TY - JOUR

T1 - Job insecurity and risk of coronary heart disease

T2 - Mediation analyses of health behaviors, sleep problems, physiological and psychological factors

AU - Magnusson Hanson, Linda L.

AU - Rod, Naja H.

AU - Vahtera, Jussi

AU - Virtanen, Marianna

AU - Ferrie, Jane

AU - Shipley, Martin

AU - Kivimäki, Mika

AU - Westerlund, Hugo

PY - 2020

Y1 - 2020

N2 - Job insecurity has been linked to increased risk of coronary heart disease (CHD), but underlying mechanisms remain uncertain. Our aim was to assess the extent to which this association is mediated through life style, physiological, or psychological factors. A total of 3917 men and women free from CHD provided data on job insecurity in the Whitehall II cohort study in 1997−1999. The association between job insecurity and CHD was decomposed into a direct and indirect effect mediated through unhealthy behaviors (smoking, high alcohol consumption, physical inactivity), sleep disturbances, ‘allostatic load’, or psychological distress. The counterfactual analyses on psychological distress indicated a marginally significant association between job insecurity and incident CHD (hazard ratio (HR) 1.32; 95 % confidence interval (CI) 1.00–1.75). This association was decomposed into a direct (HR 1.22, 95 %CI 0.92–1.63) and indirect association (1.08, 95 %CI 1.01–1.15), suggesting that about 30 % of the total relationship was mediated by psychological distress. No mediation was indicated via health behaviors, sleep disturbances, or allostatic load, although job insecurity was related to disturbed sleep and C-reactive protein, which, in turn were associated with CHD. In conclusion, our results suggest that psychological distress may play a role in the relation between job insecurity and CHD.

AB - Job insecurity has been linked to increased risk of coronary heart disease (CHD), but underlying mechanisms remain uncertain. Our aim was to assess the extent to which this association is mediated through life style, physiological, or psychological factors. A total of 3917 men and women free from CHD provided data on job insecurity in the Whitehall II cohort study in 1997−1999. The association between job insecurity and CHD was decomposed into a direct and indirect effect mediated through unhealthy behaviors (smoking, high alcohol consumption, physical inactivity), sleep disturbances, ‘allostatic load’, or psychological distress. The counterfactual analyses on psychological distress indicated a marginally significant association between job insecurity and incident CHD (hazard ratio (HR) 1.32; 95 % confidence interval (CI) 1.00–1.75). This association was decomposed into a direct (HR 1.22, 95 %CI 0.92–1.63) and indirect association (1.08, 95 %CI 1.01–1.15), suggesting that about 30 % of the total relationship was mediated by psychological distress. No mediation was indicated via health behaviors, sleep disturbances, or allostatic load, although job insecurity was related to disturbed sleep and C-reactive protein, which, in turn were associated with CHD. In conclusion, our results suggest that psychological distress may play a role in the relation between job insecurity and CHD.

KW - Allostatic load

KW - Cardiovascular disease

KW - Depressive symptoms

KW - Job insecurity

KW - Mechanisms

KW - Sleep

U2 - 10.1016/j.psyneuen.2020.104706

DO - 10.1016/j.psyneuen.2020.104706

M3 - Journal article

C2 - 32460194

AN - SCOPUS:85085054692

VL - 118

JO - Psychoneuroendocrinology

JF - Psychoneuroendocrinology

SN - 0306-4530

M1 - 104706

ER -