The impact of job insecurity on long-term self-rated health - results from the prospective population-based MONICA/KORA study.

BACKGROUND: Job insecurity has been associated with impaired self-rated health (SRH) in cross-sectional studies, but prospective findings with short, medium and long-term follow-up yielded mixed findings. Therefore, the aim of the present study was to assess the long-term association between perceived job insecurity and SRH, after controlling for baseline levels of health status and life-style choices. Furthermore, three different follow-up periods (14, 19 and 24 years) were considered. METHODS: Data were derived from the prospective population-based MONICA/KORA cohort study (southern Germany). N = 4356 participants (2622 men and 1734 women), aged between 25 and 64 years at baseline, were included in the sample, mean follow-up was after 19.1 years. Job insecurity, SRH and risk factors were assessed at baseline during three independent surveys (1984-1995). SRH was additionally assessed in 2009. The association of job insecurity and impaired SRH at follow-up was estimated using logistic regression analyses. RESULTS: Overall, perceiving job insecurity at baseline was significantly associated with a 20% higher risk of developing impaired SRH at follow-up in the pooled analysis (OR = 1.20, 95% CI = 1.01-1.43, p = .034), even after controlling for baseline SRH, socio-demographic characteristics, lifestyle, clinical and work-related factors. The association was strongest and significant after 14 years (OR = 1.58, 95% CI 1.17-2.13, p = .003) and weaker and not significant to 19 (OR = 1.20, 95% CI 0.89-1.62, p = .24) and 24 years (OR = 0.98, 95% CI 0.73-1.32, p = .89) of follow-up in the fully adjusted models. CONCLUSIONS: We found that perceived job insecurity during working life was independently and significantly associated with impaired SRH both cross-sectionally as well as after 14 years, but not after 19 and 24 years.

Can a workplace leadership intervention reduce job insecurity and improve health? Results from a field study.

PURPOSE: To examine the effectiveness of an intervention in the workplace designed to reduce job insecurity among employees affected by organizational change. METHODS: Supervisors were randomly allocated to an intervention (IG) or waiting-list-control group (CG) and the intervention was administered over a period of 3 months, comprising six group sessions. N = 103 supervisors and their team members (mean age 41.80 ± 9.60 years, 60.19% male) provided data prior to (t0) and 3 months post-intervention (t1) by means of questionnaires and hair samples. Job insecurity (COPSOQ), mental health (HADS) and somatic health (GBB, hair cortisol concentration) were measured. RESULTS: Job insecurity was reduced to a marginally significant degree in the IG compared to the CG at t1 (B = - 5.78, p = .06, CI [- 11.73, 0.17]). Differential effects for supervisors and team members were not found. No effects on health could be observed overall in the IG, but supervisors in the IG reported a significant decrease in exhaustion tendency (B = - 0.92, p = 0.01, CI [- 1.64, - 0.20]) and a non-significant trend towards higher levels of anxiety (B = 2.98, p = 0.10, CI [- 0.57, 6.54]) compared to team members. CONCLUSIONS: This is the first study to provide some evidence for the effectiveness of an intervention that aimed at reducing job insecurity during organizational change. Health-related effects were observed in supervisors but not in team members. Further intervention studies are needed to add to the current knowledge base.

Effects of psychosocial work characteristics on hair cortisol - findings from a post-trial study.

Prolonged work stress, as indicated by the effort-reward imbalance (ERI) model, jeopardizes health. Cortisol represents a candidate mechanism connecting stress to ill health. However, previous findings appear inconclusive, and recommendations were made to assess work stress at multiple time points and also to investigate ERI (sub-)components. This study therefore examines the effects of two single time points, as well as the mean and change scores between time points of ERI and its components on hair cortisol concentration (HCC), a long-term cortisol measurement. Participants were 66 male factory workers (age: 40.68 ± 6.74 years; HCC: 9.00 ± 7.11 pg/mg), who were followed up after a stress management intervention (2006-2008). In 2008 (T1) and 2015 (T2), participants completed a 23-item ERI questionnaire, assessing effort, the three reward components (esteem, job security, job promotion) and over-commitment. In 2015, participants also provided a 3-cm hair segment close to the scalp for HCC analysis, as well as information on relevant confounders (i.e. medication intake, age, work characteristics, socioeconomic and lifestyle factors, number of stressful life events). Linear regressions revealed hardly any cross-sectional or longitudinal effect of ERI and its components on HCC. Only the change scores between T1 and T2 of job security were negatively associated with lower HCC in unadjusted (ß = -.320; p = .009) and adjusted (ß = -.288; p = .044) models. In this study, only a decrease of perceived job security over time was significantly associated with higher HCC, and other predictors were not related to this outcome. Especially after correction for multiple testing, this study revealed just a weak association of different psychosocial work measurements with HCC. Lay summary This study showed that an increase in perceived job insecurity is correlated with higher levels of the stress hormone cortisol. The higher levels of cortisol might represent a biological explanation for the negative health effects of job insecurity. The association was, however, relatively low, and more and more voices are questioning whether cortisol in hair is a reliable marker for perceived work stress.

The long-term impact of a change in Effort-Reward imbalance on mental health-results from the prospective MAN-GO study.

Background: Little is yet known on the long-term effects of stress management interventions (SMIs) in the workplace. The aim this study was to prospectively examine the effect of an improvement of psychosocial working conditions measured by the Effort-Reward (E-R) Imbalance model within 2 years following an SMI, and mental health 7 years later. Methods: The study sample consisted of 97 male industrial workers from southern Germany. Data were collected pre- and post-intervention in 2006 (T1) and 2008 (T2), respectively, as well as in 2015 (T3). Change scores were computed by subtracting T1 from T3 values. The associations between E-R ratio at T1, T2 and the change score, respectively, with depression and anxiety 7 years later were estimated by means of linear regression analysis. Analyses were adjusted for baseline levels of the exposure and outcome variables, socio-demographic-, health- and work-related covariates. Results: Within-person comparisons revealed a significant reduction (i.e. improvement) in E-R ratio post-intervention (-0.103, SD 0.24, P = 0.000). This improvement in the E-R ratio was significantly associated with lower anxiety (ß = 0.358, P = 0.001) and depression (ß = 0.246, P = 0.031) scores in the fully adjusted models. The association between change scores and mental health were slightly stronger than associations with absolute values at T1 and T2. Conclusions: An improvement in E-R ratio following an SMI, was significantly associated with lower anxiety and depression 7 years later. These results strongly support the importance of improving psychosocial working conditions in order to protect the mental health of employees in the long-run.

Long-Term Effectiveness of Stress Management at Work: Effects of the Changes in Perceived Stress Reactivity on Mental Health and Sleep Problems Seven Years Later.

The reduction of stress reactivity resulting from stress management interventions prevents disorders and improves mental health, however, its long-term sustainability has been little examined. The objective of this study was, therefore, to determine the effectiveness of a stress management intervention, designed to improve stress reactivity, for mental health and sleep problems seven years later, using longitudinal data from 101 male industrial workers. Linear regressions estimated the adjusted effects of the changes in stress reactivity in general as well as in its six subdimensions (work overload, social conflict, social stress, failure at work, and anticipatory and prolonged reactivity) on depression, anxiety, and sleep problems seven years later. The improvement of the prolonged reactivity had positive effects on depression, anxiety, and sleep problems (unstandardized regression coefficients [Bs] ≥ 0.35, all p-values ≤ 0.01). Depression and sleep problems were further improved by a reduction of the reactivity to social conflicts (Bs ≥ 0.29, p-values < 0.05), and an improvement in the overall reactivity score positively influenced sleep problems (B = 0.07, p = 0.017). In conclusion, the improvement of stress reactivity resulting from a work stress intervention was effective and generally long-lasting in preventing mental health and sleep problems. The reduction of the prolonged reactivity seems of particular importance and efficient in inhibiting negative stress manifestations.

Associations of work stress with hair cortisol concentrations - initial findings from a prospective study.

There is ample evidence supporting the link between stress at the workplace and physical and mental health. One of the pathways potentially mediating those associations may involve the hypothalamic-pituitary-adrenal (HPA) axis, with cortisol as an end product. While theoretically plausible, findings on the association of self-reported work stress with hair cortisol concentrations (HCC) are inconclusive, being potentially biased by omitted pertinent factors. This issue can be addressed, among others, by eliminating time-invariant factors through consideration of variation within persons over time. To this end, the present study examined the association between variation in HCC and perceived work stress - as assessed by the Effort-Reward-Imbalance (ERI) model - between two points in time (t1 and t2) over one year in a sample of 40 male factory workers. Neither a cross-sectional association, nor a link between change in ERI and HCC levels at t2 was observed. There was however a robust association of the change in ERI with the change of HCC. This effect was independent of baseline HCC and other confounders (Beta = 0.414, S.E. = 0.155, p = 0.012). Accordingly, this is the first study revealing prospective evidence for the associations of work stress with HCC, while excluding potentially time-stable confounding factors, like genetic factors or phenotypic hair color.

Do Working Conditions of Patients in Psychotherapeutic Consultation in the Workplace Differ from Those in Outpatient Care? Results from an Observational Study.

In previous studies, it was found that patients treated at a psychosomatic outpatient clinic (PSOC) for common mental disorders showed more severe symptoms than those who used a psychotherapeutic consultation service at the workplace (PSIW). This study examines whether the higher symptom severity of the PSOC patients in comparison to their PSIW counterparts is also related to higher levels of occupational stress as measured by the demand-control-support model (DCS). N = 253 participants (PSIW n = 100; PSOC n = 153) provided self-reported data on demands, decision latitude, social support, and health before consultation. The association between mental health care setting, symptom level and demands, decision latitude, and social support was assessed by means of a path model. Results of the path model indicated that the higher level of depression in PSOC patients was related to higher levels of demands and lower levels of social support. Demands and social support were found to be indirectly associated with treatment setting. No interaction effect between demands, decision latitude, social support, and depression was found. Results of this study reveal that the working conditions influenced the pathway to care process via symptom severity.

Long-Term Effectiveness of a Stress Management Intervention at Work: A 9-Year Follow-Up Study Based on a Randomized Wait-List Controlled Trial in Male Managers.

OBJECTIVE: Short- and medium-term effectiveness (up to 3 years) of individual level stress management interventions (SMI) at work were demonstrated, yet long-term effectiveness remains unexplored. We therefore aimed to address this research gap. METHODS: 94 male middle managers participated in a randomized wait-list controlled trial between 2006 and 2008 and in a post-trial-follow-up survey in 2015. During the first two years, all received an 18-hour psychotherapeutic SMI intervention which was based on the Effort-Reward Imbalance (ERI) model: tackling stressor on mismatch between effort and reward and promoting recovery on overcommitment. Work stress (i.e., ERI indicators) was the primary outcome, and the secondary outcome was depressive symptoms. The long-term effectiveness of the SMI was examined by mixed modeling, using an external control group (n = 94). RESULTS: Effort and reward were substantially improved with significant intervention ⁎ time interaction effects (p < 0.001) compared to the external control group; effects on overcommitment and depressive symptoms were also significant (p < 0.05 and p < 0.01, resp.), though their trajectories in the intervention group were less sustainable. CONCLUSIONS: The effectiveness of this psychotherapeutic SMI at work based on the ERI model was observed over a 9-year period, particularly on the effort-reward ratio.

Mid-life job insecurity associated with subjective well-being in old age: results from the population-based MONICA/KORA study.

OBJECTIVE: This study aimed to examine prospectively the influence of exposure to job insecurity during working life on subjective well-being (SWB) after retirement, an association which has not been studied to date. METHOD: Data were derived from the prospective population-based MONICA/KORA study conducted in southern Germany. Participants were recruited and data were collected during three independent surveys between 1984-1995 (T1) and followed up in 2009 (T2). The study sample consisted of 1801 employed participants (1146 male/ 655 female) aged 41-72 years at T1 and ≥ 65 years at T2, without missing data. Self-administered questionnaires and clinical examinations were used to assess job insecurity and risk factors at T1 and SWB at T2. Mean follow-up was 19.6 years. Logistic regression analyses were performed to determine the association of job insecurity with SWB after retirement. We accounted for an extensive set of sociodemographic, lifestyle-, health- and work-related risk factors. RESULTS: At T1, 39.5% of the participants reported job insecurity, which was associated with a 1.40-fold [95% confidence interval (95% CI) 1.08-1.82] risk of low SWB at T2 in models adjusted for sociodemographic and lifestyle- and health-related conditions at T1. Additional adjustment for a set of work-related risk factors at T1 had little effect on this association. CONCLUSIONS: Exposure to job insecurity at midlife was associated with low SWB in retirement, even after controlling for an extensive set of risk factors. This shows that the negative effects of unstable working conditions might persist well into retirement, long after cessation of employment.