Stress and Long Hours at Work Double Risk of Depression

Work and family are the two domains from which most adults gain satisfaction in life; equally they are the common sources of stressful experiences. The working environment continues to change with globalization of the world economy and economic rationalization driving job restructuring and outsourcing, greater part-time and contract work, and greater workload demands that commonly occur in a context of higher job insecurity. There is thus not an unreasonable perception in the community that work is increasingly the source of much of our stress and distress.

The implications of work-related stress include the effects on worker satisfaction and productivity, their mental and physical health, absenteeism and its economic cost, the wider impact on family function and finally, the potential for employer liability. While depression is the most likely adverse psychological outcome, the range of other possible “psychological” problems include “burn-out”, alcohol abuse, unexplained physical symptoms, “absenteeism”, chronic fatigue and accidents, sick building syndrome and repetitive strain injury.

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Stress at work

Multiple studies confirm that on-the-job stress and unsupportive workplaces may foster depression in the affected employees. In the 2007 study, performed by Emma Robertson Blackmore, PhD, of New York's University of Rochester, more than 24,300 workers in Canada were interviewed about their depression symptoms. Based on the interviews, the researchers concluded that 4.6% of the workers qualify for a diagnosis of major depression.

The results confirmed that work stress stood out among the depressed employees. "High job strain, low levels of social support in the workplace, low job security, and increased psychological demands were associated with major depressive episodes in men," concluded the researchers.

The risk list was slightly different for women. High-stress jobs were not so substantial factor for depression, but "among women, lower levels of social support and lack of decision authority were associated with having major depressive episodes," reported Blackmore and colleagues.

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These results were consistent with findings of the research, carried out by Maria Melchior and colleagues at the Institute of Psychiatry, Kings College London. The researchers followed up with more than 1000 participants in Dunedin, New Zealand. The initial assessment was performed in 1972-1973, when they were babies, and followed them up to their age of 32.

The participants were given a questionnaire that asked questions about the psychological and physical demands of their job, their freedom to make decisions at work, as well as the support that they receive at work from colleagues. During the same visit, the participants were assessed for any psychiatric disorders using a validated interview, by an interviewer who was unaware of the other scores. Participants were considered to have a new diagnosis of depression or anxiety disorder if they met the diagnostic criteria at the time of interview, and had no previous diagnosis or related medication or hospital treatment.

The results showed that participants exposed to high psychological job demands had twice the risk for major depression disorder or generalized anxiety disorder compared with those with low job demands.

It was found that women, who reported high psychological job demands, such as working long hours, working under pressure or without clear direction, were 75 per cent more likely to suffer from clinical depression or general anxiety disorder than women who reported the lowest level of psychological job demands.

Men with high psychological job demands were 80 per cent more likely to suffer from depression or anxiety disorders than men with lower demands. Men with low levels of social support at work were also found to be at increased risk of depression, anxiety or both.

The researchers found that almost half of the cases of depression or generalized anxiety disorder newly diagnosed at age-32 were directly related to workplace stress and high job demands.

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Long hours at work

A new British study reported another interesting finding. Working long hours appeared to substantially increase a person's risk of becoming depressed, regardless of how stressful the actual work is.

The study, which followed 2,123 British civil servants for six years, found that workers who put in an average of at least 11 hours per day at the office had roughly two and a half times higher odds of developing depression than their colleagues who clocked out after seven or eight hours.

The link between long workdays and depression persisted even after the researchers took into account factors such as job strain, the level of support in the workplace, alcohol use, smoking, and chronic physical diseases.

Although the findings are "consistent with previous studies, the degree of increased risk was surprising," says Bryan Bruno, M.D., chair of the psychiatry department at Lenox Hill Hospital, in New York City, who was not involved in the research. "The biggest condition that I work with is depression, and it is often related to work stressors."

Overworked junior and mid-level employees appear to be more prone to depression than people higher up the food chain, the study suggests. The length of the workday didn't have a perceptible impact on the mental health of higher-paid, top-level employees such as cabinet secretaries, directors, team leaders, and policy managers.

That's likely due to the amount of control higher-ups have over their own work, says Alan Gelenberg, M.D., who, as the chair of the psychiatry department at Pennsylvania State University, in University Park, is a higher-up himself.

"We have more control over what we work on; we can choose the fun stuff," says Gelenberg, who was not involved in the study. "I do mostly what I want to do, and when I put in an extra hard week, it's my choice."

For those lower on the totem pole, the researchers say long hours at the office could contribute to depression in several ways—by creating family or relationship conflicts, for instance, or by elevating levels of the stress hormone cortisol.

Job insecurity and sleep deprivation also may help explain the increased risk of depression, Bruno says, noting that previous research has shown that poor sleep is a key ingredient in work-related depression. "I often really focus on that symptom," he says, referring to his own patients.

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Recent studies on overtime and depression have reported similar results, but most used a less rigorous standard for measuring depression. The new study included face-to-face consultations and used the American Psychiatric Association's official criteria for clinical depression, making it one "one of the rare studies" to do so, says lead author Marianna Virtanen, Ph.D., a researcher at the Finnish Institute of Occupational Health, in Helsinki.

The new research drew upon data from a long-running study, known as Whitehall II, that includes employees from 20 London-based branches of the British civil service. The study participants Virtanen and her colleagues focused on were all deemed mentally healthy when they were first evaluated between 1991 and 1993. Six years later, slightly more than 3% of the employees were found to have experienced clinical depression within the previous year. The more overtime they worked, the more likely they were to be depressed.

The majority of the study participants (52%) worked a normal seven- or eight-hour workday. Thirty-seven percent averaged nine- or 10-hour days, and 11% worked 11 hours or more.

The new discovery shows that people are accustomed to working long hours every day has the potential to severely depressed.

The study showed that a person's inability to manage time for work and family care will extend the increased levels of stress hormones. The investigation also showed that long working primarily work the night shift is associated with cardiovascular disease, cancer, family problems and mental disorders.

World Health Organization (WHO) predicts that in 2030 the number of individuals affected by the global depression syndrome would become higher than other health problems.

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