Effort reward imbalance is associated with vagal withdrawal in Danish public sector employees

Objective assessment of mental stress in individuals with different levels of effort reward imbalance or overcommitment using heart rate variability: a systematic review

BACKGROUND

Workloads are increasing and could cause mental stress, e.g., in the form of subjective effort reward imbalance (ERI) and overcommitment (OC). The heart rate variability (HRV) is a valid method for objective monitoring of workload. The aim of this project is to systematically evaluate the literature on HRV as an objective indicator for mental stress in individuals with different levels of ERI or OC.

METHODS

A systematic literature review examining HRV of employees in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for reporting systematic reviews was performed. Electronic databases used were PubMed, Ovid, Cochrane Libary, Scopus and Web of Science, PsyInfo, Psyndex, and Livio. Only articles from 2005 to 2021 were included. Inclusion criteria were case-control studies, intervention studies, cross-sectional studies, or longitudinal studies with different levels of ERI and/or OC, >10 participants in each group, measurement of 24h HRV by using Holter ECG or chest belt, and full-text in English or German language. The methodological quality was evaluated by using a modified STARD for HRV.

RESULTS

Five studies matched the inclusion criteria by using HRV (24-h ECG) with a different HRV analysis at day and night. It showed an adaptation of HRV with higher ERI or OC with reduced parasympathetic HRV parameters, but the studies were not comparable.

CONCLUSIONS

There is a need for occupational health studies that examine strains and stress of different employees with predominantly mental stress. The well-established parasympathetic mediated HRV parameters seem to be suitable parameters to objectify the stress.

A Stress Relief App Intervention for Newly Employed Nursing Staff: Quasi-Experimental Design

Background

Most newly employed nurses have limited practical experience, lack problem-solving abilities, and have low resistance to stress, and therefore often opt to resign from the nursing profession.

Objective

This study aimed to assess the effectiveness of a stress relief app (SR_APP) to monitor the stress levels of newly employed nurses.

Methods

We conducted a quasi-experiment to assess changes in stress levels of newly employed nurses at a case hospital, in which the experimental group used the SR_APP and the control group did not. In-depth interviews were conducted to reveal insights regarding their stress. The app usage experiences of experimental group members were assessed via a questionnaire.

Results

All the participants appreciated the experiment and were interested to know more about managing their stress. The experimental group members showed significant differences in heart rate variability scores before and after using the SR_APP, and they reported high levels of intention to use and satisfaction with regard to the SR_APP.

Conclusions

The SR_APP can be effective in helping newly employed nurses to manage their stress.

Associations of sympathetic and parasympathetic activity in job stress and burnout: A systematic review

This systematic review examines the relationship between sympathetic and parasympathetic activity on the one hand and job stress and burnout on the other, and is registered at PROSPERO under CRD42016035918. Background: Previous research has shown that prolonged job stress may lead to burnout, and that differences in heart rate variability are apparent in people who have heightened job stress. Aims: In this systematic review, the associations between job stress or burnout and heart rate (variability) or skin conductance are studied. Besides, it was investigated which–if any–guidelines are available for ambulatory assessment and reporting of the results. Methods: We extracted data from relevant databases following the PRESS checklist and contacted authors for additional resources. Participants included the employed adult population comparing validated job stress and burnout questionnaires examining heart rate and electrodermal activity. Synthesis followed the PRISMA guidelines of reporting systematic reviews. Results: The results showed a positive association between job stress and heart rate, and a negative association between job stress and heart rate variability measures. No definite conclusion could be drawn with regard to burnout and psychophysiological measures. No studies on electrodermal activity could be included based on the inclusion criteria. Conclusions: High levels of job stress are associated with an increased heart rate, and decreased heart rate variability measures. Recommendations for ambulatory assessment and reporting (STROBE) are discussed in light of the findings.

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.

Improving Managers' Psychophysical Well-Being: Effectiveness of Respiratory Sinus Arrhythmia Biofeedback

High work stress has been consistently associated with disturbed autonomic balance, specifically, lowered vagal cardiac control and increased sympathetic activity, which may lead to increased cardiovascular risk. Stress management procedures have been proposed to reduce autonomic dysfunctions related to work stress in different categories of workers exposed to heightened work demands, while a limited number of studies addressed this issue in managers. The present study was aimed at evaluating the effectiveness of a respiratory sinus arrhythmia (RSA) biofeedback (BF) intervention on psychological and physiological outcomes, in managers with high-level work responsibilities. Thirty-one managers leading outstanding private or public companies were randomly assigned to either a RSA-BF training (RSA-BF; N = 16) or a control group (N = 15). The RSA-BF training consisted of five weekly 45 min sessions, designed to increase RSA, whereas controls had to provide a daily stress diary once a week. After the training, managers in both groups reported reduced heart rate at rest, lower anxiety levels and improvement in health-related quality of life. More importantly, managers in the RSA-BF group showed increased vagal control (as indexed by increased RSA), decreased sympathetic arousal (as indexed by reduced skin conductance and systolic blood pressure) and lower emotional interferences, compared to managers in the control group. Results from this study showed that RSA-BF training was effective in improving cardiac autonomic balance at rest. Moreover, findings from this study underline the effectiveness of biofeedback in reducing psychophysiological negative outcomes associated with stress in managers.

Office workers with high effort-reward imbalance and overcommitment have greater decreases in heart rate variability over a 2-h working period

PURPOSE

High levels of workplace psychosocial factors have been associated with adverse cardiovascular outcomes, possibly through the pathway of increasing autonomic arousal. The purpose of this study was to investigate whether the workplace psychosocial factors of effort-reward imbalance (ERI) and overcommitment were associated with greater decreases in heart rate variability (HRV) across a 2-h working period in a cohort of office workers performing their own work at their own workplaces.

METHODS

Measurements of HRV in 5-min time epochs across a 2-h morning or afternoon working period, as well as self-reports of ERI and overcommitment, were collected for 91 office workers.

RESULTS

There was a negative and significant (p < 0.01) ERI*time interaction for the standard deviation of the interval between normal heart beats (SDNN), the square root of the mean squared differences of successive normal heart beats (RMSSD), and the power in the high-frequency range of the heart rate signal (HF power), and a positive and significant ERI*time interaction for the ratio of power in the low-frequency range of the heart rate signal divided by the HF power (LF/HF ratio). There was a positive and significant overcommitment*time interaction for the LF/HF ratio (p < 0.01) in the morning, and a negative and significant overcommitment*time interaction for SDNN, RMSSD, and HF power (p < 0.01) in the afternoon.

CONCLUSIONS

The results indicate that participants exposed to high levels of ERI and overcommitment exhibited a more adverse cardiovascular response (a greater decrease in HRV throughout the 2-h measurement period) compared to their colleagues with lower levels of these factors.

The role of physical activity and heart rate variability for the control of work related stress

Physical activity (PA) and exercise are often used as tools to reduce stress and therefore the risk for developing cardiovascular diseases (CVD). Meanwhile, heart rate variability (HRV) has been utilized to assess both stress and PA or exercise influences. The objective of the present review was to examine the current literature in regards to workplace stress, PA/exercise and HRV to encourage further studies. We considered original articles from known databases (PubMed, ISI Web of Knowledge) over the last 10 years that examined these important factors. A total of seven studies were identified with workplace stress strongly associated with reduced HRV in workers. Longitudinal workplace PA interventions may provide a means to improve worker stress levels and potentially cardiovascular risk with mechanisms still to be clarified. Future studies are recommended to identify the impact of PA, exercise, and fitness on stress levels and HRV in workers and their subsequent influence on cardiovascular health.

Autonomic nervous system activity and workplace stressors--a systematic review

AIM

This systematic review evaluates and summarizes the evidence of the association between psychosocial work environment as indicated by several work-stress models such as Job-Demand-Control (JDC), Effort-Reward-Imbalance (ERI), or Organizational Justice (OJ) and autonomic nervous system (ANS) function as indexed by heart rate variability (HRV).

METHOD

We conducted a systematic literature search following the PRISMA-Statement in eleven databases including Medline, Web of Science and PsycINFO to address medical as well as psychological aspects of the relation between psychosocial work-stress models and HRV.

RESULTS

We identified 19 publications with a total of 8382 employees from ten countries reporting data from the years 1976-2008. Overall, nine of all studies report a negative and significant association between vagally-mediated HRV and measures of stress at work, while eight of all studies report a negative and significant association to mixed sympathetic and parasympathetic measures of HRV.

CONCLUSIONS

This systematic review provides evidence that adverse psychosocial work conditions are negatively associated with ANS function as indexed by HRV.

Occupation as a risk factor for hypertensive disorders of pregnancy

BACKGROUND

Hypertensive disorders of pregnancy (HDP) are leading causes of morbidity and mortality and have been rising in incidence. Little is known about the effects of worker classifications on HDP. This large-scale study examines associations between occupational classifications and HDP.

METHODS

We examined 385,537 Texas Electronic Registrar Birth Registration 2005 birth certificates. Maternal occupations were coded using the Standard Occupational Classification (SOC). Crude and adjusted risks for HDP among working women within occupational groupings were analyzed and compared with risks of nonemployed women.

RESULTS

The risk of developing HDP varies across SOC occupational classifications. After controlling for known confounders, women employed in business, management, and the legal and social services, teaching, counseling, and healthcare professions are at higher risk for developing HDP than women employed in support industries, such as food preparation, housekeeping, cosmetic and personal care services, or nonemployed women. Women employed in computer, engineering, architectural, and scientific occupations also carry greater risks, although these increased risks do not affect women of normal weight.

CONCLUSIONS

Worker classification is an independent risk factor for HDP. Additional work must be done to examine the complex interactions among individual maternal genetics, biology, and physical and mental abilities and how they affect adverse health outcomes. Examining job stressors may shed light on these occupational variations and their potential HDP associations. Strategies to mitigate job stressors in the workplace should be considered.