Lipid lowering through work stress reduction

Changes implemented during a workplace psychosocial intervention and their consistency with intervention priorities

OBJECTIVES

To describe the changes implemented as part of a workplace psychosocial intervention.

METHODS

The intervention was conducted in a public organization employing 1630 white-collar workers. The intervention was defined as all changes implemented to reduce adverse psychosocial work factors. A logbook was held to describe the changes implemented in the intervention group and in a comparable control group (N = 1282).

RESULTS

Social support and reward were the psychosocial factors most targeted (41% to 83%). In comparison with the control group, the intervention group implemented four times more major changes and implemented changes, improving the employees' workload.

CONCLUSIONS

Changes mainly targeted social support and reward. The intervention group implemented four times more major changes than the control group. The intervention group implemented changes targeting the workload, whereas no such changes were implemented in the control group.

A five-year rehabilitation programme for younger women after a coronary event reduces the need for hospital care

AIMS

Cardiovascular disease (CVD) is the dominant diagnosis in in-patient care in Sweden and the third most common cause for long-term sick leave and disability pension. Women are higher consumers of health care than men and have higher frequencies of sickness absenteeism. The aim of this paper was to evaluate whether a five-year long rehabilitation programme for women with CVD affected the use of hospital care and sickness absenteeism.

METHODS

130 women below 65 years of age with CVD were randomized to either intervention (n = 69, mean age 52.4 years) with an intensive lifestyle programme (e.g. physical exercise, smoking cessation, dietary advice), including stress management or to standard care (n = 61, mean age 54.3 years). All patients went through baseline medical examinations, including self-administered questionnaires. This procedure was repeated yearly during the rehabilitation period. The frequency of cardiac-related healthcare use was followed via official registers.

RESULTS

Emergency visits and number of in-patient days decreased significantly in the intervention group from year one to year five (p < 0.05) but remained unchanged in the control group. Scheduled doctor visits decreased significantly in both groups. There were no significant differences between groups regarding proportion of women on sick leave after one, three and five years.

CONCLUSIONS

This extensive intervention programme reduced visits at emergency wards and numbers of in-patient days, which in the long run may have beneficial effects on public finances and the patient's quality of life. The study confirmed previous findings from interventions showing difficulties in influencing sick-leave rates.

Psychosocial work environment and lifestyle as related to lipid profiles in perimenopausal women

OBJECTIVE

The aim of the study was to characterize lipid profiles of perimenopausal women and to relate these to the psychosocial work environment and lifestyle using a longitudinal design.

METHODS

A population-based sample of 107 women, aged 47-53 years, participated in a baseline study and in a follow-up 2 years later. Psychosocial work stress was measured using the Job Content Questionnaire. The women also completed a health questionnaire and participated in a psychological interview. Fasting blood samples were analyzed for concentrations of total cholesterol, high and low density lipoprotein (HDL, LDL) cholesterol and triglycerides.

RESULTS

Multiple regression analyses showed that work control was a significant predictor of higher HDL cholesterol (p<0.05), lower LDL cholesterol/HDL cholesterol ratio (p<0.01) and lower total cholesterol/HDL cholesterol ratio (p<0.01). Job strain predicted a higher LDL cholesterol/HDL cholesterol ratio (p<0.01) and higher total cholesterol/HDL cholesterol ratio (p<0.05). Lifestyle variables smoking, body mass index and waist/hip ratio predicted an unfavorable lipid profile, whereas alcohol consumption predicted a favorable lipid profile. Age but not menopausal status was associated with lipid levels at baseline and on follow-up. Use of hormone replacement therapy was a significant predictor of lower cholesterol levels in the multivariate analyses.

CONCLUSIONS

Our results demonstrated a significant association between the psychosocial work environment and women's cardiovascular health at menopause. Job strain was a significant contributor to an atherogenic lipid profile, whereas work control predicted a favorable profile. Hence, the argument is now compelling that psychosocial factors should be included in the risk profiles for cardiovascular disease in women.

A systematic review of the job-stress intervention evaluation literature, 1990-2005

Ninety reports of systematic evaluations of job-stress interventions were rated in terms of the degree of systems approach used. A high rating was defined as both organizationally and individually focused, versus moderate (organizational only), and low (individual only). Studies using high-rated approaches represent a growing proportion of the job-stress intervention evaluation literature. Individual-focused, low-rated approaches are effective at the individual level, favorably affecting individual-level outcomes, but tend not to have favorable impacts at the organizational level. Organizationally-focused high- and moderate-rated approaches are beneficial at both individual and organizational levels. Further measures are needed to foster the dissemination and implementation of systems approaches to examining interventions for job stress.

Striving for balance: A grounded theory study of health experiences of nurses with musculoskeletal problems

BACKGROUND

Musculoskeletal disorders (MSD) are one of the major causes of the high levels of long-term sickleave and early retirement, and healthcare personnel are among the occupational groups most affected. Only limited research in the area has focused on the experiences of those affected, and to increase the understanding of MSD, all dimensions of the health experiences need to be taken into consideration.

OBJECTIVES

The aim of this paper was to explore the experiences of illness and wellness among female healthcare personnel with musculoskeletal symptoms.

DESIGN

A qualitative grounded theory approach guided the study in data collection and analysis.

SETTINGS

Medical and surgical ward units at three hospitals; one university hospital and two minor hospitals.

PARTICIPANTS

Eight women, registered nurses and nursing aides, with neck, shoulder and/or back problems in early stages.

METHODS

A grounded theory approach was used with narrative thematic interviews and parallel data analysis with constant comparisons.

RESULTS

The analysis revealed a process of striving to reach a balance between illness and wellness, through accepting and handling illness. Illness appeared as a threat and an experience, while experiences of wellness were simultaneously nurtured. The informants were striving for balance through an inner reasoning leading to acceptance and by handling illness in various ways depending on the character of the illness.

CONCLUSION

This paper indicates the diversity of the illness experience, the parallel importance of wellness, and the process of balancing these two in order to feel well enough. As previous research has shown that MSD has a multifactorial cause, a holistic view of health promotion, prevention and rehabilitation may provide a more effective tool than the bodily physical focus most frequently used today.

The psychosocial and health effects of workplace reorganisation. 1. A systematic review of organisational-level interventions that aim to increase employee control

OBJECTIVE

Systematic review of the health and psychosocial effects of increasing employee participation and control through workplace reorganisation, with reference to the "demand-control-support" model of workplace health.

DESIGN

Systematic review (QUORUM) of experimental and quasi-experimental studies (any language) reporting health and psychosocial effects of such interventions.

DATA SOURCES

Electronic databases (medical, social science and economic), bibliographies and expert contacts.

RESULTS

We identified 18 studies, 12 with control/comparison groups (no randomised controlled trials). Eight controlled and three uncontrolled studies found some evidence of health benefits (especially beneficial effects on mental health, including reduction in anxiety and depression) when employee control improved or (less consistently) demands decreased or support increased. Some effects may have been short term or influenced by concurrent interventions. Two studies of participatory interventions occurring alongside redundancies reported worsening employee health.

CONCLUSIONS

This systematic review identified evidence suggesting that some organisational-level participation interventions may benefit employee health, as predicted by the demand-control-support model, but may not protect employees from generally poor working conditions. More investigation of the relative impacts of different interventions, implementation and the distribution of effects across the socioeconomic spectrum is required.

Low control at work and the risk of suicide in Japanese men: a prospective cohort study

BACKGROUND

Although adverse psychosocial job characteristics are suspected predictors of suicide death, prospective studies based on established stress instruments are limited.

METHODS

In a multicenter community-based Japanese cohort study, we prospectively investigated the association between psychosocial job characteristics and the risk of death from suicide among male workers. Baseline examination was conducted from 1992 to 1995 to determine the socioeconomic, behavioural and biological variables in addition to the psychosocial job characteristics of 3,125 male workers aged 65 and under and free from major illness. Low job control and high job demands were measured as adverse psychosocial job characteristics according to a job demand-control model questionnaire. Suicide deaths were identified using the Cause-of-Death Register.

RESULTS

During the 9-year follow-up, 14 suicides were identified. The suicide death rate was 48.1 per 100,000 person years. Multivariate analysis revealed a more than fourfold increase in the risk of suicide among men with low control at work (relative risk: 4.10; 95% confidence interval: 1.31-12.83) compared with counterpart men after adjustment for age, marital status, educational attainment, occupation, smoking status, alcohol consumption, total cholesterol level, and study area. Job demands were not associated with risk of death from suicide.

CONCLUSIONS

By using a job demand-control model questionnaire, low control at work was revealed as a predictor of suicide death among Japanese male workers. The finding implies that job redesign aimed at increased worker control could be a worthwhile strategy in preventing, or at least reducing, the risk of suicide death.

Psychosocial stress and atherosclerosis: family and work stress accelerate progression of coronary disease in women. The Stockholm Female Coronary Angiography Study

OBJECTIVE

To examine the impact of psychosocial stress, experienced in the family and work life, on the progression of coronary atherosclerosis in women cardiac patients.

DESIGN

Longitudinal follow-up study. The mean luminal diameter change over 3 years was averaged over 10 predefined coronary segments, representing the entire coronary tree. Stress in family life was measured by using the Stockholm Marital Stress Scale and that of work life by the demand-control questionnaire.

SUBJECTS

Amongst patients enrolled in the Stockholm Female Coronary Angiography Study, 80 women were evaluated for stress exposure and coronary atherosclerosis progression using serial quantitative coronary angiography.

RESULTS

Multi-variable-controlled mixed models anova analyses revealed that women with high stress from either family or work had significant disease progression over 3 years, whereas those with low stress had only slight progression. In women who were free of stress from either family or work life, i.e. they were satisfied with both of these life domains, the coronary artery changes had regressed. Their mean coronary luminal diameter increased by 0.22 mm (95% CI: 0.10; 0.35 mm) when compared with women who experienced stress from both sources, whose luminal diameter decreased by 0.20 mm (95% CI: -0.14; -0.25). These associations were independent of baseline luminal diameter and standard cardiovascular risk factors, including age smoking, hypertension and HDL at baseline.

CONCLUSIONS

Stress from family or work life may accelerate coronary disease processes in women, whereas relative protection may be obtained from a satisfactory job and a happy marriage.

Comprehensive Health Promotion Interventions at the Workplace: Experiences With Health Circles in Germany

Health circles, the central element of a comprehensive health promotion approach that has been developed in Germany in recent years, emphasize organizational and psychosocial factors while actively involving employees in the process. Through an extensive review the authors identified 11 studies, presenting the results of 81 health circles. The scientific quality of the data is limited: only 3 studies used (nonrandomized) control groups, whereas the remaining studies are based on retrospective before-and-after comparison. Nonetheless, the available data suggest that health circles are an effective tool for the improvement of physical and psychosocial working conditions and have a favorable effect on workers' health, well-being, and sickness absence. More rigorous studies are needed to confirm these results.

Psychosocial factors and public health: a suitable case for treatment?

Adverse psychosocial exposure or "misery" is associated with physical disease. This association may not be causal. Rather it may reflect issues of reverse causation, reporting bias, and confounding by aspects of the material environment typically associated with misery. A non-causal relation will not form the basis of effective public health interventions. This may be why psychosocial interventions have, so far, showed little effect on objective physical health outcomes. This paper reviews evidence for the "psychosocial hypothesis" and suggests strategies for clarifying these issues. It concludes that, although misery is clearly a bad thing as it erodes people's quality of life, there is little evidence that psychosocial factors cause physical disease. In the absence of better evidence, suggestions that psychosocial interventions are needed to improve population physical health, in both absolute and relative terms, seem premature.

The changing organization of work and the safety and health of working people: a commentary

Recent trends in the organization of work may affect worker health through a variety of pathways--by increasing the risk of stress-related illnesses, such as cardiovascular disease, musculoskeletal disorders, and psychological disorders, by increasing exposure to hazardous substances and violence on the job, or by affecting occupational health services and training programs. Much remains to be learned about the nature of changes in work organization, and how they affect worker health and safety. While available evidence is limited, such evidence suggests that recent trends in work organization may be increasing the risk of occupational illnesses. In a groundbreaking publication, the National Institute for Occupational Safety and Health has provided a concise summary of available knowledge and a detailed agenda for research and development.

[Improvement of work environment]

As a result of a literature review on methodology and the effectiveness of work-environment oriented workplace stress reduction, it is suggested that improvement of the work environment is effective in reducing workers' job stressors and psychological and physiological stress reaction, from a limited number of controlled studies including RCT, as well as a number of case studies and before-after comparison studies. An expert-guided, supervisor and worker participated approach also seems effective. The author proposes five practical steps toward an effective improvement of the work environment based on the review. Remaining topics include the need for more well-designed studies, investigation of the relationship between intervention type and outcome, as well as modifying effects according to social situations, and instruments for implementation.

Employee effects of an educational program for managers at an insurance company

BACKGROUND

Possible health effects for employees of efforts to improve the psychosocial competence of managers have not been studied scientifically in the past.

OBJECTIVE

To explore how efforts to improve management will change the work environment and health of the employees.

METHODS

Managers of the experimental department in a large insurance corporation underwent 2-hour biweekly training sessions for 1 year-altogether, 60 hours. A control group of employees in other departments in the corporation not affected by the modification was followed with the same assessments. Morning blood samples for the assessment of serum cortisol were collected both at baseline and after 1 year in 155 participants in the experimental group and in 147 subjects in the control group. Liver enzymes and lipids were also assessed. In the questionnaire part of the 1-year follow-up study, there were 119 participants in the experimental group and 132 in the control group.

RESULTS

When repeated-measures ANOVA was used, a significant interaction effect was found for the level of serum cortisol; serum cortisol levels were decreased in the intervention group and were unchanged in the control group (ANOVA two-way interaction, p =.02; after exclusion of the managers, p =.005). A significant interaction effect was also observed for decision authority, with increased decision authority in the intervention group and, conversely, a decreased level in the control group (p =.001; after exclusion of managers, p =.02).

CONCLUSIONS

The study indicates that a moderately intensive psychosocial manager program lasting for 1 year can be beneficial for the employees with regard to both lowered serum cortisol and improved authority over decisions.

Biological correlates of social support and pressure at work in managers

The aim was to explore the patterns of correlations between psychosocial stress indices and neuroendocrinological factors in managers. Fifty-eight male managers in three Swedish companies constituted the sample. They answered two questionnaires with 17 selected stress indices and also an organizational test. The indices have been analyzed by means of computations of age adjusted partial correlations with nine different variables analyzed in fasting blood samples. The serum concentrations of lipids were the variables most strongly correlated with psychosocial factors. Neither smoking nor physical activity changed the correlations significantly. Good social support at work and in private life was consistently associated with low adverse serum lipids and corresponding lipoproteins. On the other hand, some indices of social support were associated with indices of high arousal levels. This may indicate a possible psychophysiological "load effect" of some aspects of social support in managers. The analyses of corporate culture measured as "Rules of the Game" indicated that "bureaucracy" was significantly associated with high LDL-cholesterol and low HDL-cholesterol. Managers have special conditions and therefore the patterns of associations between psychosocial conditions and coping strategies on one hand and endocrine-biochemical state on the other hand may be different from those of other groups. To what extent such differences are due to individual characteristics or environmental factors needs to be further investigated. According to the results, however, good social support is in general health promoting also to managers, at least with regard to serum lipids. Bureaucracy, on the other hand, seems to be dangerous to the health of managers.

Psychosocial stressors and well-being in health care workers. The impact of an intervention program

There have been few prospective studies of the impact of workplace interventions on employee and organizational well-being within health care settings. This study was conducted at a large regional hospital in Sweden in 1994 with a follow-up in 1995. Effects of a structured organizational and staff intervention program on perceived psychosocial work quality, supporting resources and self-reported health and well-being were evaluated. Based on department-specific results from the baseline assessment in 1994, each department formulated their own improvement goals. They also made their own decisions on relevant improvement activities. Since there was no formal reference group in this study, departments with high and low rating levels, respectively, with regard to intervention activities were compared. Despite an overall worsening in most of the measures most likely due to a notice of 20% staff reduction prior to the follow-up assessment, the intervention appeared to have attenuated negative changes in the high as compared with the low activity group. Manager-rated impact of the program as well as positive staff attitudes and staff involvement in the enhancement process were identified as important determinants for more favourable changes. The study points out the relevance of structured workplace interventions for organizational and employee well-being especially in times of cut-backs and organizational turmoil. Department-specific factors will determine the impact of such programs. The study indicates that the psychosocial impact of personnel cut-backs in health care may be attenuated through management initiatives.

Lipid profile and socioeconomic status in healthy middle aged women in Sweden

STUDY OBJECTIVE

To examine the relationship between socioeconomic status (SES) and full lipid profile in middle aged healthy women.

PARTICIPANTS

These comprised 300 healthy Swedish women between 30 and 65 years who constitute the control group of the Stockholm female coronary risk study, a population based, case-control study of women with coronary heart disease (CHD). The age matched control group, drawn from the census register of greater Stockholm, was representative of healthy Swedish women aged 30-65 years. Five measures of SES were used; educational level, occupation, decision latitude at work, annual income, and size of house or apartment.

MAIN RESULTS

Swedish women with low decision latitude at work, low income, low educational level, blue collar jobs, and who were living in small houses or apartments had an unhealthy lipid profile, suggesting an increased risk of CHD. Part of this social gradient in lipids was explained by an unhealthy lifestyle, but the lipid gradients associated with decision latitude at work and annual income were independent of these factors. Decision latitude, educational level, and annual income had the strongest associations with lipid profile. These associations were independent of age, menopausal status, smoking, sedentary lifestyle, alcohol consumption, obesity, excess abdominal fat, and unhealthy dietary habits. Of the lipid variables, low high density lipoprotein cholesterol (HDL) levels were most consistently associated with low SES.

CONCLUSIONS

Decision latitude at work was the strongest SES predictor of HDL levels in healthy middle aged Swedish women, after simultaneous adjustment for other SES measures, age, and all lifestyle factors in the multivariable regression model.