Ellen M. Hall

Job strain, work place social support, and cardiovascular disease: a cross-sectional study of a random sample of the Swedish working population.

This cross-sectional study investigates the relationship between the psychosocial work environment and cardiovascular disease (CVD) prevalence in a randomly selected, representative sample of 13,779 Swedish male and female workers. It was found that self-reported psychological job demands, work control, and co-worker social support combined greater then multiplicatively in relation to CVD prevalence. An age-adjusted prevalence ratio (PR) of 2.17 (95% CI-1.32, 3.56) was observed among workers with high demands, low control, and low social support compared to a low demand, high control, and high social support reference group. PRs of approximately 2.00 were observed in this group after consecutively controlling for the effects of age together with 11 other potential confounding factors. The magnitude of the age-adjusted PRs was greatest for blue collar males. Due to the cross-sectional nature of the study design, causal inferences cannot be made. The limitations of design and measurement are discussed in the context of the methodological weaknesses of the work stress field.

Long-term psychosocial work environment and cardiovascular mortality among Swedish men.

OBJECTIVES This study examined the effect of cumulative exposure to work organization--psychological demands, work control, and social support on prospectively measured cardiovascular disease mortality risk. METHODS The source population was a national sample of 12517 subjects selected from the Swedish male population by Statistics Sweden in annual surveys between 1977 and 1981. Over a 14-year follow-up period, 521 deaths from cardiovascular disease were identified. A nested case-control design was used. Work environment exposure scores were assigned to cases and controls by linking lifetime job histories with a job exposure matrix. RESULTS Conditional logistic regression analysis was used in examining cardiovascular mortality risk in relation to work exposure after adjustment for age, year last employed, smoking, exercise, education, social class, nationality, and physical job demands. In the final multi-variable analysis, workers with low work control had a relative risk of 1.83 (95% confidence interval [CI] = 1.19, 2.82) for cardiovascular mortality. Workers with combined exposure to low control and low support had a relative risk of 2.62 (95% CI=1.22, 5.61). CONCLUSIONS These results indicate that long-term exposure to low work control is a risk factor for cardiovascular disease mortality.

Smoking and sedentary behavior as related to work organization

There is little research which has investigated whether working life may affect health behaviors. However, there is data suggesting that smoking as well as leisure activities are affected during times of stress. Both theoretical work and research suggests that work may socialize people such that the use of leisure time for active pursuits, including exercise, may be contingent upon jobs which promote interaction, learning, and activity on the job. In investigating whether the psychosocial structure of work might affect smoking and sedentary behavior, a subsample (n = 7.201) of a representative sample of the Swedish population aged 16-65 years was selected for study. Reports on job characteristics and health behaviors were obtained in personal or telephone interviews and a logistic regression analysis was performed. In general, job demands like shift work, piece work, hazardous exposure, and physical load tended to be associated with smoking and sedentary behavior, whereas job resources, including personal autonomy, were predictive of regular exercise, but unrelated to smoking behavior. Correlational patterns varied somewhat between sexes. The implications of these findings with respect to work organization, considerations in epidemiological research, and the conduct of health promotion programs are discussed.

The psychosocial work environment of physicians. The impact of demands and resources on job dissatisfaction and psychiatric distress in a longitudinal study of Johns Hopkins Medical School graduates.

This study examines the relationship between the psychosocial work environment and cross-sectional job dissatisfaction and prospective psychiatric distress in a cohort of Hopkins Medical School graduates in midcareer. An instrument was constructed consisting of five scales: psychological job demands, patient demands, work control, physician resources, and coworker support. The results of scale reliability and factor analysis are presented. Higher job demands were found to be associated with increases in job dissatisfaction and psychiatric distress and greater resources were associated with decreased levels of dissatisfaction and distress. In multiple-regression analysis, only work control and social support were found to be independently associated with dissatisfaction and distress. These results suggest that the presence of control and social support at work protects physicians from developing job dissatisfaction and psychiatric distress.

Depression in unemployed Swedish women

Two groups of Swedish women--51 employed and 96 unemployed--were compared in terms of their scores on the Beck Depression Inventory (BDI). It was hypothesized that unemployed women would be more depressed than their employed counterparts and further that the distress of unemployment would be reflected in elevations in cortisol values among those who were out of work. It was found, even when controlling for social support, stressful life events and marital status, that depression as seen in the BDI scores, was greater in the unemployed group. However, no relationship was observed between either cortisol and employment status or cortisol and depression.

Social Support in the Work Environment and Cardiovascular Disease

Since the early 1980s considerable scientific attention has been focused on how psychosocial work organization influences physical and mental health. These issues are currently of particular concern because of the rapid changes occurring in the nature of work, including the large-scale introduction of new technological systems, the decline in manufacturing and farming, and the rise in service industries. Work environment researchers are confronted with a central question: How can we delineate what constitutes a healthy (as opposed to harmful) workplace? In responding to this question, we first examine epidemiological and other nontheoretical studies of the general relationship between work, social relations, and cardiovascular health status. We then examine theoretical formulations and related findings from two research traditions: socio-medical research and the sociology of work. Because of the relatively sparse evidence concerning the specific relationship between workplace social support and cardiovascular disease, we broaden our discussion to include other stress-related outcomes. Although we refer to empirical research (both our own and that of others), we also develop theoretical linkages between the study of work relations, social support, behavior, and cardiovascular disease.

Dialectic between conceptual and causal inquiry in psychosocial work-environment research.

In this article, the authors discuss the ongoing tension between etiologically oriented research--particularly that focused on the demand-control model--and the need to conceptually expand the work stress field to include gender and class-specific exposure contexts. Epidemiological research on the effects of low levels of work control is critically reviewed, and new methods of long-term psychosocial work-exposure assessment are presented. The process of conceptually expanding the demand-control model is discussed with respect to including other important variables, such as work-related social support, and specifying the nature of the gendered work process that involves developing new concepts and measures of the invisible and emotional labor often performed by women.

A case study of stress and mass psychogenic illness in industrial workers

Outbreaks of fainting, nausea, and weakness among several hundred workers led to an investigation of industrial conditions. Repeated and extensive monitoring failed to detect levels of any substance that might explain these reactions. In a subsequent investigation of the psychosocial environment, the authors used a combination of observations, inventories, and interviews to determine whether psychosocial factors might explain this phenomenon. A multiple regression analysis identified (in order of importance) work intensity, mental strain, work/home problems, education, and sex as independent predictors explaining 33% of the overall severity of illness. The work was high-pressured, repetitive, monotonous, and noisy. This profile is consistent with reports of mass psychogenic illness and with research indicating that such work can be distressing and unhealthy.