Primary Care Research

Psychosocial stress in the work environment may play a role in development of alcohol dependence among men

Studies of alcohol dependence in adults has largely focused on genetic and personality factors or on general socioeconomic conditions. However, a new large-scale study of British civil servants suggests a role for a stressful psychosocial work environment, in particular high work effort with little reward, in the development of alcohol dependence among men. These associations between work characteristics and alcohol dependence did not appear to be mediated through physical illness, poor mental health, or adverse changes in social supports or network size.

Neither job demands nor job control was associated with alcohol dependence in men or women. Most other studies of psychosocial work characteristics and alcohol, which have used measures of alcohol consumption rather than alcohol problems or alcohol dependence, have found no or little association between work characteristics and the amount of alcohol consumed. This is the first documented evidence of effort-reward imbalance at work as a risk factor for alcohol dependence in men, notes lead author, Jenny Head, of the University College of London.

The findings were based on analysis of alcohol dependence, measured with a standard alcohol questionnaire in 1991-1993, among British civil servants who participated in the Whitehall II study of London-based civil servants from 1985 to 1988. The researchers measured psychosocial work environment by self-report answers to questions regarding job demand, support, and control, as well as job effort and reward balance. Effort-reward imbalance at work was associated with alcohol dependence in men, after adjustment for employment grade and other baseline factors related to alcohol dependence (for example, limited social support). Men with high job demands or with low work social supports had a slightly reduced risk of alcohol dependence. The study was supported in part by the Agency for Healthcare Research and Quality (HS06516).

See "The psychosocial work environment and alcohol dependence: A prospective study," by Jenny Head, Stephen A. Stansfeld, and Johannes Siegrist, in Occupational and Environmental Medicine 61, pp. 219-224, 2004.

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