Abstract
BackgroundDespite improvements in treatment, acute coronary syndrome remains a substantial cause for prolonged sick absences and premature retirement. Knowledge regarding what benefits return to work is limited, especially the effect of psychological processes and psychosocial work factors. The purposes of this cross-sectional study were two-fold: to examine associations between adverse psychosocial job conditions and fear-avoidance beliefs towards work, and to determine whether such beliefs mediated the relationship between work conditions and expected return to work in acute coronary syndrome survivors.MethodsStudy inclusion criteria: acute myocardial infarction or unstable angina diagnosis, below 65 years of age, being a resident in the West county of Sweden and currently working. In all, 509 individuals (21.8 % women) accepted study participation and for whom all data of study interest were available for analysis. Psychosocial work variables; job demand-control and effort-reward imbalance, were assessed with standard questionnaire batteries. Linear regression models were used to investigate relationships between psychosocial factors and fear-avoidance, and to evaluate mediator effects for fear-avoidance. Both total sample and gender stratified analyses were calculated.ResultsFear-avoidance beliefs about work were associated to psychosocial job environments characterized by high strain (β 1.4; CI 1.2–1.6), active and passive work and high effort-reward imbalance (β 0.6; CI 0.5–0.7). Further, such beliefs also mediated the relationship between adverse work conditions and expected time for return to work. However, these results were only observed in total sample analyses or among or male participants. For women only high strain was linked to fear-avoidance, and these relationships became non-significant when entering chosen confounders.ConclusionsThis cross-sectional study showed that acute coronary syndrome survivors, who laboured under adverse psychosocial work conditions, held fear-avoidance beliefs towards their workplace. Furthermore, these beliefs mediated the relationships between - high strained or high effort-reward imbalanced work - and expected return to work. However, mentioned results were primarily found among men, which could results from few female study participants or gender differences in return to work mechanisms. Still, an earlier return to work might be promoted by interventions focusing on improved psychosocial work conditions and cognitive behavioural therapy targeting fear-avoidance beliefs.
Highlights
Despite improvements in treatment, acute coronary syndrome remains a substantial cause for prolonged sick absences and premature retirement
Söderberg et al BMC Public Health (2015) 15:1263 (Continued from previous page). This cross-sectional study showed that acute coronary syndrome survivors, who laboured under adverse psychosocial work conditions, held fear-avoidance beliefs towards their workplace
For our linear regression analyses we considered the following confounders: age, occupational status, pre-morbid work ability, social support at the work, self-efficacy, attitudes towards sick leave and general mental health, factors which all previously have been associated to return to work (RTW) [29,30,31]
Summary
Acute coronary syndrome remains a substantial cause for prolonged sick absences and premature retirement. Knowledge regarding what benefits return to work is limited, especially the effect of psychological processes and psychosocial work factors. The purposes of this cross-sectional study were two-fold: to examine associations between adverse psychosocial job conditions and fear-avoidance beliefs towards work, and to determine whether such beliefs mediated the relationship between work conditions and expected return to work in acute coronary syndrome survivors. Advances in the treatment of acute coronary syndromes (ACS), e.g. pharmacological treatment and revascularisation procedures, have increased survival and augmented the numbers of ACS survivors in the work force [1] These advances have, not been reflected in improved rehabilitation outcomes, as ACS remains a widespread cause for extended work absences [1, 2] and premature retirement [3]. The lack is noteworthy, since one review study [5] found that psychosocial factors, in particular job stress and the perception of not being able to cope with job stress, were stronger predictors for work resumption than disease severity
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