Psychosocial factors at work and depression in three countries of Central and Eastern Europe

Abstract

Psychosocial factors at work have been found to predict a range of health outcomes but their effect on mental health outcomes has not been extensively studied. This paper explores the relationship between psychosocial factors at work and depression in three countries of Central and Eastern Europe. The data come from a cross-sectional study of working men (n=645) and women (n=523) aged 45–64 years, randomly selected from population registers in Novosibirsk (Russia), Krakow (Poland) and Karvina-Havirov (Czech Republic). The questionnaire included questions on the effort and reward at work, job control, the full CES-D scale of depression, and a range of other characteristics. Linear regression was used to estimate the association between depression score and work characteristics: the logarithm of the effort–reward ratio, and continuous job control score. The means of the depression score were 10.5 for men and 14.2 for women. After controlling for age, sex and country, effort-reward ratio (logarithmically transformed) was strongly related to depression score; a 1 SD increase in the log transformed effort-reward ratio was associated with an increase in the depression of 2.0 points (95% CI 1.5; 2.4), and further adjustment did not materially change the effect. Job control was inversely associated with depression score in Poland and the Czech Republic (not in Russia) but the association was largely eliminated by controlling for socioeconomic characteristics. This study suggests that the effort–reward imbalance at work is related to prevalence of depression in these central and eastern European populations.

Introduction

The influence of psychosocial factors at work on health has been studied extensively over the last two decades (Karasek & Theorell, 1990; Siegrist, 1996; Marmot, Siegrist, Theorell, & Feeney, 1999; Cooper, 1998). Most studies have focused on the relation with cardiovascular disease (Siegrist, Peter, Junge, Cremer, & Seidel, 1990; Karasek et al., 1988; Johnson, Stewart, Hall, Fredlund, & Theorell, 1996; Bosma, Peter, Siegrist, & Marmot, 1998) but several other health outcomes have also been examined, including self-rated health, sickness absence, neck and low back pain, psychiatric disorder and depression (North, Syme, Feeney, Shipley, & Marmot, 1996; Isacsson, Hanson, Ranstam, Rastam, & Isacsson, 1995; Tsutsumi, Kayaba, Theorell, & Siegrist, 2001; Stansfeld, Fuhrer, Shipley, & Marmot, 1999; Pikhart et al., 2001; Peter & Siegrist, 1997). This paper examines whether psychosocial work environment is associated with depression. Depression is related to several cardiovascular risk factors and, possibly, to the risk of cardiovascular disease (Dinan, 1999; Musselman, Evans, & Nemeroff, 1998; Rozanski, Blumenthal, & Kaplan, 1999; Glassman & Shapiro, 1998), and may potentially be one of the mechanisms linking psychosocial factors at work with chronic diseases.

Two theoretical models of psychosocial factors at work have been the most influential in the study of health. First model is the job strain model developed by Karasek and Theorell (1990) (Karasek et al., 1988). This model consists of several dimensions—job demand, decision latitude (job control), and social support at work, and it appears that the combination of unfavourable characteristics is associated with ill health (Karasek et al., 1988; Johnson & Hall, 1988; Johnson et al., 1996). The second widely used model is the effort–reward imbalance model developed by Siegrist, Peter, and Junge et al. (1990) and Siegrist (1996). This model emphasizes the imbalance between high effort at work and low reward received in turn, where rewards concern money, esteem and career opportunities, including job security. Thus, this model addresses the impact of selected labour market conditions (level of salary, career opportunities, job instability and unemployment) on health in addition to the more proximal job conditions.

Relatively few studies investigated the association between psychosocial factors at work with depression but it appears that the rates of depression are higher in persons with job stress (Tsutsumi et al., 2001; Stansfeld et al., 1999; Gershon, Lin, & Li, 2002; Wang & Patten, 2001; Tyssen, Vaglum, Gronvold, & Ekeberg, 2000; Kawakami & Haratani, 1999; Frank & Dingle, 1999; Stansfeld, Head, & Marmot, 1998; Kawakami, Araki, Kawashima, Masumoto, & Hayashi, 1997; Boey, Chan, Ko, Goh, & Lim, 1997; Tsukamoto, Igata, Hayashi, & Suzuki, 1995; Stahl & Hauger, 1994; Fujigaki, Asakura, & Haratani, 1994; Kawakami, Haratani, & Araki, 1992; Phelan et al., 1991; Suzuki, Tsukamoto, & Abe, 1990; Kawakami, Araki, & Kawashima, 1990).

The study was conducted in middle-aged subjects from three post-communist countries of Central and Eastern Europe. We have previously shown, in a different dataset, that psychosocial factors at work were associated with self-rated health in Eastern European populations (Pikhart et al., 2001). In this paper, we examined whether effort–reward imbalance and low job control at wok were related to scores on a depression scale.