Association between psychosocial work characteristics and health functioning in American women: prospective study.

OBJECTIVE To examine prospectively the relation between psychosocial work characteristics and changes in health related quality of life over four years in a cohort of working women in the United States. DESIGN Longitudinal cohort study. SETTING United States. PARTICIPANTS 21 290 female registered nurses who completed the Karasek's job content questionnaire and a modified version of the short form 36 questionnaire (SF-36) as used for a survey of health status by the medical outcomes study. MAIN OUTCOME MEASURES Seven dimensions of health status: physical functioning, role limitations due to physical health problems, bodily pain, vitality, social functioning, role limitations due to emotional problems, and mental health. RESULTS Examined separately low job control, high job demands, and low work related social support were associated with poor health status at baseline as well as greater functional declines over the four year follow up period. Examined in combination, women with low job control, high job demands, and low work related social support ("iso-strain" jobs) had the greatest functional declines. These associations could not be explained by age, body mass index, comorbid disease status, alcohol consumption, smoking status, education level, exercise level, employment status, marital status, or presence of a confidant. CONCLUSIONS Adverse psychosocial work conditions are important predictors of poor functional status and its decline over time.