Psychosocial factors at work and depression in three countries of Central and Eastern Europe
Introduction
The influence of psychosocial factors at work on health has been studied extensively over the last two decades (Karasek & Theorell, 1990; Siegrist, 1996; Marmot, Siegrist, Theorell, & Feeney, 1999; Cooper, 1998). Most studies have focused on the relation with cardiovascular disease (Siegrist, Peter, Junge, Cremer, & Seidel, 1990; Karasek et al., 1988; Johnson, Stewart, Hall, Fredlund, & Theorell, 1996; Bosma, Peter, Siegrist, & Marmot, 1998) but several other health outcomes have also been examined, including self-rated health, sickness absence, neck and low back pain, psychiatric disorder and depression (North, Syme, Feeney, Shipley, & Marmot, 1996; Isacsson, Hanson, Ranstam, Rastam, & Isacsson, 1995; Tsutsumi, Kayaba, Theorell, & Siegrist, 2001; Stansfeld, Fuhrer, Shipley, & Marmot, 1999; Pikhart et al., 2001; Peter & Siegrist, 1997). This paper examines whether psychosocial work environment is associated with depression. Depression is related to several cardiovascular risk factors and, possibly, to the risk of cardiovascular disease (Dinan, 1999; Musselman, Evans, & Nemeroff, 1998; Rozanski, Blumenthal, & Kaplan, 1999; Glassman & Shapiro, 1998), and may potentially be one of the mechanisms linking psychosocial factors at work with chronic diseases.
Two theoretical models of psychosocial factors at work have been the most influential in the study of health. First model is the job strain model developed by Karasek and Theorell (1990) (Karasek et al., 1988). This model consists of several dimensions—job demand, decision latitude (job control), and social support at work, and it appears that the combination of unfavourable characteristics is associated with ill health (Karasek et al., 1988; Johnson & Hall, 1988; Johnson et al., 1996). The second widely used model is the effort–reward imbalance model developed by Siegrist, Peter, and Junge et al. (1990) and Siegrist (1996). This model emphasizes the imbalance between high effort at work and low reward received in turn, where rewards concern money, esteem and career opportunities, including job security. Thus, this model addresses the impact of selected labour market conditions (level of salary, career opportunities, job instability and unemployment) on health in addition to the more proximal job conditions.
Relatively few studies investigated the association between psychosocial factors at work with depression but it appears that the rates of depression are higher in persons with job stress (Tsutsumi et al., 2001; Stansfeld et al., 1999; Gershon, Lin, & Li, 2002; Wang & Patten, 2001; Tyssen, Vaglum, Gronvold, & Ekeberg, 2000; Kawakami & Haratani, 1999; Frank & Dingle, 1999; Stansfeld, Head, & Marmot, 1998; Kawakami, Araki, Kawashima, Masumoto, & Hayashi, 1997; Boey, Chan, Ko, Goh, & Lim, 1997; Tsukamoto, Igata, Hayashi, & Suzuki, 1995; Stahl & Hauger, 1994; Fujigaki, Asakura, & Haratani, 1994; Kawakami, Haratani, & Araki, 1992; Phelan et al., 1991; Suzuki, Tsukamoto, & Abe, 1990; Kawakami, Araki, & Kawashima, 1990).
The study was conducted in middle-aged subjects from three post-communist countries of Central and Eastern Europe. We have previously shown, in a different dataset, that psychosocial factors at work were associated with self-rated health in Eastern European populations (Pikhart et al., 2001). In this paper, we examined whether effort–reward imbalance and low job control at wok were related to scores on a depression scale.
Section snippets
Subjects
The data come from the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) Study, a cross-sectional study of urban population samples in Novosibirsk (Russia), Krakow (Poland) and the twin city Karvina-Havirov (Czech Republic) in 1999–2000. Men and women aged 45–64 were randomly selected from population registers; they were first sent an explanatory letter with invitation to participate in the study. In the Czech Republic and Poland, questionnaire data were collected by a home
Results
The analysis is based on 1168 working individuals with valid (non-missing) data on CES-D, all work characteristics and all other covariates used in presented analysis. These subjects are described in Table 1. Distributions of the main variables were similar in men and women and in all three populations with a few exceptions. In all countries mean CES-D score was higher in women than in men (mean difference was 3.6 points). Overall, the mean values of CES-D score were 10.53 (standard deviation
Discussion
In this study of population samples from three Central and Eastern European countries, we found strong associations between depressive symptoms (characterised by CES-D scale) and effort–reward imbalance at work, material deprivation and marital status. There were weak associations between depression score and education and history of unemployment but depression was not associated with job control after controlling for socioeconomic factors.
Most studies of psychosocial work environment and
Acknowledgements
The study was funded by the Wellcome Trust (grant no. 056268). MM is recipient of the MRC Research Professorship. The authors would like to thank the ESF scientific programme Social Variations in Health Expectancy in Europe for support and useful discussions.
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