American Journal of Epidemiology Advance Access originally published online on March 29, 2006
American Journal of Epidemiology 2006 163(10):891-892; doi:10.1093/aje/kwj121
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Response to Invited Commentary |
Rugulies et al. Respond to "Tapping the Tip of the Iceberg"
From the National Institute of Occupational Health, Copenhagen, Denmark
Correspondence to Dr. Reiner Rugulies, National Institute of Occupational Health, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark (e-mail: rer{at}ami.dk).
Received for publication February 14, 2006. Accepted for publication February 16, 2006.
We thank Drs. Fischer and Thayer for their insightful and inspiring commentary (1
) on our paper (2) that showed that low influence at work and low support from supervisors among women and job insecurity among men increased the risk of severe depressive symptoms. Fischer and Thayer put our research into a broad perspective, ranging from individual vulnerability and biologic consequences of psychosocial exposures to potential consequences for social security systems. We agree with the substance of Fischer and Thayer's comments, and we would like to add a few thoughts to the discussion.
Fischer and Thayer point out that adverse psychosocial working conditions might cause "biologic system alterations ... that may chronically severely affect population health" (1, p. 889). Although these biologic system alterations have been discussed as pathways linking chronic stressors to risk of cardiovascular disease (3–5), it is an interesting question if we can use a similar approach regarding psychological system alterations and subsequent risk of psychological disorders. For example, does chronic exposure to adverse conditions lead to alterations in cognitions (e.g., cynicism) or emotions (e.g., anxiety) that might act as intermediate steps in a pathway leading to psychological disorders of clinical significance? Further, to what extent are symptoms of reduced psychological health, such as feeling burned out, fatigued, or distressed (6–8), part of this pathway? Are these symptoms and clinical psychological disorders different points on a continuum, or has each of these symptoms specific causal effects on the risk of clinical psychological disorders?
We concur with Fischer and Thayer that, in today's societies with their aging workforces, adverse psychosocial working conditions and their health consequences could constitute a severe threat to "our social system due to insurmountable expenses for health care and early retirement" (1, p. 889). Recent statistics show that psychological disorders are now the major cause for early retirement in Denmark (9). Our findings suggest that improving working conditions could reduce the risk of psychological disorders and consequently might help to sustain people's workability and to reduce early retirement.
Regarding prevention efforts, it would be important to know if specific occupational groups have an increased risk of psychological disorders. Because of the low number of cases in our cohort, we could not do such an analysis. However, a recent population-based, case-control study by Wieclaw et al. (10) found that working in human service professions (e.g., teaching and health care) was a risk factor for affective disorders among women in Denmark. When job titles were analyzed in more detail, both men and women who worked as social workers and as professionals caring for the disabled showed significantly increased risks of affective disorders. These findings suggest that it could be a promising strategy to investigate in more depth the specific psychosocial working conditions of employees who provide service to other people.
At the end of their commentary, Fischer and Thayer conclude: "In the future, job insecurity will become a reality for most employees" (1, p. 889). We do not doubt this prediction. However, we would like to emphasize that, even in today's globalized economy, legislators can influence job security through laws and regulations. The current political and public debate in Europe is focused mainly on the question of whether more flexibility in the labor market, for example, reducing legal protections against dismissal, might or might not stimulate economic growth and more employment (11). In our view, a discussion of the possible health consequences of increased job insecurity is widely missing. We hope that the findings from our study and from the work of others (12–14) will help to qualify this debate.
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ACKNOWLEDGMENTS |
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Conflict of interest: none declared.
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References |
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 TOP References |
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[Free Full Text] - Rugulies R, Bültmann U, Aust B, et al. Psychosocial work environment and incidence of severe depressive symptoms: prospective findings from a 5-year follow-up of the Danish Work Environment Cohort Study. Am J Epidemiol 2006;163:877–87.
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- Borritz M, Bültmann U, Rugulies R, et al. Psychosocial work characteristics as predictors for burnout: findings from 3-year follow up of the PUMA study. J Occup Environ Med 2005;47:1015–25.[CrossRef][Web of Science][Medline]
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- Dansk Arbejdsgiverforening. Vækst i psykiske lidelser. (In Danish). [Increase in psychological disorders]. Copenhagen, Denmark: Confederation of Danish Employers, 2006. (http://arkivwww.da.dk/nyhed/agenda/frontpageagenda/superShowAgenda.asp?Article=http://arkivwww.da.dk/nyhed/agenda/frontpageagenda/2006/2006-1/3.htm).
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