Job control as a predictor of mental and cardiovascular health: a prospective multicohort study
Year: 2015
Type: dissertation
Study design: Observational Study
Abstract: Job control has been a key concept in research on the psychosocial work environment and employee health for decades. A general hypothesis is that the more job control employees have, the lower their risk of stress-related diseases. However, the evidence to date has been inconclusive. The two components of job control, skill discretion and decision authority, may be differentially associated with health, which is a possible explanation for previous mixed findings. Therefore, this study examined the longitudinal associations of job control and its components separately, along with mental health and incident cardiovascular disease. The samples used were the Still Working study (N=13 868), the Finnish Public Sector Study (N=60 202) and the Individual-Participant Data Meta-analysis in the Working Populations consortium (N=197 473). Survey responses to job control scales were linked to information on sickness absences and hospitalizations due to psychiatric disorders and hospitalizations and mortality from cardiovascular diseases derived from national registers for initially healthy employees. The follow-up period ranged from one year for sickness absence to 20 years for mortality. The data were analyzed using Cox proportional hazard models, probit regression and random-effects meta-analysis. Employees from hospital wards were linked to information on hospital ward overcrowding in an instrumental variable regression analysis of an external measure for job control. Skill discretion and decision authority showed different, to some extent opposite and subgroup specific associations with mental and cardiovascular health. In several analyses a high decision authority was associated with an increased risk of future mental or cardiovascular ill health. In the Still Working cohort study, the adjusted hazard ratio for cardiovascular mortality was 1.47 (95% confidence interval, CI, 1.12, 1.93) for high decision authority and 1.01 (95% CI 0.76, 1.34) for high skill discretion. Job control as a combined construct was not associated with incident cardiovascular disease in the meta-analysis of prospective studies when adjusted for age, sex and socio-economic status (hazard ratio 0.95, 95% CI 0.75-1.19 for highest quartile vs. lowest quartile). In the instrumental variable regression hospital ward overcrowding did not function as an external indicator for job control. Job control appears to be an equivocal concept in terms of health risk as its components were differently associated with health outcomes. These findings suggest that decision authority and skill discretion need to be separated and different work contexts should be differentiated in studies on job control, mental health and cardiovascular diseases.
Source: Työväentutkimus Vuosikirja
Author: Matti Joensuu
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Työsuojelurahasto
OpenAlex ID: W1563201330