International Journal of Medical and Health Sciences€¦ · from a Delhi based R&D organization. 1120 employees were males and 323 were females.The mean age of employees ranged from

Int J Med Health Sci. April 2013,Vol-2;Issue-2 235

International Journal of Medical and Health Sciences

Journal Home Page: http://www.ijmhs.net ISSN:2277-4505

Psychosocial Predictors Of Coronary Risk Factors Among Employees In A

Government Organisation

Nishi Misra

1*, Arunima Gupta

2

1Scientist ‘E’, Defence Institute of Psychological Research,Lucknow Road, Timarpur, Delhi-110054.

2Scientist ‘F’, Defence Institute of Psychological Research,Lucknow Road, Timarpur, Delhi-110054.

ABSTRACT

Introduction: The link between body and mind is a very powerful one.Coronary artery disease (CAD) is no

exception. Research has linked several risk factors to cardiovascular disease which can be categorized as

physiological, behavioural and psychosocial. Aims:The study was carried out with aims to determine(i)

gender and age differences on psychosocial risk factors of CAD (ii) identify psychosocial predictors of bio-

behavioural risk factors (iii) Suggest preventive measures for at risk groups. Materials and Method:The

sample comprised 1443 employees from a Govt. organization (1120 males, 323 females).General health

questionnaire, stressful life events scale, work locus of control and social support scale were the tools used.

Results:Results revealed that male employees had significantly higher stress than females, employees in 25-

35 age group reported higher number of general health problems, had higher stress scores and lower social

support as compared to their counterparts, employees having a family history of CAD obtained higher stress

scores and low perceived social support as compared to their counterparts, body mass index>30 was

predicted by stressful life events and social support, low density lipoprotein was predicted by General

Health, triglycerides>200 was predicted by stressful life events, cholesterol>200 was predicted by stressful

life events, work locus of control and social support, known hypertension was predicted by general health

and social support. Conclusion: Need for individual handling of coronary risk prone cases on psychosocial

and bio-behavioural variables is suggested. Preventive measures for CAD risk-prone employees have been

proposed.

KEYWORDS: CAD, Bio-behavioural risk,Psychosocial risk.

INTRODUCTION

Coronary Artery Disease (CAD) is a condition in

which the blood vessels get blocked due to

deposition of cholesterol, affecting blood-supply

to the heart. According to the latest predictions,

CAD will be the number one killer in 2020,

causing 14.2% of all deaths [1] What is even more

distressing is the fact that the disease affects the

productive work force aged 35 to 65 years. Such

premature CAD can have devastating

consequences for an individual, the family and

society.

Framingham Heart Study in USA played a vital

role in defining the contribution of risk factors for

CAD occurrence in the general population [2].

The major risk factors found important were

cigarette smoking, hypertension, high serum

cholesterol, and various cholesterol fractions, low

Original article

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levels of high density lipoprotein cholesterol, and

diabetes mellitus.

Factors other than those termed as major risk

factors also contributing to CAD are obesity,

physical inactivity, family history of premature

CAD, hypertriglyceridaemia, small dense low

density lipoprotein (LDL) particles, increased

lipoprotein levels, and abnormalities in several

coagulation factors. Personal habits such as type

A behavior, cigarette smoking, lack of exercise

and dietary habits were also considered as risk

factors for CAD. Psychosocial factors that include

psychological factors and socio-economic status

are not listed in the Framingham risk factor list

but are important [3]. These include: poor social

support, low level of job control, lack of social

cohesion, hostility, anger and other negative

emotions, coping styles, depression, Type-A

behavior, lack of religious affiliations and job

stress and strain.

Researchers have found that jobs that combined a

high level of psychological demand with a low

level of self-esteem and autonomy were

associated with higher rates of heart disease [4]. A

study conducted in India for exploring the link

between stressful life events and subsequent

Myocardial Infarction (MI) showed that an MI

patient faced stresses twice as much as control

group [5].

The role of stressful life events in developing

stroke has shown that patients had a higher score

of stressful life events than controls.Mean score of

family problems was 11.2 for stroke patients

compared to 8.2 among control group patients.

51% of patients in case group had life changes

compared to 27.8% in control group [6]. It has

been found that symptomatic patients with Long

QT Syndrome (LQTS) had experienced more

stressful life events and vital exhaustion which

was more than three times higher among patients

with LQTS with arrhythmic events than in

asymptomatic LQTS mutation carriers[7].

Depression may predict initial disease onset [8]

and has also been found to complicate recovery

from cardiovascular events [9].

Social support is regarded as a preventive factor

for CAD. It has been conceptualized in terms of

two broad domains: functional and structural

support. Functional support describes the aid and

encouragement that is provided to the individual

by the social network. Structural support refers to

the characteristic of the network of people

surrounding an individual and his/her interaction

with this network.Individuals with higher social

support were less likely to smoke [10], more

likely to perform physical activity during leisure

time and had better adherence to medical

recommendations [11]. Social support has been

found to be associated with better regulation of

blood pressure and reduced cardiovascular

reactivity to acute stress [12].Patients with

unrecognized acute myocardial infarction scored

higher on the chance LOC than patients with

diagnosed Acute Myocardial Infarction

(AMI)[13]. Patients who were rated as internals

were more co-operative and less depressed than

were externals throughout their stay in the

intensive care unit [14].

The present study was conducted with the aims:To

determine gender and age differences on

psychosocial risk factors of CAD,identify

psychosocial risk predictors in CAD prone people

and suggest preventive measures for at-risk

groups. It was hypothesized that (i) there will be

gender and age differences on psychosocial risk

factors of CAD, (ii) Employees with family

history of CAD will have poor general health, will

score high on stress, low on social support and

(iii) bio-behavioural risk factors of CAD will be

predicted by psychosocial risk factors.

MATERIALS AND METHODS

Sample: The sample comprised 1443 employees

from a Delhi based R&D organization. 1120

employees were males and 323 were females.The

mean age of employees ranged from 25 to 55

years.

Tools

1.General Health Questionnaire-12[15]:The

General Health Questionnaire (GHQ) is a measure

of current mental health. The scale asked whether

the respondent had experienced a particular

symptom or behavior recently. Each item was

rated on a four-point scale giving a total score

ranging from 0 to 36. A score of 16 or below on

the GHQ meant low level of risk, scores from 20

to 26 meant average level of risk, and scores

ranging from 27 and above meant high level of

risk.


2.The Social Readjustment Rating Scale[16]:The

numbers of "Life Change Units" that apply to

events in the past year of an individual's life were

added and the final score gave a rough estimate of

how stress affected health. Scores on this scale

ranged from 11 to 1246. If scores were less than

150, it denoted slight risk of illness(30% chance),

if scores ranged from 150 to 299 it meant

moderate risk of illness (50% chance)and scores

above 300 meant high risk of illness (80%

chance).

3.Social Support Scale (adapted from

Multidimensional Scale of Perceived Social

Support [17].The scale had eight items.

Employees were asked to rate on a six point rating

scale, ranging from 0 to 5 (0= not available, 5=

extremely helpful), how helpful had been his/her

parents, relatives, partner/spouse, friends,

neighbours, superiors, co-workers and

subordinates. Scores on this scale ranged from 0

to 40.

4.Work Locus of Control [18].The shorter version

of the scale having eight items, both internally and

externally worded was used. Scores on the scale

ranged from 8 to 48. Each item had a score from 1

to 6. High scores on the scale represented

externality. Responses to the items were

numbered from 1 representing strongest

disagreement to 6 representing strongest

agreement with each.

Procedure

A note explaining the objective of the study

inviting names of volunteers who were willing to

participate in the study was circulated. The

workplace was visited by the medical experts

along with their team of technical experts. The

volunteers were required to sign an informed

consent after reading in detail the purpose of the

study. They were thereafter required to fill up a

pro forma containing their personal information in

the form of socio-demographic details followed

by details of physical activity, smoking history,

diet, menstrual history (in case of female

employees), medication taken, history of past

illness, family history of illness, occupational

history and the like.

The employees were thereafter subjected to

routine physical/ medical examination e.g. blood

pressure, pulse, blood and urine investigations.

Once the testing for sugar fasting was being done,

they were told to utilize the time in filling up the

general health questionnaire, stressful life events

scale, work locus of control scale and social

support scale. The data gathered were scored

quantitatively and Statistical Package for Social

Sciences (SPSS) (version 16) package was

utilized for statistical analysis of data and t-test

and logistic regression were computed.

RESULTS

Table 1 reveals that males and females did not

differ significantly on any of the psychosocial risk

factors of CAD except on stressful life events

wherein females reported significantly lesser

number of stressful life events as compared to

males. Table 2a reveals that the general health

scores of younger age-group (25-35 years) were

significantly poor as compared to the older age

group (36-45 years). The younger age group also

reported as receiving significantly lesser social

support as compared to their counterparts. Table

2b shows that the younger age group reported

poor general health and more number of stressful

life events as compared to the employees falling

in 46-55 years group.

Table 3 depicts that employees having a family

history of CAD reported more number of stressful

life events and lesser social support as compared

to employees without a family history of CAD.

Logistic Regression analysis was carried out for

determining the significant predictors of bio-

behavioural risk factors. Table 4 showing logistic

regression reveals that smoking and BP>140/90

was not significantly predicted by any

psychosocial variable.


Table 1: Gender differences on Psychosocial Risk

PS Risk Gender N Mean S.D. df t

GHQ

Male 1157 19.25 5.23

1489 1.42

Female 334 19.70 4.72

SLE

Male 996 125.87 102.38

1293 2.51**

Female 299 109.43 89.02

WLOC

Male 1132 24.50 24.50

1451 1.78

Female 321 23.46 23.46

SS

Male 1138 27.90 27.90

1464 .43

Female 328 28.15 28.15

PS Risk= Psycho Social Risk, GHQ=General Health Questionnaire, SLE=Stressful Life Events, WLOC=Work Locus of Control,

SS=Social Support, ** Significant at 0.01 level

Table 2a : Age Differences on Psychosocial Risk

PS Risk Age Group N Mean SD t

GHQ 1 402 19.85 4.18

2.18* 2 351 19.09 5.34

SLES 1 361 132.33 90.48

1.33 2 300 121.57 116.70

WLOC 1 395 24.69 8.16

.408 2 342 24.95 8.89

SS

1 398 27.04 8.42

3.49** 2 341 29.35 9.57

PS Risk = Psycho Social Risk, GHQ=General Health Questionnaire, SLE=Stressful Life Events, WLOC=Work Locus of Control,

SS=Social Support, Age-group 1= 25-35 years, Age-group 2=36-45 years, *Significant at 0.05 level, **Significant at 0.01 level


Table 2b: Age Differences on Psychosocial Risk

PS Risk Age Group N Mean SD t

GHQ 1 402 19.85 4.18

1.93* 3 762 19.24 5.50

SLES

1 361 132.33 90.48

2.45**

3 653 117.14 96.63

WLOC

1 395 24.69 8.16

1.64 3 740 23.75 9.75

SS 1 398 27.04 8.42

1.54 3 752 27.89 9.27


SS=Social Support, Age-group 1= 25-35 years, Age-group 3=46 years and above, *significant at 0.05 level, **significant at 0.01

level

Table 3: Family History of CAD & Psychosocial Risk

PS Risk Family

History N Mean SD df t

GHQ No 994 19.88 4.81

1155 0.307 Yes 163 19.76 4.21

SLES No 994 125.73 95.66

1155 3.28** Yes 163 152.96 112.30

WLOC No 988 24.69 8.58

1148 1.85 Yes 162 23.35 8.50

SS No 989 28.95 8.44

1149 1.95* Yes 162 27.54 8.84


SS=Social Support, *significant at 0.05 level, ** significant at 0.01 level


Table 4: Psychosocial Predictors of Smoking & BP>140/90

Independent

Variable

Dependent

Variable Sig Wald β χ2 Sig

GHQ

Smoking

0.838 0.042 0.003

0.118 0.998 SLES 0.992 0.000 0.000

WLOC 0.981 0.001 0.000

SS 0.771 0.085 -.003

GHQ

BP>140/90

0.216 1.53 -.02

7.062 0.133

SLES 0.100 2.70 -.001

WLOC 0.271 1.21 -.010

SS 0.589 0.29 -.005

BP=Blood Pressure, GHQ=General Health Questionnaire, SLE=Stressful Life Events, WLOC=Work Locus of Control, SS=Social

Support.

Table 5 shows that BMI>30 was best predicted by

stressful life events and social support, whereas

LDL>160 was significantly predicted by general

health. Sugar PP>200 was not predicted by any of

the variable whereas triglycerides>200 was

significantly predicted by stressful life events as

shown in table 6.

Cholesterol>200 was significantly predicted by

stressful life events, work locus of control and

social support and known hypertension was

significantly predicted by general health and

social support as revealed in Table 7. Table 8

reveals that known diabetes mellitus was not

significantly predicted by any of the psychosocial

variable.


Table 5: Psychosocial Predictors of BMI>30 and LDL>160

GHQ=General Health Questionnaire, SLE=Stressful Life Events, WLOC=Work Locus of Control, SS=Social Support,

BMI=Body Mass Index, LDL=Low Density Lipoprotein, *Significant at 0.05 level,** Significant at 0.01 level.

Table 6: Psychosocial Predictors of Sugar PP>200 & Triglycerides>200

Independent

Variable

Dependent


GHQ

Sugar PP>200

-0.908 0.013 0.003

2.86 0.58 SLES 0.430 0.623 0.001

WLOC 0.211 1.564 -.015

SS 0.566 0.330 -.007

GHQ

Trig>200

0.099 2.72 0.026

11.09 0.026*

SLES 0.020* 5.38 -.002

WLOC 0.349 0.88 -.008

SS 0.244 1.36 0.010

Sugar PP=Sugar Post Palatum, Trig.= Triglycerides, GHQ=General Health Questionnaire, SLE=Stressful Life Events,

WLOC=Work Locus of Control, SS=Social Support,* Significant at 0.05 level.

Independent

Variable

Dependent


GHQ

BMI>30

0.175 1.84 -0.027

11.57 0.021*

SLES 0.032* 4.59 -0.002

WLOC 0.477 0.50 -0.008

SS 0.055* 3.68 0.021

GHQ

LDL>160

0.002** 9.84 0.075

13.11 0.011*

SLES 0.137 2.22 -.002

WLOC 0.760 0.093 -.004

SS 0.351 0.87 0.013


Table 7: Psychosocial Predictors of Cholesterol>200 & Known Hypertension

Independent

Variable

Dependent


GHQ

Chol>200

0.381 0.766 0.012

25.95 0.000** SLES 0.003** 9.11 -.002

WLOC 0.005** 7.93 -.020

SS 0.007** 7.32 0.020

GHQ

Known

Hypertension

0.015** 5.87 -.059

17.49 0.002**

SLES 0.710 0.14 0.000

WLOC 0.169 1.89 0.020

SS 0.002** 9.40 -.040

Chol.= Cholesterol, GHQ=General Health Questionnaire, SLE=Stressful Life Events, WLOC=Work Locus of Control, SS=Social

Support,** Significant at 0.01 level

Table 8: Psychosocial Predictors of Diabetes Mellitus

Independent

Variable

Dependent

Variable Sig Wald B X2 Sig

GHQ

Known DM

0.119 2.433 -.057

5.49 0.24

SLES 0.492 0.472 0.001

WLOC 0.784 0.075 0.006

SS 0.177 1.824 -.027

DM=Diabetes Mellitus, GHQ=General Health Questionnaire, SLE=Stressful Life Events, WLOC=Work Locus of Control,

SS=Social Support.


DISCUSSION

-

-

revealed we

8 revealed hat

predicted

b

-

wa

as

es

.

.

Triglycerides>200 were predicted by

stressful life events, although in contrary

direction.

.


• Dichotomous scores on bio-behavioural

variables were provided. The exact values

on variables such as blood pressure,

cholesterol level etc. would have yielded

better results.

• There was high variability of scores on

stressful life events of employees which

could have vitiated the results.

• Use of self-report measures was possible

in the study as it covered a large

population of employees.

• Limited controlled testing conditions were

possible in the study because of its nature.

• Employees’ emotive responses to stress,

i.e., their subjective response in addition to

objective responses could have helped in

better evaluation of results.

Suggested Intervention for CAD Risk

Group

• Once a case is identified with high risk for

CAD, individual handling of identified

case is needed on psychosocial and bio-

behavioural variables

• Detailed psycho social profiling of

diagnosed CAD cases and high risk group

is needed for providing any therapeutic

care.

• Psychosocial Intervention in the form of

psycho-education about CAD and its

possible causes and consequences

followed by behavioural management

which involves teaching of relaxation and

meditation techniques is essential for at

risk group.

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__________________________________________

*Corresponding author: Dr. Nishi Misra

Email: [email protected]

mailto:[email protected]

Documents

International Journal of Medical and Health Sciences€¦ · from a Delhi based R&D organization. 1120 employees were males and 323 were females.The mean age of employees ranged from