Social Support for Stress Prevention in Hospital Settings

Article excerpt


Aims: The purpose of this study was to identify the effects of social support, interacting with work stressors, on psychological stress prevention in a public hospital, based on Karasek's demand-control-support (DCS) model.

Methods: A self-administered survey was conducted with 240 employees of a public hospital in the south-east of the United States. The survey asked for demographic information, details on job demands and job control as work stressors, social support, and depressive symptoms as the representative psychological stress symptoms.

Results: Social support was detected as a primary interpersonal positive factor buffering depressive symptoms. Social support was also related to job control and depressive symptoms in the simple correlation. Only the main effect model with general characteristics was significantly accepted in hierarchical regression analysis (p=.04).

High social support was associated with low depressive symptom scores, which means that social support had a positive association with health care employees' mental well being. However, any two-way or three-way interaction model was not accepted. The main effect part of the demand-control-support model was supported; however, interactions between demands, control, and support failed to be supported.

Key words

social support; depressive symptom; psychological stress; demand-control-support model


Stress prevention is a primary research topic from a community health promotion perspective, in particular, depression as the representative stress symptom in a core issue of mental well-being. The annual cost of work stress to U.S. businesses, for example, is thought to be more than $100 billion per annum even as a very conservative estimation.1 The primary reason for the estimated cost of psychological stress at work is not only the increased medical cost of high levels of stress, but also organizational productivity loss.2

Depression, a major psychological stress indicator, was alone estimated to cost $44 billion annually due to its deleterious effects on absenteeism, job performance, and other work behaviours.3,4 Other factors stemming from work stress and adding tremendously to the costs include medical expenditures related to disease, accidents, and suicide. Depression is comprehensively associated with multi-level psychological symptoms from simple discomfort and fatigue to burn-out, and also related to workforce financial loss, because depression has higher rates of short-term disability and relapse than any other common medical condition.5 Kessler and his colleagues in a nationwide study reported that depressed workers had between 1.5 and 3.2 more short-term disability days per month than those without depression.4 The disability days for depression were greater than the disability days for heart disease, lower back pain or diabetes mellitus.6

The demand-control-support model (DCS) is one of the most frequently used work stress models. The DCS model explains the major drivers of work stress and how they affect mental and physical wellbeing in the simple job content framework.7 Karasek operationalized job demands (how much my company requires me to manage at work) and job control (how much I can control the workload) as two major constructs arousing workers' psychological stress.8 Social support has been typically operationalized through individual's perceptions of the amount of supervisor and/or co-worker support to finish their job. The highest level of psychological stress would be expected in the 'high strain, isolated' group suffering from high demands, low control, and low support.2,9

The effects of social support at work on depressive symptoms tend to be stronger and more diverse than job demands or job control based on the other worksite health promotion models, and empirical research findings of worksite mental wellbeing. NIOSH model10 and House's framework of occupational stress employed social support11 as a main and moderating variable, affecting Stressors as well as stress outcomes at worksite. …