Olga Evans

The contribution of gender-role orientation, work factors and home stressors to psychological well-being and sickness absence in male- and female-dominated occupational groups

The associations of work stress, types of work and gender-role orientation with psychological well-being and sickness absence were investigated in a questionnaire survey of 588 male and female nurses and 387 male and female accountants. We hypothesised that health might be impaired among women working in the male-dominated occupation (accountancy), and men in the female-dominated occupation (nursing), but that effects might be moderated by job strain (perceptions of high demand and low control), work and home hassles, and traditional male (instrumentality) and female (expressivity) psychological characteristics. Responses were analysed from 172 female and 61 male nurses, and from 53 female and 81 male commercial accountants. Female accountants were more likely than other groups to have high anxiety scores on the Hospital Anxiety and Depression Scales, while male nurses had the highest rates of sickness absence. Male nurses and female accountants also reported more work-related hassles than did female nurses and male accountants. Men and women in the same occupation did not differ in job strain or job social support, but nurses reported greater job strain than accountants, due to higher ratings of demands and lower skill utilisation. After adjusting for age, sex, occupation, paid work hours and a measure of social desirability bias, risk of elevated anxiety was independently associated with higher job strain, lower job social support, more work hassles, more domestic responsibility, lower instrumentality and higher expressivity. The association between sex and anxiety was no longer significant after instrumentality had been entered into the regression model. Sickness absence of more than three days over the past 12 months was independently associated with higher job strain, more work hassles, lower instrumentality and higher expressivity. The results suggest that when men and women occupy jobs in which they are in the cultural and numerical minority, there may be adverse health effects that are gender-specific. Psychological traits related to socially constructed gender roles may also be relevant, and mediate in part the differences in psychological well-being between men and women.

Cardiovascular Risk and Responsivity to Mental Stress: The Influence of Age, Gender and Risk Factors

Background Exaggerated cardiovascular and neuroendocrine responses to mental stress may enhance cardiovascular disease risk, Coronary heart disease and hypertension increase in prevalence with advancing age, whereas the excess male/female ratio declines in later middle age. Psychosocial factors may contribute to these changing risk profiles. The hypothesis that cardiovascular and neuroendocrine stress responses are associated with age and gender differences in cardiovascular disease risk was tested. Method 132 healthy men and women from younger (30–40 years) and older (55–65 years) age bands were selected at random from general practice lists. They performed a series of mental stress tests during which blood pressure, heart rate, cardiovascular baroreflex sensitivity, Cortisol, respiration patterns and electrodermal activity were monitored. A submaximal exercise test was performed and psychological characteristics were assessed by questionnaire. Results At rest, systolic and diastolic blood pressure was higher in men than in women, while cardiac baroreflex sensitivity was greater in younger than in older participants. Blood pressure responses to tasks were substantial, with changes from the baseline averaging 18.6/8.11, 26.0/13.5 and 40.7/19.0 mmHg for computerized problem solving, mirror drawing and speech tasks, respectively. Men and women in the older age band did not differ from each other in blood pressure, heart rate or baroreflex sensitivity responses. Systolic blood pressure responses (mean ± SEM) were larger in older than in younger women (mean peak difference 6.87 ± 2.67 mmHg), and in the younger male compared with the younger female groups (mean peak difference 7.20 ± 2.97 mmHg). Diastolic blood pressure and heart rate responses to mental stress were larger in younger than in older age participants of both sexes. Baroreflex sensitivity was inhibited during behavioural tasks, with significantly greater suppression in younger than in older groups (5.28 ± 0.52 and 2.62 ± 0.35 ms/mmHg, respectively). Cortisol responses were greater in men than in women, but did not vary with age. Across the entire sample, systolic blood pressure responsivity was negatively related to the expression of anger. Among older men, heightened blood pressure responses were associated with elevated fasting low-density lipoprotein cholesterol levels, and with lower concentrations of high-density lipoprotein cholesterol. Conclusions Systolic blood pressure stress responsivity increases with age in women but not in men. Other data do not support the notion that stress responsivity mediates age and gender differences in cardiovascular disease risk. However, in middle-aged men, exaggerated cardiovascular stress responsivity is associated with an unfavourable risk profile.

Social support at work, heart rate, and cortisol: a self-monitoring study.

This study assessed the influence of work social support on self-monitored heart rate, blood pressure, and salivary cortisol recorded on 3 work days and 2 leisure days from 61 nurses and 32 accountants (40 men, 53 women). Heart rate and blood pressure were higher during the day at work than in the evening or on leisure days. Cortisol was higher on leisure than work days and was lower in the evening than in the day. Low social support at work was associated with elevated heart rate during the daytime and evening of work days, an effect that persisted after controlling for psychological distress, age, sex, smoking, and physical activity. Work social support was not related to cortisol on work days, but on leisure days cortisol was elevated among individuals reporting high social support. There were few differences between men and women, and no important occupational effects.

Control over work pace, job strain and cardiovascular responses in middle-aged men.

Objective: To assess the effects of control over work pace on cardiovascular stress responses in healthy middle-aged men. Design: The study involved administration in the laboratory of visual matrix and mirror drawing tasks, the pace of tasks being either under the control of the subject (self-paced) or determined externally (externally paced). The work demands in the two conditions were equated. Method: Forty men aged 55-65 years were randomly assigned to self-paced or externally paced conditions. Blood pressure (recorded continuously using the Finapres), heart rate, cardiac baroreflex sensitivity, salivary cortisol, skin conductance and breathing pattern were monitored at rest, during task performance and at recovery following tasks. Results: Blood pressure and heart rate responses were significantly greater under the externally paced than self-paced conditions. The mean increase in blood pressure during the visual matrix task averaged 19.8/9.4 versus 34.1/15.5 mmHg for the self- and externally paced conditions, and 28.2/13.7 versus 41.8/19.5 mmHg in response to mirror drawing, respectively. Performance of the matrix task was less accurate under externally paced than self-paced conditions, but the two groups did not differ in mirror drawing. A reduction in baroreflex sensitivity and increases in cortisol, respiration rate, tidal volume and skin conductance responses were recorded during tasks, but these responses did not distinguish the two groups. Men were divided on the basis of reported job strain associated with their regular work, using the demand—control model. Blood pressure and heart rate responses were particularly pronounced among men reporting high job strain who were allocated to the externally paced condition. Conclusions: Middle-aged men showed greater stress-related cardiovascular responses when they performed tasks at a pace that they could not control. This pattern may be relevant to the mechanisms through which job strain (high demands associated with low control) influences cardiovascular disease risk.

Cardiovascular stress reactivity and job strain as determinants of ambulatory blood pressure at work.

Objective To test the hypothesis that cardiovascular reactivity to laboratory mental stressors interacts with job strain in predicting blood pressure at work. Design Ambulatory monitoring of blood pressure and heart rate was carried out for an 8-h period on a work day and on an equivalent non-work day in 49 male firefighters. Methods Participants were recruited from a larger cohort (n = 90) on the basis of showing high or low systolic reactions to mental arithmetic 15–24 months previously, coupled with high or low ratings of perceived job strain (high demand-low control). Four groups were tested: low job strain-low systolic reactors (n = 12), low job strain-high systolic reactors (n = 12), high job strain-low systolic reactors (n = 12) and high job strain-high systolic reactors (n = 13). Results Systolic blood pressure (SBP) was higher on work than non-work days, and diastolic blood pressure and heart rate were higher at work in the morning but not in the afternoon. These effects were due partly to posture and physical activity differences between the two days. Neither job strain nor laboratory reactivity independently predicted ambulatory blood pressure. However, SBP was significantly higher during the afternoon at work in the high job strain-high systolic reactors than in the other groups. This was independent of baseline SBP, and was not due to differences in posture or activity at the time of recordings. Ambulatory SBP reactivity (difference between ambulatory values and workplace resting levels) in the afternoon at work was also elevated significantly in high job strain-high systolic reactors compared with in the other groups. Conclusions The results support the hypothesis that individual differences in the appraisal of work stress modulate the relationship between stress reactivity and ambulatory blood pressure.

Perceptions of control over work: psychophysiological responses to self-paced and externally-paced tasks in an adult population sample.

This experiment tested the hypothesis that perceptions of control over work pace would modulate cardiovascular reactions to mental stress tests. One hundred and thirty two adults aged 30-65 years (64 men and 68 women) were randomized to self-paced and externally-paced task conditions. The self-paced group carried out visual matrix problem solving and mirror tracing tasks at their own pace. Work pace requirements were imposed on the externally-paced group, with performance requirements being set to equate those in the self-paced condition. This was done to equate work demands. Blood pressure (assessed with the Finapres), heart rate, cardiac baroreceptor reflex sensitivity, skin conductance, respiration rate and tidal volume were monitored. Behavioural performance of the mirror tracing task was comparable in the two conditions, but the externally-paced group attempted more problems and made more errors on the visual matrix task. Systolic blood pressure reactions to mirror drawing were greater in the external than self-paced conditions (mean increases of 27.5 +/- 16.1 vs. 23.1 +/- 18.5 mmHg, P < 0.025), and electrodermal responsivity was also heightened in the externally-paced group (P < 0.05). No differences were recorded in diastolic blood pressure, heart rate, baroreflex sensitivity or respiratory parameters. Results are discussed in relation to the literature on control and physiological stress responsivity, and their implications for understanding the health consequences of lack of control at work are considered.