The contribution of working conditions and social support to the onset of depressive and anxiety disorders among male and female employees
Introduction
Depressive and anxiety disorders are both common and important in the general population (Bijl, Ravelli, & van Zessen, 1998; Ohayon & Schatzberg, 2002; Wittchen, Essau, von Zerssen, Krieg, & Zaudig, 1992). Working conditions and social support represent two domains of environmental factors that may be important to understand pathways to anxiety and depression (Garnefski, van Egmond, & Straatman, 1990; Graaf, Bijl, Ravelli, Smit, & Vollebergh, 2002; Murphy, Olivier, Monson, Sobol, Federman, & Leighton, 1991; Piccinelli & Wilkinson, 2000; Wilhelm, Kovess, Rios-Seidel, & Finch, 2004).
Working can be disadvantageous as well as beneficial for mental health depending, among other things, on the quality of working conditions (Harnois &Gabriel, 2000). The relationship between working conditions and job stress has been confirmed in cross-sectional studies (Karasek & Theorell, 1990; Pugliesi, 1999; Spielberger, Vagg, & Wasala 2003). One important aspect of working conditions is the security of the worker's position: uncertainty about the employment position causes stress (Siegrist, 1996). According to the Demand/Control Model (Karasek & Theorell, 1990), the psychological demands imposed by the job (work load) and the degree to which the worker may exert decision latitude are two other important aspects of working conditions, which are related to job stress. The decision latitude one may exert depends on the level of autonomy and the professional skills of the worker. According to the model, rising psychological demands may cause job stress. Higher degrees of decision latitude may reduce job stress and may buffer the effect of psychological demands. In several cross-sectional studies support was found for the association of psychological demands and decision latitude with anxiety and depressive symptoms (Demerouti, Bakker, de Jonge, Janssen, & Schaufeli, 2001; de Jonge & Kompier, 1997; Sanne, Mykletun, Dahl, Moen, & Tell, 2005; Stansfeld, Fuhrer, Shipley, & Marmot, 1999).
Despite the fact that various studies have demonstrated an association between poor working conditions and poor mental health, Wilhelm et al. (2004) concluded in their literature review that, due to a lack of longitudinal research, the direction of the relationship between working conditions and depressive and anxiety disorders remains unclear. Poor working conditions can result in mental health problems, but mental health problems may also contribute to poor working conditions. In addition, the assessment of mental health in most previous studies has been rather broad with a lack of discrimination between depressive and anxiety symptoms. The present study deals with these prior limitations: we use longitudinal data of a large representative cohort of working persons, and will assess the incidence of depressive and anxiety disorders among persons who start out without depressive and anxiety disorders. Our first hypothesis (‘Working conditions Hypothesis’) is that poor working conditions (low job security, low decision latitude, and high psychological demands) increase the risk of 2-year incident depressive and anxiety disorders.
Besides the knowledge of the impact of working conditions on mental health, the awareness of the importance of support from the social network is growing (Baum, 1999; McKenzie, Whitley, & Weich, 2002). A good, stable social network that provides social support can positively influence mental health (Brown & Gary, 1987; Kendler, Myers, & Prescott, 2005). In addition to a direct effect, social support may, according to the buffering hypothesis, be especially effective in stressful circumstances (Greenblatt, Becerra, & Serafetinides, 1982; Olstad, Sexton, & Sogaard, 2001), and could theoretically reduce the negative effect of poor working conditions. The buffering effect of social support from co-workers on the relationship between work stressors and mental health was not supported in studies by Loscocco and Spitze (1990) and Sanne et al. (2005). However, it could be that social support from intimate others may be a more important source of social support that provides buffering. In a prospective population study, Olstad et al. (2001) indeed found a buffering effect of overall social support on the relationship between work stress and a general indicator of mental distress. Whether this protective effect is also strong enough to reduce the incidence of mental disorders remains to be demonstrated. The present study will examine the buffering effect of social support, and hypothesizes that social support buffers the negative effect of poor working conditions on incident depressive and anxiety disorders (‘buffering effect hypothesis’).
A consistent finding in previous research is that the incidence of depressive and anxiety disorders in women is approximately twice as high as among men (Alonso et al., 2004; Bebbington, 1998; Bijl, Ravelli, & van Zessen, 1998; de Graaf et al., 2002; Weich, Sloggett, & Lewis, 1998). In general, men report better working conditions than women (Blidt & Michélsen, 2002; Pugliesi, 1999; Roxburgh, 1996). Research also shows that gender differences in social support exist: women provide and receive more social support than men receive and they appear to be more sensitive to the effect of social support (Beehr, Farmer, Glazer, Gudanowski, & Nair, 2003; Pugliesi & Shook, 1998; Reevy & Maslach, 2001; Walen & Lachman, 2000). It has been suggested that because women not only receive, but also give more social support than men do, they may be more negatively affected by emotional strain of network members (Fuhrer et al., 1999; Stansfeld et al., 1998; Walen & Lachman, 2000). And in line with this suggestion, in some studies women even appeared to profit less from social support than men (Stansfeld et al., 1998; Schwarzer & Gutiérrez-Dona, 2005). Therefore, because women may have more unfavorable working conditions and may profit less from social support than men do, the female preponderance of depressive and anxiety disorders could be partly due to the social circumstances. Consequently, the final hypothesis of the present study is that working conditions and social support contribute to the explanation of gender differences in the incidence of Depressive and Anxiety Disorders (‘Gender differences Hypothesis’).
Using 2-year longitudinal data of the Netherlands Mental Health Survey and Incidence Study (NEMESIS), we will explore whether work characteristics and social support contribute to the onset of depressive and anxiety disorders in a large general population of working men and women without baseline depressive and anxiety disorders.
Section snippets
Sampling and procedures
The NEMESIS is an epidemiological study in the Dutch general population to determine the prevalence, incidence and course of psychiatric disorders using assessments in 1996, 1997 and 1999. A representative sample of 7076 adults, aged 18–64 years, was interviewed by trained and intensively monitored interviewers. The primary diagnostic instrument was the Composite International Diagnostic Interview (CIDI, Robins et al., 1988), designed to assess mental disorders according to the Diagnostic and
Differences in working conditions and social support between working men and women
Table 1 shows study characteristics among the 2646 working male and female adults. Women were younger, had lower levels of education, and had a higher number of diseases than men. Compared to men, women worked fewer hours a week and had less often an executive position. Men reported higher levels of psychological demands at work and more decision latitude than women did. Women reported receiving more daily emotional support than men did.
Incidence of depressive and anxiety disorders in working and women
The 2-year incidence of anxiety and depressive disorders
Discussion
In this study, we tested three hypotheses concerning the relationships of both working conditions and social support with the incidence of depressive and anxiety disorders. For the working conditions hypothesis, we expected that better working conditions decrease the risk of depressive and anxiety disorders. This was supported in the case of psychological demands, but not for the effects of decision latitude and job-security. The hypothesized interaction between psychological demands and
Acknowledgments
Netherlands Mental Health Survey and Incidence Study is being conducted by the Netherlands Institute of Mental Health and Addiction (Trimbos-instituut) in Utrecht. Financial support has been received from the Netherlands Ministry of Health, Welfare and Sport. We would like to thank J.H. Smit and R. van Dyck (both of Department of Psychiatry, VU University Medical Centre, Amsterdam) for their contribution and comments on previous versions of this manuscript.
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