Environmental and individual correlates of distress: Testing Karasek's Demand-Control model in 99 primary care clinical environments

Justin Presseau, Marie Johnston, Derek W. Johnston, Marko Elovainio, Susan Hrisos, Nick Steen, Elaine Stamp, Jill J. Francis, Jeremy M. Grimshaw, Gillian Hawthorne, Margaret Hunter, Martin P. Eccles

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objectives

Karasek's job demand-control model postulates that demand, control, and distress are environmental rather than individual features although these levels are often confounded. The objective was to investigate whether job demand, control, and demandxcontrol predict environmental and individual distress in primary care clinicians, and the mediating role of distress in the relationships between demand and control with intention to leave and absenteeism.

Design

Predictive national survey.

Methods

We invited 2,079 staff from 99 general practices in the United Kingdom (843 GPs and nurses, 1,236 administrators) to complete postal questionnaires assessing distress, intention to leave, absenteeism, job demand, and control. Random intercept multilevel models and bootstrapped mediation models were run to test the study hypotheses.

Results

One thousand five hundred and ninety staff completed questionnaires (77% staff-level response rate; complete responses by >= 80% of all workers in 68 work environments). There was evidence of environmental variation between practices in intention to leave, absenteeism, job demand, and control, but not distress. Job demand and control both significantly predicted distress, and control moderated the relationship between demand and distress with the effects of demand being reduced at low levels by high control. A small indirect effect via distress was observed for the relationship between job demand and absenteeism, and between job control and intention to leave. No support was found for environmental effects of work settings on distress, but there was evidence of individual-level effects.

Conclusions

There is a need for considering environmental and individual levels and a danger of generalizing conclusions from one level to the other.

Statement of contribution

What is already known on this subject?

Karasek's job demand-control model shows consistent prediction of distress in health professionals.

Environmental and individual features of distress, demand, and control are often confounded.

What does this study add?

Nationally representative UK survey of doctors, nurses, and admin primary care staff.

Test individual and environment effect of demand and control on distress, absenteeism, leaving intention.

Indirect effect of demand on absenteeism via distress and of control on intention to leave via distress.

Original languageEnglish
Pages (from-to)292-310
Number of pages19
JournalBritish Journal of Health Psychology
Volume19
Issue number2
Early online date15 Oct 2013
DOIs
Publication statusPublished - May 2014

Keywords

  • intention to leave
  • environment
  • primary care
  • absenteeism
  • control
  • demand
  • distress
  • sickness absence
  • multilevel analysis
  • job-satisfaction
  • work-environment
  • mental-health
  • stress
  • nurses
  • level
  • leave
  • strain

Cite this

Environmental and individual correlates of distress : Testing Karasek's Demand-Control model in 99 primary care clinical environments. / Presseau, Justin; Johnston, Marie; Johnston, Derek W.; Elovainio, Marko; Hrisos, Susan; Steen, Nick; Stamp, Elaine; Francis, Jill J.; Grimshaw, Jeremy M.; Hawthorne, Gillian; Hunter, Margaret; Eccles, Martin P.

In: British Journal of Health Psychology, Vol. 19, No. 2, 05.2014, p. 292-310.

Research output: Contribution to journalArticle

Presseau, J, Johnston, M, Johnston, DW, Elovainio, M, Hrisos, S, Steen, N, Stamp, E, Francis, JJ, Grimshaw, JM, Hawthorne, G, Hunter, M & Eccles, MP 2014, 'Environmental and individual correlates of distress: Testing Karasek's Demand-Control model in 99 primary care clinical environments' British Journal of Health Psychology, vol. 19, no. 2, pp. 292-310. https://doi.org/10.1111/bjhp.12073
Presseau, Justin ; Johnston, Marie ; Johnston, Derek W. ; Elovainio, Marko ; Hrisos, Susan ; Steen, Nick ; Stamp, Elaine ; Francis, Jill J. ; Grimshaw, Jeremy M. ; Hawthorne, Gillian ; Hunter, Margaret ; Eccles, Martin P. / Environmental and individual correlates of distress : Testing Karasek's Demand-Control model in 99 primary care clinical environments. In: British Journal of Health Psychology. 2014 ; Vol. 19, No. 2. pp. 292-310.
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abstract = "ObjectivesKarasek's job demand-control model postulates that demand, control, and distress are environmental rather than individual features although these levels are often confounded. The objective was to investigate whether job demand, control, and demandxcontrol predict environmental and individual distress in primary care clinicians, and the mediating role of distress in the relationships between demand and control with intention to leave and absenteeism.DesignPredictive national survey.MethodsWe invited 2,079 staff from 99 general practices in the United Kingdom (843 GPs and nurses, 1,236 administrators) to complete postal questionnaires assessing distress, intention to leave, absenteeism, job demand, and control. Random intercept multilevel models and bootstrapped mediation models were run to test the study hypotheses.ResultsOne thousand five hundred and ninety staff completed questionnaires (77{\%} staff-level response rate; complete responses by >= 80{\%} of all workers in 68 work environments). There was evidence of environmental variation between practices in intention to leave, absenteeism, job demand, and control, but not distress. Job demand and control both significantly predicted distress, and control moderated the relationship between demand and distress with the effects of demand being reduced at low levels by high control. A small indirect effect via distress was observed for the relationship between job demand and absenteeism, and between job control and intention to leave. No support was found for environmental effects of work settings on distress, but there was evidence of individual-level effects.ConclusionsThere is a need for considering environmental and individual levels and a danger of generalizing conclusions from one level to the other.Statement of contributionWhat is already known on this subject?Karasek's job demand-control model shows consistent prediction of distress in health professionals.Environmental and individual features of distress, demand, and control are often confounded.What does this study add?Nationally representative UK survey of doctors, nurses, and admin primary care staff.Test individual and environment effect of demand and control on distress, absenteeism, leaving intention.Indirect effect of demand on absenteeism via distress and of control on intention to leave via distress.",
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T2 - Testing Karasek's Demand-Control model in 99 primary care clinical environments

AU - Presseau, Justin

AU - Johnston, Marie

AU - Johnston, Derek W.

AU - Elovainio, Marko

AU - Hrisos, Susan

AU - Steen, Nick

AU - Stamp, Elaine

AU - Francis, Jill J.

AU - Grimshaw, Jeremy M.

AU - Hawthorne, Gillian

AU - Hunter, Margaret

AU - Eccles, Martin P.

N1 - Funded by Diabetes UK

PY - 2014/5

Y1 - 2014/5

N2 - ObjectivesKarasek's job demand-control model postulates that demand, control, and distress are environmental rather than individual features although these levels are often confounded. The objective was to investigate whether job demand, control, and demandxcontrol predict environmental and individual distress in primary care clinicians, and the mediating role of distress in the relationships between demand and control with intention to leave and absenteeism.DesignPredictive national survey.MethodsWe invited 2,079 staff from 99 general practices in the United Kingdom (843 GPs and nurses, 1,236 administrators) to complete postal questionnaires assessing distress, intention to leave, absenteeism, job demand, and control. Random intercept multilevel models and bootstrapped mediation models were run to test the study hypotheses.ResultsOne thousand five hundred and ninety staff completed questionnaires (77% staff-level response rate; complete responses by >= 80% of all workers in 68 work environments). There was evidence of environmental variation between practices in intention to leave, absenteeism, job demand, and control, but not distress. Job demand and control both significantly predicted distress, and control moderated the relationship between demand and distress with the effects of demand being reduced at low levels by high control. A small indirect effect via distress was observed for the relationship between job demand and absenteeism, and between job control and intention to leave. No support was found for environmental effects of work settings on distress, but there was evidence of individual-level effects.ConclusionsThere is a need for considering environmental and individual levels and a danger of generalizing conclusions from one level to the other.Statement of contributionWhat is already known on this subject?Karasek's job demand-control model shows consistent prediction of distress in health professionals.Environmental and individual features of distress, demand, and control are often confounded.What does this study add?Nationally representative UK survey of doctors, nurses, and admin primary care staff.Test individual and environment effect of demand and control on distress, absenteeism, leaving intention.Indirect effect of demand on absenteeism via distress and of control on intention to leave via distress.

AB - ObjectivesKarasek's job demand-control model postulates that demand, control, and distress are environmental rather than individual features although these levels are often confounded. The objective was to investigate whether job demand, control, and demandxcontrol predict environmental and individual distress in primary care clinicians, and the mediating role of distress in the relationships between demand and control with intention to leave and absenteeism.DesignPredictive national survey.MethodsWe invited 2,079 staff from 99 general practices in the United Kingdom (843 GPs and nurses, 1,236 administrators) to complete postal questionnaires assessing distress, intention to leave, absenteeism, job demand, and control. Random intercept multilevel models and bootstrapped mediation models were run to test the study hypotheses.ResultsOne thousand five hundred and ninety staff completed questionnaires (77% staff-level response rate; complete responses by >= 80% of all workers in 68 work environments). There was evidence of environmental variation between practices in intention to leave, absenteeism, job demand, and control, but not distress. Job demand and control both significantly predicted distress, and control moderated the relationship between demand and distress with the effects of demand being reduced at low levels by high control. A small indirect effect via distress was observed for the relationship between job demand and absenteeism, and between job control and intention to leave. No support was found for environmental effects of work settings on distress, but there was evidence of individual-level effects.ConclusionsThere is a need for considering environmental and individual levels and a danger of generalizing conclusions from one level to the other.Statement of contributionWhat is already known on this subject?Karasek's job demand-control model shows consistent prediction of distress in health professionals.Environmental and individual features of distress, demand, and control are often confounded.What does this study add?Nationally representative UK survey of doctors, nurses, and admin primary care staff.Test individual and environment effect of demand and control on distress, absenteeism, leaving intention.Indirect effect of demand on absenteeism via distress and of control on intention to leave via distress.

KW - intention to leave

KW - environment

KW - primary care

KW - absenteeism

KW - control

KW - demand

KW - distress

KW - sickness absence

KW - multilevel analysis

KW - job-satisfaction

KW - work-environment

KW - mental-health

KW - stress

KW - nurses

KW - level

KW - leave

KW - strain

U2 - 10.1111/bjhp.12073

DO - 10.1111/bjhp.12073

M3 - Article

VL - 19

SP - 292

EP - 310

JO - British Journal of Health Psychology

JF - British Journal of Health Psychology

SN - 1359-107X

IS - 2

ER -