Job stressors and coping characteristics in work-related disease: Issues of validity

There is now broad evidence that stressful work conditions and critical person characteristics contribute to the development of coronary dysfunction and disease via sustained autonomic nervous system activation. To improve the prediction of coronary risk and disease we combined information on psychosocial work stressors and work-related coping characteristics ('need for control') in several studies. The theoretical model termed 'effort-reward imbalance' assumes that high extrinsic (e.g. work pressure, cumulative workload) and intrinsic (e.g. 'need for control') effort spent at work in combination with low reward obtained (e.g. status control, esteem, monetary gratification) trigger sustained neuro-hormonal activation. In this paper the results of a 6 year prospective study conducted in 416 male blue-collar workers underline the validity of this model. The main findings indicate that components of effort-reward imbalance are strongly related to new coronary events and to elevated levels of established coronary risk factors (e.g. hypertension, atherogenic lipids) as well as to reduced cardiovascular responsiveness. It is concluded that the results clearly demonstrate the validity of effort-reward imbalance as an important predictor of coronary risk and disease, and indicate the need for structural and behavioural intervention in the workplace to prevent coronary heart dseases.