Pikhart H, Bobak M, Siegrist J, Pajak A, Rywik S, Kyshegyi J, Gostautas A, Skodova Z, Marmot M
International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, UK.
J Epidemiol Community Health. 2001 Sep;55(9):624-30. doi: 10.1136/jech.55.9.624.
To examine whether psychosocial factors at work are related to self rated health in post-communist countries.
Random samples of men and women in five communities in four countries were sent a postal questionnaire (Poland, Czech Republic and Lithuania) or were invited to an interview (Hungary). Working subjects (n=3941) reported their self rated health in the past 12 months (5 point scale), their socioeconomic circumstances, perceived control over life, and the following aspects of the psychosocial work environment: job control, job demand, job variety, social support, and effort and reward at work (to calculate a ratio of effort/reward imbalance). As the results did not differ by country, pooled analyses were performed. Odds ratios of poor or very poor health ("poor health") were estimated for a 1 SD increase in the scores of work related factors.
The overall prevalence of poor health was 6% in men and 7% in women. After controlling for age, sex and community, all work related factors were associated with poor health (p<0.05). After further adjustment for perceived control, only two work related factors remained associated with poor health; the odds ratios (95% confidence intervals) for 1 SD increase in the effort/reward ratio (log transformed) and job variety were 1.51 (1.29, 1.78) and 0.82 (0.73, 1.00), respectively. Further adjustment for all work related factors did not change these estimates. There were no interactions between individual work related factors, but the effects of job control and social support at work differed by marital status, and the odds ratio of job demand increased with increasing education.
The continuous measure of effort/reward imbalance at work was a powerful determinant of self rated health in these post-communist populations. Although the cross sectional design does not allow firm conclusions as to causality, this study suggests that the effect of the psychosocial work environment is not confined to Western populations.
探讨后共产主义国家工作中的社会心理因素是否与自评健康状况相关。
在四个国家的五个社区中，对男性和女性进行随机抽样，向他们邮寄问卷（波兰、捷克共和国和立陶宛），或者邀请他们接受访谈（匈牙利）。在职受试者（n = 3941）报告了他们过去12个月的自评健康状况（五分制）、社会经济状况、对生活的感知控制，以及社会心理工作环境的以下方面：工作控制、工作需求、工作多样性、社会支持以及工作中的努力与回报（用于计算努力/回报失衡比率）。由于各国结果无差异，因此进行了汇总分析。针对与工作相关因素得分每增加1个标准差，估计健康状况差或非常差（“健康状况不佳”）的比值比。
男性健康状况不佳的总体患病率为6%，女性为7%。在控制年龄、性别和社区因素后，所有与工作相关的因素均与健康状况不佳相关（p<0.05）。在进一步调整感知控制因素后，只有两个与工作相关的因素仍与健康状况不佳相关；努力/回报比（对数转换）和工作多样性每增加1个标准差，比值比（95%置信区间）分别为1.51（1.29, 1.78）和0.82（0.73, 1.00）。对所有与工作相关的因素进行进一步调整后，这些估计值未发生变化。各个与工作相关的因素之间不存在交互作用，但工作控制和社会支持的影响因婚姻状况而异，工作需求的比值比随教育程度的提高而增加。
工作中努力/回报失衡的连续测量是这些后共产主义人群自评健康状况的一个有力决定因素。尽管横断面设计无法就因果关系得出确凿结论，但本研究表明，社会心理工作环境的影响并不局限于西方人群。
