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Arbejde og stress. Nye udviklingstendenser i en globaliseret økonomi Den 2. stressforskningskonference 7-11-2005 SIF

Tage Søndergürd Kristensen


The new challenges Outsourcing, downsizing, privatization, precarious work, job insecurity


Blood pressure and pulse among Norwegian metal workers (N = approx. 180) Threat of closure

BP (mm Hg)

80 Pulse

160 150 140 130

142

SBP 129

130

145

143

135 129

70

69

120 110

Pulse 63

63

100 90

84

85

1982

1983

86

90

94

96

91

DBP

80 1984

1985

1986

1987

1988

Erikssen et al. Tidsskr Nor Laegeforen. 1990;110:2873-7.

78 76 74 72 70 68 66 64 62 60 58


Hospital admissions for CVD in a group of unemployed men compared with a control group 1,8 1.8

1.60

1,6 1.6 1,4 1.4 1,2 1.2 11 0,8 0.8

1.04 0.80

0.6 0,6 0,4 0.4 0,2 0.2 00

Before factory closure (2 years)

During factory closure (3 years)

Iversen et al. BMJ 1989;299:1073-6.

After factory closure (3 years)


Threats to employment security among white-collar workers in Whitehall A five-year follow-up study N=8354

RR

New cases of ischemia* 2

1.60

1

0

1.40

1.45

Men

Women Total Department under privatization

1.0

Control departments

*ECG or angina Ferrie et al. AJPH 1998;88:1030-1036.


Organisational downsizing and mortality A 7.5 years’ follow-up study of 22.430 public employees who kept their jobs. RR*

Other deaths

CVD 2.0

2.02 1.5

1.2 1.01

0

1.0

1.0

None

1.2

Minor

Major

None

Extent of downsizing *Controlled for age, gender, SES, occupation Vahtera et al. BMJ 2004;328:555-558.

Minor

Major


Impact of work-related events immediately before myocardial infarction A case-crossover study of 660 cases Relative risk

7

Last day

Last week 6.0

6.0 6.0 6

5 5.0 4.0 4 3.0 3

2 2.0 1 1.0

1.0

1.0

0 No

Yes

High pressure deadline

Mรถller et al. JECH 2005;59:23-30

No

Yes

Pressure from competition


A simple model Job insecurity, downsizing, outsourcing, privatization

Loss of control, loss of social support, loss of meaning, loss of predictability, loss of rewards

Stress, uncertainty, hopelessness, low self esteem


The new fatigue


The development of four different symptoms in the adult Swedish population 1986 - 2001

Percent Fatigue Back trouble Sleep trouble

Distress

Gustafsson & Lundberg, eds. Arbetsliv och h채lsa, 2004.


Work-related burnout and sleeping problems two years later Results from the PUMA baseline and 2 years’ follow-up Karolinska sleep questionnaire (scale) 50 45 40 35 30 25.1 25 20 15 10 5 0 Low

44.6

32.6

34.4

Quartiles

N = 1014; Data from NIOH, Denmark

High

Work-related burnout


Burnout as predictor of ischaemic heart diseas A 4.2 years’ follow-up study of 3,877 Dutch male employees from Rotterdam ”Have you ever been burned out?”

No Yes

RR* for IHD* 3

2.13 22

11

1

00 Yes

No

Burnout * Controlled for age, BP, smoking, cholesterol. 59 cases. Appels & Schouten. Behav Med 1991;Summer:53-59

74% 26%


Exhaustion and CHD A 9.5 years’ follow-up study of 3,365 Dutch men. Cases per 1000 50 50

45

40 40 30 30

30 26

20 20 10 10 00

None

Medium

High

Degree of exhaustion by the end of the working day. Appels & Otten. Br J Clin Psychol 1992;31:351-356


Vital exhaustion, IHD and death 6 years of follow-up of 9,563 adults from Copenhagen RR*

33

IHD

22

1.6

1.8

2.2 1.6

11

1

1.2

1.1

Mortality

00

0

0

1-4

1-4

5-9

5-9

10+

Vital exhaustion

10+

* Adjusted for 13 biological, behavioural and social factors Prescott et al. Int J Epidemiol 2003;32:990-7


Sleep quality and myocardial infarction 3 years of follow-up of 416 middle-aged German blue-collar workers RR 3.8

4 3

2.6

2 1 0

1.0

No

1.0

Yes

Wake up early Siegrist. J Chron Dis 1987;40:571-578.

No

Yes

Difficulty staying asleep


Psychological risk factors for CHD among homemakers from Framingham A 20-year follow-up study of 362 women RR * 7.8

88 77

6.2

66 55

3.9

44 33 22 11 00

1.0 + Tension

1.0 + Symptoms of anxiety

*Adjusted for CVD risk factors. Eaker et al. Am J Epidemiol 1992;135:854-864.

1.0 + Trouble falling asleep


Sleep and risk of IHD A study of 71,617 American nurses followed for 10 years

2,0

Adjusted for 14 factors

Age-adjusted

2,5 RR 1.8

1.6

1,5

1.4

1.3 1.1

1,0

1.4 1.2

1.0

1.1

1.0

0,5 0,0

-5

6

7

8

9+

The Nurses’ Health Study Ayas et al. Arch Intern Med 2003;163:205-9

-5

6

7

8

9+


CVD, sleep quality and ”need for recovery” after work Results from 32 months of follow-up of the Maastrict Cohort Study on fatigue RR 4

3.16

2.82

33

22 1

1

11

1.22

00 Good

Poor

Sleep quality

Low

Medium

High

Need for recovery

N=7,944 workers. 18-65 years. 42 cases. Van Amelsvoort et al. Occup Environ Med 2003;60:83-87.


Long working hours and short sleep as risk factors for AMI A case control study of working Japanese men 40-79 years of age 260 cases and 445 matched healthy controls RR* 2.1 2

1.8 1.3 1

1

1.1

0

1

1

0

<40

41-60

61+

Working hours/week past year

2+

Days/week with <5 hours of sleep

*Adjusted for smoking, alcohol, BMI, BP, DM, cholesterol, heart disease in family, job type and sedentary job Lin er al. Occup Environ Med 2002;59:447-51.


Depression and CHD A meta-analysis Relative risk among initially healthy subjects. Analysis of 11 studies RR Clinical depression

2.69 (1.63-4.43)

Depressive mood

1.49 (1.16-1.92)

Overall estimate

1.64 (1.29-2.08)

Rugulies. Am J Prev Med 2002;23:51-61.


The new fatigue

Long working hours

Fatigue Family/ work conflict

Shift work, 24 h society

Need for recovery

Burnout

Stress High emotional demands

High work pace

Withdrawal

Conflicts, bullying

Depression

Sleep problems

Cardiovascular disease


Burnout and engagement â&#x20AC;&#x201C; two sides of the same coin? Vigor Hard core business

Engagement

Withdrawal /cynicism

Dedication

Burnout

Tired idealist Exhaustion

After Schaufeli et al.


Family and private life


Work-family (im)balance Do you experience a conflict between work and family, so that you feel you should be â&#x20AC;?both places at the same timeâ&#x20AC;?? Yes, often 7% Yes, regularly 29% Does your work take too much of your energy so that your private life suffers? Yes, certainly 10% Yes, to some degree 34% N=3517 Danish employees. 2005.


Stress at work and in the family of American men The proportion who got a divorce during 9 years 30 %

19.7%

20

11.9% 10

6.5%

8.2%

0 0

1

2

3+

Number of work stressors

N = 10,904 married men in the MRFIT study Matthews & Gump. Arch Intern Med 2002;162:309-15.

DK-2004-001


Stress and CVD mortality among American middle-aged men 9 yearsâ&#x20AC;&#x2122; follow-up of 12,336 men in the MRFIT Work stress

Family stress

RR*

RR*

2

2

1.00

1.07

1.19

1.43

1.34 1.00

1

1

0

0 0

1

1.40

2

3+

Still married

Number of work stressors

Separaret

Divorced

Events among married men

*Controlled for eight important confounders. Matthews & Gump. Arch Intern Med 2002;162:309-15.

ENG-2004-001


Is marriage worse than work? (For women) A follow-up study of 292 female heart patients in Stockholm Work stress

Marital Stress

RR* For new events

RR* For new events 2.8

3

2.9

3

22

22

1.7 (NS) 1.3 (NS)

1

11

11

00

Low

Moderate

Severe

00

1

Low

Moderate

* Adjusted for age, diagnosis, SBP, DM, smoking, lipids and estrogen status. Orth-GomĂŠr et al. JAMA 2000;284:3008-14.

Severe


Psychosocial factors and acute myocardial infarction: The INTERHEART STUDY 11,119 cases and 13,648 controls from 52 countries RR* 2.14

2.12

22 1.52

1.38

1.19

11

1

1

1.48

1.33

1.23 1

1

Work stress

Home stress

Financial stress

Rosengren et al. www.the lancet.com Sept. 3,2004:1-10

O n or e m or e T w o

N on e

L M ow od er at e Se ve re

S Pe om rm e an en t

N on e

S Pe om rm e an en t

N on e

00

Life events


Work and product quality â&#x20AC;&#x201C; is there an association?


The Sirdal model for work environment and output quality Output quality

Client satisfaction and competence

Programs for improvement of work environment and output quality

Work environment

Health and well-being of the employees


Stress level among the nurses and patient incidents A study of 293 nurses over 3 months Patient incidents (falls, medication errors, other errors)

% 3,0

2.1 2,0 2.0

2.2

1.8 1.6

1.0

1.1

1,0 1.0

0.6

0,0 0-4

4-5

5 - 5.5

5.5 - 6

6 - 6.5

6.5 - 7

Average stress score (VAS scale) in 48 units Dugan et al. J Nurs Care Qual 1996;10:46-58

7 - 10


Association between burnout level and critical incidents A study of 678 Japanese nurses at Tokyo University Hospital Level of burnout Low 1 29%

2 38%

Mistakes related to transfusions

2%

Mistakes related to medication

Falling patient

Mistakes related to operations/anaesthesia P< 0.05 Odagiri, Kristensen & Shimomitsu, 2005

3 45%

High 4 51%

Total 41%

4%

7%

9%

6%

41%

53%

52%

62%

53%

9%

2%

3%

3%

4%


Staff workload and hospital mortality Relative risk for death

A 4-year study in an adult intensive care unit (337 hospital deaths)

4

3.1 3.03

2.0

1.9

2.02

1.0 1.01

0

Low

Medium

Overall workload Tarnow-Mordi et al. Lancet 2000;356:185-189

High


Patient-to-nurse ratio: Possible consequences for nurses and patients An American study including 10,184 nurses, 232,342 patients, and 168 hospitals Relative risk* 2

NURSES

1.5 1,5

1.15

1.23 1.0 1.01

PATIENTS

1.0

1.0

1.07

1.0

1.07

0.5 0,5

0 High burnout

Job dissatisfaction

Patient mortality

Failure to rescue

* RR associated with an increase of 1 patient per nurse. Adjusted. Aiken et al. JAMA 2002;288:1987-1993


Errors in patient treatment before and after a stress management programme Errors per hospital per year Year before Year after

Control hospitals Intervention hospitals 22 hospitals in each group. Matched on three criteria. * p<0,01

Jones et al. J Applied Psychol 1998;73:727-735.

1,64 1,41

1,59 0,41*


The effect of a stress management programme for the incidence of medical treatment errors

Jones et al: J Applied Psychol 1988;73:727-353


Many challenges – one solution? • • • • •

The globalized economy Competitiveness of private business Quality of the public services The new fatigue Family-work conflict

- and the ”golden nuggets” of psychosocial work environment and private life: influence, meaning, support, predictability, rewards, demands


The End This presentation (and many others) may be found at www.ami.dk/presentations


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