The psychosocial work environment: How much do we know to optimize sustainable employability? Els Clays Department of Public Health, Ghent University Brussels, 15/09/16
Presentation outline Background and Introduction Work Stress and Coronary Heart Disease Need for an Integrated Approach General Conclusions 2
Sustainable employability = the extent to which employees are able to work, either with or for the organization, in a productive, motivated and healthy way and continue to do so at older ages! guarantee long-term employment 3
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Policy priorities: Boosting employment levels + prolonging working life = avoiding premature dropout & long-term sickness absence 5
Healthy active ageing: effects of retirement: + or for health? 6
Healthy active ageing: occupational determinants? Adapted from: Holman D, McClelland C. Job quality in growing and declining economic sectors of the EU. Work and Life Quality in New and Growing Jobs working paper 2011.3. Manchester Business School: University of Manchester; May, 2011 7
DANES (Danish Natinal Working Environment Survey): voluntary early retirement in 60-64 yr old eployees Job satisfaction Influence Development possibilities No age discrimination Vester Thorsen et al. Int Arch Occup Environ Health (2016) 89:891 900 Recognition 8
Middle-aged cohort from the general population of Malmö: 12-yr follow-up of disability pension Canivet et al. Int Arch Occup Environ Health (2013) 86:307 319 9
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Presentation outline Background and Introduction Work Stress and Coronary Heart Disease Need for an Integrated Approach General Conclusions 11
Work Stress & Coronary Heart Disease December 2013 Cardiovascular disorders constitute a major burden for health of working populations throughout the world with as much as 50% of all causes of death and at least 25% of work disability. 12
Psychosocial epidemiology Pekka Martikainen et al. Int. J. Epidemiol. 2002;31:1091-1093 13
Methodological challenges Work stress CHD causal? 14
Exposure assessment Job stress exposure = objective characteristics of the psychosocial work environment Subjective measure: self-report questionnaires self-report / subjectivity bias? (social desirability, positive / negative affectivity, ) Methods in Epidemiology - Leuven, Sept. 17th 2015 15
Exposure assessment: theoretical foundation Job Demand-Control model Methods in Epidemiology - Leuven, Sept. 17th 2015 Karasek & Theorell, 1990. 16
Job Content Questionnaire Job Demands job requires working very fast job requires working very hard do an excessive amount of work not enough time to get the job done conflicting demands from others Karasek et al., 1998. Job Control job requires to learn new things job does not involve repetitive work job requires to be creative job requires high level of skill do variety of different things opportunities to develop abilities job allows to make decisions freedom to decide how to do work have a lot of say about what happens Methods in Epidemiology - Leuven, Sept. 17th 2015 17
Job Content Questionnaire Do self-report answers reflect objective characteristics of the psychosocial work environment? proportion of explained variance by job title? correlation with expert ratings? Job Control > Job Demands Methods in Epidemiology - Leuven, Sept. 17th 2015 18
Outcome assessment Self-report / subjectivity bias? = particularly problematic when both exposure + outcome data are self-reported in a cross-sectional design importance of objective CVD outcomes Methods in Epidemiology - Leuven, Sept. 17th 2015 19
Outcome assessment Clays et al., High job strain and ambulatory blood pressure in middle-aged men and women from the Belgian Job Stress Study. JOEM 2007. Information bias due to awareness of job strain? Information bias due to awareness of hypertension? Methods in Epidemiology - Leuven, Sept. 17th 2015 20
Clays et al., Behavioural and psychosocial correlates of nondipping blood pressure pattern among middle-aged men and women at work. J Human Hypertens 2011. Methods in Epidemiology - Leuven, Sept. 17th 2015 21
Study Design Job Strain Coronary Heart Disease Prospective cohort studies direct assessment of incidence rates and risk power: requires large sample size Methods in Epidemiology - Leuven, Sept. 17th 2015 22
IPD-Work Consortium of European cohort studies (Individual-participant-data meta-analysis in working populations) Promoter: Prof. dr. Mika Kivimäki
N = 197.473 men and women from 13 cohorts, free of baseline CHD Mean follow-up of 7.5 yr: 2358 events recorded Methods in Epidemiology - Leuven, Sept. 17th 2015 24
Methods in Epidemiology - Leuven, Sept. 17th 2015 25
Study Design Job Strain Coronary Heart Disease Prospective cohort studies direct assessment of incidence rates and risk power: requires large N Observational design potential for large confounding reverse causation bias Methods in Epidemiology - Leuven, Sept. 17th 2015 26
Methods in Epidemiology - Leuven, Sept. 17th 2015 27
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Population Attributable Risk (PAR) = 3 4 % although substantially less than for standard risk factors like smoking, a notable proportion of CHD events in working populations is accounted to job strain Methods in Epidemiology - Leuven, Sept. 17th 2015 29
PAR in Job Strain CHD 1) Effect size HR 1.23 = conservative estimate Methods in Epidemiology - Leuven, Sept. 17th 2015 30
PAR in Job Strain CHD 1) Effect size HR 1.23 = conservative estimate 2) Prevalence of exposure How to define job strain? Methods in Epidemiology - Leuven, Sept. 17th 2015 31
Job Strain categorization Median split procedure: use population specific cut- Points (± 15%) misclassifications? Methods in Epidemiology - Leuven, Sept. 17th 2015 32
Job Strain categorization Kivimäki et al., Lancet 2012. Methods in Epidemiology - Leuven, Sept. 17th 2015 33
Job Strain categorization Dose-response relation? (cfr. biological gradient) Methods in Epidemiology - Leuven, Sept. 17th 2015 34
Methods in Epidemiology - Leuven, Sept. 17th 2015 Kivimäki et al., Lancet 2015. 35
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Presentation outline Background and Introduction Work Stress and Coronary Heart Disease Need for an Integrated Approach General Conclusions 37
Work Stress & Coronary Heart Disease Need for an integrated approach: Define mechanisms: direct physiological pathways vs. indirect behavioral pathways Take into account physical work demands Take workplace or organizational context into account 38
Job Strain CVD: mechanisms Pekka Martikainen et al. Int. J. Epidemiol. 2002;31:1091-1093 Hypothalamic-Pituitary-Adrenal axis (cortisol) Autonomic nervous system (Heart Rate Variability) Methods in Epidemiology - Leuven, Sept. 17th 2015 39
Job Strain CVD: mechanisms Pekka Martikainen et al. Int. J. Epidemiol. 2002;31:1091-1093 Methods in Epidemiology - Leuven, Sept. 17th 2015 40
Heikkilä et el., AJPH 2013. Methods in Epidemiology - Leuven, Sept. 17th 2015 41
Heikkilä et el., AJPH 2013. Methods in Epidemiology - Leuven, Sept. 17th 2015 42
Work Stress & Coronary Heart Disease Need for an integrated approach: Define mechanisms: direct physiological pathways vs. indirect behavioral pathways Take into account physical work demands Take workplace or organizational context into account 43
Additive combined effects of high OPA & low LTPA: particularly within workers having a low level of cardiorespiratory fitness
Physical work demands Musculoskeletal symptoms CHD Sickness absence Psychosocial risk factors
Work Stress & Coronary Heart Disease Need for an integrated approach: Define mechanisms: direct physiological pathways vs. indirect behavioral pathways Take into account physical work demands Take workplace or organizational context into account 50
Presentation outline Background and Introduction Work Stress and Coronary Heart Disease Need for an Integrated Approach General Conclusions 53
To conclude The psychosocial work environment: How much do we know to optimize sustainable employability? 54
Thank you! Contact: els.clays@ugent.be