Mobbing in Organisationen - Überblick zum Stand der Forschung

Zusammenfassung. Dieser Beitrag gibt einen Überblick über den Stand der empirischen Mobbingforschung. Es werden verschiedene Aspekte von Mobbing diskutiert und es wird eine Definition entwickelt. Im Anschluß werden verschiedene europäische Studien zusammenfassend diskutiert in Hinblick auf Verbreitung von Mobbing, Beginn, Dauer, geschlechtsspezifische Aspekte, Position der Mobber sowie Vorkommen von Mobbing in unterschiedlichen Branchen. Im Anschluß daran werden verschiedene Ursachen von Mobbing in der Organisation, im sozialen System (Arbeitsgruppe), im Täter sowie im Opfer diskutiert und empirische Daten dazu vorgestellt. Weiter werden betriebliche und gesundheitliche Folgen von Mobbing beschrieben. Abschließend werden Risikofaktoren von Mobbing zusammengestellt.

Self-criticism, dependency and depressive symptoms in a nationwide sample of Norwegian physicians

This cross-sectional study examines the associations between dysfunctional beliefs concerning self-criticism and dependency and self-reported depressive symptoms in a nationwide representative sample of Norwegian physicians (N = 836). The dysfunctional beliefs were measured by the Dysfunctional Attitudes Scale (DAS), and depressive symptoms by the "severe depression" subscale of the General Health Questionnaire. Women reported more depressive symptoms than men, whereas men reported more dysfunctional attitudes, especially concerning self-criticism. Both self-criticism and dependency were significantly associated with level of depressive symptoms in male doctors when age and their medical speciality were controlled, whereas no such relationship was demonstrated in female doctors, except for a bivariate association between depressive symptoms and two single indicators of dependency.

The costs of work-related musculoskeletal disorders in automotive manufacturing

Inadequate application of ergonomic principles to the design of workplaces and individual jobs has adverse consequences for worker health and safety, especially in terms of strains, sprains, and other musculoskeletal disorders. In addition to the human pain and suffering, other losses are externalized to workers, with adverse financial and psychosocial impacts. There are also costs to employers through workers' compensation claims, scrap, and decreased production quality, medical insurance premiums, labor turnover, and adverse impacts on labor relations, although many of these are not linked by traditional accounting methods to ergonomic problems per se. Data collected in five plants of two major U.S. automotive manufacturing companies in the last decade have been used to estimate some of the costs associated with work-related musculoskeletal disorders (MSDs), only some of which resulted in workers compensation claims. In one plant in 1984-85, the payroll cost of all back and shoulder disorders was at least $320 per year per worker, not including workers' compensation premiums or claims paid. A large proportion of these costs were accrued by "unreported" cases, that is, cases that either had never been reported to the plant clinic or had been reported in the past and were considered administratively to have recovered. In the other four plants, annual costs associated with in-plant medical visits for MSDs in 1989-93 were almost as high as those resulting from compensation claims. At least one-half of these disorders were estimated to be attributable to physical ergonomic exposures in the workplace and thus preventable. These data are consistent with estimates by others that the real costs to employers are at least two to three times the amount paid in workers' compensation cases, and that at least 50 percent of all work-related musculoskeletal disorders among the working population could be prevented by appropriate ergonomic job design. Furthermore, recent experience with ergonomics programs in various manufacturing and service settings shows that they are cost-effective in reducing morbidity, work absenteeism, and workers' compensation claims; payback periods for workplace modifications can be as short as a few months. Further investigations should explore the reasons that monetary costs and other impacts on profitability do not always motivate employers to improve working conditions.

Sex comparisons in life satisfaction and psychosocial adjustment scores with an older adult sample: examining the effect of sex role differences in older cohorts

The present study examined how sex and other individual-difference factors (i.e., age level, locus of control orientation, and self-actualization subscale scores) relate to older adults' scores on life satisfaction and psychosocial adjustment. Seventy-eight older adults (n = 39 females) were recruited from independent-living retirement communities located in Pennsylvania. Results indicated that females in the sample were not significantly different in mean life satisfaction scores but were significantly lower in mean psychosocial adjustment scores than males in the sample. There were no significant age-level differences in mean scores. Qualitative data from unstructured post-testing interviews revealed that women were more likely to express regret and sometimes frustration toward perceived "missed opportunities" in life (e.g., career) due to expected social roles of being a wife and mother in the decades ranging from the 1920s through the 1960s; these feelings of regret or frustration were not expressed by any of the males in the study.

Psychosocial job factors, physical workload, and incidence of work-related spinal injury: a 5-year prospective study of urban transit operators

STUDY DESIGN

Five-year prospective cohort study of 1449 transit operators.

OBJECTIVES

To investigate psychosocial job factors as predictors of work-related spinal injuries, controlling for current and past physical workload.

SUMMARY OF BACKGROUND DATA

The association between psychosocial job factors and spinal disorders may be confounded by physical workload. A 1991 prospective study of Boeing workers found psychosocial but not physical factors to be associated with spinal injuries. However, data on physical workload were limited. Recent cross-sectional studies of transit drivers showed both physical and psychosocial factors to be independently associated with back and neck pain. This study was designed to test these findings prospectively.

METHODS

Spinal injuries were ascertained from workers' compensation records, employment history from company records, and psychosocial factors from questionnaires. Logistic regression models adjusted for age, gender, height, weight, vehicle type, and current and past physical workload.

RESULTS

During follow-up, 320 drivers reported a first spinal injury. Spinal injury was predicted by psychological job demands (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.33-1.95); job dissatisfaction (OR, 1.56; 95% CI, 1.09-2.23); and the frequency of job problems (OR, 1.52; 95% CI, 1.02-2.26). Marginally significant associations were found for low supervisor support (OR, 1.30; 95% CI, 0.99-1.72) and female gender (OR, 1.49; 95% CI, 0.95-2.32). Compared with full-time work, part-time work was associated with a 2.7-fold reduced risk for spinal injury (OR, 0.37; 95% CI, 0.15-0.93). Cable car crews performing the heaviest physical labor had a threefold increased risk of spinal injury compared with bus drivers (OR, 3.04; 95% CI, 1.85-5.00).

CONCLUSIONS

Physical workload and psychosocial job factors both independently predict spinal injury in transit vehicle operators.

Psychosocial stressors and well-being in health care workers. The impact of an intervention program

There have been few prospective studies of the impact of workplace interventions on employee and organizational well-being within health care settings. This study was conducted at a large regional hospital in Sweden in 1994 with a follow-up in 1995. Effects of a structured organizational and staff intervention program on perceived psychosocial work quality, supporting resources and self-reported health and well-being were evaluated. Based on department-specific results from the baseline assessment in 1994, each department formulated their own improvement goals. They also made their own decisions on relevant improvement activities. Since there was no formal reference group in this study, departments with high and low rating levels, respectively, with regard to intervention activities were compared. Despite an overall worsening in most of the measures most likely due to a notice of 20% staff reduction prior to the follow-up assessment, the intervention appeared to have attenuated negative changes in the high as compared with the low activity group. Manager-rated impact of the program as well as positive staff attitudes and staff involvement in the enhancement process were identified as important determinants for more favourable changes. The study points out the relevance of structured workplace interventions for organizational and employee well-being especially in times of cut-backs and organizational turmoil. Department-specific factors will determine the impact of such programs. The study indicates that the psychosocial impact of personnel cut-backs in health care may be attenuated through management initiatives.

A longitudinal study of job strain and ambulatory blood pressure: results from a three-year follow-up

OBJECTIVE

This study was conducted to investigate the hypothesis that exposure to "job strain" is related to increased ambulatory blood pressure (ABP).

METHOD

Participants were 195 men who wore an ABP monitor for 24 hours on two occasions 3 years apart. Job strain status, evaluated at each assessment, was used to identify four groups: those not having job strain at either assessment (N = 138), those having job strain at both times (N = 15), and two crossover groups. Regression analysis was used to examine the cross-sectional associations of ABP with job strain, controlling for other known risk factors. Repeated-measures analysis of variance was used to examine the association of ABP change with the category of job strain change.

RESULTS

The cross-sectional analysis of the Time 2 data yielded almost identical, highly significant effects of job strain on ABP as was shown in our previously published Time 1 analysis. Those in high strain jobs at both times had systolic/diastolic ABPs at work and at home that were, on average, 11/7 mm Hg higher than those with no job strain at both times; the crossover groups had intermediate levels of ABP. The longitudinal analysis showed that those with a high strain job at Time 1, but not at Time 2, had a significant decrease in work and home ABP of approximately 5/3 mm Hg.

CONCLUSIONS

The previously reported cross-sectional association between job strain and ABP was replicated at follow-up. The group repeatedly exposed to job strain had higher levels of ABP at Time 2 than either crossover group. Furthermore, change in job strain status partially predicted change in ABP. These results provide new evidence supporting the hypothesis that job strain is an occupational risk factor in the etiology of essential hypertension.

Health risk influence on medical care costs and utilization among 2,898 municipal employees

INTRODUCTION

Although worksite health promotion programs are credited with stabilizing medical benefits costs, research is needed to characterize the medical costs of cohorts with selected health risk factors. The purpose of this study was to compare medical cost outcomes in City of Birmingham, Alabama, employees who differ on selected health risk factors.

METHODS

Health risk appraisal and medical claims cost data were examined in 2,898 employees participating in health screening during 1992 and 1993. Probit analysis was employed to test the null hypotheses that there are no differences in (1) probability of medical service utilization and (2) probability of medical service cost quartile (high, moderate, and low) between groups characterized by risks. Age, gender, race, education, marital status, and diabetes were included as covariates in each model examined. In addition, smoking habits was included as a covariate in models involving risk taking behavior and psychosocial risk.

RESULTS

Significant differences in medical care utilization and costs were found between risk groups based on psychosocial risk, cardiovascular disease risk, and total risk. No association was found between risk-taking behavior and utilization and costs.

CONCLUSION

Subjects reporting psychosocial, cardiovascular disease, and total risk factors were more likely to use medical services and to be in the high or high/moderate cost categories.

Dyspepsia in relation to Helicobacter pylori infection and psychosocial work stress in white collar employees

OBJECTIVE

We undertook an investigation of the relationship between psychosocial work stress and Helicobacter pylori (H. pylori) infection with dyspepsia.

METHODS

We conducted a cross-sectional study among 189 employees of a health insurance company in the city of Ulm, Germany.

RESULTS

A clear association between work-related psychosocial factors and the occurrence of dyspeptic symptoms during the past 3 months was evident. Persons who were considered to have a critical style of coping with work demands suffered more often from dyspeptic symptoms. Current infection with H. pylori was not associated with prevalence of dyspeptic symptoms. These results were also confirmed by adjustment for age, gender, smoking status, education, and use of antiinflammatory drugs within the past 3 months, by means of multivariate analysis. The odds ratio (OR) for having a dyspepsia symptom score in the upper tertile versus the 1st or 2nd was 3.22 (95% confidence interval [CI], 1.56-6.65), given that the employee was considered to have a critical style of coping with work demands. The OR for having a dyspepsia symptom score in the upper tertile given H. pylori infection was 1.23 (95% CI, 0.44-3.46), indicating no association of current H. pylori infection with dyspeptic symptoms.

CONCLUSIONS

A critical style of coping with work demands may be an important determinant for dyspepsia-like symptoms. Therefore, in the absence of an underlying disease, specific intervention programs should be targeted at the behavior of the affected individual (e.g., stress-reduction programs) rather than on the treatment of specific symptoms or infection with H. pylori.

High effort, low reward, and cardiovascular risk factors in employed Swedish men and women: baseline results from the WOLF Study

STUDY OBJECTIVE

To examine associations between measures of work stress (that is, the combination of high effort and low reward) and cardiovascular risk factors.

DESIGN

Cross sectional first screening of a prospective cohort study.

SETTING AND PARTICIPANTS

The study was conducted among 5720 healthy employed men and women living in the greater Stockholm area aged 19-70 years. All analyses were restricted to subjects with complete data (n = 4958). The investigation of associations between indicators of effort-reward imbalance and cardiovascular risk factors was restricted to the age group 30-55 years (n = 3427).

MAIN RESULTS

Subjects reporting high effort and low reward at work had a higher prevalence of well known risk factors for coronary heart disease. After adjustment for relevant confounders, associations between a measure of extrinsic effort and reward (the effort-reward ratio) and hypertension (multivariate prevalence odds ratio (POR) 1.62-1.68), increased total cholesterol (upper tertile 220 mg/dl)(POR = 1.24) and the total cholesterol/high density lipoprotein(HDL)-cholesterol ratio (upper tertile 4.61)(POR 1.26-1.30) were found among men. Among women a measure of high intrinsic effort (immersion) was related to increased low density lipoprotein (LDL)-cholesterol (upper tertile 130 mg/dl)(POR 1.37-1.39). Analyses of variance showed increasing mean values of LDL cholesterol with an increasing degree of the effort-reward ratio among men and increased LDL-cholesterol among women with high levels of intrinsic effort (upper tertile of immersion).

CONCLUSIONS

Findings lend support to the hypothesis that effort-reward imbalance represents a specific constellation of stressful experience at work related to cardiovascular risk. The relation was not explained by relevant confounders (for example, lack of physical exercise, body weight, cigarette smoking).

Predictors of a healthy workplace for Swedish and English psychiatrists

BACKGROUND

Few studies have attempted to analyse the organisational aspects of the workplace that may affect the well-being of psychiatrists and even fewer have offered insights into what a positive workplace might look like. This study provides an outline of such a workplace, with reference to individual and organisational factors. In addition, a comparison is made between two European cities to check for cultural differences.

METHOD

Three hundred and eighty psychiatrists from Stockholm and Birmingham responded to a previously tested questionnaire on their work environment.

RESULTS

Predictors of a positive workplace for psychiatrists were: high self-esteem, satisfactory support with work-related problems, lower perceived workload, positive view of leadership, low work-related exhaustion and having a sense of participation in the organisation. There were few cultural differences.

CONCLUSIONS

Measures should be taken to improve leadership skills for managers, to offer more support for work-related problems, and to allow psychiatrists to participate more in the organisation.

Gender, work roles and psychosocial work characteristics as determinants of health

This paper aims to identify gender similarities and differences in psychosocial work characteristics for those in and out of paid employment, to inform research on possible health-related effects. Specifically five questions are addressed: do women report poorer work characteristics than men; are gender differences related to specific characteristics; do work characteristics differ between full- and part-time women workers and between those in paid and unpaid work; are socio-economic gradients in work characteristics similar for men and women; and, if there are gradients, do they differ between women in paid and unpaid work? Analyses are based on the 33 year follow-up of the 1958 British birth cohort. Four psychosocial work characteristics were examined: learning opportunities, monotony, pace of work, and flexibility of breaks. Women reported more negative work characteristics than men, primarily because of differences in learning opportunities (26% lacked opportunity compared with 13% of men) and monotonous work (47 and 31% respectively). Women in full-time employment reported fewer negative characteristics (27%) than part-time (39%) or home-workers (36%). Home-workers had fewer opportunities for learning (36%) and greater monotony (49%) than paid workers (21 and 22% respectively), however fewer home-workers reported inability to control the work pace (11% compared to 23%) and inflexibility of breaks (21% compared to 47%). Socio-economic gradients in work characteristics were similar among men and women, except for flexibility of break times. A socio-economic gradient in work characteristics was found for full- and part-time workers, but not among home-workers. Differences in self reported health were also examined: a social gradient was found for all employment status groups, being strongest for home-workers despite the absence of a gradient in negative work characteristics. In conclusion, these marked gender differences in psychosocial work characteristics need to be considered in future research on work and health.

Predictive value of determinations of zinc protoporphyrin for increased blood lead concentrations

Blood lead (PbB) and red cell zinc protoporphyrin (ZPP) concentrations are widely used biomarkers for lead toxicity. It is uncertain, however, whether either or both are needed for monitoring lead exposure and how discordant PbB and ZPP values should be interpreted. We reviewed the results of PbB and ZPP determinations in 94 workers in a lead-battery plant over a 13-year period and retrieved all 807 sets of tests in which both PbB and ZPP were available, with a follow-up PbB value 6 months later. PbB exceeded 1.93 μmol/L (40 μg/dL) in 414 (51%), and 2.90 μmol/L (60 μg/dL) in 105 (14%) of the blood samples. We derived the test properties of various ZPP concentrations for concurrent “toxic” PbB concentrations, defined as ≥1.93 and 2.90 μmol/L (40 and 60 μg/dL). The results indicated that, given a population of lead-exposed workers with a 10% prevalence of PbB of ≥2.90 μmol/L (60 μg/dL), a policy of testing PbB only in those with ZPP >0.71 μmol/L (40 μg/dL) would obviate 42% of the PbB tests, but would miss about three cases with toxic PbB concentrations in every 200 workers at risk. A finding of increased ZPP concentrations with a concurrent “nontoxic” PbB was associated with an increased risk of a toxic PbB concentration 6 months later. We conclude that (a) screening by testing only ZPP does not safeguard exposed persons against lead toxicity, and (b) the frequency of PbB monitoring should be guided by estimates of the risk of future lead toxicity in individual workers.

Work and strain on physicians in Finland

In this study we compared the Karasek job demand-control model with an alternative model in an attempt to explain strain on Finnish physicians (n = 91) at work. Based on previous research, job demands were studied in terms of time pressure and demands related to patients. LISREL (8) analysis was used to test the models. The three factor model, providing the most parsimonious explanation of the data, suggested that time pressure, patient-related stress and controllability all have unique predictive ability of strain on Finnish physicians.

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

OBJECTIVES

This study examined the role of decision latitude and job strain in the etiology of a first myocardial infarction.

METHODS

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).

RESULTS

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.

CONCLUSIONS

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.

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. The aim of this study was therefore to examine, in women and men, the cross sectional relations between psychosocial work variables (psychological demands, decision latitude, and social support) and cardiovascular risk factors (hypertension, hyperlipidaemia, diabetes, overweight, smoking, and alcohol consumption).

PARTICIPANTS

The original cohort comprised 20,625 volunteers (men aged from 40 to 50 and women from 35 to 50) employed by the French Company Electricité De France-Gaz De France and followed up yearly since 1989. The study was restricted to the 13,226 volunteers in the cohort who were still working and answered a self administered questionnaire on psychosocial work factors in 1995.

DESIGN

Data were based on replies to this questionnaire. Three psychosocial work environment exposure scores were used to assess psychological demands, decision latitude, and social support at work respectively. The main outcome measures were the prevalence of hypertension, hyperlipidaemia, and diabetes within the previous 12 months, overweight, smoking, and alcohol consumption.

MAIN RESULTS

Psychosocial work factors were significantly associated with hypertension, hyperlipidaemia, overweight, smoking, and alcohol consumption, but not with diabetes. In men, low decision latitude was associated with hypertension, high decision latitude and high social support with overweight, low decision latitude with alcohol consumption. Moreover, the risk of hyperlipidaemia increased in men exposed to both high psychological demands and low social support. In women, low decision latitude was related to hyperlipidaemia, high psychological demands with overweight, high psychological demands and high decision latitude with smoking, and low social support with alcohol consumption.

CONCLUSIONS

These cross sectional results underline the potential effects of psychosocial work characteristics on cardiovascular risk factors and the differences between the effects of job stress in men and women, and confirm the direct mechanisms (through physiological variables) and indirect mechanisms (through behavioural risk factors) potentially involved in the relation between psychosocial work characteristics and cardiovascular disease.

Dutch monitor on stress and physical load: risk factors, consequences, and preventive action

OBJECTIVES

Due to recent changes in legislation on occupational health and safety, a national monitor on stress and physical load was developed in The Netherlands to monitor (a) risks and consequences of stress and physical load at work, (b) preventive actions in companies to reduce these risks, and (c) organisational and environmental variables that facilitate preventive actions.

METHODS

Information was gathered from employers, employees, and employees' representatives. The monitor was used with a nationally representative sample of companies in industry, wholesale trade, and banking and finance, 782 companies in total.

RESULTS AND CONCLUSIONS

The information from the employees, aggregated at the company level, was not found to be correlated with that from the employer from the same companies. Although many employers do recognise risk factors for both physical load and stress as a problem they often seem to underestimate the problem when compared with employees or their representatives. This is particularly the case for psychosocial risk factors. Also, the perception of outcome measures, especially employers who consider emotional exhaustion to be work related, were fewer than the employees' representatives of the same organisation. Preventive measures on physical load are much more popular than measures against stress. It is the responsibility of the employer to take more preventive action of all kinds. They need to recognise risk factors as problems and health outcomes to be related to work. Employees of larger companies should participate with employers to consider effective measures, and more use should be made of support at branch level. For specific preventive measures, specific predictors emerged. Except for measures to prevent work stress, information from employees did not sufficiently contribute to the initiation of preventive measures in the workplace.

Two alternative job stress models and the risk of coronary heart disease

OBJECTIVES

This study examined the association between two alternative job stress models-the effort-reward imbalance model and the job strain model-and the risk of coronary heart disease among male and female British civil servants.

METHODS

The logistic regression analyses were based on a prospective cohort study (Whitehall II study) comprising 6895 men and 3413 women aged 35 to 55 years. Baseline measures of both job stress models were related to new reports of coronary heart disease over a mean 5.3 years of follow-up.

RESULTS

The imbalance between personal efforts (competitiveness, work-related overcommitment, and hostility) and rewards (poor promotion prospects and a blocked career') was associated with a 2.15-fold higher risk of new coronary heart disease. Job strain and high job demands were not related to coronary heart disease; however, low job control was strongly associated with new disease. The odds ratios for low job control were 2.38 and 1.56 for self-reported and externally assessed job control, respectively. Work characteristics were simultaneously adjusted and controlled for employment grade level, negative affectivity, and coronary risk factors.

CONCLUSIONS

This is apparently the first report showing independent effects of components of two alternative job stress models-the effort-reward imbalance model and the job strain model (job control only)-on coronary heart disease.

Job hassles and cardiovascular reaction patterns among urban bus drivers

Forty-six bus drivers took pan in a longitudinal field study of cardiovascular reactions to urban driving. "Job hassles" were recorded by observers using a standardized list of stress-related events in traffic and on the bus. Measures of blood pressure, heart rate, and ratings of perceived mental strain were obtained after each route segment. Intraindividual correlations between psychophysiological recordings and job hassles were calculated and submitted to cluster analysis. Two reaction patterns were identified, 1 characterized by consistently, although modestly, positive associations between the frequency of job hassles and psychophysiological reactions, the other characterized by a low association between the frequency of hassles and indicators or psychophysiological arousal. The former group displayed significantly higher blood pressure and mental strain ratings in the unwinding phase after work than did the latter group of workers. The results are discussed in terms of rate or "unwinding" after exposure to stressful conditions.

Cardiovascular and endocrine responses to experimental stress: effects of mental effort and controllability

The objective of the study was to investigate the unique and interactive effects of the controllability of a task and mental effort required by that task on cardiovascular and endocrine reactivity, when both were manipulated independently. A 2 x 2 factorial design was used, with two levels of mental effort and two levels of control. Twenty-four healthy male subjects participated in each experimental condition. Heart rate, blood pressure, catecholamine and cortisol responses were determined. High effort lead to greater increases in heart rate, blood pressure and norepinephrine levels. Uncontrollability lead to higher cortisol, blood pressure and norepinephrine responses. In addition, there was an effort x control interaction effect on the diastolic blood pressure response. In conclusion, effort has clear sympathetic effects, whereas control influences both the sympathetic nervous system and the release of cortisol. Having control seems to be most beneficial in high effort situations, at least with respect to sympathetic reactivity.

Karoshi--death from overwork: occupational health consequences of Japanese production management

There is considerable international interest in Japanese production management (JPM), known in the West as "lean production." Advocates of this new form of management argue that it improves both economic productivity and health. In Japan, however, the relationship between JPM and sudden death due to cardiovascular and cerebrovascular disease has been an important topic of debate since the 1970s. Japanese have named these types of deaths karoshi, which means "death from overwork." In North America and Western Europe a number of studies have demonstrated a significant relationship between high job strain (high production demands and low levels of control and social support) and cardiovascular disease. This article reviews the elements of JPM and examines their potential health consequences. The authors present an overview of karoshi, discuss its possible connections to specific ideological and organizational characteristics of JPM, and suggest the job strain mechanism as a possible pathway between karoshi and JPM. They conclude by discussing the need for comparative research that examines the health effects of work organization and management methods cross-culturally.

Chronic work stress, sickness absence, and hypertension in middle managers: general or specific sociological explanations?

The issue of differential prediction of health outcomes by sociological models of work stress has received little attention so far. This paper argues, both on theoretical and empirical grounds, that active coping with the experience of chronic work stress is more likely to be associated with physical health consequences of sustained autonomic arousal such as hypertension, whereas passive coping may predispose individuals to withdrawal behavior such as sickness absence from work. Based on data from a cross-sectional study on 189 male middle-aged (40-55, 48.3 +/- 4.6 years) middle managers in a car-producing company in Germany, this hypothesis is tested in the framework of the theoretical model of effort-reward imbalance at work. More specifically, the simultaneous manifestation of high effort and low reward at work, indicative of active coping, is expected to statistically predict the risk of being hypertensive. Conversely, suffering from low occupational rewards in the absence of signs of sustained effort, indicative of passive coping, is expected to predict sickness absence (SA) behavior. Multivariate odds ratios (OR) derived from logistic regression analysis and adjusted for important confounders indicate that three measures of low reward are associated with short-term SA (OR ranging from 3.30 to 9.15), that one measure of low reward is associated with long-term SA (OR: 2.67) and that two measures of low reward are associated with number of SA episodes (OR 4.05 and 6.33), whereas no indicator of high effort at work is significantly associated with SA. On the other hand, the OR of being hypertensive is 5.77 in middle managers who suffer from high effort and low reward simultaneously. In conclusion, a sociological model of work stress which allows for differential prediction of health outcomes according to the important notions of active versus passive coping with work demands finds preliminary empirical support.

Do health questionnaires which do not consider sex differences miss important information?

The influence of gender on subsets of scores of Sense of Coherence, Hardiness, and personality traits was assessed in relation to psychological well-being using the Sense of Coherence Questionnaire, the Dispositional Resilience Scale, the Eysenck Personality Inventory, and the 12-item General Health Questionnaire. In a sample of Open University students (67 men aged 21 to 71 years and 239 women aged 19 to 66 years) sex differences were found in subsets of scores of Sense of Coherence, Hardiness, personality, and psychological well-being.

Workplace demands, economic reward, and progression of carotid atherosclerosis

BACKGROUND

Characteristics of the work environment have been associated with cardiovascular morbidity and mortality, but it is unclear whether these factors are associated with preclinical manifestations of disease.

METHODS AND RESULTS

We investigated the association between job demands, economic reward, and the 4-year progression of carotid atherosclerosis in a population-based sample of 940 Finnish men. Data from the Kuopio Ischemic Heart Disease Risk Factor Study were used to estimate changes in plaque height, maximum and mean intima-media thicknesses across combinations of job demands, and income. Associations were examined in relation to atherosclerotic risk factors and were stratified by baseline levels of atherosclerosis and prevalent ischemic heart disease. Men who had jobs with high demands and low economic rewards had significantly greater 4-year progression of plaque height (0.33 mm, P = .008) and maximum intima-media thickness (0.32, P = .03) than men with low-demand, high-income jobs. The magnitude of these differences was not greatly attenuated by risk factor adjustment and did not differ when examined by the level of workplace resources, social support, or employment status. Larger differences were observed in a subsample of men who had more advanced atherosclerosis at baseline.

CONCLUSIONS

These results show that men with demanding work that produces little economic reward have significantly greater progression of carotid atherosclerosis than more advantaged men. The relationship between job demands and health should be understood in a broad framework of interacting economic conditions, social circumstances, and behaviors that cascade over the life course and may ultimately contribute to socioeconomic inequalities in morbidity and mortality.

Social context and psychosocial influences on blood pressure among American Samoans

This study explores social and explores social and economic influences on health within a model formulated to address explicitly both individual and household level phenomena. Dressler's lifestyle incongruity model is used as a basis from which to predict the effects of intracultural contexts of variability on blood pressure. The sample for this survey consists of 134 Samoan men and women living in American Samoa. Based on previous experience and ethnographic sources, two key intracultural contexts were examined; gender, i.e., male-female differences in response to psychosocial stress, and household employment as indicated by whether or not both spouses in a household are employed. Our analysis indicates that lifestyle incongruity, defined as the difference between the material culture presented by a household and the economic resources of the family, is significantly associated with both systolic and diastolic blood pressure. Furthermore, males and females show opposite blood pressure associations with both lifestyle incongruity (male blood pressure increases with increasing incongruity while female blood pressure does not) and household employment (male blood pressure is higher when both spouses work but female blood pressure is lower).

Doctors' perceptions of the links between stress and lowered clinical care

We know from numerous industrial studies that stress, particularly in the form of tiredness and sleep deprivation, has a detrimental effect upon work performance, though this is not so clear-cut in studies of doctors, despite their stress levels being particularly high. This study explores the doctors' views on this using anonymous questionnaires from a population of 225 hospital doctors and general practitioners, 82 of whom reported recent incidents where they considered that symptoms of stress had negatively affected their patient care. The qualitative accounts they gave were coded for the attribution (type of stress symptom) made, and the effect it had. Half of these effects concerned lowered standards of care; 40% were the expression of irritability or anger; 7% were serious mistakes which still avoided directly leading to death; and two resulted in patient death. The attributions given for these were largely to do with tiredness (57%) and the pressure of overwork (28%), followed by depression or anxiety (8%), and the effects of alcohol (5%). The data are discussed in terms of the links made by the doctors between their fatigue or work pressure and the way they care for patients. It presumes that these incidents had been previously unreported and talks about the effects this secrecy has on the emotional state of the doctors concerned. It offers ways forward for tackling the problem, of interest to the profession, managers and commissioners.

Workplace conditions, socioeconomic status, and the risk of mortality and acute myocardial infarction: the Kuopio Ischemic Heart Disease Risk Factor Study

OBJECTIVES

This study investigated whether the association between workplace conditions and the risk of all-cause and cardiovascular mortality and acute myocardial infarction differed by socioeconomic status.

METHODS

Prospective data were used to examine these associations in 2297 Finnish men, with adjustment for prevalent diseases and biological, behavioral, and psychosocial covariates, and stratified by employment status and workplace social support.

RESULTS

Elevated age-adjusted relative hazards for all-cause mortality were found for men who reported high demands, low resources, and low income; high demands, high resources, and low income; and low demands, high resources, and low income. Similar patterns were found for cardiovascular mortality. In contrast, elevated age-adjusted relative hazards for acute myocardial infarction were observed only in men who reported high demands, low resources, and low income. These results did not differ by level of workplace social support or employment status.

CONCLUSIONS

The negative effects of workplace conditions on mortality and of myocardial infarction risk depended on income level and were largely mediated by known risk factors.

Star wars and strategic defense initiatives: work activity and health symptoms of unionized bank tellers during work reorganization

Work activity and health symptoms of bank tellers whose work was undergoing reorganization were examined during a university-union study of the health effects of work in women's traditional jobs. Data were gathered through collective and individual interviews, analysis of work activity, and a questionnaire administered to 305 tellers. Employees worked in a standing posture over 80 percent of the time. More than two-thirds frequently suffered pain in back, legs, and feet. The average teller had been involved in 3.7 robberies as a direct victim and six as a witness. Work required feats of memory and concentration. In order to meet job demands, tellers engaged in supportive activities and teamwork. The introduction of individualized objectives threatened the employees' ability to collaborate and induced distress. More than twice as many tellers as other female workers in Québec experience psychological distress (Ilfeld scale), related to: robbery during the past two years (odds ratio = 1.7; confidence interval = 1.0-2.9); difficult relations with superiors (O.R. = 2.6; C.I. = 1.3-5.3); and full-time work (O.R. = 2.3; C.I. = 1.3-3.9). Diverse methods enriched the analysis, and union participation allowed the proposal of concrete correction measures.

The challenges of future behavioral medicine

To a large extent, behavioral medicine originates from the United States, and more specifically from the scientific traditions of pragmatism and behaviorism. The core notion of individual learning, mastery, and development embedded in these traditions has lent support to an almost exclusive concern with individual behavioral modification. However, individual mastery and welfare are increasingly threatened by powerful adverse socioeconomic and sociocultural developments, especially by growing social inequalities in health and by expanding social disintegration. Social differentials in morbidity and mortality are documented even in the most economically advanced countries where health-damaging lifestyles (e.g., cigarette smoking, diet) and stressful conditions of relative deprivation in occupational life and elsewhere contribute to the observed pattern. In addition, detrimental effects on health produced by social disintegration are manifest, most notably in societies that undergo rapid socioeconomic change. Implications of these developments for future behavioral medicine are discussed at the level of scientific analysis and of preventive and therapeutic intervention.