Combined and Selective Effects of Psychosocial Stressors in Nurses Rachel McNamara CWERC Seminar 7 April 2008.

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Presentation transcript:

Combined and Selective Effects of Psychosocial Stressors in Nurses Rachel McNamara CWERC Seminar 7 April 2008

Combined & selective effects of psychosocial stressors Objectives: Are additional psychosocial stressors associated with acute ill health in addition to NOF? Is exposure to multiple stressors associated with a more negative outcome? Are the effects of particular stressors selective?

Combined & selective effects of psychosocial stressors Background: Additive & selective associations between multiple stressors & health outcomes (Smith et al., 2004) Bullying, anxiety & depression (Quine, 2001) & psychosomatic complaints (e.g. dizziness, chest pain: Mikkelsen & Einarsen, 2001) High demands/low control & high effort/low reward associated with CVD risk factors & psychiatric disorder (e.g. Kivimaki et al., 2002; Stansfeld et al., 1998, 1999) Link between high demands/low control & high effort/low reward & comparatively minor health complaints (Smith et al., 2004)

Combined & selective effects of psychosocial stressors Additional stressors: Bullying (e.g. persistent attempts to undermine work) Leader-Member Exchange (e.g. how well does your manager recognise your potential?) Team-Member Exchange (e.g. how well do other members of your team recognise your potential?) Role Conflict (e.g. I feel I have enough time to complete my work) Role Ambiguity (e.g. I feel certain about how much authority I have) Supportive Organisational Culture (e.g. being people oriented)

Combined & selective effects of psychosocial stressors Work stress NOF (p<.0001)OR = % CI ( ) Clinical depression NOF (p<.0001)OR = % CI ( ) Clinical anxiety NOF (p<.0001)OR = % CI ( ) Bullying (p<.0001) OR = % CI ( ) 14-day symptoms NOF (p<.004) OR = % CI ( ) Bullying (p<.0001) OR = % CI ( ) 14-day LRTIs Bullying (p<.0001) OR = % CI ( )

Combined & selective effects of psychosocial stressors Work stress _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Combined & selective effects of psychosocial stressors Anxiety Depression NOF 1NOF 2NOF 3 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Combined & selective effects of psychosocial stressors NOF 1NOF 2NOF 3 14-day symptoms 14-day LRTIs _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Combined & selective effects of psychosocial stressors Work stress (p<.0001) Low JD/low E/low WHOR = 0.15***95% CI ( ) Low JD/low E/high WHOR = % CI ( ) High JD/low E/low WHOR = % CI ( ) High JD/low E/high WHOR = % CI ( ) Low JD/high E/low WHOR = % CI ( ) Low JD/high E/high WHOR = % CI ( ) High JD/high E/low WHOR = 4.26***95% CI ( ) High JD/high E/high WHOR = 6.19***95% CI ( ) ***(p<.0001) +(p<.05) JD = job demand E = Intrinsic/extrinsic effort WH = working hrs/hazards

Combined & selective effects of psychosocial stressors Anxiety (p<.0001) Low effort/low bullyingOR = 0.21***95% CI ( ) Low effort/high bullyingOR = % CI ( ) High effort/low bullyingOR = % CI ( ) High effort/high bullyingOR = 4.95***95% CI ( ) Low work hrs/low hazardsOR = 0.41*95% CI ( ) Low work hrs/high hazardsOR = % CI ( ) High work hrs/low hazardsOR = % CI ( ) High work hrs/high hazardsOR = % CI ( ) Depression (p<.0001) ***(p<.0001) *(p<.01)

Combined & selective effects of psychosocial stressors 14-day symptoms (p<.0001) ERI categories/low bullyingOR = 0,46***95% CI ( ) ERI categories/high bullyingOR = % CI ( ) High effort, low reward/low bullyingOR = % CI ( ) High effort, low reward/high bullyingOR = 1.66*95% CI ( ) BullyingOR = % CI ( ) 14-day LRTIs (p<.008) ***(p<.0001) *(p<.01)

Combined & selective effects of psychosocial stressors Conclusions: Of novel psychosocial stressors, only bullying significantly predicted psychological well-being & acute health in addition to NOF Exposure to multiple stressors associated with a more negative outcome (additive influence on health & well-being) Relationship between stressors & health is complex: not simply additive Components of NOF selectively associated with outcomes (e.g. job demand, effort & work-stress; effort, bullying and anxiety)