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Introduction to Work-Related Stressors

“Work, so fundamental to basic survival and health, as well as to wealth, well-being, and positive social identity, has its darker and more costly side too.1 Work can negatively affect our health, an impact that goes well beyond the usual counts of injuries, accidents, and illnesses from exposure to toxic chemicals. The ways in which work is organized—particularly its pace, intensity and the space it allows or does not allow for control over one’s work process and for realizing a sense of self-efficacy, justice, and employment security—can be as toxic or benign to the health of workers over time as the chemicals they breathe in the workplace air. Certain ways in which work is organized have been found to be detrimental to mental and physical health and overall well-being, causing depression and burnout [1-2], as well as contributing to a range of serious and chronic physical health conditions, such as musculoskeletal disorders, hypertension, chronic back pain, heart disease, stroke, Type II diabetes, and even death [3-5]. Accordingly, many occupational health scientists refer to these particularly noxious characteristics of work as hazards or risk factors of the psychosocial work environment to which employees are exposed.”

Work-Related Psychosocial Stressors

“Researchers have thought about and measured work stressors in various ways over the last 30 years [54-57]. The most highly studied type of work stressor is “job strain,” that is, work which combines high psychological job demands with low job decision latitude or job control [11]. A more recently developed and important way of describing job stress is “effort-reward imbalance,” a “mismatch between high workload (high demand) and low control over long-term rewards” [58, p. 1128]. Low reward includes low “esteem reward” (respect and support), low income, and low “status control” (poor promotion prospects, employment insecurity, and status inconsistency). Another stressor, “organizational injustice,” has been defined in three ways: a) distributive injustice—is one unfairly rewarded at work?; b) procedural injustice—do decision-making procedures at work fail to provide for  input from affected parties, useful feedback, and the possibility of appeal, and are they not applied fairly, consistently, and without bias?; c) relational injustice— do supervisors fail to treat workers with fairness, politeness, and consideration [59]? In addition, research studies have examined “threat-avoidant” vigilant work, i.e., work that involves continuously maintaining a high level of vigilance in order to avoid disaster, such as loss of human life [56]. This is a feature of a number of occupations at high risk for CVD, e.g., truck drivers, air traffic controllers, and sea pilots. More recently, researchers have been investigating the health effects of employment insecurity and “downsizing” [60].”



1. Rugulies, R., U. Bultmann, B. Aust, and H. Burr, Psychosocial Work Environment and Incidence of Severe Depressive Symptoms: Prospective Findings from a 5-Year Follow-up of the Danish Work Environment Cohort Study, American Journal of Epidemiology, 163:10, pp. 877-887, 2006.

2. Rafferty, Y., R. Friend, and P. Landsbergis, The Association between Job Skill Discretion, Decision Authority and Burnout, Work and Stress, 15:1, pp. 73-85, 2001.

3. Belkic, K., P. Landsbergis, P. Schnall, and D. Baker, Is Job Strain a Major Source of Cardiovascular Disease Risk?, Scandinavian Journal of Work Environment and Health, 30:2, pp. 85-128, 2004.

4. Krause, N., D. R. Ragland, B. A. Greiner, S. L. Syme, and J. M. Fisher, Psychosocial Job Factors Associated with Back and Neck Pain in Public Transit Operators, Scandinavian Journal of Work Environment and Health, 23:3, pp. 179-186, 1997.

5. Krause, N. and D. R. Ragland, Occupational Disability Due to Low Back Pain: A New Interdiscipline Classification Based on a Phase Model of Disability, Spine, 19:9, pp. 1011-1020, 1994.

54. Schnall, P. L., P. A. Landsbergis, and D. Baker, Job Strain and Cardiovascular Disease, Annual Review of Public Health, 15, pp. 381-411, 1994.

55. Kristensen, T. S., M. Kronitzer, and L. Alfedsson, Social Factors, Work, Stress and Cardiovascular Disease Prevention, The European Heart Network, Brussels, Belgium, 1998.

56. Belkic, K., P. A. Landsbergis, P. Schnall, et al., Psychosocial Factors: Review of the Empirical Data among Men, in The Workplace and Cardiovascular Disease Occupational Medicine: State of the Art Reviews, Schnall, P., K. Belkic, P. A. Landsbergis, and D. Baker (eds.), Hanley and Belfus, Philadelphia, PA, pp. 24-46, 2000.

57. Belkic, K., P. Landsbergis, P. Schnall, and D. Baker, Is Job Strain a Major Source of Cardiovascular Disease Risk?, Scandinavian Journal of Work Environment and Health, 30:2, pp. 85-128, 2004.

58. Siegrist, J., R. Peter, A. Junge, P. Cremer, and D. Seidel, Low Status Control, High Effort at Work and Ischemic Heart Disease: Prospective Evidence from Blue Collar Men, Social Science and Medicine, 31, pp. 1127-1134, 1990.

59. Kivimaki, M., M. Virtanen, M. Elovainio, A. Kouvonen, A. Vaananen, and J. Vahtera, Work Stress in the Etiology of Coronary Heart Disease—A Meta-Analysis, Scandinavian Journal of Work Environment and Health, 32:6(Special Issue), pp. 431-442, 2006.

Taken from: Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.

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