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

2. 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?

3. 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)

4. 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)

5. Combined & selective effects of psychosocial stressors Work stress NOF (p<.0001)OR = 5.3595% CI (3.44-8.31) Clinical depression NOF (p<.0001)OR = 7.7295% CI (3.48-17.14) Clinical anxiety NOF (p<.0001)OR = 4.9395% CI (3.21-7.56) Bullying (p<.0001) OR = 2.9895% CI (1.53-3.41) 14-day symptoms NOF (p<.004) OR = 1.6495% CI (1.18-2.28) Bullying (p<.0001) OR = 2.0895% CI (1.50-2.90) 14-day LRTIs Bullying (p<.0001) OR = 2.2595% CI (1.49-3.40)

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

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

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

9. Combined & selective effects of psychosocial stressors Work stress (p<.0001) Low JD/low E/low WHOR = 0.15***95% CI (1.00-2.40) Low JD/low E/high WHOR = 0.6195% CI (0.35-1.06) High JD/low E/low WHOR = 0.53+95% CI (0.32-0.89) High JD/low E/high WHOR = 0.7595% CI (0.40-1.41) Low JD/high E/low WHOR = 0.8495% CI (0.49-1.45) Low JD/high E/high WHOR = 1.2395% CI (0.61-2.46) High JD/high E/low WHOR = 4.26***95% CI (2.79-6.49) High JD/high E/high WHOR = 6.19***95% CI (3.71-10.32) ***(p<.0001) +(p<.05) JD = job demand E = Intrinsic/extrinsic effort WH = working hrs/hazards

10. Combined & selective effects of psychosocial stressors Anxiety (p<.0001) Low effort/low bullyingOR = 0.21***95% CI (0.15-0.30) Low effort/high bullyingOR = 0.7195% CI (0.38-1.31) High effort/low bullyingOR = 1.3895% CI (0.95-1.99) High effort/high bullyingOR = 4.95***95% CI (2.72-9.02) Low work hrs/low hazardsOR = 0.41*95% CI (0.22-0.77) Low work hrs/high hazardsOR = 1.4195% CI (0.80-2.47) High work hrs/low hazardsOR = 1.1995% CI (0.64-2.24) High work hrs/high hazardsOR = 1.4695% CI (0.85-2.50) Depression (p<.0001) ***(p<.0001) *(p<.01)

11. Combined & selective effects of psychosocial stressors 14-day symptoms (p<.0001) ERI categories/low bullyingOR = 0,46***95% CI (0.36-0.58) ERI categories/high bullyingOR = 1.2195% CI (0.88-1.66) High effort, low reward/low bullyingOR = 1.0995% CI (0.72-1.64) High effort, low reward/high bullyingOR = 1.66*95% CI (1.16-2.39) BullyingOR = 1.9695% CI (1.19-2.31) 14-day LRTIs (p<.008) ***(p<.0001) *(p<.01)

12. 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)