Psychosocial work environment and mental health: Job-strain and effort-reward imbalance models in a context of major organizational changes

This study explored the association between the two job-stress models, job-strain and effort-reward imbalance, and mental health outcomes in a working population exposed to major organizational changes. The cross-sectional study was based on 680 subjects, 504 men and 176 women. Psychosocial factors at work included: psychological demands, decision latitude, social support, effort, reward, and overcommitment. Mental health outcomes were depressive symptoms (CES-D) and psychiatric disorders (GHQ-12). Job strain, low decision latitude, effort-reward imbalance, and low reward (especially job instability) were found to be associated with depressive symptoms and/or psychiatric disorders among men. Overcommitment at work was a risk factor for both men and women. Social support at work played a role to reduce depressive symptoms for women. These findings emphasize the deleterious effects of psychosocial work environment on mental health during major organizational changes.     

Psychosocial work environment and mental health--a meta-analytic review

OBJECTIVES: To clarify the associations between psychosocial work stressors and mental ill health, a meta-analysis of psychosocial work stressors and common mental disorders was undertaken using longitudinal studies identified through a systematic literature review. METHODS: The review used a standardized search strategy and strict inclusion and quality criteria in seven databases in 1994-2005. Papers were identified from 24,939 citations covering social determinants of health, 50 relevant papers were identified, 38 fulfilled inclusion criteria, and 11 were suitable for a meta-analysis. The Comprehensive Meta-analysis Programme was used for decision authority, decision latitude, psychological demands, and work social support, components of the job-strain and iso-strain models, and the combination of effort and reward that makes up the effort-reward imbalance model and job insecurity. Cochran's Q statistic assessed the heterogeneity of the results, and the I2 statistic determined any inconsistency between studies. RESULTS: Job strain, low decision latitude, low social support, high psychological demands, effort-reward imbalance, and high job insecurity predicted common mental disorders despite the heterogeneity for psychological demands and social support among men. The strongest effects were found for job strain and effort-reward imbalance. CONCLUSIONS: This meta-analysis provides robust consistent evidence that (combinations of) high demands and low decision latitude and (combinations of) high efforts and low rewards are prospective risk factors for common mental disorders and suggests that the psychosocial work environment is important for mental health. The associations are not merely explained by response bias. The impact of work stressors on common mental disorders differs for women and men.     

How to deal with stress in organizations?--a health perspective on theory and practice

This review is focused on organizational aspects of stress reduction. Theoretical models are presented. The association with a few health outcomes (cardiovascular disease, musculoskeletal disorders, and functional gastrointestinal illness) is examined. A few examples of evaluations of health consequences of improved work organization are introduced. Realistic expectations are discussed against the background of etiologic fractions. Concepts like psychological demands, decision latitude, social support, and effort-reward balance or imbalance are discussed and related to practical reorganizational efforts.     

Work characteristics and health of correctional officers

BACKGROUND: The association between the psychosocial work environment and mental health problems has been well documented over the past years. Karasek and Theorell's job strain model and Siegrist's effort/reward imbalance model have been associated to several physical and mental health problems. Moreover, in the last decade, the Quebec correctional services sector has known an important increase in sickness benefit claims for mental health problems. This study aimed to describe the psychosocial work characteristics and health of Quebec correctional officers and to determine the occupational risk factors associated to psychological distress among them. METHODS: This cross-sectional study was realized among 1034 correctional officers from 18 prisons in the province of Quebec, 668 men and 366 women. The response rate was 76%. Psychological demands, decision latitude, social support at work, reward, and psychological distress have been documented by telephone interviews during spring 2000. RESULTS: Correctional officers were more exposed to adverse psychosocial factors at work than a comparable sample of Quebec workers and they reported more health problems. Results showed that the same sources of psychological distress affected men and women, but sometimes at different degrees. High psychological demands combined with low or high decision latitude, and effort/reward imbalance were associated to psychological distress independently of potential confounding factors. Among other work factors associated to the report of high psychological distress among correctional officers were low social support at work, and conflicts with colleagues and superiors. CONCLUSION: Many adverse psychosocial factors at work were in excess among correctional officers compared to workers from the general population. These factors, also related to high levels of psychological distress, could be addressed with the goal of primary prevention of mental health problems at work.     

Prospective evaluation of the impact of organizational change on perceived stress and health in assembly-line workers in an automobile plant

BACKGROUND: Although the competitive climate of the automobile industry is modifying the organization of work in French plants, the health consequences of these changes have not been investigated. The objective of this study was to determine the health impact on employees of an automobile manufacturing plant in northern France of a change to a "Total Quality Management" type of organization. METHODS: This before-and-after study concerned 80 factory employees. The health impact of their work was measured before the change and then 4 and 12 months after the reorganization began, with a French version of the Job Content Questionnaire, which assesses stress at work, a self-rated health scale, and the rate of infirmary visits. Paired comparisons were used to assess before-and-after changes. RESULTS: Scores for psychological and physical demands increased significantly at 4 and 12 months after the organizational changes began, while the self-rated health score diminished significantly during both follow-ups. Decision latitude and social support scores remained unchanged during follow-up, and the number of subjects under stress in the study group (high psychological demands and low decision latitude) did not increase significantly. Finally, the rate of infirmary visits increased significantly during the study period. CONCLUSION: These results show that employees'reaction to these organizational modifications differed according to the scale studied and that their overall perceptions were more complex than expected in view of the changes that occurred.     

Health care restructuring, work environment, and health of nurses

BACKGROUND: In the last 15 years, the health care system has undergone significant restructuring. The study's objective was to examine the psychosocial work environment and the health of nurses after major restructuring in comparison with two reference populations. METHODS: This cross-sectional study involved 2,006 nurses from 16 health centers. A questionnaire measured current work characteristics: psychological demands, decision latitude, and social support at work from Karasek's Job Content Questionnaire, organizational changes, and health effects. Prevalence ratios and binomial regression were used to examine the associations between current work characteristics, changes and psychological distress (PSI). RESULTS: There was a considerable increase in the prevalence of PSI and of adverse psychosocial work factors in comparison to the prevalence reported by a comparable group of nurses in 1994. These adverse factors were also more prevalent among nurses than among Québec working women and they were independently associated with psychological distress. CONCLUSION: Workplace interventions should be based on elements identified by many nurses as being problematic.     

The psychosocial work environment and alcohol dependence: a prospective study

Aims: To examine whether a stressful psychosocial work environment predicts alcohol dependence.

Methods: Alcohol dependence of participants in the Whitehall II occupational cohort of London based civil servants (1985–88) was measured in 1991–93 using the CAGE questionnaire. The psychosocial work environment was measured by self report questions on the job demand-support-control model and on the model of effort-reward imbalance. Potential mediators including physical illness and poor mental health (GHQ) were measured at follow up in 1989.

Results: Effort-reward imbalance at work was associated with alcohol dependence in men after adjustment for employment grade and other baseline factors related to alcohol dependence. Although effort-reward imbalance predicted future longstanding illness, poor mental health and negative aspects of close relationships, the association between effort-reward imbalance and alcohol dependence in men was only partially mediated through these health and social support measures. In women, low decision latitude was related to alcohol dependence to some extent, but alcohol dependence among women was more prevalent in higher occupational grades. Men with high job demands or with low work social supports had a slightly reduced risk of alcohol dependence. No association was found between objectively assessed demands, job control, and alcohol dependence in either men or women.

Conclusion: A stressful psychosocial work environment in terms of effort-reward imbalance was found to be a risk factor for alcohol dependence in men. In view of the public health importance of alcohol dependence in working populations these findings call for more emphasis on psychosocial factors in occupational health research and prevention.

     

Development and implementation of a participative intervention to improve the psychosocial work environment and mental health in an acute care hospital

Objectives

To describe the development and implementation phases of a participative intervention aimed at reducing four theory grounded and empirically supported adverse psychosocial work factors (high psychological demands, low decision latitude, low social support, and low reward), and their mental health effects.

Methods

The intervention was realised among 500 care providers in an acute care hospital. A prior risk evaluation was performed, using a quantitative approach, to determine the prevalence of adverse psychosocial work factors and of psychological distress in the hospital compared to an appropriate reference population. In addition, a qualitative approach included observation in the care units, interviews with key informants, and collaborative work with an intervention team (IT) including all stakeholders.

Results

The prior risk evaluation showed a high prevalence of adverse psychosocial factors and psychological distress among care providers compared to a representative sample of workers from the general population. Psychosocial variables at work associated with psychological distress in the prior risk evaluation were high psychological demands (prevalence ratio (PR) = 2.27), low social support from supervisors and co‐workers (PR = 1.35), low reward (PR = 2.92), and effort‐reward imbalance (PR = 2.65). These results showed the empirical relevance of an intervention on the four selected adverse psychosocial factors among care providers. Qualitative methods permitted the identification of 56 adverse conditions and of their solutions. Targets of intervention were related to team work and team spirit, staffing processes, work organisation, training, communication, and ergonomy.

Conclusion

This study adds to the scarce literature describing the development and implementation of preventive intervention aimed at reducing psychosocial factors at work and their health effects. Even if adverse conditions in the psychosocial environment and solutions identified in this study may be specific to the healthcare sector, the intervention process used (participative problem solving) appears highly exportable to other work organisations.     

Job strain,psychological distress,and burnout in nurses

The first phase of this longitudinal study consisted of a questionnaire completed by a cohort of 1,891 nurses (aged 23–65 years) from six acute care hospitals from the province of Québec. This study was set up to investigate the association between the psychosocial environment of work and mental health. After adjusting for counfounding factors, a combination of high psychological demands and low decision latitude was associated with psychological distress and emotional exhaustion, one of the three dimensions of burnout. Social support at work, although associated with each of the mental health indicators, did not modify their association with job strain. The present study identified conditions of the work environment that are modifiable and provide the basis for interventions that focus beyond the modification of individual coping strategies. Am. J. Ind. Med. 34:20–28, 1998. © 1998 Wiley-Liss, Inc.     

Job demands, job resources, and work engagement of Japanese employees: a prospective cohort study

Purpose

Research on the prospective association of job demands and job resources with work engagement is still limited in Asian countries, such as Japan. The purpose of the present study was to investigate the prospective association of job demands (i.e., psychological demands and extrinsic effort) and job resources (i.e., decision latitude, supervisor support, co-worker support, and extrinsic reward), based on the job demands-control (JD-C) [or demand-control-support (DCS)] model and the effort-reward imbalance (ERI) model, with work engagement among Japanese employees.

Methods

The participants included 423 males and 672 females from five branches of a manufacturing company in Japan. Self-administered questionnaires, including the Job Content Questionnaire (JCQ), the Effort-Reward Imbalance Questionnaire (ERIQ), the nine-item Utrecht Work Engagement Scale (UWES-9), and demographic characteristics, were administered at baseline (August 2009). At one-year follow-up (August 2010), the UWES-9 was used again to assess work engagement. Hierarchical multiple regression analyses were conducted.

Results

After adjusting for demographic characteristics and work engagement at baseline, higher psychological demands and decision latitude were positively and significantly associated with greater work engagement at follow-up (β = 0.054, p = 0.020 for psychological demands and β = 0.061, p = 0.020 for decision latitude).

Conclusions

Having higher psychological demands and decision latitude may enhance work engagement among Japanese employees.     

Psychological distress and associated factors among Japanese nursery school and kindergarten teachers: a cross-sectional study

The understaffing of nursery schools and kindergartens and the increasing workload of childcare workers are becoming significant issues in Japan. In this study, a cross-sectional survey was conducted to investigate the stress experienced by childcare workers and its antecedents. We distributed 2,640 questionnaires to childcare workers in Miyagi prefecture, obtaining a response rate of 51.9% (n=1,370). Finally, 1,210 valid questionnaires were used in the analysis. As a stress indicator, psychological distress was measured with the Kessler Screening Scale for Psychological Distress (K6). The mean K6 score was 7.0 (SD=5.4), and the prevalence of psychological distress (K6 score ≥5) was 60.0%. Considering work-related factors, the mean scores were as follows: supervisor support 11.8 (2.6), coworker support 12.1 (2.0), work engagement 3.2 (1.2), and effort-reward ratio 0.93 (0.53). A multivariate logistic regression analysis with adjustment for possible confounders revealed that increased psychological distress was associated with higher effort-reward ratio, lower support from supervisors and coworkers, lower work engagement, and insufficient sleep. These results suggest that elevated psychological distress is strongly associated with effort-reward imbalance, while high work engagement in childcare workers helped to reduce their distress.     

The relationship between psychosocial work characteristics and fatigue and psychological distress

OBJECTIVES: To examine the associations between psychosocial work characteristics and fatigue in employees in the Maastricht Cohort Study. A second objective was to compare the relationships for fatigue versus psychological distress with these psychosocial work characteristics. METHODS: The design was cross-sectional and included 11,020 employees who responded to the self-administered baseline questionnaire of the Maastricht Cohort Study. Fatigue was measured with the Checklist Individual Strength, a 20-item self-report instrument. Psychological distress was measured with the 12-item version of the General Health Questionnaire. Psychosocial work characteristics comprised: psychological demands, decision latitude, and social support at work as measured by the Job Content Questionnaire, as well as emotional demands at work, physical demands at work, job insecurity, and conflict with supervisor/co-worker, which were assessed with items from existing Dutch questionnaires. RESULTS: Low decision latitude and low social support at work were associated with fatigue in both men and women. Associations were also found between emotional demands at work, job insecurity, physical demands and conflict with supervisor and fatigue in men; and high psychological demands and fatigue in women. As regards psychological distress, there was no association with low decision latitude, but strong associations with emotional demands and conflict with supervisor in both genders. CONCLUSIONS: The study provides strong support for associations between psychosocial work characteristics and fatigue in men and women, even after adjustment for psychological distress. Moreover, it suggests some differential effects of psychosocial work characteristics on fatigue and psychological distress.     

The incorporation of different demand concepts in the job demand-control model: effects on health care professionals

This paper reports a study of 212 health care professionals that focuses on job characteristics as predictors of employee health. By means of covariance structure modelling (LISREL 8) we tested the interactive assumptions of the Karasek (1979) Job Demand-Control (JD-C) Model [Karasek, R.A., Jr., 1979. Job demands, job decision latitude, and mental strain: implications for job redesign. Administrative Science Quarterly, 24, 285-307.] using three different concepts of job demands (i.e. psychological job demands, physical demands and emotional demands) in combination with a more focused measure of decision latitude (i.e. job autonomy) to predict employee health (i.e. job satisfaction, job involvement, emotional exhaustion and psychosomatic health complaints). Controlling for gender and age, the results partly support the JD-C hypotheses by finding three out of twelve assumed interaction effects. More specifically, different outcome variables are predicted by different combinations of job autonomy with the three kinds of job demands, respectively. In conclusion, although we refute the central hypotheses of the JD-C model to a large extent, the current (interactive) findings are quite illuminating and will be discussed in the context of their theoretical and practical implications. Researchers as well as practitioners have to broaden their perspective on 'job demands' in health care work and need to focus on different kinds of job demands to capture the complexity of this work setting.     

Different timetables for change: understanding processes in reorganizations--a qualitative study in a psychiatric sector in Sweden

PURPOSE: It is well-known that a decrease in economic resources in health care results in increased workload, stress and pressure on personnel. The main aim of this study was to explore and understand how personnel in health care were influenced by multiple obligations in the context of a changing surrounding. DESIGN/METHODOLOGY/APPROACH: Personnel within psychiatry were interviewed in an open-ended, interactive mode. The transcribed interviews were analysed using grounded theory as the method of study. FINDINGS: These professionals working within a turbulent work situation experienced a struggle between external demands and internal obligations of an ethical or ideological character. For many of them earlier psychological contracts were broken, earlier organizational culture was overthrown and their professional authority was threatened. They were required to change or abandon well-established professional identities. Fundamental changes such as the transition of theoretical framework or revision of internal obligations have quite a different timetable from a technical change of method or organizational structure. PRACTICAL IMPLICATIONS: The findings of two timetables for change should be addressed when considering reorganizations. If these findings are applied to personnel in health care, seeing them also as patients in the system may be avoided. ORIGINALITY/VALUE: The different timetables for external change and internal reorganization, with support from findings in in-depth interviews, have not been described until now.     

Stress im Krankenhaus

Background

Considerable workloads have been repeatedly reported for health care professionals. However, a survey regarding the psychosocial workloads and resources of nonphysician health care professionals in hospitals which considers the effort–reward imbalance model, the job–demand control model and work-related self-efficacy has not been conducted so far.

Methods

A total of 177 nonphysician surgical staff composed of surgical technologists and surgical nurses (80% female, 16% in a leading position, 30% in education) were interviewed in written form. The survey was carried out using validated questionnaires over a period of 7 weeks.

Results

About 80% of the nonphysician health care professionals were exposed to high efforts and low rewards (effort–reward imbalance). Furthermore, it emerges that 14% show heavy job demands and low decision latitude (job strain). Thereby, the prevalence did not differ between women and men. Managers, on the other hand, did not report a job strain, and trainees were less likely to have an effort–reward imbalance. In addition, the negative affect in a work week was associated with high efforts and low rewards. In contrast, the positive affect was associated with the experience of activity/decision latitude, belief in the own self-efficacy and a negative ratio of effort and reward.

Discussion

Nonphysician health care professionals in surgical fields clearly exhibit psychosocial workloads which increase the risk for stress-associated diseases. Relations with the emotional affects within a work week show need for prevention and health promotion.

     

A review of empirical studies on the model of effort-reward imbalance at work: reducing occupational stress by implementing a new theory

The present study reviews empirical studies of a new occupational stress model of effort-reward imbalance at work to examine its validity as an occupational stress measure and the theory-based intervention approach to occupational stress reduction. The effort-reward imbalance model is valid for demonstrating a stressful work environment that reflects the current labor market and predicts health conditions among a wide range of working populations. The stressful aspects of work measured by the effort-reward imbalance model are different from those shown in the job demand-control model, and the adverse health effects are independent of each other, which suggests that the two models are complementary. The evidence indicates that it is efficient to select psychosomatic symptoms as short-range target outcomes and sick leave as a medium-range target outcome of the theory-based intervention. In addition, it would be preferable to simultaneously measure job satisfaction, morale, motivation, and performance as organizational level outcomes. Although employees engaged in diverse occupations can be target populations, high effectiveness is expected, particularly in service occupations that work shifts. Studies are necessary to determine how long and how intensely interventions are implemented. Target work environments are selected from the perspective of securing or improving employees' sense of fairness and reciprocity by approaching them. Since the theory-based intervention depends largely on organizational changes that are beyond the individual employees' ability, the cooperation of employers is necessary.     

Psychosocial job factors and the one-year evolution of back-related functional limitations

OBJECTIVES: This 1-year prospective study aimed at assessing the association between some psychosocial job characteristics and back-related functional limitations. METHODS: The participants were 849 workers who sought medical consultation for nonspecific back pain in primary care settings of the Quebec City area. Information on job decision latitude, psychological demands, and social support at work was collected during a telephone interview conducted after the medical consultation. Back-related functional limitations were measured at baseline and 1 year later with the Roland-Morris Disability Questionnaire. The analyses were stratified by gender. Social support at work and the type of back pain were considered potential effect modifiers. Several potential confounders were also considered in the multiple regression analyses that were conducted to isolate the effect of the job psychological demands and decision latitude on the 1-year level of back-related functional limitations. RESULTS: A modest difference in the 1-year Roland-Morris average scores was found only among the women and only for the association between job decision latitude with back-related functional limitations, according to the level of social support at work. This difference was of limited clinical significance. Analyses by type of back pain showed, however, a clinically significant association between the combination of high psychological demands and low decision latitude and back-related functional limitations only for subjects with persistent pain. CONCLUSIONS: Job psychological demands and decision latitude have little influence on the 1-year evolution of back-related functional limitations for one-time and recurrent back-pain problems. However, our results suggest that this association could be important for workers with persistent pain.     

工作付出与获得平衡状态对乡镇企业工人心理健康的影响

目的研究不同付出与获得平衡状态乡镇企业工人的心理健康状况。方法抽取不同行业的乡镇企业工人576人，填写付出与获得不平衡自评问卷调查表和症状自评量表。结果乡镇企业工人心理健康状况随付出与获得不平衡水平的加剧而下降..不平衡状态、分界点组躯体化症状、忧郁等9个因子的得分均明显高于平衡状态组，差异有统计学意义（P〈0.05）。不平衡状态组的躯体化症状、忧郁、焦虑、人际敏感、精神病性得分高于分界点组，差异有统计学意义（P〈0.05）。超负荷状态组躯体化症状等7个因子分高于未超负荷状态组，差异有统计学意义（P〈0.05）。不平衡状态和超负荷状态下，除恐怖因子外，男性组分别有5个因子分和3个因子分较女性组高，差异有统计学意义（P〈0.05）。     

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.

 

     

Validity of occupational stress and decision latitude on health in the National Population Health Survey of 1994-95]

Psychosocial environment at work is now considered a health determinant. The National Population Health Survey (NPHS) of 1994-95 is the first study in which psychological demands and decision latitude at work were measured in a random sample of the Canadian population. However, psychometric properties of the scales used in NPHS to measure these factors are not known. The objective of the present paper was to evaluate some validity parameters of the scales used in the NPHS by comparison to the original scales recommended by Karasek to measure these factors. Results of the current study support the validity of the decision latitude scale. However, validity of the psychological demand scale is more limited.