The psychosocial work environment and alcohol dependence: a prospective study
- 1Department of Epidemiology and Public Health, University College London, UK
- 2Department of Psychiatry, Institute of Community Health Sciences, Barts and the London, Queen Mary’s School of Medicine and Dentistry, Queen Mary, London, UK
- 3Department of Medical Sociology, University of Duesseldorf P.B. 10 10 07 40001, Dusseldorf, Germany
- Correspondence to: Ms J Head Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK;
- Accepted 5 June 2003
Aims: To examine whether a stressful psychosocial work environment predicts alcohol dependence.
Methods: Alcohol dependence of participants in the Whitehall II occupational cohort of London based civil servants (1985–88) was measured in 1991–93 using the CAGE questionnaire. The psychosocial work environment was measured by self report questions on the job demand-support-control model and on the model of effort-reward imbalance. Potential mediators including physical illness and poor mental health (GHQ) were measured at follow up in 1989.
Results: Effort-reward imbalance at work was associated with alcohol dependence in men after adjustment for employment grade and other baseline factors related to alcohol dependence. Although effort-reward imbalance predicted future longstanding illness, poor mental health and negative aspects of close relationships, the association between effort-reward imbalance and alcohol dependence in men was only partially mediated through these health and social support measures. In women, low decision latitude was related to alcohol dependence to some extent, but alcohol dependence among women was more prevalent in higher occupational grades. Men with high job demands or with low work social supports had a slightly reduced risk of alcohol dependence. No association was found between objectively assessed demands, job control, and alcohol dependence in either men or women.
Conclusion: A stressful psychosocial work environment in terms of effort-reward imbalance was found to be a risk factor for alcohol dependence in men. In view of the public health importance of alcohol dependence in working populations these findings call for more emphasis on psychosocial factors in occupational health research and prevention.