Tag Archives: Cholesterol

Work stress and ill health – what’s the link?

Lots of studies have suggested stress can be a cause of ill health – and that leads to people ceasing to work before they reach retirement age. But most have offered only a snapshot on the issue. José Ignacio Cuitún Coronado and  Tarani Chandola from the University of Manchester describe a major new study, which has shed new light on how work stress can affect an employee’s health over a longer period.

Many animals have the ability to adapt to environmental changes and pressures so that they’re better prepared the next time they happen. Bears can put on fat as winter approaches, for instance, to help them stave off hunger and stay warm.

And human beings can do this too. Stressful situations trigger chemical responses which can help to give us extra resources when things are tough. Our neuroendocrine systems, for instance, trigger hormonal responses which enhance our physical performance when we need it most.

But these valuable systems can have a down-side. In our research, we wanted to look at how repeated exposure to stressful situations might contribute to health problems, particularly in people nearing the end of their working lives. We call this stress-induced effect ‘Allostatic Load’ – the wear and tear” on the body that accumulates as an individual is exposed to repeated or chronic stress because of fluctuating hormonal responses.

Given that many governments are looking for ways to extend working lives, there’s particular interest in finding out how stress can affect the health of older workers. We were able to tap into a rich source of information – the English Longitudinal Study of Ageing (ELSA), which has followed a representative sample of almost 10,000 over-50s since 2002.

These participants have been interviewed regularly and one of the things they’ve been asked to report is whether they’ve experienced a sense of imbalance between the effort they put into their jobs and the rewards they get out.

This gave us a sample of 2663 older adults, all over 50 and living in England, who’d reported these feelings at least once and who’d been assessed as having had an adverse reaction to them. We wanted to know whether repeated episodes had a bigger effect than just one, and whether the effect would be just as strong for past episodes as it was for more recent ones.

Health testing

Between 2004-5 and 2014-16 the group were asked about stress at work, but they also underwent physical tests to see how the various systems in their bodies were bearing up.

They were visited by nurses who carried out a battery of tests including taking hair samples to assess levels of the stress-related hormone cortisol, carrying out blood pressure checks to provide information on their cardio-vascular systems, white blood cell counts to assess their immune systems and cholesterol checks on their metabolic systems. Participants also had measurements taken of their waist to height ratios – a good indicator of coronary heart disease risk factors.

Overall, we found the more occasions of work-stress a participant had reported, the greater their ‘Allostatic Load’ index – that is, the greater the amount of biological wear and tear.

Moreover, the evidence suggests that employees who had experienced stress more recently, towards the end of their working lives, had higher levels of health risk when compared to those who had experienced it earlier in their careers.

This suggests there is an association between repeated reports of stress at work and biological stress mechanisms, which in turn could lead to stress-related disorders such as coronary heart disease, type 2 diabetes or depression. This also suggests that previous cross-sectional studies which reported small or inconsistent associations may have suffered because they were only measuring one effect at one time.

Work-related stress is one of the reasons for labour market exit – and our findings would suggest that earlier, snapshot studies may have underestimated the true effect of work-related stress on health over a lifetime.

As this is an observational study, we cannot make any causal claims. There may be other factors that we have not taken into account that may explain the association between stress and disease risk. For example, sleep problems may be relevant – though they may also be part of the journey from stress to ill-health.

But equally it is possible that cumulative exposure to work stress is resulting in damage to employees’ physical health, which is then leading to disability and an early exit from the world of work. So, if we want to extend working lives then reducing work-related stress could be one of the keys to achieving that goal.

Allostatic Load and Effort-Reward Imbalance: Associations over the Working-Career, by José Ignacio Cuitún Coronado, Tarani Chandola and Andrew Steptoe, is published in the International Journal of Environmental Research and Public Health.

Having a baby early? It might not be good for you later

Being employed is generally good for your health. That’s what a large body of research has shown over the years. But what about when you put having a family into the mix? That’s a question that Dr Anne McMunn at the ESRC International Centre for Lifecourse Studies at UCL has been asking in a series of studies looking at the interplay between work-family life and health in middle age. Here she outlines her findings and explains why having children early may not be good for you.

When couples think about starting a family, they may make decisions around a host of concerns. Finances, careers, childcare all spring readily to mind as things that could crop up in discussions about when it might be best to have a child. Not many people will stop and think about how and when having a child might affect their health later on in life – but maybe they should.

Research to date has shown that combining paid work with family responsibilities is usually linked with better health outcomes, although existing research has a number of shortcomings: men are often excluded, health measures have tended to be self-reported rather than objective, few studies take account of the role health plays in whether or not people work, get married and have children in the first place, and, crucially, few studies look across the lifecourse at the timings of entry into parenthood.

Combining work and family life

Using the National Child Development Study, which is following the lives of 17 thousand people born in 1958, our research has looked at how they combined their work and family lives between the ages of 16 and 42 and what that meant for their health in their mid 40s.

The thinking behind the research was that those people with more stressful work-family lives (often characterised by having children very young, being unemployed, and not marrying or forming a long-term partnership) would go on to have physical signs or indicators of poor health such as high cholesterol and blood pressure, being overweight etc.

All the men and women in the study were ascribed one of 12 lifecourse types e.g. ‘Work, Later family’, ‘Later family, Work break’, ‘Teen parent’.

Table 1-1

Almost all men were in a group characterised by long-term full-time employment, with most (34%) entering family life later (the ‘Work, Later family’ group), with nearly as many entering family life earlier (the ‘Work, Earlier family’ group at 32%). Conversely fewer than half of women (47%) were in a group characterised by long-term full-time employment. The ‘Part-time work, Earlier Family’ was the most common group (18%) for women.

Similar proportions of men and women were in the ‘Work, Cohabitation, Later Parent’ group (7% and 5%, respectively), the ‘Work, Marriage, Non-Parent’ group (8% of men, 9% of women) and the ‘Work, No Family’ group (13% of men, 10% of women). Only 4% of women were in the ‘No Paid Work, Earlier Family’ group, and few men or women were in groups characterised by marital dissolution, teen parenthood or weak ties to work or family.

Early parenthood – poorer health

As we expected, those men and women who were in full-time long-term employment, were married and had children later on enjoyed better health. Early parenthood, especially teen parenthood was clearly linked to poorer health, regardless of whether they were in paid work or in a stable long-term marriage.

For example, the waist circumference of teen parents was four inches larger, on average, than those who were in full-time long-term employment, were married and had children later (fat accumulated around the waistline is known to be particularly risky for health). Groups who entered parenthood earlier had 10-18% more fat circulating in the blood and 2-8% less of the ‘good’ HDL cholesterol than those who were in full-time long-term employment, were married and had children later.

Teen parents tended to be less well educated, which accounted for some of the link. However, even those who had stable employment and marriages, but had children early, had poorer health.

It seems that for both men and women, having children early is linked with poor health later on, possibly as a result of chronic stress from parenting in straitened circumstances with fewer financial and emotional resources.

Less human and social capital

Authors of other studies showing links between early parenthood and health problems such as depression, heart disease and long term illnesses, speculate that younger parents have accumulated less human and social capital to cope with the stresses of parenting. It is also possible that those who are older when they become parents have had time to establish healthier behaviours such as exercise and healthy eating prior to starting their families, making it easier to maintain those behaviours through the busy parenting years.

There is need for further evidence on how timing of parenthood influences health and we are currently replicating this study with participants from the 1970 birth cohort.

In the meantime, perhaps those family planning discussions around finances, careers and childcare should incorporate an extra question? If we have a child now rather than later, how might it affect our health later on? It’s a question that will be of interest not just to prospective parents, but to all those concerned with improving the long term health and well-being of our society.

Work-family life courses and metabolic markers in mid-life: evidence from the British National Child Development Study is research by Anne McMunn, Rebecca E Lacey, Meena Kumari, Diana Worts, Peggy McDonough and Amanda Sacker.

Photo credit: Darren Johnson