J Epidemiol Community Health 2001;55:624-630 ( September )

Research report

Psychosocial work characteristics and self rated health in four post-communist countries H Pikhart^a, M Bobak^a, J Siegrist^b, A Pajak^c, S Rywik^d, J Kyshegyi^e, A Gostautas^f, Z Skodova^g, M Marmot^a

^a International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, UK, ^b Department of Medical Sociology, University of Duesseldorf, Germany, ^c Department of Clinical Epidemiology, School of Public Health, Jagiellonian University, Krakow, Poland, ^d Department of Epidemiology, National Institute of Cardiology, Warsaw, Poland, ^e National Institute of Health Promotion, Budapest, Hungary, ^f Institute of Cardiology, Medical Academy, Kaunas, Lithuania, ^g Department of Preventive Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic

Correspondence to: Dr Pikhart, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK (hynek{at}public-health.ucl.ac.uk)

Accepted for publication 18 January 2001

STUDY OBJECTIVESTo examine whether psychosocial factors at work are related to self rated health in post-communist countries.
DESIGN AND SETTINGSRandom 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.
MAIN RESULTSThe 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.
CONCLUSIONSThe 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.


Keywords: self rated health; psychosocial work characteristics; effort-reward imbalance

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© 2001 by Journal of Epidemiology and Community Health
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