Research report
Work stress, mental health and antidepressant medication findings from the Health 2000 Study

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Abstract

Background

Population-based studies on the association between work stress and mental disorders are scarce, and it is not known whether work stress predicts mental disorders requiring treatment.

Aims

To examine the associations of work stress with DSM-IV mental disorders and subsequent antidepressant medication.

Methods

3366 participants from a representative sample of the Finnish working population responded to a survey (The Health 2000 Study). 12-month prevalence of depressive or anxiety disorders was examined with the Composite International Diagnostic Interview. Data on antidepressant prescriptions with a 3-year follow-up period were collected from a nationwide register of Social Insurance Institution.

Results

In men and women, high job demands, low job control and high job strain were associated with 12-month prevalence of depressive or anxiety disorders. After adjustment for lifetime and baseline mental disorders, men with high job demands and high job strain had increased risk of future antidepressant medication.

Conclusions

Work stress is associated with mental disorders among both sexes and among men it is a risk factor for mental disorders treated with antidepressant medication.

Introduction

Studies from several countries have reported an increase in work stress (Schaufeli and Enzmann, 1998), and that mental disorders, especially depression, are growing reasons for work disability and early retirement (Kruijshaar et al., 2003, Stewart et al., 2003, Gould and Nyman, 2004). Along with such evidence, concern is growing about the adverse effects that work stress may have on mental health. The Job Strain Model (Karasek, 1979, Karasek and Theorell, 1990, Van der Doef and Maes, 1999, De Lange et al., 2003, Theorell, 2003), also known as the Demand–Control Model, has been one of the most influential theories in research on psychosocial work characteristics and health. The model posits that a combination of high job demands and low job control, referred to as job strain, is a risk factor for health problems. Although most previous research has focused on the relationship between work strain and cardiovascular diseases, there is some evidence that high job strain, high demands and low control are also associated with mental health problems (Karasek, 1979, Bromet et al., 1988, Karasek and Theorell, 1990, Stansfeld et al., 1997, Stansfeld et al., 1999, Cropley et al., 1999, Van der Doef and Maes, 1999, Mausner-Dorsch and Eaton, 2000, Paterniti et al., 2002, Stansfeld, 2002, De Lange et al., 2003, Theorell, 2003, Wang, 2005) and self-reported use of psychopharmacological medication (Karasek, 1979, Moisan et al., 1999).

However, most research has been cross-sectional and few published longitudinal studies have used symptoms or self-certified psychiatric sickness absences as an outcome measure. Some of these studies have reported null findings (Van der Doef and Maes, 1999, Ylipaavalniemi et al., 2005). Two used a clinical or standardised interview and reported that high job demands and high work stress were associated with new affective disorder (Bromet et al., 1988), and new major depressive episode (Wang, 2005). However, these studies involved a selected vocational group of men (Bromet et al., 1988), or did not report results based on the original classification of the Job Strain Model (Bromet et al., 1988, Wang, 2005). A major limitation in earlier research is related to common method variance, i.e. both work stress and mental health have been based on subjective assessments.

Register data on antidepressant medication offers an opportunity to avoid such a bias since prescriptions are based on physicians' diagnoses. Antidepressant medication can also be considered as an indicator of mental disorders requiring pharmacological treatment. According to clinical practice guidelines on managing depression, in depressive disorders with significant disability, treatment with antidepressant medication is recommended (Finnish Psychiatric Association, 2004, National Institute for Clinical Excellence, 2004). Prospective evidence on the relationship between work stress and antidepressant use would therefore be important in terms of prevention of disabling mental disorders. Thus far, it is not known whether work stress predicts antidepressant use.

In sum, limitations in previous studies include lack of structured psychiatric interviews in the assessment of mental disorders and bias due to common-method variance, recall problems and non-generalisability to the general population. In this population-based study, we examined whether high job demands, low job control and high job strain are associated with prevalence of depressive or anxiety disorders assessed by a standardised psychiatric interview. We also examined whether these stress indicators predict clinically significant depressive or anxiety disorders as measured by register-based antidepressant medication.

Section snippets

Study sample

A multidisciplinary epidemiologic health survey, the Health 2000 Study, was carried out in the years 2000–2001 in Finland. The two-stage stratified cluster sample was representative of the Finnish population (0.24% sample) and included 8028 subjects aged 30 years or over (Aromaa and Koskinen, 2004). Stratification and sampling were conducted as follows: The strata were the five university hospital districts, each serving about 1 million inhabitants and differing in several features related to

Results

Table 1 presents the characteristics of the study participants for men and women. Men were younger, had higher household income, were more often in manual occupations or self-employed, and were more likely to be married or co-habiting than women. Men also reported lifetime mental disorders less often and had a lower prevalence of 12-month mental disorders than women. Men had higher job control and were more often in low-strain and active jobs whereas women were more often in passive and

Discussion

This population-based study of 3366 men and women showed that high work stress, as indicated in the Job Strain Model, was associated with DSM-IV diagnoses of depressive or anxiety disorders. In men, high job demands and high job strain were also associated with increased risk of antidepressant medication at follow-up. Because we adjusted the analyses for lifetime mental disorders and 12-month depressive and anxiety disorders, we were largely able to control for their possible confounding

Conclusion

Psychosocial work stress is associated with DSM-IV depressive or anxiety disorders among both sexes and among men it is a risk factor for mental disorders treated with antidepressant medication. As mental disorders account for a considerable proportion of the disease burden and are a major cause of work disability, psychosocial factors at work should be regarded as a target worthy of priority in the promotion of mental health at workplaces.

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  • Cited by (0)

    Contributors: MV, guarantor for the paper, with TH, MK, KA, JV, AA and JL designed the hypothesis, analysed the data and wrote the paper. MK, and JV were supported by the Academy of Finland (projects 104891, 105195 and 77560) and the Finnish Work Environment Fund. Conflict of interest: None.

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