Behavioral Medicine Approaches to Cardiovascular Disease Prevention

By Kristina Orth-Gomér; Neil Schneiderman | Go to book overview

Chapter 6
The Demand-Control-Support Model for Studying Health in Relation to the Work Environment: An Interactive Model

Töres Theorell National Institute of Psychosocial Factors and Health and Department of Occupational Medicine, Karolinska Institute

The relationship between the psychosocial environment and cardiovascular illness risk has attracted considerable attention during recent years. In modern Western societies this seems to be logical, because physical demands are diminishing and the increasing complexity of a modern society is increasing the demands on psychosocial interaction. In several countries, an increasing number of employers' unions and trade unions have realized that a functioning psychosocial work environment heavily depends on good work organization.

Another reason that development in this field is accelerating is that methods for monitoring physiological and endocrinological processes, which are consequences of a bad psychosocial work environment, have become cheap and practically feasible. When mechanisms in the interplay between the environment and bodily function become known, the medical occupation may accept these relationships more willingly.

In the 1960s and 1970s, several systematic studies of work conditions were made. For instance, in a retrospective study of two bank groups in Belgium, Kornitzer et al. ( 1) observed that employees in one group -- private banks -- had a higher incidence of coronary heart disease than employees in the other group -- state-owned banks. This could not be explained by biomedical risk factors ( 2). The Komitzer group later discussed the complex relationships among stress, biomedical risk factors, and cardiovascular risk ( 3). This study was one of the first to indicate a possible relationship between certain kinds of work conditions -- work demands (which were higher in the private banks) -- and risk of myocardial infarction (MI). Other cross-sectional studies during the late 1950s

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