The Fourth International Congress of Behavioral Medicine was held in Washington, D.C. during March 13-16, 1996. A number of sessions on job stress and job strain were held. We present here a few of the more interesting abstracts that seem informative to the job stress research community
Robert Karasek, Ph.D., University of Massachucetts Lowell,
USA.
This paper maintains that the currently evolving conditions of
work in the industrialized world leads us to new definitions of
social class. Conventional definitions of social class are based
on wellbeing as reflected in possession of economic goods: (a)
income level; or (b) job factors, relating to work's organization,
which are conventionally overlooked - low job control for example
- help explain why low status work may have fewer mental demands
but more psychological distress than high status work. Analysis
of occupational income data, together with psychosocial job data,
also reveal similar failures of conventional class concepts in
the health sphere.
A new model of social class which includes psychosocial job factors
is introduced. Workers with "high strain" jobs reap
an otherwise "invisible" cost of modern production in
terms of illness risk, dissatisfaction and poor self-esteem. "Active"
job holders reap a benefit in terms of creativity, skill development,
and self esteem that is "invisible" in terms of physical
demands or wage. Our current occupational/political system is
based on our conventional social class model and is now applied
to resolve conflicts stated in terms of economic rewards, and
physical demands - omitting psychosocial factors from modern political
discussions. The paper concludes with a discussion about how the
current U.S. political conflict reflects an emerging split between
elites of the "old" and the "new" social class
system and the potential health impact of these changes.
Corresponding Author: Robert Karasek, Ph.D., Michael G. Marmot,
Ph.D., M.D. University College London Medical School, London,
U.K.
Chair: Jeffrey V. Johnson, Ph.D., John Hopkins University
Participants: Robert A. Karasek, PhD., University of Massachusetts
at Lowell, and John Frank, M.D., Ontario Institute for Work and
Health, and Stephen Stansfeld, Ph.D., University College London
Medical School, and M. Harvey Brenner, Ph.D., John Hopkins University
Discussant: Johannes Siegrist, Ph.D., Heinrich Heine University
Dusseldorf.
Differential exposure to adverse work environment conditions varies
as a function of social class in most modern societies. Physical
and chemical aspects as well as psychosocial work organization
have been shown to be consistently more aversive for those in
lower level production and service jobs. Research suggests that
work that is monotonous, low skilled jobs with low control place
individuals at risk for psychophysiological stress reactions and
for cardiovascular disease, muscle skeletal disorders, and other
health problems. The life course patterns of individuals in lower
social class positions does not improve over tine and consists
of high effort and low reward.
The papers in this symposium will examine whether differential
exposure to working conditions is a pathway that links social
position to health inequality. An international approach will
be taken with presentations from the U.S., the U.K., Canada, and
Germany. Individual papers will present new conceptualizations
of class, and will discuss the complex relationship between social
status position and the nature of work experience.
Corresponding Author: Jeffrey V. Johnson, Ph.D., Social and Behavioral
Sciences, John Hopkins School of Social Hygiene and Public Health,
624 N. Broadway, Baltimore, MD, USA.
Stephen A. Stansfeld, Ph.D., Jennifer Head, Ph.D., Michael
G. Marmot, Ph.D.,M.D. University College London Medical School,
London, U.K.
Many stress studies have shown higher rates of psychiatric disorder
related to lower socioecononic status. These differences have
been attributed to differing rates of life events and social disadvantage
by social class. The contribution of work characteristics to these
differences has been little studied. Associations between work
characteristics, employment grade, and psychiatric disorder are
described from the Whitehall ll study, a cohort study of 6,895
male and 3,414 female London-based civil servants, aged 35-55
years at baseline. Work characteristics were measured at baseline
in 1985 using a self-report questionnaire. Psychiatric disorder
was measured by the General Health Questionnaire (GHQ) and also
by sickness absence attributed to psychiatric disorder. Socio-economic
status was defined by employment grade in terms of income and
status. In initial cross-sectional analysis there was no gradient
in GHQ score by employment grade. However, there was an employment
grade gradient for a subscale of the GHQ, measuring depression.
There was also a gradient in the sickness absence such that those
in the lower employment grades had higher rates of psychiatric
sickness absence. Explanations for this include that there is
confounding between work characteristics and employment grade
of that work characteristics are mediating factors for the effect
of employment grade on health.
Corresponding Author: Stephen A. Stansfeld, Ph.D., Department
of Epidemiology, University College London Medical School, 1-19
Torrington Place, London WC1E 6BT, U.K.
Joeseph Schwartz, Ph.D., Suny-Stonybrook, Paul Landsbergis,
Ed.D., Peter L. Schnall, M.D.,M.P.H., and Thomas G. Pickering,
M.D., D.Phil., Cornell University Medical Center
Objective: To evaluate the relationship of blood pressure
(BP) to job strain varies by age and body mass (BMI).
Backround: The Cornell Worksite BP study's primary goal
has been to estimate and test the effect of job strain, defined
according to Karasek's Job Demands/Job Control model, on changes
in ambulatory blood pressure and cardiovascular functioning.
Sample: 292 men, 80 women (25% minority) from nine NYC
worksites, all aged 30-60 at recruitment with no evidence of CHD
or severe hypertension. Three and 6 year follow-up was obtained
for 78% and 81% of the sample, with most of the attrition due
to geographic mobility.
Data: Job strain was assessed with the Job Content Questionnaire.
Height and weight were measured by a nurse/technician once or
twice each wave; multiple measures were averaged. Subjects wore
a Spacelabs ambulatory blood pressure monitor and recorded their
location at the time of each reading. Average work, home and sleep
systolic and diastolic BP (6 dependent variables) were calculated
at baseline, 3-years and 6-years.
Analysis: A multi-level "mixed" model was used
to predict each BP measure from both between-person factors (sex,
race) and within-subject factors (age, BMI and job strain). Interactions
of change in job strain with age and BMI were tested.
Results: 11 (of 12) interaction effects were positive (most
at p<.10, one at p<.004). Graphic representations of the
relationship reveal that the association between a change in job
strain and BP is small for those under 40 and/or below average
BMI, but much larger for those near 60 or substantially overweight.
Conclusion: Though not definitive, the results strongly
suggest the presence of a synergistic effect on BP of age and
BMI with job strain.
Corresponding Author: Joeseph E. Schwartz, Ph.D., Department of
Psychiatry and Behavioral Sciences, Putnam Hall - South Campus,
SUNY - Stonybrook, NY 11794-8790.
Gudrun Sartory, Ph.D., Bernhard Muller, Dipl.psych., Joeseph
Metsch, Dipl.psych., Clinical Psychology, University of Wuppertal,
Raymund Pothmann, MD, Sociopodiatric Center, Oberhausen.
The efficacy of stress management training combined with either
cephalic vasomotor fedback (BF; N=15) or relaxation training (PR;
N=15) was compared with that of treatment with a beta blocker
(metoprolol) (N=13) in childhood migraine. The children (17 girls
and 26 boys) were aged 8 to 16 years (mean 11.3) and had suffered
from migraine for an average of 4.6 years. The pre- and post-treatment
phase lasted 4 weeks each and psychological treatment for 6 weeks,
(50 mg/day in children under 40 kg and 100 mg/day in those above).
The standardized stress management training consisted of exploration
of stressors and stress reactions followed by the training of
stress and pain management skills and their application during
distress. This took up abouut half the time in each session and
the other half was devoted to either cephalic biofeedback training
or to progressive muscle relaxation training. Children completed
a headache diary throughout, recording frequency dutation and
intensity of headache episodes as well as intake of analgesics.
In the psychologically treated groups, ability to control the
vasomotor activity of the temporal artery was assessed. PR resulted
in a significantly more improved headache index, (80%) than MET
(41.7%) with BF (53.3%) in between. Comparing pre- to post-treatment
levels, headache activity revealed significant improvements regarding
frequency in the PR and BF groups, duration in the BF group and
for intensity in the PR Group. A subgroup of children in the metoprolol
group increased their analgesics intake after treatment. PR constitutes
a more effective treatment stategy in children with migraine than
the prophylatic treatment with beta blockers.
Corresponding Author: Gudrun Sartory, Ph.D., Clical Psychology,
FB 3, University of Wuppertal, Max Horkheimer Strass 20, 42119
Wuppertal, FRG.