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

Workplace expansion, long-term sickness absence, and hospital admission

BACKGROUND

Downsizing has in previous studies, as well as in public debate, been associated with increased sickness absence. No studies have, however, looked at the long-term relation between workplace expansion and morbidity.

METHODS

We investigated exposure to personnel change during 1991-96 in relation to long-term (90 days or longer) medically certified sickness absence and hospital admission for specified diagnoses during 1997-99 in 24?036 participants with a complete employment record in the biennial national Swedish Work Environment Surveys from 1989 to the end of 1999.

FINDINGS

Accumulated exposure to large expansion (> or =18% per year) was related to an increased risk of long-term sickness absence (odds ratio 1.07 [95% CI 1.01-1.13], p=0.013) and hospital admission (1.09 [1.02-1.16], p=0.017). In this context, odds ratio signifies the change in odds for each additional year of exposure, varying from 0 to 6. Moderate expansion (> or =8% and <18% per year), was associated with a decreased risk of admission (0.91 [0.84-0.98], p=0.012). Moderate downsizing (> or =8% and <18% per year) was associated with an increased risk of sickness absence (1.07 [1.02-1.12], p=0.003). The strongest association between large expansion and sickness absence was in women in the public sector (1.18 [1.08-1.30], p=0.0002), corresponding to an odds ratio of 2.77 [1.62-4.74] between full exposure (all 6 years) and no exposure.

INTERPRETATION

This study confirms earlier findings that downsizing is associated with health risks. It also shows that repeated exposure to rapid personnel expansion, possibly connected with centralisation of functions, statistically predicts long-term sickness absence and hospital admission. Although no conclusions about causal pathways can be drawn from our results, this exposure should be considered in future studies, policy making, and occupational health care practice.

Health inequalities and the psychosocial environment—two scientific challenges

As social inequalities in health continue to be a key public health problem, scientific advances in explaining these inequalities are needed. It is unlikely that there will be a single explanation of social inequalities in health. This introductory paper sets out one explanatory framework, exposure to adverse psychosocial environments during midlife, and particularly at work. We argue that exposure to an adverse psychosocial environment, in terms of job tasks, defined by high demands and low control and/or by effort-reward imbalance, elicits sustained stress reactions with negative long-term consequences for health. These exposures may be implicated in the association of socioeconomic status with health in two ways. First, these exposures are likely to be experienced more frequently among lower socioeconomic groups. Second, the size of the effects on health produced by adverse working conditions may be higher in lower status groups, due to their increased vulnerability. In this special issue, these arguments are illustrated by a collection of original contributions from collaborative research across Europe. The papers, in our view, advance the case for the robust associations between measures of adverse psychosocial environment and ill health, as they are based on comparative studies across several European countries and as they combine different types of study designs. This collaboration was enabled and supported by a European Science Foundation scientific programme on 'Social Variations in Health Expectancy in Europe'.

Fragebogen zur Messung beruflicher Gratifikationskrisen

Zusammenfassung: Das zur Erklärung gesundheitlicher Risiken infolge chronischer psychomentaler und sozioemotionaler Arbeitsbelastungen entwickelte Modell beruflicher Gratifikationskrisen ist in verschiedenen, z.T. internationalen epidemiologischen und experimentellen Untersuchungen anhand eines standardisierten Messverfahrens erfolgreich überprüft worden. Erstmals werden hier Ergebnisse der psychometrischen Testung des Messverfahrens an einer für die erwerbstätige Bevölkerung Deutschlands repräsentativen Stichprobe vorgestellt (N = 666 Männer und Frauen; durchschnittliches Alter: 40.1±11.2). Die das Modell messenden Skalen werden bezüglich interner Konsistenz, Item-Skalen- und Interskalen-Korrelationen sowie kriterienbezogener Validität charakterisiert. Ferner wird die faktorielle Validität des Messmodells durch konfirmatorische Testung von vier alternativen Strukturmodellen überprüft, wobei der Modell-Fit der theoriekonform spezifizierten derjenigen der weniger spezifizierten überlegen ist. Zusammenfassend zeigen sich für die deutschsprachige Fassung der zur Modellmessung eingesetzten Skalen befriedigende psychometrische Kennwerte, die den weiteren Einsatz des Verfahrens rechtfertigen.