Low social support from co-workers, little decision-making authority, imbalances between effort and reward, and other such negative job features can help trigger cardiovascular disease, according to research presented at the International Commission on Occupational Health's Fourth International Conference on Work Environment and Cardiovascular Diseases, held March 9-11 in Newport Beach, Calif.

The APA co-sponsored event attracted multidisciplinary attendees, including physicians, epidemiologists, registered nurses, psychologists, human factors researchers and other experts in public health from more than 40 countries.

Much of the research that attendees presented looked at how physical and mental stressors--everything from diesel particles in the air at blue-collar job sites to tighter deadlines and increased workload in a global economy--contribute to workers' development of cardiovascular disease (CVD), which the World Health Organization predicts will be the most common cause of death worldwide by 2020.

Keynote speaker Tage Kristensen, MD, cited a Norwegian study showing that even just the rumor of a factory's closure caused enough stress that workers' average pulse and blood pressure spiked.

"If rumors alone can do this for one factory," said Kristensen, a professor at the National Institute of Occupational Health in Copenhagen, Denmark, "what about globalization and its effects on people around the world? This is a very serious health problem."

Conference attendees presented research on what types of psychosocial stressors give rise to CVD, as well as how they do so. Their research indicates that stressors such as low reward for one's effort on the job, a hostile work environment or long hours can help determine a worker's risk for cardiovascular disease.

Lack of authority

Researchers cited lack of authority--having little say at one's job or no ability to make decisions at work--as a key psychological determinant of job stress that could cause CVD.

Jeffrey Johnson, PhD, a professor in the University of Maryland's department of family and community health, noted that many blue-collar workers in high-strain jobs with low control and little authority are at greater risk for developing CVD than people working nonmanual jobs.

Johnson added that decision authority can be a double-edged sword for middle managers: They endure resentment from those below them but still don't have ultimate decision-making power in their positions.

Social support in general on the job is a key factor as well. Psychologist Reiner Rugulies, PhD, a senior researcher also of Denmark's National Institute of Occupational Health, reported findings from a five-year follow-up of 3,488 workers in the Danish Work Environment Cohort Study between 1995 and 2000: Those with low influence at work, low social support and high job insecurity were more likely to experience high psychological distress.

In fact, Rugulies and colleagues noted a direct relationship between distress and social support: For every five-point increase of participants in the measurement scales they used to measure support, the researchers found psychological distress decreased about 15 percent.

Increased job demands

Coupled with the strain from low support is strain from more pressure at work. A 2001 European Foundation survey of workers on that continent found that 60 percent of respondents said they endured tight deadlines on the job, a figure up from 49 percent in 1990.

As technology has improved, allowing workers to accomplish more in less time, and business has continued to globalize, these pressures have only increased, said Tores Theorell, MD, a professor of psychosocial medicine in the public health sciences department of the Karolinska Institute in Stockholm, Sweden. The impact on worker's health is acute, he noted, citing findings from the Stockholm Heart Epidemiology Program study that found among 1,381 Swedish workers an increase in job demands or interpersonal conflicts at work could increase the risk of myocardial infarction--in other words, a heart attack.

Notably, in a self-report survey from that study, participants who reported having pressure or facing competition at work faced a risk of myocardial infarction six times greater than normal during the following 24 hours. The findings were published in the Journal of Epidemiology and Community Health (Vol. 59, No. 1, pages 23-30).

Ways to help

Along with a discussion of the problem's scope, the conference included a session devoted to ways to reduce psychological pressures in the workplace.

Psychologist Joel Bennett, PhD, president of Organizational Wellness and Learning Systems, a consulting and training service, presented results of a preliminary study using a Web-based program that trains executives on health risks in the workplace. It emphasizes how these managers can promote health among their employees. Twenty senior managers from various organizations took the training program online, and most of them were supportive of the concept, which Bennett will refine in a second developmental phase.

Other training programs have proven successful. Theorell mentioned a 2001 intervention he and colleagues conducted that gave managers at an insurance company a yearlong training program about what psychosocial elements employees need--such as social support, more decision-making authority over their own jobs and the like. After the program, their employees' morning cortisol levels decreased. This did not happen in a similar control division whose managers received no such training. Compared to the control department, decision authority developed favorably in the experimental division. The findings were published in Psychosomatic Medicine (Vol. 63, No. 5, pages 724-733).

"There's lots of things we can do to help people," he explained, "and they really aren't very complicated."

Further Reading

For more information on the International Commission on Occupational Health, visit www.icoh.org.sg.