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Can high psychological job demands, low decision latitude, and high job strain predict disability pensions? A 12-year follow-up of middle-aged Swedish workers

Journal article
Authors C. Canivet
B. Choi
R. Karasek
M. Moghaddassi
Carin Staland Nyman
Per-Olof Östergren
Published in International Archives of Occupational and Environmental Health
Volume 86
Issue 3
Pages 307-319
ISSN 0340-0131
Publication year 2013
Published at Institute of Medicine, Department of Public Health and Community Medicine
Pages 307-319
Language en
Keywords Disability leave, Stress, physiological, Stress, psychological, Gender, Longitudinal studies, sickness absence, cardiovascular-disease, construction workers, psychosocial factors, risk-factors, life-style, health, population, stress, environment, aspl, AvshalomCaspl, AMilne, Barry J.Milne, BJDanese, AndreaDanese, APoulton, RichiePoulton
Subject categories Occupational medicine


OBJECTIVES: The aim of this study was to investigate whether job strain, psychological demands, and decision latitude are independent determinants of disability pension rates over a 12-year follow-up period. METHODS: We studied 3,181 men and 3,359 women, all middle-aged and working at least 30 h per week, recruited from the general population of Malmö, Sweden, in 1992. The participation rate was 41 %. Baseline data include sociodemographics, the Job Content Questionnaire, lifestyle, and health-related variables. Disability pension information was obtained through record linkage from the National Health Insurance Register. RESULTS: Nearly 20 % of the women and 15 % of the men were granted a disability pension during the follow-up period. The highest quartile of psychological job demands and the lowest quartile of decision latitude were associated with disability pensions when controlling for age, socioeconomic position, and health risk behaviours. In the final model, with adjustment also for health indicators and stress from outside the workplace, the hazard ratios for high strain jobs (i.e. high psychological demands in combination with low decision latitude) were 1.5 in men (95 % CI, 1.04-2.0) and 1.7 in women (95 % CI, 1.3-2.2). Stratifying for health at baseline showed that high strain tended to affect healthy but not unhealthy men, while this pattern was reversed in women. CONCLUSIONS: High psychological demands, low decision latitude, and job strain were all confirmed as independent risk factors for subsequent disability pensions. In order to increase chances of individuals remaining in the work force, interventions against these adverse psychosocial factors appear worthwhile.

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