When reciprocity fails: effort-reward imbalance in relation to coronary heart disease and health functioning within the Whitehall II study

Adverse psychosocial working conditions and risk of severe depressive symptoms. Do effects differ by occupational grade?

BACKGROUND

Depression is a major concern for public health. Both adverse working conditions and low socio-economic position are suspected to increase risk of depression. In a representative sample of the Danish workforce we investigated (i) whether adverse psychosocial working conditions, defined by the effort-reward imbalance (ERI) model, predicted onset of severe depressive symptoms after 5-year follow-up and (ii) whether the effect of ERI was differential across occupational grades.

METHODS

A cohort of 2701 Danish employees filled in a questionnaire on work and health in 2000 and 2005. ERI was measured with four effort and seven reward items. Depressive symptoms were assessed with the five-item Mental Health Inventory. Participants scoring ≤ 52 points were defined as cases. We used logistic regression to investigate the association of ERI and occupational grade in 2000 with onset of severe depressive symptoms in 2005. Analyses were adjusted for socio-demographics, health behaviours, survey method, self-rated health, sleep disturbances and non-severe depressive symptoms at baseline.

RESULTS

High ERI predicted onset of severe depressive symptoms at follow-up, after adjustment for co-variates and occupational grade (OR = 2.19, 95% CI = 1.12-4.25). Participants with high ERI and low occupational grade showed a considerably higher OR (2.43, 95% CI = 1.07-5.53) compared to participants with low/medium ERI and low grade (OR = 1.45, 95% CI = 0.72-2.92), high ERI and high grade (OR = 1.26, 95% CI = 0.59-2.70) and low/medium ERI and high grade (reference group).

CONCLUSION

Adverse psychosocial working conditions predicted onset of severe depressive symptoms. The effect was stronger among employees of lower occupational grades compared to those of higher grades.

Depressão em trabalhadores de linhas elétricas de alta tensão

OBJETIVO: Investigar a associação entre desequilíbrio esforços-recompensas no trabalho e sintomas depressivos em trabalhadores de linhas elétricas de alta tensão. MÉTODOS: Estudo de corte transversal realizado em 158 trabalhadores de uma empresa de energia elétrica no Nordeste do Brasil. As dimensões do modelo esforço-recompensa (ERI) constituíram as variáveis independentes principais e a variável resposta foi depressão, medida pela escala Center for Epidemiologic Studies Depression (CES-D). Os dados foram analisados com técnicas de regressão logística múltipla. RESULTADOS: Trabalhadores no grupo de baixa recompensa apresentaram prevalência de depressão 6,2 vezes maior em relação àqueles no grupo de alta recompensa. A prevalência de depressão foi 3,3 vezes maior entre os trabalhadores em condição de desequilíbrio esforço-recompensa do que entre aqueles em situação de equilíbrio. CONCLUSÕES: A prevalência de depressão estava fortemente associada às dimensões de esforços e recompensas presentes no trabalho dos eletricitários.

Work-Life Factors and Cardiovascular Disease in Paediatric Occupational Therapists

Introduction:

With cardiovascular disease (CVD) increasing for female workers, there is a need to understand the factors associated with CVD in members of the occupational therapy, predominantly female, profession. The association between burnout and physical health effects, such as CVD, has not been investigated in paediatric occupational therapists.

Method:

Associations between CVD and demographic and work-life factors were investigated in a nationwide postal survey of 486 paediatric occupational therapists.

Results:

The prevalence of CVD in the study population was 11.02%. Private practitioners, older therapists and those with additional self-reported health problems from respiratory disease had increased odds of reporting CVD. In contrast, lower odds of CVD were found for therapists with access to social support, a secure attachment style and income satisfaction.

Conclusion:

Understanding demographic, personal and work-related variables associated with CVD in paediatric occupational therapists provides valuable information about members of the profession. The identification of potentially modifiable work-life factors that are inversely associated with CVD, such as social support and having a secure attachment style, suggests further avenues for research and intervention. Ongoing vigilance, and education directed towards self-care as well as client care, is required to ensure optimal health for colleagues.

Long-term effects of psychosocial work stress in midlife on health functioning after labor market exit--results from the GAZEL study

OBJECTIVES

To study long-term effects of psychosocial work stress in mid-life on health functioning after labor market exit using two established work stress models.

METHODS

In the frame of the prospective French Gazel cohort study, data on psychosocial work stress were assessed using the full questionnaires measuring the demand-control-support model (in 1997 and 1999) and the effort-reward imbalance model (in 1998). In 2007, health functioning was assessed, using the Short Form 36 mental and physical component scores. Multivariate regressions were calculated to predict health functioning in 2007, controlling for age, gender, social position, and baseline self-perceived health.

RESULTS

Consistent effects of both work stress models and their single components on mental and physical health functioning during retirement were observed. Effects remained significant after adjustment including baseline self-perceived health. Whereas the predictive power of both work stress models was similar in the case of the physical composite score, in the case of the mental health score, values of model fit were slightly higher for the effort-reward imbalance model (R(2): 0.13) compared with the demand-control model (R²: 0.11).

CONCLUSIONS

Findings underline the importance of working conditions in midlife not only for health in midlife but also for health functioning after labor market exit.

Culture, history, and health in an Australian aboriginal community: the case of utopia

The poor health of Indigenous Australians is well established. However, the health of residents of one remote community in the Northern Territory of Australia called Utopia has been found recently to be much better than expected. In this article, we draw on historical anthropological research to explain this finding. We trace how cultural and social structures were maintained through changing eras of government policy from the 1930s, and show how these structures strengthened psychosocial determinants of health. We argue that the mainstream psychosocial determinants of social cohesion and self-efficacy are usefully reconceptualized in an Indigenous context as connectedness to culture and land, and collective efficacy, respectively. Continuity of cultural and social structures into the 1940s was facilitated by a combination of factors including the relatively late colonial occupation, the intercultural practices typical of the pastoral industry, the absence of a mission or government settlement, and the individual personalities and histories of those connected to Utopia.

The effects of repeated handling and corticosterone treatment on behavior in an amphibian (Ocoee salamander: Desmognathus ocoee)

Exposure to unpredictable challenges triggers a stress response that helps an animal cope by ensuring energy availability and increasing expression of anti-predator behaviors. At the same time, stress responses typically suppress activities non-essential to immediate survival, such as growth and reproduction. Glucocorticoid hormones are key mediators of the stress response. We measured the effects of repeated exposure to a handling stressor and repeated elevation of plasma levels of the glucocorticoid hormone, corticosterone (CORT) in a terrestrial salamander, Desmognathus ocoee. Subjects were handled daily or treated every day with a dermal patch containing CORT. Compared to control treatments, chronic handling and treatment with CORT both resulted in decreased body weight. Repeated handling, but not treatment with CORT, reduced feeding in females and activity in both males and females. Treatments had no effect on white blood cell differentials. Despite a nonsignificant trend for courtship to be delayed in handled animals, most salamanders in all treatment groups courted and mated. Courtship and mating may be relatively resistant to the effects of repeated handling and elevated plasma CORT because courtship and mating are energetically inexpensive in this species.

Heart rate variability related to effort at work

Changes in autonomic nervous system function have been related to work stress induced increases in cardiovascular morbidity and mortality. Our purpose was to examine whether various heart rate variability (HRV) measures and new HRV-based relaxation measures are related to self-reported chronic work stress and daily emotions. The relaxation measures are based on neural network modelling of individual baseline heart rate and HRV information. Nineteen healthy hospital workers were studied during two work days during the same work period. Daytime, work time and night time heart rate, as well as physical activity were recorded. An effort-reward imbalance (ERI) questionnaire was used to assess chronic work stress. The emotions of stress, irritation and satisfaction were assessed six times during both days. Seventeen subjects had an ERI ratio over 1, indicating imbalance between effort and reward, that is, chronic work stress. Of the daily emotions, satisfaction was the predominant emotion. The daytime relaxation percentage was higher on Day 2 than on Day 1 (4 ± 6% vs. 2 ± 3%, p < 0.05) and the night time relaxation (43 ± 30%) was significantly higher than daytime or work time relaxation on the both Days. Chronic work stress correlated with the vagal activity index of HRV. However, effort at work had many HRV correlates: the higher the work effort the lower daytime HRV and relaxation time. Emotions at work were also correlated with work time (stress and satisfaction) and night time (irritation) HRV. These results indicate that daily emotions at work and chronic work stress, especially effort, is associated with cardiac autonomic function. Neural network modelling of individual heart rate and HRV information may provide additional information in stress research in field conditions.

Occupational stress, job characteristics, coping, and the mental health of nurses

OBJECTIVES

 This study investigated the relationships between job characteristics and coping in predicting levels of anxiety and depression in nurses. The study was based on current theories of occupational stress, and predictors included job demands, social support, decision authority and skill discretion control, effort, over-commitment, rewards, and ways of coping. It was predicted that job demands, extrinsic effort, over-commitment, and negative coping behaviours would be positively associated with depression and anxiety, and social support, rewards, decision authority, skill discretion control, and positive coping would be negatively associated with depression and anxiety.

METHODS

 Participants were 870 nurses, who responded to a bulk mail sent randomly to 4,000 nurses from the south of England.

RESULTS

 The results showed that job demands, extrinsic effort, and over-commitment were associated with higher levels of anxiety and depression. Social support, rewards, and skill discretion were negatively associated with mental health problems. Few interactions were found between the variables. Coping behaviours significantly added to the explanation of variance in anxiety and depression outcomes, over and above the use of demand-control-support, and effort-reward factors alone.

CONCLUSION

 The results from the study demonstrated the importance of coping factors in work-stress research, in accordance with the multi-factorial premise of transactional stress models. It is argued that multi-factor research is needed to help develop effective organizational interventions.

Effort-reward imbalance at work and recurrent coronary heart disease events: a 4-year prospective study of post-myocardial infarction patients

OBJECTIVE

Prospective studies have shown that effort-reward imbalance (ERI) at work is associated with the incidence of a first coronary heart disease (CHD) event. However, it is unknown whether ERI at work increases the risk of recurrent CHD events. The objective of this study was to determine whether ERI at work and its components (effort and reward) increase the risk of recurrent CHD in post-myocardial infarction (post-MI) workers.

METHODS

We carried out a prospective cohort study of 669 men and 69 women who returned to work after a first MI. ERI at work was assessed by telephone interview using validated scales of reward and psychological demands. The outcome was a composite of fatal CHD, nonfatal MI, and unstable angina. CHD risk factors were documented in medical files and by interview. The participants were followed up for a mean period of 4.0 years (1998-2005).

RESULTS

During the follow-up, 96 CHD events were documented. High ERI and low reward were associated with recurrent CHD (respective adjusted hazard ratios [HRs] = 1.75, 95% confidence interval [CI] = 0.99-3.08, and HR = 1.77, 95% CI = 1.16-2.71). There was a gender interaction showing stronger effects among women (respective adjusted HRs for high ERI and low reward: HR = 3.95, 95% CI = 0.93-16.79, and HR = 9.53, 95% CI = 1.15-78.68).

CONCLUSIONS

Post-MI workers holding jobs that involved ERI or low reward had increased risk of recurrent CHD.

What do we know about the non-work determinants of workers' mental health? A systematic review of longitudinal studies

Background

In the past years, cumulative evidence has convincingly demonstrated that the work environment is a critical determinant of workers' mental health. Nevertheless, much less attention has been dedicated towards understanding the pathways through which other pivotal life environments might also concomitantly intervene, along with the work environment, to bring about mental health outcomes in the workforce. The aim of this study consisted in conducting a systematic review examining the relative contribution of non-work determinants to the prediction of workers' mental health in order to bridge that gap in knowledge.

Methods

We searched electronic databases and bibliographies up to 2008 for observational longitudinal studies jointly investigating work and non-work determinants of workers' mental health. A narrative synthesis (MOOSE) was performed to synthesize data and provide an assessment of study conceptual and methodological quality.

Results

Thirteen studies were selected for evaluation. Seven of these were of relatively high methodological quality. Assessment of study conceptual quality yielded modest analytical breadth and depth in the ways studies conceptualized the non-work domain as defined by family, network and community/society-level indicators. We found evidence of moderate strength supporting a causal association between social support from the networks and workers' mental health, but insufficient evidence of specific indicator involvement for other analytical levels considered (i.e., family, community/society).

Conclusions

Largely underinvestigated, non-work determinants are important to the prediction of workers' mental health. More longitudinal studies concomitantly investigating work and non-work determinants of workers' mental health are warranted to better inform healthy workplace research, intervention, and policy.

Impact of common mental disorders on sickness absence in an occupational cohort study

OBJECTIVES

Common mental disorders are associated with impaired functioning and sickness absence. We examine whether sub-clinical as well as clinical psychiatric morbidity predict long spells of sickness absence for both psychiatric and non-psychiatric illness. We also examine whether recent common mental disorders and those present on two occasions have a stronger association with sickness absence than less recent and single episodes of disorder.

METHODS

Common mental disorders measured by the General Health Questionnaire were linked with long spells of sickness absence in 5104 civil servants from the longitudinal Whitehall II Study. Negative binomial models were used to estimate rate ratios for long spells of sickness absence with and without a psychiatric diagnosis (mean follow-up 5.3 years).

RESULTS

Clinical but not sub-threshold common mental disorders were associated with increased risk of long spells of psychiatric sickness absence for men, but not for women, after adjusting for covariates (rate ratios (RR) 1.67, 95% CI 1.13 to 2.46). Risk of psychiatric sickness absence was associated with recent common mental disorders (RR 2.08, 95% CI 1.29 to 3.35) and disorder present on two occasions (RR 1.65, 95% CI 0.98 to 2.71) for men only. Common mental disorders were not associated with increased risk of non-psychiatric sickness absence after adjustment for covariates.

CONCLUSIONS

Identification and treatment of common mental disorders may reduce the economic burden of long term psychiatric sickness absence. Our results suggest that public health and clinical services should focus on the identification of workers with elevated mental health symptoms. Studies are needed of the efficacy of early identification and management of mental health symptoms for the prevention of long spells of sickness absence.

Effects of occupational stress, job characteristics, coping, and attributional style on the mental health and job satisfaction of university employees

Well-being at work has been shown to be influenced by job characteristics and individual differences in coping styles. This study investigated the relationships between job demands, control, social support, efforts, rewards, coping, and attributional style in predicting anxiety, depression, and job satisfaction in a sample of 307 university employees from the UK. Results were compared to those from a sample of 120 members of the general population. Workplace demands, intrinsic and extrinsic effort, and negative coping and attributional behaviors were associated with high levels of depression and anxiety and low job satisfaction in university employees. Rewards, social support, job control, and positive coping and attributional behaviors were associated with lower levels of depression and anxiety and high job satisfaction. The study adds to the growing research on university samples by showing that a transactional approach should be adopted. This has implications for interventions and suggests that rather than just trying to change job characteristics one should identify at-risk individuals in this population and help them adopt appropriate positive coping styles.

The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review

PURPOSE

A systematic review was carried out to assess evidence for the association between different models of stress at work, and cardiovascular morbidity and mortality.

METHODS

A literature search was conducted using five databases (MEDLINE, Cochrane Library, EMBASE, PSYNDEX and PsycINFO). Inclusion criteria for studies were the following: self-reported stress for individual workplaces, prospective study design and incident disease (myocardial infarction, stroke, angina pectoris, high blood pressure). Evaluation, according to the criteria of the Scottish Intercollegiate Guidelines Network, was done by two readers. In case of disagreement, a third reader was involved.

RESULTS

Twenty-six publications were included, describing 40 analyses out of 20 cohorts. The risk estimates for work stress were associated with a statistically significant increased risk of cardiovascular disease in 13 out of the 20 cohorts. Associations were significant for 7 out of 13 cohorts applying the demand-control model, all three cohorts using the effort-reward model and 3 out of 6 cohorts investigating other models. Most significant results came from analyses considering only men. Results for the association between job stress and cardiovascular diseases in women were not clear. Associations were weaker in participants above the age of 55.

CONCLUSIONS

In accordance with other systematic reviews, this review stresses the importance of psychosocial factors at work in the aetiology of cardiovascular diseases. Besides individual measures to manage stress and to cope with demanding work situations, organisational changes at the workplace need to be considered to find options to reduce occupational risk factors for cardiovascular diseases.

Detailed assessment of the hemodynamic response to psychosocial stress using real-time MRI

PURPOSE

To demonstrate that combining the Montreal Imaging Stress Task (MIST) with real-time cardiac magnetic resonance imaging (MRI) allows detailed assessment of the cardiovascular mental stress response.

MATERIALS AND METHODS

22 healthy volunteers (1:1 M:F, 26-64 years) underwent MRI during rest and the MIST. Real-time spiral phase contrast MR, accelerated with sensitivity encoding (SENSE) was used to assess stroke volume (SV), and radial k-t SENSE was used to assess ventricular volumes. Simultaneous heart rate (HR) and blood pressure (BP) measures allowed calculation of cardiac output (CO), systemic vascular resistance (SVR), and arterial compliance (TAC). Endocrine responses were assessed using salivary cortisol.

RESULTS

In response to stress, BP increased due to increased CO and reduced TAC but not increased SVR, which fell. HR, not SV, determined CO increases. Greater BP responses occurred in men due to greater CO increases and relatively higher SVR. Older participants had greater BP responses due to greater falls in TAC. Greater cortisol response was correlated with greater falls in TAC but resting cortisol and TAC were not related.

CONCLUSION

This new approach allows detailed, accurate assessment of stress physiology. Preliminary findings suggest stress exposes relationships, not seen at rest, of cardiovascular function with age, sex, and endocrine function.

The Relationship between Adult Attachment Styles and Work-Related Self-Perceptions for Australian Paediatric Occupational Therapists

Introduction:

An attachment framework has been increasingly employed to inform our understanding of the ways in which early childhood relationships have an impact upon people's adaptation to the workplace. Evidence supports the presence of four attachment-related work orientations in adulthood (secure, cautious, support-seeking and self-reliant), which correspond to a secure and three insecure attachment patterns in early childhood. Although these work orientations have been investigated in several working populations, they have not yet been considered within a sample of occupational therapists.

Method:

The present exploratory study considered the results of a nationwide survey of 486 paediatric occupational therapists, and investigated the associations between attachment styles and a range of demographic variables and work-related self-perceptions.

Results:

Consistent with hypotheses, those with a secure attachment style reported a high investment of skill and energy in their job and low levels of over commitment. Conversely, cautious attachment and, to a lesser extent, support-seeking attachment were linked with feeling overcommitted and perceiving low returns in terms of recognition and prestige from their work.

Conclusion:

Understanding how practitioners' predominant attachment style is associated with work-related self-perceptions may offer insights into their behaviours and needs. This, in turn, can inform the provision of appropriate supports, with potential benefits for staff satisfaction, retention, health, wellbeing and, ultimately, client care.

Subjective underchallenge at work and its impact on mental health

PURPOSE

To investigate the relation between subjective underchallenge at work and the degree of depressiveness and life satisfaction.

METHODS

A representative sample of the German general population of N = 1,178 (52.5% men; age: M = 40.4 years, SD = 11.3) was included in this study. Measurements contain Satisfaction with Life Scalè (SWLS) and the Patient Health Questionnairè (PHQ-D). To assess subjective underchallenge at work, a ten-item scale was developed for the purpose of this study. The association between subjective underchallenge at work, life satisfaction and depressiveness was examined by means of path analyses.

RESULTS

A significant positive association was found between subjective underchallenge at work and depressiveness, mediated by life satisfaction. This association was not moderated by income but by level of education. Participants with a medium educational level displayed a weaker association than participants with either a high or a low educational level.

CONCLUSION

Not only work overload but also feeling underchallenged at work can have a negative impact on mental health and well-being. This is not an issue for blue-collar workers only and deserves more attention in future research.

Health-related quality of life and working conditions among nursing providers

OBJECTIVE

To evaluate working conditions associated with health-related quality of life (HRQL) among nursing providers.

METHODS

Cross-sectional study conducted in a university hospital in the city of São Paulo, Southeastern Brazil, during 2004-2005. The study sample comprised 696 registered nurses, nurse technicians and nurse assistants, predominantly females (87.8%), who worked day and/or night shifts. Data on sociodemographic information, working and living conditions, lifestyles, and health symptoms were collected using self-administered questionnaires. The following questionnaires were also used: Job Stress Scale, Effort-Reward Imbalance (ERI) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Ordinal logistic regression analysis using proportional odds model was performed to evaluate each dimension of the SF-36.

RESULTS

Around 22% of the sample was found to be have high strain and 8% showed an effort-reward imbalance at work. The dimensions with the lowest mean scores in the SF-36 were vitality, bodily pain and mental health. High-strain job, effort-reward imbalance (ERI>1.01), and being a registered nurse were independently associated with low scores on the role emotional dimension. Those dimensions associated to mental health were the ones most affected by psychosocial factors at work.

CONCLUSIONS

Effort-reward imbalance was more associated with health than high-strain (high demand and low control). The study results suggest that the joint analysis of psychosocial factors at work such as effort-reward imbalance and demand-control can provide more insight to the discussion of professional roles, working conditions and HRQL of nursing providers.

Psychosocial factors in the development of heart disease in women: current research and future directions

OBJECTIVE

To review the recent (1995-2009) literature on psychosocial risk and protective factors for coronary heart disease (CHD) among women, including negative emotions, stress, social relationships, and positive psychological factors.

METHODS

Articles for the review were identified using PubMed and bibliographies of relevant articles. Eligible studies included at least 100 women and either focused on a) exclusively female participants or b) both men and women, conducting either gender-stratified analyses or examining interactions with gender. Sixty-seven published reports were identified that examined prospective associations with incident or recurrent CHD.

RESULTS

In general, evidence suggests that depression, anxiety disorders, anger suppression, and stress associated with relationships or family responsibilities are associated with elevated CHD risk among women, that supportive social relationships and positive psychological factors may be associated with reduced risk, and that general anxiety, hostility, and work-related stress are less consistently associated with CHD among women relative to men.

CONCLUSIONS

A growing literature supports the significance of psychosocial factors for the development of CHD among women. Consideration of both traditional psychosocial factors (e.g., depression) and factors that may be especially important for women (e.g., stress associated with responsibilities at home or multiple roles) may improve identification of women at elevated risk as well as the development of effective psychological interventions for women with or at risk for CHD.

The physical activity, stress and metabolic syndrome triangle: a guide to unfamiliar territory for the obesity researcher

Research aimed at deciphering the aetiology of obesity and the metabolic syndrome remains focused on two behavioural factors, namely diet and physical activity, even though epidemiologic research suggests that these two cornerstones of treatment and prevention account for only a small-to-moderate portion of the variance in these phenotypes. In recent years, this observation has prompted the intensified investigation of the pathogenic potential of factors that extend beyond the traditional concept of energy imbalance and examine the putative causes of this imbalance. Psychosocial stress has emerged as one such factor, raising the need for researchers to be informed about this expansive and complex literature. The purpose of this review is twofold (i) To introduce obesity researchers to fundamental concepts and historically important theoretical developments in the stress field and (ii) To outline the dyadic and triadic interactions between stress, physical activity and the metabolic syndrome. Although the expansion of the research focus to multiple, diverse and interacting putative causal agents will certainly increase the complexity of the research enterprise, this step seems essential for the comprehension and effective response to the continuing rise in the prevalence of obesity and the metabolic syndrome.

Perceived reciprocity in social exchange and health functioning in early old age: prospective findings from the GAZEL study

OBJECTIVES

To assess prospectively the effects of perceived non-reciprocity of exchange in three different types of social engagement on health functioning in early old age.

METHODS

In the frame of the prospective French GAZEL cohort study, data on reciprocity in three types of role-related social engagement (principal regular activity in everyday life, marital role relationship, trusting relationships in civic life) were collected from 8679 men and 2742 women (mean age: 60.4 years) in 2005. Two years later, health functioning was assessed using the SF-36 mental and physical component scores, as well as self-perceived health. Multivariate regressions were calculated, controlling for important confounders including baseline self-perceived health.

RESULTS

Consistent effects of perceived non-reciprocity in all three types of social exchange on mental and physical health functioning were observed. After adjustment for relevant confounders including baseline self-perceived, health effects were attenuated, but largely remained significant.

CONCLUSIONS

Findings underline the importance of the quality of social exchange (reciprocity vs. non-reciprocity) for health functioning in early old age.

Higher overcommitment to work is associated with higher plasma cortisol but not ACTH responses in the combined dexamethasone/CRH test in apparently healthy men and women

BACKGROUND

Overcommitment (OC) is a pattern of excessive striving that has been associated with alterations in the hypothalamus-pituitary-adrenal (HPA) system. To investigate whether overcommitment is associated with alterations in HPA system function we measured cortisol and adrenocorticotropin (ACTH) release in response to the combined dexamethasone/CRH test.

METHODS

We recruited 92 men and 108 women of a wide range of OC scores including the minimum (6) and maximum (24) of possible OC scores (mean+/-SEM: 13.25+/-.27). We repeatedly measured plasma cortisol and ACTH levels in the combined dexamethasone/CRH test after injection of 100mul CRH preceded by administration of 1.5mg dexamethasone the night before. Moreover, we assessed depressive symptoms (Beck Depression Inventory, BDI) and work stress (effort-reward-imbalance, ERI).

RESULTS

Independent of age and gender, higher OC was associated with higher repeated cortisol (interaction time-by-OC: p=.014, f=.15) but not ACTH (p=.22) secretion in the combined dexamethasone/CRH test. Similarly, higher cortisol (beta=.16, p=.029, R(2)=.02) but not ACTH (p=.47) increase following CRH injection was predicted by higher OC. Depressive symptoms (BDI score) and work stress scores (effort-reward-ratio) did not relate to neuroendocrine responses to the dexamethasone/CRH test. Controlling for depressive symptoms and work stress scores in addition to age and gender did not change results. OC was not associated with ACTH or cortisol pre-test levels.

DISCUSSION

Whereas OC was not associated with alterations in negative feedback sensitivity after dexamethasone administration, our findings indicate that with increasing OC scores, a higher reactivity of the adrenal cortex together with a normal reactivity of the pituitary is observed following subsequent stimulation by CRH injection.

Work stress of primary care physicians in the US, UK and German health care systems

Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005 to 2007. Results demonstrate country-specific differences in work stress with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions.

The influence of occupational stress factors on the nicotine dependence: a cross sectional study

OBJECTIVE

This study analyses the association between occupational stress factors and nicotine dependence. Our hypothesis is that occupational stress factors increase nicotine dependence.

METHODS

Data were taken from the Cologne Smoking Study, a case-control study that examines which genetic/psychosocial factors lead to a higher risk for smokers to suffer from cardiac infarction, lung cancer and/or to become addicted to nicotine. Our sample consisted of N = 197 currently smoking and employed participants. Nicotine dependence was measured using the Fagerström Test for Nicotine Dependence (FTND). The extent of the stress factors experienced at work was assessed using the Effort-Reward Imbalance scale (ERI). Logistic regression was used for the statistical analysis.

RESULTS

Contrary to our hypothesis, the results show that occupational stress factors are actually associated with lower levels of nicotine dependence (N = 197; adjusted OR = 0.439; p = .059).

CONCLUSIONS

One possible explanation for the study's findings is that the participants have a heavy workload and can only smoke in their spare time. Another reason may be workplace smoking bans. Furthermore, the Fagerström Test for Nicotine Dependence is unable to examine nicotine dependence during working hours.

Assessing the contribution of working conditions to socioeconomic disparities in health: a commentary

INTRODUCTION

Occupational health researchers can play a pivotal role in increasing our understanding of the role of physical and psychosocial working conditions in producing socioeconomic health disparities and trends of increasing socioeconomic health disparities, contributing to interventions to reduce such disparities, and helping to improve public education materials on this subject. However, a number of methodological challenges in this field need to be considered.

METHODS

Commentary, including a review of selected studies.

RESULTS/CONCLUSION

Research needs to be guided by models of the associations between social (socioeconomic position (SEP), race/ethnicity, immigration status, and gender) and occupational variables and health, to avoid inappropriate control for confounding, and to specify causal pathways (mediation) and interaction effects. Different approaches to the theory and measurement of SEP also need to be tested.

Work stress and health in Western European and post-communist countries: an East-West comparison study

BACKGROUND

There is evidence that psychosocial factors at work influence the risk of poor health in Western societies, but little is known about the effect of work stress in the former communist countries. The aim of this paper is to compare the association of work stress with self-rated health in Western European and post-communist countries.

METHODS

Data from four epidemiological studies were used: the HAPIEE study (Poland, Russia and the Czech Republic), the Hungarian Epidemiological Panel (Hungary), the Heinz Nixdorf Recall study (Germany) and the Whitehall II study (UK). The overall sample consisted of 18 494 male and female workers aged 35-65 years.

RESULTS

High effort-reward imbalance at work was associated with poor self-rated health. The adjusted odds ratios for the highest versus lowest quartile of the effort-reward ratio were 3.8 (95% CI 1.9 to 7.7) in Hungary, 3.6 (95% CI 2.3 to 5.7) in the Czech Republic, 2.5 (95% CI 1.5 to 4.1) in the UK, 2.3 (95% CI 1.6 to 3.5) in Germany, 1.5 (95% CI 1.0 to 2.1) in Poland and 1.4 (95% CI 1.1 to 1.8) in Russia. The differences in odds ratios between countries were statistically significant (p<0.05). A similar pattern was observed for the effect of overcommitment on poor health.

CONCLUSION

The association of effort-reward imbalance at work and of a high degree of work-related overcommitment with poor self-rated health was seen in all countries, but the size of the effects differed considerably. It does not appear that the effects in Eastern Europe are systematically stronger than in the West.

Work stress and driving anger in Japan

We investigated the relationship between work stress arising from effort-reward imbalance at work (ERI) and driving anger in a community sample of workers in Nagoya, a mid-sized city in Japan. We hypothesised that ERI would exert a positive effect on driving anger via its influence on trait anger. The study also pioneered the use of the Driving Anger Scale (DAS) in a non-western country and explored cultural differences in the experience of anger on the road. A random sample of 215 (N = 138, 64% females; N = 77, 36% males) full-time Japanese workers was obtained through random selection of one participant per household in three randomly selected suburbs (response rate 71% of each eligible participant approached). Participants completed a confidential self-report questionnaire. Japanese motorists reported significantly higher levels of ERI than all comparative western samples, and lower total driving anger and anger on all DAS subscales compared with American and Australian samples. British and Japanese drivers did not differ significantly on total driving anger. The findings indicate that Japanese may possess a different acceptance and expression of anger on the road. Hierarchical multiple regression analyses supported our hypothesis. Stress experienced in the workplace originating from a perceived disparity in extrinsic efforts and rewards was associated with increased enduring feelings of anger in employees, and through this anger an elevated level of aggressive feelings on the road. Stress from ERI may spill over into other domains, and changes at work are necessary to alleviate the impact on the individual, organisation and economy.

Distribution of effort-reward imbalance in Denmark and its prospective association with a decline in self-rated health

OBJECTIVE

To analyze the distribution of effort-reward imbalance (ERI) and to investigate its impact on self-rated health in a representative sample of the Danish workforce.

METHODS

We studied 4977 employees who responded to a questionnaire in 2000, of which 3470 responded to a follow-up survey in 2005.

RESULTS

The highest (ie, most unfavorable) ERI ratio was found in executives in the public sector, social workers, managing clerks in the public sector, and medical secretaries. A one standard deviation increase of the ERI ratio predicted a 12% (95% confidence intervals = 1.01 to 1.24) decline in self-rated health after adjustment for all covariates.

CONCLUSIONS

This is the first study that identified job groups with a high exposure to ERI in a representative sample of a national workforce. ERI was a risk factor for a decline in self-rated health.

Psychosocial work environment and its association with socioeconomic status. A comparison of Spain and Denmark

Aims: The purpose of this study was to describe psychosocial work environment inequalities among wage earners in Spain and Denmark. Methods: Data came from the Spanish COPSOQ (ISTAS 21) and the Danish COPSOQ II surveys both performed in 2004—05 and based on national representative samples of employees with a 60% response rate. Study population was 3,359 Danish and 6,685 Spanish women and men. Only identical items from both surveys were included to construct 18 psychosocial scales. Socioeconomic status was categorized according to the European Socioeconomic Classification System. Analysis included ordinal logistic regression and multiple correspondence analysis after categorizing all scales. Results: A relationship between socioeconomic status and psychosocial work environment in both Denmark and Spain was observed, with wider social inequalities in Spain for many scales, describing a strong interaction effect between socioeconomic status and country. Conclusions: Socioeconomic status is related to psychosocial work environment and some adverse psychosocial conditions tend to cluster in lower socioeconomic status groups in both Spain and Denmark. This effect could be modified by a country’s characteristics, such as economic and labour market structures, normative regulations and industrial relations including work organization. Hence, preventive strategies to reduce social inequalities in working conditions should consider the combination of actions at the macro and micro levels.

Do pre-employment influences explain the association between psychosocial factors at work and coronary heart disease? The Whitehall II study

OBJECTIVES

To examine whether the association between psychosocial factors at work and incident coronary heart disease (CHD) is explained by pre-employment factors, such as family history of CHD, education, paternal education and social class, number of siblings and height.

METHODS

A prospective cohort study of 6435 British men aged 35-55 years at phase 1 (1985-1988) and free from prevalent CHD at phase 2 (1989-1990) was conducted. Psychosocial factors at work were assessed at phases 1 and 2 and mean scores across the two phases were used to determine long-term exposure. Selected pre-employment factors were assessed at phase 1. Follow-up for coronary death, first non-fatal myocardial infarction or definite angina between phase 2 and 1999 was based on clinical records (250 events, follow-up 8.7 years).

RESULTS

The selected pre-employment factors were associated with risk for CHD: HRs (95% CI) were 1.33 (1.03 to 1.73) for family history of CHD, 1.18 (1.05 to 1.32) for each quartile decrease in height and 1.16 (0.99 to 1.35) for each category increase in number of siblings. Psychosocial work factors also predicted CHD: 1.72 (1.08 to 2.74) for low job control and 1.72 (1.10 to 2.67) for low organisational justice. Adjustment for pre-employment factors changed these associations by 4.1% or less.

CONCLUSIONS

In this occupational cohort of British men, the association between psychosocial factors at work and CHD was largely independent of family history of CHD, education, paternal educational attainment and social class, number of siblings and height.

Participation in socially-productive activities, reciprocity and wellbeing in later life: baseline results in England

This paper examines whether participation in social activities is associated with higher levels of wellbeing among post-retirement age people in England, and, if so, whether these relationships are explained by the reciprocal nature of these activities. Cross-sectional analysis of relationships between social activities (including paid work, caring and volunteering) and wellbeing (quality of life, life satisfaction and depression) was conducted among participants of one wave of the English Longitudinal Study of Ageing (ELSA) who were of state pension age or older. Participants in paid or voluntary work generally had more favourable wellbeing than those who did not participate in these activities. Caring was not associated with wellbeing, although female carers were less likely to be depressed than non-carers. Carers, volunteers and those in paid work who felt adequately rewarded for their activities had better wellbeing than those who were not participating in those activities, while those who did not feel rewarded did not differ from non-participants. These results point to the need to increase the rewards that older people receive from their productive activities, particularly in relation to caring work.

Extrinsic high-effort and low-reward conditions at work among institutional staff caring for people with intellectual disabilities in Taiwan

The purposes of the present study were to determine whether extrinsic high-effort/low-reward conditions at work are associated with personal characteristics and the organizational environments. A cross-sectional survey was conducted (76.7% response rate, N=1243) by recruiting the staff caring for people with intellectual disabilities of Taiwan in 2006. Conditions at work were measured using Siegrist's Effort-Reward Imbalance (ERI) model, the questionnaire included 23 Likert scaled items and it divided into three scales: effort, reward and overcommitment. Multiple logistic regression modeling was conducted for extrinsic high-effort/low-reward status in relation to staff and working environmental factors. We found that 15.1% staff were in the low-effort/low-reward group, 35.9% was in the low-effort/high-reward group, 17.9% belonged to the high-effort/high-reward group and 31.1% was included in the high-effort/low-reward group. Controlling for many personal demographic and organizational characteristics, the factors of perceived job support (OR=0.91; 95% CI=0854-0.97), job control (OR=0.954, 95% CI=0.934-0.974), job demand (OR=1.155, 95% CI=1.109-1.203) and job stress (felt sometimes stressful compare to no stress at all, OR=2.305, 95% CI=1.161-4.575) of the staff were significantly correlated to the extrinsic high effort/low reward at work in the multiple logistic regression model. The present study highlights that the service providers need to be aware and understand the experiences that their staff encounters in the organizational, interpersonal and personal level regarding unfair working conditions such as high effort/low reward to improve the positive health of the staff.

Job stress and coronary heart disease: a case-control study using a Chinese population

OBJECTIVES

This study was to examine the association between job stress and coronary heart disease (CHD) in a Chinese population.

METHODS

The 388 participants aged 30 to 70 yr who received coronary angiography for suspected or known ischemic heart disease were enrolled in this series, which included 292 CHD cases and 96 controls. The job stress before CHD onset was measured by the effort-reward imbalance (ERI) model.

RESULTS

In the results, compared with the baseline, high ERI, high extrinsic effort or high overcommitment increased the risk of CHD with odds ratios (OR) of 2.8, 2.7 and 2.8 respectively after adjustment for the traditional CHD risk factors, such as age, gender, primary hypertension, diabetes mellitus, hyperlipidemia, smoking, body mass index, CHD family history, educational level, and marital status. The combination of high ERI and high overcommitment led to the highest risk of CHD with adjusted OR 5.5. However, high reward reduced the risk of CHD with an adjusted OR of 0.4 in comparison to low reward. Dose-response relationships were also observed.

CONCLUSIONS

Job stress evaluated by the ERI model significantly increased the risk of CHD, and it may be an important risk factor independent of the traditional risk factors of CHD in the Chinese population.

Chronic work stress and exhaustion is associated with higher allostastic load in female school teachers

Epidemiological studies have shown that chronic work stress or unfavourable psychosocial work conditions are prospectively associated with different adverse health outcomes. The aim of the present cross-sectional study was to investigate the relationship between work-related chronic stress as well as exhaustion and a cumulative measure of physiological wear-and-tear called allostastic load (AL). AL could be a possible biological pathway for how chronic work stress and exhaustion lead to health impairments in the long run. As the teaching profession has been proposed to be a potentially high stressful occupation, chronic work stress (effort-reward-imbalance) and exhaustion were assessed in 104 female school teachers. AL was first analyzed according to McEwen's classical model comprised of ten parameters including cortisol, epinephrine and norepinephrine, dehydroepiandrosterone-sulphate (DHEA-S), waist/hip-ratio (WHR), glycosylated haemoglobin (HbA1c), high-density lipoprotein (HDL), total cholesterol/HDL-ratio, and systolic and diastolic blood pressure. Additionally it was extended to include tumor-necrosis-factor-alpha (TNF-alpha), C-reactive protein (CRP), fibrinogen, D-dimer, percent-body-fat, triglycerides, and glucose levels. A substantial proportion of our sample was highly exhausted whereas relatively few teachers showed high effort-reward-imbalance. AL scores were significantly higher in women high on effort-reward-imbalance or suffering from exhaustion. Although all teachers had been in a good health status, chronic work stress as well as exhaustion appears to be associated with changes in a multi-system summary indicator of physiological risk.

Reciprocal relations between effort-reward imbalance at work and adverse health: a three-wave panel survey

Siegrist's [1996. Adverse health effects of high-effort/low-reward conditions. Journal of Occupational Health Psychology, 1, 27-41.] Effort-Reward Imbalance (ERI) Model assumes that ERI at one point in time influences health at a later point in time. Empirical cross-sectional and longitudinal findings have supported the influence of ERI on adverse health. However, the ERI model does not explicitly take into account that the relation between ERI and adverse health may be also explained by reversed causal relations, or even reciprocal (bi-directional) relations in which ERI and health mutually influence each other. The present 3-wave panel study among 211 Japanese male blue-collar workers in one construction machinery company examined reciprocal relations between ERI and adverse health (i.e., psychological distress and physical complaints) with a 1-year time-lag per wave. Hypotheses were tested using structural equation modeling (Amos 7.0J). Results showed cross-lagged and causally dominant effects of ERI on both psychological distress and physical complaints after 1 year for both Time 1-Time 2 and Time 2-Time 3. In addition, cross-lagged effects of psychological distress on ERI were found after 1 year for both Time 1-Time 2 and Time 2-Time 3. These findings suggest that (perceived) ERI and employee health influence each other reciprocally rather than uni-directionally, and underline the importance of studying reversed causal effects in the relation between ERI and employee health.

Reciprocal affiliation among adolescent rats during a mild group stressor predicts mammary tumors and lifespan

OBJECTIVE

Although the detrimental physical health effects of social isolation have been known for three decades, the answers to how and why social relationships generally improve health remain elusive. Social relationships are not always beneficial, and we examined a structural dimension that may bring about their salubrious effects: affiliative reciprocity during a stressor.

METHODS

In a lifespan study, female rats lived with their sisters and were tested for temperament, affiliative reciprocity during an everyday stressor at puberty, corticosterone response to a stressor, mammary tumor development and diagnosis, and death.

RESULTS

Rats that affiliated more reciprocally during a mild group stressor survived longer (p = .0005), having exhibited a lower corticosterone peak in response to an acute novel stressor in late adulthood (p = .0015), and longer time to the development of spontaneous mammary tumors (p = .02). These effects could not be explained solely by the number of affiliative interactions or individual temperament. Indeed, affiliative reciprocity and neophobia were independent and predicted mortality additively (p = .0002).

CONCLUSIONS

Affiliative reciprocity during a stressor, a structural quality of social interactions, protected females from early mammary tumor development (the primary pathology in Sprague-Dawley rats) and early all-cause mortality. Conversely, lack of reciprocity (whether disproportionately seeking or receiving attempted affiliation) was as potent a risk factor as neophobia. Thus a social role increased risk additively with individual temperament. Our data indicate that affiliative reciprocity functions as a buffer for everyday stressors and are likely mediated by attenuated reactivity of the hypothalamic-pituitary-adrenal axis.

The impact of effort-reward imbalance on quality of life among Japanese working men

Health-related quality of life (HRQL) is an important measure of health outcome in working and healthy populations. Here, we investigated the impact of effort-reward imbalance (ERI), a representative work-stress model, on HRQL of Japanese working men. The study targeted 1,096 employees from a manufacturing plant in Japan. To assess HRQL and ERI, participants were surveyed using the Japanese version of the Short-Form 8 Health Survey (SF-8) and effort-reward imbalance model. Of the 1,096 employees, 1,057 provided valid responses to the questionnaire. For physical summary scores, the adjusted effort-reward imbalance odds ratios of middle vs. bottom and top vs. bottom tertiles were 0.24 (95% confidence interval, 0.08-0.70) and 0.09 (95% confidence interval, 0.03-0.28), respectively. For mental summary scores, ratios were 0.21 (95% confidence interval, 0.07-0.63) and 0.07 (95% confidence interval, 0.02-0.25), respectively. These findings demonstrate that effort-reward imbalance is independently associated with HRQL among Japanese employees.

[Psychosocial stress and disease risks in occupational life. Results of international studies on the demand-control and the effort-reward imbalance models]

Given the far-reaching changes of modern working life, psychosocial stress at work has received increased attention. Its influence on stress-related disease risks is analysed with the help of standardised measurements based on theoretical models. Two such models have gained special prominence in recent years, the demand-control model and the effort-reward imbalance model. The former model places its emphasis on a distinct combination of job characteristics, whereas the latter model's focus is on the imbalance between efforts spent and rewards received in turn. The predictive power of these models with respect to coronary or cardiovascular disease and depression was tested in a number of prospective epidemiological investigations. In summary, twofold elevated disease risks are observed. Effects on cardiovascular disease are particularly pronounced among men, whereas no gender differences are observed for depression. Additional evidence derived from experimental and ambulatory monitoring studies supplements this body of findings. Current scientific evidence justifies an increased awareness and assessment of these newly discovered occupational risks, in particular by occupational health professionals. Moreover, structural and interpersonal measures of stress prevention and health promotion at work are warranted, with special emphasis on gender differences.

Psychosocial work environment and well-being: a cross-sectional study at a thermal power plant in China

To investigate the effects of the job demand-control (DC) model and the effort-reward imbalance (ERI) model on worker's well-being, self-reports for psychosocial work conditions and well-being were made by a sample of 878 workers at a thermal power plant in China using the main dimensions of DC and ERI questionnaires. Logistic regression analyses were employed controlling for age, gender, and educational level, and negative and positive affection among others. Workers reporting high job demands and low job control or high efforts and low rewards had elevated risks of job dissatisfaction, psychosomatic complaints and depressive symptoms. Odds ratios were generally higher in workers reporting both high efforts and low rewards. Furthermore, low reward proved to be a stronger predictor of poor well-being when both job stress models were simultaneously adjusted. To some extent, interaction effects were found for social support, but no interaction effects were found for overcommitment. The findings indicate independent effects of both the DC model and the ERI model on well-being. Future work should explore the combined effects of these two models of psychosocial stress at work on health more thoroughly.

Job stress, gene polymorphism of beta2-AR, and prevalence of hypertension

OBJECTIVE

To study the interactive effect of job stress and genetic susceptibility (or gene polymorphism) on hypertension.

METHODS

A cross-sectional epidemiological study was conducted in 452 workers from a thermal power plant in China. Extrinsic effort, occupational reward, and over-commitment were measured. Hypertensive patients were defined by three phases of screening, reexamination, and final diagnosis. beta2-AR genotypes and allele frequencies at amino acid positions 16 (beta2-AR-16: Arg-->Gly) and 27 (beta2-AR-27: Gln-->Glu) were identified by PCR-RFLP.

RESULTS

Job stress was related with the prevalence of hypertension in males (P < 0.05), whereas no significant relationship was found in females (P > 0.05). Differences in genotypes and allele frequencies of the beta2-AR-16 were statistically significant between the hypertension and control groups (P < 0.05), whereas those of beta2-AR-27 were not (P > 0.05). The prevalence of hypertension was higher in individuals carrying Gly16 allele than in those carrying Arg16 allele of the high job stress group (P < 0.01 or 0.05).

CONCLUSION

High job stress and polymorphism of beta2-AR-16 have an interactive effect on the prevalence of hypertension in male workers.