Showing papers in "Stress Medicine in 1995"

The demand-control-support model: Methodological challenges for future research.

Abstract: The demand-control-support model was developed by R. Karasek and his colleagues during the 1980s. The model operates with three main dimensions: job demands, job decision latitude and job social support. According to the model, workers with jobs characterized by high demands, low decision latitude and low social support (so-called iso-strain) have a higher risk of poor psychological well-being and cardiovascular diseases (CVD). The model has been tested in relation to CVD in 16 epidemiological studies of which only two have been negative. Moreover, the model has been used in studies with a large number of other endpoints. Recently the model and the methods used in connection with the model have been criticized by several research workers. In this article the studies on iso-strain and CVD are reviewed and a number of methodological problems are discussed. It is recommended that future studies are prospective and use non-representative population samples of well-chosen occupations. Each of the key variables -job stressors, stress and sickness - should be measured in three independent ways in order to increase the methodological and theoretical strength of the research performed.

The Stress Profile: a psychosocial approach to measuring stress

Abstract: The Stress Profile is a psychosocial instrument for measuring stress in life in general and at work at the levels of the individual, the group and the organization. It has been tested and standardized on more than 4000 men and women. The present article outlines the design and the developmental stages of the Profile. It also describes its use at individual and company levels. The impact of the scientific development of behavioural medicine has greatly improved and extended the application of behavioural methods. The Stress Profile is based on this methodological and scientific development. It is a questionnaire consisting of 224 questions, 20 of which concern background variables and ten criteria. The remaining questions map a number of areas derived from current stress research. The data are computer processed and a graphic profile is produced. This presentation includes illustrations of results from Swedish companies, where the Stress Profile has been used.

Stress in nurses: The effects of coping and social support

Abstract: Sources of stress, job satisfaction and coping were investigated in 245 general hospital nurses using standardized questionnaires. It was hypothesized that coping strategies, social support and job satisfaction would moderate or buffer the effects of the stressor on psychological distress, such that those who were lower in coping skills, social support and job satisfaction would be more reactive to stress effects. Negative main effects on mental well-being, as measured by the General Health Questionnaire, were found for workload, lack of social support, inadequate preparation, conflict with other nurses, conflict with doctors and use of avoidance coping strategies. Proposed buffering effects were investigated using multiple regression analysis to control for the main effects. Although consistently in the predicted direction, the buffering effects were found to be very small and non-significant. It was concluded that for stress in nurses the results supported a transactional model rather than an interactive model for social support and coping.

Review of bus drivers' occupational stress and stress prevention

Abstract: Although heterogeneous in methodology and content, 32 studies from 13 countries on bus drivers' work and health are similar in their conclusions Bus-driving–characterized by high demands, low control and low support – can be regarded as a classic example of high-strain occupation, with high risks of physical and mental occupational ill-health, leading to absenteeism and to decreased productivity of employees and enterprises Several recommendations – some of them already being implemented by bus companies – are presented in order to reduce work stress in bus drivers They relate to: (a) ergonomics of the bus cabin, (b) job rotation and ‘combination jobs’, (c) timetables, shift schedules and quality of break periods, and (d) the social work environment and management style Stress monitoring and stress reduction is not merely a technical process based on a technical analysis and on the simple ‘straightforward’ realization of recommendations and findings It relates to changing and improving organizations and organizational processes Such organization changes can best be obtained through a stepwise and participative approach There are indications that those companies that invest in preventive measures receive their rewards

Adverse impacts experienced by police officers following exposure to sex discrimination and sexual harassment

Abstract: Adverse psychological and physical impacts have been related to experience of detriment arising from sex discrimination. In the present study detriment was operationalized in terms of differential career progress, unequal access to organizational benefits and experience of sexual harassment. A national UK sample of 1802 police women, 510 police men and 164 civilian women took part in the study. Results revealed gender differences in exposure to detriment and the suffering of associated adverse impacts. Subjective rating of impacts by police women revealed the greatest impact to be associated with frustrated career progression and the least from experience of sexual harassment. A multiple regression analysis suggested the reverse order when predicting elevated GHQ(28) scores for women officers. This is accounted for by cultural factors, which are also proposed to be influential in rates of reporting sources of discrimination.

Psychotherapeutic perspectives in urethral syndrome

Abstract: Urethral syndrome (urinary symptoms and pain without organic lesions) is a frequent female pathology but its aetiology is obscure and its treatment undetermined. A number of studies have highlighted emotional disturbances in these patients. To assess the efficacy of psychotherapy in the treatment of this syndrome, the authors studied 36 patients diagnosed with urethral syndrome. Of these, 13 were randomly selected for short-term dynamic psychotherapy. The remaining 23 patients were treated with traditional urological therapies and used as the control group. After the medical diagnosis and during follow-up at 6 months and 4 years, one psychological questionnaire (SQ) was administered together with a specially prepared clinical questionnaire. The urinary symptomatology and pain disappeared completely in over 70 per cent of the patients who had completed the psychotherapy. For the remaining patients, at the termination of the treatment the symptomatology had improved to the point that it was no longer a problem. These results proved stable in time and were associated with a general improvement in psychic status, particularly for the depression, anxiety and hostility levels. In the controls, on the other hand, no significant improvement was noted in the parameters examined.

Effects of private self‐consciousness and control on the occupational stress‐strain relationship

Abstract: It was hypothesized, based on the cybernetic stress model, that the occupational stress-strain relationship is moderated by private self-consciousness (PSC) and control. If the possibility to control is perceived as favourable, high PSC was assumed to buffer against strain by increasing the likelihood of active coping with stressors. In the opposite case, when the possibilities of controlling job stressors are experienced as low, high PSC was assumed to exacerbate the relationship between stress and strain, because paying attention to internal reactions to stressors beyond one's control only intensifies the experience of distress. Support for these hypotheses was obtained by the questionnaire method and hierarchical moderated regression analyses with a sample of 377 nurses. Consistently with the cybernetic model, the effects of work overload on mental strain symptoms depended on perceived control, especially among high PSC individuals. Work overload produced fewest mental symptoms when PSC and control were high, and most mental symptoms when PSC was high but control low. If PSC was low, the erects of stressors were between the two extremes. Implications for further research on the cybernetic stress model are discussed

Occupational stress in female and male graduate managers — A comparative study

Abstract: Levels of occupational stress were examined using an adapted version of the occupational Stress Indicator (OSI) in 126 female graduate managers and 220 male graduate managers occupying a range of managerial jobs throughout the UK. In comparison with the most recently established normative group of white-collar workers, management graduates reported greater pressure with regard to career and achievement, higher Type A behaviour pattern scores, higher levels of job satisfaction and higher mental ill-health scores. When comparing the male and female graduates on OSI variables, female graduate managers scored significantly higher pressure scores on all seven ‘sources of pressure’ subscales, including the added gender factor related to discrimination and prejudice. While females were more likely than males to adopt positive coping strategies, they had lower overall job satisfaction scores and were more at risk of mental and physical ill-health (particularly those in junior and middle management positions). Multivariate analyses disclosed that predictors of physical ill-health, mental health and job dissatisfaction were often quite dissimilar for male and females. The research implications of the findings are discussed with special emphasis on organizational and policy change strategies required in the 1990s.

Discourse analysis and psychological adaptation to high altitude hypoxia

Abstract: In order to contribute to the study of psychological adaptation to extreme environments, a discourse analysis was carried out on 10 European lowlanders during a 3-week scientific expedition under survival conditions at the top of Mount Sajama (6542 m). This discourse analysis was part of a large scientific investigation (involving 12 scientific and medical research procedures) on human adaptation to high altitude chronic hypoxia. The study of discourse was carried out on several freely delivered oral accounts on the same topic, which was always the survival experience itself. This study involved a method developed by Benzecri and Reinert which is partly described in the first part of the article. With this textual analysis technique, it was possible to determine the main word distribution patterns within a discourse and to identify the repetitive language patterns most frequently used. The results on the overall corpus, consisting of the pooled discourses, indicated three specific classes of vocabulary from which three different types of discourse were identified. The data showed that the speaker's discourse did not change during exposure to extreme environmental conditions; the discourse was not correlated with the events but referred only to the speaker himself. The three types of discourse had one main focus: the anxiety, fear or extreme fear (anguish) experienced by all the subjects as psychological states. In response to these feelings, they used various psychological strategies to escape or to face the situation in different ways, as shown by the terms of the different types of discourse. One question which arises about this discourse analysis is: what was tested when the subjects were examined with regard to their psychological acclimatization to altitude? The biological effects of severe chronic hypoxia, or those of stress in response to the fear caused by the extreme environment or/and by psychological adaptation to high altitude.

Occupational stress in Australian business and professional women

Abstract: Occupational stress was measured in 161 Australian managerial and professional women through the use of the self-report measure the Occupational Stress Indicator. Normative data were obtained reporting scale reliabilities, and differences between women according to marital and parental status and most stressful roles. The wife role had the highest mean score for the'most stressful role'. Women with three or more children reported poorer physical health, and having parental status was associated with headaches, exhaustion, overeating, smoking and drinking. Nonetheless, this group also had significantly high scores for job satisfaction. Having children under 18 years of age was associated with the experience of a decrease in sexual interest, as was having full-time work status. Single women suffered poorer reported mental health than married women and scored highest for Type A behaviour

Inventorying stressing life events as related to health change in the elderly

Abstract: A 54-item inventory of stressing life events (SLE) was developed for assessing their prevalence in elderly populations. The SLE was sensitive to numerous life changes in this population, although only 11 of the items were reported as occurring in the previous 6 months by 10 per cent or more of the study participants. Scores on the SLE were shown to be significantly related to seeking of physician services in managed care settings and to seeking of emergency medical services regardless of setting. Stressing life events may thus have significantly greater impact on health change in the elderly than they do in younger populations.

Stress reduction, preoperative hypnosis and perioperative suggestion in maxillofacial surgery: Somatic responses and recovery

Abstract: Preoperative hypnosis and stress reduction in combination with suggestions in general anaesthesia were investigated in maxillofacial surgery. Nineteen patients were prospectively matched to control patients and received a ‘hypnosis tape’ with suggestions directed at reduced bleeding, less postoperative swelling and improved recovery. Postsurgical oedema, pyrexia and the consumption of anxiolytics postoperatively were significantly reduced in the hypnosis group.

Stress management for psoriasis patients : the effectiveness of biofeedback and relaxation techniques

Abstract: Previous studies have found evidence of a connection between stress and the appearance of psoriasis symptoms It was therefore hypothesized that stress management techniques such as biofeedback and relaxation could be effective in ameliorating the severity of the symptoms Thirty-two psoriatics were randomly divided into three groups, one trained in biofeedback and relaxation techniques, one in relaxation alone and the third receiving no treatment The subjects' condition was evaluated by a physician at the start and end of the 3-month study Additionally, at the end of the study, the subjects were asked to assess the degree to which their symptoms had improved relative to the start of the study and relative to the same season of the previous year The results indicated that, in comparison to the waiting list group, the biofeedback and relaxation group reported considerable improvement in their condition relative to the same season of the previous year No significant differences were found between the groups regarding the degree of improvement relative to the start of the study It is suggested that the fact that psoriasis is subject to seasonal variations may account for the differential findings

Chinese version of the OSI: A study of reliability and factor structures

Abstract: SUMMARY This article examines the reliability of the Occupational Stress Indicator (OSI) in its Chinese version as well as factor structures for three of its scales - stressors, coping and job satisfaction. Estimates of reliability obtained by item-total correlation coefficients and Cronbach's alphas are quite acceptable. Factor analyses using the principal components technique have also found psychologically meaningful structures. Stress has become one of the most serious health issues of the twentieth century - a problem not just for individuals in terms of physical and mental disability, but for employers and governments, who have started to assess the financial damage.' Matteson and Ivancevich2 estimate that stress causes half of absenteeism, 40 per cent of turnover, and that 5 per cent of the total workforce covers for reduced productivity due to preventable stress ($300 billion for the US economy annually). Although other sources may quote different figures, it is obvious that occupational stress has serious consequences for both individual employees and organizations. The problem of occupational stress is particularly relevant for countries undergoing enormous economic and social changes. Taiwan is one such society, with the transformation of its industrial structure from labour-intensive to high-tech, as well as rapid westernization in both work and lifestyles. In this context, it is important for psychologists, occupational physicians, managerial executives and even government policy-makers to not only understand and appreciate, but also accurately assess the

Anger and blame in three technological disasters

Abstract: This article describes an investigation into the long-term reactions of disaster survivors, including the extent of their psychological distress and the ways in which they apportion blame for what happened to them. Three technological disasters were chosen to cover a range of traumatic experiences and degrees of possible blame. The main results were the identification of continuing high levels of distreess, intermingled with high levels of specifically targeted anger, and blame which was relatively sharply focused on those named publicly as having caused the accidents. There were also strong fears of other disasters happening again and a widespread perception that justice was not done.

War and the family

Abstract: Although war can impose powerful stresses on family relationships and functions, and its horrors have been described since Euripides wrote The Trojan Women, the subject has received little scientific study. The American Civil War had significant effects on the family and increasing industrialization further disrupted family ties and transformed women's roles. Twentieth-century wars have had both immediate and delayed effects on the family, ranging from anxiety and grief about losses and separations to increased antisocial behavior and juvenile delinquency. Subsequent problems stem from readjustments to civilian life, high divorce rates and women assuming more powerful roles in the family and society. Analysis of a random sample of child guidance clinic records 1923-1983 revealed an increase in children's academic problems and aggressive behaviors during and after World War II. Increases in anxiety and obsessive and aggressive behaviors were evident following the Vietnam conflict along with the adverse effects of post traumatic stress disorder on family life. Although US participation in the Gulf War was limited, disruptive effects were seen in the children of affected military families, and for Iraqi children the consequences were devastating. War generally accelerates dormant changes in family life not yet fully apparent or appreciated

Work and career experiences and emotional well‐being of managerial and professional women

Abstract: This study examined a research model developed to understand emotional well-being among managerial and professional women. Data were collected from 792 women using questionnaires completed anonymously. Although considerable diversity was present in the sample, most women were in early career, married but still without children. Four groups of predictor variables identified in previous research were considered: personal demographic variables. Organizational and situational characteristics, work experiences associated with job and career satisfaction and work outcomes. Work experiences and work outcomes were fairly consistently and significantly related to self-reported emotional well-being. Implications for managerial women and their employing organizations are offered.

Psychophysiological study of hypertension in black, Indian and white African students

Abstract: The objective of the study was to test the hypothesis that behavioural stress is associated with hypertension in developing countries. It forms part (students only) of a large study on the population of South Africa. The cross-sectional study involved 2902 black, white and Indian African students, stratified by year of study, gender and ethnicity. Harburg's anger-coping scale and James' active coping scale (JHACS) were used. For assessment of socioeconomic status a coefficient of family instability (CFIS) was used. Traditional risk factors of hypertension (family history, alcohol consumption, smoking, urbanization) and biological parameters (systolic and diastolic blood pressure, pulse rate, body mass and skinfold, glucose tolerance) were taken. Hypertension was defined as blood pressure higher than 160/95 mmHg. A significant association between suppressed anger, high CFIS and blood pressure level in all three ethnic groups was found, most strongly expressed in male black students. The risk for hypertension was increased if this construct was combined with high JHACS score and/or poor performance at the university. After controlling for biological variables, this psychological construct still had strong association with blood pressure level/hypertension incidence in black males only. The person-environment interaction (gender, ethnicity, years of study, urbanization) might thus represent a behavioural stress that promotes development of hypertension in African developing countries.

Identifying A psychological profile of Type A behaviour pattern

Abstract: A conceptual model of Type A behaviour pattern (TABP) is presented which frames the pattern in terms of current cognitive-behavioural psychology and in the wider context of the psychosocial risk factors of CHD. Type A behaviours are considered as stemming from Type A appraisals, elicited in specific situations in individuals with enhanced emotional reactivity who hold a system of beliefs identifiable as Type A. A study was performed in order to assess the possible associations of personality dimensions such as extraversion and neuroticism to TABP and identify specific dysfunctional beliefs associated with TABP. The Bortner Rating Scale (BRS) was administered as a measure of TABP, together with the Maudsley Personality Inventory (MPI) for measuring extraversion and neuroticism and a shortened version of the Dysfunctional Attitude Scale (DAS), in a random subsample of a male white-collar population screened in the worksite for cardiovascular risk factors (N = 200). BRS scores showed a high direct correlation with DAS total scores (r = 0.64), a significant one with neuroticism (r = 0.29) and a weaker one with extraversion (r = 0.15). DAS was factor analysed and a solution found identifying eight factors. Two of them were correlated with TABP, namely ‘support-reliance’, directly correlated, and ‘self-confidence’, inversely. At a robust stepwise multiple regression analysis, using the above psychometric measures as independent variables and BRS scores as dependent variable, a model was found accounting for 35 per cent of variance of TABP distribution. The findings give partial support to the model proposed. The identified dysfunctional beliefs involved a higher sense of dependency of Type A individuals. A prospective study is under way to assess the possible predictive power of these cognitive factors. If confirmed, the model could partially account for inconsistencies of empirical findings in TABP studies.

Psychophysiological reactivity, depression, neuroticism and type a behaviour: An interactive effect?

Abstract: The greater reactivity in Type A subjects is a controversial issue. It is possible that anxiety, neuroticism and depression interact with Type A behaviour pattern, giving rise to different psychophysiological reactivity. To evaluate this hypothesis we studied 70 Italian healthy male volunteers. All were blue-collar workers. Cardiac health was confirmed by a detailed family and medical history. Individual assessment included the Structured Interview, the Eysenck Personality Questionnaire (EPQ), the State-Trait Anxiety Inventory (STAI) and the Depression Questionnaire (QD). To assess cardiac (rate-pressure product) and electrodermic (skin conductance level) psychophysiological reactivity we used the following tasks: (1) Interactive Concentration Test (ICT); (2) Mental Arithmetic (MAT); (3) Workside Noises (WN). In Type A (A1 + A2) subjects a higher neuroticism score was associated with greater reactivity whereas in non A (X + B) subjects a lower neuroticism score was associated with greater reactivity. Subjects classified as Type A with lower depression scores had greater cardiovascular responses, whereas in non A subjects higher depression scores were associated with greater reactivity.

Pain, stress and depression: Psychoneurophysiology and therapy

Abstract: Depression is probably the most common illness in the world, and it is much maligned by patients and physicians as well as the insurance industry. We have found that all patients with depression have one or more chemical and neurochemical abnormalities. More importantly, we have found that 85 per cent of patients can be brought out of depression within 2 weeks without drug therapy. The therapy program consists of education, cranial electrical stimulation, music, photostimulation, insight meditation and magnesium supplements. Interestingly, videotaped education is more effective than live lectures

Changes in urinary cortisol associated with hypthalamically elicited restlessness

Abstract: Using unanaesthetized and free-moving mature female cats, we examined changes of cortisol levels in 24-hr urine accompanying emotional behaviour such as restlessness elicited by electrical stimulation of the anteromedial hypothalamus(AMH). Urine was collected every 24 hr for 9 consecutive days and stimulation was applied for only the middle 3 days with chronically implanted electrodes placed in the AMH. Cat urine was hydrolysed with β-glucuronidase and sulphatase; the levels of free cortisol, glucuronide and sulphate were determined by fluorescence polarization immunoassay. The mean (fSD) of the total cortisol level calculated in terms of the creatinine level in the 3 days before stimulation was 13.04 ± 4.89 ng/mg creatinine; the mean for the 3 days during stimulation was 19.06 ± 7.56 ng/mg creatinine; and the mean for the 3 days after stimulation was 13.97 ± 4.10 ng/mg creatinine. The cortisol level during stimulation showed a significant increase compared with that before stimulation (p < 0.05) and almost recovered to the prestimulation level 3 days after stimulation. These results indicate that the emotional behaviour such as restlessness induced by AMH stimulation in cats may have some relation to emotional stress.

Predictors of symptom increase among managers: The role of environmental, personal and situational characteristics

Abstract: This study examines the personal and situational characteristics associated with health status change in a sample of 572 managers. Organizational, social and demographic characteristics, environmental perceptions, coping resources and constraints, self-focused beliefs, characteristics of recent stressful events, appraisals of the event and coping strategies all make an independent contribution to symptom increases. When relatively stable background characteristics are held constant, the greatest associations with symptom increases are for trait anxiety, comforting physically coping, the nature of the most recent stressful event, environmental uncontrollability and organizational instability through mergers and acquisitions.

Should heart attack patients return to stressful jobs

Abstract: A paper by Hlatky et al which appeared in Circulation last August, has received considerable media attention, since it purported to show no relationship between high job stress levels and any increase in coronary heart disease In a subsequent interview, Hlatky indicated that a major conclusion from the study was that heart attack patients could return to work without any risk Another author suggested that 'people with a history of heart disease may benefit from working-even in a stressful environment' I was asked to comment on this by a reporter from Medical Tribune, since most studies have shown a clear correlation between job stess, and coronary morbidity and mortality, as well as hypertension, which was not discussed My main concern was that the end point was the degree of coronary atherosclerosis as assessed by coronary angiography, which is quite different than conventional clinical criteria The assumption is made that this measurement is an accurate predictor of future coronary events, and several caveats should be considered As the authors themselves concede, coronary angiography 'is an imperfect measure of coronary atherosclerosis' There is also considerable interinterpreter disagreement, and even different conclusions when the identical angiogram is reviewed by the same individual months later Coronary occlusion often occurs at sites quite different than those predicted by angiography Many individuals who die from other causes may have severe coronary occlusive disease without ever having experienced angina or any other cardiac symptoms It is possible to have a coronary occlusion without a myocardial infarction, myocardial necrosis without coronary obstruction, and sudden arrhythmic death without evidence of either There are other possible methodological flaws based on demographics This was a 90% white, upper level socioeconomic cohort, from a localized geographical area, studied at only one facility, and marital status was not considered Job stress was evaluated at only one point in time, and was associated with the stress of hospitalization for angiography This may have influenced responses based on prior experience with the use of questionnaires to rate Type A behavior in similar settings Job strain was rated based on the high psychological demand-low decision making model utilized by Karasek and Theorell It has subsequently been suggested that social support is another factor that should be considered Since it is not clear that Hlatky et al actually measured what they thought they were measuring, the results are inconsistent with prior studies, and the conclusions and recommendations are counterintuitive, I have invited the authors of Healthy Work, who developed the questionnaire that was utilized, to add their comments

Love and hate: their many guises and stressful effects

Abstract: A discussion of the terms ‘love’ and ‘hate’ is given. This is followed by tabular summaries of the contrasting word associations of love and hate. Then a review is given of the scientific studies and hypotheses relative to the different stressful, psychological, physiological, pathological and sociological outcomes from the practice of love, hate and associated emotions.