Stansfeld S A, Clark C, Caldwell T, Rodgers B, Power C
Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, London, UK.
Occup Environ Med. 2008 Sep;65(9):634-42. doi: 10.1136/oem.2007.036640. Epub 2008 Apr 3.
The association between work stressors and adult psychiatric diagnoses may be biased by prior psychological distress influencing perception of work or selection into unfavourable work. This study examines the extent to which the association between work stressors and adult psychiatric diagnoses is explained by associations with earlier psychological distress and whether childhood and early adulthood psychological distress influences reported midlife work characteristics.
Follow-up at 45 years of age of 8243 participants in paid employment from the 1958 British Birth Cohort. Karasek's work characteristics and psychiatric diagnoses (Revised Clinical Interview Schedule) were measured at 45 years. Childhood internalising and externalising problems were measured at 7, 11 and 16 and malaise at 23 and 33 years.
Internalising behaviours in childhood and early adult psychological distress predicted adverse work characteristics in mid-adulthood. High job demands (women: relative risk (RR) = 1.75, 95% CI 1.2 to 2.5; men: RR = 4.99, 95% CI 2.5 to 10.1), low decision latitude (RR = 1.46, 95% CI 1.1 to 1.9), high job strain (OR = 1.88, 95% CI 1.5 to 2.4), low work social support (RR = 1.97, 95% CI 1.5 to 2.6) and high job insecurity (OR = 1.86, 95% CI 1.4 to 2.4) were associated with mid-adulthood diagnoses. The association between work stressors and mid-adulthood diagnoses remained after adjustment for internalising behaviours and malaise at 23 and 33 years although diminished slightly in magnitude (eg, adjusted RR for support = 1.82, 95% CI 1.4 to 2.4; job strain OR = 1.78, 95% CI 1.4 to 2.3).
Childhood and early adulthood psychological distress predict work characteristics in mid-adulthood but do not explain the associations of work characteristics with depressive episode and generalised anxiety disorder in midlife. Work stressors are an important source of preventable psychiatric diagnoses in midlife. Psychological distress may influence selection into less advantaged occupations with poorer working conditions that may increase the risk of future depressive and anxiety disorders.
工作压力源与成人精神疾病诊断之间的关联可能会受到先前心理困扰的影响，这种心理困扰会影响对工作的认知或导致进入不利的工作环境。本研究探讨工作压力源与成人精神疾病诊断之间的关联在多大程度上可由与早期心理困扰的关联来解释，以及儿童期和成年早期的心理困扰是否会影响报告的中年工作特征。
对1958年英国出生队列中8243名有薪就业参与者进行45岁时的随访。在45岁时测量了Karasek的工作特征和精神疾病诊断（修订临床访谈时间表）。在7岁、11岁和16岁时测量儿童期内化和外化问题，在23岁和33岁时测量不适。
儿童期的内化行为和成年早期的心理困扰预示着成年中期的不良工作特征。高工作要求（女性：相对风险（RR）=1.75，95%置信区间1.2至2.5；男性：RR = 4.99，95%置信区间2.5至10.1）、低决策自由度（RR = 1.46，95%置信区间1.1至1.9）、高工作压力（比值比（OR）=1.88，95%置信区间1.5至2.4）、低工作社会支持（RR = 1.97，95%置信区间1.5至2.6）和高工作不安全感（OR = 1.86，95%置信区间1.4至2.4）与成年中期诊断相关。在对23岁和33岁时的内化行为和不适进行调整后，工作压力源与成年中期诊断之间的关联仍然存在，尽管幅度略有减小（例如，调整后的支持RR = 1.82，95%置信区间1.4至2.4；工作压力OR = 1.78，95%置信区间1.4至2.3）。
儿童期和成年早期的心理困扰预示着成年中期的工作特征，但不能解释成年中期工作特征与抑郁发作和广泛性焦虑症之间的关联。工作压力源是中年可预防精神疾病诊断的重要来源。心理困扰可能会影响人们选择进入工作条件较差的不太有利的职业，这可能会增加未来患抑郁和焦虑症的风险。
