Stansfeld Stephen, Candy Bridget
Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Joseph Rotblat Building, Barts and London, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London EC1 6BQ, United Kindom.
Scand J Work Environ Health. 2006 Dec;32(6):443-62. doi: 10.5271/sjweh.1050.
To clarify the associations between psychosocial work stressors and mental ill health, a meta-analysis of psychosocial work stressors and common mental disorders was undertaken using longitudinal studies identified through a systematic literature review.
The review used a standardized search strategy and strict inclusion and quality criteria in seven databases in 1994-2005. Papers were identified from 24,939 citations covering social determinants of health, 50 relevant papers were identified, 38 fulfilled inclusion criteria, and 11 were suitable for a meta-analysis. The Comprehensive Meta-analysis Programme was used for decision authority, decision latitude, psychological demands, and work social support, components of the job-strain and iso-strain models, and the combination of effort and reward that makes up the effort-reward imbalance model and job insecurity. Cochran's Q statistic assessed the heterogeneity of the results, and the I2 statistic determined any inconsistency between studies.
Job strain, low decision latitude, low social support, high psychological demands, effort-reward imbalance, and high job insecurity predicted common mental disorders despite the heterogeneity for psychological demands and social support among men. The strongest effects were found for job strain and effort-reward imbalance.
This meta-analysis provides robust consistent evidence that (combinations of) high demands and low decision latitude and (combinations of) high efforts and low rewards are prospective risk factors for common mental disorders and suggests that the psychosocial work environment is important for mental health. The associations are not merely explained by response bias. The impact of work stressors on common mental disorders differs for women and men.
为阐明心理社会工作压力源与心理健康问题之间的关联，我们通过系统文献回顾确定了纵向研究，对心理社会工作压力源与常见精神障碍进行了一项荟萃分析。
该回顾在1994 - 2005年期间使用标准化搜索策略以及严格的纳入和质量标准，检索了七个数据库。从24939篇涵盖健康社会决定因素的文献中筛选出相关论文，共识别出50篇，其中38篇符合纳入标准，11篇适合进行荟萃分析。使用综合荟萃分析程序对决策权威、决策自由度、心理需求、工作社会支持（工作压力模型和等压力模型的组成部分）以及构成努力 - 回报失衡模型和工作不安全感的努力与回报组合进行分析。 Cochr an's Q统计量评估结果的异质性，I2统计量确定研究之间的不一致性。
尽管男性在心理需求和社会支持方面存在异质性，但工作压力、低决策自由度、低社会支持、高心理需求、努力 - 回报失衡和高工作不安全感均预示着常见精神障碍。工作压力和努力 - 回报失衡的影响最为显著。
这项荟萃分析提供了有力且一致的证据，表明高要求与低决策自由度的（组合）以及高努力与低回报的（组合）是常见精神障碍的前瞻性风险因素，并表明心理社会工作环境对心理健康很重要。这些关联不仅仅是由反应偏差所解释的。工作压力源对常见精神障碍的影响在女性和男性中有所不同。
