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Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study.
Open accessAbstract
OBJECTIVES: The impact of work on the risk of future psychiatric disorder has been examined in few longitudinal studies. This was examined prospectively in a large epidemiological study of civil servants. METHODS: In the Whitehall II study, a longitudinal, prospective cohort study of 6895 male and 3413 female London based civil servants, work characteristics measured at baseline (phase 1: 1985-8) and first follow up (phase 2: 1989) were used to predict psychiatric disorder measured by a 30 item general health questionnaire (GHQ) at phase 2 and phase 3 follow up (phase 3: 1991-3). Work characteristics and GHQ were measured at all three phases. RESULTS: Low social support at work and low decision authority, high job demands and effort-reward imbalance were associated with increased risk of psychiatric disorder as assessed by the GHQ at follow up adjusting for age, employment grade, and baseline GHQ score. CONCLUSIONS: Social support and control at work protect mental health while high job demands and effort-reward imbalance are risk factors for future psychiatric disorder. Intervention at the level of work design, organisation, and management might have positive effects on mental health in working populations.
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“In total, five cohort studies demonstrate that there is moderate-quality evidence that low coworkers support1 2 16 21 with a pooled OR 1.29 (95% CI 1.17 to 1.43) and low supervisor support1 2 15 16 21 with a pooled OR 1.27 (95% CI 1.14 to 1.40) increase the incidence of SRD.”
From Work-related psychosocial risk factors for stress-related mental disorders: an updated systematic review and meta-analysis (2020) · cites this paper as [16]
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“Two cohort studies2 16 demonstrate that there is moderate-quality evidence that low decision autonomy increases the incidence of SRD with a pooled OR of 1.34 (95% CI 1.20 to 1.49) (see table 3).”
From Work-related psychosocial risk factors for stress-related mental disorders: an updated systematic review and meta-analysis (2020) · cites this paper as [16]
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“Two cohort studies16 17 demonstrate that there is moderate-quality evidence for no increased incidence of SRD due to low skill discretion, with an OR of 1.11 (95% CI 0.94 to 1.32).”
From Work-related psychosocial risk factors for stress-related mental disorders: an updated systematic review and meta-analysis (2020) · cites this paper as [16]
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“Six cohort studies16 18 19 24 25 demonstrate that there is moderate-quality evidence that effort-reward imbalance increases the incidence of SRD, with a pooled OR of 1.91 (95% CI 1.70 to 2.15) (see table 3 and figure 2).”
From Work-related psychosocial risk factors for stress-related mental disorders: an updated systematic review and meta-analysis (2020) · cites this paper as [16]
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“All studies defined SRD based on self-report with validated and standardised questionnaires, that is, (shortened) GHQ,1 15 16 19 20 22 Kessler 6,3 25 Maslach Burnout Inventory,2 21 Copenhagen Psychosocial Questionnaire-Copenhagen Burnout Inventory,24 27 Setterlind Stress Inventory Profile,17 fatigue inventory,18 Brief Job Stress Questionnaire27 and burnout screening scale.26”
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“No statistically significant difference between subgroups of men and women was found.16 18 25”
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“Des études, nombreuses dans la littérature internationale, témoignent de la validité prédictive du modèle de Karasek pour les maladies cardio-vasculaires [2], les pathologies mentales [4, 20, 25], mais aussi des indicateurs globaux de santé, tels la santé perçue, la qualité de vie, ou l’absentéisme pour raison de sant…”
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“Numerous studies have shown, however, that other psychosocial work factors, such as social support (10, 11) and organizational justice (12, 13), may contribute to mental health.”
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“…at work but receiving low rewards in terms of being valued, income, and promotion seems to be a potent risk factor for other health outcomes in the Whitehall II study as well, including coronary heart disease, 10 psychiatric disorders, 24 and health functioning, 28 and in other investigations.”
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“…at work and wellbeing among post-pension age people is in line with earlier studies of those of working age andmental health (Pikhart et al. 2004; Stansfeld et al. 1999) and poor reported health (Niedhammer et al. 2004; Stansfeld et al. 1998), and was evident despite the likelihood that those in…”
ResultMental Ill-Health and the Differential Effect of Employee Type on Absenteeism and Presenteeism
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“Increased working hours and high work demands negatively impact work life balance(70) and may in themselves worsen mental health.(62,71,72) Therefore, a negative feedback loop may be established and the employee’s mental health progressively worsens to a situation where time absent is required.”
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Barry, M. M. (2009) · International Journal of Mental Health Promotion · doi:10.1080/14623730.2009.9721788 · Cited by 239
“A poor work environment, characterised by features such as high demand/low control and effort-reward imbalance, is one of the main factors explaining the higher prevalence of depressive symptoms among participants in lower employment grades (Stansfeld et al , 1999).”
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Dallman, M. F., Pecoraro, N. C., La Fleur, S. E., Warne, J. P., Ginsberg, A. B., Akana, S. F., Laugero, K. C., Houshyar, H., Strack, A. M., Bhatnagar, S., et al. (2006) · Progress in Brain Research · doi:10.1016/s0079-6123(06)53004-3 · Cited by 198
Social reciprocity and health: New scientific evidence and policy implications
Siegrist, J. (2005) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.03.017 · Cited by 194
Li, J., Yang, W., Cheng, Y., Siegrist, J., & Cho, S. (2005) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-004-0581-7 · Cited by 191
“…Kunming, China and Marmot 2003; Peter et al. 2002; for review of earlier studies: Schnall et al. 2000), mild-to-moderate psychiatric symptoms (Stansfeld et al. 1999; Tsutsumi et al. 2001b), psychosomatic symptoms and self-reported health, among others (Ostry et al. 2003; Pikhart et al. 2001;…”
BackgroundInfluentialPsychosocial work characteristics and self rated health in four post-communist countries
Pikhart, H., Bobák, M., Siegrist, J., Pająk, A., Rywik, S. L., Kyshegyi, J., Goštautas, A., Škodová, Z., & Marmot, M. G. (2001) · Journal of Epidemiology & Community Health · doi:10.1136/jech.55.9.624 · Cited by 189
Self-citationWork stress and reduced health in young physicians: prospective evidence from Swiss residents
Buddeberg‐Fischer, B., Klaghofer, R., Stamm, M., Siegrist, J., & Buddeberg, C. (2008) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-008-0303-7 · Cited by 197
“... the ERI model investigate the relationship of eVort–reward imbalance and employee health in a cross-sectional design (de Jonge et al. 2000; Godin and Kittel 2004; Kageyama et al. 2001; Kudielka et al. 2005; Larisch et al. 2003; Niedhammer et al. 2004; Pikhart et al. 2004; Preckel et al. 2005; Rockenbauch et al. 20…”
MethodMarchand, A., Demers, A., & Durand, P. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2004.11.037 · Cited by 215
Godin, I., & Kittel, F. (2003) · Social Science & Medicine · doi:10.1016/s0277-9536(03)00345-9 · Cited by 192
Power, C., Stansfeld, S. A., Matthews, S., Manor, O., & Hope, S. (2002) · Social Science & Medicine · doi:10.1016/s0277-9536(01)00325-2 · Cited by 187
Self-citationStress, Aging, and Brain Oxidative Damage
Liu, J., & Mori, A. (1999) · Neurochemical Research · doi:10.1023/a:1022597010078 · Cited by 186
“Effortreward imbalance is shown to be associated with cardiovascular risk and diseases (14,15) as well as with psychiatric disorders (16).”
BackgroundOccupation and mental health in a national UK survey
Stansfeld, S. A., Rasul, F., Head, J. A., & Singleton, N. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0173-7 · Cited by 185
“Administrative and performance expectations despite low financial rewards add to effort-reward imbalance of these occupations [25, 29].”
BackgroundSelf-citationThe impact of job demands and workload on stress and fatigue
Macdonald, W. (2003) · Australian Psychologist · doi:10.1080/00050060310001707107 · Cited by 185
Steptoe, A., Siegrist, J., Kirschbaum, C., & Marmot, M. G. (2004) · Psychosomatic Medicine · doi:10.1097/01.psy.0000126198.67070.72 · Cited by 183
Self-citationStansfeld, S. A., Head, J. A., Fuhrer, R., Wardle, J., & Cattell, V. (2003) · Journal of Epidemiology & Community Health · doi:10.1136/jech.57.5.361 · Cited by 182
Self-citationPsychosocial factors at work and depression in three countries of Central and Eastern Europe
Pikhart, H., Bobák, M., Pająk, A., Malyutina, S. K., Kubínová, R., Topor, R., Sebakova, H., IuP, N., & Marmot, M. G. (2003) · Social Science & Medicine · doi:10.1016/s0277-9536(03)00350-2 · Cited by 181
Self-citationManaging people and performance: an evidence based framework applied to health service organizations
Michie, S., & West, M. A. (2004) · International Journal of Management Reviews · doi:10.1111/j.1460-8545.2004.00098.x · Cited by 188
“Research with UK civil servants has shown that social support and control at work protect mental health, whereas high job demands and effort– reward imbalance are risk factors for psychological ill-health (Stansfeld et al. 1999).”
BackgroundPsychosocial work environment and burnout among emergency medical and nursing staff
Escribà‐Agüir, V., Martín‐Baena, D., & Pérez‐Hoyos, S. (2006) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-006-0110-y · Cited by 173
“), rather than with personal factors (Schaufeli 1999; Stansfeld et al. 1999; Ramı́rez et al. 1995, 1996; Visser et al. 2003; Sibbald et al. 2003; Greenglass et al. 1998; Imai et al. 2004).”
BackgroundMika Kivimaki, B., Ferrie, J. E., Head, J. A., Shipley, M. J., Vahtera, J., & Marmot, M. G. (2004) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2003.019026 · Cited by 168
Self-citationLi, J., Yang, W., & Cho, S. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.07.011 · Cited by 171
Scheuch, K., Haufe, E., & Seibt, R. (2015) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2015.0347 · Cited by 210
Work Performance of Employees with Depression: The Impact of Work Stressors
Lerner, D., Adler, D. A., Rogers, W. H., Chang, G., Lapitsky, L., McLaughlin, T., & Reed, J. (2010) · American Journal of Health Promotion · doi:10.4278/ajhp.090313-quan-103 · Cited by 171
Globalization, Work, and Cardiovascular Disease
Schnall, P. L., Dobson, M., & Landsbergis, P. A. (2016) · International Journal of Health Services · doi:10.1177/0020731416664687 · Cited by 168
Clays, E., Bacquer, D. D., Leynen, F., Kornitzer, M., Kittel, F., & Backer, G. D. (2007) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.1140 · Cited by 161
“However, when these variables were controlled in prospective studies, occupational stressors generally remained as independent predictors of mental health indicators (32, 56).”
The Prevalence of Psychological Distress in Employees and Associated Occupational Risk Factors
Hilton, M. F., Whiteford, H. A., Sheridan, J. S., Cleary, C. M., Chant, D. C., Wang, P. S., & Kessler, R. C. (2008) · Journal of Occupational & Environmental Medicine · doi:10.1097/jom.0b013e31817e9171 · Cited by 154
Niedhammer, I., Chastang, J., David, S., Barouhiel, L., & Barrandon, G. (2006) · International Journal of Occupational and Environmental Health · doi:10.1179/oeh.2006.12.2.111 · Cited by 152
Marchand, A., Demers, A., & Durand, P. (2005) · Sociology of Health & Illness · doi:10.1111/j.1467-9566.2005.00458.x · Cited by 167
Work stress, mental health and antidepressant medication findings from the Health 2000 Study
Virtanen, M., Honkonen, T., Mika Kivimaki, B., Ahola, K., Vahtera, J., Aromaa, A., & Lönnqvist, J. K. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.05.034 · Cited by 155
Stafford, M., Silva, M. D., Stansfeld, S. A., & Marmot, M. G. (2007) · Health & Place · doi:10.1016/j.healthplace.2007.08.006 · Cited by 147
Self-citationWeyers, S., Peter, R., Bøggild, H., Jeppesen, H. J., & Siegrist, J. (2006) · Scandinavian Journal of Caring Sciences · doi:10.1111/j.1471-6712.2006.00376.x · Cited by 143
Wang, J., Schmitz, N., Dewa, C. S., & Stansfeld, S. A. (2009) · American Journal of Epidemiology · doi:10.1093/aje/kwp037 · Cited by 145
Self-citationWieclaw, J., Agerbo, E., Mortensen, P. B., Burr, H., Tüchsen, F., & Bonde, J. P. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-280 · Cited by 150
Contribution of Burnout to the Association Between Job Strain and Depression: the Health 2000 Study
Ahola, K., Honkonen, T., Mika Kivimaki, B., Virtanen, M., Isometsä, E. T., Aromaa, A., & nnqvist, J. L. (2006) · Journal of Occupational and Environmental Medicine · doi:10.1097/01.jom.0000237437.84513.92 · Cited by 142
“Subjective evaluation of work characteristics has been shown to be more strongly related to mental well-being than objective evaluation.(27) The Dutch version of the general burnout inventory used by us has been shown to be clinically valid.”
MethodPsychosoziale Belastungen und Erkrankungsrisiken im Erwerbsleben
Siegrist, J., & Dragano, N. (2008) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-008-0461-5 · Cited by 138
Effort‐reward imbalance, over‐commitment and work‐life conflict: testing an expanded model
Kinman, G., & Jones, F. A. (2008) · Journal of Managerial Psychology · doi:10.1108/02683940810861365 · Cited by 142
“Cross-sectional and longitudinal research provides evidence for the extrinsic ERI hypothesis, whereby a co-manifestation of high effort at work and low reward has been found to predict cardiovascular risk factors and psychiatric disorders (e.g. Stansfeld et al., 1999; Siegrist, 2001).”
BackgroundEmployment conditions and health inequalities.
Benach, J., Muntaner, C., & Santana, V. S. (2007) · Middlesex University Research Repository (Middlesex University Of London) · Cited by 138
Cocker, F., Martin, A. J., Scott, J. L., Venn, A., & Sanderson, K. A. (2013) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph10105062 · Cited by 136
“Organizational features common in SMEs, such as multiple roles, long work hours and emotional and financial commitment may increase the likelihood of experiencing role ambiguity, work/life imbalance, and financial pressure, all of which have been identified as precipitants of job stress, burnout [12], psychological di…”
Background
Metadata
- Authors
- Stansfeld, S. A., Fuhrer, R., Shipley, M. J., & Marmot, M. G.
- Affiliations
- University College London (GB)
- The Royal Free Hospital (GB)
- Venue
- Occupational and Environmental Medicine
- Publisher
- BMJ
- Published
- 1999-05
- Volume
- 56
- Issue
- 5
- Pages
- 302-307
- ISSN
- 0007-1072 (ISSN-L)
- 1351-0711
- 1470-7926
- PMC
- PMC1757742
- OpenAlex
- W2111757965
- Cited by
- 800
- References
- 33
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 5 · 2023: 13 · 2022: 16 · 2021: 21 · 2020: 22 · 2019: 23 · 2018: 16 · 2017: 58 · 2016: 21 · 2015: 34 · 2014: 31 · 2013: 39 · 2012: 40
- FWCI
- 37.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Occupational and Environmental Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- John D. and Catherine T. MacArthur Foundation
- British Heart Foundation
- Health and Safety Executive
- Medical Research Council
- National Heart, Lung, and Blood Institute (2 RO1 HL 36310, HL36310, R01HL036310)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Workplace Health and Well-being
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Employment and Welfare Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Burnout
- Keywords
- mental illness, job characteristics, mental health, social support at work, decision-making power, job demands, effort-reward imbalance, public sector employees, occupational stress, job design, Whitehall II study
- MeSH terms
- Adult, Mental Disorders, Female, Government Agencies, Humans, Male, Middle Aged, Occupational Diseases, Prospective Studies, Social Support, Work, Work Schedule Tolerance
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