Arbejde og stress.Nye udviklingstendenser i en

globaliseret økonomi

Den 2. stressforskningskonference7-11-2005

SIF

Tage Søndergård Kristensen

The new challengesOutsourcing, downsizing, privatization,

precarious work, job insecurity

Blood pressure and pulse amongNorwegian metal workers

80

90

100

110

120

130

140

150

160

1982 1983 1984 1985 1986 1987 1988586062646668707274767880

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

BP (mm Hg)(N = approx. 180)Threat of closure Pulse

SBP

Pulse

DBP

129 129130135

142 145 143

63 63

6970

84 85 8690

94 9691

Hospital admissions for CVD in a group of unemployed men compared with a control group

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

00,20,40,6

0,81

1,2

1,41,6

1,8

0.80

1.04

1.60

Before factoryclosure

(2 years)

During factoryclosure

(3 years)

After factoryclosure

(3 years)

0

1.81.61.41.2

10.80.6

0.40.2

0

1

2New cases of ischemia*

Threats to employment security among white-collar workers in Whitehall

A five-year follow-up studyN=8354

1.0

1.401.60

1.45

Controldepartments

RR

Men Women TotalDepartment under privatization

*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 employeeswho kept their jobs.

0

1

2

1.0

1.5

1.01.2

2.0

1.2

RR*

None Minor Major None Minor Major

Extent of downsizing

2.0

1.0

0

CVD Otherdeaths

Vahtera et al. BMJ 2004;328:555-558.

*Controlled for age, gender, SES, occupation

Impact of work-related events immediatelybefore myocardial infarction

0

1

2

3

4

5

6

7

0

1

2

3

4

5

6

7

No Yes No Yes

1.0

2.0

3.0

4.0

5.0

6.06.0

Relative risk

Möller et al. JECH 2005;59:23-30

A case-crossover study of 660 cases

1.0 1.0

6.0

High pressure deadline Pressure from competition

Last day Last week

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

PercentFatigue

Back trouble

Sleep trouble

Distress

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

05

101520253035404550

Work-relatedburnout

Work-related burnout and sleeping problemstwo years later

Results from the PUMA baseline and 2 years’ follow-up

N = 1014; Data from NIOH, Denmark

25.1

32.6 34.4

44.6

Low HighQuartiles

Karolinska sleepquestionnaire (scale)

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 74%Yes 26%

0

1

2

3

Burnout

* Controlled for age, BP, smoking, cholesterol. 59 cases.

Appels & Schouten. Behav Med 1991;Summer:53-59

1

2.13

No Yes

2

1

0

RR* for IHD*

Exhaustion and CHD

A 9.5 years’ follow-up study of 3,365 Dutch men.

0

10

20

30

40

50

2630

4550

40

30

20

10

0None Medium High

Degree of exhaustion by the end of the working day.

Cases per 1000

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

* Adjusted for 13 biological, behavioural and social factors

Prescott et al. Int J Epidemiol 2003;32:990-7

Vital exhaustion0

1

2

3

0 1-4 5-9 10+

IHD

Mortality

1 1.1

1.6 1.8

1.2

2.2

1.6

3

2

1

0 1-4 5-9 10+0

RR*

Sleep quality and myocardial infarction

3 years of follow-up of 416 middle-aged German blue-collar workers

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

0

1

2

3

4

RR

1.0

3.8

1.0

2.6

No NoYes YesWake up early Difficulty

staying asleep

Psychological risk factors for CHD among homemakers from Framingham

*Adjusted for CVD risk factors.

Eaker et al. Am J Epidemiol 1992;135:854-864.

A 20-year follow-up study of 362 women

0

1

2

3

4

5

6

7

8

1.0

7.8RR *

6.2

3.9

1.0

876543210

- + - + - +

1.0

Tension Symptomsof anxiety

Troublefallingasleep

Sleep and risk of IHD

A study of 71,617 American nurses followed for 10 years

Ayas et al. Arch Intern Med 2003;163:205-9

0,0

0,5

1,0

1,5

2,0

2,5

1.8

1.31.1 1.0

-5

RR

1.61.4

1.2 1.1 1.0

1.4

6 7 8 9+ - 5 6 7 8 9+

Adjusted for 14 factorsAge-adjusted

The Nurses’ Health Study

0

1

2

3

4RR

CVD, sleep quality and ”need for recovery” after work

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

Sleep quality Need for recovery

Results from 32 months of follow-up of the Maastrict Cohort Study on fatigue

3

2

1

0

1 11.22

3.162.82

Good Poor Low Medium High

0

1

2

RR*

Long working hours and short sleep as risk factors for AMI

*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.

Working hours/weekpast year

Days/week with <5 hours of sleep

A case control study of working Japanese men 40-79 years of age260 cases and 445 matched healthy controls

<40 41-60 61+ 0 1 2+

11.3

1.8

1 1.1

2.1

Depression and CHDA meta-analysis

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.

Relative risk among initially healthy subjects.

Analysis of 11 studies

The new fatigue

Long workinghours

Shift work,24 h society

Family/work

conflict

High emotionaldemands

High workpace

Conflicts,bullying

Fatigue

Burnout Need forrecovery

Withdrawal Depression

Sleep problems

Cardiovasculardisease

Stress

Burnout and engagement – two sides of the same coin?

After Schaufeli et al.

Hard core business

Withdrawal/cynicism

Burnout Tired idealist

Dedication

Engagement

Exhaustion

Vigor

Family and private life

Work-family (im)balance

Do you experience a conflict between work and family, so that you feel you should be ”both places at thesame time”?

Yes, often 7%Yes, regularly 29%

Does your work take too much of your energy so thatyour 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

N = 10,904 married men in the MRFIT study

Matthews & Gump. Arch Intern Med 2002;162:309-15.

0

10

20

30

0 1 2 3+

%

6.5%8.2%

11.9%

19.7%

Numberof work stressors

DK-2004-001

0

1

2

0 1 2 3+0

1

2

Still married Separaret Divorced

RR* RR*

Work stress Family stress

Stress and CVD mortality among American middle-aged men

9 years’ follow-up of 12,336 men in the MRFIT

*Controlled for eight important confounders.

Matthews & Gump. Arch Intern Med 2002;162:309-15. ENG-2004-001

1.00 1.07 1.191.34

1.00

1.43 1.40

Number of work stressors Events among married men

Is marriage worse than work?(For women)

0

1

2

3

0

1

2

3

* Adjusted for age, diagnosis, SBP, DM, smoking, lipids and estrogen status.

Orth-Gomér et al. JAMA 2000;284:3008-14.

A follow-up study of 292 female heart patients in Stockholm

Low Moderate Severe

1

2.8 2.9

2

1

0

RR* For new events

Low Moderate Severe

11.3 (NS)

1.7 (NS)2

1

0

RR* For new events

Marital Stress Work stress

0

1

2

None

Some

Perman

ent

None

Some

Perman

ent

LowM

oder

ateSe

vere

None

OneTwo o

r mor

e

RR*

Psychosocial factors and acute myocardial infarction: TheINTERHEART STUDY

Work stress Home stress Financial stress Life events

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

11,119 cases and 13,648 controls from 52 countries

2

1

0

1

1.38

1

2.14 2.12

1.52

11.19

1.33

11.23

1.48

Work and product quality –is there an association?

The Sirdal model for work environment and output quality

Output quality

Work environment Health and well-being of the employees

Client satisfaction and competence

Programs forimprovement

of work environ-ment and output

quality

Stress level amongthe nurses and patient incidents

0,0

1,0

2,0

3,0

0 - 4 4 - 5 5 - 5.5 5.5 - 6 6 - 6.5 6.5 - 7 7 - 10

A study of 293 nurses over 3 months

Average stress score (VAS scale) in 48 units

%

Patient incidents (falls, medication errors, other errors)

0.6

1.0 1.1

1.61.8

2.1 2.2

1.0

2.0

Dugan et al. J Nurs Care Qual 1996;10:46-58

Association between burnout leveland critical incidents

A study of 678 Japanese nurses at Tokyo University Hospital

Level of burnout

Low High1 2 3 4 Total

Falling patient 29% 38% 45% 51% 41%

Mistakes related to transfusions 2% 4% 7% 9% 6%

Mistakes related to medication 41% 53% 52% 62% 53%

Mistakes related to operations/anaesthesia 9% 2% 3% 3% 4%

P< 0.05

Odagiri, Kristensen & Shimomitsu, 2005

Staff workload and hospital mortality

0

1

2

3

4

1.0

2.0 1.9

3.1

Low Medium High

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

1.0

2.0

3.0

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

Overall workload

Relative risk for death

Patient-to-nurse ratio: Possibleconsequences for nurses and patients

0

0,5

1

1,5

2

0.5

1.0

1.5

Aiken et al. JAMA 2002;288:1987-1993

An American study including 10,184 nurses, 232,342 patients, and 168 hospitals

High burnout Job dissatisfaction Patient mortality Failure to rescue

Relative risk*

1.0

1.23

1.0

1.15

1.01.07

1.01.07

NURSES PATIENTS

* RR associated with an increase of 1 patient per nurse. Adjusted.

Errors in patient treatment beforeand after a stress management

programme

Errors per hospital per yearYear before Year after

Control hospitals 1,64 1,59Intervention hospitals 1,41 0,41*

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

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

The effect of a stress management programme for theincidence 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

www.ami.dk/presentations

This presentation (and many others)may be found at