Rebecca Fuhrer

Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study.

OBJECTIVES: The impact of work on the risk of future psychiatric disorder has been examined in few longitudinal studies. This was examined prospectively in a large epidemiological study of civil servants. METHODS: In the Whitehall II study, a longitudinal, prospective cohort study of 6895 male and 3413 female London based civil servants, work characteristics measured at baseline (phase 1: 1985-8) and first follow up (phase 2: 1989) were used to predict psychiatric disorder measured by a 30 item general health questionnaire (GHQ) at phase 2 and phase 3 follow up (phase 3: 1991-3). Work characteristics and GHQ were measured at all three phases. RESULTS: Low social support at work and low decision authority, high job demands and effort-reward imbalance were associated with increased risk of psychiatric disorder as assessed by the GHQ at follow up adjusting for age, employment grade, and baseline GHQ score. CONCLUSIONS: Social support and control at work protect mental health while high job demands and effort-reward imbalance are risk factors for future psychiatric disorder. Intervention at the level of work design, organisation, and management might have positive effects on mental health in working populations.

The importance of low control at work and home on depression and anxiety: do these effects vary by gender and social class?

In this study we consider both a gender model, a model that focuses on the stress associated with social roles and conditions in the home environment, and a job model, which addresses the stressful characteristics of the work environment, to investigate patterns of womens and mens psychological morbidity across different social positions. Using data from the Whitehall II Study, a longitudinal study of British civil servants, we hypothesise that a lack of control in the home and work environments affects depression and anxiety differently for women and men and across three social class groups. Both women and men with low control either at work or at home had an increased risk of developing depression and anxiety. We did not find an interaction between low control at home and work. We did, however, find that the risks associated with low control either at home or work were not evenly distributed across different social positions, measured by employment grade. Women in the lowest or middle employment grades who also reported low control at work or home were at most risk for depression and anxiety. Men in the middle grade with low work control were at risk for depression while those in the lowest grade were at risk for anxiety. Men in the middle and highest grades, however, were at greatest risk for both outcomes if they reported low control at home. We conclude that, in addition to social roles and characteristics of the work environment, future investigations of gender inequalities in health incorporate variables associated with control at home and social position.

The Association Between Blood Pressure, Hypertension, and Cerebral White Matter Lesions Cardiovascular Determinants of Dementia Study

Cerebral white matter lesions are frequently observed on magnetic resonance imaging (MRI) scans in elderly people and are associated with stroke and dementia. Elevated blood pressure is presumed one of the main risk factors, although data are almost exclusively derived from cross-sectional studies. We assessed in 10 European cohorts the relation between concurrently and previously measured blood pressure levels, hypertension, its treatment, and severe cerebral white matter lesions. In total, 1805 nondemented subjects aged 65 to 75 years were sampled from ongoing community-based studies that were initiated 5 to 20 years before the MRI. White matter lesions in the periventricular and subcortical region were rated separately using semiquantitative measures. We performed logistic regression analyses adjusted for potential confounders in 1625 people with complete data. Concurrently and formerly assessed diastolic and systolic blood pressure levels were positively associated with severe white matter lesions. Both increases and decreases in diastolic blood pressure were associated with more severe periventricular white matter lesions. Increase in systolic blood pressure levels was associated with more severe periventricular and subcortical white matter lesions. People with poorly controlled hypertension had a higher risk of severe white matter lesions than those without hypertension, or those with controlled or untreated hypertension. Higher blood pressure was associated with an increased risk of severe white matter lesions. Successful treatment of hypertension may reduce this risk; however, a potential negative effect of decreasing diastolic blood pressure level on the occurrence of severe periventricular white matter lesions should be taken into account.

Work and psychiatric disorder in the Whitehall II Study.

It is important that the effects of work on mental health are investigated when work practices are changing rapidly and there is decreasing job security. This has been examined in the Whitehall II Study, a cohort study of 6895 male and 3413 female, London-based civil servants, aged 35-55 years at baseline in 1985. Work characteristics were measured by modified Karasek indices in a self-report questionnaire. Psychiatric disorder was measured by the 30-item General Health Questionnaire (GHQ). In longitudinal analyses in men and women, high work social support predicted lower GHQ scores, and high job demands predicted higher GHQ scores at follow-up. High work social support and high skill discretion were protective against taking short spells of psychiatric sickness absence. The protective effects of social support at work and the potential risk of job demands have implications for management, job design, training, and further research.

Social inequalities in depressive symptoms and physical functioning in the Whitehall II study: exploring a common cause explanation

Study objective: This study investigated which risk factors might explain social inequalities in both depressive symptoms and physical functioning and whether a common set of risk factors might account for the association between depressive symptoms and physical functioning. Design: A longitudinal prospective occupational cohort study of female and male civil servants relating risk factors at baseline (phase 1: 1985–8) to employment grade gradients in depressive symptoms and physical functioning at follow up (phase 5: 1997–9). Analyses include the 7270 men and women who participated at phase 5. Setting: Whitehall II Study: 20 London based white collar civil service departments. Participants: Male and female civil servants, 35–55 years at baseline. Main results: Depressive symptoms were measured by a subscale of items from the 30 item General Health Questionnaire. Physical functioning was measured by a subscale of the SF-36. Employment grade was used as a measure of socioeconomic position as it reflects both income and status. The grade gradient in depressive symptoms was entirely explained by risk factors including work characteristics, material disadvantage, social supports, and health behaviours. These risk factors only partially explained the gradient in physical functioning. The correlation between depressive symptoms and physical functioning was reduced by adjustment for risk factors and baseline health status but not much of the association was explained by adjustment for risk factors. Among women, the association between depression and physical functioning was significantly stronger in the lower grades both before and after adjustment for risk factors and baseline health. For women, there was only a significant grade gradient in depressive symptoms among those reporting physical ill health. Conclusions: Some risk factors contribute jointly to the explanation of social inequalities in mental and physical health although their relative importance differs. Work is most important for inequalities in depressive symptoms in men, and work and material disadvantage are equally important in explaining inequalities in depressive symptoms in women while health behaviours are more important for explaining inequalities in physical functioning. These risk factors did not account for the association between mental health and physical health or the greater comorbidity seen in women of lower socioeconomic status. The risk of secondary psychological distress among those with physical ill health is greater in the low employment grades.

Social relations and depressive symptomatology in a sample of community-dwelling French older adults.

This study examined the association between social relations and mental health, specifically the relative contribution of social networks and social support to depressive symptomatology. The culturally unique representative sample consisted of 3,777 noninstitutionalized older persons living in southwestern France. The findings indicated that French older adults generally had more than 8 people in their networks, their networks consisted mostly of family members, and they felt understood by most of their network members. These older adults reported being satisfied with their social relations. Sociodemographic variables contribute (R2 = .143) to depressive symptomatology, as did social network (incremented R2 = .033) and social support (incremented R2 = .09) variables. Sociodemographic, social network, and social support variables together increased the variance explained still further (incremented R2 = .108). Results were consistent with similar analyses in the U.S. and indicated that social support variables account for more variance in depressive symptomatology than social network variables.

Gender, social relations and mental health: prospective findings from an occupational cohort (Whitehall II study)

Gender differences in social support tend to suggest that women have larger social networks and both give and receive more support than men. Nevertheless, although social support has been identified as protective of mental health, women have higher rates of psychological distress than men. We examine the prospective association between social support and psychological distress by gender in a cohort study of middle aged British Civil Servants, the Whitehall II study. In this sample we found that women have a larger number of close persons than men although men have larger social networks. We also found that the effects of marital status, social support within and outside the workplace and social networks on subsequent occurrence of psychological distress were similar for men and women independently of baseline mental health status.

Marital status and risk of Alzheimer’s disease A French population-based cohort study

Objective: To analyze the relationship between marital status and risk of AD or dementia. Methods: This study was carried out from the Personnes Agées QUID (PAQUID) cohort, an epidemiologic study on normal and pathologic aging after age 65 years. The PAQUID cohort began in 1988. Individuals were followed up at 1, 3, and 5 years, with an active detection of dementia. Marital status was divided into four categories: widowed, never married, divorced or separated, and the reference category, married or cohabitant. The longitudinal relationship between marital status and risk of incident AD or dementia was analyzed by a Cox model with delayed entry. Results: Among the 3,675 individuals initially not demented, 2,106 were married or cohabitants, 1,287 were widowers, 179 were never married, and 103 were divorced or separated. Among the 2,881 individuals reevaluated at least once for the risk of dementia during the 5-year follow-up, 190 incident cases of dementia were identified, including 140 with AD. The relative risks (RRs) of dementia (RR = 1.91, p = 0.018) and of AD (RR = 2.68, p < 0.001) were increased for the never-married individuals compared with those who were married or cohabitants. This excess of risk was specifically associated with AD. Adjustment for other risk factors of dementia (education, wine consumption), or for factors reflecting social environment, leisure activities, and depression, did not modify the risk of AD for never-married individuals (RR = 2.31, p = 0.02). Conclusions: We confirmed an association between marital status and AD, with an excess risk observed among never-married individuals. This association may provide clues about the pathogenesis of AD.

Cognitive ability in childhood and cognitive decline in mid-life: longitudinal birth cohort study

Abstract Objective To examine the association between cognitive ability in childhood and mid-life cognitive decline in the normal population. Design Longitudinal, population based, birth cohort study. Participants 2058 men and women born in 1946. Main study measures Ability in childhood measured by AH4 and test of verbal comprehension at age 15 years. Ability in adulthood measured by the national adult reading test (NART) at age 53 years. Outcome measures were decline in memory (word list learning) and speed and concentration (timed visual search) from age 43 to 53 years. Results Ability in childhood was significantly and negatively associated with decline in memory (β = 0.09, P = 0.005, for men; 0.10, P < 0.001, for women) and search speed (β = 0.13, P < 0.001, for men; 0.08, P = 0.01, for women), independent of educational attainment, occupational social class, and a range of health indicators. The adult reading test was also significantly and negatively associated with decline in these outcomes (for memory β = 0.21, P < 0.001, for men; 0.17, P < 0.001, for women; and for search speed β= −0.05 for men; 0.10, P = 0.008 for women) independent of educational attainment, social class, and childhood ability. Conclusions Ability in childhood can protect against cognitive decline in mid-life and beyond. Results for the adult reading test indicate that the protective effect of ability may also be acquired in adulthood.

Subjective Cognitive Complaints and Cognitive Decline: Consequence or Predictor? The Epidemiology of Vascular Aging Study

Objectives: To explore whether more cognitive complaints are associated with previous or future cognitive decline.