Psychosocial work environment and cardiovascular risk factors in an occupational cohort in France

STUDY OBJECTIVE: Concordant results have been reported in several studies for the effects of job stress on cardiovascular disease, but the potential mechanisms of these effects have seldom been explored. The aim of this study was therefore to examine, in women and men, the cross sectional relations between psychosocial work variables (psychological demands, decision latitude, and social support) and cardiovascular risk factors (hypertension, hyperlipidaemia, diabetes, overweight, smoking, and alcohol consumption). PARTICIPANTS: The original cohort comprised 20,625 volunteers (men aged from 40 to 50 and women from 35 to 50) employed by the French Company Electricite De France-Gaz De France and followed up yearly since 1989. The study was restricted to the 13,226 volunteers in the cohort who were still working and answered a self administered questionnaire on psychosocial work factors in 1995. DESIGN: Data were based on replies to this questionnaire. Three psychosocial work environment exposure scores were used to assess psychological demands, decision latitude, and social support at work respectively. The main outcome measures were the prevalence of hypertension, hyperlipidaemia, and diabetes within the previous 12 months, overweight, smoking, and alcohol consumption. MAIN RESULTS: Psychosocial work factors were significantly associated with hypertension, hyperlipidaemia, overweight, smoking, and alcohol consumption, but not with diabetes. In men, low decision latitude was associated with hypertension, high decision latitude and high social support with overweight, low decision latitude with alcohol consumption. Moreover, the risk of hyperlipidaemia increased in men exposed to both high psychological demands and low social support. In women, low decision latitude was related to hyperlipidaemia, high psychological demands with overweight, high psychological demands and high decision latitude with smoking, and low social support with alcohol consumption. CONCLUSIONS: These cross sectional results underline the potential effects of psychosocial work characteristics on cardiovascular risk factors and the differences between the effects of job stress in men and women, and confirm the direct mechanisms (through physiological variables) and indirect mechanisms (through behavioural risk factors) potentially involved in the relation between psychosocial work characteristics and cardiovascular disease.

 

     

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.     

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.     

Psychometric properties of the French version of the Karasek Job Content Questionnaire: a study of the scales of decision latitude, psychological demands, social support, and physical demands in the GAZEL cohort

OBJECTIVES: The objective of this study was to explore the psychometric properties of the French version of the Karasek Job Content Questionnaire (JCQ) for the recommended scales of psychological demands, decision latitude, social support, and physical demands. Internal consistency, factorial validity, and convergent validity were examined in a large occupational cohort of men and women. METHODS: This study was based on the GAZEL cohort composed of workers aged 40-50 years for men and 35-50 years for women employed by the French national electric and gas company Electricité De France-Gaz De France (EDF-GDF) in 1989. This cohort has been followed up since 1989 by means of yearly self-administered questionnaires and by the collection of data provided by the company. RESULTS: The study population included the 11,447 GAZEL subjects, 8,277 men and 3,170 women, who were working and who answered the French version of the JCQ in 1997. Cronbach's alpha coefficients higher than 0.65 supported the internal consistency of the JCQ scales and subscales. The results of exploratory factor analysis were consistent with the expected dimensions. Physical demands, supervisor support, and co-worker support were clearly found. However, for decision latitude, 'repetitive work' and 'learn new things' displayed low factor loadings. For psychological demands, low factor loadings were observed for 'conflicting demands', 'wait on others', and 'no excessive work'. Confirmatory factor analysis supported the instrument construct in six latent factors: psychological demands, skill discretion, decision authority, supervisor support, co-worker support, and physical demands, although the items mentioned earlier displayed low standardized factor loadings. The associations between the JCQ scales and gender, age, educational level, occupational grade, and job satisfaction were explored using analysis of variance and chi-square test, and supported the convergent validity. CONCLUSION: Although our results of factor analysis could invite the revision of the two scales of decision latitude and psychological demands, this study provided evidence of the validity of the French version of the four JCQ scales of psychological demands, decision latitude, social support, and physical demands among a large population consisting of French working men and women.     

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.     

职业紧张对心理健康的影响

目的探讨工作需求和工作控制水平对心理健康的影响以及工作需求与控制间的交互作用效应.方法采用修订的工作需求-控制量表和职业紧张反应测量工具对93名男性铁路货运编组站调度员进行测试,应用单应变量多因素方差分析、非参数统计方法--Kruskal-Wallis H法和Modian法、逐步回归分析对数据进行统计分析.结果非参数统计结果表明,决定自由度各组间心理卫生评分差异有显著性(平均秩次55.57,47.95,48.42,33.50,P＜0.05),工作时间需求各组间心理卫生评分(37.45,40.01,58.35)、抑郁症评分(36.45,42.25,53.61)、每日紧张感评分(33.00,44.96,56.12)、工作满意感评分(53.18,46.91,32.43)的差异均有显著性(P＜0.05).方差分析结果表明,工作时间需求和决定自由度对身心抱怨(R2=0.24)、焦虑症(R2=0.26)和白天疲劳(R2=0.28)三个应变量存在着有明显意义的交互作用(P＜0.05).逐步回归分析表明,工作时间需求和工作负荷需求对应变量的决定系数(R2)大多大于0.05,且工作时间需求的决定系数(R2)大于工作负荷需求.工作时间需求和决定自由度的乘积变量进入了身心抱怨、焦虑和白天疲劳评分的预测方程,且乘积变量的决定系数(R2)几乎均在0.05以上.结论工作时间需求和决定自由度对部分心理性紧张反应存在着明显的影响,时间需求越大,心理性紧张反应越大,工作时间需求的作用大于决定自由度,二者对部分紧张反应结局变量有交互作用效应.     

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.     

Importance of psychosocial work factors on general health outcomes in the national French SUMER survey

AIM: To examine the associations between psychosocial work factors and general health outcomes, taking into account other occupational risk factors, within the national French working population. METHODS: The study was based on a large national sample of 24 486 women and men of the French working population who filled in a self-administered questionnaire in 2003 (response rate: 96.5%). Psychosocial work exposures included psychological demands, decision latitude, social support, workplace bullying and violence from the public. The three health indicators studied were self-reported health, long sickness absence (>8 days of absence) and work injury. Adjustment was made for covariates: age, occupation, work status, working hours, time schedules, physical, ergonomic, biological and chemical exposures. Men and women were studied separately. RESULTS: Low levels of decision latitude, and of social support, and high psychological demands were found to be risk factors for poor self-reported health and long sickness absence. High demands were also found to be associated with work injury. Workplace bullying and/or violence from the public also increased the risk of poor health, long sickness absence and work injury. CONCLUSION: Psychosocial work factors were found to be strong risk factors for health outcomes; the results were unchanged after adjustment for other occupational risk factors. Preventive efforts should be intensified towards reducing these psychosocial work exposures.     

Psychosocial work exposures of the job strain model and cardiovascular mortality in France: results from the STRESSJEM prospective study

Objectives:The study aims to explore the prospective associations of the psychosocial work exposures of the job strain model with cardiovascular mortality, including mortality for ischemic heart diseases (IHD) and stroke, using various time-varying exposure measures in the French working population of employees.Methods:The study was based on a cohort of 798 547 men and 697 785 women for which job history data from 1976 to 2002 were linked to mortality data and causes of death from the national death registry. Psychosocial work exposures from the validated job strain model questionnaire were assessed using a job-exposure matrix (JEM). Three time-varying measures of exposure were studied: current, cumulative, and recency-weighted cumulative exposure. Cox proportional hazards models were used to examine the associations between psychosocial work exposures and cardiovascular mortality.Results:Within the 1976–2002 period, there were 19 264 cardiovascular deaths among men and 6181 among women. Low decision latitude, low social support, job strain, iso-strain, passive job, and high strain were associated with cardiovascular mortality. Most of these associations were also observed for IHD and stroke mortality. The comparison between the different exposure measures suggested that current exposure may be more important than cumulative (or past) exposure. The population fractions of cardiovascular mortality attributable to job strain were 5.64% for men and 6.44% for women.Conclusions:Psychosocial work exposures of the job strain model may play a role in cardiovascular mortality. The estimated burden of cardiovascular mortality associated with these exposures underlines the need for preventive policies oriented toward the psychosocial work environment.     

Job strain, social support at work, and incidence of myocardial infarction

OBJECTIVES: The combination of high psychological job demands and low decision latitude (high job strain) has been associated with an increased risk of coronary heart disease. It has been proposed that this may also be the case for low social support at work. The aim of this study was to analyse the relations between these psychosocial factors and incidence of myocardial infarction. METHODS: Associations between psychosocial work characteristics and incidence of myocardial infarction was investigated through a population based case-control study. The study base comprised employed men and women in five Swedish counties during the years 1976-84. Cases of first myocardial infarction were identified from hospital discharge registers and death records from outside hospital, controls were selected through a random sample, and psychosocial work environment was assessed through a job exposure matrix on the basis of the occupation in the 1970 and 1975 censuses. RESULTS: An increased incidence of myocardial infarction was found for men and women in occupations characterised by low decision latitude. For men this increase was seen primarily in combination with high psychological demands (high job strain) and low social support at work. Younger men (30-54 years of age) in occupations with both high job strain and low social support at work had a relative risk of 1.79 (95% confidence interval (95% CI) 1.22 to 2.65) compared with subjects in low strain and high social support jobs after controlling for age, county of residence, and socioeconomic group. CONCLUSIONS: Our results indicate that jobs characterised by low decision latitude, high job strain, or low social support at work may be associated with an increased risk of acute myocardial infarction. If these associations are causal they may be of substantial importance from the point of view of workers' health.

 

     

Psychometric properties of the Korean version of the job content questionnaire: data from health care workers

Objectives To test the validity and reliability of selected scales, namely, decision latitude, psychological job demand, social support, job insecurity, and macro-level decision latitude from the Korean version of the job content questionnaire (K-JCQ), as part of a psychosocial epidemiological study among university hospital workers. Methods K-JCQ was developed by translation and back translation complying with the JCQ usage policy, and its psychometric properties were explored among 338 workers (290 females and 48 males) in a university hospital in Korea. Internal consistency was examined using Cronbach’s alpha correlation coefficients. Factorial validity was tested using exploratory factor analysis. Pearson’s correlation coefficients were used for test–retest reliability among a subset of 157 workers who responded to a repeat survey. Criterion-related validity was assessed by investigating the effects of the scales on job satisfaction and self-identity through work in multiple regression models. Results Cronbach’s alpha for all selected scales was higher than 0.6, except for job insecurity (0.53) and macro-level decision authority (0.52), indicating appropriate internal consistency. Correlation coefficients between test and retest scales of decision latitude, psychological job demand, and social support were 0.60, 0.41, and 0.35, respectively. Exploratory factor analysis found three- and four-factor models, i.e., with and without macro-level decision latitude, respectively, closely corresponding to the theoretical constructs. High levels of decision latitude and social support, and low levels of psychological job demand and job insecurity were significantly associated with high level of job satisfaction. Higher self-identity through work was positively related to decision latitude and social support. Conclusions These findings suggest that K-JCQ is valid and reliable for assessing psychosocial job stress among Korean workers. Macro-level decision latitude showed a separate factorial structure and was strongly associated with task-level decision latitude.     

External validation of psychological job demands in a bus driver sample

Psychosocial risk factors have been considered as characteristics of the work environment rather than an individual issue, but their presence in the workplace is usually measured by self-reported questionnaires, based on worker attitudes. The objective of the study was to compare a self-reported measure of psychological job demands in a bus driver sample with selected indicators of bus company activity, as external 'objective' indicators, in order to assess its external validity. The final sample included 713 drivers in 41 routes. Self-reported measures of psychosocial work risk factors were obtained by the Job Content Questionnaire (JCQ). Four external indicators were available for each route: passengers, break times, bus incidents, and regulating actions. Spearman's correlation coefficient was estimated to assess the validity. Correlation coefficients showed that self-reported psychological demands were statistically significant correlated (p<0.05) with two external indicators: bus incidents (rho=0.397), and regulating actions (rho=0.475). Self-reported psychosocial risk factors have been compared with independent external indicators of the psychosocial work environment, trying to avoid any subject's perception. According to our results, psychological demands measured by the JCQ seem to reflect the actual psychosocial work environment. Other studies are necessary to confirm these results and to assess job control and job social support. This would be another step in improving our knowledge of the quality of measurement of psychosocial risk factors.     

Psychometric evaluation of the Chinese (mainland) version of Job Content Questionnaire: a study in university hospitals

To evaluate the psychometric properties of the Chinese (mainland) version of Job Content Questionnaire (JCQ), this validation study was conducted in university hospitals among 193 men and 581 women health care workers. The Cronbach's alpha coefficients for decision latitude, psychological job demands and social support ranged from 0.56 to 0.82, which indicated that psychological job demands had lower internal consistency. The decision latitude displayed a negative correlation with psychological job demands and a positive correlation with social support. Exploratory factor analysis showed 3 meaningful factors that could explain the 3 theoretical dimensions of job strain model. Apart from some uncertainty over psychological job demands particularly, it is concluded that the Chinese (mainland) version of JCQ is a reliable and valid instrument for measuring job stressors, and is applicable to Chinese working population.     

A procedure for linking psychosocial job characteristics data to health surveys.

A system is presented for linking information about psychosocial characteristics of job situations to national health surveys. Job information can be imputed to individuals on surveys that contain three-digit US Census occupation codes. Occupational mean scores on psychosocial job characteristics-control over task situation (decision latitude), psychological work load, physical exertion, and other measures-for the linkage system are derived from US national surveys of working conditions (Quality of Employment Surveys 1969, 1972, and 1977). This paper discusses a new method for reducing the biases in multivariate analyses that are likely to arise when utilizing linkage systems based on mean scores. Such biases are reduced by modifying the linkage system to adjust imputed individual scores for demographic factors such as age, education, race, marital status and, implicitly, sex (since men and women have separate linkage data bases). Statistics on the linkage system's efficiency and reliability are reported. All dimensions have high inter-survey reproducibility. Despite their psychosocial nature, decision latitude and physical exertion can be more efficiently imputed with the linkage system than earnings (a non-psychosocial job characteristic). The linkage system presented here is a useful tool for initial epidemiological studies of the consequences of psychosocial job characteristics and constitutes the methodological basis for the subsequent paper.     

Job Demands,Job Resources,and Job Performance in Japanese Workers: A Cross-sectional Study

This study investigated the cross-sectional association of job demands (i.e., psychological demands) and job resources (i.e., decision latitude, supervisor support, co-worker support, and extrinsic reward) with job performance. A total of 1,198 workers (458 males and 740 females) from a manufacturing company in Japan completed a self-administered questionnaire that included the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire, World Health Organization Health and Work Performance Questionnaire, and demographic survey. Hierarchical multiple regression analyses were conducted. After adjusting for demographic characteristics, decision latitude (β=0.107, p=0.001) and extrinsic reward (β=0.158, p<0.001) were positively and significantly associated with job performance while supervisor support (β=−0.102, p=0.002) was negatively and significantly associated with job performance. On the other hand, psychological demands or co-worker support was not significantly associated with job performance. These findings suggest that higher decision latitude and extrinsic reward enhance job performance among Japanese employees.     

Job strain,job demands,decision latitude,and risk of coronary heart disease within the Whitehall II study

STUDY OBJECTIVES: To investigate the association between job strain and components of the job strain model and coronary heart disease (CHD) risk. DESIGN: Prospective cohort study (Whitehall II study). At the first phase of the study (1985-1988), data on self reported psychosocial work characteristics were collected from all participants. Participants were followed up until the end of phase 5 (1997-2000), with mean length of follow up of 11 years. SETTING: London based office staff in 20 civil service departments. PARTICIPANTS: 6,895 male and 3,413 female civil servants aged 35-55. OUTCOME MEASURES: Incident validated CHD. MAIN RESULTS: People with concurrent low decision latitude and high demands (job strain) were at the highest risk for CHD. High job demands, and, less consistently, low decision latitude, predicted CHD incidence. The effect of job strain on CHD incidence was strongest among younger workers, but there was no effect modification by social support at work, or employment grade. CONCLUSIONS: Job strain, high job demands, and, to some extent, low decision latitude, are associated with an increased risk of CHD among British civil servants.     

Health and psychosocial work characteristics of employees who did or did not consult the general practitioner in relation to work

OBJECTIVES: To examine how health problems and psychosocial work characteristics are associated with having visited or not having visited the general practitioner (GP) in relation to work. METHODS: Baseline self-reported data of the Maastricht Cohort Study about fatigue at work were used to gather information about fatigue (Checklist Individual Strength), presence of at least one long-term disease, likelihood of having a mental illness (General Health Questionnaire), and psychosocial work characteristics (psychological job demands, decision latitude and social support at work, as measured with the Job Content Questionnaire). The cohort participants indicated having visited (VISITORS) or not having visited (NON-VISITORS) the GP in relation to work. Differences between these groups were measured by multiple logistic regression analyses. RESULTS: When compared with VISITORS and taking into account the influence of sociodemographic characteristics and mutual associations between reported health problems and psychosocial work characteristics, a lower percentage of NON-VISITORS reported at least one long-term disease and NON-VISITORS presented lower levels of fatigue and psychological job demands, and higher levels of decision latitude and social support at work. CONCLUSIONS: The results of this study indicate that NON-VISITORS reported fewer health problems and a more positive perception of their work environment than VISITORS did. Interrelationships between psychosocial work characteristics and health variables should be taken into consideration when studying their associations with visiting the GP in relation to work.     

Experimental manipulation of psychosocial exposure and questionnaire sensitivity in a simulated manufacturing setting

Purpose  The objectives of this study were to determine the efficacy of experimental manipulations of psychosocial exposures and to evaluate the sensitivity of a psychosocial questionnaire by determining the factors perceived. Methods  A 50-item questionnaire was developed from the job content questionnaire (JCQ) and the quality of worklife survey (QWL). The experiment involved simulated work at different physical and psychosocial levels. Forty-eight participants were exposed to two levels of one psychosocial manipulation (job control, job demands, social support, or time pressure). Results  Significantly different questionnaire responses supported the effectiveness of psychosocial manipulations. Exploratory factor analysis revealed five factors: skill discretion and decision authority, stress level and supervisor support, physical demands, quality of coworker support, and decision-making support. Conclusions  These results suggest that psychosocial factors can be manipulated experimentally, and that questionnaires can distinguish perceptions of these factors. These questionnaires may be used to assess perceptions of psychosocial factors in experimental settings.     

Psychosocial factors at work and self reported health: comparative results of cross sectional and prospective analyses of the French GAZEL cohort

Background: Psychosocial factors at work have been found to be significant contributors to health, especially cardiovascular health.

Aims: To explore the relation between psychosocial factors at work and self reported health, using cross sectional and prospective analyses for a large occupational cohort of men and women.

Methods: Psychosocial factors at work were evaluated using the Karasek questionnaire, designed to measure psychological demands, decision latitude, social support, and physical demands. Self reported health was used as health outcome. Covariates included chronic diseases, and sociodemographic, occupational, and behavioural factors. The cross sectional and prospective analyses concerned respectively 11 447 and 7664 workers. Men and women were analysed separately.

Results: Cross sectional analysis revealed significant associations between psychological demands, decision latitude, social support, and physical demands, and self reported health for both men and women. Prospective analysis showed that high psychological demands for both genders, low decision authority for men, and low social support and high physical demands for women were predictive of poor self reported health. These results were independent of potential confounding variables.

Conclusions: Results highlight the predictive effects of psychosocial factors at work on self reported health in a one year follow up study. They also underline the need for longitudinal study design and separate analyses for men and women in the field of psychosocial factors at work.