Ever since the classic Whitehall studies (Marmot et al., Reference Marmot1991), demonstrating the negative impact of work on mortality among British civil servants, there has been a plethora of studies demonstrating the role of work on modifying health outcomes. In brief, the results should have an inverse association between level (grade) of employment and mortality from coronary heart disease and a range of other causes resulting in men in the lowest grade having a three-fold higher mortality rate than those in the highest grades. Those in the lower level of employment also had higher prevalence of other risk factors such as smoking, obesity, and more baseline illness yet controlling for such factors accounted for 40% of the difference in mortality, resulting in an adjusted relative risk of 2.1 for CHD mortality compared to the highest levels. Besides these significant negative effects on physical health, increased attention has also been devoted to work factors as leading to occupational burnout along with associated negative mental health outcomes (Leiter et al., Reference Leiter, Bakker and Maslach2014). At times lost in these important findings are the protective effects that work can have on health, including in regard to mental health outcomes and cognitive function.
To facilitate the measurement and ascertainment of these factors in the current issue of International Psychogeriatrics, Hussenoeder et al. (Reference Hussenoeder, Conrad, Riedel-Heller and Rodriguez2020) present data on the development of a questionnaire to measure protective mental work demands. This questionnaire builds on their previous work on identifying, understanding, and categorizing workplace-related mental demands and their impact on cognitive function and dementia risk (Hussenoeder et al., Reference Hussenoeder, Riedel-Heller, Conrad and Rodriguez2019). Such work-related protective factors have been shown to be associated with lower risk of dementia (Then et al., Reference Then2017) and slower rate of cognitive decline after retirement (Fisher et al., Reference Fisher, Stachowski, Infurna, Faul, Grosch and Tetrick2014). While the previous work identified five categories of protective factors, the final structure of the proposed questionnaire coalesces around four categories of protective factors: mental workload, which is measured with three items; verbal demands, measured in four items; information load, assessed by six items; and extended job control, ascertained by six items. Mental workload, which previous studies had identified as protective against cognitive impairment, is broadly defined as a measure of work-related cognitive stimulation due to the complex work environment. Verbal demands are defined as the cognitive stimulation of work tasks that contribute to the accumulation of knowledge, facts, and verbal skills associated with four cognitive domains: language, learning, memory, and perceptual–motor skills. Information load, which correlates closely with verbal demands, seems to be an empirical validation of the concept of complexity in work with data and things, previously shown to be associated with better cognitive performance in later life. Finally, job control, defined as the extent to which one can use personal judgment or decision authority to assert control in the workplace, brings the discussion back to another classic finding from the Whitehall II study in which low job control was found to be associated with increased risk of future coronary heart disease (Bosma et al., Reference Bosma, Marmot, Hemingway, Nicholson, Brunner and Stansfeld1997). These four protective factors are measured with 19 items in Likert-scale format. The original questionnaire was developed in German and needs validation in English, with versions in either language available per request to the authors.
Understanding the role of work conditions both as risk factors and protective factors for health will inform the important debate about the future of work itself. The Future of Work Initiative priorities, organized by the CDC’s National Institute of Occupational Safety and Health in the USA, includes proposals on incoming changes on workplace, work, and workforce (Tamers et al., Reference Tamers2020) – and each category can benefit from better understanding potential protective mental work demands. Issues impacting the workplace include: organizational design, technological job displacement, and work arrangement – these will affect and influence information load and job control. Issues impacting work itself include artificial intelligence, robotics, and technologies – which in turn impact mental workload on workers. The workforce issues include demographic changes, economic security, and skills training and education, which deals with levels of verbal demands and information load. These important big themes in occupational health will be informed by the science of risk factors as well as protective factors identification and measurement.
The questionnaire developed by Hussenoeder and collaborators fills the important gap in the area of identification and measurement of such factors. Having such questionnaire will help researchers quantify the effects of such factors in mental health. Important work remains to be done in translating the questionnaire to other languages and settings and validating the scale longitudinally. Once in use, the questionnaire can offer valuable information to organize mentally healthier workplaces that protect cognitive function and minimize dementia risk among workers. This work is critical at a time of significant demographic changes including a multi-generational workforce and the emergence of a productive aging population – such trends are only compounded by the re-organization of the workplace triggered by the COVID-19 pandemic and the upcoming work of recovery ahead.
You have
Access
Ever since the classic Whitehall studies (Marmot et al., Reference Marmot1991), demonstrating the negative impact of work on mortality among British civil servants, there has been a plethora of studies demonstrating the role of work on modifying health outcomes. In brief, the results should have an inverse association between level (grade) of employment and mortality from coronary heart disease and a range of other causes resulting in men in the lowest grade having a three-fold higher mortality rate than those in the highest grades. Those in the lower level of employment also had higher prevalence of other risk factors such as smoking, obesity, and more baseline illness yet controlling for such factors accounted for 40% of the difference in mortality, resulting in an adjusted relative risk of 2.1 for CHD mortality compared to the highest levels. Besides these significant negative effects on physical health, increased attention has also been devoted to work factors as leading to occupational burnout along with associated negative mental health outcomes (Leiter et al., Reference Leiter, Bakker and Maslach2014). At times lost in these important findings are the protective effects that work can have on health, including in regard to mental health outcomes and cognitive function.
To facilitate the measurement and ascertainment of these factors in the current issue of International Psychogeriatrics, Hussenoeder et al. (Reference Hussenoeder, Conrad, Riedel-Heller and Rodriguez2020) present data on the development of a questionnaire to measure protective mental work demands. This questionnaire builds on their previous work on identifying, understanding, and categorizing workplace-related mental demands and their impact on cognitive function and dementia risk (Hussenoeder et al., Reference Hussenoeder, Riedel-Heller, Conrad and Rodriguez2019). Such work-related protective factors have been shown to be associated with lower risk of dementia (Then et al., Reference Then2017) and slower rate of cognitive decline after retirement (Fisher et al., Reference Fisher, Stachowski, Infurna, Faul, Grosch and Tetrick2014). While the previous work identified five categories of protective factors, the final structure of the proposed questionnaire coalesces around four categories of protective factors: mental workload, which is measured with three items; verbal demands, measured in four items; information load, assessed by six items; and extended job control, ascertained by six items. Mental workload, which previous studies had identified as protective against cognitive impairment, is broadly defined as a measure of work-related cognitive stimulation due to the complex work environment. Verbal demands are defined as the cognitive stimulation of work tasks that contribute to the accumulation of knowledge, facts, and verbal skills associated with four cognitive domains: language, learning, memory, and perceptual–motor skills. Information load, which correlates closely with verbal demands, seems to be an empirical validation of the concept of complexity in work with data and things, previously shown to be associated with better cognitive performance in later life. Finally, job control, defined as the extent to which one can use personal judgment or decision authority to assert control in the workplace, brings the discussion back to another classic finding from the Whitehall II study in which low job control was found to be associated with increased risk of future coronary heart disease (Bosma et al., Reference Bosma, Marmot, Hemingway, Nicholson, Brunner and Stansfeld1997). These four protective factors are measured with 19 items in Likert-scale format. The original questionnaire was developed in German and needs validation in English, with versions in either language available per request to the authors.
Understanding the role of work conditions both as risk factors and protective factors for health will inform the important debate about the future of work itself. The Future of Work Initiative priorities, organized by the CDC’s National Institute of Occupational Safety and Health in the USA, includes proposals on incoming changes on workplace, work, and workforce (Tamers et al., Reference Tamers2020) – and each category can benefit from better understanding potential protective mental work demands. Issues impacting the workplace include: organizational design, technological job displacement, and work arrangement – these will affect and influence information load and job control. Issues impacting work itself include artificial intelligence, robotics, and technologies – which in turn impact mental workload on workers. The workforce issues include demographic changes, economic security, and skills training and education, which deals with levels of verbal demands and information load. These important big themes in occupational health will be informed by the science of risk factors as well as protective factors identification and measurement.
The questionnaire developed by Hussenoeder and collaborators fills the important gap in the area of identification and measurement of such factors. Having such questionnaire will help researchers quantify the effects of such factors in mental health. Important work remains to be done in translating the questionnaire to other languages and settings and validating the scale longitudinally. Once in use, the questionnaire can offer valuable information to organize mentally healthier workplaces that protect cognitive function and minimize dementia risk among workers. This work is critical at a time of significant demographic changes including a multi-generational workforce and the emergence of a productive aging population – such trends are only compounded by the re-organization of the workplace triggered by the COVID-19 pandemic and the upcoming work of recovery ahead.