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ABSTRACT: Nonmedical determinants of medical decision making were investigated in an international research project in the United States, the United Kingdom, and Germany. The key question in this paper is whether and to what extent doctors' diagnostic and therapeutic decisions in coronary heart disease (CHD) are influenced by patient gender.
A factorial experiment with a videotaped patient consultation was conducted. Professional actors played the role of patients with symptoms of CHD. Several alternative versions were taped featuring the same script with patient-actors of different gender, age, race, and socioeconomic status. The videotapes were presented to a randomly selected sample of 128 primary care physicians in each country. Using an interview with standardized and open-ended questions, physicians were asked how they would diagnose and treat such a patient after they had seen the video.
Results show gender differences in the diagnostic strategies of the doctors. Women were asked different questions, CHD was mentioned more often as a possible diagnosis for men than for women, and physicians were less certain about their diagnosis with female patients. Gender differences in management decisions (therapy and lifestyle advice) are less pronounced and less consistent than in diagnostic decisions. Magnitude of gender effect on doctors' decisions varies between countries with smaller influences in the United States.
Although patients with identical symptoms were presented, primary care doctors' behavior differed by patients' gender in all 3 countries under study. These gender differences suggest that women may be less likely to receive an accurate diagnosis and appropriate treatment than men.
Women s Health Issues 18(3):191-8. · 1.61 Impact Factor
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ABSTRACT: To assess the biological correlates of effort-reward imbalance and overcommitment to work using measurements over the working day.
Participants were 197 working men and women aged 45 to 59 years, recruited from the Whitehall II epidemiological cohort. Salivary cortisol was sampled on waking, 30 minutes later, and then at 2-hour intervals from 8:00 hours to 22:00 hours. Blood pressure was measured every 20 minutes using ambulatory methods. Effort-reward imbalance and overcommitment to work were assessed with standard questionnaires.
Cortisol responses to waking were positively associated with overcommitment in men, with mean increases between waking and 30 minutes of 14.5 and 4.2 nmol/l in high and low overcommitment groups, after adjustment for age, socioeconomic position, smoking, time of waking up, and job demands. Cortisol averaged from 8 samples over the working day was also related to overcommitment in men, with an average difference of 22% between high and lower overcommitment groups. Overcommitment predicted systolic blood pressure over the day in men after adjustment for age, smoking, body mass index, physical activity, and job control, with adjusted means of 132.2 and 125.8 mm Hg in high and low overcommitment groups. There was a significant interaction between overcommitment, socioeconomic position, and time of day in men (p =.016), because systolic pressure was higher in lower status overcommitted men, and rose over the day. Neither effort-reward imbalance nor overcommitment predicted biological responses in women.
Chronic neuroendocrine and cardiovascular activation may mediate in part the impact of overcommitment to work on cardiovascular disease risk in men.
Psychosomatic Medicine 66(3):323-9. · 3.97 Impact Factor
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ABSTRACT: An inverse relation between socio-economic class and occurrence of ischemic heart disease (IHD) in advanced societies is an often replicated finding from empirical studies. Yet, the processes which produce these effects remain an open question. One promising explanation concerns the prevalence of stressful working life, especially of distinct 'job strain' occupations. Based on these considerations, we develop a refined concept of work-related socio-emotional distress which considers a mismatch between high workload and low control over occupational status (e.g. job insecurity, poor promotion prospects, status inconsistency) as crucial distress-provoking conditions. Moreover, we assume that the effect of this condition on IHD risk is substantially increased by the presence of a distinct individual pattern of coping with work demand ('need for control'). Based on data from a 6.5 years prospective study on IHD incidence (n = 21) in a cohort of 416 middle-aged blue-collar men this concept is tested using logistic regression analysis. Results indicate that status inconsistency [multivariate odds ratio (o.r.): 4.4], job insecurity (o.r. 3.4), work pressure (o.r. 3,4) and 'need for control' (o.r. 4,5) independently predict IHD occurrence after adjusting for major confounding somatic and behavioral coronary risk factors. In conclusion, a refined model of work-related socio-emotional distress substantially contributes to the explanation of high IHD incidence among blue-collar men.
Social Science & Medicine. 31(10):1127-1134.
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ABSTRACT: Key measures of Siegrist's (1996) Effort-Reward Imbalance (ERI) Model (i.e., efforts, rewards, and overcommitment) were psychometrically tested.
To study change in organizational interventions, knowledge about the type of change underlying the instruments used is needed. Next to assessing baseline factorial validity and reliability, the factorial stability over time - known as alpha-beta-gamma change - of the ERI scales was examined.
Psychometrics were tested among 383 and 267 healthcare workers from two Dutch panel surveys with different time lags.
Baseline results favored a five-factor model (i.e., efforts, esteem rewards, financial/career-related aspects, job security, and overcommitment) over and above a three-factor solution (i.e., efforts, composite rewards, and overcommitment). Considering changes as a whole, particularly the factor loadings of the three ERI scales were not equal over time. Findings suggest in general that moderate changes in the ERI factor structure did not affect the interpretation of mean changes over time.
Occupational health researchers utilizing the ERI scales can feel confident that self-reported changes are more likely to be due to factors other than structural change of the ERI scales over time, which has important implications for evaluating job stress and health interventions.
International Journal of Behavioral Medicine 15(1):62-72. · 2.63 Impact Factor
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Hugo Westerlund,
Jussi Vahtera,
Jane Ferrie,
Archana Singh-Manoux,
Jaana Pentti,
Maria Melchior,
Constanze Leineweber,
Markus Jokela, Johannes Siegrist,
Marcel Goldberg,
Marie Zins,
Mika Kivimäki
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ABSTRACT: Longitudinal modelling of repeat data showed that retirement did not change the risk of major chronic diseases but was associated with a substantial reduction in mental and physical fatigue and depressive symptoms, particularly among people with chronic diseases.
BMJ / BMJ (CLINICAL RESEARCH ED); Br Med J; British Medical Journal; Brit Med J.
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ABSTRACT: The aim of the study is to analyse the association between psychosocial stress at work and burnout among clinicians in surgery in Germany. For the conceptualisation of work stress the demand-control model (job strain) and the effort-reward imbalance model (ERI) were used. Based on a stratified probability sample a mail survey of 1 311 clinicians from 489 hospitals was conducted. Burnout was measured by the Copenhagen Burnout Inventory. Results of logistic regressions show that both models are significantly associated with burnout (odds ratio job strain: 6.53 (95% confidence interval 4.50-9.46), odds ratio ERI: 5.39 (95% confidence interval 3.94-7.36). Clinicians who are exposed to both, job strain and ERI, have an additionally increased risk. The demand-control model and the effort-reward imbalance model suggest theory-driven interventions for job related health promotion measures which aim for improved working conditions and a decrease of health risks among clinicians in surgery.
PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie 60(9-10):374-9. · 1.02 Impact Factor
