Tag Archives: Diabetes

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.

A question of support: working longer and what works

As more of us work for longer, it’s important to recognise the needs of older workers: and that includes the fact that as we age we are more likely to suffer from long-term illnesses. To what extent do our working conditions affect our decisions about whether or not to continue in a job despite having a chronic disease? Maria Fleischmann, research associate in the Department of Epidemiology and Public Health at University College London, has been asking what might help to prolong working life for older people. Could factors such as having supportive colleagues and managers, or a clear understanding of who does what, make a difference?

There is strong evidence that people with long-term illnesses leave work early. While three quarters of healthy European 50-somethings have jobs, the figure from those with chronic disease is much lower. Among those with one condition such as diabetes or heart disease, the employment level is around 70 per cent – and for those with two or more that drops to around 50 per cent. Conversely, those who are able to stay well are significantly more likely to continue working beyond pensionable age.

As our working lives grow longer, it’s important to acknowledge that older workers with chronic diseases may have different needs from those who are well – they may not be able to work such long hours, for instance.

So, what are the factors that can make a difference? We know, for instance, that people are likely to remain in work for longer if they have a high level of control over their own hours. Shift workers, on the other hand, are more likely both to become unwell and to leave work early.

Deciding to stay on at work

But what about the factors that are harder to see? What about a worker’s sense of his or her own job stability, or of how harmonious the relationships are between co-workers? Does it help if an employee feels he or she generally knows who does what, or how to respond to a given situation? These types of factors – collectively known as ‘psychosocial factors’ – are also believed to affect peoples’ decisions about whether to stay on at work.

We used data from the Whitehall II study, which has been following the lives, work histories and health experiences of just over 10,000 London-based civil servants since the mid-1980s, when they were all aged 35-55. We looked at the participants in mid-life, around 14 years before retirement age, to see how factors such as levels of autonomy and of support from supervisors or co-workers might affect their decisions if they became ill with diabetes, coronary heart disease, stroke or malignant cancer.

And we found that while good ‘psycho-social’ working conditions were helpful generally in supporting workers to stay on in their jobs, they didn’t appear to make any extra difference for those who became ill.

The participants in the Whitehall II study were asked questions such as: ‘Do you have to do the same thing over and over again?’ and ‘Do you have a choice in deciding how to do your work?’ They were also asked whether they felt they had good support from colleagues and superiors and how demanding they felt their job was. They were also asked to describe their level of education, their mental health and whether they had a partner who worked.

We were able to use their answers to assess whether these factors made a difference when they developed illnesses later in life.

Chronic illness

We could see that six out of 10 participants left work between the first phase of the study in 1985 and the last one used for this study, in 2007-9. During the same period the proportion suffering from chronic illness had increased from less than two per cent to almost 30 per cent.

So why had they left, and how might those ‘psychosocial’ working conditions have affected those decisions?

Among the whole group of participants, we found clear evidence that those who felt they had reasons to be happy in their work were more likely to stay on. Specifically, those who felt they were using a wide range of job skills – known as skill discretion – and those who felt they had good social support at work were more likely to stay on for longer.

However, we did not find evidence that those ‘psychosocial’ factors would make more of a difference in whether or not a worker stayed on if he or she were chronically unwell. Or rather, good working conditions were equally important for workers both ill and well.

So, we know that good social and psychological conditions at work are likely to be helpful in keeping employees at work as their careers near their end. And we know that chronic illness is a major reason why people leave work early. But from our study, we cannot say that such good working practices will be a particular deciding factor for those who become unwell.

How and why people leave work

There were some interesting factors in our results: first, we were able to look at the different ways in which people left their jobs, and the reasons why they did so. So those who used a wide range of skills had a reduced risk of leaving work earlier through retirement or ill-health, but this was not related to the risk of leaving work earlier through unemployment; while those who had good social support had a reduced risk of leaving earlier through ill health or unemployment, but not so much when we looked at leaving earlier through retirement.

And while previous studies had tended to measure working conditions at the time of leaving, ours looked at those conditions several years beforehand.

There is certainly scope for more detailed research on this issue – and there is plenty of reason for both researchers and policy advisors to continue to focus on how employers can help chronically ill workers to stay in their jobs.

Can favourable psychosocial working conditions in midlife moderate the risk of work exit for chronically ill workers? A 20-year follow-up of the Whitehall II study is research by Maria Fleischmann, Ewan Carr, Stephen A Stansfeld, Baowen Xue and Jenny Head. It is published in the BMJ Journal of Occupational and Environmental Medicine and is part of the renEWL project on Extended Working Lives.