High Decision Latitude Research Articles

Arterial blood pressure and blood lipids as cardiovascular risk factors and occupational stress in Taiwan

Background: This study is to determine whether occupational stress (defined as high psychological demands and low decision latitude on the job) is associated with increased blood pressure and abnormal level of blood lipids as cardiovascular risk factors. Methods: We conducted a cross-sectional study at three work sites of 526 white-collar male workers aged 20 to 66 years without evidence of cardiovascular disease. Systolic, diastolic blood pressure, serum total, high-density lipoprotein cholesterol and plasma triglyceride were measured. Occupational stress index was derived from data collected in the job strain questionnaire. Results: In multiple linear regression models, occupational stress index was significantly related to diastolic blood pressure and plasma triglyceride, after adjusting for age, education, smoking, and alcohol consumption. A higher occupational stress index was directly associated with higher systolic, diastolic blood pressure and higher level of plasma triglyceride. Conclusions: These data from a white-collar working population confirm independent relations between occupational stress defined in the job demand–control model and diastolic blood pressure observed in predominantly Western populations and extend the range of associations to plasma triglyceride than do previous studies.

Reported neck and shoulder problems in female industrial workers: the importance of factors at work and at home

A study was performed to determine how exposure to physical and psychosocial factors at work and at home influences self-reported musculoskeletal problems of the neck, shoulders and thoracic spine. A group of 173 Swedish female blue collar workers, aged 20–45 yr, with monotonous work tasks in the metal and food industries completed questionnaires with a total of 184 questions relating to health status and demographic factors, exposure factors (work-related and domestic factors, questions on lifestyle e.g. smoking, physical activity level and leisure activities), and outcome (musculoskeletal problems). The women were placed in one case group with ‘continuous’ problems in the ‘neck and shoulder’ region, or one referent group, in a nested case-referent study. Frequencies, mean values, factor analyses, analysis of the correlation between exposure and effect variables, and odds ratios with 95% confidence intervals were all calculated. The results showed that an increased risk of suffering from musculo-skeletal problems of the neck and shoulder region among female blue collar workers was related to working in a monotonous fixed position, working with the hands and arms lifted and unsupported, and having a high decision latitude. Single women without children below the age of 13 reported fewer problems than women with a partner, children <13 yr of age or both. Relevance to industry The results of this study indicate the importance of good work place design but that much still needs to be done to provide safe working conditions, and also that factors both at work and at home are of importance in the production of neck and shoulder problems.

Job strain and psychotropic drug use among white-collar workers

The main objective of this study was to measure the association between simultaneous exposure to high psychological demand and low decision latitude at work and the use of psychotropic drugs among white-collar workers. A second objective was to determine whether social support at work modified this association. A cross-sectional study was performed that included 2786 workers from the public sector in the Greater Quebec City area. A self-administered questionnaire was used in order to evaluate psychological demand, decision latitude and social support at work. Psychotropic drug use was measured over a period of 2 days. The prevalence of psychotropic drug use among the participants was found to be 3.9%, even though 20.5% were exposed to job strain. The association between job strain and psychotropic drug use, after adjustment for social support at work, age, gender, education, family income, employment status, occupation, stressful life events, cigarette smoking, alcohol consumption and physical activity, was statistically significant (odds ratio: 4.5, 95% CI 1.7?12.2). Social support did not appear to modify this association. The results of this study suggest that job strain might be a determinant of psychotropic drug use among white collar workers. Social support at work does not appear, however, to modify this association.

Job strain, social support at work, and incidence of myocardial infarction.

OBJECTIVES: The combination of high psychological job demands and low decision latitude (high job strain) has been associated with an increased risk of coronary heart disease. It has been proposed...

Job strain, psychological distress, and burnout in nurses.

The first phase of this longitudinal study consisted of a questionnaire completed by a cohort of 1,891 nurses (aged 23-65 years) from six acute care hospitals from the province of Québec. This study was set up to investigate the association between the psychosocial environment of work and mental health. After adjusting for confounding factors, a combination of high psychological demands and low decision latitude was associated with psychological distress and emotional exhaustion, one of the three dimensions of burnout. Social support at work, although associated with each of the mental health indicators, did not modify their association with job strain. The present study identified conditions of the work environment that are modifiable and provide the basis for interventions that focus beyond the modification of individual coping strategies.

Job strain, psychological distress, and burnout in nurses

The first phase of this longitudinal study consisted of a questionnaire completed by a cohort of 1,891 nurses (aged 23–65 years) from six acute care hospitals from the province of Québec. This study was set up to investigate the association between the psychosocial environment of work and mental health. After adjusting for counfounding factors, a combination of high psychological demands and low decision latitude was associated with psychological distress and emotional exhaustion, one of the three dimensions of burnout. Social support at work, although associated with each of the mental health indicators, did not modify their association with job strain. The present study identified conditions of the work environment that are modifiable and provide the basis for interventions that focus beyond the modification of individual coping strategies. Am. J. Ind. Med. 34:20–28, 1998. © 1998 Wiley-Liss, Inc.

Decision latitude, job strain, and myocardial infarction: a study of working men in Stockholm. The SHEEP Study Group. Stockholm Heart epidemiology Program.

This study examined the role of decision latitude and job strain in the etiology of a first myocardial infarction. Eligible case patients were all full-time working men 45 to 64 years of age who suffered a first myocardial infarction during the period January 1992 to January 1993 in the greater Stockholm region. Referents were selected from the general population. Participation rates were 82% (case patients) and 75% (referents). Both inferred and self-reported low decision latitude were associated with increased risk of a first myocardial infarction, although this association was weakened after adjustment for social class. A decrease in inferred decision latitude during the 10 years preceding the myocardial infarction was associated with increased risk after all adjustments, including chest pain and social class. The combination of high self-reported demands and low self-reported decision latitude was an independent predictor of risk after all adjustments. Both negative change in inferred decision latitude and self-reported job strain are important risk indicators in men less than 55 years of age and in blue-collar workers.

Job strain and health behaviors: results of a prospective study.

To assess the association between job demands, job decision latitude, and job strain (defined by Karasek as a combination of high demands and low decision latitude) and cardiovascular disease-related health behaviors such as cigarette smoking, alcohol use, lack of exercise, and overweight. Cross-sectional and prospective. Nine New York City public and private sector worksites. Two hundred eighty-five male employees, aged 30 to 60, in a wide variety of white-collar and blue-collar job titles. Medical examinations and surveys, which included demographic, health behavior, and job characteristics data. Prospectively, among 189 men, increase in job decision latitude over 3 years was associated with decrease in cigarette smoking, by analysis of covariance, controlling for age, race, education, marital status, and number of children at home (F (8, 180) = 4.37, p = .005). The largest increase in latitude occurred among the 13 men who quit smoking. However, change in job characteristics was not associated with change in overweight or alcohol use. Cross-sectional analyses did not produce consistent associations. The effectiveness of smoking cessation may be aided by modification of structural features of the work environment, such as job decision latitude. This study is limited by the small number of subjects who were engaged in high risk behaviors.

Psychosocial work environment and cardiovascular risk factors in an occupational cohort in France.

STUDY OBJECTIVE: Concordant results have been reported in several studies for the effects of job stress on cardiovascular disease, but the potential mechanisms of these effects have seldom been explored....

Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude? Results from Stockholm Heart Epidemiology Program (SHEEP)

The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material is a population-based case-referent study having incident first events of myocardial infarction as outcome (SHEEP: Stockholm Heart Epidemiology Program). The analysis is restricted to males 45–64 yr of age with a more detailed analysis confined to those still working at inclusion. In total, 1047 cases and 1450 referents were included in the analysis. Exposure categories of job strain were formed from self reported questionnaire information. The results show that high demands and low decision latitude interact with a synergy index of 7.5 (95% C.I.: 1.8–30.6) providing empirical support for the core mechanism of the job strain model. Manual workers are more susceptible when exposed to job strain and its components and this increased susceptibility explains about 25–50% of the relative excess risk among manual workers. Low decision latitude may also, as a causal link, explain about 30% of the socioeconomic difference in risk of myocardial infarction. The distinction between the interaction and the causal link mechanisms identifies new etiologic questions and intervention alternatives. The specific causes of the increased susceptibility among manual workers to job strain and its components seem to be an interesting and important research question.

Determinants of self-reported neck-shoulder and low back symptoms in a general population.

A combined cross-sectional and longitudinal design. To investigate relation between, on one hand, self-reported neck-shoulder symptoms and, on the other hand, low back symptoms and self-reported work-related physical load, psychosocial factors, and individual characteristics and to study the influence of physical capacity in adolescence on neck-shoulder and low back symptoms in adulthood. Heavy physical work and exposure to vibration constitute risk factors for low back problems, and repetitive and static work are risk factors for neck-shoulder symptoms in many jobs. The interplay between individual factors and work-related psychosocial and physical exposure, however, is not well documented. This study addresses effects of adolescent capacity on this interplay in a general population. A random sample of 425 Swedish students was investigated when the students were 16 years and 34 years of age. Sixty-five percent participated in both examinations; only those who worked > or = 16 hours/week at the follow-up period, 148 men and 90 women, were included in these analyses. Data about musculoskeletal symptoms, work, and sociodemographic and individual characteristics were collected at the age of 34 years; physical performance data were collected at the ages of 16 years and 34 years. Among the men, self-employment and worry were associated with neck-shoulder symptoms; among the women, monotonous work and high decision latitude were associated with neck-shoulder symptoms. Low back problems were related to monotonous work among men and women and to exposure to vibration among men. Performance in certain fitness tests at the ages of 16 years and 34 years was negatively associated with musculoskeletal symptoms. The inverse relationships between performance at the age of 16 years and adult musculoskeletal symptoms may imply benefits of early fitness training.

Reliability and validity of the French version of the 18-item Karasek job content questionnaire

Previous studies have shown that job strain, a combination of high psychological demands and low decision latitude, may be involved in the development of cardiovascular diseases and other health outcomes. In 1985, Karasek recommended a standard questionnaire to measure psychological demands (nine items) and job decision latitude (nine items). The internal consistency, factorial validity, discriminant validity, and 1-year stability of the French version of this instrument were evaluated in a population of 8263 white collar workers. Participants filled out the questionnaire during working hours in the context of a larger cardiovascular study. A subgroup of the study population completed the questionnaire again 1 year later (n = 953). Internal consistency was adequate: .74 for men and .73 for women for psychological demands and .83 for men and .81 for women for decision latitude. The results of the factor analysis were consistent with the two dimensions expected from the theory, although some items had high loading on two factors. Variations in the means of psychological demand and decision latitude scores and variations in the prevalence of high job strain by gender, job category, and age support the discriminant validity. These results were generally comparable to those observed with the English version. The percentages of workers remaining, after 1 year, in the same category of psychological demands, decision latitude, and job strain were 86.6, 86.1 and 75.2% respectively. These data provide evidence of the reliability and validity of the French version of these psychological demand and decision latitude scales

Psychosocial correlates of job strain in a sample of working women.

This study identifies potential mediators of job strain effects on health by determining whether psychosocial factors known to predict an increased risk of cardiovascular disease and all-cause mortality are higher among women who report high levels of job strain. Measures of job strain and other psychosocial risk factors were obtained in a sample of 152 female employees of a local corporation. Canonical correlation and analyses of covariance were used to assess relationships between job demands and decision latitude and other psychosocial risk factors. A significant (P = .002) solution to the canonical correlation analysis showed that high job demands and low decision latitude were correlated with a pattern of psychosocial factors consisting of (1) increased levels of negative emotions like anxiety, anger, depression, and hostility; (2) reduced levels of social support; and (3) a preponderance of negative compared with positive feelings in dealings with coworkers and supervisors. This pattern was confirmed by analyses of covariance that adjusted for demographic and specific job characteristics. The canonical correlation analysis results provide empirical support for the job strain construct. The most important finding is that health-damaging psychosocial factors like job strain, depression, hostility, anxiety, and social isolation tend to cluster in certain individuals.

Job strain and psychological distress in white-collar workers.

In line with Karasek's job strain model, the objective of the study was to determine whether workers submitted to high job strain, a combination of high psychological demand and low decision latitude, develop more psychological distress than workers not submitted to high job strain. A second objective was to determine whether social support at work modifies the association between job strain and psychological distress. The design was cross-sectional and included white-collar workers in the Québec city area. A self-administered 26-item questionnaire (the Job Content Questionnaire) measured psychological demand, decision latitude, and social support at work. Psychological distress was measured by the Psychiatric Symptom Index, a 14-item self-administered instrument. Among the 2889 participants, the prevalence of psychological distress was 27.8%. High job strain was present in 20.5% of the subjects. The crude odds ratio (OR) of high job strain with psychological distress was 3.52 [95% confidence interval (95% CI) 2.54-4.88]. The OR adjusted for age, gender, employment status, occupation, social support at work, nonwork social support, cynicism, hostility, domestic load, and stressful life events during the last 12 months was still significant (OR 2.45, 95% CI 1.66-3.62). Our results support the association between job strain and psychological distress. Social support at work, although significantly associated with psychological distress, did not modify the association between job strain and psychological distress.

Behavioral determinants of occupational exposure to chemical agents.

In the demand-control model (see T. Theorell & R. A. Karasek, 1996), it is hypothesized that workers in active jobs (high demands-high decision latitude) can exert effective coping strategies when confronted with environmental stessors. Thus, when exposed to similar levels of a chemical agent, lower concentrations of this agent in blood could be expected in these workers in comparison with workers in passive jobs. This theory was tested in 2 studies of lead-exposed workers: 18 male Caucasian workers from an electric accumulatory factory and 18 male Caucasian workers from a lead smelting factory. The results did not follow the hypothesized outcomes. In the work environment of the workers in active jobs, lower concentrations of lead in air were measured, but higher levels of lead in blood were observed in these workers. The opposite was true of workers in passive jobs. Differences in hygienic behavior at work may explain these unexpected results.

Behavioral determinants of occupational exposure to chemical agents.

In the demand-control model (see T. Theorell & R. A. Karasek, 1996), it is hypothesized that workers in active jobs (high demands-high decision latitude) can exert effective coping strategies when confronted with environmental stessors. Thus, when exposed to similar levels of a chemical agent, lower concentrations of this agent in blood could be expected in these workers in comparison with workers in passive jobs. This theory was tested in 2 studies of lead-exposed workers: 18 male Caucasian workers from an electric accumulatory factory and 18 male Caucasian workers from a lead smelting factory. The results did not follow the hypothesized outcomes. In the work environment of the workers in active jobs, lower concentrations of lead in air were measured, but higher levels of lead in blood were observed in these workers. The opposite was true of workers in passive jobs. Differences in hygienic behavior at work may explain these unexpected results.

Job strain and the prevalence and outcome of coronary artery disease.

It has been hypothesized that jobs that have both high psychological demands and low decision latitude ("job strain") can lead to coronary disease. The objective of this study was to test whether job strain was correlated with the presence of coronary disease at angiography or with long-term outcome in patients with angiographic coronary disease. Employed patients under the age of 65 years undergoing diagnostic coronary angiography completed a self-administered questionnaire about their job duties and work environment. Job strain was measured by the method of Karasek. Patients were separated into three groups, based on extent of coronary disease: significant disease (> or = 75% stenosis), insignificant disease (> 0% but < 75% stenosis), and normal coronary arteries. Statistical analyses were performed using logistic regression and the Cox proportional hazards model. The 1489 patients enrolled had a median age of 52 years; 76% were male and 88% were white. By design, all patients were employed, 60% in white-collar jobs and only 16% in jobs requiring heavy labor. Traditional cardiac risk factors were most prevalent in the 922 patients with significant coronary artery disease, at intermediate levels in the 204 patients with insignificant disease, and least prevalent in the 363 patients with normal coronary arteries (all P < .01). Job strain was actually more common in patients with normal coronary arteries (35%) than in patients with insignificant (26%) or significant disease (25%, P < .002). In a multivariate analysis, job strain was not significantly correlated with the presence of coronary disease. Job strain was not correlated with angina frequency at the time of angiography. Job strain was not a predictor of cardiac events (cardiac death or nonfatal myocardial infarction) during follow-up. Job strain was not correlated with the prevalence or severity of coronary artery disease in a cohort of patients undergoing coronary angiography. The outcome of patients with angiographically defined coronary disease was not affected by the level of job strain as measured by the method of Karasek.

The impact of decision latitude, psychological load and social support at work on musculoskeletal symptoms

The study was based on questionnaires and the subjects consisted of 755 male and female employees in different occupations. The aim was to explore the relationship between the combined effects of perceived decision latitude (control), psychological load and social support at work on work-related neck, shoulder and low-back symptoms. Prevalence rate ratios, stratified for age and sex, were calculated for different combinations in the 3-dimensional model where the theoretically lowest strain group (i.e. low psychological load, high decision latitude and high social support) was used as a reference category. Persons who perceived their psychological work-load as high and their decision latitude as low reported more musculoskeletal symptoms than persons with low psychological load and high decision latitude. The addition of social support at work is a significant dimension in moderating decision latitude; without support from supervisors and fellow workers it was not sufficient to reduce the impact of psychological load on musculoskeletal symptoms. The use of the 3-dimensional model provided a good picture of what structural characteristics of working life could constitute an increased risk for the occurrence of musculoskeletal symptoms.

Predictors of job satisfaction and job influence--results from a national sample of Swedish nurses.

Results from a questionnaire study on work conditions, job satisfaction, job influence, health and well-being, based on a representative sample of 3,500 Swedish nurses, indicate a high rate of overall job satisfaction. High decision latitude, consistency between work assignments and education, as well as low sickness absenteeism did all associate with high job satisfaction, number of working years did not. Compared to nurses satisfied with their jobs, twice as many sick days were found among those dissatisfied. Greater job influence related to lower job demands, more stimulating work and skills development as well as more responsibility and involvement. Anxiety and depression, intellectual satisfaction, job demands, job control and perceived general health explained 22% of the total variance in job satisfaction. The study has identified some key factors influencing overall job satisfaction. By focusing on these, job satisfaction among nurses should improve.

The Effects of Task Demand and Decision Latitude on Cardiovascular Reactivity to Stress

This study investigated the effects of task demand (absence or presence of time pressure) and decision latitude (choice or no choice over a task) on cardiovascular and affective responses to stressful tasks among 70 college students. Subjects also rated whether they felt under pressure and the extent to which they felt in control. Time pressure was related to elevated systolic blood pressure (SBP) responses among men and increased negative affect for both sexes. Lack of choice over the task also resulted in increased negative affect in both sexes. The least stressful condition--having a choice in the absence of time pressure--resulted in reduced negative affect. In addition to the effects of manipulated decision latitude and demand, perceptions of being in control were associated with reduced SBP among women who had a choice. Perceived control also contributed to reduced negative affect among men. These results suggest that the postulated negative effects of high demand and low decision latitude (ie, job strain) on cardiovascular health may be mediated in part by increased cardiovascular reactivity and negative affect.