Decreasing employees' work stress by a participatory, organizational level work stress prevention approach: a multiple-case study in primary education.

BACKGROUND: Work stress is an important problem among employees in education in the Netherlands. The present study aims to investigate the effects of a participatory organizational level work stress prevention approach to reduce (quantitative) job demands, increase resources (i.e. autonomy, supervisor and coworker support) and to reduce work stress and increase job satisfaction of employees in primary education. METHODS: This study makes use of a multiple case study research design. The stress prevention approach is implemented at 5 primary schools and questionnaires were filled out by 119 employees of the 5 schools at baseline and 1 year later, measuring job demands, resources, work stress, job satisfaction and implementation factors. RESULTS: Multilevel analyses showed a significant decrease in job demands and a significant increase in job satisfaction between baseline and follow up. In addition, employees that were more satisfied with the communication about the intervention showed more improvements in autonomy and job satisfaction. However, employees reporting an increased dialogue in work stress between employees and management showed a smaller decrease in job demands. CONCLUSION: The study shows a decrease in job demands and an increase in job satisfaction in the schools that implemented a stress prevention approach. Results of the study underline the importance of communication about the intervention as part of the implementation process, impacting the effectiveness of the intervention to improve autonomy and job satisfaction. TRIAL REGISTRATION: ISRCTN registry, study ID: ISRCTN14697835, registration date: 11-10-2019 (retrospectively registered).

Development of a new measure for mental retirement; testing of a three-factor structure of mentale retirement in different subgroups.

BACKGROUND: The aim of this study is to develop a new measure for the concept of mental retirement and test the construct validity of the measure. Employees who are 'mentally retired' are present at their work physically, but have already said their goodbyes mentally. Mental retirement has a three-factor structure: developmental proactivity, work engagement and perceived appreciation. METHODS: We use data from employees (N = 867) of five different organizations in the Netherlands. Mental retirement was assessed with 11 items in an online survey. In addition, socio-demographic characteristics like age, level of education and occupation, were measured. Next to tests of internal consistency, a confirmatory factor analysis (CFA) is performed to test the three-factor structure of mental retirement in this population and in different subgroups (age, education, occupation). RESULTS: The internal consistency varies from .80 to .94 for the developmental proactivity scale and the work engagement scale, respectively (appreciation was measured with one item). For the CFA, the three-factor model fits the data adequately. Multiple group analyses also shows equal factor loadings in all subgroups, but the mean levels of mental retirement differ across subgroups. CONCLUSIONS: This study confirms the three-factor model of mental retirement in a general group of employees as well as across different subgroups. However, this study only tested the construct validity. Future research should study validity more extensively and be longitudinal in nature. In addition, the causal chain of antecedent variables to mental retirement and its outcomes should be considered. These studies could also focus on the effects of interventions aiming at preventing or decreasing the level of mental retirement in organizations.

Effect of a participative action intervention program on reducing mental retirement.

BACKGROUND: The present study aimed to investigate the effects of a stepwise, bottom-up participatory program with a tailor-made intervention process addressing the level of mental retirement in a sample of Dutch employees. Mental retirement refers to feelings of being disconnected from your work and your organization. Prevention of mental retirement is important since sustainable employability is becoming more important in today's society due to the ageing of the working population and the changes in skills demands. METHODS: This prospective cohort study with a one-year follow-up employs a sample of 683 employees of three organizations in The Netherlands, who filled out two questionnaires: at baseline and 1 year later. The dependent measure was mental retirement, which consists of three sub-concepts: developmental pro-activity, work engagement and perceived appreciation. RESULTS: Multilevel analysis (N = 466) showed that employees who more actively participated in the intervention(s) had a small but statistically significant larger decrease in mental retirement at follow-up. CONCLUSIONS: The stepwise, bottom-up participatory program with a tailor-made intervention process shows a tendency to decrease the level of mental retirement in Dutch employees. However, the implementation of interventions could be further improved since it turned out to be very challenging to keep up participants' commitment to the program. Future research should study the effectiveness of this program further with an improved study design (control group, multiple follow-ups, several data sources).

The association between exposure to psychosocial work factors and mental health in older employees, a 3-year follow-up study.

PURPOSE: Unfavourable exposure to psychosocial work factors threatens older employees' mental health, and their sustained employment. This study assesses whether an improved compared to stable unfavourable and stable favourable exposure to psychosocial work factors is associated with a change in mental health in older employees at 3-year follow-up. METHODS: The current study used data from the Study on Transitions in Employment, Ability and Motivation (STREAM), in workers aged 45-65 years (n = 5249). Two-year (2010-2012) exposure was assessed for psychological demands, autonomy, support, mental load, and distributive justice. Linear regression analyses were performed to compare improved exposure to unfavourable psychosocial work factors with stable unfavourable and stable favourable exposure and mental health at follow-up (2013), corrected for confounders. Analyses were stratified for age groups (45-54 and 55-65 years) and gender. RESULTS: In certain subgroups, stable unfavourable exposure to psychological demands, autonomy, support, and distributive justice was associated with a significantly lower mental health score than improved exposure. Stable favourable exposure to support was associated with a higher mental health score than improved support, whereas stable favourable exposure to autonomy was associated with a lower mental health score compared to improved exposure. CONCLUSIONS: There is a longitudinal association between changes in exposure to psychosocial work factors and mental health. Improvement in unfavourable exposure to psychosocial work factors was associated with improved mental health. This is important information for organisations that consider deploying measures to improve the psychosocial work environment of older workers.

The role of autonomy and social support in the relation between psychosocial safety climate and stress in health care workers.

BACKGROUND: Health care workers are exposed to psychosocial work factors. Autonomy and social support are psychosocial work factors that are related to stress, and are argued to largely result from the psychosocial safety climate within organisations. This study aimed to assess to what extent the relation between psychosocial safety climate and stress in health care workers can be explained by autonomy and social support. METHODS: In a cross-sectional study, psychosocial safety climate, stress, autonomy, co-worker support, and supervisor support were assessed using questionnaires, in a sample of health care workers (N = 277). Linear mixed models analyses were performed to assess to what extent social support and autonomy explained the relation between psychosocial safety climate and stress. RESULTS: A lower psychosocial safety climate score was associated with significantly higher stress (B = -0.21, 95% CI = -0.27 - -0.14). Neither co-worker support, supervisor support, nor autonomy explained the relation between psychosocial safety climate and stress. Taken together, autonomy and both social support measures diminished the relation between psychosocial safety climate and stress by 12% (full model: B = -0.18, 95% CI = -0.25 - -0.11). CONCLUSIONS: Autonomy and social support together seemed to bring about a small decrease in the relation between psychosocial safety climate and stress in health care workers. Future research should discern whether other psychosocial work factors explain a larger portion of this relation. TRIAL REGISTRATION: This study was registered in the Netherlands National Trial Register, trial code: NTR5527 .

Stress Prevention@Work: a study protocol for the evaluation of a multifaceted integral stress prevention strategy to prevent employee stress in a healthcare organization: a cluster controlled trial.

BACKGROUND: Adequate implementation of work-related stress management interventions can reduce or prevent work-related stress and sick leave in organizations. We developed a multifaceted integral stress-prevention strategy for organizations from several sectors that includes a digital platform and collaborative learning network. The digital platform contains a stepwise protocol to implement work-related stress-management interventions. It includes stress screeners, interventions and intervention providers to facilitate access to and the selection of matching work-related stress-management interventions. The collaborative learning network, including stakeholders from various organizations, plans meetings focussing on an exchange of experiences and good practices among organizations for the implementation of stress prevention measures. This paper describes the design of an integral stress-prevention strategy, Stress Prevention@Work, and the protocol for the evaluation of: 1) the effects of the strategy on perceived stress and work-related outcomes, and 2) the barriers and facilitators for implementation of the strategy. METHODS: The effectiveness of Stress Prevention@Work will be evaluated in a cluster controlled trial, in a large healthcare organization in the Netherlands, at six and 12 months. An independent researcher will match teams on working conditions and size and allocate the teams to the intervention or control group. Teams in the intervention group will be offered Stress Prevention@Work. For each intervention team, one employee is responsible for applying the strategy within his/her team using the digital platform and visiting the collaborative learning network. Using a waiting list design, the control group will be given access to the strategy after 12 months. The primary outcome is the employees' perceived stress measured by the stress subscale of the Depression, Anxiety, and Stress Scale (DASS-21). Secondary outcome measures are job demands, job resources and the number of preventive stress measures implemented at the team level. Alongside the trial, a process evaluation, including barriers and facilitators of the implementation of Stress Prevention@Work, will be conducted in one healthcare organisation. DISCUSSION: If Stress Prevention@Work is found to be effective in one healthcare organisation, further implementation on a broader scale might lead to increased productivity and decreased stress and sick leave in other organizations. Results are expected in 2018. TRIAL REGISTRATION: NTR5527 . Registered 7 Dec 2015.

Long working hours and cancer risk: a multi-cohort study.

BACKGROUND: Working longer than the maximum recommended hours is associated with an increased risk of cardiovascular disease, but the relationship of excess working hours with incident cancer is unclear. METHODS: This multi-cohort study examined the association between working hours and cancer risk in 116 462 men and women who were free of cancer at baseline. Incident cancers were ascertained from national cancer, hospitalisation and death registers; weekly working hours were self-reported. RESULTS: During median follow-up of 10.8 years, 4371 participants developed cancer (n colorectal cancer: 393; n lung cancer: 247; n breast cancer: 833; and n prostate cancer: 534). We found no clear evidence for an association between working hours and the overall cancer risk. Working hours were also unrelated the risk of incident colorectal, lung or prostate cancers. Working ⩾55 h per week was associated with 1.60-fold (95% confidence interval 1.12-2.29) increase in female breast cancer risk independently of age, socioeconomic position, shift- and night-time work and lifestyle factors, but this observation may have been influenced by residual confounding from parity. CONCLUSIONS: Our findings suggest that working long hours is unrelated to the overall cancer risk or the risk of lung, colorectal or prostate cancers. The observed association with breast cancer would warrant further research.

Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals.

BACKGROUND: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. METHODS: We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. FINDINGS: We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603,838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528,908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001). INTERPRETATION: Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours. FUNDING: Medical Research Council, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), US National Institutes of Health, British Heart Foundation.

Job strain and the risk of stroke: an individual-participant data meta-analysis.

BACKGROUND AND PURPOSE: Psychosocial stress at work has been proposed to be a risk factor for cardiovascular disease. However, its role as a risk factor for stroke is uncertain. METHODS: We conducted an individual-participant-data meta-analysis of 196 380 males and females from 14 European cohort studies to investigate the association between job strain, a measure of work-related stress, and incident stroke. RESULTS: In 1.8 million person-years at risk (mean follow-up 9.2 years), 2023 first-time stroke events were recorded. The age- and sex-adjusted hazard ratio for job strain relative to no job strain was 1.24 (95% confidence interval, 1.05;1.47) for ischemic stroke, 1.01 (95% confidence interval, 0.75;1.36) for hemorrhagic stroke, and 1.09 (95% confidence interval, 0.94;1.26) for overall stroke. The association with ischemic stroke was robust to further adjustment for socioeconomic status. CONCLUSION: Job strain may be associated with an increased risk of ischemic stroke, but further research is needed to determine whether interventions targeting job strain would reduce stroke risk beyond existing preventive strategies.

Who gets fired, who gets re-hired: the role of workers' contract, age, health, work ability, performance, work satisfaction and employee investments.

PURPOSE: Many workers have been dismissed in the past few years, either becoming unemployed or finding re-employment. The current study examined whether dismissal and its follow-up for the employee (re-employment versus unemployment) could be predicted from workers' employment contract and age, and their health status, work ability, work performance, work satisfaction and employee investments at baseline. METHODS: Our sample comprised a selection of participants from the Netherlands Working Conditions Survey 2010 who participated in a follow-up questionnaire in 2012 (N = 2,644). We used logistic regression analyses to test our hypotheses. RESULTS: Temporary employment, low health status, low work ability, poor work performance, low work satisfaction and no employee investments in terms of training predicted future dismissal. Furthermore, older workers and workers reporting decreased work performance due to impaired health at baseline had a lower chance of re-employment after being dismissed. Interestingly, after taking into account all predictors, former temporary workers without permanent employment prospects had much better chances of re-employment after their dismissal than former permanent workers. CONCLUSIONS: Temporary, less healthy, low work ability, poor performing, dissatisfied and "under-invested" workers are at risk for dismissal, whereas older and less healthy workers are (also) at risk for long-term unemployment after being dismissed.

Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data.

BACKGROUND: Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies. METHODS: We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death. FINDINGS: 30,214 (15%) of 197,473 participants reported job strain. In 1·49 million person-years at risk (mean follow-up 7·5 years [SD 1·7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1·23 (95% CI 1·10-1·37). This effect estimate was higher in published (1·43, 1·15-1·77) than unpublished (1·16, 1·02-1·32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1·31, 1·15-1·48) and 5 years (1·30, 1·13-1·50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3·4%. INTERPRETATION: Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking. FUNDING: Finnish Work Environment Fund, the Academy of Finland, the Swedish Research Council for Working Life and Social Research, the German Social Accident Insurance, the Danish National Research Centre for the Working Environment, the BUPA Foundation, the Ministry of Social Affairs and Employment, the Medical Research Council, the Wellcome Trust, and the US National Institutes of Health.

Design of the DISCovery project: tailored work-oriented interventions to improve employee health, well-being, and performance-related outcomes in hospital care.

BACKGROUND: It is well-known that health care workers in today's general hospitals have to deal with high levels of job demands, which could have negative effects on their health, well-being, and job performance. A way to reduce job-related stress reactions and to optimize positive work-related outcomes is to raise the level of specific job resources and opportunities to recover from work. However, the question remains how to translate the optimization of the balance between job demands, job resources, and recovery opportunities into effective workplace interventions. The aim of the DISCovery project is to develop and implement tailored work-oriented interventions to improve health, well-being, and performance of health care personnel. METHODS/DESIGN: A quasi-experimental field study with a non-equivalent control group pretest-posttest design will be conducted in a top general hospital. Four existing organizational departments will provide both an intervention and a comparison group. Two types of research methods are used: (1) a longitudinal web-based survey study, and (2) a longitudinal daily diary study. After base-line measures of both methods, existing and yet to be developed interventions will be implemented within the experimental groups. Follow-up measurements will be taken one and two years after the base-line measures to analyze short-term and long-term effects of the interventions. Additionally, a process evaluation and a cost-effectiveness analysis will be carried out. DISCUSSION: The DISCovery project fulfills a strong need for theory-driven and scientifically well-performed research on job stress and performance interventions. It will provide insight into (1) how a balance between job demands, job resources, and recovery from work can be optimized, (2) the short-term and long-term effects of tailored work-oriented effects, and (3) indicators for successful or unsuccessful implementation of interventions.

Job strain as a risk factor for leisure-time physical inactivity: an individual-participant meta-analysis of up to 170,000 men and women: the IPD-Work Consortium.

Unfavorable work characteristics, such as low job control and too high or too low job demands, have been suggested to increase the likelihood of physical inactivity during leisure time, but this has not been verified in large-scale studies. The authors combined individual-level data from 14 European cohort studies (baseline years from 1985-1988 to 2006-2008) to examine the association between unfavorable work characteristics and leisure-time physical inactivity in a total of 170,162 employees (50% women; mean age, 43.5 years). Of these employees, 56,735 were reexamined after 2-9 years. In cross-sectional analyses, the odds for physical inactivity were 26% higher (odds ratio = 1.26, 95% confidence interval: 1.15, 1.38) for employees with high-strain jobs (low control/high demands) and 21% higher (odds ratio = 1.21, 95% confidence interval: 1.11, 1.31) for those with passive jobs (low control/low demands) compared with employees in low-strain jobs (high control/low demands). In prospective analyses restricted to physically active participants, the odds of becoming physically inactive during follow-up were 21% and 20% higher for those with high-strain (odds ratio = 1.21, 95% confidence interval: 1.11, 1.32) and passive (odds ratio = 1.20, 95% confidence interval: 1.11, 1.30) jobs at baseline. These data suggest that unfavorable work characteristics may have a spillover effect on leisure-time physical activity.

Can labour contract differences in health and work-related attitudes be explained by quality of working life and job insecurity?

STUDY AIM: We hypothesise that due to a lower quality of working life and higher job insecurity, the health and work-related attitudes of temporary workers may be less positive compared to permanent workers. Therefore, we aimed to (1) examine differences between contract groups (i.e. permanent contract, temporary contract with prospect of permanent work, fixed-term contract, temporary agency contract and on-call contract) in the quality of working life, job insecurity, health and work-related attitudes and (2) investigate whether these latter contract group differences in health and work-related attitudes can be explained by differences in the quality of working life and/or job insecurity. METHODS: Data were collected from the Netherlands Working Conditions Survey 2008 (N = 21,639), and Hypotheses were tested using analysis of variance and cross-table analysis. RESULTS: Temporary work was associated with fewer task demands and lower autonomy and was more often passive or high-strain work, while permanent work was more often active work. Except for on-call work, temporary work was more insecure and associated with worse health and work-related attitude scores than permanent work. Finally, the quality of working life and job insecurity partly accounted for most contract differences in work-related attitudes but not in health. CONCLUSIONS: Especially agency workers have a lower health status and worse work-related attitudes. Job redesign measures regarding their quality of working life and job insecurity are recommended.

A hard day's night: a longitudinal study on the relationships among job demands and job control, sleep quality and fatigue.

This prospective four-wave study examined (i) the causal direction of the longitudinal relations among job demands, job control, sleep quality and fatigue; and (ii) the effects of stability and change in demand-control history on the development of sleep quality and fatigue. Based on results of a four-wave complete panel study among 1163 Dutch employees, we found significant effects of job demands and job control on sleep quality and fatigue across a 1-year time lag, supporting the strain hypothesis (Demand-Control model; Karasek and Theorell, Basic Books, New York, 1990). No reversed or reciprocal causal patterns were detected. Furthermore, our results revealed that cumulative exposure to a high-strain work environment (characterized by high job demands and low job control) was associated with elevated levels of sleep-related complaints. Cumulative exposure to a low-strain work environment (i.e. low job demands and high job control) was associated with the highest sleep quality and lowest level of fatigue. Our results revealed further that changes in exposure history were related to changes in reported sleep quality and fatigue across time. As expected, a transition from a non-high-strain towards a high-strain job was associated with a significant increase in sleep-related complaints; conversely, a transition towards a non-high-strain job was not related to an improvement in sleep-related problems.

Process Evaluation of a Digital Platform-Based Implementation Strategy Aimed at Work Stress Prevention in a Health Care Organization.

OBJECTIVE: The objective was to evaluate the process and feasibility of a digital platform-based implementation strategy aimed at work stress prevention. METHODS: The process evaluation was performed alongside a controlled trial within a health care organization, in the experimental group (N = 221). Mental models, context, and barriers and facilitators were measured. In addition, dose delivered, reach, and dose received were assessed. RESULTS: Employees reported relatively high readiness for change. Personnel shortage and a recent restructuring of the organization hindered use of the strategy. Low management support and high turnover stagnated strategy deployment. Dose delivered was 13/15, reach was 11/15, and dose received was 5/15. CONCLUSIONS: Strategy implementation was moderately successful, as sustained strategy use by the teams appeared to be a challenge. The strategy can be feasible with sufficient management support and resources.

Different mechanisms to explain the reversed effects of mental health on work characteristics.

OBJECTIVES: The number of longitudinal studies reporting evidence for reversed effects of strain on work is growing, but evidence regarding the mechanisms underlying such effects is scarce. In this study, earlier longitudinal findings were reviewed, and the following four mechanisms for reversed effects were proposed that reflect within-person or environmental changes: (i) the rosy perception mechanism, (ii) the gloomy perception mechanism, (iii) the upward selection mechanism, and (iv) the drift mechanism. METHODS: These mechanisms were tested using structural equation modeling and longitudinal data from a Dutch four-phase study (N=1588 participants). RESULTS: The results revealed that work characteristics and mental health influenced each other reciprocally and longitudinally. The reversed effects were examined in more detail, and it was found that these could be accounted for by both within-person and environmental change mechanisms. The rosy perception mechanism was found to explain the positive effects from health on job demands; the upward selection mechanism explained the positive (environmental) effects from health on job control; the gloomy perception mechanism explained the reversed (evaluation) effects from health on supervisory social support. No support was found for the drift mechanism. CONCLUSIONS: Mechanisms that may explain reversed causation are yet poorly understood. The main contribution of the present study lies in the fact that it proposes (i) a conceptual framework with which to analyze the effects of health on work characteristics and (ii) methods for testing these mechanisms. The study revealed that there is good reason to pursue research on reversed causality.

Disentangling the causal relationships between work-home interference and employee health.

OBJECTIVES: The present study was designed to investigate the causal relationships between (time- and strain-based) work-home interference and employee health. The effort-recovery theory provided the theoretical basis for this study. METHODS: Two-phase longitudinal data (with a 1-year time lag) were gathered from 730 Dutch police officers to test the following hypotheses with structural equation modeling: (i) work-home interference predicts health deterioration, (ii) health complaints precede increased levels of such interference, and (iii) both processes operate. The relationship between stable and changed levels of work-home interference across time and their relationships with the course of health were tested with a group-by-time analysis of variance. Four subgroups were created that differed in starting point and the development of work-home interference across time. RESULTS: The normal causal model, in which strain-based (but not time-based) work-home interference was longitudinally related to increased health complaints 1 year later, fit the data well and significantly better than the reversed causal model. Although the reciprocal model also provided a good fit, it was less parsimonious than the normal causal model. In addition, both an increment in (strain-based) work-home interference across time and a long-lasting experience of high (strain-based) work-home interference were associated with a deterioration in health. CONCLUSIONS: It was concluded that (strain-based) work-home interference acts as a precursor of health impairment and that different patterns of (strain-based) work-home interference across time are related to different health courses. Particularly long-term experience of (strain-based) work-home interference seems responsible for an accumulation of health complaints.

Job strain in relation to ambulatory blood pressure, heart rate, and heart rate variability among female nurses.

OBJECTIVE: This study examined the effects of exposure to job strain on independent predictors of cardiovascular disease (ambulatory blood pressure, heart rate, and heart rate variability). METHODS: The participants comprised a homogeneous group of 159 healthy female nurses [mean age 35.9 (SD 8.5) years]. The choice of this population minimized variance attributable to gender, socioeconomic status, and work characteristics. Job demands, decision latitude, and social support were measured with the Karasek job content questionnaire, which was administered twice with an average interval of 12.2 months. The nurses' scores for job demands and decision latitude on both occasions were used to define their job-strain category. Ambulatory blood pressure, heart rate, and heart rate variability were assessed on a workday and a day of leisure. RESULTS: No effect on the ambulatory levels of blood pressure, heart rate, or heart rate variability was found for job strain by itself or in interaction with social support. In addition, job strain was not associated with differences in short-term or long-term physiological recovery during sleep after a workday or a day of leisure. High job demand was associated with higher systolic blood pressure at work and with higher diastolic blood pressure at work, but the latter association was found only when decision latitude was concurrently high, rather than low. CONCLUSIONS: High job strain among young female nurses is not associated with an unfavorable ambulatory cardiovascular profile. The robust effect of job strain on male health appears to be less apparent for women.

Effects of stable and changing demand-control histories on worker health.

OBJECTIVES: The present study examined effects of stability and change in exposure to job demands and job control (demand-control histories) in relation to the strain hypothesis of Karasek's demand-control model. METHODS: The hypotheses [(i) high (low) levels of ill health were expected for workers exposed to stable 1 levels of high (low) job demands and low (high) job control; (ii) decreases (increases) in strain-related health outcomes were expected for workers with positive (negative) changes in job demands and job control; (iii) workers reporting major changes in job demands or control were expected to report more "objective" job changes] were tested with a group-by-time analysis of variance using data from a four-phase Dutch cohort study on musculoskeletal disorders, absenteeism, stress, and health. Associations between demand-control histories and job changes were tested in a log-linear analysis. RESULTS: The hypotheses for the stable exposure groups were supported for depression and job satisfaction. Those for positive and negative changes were partially supported. There was no relation, however, between the level of stability or changes in exposure to demands and control for the registered duration and frequency of sickness absence. Finally, the results showed that workers reporting major changes in demand-control histories over time had more job changes, and those reporting job changes towards high strain jobs evaluated the changes as more distressful. CONCLUSIONS: This longitudinal study supports the strain hypothesis of the demand-control model and shows a significant association between major changes in demand-control histories and job changes.