Friday, July 25, 1997

Study: feeling out of control at work is deadly

By ROBERT BARR

Associated Press

LONDON (AP) - While you daydream about strangling your boss, beware: It's more likely that your employer is killing you.

A study of British civil servants suggests that a feeling of little or no control at work explains why the Dagwoods and Dilberts of the world have the greater risk of heart disease - 50 percent higher than the people in the executive suite.

The study published in The Lancet, a British medical journal, was directed by Professor Michael Marmot of the International Center for Health and Society at University College, London. It used data from a study of 7,372 men and women employed in the British civil service, tracked from 1985 to 1993.

"The issue of control I think is a relatively new idea but certainly one that makes a lot of sense," commented Dr. Robert Carney, professor of medical physiology at Washington University in St. Louis.

Asked if bosses are a big source of job stress, Carney said: "Oh, absolutely."

A study of British bureaucrats started in the 1960s found that those in low-status jobs had a significantly larger risk of heart disease. In general, their health was worse and they died sooner; they were more likely to smoke and less likely to exercise.

In this study, Marmot's team looked at the effect of smoking, inactivity, high blood pressure and the feeling of loss of control.

When they adjusted to discount the effect of feeling out of control, the increased risk of heart disease among low-status workers dropped to just 18 percent - making that the largest single risk factor identified in the study.

The feeling of low control was reported by 8.7 percent of the men and 10.1 percent of the women at the highest grades of civil servants, while at the lowest grades the figures shot up to 77.9 percent for men and 75.3 percent of women.

"Low control, but not high demand, at work is associated with increased incidence of (heart disease) independently of measures of socioeconomic status, and ... low control is associated with higher plasma fibrinogen concentrations," the study concluded.

Elevated levels of fibrinogen, a protein that binds blood cells together to form clots, could increase the risk of a heart attack.

Carney said stress hormones can trigger higher levels of fibrinogen. They also can raise the pulse, and make the heart less flexible in responding to changing demand.

If the higher risk of heart disease was simply a product of low social and economic status, there are few remedies "short of a revolution," commented Leonard Syme and Jennifer Balfour of the School of Public Health at the University of California, Berkeley.

However, they wrote in a separate report in The Lancet, "there are more opportunities to intervene on control."

"For example, if by control we mean learning to deal with the forces that impinge on people's lives, it is possible to help people to do that more effectively."

Eric Brunner, a research fellow at University College who worked with Marmot on the study, said the villain is more likely to be a rigid organization than a single tyrannical boss.

"It would be foolish always to blame the organization, but the organization has to provide a framework for people who do have problems, maybe even to help them into other jobs," Brunner said in a telephone interview.

Carney said he urges his own patients "to take as much control over your life as possible." Stand up to the boss, perhaps, or get another job.

And spare a thought for the boss.

"It can happen to bosses as well as people in the lower echelons," Carney said. "If you feel you don't have options, it can be a very stressful."