Psychosocial work environment and the risk of coronary heart disease

Objectives: Remarkable changes in the working situation have led to the inc reasing importance of psychomentally and socio-emotionally demanding condit ions at work. With the help of theoretical models, those highly prevalent p sychosocial work environments were conceptualized which influence the risk of coronary heart disease by enhanced activation of the autonomic nervous s ystem. One of the most prominent theoretical approaches, the job strain mod el, and a more recent approach, the effort-reward imbalance model, are disc ussed in the paper. Empirical evidence: Findings from prospective and cross -sectional studies indicate that job strain and effort-reward imbalance at work define specific conditions of chronic work stress that are associated with an elevated risk of coronary heart disease (CHD). Respective multivari ate odds-ratios range from 1.2 to 5.0 with respect to job strain, and from 1.5 to 6.1 with respect to effort-reward imbalance. These associations are explained neither by established behavioral or biomedical risk factors nor by physical and chemical hazards at work, rather they define independent, n ew work-related risk conditions. There is additional evidence that effort-r eward imbalance may mediate the association of some traditional occupationa l exposures, such as shift work, with cardiovascular risk: in a cross-secti onal study, prevalence odds ratios of hypertension and atherogenic lipids a ttributable to effort-reward imbalance were relatively highest among shiftw orkers as compared to daytime workers. Preliminary results from interventio n programs based on the theoretical models document favorable effects on he alth. Conclusions: Information derived from theoretical models on psychosoc ial work environment may help to better identify populations at risk and to develop and apply specific, theory-guided preventive activities in the fut ure.