Effort-reward imbalance at work and pre-clinical biological indices of ill-health: the case for salivary immunoglobulin A

General work stress and suicide cognitions in health-care workers: mediating effect of hopelessness and job satisfaction

Individuals with a satisfactory level of job satisfaction are much less likely to feel hopeless about their future and are more likely to perform efficiently in the workplace. General work stress (i.e., the work-related stress subjectively experienced) is a significant predictor of suicide cognitions. Furthermore, it has been posited that satisfaction and hope are fundamental to life from an existential perspective. We, therefore, tested a hypothetical model of general work stress, suicide cognitions, hopelessness, and job satisfaction. The data were collected from 416 health-care workers through a convenience sampling method. The mediation analysis results revealed significant negative and positive relationships among general work stress, suicide conceptions, hopelessness, and job satisfaction. The findings indicate that hopelessness and job satisfaction have a parallel mediating effect in the relationship between general work stress and suicide cognitions. The result of the study is of great importance, which suggests that interventions to alleviate hopelessness and work stress and to boost the job satisfaction of medical staff may help prevent suicide cognitions.

Construction of a Musculoskeletal Discomfort Scale for the Lower Limbs of Workers: An Analysis Using the Multigroup Item Response Theory

Musculoskeletal symptoms are a major occupational health problem in workers, and these can affect all professional occupations. Previous studies have proposed metrics capable of evaluating the musculoskeletal discomfort experienced by workers. However, no study has developed a metric that considers professional groups. Thus, this study aimed to develop a scale for musculoskeletal discomfort in the lower limbs to compare self-reported symptoms among education, health, and industry professionals. The sample included 159 teachers, 167 health professionals, and 401 industrial operators who relayed their symptoms using a diagram of the hips, thighs, knees, lower legs, and feet. Factor and multigroup item response theory analyses were used to construct a musculoskeletal discomfort scale consisting of seven levels and to assess and compare the identified symptoms. The results showed that the progressive evolution of discomfort differed for each profession, demonstrating that each context and work environment affects workers differently, which may explain the different patterns of symptom responses among professional groups.

Do men and women have different musculoskeletal symptoms at the same musculoskeletal discomfort level?

Owing to biological and social factors, illness-related musculoskeletal symptoms tend to vary between men and women. However, in the past, conceptualised discomfort metrics were applied uniformly to both genders. This study aimed to develop a scale to measure musculoskeletal discomfort that compares the symptoms between men and women. The scale aimed to determine the gender-based response patterns related to symptoms. A total of 707 men and 1302 women reported their symptoms on a body map. Factor analysis and item response theory were used to differentiate the identified symptoms in the construction of a musculoskeletal discomfort scale. Differences in work exposure appeared to explain the symptom patterns between men and women. The scale had eight levels, and it was found that at the same level of discomfort, men and women reported symptoms in different body regions.Practitioner summary: On this discomfort scale, the response patterns of men and women were categorised into eight levels. Symptoms differed by gender at the same musculoskeletal discomfort level. This is in contrast to previous studies in which scales were devised without considering differences between the genders.Abbreviations: WMSDs: work-related musculoskeletal disorders; BMI: body mass index; FA: factor analysis; IRT: item response theory; KMO: Kaiser-Meyer-Olkin; BST: Bartlett's test of sphericity; F: factor loading; h2: communality; α: Cronbach's alpha; ωt: McDonald's omega; ai: parameters of discrimination of the items; bik: parameters of difficulty of response categories; θj: latent trait; RMSEA: root mean square error of approximation; CFI: comparative fit index; TLI: Tucker-Lewis index; odu: musculoskeletal discomfort units; RA: rarely; OF: often; AL: always.

Effects of multiple risk factors on upper limb musculoskeletal disorders among workers in inner Brazil

BACKGROUND: The literature discussing musculoskeletal diseases of inner northeastern workers is scarce, although 67,559 cases were reported in Brazil between 2007 and 2016. OBJECTIVE: This study aimed to evaluate the effect of multiple risk factors that influence the symptoms of work-related musculoskeletal disorders (WMSDs) in wrists, elbows, and shoulders in workers from four different economic sectors. METHODS: A sample included 420 workers from the inner regions of the Brazilian states of Alagoas and Bahia. The Nordic Musculoskeletal Questionnaire was used to capture pain symptoms on both sides of the body (left and right). Sociodemographic variables, items from the biomechanical exposure and organizational conditional, in addition to other questionnaires (JCQ, COPSOQ II, ERI) were used to assess the characteristics and occupational risks of the respondents. Ordinal logistic regression model was using to identify the relationship between symptoms and factors. RESULTS: This study highlights the psychosocial, biomechanical, occupational, and sociodemographic variables contributed to development of WMSDs. Use of hand-vibrating tool increased the likelihood of symptoms manifesting on the body. On the other hand, high job control and high job insecurity reduced the likelihood of developing symptoms. On the other hand, high job control and job satisfaction reduced the likelihood of developing symptoms. Factors such as age, curved spine, high job insecurity and excessive commitment contributed to the development of WMSDs only on one side of the body. CONCLUSIONS: The development of WMSDs is multifactorial. Sociodemographic, occupational, biomechanical, and psychosocial factors may commonly contribute to WMSD manifesting only on one side of the body more than on both sides.

Assessment of the influence of psychosocial factors on musculoskeletal disorder symptom intensity

BACKGROUND

Previous studies have observed that psychosocial factors are associated with an increase in work-related musculoskeletal disorders (WMSDs) in European countries. However, the influence of psychosocial factors on the WMSD symptoms has not been studied in detail. Additionally, working conditions differ between developing and developed countries.

OBJECTIVE

In this study, the influence of psychosocial factors on WMSD symptoms among men and women in the footwear industry in northeastern Brazil is investigated.

METHODS

A questionnaire survey was conducted to evaluate workers' perceptions of psychosocial factors and WMSD symptoms. The influence of psychosocial factors on WMSD symptom trends was observed through ordinal logistic regression models.

RESULTS

It was found that different psychosocial factors are related to WMSD symptom intensification. Factors such as "job insecurity" and "low social support," which are not associated with the worsening of WMSD symptoms in developed countries, showed a noticeable influence in the sample analyzed.

CONCLUSION

These findings may be associated with differences in working conditions and economic problems in developing countries, suggesting that some psychosocial factors have a different effect on workers' perceptions in developing countries.

Social support moderates the effect of stress on the cortisol awakening response in dementia family caregivers

Dementia caregiving has been associated with a range of adverse effects on the physical health of the caregiver. However, the specific mechanisms underlying the relationship between dementia caregiver stress and ill health remain unclear. The aim of this study was to investigate, using available prospective data, the relationship between perceived stress (burden) and pre-clinical indices of ill-health (cortisol awakening response and secretory immunoglobulin A) amongst dementia caregivers. The potential moderating effect of social support on the perceived stress-physiological stress/health relationship was also explored. Participants (N = 31) were caregivers of community-dwelling older adults living with dementia who were enroled in a psychoeducation support program and provided data (study questionnaire and saliva samples) at two timepoints (T1 and T2), 10 weeks apart. Hierarchical regressions were used to determine if changes in stress and social support predicted change in each of the physiological outcomes. Findings indicate that caregivers with more hours of care at T1, or with greater satisfaction with social support, were more likely to exhibit an adaptive cortisol awakening response at T2. Moreover, social support was found to buffer the effect of caregiver stress and hours of caregiving on the cortisol awakening response. Implications for future interventions targeting caregiver health are discussed.

Salivary Biomarkers and Work-Related Stress in Night Shift Workers

Work organization, such as shifts and night work, can interfere with the perception of work-related stress and therefore on the development of pathological conditions. Night shift work, particularly, can have a negative impact on workers’ wellbeing by interfering with the biological sphere. The aim of this study is to evaluate the associations between work activities, shift work effects and stress-related responses in 106 dock workers enrolled in southeast Italy. Dock workers’ tasks consist of complex activities that seemed to affect more sleep quality than work-related stress. An analysis of salivary biomarkers such as cortisol, α-amylase, melatonin and lysozyme was performed along with validated psycho-diagnostic questionnaires. Alpha-amylase showed a significant negative correlation with the effort/reward imbalance score; thus, the measurement of salivary α-amylase is proposed as a sensitive and non-invasive biomarker of work-related stress. This study may provide new insights into developing strategies for the management of night shift work. Salivary biomarkers should be further investigated in the future in order to develop simple and effective tools for the early diagnosis of work-related stress or its outcomes.

Empathy and job resources buffer the effect of higher job demands on increased salivary alpha amylase awakening responses in direct-care workers

The job demands-resources (JD-R) model has rarely been used in conjunction with physiological indicators of stress and ill-health. This study explored the associations between the JD-R model and physiological indicators of the stress response, while considering potential moderators of this relationship. Across 2 timepoints (summer-winter) direct-care workers completed questionnaires assessing job demands, job resources, empathy and self-efficacy, and provided morning saliva samples to assess physiological indices of stress and ill-health. Changes in job resources and empathy were positively correlated with changes in the cortisol awakening response (CAR). Further, changes in both job resources and empathy independently buffered the impact of higher job demands on increased salivary alpha amylase awakening response (sAA-AR) concentrations. These findings suggest that despite increased job demands, the sAA-AR decreased for direct-care workers that had perceived high job resources or who reported higher empathy. Potentially, job resources and empathy may act as a protective factor against the development of poor health associated with workplace stress.

An online mindfulness-based program is effective in improving affect, over-commitment, optimism and mucosal immunity

Previous studies have demonstrated mindfulness-based programs are effective in reducing workplace stress; however, few have investigated the effectiveness of online mindfulness-based programs. Physiological measures are also underutilised when examining the efficacy of these programs. Therefore, we assessed the efficacy of an online mindfulness-based program on both short-term and more enduring aspects of psychological and physiological measures of stress and ill-health. Participants (N = 22) completed an 8-week online mindfulness-based program. Immediately before and after a mindfulness session, participants completed questionnaires to assess the short-term effects on mood and state anxiety and provided saliva samples to assess salivary alpha amylase (sAA) concentrations. Additionally, pre and post the 8-week intervention, participants completed questionnaires assessing workplace stress, over-commitment, work engagement, dispositional mindfulness and personal resources. Saliva samples were collected to measure the cortisol awakening response, sAA awakening response and secretory immunoglobulin A (sIgA). Our findings demonstrate that online mindfulness-based programs induce short-term improvements in fatigue and anxiety in employees. Additionally, we also report a decrease in over-commitment and increases in optimism and mucosal immunity (sIgA) following the program.

The salivary alpha amylase awakening response is related to over-commitment

We assessed the relationship between physiological and psychological measures of workplace stress as measured by the effort-reward imbalance (ERI) model, with a seldom studied sample of owner-operator dairy farmers. Dairy farmers (N = 74) self-reported ERI, over-commitment (OC), dedication, and health then provided awakening saliva samples that were used to calculate the salivary alpha amylase awakening response (sAA-AR), cortisol awakening response (CAR), and salivary immunoglobulin A (sIgA) level. ERI, OC, and dedication levels were not related with sIgA or the CAR, but more over-committed farmers had a less pronounced sAA-AR. OC was more associated than ERI with the physiological indicators of stress, potentially due to the owner-operator sample used in this investigation. The suitability of sAA as a viable physiological measure of autonomic nervous system activity has been debated, but our findings promote its inclusion in future occupational stress research.

Allostatic Load and Effort-Reward Imbalance: Associations over the Working-Career

Although associations between work stressors and stress-related biomarkers have been reported in cross-sectional studies, the use of single time measurements of work stressors could be one of the reasons for inconsistent associations. This study examines whether repeated reports of work stress towards the end of the working career predicts allostatic load, a measure of chronic stress related physiological processes. Data from waves 2 to 6 of the English Longitudinal Study of Ageing (ELSA) were analysed, with a main analytical sample of 2663 older adults (aged 50+) who had at least one measurement of effort-reward imbalance between waves 2–6 and a measurement of allostatic load at wave 6. Cumulative work stress over waves 2–6 were measured by the effort-reward imbalance model. ELSA respondents who had reported two or more occasions of imbalance had a higher (0.3) estimate of the allostatic load index than those who did not report any imbalance, controlling for a range of health and socio-demographic factors, as well as allostatic load at baseline. More recent reports of imbalance were significantly associated with a higher allostatic load index, whereas reports of imbalance from earlier waves of ELSA were not. The accumulation of work related stressors could have adverse effects on chronic stress biological processes.

A Systematic Review and Meta-analysis of the Effort-Reward Imbalance Model of Workplace Stress and Hypothalamic-Pituitary-Adrenal Axis Measures of Stress

OBJECTIVE

The association between effort-reward imbalance (ERI) and various health outcomes has been well documented over the past 20 years, but the mechanisms responsible for this association remain unclear. The present meta-analysis assessed the associations of ERI and overcommitment (OC) in the workplace with hypothalamic-pituitary-adrenal (HPA) axis measures.

METHODS

Electronic databases were searched with the phrase "effort*reward*imbalance," which yielded 319 studies leading to 56 full-text studies being screened. Thirty-two studies within 14 articles met inclusion criteria and were meta-analyzed using mixed and random effects models.

RESULTS

Greater ERI was associated with increased HPA axis activity (r = .09, p < .001, k = 14, N = 2541). The cortisol awakening response (r = .14, p < .001, k = 9, N = 584) and cortisol waking concentrations (r = .12, p = .01, k = 6, N = 493) were the only HPA measures associated with ERI. OC was also associated with greater HPA axis activity (r = .06, p < .01, k = 10, N = 1918). Cortisol (PM) (r = .13, p = .02, k = 3, N = 295) was the only HPA measure associated with OC.

CONCLUSIONS

ERI and OC were similarly related with HPA responsivity. However, because OC moderated the relationship between ERI and HPA axis markers, the importance of OC should not be overlooked. Because OC is likely more malleable than ERI to intervention, this may be a promising avenue for future research.

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.

An experimental examination of the effort-reward imbalance model of occupational stress: Increased financial reward is related to reduced stress physiology

Effort-reward imbalance in the workplace is linked to a variety of negative health and organisational outcomes, but it has rarely been assessed experimentally. We manipulated reward (while keeping effort constant) in a within-subjects design with female participants (N=60) who were randomly assigned to high and standard reward conditions within a simulated office environment. Self-report, behavioural (task performance), and physiological (heart rate variability, salivary alpha amylase) measures assessed the impact of increased financial reward. Participants reported increased perceptions of reward, performed moderately better on the task, and were less physiologically reactive in the high reward versus the standard condition. These findings highlight the importance of assessing both subjective self-reports of stress together with objective physiological measures of stress, and suggest that increasing monetary rewards has the potential to decrease stress physiological reactivity, and in turn, reduce the risk of ill-health in employees, and may also positively influence task efficacy.

A systematic review and meta-analysis of the effort-reward imbalance model of workplace stress with indicators of immune function

OBJECTIVE

Despite considerable research into associations between the effort reward imbalance (ERI) model and various health outcomes over the past 20years, the underlying mechanisms responsible for the association remain unclear. Recently, ERI investigations have examined associations with immune sub-systems (e.g., leukocytes, cytokines and immunoglobulins). Synthesis of the amalgamated research evidence will aid clarity to this field of enquiry. We conducted a meta-analysis and reviewed the associations of ERI and over-commitment (OC) in the workplace with immunity.

METHOD

Electronic databases were searched with the phrase 'effort reward imbalance' which initially yielded 319 studies leading to 57 full text studies being screened. Seven studies that met inclusion criteria were combined using mixed and random effects models.

RESULTS

Greater ERI was associated with lower immunity (r=-0.09, CI -0.14, -0.05, p<0.001). Sub-group analyses revealed the effect with mucosal immunity was stronger (r=-0.33, CI -0.47 to -0.18) than trends between both cytokine (r=-0.04, CI -0.07, -0.01) and leukocyte sub-groups (r=-0.02 CI -0.04, 0.01) respectively (k=7, N=9952). Over-commitment was also associated with lower immunity (r=-0.05, CI -0.09, 0.01, p=0.014); subgroup (leukocytes, cytokines, mucosal immunity) associations, however, were homogenous (Q=1.83, df=2, p=0.400, k=6, N=2358).

CONCLUSIONS

Greater ERI and OC were both associated with lower immunity. The association between mucosal immunity and ERI was stronger than the cytokine and leukocyte sub-groups. OC moderated the relationship between ERI and immunity.

Associations of Extrinsic and Intrinsic Components of Work Stress with Health: A Systematic Review of Evidence on the Effort-Reward Imbalance Model

Mainstream psychological stress theory claims that it is important to include information on people’s ways of coping with work stress when assessing the impact of stressful psychosocial work environments on health. Yet, some widely used respective theoretical models focus exclusively on extrinsic factors. The model of effort-reward imbalance (ERI) differs from them as it explicitly combines information on extrinsic and intrinsic factors in studying workers’ health. As a growing number of studies used the ERI model in recent past, we conducted a systematic review of available evidence, with a special focus on the distinct contribution of its intrinsic component, the coping pattern “over-commitment”, towards explaining health. Moreover, we explore whether the interaction of intrinsic and extrinsic components exceeds the size of effects on health attributable to single components. Results based on 51 reports document an independent explanatory role of “over-commitment” in explaining workers’ health in a majority of studies. However, support in favour of the interaction hypothesis is limited and requires further exploration. In conclusion, the findings of this review support the usefulness of a work stress model that combines extrinsic and intrinsic components in terms of scientific explanation and of designing more comprehensive worksite stress prevention programs.

Effort-Reward Imbalance and Post-Traumatic Stress After a Workplace Terror Attack

Objective

Following adverse work conditions, health consequences can be explained by an imbalance between the effort made and the reward received. We investigated the association between extra effort, perceived reward, and post-traumatic stress disorder (PTSD). The Effort-Reward Imbalance Model was used to examine whether extra effort at work in the aftermath of a workplace-related terrorist attack affected the risk of PTSD and the effects of reward for extra effort from a leader or colleagues.

Methods

Cross-sectional data were collected 10 months after a terrorist attack in Norway in 2011. Out of 3520 Ministry employees invited, 1927 agreed to participate. Employees reported any extra effort performed as a result of the bomb explosion and any reward received from a leader or colleagues. PTSD was assessed with the PTSD Checklist.

Results

Employees who reported extra effort displayed increased risk for PTSD (odds ratio [OR]=1.71, 95% confidence interval [CI]: 1.15-2.55, P=0.008). Perceived reward for extra effort from a leader was associated with lower risk for PTSD (OR=0.39, 95% CI: 0.23-0.64, P<0.001) but not perceived reward from colleagues.

Conclusions

Extra effort may increase the risk of PTSD, but reward from a leader may mitigate this effect. The Effort-Reward Imbalance Model appears to be an appropriate approach that may contribute to understanding of the etiology of work-related PTSD. (Disaster Med Public Health Preparedness. 2016;10:219–224)

Salivary Immunoglobulin A Secretion Rate Is Negatively Associated with Cancer Mortality: The West of Scotland Twenty-07 Study

Immunoglobulins are essential for combating infectious disease although very high levels can indicate underlying pathology. The present study examined associations between secretory immunoglobulin A (sIgA) in saliva and mortality rates in the general population. Participants were 639 adults from the eldest cohort of the West of Scotland Twenty-07 Study aged 63 years at the time of saliva sampling in 1995. From unstimulated 2-minute saliva samples, saliva volume and S-IgA concentration were measured, and S-IgA secretion rate determined as their product. Mortality data were tracked for 19 years. Cox proportional hazard models were applied to compute hazard ratios (HR) for all-cause mortality from sIgA secretion rate. Associations were adjusted for gender, assay batch, household occupational group, smoking, medication usage, and self-reported health. There was a negative association between log sIgA secretion rate and all-cause mortality, HR = 0.81, 95%CI = 0.73–0.91, p < .001. Further analysis of specific causes of mortality revealed that the all-cause association was due to an underlying association with cancer mortality and in particular with cancers other than lung cancer. The HR for non-lung cancer was 0.68 (95%CI = 0.54 to 0.85) implying a 32% reduction in mortality risk per standard deviation rise in log sIgA secretion rate. Effects were stronger for men than women. For deaths from respiratory diseases, sIgA secretion had a non-linear relationship with mortality risk whereby only the very lowest levels of secretion were associated with elevated risk. SIgA concentration revealed a similar but weaker pattern of association. In the present study, higher secretion rates of sIgA were associated with a decreased risk of death from cancer, specifically non-lung cancer, as well as from respiratory disease. Thus, it appears that sIgA plays a protective role among older adults, and could serve as a marker of mortality risk, specifically cancer mortality.

An experimental study of the job demand-control model with measures of heart rate variability and salivary alpha-amylase: Evidence of increased stress responses to increased break autonomy

We assessed in an experimental design whether the stress response towards a work task was moderated by the autonomy to choose a break during the assigned time to complete the task. This setting is defined in accordance with the theoretical framework of the job-demand-control (JDC) model of work related stress. The findings from naturalistic investigations of a stress-buffering effect of autonomy (or 'buffer hypothesis') are equivocal and the experimental evidence is limited, especially with relation to physiological indices of stress. Our objective was to investigate if increased autonomy in a particular domain (break time control) was related with adaptive physiology using objective physiological markers of stress; heart rate variability (HRV) and salivary alpha amylase (sAA). We used a within-subject design and the 60 female participants were randomly assigned to an autonomy (free timing of break) and standard conditions (fixed timing of break) of a word processing task in a simulated office environment in a random order. Participants reported increased perceptions of autonomy, no difference in demand and performed worse in the task in the break-time autonomy versus the standard condition. The results revealed support for the manipulation of increased autonomy, but in the opposing direction. Increased autonomy was related with dysregulated physiological reactivity, synonymous with typical increased stress responses. Potentially, our findings may indicate that autonomy is not necessary a resource but could become an additional stressor when it adds additional complexity while the amount of work (demands) remains unchanged. Further, our findings underscore the need to collect objective physiological evidence of stress to supplement self-reported information. Self-report biases may partially explain the inconsistent findings with the buffer hypothesis.

The effort-reward imbalance work-stress model and daytime salivary cortisol and dehydroepiandrosterone (DHEA) among Japanese women

We examined the influence of work-related effort-reward imbalance and overcommitment to work (OC), as derived from Siegrist's Effort-Reward Imbalance (ERI) model, on the hypothalamic-pituitary-adrenocortical (HPA) axis. We hypothesized that, among healthy workers, both cortisol and dehydroepiandrosterone (DHEA) secretion would be increased by effort-reward imbalance and OC and, as a result, cortisol-to-DHEA ratio (C/D ratio) would not differ by effort-reward imbalance or OC. The subjects were 115 healthy female nursery school teachers. Salivary cortisol, DHEA, and C/D ratio were used as indexes of HPA activity. Mixed-model analyses of variance revealed that neither the interaction between the ERI model indicators (i.e., effort, reward, effort-to-reward ratio, and OC) and the series of measurement times (9:00, 12:00, and 15:00) nor the main effect of the ERI model indicators was significant for daytime salivary cortisol, DHEA, or C/D ratio. Multiple linear regression analyses indicated that none of the ERI model indicators was significantly associated with area under the curve of daytime salivary cortisol, DHEA, or C/D ratio. We found that effort, reward, effort-reward imbalance, and OC had little influence on daytime variation patterns, levels, or amounts of salivary HPA-axis-related hormones. Thus, our hypotheses were not supported.