregnancy and Childbirth
This category includes responses about pregnancy and childbirth.
Economy
This category includes responses that refer to financial problems, for example “economy” or “debt”.
Death of Significant Other
This category includes responses concerning death of significant others. Items are excluded if they refer to psychological reactions to such losses, these are placed in one of the internal categories.
Lack of Social Support
Items are put here when they contain responses that describe other people’s lack of meeting the person’s social and emotional needs, for instance “lack of respect” or “violation of trust”. The category captures lack of support in the person’s social network. Items are excluded if significant others are mentioned, these are placed in the Personal relationships category.
Life Situation
This category contains items referring to a difficult life situation. Items are excluded if they describe life situation more specifically, exemplified by “difficult life situation because of workload”. This is placed in one of the more specific external categories, in this case Work.
Unpredictability
This category pertains to items regarding unpredictability as causal factor. Here we picture that the respondent perceives the external situation as unpredictable.
Sexual Orientation
Items are placed here when they refer to sexual orientation, and problems dealing with this.
Maltreatment
This category includes items that mention maltreatment by health professionals.
Other External Factors
Items are placed here when they don’t fit in any of the more specific categories, but still refer to clearly external factors, e.g. “the ways of the world”, “school”, “environment”, “private things”. They are often general in character. Items that refer to psychological states are excluded, and placed in one of the internal categories.
Expectations
Items are placed here when they refer to the respondent’s own expectations regarding own achievements, perfectionism, need for achievement, lack of and fear of not meeting these expectations, such as “expects too much”, “fear of not being good enough”. It is crucial that the expectation is the person’s own. Items are excluded if they refer to
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Other people’s expectations, these are placed in external category other external factors.
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Expectations of significant others, they are placed in the personal relationships category.
Self-regulation
Items are placed here when they refer to internal difficulties regulating external stressors, or over-focusing on outer demands at the cost of own needs. To exemplify, “difficult to say no”.
Self-image
Includes items that refer to self-image, self-esteem and self-worth, for instance “low self-esteem”, “lack of belief in myself”, “negative self-image”.
Psychiatric Diagnoses
This includes items that refer to specific psychiatric diagnoses, such as “depression” and “PTSD”. Items are excluded if they refer to psychological complaints and symptoms, and somatic diagnoses.
Psychological Complaints
This category contains items that refer to subjective health complaints and symptoms that are psychological of nature, for example “rumination” or “sleep disturbance”. Items are excluded if they refer to specific psychiatric diagnoses.
Emotional Reactions
Items are put here if they refer to psychological reactions of emotional nature, exemplified by “grief”. Reactions that are less intense, and can be viewed as a personal tendency or personality trait, for instance “worrying” or “guilt”, are placed in the category for psychological complaints.
Lack of Coping
This category is related to the classic definition of coping, where the person has sufficient resources to deal with external demands. It contains responses that describe maladaptive coping strategies, or lack of ability to cope, such as “lack of coping with divorce”, “lack of control” or “social isolation”.
Personal Vulnerability
This category contains responses that refer to personality traits and tendencies that are viewed as fairly stable in psychological literature or by the respondent, for example “vulnerability”, “temperament” and “personality”. Items are excluded if they refer to tendencies that are symptoms of psychiatric diagnoses or psychological health complaints, exemplified by “worrying”. These are placed in the psychological complaints category.
Behavior and Lifestyle
This category contains responses that refer to the person’s own actions or behavioral strategies, for instance “moved abroad” or “drug abuse”, and personal lifestyle, e.g. “diet”.
Do Not Know
This category pertains only to responses reflecting that participants do not know which factors they believe caused their illness.
Responsibility
This category contains items referring to responsibility as causal factor of disorder.
Appendix 2: Coding Manual for the Work-Related Category System
Categories from the selective analysis are work stress, leadership, reduced work participation, job dissatisfaction, work conflict, social work environment, job insecurity and change, and physical strain. All items are to be given at least one code, the primary code. Response items that do not specify aspects of the work situation, like “work” or “bad work situation”, are to be coded in the “Unspecified” category. When a response item fits several categories, it is given additional codes corresponding to all relevant categories. The primary code is based on the first-mentioned category in the response item, or the code considered to be best-fitting. To exemplify, the item “workload and conflict at work” is primarily coded in the Work stress category, and given an additional code for the Work conflict category. Descriptions with inclusion and exclusion criteria for the various categories are as follow:
Work Stress
This category includes all responses referring to excessive workloads, pressure and/or expectations from superiors, and lack of coping at work. Items are not put in this category if they mention social stressors; these are to be coded in one of the categories pertaining to social processes. Typically, responses are related to too extensive workloads or work hours, multitasking, the subjective feeling of stress or burnout related to work, and stress caused by the double-burden of work and family.
Leadership
The category pertains to causal attribution of CMDs to negative experiences related to superiors in a workplace hierarchy. Responses may refer to lack of support and understanding from workplace management, lack of training, guidance and individual arrangements in relation to work tasks, conflicts with management, diffusion of responsibility and lack of management skills, conflict with leaders and perceived conflict within the management group and hostile or unfair bosses. Hostile leadership is included in this category because it is viewed as a different phenomenon than bullying: It is regarded as a general tendency in these bosses´ leadership styles, not directed at individual employees. Responses are excluded from this category and coded in the Workplace bullying category if they refer to leaders targeting individual employees negatively.
Reduced Work Participation
Items are placed in this category that refer to reduced work participation in the form of sickness absence, disability and unemployment, and problems relating to this.
Job Dissatisfaction
This category contains all items mentioning job satisfaction, without mentioning a reason for lack of job satisfaction that can be placed in any of the other categories. Responses typically refer to not getting the right kind of job, or not being satisfied with work tasks.
Work Conflict
Items are placed in this category if referring to work conflicts with colleagues and customers, and conflicts where the other party is not specified. Responses referring to conflicts with superiors are to be coded in the category leadership.
Social Work Environment
This category is thought to capture negative social climate and lack of social support at work. Respondents may refer to lack of support from colleagues, having too few colleagues, negative work climates, problems with romantic relationships at work, and difficult relationships in general with colleagues. This category also covers all forms of bullying and harassment at the workplace, and includes responses referring to bullying, violence, general harassment, sexual harassment and threats from management, colleagues and customers.
Job Insecurity and Change
This category is thought to capture causal attribution of CMDs to different forms of job insecurity, unpredictability, job change and problems with dealing with a new job, fear of getting sick listed, reorganization and organizational changes at the workplace, and problems related to this.
Workplace Bullying
This category covers all forms of bullying and harassment at the workplace, and includes responses referring to bullying, violence, general harassment, sexual harassment and threats from management, colleagues and customers.
Physical Strain
This category pertains to all response items regarding work-related physical injury, accidents and bodily strain. Items are included that mention shiftwork, as this is thought to be straining primarily because of sleep deprivation or disrupted circadian rhythm.