Job strain, effort-reward imbalance and ambulatory blood pressure: results of a cross-sectional study in call handler operators

Variation in blood pressure and heart rate of radiological technologists in worktime tracked by a wearable device: A preliminary study

The aim of this preliminary study was to measure the systolic BP (SBP) and diastolic BP (DBP) and heart rate (HR) of radiological technologists by WD, and evaluate variation among individuals by worktime, day of the week, job, and workplace. Measurements were obtained using a wristwatch-type WD with optical measurement technology that can measure SBP and DBP every 10 minutes and HR every 30 minutes. SBP, DBP, and HR data obtained at baseline and during work time were combined with the hours of work, day of the week, job, and workplace recorded by the participants in 8 consecutive weeks. We calculated the mean, the ratio to baseline and coefficient of variation [CV(%)] for SBP, DBP, and HR. SBP, DBP, and HR values were significantly higher during work hours than at baseline (p<0.03). The ratio to baseline values ranged from 1.02 to 1.26 for SBP and from 1.07 to 1.30 for DBP. The ratio to baseline for SBP and DBP showed CV(%) of approximately 10% according to the day of the week and over the study period. For HR, ratio to baseline ranged from 0.95 to 1.29. The ratio of mean BP to baseline was >1.2 at the time of starting work, middle and after lunch, and at 14:00. The ratio to baseline of SBP were 1.2 or more for irradiation, equipment accuracy control, registration of patient data, dose verification and conference time, and were also working in CT examination room, treatment planning room, linac room, and the office. CV(%) of BP and HR were generally stable for all workplaces. WD measurements of SBP, DBP, and HR were higher during working hours than at baseline and varied by the individuals, work time, job, and workplace. This method may enable evaluation of unconscious workload in individuals.

Psychosocial work factors and blood pressure among 63 800 employees from The Netherlands in the Lifelines Cohort Study

OBJECTIVES

Previous studies on the association between psychosocial work factors and blood pressure mainly focused on specific occupations or populations and had limited sample sizes. We, therefore, investigated the associations between psychosocial work factors and blood pressure in a large general working population in the Netherlands.

METHODS

We included 63 800 employees from the Netherlands, aged 18-65 years, with blood pressure measurements and a reliable job code at baseline. Psychosocial work factors (job strain, effort-reward imbalance (ERI) and emotional demands) in the current job were estimated with three recently developed psychosocial job exposure matrices. To examine the associations, regression analyses adjusted for covariates (age, sex, body mass index, education, monthly income, pack-years, smoking, alcohol consumption and antihypertensive medication (not included for hypertension)) were performed.

RESULTS

Higher job strain was associated with higher systolic blood pressure (SBP) (B (regression coefficients) (95% CI) 2.14 (1.23 to 3.06)) and diastolic blood pressure (DBP) (B (95% CI) 1.26 (0.65 to 1.86)) and with higher odds of hypertension (OR (95% CI) 1.43 (1.17 to 1.74)). Higher ERI was associated with higher DBP (B (95% CI) 4.37 (3.05 to 5.68)), but not with SBP or hypertension. Higher emotional demands were associated with lower SBP (B (95% CI) -0.90 (-1.14 to -0.66)) and lower odds of hypertension ((OR) (95% CI) 0.91 (0.87 to 0.96)).

CONCLUSIONS

In the general working population, employees in jobs with high job strain and ERI have higher blood pressure compared with employees with low job strain and ERI. Emotional demands at work are inversely associated with blood pressure.

The relation of work-related factors with ambulatory blood pressure and nocturnal blood pressure dipping among aging workers

Objectives

Individuals with reduced nocturnal blood pressure (BP) dipping are at increased risk of cardiovascular disease compared to persons with normal BP dipping. Although the relation of work-related factors and BP has been studied extensively, very little is known of the association between work-related factors and 24-h BP patterns in aging workers. We examined the cross-sectional relation of work-related risk factors, including occupational status, work-time mode, job demands and job control, with ambulatory BP in aging workers, focusing on nocturnal BP dipping.

Methods

208 workers (mean age 62 ± 3 years; 75% women) from two Finnish population-based cohort studies underwent 24-h ambulatory BP monitoring. Work-related factors were inquired using a questionnaire. Nocturnal BP dipping was calculated as [1 − (asleep BP/awake BP)] × 100.

Results

Shift workers demonstrated a higher nocturnal diastolic BP dipping than regular day workers (19% vs. 17%, p = 0.03) and had a significantly higher systolic awake BP than regular day workers (136.5 mmHg vs. 132.5 mmHg, p = 0.03). Participants with high job demands demonstrated a smaller nocturnal systolic BP dipping than participants with low job demands (14% vs. 16%, p = 0.04). We did not observe significant differences in nocturnal systolic or diastolic BP dipping between groups categorized by occupational status or job control.

Conclusions

Although shift workers have a higher daytime BP than regular daytime workers, they exhibit greater nighttime BP dipping. Participants with high job demand had smaller nighttime BP dipping than participants with low job demand. Job control or occupation did not affect the 24-h ambulatory BP profile of aging workers.

Effort-reward imbalance and ambulatory blood pressure among female Las Vegas hotel room cleaners

BACKGROUND

Effort-reward imbalance (ERI) was hypothesized to be associated with ambulatory blood pressure (ABP) and pulse pressure (PP) among female hotel room cleaners.

METHODS

ERI, ABP, and PP were assessed among 419 cleaners from five hotels during 18 waking hours. Adjusted linear regression models were used to assess associations of ERI with ABP and PP during 18-hours, work hours, and after work hours.

RESULTS

There was a pattern of higher ERI being associated with higher 18-hour systolic ABP and 18-hour PP although the results were imprecise. An increase of ERI by half its range was associated with a 1.6 mmHg (95% CI, -1.6-4.7) increase in 18-hour systolic blood pressure (SBP) and a 0.7 mmHg (95% CI, -1.1-2.5) increase in 18-hour PP. An increase in rewards by half its range was associated with a 2 mmHg decrease in after-hours SBP (-2.2, 95% CI, -5.4-1.0) and after-hours PP (-1.9, 95% CI, -3.8-0.0). Among females 45 years or older, ERI was associated with 2.1 and 2.2 mmHg increase in 18-hour and work hours diastolic ABP, respectively, compared to a 0 mmHg change in 18-hour and work hours diastolic ABP in younger women. The number of dependents at home attenuated the association.

CONCLUSIONS

ERI was positively associated with ABP, particularly SBP, and the association was modified by age and the number dependents at home, although the estimates were imprecise. Workplace interventions that integrate stress management and active ABP surveillance appear warranted. However, larger studies with Latina women need to confirm our results.

Work Stress and Altered Biomarkers: A Synthesis of Findings Based on the Effort-Reward Imbalance Model

While epidemiological studies provide statistical evidence on associations of exposures such as stressful work with elevated risks of stress-related disorders (e.g., coronary heart disease or depression), additional information on biological pathways and biomarkers underlying these associations is required. In this contribution, we summarize the current state of the art on research findings linking stressful work, in terms of an established theoretical model-effort-reward imbalance-with a broad range of biomarkers. Based on structured electronic literature search and recent available systematic reviews, our synthesis of findings indicates that associations of work stress with heart rate variability, altered blood lipids, and risk of metabolic syndrome are rather consistent and robust. Significant relationships with blood pressure, heart rate, altered immune function and inflammation, cortisol release, and haemostatic biomarkers were also observed, but due to conflicting findings additional data will be needed to reach a firm conclusion. This narrative review of empirical evidence supports the argument that the biomarkers under study can act as mediators of epidemiologically established associations of work stress, as measured by effort-reward imbalance, with incident stress-related disorders.

Effort-Reward Imbalance at Work and the Prevalence of Unsuccessfully Treated Hypertension Among White-Collar Workers

We examined the association between effort-reward imbalance (ERI) exposure at work and unsuccessfully treated hypertension among white-collar workers from a large cohort in Quebec City, Canada. The study used a repeated cross-sectional design involving 3 waves of data collection (2000-2009). The study sample was composed of 474 workers treated for hypertension, accounting for 739 observations. At each observation, ERI was measured using validated scales, and ambulatory blood pressure (BP) was measured every 15 minutes during the working day. Unsuccessfully treated hypertension was defined as daytime ambulatory BP of at least 135/85 mm Hg and was further divided into masked and sustained hypertension. Adjusted prevalence ratios and 95% confidence intervals were estimated. Participants in the highest tertile of ERI exposure had a higher prevalence of unsuccessfully treated hypertension (prevalence ratio = 1.45, 95% confidence interval: 1.16, 1.81) after adjustment for gender, age, education, family history of cardiovascular diseases, body mass index, diabetes, smoking, sedentary behaviors, and alcohol intake. The present study supports the effect of adverse psychosocial work factors from the ERI model on BP control in treated workers. Reducing these frequent exposures at work might lead to substantial benefits on BP control at the population level.

Effort-reward imbalance at work and 5-year changes in blood pressure: the mediating effect of changes in body mass index among 1400 white-collar workers

PURPOSE

A number of prospective studies have documented the effect of adverse psychosocial work factors (work stress) on high blood pressure (BP). Weight gain could be an important pathway by which work stress exerts its effect on BP. No previous prospective study has examined this mediating effect. The aim of the present study was to examine the mediating effect of body mass index (BMI) in the association between psychosocial work factors from Siegrist's effort-reward imbalance model (ERI) and ambulatory BP (ABP).

METHODS

A prospective study was conducted among 1436 white-collar workers. Data were collected three times during a 5-year period. ERI was measured using validated scales, at each time. BMI was measured by a trained assistant. ABP was measured every 15 min during a working day.

RESULTS

ERI exposure onset over 3 years was indirectly associated with ABP changes (0.49 mmHg; 95 % CI 0.05, 1.22), through BMI changes, in women with baseline BMI ≥25 kg/m². An effect of similar magnitude and of borderline significance was observed for ERI chronic exposure. No mediating effect was observed among men, and using ERI exposure over 5 years.

CONCLUSION

The mediating effect of BMI was of small magnitude and observed in certain subgroups and time frame only. Subgroup-specific mediating pathways might be involved to explain the effect of work stress on cardiovascular diseases risk.

Psychophysiological Assessment of Stress Under Ecological Settings

Abstract. Stress can negatively impact one’s health and well-being, however, despite the recent evolution in stress assessment research methodologies, there is still little agreement about stress conceptualization and assessment. In an attempt to summarize and reflect on this evolution, this paper aims to systematically review research evidence of ecological approaches on psychophysiological stress assessment. Thus, a literature search of electronic databases was conducted spanning 22 years (1990–2012) and 55 studies were reviewed. Studies were considered for inclusion if they contemplated both psychological and physiological measures of stress under ecological settings. This review focuses on five themes: methodology terminology, research population, study design, measurement, and technology. Findings support the need to use a common methodology terminology in order to increase scientific rigor. Additionally, there seems to be an increasing tendency for the use of these methods by multidisciplinary teams among both clinical and nonclinical populations aiming to understand the relationship between stress and disease. Most of the studies reviewed contemplated a time-based protocol and different conceptualizations of stress were found, resulting in the use of different subjective measures. Findings reinforce the importance of combining subjective and objective measures while also controlling for possible time- or situation-dependent confounders’. Advances in technology were evident and different assessment techniques were found. The benefits and challenges of ecological protocols to assess stress are discussed and recommendations for future research are provided, aiming to overcome previous limitations and advance scientific knowledge in the area.

Job stress and work-related musculoskeletal symptoms among intensive care unit nurses: a comparison between job demand-control and effort-reward imbalance models

BACKGROUND

The aims of this study were to compare job demand-control (JDC) and effort-reward imbalance (ERI) models in examining the association of job stress with work-related musculoskeletal symptoms and to evaluate the utility of a combined model.

METHODS

This study analyzed cross-sectional survey data obtained from a nationwide random sample of 304 intensive-care unit (ICU) nurses. Demographic and job factors were controlled in the analyses using logistic regression.

RESULTS

Both JDC and ERI variables had strong and statistically significant associations with work-related musculoskeletal symptoms. Effort-reward imbalance had stronger associations than job strain or iso-strain with musculoskeletal symptoms. Effort-reward imbalance alone showed similar or stronger associations with musculoskeletal symptoms compared to combined variables of the JDC and ERI models.

CONCLUSIONS

The ERI model appears to capture the magnitude of the musculoskeletal health risk among nurses associated with job stress at least as well and possibly better than the JDC model. Our findings suggest that combining the two models provides little gain compared to using effort-reward imbalance only.

The interaction effect of effort-reward imbalance and overcommitment on hypertension among Chinese workers: findings from SHISO study

BACKGROUND

No previous studies investigated the interaction of effort-reward imbalance (ERI) and overcommitment on blood pressure. Our aim was to investigate associations of ERI and overcommitment (and their interaction) with blood pressure and hypertension within a Chinese population.

METHODS

Seven hundred thirty-four participants from the Stress and Health in Shenzhen Workers study completed a demographics, job stressor and risk factor questionnaire, and their blood pressure was measured by mercury sphygmomanometers. Risk factors for blood pressure were analyzed by multiple linear regression and risk factors for hypertension by Poisson regression.

RESULTS

Overcommitment was associated with diastolic blood pressure after adjustment for confounders and ERI among men (β = 0.17, P < 0.05); ERI was also associated with diastolic blood pressure and systolic blood pressure after adjustment for confounders and overcommitment. High overcommitment (PR 1.91, 95% CI 1.35-2.69), and ERI (PR = 2.47, 95% CI 1.62-3.75) were each associated with risk of hypertension after adjusting for confounders. After adjusting for ERI, the association with overcommitment was no longer significant (PR = 1.24, 95% CI 0.85-1.82) However, after controlling for overcommitment, ERI remained significantly associated with hypertension risk (PR = 2.38, 95% CI 1.53-3.71). When high overcommitment and high ERI was combined, hypertension risk was highest (adjusted PR = 2.99, 95% CI 1.82-4.91, adjusted synergy index 5.85). The interaction was significant when it was tested by an interaction term in the regression (P < 0.001).

CONCLUSIONS

The interaction effect of overcommitment and ERI on hypertension was independent and synergistic.

Job strain and ambulatory blood pressure: a meta-analysis and systematic review

We reviewed evidence of the relationship between job strain and ambulatory blood pressure (ABP) in 29 studies (1985-2012). We conducted a quantitative meta-analysis on 22 cross-sectional studies of a single exposure to job strain. We systematically reviewed 1 case-control study, 3 studies of cumulative exposure to job strain, and 3 longitudinal studies. Single exposure to job strain in cross-sectional studies was associated with higher work systolic and diastolic ABP. Associations were stronger in men than women and in studies of broad-based populations than those with limited occupational variance. Biases toward the null were common, suggesting that our summary results underestimated the true association. Job strain is a risk factor for blood pressure elevation. Workplace surveillance programs are needed to assess the prevalence of job strain and high ABP and to facilitate workplace cardiovascular risk reduction interventions.

Repeated exposure to effort-reward imbalance, increased blood pressure, and hypertension incidence among white-collar workers: effort-reward imbalance and blood pressure

OBJECTIVES

To determine whether men and women with repeated ERI exposure have increased BP means or higher hypertension incidence over a 3-year follow-up. To examine the potential modifying effect of age and overcommitment.

METHODS

The study cohort was composed of 1,595 white-collar workers (629 men and 966 women) assessed at baseline and 3-year follow-up. Ambulatory BP measures were taken every 15 min during a working day. ERI at work was self-reported using validated scales. BP means at follow-up and cumulative incidence of hypertension were respectively modeled with analyses of covariance (ANCOVA) and log-binomial regression.

RESULTS

Among men, no association was observed between repeated ERI exposure and BP. Among women, age had a modifying effect. Women <45 years old exposed to ERI at both times had significantly higher BP means at follow-up (122.2/78.9 mmHg) than those unexposed (120.4/77.4 mmHg). In women ≥45 years old, the cumulative incidence of hypertension was 2.78 (95% CI: 1.26-6.10) times higher among those exposed to ERI at both times. Men and women in the higher tertile of overcommitment had higher BP means (men: 128.9/82.2 mmHg, women: 121.9/78.0 mmHg) than those in the lower tertile (men: 127.2/81.3 mmHg, women: 120.6/77.0 mmHg).

CONCLUSION

This prospective study showed that, among women, repeated ERI exposure led to a significant age-specific increase in BP means and a major age-specific increase in hypertension incidence. These results suggest that primary intervention aimed at reducing ERI may contribute to lower BP and prevent hypertension in women.