Work-Related Stress Questionnaire: confirmatory factor analysis for construct validation by the PHRASI study

OBJECTIVE

The purpose of this study is to validate the 13-item version of the Work-Related Stress Questionnaire (WRSQ) on a representative sample of Italian public health residents.

MATERIALS AND METHODS

The WRSQ was administered as part of the Public Health Residents' Anonymous Survey in Italy (PHRASI) from 14 June to 26 July 2022. Collinearity between each questionnaire item was assessed with Kendall's τ statistic. The latent factors identified associating similar items based on the authors' observations were workplace, job demand, support and unpleasant workplace. Goodness-of-fit was assessed with confirmatory factor analysis calculating: Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), Standardized Root-Mean-Residual (SRMR). Cronbach's alpha (α) and Omega McDonald (ω) were calculated to evaluate the reliability of the questionnaire. R 4.2.2 was used to perform the analyses.

RESULTS

379 Public Health residents (58% women) responded to the questionnaire. No significant collinearity was found between the items (τ range -0.31 to 0.49). Confirmatory Factor Analysis showed CFI = 0.975, TLI = 0.967, RMSEA = 0.041 and SRMR = 0.051. Internal consistency of the WRSQ Total Score was α = 0.80 and ω = 0.85.

CONCLUSIONS

Although validated in a sectorial subpopulation of healthcare workers, the WRSQ proved to be an excellent tool for assessing work-related stress. Unpleasant workplace latent factors showed lower factor loading and internal consistency than others. This could be due to the fact that topics investigated with unpleasant workplace items (e.g., abuse and discrimination) are experienced on a less regular basis than the ones assessed through the other items.

One-year trajectories of mental health and work outcomes post return to work in patients with common mental disorders

BACKGROUND

We investigated one-year trajectories of symptom recovery, work functioning and the return to work percentage (RTW%) among patients with common mental disorders (CMDs).

METHODS

Data were used from a cluster-randomised controlled trial evaluating a problem-solving intervention for CMD patients (N = 158) who had returned to work. Information on anxiety and depressive symptoms, work functioning and RTW% was collected at baseline and 3, 6 and 12 months follow-up. Latent class growth analyses were used to identify trajectories for the four outcomes and investigate how these trajectories clustered in higher order latent classes. Additionally, we investigated the relation between patient characteristics and class membership.

RESULTS

We identified four trajectories for all four outcomes and derived three higher order latent classes: slow recovery (42% [66/158]) (high anxiety and depressive symptoms, moderate to low work functioning and fast RTW); fast recovery (25% [40/158]) (low anxiety and depressive symptoms, high work functioning and fast RTW); and gradual recovery (33% [52/158] (decreasing anxiety and depressive symptoms, increasing or low work functioning and fast RTW). Participants with a higher work engagement and readiness to stay at work were more likely to belong to the fast recovery class.

LIMITATIONS

Due to the relatively small sample size, some trajectories consisted of few participants. Symptom severity was self-reported.

CONCLUSIONS

Many CMD patients experience high levels of mental health symptoms and work functioning problems during the year post RTW. Creating realistic recovery expectations (for both patients and their environments) could be important for successful and sustainable recovery and work participation.

Impact of childhood and adulthood psychological health on labour force participation and exit in later life

BACKGROUND

Adulthood psychological health predicts labour force activity but few studies have examined childhood psychological health. We hypothesized that childhood psychological ill-health would be associated with labour force exit at 55 years.

METHOD

Data were from the 55-year follow-up of the National Child Development Study (n = 9137). Labour force participation and exit (unemployment, retirement, permanent sickness, homemaking/other) were self-reported at 55 years. Internalizing and externalizing problems in childhood (7, 11 and 16 years) and malaise in adulthood (23, 33, 42, 50 years) were assessed. Education, social class, periods of unemployment, partnership separations, number of children, and homemaking activity were measured throughout adulthood.

RESULTS

Childhood internalizing and externalizing problems were associated with unemployment, permanent sickness and homemaking/other at 55 years, after adjustment for adulthood psychological health and education: one or two reports of internalizing was associated with increased risk for unemployment [relative risk (RR) 1.59, 95% confidence interval (CI) 1.12-2.25; RR 2.37, 95% CI 1.48-3.79] and permanent sickness (RR 1.32, 95% CI 1.00-1.74; RR, 1.48, 95% CI 1.00-2.17); three reports of externalizing was associated with increased risk for unemployment (RR 2.26, 95% CI 1.01-5.04), permanent sickness (RR 2.63, 95% CI 1.46-4.73) and homemaking/other (RR 1.95, 95% CI 1.00-3.78).

CONCLUSIONS

Psychological ill-health across the lifecourse, including during childhood, reduces the likelihood of working in older age. Support for those with mental health problems at different life stages and for those with limited connections to the labour market, including homemakers, is an essential dimension of attempts to extend working lives.

Job stress: an in-depth investigation based on the HSE questionnaire and a multistep approach in order to identify the most appropriate corrective actions

BACKGROUND

Psychosocial hazards and work-related stress have reached epidemic proportions in Europe. The Italia law introduced in 2008 the obligation for Italian companies to assess work related stress risk in order to protect their workers' safety and health. The purpose of our study was to propose an accurate measurement tool, using the HSE indicator tool, for more appropriate and significant work-related stress' prevention measures.

METHODS

The study was conducted on 204 visual display unit (VDU) operators: 106 male and 98 female. All subjects were administered the HSE questionnaire. The sample was studied through a 4 step process, using HSE analysis tool and a statistical analysis, based on the odds ratio calculation.

RESULTS

The assessment model used demonstrated the presence of work related stress in VDU operators and additional "critical" aspects which had failed to emerge by the classical use of HSE analysis tool.

DISCUSSION

The approach we propose allows to obtain a complete picture of the perception of work-related stress and can point out the most appropriate corrective actions.

Childhood adversity and midlife suicidal ideation

BACKGROUND

Childhood adversity predicts adolescent suicidal ideation but there are few studies examining whether the risk of childhood adversity extends to suicidal ideation in midlife. We hypothesized that childhood adversity predicts midlife suicidal ideation and this is partially mediated by adolescent internalizing disorders, externalizing disorders and adult exposure to life events and interpersonal difficulties.

METHOD

At 45 years, 9377 women and men from the UK 1958 British Birth Cohort Study participated in a clinical survey. Childhood adversity was prospectively assessed at the ages of 7, 11 and 16 years. Suicidal ideation at midlife was assessed by the depressive ideas subscale of the Revised Clinical Interview Schedule. Internalizing and externalizing disorders were measured by the Rutter scales at 16 years. Life events, periods of unemployment, partnership separations and alcohol dependence were measured through adulthood.

RESULTS

Illness in the household, paternal absence, institutional care, parental divorce and retrospective reports of parental physical and sexual abuse predicted suicidal ideation at 45 years. Three or more childhood adversities were associated with suicidal ideation at 45 years [odds ratio (OR) 4.31, 95% confidence interval (CI) 2.67-6.94]. Psychological distress at 16 years partially mediated the associations of physical abuse (OR 3.41, 95% CI 2.29-5.75), sexual abuse (OR 4.99, 95% CI 2.90-11.16) with suicidal ideation. Adult life events partially mediated the association of parental divorce (OR 6.34, 95% CI -7.16 to 36.75) and physical (OR 9.59, 95% CI 4.97-27.88) and sexual abuse (OR 6.59, 95% CI 2.40-38.36) with suicidal ideation at 45 years.

CONCLUSIONS

Adversity in childhood predicts suicidal ideation in midlife, partially mediated by adolescent internalizing and externalizing disorders, adult life events and interpersonal difficulties. Understanding the pathways from adversity to suicidal ideation can inform suicide prevention and the targeting of preventive interventions.

Sociodemographic Factors, Smoking and Common Mental Disorder in the Renfrew and Paisley (MIDSPAN) Study

The relationships between common mental disorder measured by the General Health Questionnaire and sociodemographic variables and cigarette smoking were examined from baseline data in a community study of 15,406 men and women, aged between 45 and 64 years from two towns close to Glasgow. Between 1972 and 1976 all those respondents from Renfrew and Paisley between the ages of 45 and 64 years who met the residency criteria were invited to attend community clinics, where a clinical examination was carried out and the General Health Questionnaire was completed by 3783 (53.6 percent) men, and 4683 (56.1 percent) women. Women had a higher risk of disorder than men did. More women (20.3 percent) than men (15.4 percent) were possible cases of common mental disorder. Women showed a decrease in disorder with age but no apparent trend in men was observed. Marital status was significantly associated with disorder, with the widowed and separated showing especially high rates of psychiatric disorder. Married men, in contrast to married women, had relatively low levels of psychiatric disorder. Both social class and level of deprivation of the area were associated with psychiatric disorder. For both men and women there was a trend in disorder associated with social class; men in social class V had twice the level of psychiatric disorder compared to those in social class II. For women there was a shallow gradient showing higher levels of disorder with lower social class. Smoking habits were also related to psychiatric disorder; never- and exsmokers had relatively low rates of psychiatric disorder whereas, among current smokers, risk of psychiatric disorder, increased with the number of cigarettes smoked, though only for women.

Noise sensitivity and future risk of illness and mortality

Aircraft and road traffic noise exposure increase the risk of cardiovascular disease (CVD). Noise annoyance is the most frequent response to environmental noise. Noise annoyance has been shown to modify the association of transport noise exposure on CVD and noise sensitivity moderates the annoyance response to noise. This study uses prospective data from phases 1, 3, 5, 7 and 9 in 3630 male and female civil servants from the UK Whitehall II Study to examine whether a single question on noise sensitivity measured by annoyance responses to noise in general predicts physical and mental ill-health and mortality. Non-fatal myocardial infarction and stroke morbidity over the follow-up were defined by MONICA criteria based on study ECGs, hospital records, hospital admission statistics or General Practitioner confirmation. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D) and psychological distress by the General Health questionnaire (GHQ). There was no association between noise sensitivity and CVD morbidity or mortality except in people from lower employment grades where there was an association with angina. Noise sensitivity was a consistent predictor of depressive symptoms and psychological distress at phases 3, 5 and 7. High noise sensitivity scores at baseline predicted GHQ caseness at phase 3 adjusting for age, sex, employment grade, self-rated health and GHQ caseness at baseline (OR=1.56 95% CI 1.29-1.88). Noise sensitivity has been identified as a predictor of mental ill-health. More longitudinal research is needed including measures of noise exposure.

Use of self-administered instruments to assess psychiatric disorders in older people: validity of the General Health Questionnaire, the Center for Epidemiologic Studies Depression Scale and the self-completion version of the revised Clinical Interview Schedule

BACKGROUND

Diagnosis of depressive disorder using interviewer-administered instruments is expensive and frequently impractical in large epidemiological surveys. The aim of this study was to assess the validity of three self-completion measures of depressive disorder and other psychiatric disorders in older people against an interviewer-administered instrument.

METHOD

A random sample stratified by sex, age and social position was selected from the Whitehall II study participants. This sample was supplemented by inclusion of depressed Whitehall II participants. Depressive disorder and other mental disorders were assessed by the interviewer-administered structured revised Clinical Interview Schedule (CIS-R) in 277 participants aged 58-80 years. Participants also completed a computerized self-completion version of the CIS-R in addition to the General Health Questionnaire (GHQ) and the Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

The mean total score was similar for the interviewer-administered (4.43) and self-completion (4.35) versions of the CIS-R [95% confidence interval (CI) for difference -0.31 to 0.16]. Differences were not related to sex, age, social position or presence of chronic physical illness. Sensitivity/specificity of self-completion CIS-R was 74%/98% for any mental disorder and 75%/98% for depressive episode. The corresponding figures were 86%/87% and 78%/83% for GHQ and 77%/89% and 89%/86% for CES-D.

CONCLUSIONS

The self-completion computerized version of the CIS-R is feasible and has good validity as a measure of any mental disorder and depression in people aged ≥ 60 years. GHQ and CES-D also have good criterion validity as measures of any mental disorder and depressive disorder respectively.

Common mental disorders, unemployment and psychosocial job quality: is a poor job better than no job at all?

BACKGROUND

Employment is associated with health benefits over unemployment, but the psychosocial characteristics of work also influence health. There has, however, been little research contrasting the prevalence of psychiatric disorders among people who are unemployed with those in jobs of differing psychosocial quality.

METHOD

Analysis of data from the English Adult Psychiatric Morbidity Survey (APMS) considered the prevalence of common mental disorders (CMDs) among 2603 respondents aged between 21 and 54 years who were either (i) employed or (ii) unemployed and looking for work at the time of interview in 2007. Quality of work was assessed by the number of adverse psychosocial job conditions reported (low control, high demands, insecurity and low job esteem).

RESULTS

The prevalence of CMDs was similar for those respondents who were unemployed and those in the poorest quality jobs. This pattern remained after controlling for relevant demographic and socio-economic covariates.

CONCLUSIONS

Although employment is thought to promote mental health and well-being, work of poor psychosocial quality is not associated with any better mental health than unemployment. Policy efforts to improve community mental health should consider psychosocial job quality in conjunction with efforts to increase employment rates.

Occupations, work characteristics and common mental disorder

BACKGROUND

The present study aimed to assess the prevalence of common mental disorders (CMDs) by occupation in a representative sample of the English adult population. Another aim was to examine whether the increased risk of CMD in some occupations could be explained by adverse work characteristics. Method We derived a sample of 3425 working-age respondents from the Adult Psychiatric Morbidity Survey 2007. Occupations were classified by Standard Occupational Classification group, and CMD measured by the Revised Clinical Interview Schedule. Job characteristics were measured by questionnaire, and tested as explanatory factors in associations of occupation and CMD.

RESULTS

After adjusting for age, gender, housing tenure and marital status, caring personal service occupations had the greatest risk of CMD compared with all occupations (odds ratio 1.73, 95% confidence interval 1.16-2.58). The prevalence of adverse psychosocial work characteristics did not follow the pattern of CMD by occupation. Work characteristics did not explain the increased risk of CMDs associated with working in personal service occupations. Contrary to our hypotheses, adding work characteristics individually to the association of occupation and CMD tended to increase rather than decrease the odds for CMD.

CONCLUSIONS

As has been found by others, psychosocial work characteristics were associated with CMD. However, we found that in our English national dataset they could not explain the high rates of CMD in particular occupations. We suggest that selection into occupations may partly explain high CMD rates in certain occupations. Also, we did not measure emotional demands, and these may be important mediators of the relationship between occupation type and CMDs.

Born into adversity: psychological distress in two birth cohorts of second-generation Irish children growing up in Britain

Background

Worldwide, the Irish diaspora experience health inequalities persisting across generations. The present study sought to establish the prevalence of psychological morbidity in the children of migrant parents from Ireland, and reasons for differences.

Methods

Data from two British birth cohorts were used for analysis. Each surveyed 17 000 babies born in one week in 1958 and 1970 and followed up through childhood. Validated scales assessed psychological health.

Results

Relative to the rest of the cohort, second-generation Irish children grew up in material hardship and showed greater psychological problems at ages 7, 11 (1958 cohort) and 16 (both cohorts). Adjusting for material adversity and maternal psychological distress markedly reduced differences. Relative to non-Irish parents, Irish-born parents were more likely to report chronic health problems (odds ratio [OR]: 1.29; 95% confidence interval [CI]: 1.08–1.54), and Irish-born mothers were more likely to be psychologically distressed (OR: 1.44; 95% CI: 1.13–1.84, when child was 10). Effect sizes diminished once material adversity was taken into account.

Conclusions

Second-generation Irish children experienced high levels of psychological morbidity, but this was accounted for through adverse material circumstances in childhood and psychological distress in parents. Public health initiatives focusing on settlement experiences may reduce health inequalities in migrant children.

Annoyance and other reaction measures to changes in noise exposure - a review

INTRODUCTION

Noise is increasingly recognised as a potentially important environmental pollutant but most studies on human responses to noise exposure relate to steady state situations. Effects may differ when noise changes rapidly, e.g. after noise mitigation interventions or with changes in road or airport configurations.

METHODS

A systematic review of studies on human reactions to changes in environmental noise exposures published from 1980 to March 2011 was conducted.

RESULTS

41 papers satisfied the inclusion criteria. The most commonly studied outcomes were annoyance (23 papers) and sleep disturbance (11 papers). Other reactions were well-being, activity disturbance and use of living environment. No studies including physiological or disease measures were identified. The most commonly used study design was a written survey. Studies were methodologically diverse and it was not possible to conduct a formal meta-analysis. Annoyance was not necessarily decreased by reducing noise exposure. Non-acoustical factors influenced annoyance ratings and some of these were not identical to those in steady state conditions. There was insufficient evidence to recommend sleep disturbance as an alternative measure of reactions in changed noise conditions.

CONCLUSIONS

Surveys of health effects in changed noise situations should be conducted both before and after the change. Annoyance as a reaction indicator should be evaluated with caution as non-acoustical factors play an important role in annoyance ratings. Technical interventions reducing noise levels may therefore not have impacts on annoyance proportionate to their impacts on sound levels. Further studies, investigating impacts on health endpoints (e.g. blood pressure) in changed noise situations are needed.

Long working hours and symptoms of anxiety and depression: a 5-year follow-up of the Whitehall II study

BACKGROUND

Although long working hours are common in working populations, little is known about the effect of long working hours on mental health.

METHOD

We examined the association between long working hours and the onset of depressive and anxiety symptoms in middle-aged employees. Participants were 2960 full-time employees aged 44 to 66 years (2248 men, 712 women) from the prospective Whitehall II cohort study of British civil servants. Working hours, anxiety and depressive symptoms, and covariates were measured at baseline (1997-1999) followed by two subsequent measurements of depressive and anxiety symptoms (2001 and 2002-2004).

RESULTS

In a prospective analysis of participants with no depressive (n=2549) or anxiety symptoms (n=2618) at baseline, Cox proportional hazard analysis adjusted for baseline covariates showed a 1.66-fold [95% confidence interval (CI) 1.06-2.61] risk of depressive symptoms and a 1.74-fold (95% CI 1.15-2.61) risk of anxiety symptoms among employees working more than 55 h/week compared with employees working 35-40 h/week. Sex-stratified analysis showed an excess risk of depression and anxiety associated with long working hours among women [hazard ratios (HRs) 2.67 (95% CI 1.07-6.68) and 2.84 (95% CI 1.27-6.34) respectively] but not men [1.30 (0.77-2.19) and 1.43 (0.89-2.30)].

CONCLUSIONS

Working long hours is a risk factor for the development of depressive and anxiety symptoms in women.

Migration, social mobility and common mental disorders: critical review of the literature and meta-analysis

OBJECTIVE

Changes in socio-economic position in people who migrate may have adverse associations with mental health. The main objective of this review was to assess the association of social mobility with common mental disorders in migrant and second-generation groups, to inform future research.

DESIGN

Systematic review and meta-analysis of English-language studies assessing the association of social mobility in migrant or second-generation groups with common mental disorders. Approaches to operationalise 'social mobility' were reviewed.

RESULTS

Twelve studies (n=18,548) met criteria for retrieval. Very few included second-generation groups, and most studies were cross-sectional in design. Approaches to operationalise 'social mobility' varied between studies. Downward intragenerational social mobility was associated with migration in the majority of studies. Random effects meta-analysis (n=5179) suggested that migrants to higher income countries who experienced downward mobility or underemployment were more likely to screen positive for common mental disorders, relative to migrants who were upwardly mobile or experienced no changes to socio-economic position. Conclusions on second-generation groups were limited by the lack of research highlighted for these groups. Downward intragenerational mobility associated with migration may be associated with vulnerability to common mental disorders in some migrant groups.

CONCLUSION

Given the increasing scale of global migration, further research is needed to clarify how changes to socio-economic position associated with international migration may impact on the mental health of migrants, and in their children.

Common mental disorders, unemployment and welfare benefits in England

OBJECTIVES

Individuals who are out of work have a higher rate of common mental disorders (CMD) than individuals who are employed. People who are unemployed in the UK are entitled to welfare benefits to alleviate financial strain. This study examined rates of CMD in individuals who were employed, unemployed and receiving various UK benefits. It also investigated associations between duration of unemployment, gender and CMD.

STUDY DESIGN

An analysis of 5090 working-age participants from the Adult Psychiatric Morbidity Survey 2007, a stratified probability sample survey conducted among adults aged 16 years and over living in private households in England.

METHODS

CMD was assessed using the Clinical Interview Schedule (Revised). Information was gathered on sociodemographics, employment, income, benefits and debt. Data were analysed using logistic regression.

RESULTS

Risk of CMD was significantly greater in individuals classified as: unemployed; economically inactive; not working due to physical health reasons; unable to find a suitable job; receiving housing, care or sickness benefit; and receiving income support. However, risk of CMD was not significantly greater in individuals receiving jobseeker's allowance. Individuals unemployed for less than 1 year or more than 3 years had a higher risk of CMD. Some interactions with gender were significant, with associations being greater in men than women.

CONCLUSIONS

Job loss events are not the only reason for unemployed people to develop CMD. The state of unemployment itself may be detrimental to mental health. Risk of CMD is increased in those who have been out of work for 3 years or more. Associations between benefits and mental health are likely to be due to social, health or economic circumstances associated with benefit eligibility.

The development of Weinstein's noise sensitivity scale

Many studies have shown the significant correlation between noise annoyance and noise sensitivity identified by Weinstein's noise sensitivity scale (WNS). However, the validity of the scale has not been sufficiently assessed. This study was designed to investigate the validity of each question in WNS and to develop a more valid noise sensitivity measurement scale. A questionnaire study was conducted in a residential area along trunk roads in Kusatsu, Japan, and 301 responses were collected. In this paper, noise sensitivity was defined as the factor that induced individual variability in reactions caused by noise exposure and that is not affected by the noise exposure. The relationship between noise exposure and answers to each question in WNS was investigated by multiple logistic regression analysis, and the influence of response bias on the score of WNS was examined. The results showed that WNS contained some questions that were inappropriately related to noise exposure level and that the score was affected by response bias. The reported correlation between annoyance and the score of WNS could be confounded by noise exposure and response bias. A noise sensitivity measurement scale named WNS-6B was newly developed, excluding the biased questions from the original WNS and applying binary coding to six-response options in order to reduce the response bias. WNS-6B seemed to be more appropriate to assess noise sensitivity than the original scale.

Psychological distress, physical illness and risk of myocardial infarction in the Caerphilly study

BACKGROUND

Studies have found associations between psychological distress (PD) and increased risk of myocardial infarction (MI). However, it is not clear whether the relationship reflects the subtle influence of pre-existing illness on both PD and MI. This study examines the association between PD and MI in a prospective epidemiological study of 1864 middle-aged men to examine if the association is explained by existing illness.

METHOD

This study was a prospective cohort study modelling the association between PD, measured using the 30-item General Health Questionnaire (GHQ) and non-fatal myocardial infarction (NFMI) and fatal/non-fatal myocardial infarction (FNFMI). The relationship was modelled in a series of logistic regression models adjusted for age, then cigarette smoking, then social position, and finally for all sociodemographic characteristics, coronary heart disease (CHD) risk factors, and baseline CHD.

RESULTS

PD was associated with a 70% and 68% increased risk of NFMI and FNFMI in fully adjusted analysis. However, PD was not associated with an increased risk of NFMI and FNFMI in analyses excluding those with baseline CHD. Further, being psychologically distressed and physically ill was associated with a greater than twofold risk of NFMI and FNFMI, 2.37 (95% CI 1.33-4.20) and 2.33 (95% CI 1.32-4.12) respectively.

CONCLUSIONS

This study suggests that PD is a moderator of the increased risk of MI associated with existing physical illness. PD in men who are physically ill is a marker of an underlying chronic physical illness. The prospective association of PD with MI is not independent of baseline physical illness.

Drinking histories of self-identified lifetime abstainers and occasional drinkers: findings from the 1958 British Birth Cohort Study

AIMS

To investigate the validity of retrospective items used to distinguish people who have rarely or never consumed alcohol.

METHODS

The 1958 British Birth Cohort Study has followed 9377 individuals until age 45. Previous drinking (at 16, 23, 33 and 42 years) was investigated for two groups of 45-year-old non-drinkers, those reporting never having consumed alcohol ('never drinkers', n = 143, 1.5%), and having only consumed very infrequently ('occasional-only drinkers', n = 1149, 12.3%).

RESULTS

67% of never drinkers previously reported drinking, 25% were past weekly/daily drinkers; 56% of occasional-only drinkers reported weekly/daily consumption. The validity of the retrospective items was progressively questionable when presumed to cover longer time periods.

CONCLUSIONS

Substantial measurement error was evident when identifying 'occasional-only' and 'never' drinkers using retrospective items covering the lifecourse. Researchers investigating potential health benefits associated with moderate drinking need to incorporate more sophisticated methods when identifying sub-groups of non-drinkers.

Building health: an epidemiological study of "sick building syndrome" in the Whitehall II study

OBJECTIVES

Sick building syndrome (SBS) is described as a group of symptoms attributed to the physical environment of specific buildings. Isolating particular environmental features responsible for the symptoms has proved difficult. This study explores the role and significance of the physical and psychosocial work environment in explaining SBS.

METHODS

Cross sectional data on the physical environment of a selection of buildings were added to individual data from the Whitehall II study--an ongoing health survey of office based civil servants. A self-report questionnaire was used to capture 10 symptoms of the SBS and psychosocial work stress. In total, 4052 participants aged 42-62 years working in 44 buildings were included in this study.

RESULTS

No significant relation was found between most aspects of the physical work environment and symptom prevalence, adjusted for age, sex, and employment grade. Positive (non-significant) relations were found only with airborne bacteria, inhalable dust, dry bulb temperature, relative humidity, and having some control over the local physical environment. Greater effects were found with features of the psychosocial work environment including high job demands and low support. Only psychosocial work characteristics and control over the physical environment were independently associated with symptoms in the multivariate analysis.

CONCLUSIONS

The physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms.

Illicit and traditional drug use among ethnic minority adolescents in East London

OBJECTIVES

To explore ethnic variations in the use of illicit and traditional drugs, and the association of indicators of acculturation with drug use among an ethnically diverse representative sample of early adolescents in East London.

STUDY DESIGN

A cross-sectional questionnaire survey.

METHODS

Confidential questionnaires were used to assess 2789 male and female pupils in years 7 and 9, aged 11-14 years old, from a representative sample of 28 secondary schools in East London.

RESULTS

In total, 10.8% reported having ever tried illicit drugs and 7.3% reported ever using cannabis. Compared with white British adolescents, cannabis use in the previous month was significantly higher amongst black Caribbean adolescents. Lifetime cannabis use was significantly higher amongst black Caribbean and mixed ethnicity young people, but was lower amongst Bangladeshi, Indian and Pakistani adolescents. Living in UK for 5 years or less markedly reduced the risk of lifetime and recent cannabis use when controlled for ethnicity and social class. Glue or solvent use was reported in 3.2% of adolescents, with use significantly higher amongst Bangladeshi young people. Lifetime paan use was reported by 14.1% of the sample, and was almost completely confined to South Asian or mixed ethnicities.

CONCLUSIONS

Ethnic differences in illicit drug use were found in the study population, and significant differences were found between ethnic groups often identified as 'black.' Further research is needed in understanding cultural-specific risk and protective factors in different ethnic groups, and the importance of cultural identity in mediating health risk behaviors. The high use of paan and glue/gas/solvents by Bangladeshi young people poses an unappreciated public health problem that may require targeted interventions.

Aircraft and road traffic noise and children's cognition and health: a cross-national study

BACKGROUND

Exposure to environmental stressors can impair children's health and their cognitive development. The effects of air pollution, lead, and chemicals have been studied, but there has been less emphasis on the effects of noise. Our aim, therefore, was to assess the effect of exposure to aircraft and road traffic noise on cognitive performance and health in children.

METHODS

We did a cross-national, cross-sectional study in which we assessed 2844 of 3207 children aged 9-10 years who were attending 89 schools of 77 approached in the Netherlands, 27 in Spain, and 30 in the UK located in local authority areas around three major airports. We selected children by extent of exposure to external aircraft and road traffic noise at school as predicted from noise contour maps, modelling, and on-site measurements, and matched schools within countries for socioeconomic status. We measured cognitive and health outcomes with standardised tests and questionnaires administered in the classroom. We also used a questionnaire to obtain information from parents about socioeconomic status, their education, and ethnic origin.

FINDINGS

We identified linear exposure-effect associations between exposure to chronic aircraft noise and impairment of reading comprehension (p=0.0097) and recognition memory (p=0.0141), and a non-linear association with annoyance (p<0.0001) maintained after adjustment for mother's education, socioeconomic status, longstanding illness, and extent of classroom insulation against noise. Exposure to road traffic noise was linearly associated with increases in episodic memory (conceptual recall: p=0.0066; information recall: p=0.0489), but also with annoyance (p=0.0047). Neither aircraft noise nor traffic noise affected sustained attention, self-reported health, or overall mental health.

INTERPRETATION

Our findings indicate that a chronic environmental stressor-aircraft noise-could impair cognitive development in children, specifically reading comprehension. Schools exposed to high levels of aircraft noise are not healthy educational environments.

Psychological distress, physical illness, and risk of coronary heart disease

STUDY OBJECTIVE

The aims of this study are to confirm the association between psychological distress and coronary heart disease (CHD) using an epidemiological community study with hospital admissions data and to examine if any association is explained by existing illness.

DESIGN

Prospective cohort study modelling the association between psychological distress, measured using the 30 item general health questionnaire (GHQ), and hospital admissions data for CHD (ICD 410-414), using proportional hazards modelling adjusted for sociodemographic, CHD risk factors, and angina, bronchitis, diabetes, ischaemia, and stroke.

SETTING

Two suburbs of Glasgow, Renfrew and Paisley, in Scotland.

PARTICIPANTS

6575 men and women aged 45-64 years from Paisley.

MAIN RESULTS

Five year CHD risk in distressed men compared with non-distressed men was 1.78 (95% confidence intervals (CI), 1.15 to 2.75) in age adjusted analysis, 1.78 (95% CI, 1.14 to 2.79) with sociodemographic and CHD risk factor adjustment, and 1.61 (95% CI 1.02 to 2.55) with additional adjustment for existing illness. Psychological distress was unrelated to five year CHD risk in women. In further analysis, compared with healthy, non-distressed men, distressed physically ill men had a greater risk of CHD than non-distressed physically ill men, a relative risk of 4.01 (95% CI 2.42 to 6.66) compared with 2.12 (95% CI 1.35 to 3.32).

CONCLUSION

The association of psychological distress with an increased risk of five year CHD risk in men could be a function of baseline physical illness but an effect independent of physical illness cannot be ruled out. Its presence among physically ill men greatly increases CHD risk.

Mental health needs, service use and costs among Somali refugees in the UK

OBJECTIVE

To assess the mental health needs and service use of Somali refugees living in London.

METHOD

Subjects (n = 143) were sampled from conventional and non-conventional sites. Needs and service use were measured using the Camberwell Assessment of Need and the Client Service Receipt Inventory, respectively. Comparisons between sites were made and cost predictors identified.

RESULTS

Basic needs occurred frequently but were often not fully addressed. The mean number of needs was around four out of a possible 22. The most used services were GPs, other clinicians and refugee services. Higher non-inpatient costs were associated with length of stay in the UK and lower costs with being at risk of suicide and having panic disorder or agoraphobia.

CONCLUSION

Somali refugees living in London have a relatively high level of need but a low level of service use. Refugee characteristics could only account for a limited amount of cost variation.

The psychosocial work environment and alcohol dependence: a prospective study

AIMS

To examine whether a stressful psychosocial work environment predicts alcohol dependence.

METHODS

Alcohol dependence of participants in the Whitehall II occupational cohort of London based civil servants (1985-88) was measured in 1991-93 using the CAGE questionnaire. The psychosocial work environment was measured by self report questions on the job demand-support-control model and on the model of effort-reward imbalance. Potential mediators including physical illness and poor mental health (GHQ) were measured at follow up in 1989.

RESULTS

Effort-reward imbalance at work was associated with alcohol dependence in men after adjustment for employment grade and other baseline factors related to alcohol dependence. Although effort-reward imbalance predicted future longstanding illness, poor mental health and negative aspects of close relationships, the association between effort-reward imbalance and alcohol dependence in men was only partially mediated through these health and social support measures. In women, low decision latitude was related to alcohol dependence to some extent, but alcohol dependence among women was more prevalent in higher occupational grades. Men with high job demands or with low work social supports had a slightly reduced risk of alcohol dependence. No association was found between objectively assessed demands, job control, and alcohol dependence in either men or women.

CONCLUSION

A stressful psychosocial work environment in terms of effort-reward imbalance was found to be a risk factor for alcohol dependence in men. In view of the public health importance of alcohol dependence in working populations these findings call for more emphasis on psychosocial factors in occupational health research and prevention.

Social inequalities in depressive symptoms and physical functioning in the Whitehall II study: exploring a common cause explanation

STUDY OBJECTIVE

This study investigated which risk factors might explain social inequalities in both depressive symptoms and physical functioning and whether a common set of risk factors might account for the association between depressive symptoms and physical functioning.

DESIGN

A longitudinal prospective occupational cohort study of female and male civil servants relating risk factors at baseline (phase 1: 1985-8) to employment grade gradients in depressive symptoms and physical functioning at follow up (phase 5: 1997-9). Analyses include the 7270 men and women who participated at phase 5.

SETTING

Whitehall II Study: 20 London based white collar civil service departments.

PARTICIPANTS

Male and female civil servants, 35-55 years at baseline.

MAIN RESULTS

Depressive symptoms were measured by a subscale of items from the 30 item General Health Questionnaire. Physical functioning was measured by a subscale of the SF-36. Employment grade was used as a measure of socioeconomic position as it reflects both income and status. The grade gradient in depressive symptoms was entirely explained by risk factors including work characteristics, material disadvantage, social supports, and health behaviours. These risk factors only partially explained the gradient in physical functioning. The correlation between depressive symptoms and physical functioning was reduced by adjustment for risk factors and baseline health status but not much of the association was explained by adjustment for risk factors. Among women, the association between depression and physical functioning was significantly stronger in the lower grades both before and after adjustment for risk factors and baseline health. For women, there was only a significant grade gradient in depressive symptoms among those reporting physical ill health.

CONCLUSIONS

Some risk factors contribute jointly to the explanation of social inequalities in mental and physical health although their relative importance differs. Work is most important for inequalities in depressive symptoms in men, and work and material disadvantage are equally important in explaining inequalities in depressive symptoms in women while health behaviours are more important for explaining inequalities in physical functioning. These risk factors did not account for the association between mental health and physical health or the greater comorbidity seen in women of lower socioeconomic status. The risk of secondary psychological distress among those with physical ill health is greater in the low employment grades.

A Review of Environmental Noise and Mental Health

The question of whether environmental noise exposure causes mental ill-health is still largely unanswered. This paper reviews the studies of environmental and industrial noise and mental ill-health published between 1993 and 1998 and suggests possibilities for future research. Recent community based studies suggest high levels of environmental noise are associated with mental health symptoms such as depression and anxiety but not with impaired psychological functioning. Several studies find that self-reported noise sensitivity does not interact with noise exposure to lead to increased vulnerability to mental ill-health. Chronic aircraft noise exposure in children impairs quality of life but does not lead to depression or anxiety. Further research on environmental noise and mental health should be accompanied by more accurate and detailed measurement of noise exposure and consideration of the impact of other environmental stressors and careful measurement of confounding factors such as social class. Target study populations exposed to noise should be chosen to avoid those where noise exposure is likely to have led to noise sensitive individuals moving away from the area. There should also be greater use of standardised instruments to measure a wider range of mental health outcomes. Also other physiological outcomes such as hormonal measures could with benefit be measured simultaneously.

The effects of chronic aircraft noise exposure on children's cognition and health: 3 field studies

This article provides a review of three of the most important field studies to have examined the non-auditory effects of chronic aircraft noise exposure on children's cognition and health. The design of each of the studies is outlined, relevant methodological issues are highlighted and the findings from the studies are reported. Effects are reported on annoyance and quality of life, motivation and helplessness, stress responses as indexed by neuroendocrine tests and blood pressure measurements. In terms of cognitive performance, effects are reported on reading, attention and long-term and working memory.

Qualitative responses of children to environmental noise

Results from recent quantitative research consistently demonstrate that children are a high risk group, vulnerable to the adverse effects of noise exposure, especially effects on cognitive performance, motivation and annoyance. The aims of the two qualitative studies reported in this paper are to explore children's a) perception of noise exposure; b) perceived risk of and attitudes towards noise pollution; c) coping strategies; and d) the annoyance response. The Millennium Conference Study involved focus group interviews with an international sample (n=36) unselected by exposure. The West London Schools Study involved individual interviews, conducted with a purposively selected sample (n=18) exposed to aircraft noise. The children in the focus groups reported being most affected by neighbours' noise and road traffic noise, whereas children exposed to aircraft noise were most affected by aircraft noise. As expected, the impact of noise pollution on everyday activities (e.g. schoolwork, homework and playing) was larger for the children exposed to high levels of aircraft noise compared with the low noise exposed children and focus group samples. The range of coping strategies that children employed to combat noise exposure in their lives was dependent upon the amount of control they had over the noise source. The emotional response of children describing the annoyance reaction to noise was consistent with adult reactions and it would seem that child noise annoyance is the same construct. Future research should employ qualitative methods to supplement quantitative investigations.

Association between organizational inequity and incidence of psychiatric disorders in female employees

BACKGROUND

Prior research on work-related factors in the aetiology of psychiatric disorders has been concentrated on job control, job demands and social support. To broaden the view to managerial procedures, we examined whether the extent to which employees are treated with equity in the workplace predicts their mental health. Organizational equity refers to decision-making procedures, which are consistently applied, open, correctable and include input from affected parties (procedural justice). It also refers to respectful and considerate treatment of individuals by supervisors (relational justice).

METHOD

A cohort of 1786 female hospital employees with no psychiatric disorder at baseline responded to a questionnaire on organizational equity. From the responses, both an individual score and a work unit mean score were assigned to each participant. The outcome was new reports of doctor-diagnosed psychiatric disorders during the 2-year follow-up. Odds ratios and 95% confidence intervals were corrected for clustering of the data.

RESULTS

After adjustment for age and salary, odds ratio of new psychiatric disorders for self-reported low procedural justice was 1.9 (95% CI 1.1 to 3.2). Corresponding odds ratio for low procedural justice, as assessed with work unit mean scores, was 1.7 (95% CI 1.5 to 2.0). These associations remained statistically significant after additional adjustment for mental distress at baseline and job control, job demands and social support. Relational justice did not predict psychiatric disorders.

CONCLUSION

Research on organizational equity provides new information about potential work-related determinants of mental health. Low procedural justice seems to be an independent risk factor for psychiatric disorders in female employees.

Change in health inequalities among British civil servants: the Whitehall II study

STUDY OBJECTIVE

Despite an overall decline in mortality rates, the social gradient in mortality has increased over the past two decades. However, evidence on trends in morbidity and cardiovascular risk factors indicates that socioeconomic differences are static or narrowing. The objective of this study was to investigate morbidity and cardiovascular risk factor trends in white collar British civil servants.

DESIGN

Self rated health, longstanding illness, minor psychiatric morbidity (General Health Questionnaire (GHQ) 30 score, GHQ caseness and GHQ depression subscale), cholesterol, diastolic and systolic blood pressure, body mass index, alcohol over the recommended limits, and smoking were collected at baseline screening (1985-88) and twice during follow up (mean length of follow up 5.3 and 11.1 years). Employment grade gradients in these measures at each phase were compared.

SETTING

Whitehall II, prospective cohort study.

PARTICIPANTS

White collar women and men aged 35-55, employed in 20 departments at baseline screening. Analyses included 6770 participants who responded to all three phases.

RESULTS

Steep employment grade gradients were observed for most measures at second follow up. In general, there was little evidence that employment grade gradients have increased over the 11.1 years of follow up, but marked increases in the gradient were observed for GHQ score (p<0.001) and depression (p=0.05) in both sexes and for cholesterol in men (p=0.01).

CONCLUSIONS

There is little evidence of an increase in inequality for most measures of morbidity and cardiovascular risk factors in white collar civil servants over the 11.1 years to 1998. Inequalities have increased significantly for minor psychiatric morbidity in both sexes and for cholesterol in men.

Childhood and adulthood risk factors for socio-economic differentials in psychological distress: evidence from the 1958 British birth cohort

Social inequalities in psychological status have been attributed to health selection and to social causation. We used data from the 1958 British birth cohort, followed over three decades, to identify causes of inequality in adulthood. Psychological status prior to labour market entry influenced inter-generational mobility, but selection effects were weaker for intra-generational mobility, between age 23 and 33. However, selection failed to account for social differences in risk of distress of approximately threefold in classes IV&V compared with I&II. Both childhood and adult life factors appeared to contribute to the development of inequalities. The principal childhood factors were ability at age 7 for both sexes and adverse environment (institutional care for men and low class for women). Adult life factors varied, with stronger effects for work factors (job strain and insecurity) for men and qualifications on leaving school, early child-bearing and financial hardship for women. Gradients in psychological distress reflect the cumulative effect of multiple adversities experienced from childhood.

Adrenocortical, autonomic, and inflammatory causes of the metabolic syndrome: nested case-control study

BACKGROUND

The causes of metabolic syndrome (MS), which may be a precursor of coronary disease, are uncertain. We hypothesize that disturbances in neuroendocrine and cardiac autonomic activity (CAA) contribute to development of MS. We examine reversibility and the power of psychosocial and behavioral factors to explain the neuroendocrine adaptations that accompany MS.

METHODS AND RESULTS

This was a double-blind case-control study of working men aged 45 to 63 years drawn from the Whitehall II cohort. MS cases (n=30) were compared with healthy controls (n=153). Cortisol secretion, sensitivity, and 24-hour cortisol metabolite and catecholamine output were measured over 2 days. CAA was obtained from power spectral analysis of heart rate variability (HRV) recordings. Twenty-four-hour cortisol metabolite and normetanephrine (3-methoxynorepinephrine) outputs were higher among cases than controls (+ 0.49, +0.45 SD, respectively). HRV and total power were lower among cases (both -0.72 SD). Serum interleukin-6, plasma C-reactive protein, and viscosity were higher among cases (+0.89, +0.51, and +0.72 SD). Lower HRV was associated with higher normetanephrine output (r=-0.19; P=0.03). Among former cases (MS 5 years previously, n=23), cortisol output, heart rate, and interleukin-6 were at the level of controls. Psychosocial factors accounted for 37% of the link between MS and normetanephrine output, and 7% to 19% for CAA. Health-related behaviors accounted for 5% to 18% of neuroendocrine differences.

CONCLUSIONS

Neuroendocrine stress axes are activated in MS. There is relative cardiac sympathetic predominance. The neuroendocrine changes may be reversible. This case-control study provides the first evidence that chronic stress may be a cause of MS. Confirmatory prospective studies are required.

Gender differences in self-reported minor mental disorder and its association with suicide. A 20-year follow-up of the Renfrew and Paisley cohort

BACKGROUND

Suicide rates are around three times higher in men than women; in contrast women have a higher prevalence of community-diagnosed depression. To investigate this paradox we examined the association of General Health Questionnaire (GHQ)-caseness (score > or = 4), a measure of possible minor mental disorder, with suicide risk in a general population cohort.

METHODS

Data were derived from a cohort study based on the 8,466 men and women in the Renfrew and Paisley cohort who completed a 30-item GHQ in the period from 1972 to 1976 and who were followed up to 1995 for all-cause and suicide mortality.

RESULTS

The long-term suicide risk associated with possible minor mental disorder was higher in men [hazard ratio 6.78 (1.36-33.71)] than women [hazard ratio 1.66 (0.43-6.45)]; test for interaction between gender and GHQ with respect to suicide risk: p = 0.09.

CONCLUSION

These findings indicate either that the long-term risk of suicide in the context of a past episode of minor mental disorder is higher in males than females or that there are sex differences in the validity of responses to mental health screening questionnaires. Further research is required to replicate our finding in larger studies and, if confirmed, clarify which explanation underlies it.

Socioeconomic position, health, and possible explanations: a tale of two cohorts

OBJECTIVES

We examined whether the social gradient for measures of morbidity is comparable in English and French public employees and investigated risk factors that may explain this gradient.

METHODS

This longitudinal study of 2 occupational cohorts-5825 London civil servants and 6818 French office-based employees-used 2 health outcomes: long spells of sickness absence during a 4-year follow-up and self-reported health.

RESULTS

Strong social gradients in health were observed in both cohorts. Health behaviors showed different relations with socioeconomic position in the 2 samples. Psychosocial work characteristics showed strong gradients in both cohorts. Cohort-specific significant risk factors explained between 12% and 56% of the gradient in sickness absence and self-reported health.

CONCLUSIONS

Our cross-cultural comparison suggests that some common susceptibility may underlie the social gradient in health and disease, which explains why inequalities occur in cultures with different patterns of morbidity and mortality.

Effects of chronic job insecurity and change in job security on self reported health, minor psychiatric morbidity, physiological measures, and health related behaviours in British civil servants: the Whitehall II study

STUDY OBJECTIVE

To determine the effect of chronic job insecurity and changes in job security on self reported health, minor psychiatric morbidity, physiological measures, and health related behaviours.

DESIGN

Self reported health, minor psychiatric morbidity, physiological measures, and health related behaviours were determined in 931 women and 2429 men who responded to a question on job insecurity in 1995/96 and again in 1997/99. Self reported health status, clinical screening measures, and health related behaviours for participants whose job security had changed or who remained insecure were compared with those whose jobs had remained secure.

SETTING

Prospective cohort study, Whitehall II, all participants were white collar office workers in the British Civil Service on entry to the study.

MAIN RESULTS

Self reported morbidity was higher among participants who lost job security. Among those who gained job security residual negative effects, particularly in the psychological sphere were observed. Those exposed to chronic job insecurity had the highest self reported morbidity. Changes in the physiological measures were limited to an increase in blood pressure among women who lost job security and a decrease in body mass index among women reporting chronic job insecurity. There were no significant differences between any of the groups for alcohol over the recommended limits or smoking.

CONCLUSION

Loss of job security has adverse effects on self reported health and minor psychiatric morbidity, which are not completely reversed by removal of the threat and which tend to increase with chronic exposure to the stressor.

How gender affects patterns of social relations and their impact on health: a comparison of one or multiple sources of support from "close persons"

Numerous studies have reported gender differences in the effects of social relations on morbidity and mortality. When studying health and associated factors, one cannot ignore that sex differences exist and methods that are not "gender-fair" may lead to erroneous conclusions. This paper presents a critical analysis of the health/social relations association from a measurement perspective, including the definitions of people's networks and how they differ by gender. Findings from the Whitehall II Study of Civil Servants illustrate that women report more close persons in their primary networks, and are less likely to nominate their spouse as the closest person, but both men and women report the same proportion of women among their four closest persons. Women have a wider range of sources of emotional support. To date, most epidemiological studies have habitually analysed support provided by the closest person or confidant(e). We compared the health effects of social support when measured for the closest person only and when information from up to four close persons was incorporated into a weighted index. Information from up to four close persons offered a more accurate portrayal of support exchanged, and gender differences were attenuated, if not eliminated, when this support index was used to predict physical and psychological health.

Multilevel modelling of aircraft noise on performance tests in schools around Heathrow Airport London

STUDY OBJECTIVE

To examine the effects of chronic exposure to aircraft noise on children's school performance taking into account social class and school characteristics.

DESIGN

This is a cross sectional study using the National Standardised Scores (SATs) in mathematics, science, and English (11 000 scores from children aged 11 years). The analyses used multilevel modelling to determine the effects of chronic aircraft noise exposure on childrens' school performance adjusting for demographic, socioeconomic and school factors in 123 primary schools around Heathrow Airport. Schools were assigned aircraft noise exposure level from the 1994 Civil Aviation Authority aircraft noise contour maps.

SETTING

Primary schools.

PARTICIPANTS

The sample were approximately 11 000 children in year 6 (approximately 11 years old) from 123 schools in the three boroughs surrounding Heathrow Airport.

MAIN RESULTS

Chronic exposure to aircraft noise was significantly related to poorer reading and mathematics performance. After adjustment for the average socioeconomic status of the school intake (measured by percentage of pupils eligible for free school meals) these associations were no longer statistically significant.

CONCLUSIONS

Chronic exposure to aircraft noise is associated with school performance in reading and mathematics in a dose-response function but this association is confounded by socioeconomic factors.

The West London Schools Study: the effects of chronic aircraft noise exposure on child health

BACKGROUND

Previous field studies have indicated that children's cognitive performance is impaired by chronic aircraft noise exposure. However, these studies have not been of sufficient size to account adequately for the role of confounding factors. The objective of this study was to test whether cognitive impairments and stress responses (catecholamines, cortisol and perceived stress) are attributable to aircraft noise exposure after adjustment for school and individual level confounding factors and to examine whether children exposed to high levels of social disadvantage are at greater risk of noise effects.

METHODS

The cognitive performance and health of 451 children aged 8-11 years, attending 10 schools in high aircraft noise areas (16 h outdoor Leq > 63 dBA) was compared with children attending 10 matched control schools exposed to lower levels of aircraft noise (16 h outdoor Leq < 57 dBA).

RESULTS

Noise exposure was associated with impaired reading on difficult items and raised annoyance, after adjustment for age, main language spoken and household deprivation. There was no variation in the size of the noise effects in vulnerable subgroups of children. High levels of noise exposure were not associated with impairments in mean reading score, memory and attention or stress responses. Aircraft noise was weakly associated with hyperactivity and psychological morbidity.

CONCLUSIONS

Chronic noise exposure is associated with raised noise annoyance in children. The cognitive results indicate that chronic aircraft noise exposure does not always lead to generalized cognitive effects but, rather, more selective cognitive impairments on difficult cognitive tests in children.

A follow-up study of effects of chronic aircraft noise exposure on child stress responses and cognition

BACKGROUND

Children are a high-risk group vulnerable to the effects of chronic aircraft noise exposure. This study examines the effects of aircraft noise exposure on children's health and cognition around London Heathrow airport and tests sustained attention as an underlying mechanism of effects of noise on reading and examines the way children adapt to continued exposure to aircraft noise.

METHODS

In this repeated measures epidemiological field study, the cognitive performance and health of 275 children aged 8-11 years attending four schools in high aircraft noise areas (16-h outdoor Leq > 66 dBA) was compared with children attending four matched control schools exposed to lower levels of aircraft noise (16-h outdoor Leq < 57 dBA). The children first examined at baseline were examined again after a period of one year at follow-up. Health questionnaires and cognitive tests were group administered to the children in the schools.

RESULTS AND CONCLUSIONS

At follow-up chronic aircraft noise exposure was associated with higher levels of annoyance and perceived stress, poorer reading comprehension and sustained attention, measured by standardized scales after adjustment for age, social deprivation and main language spoken. These results do not support the sustained attention hypothesis previously used to account for the effects of noise on cognition in children. The reading and annoyance effects do not habituate over a one-year period and do not provide strong evidence of adaptation.

Psychological distress and work and home roles: a focus on socio-economic differences in distress

BACKGROUND

Home and work factors have been linked to psychological status, but less is known about their contribution to social inequalities in psychological status. We examine whether social inequalities in psychological distress can be explained by work-home factors and whether the impact of these potential explanatory factors is similar for men and women.

METHODS

Data are from the 1958 British birth cohort study. We sought to explain social class differences in psychological distress at age 33. Explanatory factors were classified as work-home roles: i.e. employment, marital status, domestic responsibility, children and elderly care; and work-home characteristics: i.e. job-strain, insecurity, unsocial working hours, youngest child's age, number of children and level of involvement in childcare.

RESULTS

A social gradient in psychological distress was found: odds ratios for classes IV and V v. I and II were 2.65 (men) and 3.02 (women). Work factors had consistently stronger associations with psychological distress and with social class among men than women. Work factors had a greater impact on class differences in psychological distress in men. Associations for home roles and characteristics were less consistent and their combined effect on class differences in distress was negligible for both sexes.

CONCLUSION

Explanations for the social gradient differ for men and women. Work may be more important for men than women, but the impact of home factors was not strong during the early adulthood of this cohort.

Job insecurity in white-collar workers: toward an explanation of associations with health

This article describes 2 studies that examined changes in psychosocial work characteristics (job strain model) and health-related behaviors as potential explanations of the job insecurity-health relationship in a longitudinal cohort of white-collar British civil servants. Job insecurity arising from anticipation of change was associated with a modest increase in self-reported morbidity, whereas chronic job insecurity was associated with some adverse physiological changes. Anticipation of change and chronic job insecurity were associated with adverse changes in other psychosocial work characteristics, but few changes were significant and consistent across both exposure groups. Changes in health-related behaviors associated with either exposure were slight. Apart from a minor role for social support at work in both sexes and a modest role for job demands in women, adverse changes in these factors explain little of the job insecurity-health relationship.

Employment status and health after privatisation in white collar civil servants: prospective cohort study

OBJECTIVES

To determine whether employment status after job loss due to privatisation influences health and use of health services and whether financial strain, psychosocial measures, or health related behaviours can explain any findings.

DESIGN

Data collected before and 18 months after privatisation.

SETTING

One department of the civil service that was sold to the private sector.

PARTICIPANTS

666 employees during baseline screening in the department to be privatised.

MAIN OUTCOME MEASURES

Health and health service outcomes associated with insecure re-employment, permanent exit from paid employment, and unemployment after privatisation compared with outcomes associated with secure re-employment.

RESULTS

Insecure re-employment and unemployment were associated with relative increases in minor psychiatric morbidity (mean difference 1.56 (95% confidence intervals interval 1.0 to 2.2) and 1.25 (0.6 to 2.0) respectively) and having four or more consultations with a general practitioner in the past year (odds ratio 2.04 (1.1 to 3.8) and 2.39 (1.2 to 4.7) respectively). Health outcomes for respondents permanently out of paid employment closely resembled those in secure re-employment, except for a substantial relative increase in longstanding illness (2.25; 1.1 to 4.4). Financial strain and change in psychosocial measures and health related behaviours accounted for little of the observed associations. Adjustment for change in minor psychiatric morbidity attenuated the association between insecure re-employment or unemployment and general practitioner consultations by 26% and 27%, respectively.

CONCLUSIONS

Insecure re-employment and unemployment after privatisation result in increases in minor psychiatric morbidity and consultations with a general practitioner, which are possibly due to the increased minor psychiatric morbidity.

Chronic aircraft noise exposure, stress responses, mental health and cognitive performance in school children

BACKGROUND

Previous research suggests that children are a high risk group vulnerable to the effects of chronic noise exposure. However, questions remain about the nature of the noise effects and the underlying causal mechanisms. This study addresses the effects of aircraft noise exposure on children around London Heathrow airport, in terms of stress responses, mental health and cognitive performance. The research also focuses on the underlying causal mechanisms contributing to the cognitive effects and potential confounding factors.

METHODS

The cognitive performance and health of 340 children aged 8-11 years attending four schools in high aircraft noise areas (16 h outdoor Leq > 66 dBA) was compared with children attending four matched control schools exposed to lower levels of aircraft noise (16 h outdoor Leq < 57 dBA). Mental health and cognitive tests were group administered to the children in the schools. Salivary cortisol was measured in a subsample of children.

RESULTS

Chronic aircraft noise exposure was associated with higher levels of noise annoyance and poorer reading comprehension measured by standardized scales with adjustments for age, deprivation and main language spoken. Chronic aircraft noise was not associated with mental health problems and raised cortisol secretion. The association between aircraft noise exposure and reading comprehension could not be accounted for by the mediating role of annoyance, confounding by social class, deprivation, main language or acute noise exposure.

CONCLUSIONS

These results suggest that chronic aircraft noise exposure is associated with impaired reading comprehension and high levels of noise annoyance but not mental health problems in children.

Job insecurity in white-collar workers: toward an explanation of associations with health

This article describes 2 studies that examined changes in psychosocial work characteristics (job strain model) and health-related behaviors as potential explanations of the job insecurity-health relationship in a longitudinal cohort of white-collar British civil servants. Job insecurity arising from anticipation of change was associated with a modest increase in self-reported morbidity, whereas chronic job insecurity was associated with some adverse physiological changes. Anticipation of change and chronic job insecurity were associated with adverse changes in other psychosocial work characteristics, but few changes were significant and consistent across both exposure groups. Changes in health-related behaviors associated with either exposure were slight. Apart from a minor role for social support at work in both sexes and a modest role for job demands in women, adverse changes in these factors explain little of the job insecurity-health relationship.

Predictors of early retirement in British civil servants

BACKGROUND

it is uncertain how recent changes in labour force dynamics may have influenced the increasing numbers of people taking early retirement in industrialized countries. The Whitehall II study provides an opportunity to examine the predictors of early retirement in one of the largest employers in the United Kingdom.

METHODS

we examined the factors predicting early retirement in a 7-year follow-up period from 1988 to 1995 using longitudinal data on 2532 male and female London-based civil servants aged between 50 and 59.5 years. Baseline data on employment grade and duration of time working for the Civil Service were obtained from self-completed questionnaires. The primary factors examined included health, work characteristics, questions about job demands and job satisfaction and financial insecurity, wealth and material problems. Time until early retirement was analysed using Cox proportional hazards model.

RESULTS

of the 2532 civil servants, 26.7% retired early during the follow-up period. We found that men and women in the higher-paid employment grades, those that had suffered from ill health and those that were less satisfied with their jobs were more likely to retire early, whereas material problems tended to keep people working.

CONCLUSIONS

our results show that self-perceived health, employment grade and job satisfaction are all independent predictors of early retirement. Qualitative analyses may further advance our understanding of the retirement process.

Anger and incident heart disease in the caerphilly study

OBJECTIVE

The idea that anger may predict ischemic heart disease (IHD) is more than 30 years old. Some, but not all, prospective studies have supported this suggestion. Attention has focused on hostility as the critical component of anger for IHD risk. This idea is explored using prospective data from the Caerphilly study.

METHODS

A sample of 2890 men aged 49 to 65 years living in and around Caerphilly, South Wales, was identified. Anger was assessed using the Framingham scales comprising "anger symptoms," "anger in," "anger out," and "anger discuss." A new "suppressed anger" scale was also constructed. Cardiovascular risk factors assessed included baseline blood pressure, total and high-density lipoprotein cholesterol, fibrinogen, white cell count, psychiatric caseness as assessed by the General Health Questionnaire, social support, smoking habit, alcohol consumption, leisure exercise, body mass index, and calorie intake. Prediction of IHD, measured as the occurrence of a major event over a follow-up period of 9 years, was assessed using multiple logistic regression analysis.

RESULTS

A low anger out score predicted increased risk of a major IHD event (relative odds (RO) = 1.70; 95% confidence interval = 1.26-2.29 for all RO). This association was unchanged on controlling for physiological risk factors (RO = 1.74), psychosocial risk factors (RO = 1.72), and behavioral risk factors (RO = 1.69). Suppressed anger showed associations with incident IHD similar to those of anger out but identified the population at risk more closely.

CONCLUSIONS

Anger out and suppressed anger were predictive of incident IHD. Neither of these constructs are overtly similar to hostility. These findings suggest there may be mechanisms other than hostility by which anger predicts IHD risk and that a conceptually varied approach to anger is currently appropriate.

Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study

OBJECTIVES

The impact of work on the risk of future psychiatric disorder has been examined in few longitudinal studies. This was examined prospectively in a large epidemiological study of civil servants.

METHODS

In the Whitehall II study, a longitudinal, prospective cohort study of 6895 male and 3413 female London based civil servants, work characteristics measured at baseline (phase 1: 1985-8) and first follow up (phase 2: 1989) were used to predict psychiatric disorder measured by a 30 item general health questionnaire (GHQ) at phase 2 and phase 3 follow up (phase 3: 1991-3). Work characteristics and GHQ were measured at all three phases.

RESULTS

Low social support at work and low decision authority, high job demands and effort-reward imbalance were associated with increased risk of psychiatric disorder as assessed by the GHQ at follow up adjusting for age, employment grade, and baseline GHQ score.

CONCLUSIONS

Social support and control at work protect mental health while high job demands and effort-reward imbalance are risk factors for future psychiatric disorder. Intervention at the level of work design, organisation, and management might have positive effects on mental health in working populations.

Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study

OBJECTIVES

The impact of work on the risk of future psychiatric disorder has been examined in few longitudinal studies. This was examined prospectively in a large epidemiological study of civil servants.

METHODS

In the Whitehall II study, a longitudinal, prospective cohort study of 6895 male and 3413 female London based civil servants, work characteristics measured at baseline (phase 1: 1985-8) and first follow up (phase 2: 1989) were used to predict psychiatric disorder measured by a 30 item general health questionnaire (GHQ) at phase 2 and phase 3 follow up (phase 3: 1991-3). Work characteristics and GHQ were measured at all three phases.

RESULTS

Low social support at work and low decision authority, high job demands and effort-reward imbalance were associated with increased risk of psychiatric disorder as assessed by the GHQ at follow up adjusting for age, employment grade, and baseline GHQ score.

CONCLUSIONS

Social support and control at work protect mental health while high job demands and effort-reward imbalance are risk factors for future psychiatric disorder. Intervention at the level of work design, organisation, and management might have positive effects on mental health in working populations.