Work stressors: effects on health and sickness absence

Findings from Whitehall II and other studiesFindings from Whitehall II and other studies

Jane E. FerrieJane E. Ferrie

Department of Epidemiology and Public HealthDepartment of Epidemiology and Public Health

University College LondonUniversity College London

2

Moves to private sector practiceMoves to private sector practice

Job insecurityJob insecurity

Temporary employmentTemporary employment

Labour market stressorsLabour market stressors

Moves to private sector practice Moves to private sector practice (transfer to an executive agency)(transfer to an executive agency) effects on health and sickness absence effects on health and sickness absence (men)(men)

* adjusted for age, employment grade, marital status & health at the beginning of the follow-up period

0

0.5

1

1.5

2

2.5

systolic bp diastolic bp weight

0

10

20

30

40

50

60

physical ill-health*

longstanding illness*

sickness absence

mental ill-health

Ferrie et al. J Occup. Health Psychology 20013

rela

tive

incr

ease

in c

ardi

ovas

cula

r ris

k fa

ctor

s co

mpa

red

to m

en n

ot

tran

sfer

red

to a

genc

ies*

% e

xces

s ill

-hea

lth c

ompa

red

to m

en

not

tran

sfe

rred

to

ag

enci

es*

Job insecurity and health in womenJob insecurity and health in women

60

80

100

120

140

160

180

200

220

240

260

poor physical health poor mental health depression longstanding illness

Incr

ease

in il

l-hea

lth*

remained securegained job securitylost job securitychronic job insecurity

*adjusted for age, employment grade & health at the beginning of follow-up

Ferrie et al. J. Epidemiology Community Health 20024

Ferrie et al. Am. J. Public Health 1998

Job insecurity and coronary artery diseaseJob insecurity and coronary artery disease

*adjusted for age, grade and CAD before the threat of privatisation

5

Job insecurity and sickness absenceJob insecurity and sickness absence

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

1.1

Women Men

Secure (Controls) Insecure - Short spells Insecure - Long spells

Od

ds

Rat

ios*

*adjusted for age, employment grade and health status

Ferrie et al 2001 J. Occup. Health Psychol6

Temporary employment and sickness absence

0

0.5

1

Baseline Follow-up

Permanent Temp - Perm Temporary

Rat

e R

atio

s*

*adjusted for age, sex, income, and number of contracted days

Virtanen et al 2003 Occup Environ Med7

Temporary employment and early death

0

0.5

1

1.5

2

Women Men

Permanent Temp - Perm Temporary

Haz

ard

Rat

ios*

*adjusted for age, occupational status and income

Virtanen et al 2003 Am. J. Epidemiol8

Conceptualising Work Stress Conceptualising Work Stress Major work stress models Major work stress models (questionnaire based(questionnaire based measures)measures)

Job strain (Demand-Control) model Job strain (Demand-Control) model

Effort-Reward Imbalance modelEffort-Reward Imbalance model

Organisational Justice model (fair treatment)Organisational Justice model (fair treatment)

9

Conceptualising Work Stress Conceptualising Work Stress Major work stress modelsMajor work stress models

Job strain (Demand-Control) modelJob strain (Demand-Control) model

Effort-Reward Imbalance modelEffort-Reward Imbalance model

Organisational Justice model (fair treatment)Organisational Justice model (fair treatment)

10

in 1979 Robert Karasek argued that work stress results "from the joint effects

of the demands of a work situation and the range of decision-making freedom

available to the worker facing those demands……….” Job strain occurs

when psychological job demands are high and job control is low"

Example question on job demands:-Do you have enough time to do everything?

Example question on job control:-Do you have a say in your own work speed?

Job strain (Demand-Control) modelJob strain (Demand-Control) model

11

Job Strain ModelJob Strain Model

Karasek and Theorell 1990

Job controlLO

W

HIG

H

LOW HIGH

passivehigh

strain

activelow

strain

Psychological job demands

job strain

12

Job strain and new coronary heart diseaseJob strain and new coronary heart disease Meta-analysis of prospective studiesMeta-analysis of prospective studies

13Kivimäki et al 2006 Scan J Work Environ Health

Job strain and sickness absenceJob strain and sickness absence Meta-analysisMeta-analysis

0.8

0.9

1

1.1

1.2

1.3

1.4

1.5

1.6

3 days or less more than 3 days

control group crude odds ratios adjusted odds ratios*

Od

ds

Rat

ios

*adjusted for age, demographic factors, behaviour, health status, occupation and baseline sickness absence

Duijts et al 2007 J. Clin Epidemiol14

Influence of change in job strain on Influence of change in job strain on sickness absencesickness absence

Hazard ratio for long spells of sickness absence, stable = reference

Work demands Job control

Head et al. J Epidemiol Community Health 2006

0.8

0.9

1

1.1

1.2

1.3

1.4

Decrease

Increase

0.8

0.9

1

1.1

1.2

1.3

1.4

Increase

Decrease

15

Conceptualising Work Stress Conceptualising Work Stress Major work stress models Major work stress models (questionnaire based(questionnaire based measures)measures)

Job strain (Demand-Control) model Job strain (Demand-Control) model

Effort-Reward Imbalance modelEffort-Reward Imbalance model

Organisational Justice model (fair treatment)Organisational Justice model (fair treatment)

16

Reciprocal exchange underlies all transactions in society

Digression from this reciprocity produces stress

In the workplace reciprocity depends on a balance

between perceived efforts spent and rewards received

Efforts: Responsibility Time pressure

Work load Rewards: Esteem

Career opportunitiesPay

Effort-Reward Imbalance (ERI)Effort-Reward Imbalance (ERI)

17

0.9

1

1.1

1.2

1.3

1.4

Low Effort-Reward Ratio

Medium Low Medium High High Effort-Reward Ratio

Lik

elih

oo

d o

f C

HD

(H

azar

d R

atio

)*

Effort-Reward Imbalance at work and Effort-Reward Imbalance at work and coronary heart diseasecoronary heart disease

*adjusted for age, sex and employment grade

Kuper et al. Occup. Environ. Med. 200218

Effort-Reward Imbalance and Effort-Reward Imbalance and sickness absencesickness absence

0.8

0.9

1

1.1

1.2

1.3

1.4

Short-spells (women) Long spells (men)

Low Intermediate High

Od

ds

Rat

ios*

*adjusted for age, employment grade and health status

Head et al 2007 J. Psychosomatic Research19

Conceptualising Work Stress Conceptualising Work Stress Major work stress modelsMajor work stress models

Job strain (Demand-Control) model Job strain (Demand-Control) model

Effort-Reward Imbalance modelEffort-Reward Imbalance model

Organisational Justice model (fair treatment)Organisational Justice model (fair treatment)

20

Organisational JusticeOrganisational Justice

Procedural componentProcedural component decision-making procedures include input from affected parties, are consistently applied, open and ethical

Relational componentRelational component respectful and considerate treatment of employees by supervisors

21

refers to the extent to which employees are treated with refers to the extent to which employees are treated with fairness and justice at their workplacefairness and justice at their workplace

1.00 1.00

0.60

0.48

0.00

0.20

0.40

0.60

0.80

1.00

Poor self-rated health Poor mental health

25% withlowest justice

25% withhighest justice

Odd

s ra

tio*

Elovainio et al. (2001) Am J Public Health

*adjusted for demographic and behavioural risk factors

Organisational justice

Organisational Justice and healthOrganisational Justice and health

22

Organisational Justice Organisational Justice (relational component)(relational component) and sickness absence in womenand sickness absence in women

0.8

0.9

1

1.1

1.2

1.3

1.4

Short-spells Long spells

Low Intermediate High

Od

ds

Rat

ios*

*adjusted for age, employment grade and health status

Head et al 2007 J. Psychosomatic Research23

Does a change in organisational Does a change in organisational justice lead to a change in health?justice lead to a change in health?

24

0.00

0.25

0.50

0.75

1.00

1.25

1.50

1.75

Adversechange

No change Favourablechange

Men

Women

Change in Organisational JusticeChange in Organisational Justice

Od

ds

of

new

-on

set

com

mo

n m

enta

l d

iso

rder

s

Ferrie et al. Occup Environ Med 200625

SummarySummary

Changes in the labour market have adverse effects job Changes in the labour market have adverse effects job security and other aspects of the psychosocial work security and other aspects of the psychosocial work environment, such as job demands, the ratio of effort environment, such as job demands, the ratio of effort to reward, etcto reward, etc

Psychosocial stressors in the work environment have Psychosocial stressors in the work environment have adverse effects on health and well-beingadverse effects on health and well-being

Reductions in levels of work stress result in health Reductions in levels of work stress result in health improvements and healthy levels of sickness absenceimprovements and healthy levels of sickness absence

26

SSickness ickness AAbsence bsence RResearch esearch CCollaborationollaboration

SARCSARC: Four-country collaboration - Finland, France, Sweden : Four-country collaboration - Finland, France, Sweden and the UKand the UK

Studies: 10-town study (Finland), GAZEL study (France), Studies: 10-town study (Finland), GAZEL study (France), Östergötland and SLOSH studies (Sweden), and the Whitehall II Östergötland and SLOSH studies (Sweden), and the Whitehall II study (UK)study (UK)

Researchers : Mika KivimResearchers : Mika Kivimäki and Jussi Vahtera (äki and Jussi Vahtera (10-town10-town), Maria ), Maria Melchior and Archana Singh-Manoux (Melchior and Archana Singh-Manoux (GAZELGAZEL), Kristina ), Kristina Alexanderson (Alexanderson (ÖstergötlandÖstergötland) and Hugo Westerlund () and Hugo Westerlund (SLOSHSLOSH) ) and Jane Ferrie and Jenny Head (and Jane Ferrie and Jenny Head (Whitehall IIWhitehall II))

SARCSARC meetings are supported by a grant from the ESRCmeetings are supported by a grant from the ESRC

27