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.     

Effort-reward imbalance and depression in Japanese medical residents

The effort-reward imbalance is an important psychosocial factor which is related to poor health among employees. However, there are few studies that have evaluated effort-reward imbalance among medical residents. The present study was done to determine the association between psychosocial factors at work as defined by the effort-reward imbalance model and depression among Japanese medical residents. We distributed a questionnaire to 227 medical residents at 16 teaching hospitals in Japan at the end of August 2005. We asked participants to answer questions which included demographic information, depressive symptoms, effort-reward imbalance, over-commitment and social support. Depression was evaluated using the Japanese version of the Center for Epidemiologic Studies-Depression (CES-D) scale. The effort-reward imbalance and over-commitment were assessed by the Effort-Reward Imbalance (ERI) questionnaire which Siegrist developed. Social support was determined on a visual analog scale. Logistic regression analysis was performed to determine the associations between effort-reward imbalance and depressive symptoms. Depressive symptoms were found in 35 (29.2%) 1st-year residents and 21 (27.6%) 2nd-year residents. The effort-reward ratio >1 (OR, 8.83; 95% CI, 2.87-27.12) and low social support score (OR, 2.77, 95% CI, 1.36-5.64) were associated with depressive symptoms among medical residents. Effort-reward imbalance was independently related to depression among Japanese medical residents. The present study suggests that balancing between effort and reward at work is important for medical residents' mental health.     

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.

     

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.     

The contribution of working conditions and social support to the onset of depressive and anxiety disorders among male and female employees

Poor working conditions may be an important source of stress and may therefore contribute to the development of depressive and anxiety disorders. Social support may act as a buffer and protect against the development of depression or anxiety in the face of poor working conditions. With longitudinal data from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), the effect of working conditions and social support on the incidence of depressive and anxiety disorders was examined among 2646 working men and women, aged 18 through 65 years. Three dimensions of self reported working conditions were assessed: psychological demands, decision latitude and job security. Social support was assessed through validated scales for daily emotional support. About 10.5% of working women and 4.6% among working men developed an incident depressive and/or anxiety disorder over 2 years. Psychological demands predicted the incidence of depressive and anxiety disorders in both men and women (RR per score increase=2.29, 95% CI: 1.44-3.63), whereas decision latitude and job security did not. Social support protected against the incidence of depressive and anxiety disorders. This effect was stronger for men compared to women. Social support did not buffer the unfavorable mental effect of working conditions. Women were more likely to report low levels of decision latitude, whereas men reported higher psychological demands. Working conditions did not explain sex differences in the incidence of depressive and anxiety disorders.     

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.

 

     

医务人员工作中社会心理因素与抑郁症状的关系

目的 探讨医务人员工作上的付出-获得不平衡与抑郁症状之间的关系.方法 付出-获得不平衡采用付出-获得不平衡（the Effort-Reward Imbalance,ERI）量表测量,抑郁情绪调查采用美国流调中心的抑郁自评（Center of Epidemiology Survey Depression,CES-D）量表测量医务人员的抑郁症状.研究对象来自在浙江大学6个附属医院工作的1 179名医务人员.调查表包括ERI量表、CES-D量表和一些基本特征.使用Spearman相关分析、Mann-Whitney检验、Pearson χ^2检验或似然比χ^2检验进行单因素分析;用多元Logistic回归方法分析医务人员中工作上的付出-获得不平衡与抑郁症状之间的关系.结果 医务人员抑郁症状的阳性率为48.12%（95% CI：45.08%～51.16%）,护士抑郁症状的阳性率为52.40%（95%CI：47.87%～56.93%）,较医生抑郁症状的阳性率[44.70%（95%CI：10.64%～48.77%）]高,差异有统计学意义（χ^2=6.077,P=0.014）.工作高付出-低获得和超负荷是医务人员抑郁症状发生的相关因素（OR=1.859,95%CI：1.337～2.585;OR=2.207,95%CI：1.656～2.942）.结论 医务人员抑郁症状的发生与工作高付出-低获得、超负荷有关.     

Psychosocial factors at work and depression in three countries of Central and Eastern Europe

Psychosocial factors at work have been found to predict a range of health outcomes but their effect on mental health outcomes has not been extensively studied. This paper explores the relationship between psychosocial factors at work and depression in three countries of Central and Eastern Europe. The data come from a cross-sectional study of working men (n = 645) and women (n = 523) aged 45-64 years, randomly selected from population registers in Novosibirsk (Russia), Krakow (Poland) and Karvina-Havirov (Czech Republic). The questionnaire included questions on the effort and reward at work, job control, the full CES-D scale of depression, and a range of other characteristics. Linear regression was used to estimate the association between depression score and work characteristics: the logarithm of the effort-reward ratio, and continuous job control score. The means of the depression score were 10.5 for men and 14.2 for women. After controlling for age, sex and country, effort-reward ratio (logarithmically transformed) was strongly related to depression score; a 1 SD increase in the log transformed effort-reward ratio was associated with an increase in the depression of 2.0 points (95% CI 1.5; 2.4), and further adjustment did not materially change the effect. Job control was inversely associated with depression score in Poland and the Czech Republic (not in Russia) but the association was largely eliminated by controlling for socioeconomic characteristics. This study suggests that the effort-reward imbalance at work is related to prevalence of depression in these central and eastern European populations.     

Effort-reward imbalance model and self-reported health: cross-sectional and prospective findings from the GAZEL cohort

Psychosocial factors at work have been found to be significant contributors to health, especially cardiovascular health. This study is aimed at exploring the relationship between psychosocial factors at work as defined by the effort-reward imbalance (ERI) model and self-reported health, using alternative formulations of this model, and comparing cross-sectional and prospective analyses for a large occupational cohort of men and women. The French version of the ERI model was used to measure the three scales of effort, reward, and overcommitment. Self-reported health was used as health outcome. Covariates included chronic diseases, frequent depressive symptoms, and personal, occupational, and behavioural factors. The cross-sectional and prospective analyses concerned, respectively, 10175 and 6286 workers. Men and women were analysed separately. Cross-sectional analysis revealed that ERI was significantly associated with self-reported health whatever the formulation used (ratio over one, quartiles, continuous ratio, or log-transformed ratio) for both genders. When effort and reward were studied as two separate variables, reward was a significant risk factor for both genders, whereas effort was for men only. Overcommitment was also found to be a risk factor for self-reported health for both sex. Prospective analysis showed that ERI was a significant predictor of poor self-reported health for men and women for two formulations (continuous ratio and log-transformed ratio). For both genders, effort did not predict self-reported health, but reward did. Overcommitment was predictive of poor self-reported health for men only. Our results highlighted the predictive effects of the ERI model on self-reported health in a 1-year follow-up study. They urged to explore various formulations of the ERI model. They also underlined the need for longitudinal study design and separate analyses for men and women in the field of psychosocial factors at work.     

某热电厂工人工作满意感与职业应激相关因素的关系

目的 探讨热电厂工人工作满意感与职业应激相关因素的关系.方法 采用整群抽样的方法对某热电厂875名工人进行调查,用职业应激测量工具、工作内容问卷和付出-回报失衡问卷等测试热电厂工人的工作满意感、职业应激因素、应激反应、个体特征、应付策略和社会支持.结果 不同性别、文化程度、婚姻状况、吸烟和饮酒组间工作满意感评分比较,差异无统计学意义(P＞0.05).不同年龄和工龄组间工作满意感评分比较,差异有统计学意义(P＜0.01).相关分析结果表明,工作满意感与对人的责任、对事的责任、提升机会、决定水平、工作稳定性、回报、心理卫生、正性情感、自尊感、上级支持、同事支持和应对策略呈正相关(P＜0.01或P＜0.05),与角色模糊、角色冲突、工作前景未知性、工作需求、负性情感、抑郁症状和工作心理控制源呈负相关(P＜0.01或P＜0.05).方差分析结果表明,工作满意感评分高组对人的责任、对事的责任、提升机会、决定水平、工作稳定性、回报、心理卫生、正性情感、自尊感和缓解因素评分明显高于工作满意感评分中等或低水平者(P＜0.01),而工作满意感评分高组角色模糊、角色冲突、工作前景未知性、工作需求、工作心理控制源和抑郁症状评分低于工作满意感中等或低水平者(P＜0.01或P＜0.05).多因素logistic回归分析结果表明,低回报者发生工作不满意感的风险约为高回报者的4倍(OR=3.773),低社会支持和工作心理控制源外控者发生工作不满意感的风险是高社会支持和内控者的2倍多(OR值分别为2.419和2.219).每日紧张感、低控制策略、低支持策略、低决定水平和负性情感均是工作不满意的危险因素(OR=1.125～1.790),而自尊感和正性情感可使工作不满意感发生的风险降低.结论 增加工作中的决定水平、社会支持和应对策略、回报,减少角色冲突与模糊、工作需求、负性情感,可提高工人的工作满意感水平.     

High effort, low reward, and cardiovascular risk factors in employed Swedish men and women: baseline results from the WOLF Study

STUDY OBJECTIVE: To examine associations between measures of work stress (that is, the combination of high effort and low reward) and cardiovascular risk factors. DESIGN: Cross sectional first screening of a prospective cohort study. SETTING AND PARTICIPANTS: The study was conducted among 5720 healthy employed men and women living in the greater Stockholm area aged 19-70 years. All analyses were restricted to subjects with complete data (n = 4958). The investigation of associations between indicators of effort-reward imbalance and cardiovascular risk factors was restricted to the age group 30-55 years (n = 3427). MAIN RESULTS: Subjects reporting high effort and low reward at work had a higher prevalence of well known risk factors for coronary heart disease. After adjustment for relevant confounders, associations between a measure of extrinsic effort and reward (the effort-reward ratio) and hypertension (multivariate prevalence odds ratio (POR) 1.62-1.68), increased total cholesterol (upper tertile 220 mg/dl)(POR = 1.24) and the total cholesterol/high density lipoprotein(HDL)-cholesterol ratio (upper tertile 4.61)(POR 1.26-1.30) were found among men. Among women a measure of high intrinsic effort (immersion) was related to increased low density lipoprotein (LDL)-cholesterol (upper tertile 130 mg/dl)(POR 1.37-1.39). Analyses of variance showed increasing mean values of LDL cholesterol with an increasing degree of the effort-reward ratio among men and increased LDL-cholesterol among women with high levels of intrinsic effort (upper tertile of immersion). CONCLUSIONS: Findings lend support to the hypothesis that effort-reward imbalance represents a specific constellation of stressful experience at work related to cardiovascular risk. The relation was not explained by relevant confounders (for example, lack of physical exercise, body weight, cigarette smoking).     

Association between job stress and depression among Japanese employees threatened by job loss in a comparison between two complementary job-stress models.

OBJECTIVES: This study compared the separate effects produced by two complementary stress models--the job demand-control model and the effort-reward imbalance model--on depression among employees threatened by job loss. METHODS: A cross-sectional analysis was conducted to examine these associations among 190 male and female employees who responded to a self-administered questionnaire in a small Japanese plant with economic hardship. The employees were engaged in 2 job types--direct assembly line and indirect supportive tasks--and the latter was threatened by job loss because of downsizing. Independent variables were measured by the Japanese versions of Karasek's demand-control questionnaire and Siegrist's effort-reward imbalance questionnaire. Depression was assessed by the Center for Epidemiologic Studies Depression Scale. RESULTS: The employees with indirect supportive tasks (target for downsizing) were more likely to have depressive symptoms than direct assembly-line workers. Job strain, a combination of high demand and low control at work, was more frequent among the latter, while the combination of high effort and low reward was more frequent among the former. After adjustment for work environment factors, low control [odds ratio (OR) 4.7], effort reward imbalance (OR 4.1), and overcommitment (the person characteristic included in the effort-reward imbalance model) (OR 2.6) were independently related to depression. There is some indication that these effects were particularly strong in the subgroup suffering from potential job loss. CONCLUSIONS: This study confirms that the 2 job stress models identify different aspects of stressful job conditions. Moreover, effort-reward imbalance and low control at work are both associated with symptoms of depression.     

Gender differences in job strain, effort-reward imbalance, and health functioning among Chinese physicians

To examine the association between work stress measured by job strain and effort-reward imbalance (ERI) and health functioning in a sample of hospital-based Chinese physicians, a self-reported survey with a standardized questionnaire was conducted in three hospitals in China, among 256 men and 266 women. It was found that both job strain and ERI were associated with impaired health functioning in men and women, but that ERI indicated a stronger association. Men's job control was significantly higher, and was related to men's physical health; whereas women perceived relatively higher job reward which predicted women's mental health. The findings provide evidence of the adverse effects on health functioning of both job strain and ERI, but ERI appears to have more explanatory power as a model of work stress in this sample of Chinese physicians. In addition, gender differences of work stress with respect to health are present.     

A longitudinal study comparing the effort-reward imbalance and demand-control models using objective measures of physician utilization

BACKGROUND: The objectives of this study were to compare the predictive validity of the demand-control and effort-reward imbalance models using objective measures of physician utilization. METHODS: Self-reports for psychosocial work conditions were obtained in interviews with 1,028 workers using the demand-control and effort-reward imbalance models. Physician utilization outcomes were obtained through linkage to the British Columbia Linked Health Database. Outcomes were any visit to a physician for mental health reasons and 30 or more physician visits for any reason. The predictive validity of both models was compared in a longitudinal study using logistic regression. RESULTS: Neither job strain nor effort-reward imbalance predicted either outcome. However, low esteem reward and low status control increased the risk for 30 or more physician visits by, respectively, approximately 60% and 30%. CONCLUSIONS: In a sample of middle-aged blue-collar current and ex-sawmill workers in Western Canada, followed prospectively, after controlling for sociodemographic and workplace confounders, and reducing the potential for adverse health selection into high-stress jobs, low esteem reward and low status control were associated with a significantly greater risk for 30 or more physician visits for any reason.     

Injustice at work and incidence of psychiatric morbidity: the Whitehall II study

Background

Previous studies of organisational justice and mental health have mostly examined women and have not examined the effect of change in justice.

Aim

To examine effects of change in the treatment of employees by supervisors (the relational component of organisational justice) on minor psychiatric morbidity, using a cohort with a large proportion of men.

Methods

Data are from the Whitehall II study, a prospective cohort of 10 308 white‐collar British civil servants (3143 women and 6895 men, aged 35–55 at baseline) (Phase 1, 1985–88). Employment grade, relational justice, job demands, job control, social support at work, effort–reward imbalance, physical illness, and psychiatric morbidity were measured at baseline. Relational justice was assessed again at Phase 2 (1989–90). The outcome was cases of psychiatric morbidity by Phases 2 and 3 (1991–93) among participants case‐free at baseline.

Results

In analyses adjusted for age, grade, and baseline physical illness, women and men exposed to low relational justice at Phase 1 were at higher risk of psychiatric morbidity by Phases 2 and 3. Adjustment for other psychosocial work characteristics, particularly social support and effort–reward imbalance, partially attenuated these associations. A favourable change in justice between Phase 1 and Phase 2 reduced the immediate risk (Phase 2) of psychiatric morbidity, while an adverse change increased the immediate and longer term risk (Phase 3).

Conclusion

This study shows that unfair treatment by supervisors increases risk of poor mental health. It appears that the employers'' duty to ensure that employees are treated fairly at work also has benefits for health.     

公务员工作压力与抑郁症状之间的关系

目的探讨公务员工作压力和抑郁症状之间的关系。方法工作压力采用中文版的付出一获得不平衡量表，抑郁评价采用中文版CES—D量表。采用问卷形式对474名浙江省公务员进行横断面调查，调查内容包括工作付出、获得、超负荷，抑郁症状和一般情况。采用方差分析、秩和检验或X^2检验进行单因素分析，采用logistic回归进行多因素分析。使用Epidata2003建立数据库。采用SPSS13．0进行统计分析。结果本次调查结果显示浙江省公务员抑郁症状阳性率为41．56％（95％CI：39．30％～43．82％）。采用多元logistic回归校正了其他因素后，工作中付出一获得不平衡的0R=1．772（95％CI：0．369～8．508）。公务员抑郁症状与超负荷（OR=3．468，95％CI=1．542～7．801）、单身（OR=2．661，95％CI=1．017～6．963）、社会支持（0R=2．088，95％CI：1．246～3．498）和亚健康状态（0R=2．475，95％CI：1．110～5．520）有关。结论公务员工作超负荷对其健康状况有负面影响。     

The effects of work organization on the health of immigrant manual workers: A longitudinal analysis

This analysis uses a longitudinal design to examine the associations of work organization and health outcomes among Latino manual workers. Participants included 247 Latino workers who completed baseline and 1-year follow-up interviews and clinical examinations. Health outcome measures were epicondylitis, rotator cuff syndrome, back pain, and depressive symptoms. Independent measures were measures of job demand, job control, and job support. Workers commonly experienced rotator cuff syndrome (6.5%), back pain (8.9%), and depressive symptoms (11.2%); fewer experienced epicondylitis (2.4%). Psychological demand was associated with rotator cuff syndrome; awkward position and decision latitude were associated with back pain. Decreased skill variety but increased decision latitude was associated with elevated depressive symptoms. Work context factors are important for health outcomes among vulnerable workers. Further research is needed to expand upon this work, particularly cultural perspectives on job support.