Sleep complaints in middle‐aged women and men: the contribution of working conditions and work–family conflicts

This study aimed to examine how physical working conditions, psychosocial working conditions and work–family conflicts are associated with sleep complaints, and whether health behaviours explain these associations. We used pooled postal questionnaire surveys collected in 2001–2002 among 40–60‐year‐old employees of the City of Helsinki (n = 5819, response rate 66%). Participants were classified as having sleep complaints if they reported sleep complaints at least once a week on average (24% of women and 20% of men). Independent variables included environmental work exposures, physical workload, computer work, Karasek’s job strain and work–family conflicts. Age, marital status, occupational class, work arrangements, health behaviours and obesity were adjusted for. Most working conditions were associated strongly with sleep complaints after adjustment for age only. After adjustment for work–family conflicts, the associations somewhat attenuated. Work–family conflicts were also associated strongly with women’s [odds ratio (OR) 5.90; confidence interval (CI) 4.16–8.38] and men’s sleep (OR 2.56; CI 1.34–4.87). The associations remained robust even after controlling for unhealthy behaviours, obesity, health status, depression and medications. Physically strenuous working conditions, psychosocial job strain and work–family conflicts may increase sleep complaints. Efforts to support employees to cope with psychosocial stress and reach a better balance between paid work and family life might reduce sleep complaints. Sleep complaints need to be taken into account in worksite health promotion and occupational health care in order to reduce the burden of poor sleep.     

Total workload as related to psychological well-being and symptoms in full-time employed female and male white-collar workers

Most research on the combined effects of paid and unpaid workload has related these factors to stress, depression, and physical symptoms. Thus, comparative knowledge concerning positive aspects of human functioning, such as health and well-being and how they relate to total workload of employed women and men, is limited. Our aim in this study was to investigate how total workload including paid and unpaid work is related to psychological well-being and symptoms in full-time employed women and men. We obtained data on workload, general symptoms, and the Ryff scales covering self-acceptance, environmental mastery, positive relations, personal growth, purpose in life, and autonomy from questionnaires mailed to a stratified sample of highly educated white-collar workers aged between 32 and 58 years. Data from women (n = 430) and men (n = 400) living in partner relationships with at least one child showed that increasing hours of unpaid work was associated with decreasing levels of self-acceptance and environmental mastery in women, whereas paid work was associated with increasing levels of personal growth and decreasing levels of purpose in life. For men, paid work was associated with increasing levels of personal growth and more symptoms. We discuss factors underlying the gender-specific relationships between paid and unpaid work, psychological well-being, and symptoms.     

Social Integration,Socioeconomic Conditions and Type of Ill Health Preceding Disability Pension in Young Women: a Swedish Population-Based Study

Background

Disability pension has increased in recent decades and is seen as a public health and socioeconomic problem in Western Europe. In the Nordic countries, the increase has been particularly steep among young women.

Purpose

The aim was to analyze the influence of low social integration, socioeconomic risk conditions and different measures of self-reported ill health on the risk of receiving disability pension in young women.

Method

The study comprised all Swedish women born in 1960 to 1979, who had been interviewed in any of the annual Swedish Surveys of Living Conditions (1990–2002). The assumed predictors were related to disability pension by Cox proportional hazard regression. The mean number of years of follow-up for the 10,936 women was 7 years (SD 3.8), and the study base was restricted to the ages 16 to 43 years of age.

Results

An increased risk of receiving a disability pension was found among lone women, those who had sparse contacts with others, job-seeking women, homemakers, as well as women with low education, and poor private financial situations. A tenfold increase in the risk of receiving a disability pension was found among women reporting a long-standing illness and poor self-rated health, compared to women without a long-standing illness and good self-rated health. Psychiatric diagnoses and symptoms/unspecified illness were the strongest predictors of disability pension, particularly before 30 years of age.

Conclusion

The study suggests that weak social relations and weak connections to working life contribute to increase the risk of disability pension in young women, also after control for socioeconomic conditions and self-reported ill health. Self-rated health was the strongest predictor, followed by long-standing illness and not having a job (job seekers and homemakers).     

Low socio-economic status, smoking, mental stress and obesity predict obstructive symptoms in women, but only smoking also predicts subsequent experience of poor health

This study was conducted among female subjects to assess the possible association between selected risk factors and lung function as well as airway symptoms in a 32-year perspective. The Prospective Population Study of Women was initiated in 1968-1969 in G?teborg, Sweden (population about 450,000) with follow-ups in 1974-1975, 1980-1981, 1992-1993 and 2000-2001. Women born in 1930, representative of women of the same age in the general population in 1968, were selected. Initially, 372 participants were included in the cohort. In 2000-2001, 231 of these women (73%), now 70 years old, underwent lung function tests. The main outcome measures were lung function values, airway symptoms and health outcome in 2000-2001 in relation to self-reported exposures in 1968-1969 including smoking status. Smoking in 1968-1969 was associated with self-reported chronic bronchitis, obstructive symptoms and poor health 32 years later as well as lower lung function values, compared to non-smokers. Obesity, low socio-economic status and self-reported mental stress in 1968-1969 were associated with obstructive symptoms 32 years later. There are only a few longitudinal studies concerning women's health problems in this field and epidemiological studies of lung function impairment in women and risk factors in a long-term perspective are scarce. The results of the study suggest that life-style factors such as mental stress, obesity and smoking among women are related to airway symptoms and also quality of life many years later.     

Working despite pain: Factors associated with work attendance versus dysfunction

A cross-sectional investigation of psychosocial variables in 63 female employees matched for experienced pain was conducted to study the difference between back pain sufferers who were working (Copers) and those who were off work (Dysfunctional). The subjects reported moderate to severe pain often or always during the past year and were employed at the same hospital. Thirty-seven women who had not been off work for pain made up the Copers group, whereas 26 women who had been off work for their pain made up the Dysfunctional group. Subjects were interviewed and completed a battery of questionnaires designed to penetrate level of dysfunction, perceived health, work and social satisfaction, perceived workload, coping strategies, and pain beliefs. Multiple covariate analyses that controlled for perceived workload, smoking, low-back mobility, and obesity revealed significant differences between the groups on levels of functioning, pain beliefs, and coping strategies used. Dysfunctional subjects had stronger beliefs that pain was directly related to activities that they had little control over their pain, that their health was poor, and that they tended to focus more on their pain. A discriminant analysis correctly classified 83% of the subjects as to work status based on six psychosocial variables. These results not only demonstrate the importance of psychosocial factors in back pain, but underscore the fact that work absence for back pain may he controlled by psychological factors related to beliefs and coping strategies. Future research may attempt to use these factors in the screening of patients.     

The prevalence and determinants of antepartum mental health problems among women in the USA: a nationally representative population-based study

Mental health problems disproportionately affect women, particularly during childbearing years. We sought to estimate the prevalence of antepartum mental health problems and determine potential risk factors in a representative USA population. We examined data on 3,051 pregnant women from 11 panels of the 1996–2006 Medical Expenditure Panel Survey. Poor antepartum mental health was defined by self report of mental health conditions or symptoms or a mental health rating of “fair” or “poor.” Multivariate regression analyses modeled the odds of poor antepartum mental health; 7.8% of women reported poor antepartum mental health. A history of mental health problems increased the odds of poor antepartum mental health by a factor of 8.45 (95% CI, 6.01–11.88). Multivariate analyses were stratified by history of mental health problems. Significant factors among both groups included never being married and self-reported fair/poor health status. This study identifies key risk factors associated with antepartum mental health problems in a nationally representative sample of pregnant women. Women with low social support, in poor health, or with a history of poor mental health are at an increased risk of having antepartum mental health problems. Understanding these risk factors is critical to improve the long-term health of women and their children.     

Mental health, family function and obesity in African-American women

CONTEXT: African-American women are disproportionately affected by obesity and its related diseases. How psychological and psychosocial factors that affect this population differ across weight categories remains poorly understood. PURPOSE: To determine whether poor mental health and family functioning are associated with obesity in African-American women. METHODS: African-American women patients aged 21-65 years were interviewed at three primary care centers. Four well-established assessment tools were used to measure general mental and physical health status, family functioning, depressive symptoms and anxiety levels. Demographics, health behaviors and family and personal histories of overweight were assessed. RESULTS: Among 113 patients, after controlling for age and parity, obese women had significantly higher anxiety levels, poorer perception of their physical health, more often were overweight as a child, had overweight parents or siblings and experienced more psychosocial problems in their family growing up, compared to overweight and normal weight women. CONCLUSIONS: The observed findings of poor mental health, perception of physical health and family function in obese African-American women support a need for clinical attention and further study.     

Psychosocial predictors of long-term mortality among women with suspected myocardial ischemia: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation

This paper evaluated long-term associations between psychosocial factors and premature mortality among women with suspected coronary artery disease (CAD). We tracked total mortality events over a median 9.3 years in a cohort of 517 women [baseline mean age = 58.3 (11.4) years]. Baseline evaluations included coronary angiography, psychosocial testing, and CAD risk factors. Measures included the Spielberger Trait Anxiety Scale, Beck Depression Inventory, self-rated health, and Social Network Index. Cox regression analysis was used to assess relationships. Covariates included age, CAD risk factors, and CAD severity. BDI scores (HR 1.09, 95 % CI 1.02–1.15), STAI scores (HR .86, 95 % CI .78–.93), and very good self-rated health (relative to the poor self-rated health group; HR .33, 95 % CI .12–.96) each independently predicted time to mortality outcomes in the combined model. SNI scores (HR .91, 95 % CI .81–1.06) and other self-rated health categories (i.e., fair, good, and excellent categories) were not significant mortality predictors after adjusting for other psychosocial factors. These results reinforce and extend prior psychosocial research in CAD populations.     

Perceived social support predicts self-reported and objective health and health behaviors among pregnant women

Perinatal health and health behaviors play a crucial role in maternal and neonatal health. Data examining psychosocial factors which predict self-reported health and health behaviors as well as objective indicators downstream of health behaviors among pregnant women are lacking. In this longitudinal study design with 131 pregnant women, perceived social support was examined as a predictor of self-rated health and average levels of sleep quality, health-promoting and health-impairing behaviors, and red blood cell (RBC) polyunsaturated fatty acids across early, mid, and late pregnancy. Participants provided a blood sample and fatty acid methyl esters were analyzed by gas chromatography. Measures included the Multidimensional Scale of Perceived Social Support, Pittsburgh Sleep Quality Index, and Prenatal Health Behavior Scale. Regression models demonstrated that, after adjustment for income, race/ethnicity, age, relationship status, pre-pregnancy body mass index, greater social support was associated with better self-rated health (p?=?0.001), greater sleep quality (p?=?0.001), fewer health-impairing behaviors (p?=?0.02), and higher RBC omega-3 fatty acids (p?=?0.003). Associations among social support with health-promoting behaviors, RBC omega-6 fatty acids, or gestational weight gain were not significant. Findings underscore the benefits of perceived social support in the context of pregnancy. Examination of pathways that link social support with these outcomes will be meaningful in determining the ways in which perinatal psychosocial interventions may promote health.

     

Job insecurity in white-collar workers: toward an explanation of associations with health

This article describes 2 studies that examined changes in psychosocial work characteristics (job strain model) and health-related behaviors as potential explanations of the job insecurity-health relationship in a longitudinal cohort of white-collar British civil servants. Job insecurity arising from anticipation of change was associated with a modest increase in self-reported morbidity, whereas chronic job insecurity was associated with some adverse physiological changes. Anticipation of change and chronic job insecurity were associated with adverse changes in other psychosocial work characteristics, but few changes were significant and consistent across both exposure groups. Changes in health-related behaviors associated with either exposure were slight. Apart from a minor role for social support at work in both sexes and a modest role for job demands in women, adverse changes in these factors explain little of the job insecurity-health relationship.     

Concern about tall stature during adolescence and depression in later life

OBJECTIVE: This retrospective cohort study aimed to examine the long-term psychosocial outcomes for women assessed or treated during adolescence for tall stature. METHOD: Women assessed or treated for tall stature identified from the records of Australian paediatricians were eligible to participate. Psychosocial outcomes were measured using the depression, mania and eating disorders modules of the Composite International Diagnostic Interview (CIDI), the SF-36, and an index of social support. RESULTS: There was no significant difference between treated and untreated women in the prevalence of 12 month or lifetime major depression, eating disorders, scores on the SF-36 mental health summary scale, or the index of social support. However, compared with the findings of population-based studies, the prevalence of major depression in both treated and untreated tall girls was high (12 month prevalence: untreated 10.7%, treated 11.2%; lifetime prevalence: untreated 29.4%, treated 26.6%). Factors significantly associated with lifetime major depression in this study were self-reported difficulties during adolescence being the reason for seeking a medical assessment of height (OR 2.25, 95% CI 1.4-3.6) and a negative experience of the assessment or treatment procedures (OR 2.04, 95% CI 1.4-3.0). CONCLUSION: Long-term follow-up of a large cohort of tall girls showed that psychological outcomes among both treated and untreated women were poor and that the intended psychosocial benefit of treatment may not have been realized. The findings highlight the importance of attending to the mental health of adolescents presenting for management of conditions where self-concept and body image are a primary focus.     

Gender differences in job strain, social support at work, and psychological distress

Using the demand-control-support model of job strain, the authors examined gender differences in the relationship between psychosocial work exposures and psychological distress in a cross-sectional sample of 7,484 employed Canadians. Compared with low-strain work, high-strain and active work were associated with a significantly higher level of distress in both men and women. Differences in psychological distress in relation to psychosocial work exposures were greater for men than for women. Low social support was associated with higher distress across all categories of job strain, and the combined effect of low social support and high job strain was associated with the greatest increase in distress. This pattern was similar in men and women. This study suggests that psychosocial work exposures may be a more significant determinant of psychological well-being in male workers compared with female workers.     

Psychosocial factors, gender, and sleep

Low social support may contribute to poor sleep, more so than adverse aspects of demand and control and more so for women than men. This study on 1,179 working individuals, 623 women and 556 men, from the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study investigated the association between sleep and psychosocial factors. Chi-square analyses investigated the associations among sleep and demand, control, social networks, and emotional support. A logit log-linear model analyzed interactions. More women reported poorer sleep when perceiving adverse psychosocial factors. Interactive effects were found between adverse scores on demand, control, and emotional support. A multivariate partial least square analysis showed that poorer health, pain, and adverse aspects of emotional support and social networks contributed significantly to the pattern of poor sleep.     

Stress and workload of men and women in high-ranking positions

Psychological and physiological stress responses related to work and family were investigated in 21 female and 21 male managers and professional specialists in high-ranking positions. The main result was that both women and men experienced their jobs as challenging and stimulating, although almost all data indicated a more favorable situation for men than for women. In addition, women were more stressed by their greater unpaid workload and by a greater responsibility for duties related to home and family. Women had higher norepinephrine levels than men did, both during and after work, which reflected their greater workload. Women with children at home had significantly higher norepinephrine levels after work than did the other participants. The possible long-term health consequences of women's higher stress levels are discussed.     

Does it make sense in a coherent way? determinants of sense of coherence in swedish women 40 to 50 years of age

The aim of this study was to explore how socioeconomic and psychosocial life experiences in childhood and at adult age influence the level of sense of coherence (SOC) in women. The idea was to seek empirical support for establishing whether SOC is an individual construct being developed in early life and basically resistant toward adverse environmental factors or rather an entity influenced by adult psychosocial factors and as such, sensitive to health promotion activities; that is, if evidence could be found for a causal direction from classic factors involved in health promotion, such as social network and support, to SOC. A questionnaire (Krantz & Ostergren, 1999) was mailed to a random sample of 486 women, equivalent to 50% of the women between the ages of 40 and 50 in a medium-sized municipality (population 13,200) in Sweden. The response rate was 81.7% (397 women). Odds ratios (OR) were used to estimate bivariate associations between socioeconomic and psychosocial variables and low SOC. Logistic regression analysis was used to test for confounding and as a method of analyzing the structure of tentative causal chains. It was found that adult factors such as job strain (OR = 3.42, 95% confidence interval [CI] = 2.11-5.54), low social support (OR = 4.00, CI = 2.48-6.46), and low social anchorage (OR = 4.14, CI = 2.57-6.67) were independent predictors for low SOC in adult women. Childhood conditions such as family disruption and child abuse proved not to influence SOC to a statistically significant degree. Our study suggests that SOC is an entity partly associated with an individual's position in the social structure and partly by work conditions and social network and support rather than by childhood conditions. We could not claim this study to be a critical test of Antonovsky's (1979) theories in the full refutationistic sense. To approach this goal, it would take a carefully designed prospective study assessing the effect of different factors on SOC in a true life course perspective.     

An analysis of relationships among environmental noise,annoyance and sensitivity to noise,and the consequences for health and sleep

The complex relationship among long-term exposure to environmental noise, self-reports of health, and sleep was investigated in a multifactorial design. Forty-seven women and 35 men living beside a street with moderate to heavy traffic took part. They answered questions concerning health complaints, usual sleep patterns, sleep the actual week of testing, their subjective responses to noise, psychosocial relations, anxiety, stressful life events, type A behavior, and attitudinal factors that could explain their responses to noise. No detrimental relations among objective noise levels, health, and sleep could be shown. There were, however, strong correlations between the subjective noise responses of annoyance and sensitivity and health complaints. Only women revealed a relationship between poor sleep quality and sensitivity. The stronger relationship among noise sensitivity, health complaints, and poor sleep quality for women than for men could be explained by the degree of exposure to noise as evidenced by their longer residence and greater time spent at home.This study was supported by grants from the Norwegian National Pollution Agency, the Nordic Noise Group, and the Norwegian Research Council for Science and the Humanities.     

Associations between psychological demands, decision latitude, and job strain with smoking in female hotel room cleaners in Las Vegas

Background: Little is known of the impact of the work environment on smoking among women holding low-paid jobs in the service sector. Purpose: To study the associations between the components of the demand-control model with smoking in hotel room cleaners. Methods: We conducted a survey on work and health among 776 female hotel room cleaners in Las Vegas. Associations between psychosocial work characteristics and smoking were analyzed with multivariate regression analyses. Results: Psychosocial work characteristics were associated with smoking after adjustment for covariates. Effect estimates were substantially reduced by additional adjustment for ethnicity, but remained significant for high psychological demands and smoking prevalence (OR = 1.97, p = 0.02), high job strain and smoking prevalence (OR = 1.87 ,p = 0.04), and high job strain and smoking intensity (coefficient = 3.52, p = 0.03). When analyses were restricted to Hispanic workers and further adjusted for place of birth, low decision latitude (coefficient = 3.94, p = 0.04) and high job strain (coefficient = 4.57, p = 003) were associated with smoking intensity but not with smoking status. Conclusion: Workplace smoking cessation programs may benefit from a primary prevention component reducing job strain among service workers. More research is needed on perceived and objective differences in psychosocial work characteristics across ethnic, immigrant, and other social groups within the same occupation.     

Occupational conditions exceed the importance of non-occupational conditions and ill health in explaining future unemployment among women and men

Summary Background: Unemployment is relatively common today, but the importance of work characteristics in relation to future unemployment has seldom been studied. Methods: The relation between occupational and non-occupational factors, as well as ill health, in 1993 and unemployment in 1997 has been examined using an exploratory approach. Both analyses of associations and cluster analysis have been performed. Results: Reduced psychological well-being and some occupational factors mainly related to job insecurity and, among women, also few opportunities for development at work – were found to be risk indicators for unemployment later on. To some extent, also earlier unemployment periods predicted unemployment in 1997. The influence of reduced psychological well-being and earlier unemployment periods on the associations between occupational factors in 1993 and 1997 consisted mainly of a decrease of the influence of job insecurity. Seven clusters were identified. One of them was male dominated, where the level of unemployment was very high and the individuals had reduced psychological well-being, insecure working conditions and demanding living conditions. The female equivalent was characterised by a high level of unemployment, multi-demands at work and poor musculoskeletal health. Conclusions: Reduced psychological well-being and job insecurity were risk indicators for later unemployment among both genders, as were also few opportunities for development at work among women. These factors predicted unemployment, also when age and other non-occupational factors were taken into consideration. The cluster analysis identified groups of individuals with highly demanding occupational and non-occupational conditions in 1993 and a high level of unemployment in 1997. Received July 28, 2002; accepted November 20, 2002 Published online January 31, 2003 Correspondence: Carina Bildt, Gender and Work, National Institute for Working Life, S-112 79 Stockholm, Sweden; e-mail carina.bildt@niwl.se     

Cardiovascular effects of social support in the work place: twenty-four-hour ECG monitoring of men and women

Psychosocial work characteristics, such as work demand, work control, and social support at work, have been shown to be related to the development of coronary heart disease in epidemiological studies. However, the mechanisms which mediate the social and psychological effects on the cardiovascular system are not known. We have studied the direct cardiovascular effects of psychosocial work environment characteristics in 148 working men and women, representing seven different occupational groups (physicians, teachers, musicians, policemen, train engineers, prison personnel, and saw mill workers). Besides standardized measures of work demand, work control, and social support, ambulatory 24-hour monitoring of electrocardiograms in the customary work and home environment was performed. Systolic and diastolic blood pressure were measured as well as other standard physiologic risk factors for coronary heart disease. Mean heart rates were found to be significantly higher in persons reporting low social support at work. This effect was maintained during working hours as well as during leisure time and rest. Of the other related physiologic risk factors, systolic, but not diastolic blood pressure was found to be higher in persons reporting low social support. Smoking, alcohol consumption and relative body mass index were not related to social support at work. Controlling for age, sex and physical strain at work, strengthened the association of low social support with elevated heart rates.     

Age, working conditions, and sleep disorders: a longitudinal analysis in the French cohort E.S.T.E.V.

STUDY OBJECTIVES: To investigate the effects of occupational factors on both the incidence and the disappearance of sleep disorders after a five-year follow-up period. DESIGN: A prospective longitudinal investigation E.S.T.E.V. carried out in 1990 and 1995. SETTING: Seven regions of France. SUBJECTS: A random sample of employed men and women born in 1938, 1943, 1948, and 1953. In 1990, 21,378 subjects were interviewed (87% of those contacted), and 88% were interviewed again in 1995. MEASURES: Sleep disorders (SD), objectifiable and psychosocial working conditions. RESULTS: Prevalence of SD increased with age and were more frequent among women than men in every age group. Incidence of SD varied little with age, but their disappearance decreased with age. After adjustment for age and sex, SD in 1995 were found to be associated both with objectifiable working conditions and with psychosocial aspects of the way work is experienced. Among objectifiable occupational risk factors, shift work, work week often longer than 48 hours, and exposure to vibrations appeared to be the principal risk factors for SD. Among psychosocial occupational factors, finding it difficult or irksome to have to hurry appeared to be the principal risk factor. CONCLUSIONS: Taking into account the adjustments for health criteria, sociodemographic characteristics, and leisure activities, these results suggest useful courses of action for prevention which, it seems to us, must not be only limited to objectifiable working conditions. Issues about work organization, while clearly difficult to resolve, must also be taken into account.