High job strain leads to heart disease in women: Study

Demanding jobs with low control increase risk of complications by 40 per cent

Women with high levels of job strain have a significantly higher risk of cardiovascular disease, including heart attack, compared to those with less stressful jobs, according to a major study in the United States.

Women who reported having a demanding job with little decision-making authority and very few creative opportunities — referred to as job strain — were 40 per cent more likely to suffer a heart attack, ischemic stroke or coronary bypass surgery than their less strained colleagues.

Specifically, the risk of heart attack was 88 per cent higher for women with high job strain.

“We’ve seen this happening for decades so the results are not suprizing at all,” said Linda Duxbury, a professor at Carleton University’s Sprott School of Business in Ottawa. “However, it’s important because this means we haven’t been paying enough attention to the stuff we know.”

Women in positions with high job strain often do not have many opportunities for movement and growth within an organization so they end up being “trapped” in a job that is associated with cardiovascular disease, said Nieca Goldberg, director of New York University’s women’s heart program in New York City.

These positions have high demand and low control which elicits the fight or flight response from the adrenal system. This raises blood pressure, blood sugar and heart rate, and this constant stress response has a profound physiological impact, said Duxbury.

“There’s enough evidence to suggest the demand-control dimension operates all the way up from blue collar to white collar jobs,” said Peter Kaufmann, deputy chief of clinical applications and prevention, at the National Heart, Lung and Blood Institute in Bethesda, MD. “But the blue collars are at a higher risk because they have the least control.”

In addition, job insecurity — or the fear of losing one’s job — was linked to risk factors for cardiovascular disease such as high blood pressure, increased cholesterol and excess body weight, caused by constant worry, said Goldberg. However, job insecurity is not directly associated with cardiovascular disease.

“Job insecurity means I don’t know if I’m going to have income next week, if I can pay for this, give the kids money for that, go on vacation or pay the mortgage,” said Duxbury. “You can’t have more lack of control than that.”

The Women’s Health Study, funded by the National Institutes of Health in the U.S., surveyed more than 17,000 female professionals, mainly in the health-care sector, and followed them for 10 years.

The women, whose average age was 57, answered questions about heart disease risk factors and true or false questions to evaluate job strain and job insecurity, which included “My job requires working very fast” and “I am free from competing demands that others make.”

This study is one of the first of its kind that is longitudinal in design, which helps determine the temporal association between job strain and the development of cardiovascular risk factors, said Mercedes Carnethon, spokesperson for the American Heart Association.

“Prior research has been largely cross-sectional — both measures collected at the same point of time —  and with that type of design, it’s not possible to determine whether one preceded the other,” she said.

There are many things employers can do to reduce the risk of job strain in female employees and they all start with management — the most critical piece no matter what sector, said Duxbury.

First, organizations need to pay more attention to performance management, she said. Feedback and performance appraisals should be offered on a regular basis as well as active coaching and mentoring.

“Organizations need to pay as much attention to how they manage the people dimension of the jobs as they do to operations,” said Duxbury. “They need to give mangers the skill set, the time and the incentive for people management.”

She suggests offering training to managers in areas such as people skills and conflict resolution, and making it all worth their while by including people management metrics in their scorecards.

This will allow the manager to become more involved with each employee, be understanding, a good listener and help the employee deal with any issues they may be facing, said Duxbury.

“If you have a manager who gets it, you have much more control over the situation and more degrees of freedom,” she said.
Managers should also make sure to respect their employees’ and encourage them to want to achieve a higher level in the job, said Goldberg.

“The boss should ask workers to contribute their suggestions and make them feel as if they are part of the solution in the business,” she said.

In addition to fostering an environment of more control, employers should also provide programs for acquiring skills for managing stress, such as mindfulness-based meditation, health education and time management, said Kaufmann.

If employers don’t start taking the people management piece seriously, it will continue to take a toll on the organization, said Duxbury. Absenteeism and health-care costs will keep increasing and recruitment, retention and succession planning will be even more challenging, she said.

An organization will likely see many financial benefits when it starts taking its employees’ health seriously, said Kaufmann.

“Taking an interest in the employee’s health can reduce absenteeism and increase productivity, so the economic benefits can be very substantial,” said Kaufmann. “A happy employee is a faithful employee.”

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