Job Stress May Be a 'Substantial Contributor' to Mental Illness

Megan Brooks

May 18, 2018

Having a demanding job over which one has little control may raise the risk of developing common mental disorders in midlife, new research suggests.

If causality is assumed, it is possible that 14% of new cases of depression, anxiety, and other common mental disorders could be prevented by eliminating high levels of job strain, report Samuel Harvey, PhD, from the University of New South Wales School of Psychiatry, Sydney, Australia, and colleagues.

The study was published online May 10 in Lancet Psychiatry.

Employer Wake-up Call

The term "job strain" refers to the combination of high pace, high intensity, conflicting demands, and low control or capacity for decision making in one's job.

Several prior studies support an association between job strain and physical and mental health problems, but those studies have been criticized because of problems regarding causation and confounding.

In response to those concerns, Harvey and colleagues applied multivariate logistic regression to analyze the prospective association between job strain at age 45 years and the risk for common mental disorders at age 50 years. They controlled for lifetime psychiatric history and a wide range of other possible confounding variables.

Data for the analysis came from 6870 participants in the UK National Child Development Study, a large British birth cohort. Participants completed questionnaires that asked about decision authority and about job pace, intensity, and conflicting demands.

The analysis took into account non-workplace factors such as divorce; financial problems; housing instability; other stressful life events, such as death or illness; and individual workers' temperament and personality.

In the final model, which was adjusted for all measured confounders, high job demand, low job control, and high job strain were found to be significant independent predictors of the future onset of common mental disorders.

Table. Association Between Job Strain Variables and New Onset of Common Mental Disorders

High job demand OR, 1.70; 95% CI, 1.25 - 2.32 P = .0008
High job strain OR 2.22; 95% CI, 1.59 - 3.09 P < .0001
Low job control OR 1.89; 95% CI, 1.29 - 2.77 P = .0010)
OR, odds ratio; CI, confidence interval


The findings, the researchers note, highlight the potential public health effect of addressing factors associated with job strain in the workplace.

"Previous research on interventions aimed at increasing employee control or improving job design has shown some promise in the promotion of mental health and reduction of stress in the workplace," they write. "To capitalize on this potential, more methodologically rigorous evaluation of workplace interventions should be focused on these modifiable risk factors."

Long-term Personal, Societal Consequences

The author of a linked comment says this study makes a "substantial contribution to this area of research by confirming aspects of the job demand–control model and the long-term effect of job strain on common mental disorders.

"Their findings suggest that job strain has long-term personal, organizational, and societal consequences, and early interventions specifically aimed at improving employee control and involvement in decision making are needed," writes Sabir Giga, PhD, of the Division of Health Research, Lancaster University, United Kingdom.

In addition, the methods used by the investigators could be used to explore other research areas, such as the link between long-term high and low job strain on neurodegenerative conditions such as dementia and Parkinson's disease, Giga says.

The study was funded by iCare Foundation and Mental Health Branch, NSW Health. Dr Harvey and Dr Giga have disclosed no relevant financial relationships.

Lancet Psychiatry. Published online May 10, 2018. Abstract, Comment

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