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34. Psychosocial and Organizational Factors

Chapter Editors: Steven L. Sauter, Lawrence R. Murphy, Joseph J. Hurrell and Lennart Levi


Table of Contents

Tables and Figures

Psychosocial and Organizational Factors
Steven L. Sauter, Joseph J. Hurrell Jr., Lawrence R. Murphy and Lennart Levi

Theories of Job Stress

Psychosocial Factors, Stress and Health
Lennart Levi

Demand/Control Model: A Social, Emotional, and Physiological Approach to Stress Risk and Active Behaviour Development
Robert Karasek

Social Support: An Interactive Stress Model
Kristina Orth-Gomér

Factors Intrinsic to the Job

Person - Environment Fit
Robert D. Caplan

Workload
Marianne Frankenhaeuser

Hours of Work
Timothy H. Monk

Environmental Design
Daniel Stokols

Ergonomic Factors
Michael J. Smith

Autonomy and Control
Daniel Ganster

Work Pacing
Gavriel Salvendy

Electronic Work Monitoring
Lawrence M. Schleifer

Role Clarity and Role Overload
Steve M. Jex

Interpersonal Factors

Sexual Harassment
Chaya S. Piotrkowski

Workplace Violence
Julian Barling

Job Security

Job Future Ambiguity
John M. Ivancevich

Unemployment
Amiram D. Vinokur

Macro-Organizational Factors

Total Quality Management
Dennis Tolsma

Managerial Style
Cary L. Cooper and Mike Smith

Organizational Structure
Lois E. Tetrick

Organizational Climate and Culture
Denise M. Rousseau

Performance Measures and Compensation
Richard L. Shell

Staffing Issues
Marilyn K. Gowing

Career Development

Socialization
Debra L. Nelson and James Campbell Quick

Career Stages
Kari Lindström

Individual Factors

Type A/B Behaviour Pattern
C. David Jenkins

Hardiness
Suzanne C. Ouellette

Self-Esteem
John M. Schaubroeck

Locus of Control
Lawrence R. Murphy and Joseph J. Hurrell, Jr.

Coping Styles
Ronald J. Burke

Social Support
D. Wayne Corneil

Gender, Job Stress and Illness
Rosalind C. Barnett

Ethnicity
Gwendolyn Puryear Keita

Stress Reactions

Selected Acute Physiological Outcomes
Andrew Steptoe and Tessa M. Pollard

Behavioural Outcomes
Arie Shirom

Well-Being Outcomes
Peter Warr

Immunological Reactions
Holger Ursin

Chronic Health Effects

Cardiovascular Diseases
Töres Theorell and Jeffrey V. Johnson

Gastrointestinal Problems
Jerry Suls

Cancer
Bernard H. Fox

Musculoskeletal Disorders
Soo-Yee Lim, Steven L. Sauter and Naomi G. Swanson

Mental Illness
Carles Muntaner and William W. Eaton

Burnout
Christina Maslach

Prevention

Summary of Generic Prevention and Control Strategies
Cary L. Cooper and Sue Cartwright

Tables

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  1. Design resources & potential benefits
  2. Self-paced vs. machine-paced profile

Figures

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 PSY005F1PSY020F1PSY020F2PSY310F1PSY030F1PSY030F2PSY100T1PSY100T3PSY360F1

 

 


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Friday, 14 January 2011 18:01

Locus of Control

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Locus of control (LOC) refers to a personality trait reflecting the generalized belief that either events in life are controlled by one’s own actions (an internal LOC) or by outside influences (an external LOC). Those with an internal LOC believe that they can exert control over life events and circumstances, including the associated reinforcements, that is, those outcomes which are perceived to reward one’s behaviours and attitudes. In contrast, those with an external LOC believe they have little control over life events and circumstances, and attribute reinforcements to powerful others or to luck.

The construct of locus of control emerged from Rotter’s (1954) social learning theory. To measure LOC, Rotter (1966) developed the Internal-External (I-E) scale, which has been the instrument of choice in most research studies. However, research has questioned the unidimensionality of the I-E scale, with some authors suggesting that LOC has two dimensions (e.g., personal control and social system control), and others suggesting that LOC has three dimensions (personal efficacy, control ideology and political control). More recently developed scales to measure LOC are multidimensional, or assess LOC for specific domains, such as health or work (Hurrell and Murphy 1992).

One of the most consistent and widespread findings in the general research literature is the association between an external LOC and poor physical and mental health (Ganster and Fusilier 1989). A number of studies in occupational settings report similar findings: workers with an external LOC tended to report more burnout, job dissatisfaction, stress and lower self-esteem than those with an internal LOC (Kasl 1989). Recent evidence suggests that LOC moderates the relationship between role stressors (role ambiguity and role conflict) and symptoms of distress (Cvetanovski and Jex 1994; Spector and O’Connell 1994).

However, research linking LOC beliefs and ill health is difficult to interpret for several reasons (Kasl 1989). First, there may be conceptual overlap between the measures of health and locus of control scales. Secondly, a dispositional factor, like negative affectivity, may be present which is responsible for the relationship. For example, in the study by Spector and O’Connell (1994), LOC beliefs correlated more strongly with negative affectivity than with perceived autonomy at work, and did not correlate with physical health symptoms. Thirdly, the direction of causality is ambiguous; it is possible that the work experience may alter LOC beliefs. Finally, other studies have not found moderating effects of LOC on job stressors or health outcomes (Hurrell and Murphy 1992).

The question of how LOC moderates job stressor-health relationships has not been well researched. One proposed mechanism involves the use of more effective, problem-focused coping behaviour by those with an internal LOC. Those with an external LOC might use fewer problem-solving coping strategies because they believe that events in their lives are outside their control. There is evidence that people with an internal LOC utilize more task-centred coping behaviours and fewer emotion-centred coping behaviours than those with an external LOC (Hurrell and Murphy 1992). Other evidence indicates that in situations viewed as changeable, those with an internal LOC reported high levels of problem-solving coping and low levels of emotional suppression, whereas those with an external LOC showed the reverse pattern. It is important to bear in mind that many workplace stressors are not under the direct control of the worker, and that attempts to change uncontrollable stressors might actually increase stress symptoms (Hurrell and Murphy 1992).

A second mechanism whereby LOC could influence stressor-health relationships is via social support, another moderating factor of stress and health relationships. Fusilier, Ganster and Mays (1987) found that locus of control and social support jointly determined how workers responded to job stressors and Cummins (1989) found that social support buffered the effects of job stress, but only for those with an internal LOC and only when the support was work-related.

Although the topic of LOC is intriguing and has stimulated a great deal of research, there are serious methodological problems attaching to investigations in this area which need to be addressed. For example, the trait-like (unchanging) nature of LOC beliefs has been questioned by research which showed that people adopt a more external orientation with advancing age and after certain life experiences such as unemployment. Furthermore, LOC may be measuring worker perceptions of job control, instead of an enduring trait of the worker. Still other studies have suggested that LOC scales may not only measure beliefs about control, but also the tendency to use defensive manoeuvres, and to display anxiety or proneness to Type A behaviour (Hurrell and Murphy 1992).

Finally, there has been little research on the influence of LOC on vocational choice, and the reciprocal effects of LOC and job perceptions. Regarding the former, occupational differences in the proportion of “internals” and “externals” may be evidence that LOC influences vocational choice (Hurrell and Murphy 1992). On the other hand, such differences might reflect exposure to the job environment, just as the work environment is thought to be instrumental in the development of the Type A behaviour pattern. A final alternative is that occupational differences in LOC are be due to “drift”, that is the movement of workers into or out of certain occupations as a result of job dissatisfaction, health concerns or desire for advancement.

In summary, the research literature does not present a clear picture of the influence of LOC beliefs on job stressor or health relationships. Even where research has produced more or less consistent findings, the meaning of the relationship is obscured by confounding influences (Kasl 1989). Additional research is needed to determine the stability of the LOC construct and to identify the mechanisms or pathways through which LOC influences worker perceptions and mental and physical health. Components of the path should reflect the interaction of LOC with other traits of the worker, and the interaction of LOC beliefs with work environment factors, including reciprocal effects of the work environment and LOC beliefs. Future research should produce less ambiguous results if it incorporates measures of related individual traits (e.g., Type A behaviour or anxiety) and utilizes domain-specific measures of locus of control (e.g., work).


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Friday, 14 January 2011 18:11

Coping Styles

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Coping has been defined as “efforts to reduce the negative impacts of stress on individual well-being” (Edwards 1988). Coping, like the experience of work stress itself, is a complex, dynamic process. Coping efforts are triggered by the appraisal of situations as threatening, harmful or anxiety producing (i.e., by the experience of stress). Coping is an individual difference variable that moderates the stress-outcome relationship.

Coping styles encompass trait-like combinations of thoughts, beliefs and behaviours that result from the experience of stress and may be expressed independently of the type of stressor. A coping style is a dispositional variable. Coping styles are fairly stable over time and situations and are influenced by personality traits, but are different from them. The distinction between the two is one of generality or level of abstraction. Examples of such styles, expressed in broad terms, include: monitor-blunter (Miller 1979) and repressor-sensitizer (Houston and Hodges 1970). Individual differences in personality, age, experience, gender, intellectual ability and cognitive style affect the way an individual copes with stress. Coping styles are the result of both prior experience and previous learning.

Shanan (1967) offered an early perspective on what he termed an adaptive coping style. This “response set” was characterized by four ingredients: the availability of energy directly focused on potential sources of the difficulty; a clear distinction between events internal and external to the person; confronting rather than avoiding external difficulties; and balancing external demands with needs of the self. Antonovsky (1987) similarly suggests that, to be effective, the individual person must be motivated to cope, have clarified the nature and dimensions of the problem and the reality in which it exists, and then selected the most appropriate resources for the problem at hand.

The most common typology of coping style (Lazarus and Folkman 1984) includes problem-focused coping (which includes information seeking and problem solving) and emotion-focused coping (which involves expressing emotion and regulating emotions). These two factors are sometimes complemented by a third factor, appraisal-focused coping (whose components include denial, acceptance, social comparison, redefinition and logical analysis).

Moos and Billings (1982) distinguish among the following coping styles:

  • Active-cognitive. The person tries to manage their appraisal of the stressful situation.
  • Active-behavioural. This style involves behaviour dealing directly with the stressful situations.
  • Avoidance. The person avoids confronting the problem.

 

Greenglass (1993) has recently proposed a coping style termed social coping, which integrates social and interpersonal factors with cognitive factors. Her research showed significant relationships between various kinds of social support and coping forms (e.g., problem-focused and emotion-focused). Women, generally possessing relatively greater interpersonal competence, were found to make greater use of social coping.

In addition, it may be possible to link another approach to coping, termed preventive coping, with a large body of previously separate writing dealing with healthy lifestyles (Roskies 1991). Wong and Reker (1984) suggest that a preventive coping style is aimed at promoting one’s well-being and reducing the likelihood of future problems. Preventive coping includes such activities as physical exercise and relaxation, as well as the development of appropriate sleeping and eating habits, and planning, time management and social support skills.

Another coping style, which has been described as a broad aspect of personality (Watson and Clark 1984), involves the concepts of negative affectivity (NA) and positive affectivity (PA). People with high NA accentuate the negative in evaluating themselves, other people and their environment in general and reflect higher levels of distress. Those with high PA focus on the positives in evaluating themselves, other people and their world in general. People with high PA report lower levels of distress.

These two dispositions can affect a person’s perceptions of the number and magnitude of potential stressors as well as his or her coping responses (i.e., one’s perceptions of the resources that one has available, as well as the actual coping strategies that are used). Thus, those with high NA will report fewer resources available and are more likely to use ineffective (defeatist) strategies (such as releasing emotions, avoidance and disengagement in coping) and less likely to use more effective strategies (such as direct action and cognitive reframing). Individuals with high PA would be more confident in their coping resources and use more productive coping strategies.

Antonovsky’s (1979; 1987) sense of coherence (SOC) concept overlaps considerably with PA. He defines SOC as a generalized view of the world as meaningful and comprehensible. This orientation allows the person to first focus on the specific situation and then to act on the problem and the emotions associated with the problem. High SOC individuals have the motivation and the cognitive resources to engage in these sorts of behaviours likely to resolve the problem. In addition, high SOC individuals are more likely to realize the importance of emotions, more likely to experience particular emotions and to regulate them, and more likely to take responsibility for their circumstances instead of blaming others or projecting their perceptions upon them. Considerable research has since supplied support for Antonovsky’s thesis.

Coping styles can be described with reference to dimensions of complexity and flexibility (Lazarus and Folkman 1984). People using a variety of strategies exhibit a complex style; those preferring a single strategy exhibit a single style. Those who use the same strategy in all situations exhibit a rigid style; those who use different strategies in the same, or different, situations exhibit a flexible style. A flexible style has been shown to be more effective than a rigid style.

Coping styles are typically measured by using self-reported questionnaires or by asking individuals, in an open-ended way, how they coped with a particular stressor. The questionnaire developed by Lazarus and Folkman (1984), the “Ways of Coping Checklist”, is the most widely used measure of problem-focused and emotion-focused coping. Dewe (1989), on the other hand, has frequently used individuals’ descriptions of their own coping initiatives in his research on coping styles.

There are a variety of practical interventions that may be implemented with regard to coping styles. Most often, intervention consists of education and training in which individuals are presented with information, sometimes coupled with self-assessment exercises that enable them to examine their own preferred coping style as well as other varieties of coping styles and their potential usefulness. Such information is typically well received by the persons to whom the intervention is directed, but the demonstrated usefulness of such information in helping them cope with real life stressors is lacking. In fact, the few studies that considered individual coping (Shinn et al. 1984; Ganster et al. 1982) have reported limited practical value in such education, particularly when a follow-up has been undertaken (Murphy 1988).

Matteson and Ivancevich (1987) outline a study dealing with coping styles as part of a longer programme of stress management training. Improvements in three coping skills are addressed: cognitive, interpersonal and problem solving. Coping skills are classified as problem-focused or emotion-focused. Problem-focused skills include problem solving, time management, communication and social skills, assertiveness, lifestyle changes and direct actions to change environmental demands. Emotion-focused skills are designed to relieve distress and foster emotion regulation. These include denial, expressing feelings and relaxation.

The preparation of this article was supported in part by the Faculty of Administrative Studies, York University.


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Friday, 14 January 2011 18:13

Social Support

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During the mid-1970s public health practitioners, and in particular, epidemiologists “discovered” the concept of social support in their studies of causal relationships between stress, mortality and morbidity (Cassel 1974; Cobb 1976). In the past decade there has been an explosion in the literature relating the concept of social support to work-related stressors. By contrast, in psychology, social support as a concept had already been well integrated into clinical practice. Rogers’ (1942) client-centred therapy of unconditional positive regard is fundamentally a social support approach. Lindeman’s (1944) pioneering work on grief management identified the critical role of support in moderating the crisis of death loss. Caplin’s (1964) model of preventive community psychiatry (1964) elaborated on the importance of community and support groups.

Cassel (1976) adapted the concept of social support into public health theory as a way of explaining the differences in diseases that were thought to be stress-related. He was interested in understanding why some individuals appeared to be more resistant to stress than others. The idea of social support as a factor in disease causation was reasonable since, he noted, both people and animals who experienced stress in the company of “significant others” seemed to suffer fewer adverse consequences than those who were isolated. Cassel proposed that social support could act as a protective factor buffering an individual from the effects of stress.

Cobb (1976) expanded on the concept by noting that the mere presence of another person is not social support. He suggested that an exchange of “information” was needed. He established three categories for this exchange:

  • information leading the person to the belief that one is loved or cared for (emotional support)
  • information leading to the belief that one is esteemed and valued (esteem support)
  • information leading to the belief that one belongs to a network of mutual obligations and communication.

 

Cobb reported that those experiencing severe events without such social support were ten times more likely to come to be depressed and concluded that somehow intimate relations, or social support, was protective of the effects of stress reactions. He also proposed that social support operates throughout one’s life span, encompassing various life events such as unemployment, severe illness and bereavement. Cobb pointed out the great diversity of studies, samples, methods and outcomes as convincing evidence that social support is a common factor in modifying stress, but is, in itself, not a panacea for avoiding its effects.

According to Cobb, social support increases coping ability (environmental manipulation) and facilitates adaptation (self-change to improve the person-environment fit). He cautioned, however, that most research was focused on acute stressors and did not permit generalizations of the protective nature of social support for coping with the effects of chronic stressors or traumatic stress.

Over the intervening years since the publication of these seminal works, investigators have moved away from considering social support as a unitary concept, and have attempted to understand the components of social stress and social support.

Hirsh (1980) describes five possible elements of social support:

  • emotional support: care, comfort, love, affection, sympathy
  • encouragement: praise, compliments; the extent to which one feels inspired by the supporter to feel courage, hope or to prevail
  • advice: useful information to solve problems; the extent to which one feels informed
  • companionship: time spent with supporter; the extent to which one does not feel alone
  • tangible aid: practical resources, such as money or aid with chores; the extent to which one feels relieved of burdens. Another framework is used by House (1981), to discuss social support in the context of work-related stress:
  • emotional: empathy, caring, love, trust, esteem or demonstrations of concern
  • appraisal: information relevant to self-evaluation, feedback from others useful in self-affirmation
  • informational: suggestions, advice or information useful in problem-solving
  • instrumental: direct aid in the form of money, time or labour.

 

House felt that emotional support was the most important form of social support. In the workplace, the supportiveness of the supervisor was the most important element, followed by co-worker support. The structure and organization of the enterprise, as well as the specific jobs within it, could either enhance or inhibit potential for support. House found that greater task specialization and fragmentation of work leads to more isolated work roles and to decreased opportunities for support.

Pines’ (1983) study of burnout, which is a phenomenon discussed separately in this chapter, found that the availability of social support at work is negatively correlated with burnout. He identifies six different relevant aspects of social support which modify the burnout response. These include listening, encouragement, giving advice and, providing companionship and tangible aid.

As one may gather from the foregoing discussion in which the models proposed by several researchers have been described, while the field has attempted to specify the concept of social support, there is no clear consensus on the precise elements of the concept, although considerable overlap between models is evident.

Interaction between Stress and Social Support

Although the literature on stress and social support is quite extensive, there is still considerable debate as to the mechanisms by which stress and social support interact. A long-standing question is whether social support has a direct or indirect effect on health.

Main effect/Direct effect

Social support can have a direct or main effect by serving as a barrier to the effects of the stressor. A social support network may provide needed information or needed feedback in order to overcome the stressor. It may provide a person with the resources he or she needs to minimize the stress. An individual’s self-perception may also be influenced by group membership so as to provide self-confidence, a sense of mastery and skill and hence thereby a sense of control over the environment. This is relevant to Bandura’s (1986) theories of personal control as the mediator of stress effects. There appears to be a minimum threshold level of social contact required for good health, and increases in social support above the minimum are less important. If one considers social support as having a direct—or main—effect, then one can create an index by which to measure it (Cohen and Syme 1985; Gottlieb 1983).

Cohen and Syme (1985), however, also suggest that an alternative explanation to social support acting as a main effect is that it is the isolation, or lack of social support, which causes the ill health rather than the social support itself promoting better health. This is an unresolved issue. Gottlieb also raises the issue of what happens when the stress results in the loss of the social network itself, such as might occur during disasters, major accidents or loss of work. This effect has not yet been quantified.

Buffering/Indirect effect

The buffering hypothesis is that social support intervenes between the stressor and the stress response to reduce its effects. Buffering could change one’s perception of the stressor, thus diminishing its potency, or it could increases one’s coping skills. Social support from others may provide tangible aid in a crisis, or it may lead to suggestions that facilitate adaptive responses. Finally, social support may be the stress-modifying effect which calms the neuroendocrine system so that the person may be less reactive to the stressor.

Pines (1983) notes that the relevant aspect of social support may be in the sharing of a social reality. Gottlieb proposes that social support could offset self-recrimination and dispel notions that the individual is him or herself responsible for the problems. Interaction with a social support system can encourage the venting of fears and can assist re-establishing a meaningful social identity.

Additional Theoretical Issues

Research thus far has tended to treat social support as a static, given factor. While the issue of its change over time has been raised, little data exist on the time course of social support (Gottlieb 1983; Cohen and Syme 1985). Social support is, of course, fluid, just as the stressors that it affects. It varies as the individual passes through the stages of life. It can also change over the short-term experience of a particular stressful event (Wilcox 1981).

Such variability probably means that social support fulfils different functions during different developmental stages or during different phases of a crisis. For example at the onset of a crisis, informational support may be more essential than tangible aid. The source of support, its density and the length of time it is operative will also be in flux. The reciprocal relationship between stress and social support must be recognized. Some stressors themselves have a direct impact on available support. Death of a spouse, for example, usually reduces the extent of the network and may have serious consequences for the survivor (Goldberg et al. 1985).

Social support is not a magic bullet that reduces the impact of stress. Under certain conditions it may exacerbate or be the cause of stress. Wilcox (1981) noted that those with a denser kin network had more difficulties adjusting to divorce because their families were less likely to accept divorce as a solution to marital problems. The literature on addiction and family violence also shows possible severe negative effects of social networks. Indeed, as Pines and Aronson (1981) point out, much of professional mental health interventions are devoted to undoing destructive relationships, and to teaching interpersonal skills and to assisting people to recover from social rejection.

There are a large number of studies employing a variety of measures of the functional content of social support. These measures have a wide range of reliability and construct validity. Another methodological problem is that these analyses depend largely on the self-reports of those being studied. The responses will therefore of necessity be subjective and will cause one to wonder whether it is the actual event or level of social support that is important or whether it is the individual’s perception of support and outcomes that is more critical. If it is the perception that is critical, then it may be that some other, third variable, such as personality type, is affecting both stress and social support (Turner 1983). For example, a third factor, such as age or socio-economic status, may influence change in both social support and outcome, according to Dooley (1985). Solomon (1986) provides some evidence for this idea with a study of women who have been forced by financial constraints into involuntary interdependence on friends and kin. She found that such women opt out of these relationships as quickly as they are financially able to do so.

Thoits (1982) raises concerns about reverse causation. It may be, she points out, that certain disorders chase away friends and lead to loss of support. Studies by Peters-Golden (1982) and Maher (1982) on cancer victims and social support appear to be consistent with this proposition.

Social Support and Work Stress

Studies on the relationship between social support and work stress indicate that successful coping is related to the effective use of support systems (Cohen and Ahearn 1980). Successful coping activities have emphasized the use of both formal and informal social support in dealing with work stress. Laid-off workers, for example, are advised to actively seek support to provide informational, emotional and tangible support. There have been relatively few evaluations of the effectiveness of such interventions. It appears, however, that formal support is only effective in the short term and informal systems are necessary for longer-term coping. Attempts to provide institutional formal social support can create negative outcomes, since the anger and rage about layoff or bankruptcy, for example, may be displaced to those who provide the social support. Prolonged reliance on social support may create a sense of dependency and lowered self- esteem.

In some occupations, such as seafarers, fire-fighters or staff in remote locations such as on oil rigs, there is a consistent, long-term, highly defined social network which can be compared to a family or kin system. Given the necessity for small work groups and joint efforts, it is natural that a strong sense of social cohesion and support develops among workers. The sometimes hazardous nature of the work requires that workers develop mutual respect, trust and confidence. Strong bonds and interdependence are created when people are dependent on each other for their survival and well-being.

Further research on the nature of social support during routine periods, as well as downsizing or major organizational change, is necessary to further define this factor. For example, when an employee is promoted to a supervisory position, he or she normally must distance him or herself from the other members of the work group. Does this make a difference in the day-to-day levels of social support he or she receives or requires? Does the source of support shift to other supervisors or to the family or somewhere else? Do those in positions of responsibility or authority experience different work stressors? Do these individuals require different types, sources or functions of social support?

If the target of the group-based interventions is also changing the functions of social support or the nature of the network, does this provide a preventive effect in future stressful events?

What will be the effect of growing numbers of women in these occupations? Does their presence change the nature and functions of support for all or does each sex require different levels or types of support?

The workplace presents a unique opportunity to study the intricate web of social support. As a closed subculture, it provides a natural experimental setting for research into the role of social support, social networks and their interrelationships with acute, cumulative and traumatic stress.


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Friday, 14 January 2011 18:27

Gender, Job Stress and Illness

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Do job stressors affect men and women differently? This question has only recently been addressed in the job stress–illness literature. In fact, the word gender does not even appear in the index of the first edition of the Handbook of Stress (Goldberger and Breznitz 1982) nor does it appear in the indices of such major reference books as Job Stress and Blue Collar Work (Cooper and Smith 1985) and Job Control and Worker Health (Sauter, Hurrell and Cooper 1989). Moreover, in a 1992 review of moderator variables and interaction effects in the occupational stress literature, gender effects were not even mentioned (Holt 1992). One reason for this state of affairs lies in the history of occupational health and safety psychology, which in turn reflects the pervasive gender stereotyping in our culture. With the exception of reproductive health, when researchers have looked at physical health outcomes and physical injuries, they have generally studied men and variations in their work. When researchers have studied mental health outcomes, they have generally studied women and variations in their social roles.

As a result, the “available evidence” on the physical health impact of work has until recently been almost completely limited to men (Hall 1992). For example, attempts to identify correlates of coronary heart disease have been focused exclusively on men and on aspects of their work; researchers did not even inquire into their male subjects’ marital or parental roles (Rosenman et al. 1975). Indeed, few studies of the job stress–illness relationship in men include assessments of their marital and parental relationships (Caplan et al. 1975).

In contrast, concern about reproductive health, fertility and pregnancy focused primarily on women. Not surprisingly, “the research on reproductive effects of occupational exposures is far more extensive on females than on males” (Walsh and Kelleher 1987). With respect to psychological distress, attempts to specify the psychosocial correlates, in particular the stressors associated with balancing work and family demands, have centred heavily on women.

By reinforcing the notion of “separate spheres” for men and women, these conceptualizations and the research paradigms they generated prevented any examination of gender effects, thereby effectively controlling for the influence of gender. Extensive sex segregation in the workplace (Bergman 1986; Reskin and Hartman 1986) also acts as a control, precluding the study of gender as a moderator. If all men are employed in “men’s jobs” and all women are employed in “women’s jobs”, it would not be reasonable to ask about the moderating effect of gender on the job stress–illness relationship: job conditions and gender would be confounded. It is only when some women are employed in jobs that men occupy and when some men are employed in jobs that women occupy that the question is meaningful.

Controlling is one of three strategies for treating the effects of gender. The other two are ignoring these effects or analysing them (Hall 1991). Most investigations of health have either ignored or controlled for gender, thereby accounting for the dearth of references to gender as discussed above and for a body of research that reinforces stereotyped views about the role of gender in the job stress–illness relationship. These views portray women as essentially different from men in ways that render them less robust in the workplace, and portray men as comparatively unaffected by non-workplace experiences.

In spite of this beginning, the situation is already changing. Witness the publication in 1987 of Gender and Stress (Barnett, Biener and Baruch 1987), the first edited volume focusing specifically on the impact of gender at all points in the stress reaction. And the second edition of the Handbook of Stress (Barnett 1992) includes a chapter on gender effects. Indeed, current studies increasingly reflect the third strategy: analysing gender effects. This strategy holds great promise, but also has pitfalls. Operationally, it involves analysing data relating to males and females and estimating both the main and the interaction effects of gender. A significant main effect tells us that after controlling for the other predictors in the model, men and women differ with respect to the level of the outcome variable. Interaction-effects analyses concern differential reactivity, that is, does the relationship between a given stressor and a health outcome differ for women and men?

The main promise of this line of inquiry is to challenge stereotyped views of women and men. The main pitfall is that conclusions about gender difference can still be drawn erroneously. Because gender is confounded with many other variables in our society, these variables have to be taken into account before conclusions about gender can be inferred. For example, samples of employed men and women will undoubtedly differ with respect to a host of work and non-work variables that could reasonably affect health outcomes. Most important among these contextual variables are occupational prestige, salary, part-time versus full-time employment, marital status, education, employment status of spouse, overall work burdens and responsibility for care of younger and older dependants. In addition, evidence suggests the existence of gender differences in several personality, cognitive, behavioural and social system variables that are related to health outcomes. These include: sensation seeking; self-efficacy (feelings of competence); external locus of control; emotion-focused versus problem-focused coping strategies; use of social resources and social support; harmful acquired risks, such as smoking and alcohol abuse; protective behaviours, such as exercise, balanced diets and preventive health regimens; early medical intervention; and social power (Walsh, Sorensen and Leonard, in press). The better one can control these contextual variables, the closer one can get to understanding the effect of gender per se on the relationships of interest, and thereby to understanding whether it is gender or other, gender-related variables that are the effective moderators.

To illustrate, in one study (Karasek 1990) job changes among white-collar workers were less likely to be associated with negative health outcomes if the changes resulted in increased job control. This finding was true for men, not women. Further analyses indicated that job control and gender were confounded. For women, one of “the less aggressive [or powerful] groups in the labour market” (Karasek 1990), white-collar job changes often involved reduced control, whereas for men, such job changes often involved increased control. Thus, power, not gender, accounted for this interaction effect. Such analyses lead us to refine the question about moderator effects. Do men and women react differentially to workplace stressors because of their inherent (i.e., biological) nature or because of their different experiences?

Although only a few studies have examined gender interaction effects, most report that when appropriate controls are utilized, the relationship between job conditions and physical or mental health outcomes is not affected by gender. (Lowe and Northcott 1988 describe one such study). In other words, there is no evidence of an inherent difference in reactivity.

Findings from a random sample of full-time employed men and women in dual-earner couples illustrates this conclusion with respect to psychological distress. In a series of cross-sectional and longitudinal analyses, a matched pairs design was used that controlled for such individual-level variables as age, education, occupational prestige and marital-role quality, and for such couple-level variables as parental status, years married and household income (Barnett et al. 1993; Barnett et al. 1995; Barnett, Brennan and Marshall 1994). Positive experiences on the job were associated with low distress; insufficient skill discretion and overload were associated with high distress; experiences in the roles of partner and parent moderated the relationship between job experiences and distress; and change over time in skill discretion and overload were each associated with change over time in psychological distress. In no case was the effect of gender significant. In other words, the magnitude of these relationships was not affected by gender.

One important exception is tokenism (see, for example, Yoder 1991). Whereas “it is clear and undeniable that there is a considerable advantage in being a member of the male minority in any female profession” (Kadushin 1976), the opposite is not true. Women who are in minority in a male work situation experience a considerable disadvantage. Such a difference is readily understandable in the context of men’s and women’s relative power and status in our culture.

Overall, studies of physical health outcomes also fail to reveal significant gender interaction effects. It appears, for example, that characteristics of work activity are stronger determinants of safety than are attributes of workers, and that women in traditionally male occupations suffer the same types of injury with approximately the same frequency as their male counterparts. Moreover, poorly designed protective equipment, not any inherent incapacity on the part of women in relation to the work, is often to blame when women in male-dominated jobs experience more injuries (Walsh, Sorensen and Leonard, 1995).

Two caveats are in order. First, no one study controls for all the gender-related covariates. Therefore, any conclusions about “gender” effects must be tentative. Secondly, because controls vary from study to study, comparisons between studies are difficult.

As increasing numbers of women enter the labour force and occupy jobs similar to those occupied by men, both the opportunity and the need for analysing the effect of gender on the job stress–illness relationship also increase. In addition, future research needs to refine the conceptualization and measurement of the stress construct to include job stressors important to women; extend interaction effects analyses to studies previously restricted to male or female samples, for example, studies of reproductive health and of stresses due to non-workplace variables; and examine the interaction effects of race and class as well as the joint interaction effects of gender x race and gender x class.


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Friday, 14 January 2011 18:39

Ethnicity

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Major changes are taking place within the workforces of many of the world’s leading industrial nations, with members of ethnic minority groups making up increasingly larger proportions. However, little of the occupational stress research has focused on ethnic minority populations. The changing demographics of the world’s workforce give clear notice that these populations can no longer be ignored. This article briefly addresses some of the major issues of occupational stress in ethnic minority populations with a focus on the United States. However, much of the discussion should be generalizable to other nations of the world.

Much of the occupational stress research either excludes ethnic minorities, includes too few to allow meaningful comparisons or generalizations to be made, or does not report enough information about the sample to determine racial or ethnic participation. Many studies fail to make distinctions among ethnic minorities, treating them as one homogeneous group, thus minimizing the differences in demographic characteristics, culture, language and socio-economic status which have been documented both between and within ethnic minority groups (Olmedo and Parron 1981).

In addition to the failure to address issues of ethnicity, by far the greater part of research does not examine class or gender differences, or class by race and gender interactions. Moreover, little is known about the cross-cultural utility of many of the assessment procedures. Documentation used in such procedures is not adequately translated nor is there demonstrated equivalency between the standardized English and other language versions. Even when the reliabilities appear to indicate equivalence across ethnic or cultural groups, there is uncertainty about which symptoms in the scale are elicited in a reliable fashion, that is, whether the phenomenology of a disorder is similar across groups (Roberts, Vernon and Rhoades 1989).

Many assessment instruments inadequately assess conditions within ethnic minority populations; consequently results are often suspect. For example, many stress scales are based on models of stress as a function of undesirable change or readjustment. However, many minority individuals experience stress in large part as a function of ongoing undesirable situations such as poverty, economic marginality, inadequate housing, unemployment, crime and discrimination. These chronic stressors are not usually reflected in many of the stress scales. Models which conceptualize stress as resulting from the interplay between both chronic and acute stressors, and various internal and external mediating factors, are more appropriate for assessing stress in ethnic minority and poor populations (Watts-Jones 1990).

A major stressor affecting ethnic minorities is the prejudice and discrimination they encounter as a result of their minority status in a given society (Martin 1987; James 1994). It is a well- established fact that minority individuals experience more prejudice and discrimination as a result of their ethnic status than do members of the majority. They also perceive greater discrimination and fewer opportunities for advancement as compared with whites (Galinsky, Bond and Friedman 1993). Workers who feel discriminated against or who feel that there are fewer chances for advancement for people of their ethnic group are more likely to feel “burned out” in their jobs, care less about working hard and doing their jobs well, feel less loyal to their employers, are less satisfied with their jobs, take less initiative, feel less committed to helping their employers succeed and plan to leave their current employers sooner (Galinsky, Bond and Friedman 1993). Moreover, perceived prejudice and discrimination are positively correlated with self-reported health problems and higher blood pressure levels (James 1994).

An important focus of occupational stress research has been the relationship between social support and stress. However, there has been little attention paid to this variable with respect to ethnic minority populations. The available research tends to show conflicting results. For example, Hispanic workers who reported higher levels of social support had less job-related tension and fewer reported health problems (Gutierres, Saenz and Green 1994); ethnic minority workers with lower levels of emotional support were more likely to experience job burn-out, health symptoms, episodic job stress, chronic job stress and frustration; this relationship was strongest for women and for management as opposed to non-management personnel (Ford 1985). James (1994), however, did not find a significant relationship between social support and health outcomes in a sample of African-American workers.

Most models of job satisfaction have been derived and tested using samples of white workers. When ethnic minority groups have been included, they have tended to be African-Americans, and potential effects due to ethnicity were often masked (Tuch and Martin 1991). Research that is available on African-American employees tends to yield significantly lower scores on overall job satisfaction in comparison to whites (Weaver 1978, 1980; Staines and Quinn 1979; Tuch and Martin 1991). Examining this difference, Tuch and Martin (1991) noted that the factors determining job satisfaction were basically the same but that African-Americans were less likely to have the situations that led to job satisfaction. More specifically, extrinsic rewards increase African-Americans’ job satisfaction, but African-Americans are disadvantaged relatively to whites on these variables. On the other hand, blue-collar incumbency and urban residence decrease job satisfaction for African-Americans but African-Americans are overrepresented in these areas. Wright, King and Berg (1985) found that organizational variables (i.e., job authority, qualifications for the position and a sense that advancement within the organization is possible) were the best predictors of job satisfaction in their sample of black female managers in keeping with previous research on primarily white samples.

Ethnic minority workers are more likely than their white counterparts to be in jobs with hazardous work conditions. Bullard and Wright (1986/1987) noted this propensity and indicated that the population differences in injuries are likely to be the result of racial and ethnic disparities in income, education, type of employment and other socio-economic factors correlated with exposure to hazards. One of the most likely reasons, they noted, was that occupational injuries are highly dependent on the job and industry category of the workers and ethnic minorities tend to work in more hazardous occupations.

Foreign workers who have entered the country illegally often experience special work stress and maltreatment. They often endure substandard and unsafe working conditions and accept less than minimum wages because of fear of being reported to the immigration authorities and they have few options for better employment. Most health and safety regulations, guidelines for use, and warnings are in English and many immigrants, illegal or otherwise, may not have a good understanding of written or spoken English (Sanchez 1990).

Some areas of research have almost totally ignored ethnic minority populations. For example, hundreds of studies have examined the relationship between Type A behaviour and occupational stress. White males constitute the most frequently studied groups with ethnic minority men and women almost totally excluded. Available research—e.g., a study by Adams et al. (1986), using a sample of college freshmen, and e.g., Gamble and Matteson (1992), investigating black workers—indicates the same positive relationship between Type A behaviour and self-reported stress as that found for white samples.

Similarly, little research on issues such as job control and work demands is available for ethnic minority workers, although these are central constructs in occupational stress theory. Available research tends to show that these are important constructs for ethnic minority workers as well. For example, African-American licensed practical nurses (LPNs) report significantly less decision authority and more dead-end jobs (and hazard exposures) than do white LPNs and this difference is not a function of educational differences (Marshall and Barnett 1991); the presence of low decision latitude in the face of high demands tends to be the pattern most characteristic of jobs with low socio-economic status, which are more likely to be held by ethnic minority workers (Waitzman and Smith 1994); and middle- and upper-level white men rate their jobs consistently higher than their ethnic minority (and female) peers on six work design factors (Fernandez 1981).

Thus, it appears that many research questions remain regarding ethnic minority populations in the occupational stress and health arena as regards ethnic minority populations. These questions will not be answered until ethnic minority workers are included in study samples and in the development and validation of investigatory instruments.


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Friday, 14 January 2011 18:40

Selected Acute Physiological Outcomes

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Andrew Steptoe and Tessa M. Pollard

The acute physiological adjustments recorded during the performance of problem-solving or psychomotor tasks in the laboratory include: raised heart rate and blood pressure; alterations in cardiac output and peripheral vascular resistance; increased muscle tension and electrodermal (sweat gland) activity; disturbances in breathing pattern; and modifications in gastrointestinal activity and immune function. The best studied neurohormonal responses are those of the catecholamines (adrenaline and noradrenaline) and cortisol. Noradrenaline is the primary transmitter released by the nerves of the sympathetic branch of the autonomic nervous system. Adrenaline is released from the adrenal medulla following stimulation of the sympathetic nervous system, while activation of the pituitary gland by higher centres in the brain results in the release of cortisol from the adrenal cortex. These hormones support autonomic activation during stress and are responsible for other acute changes, such as stimulation of the processes that govern blood clotting, and the release of stored energy supplies from adipose tissue. It is likely that these kinds of response will also be seen during job stress, but studies in which work conditions are simulated, or in which people are tested in their normal jobs, are required to demonstrate such effects.

A variety of methods is available to monitor these responses. Conventional psychophysiological techniques are used to assess autonomic responses to demanding tasks (Cacioppo and Tassinary 1990). Levels of stress hormones can be measured in the blood or urine, or in the case of cortisol, in the saliva. The sympathetic activity associated with challenge has also been documented by measures of noradrenaline spillover from nerve terminals, and by direct recording of sympathetic nervous activity with miniature electrodes. The parasympathetic or vagal branch of the autonomic nervous system typically responds to task performance with reduced activity, and this can, under certain circumstances, be indexed through recording heart rate variability or sinus arrhythmia. In recent years, power spectrum analysis of heart rate and blood pressure signals has revealed wave bands that are characteristically associated with sympathetic and parasympathetic activity. Measures of the power in these wavebands can be used to index autonomic balance, and have shown a shift towards the sympathetic branch at the expense of the parasympathetic branch during task performance.

Few laboratory assessments of acute physiological responses have simulated work conditions directly. However, dimensions of task demand and performance that are relevant to work have been investigated. For example, as the demands of externally paced work increase (through faster pace or more complex problem solving), there is a rise in adrenaline level, heart rate and blood pressure, a reduction in heart rate variability and an increase in muscle tension. In comparison with self-paced tasks performed at the same rate, external pacing results in greater blood pressure and heart rate increases (Steptoe et al. 1993). In general, personal control over potentially stressful stimuli reduces autonomic and neuroendocrine activation in comparison with uncontrollable situations, although the effort of maintaining control over the situation itself has its own physiological costs.

Frankenhaeuser (1991) has suggested that adrenaline levels are raised when a person is mentally aroused or performing a demanding task, and that cortisol levels are raised when an individual is distressed or unhappy. Applying these ideas to job stress, Frankenhaeuser has proposed that job demand is likely to lead to increased effort and thus to raise levels of adrenaline, while lack of job control is one of the main causes of distress at work and is therefore likely to stimulate raised cortisol levels. Studies comparing levels of these hormones in people doing their normal work with levels in the same people at leisure have shown that adrenaline is normally raised when people are at work. Effects for noradrenaline are inconsistent and may depend on the amount of physical activity that people carry out during work and leisure time. It has also been shown that adrenaline levels at work correlate positively with levels of job demand. In contrast, cortisol levels have not been shown typically to be raised in people at work, and it is yet to be demonstrated that cortisol levels vary according to the degree of job control. In the “Air Traffic Controller Health Change Study”, only a small proportion of workers produced consistent increases in cortisol as the objective workload became greater (Rose and Fogg 1993).

Thus only adrenaline among the stress hormones has been shown conclusively to rise in people at work, and to do so according to the level of demand they experience. There is evidence that levels of prolactin increase in response to stress while levels of testosterone decrease. However, studies of these hormones in people at work are very limited. Acute changes in the concentration of cholesterol in the blood have also been observed with increased workload, but the results are not consistent (Niaura, Stoney and Herbst 1992).

As far as cardiovascular variables are concerned, it has repeatedly been found that blood pressure is higher in men and women during work than either after work or during equivalent times of day spent at leisure. These effects have been observed both with self-monitored blood pressure and with automated portable (or ambulatory) monitoring instruments. Blood pressure is especially high during periods of increased work demand (Rose and Fogg 1993). It has also been found that blood pressure rises with emotional demands, for example, in studies of paramedics attending the scenes of accidents. However, it is often difficult to determine whether blood pressure fluctuations at work are due to psychological demands or to associated physical activity and changes in posture. The raised blood pressure recorded at work is especially pronounced among people reporting high job strain according to the Demand-Control model (Schnall et al. 1990).

Heart rate has not been shown to be consistently raised during work. Acute elevations of heart rate may nevertheless be elicited by disruption of work, for example with breakdown of equipment. Emergency workers such as fire-fighters exhibit extremely fast heart rates in response to alarm signals at work. On the other hand, high levels of social support at work are associated with reduced heart rates. Abnormalities of cardiac rhythm may also be elicited by stressful working conditions, but the pathological significance of such responses has not been established.

Gastrointestinal problems are commonly reported in studies of job stress (see “Gastrointestinal problems” below). Unfortunately, it is difficult to assess the physiological systems underlying gastrointestinal symptoms in the work setting. Acute mental stress has variable effects on gastric acid secretion, stimulating large increases in some individuals and reduced output in others. Shift workers have a particularly high prevalence of gastrointestinal problems, and it has been suggested that these may arise when diurnal rhythms in the central nervous system’s control of gastric acid secretion are disrupted. Anomalies of small bowel motility have been recorded using radiotelemetry in patients diagnosed with irritable bowel syndrome while they go about their everyday lives. Health complaints, including gastrointestinal symptoms, have been shown to co-vary with perceived workload, but it is not clear whether this reflects objective changes in physiological function or patterns of symptom perception and reporting.


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Friday, 14 January 2011 19:29

Behavioural Outcomes

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Researchers may disagree on the meaning of the term stress. However, there is a basic agreement that perceived work-related stress may be implicated in behavioural outcomes such as absenteeism, substance abuse, sleep disturbances, smoking and caffeine use (Kahn and Byosiere 1992). Recent evidence supporting these relationships is reviewed in this chapter. Emphasis is placed upon the aetiological role of work-related stress in each of these outcomes. There are qualitative differences, along several dimensions, among these outcomes. To illustrate, in contrast to the other behavioural outcomes, which are all considered problematic to the health of those engaging in them excessively, absenteeism, while detrimental to the organization, is not necessarily harmful to those employees who are absent from work. There are, however, common problems in the research on these outcomes, as discussed in this section.

The varying definitions of work-related stress have already been mentioned above. By way of illustration, consider the different conceptualizations of stress on the one hand as events and on the other as chronic demands at the workplace. These two approaches to stress measurement have seldom been combined in a single study designed to predict the sorts of behavioural outcome considered here. The same generalization is relevant to the combined use, in the same study, of family-related and work-related stress to predict any of these outcomes. Most of the studies referred to in this chapter were based on a cross-sectional design and employees’ self-reports on the behavioural outcome in question. In most of the research that concerned behavioural outcomes of work-related stress, the joint moderating or mediating roles of predisposing personality variables, like the Type A behaviour pattern or hardiness, and situational variables like social support and control, have hardly been investigated. Seldom have antecedent variables, like objectively measured job stress, been included in the research designs of the studies reviewed here. Finally, the research covered in this article employed divergent methodologies. Because of these limitations, a frequently encountered conclusion is that the evidence for work-related stress as a precursor of a behavioural outcome is inconclusive.

Beehr (1995) considered the question of why so few studies have systematically examined the associations between work- related stress and substance abuse. He argued that such neglect may be due in part to the failure of researchers to find these associations. To this failure, one should add the well-known bias of periodicals against publishing research that reports null results. To illustrate the inconclusiveness of the evidence linking stress and substance abuse, consider two large-scale national samples of employees in the United States. The first, by French, Caplan and Van Harrison (1982), failed to find significant correlations between types of work-related stress and either smoking, drug use or on-the-job caffeine ingestion. The second, an earlier research study by Mangione and Quinn (1975), did report such associations.

The study of the behavioural outcomes of stress is further complicated because they frequently appear in pairs or triads. Different combinations of outcomes are the rule rather than the exception. The very close association of stress, smoking and caffeine is alluded to below. Yet another example concerns the comorbidity of post-traumatic stress disorder (PTSD), alcoholism and drug abuse (Kofoed, Friedman and Peck 1993). This is a basic characteristic of several behavioural outcomes considered in this article. It has led to the construction of “dual diagnosis” and “triple diagnosis” schemes and to the development of comprehensive, multifaceted treatment approaches. An example of such an approach is that in which PTSD and substance abuse are treated simultaneously (Kofoed, Friedman and Peck 1993).

The pattern represented by the appearance of several outcomes in a single individual may vary, depending on background characteristics and genetic and environmental factors. The literature on stress outcomes is only beginning to address the complex questions involved in identifying the specific pathophysiological and neurobiological disease models leading to different combinations of outcome entities.

Smoking Behaviour

A large body of epidemiological, clinical and pathological studies relates cigarette smoking to the development of cardiovascular heart disease and other chronic diseases. Consequently, there is a growing interest in the pathway leading from stress, including stress at work, to smoking behaviour. Stress, and the emotional responses associated with it, anxiety and irritability, are known to be attenuated by smoking. However, these effects have been shown to be short-lived (Parrott 1995). Impairments of mood and affective states tend to occur in a repetitive cycle between each cigarette smoked. This cycle provides a clear pathway leading to the addictive use of cigarettes (Parrott 1995). Smokers, therefore, obtain only a short-lived relief from adverse states of anxiety and irritability that follow the experience of stress.

The aetiology of smoking is multifactorial (like most other behavioural outcomes considered here). To illustrate, consider a recent review of smoking among nurses. Nurses, the largest professional group in health care, smoke excessively compared with the adult population (Adriaanse et al. 1991). According to their study, this is true for both male and female nurses, and is explained by work stress, lack of social support and unmet expectations that characterize nurses’ professional socialization. Nurses’ smoking is considered a special public health problem since nurses often act as role models to patients and their families.

Smokers who express high motivation to smoke have reported, in several studies, above-average stress that they had experienced before smoking, rather than below-average stress after smoking (Parrott 1995). Consequently, stress management and anxiety reduction programmes in the workplace do have the potential of influencing motivation for smoking. However, workplace-based smoking-cessation programmes do bring to the fore the conflict between health and performance. Among aviators, as an example, smoking is a health hazard in the cockpit. However, pilots who are required to abstain from smoking during and before flights may suffer cockpit performance decrements (Sommese and Patterson 1995).

Drug and Alcohol Abuse

A recurrent problem is that often researchers do not distinguish between drinking and problem-drinking behaviour (Sadava 1987). Problem-drinking is associated with adverse health or performance consequences. Its aetiology has been shown to be associated with several factors. Among them, the literature refers to prior incidents of depression, lack of supportive family environment, impulsiveness, being female, other concurrent substance abuse and stress (Sadava 1987). The distinction between the simple act of drinking alcohol and problem drinking is important because of the current controversy on the reported beneficial effects of alcohol on low density lipoprotein (LDL) cholesterol and on the incidence of heart disease. Several studies have shown a J-shaped or U-shaped relationship between alcohol ingestion and the incidence of cardiovascular heart disease (Pohorecky 1991).

The hypothesis that people ingest alcohol even in an incipiently abusive pattern to reduce stress and anxiety is no longer accepted as adequate. Contemporary approaches to alcohol abuse view it as determined by processes set forth in a multifactorial model or models (Gorman 1994). Among risk factors for alcohol abuse, recent reviews refer to the following factors: sociocultural (i.e., whether alcohol is readily available and its use tolerated, condoned or even promoted), socio-economic (i.e., the price of alcohol), environmental (alcohol advertising and licensing laws affect the consumers’ motivation to drink), interpersonal influences (such as family drinking habits), and employment-related factors, including stress at work (Gorman 1994). It follows that stress is but one of several factors in a multidimensional model that explains alcohol abuse.

The practical consequence of the multifactorial model view of alcoholism is the decrease in the emphasis on the role of stress in the diagnosis, prevention and treatment of substance abuse in the workplace. As noted by a recent review of this literature (Peyser 1992), in specific job situations, such as those illustrated below, attention to work-related stress is important in formulating preventive policies directed at substance abuse.

Despite considerable research on stress and alcohol, the mechanisms that link them are not entirely understood. The most widely accepted hypothesis is that alcohol disrupts the subject’s initial appraisal of stressful information by constraining the spread of activation of associated information previously stored in long-term memory (Petraitis, Flay and Miller 1995).

Work organizations contribute to and may induce drinking behaviour, including problem drinking, by three basic processes documented in the research literature. First, drinking, abusive or not, may be affected by the development of organizational norms with respect to drinking on the job, including the local “official” definition of problem drinking and the mechanisms for its control established by management. Secondly, some stressful working conditions, like sustained overload or machine-paced jobs or the lack of control may produce alcohol abuse as a coping strategy alleviating the stress. Thirdly, work organizations may explicitly or implicitly encourage the development of occupationally based drinking subcultures, such as those that often emerge among professional drivers of heavy vehicles (James and Ames 1993).

In general, stress plays a different role in provoking drinking behaviour in different occupations, age groups, ethnic categories and other social groupings. Thus stress probably plays a predisposing role with respect to alcohol consumption among adolescents, but much less so among women, the elderly and college-age social drinkers (Pohorecky 1991).

The social stress model of substance abuse (Lindenberg, Reiskin and Gendrop 1994) suggests that the likelihood of employees’ drug abuse is influenced by the level of environmental stress, social support relevant to the experienced stress, and individual resources, particularly social competence. There are indications that drug abuse among certain minority groups (like Native American youth living on reservations: see Oetting, Edwards and Beauvais 1988) is influenced by the prevalence of acculturation stress among them. However, the same social groups are also exposed to adverse social conditions like poverty, prejudices and impoverished opportunities for economic, social and educational opportunities.

Caffeine Ingestion

Caffeine is the most widely consumed pharmacologically active substance in the world. The evidence bearing upon its possible implications for human health, that is whether it has chronic physiological effects on habitual consumers, is as yet inconclusive (Benowitz 1990). It has long been suspected that repeated exposure to caffeine may produce tolerance to its physiological effects (James 1994). The consumption of caffeine is known to improve physical performance and endurance during prolonged activity at submaximal intensity (Nehlig and Debry 1994). Caffeine’s physiological effects are linked to the antagonism of adenosine receptors and to the increased production of plasma catecholamines (Nehlig and Debry 1994).

The study of the relationship of work-related stress on caffeine ingestion is complicated because of the significant inter-dependance of coffee consumption and smoking (Conway et al. 1981). A meta-analysis of six epidemiological studies (Swanson, Lee and Hopp 1994) has shown that about 86% of smokers consumed coffee while only 77% of the non-smokers did so. Three major mechanisms have been suggested to account for this close association: (1) a conditioning effect; (2) reciprocal interaction, that is, caffeine intake increases arousal while nicotine intake decreases it and (3) the joint effect of a third variable on both. Stress, and particularly work-related stress, is a possible third variable influencing both caffeine and nicotine intake (Swanson, Lee and Hopp 1994).

Sleep Disturbances

The modern era of sleep research began in the 1950s, with the discovery that sleep is a highly active state rather than a passive condition of nonresponsiveness. The most prevalent type of sleep disturbance, insomnia, may occur in a transient short-term form or in a chronic form. Stress is probably the most frequent cause of transient insomnia (Gillin and Byerley 1990). Chronic insomnia usually results from an underlying medical or psychiatric disorder. Between one-third and two-thirds of patients with chronic insomnia have a recognizable psychiatric illness (Gillin and Byerley 1990).

One of the mechanisms suggested is that the effect of stress on sleep disturbances is mediated via certain changes in the cerebral system at different levels, and changes in the biochemical body functions that disturb the 24-hour rhythms (Gillin and Byerley 1990). There is some evidence that the above linkages are moderated by personality characteristics, such as the Type A behaviour pattern (Koulack and Nesca 1992). Stress and sleep disturbances may reciprocally influence each other: stress may promote transient insomnia, which in turn causes stress and increases the risk of episodes of depression and anxiety (Partinen 1994).

Chronic stress associated with monotonous, machine-paced jobs coupled with the need for vigilance—jobs frequently found in continuous-processing manufacturing industries—may lead to sleep disturbances, subsequently causing decrements in performance (Krueger 1989). There is some evidence that there are synergetic effects among work-related stress, circadian rhythms and reduced performance (Krueger 1989). The adverse effects of sleep loss, interacting with overload and a high level of arousal, on certain important aspects of job performance have been documented in several studies of sleep deprivation among hospital doctors at the junior level (Spurgeon and Harrington 1989).

The study by Mattiason et al. (1990) provides intriguing evidence linking chronic job stress, sleep disturbances and increases in plasma cholesterol. In this study, 715 male shipyard employees exposed to the stress of unemployment were systematically compared with 261 controls before and after the economic instability stress was made apparent. It was found that among the shipyard employees exposed to job insecurity, but not among the controls, sleep disturbances were positively correlated with increases in total cholesterol. This is a naturalistic field study in which the period of uncertainty preceding actual layoffs was allowed to elapse for about a year after some employees received notices concerning the impending layoffs. Thus the stress studied was real, severe, and could be considered chronic.

Absenteeism

Absence behaviour may be viewed as an employee coping behaviour that reflects the interaction of perceived job demands and control, on the one hand, and self-assessed health and family conditions on the other. Absenteeism has several major dimensions, including duration, spells and reasons for being absent. It was shown in a European sample that about 60% of the hours lost to absenteeism were due to illness (Ilgen 1990). To the extent that work-related stress was implicated in these illnesses, then there should be some relationship between stress on the job and that part of absenteeism classified as sick days. The literature on absenteeism covers primarily blue-collar employees, and few studies have included stress in a systematic way. (McKee, Markham and Scott 1992). Jackson and Schuler’s meta-analysis (1985) of the consequences of role stress reported an average correlation of 0.09 between role ambiguity and absence and -0.01 between role conflict and absence. As several meta-analytic studies of the literature on absenteeism show, stress is but one of many variables accounting for these phenomena, so we should not expect work-related stress and absenteeism to be strongly correlated (Beehr 1995).

The literature on absenteeism suggests that the relationship between work-related stress and absenteeism may be mediated by employee-specific characteristics. For example, the literature refers to the propensity to use avoidance coping in response to stress at work, and to being emotionally exhausted or physically fatigued (Saxton, Phillips and Blakeney 1991). To illustrate, Kristensen’s (1991) study of several thousand Danish slaughterhouse employees over a one-year period has shown that those who reported high job stress had significantly higher absence rates and that perceived health was closely associated with absenteeism due to illness.

Several studies of the relationships between stress and absenteeism provide evidence that supports the conclusion that they may be occupationally determined (Baba and Harris 1989). To illustrate, work-related stress among managers tends to be associated with the incidence of absenteeism but not with days lost attributed to illness, while this is not so with shop-floor employees (Cooper and Bramwell 1992). Occupational specificity of the stresses predisposing employees to be absent has been regarded as a major explanation of the meagre amount of absence variance explained by work-related stress across many studies (Baba and Harris 1989). Several studies have found that among blue-collar employees who work on jobs considered stressful—that is those that possess a combination of the characteristics of assembly-line type of jobs (namely, a very short cycle of operations and a piece-rate wage system)—job stress is a strong predictor of unexcused absence. (For a recent review of these studies, see McKee, Markham and Scott 1992; note that Baba and Harris 1989 do not support their conclusion that job stress is a strong predictor of unexcused absence).

The literature on stress and absenteeism provides a convincing example of a limitation noted in the introduction. The reference is to the failure of most research on stress-behavioural outcome relations to cover systematically, in the design of this research, both work and non-work stresses. It was noted that in research on absenteeism non-work stress contributed more than work-related stress to the prediction of absence, lending support to the view that absence may be non-work behaviour more than work-related behaviour (Baba and Harris 1989).


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Friday, 14 January 2011 19:33

Well-being Outcomes

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Jobs can have a substantial impact on the affective well-being of job holders. In turn, the quality of workers’ well-being on the job influences their behaviour, decision making and interactions with colleagues, and spills over into family and social life as well.

Research in many countries has pointed to the need to define the concept in terms of two separate dimensions that may be viewed as independent of each other (Watson, Clark and Tellegen 1988; Warr 1994). These dimensions may be referred to as “pleasure” and “arousal”. As illustrated in figure 1, a particular degree of pleasure or displeasure may be accompanied by high or low levels of mental arousal, and mental arousal may be either pleasurable or unpleasurable. This is indicated in terms of the three axes of well-being which are suggested for measurement: displeasure-to-pleasure, anxiety-to-comfort, and depression-to-enthusiasm.

Figure 1. Three principal axes for the measurement of affective well-being

Job-related well-being has often been measured merely along the horizontal axis, extending from “feeling bad” to “feeling good”. The measurement is usually made with reference to a scale of job satisfaction, and data are obtained by workers’ indicating their agreement or disagreement with a series of statements describing their feelings about their jobs. However, job satisfaction scales do not take into account differences in mental arousal, and are to that extent relatively insensitive. Additional forms of measurement are also needed, in terms of the other two axes in the figure.

When low scores on the horizontal axis are accompanied by raised mental arousal (upper left quadrant), low well-being is typically evidenced in the forms of anxiety and tension; however, low pleasure in association with low mental arousal (lower left) is observable as depression and associated feelings. Conversely, high job-related pleasure may be accompanied by positive feelings that are characterized either by enthusiasm and energy (3b) or by psychological relaxation and comfort (2b). This latter distinction is sometimes described in terms of motivated job satisfaction (3b) versus resigned, apathetic job satisfaction (2b).

In studying the impact of organizational and psychosocial factors on employee well-being, it is desirable to examine all three of the axes. Questionnaires are widely used for this purpose. Job satisfaction (1a to 1b) may be examined in two forms, sometimes referred to as “facet-free” and “facet-specific” job satisfaction. Facet-free, or overall, job satisfaction is an overarching set of feelings about one’s job as a whole, whereas facet-specific satisfactions are feelings about particular aspects of a job. Principal facets include pay, working conditions, one’s supervisor and the nature of the work undertaken.

These several forms of job satisfaction are positively intercorrelated, and it is sometimes appropriate merely to measure overall, facet-free satisfaction, rather than to examine separate, facet-specific satisfactions. A widely used general question is “On the whole, how satisfied are you with the work you do?”. Commonly used responses are very dissatisfied, a little dissatisfied, moderately satisfied, very satisfied and extremely satisfied, and are designated by scores from 1 to 5 respectively. In national surveys it is usual to find that about 90% of employees report themselves as satisfied to some degree, and a more sensitive measuring instrument is often desirable to yield more differentiated scores.

A multi-item approach is usually adopted, perhaps covering a range of different facets. For instance, several job satisfaction questionnaires ask about a person’s satisfaction with facets of the following kinds: the physical work conditions; the freedom to choose your own method of working; your fellow workers; the recognition you get for good work; your immediate boss; the amount of responsibility you are given; your rate of pay; your opportunity to use your abilities; relations between managers and workers; your workload; your chance of promotion; the equipment you use; the way your firm is managed; your hours of work; the amount of variety in your job; and your job security. An average satisfaction score may be calculated across all the items, responses to each item being scored from 1 to 5, for instance (see the preceding paragraph). Alternatively, separate values can be computed for “intrinsic satisfaction” items (those dealing with the content of the work itself) and “extrinsic satisfaction” items (those referring to the context of the work, such as colleagues and working conditions).

Self-report scales which measure axes two and three have often covered only one end of the possible distribution. For example, some scales of job-related anxiety ask about a worker’s feelings of tension and worry when on the job (2a), but do not in addition test for more positive forms of affect on this axis (2b). Based on studies in several settings (Watson, Clark and Tellegen 1988; Warr 1990), a possible approach is as follows.

Axes 2 and 3 may be examined by putting this question to workers: “Thinking of the past few weeks, how much of the time has your job made you feel each of the following?”, with response options of never, occasionally, some of the time, much of the time, most of the time, and all the time (scored from 1 to 6 respectively). Anxiety-to-comfort ranges across these states: tense, anxious, worried, calm, comfortable and relaxed. Depression-to-enthusiasm covers these states: depressed, gloomy, miserable, motivated, enthusiastic and optimistic. In each case, the first three items should be reverse-scored, so that a high score always reflects high well-being, and the items should be mixed randomly in the questionnaire. A total or average score can be computed for each axis.

More generally, it should be noted that affective well-being is not determined solely by a person’s current environment. Although job characteristics can have a substantial effect, well-being is also a function of some aspects of personality; people differ in their baseline well-being as well as in their reactions to particular job characteristics.

Relevant personality differences are usually described in terms of individuals’ continuing affective dispositions. The personality trait of positive affectivity (corresponding to the upper right-quadrant) is characterized by generally optimistic views of the future, emotions which tend to be positive and behaviours which are relatively extroverted. On the other hand, negative affectivity (corresponding to the upper left-hand quadrant) is a disposition to experience negative emotional states. Individuals with high negative affectivity tend in many situations to feel nervous, anxious or upset; this trait is sometimes measured by means of personality scales of neuroticism. Positive and negative affectivities are regarded as traits, that is, they are relatively constant from one situation to another, whereas a person’s well-being is viewed as an emotional state which varies in response to current activities and environmental influences.

Measures of well-being necessarily identify both the trait (the affective disposition) and the state (current affect). This fact should be borne in mind in examining people’s well-being score on an individual basis, but it is not a substantial problem in studies of the average findings for a group of employees. In longitudinal investigations of group scores, observed changes in well-being can be attributed directly to changes in the environment, since every person’s baseline well-being is held constant across the occasions of measurement; and in cross-sectional group studies an average affective disposition is recorded as a background influence in all cases.

Note also that affective well-being may be viewed at two levels. The more focused perspective relates to a specific domain, such as an occupational setting: this may be a question of “job-related” well-being (as discussed here) and is measured through scales which directly concern feelings when a person is at work. However, more wide-ranging, “context-free” or “general,” well-being is sometimes of interest, and measurement of that wider construct requires a less specific focus. The same three axes should be examined in both cases, and more general scales are available for life satisfaction or general distress (axis 1), context-free anxiety (axis 2) and context-free depression (axis 3).


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Friday, 14 January 2011 19:37

Immunological Reactions

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When a human being or an animal is subjected to a psychological stress situation, there is a general response involving psychological as well as somatic (bodily) responses. This is a general alarm response, or general activation or wake-up call, which affects all physiological responses, including the musculoskeletal system, the vegetative system (the autonomic system), the hormones and also the immune system.

Since the 1960s, we have been learning how the brain, and through it, psychological factors, regulates and influences all physiological processes, whether directly or indirectly. Previously it was held that large and essential parts of our physiology were regulated “unconsciously,” or not by brain processes at all. The nerves that regulate the gut, glands and the cardiovascular system were “autonomic”, or independent of the central nervous system (CNS); similarly, the hormones and the immune system were beyond central nervous control. However, the autonomic nervous system is regulated by the limbic structures of the brain, and may be brought under direct instrumental control through classical and instrumental learning procedures. The fact that the central nervous system controls endocrinological processes is also well established.

The last development to undercut the view that the CNS was isolated from many physiological processes was the evolution of psychoimmunology. It has now been demonstrated that the interaction of the brain (and psychological processes), may influence immune processes, either via the endocrine system or by direct innervation of lymphoid tissue. The white blood cells themselves may also be influenced directly by signal molecules from nervous tissue. Depressed lymphocyte function has been demonstrated to follow bereavement (Bartrop et al. 1977), and conditioning of the immune-suppressive response in animals (Cohen et al. 1979) and psychological processes were shown to have effects bearing on animal survival (Riley 1981); these discoveries were milestones in the development of psychoimmunology.

It is now well established that psychological stress produces changes in the level of antibodies in the blood, and in the level of many of the white blood cells. A brief stress period of 30 minutes may produce significant increases in lymphocytes and natural killer (NK) cells. Following more long-lasting stress situations, changes are also found in the other components of the immune system. Changes have been reported in the counts of almost all types of white blood cell and in the levels of immunoglobulins and their complements; the changes also affect important elements of the total immune response and the “immune cascade” as well. These changes are complex and seem to be bidirectional. Both increases and decreases have been reported. The changes seem to depend not only on the stress-inducing situation, but on also what type of coping and defence mechanisms the individual is using to handle this situation. This is particularly clear when the effects of real long-lasting stress situations are studied, for instance those associated with the job or with difficult life situations (“life stressors”). Highly specific relationships between coping and defence styles and several subsets of immune cells (number of lympho-, leuko- and monocytes; total T cells and NK cells) have been described (Olff et al. 1993).

The search for immune parameters as markers for long-lasting, sustained stress has not been all that successful. Since the relationships between immunoglobulins and stress factors have been demonstrated to be so complex, there is, understandably, no simple marker available. Such relationships as have been found are sometimes positive, sometimes negative. As far as psycho-logical profiles are concerned, to some extent the correlation matrix with one and the same psychological battery shows different patterns, varying from one occupational group to another (Endresen et al. 1991). Within each group, the patterns seem stable over long periods of time, up to three years. It is not known whether there are genetic factors that influence the highly specific relationships between coping styles and immune responses; if so, the manifestions of these factors must be highly dependent on interaction with life stressors. Also, it is not known whether it is possible to follow an individual’s stress level over a long period, given that the individual’s coping, defence and immune response style is known. This type of research is being pursued with highly selected personnel, for instance astronauts.

There may be a major flaw in the basic argument that immunoglobulins can be used as valid health risk markers. The original hypothesis was that low levels of circulating immunoglobulins might signal a low resistance and low immune competence. However, low values may not signal low resistance: they may only signal that this particular individual has not been challenged by infectious agents for a while—in fact, they may signal an extraordinary degree of health. The low values sometimes reported from returning astronauts and Antarctic personnel may not be a signal of stress, but only of the low levels of bacterial and viral challenge in the environment they have left.

There are many anecdotes in the clinical literature suggesting that psychological stress or critical life events can have an impact on the course of serious and non-serious illness. In the opinion of some, placebos and “alternative medicine” may exert their effects through psychoimmunological mechanisms. There are claims that reduced (and sometimes increased) immune competence should lead to increased susceptibility to infections in animals and in humans, and to inflammatory states like rheumatoid arthritis as well. It has been demonstrated convincingly that psychological stress affects the immune response to various types of inoculations. Students under examination stress report more symptoms of infectious illness in this period, which coincides with poorer cellular immune control (Glaser et al. 1992). There are also some claims that psychotherapy, in particular cognitive stress-management training, together with physical training, may affect the antibody response to viral infection.

There are also some positive findings with regard to cancer development, but only a few. The controversy over the claimed relationship between personality and cancer susceptibility has not been solved. Replications should be extended to include measures of immune responses to other factors, including lifestyle factors, which may be related to psychology, but the cancer effect may be a direct consequence of the lifestyle.

There is ample evidence that acute stress alters immune functions in human subjects and that chronic stress may also affect these functions. But to what extent are these changes valid and useful indicators of job stress? To what extent are immune changes—if they occur—a real health risk factor? There is no consensus in the field as of the time of this writing (1995).

Sound clinical trials and sound epidemiological research are required to advance in this field. But this type of research requires more funds than are available to the researchers. This work also requires an understanding of the psychology of stress, which is not always available to immunologists, and a profound understanding of how the immune system operates, which is not always available to psychologists.

 

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Friday, 14 January 2011 19:40

Cardiovascular Diseases

Written by

Töres Theorell and Jeffrey V. Johnson

The scientific evidence suggesting that exposure to job stress increases the risk for cardiovascular disease increased substantially beginning in the mid-1980s (Gardell 1981; Karasek and Theorell 1990; Johnson and Johansson 1991). Cardiovascular disease (CVD) remains the number one cause of death in economically developed societies, and contributes to increasing medical care costs. Diseases of the cardiovascular system include coronary heart disease (CHD), hypertensive disease, cerebrovascular disease and other disorders of the heart and circulatory system.

Most manifestations of coronary heart disease are caused partly by narrowing of the coronary arteries due to atherosclerosis. Coronary atherosclerosis is known to be influenced by a number of individual factors including: family history, dietary intake of saturated fat, high blood pressure, cigarette smoking and physical exercise. Except for heredity, all these factors could be influenced by the work environment. A poor work environment may decrease the willingness to stop smoking and adopt a healthy lifestyle. Thus, an adverse work environment could influence coronary heart disease via its effects on the classical risk factors.

There are also direct effects of stressful work environments on neurohormonal elevations as well as on heart metabolism. A combination of physiological mechanisms, shown to be related to stressful work activities, may increase the risk of myocardial infarction. The elevation of energy-mobilizing hormones, which increase during periods of excessive stress, may make the heart more vulnerable to the actual death of the muscle tissue. Conversely, energy-restoring and repairing hormones which protect the heart muscle from the adverse effects of energy-mobilizing hormones, decrease during periods of stress. During emotional (and physical) stress the heart beats faster and harder over an extended period of time, leading to excessive oxygen consumption in the heart muscle and the increased possibility of a heart attack. Stress may also disturb the cardiac rhythm of the heart. A disturbance associated with a fast heart rhythm is called tachyarrhythmia. When the heart rate is so fast that the heartbeat becomes inefficient a life-threatening ventricular fibrillation may result.

Early epidemiological studies of psychosocial working conditions associated with CVD suggested that high levels of work demands increased CHD risk. For example a prospective study of Belgian bank employees found that those in a privately owned bank had a significantly higher incidence of myocardial infarction than workers in public banks, even after adjustment was made for biomedical risk factors (Komitzer et al. 1982). This study indicated a possible relationship between work demands (which were higher in the private banks) and risk of myocardial infarction. Early studies also indicated a higher incidence of myocardial infarction among lower level employees in large companies (Pell and d’Alonzo 1963). This raised the possibility that psychosocial stress may not primarily be a problem for people with a high degree of responsibility, as had been assumed previously.

Since the early 1980s, many epidemiological studies have examined the specific hypothesis suggested by the Demand/ Control model developed by Karasek and others (Karasek and Theorell 1990; Johnson and Johansson 1991). This model states that job strain results from work organizations that combine high- performance demands with low levels of control over how the work is to be done. According to the model, work control can be understood as “job decision latitude”, or the task-related decision-making authority permitted by a given job or work organization. This model predicts that those workers who are exposed to high demand and low control over an extended period of time will have a higher risk of neurohormonal arousal which may result in adverse pathophysiological effects on the CVD system—which could eventually lead to increased risk of atherosclerotic heart disease and myocardial infarction.

Between 1981 and 1993, the majority of the 36 studies that examined the effects of high demands and low control on cardiovascular disease found significant and positive associations. These studies employed a variety of research designs and were performed in Sweden, Japan, the United States, Finland and Australia. A variety of outcomes was examined including CHD morbidity and mortality, as well as CHD risk factors including blood pressure, cigarette smoking, left ventricular mass index and CHD symptoms. Several recent review papers summarize these studies (Kristensen 1989; Baker et al. 1992; Schnall, Landsbergis and Baker 1994; Theorell and Karasek 1996). These reviewers note that the epidemiological quality of these studies is high and, moreover, that the stronger study designs have generally found greater support for the Demand/Control models. In general the adjustment for standard risk factors for cardiovascular disease does not eliminate nor significantly reduce the magnitude of the association between the high demand/low control combination and the risk of cardiovascular disease.

It is important to note, however, that the methodology in these studies varied considerably. The most important distinction is that some studies used the respondent’s own descriptions of their work situations, whereas others used an ‘average score’ method based on aggregating the responses of a nationally representative sample of workers within their respective job title groups. Studies utilizing self-reported work descriptions showed higher relative risks (2.0–4.0 versus 1.3–2.0). Psychological job demands were shown to be relatively more important in studies utilizing self-reported data than in studies utilizing aggregated data. The work control variables were more consistently found to be associated with excess CVD risk regardless of which exposure method was used.

Recently, work-related social support has been added to the demand-control formulation and workers with high demands, low control and low support, have been shown to have over a twofold risk for CVD morbidity and mortality compared to those with low demands, high control and high support (Johnson and Hall 1994). Currently efforts are being made to examine sustained exposure to demands, control and support over the course of the “psychosocial work career”. Descriptions of all the occupations during the whole work career are obtained for the participants and occupational scores are used for a calculation of the total lifetime exposure. The “total job control exposure” in relation to cardiovascular mortality incidence in working Swedes was studied and even after adjustment was made for age, smoking habits, exercise, ethnicity, education and social class, low total job control exposure was associated with a nearly twofold risk of dying a cardiovascular death over a 14-year follow-up period (Johnson et al. 1996).

A model similar to the Demand/Control model has been developed and tested by Siegrist and co-workers 1990 that uses “effort” and “social reward” as the crucial dimensions, the hypothesis being that high effort without social reward leads to increasing risk of cardiovascular disease. In a study of industrial workers it was shown that combinations of high effort and lack of reward predicted increased myocardial infarction risk independently of biomedical risk factors.

Other aspects of work organization, such as shift work, have also been shown to be associated with CVD risk. Constant rotation between night and day work has been found to be associated with increased risk of developing a myocardial infarction (Kristensen 1989; Theorell 1992).

Future research in this area particularly needs to focus on specifying the relationship between work stress exposure and CVD risk across different class, gender and ethnic groups.


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Page 3 of 4

" DISCLAIMER: The ILO does not take responsibility for content presented on this web portal that is presented in any language other than English, which is the language used for the initial production and peer-review of original content. Certain statistics have not been updated since the production of the 4th edition of the Encyclopaedia (1998)."

Contents

Preface
Part I. The Body
Part II. Health Care
Part III. Management & Policy
Part IV. Tools and Approaches
Part V. Psychosocial and Organizational Factors
Organizations and Health and Safety
Psychosocial and Organizational Factors
Theories of Job Stress
Prevention
Chronic Health Effects
Stress Reactions
Individual Factors
Career Development
Macro-Organizational Factors
Job Security
Interpersonal Factors
Factors Intrinsic to the Job
Part VI. General Hazards
Part VII. The Environment
Part VIII. Accidents and Safety Management
Part IX. Chemicals
Part X. Industries Based on Biological Resources
Part XI. Industries Based on Natural Resources
Part XII. Chemical Industries
Part XIII. Manufacturing Industries
Part XIV. Textile and Apparel Industries
Part XV. Transport Industries
Part XVI. Construction
Part XVII. Services and Trade
Part XVIII. Guides

Psychosocial and Organizational Factors References

Adams, LL, RE LaPorte, KA Matthews, TJ Orchard, and LH Kuller. 1986. Blood pressure determinants in a middle-class black population: The University of Pittsburgh experience. Prevent Med 15:232-242.

Adriaanse, H, J vanReek, L Zanbelt, and G Evers. 1991. Nurses’ smoking worldwide. A review of 73 surveys of nurses’ tobacco consuption in 21 countries in the period of 1959-1988. Journal of Nursing Studies 28:361-375.

Agren, G and A Romelsjo. 1992. Mortality and alcohol-related diseases in Sweden during 1971-80 in relation of occupation, marital status and citizenship in 1970. Scand J Soc Med 20:134-142.

Aiello, JR and Y Shao. 1993. Electronic performance monitoring and stress: The role of feedback and goal setting. In Proceedings of the Fifth International Conference On Human-Computer Interaction, edited by MJ Smith and G Salvendy. New York: Elsevier.

Akselrod, S, D Gordon, JB Madwed, NC Snidman, BC Shannon, and RJ Cohen. 1985. Hemodynamic regulation: Investigation by spectral analysis. Am J Physiol 241:H867-H875.

Alexander, F. 1950. Psychosomatic Medicine: Its Principles and Applications. New York: WW Norton.

Allan, EA and DJ Steffensmeier. 1989. Youth, underemployment, and property crime: Differential effects of job availability and job quality on juvenile and young arrest rates. Am Soc Rev 54:107-123.

Allen, T. 1977. Managing the Flow of Technology. Cambridge, Mass: MIT Press.

Amick, BC, III and MJ Smith. 1992. Stress, computer-based work monitoring and measurement systems: A conceptual overview. Appl Ergon 23:6-16.

Anderson, EA and AL Mark. 1989. Microneurographic measurement of sympathetic nerve activity in humans. In Handbook of Cardiovascular Behavioral Medicine, edited by N Schneiderman, SM Weiss, and PG Kaufmann. New York: Plenum.

Aneshensel, CS, CM Rutter, and PA Lachenbruch. 1991. Social structure, stress and mental health: Competing conceptual and analytic models. Am Soc Rev 56:166-178.

Anfuso, D. 1994. Workplace violence. Pers J :66-77.

Anthony, JC et al. 1992. Psychoactive drug dependence and abuse: More common in some occupations than others? J Employ Assist Res 1:148-186.

Antonovsky, A. 1979. Health, Stress and Coping: New Perspectives On Mental and Physical Well-Being. San Francisco: Jossey-Bass.

—. 1987. Unravelling the Mystery of Health: How People Manage Stress and Stay Well. San Francisco: Jossey-Bass.

Appels, A. 1990. Mental precursors of myocardial infarction. Brit J Psychiat 156:465-471.

Archea, J and BR Connell. 1986. Architecture as an instrument of public health: Mandating practice prior to the conduct of systematic inquiry. In Proceedings of the Seventeenth Annual Conference of the Environmental Design Research Association, edited by J Wineman, R Barnes, and C Zimring. Washington, DC: Environmental Design Research Association.

Aschoff, J. 1981. Handbook of Behavioral Neurobiology. Vol. 4. New York: Plenum.

Axelrod, J and JD Reisine. 1984. Stress hormones: Their interaction and regulation. Science 224:452-459.

Azrin, NH and VB Beasalel. 1982. Finding a Job. Berkeley, Calif: Ten Speed Press.

Baba, VV and MJ Harris. 1989. Stress and absence: A cross-cultural perspective. Research in Personnel and Human Resource Management Suppl. 1:317-337.

Baker, D, P Schnall, and PA Landsbergis. 1992. Epidemiologic research on the association between occupational stress and cardiovascular disease. In Behavioral Medicine: An Integrated Approach to Health and Illness, edited by S Araki. New York: Elsevier Science.

Bandura, A. 1977. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev 84:191-215.

—. 1986. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs: Prentice Hall.

Barnett, BC. 1992. . In Handbook of Stress, edited by L Goldberger and S Breznitz. New York: Free Press.

Barnett, RC, L Biener, and GK Baruch. 1987. Gender and Stress. New York: Free Press.

Barnett, RC, RT Brennan, and NL Marshall. 1994. Forthcoming. Gender and the relationship between parent-role quality and psychological distress: A study of men and women in dual-earner couples. J Fam Issues.

Barnett, RC, NL Marshall, SW Raudenbush, and R Brennan. 1993. Gender and the relationship between job experiences and psychological distress: A study of dual-earner couples. J Personal Soc Psychol 65(5):794-806.

Barnett, RC, RT Brennan, SW Raudenbush, and NL Marshall. 1994. Gender, and the relationship between marital role-quality and psychological distress: A study of dual-earner couples. Psychol Women Q 18:105-127.

Barnett, RC, SW Raudenbush, RT Brennan, JH Pleck, and NL Marshall. 1995. Change in job and marital experiences and change in psychological distress: A longitudinal study of dual-earner couples. J Personal Soc Psychol 69:839-850.

Bartrop, RW, E Luckhurst, L Lazarus, LG Kiloh, and R Penny. 1977. Depressed lymphocyte function after bereavement. Lancet 1:834-836.

Bass, BM. 1992. Stress and leadership. In Decision Making and Leadership, edited by F Heller. Cambridge: Cambridge Univ. Press.

Bass, C. 1986. Life events and gastrointestinal symptoms. Gut 27:123-126.

Baum, A, NE Grunberg, and JE Singer. 1982. The use of psychological and neuroendocrinological measurements in the study of stress. Health Pyschology (Summer):217-236.

Beck, AT. 1967. Depression: Clinical, Experimental, and Theoretical Aspects. New York: Hoeber.

Becker, FD. 1990. The Total Workplace: Facilities Management and the Elastic Organization. New York: Van Nostrand Reinhold.

Beehr, TA. 1995. Psychological Stress in the Workplace. London, U.K.: Routledge.

Beehr, TA and JE Newman. 1978. Job stress, employee health and organizational effectiveness: A facet analysis, model and literature review. Pers Psychol 31:665-669.

Bennis, WG. 1969. Organizational developments and the fate of bureaucracy. In Readings in Organizational Behavior and Human Performance, edited by LL Cummings and WEJ Scott. Homewood, Il:Richard D. Irwin, Inc. and The Dorsey Press.

Benowitz, NL. 1990. Clinical pharmacology of caffeine. Ann Rev Med 41:277-288.

Bergman, BR. 1986. The Economic Emergence of Women. New York: Basic.

Bernstein, A. 1994. Law, culture and harassment. Univ Penn Law Rev 142(4):1227-1311.

Berntson, GG, JT Cacioppo, and KS Quigley. 1993. Respiratory sinus arrhythmia: Autonomic origins, physiological mechanisms, and psychophysiological implications. Psychophysiol 30:183-196.

Berridge, J, CL Cooper and C Highley. 1997. Employee Assistance Programs and Workplace Counselling. Chisester and New York: Wiley.

Billings, AG and RH Moos. 1981. The role of coping responses and social resources in attenuating the stress of life events. J Behav Med 4(2):139-157.

Blanchard, EB, SP Schwarz, J Suls, MA Gerardi, L Scharff, B Green, AE Taylor, C Berreman, and HS Malamood. 1992. Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome. Behav Res Ther 30:175-189.

Blinder, AS. 1987. Hard Heads and Soft Hearts: Tough Minded Economics for a Just Society. Reading, Mass: Addison-Wesley.

Bongers, PM, CR de Winter, MAJ Kompier, and VH Hildebrandt. 1993. Psychosocial factors at work and musculoskeletal disease. Scand J Work Environ Health 19:297-312.

Booth-Kewley, S and HS Friedman. 1987. Psychological predictors of heart disease: A quantitative review. Psychol Bull 101:343-362.

Brady, JV, RW Porter, DG Conrad, and JW Mason. 1958. Avoidance behavior and the development of gastrointestinal ulcers. J Exp Anal Behav 1:69-73.

Brandt, LPA and CV Nielsen. 1992. Job stress and adverse outcome of pregnancy: A causal link or recall bias? Am J Epidemiol 135(3).

Breaugh, JA and JP Colihan. 1994. Measuring facets of job ambiguity: Construct validity evidence. J Appl Psychol 79:191-202.

Brenner, M. 1976. Estimating the social costs of economic policy: implications for mental and physical health and criminal aggression. Report to the Congressional Research Service of the Library of Congress and Joint Economic Committee of Congress. Washington, DC: US GPO.

Brenner, MH. March 1987. Relations of economic change to Swedish health and social well-being, 1950-1980. Soc Sci Med :183-195.

Brief, AP, MJ Burke, JM George, BS Robinson, and J Webster. 1988. Should negative affectivity render an unmeasured variable in the study of job stress? J Appl Psychol 73:193-198.

Brill, M, S Margulis, and E Konar. 1984. Using Office Design to Increase Productivity. Buffalo, NY: Workplace Design and Productivity.

Brisson, C, M Vezina, and A Vinet. 1992. Health problems of women employed in jobs involving psychological and ergonomic stressors: The case of garment workers in Quebec. Women Health 18:49-65.

Brockner, J. 1983. Low self-esteem and behavioral plasticity: Some implications. In Review of Personality and Social Psychology, edited by L Wheeler and PR Shaver. Beverly Hills, Calif.: Sage.

—. 1988. Self-Esteem At Work. Lexington, Mass: Heath.

Bromet, EJ. 1988. Predictive effects of occupational and marital stress on the mental health of a male workforce. J Organ Behav 9:1-13.

Bromet, EJ, DK Parkinson, EC Curtis, HC Schulberg, H Blane, LO Dunn, J Phelan, MA Dew, and JE Schwartz. 1990. Epidemiology of depression and alcohol abuse/dependence in a managerial and professional workforce. J Occup Med 32(10):989-995.

Buck, V. 1972. Working Under Pressure. London: Staples.

Bullard, RD and BH Wright. 1986/1987. Blacks and the environment. Humboldt J Soc Rel 14:165-184.

Bureau of National Affairs (BNA). 1991. Work and Family Today: 100 Key Statistics. Washington, DC: BNA.

Burge, S, A Hedge, S Wilson, JH Bass, and A Robertson. 1987. Sick building syndrome: A study of 4373 office workers. Ann Occup Hyg 31:493-504.

Burke, W and G Salvendy. 1981. Human Aspects of Working On Repetitive Machine-Paced and Self-Paced Work: A Review and Reappraisal. West Lafayette, Ind: School of Industrial Engineering, Purdue Univ.

Burns, JM. 1978. Leadership. New York: Harper & Row.

Bustelo, C. 1992. The “international sickness” of sexual harassment. World Press Rev 39:24.

Cacioppo, JT and LG Tassinary. 1990. Principles of Psychophysiology. Cambridge: Cambridge Univ. Press.

Cain, PS and DJ Treiman. 1981. The dictionary of occupational titles as a source of occupational data. Am Soc Rev 46:253-278.

Caldwell, DF and CA O’Reilly. 1990. Measuring person-job fit with a profile-comparison process. J Appl Psychol 75:648-657.

Caplan, RD, S Cobb, JRPJ French, RV Harrison, and SRJ Pinneau. 1980. Job Demands and Worker Health. Ann Arbor, Mich: Institute for Social Research.

Caplan, RD. 1983. Person-environment fit: Past, present, and future. In Stress Research: Issues for the Eighties, edited by CL Cooper. New York: Wiley.

Caplan, RD, S Cobb, JRPJ French, R Van Harrison, and R Pinneau. 1975. Job Demands and Worker Health: Main Effects and Occupational Differences. Washington, DC: US Department of Health, Education, and Welfare.

Caplan, RD, AD Vinokur, RH Price, and M van Ryn. 1989. Job seeking, reemployment and mental health: A randomized field experiment in coping with job loss. J Appl Psychol 74(5):759-769.

Caplin, G. 1969. Principles of Preventive Psychiatry. New York: Basic Books.

Cannon, WB. 1914. The emergency function of the adrenal medulla in pain and other emotions. Am J Physiol 33:356-372.

—. 1935. Stresses and strains of homeostasis. Am J Med Sci 189:1-14.
Canter, D. 1983. The physical context of work. In The Physical Environment At Work, edited by DJ Osborne and MM Grunberg. Chichester: Wiley.

Carayon, P. 1993. Effect of electronic performance monitoring on job design and worker stress: A review of the literature and conceptual model. Hum Factors 35(3):385-396.

—. 1994. Effects of electronic performance monitoring on job design and worker stress: Results of two studies. Int J Hum Comput Interact 6:177-190.

Cassel, JP. 1974. The contribution of the social environment to host resistance. American Journal of Epidemiology 104:161-166.

Cassel, J. 1976. The contribution of the social environment to host resistance. Am J Epidemiol 104:107-123.

Catalano, R. 1991. The health effects of economic insecurity. Am J Public Health 81:1148-1152.

Catalano, R, D Dooley, R Novaco, G Wilson, and R Hough. 1993a-a. Using ECA survey data to examine the effect of job layoffs on violent behavior. Hosp Community Psychiat 44:874-879.

Catalano, R, D Dooley, G Wilson, and R Hough. 1993b. Job loss and alcohol abuse: A test using data from the Epidemiologic Catchment Area project. J Health Soc Behav 34:215-225.

Chatman, JA. 1991. Matching people and organizations: Selection and socialization in public accounting firms. Adm Sci Q 36:459-484.

Christensen, K. 1992. Managing invisible employees: How to meet the telecommuting challenge. Employ Relat Today :133-143.

Cobb, S. 1976. Social support as a mediator of life stress. Psychosocial Medicine 38:300-314.

Cobb, S and RM Rose. 1973. Hypertension, peptic ulcer, and diabetes in air traffic controllers. J Am Med Assoc 224(4):489-492.

Cohen, A. 1991. Career stage as a moderator of the relationships between organizational commitment and its outcomes: A meta-analysis. J Occup Psychol 64:253-268.

Cohen, RL and FL Ahearn. 1980. Handbook for Mental Health Care of Disaster Victims. Baltimore: The Johns Hopkins University Press.
Cohen, S and SL Syme. 1985. Social Support and Health. New York: Academic Books.

Cohen, N, R Ader, N Green, and D Bovbjerg. 1979. Conditioned suppression of thymus-independent antibody response. Psychosom Med 41:487-491.

Cohen, S and S Spacapan. 1983. The after effects of anticipating noise exposure. In Noise As a Public Health Problem, edited by G Rossi. Milan: Centro Ricerche e Studi Amplifon.

Cole, RJ, RT Loving, and DF Kripke. 1990. Psychiatric aspects of shiftwork. Occup Med 5:301-314.

Colligan, MJ. 1985. An apparent case of mass psychogenic illness in an aluminium furniture assembly plant. In Job Stress and Blue Collar Work, edited by C Cooper and MJ Smith. London: John Wiley & Sons.

Colligan, MJ, JW Pennebaker, and LR Murphy. 1982. Mass Psychogenic Illness: A Social Psychological Analysis. Hillsdale, NJ: Erlbaum.

Colligan, MJ and RR Rosa. 1990. Shiftwork effects on social and family life. Occup Med 5:315-322.

Contrada, RJ and DS Krantz. 1988. Stress, reactivity and type A behavior: Current status and future directions. Ann Behav Med 10:64-70.

Conway, TL, RR Vickers, HW Ward, and RH Rahe. 1981. Occupational stress and variation in cigarette, coffee and alcohol consumption. Journal of Health & Social Behaviour 22:155-165.

Cooper, C. 1996. Handbook of Stress, Medicine and Health. Boca Raton, FL: CRC Press.

Cooper, CL and RS Bramwell. 1992. Predictive validity of the strain component of the occupational stress indicator. Stress Medicine 8:57-60.

Cooper, C and J Marshall. 1976. Occupational sources of stress: A review of the literature relating to coronary heart disease and mental ill health. J Occup Psychol 49:11-28.

Cooper, CL and S Cartwright. 1994. Mental Health and Stress in the Workplace: A Guide to Employers. London: HMSO.

Cooper, CL, P Liukkonen, and S Cartwright. 1996. Stress Prevention in the Workplace: Assessing the Costs and Benefits to Organisations. Dublin: European Foundation.

Cooper, CL and R Payne. 1988. Causes, Coping, and Consequences of Stress At Work. New York: Wiley.

—. 1991. Personality and Stress: Individual Differences in the Stress Process. Chichester: Wiley.

Cooper, CL and MJ Smith. 1985. Job Stress and Blue Collar Work. New York: Wiley.

Cox, S, T Cox, M Thirlaway, and C MacKay. 1982. Effects of simulated repetitive work on urinary catecholamine excretion. Ergonomics 25:1129-1141.

Cox, T and P Leather. 1994. The prevention of violence at work: Application of a cognitive behavioral theory. In International Review of Industrial and Organizational Psychology, edited by CL Cooper and IT Robertson. London: Wiley.

Crum, RM, C Mutaner, WW Eaton, and JC Anthony. 1995. Occupational stress and the risk of alcohol abuse and dependence. Alcohol, Clin Exp Res 19(3):647-655.

Cummins, R. 1989. Locus of control and social support: Clarifiers of the relationship between job stress and job satisfaction. J Appl Soc Psychol 19:772-788.

Cvetanovski, J and SM Jex. 1994. Locus of control of unemployed people and its relationship to psychological and physical health. Work Stress 8:60-67.

Csikszentmihalyi, M. 1975. Beyond Boredom and Anxiety. San Francisco: Jossey-Bass.

Dainoff, MJ and MH Dainoff. 1986. People and Productivity. Toronto: Holt, Reinhart, & Winston of Canada.

Damasio, A. 1994. Descartes’ Error: Emotion, Reason and the Human Brain. New York: Grosset/Putnam.

Danko, S, P Eshelman, and A Hedge. 1990. A taxonomy of health, safety, and welfare, implications of interior design decisions. J Interior Des Educ Res 16:19-30.

Dawis, RV and LH Lofquist. 1984. A Psychological Theory of Work Adjustment. Minneapolis, Minnesota: University of Minnesota Press.
The death of corporate loyalty. 1993. Economist 3 April, 63-64.

Dement, W. 1969. The biological role of REM sleep. In Sleep Physiology and Pathology: A Symposium, edited by A Kales. Philadelphia: JB Lippincott.

Deming, WE. 1993. The New Economics for Industry, Government, Education. Cambridge, Mass: MIT Center for Advance Engineering Study.

Dewe, PJ. 1989. Examining the nature of work stress: Individual evaluations of stressful experiences and coping. Hum Relat 42:993-1013.

Ditecco, D, G Cwitco, A Arsenault, and M Andre. 1992. Operator stress and monitoring practices. Appl Ergon 23(1):29-34.

Dohrenwend, BS and BP Dohrenwend. 1974. Stressful Life Events: Their Nature and Effects. New York: Wiley.

Dohrenwend, BS, L Krasnoff, AR Askenasy, and BP Dohrenwend. 1978. Exemplification of a method for scaling life events: The PERI life events scale. J Health Soc Behav 19:205-229.

Dooley, D. 1985. Causal inference in the study of social support. In Social Support and Health, edited by S Cohen and SL Syme. New York:Academic Books.

Dooley, D, R Catalano, and R Hough. 1992. Unemployment and alcohol disorder in 1910 and 1990: Drift versus social causation. J Occup Organ Psychol 65:277-290.

Dooley, D, R Catalano, and G Wilson. 1994. Depression and unemployment: Panel findings from the Epidemiologic Catchment Area study. Am J Community Psychol 22:745-765.

Douglas, RB, R Blanks, A Crowther, and G Scott. 1988. A study of stress in West Midlands firemen, using ambulatory electrocardiograms. Work Stress: 247-250.

Eaton, WW, JC Anthony, W Mandel, and R Garrison. 1990. Occupations and the prevalence of major depressive disorder. J Occup Med 32(11):1079-1087.
Edwards, JR. 1988. The determinants and consequences of coping with stress. In Causes, Coping and Consequences of Stress At Work, edited by CL Cooper and R Payne. New York: Wiley.

Edwards, JR and RV Harrison. 1993. Job demands and worker health: A three dimensional reexamination of the relationship between person-environment fit and strain. J Appl Psychol 78:628-648.

Elander, J, R West, and D French. 1993. Behavioral correlates of individual differences in road-traffic crash risk: An examination of methods and findings. Psychol Bull 113:279-294.

Emmett, EA. 1991. Physical and chemical agents at the workplace. In Work, Health and Productivity, edited by GM Green and F Baker. New York:Oxford University Press.

Endresen, IM, B Ellersten, C Endresen, AM Hjelmen, R Matre, and H Ursin. 1991. Stress at work and psychological and immunological parameters in a group of Norwegian female bank employees. Work Stress 5:217-227.

Esler, M, G Jennings, and G Lambert. 1989. Measurement of overall and cardiac norepinephrine release into plasma during cognitive challenge. Psychoneuroendocrinol 14:477-481.

European Foundation for the Improvement of Living and Working Conditions. 1992. First European Suvey On the Work Environment 1991-1992. Luxembourg: Office of the Official Publications of the European Community.

Everly, GS, Jr and RH Feldman. 1985. Occupational Health Promotion: Health Behavior in the Workplace. New York: John Wiley & Sons.

Faucett, J and D Rempel. 1994. VDT-related musculoskeletal symptoms: Interactions between work and posture and psychosocial factors. Am J Ind Med 26:597-612.

Feigenbaum, AV. 1991. Total quality: An international imperative. In Maintaining the Total Quality Advantage, edited by BH Peters and JL Peters. New York: The Conference Board.

Feldman, DC. l976. A contingency theory of socialization. Adm Sci Q 21:433-452.

Fenster, L, C Schaefer, A Mathur, RA Hiatt, C Pieper, AE Hubbard, J Von Behren, and S Swan. 1995. Psychological stress in the workplace and spontaneous abortion. Am J Epidemiol 142(11).

Ferber, MA, B O’Farrell, and L Allen. 1991. Work and Family: Policies for a Changing Workforce. Washington, DC: National Academy Press.

Fernandez, JP. 1981. Racism and Sexism in Corporate Life. Lexington, Mass.: Lexington Books.

—. 1990. The Politics and Reality of Family Care in Corporate America. Lexington, Mass: Lexington Books.

Fiedler, FE. 1967. A Theory of Leadership Effectiveness. New York: McGraw-Hill.

Fielding, JE and KJ Phenow. 1988. Health effects of involuntary smoking. New Engl J Med 319:1452-1460.

Fisher, C. l985. Social support and adjustment to work: A longitudinal study. J Manage 11:39-53.

Fith-Cozens, J. 1987. Emotional distress in junior house officers. Brit Med J 295:533-536.

Fitzgerald, LF and AJ Ormerod. 1993. Breaking silence: The sexual harassment of women in academia and the workplace. In Psychology of Women, edited by FL Denmark and MA Paludi. London: Greenwood Press.

Flechter, B. 1988. Occupation, marriage and disease specific mortality concordance. Soc Sci Med 27:615-622.

Ford, DL. 1985. Facets of work support and employee work outcomes: An exploratory analysis. J Manage 11:5-20.

Fox, AJ and J Levin. 1994. Firing back: The growing threat of workplace homicide. Ann Am Acad Polit SS 536:16-30.

Fox, BH. 1995. The role of psychological factors in cancer incidence and prognosis. Oncology 9(3):245-253.

—. 1989. Depressive symptoms and risk of cancer. J Am Med Assoc 262(9): 1231.

—. 1981. Psychosocial factors and the immune system in human cancer. In Psychoneuroimmunology, edited by R Ader. New York: Academic Press.

Frankenhaeuser, M. 1986. A psychobiological framework for research on human stress and coping. In Dynamics of Stress, edited by MH Appley and R Trumbull. New York: Plenum.

—. 1989. A biopsychosocial approach to work life issues. Int J Health Serv 19:747-758.

—. 1991. The psychophysiology of workload, stress and health: Comparison between the sexes. Ann Behav Med 13:197-204.

—. 1993a. Current issues in psychobiological stress research. In European Views in Psychology - Keynote Lectures, edited by M Vartiainen. Helsinki: Acta Psychologica Fennica XIII.

—. 1993b. The measurement of the total workload of men and women. In A Healthier Work Environment - Basic Concepts and Methods of Measurements, edited by L Levi. Geneva: WHO.

—. 1996. Stress and gender. Eur Rev, Interdis J Acad Eur 4.

Frankenhaeuser, M and G Johansson. 1986. Stress at work: Psychobiological and psychosocial aspects. Int Rev Appl Psychol 35:287-299.

Frankenhaeuser, M, C Lundberg, and L Forsman. 1980. Dissociation between sympathetic-adrenal and pituitary-adrenal responses to an achievement situation characterized by high controllability: Comparison between Type A and Type B males and females. Biol Psychol 10:79-91.

Frankenhaeuser, M, U Lundberg, and MA Chesney. 1991. Women, Work and Health. Stress and Opportunities. New York: Plenum.

Frankenhaeuser, M, U Lundberg, M Fredrikson, B Melin, M Tuomisto, A-L Myrsten, M Hedman, B Bergman-Losman, and L Wallin. 1989. Stress on and off the job as related to sex and occupational status in white-collar workers. J Organ Behav 10:321-346.

Frankenhaeuser, M and B Gardell. 1976. Underload and overload in working life: Outline of a multidisciplinary approach. Journal of Human Stress 2:35-46.

French, JRP and RD Caplan. 1973. Organizational stress and individual strain. In The Failure of Success, edited by AJ Marrow. New York: Amacon.

French, JRP, W Rodgers, and S Cobb. 1974. Adjustment as person-environment fit. In Coping and Adaption, edited by GV Coelho, DA Hamburg, and JE Adams. New York:Basic Books.

French, WL and CH Bell. 1990. Organizational Development. Englewood Cliffs, NJ: Prentice Hall.

French, JRP, RD Caplan, and R van Harrison. 1982. The Mechanisms of Job Stress and Strain. New York: Wiley.

Frese, M and D Zapf. 1988. Methodological issues in the study of work stress: Objective vs. subjective measurement of work stress and the question of longitudinal studies. In Causes, Coping and Consequences of Stress At Work, edited by CL Cooper and R Payne. New York: Wiley.

Friedman, M, CE Thoresen, JJ Gill, D Ulmer, LII Powell, VA Prince, et al. 1986. Alteration of type A behavior and its effect on cardiac recurrences in post myocardial infarction patients; summary results of the Recurrent Coronary Prevention Project. Am Heart J 112:653-665.

Fryer, D and R Payne. 1986. Being unemployed: A review of the literature on the psychological experience of unemployment. In International Review of Industrial Organizational Psychology, edited by CL Cooper and I Robertson. Chichester: Wiley.

Funk, SC and BK Houston. 1987. A critical analysis of the hardiness scales’ validity and utility. J Personal Soc Psychol 53:572-578.

Fusilier, MR, DC Ganster, and BT Mays. 1987. Effects of social support, role stress, and locus of control on health. J Manage 13:517-528.

Galinsky, E, JT Bond, and DE Friedman. 1993. Highlights: The National Study of the Changing Workforce. New York: Families and Work Institute.

Gamble, GO and MT Matteson. 1992. Type A behavior, job satisfaction, and stress among Black professionals. Psychol Rep 70:43-50.

Ganster, DC and MR Fusilier. 1989. Control in the workplace. In International Review of Industrial and Organizational Psychology, edited by
C Cooper and I Robertson. Chichester, U.K.:Wiley.

Ganster, DC. 1989. Worker control and well-being: A review of research in the workplace. In Job Control and Worker Health, edited by SL Sauter, JJ Hurrell, and CL Cooper. New York: Wiley.

Ganster, DC and J Schaubroeck. 1991a. Role stress and worker health: An extension of the plasticity hypothesis of self-esteem. J Soc Behav Personal 6:349-360.

—. 1991b. Work stress and employee health. J Manage 17:235-271.

Ganster, DC, BT Mayes, WE Sime, and GD Tharp. 1982. Managing occupational stress: A field experiment. J Appl Psychol 67:533-542.

Gardell, B. 1981. Psychosocial aspects of industrial production methods. In Society, Stress and Disease, edited by L Levi. Oxford: OUP.

Garrison, R and WW Eaton. 1992. Secretaries, depression and absenteeism. Women Health 18:53-76.

Gillin, JC and WF Byerley. 1990. The diagnosis and management of insomnia. New England Journal of Medicine 322:239-248.

Glaser, R, JK Kiecolt-Glaser, RH Bonneau, W Malarkey, S Kennedy, and J Hughes. 1992. Stress induced modulation of the immune response to recombinant hepatitits B vaccine. Psychosom Med 54:22-29.

Goldberg, E et al. 1985. Depressive symptoms, social networks and social support of elderly women. American Journal of Epidemiology :448-456.

Goldberger, L and S Breznitz. 1982. Handbook of Stress. New York: Free Press.

Goldstein, I, LD Jamner, and D Shapiro. 1992. Ambulatory blood pressure and heart rate in healthy male paramedics during a work day and a non-work day. Health Psychol 11:48-54.

Golemblewski, RT. 1982. Organizational development (OD) interventions: Changing interaction, structures, and policies. In Job Stress and Burnout Research, Theory, and Intervention Perspectives, edited by WE Paine. Beverly Hills:Sage Publications.

Goleman, D. 1995. Emotional Intelligence. New York: Bantam Books.

Goodrich, R. 1986. The perceived office: The office environment as experienced by its users. In Behavioral Issues in Office Design, edited by JD Wineman. New York: Van Nostrand Reinhold.

Gorman, DM. 1994. Alcohol misuse and the predisposing environment. British Medical Bulletin :36-49.

Gottlieb, BH. 1983. Social Support Strategies. Beverly Hills: Sage.

Gough, H and A Heilbrun. 1965. The Adjective Check List Manual. Palo Alto, Calif: Consulting Psychologists Press.

Gowler, D and K Legge. 1975. Stress and external relationships: The ‘hidden’ contract. In Managerial Stress, edited by D Gowler and K Legge. London: Gower.

Grandjean, E. 1968. Fatigue: Its physiological and psychological significance. Ergonomics 11(5):427-436.

—. 1986. Fitting the Task to the Man: An Ergonomic Approach. : Taylor and Francis.

—. 1987. Ergonomics in Computerized Offices. London: Taylor & Francis.

Greenglass, ER. 1993. The contribution of social support to coping strategies. Appl Psychol Intern Rev 42:323-340.

Greenhalgh, L and Z Rosenblatt. 1984. Job insecurity: Toward conceptual clarity. Acad Manage Rev (July):438-448.

Guendelman, S and MJ Silberg. 1993. The health consequences of maquiladora work: Women on the US-Mexican border. Am J Public Health 83:37-44.

Guidotti, TL. 1992. Human factors in firefighting: Ergonomic-, cardiopulmonary-, and psychogenic stress- related issues. Int Arch Occup Environ Health 64:1-12.

Gutek, B. 1985. Sex and the Workplace. San Francisco: Jossey-Bass.

Gutierres, SE, D Saenz, and BL Green. 1994. Job stress and health outcomes among Anglo and Hispanic employees: A test of the person-environment fit model. In Job Stress in a Changing Workforce, edited by GP Keita and JJ Hurrell. Washington, DC: American Psychological Association.

Hackman, JR. 1992. Group influences on individuals in organizations. In Handbook of Industrial and Organizational Psychology, edited by MD Dunnette and LM Hough. Palo Alto, Calif: Consulting Psychologists’ Press.

Hackman, JR and EE Lawler. 1971. Employee reactions to job characteristics. J Appl Psychol 55:259-286.

Hackman, JR and GR Oldham. 1975. The job diagnostic survey. J Appl Psychol 60:159-170.

—. 1980. Work Redesign. Reading, Mass: Addison-Wesley.

Hales, TR, SL Sauter, MR Peterson, LJ Fine, V Putz-Anderson, LR Schleifer, TT Ochs, and BP Bernard. 1994. Musculoskeletal disorders among visual display terminal users in a telecommunication company. Ergonomics 37(10):1603-1621.

Hahn, ME. 1966. California Life Goals Evaluation Schedule. Palo Alto, CA: Western Psychological Services.

Hall, DT. 1990. Telecommuting and the Management of Work-Home Boundaries. Working Paper No. 90-05. Boston: Boston Univ. School of Management.

Hall, E. 1991. Gender, work control and stress: A theoretical discussion and an empirical test. In The Psychosocial Work Environment: Work Organization; Democratization and Health, edited by JV Johnson and G Johansson. Amityville, NY: Baywook.

—. 1992. Double exposure: The combined impact of the home and work environments on psychosomatic strain in Swedish men and women. Int J Health Serv 22:239-260.

Hall, RB. 1969. Intraorganizational structural variation: Application of the bureaucratic model. In Readings in Organizational Behavior and Human Performance, edited by LL Cummings and WEJ Scott. Homewood, Il:Richard D. Irwin, Inc. and the Dorsey Press.

Hamilton, LV, CL Broman, WS Hoffman, and D Brenner. 1990. Hard times and vulnerable people: Initial effects of plant closing on autoworkers’ mental health. J Health Soc Behav 31:123-140.

Harford, TC, DA Parker, BF Grant, and DA Dawson. 1992. Alcohol use and dependence among employed men and women in the United States in 1988. Alcohol, Clin Exp Res 16:146-148.

Harrison, RV. 1978. Person-environment fit and job stress. In Stress At Work, edited by CL Cooper and R Payne. New York: Wiley.
Hedge, A. 1986. Open vs. enclosed workspaces: The impact of design on employees’ reactions to their offices. In Behavioral Issues in Office Design, edited by JD Wineman. New York: Van Nostrand Reinhold.

—. 1991. Design innovations in office environments. In Design Intervention: Toward a More Humane Architecture, edited by WFE Presiser, JC Vischer, and ET White. New York: Van Nostrand Reinhold.

Heilpern, J. 1989. Are American companies ‘hostile’ to quality improvement? Quality Exec (November).

Henderson, S, P Duncan-Jones, and G Byrne. 1980. Measuring social relationships. The interview schedule for social interaction. Psychol Med 10:723-734.

Henry, JP and PM Stephens. 1977. Stress, Health, and the Social Environment. A Sociobiologic Approach to Medicine. New York: Springer-Verlag.

Herzberg, F, B Mausner, and BB Snyderman. 1959. The Motivation to Work. New York: Wiley.

Hill, S. 1991. Why quality circles failed but total quality management might succeed. Br J Ind Relat (4 December):551-568.

Hirsh, BJ. 1980. Natural support systems and coping with major life changes. Am J Comm Psych 8:159-171.

Hirsch, PM. 1987. Pack Your Own Parachute. Reading, Mass: Addison-Wesley.

Hirschhorn, L. 1991. Stresses and patterns of adjustment in the postindustrial factory. In Work, Health and Productivity, edited by GM Green and F Baker. New York:Oxford University Press.

Hirshhorn, L. 1990. Leaders and followers in the postindustrial age: A psychodynamic view. J Appl Behav Sci 26:529-542.

—. 1984. Beyond Mechanization. Cambridge, Mass: MIT Press.

Holmes, TH and HR Richard. 1967. The social readjustment rating scale. J Psychosomat Res 11:213-218.

Holt, RR. 1992. Occupational stress. In Handbook of Stress, edited by L Goldberger and S Breznitz. New York: Free Press.

Holtmann, G, R Kreibel, and MV Singer. 1990. Mental stress and gastric acid secretion: Do personality traits influence the response? Digest Dis Sci 35:998-1007.

House, J. 1981. Work Stress and Social Support. Reading, Mass.: Addison-Wesley.

Houtman, I and M Kompler. 1995. Risk factors and occupational risk groups for work stress in the Netherlands. In Organizational Risk Factors for Job Stress, edited by S Sauter and L Murphy. Washington:American psychological Association.

Houston, B and W Hodges. 1970. Situational denial and performance under stress. J Personal Soc Psychol 16:726-730.

Howard, R. 1990. Values make the company. Harvard Business Rev (September-October):133-144.

Hudiberg, JJ. 1991. Winning With Quality -The FPL Story. White Plains, NY: Quality Resources.

Hull, JG, RR Van Treuren, and S Virnelli. 1987. Hardiness and health: A critique and alternative approach. J Personal Soc Psychol 53:518-530.

Hurrell, JJ Jr, MA McLaney, and LR Murphy. 1990. The middle years: Career stage differences. Prev Hum Serv 8:179-203.

Hurrell, JJ Jr and LR Murphy. 1992. Locus of control, job demands, and worker health. In Individual Differences, Personality, and Stress, edited by CL Cooper and R Payne. Chichester: John Wiley & Sons.

Hurrell JJ Jr and K Lindström. 1992. Comparison of job demands, control and psychosomatic complaints at different career stages of managers in Finland and the United States. Scand J Work Environ Health 18 Suppl. 2:11-13.

Ihman, A and G Bohlin. 1989. The role of controllability in cardiovascular activation and cardiovascular disease: Help or hindrance? In Stress, Personal Control and Health, edited by A Steptoe and A Appels. Chichester: Wiley.

Ilgen, DR. 1990. Health issues at work. American Psychologist 45:273-283.
Imai, M. 1986. Kaizen: The Key to Japan’s Competitive Success. New York: McGraw-Hill.

International Labour Organization (ILO). 1975. Making Work More Human. Report of the Director General to the International Labour Conference. Geneva: ILO.

—. 1986. Introduction to Work Study. Geneva: ILO.

Ishikawa, K. 1985. What Is Total Quality Control? The Japanese Way. Englewood Cliffs, NJ: Prentice Hall.

Israel, BA and TC Antonucci. 1987. Social network characteristics and psychological well-being: A replication and extension. Health Educ Q 14(4):461-481.

Jackson, DN. 1974. Personality Research Form Manual. New York: Research Psychologists Press.

Jackson, SE and RS Schuler. 1985. A meta-analysis and conceptual critique of research on role ambiguity and role conflict in work settings. Organ Behav Hum Decision Proc 36:16-78.

James, CR and CM Ames. 1993. Recent developments in alcoholism: The workplace. Recent Develop Alcohol 11:123-146.

James, K. 1994. Social identity, work stress and minority worker’s health. In Job Stress in a Changing Workforce, edited by GP Keita and JJ Hurrell. Washington, DC: APA.

Jenkins, CD. 1979. The coronary-prone personality. In Psychological Aspects of Myocardial Infarction and Coronary Care, edited by WD Gentry and RB Williams. St.Louis: Mosby.

Jenkins, R and N Coney. 1992. Prevention of Mental Ill Health At Work. A Conference. London: HMSO.

Jennings, R, C Cox, and CL Cooper. 1994. Business Elites: The Psychology of Entrepreneurs and Intrapreneurs. London: Routledge.

Johansson, G and G Aronsson. 1984. Stress reactions in computerized administrative work. J Occup Behav 15:159-181.

Johnson, JV. 1986. The impact of workplace social support, job demands and work control upon cardiovascular disease in sweden. PhD Dissertation, Johns Hopkins University.

Johnson, JV and EM Hall. 1988. Job strain, workplace social support and cardiovascular disease: A cross-sectional study of a random sample of Swedish working population. Am J Public Health 78:1336-1342.

—. 1994. Social support in the work environment and cardiovascular disease. In Social Support and Cardiovascular Disease, edited by S Shumaker and S Czajkowski. New York: Plenum Press.

Johnson, JV and G Johansson. 1991. The Psychosocial Work Environment: Work Organization, Democratization and Health. Amityville, NY: Baywood.

Johnson, JV, W Stewart, EM Hall, P Fredlund, and T Theorell. 1996. Long-term psychosocial work environment and cardiovascular mortality among Swedish men. Am J Public Health 86(3):324-331.

Juran, JM. 1988. Juran On Planning for Quality. New York: Free Press.

Justice, A. 1985. Review of the effects of stress on cancer in laboratory animals: The importance of time of stress application and type of tumor. Psychol Bull 98(1):108-138.

Kadushin, A. 1976. Men in a woman’s profession. Social Work 21:440-447.

Kagan, A and L Levi. 1971. Adaptation of the psychosocial environment to man’s abilities and needs. In Society, Stress and Disease, edited by L Levi. New York:Oxford University Press.

Kahn, RL. 1991. The forms of women’s work. In Women, Work and Health. Stress and Opportunities, edited by M Frankenhaeuser, U Lundberg, and MA Chesney. New York: Plenum.

Kahn, RL and P Byosiere. 1992. Stress in organizations. In Handbook of Industrial and Organizational Psychology, edited by MD Dunnette and LM Hough. Palo Alto, CA:Consulting Psychology Press.

Kahn, RL, DM Wolfe, RP Quinn, JD Snoek, and RA Rosenthal. 1964. Organisational Stress: Studies in Role Conflict and Ambiguity. Chichester: Wiley.

Kaplan, GA et al. 1991. Psychosocial factors and the natural history of physical activity. Am J Prev Medicine 7:12-17.

Kaplan, R and S Kaplan. 1989. The Experience of Nature: A Psychological Perspective. New York: Cambridge Univ. Press.

Karasek, RA. 1976. The impact of the work environment on life outside the job. Doctoral Dissertation, Massachusetts Institute of Technology, Cambridge, Mass.

—. 1979. Job demands, job decision latitude, and mental strain: Implications for job redesign. Adm Sci Q 24:285-308.

—. 1985. The Job Content Questionnaire (JCQ) and User’s Guide. Lowell, Mass: JCQ Center, Department of Work Environment, Univ. of Massachusetts Lowell.

—. 1990. Lower health risk with increased job control among white collar workers. J Organ Behav 11:171-185.

Karasek, R and T Theorell. 1990. Healthy Work, Stress, Productivity and the Reconstruction of Working Life. New York: Basic Books.

Kasl, SV. 1989. An epidemiological perspective on the role of control in health. In Job Control and Worker Health, edited by SL Sauter, JJ Hurrell Jr, and CL Cooper. Chichester: Wiley.

Kauppinen-Toropainen, K and JE Gruber. 1993. Antecedants and outcomes of woman-unfriendly experiences: A study of Scandanavian, former Soviet and American women. Psychol Women Q 17(4):431-456.

Kawakami, N, T Haratani, T Hemmi, and S Araki. 1992. Prevalence and demographic correlates of alcohol-related problems in Japanese employees. Social Psych Psychiatric Epidemiol 27:198-202.

—. 1993. Relations of work stress to alcohol use and drinking problems in male and female employees of a computer factory in Japan. Environ Res 62:314-324.

Keita, GP and SL Sauter. 1992. Work and Well Being: An Agenda for the 1990s. Washington, DC: APA.

Kelly, M and CL Cooper. 1981. Stress among blue collar workers: A case study of the steel industry. Employee Relations 3:6-9.

Kerckhoff, A and K Back. 1968. The June Bug. New York: Appelton-Century Croft.

Kessler, RC, JS House, and JB Turner. 1987. Unemployment and health in a community sample. J Health Soc Behav 28:51-59.

Kessler, RC, JB Turner, and JS House. 1988. The effects of unemployment on health in a community survey: Main, modifying and mediating effects. J Soc Issues 44(4):69-86.

—. 1989. Unemployment, reemployment, and emotional functioning in a community sample. Am Soc Rev 54:648-657.

Kleiber, D and D Enzmann. 1990. Burnout: 15 Years of Research: An International Bibliography. Gottingen: Hogrefe.

Klitzman, S and JM Stellman. 1989. The impact of physical environment on the psychological well-being of office workers. Soc Sci Med 29:733-742.

Knauth, P and J Rutenfranz. 1976. Experimental shift work studies of permanent night, and rapidly rotating, shift systems. I. Circadian rhythm of body temperature and re-entrainment at shift change. Int Arch Occup Environ Health 37:125-137.

—. 1982. Development of criteria for the design of shiftwork systems. J Hum Ergol 11 Shiftwork: Its Practice and Improvement: 337-367.

Knauth, P, E Kiesswetter, W Ottmann, MJ Karvonen, and J Rutenfranz. 1983. Time-budget studies of policemen in weekly or swiftly rotating shift systems. Appl Ergon 14(4):247-252.

Kobasa, SC. 1979. Stressful life events, personality and health: An inquiry into hardiness. J Personal Soc Psychol 37:1-11.

—. 1982. The hardy personality: Toward a social psychology of stress and health. In Social Psychology of Health and Illness, edited by G Sanders and J Suls. Hillsdale, NJ: Erlbaum.

Kobasa, SC, SR Maddi, and S Kahn. 1982. Hardines and health: A prospective study. J Personal Soc Psychol 42:168-177.

Kofoed, L, MJ Friedman, and P Peck. 1993. Alcoholism and drug abuse in patients with PTSD. Psychiatry 64:151-171.

Kogi, K. 1991. Job content and working time: The scope for joint change. Ergonomics 34(6):757-773.

Kohn, M and C Schooler. 1973. Occupational experience and psychological functioning: An assessment of reciprocal effects. Am Soc Rev 38:97-118.

Kohn, ML, A Naoi, V Schoenbach, C Schooler, et al. 1990. Position in the class structure and psychological functioning in the United States, Japan, and Poland. Am J Sociol 95(4):964-1008.

Kompier, M and L Levi. 1994. Stress At Work: Causes, Effects, and Prevention. A Guide for Small and Medium Sized Enterprises. Dublin: European Foundation.

Kornhauser, A. 1965. The Mental Health of the Industrial Worker. New York: Wiley.

Komitzer, M, F Kittel, M Dramaix, and G de Backer. 1982. Job stress and coronary heart disease. Adv Cardiol 19:56-61.

Koss, MP, LA Goodman, A Browne, LF Fitzgerald, GP Keita, and NF Russo. 1994. No Safe Haven. Washington, DC: APA Press.

Koulack, D and M Nesca. 1992. Sleep parameters of Type A and B scoring college students. Perceptual and Motor Skills 74:723-726.

Kozlowski, SWJ, GT Chao, EM Smith, and J Hedlund. 1993. Organizational downsizing: Strategies, interventions, and research implications. In International Review of Industrial and Organizational Psychology, edited by CL Cooper and I Robertson. Chichester: Wiley.

Kristensen, TS. 1989. Cardiovascular diseases and the work environment. A critical review of the epidemiologic literature on nonchemical factors. Scand J Work Environ Health 15:165-179.

—. 1991. Sickness absence and work strain among Danish slaughterhouse workers. An analysis of absence from work regarded as coping behaviour. Social Science and Medicine 32:15-27.

—. 1995. The Demand-Control-Support model: Methodological challenges for future research. Stress Medicine 11:17-26.

Krueger, GP. 1989. Sustained work, fatigue, sleep loss and performance: A review of the issues. Work and Stress 3:129-141.

Kuhnert, KW. 1991. Job security, health, and the intrinsic and extrinsic characteristics of work. Group Organ Stud :178-192.

Kuhnert, KW, RR Sims, and MA Lahey. 1989. The relationship between job security and employee health. Group Organ Stud (August):399-410.

Kumar, D and DL Wingate. 1985. The irritable bowel syndrome. Lancet ii:973-977.

Lamb, ME, KJ Sternberg, CP Hwang, and AG Broberg. 1992. Child Care in Context: Cross-Cultural Perspectives. Hillsdale, NJ: Earlbaum.

Landsbergis, PA, PL Schnall, D Deitz, R Friedman, and T Pickering. 1992. The patterning of psychological attributes and distress by “job strain” and social support in a sample of working men. J Behav Med 15(4):379-405.

Landsbergis, PA, SJ Schurman, BA Israel, PL Schnall, MK Hugentobler, J Cahill, and D Baker. 1993. Job stress and heart disease: Evidence and strategies for prevention. New Solutions (Summer):42-58.

Larson, JRJ and C Callahan. 1990. Performance monitoring: How does it affect work productivity. J Appl Psychol 75:530-538.

Last, LR, RWE Peterson, J Rappaport, and CA Webb. 1995. Creating opportunities for displaced workers: Center for Commercial Competitiveness. In Employees, Careers, and Job Creation: Developing Growth-Oriented Human Resource Strategies and Programs, edited by M London. San Francisco: Jossey-Bass.

Laviana, JE. 1985. Assessing the Impact of Plants in the Simulated Office Environment: A Human Factors Approach. Manhattan, Kans: Department of Horticulture, Kansas State Univ.

Lazarus, RS. 1966. Psychological Stress and Coping Process. New York: McGraw-Hill.

Lazarus, RS and S Folkman. 1984. Stress, Appraisal, and Coping. New York: Springer.

Lee, P. 1983. The Complete Guide to Job Sharing. New York: Walker & Co.

Leibson, B. 1990. Corporate child care: “Junior Execs” on the job. Faculty Design Manage :32-37.

Leigh, JP and HM Waldon. 1991. Unemployment and highway fatalities. J Health Policy 16:135-156.

Leino, PI and V Hänninen. 1995. Psychosocial factors at work in relation to back and limb disorders. Scand J Work Environ Health 21:134-142.

Levi, L. 1972. Stress and Distress in Response to Psychosocial Stimuli. New York: Pergamon Press.

—. 1981. Society, Stress and Disease. Vol. 4: Working Life. Oxford: Oxford Univ Press.

—. 1992. Psychosocial, occupational, environmental, and health concepts: Research results and applications. In Work and Well-Being: An Agenda for the 1990s, edited by GP Keita and SL Sauter. Washington, DC: APA.
Levi, L, M Frankenhaeuser, and B Gardell. 1986. The characteristics of the workplace and the nature of its social demands. In Occupational Stress and Performance At Work, edited by S Wolf and AJ Finestone. Littleton, Mass: PSG.

Levi, L and P Lunde-Jensen. 1996. Socio-Economic Costs of Work Stress in Two EU Member States. A Model for Assessing the Costs of Stressors At National Level. Dublin: European Foundation.

Levine, EL. 1983. Everything You Always Wanted to Know About Job Analysis. Tampa: Mariner.

Levinson, DJ. 1986. A conception of adult development. American Psychologist 41:3-13.

Levinson, H. 1978. The abrasive personality. Harvard Bus Rev 56:86-94.

Levy, BS and DH Wegman. 1988. Occupational Health: Recognizing and Preventing Work-Related Disease. Boston: Little, Brown & Co.

Lewin, K, R Lippitt, and RK White. 1939. Patterns of aggressive behaviour in experimentally created social climates. J Soc Psychol 10:271-299.

Lewis, S, DN Izraeli, and H Hootsmans. 1992. Dual-Earner Families: International Perspectives. London: Sage.

Liberatos, P, BG Link, and J Kelsey. 1988. The measurement of social class in epidemiology. Epidemiol Rev 10:87-121.

Liem, R and JH Liem. 1988. The psychological effects of unemployment on workers and their families. J Soc Issues 44:87-105.

Light, KC, JR Turner, and AL Hinderliter. 1992. Job strain and ambulatory work blood pressure in healthy young men and women. Hypertension 20:214-218.

Lim, SY. 1994. An integrated approach to upper extremity musculoskeletal discomfort in the office work environment: The role of psychosocial work factors, psychological stress, and ergonomic risk factors. Ph.D. Dissertation, University of Wisconsin-Madison.

Lim, SY and P Carayon. 1994. Relationship between physical and psychosocial work factors and upper extremity symptoms in a group of office workers. Proceedings of the 12th Triennial Congress of the International Ergonomic Association. 6:132-134.

Lindeman, E. 1944. Symptomatology and management of acute grief. American Journal of Psychiatry 101:141-148.

Lindenberg, CS, HK Reiskin, and SC Gendrop. 1994. The social system model of substance abuse among childbearing age women: A review of the literature. Journal of Drug Education 24:253-268.

Lindström, K and JJ Hurrell Jr. 1992. Coping with job stress by managers at different career stages in Finland and the United States. Scand J Work Environ Health 18 Suppl. 2:14-17.

Lindström, K, J Kaihilahti and I Torstila. 1988. Ikäkausittaiset Terveystarkastukset Ja Työn Muutos Vakuutus- Ja Pankkialalla (in Finnish With English Summary). Espoo: The Finnish Work Environment Fund.
Link, B et al. 1986. Socio-economic status and schizophrenia: Noisome occupational characteristics as a risk factor. Am Soc Rev 51:242-258.

—. 1993. Socioeconomic status and depression: The role of occupations involving direction, control and planning. Am J Sociol 6:1351-1387.
Locke, EA and DM Schweiger. 1979. Participation in decision-making: One more look. Res Organ Behav 1:265-339.
London, M. 1995. Employees, Careers, and Job Creation: Developing Growth-Oriented Human Resource Strategies and Programs. San Francisco: Jossey-Bass.

Louis, MR. l980. Surprise and sense-making: What newcomers experience in entering unfamiliar organizational settings. Adm Sci Q 25:226-251.
Lowe, GS and HC Northcott. 1988. The impact of working conditions, social roles, and personal characteristics on gender differences in distress. Work Occup 15:55-77.

Lundberg, O. 1991. Causal explanations for class inequality in health-an empirical analysis. Soc Sci Med 32:385-393.

Lundberg, U, M Granqvist, T Hansson, M Magnusson, and L Wallin. 1989. Psychological and phsiological stress responses during repetitive work at an assembly line. Work Stress 3:143-153.

Maher, EL. 1982. Anomic aspects of recovery from cancer. Social Science and Medicine 16:907-912.

MacKinnon, CA. 1978. Sexual Harassment of Working Women: A Case of Sex Discrimination. New Haven, Conn: Yale Univ. Press.

Maddi, SR, SC Kobasa, and MC Hoover. 1979. An alienation test. Journal of Humanistic Psychology 19:73-76.

Maddi, SR and SC Kobasa. 1984. The Hardy Executive: Health Under Stress. Homewood, Il: Dow-Jones Irwin.

Maddi, SR. 1987. Hardiness training at Illinois Bell Telephone. In Health Promotion Evaluation, edited by JP Opatz. Stevens Point, Wisc: National Wellness Insitutue.

—. 1990. Issues and interventions in stress mastery. In Personality and Disease, edited by HS Friedman. New York: Wiley.

Mandell, W et al. 1992. Alcoholism and occupations: A review and analysis of 104 occupations. Alcohol, Clin Exp Res 16:734-746.

Mangione, TW and RP Quinn. 1975. Job satisfaction, counterproductive behavior, and drug use at work. Journal of Applied Psychology 60:114-116.

Mann, N. 1989. The Keys to Excellence. The Story of Deming Philosophy. Los Angeles: Prestwick.

Mantell, M and S Albrecht. 1994. Ticking Bombs: Defusing Violence in the Workplace. New York: Irwin Professional.

Marans, RW and X Yan. 1989. Lighting quality and environmental satisfaction in open and enclosed offices. J Architect Plan Res 6:118-131.

Margolis, B, W Kroes, and R Quinn. 1974. Job stress and unlisted occupational hazard. J Occup Med 16:659-661.

Marino, KE and SE White. 1985. Departmental structure, locus of control, and job stress: The effect of a moderator. Journal of Applied Psychology 70:782-784.

Marmot, M. 1976. Acculturation and coronary heart disease in Japanese Americans. In The Contribution of the Social Environment to Host Resistance, edited by JP Cassel.

Marmot, M and T Theorell. 1988. Social class and cardiovascular disease: The contribution of work. Int J Health Serv 18:659-674.

Marshall, NL and RC Barnett. 1991. Race, class and multiple roles strains and gains among women employed in the service sector. Women Health 17:1-19.

Martin, DD and RL Shell. 1986. Management of Professionals. New York: Marcel Dekker.

Martin, EV. 1987. Worker stress: A practitioner’s perspective. In Stress Management in Work Setting, edited by LR Murphy and TF Schoenborn. Cincinnati, Ohio: NIOSH.

Maslach, C. 1993. Burnout: A multidimentional perspective. In Professional Burnout, edited by WB Schaufeli, C Maslach and T Marek. Washington, DC: Taylor and Francis.

Maslach, C and SE Jackson. 1981/1986. The Maslach Burnout Inventory. Palo Alto, Calif: Consulting Psychologists.

Maslow, AH. 1954. Motivation and Personality. New York: Harper.

Matteson, MT and JM Ivancevich. 1987. Controlling Work Stress. San Francisco: Jossey-Bass.

Mattiason, I, F Lindgarden, JA Nilsson, and T Theorell. 1990. Threat of unemployment and cardiovascular risk factors: Longitudinal study of quality of sleep and serum cholesterol concentrations in men threatened with redundancy. British Medical Journal 301:461-466.

Mattis, MC. 1990. New forms of flexible work arrangements for managers and professionals: Myths and realities. Hum Resour Plan 13(2):133-146.

McGrath, A, N Reid, and J Boore. 1989. Occupational stress in nursing. Int J Nursing Stud 26(4):343-358.

McGrath, JE. 1976. Stress and behavior in organizations. In Handbook of Industrial and Organizational Pyschology, edited by MD Dunnette. Chicago: Rand McNally.

McKee, GH, SE Markham, and DK Scott. 1992. Job stress and employee withdrawal from work. In Stress & Well-Being At Work, edited by JC Quick, LR Murphy, and JJ Hurrel. Washington, D.C.: APA.

McLaney, MA and JJ Hurrell Jr. 1988. Control, stress and job satisfaction. Work Stress 2:217-224.

McLean, LA. 1979. Work Stress. Boston: Addison-Wesley.

Meisner, M. 1971. The long arm of the job. Industrial Relations :239-260.

Meyer, BD. 1995. Lessons from the US unemployment insurance experiments. J Econ Lit 33:91-131.

Meyerson, D. 1990. Uncovering socially undesirable emotions: Experience of ambiguity in organizations. Am Behav Sci 33:296-307.
Michaels, D and SR Zoloth. 1991. Mortality among urban bus drivers. Int J Epidemiol 20(2):399-404.

Michelson, W. 1985. From Sun to Sun: Maternal Obligations and Community Structure in the Lives of Employed Women and Their Families. Totowa, NJ: Rowman & Allanheld.

Miller, KI and PR Monge. 1986. Participation, satisfaction, and productivity: A meta-analytic review. Acad Manage J 29:727-753.

Miller, LS and S Kelman. 1992. Estimates of the loss of individual productivity from alcohol and drug abuse and from mental illness. In Economics and Mental Health, edited by RG Frank and MG Manning. Baltimore: Johns Hopkins Univ. Press.

Miller, S. 1979. Controllability and human stress: Method, evidence and theory. Behav Res Ther 17:287-304.

Ministry of Labour. 1987. The Swedish Work Environment Act (With Amendments) and the Swedish Work Environment Ordinance (With Amendments). Stockholm: Ministry of Labour.

Mino, Y, T Tsuda, A Babazona, H Aoyama, S Inoue, H Sato, and H Ohara. 1993. Depressive states in workers using computers. Environmental Research 63(1):54-59.

Misumi, J. 1985. The Behavioural Science of Leadership Concept: Third Leadership Symposium. Carbondale, Ill: Souther Illinois Univ.

Moleski, WH and JT Lang. 1986. Organizational goals and human needs in office planning. In Behavioral Issues in Office Design, edited by J Wineman. New York: Van Nostrand Rinehold.

Monk, TH and S Folkard. 1992. Making Shift Work Tolerable. London: Taylor & Francis.

Monk, T and D Tepas. 1985. Shift work. In Job Stress and Blue Collar Work, edited by C Cooper and MJ Smith. London: John Wiley & Sons.

Moon, S and SL Sauter. 1996. Psychosocial Factors and Musculoskeletal Disorders in Office Work. : Taylor and Francis,Ltd.

Moos, RH. 1986. Work as a human context. In Psychology and Work: Productivity, Change, and Employment, edited by MS Pallak and R Perloff. Washington, DC: APA.

Moos, R and A Billings. 1982. Conceptualizing and measuring coping resources and process. In Handbook of Stress: Theoretical and Clinical Aspects, edited by L Goldberger and S Breznitz. New York: Free Press.

Morrison, EW. l993. Longitudinal study of the effects of information seeking on newcomer socialization. J Appl Psychol 78:173-183.

Morrow, PC and JC McElroy. 1987. Work commitment and job satisfaction over three career stages. J Vocationl Behav 30:330-346.

Mossholder, KW, AG Bedeian, and AA Armenakis. 1981. Role perceptions, satisfaction, and perfor-mance: Moderating effects of self-esteem and orga-nizational level. Organ Behav Hum Perform 28:224-234.

—. 1982. Group process-work outcome relationships: A note on the moderating impact of self-esteem. Acad Manage J 25:575-585.

Muntaner, C and P O’Campo. 1993. A critical appraisal of the Demand/Control model of the psychosocial work environment: Epistemological, social, behavioral and class considerations. Soc Sci Med 36:1509-1517.

Muntaner, C, A Tien, WW Eaton, and R Garrison. 1991. Occupational characteristics and the occurence of psychotic disorders. Social Psych Psychiatric Epidemiol 26:273-280.

Muntaner, C et al. 1993. Dimensions of the psychosocial work environment in five US metropolitan areas. Work Stress 7:351-363.

Muntaner, C, P Wolyniec, J McGrath, and A Palver. 1993. Work environment and schizophrenia: An extension of the arousal hypothesis to occupational self-selection. Social Psych Psychiatric Epidemiol 28:231-238.

—. 1994. Psychotic inpatients’ social class and their first admission to state or private psychiatric hospitals in Baltimore. Am J Public Health 84:287-289.

Muntaner, C, JC Anthony, RM Crum, and WW Eaton. 1995. Psychosocial dimensions of work and the risk of drug dependence among adults. Am J Epidemiol 142(2):183-190.

Murphy, LR. 1988. Workplace interventions for stress reduction and prevention. In Causes, Coping and Consequences of Stress At Work, edited by CL Cooper and R Payne. New York: Wiley.

Murrell, KFH. 1965. A classification of pacing. Int J Prod Res 4:69-74.

National Council on Compensation Insurance. 1985. Emotional Stress in the Workplace. New Legal Rights in the Eighties. New York: National Council on Compensation Insurance.

Nehling, A and G Debry. 1994. Caffeine and sport activity: A review. International Journal of Sports Medicine 15:215-223.

Nelson, DL. l987. Organizational socialization: A stress perspective. J Occup Behav 8:3ll-324.

Nelson, DL and JC Quick. 1991. Social support and newcomer adjustment in organization: Attachment theory at work? J Organ Behav 12:543-554.

Nelson, DL and CD Sutton. 1991. The relationship between newcomer expectations of job stressors and adjustment to the new job. Work Stress 5:241-251.

Newman, JE and TA Beehr. 1979. Personal and organizational strategies for handling job stress: A review of research and opinion. Personnel Psychology 32:1-43.

Niaura, R, CM Stoney, and PN Herbst. 1992. Biol Psychol 34:1-43.

National Institute for Occupational Safety and Health (NIOSH). 1988. Prevention of Work-Related Psychological Disorders in Proposed National Strategies for the Prevention of Leading Work-Related Diseases and Injuries.: NIOSH.

North, FM, SL Syme, A Feeney, M Shipley, and M Marmot. 1996. Psychosocial work environment and sickness absence among British civil servants: The Whitehall II study. Am J Public Health 86(3):332.

Northwestern National Life. 1991. Employee burnout: America’s newest epidemic. Minneapolis, Mn. Northern National Life.

Nuckolls, KB et al. 1972. Psychosocial assets, life crisis and the prognosis of pregnancy. American Journal of Epidemiology 95:431-441.

O’Donnell, MP and JS Harris. 1994. Health Promotion in the Workplace. New York: Delmar.

Oetting, ER, RW Edwards, and F Beauvais. 1988. Drugs and native-American youth. Drugs and Society 3:1-34.

Öhman, A and G Bohlin. 1989. The role of controllability in cardiovascular activation and cardiovascular disease: Help or hindrance? In Stress, Personal Control and Health, edited by A Steptoe and A Appels. Chichester: Wiley.

Ojesjo, L. 1980. The relationship to alcoholism of occupation, class and employment. J Occup Med 22:657-666.

Oldham, GR. 1988. Effects of change in workspace partitions and spatial density on employee reactions: A quasi-experiment. J Appl Psychol 73:253-258.

Oldham, GR and Y Fried. 1987. Employee reactions to workspace characteristics. J Appl Psychol 72:75-80.

Oldham, GR and NL Rotchford. 1983. Relationships between office characteristics and employee reactions: A study of the physical environment. Adm Sci Q 28:542-556.

Olff, M, JF Brosschot, RJ Benschop, RE Ballieux, GLR Godaert, CJ Heijnen, and H Ursin. 1995. Modulatory effects of defense and coping on stress-induced changes in endocrine and immune parameters. Int J Behav Med 2:85-103.

Olff, M, JF Brosschot, RJ Benchop, RE Ballieux, GLR Godaert, CJ Heijnen, and H Eursin. 1993. Defence and coping in relation to subjective health and immunology.

Olmedo, EL and DL Parron. 1981. Mental health of minority women: Some special issues. J Prof Psychol 12:103-111.

O’Reilly, CA and JA Chatman. 1991. People and organizational culture: A profile comparison approach to assessing person-organization fit. Acad Manage J 34:487-516.

Organization for Economic Cooperation and Development (OECD). 1995. OECD Economic Outlook 57. Paris: OECD.

Ornstein, S. 1990. Linking environmental and industrial/organizational psychology. In International Review of Industrial and Organizational Psychology, edited by CL Cooper and IT Robertson. Chichester: Wiley.

Ornstein, S,