Work stressors: effects on health and
sickness absence
Findings from Whitehall II and other studies
Jane E. Ferrie
Department of Epidemiology and Public Health
University College London
Labour market stressors
Moves to private sector practice
Job insecurity
Temporary employment
2
relative increase in cardiovascular risk factors
compared to men not transferred to agencies*
Moves to private sector practice (transfer to an executive agency)
effects on health and sickness absence (men)
% excess ill-health compared to men
not transferred to agencies*
60
50
40
30
20
10
0
physical
ill-health*
3
2.5
2
1.5
1
0.5
0
systolic bp diastolic bp
longstanding mental ill- sickness
illness*
health
absence
weight
* adjusted for age, employment grade, marital status & health at the
beginning of the follow-up period
Ferrie et al. J Occup. Health Psychology 2001
Job insecurity and health in women
260
remained secure
gained job security
lost job security
chronic job insecurity
Increase in ill-health*
240
220
200
180
160
140
120
100
80
60
poor physical health poor mental health
depression
longstanding illness
*adjusted for age, employment grade & health at the beginning of follow-up
4
Ferrie et al. J. Epidemiology Community Health 2002
increased likelihood of ischaemia
odds ratios*
Job insecurity and coronary artery disease
Secure
Facing privatisation
1.8
1.6
1.4
1.2
1
0.8
Women
Men
*adjusted for age, grade and CAD before the threat of privatisation
5
Ferrie et al. Am. J. Public Health 1998
Job insecurity and sickness absence
Secure (Controls)
Insecure - Short spells
Insecure - Long spells
1.1
1
0.9
Odds Ratios*
0.8
0.7
0.6
0.5
0.4
0.3
0.2
Women
Men
*adjusted for age, employment grade and health status
6
Ferrie et al 2001 J. Occup. Health Psychol
Temporary employment and sickness
absence
Permanent
Temp - Perm
Temporary
Rate Ratios*
1
0.5
0
Baseline
Follow-up
*adjusted for age, sex, income, and number of contracted days
7
Virtanen et al 2003 Occup Environ Med
Temporary employment and early death
Permanent
Temp - Perm
Temporary
Hazard Ratios*
2
1.5
1
0.5
0
Women
Men
*adjusted for age, occupational status and income
8
Virtanen et al 2003 Am. J. Epidemiol
Conceptualising Work Stress
Major work stress models (questionnaire based measures)
 Job strain (Demand-Control) model
 Effort-Reward Imbalance model
 Organisational Justice model (fair treatment)
9
Conceptualising Work Stress
Major work stress models
 Job strain (Demand-Control) model
 Effort-Reward Imbalance model
 Organisational Justice model (fair treatment)
10
Job strain (Demand-Control) model
in 1979 Robert Karasek argued that work stress results "from the joint effects
of the demands of a work situation and the range of decision-making freedom
available to the worker facing those demands……….” Job strain occurs
when psychological job demands are high and job control is low"
Example question on job demands:Do you have enough time to do everything?
Example question on job control:Do you have a say in your own work speed?
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Job Strain Model
HIGH
HIGH
Job control
LOW
low
strain
active
LOW
Psychological job demands
passive
high
strain
job strain
12
Karasek and Theorell 1990
Job strain and new coronary heart disease
Meta-analysis of prospective studies
13
Kivimäki et al 2006 Scan J Work Environ Health
Job strain and sickness absence
Meta-analysis
control group
crude odds ratios
1.6
adjusted odds ratios*
*adjusted for age, demographic factors, behaviour,
health status, occupation and baseline sickness absence
1.5
Odds Ratios
1.4
1.3
1.2
1.1
1
0.9
0.8
3 days or less
14
more than 3 days
Duijts et al 2007 J. Clin Epidemiol
Influence of change in job strain on
sickness absence
Hazard ratio for long spells of sickness absence, stable = reference
1.4
1.4
1.3
Decrease
1.2
Increase
Increase
1.2
Decrease
1.1
1.1
1
1
0.9
0.9
0.8
0.8
Work demands
15
1.3
Job control
Head et al. J Epidemiol Community Health 2006
Conceptualising Work Stress
Major work stress models (questionnaire based measures)
 Job strain (Demand-Control) model
 Effort-Reward Imbalance model
 Organisational Justice model (fair treatment)
16
Effort-Reward Imbalance (ERI)

Reciprocal exchange underlies all transactions in society

Digression from this reciprocity produces stress

In the workplace reciprocity depends on a balance
between perceived efforts spent and rewards received
Efforts:
Rewards:
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Responsibility
Time pressure
Work load
Esteem
Career opportunities
Pay
Likelihood of CHD (Hazard Ratio)*
Effort-Reward Imbalance at work and
coronary heart disease
1.4
1.3
1.2
1.1
1
0.9
Low EffortReward Ratio
Medium Low
Medium High
High EffortReward Ratio
*adjusted for age, sex and employment grade
18
Kuper et al. Occup. Environ. Med. 2002
Effort-Reward Imbalance and
sickness absence
1.4
Low
Intermediate
High
1.3
Odds Ratios*
1.2
1.1
1
0.9
0.8
Short-spells (women)
Long spells (men)
*adjusted for age, employment grade and health status
19
Head et al 2007 J. Psychosomatic Research
Conceptualising Work Stress
Major work stress models
 Job strain (Demand-Control) model
 Effort-Reward Imbalance model
 Organisational Justice model (fair treatment)
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Organisational Justice
refers to the extent to which employees are treated with
fairness and justice at their workplace
 Procedural component
decision-making procedures include input from
affected parties, are consistently applied, open
and ethical
 Relational component
respectful and considerate treatment of employees
by supervisors
21
Organisational Justice and health
1.00
1.00
1.00
Organisational
justice
Odds ratio*
0.80
0.60
25% with
lowest justice
0.60
25% with
highest justice
0.48
0.40
0.20
0.00
Poor self-rated health
Poor mental health
*adjusted for demographic and behavioural risk factors
22
Elovainio et al. (2001) Am J Public Health
Organisational Justice (relational component)
and sickness absence in women
1.4
Low
Intermediate
High
1.3
Odds Ratios*
1.2
1.1
1
0.9
0.8
Short-spells
Long spells
*adjusted for age, employment grade and health status
23
Head et al 2007 J. Psychosomatic Research
Does a change in organisational
justice lead to a change in health?
24
Odds of new-onset common mental disorders
Change in Organisational Justice
25
1.75
Men
Women
1.50
1.25
1.00
0.75
0.50
0.25
0.00
Adverse
change
No change
Favourable
change
Ferrie et al. Occup Environ Med 2006
Summary
 Changes in the labour market have adverse effects job
security and other aspects of the psychosocial work
environment, such as job demands, the ratio of effort
to reward, etc
 Psychosocial stressors in the work environment have
adverse effects on health and well-being
 Reductions in levels of work stress result in health
improvements and healthy levels of sickness absence
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Sickness Absence Research Collaboration
 SARC: Four-country collaboration - Finland, France, Sweden
and the UK
 Studies: 10-town study (Finland), GAZEL study (France),
Östergötland and SLOSH studies (Sweden), and the Whitehall II
study (UK)
 Researchers : Mika Kivimäki and Jussi Vahtera (10-town), Maria
Melchior and Archana Singh-Manoux (GAZEL), Kristina
Alexanderson (Östergötland) and Hugo Westerlund (SLOSH)
and Jane Ferrie and Jenny Head (Whitehall II)
SARC meetings are supported by a grant from the ESRC
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