Abstract
ObjectiveThe evidence on whether there is work stress related dysregulation of the hypothalamic-pituitary-adrenal axis is equivocal. This study assessed the relation between work stress and diurnal cortisol rhythm in a large-scale occupational cohort, the Whitehall II study.MethodsWork stress was assessed in two ways, using the job-demand-control (JDC) and the effort-reward-imbalance (ERI) models. Salivary cortisol samples were collected six times over a normal day in 2002–2004. The cortisol awakening response (CAR) and diurnal cortisol decline (slope) were calculated.ResultsIn this large occupational cohort (N = 2,126, mean age 57.1), modest differences in cortisol patterns were found for ERI models only, showing lower reward (β = −0.001, P-value = 0.04) and higher ERI (β = 0.002, P-value = 0.05) were related to a flatter slope in cortisol across the day. Meanwhile, moderate gender interactions were observed regarding CAR and JDC model.ConclusionsWe conclude that the associations of work stress with cortisol are modest, with associations apparent for ERI model rather than JDC model.
Highlights
Work stress has been established as a risk factor for a range of health impairments, cardiovascular disease [1], metabolic syndrome [2,3] and Type 2 diabetes mellitus [4,5]
Two dominant work stress models have been widely employed in these analyses: the job demand control (JDC) model [6] and the effort-reward imbalance (ERI) model [7]
The JDC model postulates a combination of lower control and higher work demand will trigger job strain; whereas the ERI model emphasizes social reciprocity, such that a sustained unfair trade-off between effort and reward will elicit negative emotions and further lead to adverse longterm health consequences
Summary
Ethic Statement Ethical approval for the Whitehall II study was obtained from the University College London Medical School Committees on the Ethics of Human Research. Responses were combined into summary scales, where higher scores indicate higher control, demand or support We used both binary and continuous measurements for job strain. Cortisol collection and analysis The protocol of saliva sampling used in the Whitehall II study has been reported previously [34]. A multilevel regression model was employed to predict the log cortisol, taking measurement occasion as a level one identifier, person as a level two identifier and sample time as the independent covariate. Participant characteristics and cortisol profile were analysed according to work stress categories using regression analysis for continuous variables and Chi-square test for categorical variables. Linear regression models with CAR or slope as the outcome were employed to assess the association with work stress, adjusted for age, gender, ethnicity, time of waking and time since waking.
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