Methodological and conceptual issues regarding occupational psychosocial coronary heart disease epidemiology

Abstract

OverviewPsychosocial occupational epidemiology has mainly focused on the demand-control and, to a much lesser extent, the effort-reward-imbalance (ERI) models. These models and the strong focus on them raise some conceptual and methodological issues we will address in the following letter.The conceptual issues include the empirical confirmation of the assumptions of these models, the extent to which the focus on the demand-control and ERI models is warranted, and whether the sub-dimensions of the scales in these models have common health effects. We argue that there is a lack of empirical approval of (i) the assumptions behind both models and (ii) the focus on these models.The methodological issues include how exposure to job strain is categorized, how ERI previously has been measured, and the validity of self-reports of job strain. We argue that (i) a population independent definition of job strain is lacking, (ii) the older measurements of ERI mix exposure and effect, and (iii) we know little regarding the validity of the measurement of the psychosocial working environment.Finally, we suggest that analyses of monitoring data with a broader focus on the psychosocial working environment can be used to shed light to some of the issues raised above.

Association Between Work‐Related Stress and Coronary Heart Disease: A Review of Prospective Studies Through the Job Strain, Effort‐Reward Balance, and Organizational Justice Models

“…A further issue with meta‐analyses for work stress is that concepts, such as job strain, effort‐reward imbalance, and organizational injustice, are typically characterized in a median or quartile split across the population investigated. As Burr et al outlined in their Letter to the Editor, whether certain individuals are identified as having job strain, and therefore have work stress, depends on who else is in the sample . This is problematic when work demand, control, and other work environment related characteristics vary between jobs and across countries.…”

“…As Burr et al outlined in their Letter to the Editor, whether certain individuals are identified as having job strain, and therefore have work stress, depends on who else is in the sample. 53 This is problematic when work demand, control, and other work environment related characteristics vary between jobs and across countries. If the prevalence of job strain varies between populations and is inherently dependent on the distribution of demands and control within that population, combining data from different populations as part of a metaanalysis can become challenging.…”

Association of poor psychological well‐being with co‐exposure to psychosocial factors at work in Korean regular workers

“…A recent multi‐cohort study reported that the combination of job strain and ERI was associated with a 40% higher risk of coronary heart disease, although the excess risk of each stressor separately was only 16% 22 . However, the real psychosocial work environment has a variety of possible psychosocial factors; some of these were considered in the models and others were not 20 . Thus, co‐exposure to a variety of psychosocial factors should be assessed to capture the complex reality of today's working world 21 .…”

“…There is always a trade‐off between the limitations of conceptual focus that are inherent to theoretical models and the desire to understand the full complexities of the real world 19 . Thus, the variety of possible psychosocial factors (some considered and others not considered in the models) that are present in the real psychosocial work environment should be measured to capture the complex reality of today's working world 20,21 …”

Stress in der Krankenpflege. Ergebnisse aus Befragungen mit COPSOQ

“…Im Alltagsgebrauch ist "Stress" überwie-gend negativ belegt und mit Erscheinungen von leichter Gereiztheit bis zum Zustand chronischer Erschöpfung assoziiert. Nachweise für Ursache-Wirkungs-Ketten, die bei den Lebensumständen einer Person anfangen und über die Entwicklung von Stress-Symptomen bis zu Angststörungen, Depression oder Herz-Kreislauf-Erkrankungen führen, liegen vor, sind aber nur in aufwendigen Langzeitbeobachtungen zu entdecken [2,3]. Die Erweiterung des Arbeitsschutzgesetzes um den Hinweis, dass Arbeitgeber neben den physischen Arbeitsbedingungen die psychischen Belastungen ihrer Beschäftigten untersuchen müssen, gibt der Identifikation und Prävention von Stress bei der Arbeit und seinen Ursachen ein Fundament (ArbSchG § 5).…”