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Keywords:

  • Arthritis;
  • Employment;
  • Job strain;
  • Job stress;
  • Disability;
  • Occupational stress

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. PARTICIPANTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES
  10. APPENDIX A

Objective

To develop a measure of job strain related to differing aspects of working with arthritis and to examine the demographic, illness, work context, and psychosocial variables associated with it.

Methods

Study participants were 292 employed individuals with osteoarthritis or inflammatory arthritis. Participants were from wave 3 of a 4-wave longitudinal study examining coping and adaptation efforts used to remain employed. Participants completed an interview-administered structured questionnaire, including a Chronic Illness Job Strain Scale (CIJSS) and questions on demographic (e.g., age, sex), illness and disability (e.g., disease type, pain, activity limitations), work context (e.g., job type, job control), and psychosocial variables (e.g., arthritis-work spillover, coworker/managerial support, job perceptions). Principal component analysis and multiple linear regression were used to analyze the data.

Results

A single factor solution emerged for the CIJSS. The scale had an internal reliability of 0.95. Greater job strain was reported for future uncertainty, balancing multiple roles, and difficulties accepting the disease than for current workplace conditions. Participants with inflammatory arthritis, more frequent severe pain, greater workplace activity limitations, fewer hours of work, less coworker support, and greater arthritis-work spillover reported greater job strain.

Conclusion

The findings underscore the diverse areas that contribute to perceptions of job strain and suggest that existing models of job strain do not adequately capture the stress experienced by individuals working with chronic illnesses or the factors associated with job strain. Measures similar to the CIJSS can enhance the tools researchers and clinicians have available to examine the impact of arthritis in individuals' lives.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. PARTICIPANTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES
  10. APPENDIX A

Numerous employment studies have found that adverse physical and psychosocial work conditions are related to the health of workers, including increased risk of cardiovascular disease, hypertension, musculoskeletal pain, and depression (1–7). To better understand these findings, researchers have focused on job stress, often drawing conceptual distinctions between job stressors and job strains (8, 9). Job stressors are aspects of the job and the work environment that can cause difficulties for people. They include the content of work, relationships with coworkers, and temporal aspects of work. Job strains reflect the person's appraisal of the working environment as stressful. Both job stressors and job strains are considered important contributors to subsequent health and the ability to remain employed (8, 9).

Currently, much of the research on arthritis and employment has focused on potential job stressors that relate to giving up employment. These include physically demanding work, the pace of work, lack of control over work scheduling, and relationships with others (10–19). Illness-related variables have also been examined for their contribution to work disability, including pain, disease duration, functional limitations, joint counts, and erythrocyte sedimentation rates (11, 12, 14, 15, 17–23). Largely absent from arthritis research, however, are individuals' perceptions of job strain (24, 25).

Chronic illnesses such as arthritis may contribute to perceptions of job strain in several ways. Similar to other workplace studies, the demands of work and the absence of workplace support may be associated with higher perceived strain (26, 27). But arthritis may also contribute to perceptions of strain in unique ways not examined in general workplace studies. For example, managing chronic pain, fatigue, and activity limitations at work can be difficult and perceived as stressful for many individuals. Uncertainty and unpredictability of symptoms have also been identified in arthritis research as stressful (28–31). Although rarely examined at work, uncertainty around managing a chronic illness may result in feelings of strain both in dealing with current job demands and in concerns for the future sustainability of employment (13, 32, 33). Working with arthritis might also be perceived as stressful because symptoms are often invisible to others who do not know that a person has a chronic illness or, if they are aware of arthritis, do not know how the person is feeling from day to day (34, 35). As a result, persons with arthritis must decide whether or not to disclose their condition. Strain may also result if interpersonal dynamics change as a result of arthritis-related job modifications (32, 36).

In this report we present a measure of job strain, the content of which examines perceived stress from various sources to learn what aspects of employment are viewed as stressful. Areas examined include symptoms of arthritis at work, work demands and the pace or schedule of work, utilizing training, symptom uncertainty, interpersonal strain, resources to manage arthritis, and future worries such as remaining employed, finances, and balancing multiple roles. We also examined the relationship of job strain with demographic, work context, illness, and psychosocial factors. Existing workplace studies have primarily focused on the role of work context variables, such as hours of work and type of job, in understanding job strain. Drawing on arthritis research, we expected that working with arthritis would create unique sources of strain associated not only with work context variables, but also with illness-related and psychosocial perceptions.

To examine the relationship between job strain and other factors, we included work context factors such as job field, employment status, hours of work, availability of drug and health benefits, and activity limitations at work. We also included individuals' perceptions of their jobs (e.g., job variety, opportunities for new learning), perceived support from supervisors and coworkers, and whether individuals report control over their work schedule. A greater number of work hours, more physically demanding work, more workplace activity limitations, less workplace support, less work schedule control, absence of benefits, and poorer job perceptions were expected to be associated with greater perceived strain. The relationship of age and sex with perceiving work as stressful was also examined. Some research has found that younger adults report more difficulty balancing multiple roles than older adults (37). Results for sex and job strain are mixed (38–40). Illness-related variables were also expected to be associated with strain. Persons with inflammatory arthritis (IA) were expected to report greater job strain than those with osteoarthritis (OA), as were those with more joints affected and greater fatigue and pain. Finally, individuals' appraisals of their disease have been found to be important to health and well-being in a number of studies (37, 41, 42). In the case of arthritis, individuals sometimes perceive spillover such that the demands of work interfere with taking good care of their health and arthritis symptoms and limitations interfere with work demands (37). As a result, greater perceptions of spillover should be associated with more job strain.

PARTICIPANTS AND METHODS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. PARTICIPANTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES
  10. APPENDIX A

Participants.

Respondents were employed individuals with IA or OA residing in southwestern Ontario, Canada. Respondents were interviewed at 18-month intervals as part of a longitudinal study examining coping and adaptation efforts that individuals with arthritis use to remain employed (32). Information on job strain was collected at wave 3 of the 4-wave study. To ensure that a wide range of occupations were assessed and that individuals receiving fewer health care services were not systematically excluded from the study, the sample was purposive. Participants were recruited largely from community newspaper advertisements with additional respondents coming from rheumatology and rehabilitation clinics and The Arthritis Society, Ontario Division. Eligibility criteria were as follows: a physician diagnosis of IA or OA, arthritis duration of at least 1 year, paid employment, no comorbid conditions causing physical disability, and fluency in English (13). Eligibility criteria remained the same at all waves except that individuals who left paid employment were retained in the study. Waves 1 and 2 included 491 and 413 participants, respectively. At wave 3, 292 participants were working and were included in the analyses. An additional 80 individuals were interviewed but were excluded from the analyses because they were not currently employed.

Procedure.

At wave 3, an in-depth structured questionnaire was administered to participants at home or at a location of their choice and lasted, on average, 2 hours. The questionnaires consisted of existing measures and items developed for this study. Interviewers completed a detailed, standardized training session supplemented by regular meetings. Questionnaires were monitored for data quality. Ethics approval for the study was received and informed, written consent was obtained from all participants at all waves of data collection.

Chronic Illness Job Strain Scale.

For the Chronic Illness Job Strain Scale (CIJSS), 17 job strain questions were created. Content validity was addressed by including the major concepts discussed in existing workplace studies identified from MedLine and PsychInfo databases, and with the insight of individuals living with arthritis. Specifically, at wave 2, participants were asked, “Considering everything how stressful is your present job?” Responses were on a 5-point scale (where 1 = not at all stressful and 5 = extremely stressful). An open-ended question then asked for additional comments. The first author used content analysis to code responses, dividing the responses into separate themes or constructs (43). A second member of the research team independently reviewed and verified the themes (our thanks to Dr. Jennifer Boyle). Themes included perceived stress associated with working with arthritis symptoms, disease uncertainty, work scheduling, arthritis-related absences, utilizing training, interpersonal relationships, future worries, remaining employed, and balancing multiple roles (Appendix A). Responses were on a 5-point Likert-type scale (where 1 = not at all stressful and 5 = extremely stressful).

Other measures.

Demographics.

Data on participants' age, sex, marital status, and education were collected.

Arthritis type and duration.

Respondents provided the type(s) of arthritis diagnosed by their physician and time since diagnosis. Arthritis type was coded in 3 categories: IA (rheumatoid arthritis, psoriatic arthritis), OA, or both IA and OA. In cases of multiple diagnoses, the longest duration was used.

Symptom severity.

Pain and fatigue were measured over the preceding month. Our pilot and ongoing research suggested that the frequency of severe pain was more relevant to persons working with arthritis than pain severity alone without reference to its timing (31, 37). Therefore, pain was assessed with the question, “How often did you have severe pain from your arthritis?” and fatigue was assessed with the question, “How often have you felt fatigue as a result of your arthritis?” Responses were on a 5-point Likert-type scale (where 1 = no days, 2 = a few days, 3 = some days, 4 = most days, and 5 = all days).

Joints affected.

A homunculus displaying major joints affected by arthritis was used to calculate the total number of joints affected (44).

Workplace Activity Limitations Scale.

For the Workplace Activity Limitations Scale (WALS), 12 items gauged arthritis-related activity limitations in the workplace (13, 32). Instructions asked participants to indicate their level of difficulty with activities “without any help from another person or without the help of a special gadget or piece of equipment” in order to separate activity limitations from coping efforts. Items assessed getting to, from, and around the workplace; sitting and standing for long periods; lifting; working with one's hands; crouching, bending, kneeling, and reaching; the schedule, hours, and pace of work; concentration; and meeting current job demands. Responses were on a 4-point Likert-type scale (where 0 = no difficulty, 1 = some difficulty, 2 = a lot of difficulty, and 3 = not able to do). Participants indicating that an activity was not applicable to their job were assigned a score of 0 (no difficulty) for that activity. Responses across the 12 items were summed for a total score. Reliability of the WALS using Cronbach's alpha was 0.81 at wave 3.

Occupation.

Occupation was classified using the Human Resources Development Canada National Occupation Classification Matrix 2001 (45). For these analyses, occupations were collapsed into 4 groups: business, finance, and administration; health, science, art, and sport; sales and service; and trades, transportation, and equipment operation.

Hours of work, employment status, drug benefits, workplace control.

Number of hours worked in an average week and full- or part-time employment were assessed. Participants reported whether their employer offered drug benefits and extended health benefits (e.g., access to physiotherapy/occupational therapy, social work; yes/no) and to what extent they had control over their work schedule (1 = not at all; 5 = a great deal).

Job perceptions.

Six statements assessed job perceptions. Questions examined job variety, the job as important and worthwhile, opportunities to learn and make decisions, and independent work. Responses were on a 5-point Likert-type scale (where 1 = not at all true, 3 = somewhat true, and 5 = very true). Responses were summed with higher scores indicating greater perceived independence and job value. Cronbach's alpha for the scale at wave 3 was 0.75.

Workplace support.

Items drawn from a work-family support scale were modified to assess coworker support (8 items) and managerial support (4 items) (46, 47). Item responses were on a 5-point scale (where 1 = strongly disagree and 5 = strongly agree). Example coworker items included: “I cannot talk about personal matters with my co-workers,” “I have co-workers who go out of their way to help me at work,” and “I have co-workers who would support me through tough personal times.” Example managerial items included: “My manager does things to help employees balance their work and their personal life” and “In scheduling meetings or work hours, my manager shows little concern for employees' personal needs.” Higher scores reflected higher perceived support. Internal consistency for the coworker and managerial scales using Cronbach's alpha were 0.90 and 0.86, respectively.

Arthritis-work spillover.

Six items assessed the extent to which the demands of arthritis interfered with work performance and the extent to which work interfered with managing arthritis (37). Responses were on a 5-point Likert-type scale (where 1 = strongly disagree and 5 = strongly agree). Example items included, “The demands of my arthritis make it difficult for me to do as good a job at my work as I would like” and “My condition suffers because of the demands of my work.” Cronbach's alpha for the scale at wave 3 was 0.87.

Statistical analyses.

Frequencies, means, and SDs were calculated. Pearson's correlation coefficients examined relationships among CIJSS items and principal component analysis assessed the factor structure of CIJSS questions. Cronbach's alpha coefficients examined the internal coherence of the items. Categorical variables were dummy coded. Referent categories for sex, marital status, education, diagnosis, job sector, and drug and health benefits were men; married or living as married; postgraduate education; IA; business, finance, and administration; and not receiving benefits, respectively. We used t-tests and analysis of variance tests for bivariate analyses of categorical independent variables with the CIJSS; simple regression was used for continuous variables. Multivariate hierarchical linear regression was performed with variables entered in blocks: demographic variables (e.g., age, sex), illness variables (e.g., pain, fatigue, number of joints), workplace activity limitations, work context (e.g., job type, hours of work), and psychological scales (e.g., job perceptions, workplace support). Only variables significant at the P less than 0.20 level in the bivariate analyses were included in the multivariate analyses, with the exception of age and sex, which were retained for control purposes. R2 change values identified the unique contribution to the variance of each block of variables. Analyses were conducted using SPSS software, version 13.0 for Windows (SPSS, Chicago, IL).

RESULTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. PARTICIPANTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES
  10. APPENDIX A

Three-quarters of participants were women (76.7%) and the mean age was 53 years (Table 1). The sample was relatively well educated and more than half (59.2%) were married. Half of the respondents reported OA (51.7%), 36% reported IA, and 12.3% reported both conditions. On average, individuals reported having arthritis for nearly 11 years. Approximately one-third of participants reported fatigue on most or all days and 21.2% reported severe pain on most or all days. Half of the respondents worked in business, finance, and administration or health, science, art, or sport jobs (50.2%); 70.2% reported drug benefits; and 66.1% reported extended health benefits with their job. Three-quarters of respondents worked full time with an average working week of 36.9 hours.

Table 1. Sample characteristics (n = 292)*
CharacteristicValue
  • *

    Values are the number (percentage) unless otherwise indicated. Total number may be <292 due to item nonresponse.

Demographic variables
 Age, mean ± SD years53.2 ± 9.3
 Sex
  Male68 (23.3)
  Female224 (76.7)
 Education
  Secondary school or less43 (14.7)
  Some postsecondary58 (19.9)
  Postsecondary124 (42.5)
  Postgraduate66 (22.6)
 Marital status
  Married/living as married173 (59.2)
  Divorced/separated/widowed73 (25.0)
  Never married46 (15.8)
Illness-related variables
 Arthritis type
  Inflammatory arthritis105 (36.0)
  Osteoarthritis151 (51.7)
  Both inflammatory arthritis and osteoarthritis36 (12.3)
 Duration, mean ± SD years10.8 ± 8.8
 Joints affected, mean ± SD years7.7 ± 4.7
 Pain
  No days85 (29.1)
  A few days81 (27.7)
  Some days64 (21.9)
  Most days42 (14.4)
  All days20 (6.8)
 Fatigue
  No days65 (22.3)
  A few days48 (16.4)
  Some days76 (26.0)
  Most days62 (21.2)
  All days40 (13.7)
Workplace activity limitations (12 items), mean ± SD7.1 ± 4.7
Work context variables
 Job sector
  Business, finance, administration97 (33.2)
  Health, science, art, sport108 (17.0)
  Sales and service63 (21.6)
  Trades, transportation, equipment operator24 (8.2)
 Average hours of work per week, mean ± SD36.9 ± 11.3
 Employment status
  Full time223 (76.4)
  Part time69 (23.6)
 Control over work schedule
  Not at all55 (18.8)
  A little47 (16.1)
  Somewhat60 (20.5)
  Quite a bit67 (22.9)
  A great deal63 (21.6)
 Drug benefits
  No85 (29.1)
  Yes205 (70.2)
 Extended health benefits
  No93 (31.8)
  Yes193 (66.1)
Psychosocial variables
 Managerial support, mean ± SD (range)10.0 ± 4.0 (4–20)
 Coworker support, mean ± SD (range)16.4 ± 5.3 (4–20)
 Job perceptions, mean ± SD (range)22.6 ± 4.9 (6–30)
 Arthritis-work spillover, mean ± SD (range)15.9 ± 5.1 (6–29)

The 17 chronic illness job strain items, means and SDs, are presented in Table 2. The items are presented in decreasing order of perceived stress. Among the items reported as most stressful were concerns about future uncertainty, especially related to finances, remaining employed, and future career plans. Trying to accept changes, balance multiple roles, and deal with symptoms were also reported as stressful. Less stressful for participants in the study were relationships with employers and coworkers, resources for arthritis and employment, and current work experiences such as scheduling, utilizing skills, managing absences, and day-to-day uncertainty.

Table 2. Chronic illness job strain Scale items assessing the degree of perceived stress*
ItemValue
  • *

    Values are the mean ± SD. Numbers in parentheses correspond to the order of questions in the study questionnaire. Higher scores reflect greater perceived stress.

Thoughts about the impact of arthritis on your finances now or in the future (6)2.76 ± 1.39
Accepting the changes that have occurred in your life (17)2.73 ± 1.19
Balancing your health, work, and personal life (16)2.64 ± 1.22
Symptoms of your arthritis (1)2.50 ± 1.07
Thoughts about the impact of arthritis on your ability to remain employed (9)2.42 ± 1.36
Thoughts about the impact of your arthritis on your future career plans (11)2.38 ± 1.38
Arthritis as an ongoing illness (2)2.36 ± 1.26
Demands of your job combined with your arthritis (5)2.26 ± 1.12
Uncertainty about how you will feel at work from day to day (3)2.16 ± 1.37
The “invisibility” of your arthritis (15)2.13 ± 1.25
The impact of arthritis on your ability to use your skills and training (10)2.07 ± 1.23
Scheduling of your job combined with your arthritis (4)2.03 ± 1.09
Managing absences from work related to arthritis (7)1.91 ± 1.18
Current relationships or concerns about your future relationship with your employer (12)1.82 ± 1.14
Lack of information and/or resources about how to manage arthritis and employment (8)1.82 ± 1.15
Decision to tell or not tell employer about your arthritis (14)1.68 ± 1.14
Current relationships or concerns about your future relationship with your coworkers (13)1.40 ± 0.78

The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.95 and indicated the appropriateness of using principal component factor analysis with the sample (48). A varimax rotation yielded a single factor with factor loadings of 0.57 to 0.83 for all but 2 items. These 2 items (2 and 14 in Appendix A) were subsequently omitted from the analyses. Pearson's correlation coefficients for the remaining items are presented in Table 3. All were significant at P < 0.01. The final factor accounted for 60.5% of the variance. Cronbach's alpha for the scale was 0.95.

Table 3. Chronic Illness Job Strain Scale interitem correlations and scale internal consistency*
ItemInteritem correlation matrixFactor loading
123456789101112131415
  • *

    Cronbach's α = 0.95.

  • Items 2 and 14 omitted due to poor factor loading.

  • Interitem correlations P < 0.01 among all items.

1. Symptoms of your arthritis1.00              0.81
3. Uncertainty about how you will feel at work from day to day0.671.00             0.83
4. Scheduling of your job combined with your arthritis0.600.651.00            0.75
5. Demands of your job combined with your arthritis0.740.660.771.00           0.80
6. Thoughts about the impact of arthritis on your finances now or in the future0.620.630.510.551.00          0.78
7. Managing absences from work related to arthritis0.580.600.550.570.571.00         0.76
8. Lack of information and/or resources about how to manage arthritis and employment0.500.590.490.460.490.571.00        0.70
9. Thoughts about the impact of arthritis on your ability to remain employed0.610.700.520.580.770.610.561.00       0.84
10. The impact of arthritis on your ability to use your skills and training0.630.630.570.610.620.590.580.721.00      0.83
11. Thoughts about the impact of your arthritis on your future career plans0.600.620.500.540.700.610.510.770.741.00     0.83
12. Current relationships or concerns about your future relationship with your employer0.550.580.580.590.540.590.480.590.590.671.00    0.77
13. Current relationships or concerns about your future relationship with your coworkers0.350.390.400.410.340.420.410.380.490.470.631.00   0.57
15. The “invisibility” of your arthritis0.660.650.540.600.570.600.580.650.630.620.610.431.00  0.82
16. Balancing your health, work, and personal life0.670.570.580.660.550.520.490.600.550.540.520.370.661.00 0.77
17. Accept the changes that have occurred in your life as a result of arthritis0.610.620.510.560.600.480.490.640.570.620.480.360.660.681.000.77

Pearson's correlations of the CIJSS and other measures were examined. Correlations of CIJSS with control over work schedule (r = −0.29), job perceptions (r = −0.23), WALS (r = 0.61), arthritis-work spillover (r = 0.70), managerial support (r = 0.36), and coworker support (r = 0.33) were moderate and significant at P < 0.01 for all correlations. Bivariate analyses examined the CIJSS and demographic, illness, work context, and psychosocial factors. Variables significant at P < 0.20 were included in standard multivariate linear regression analyses examining the associations of the predictor variables with CIJSS (Table 4). The total variance accounted for in the model was 72% with an adjusted R2 of 0.69. Age and sex were not significantly associated with perceptions of job strain, although there was a trend (P < 0.08) for younger participants to report greater strain. Illness variables accounted for 44% of the total variance, with individuals with OA or both IA and OA reporting less strain. Greater frequency of severe pain was also associated with more strain, and there was a trend (P < 0.06) for those with greater fatigue to report greater strain. Workplace activity limitations were associated with greater job strain, accounting for 13% of the variance. Working fewer hours each week was significantly associated with greater strain. However, work context variables accounted for only 3% of the total explained variance. Perceptions of greater arthritis-work spillover and less coworker support were both associated with more perceived strain. Psychosocial perceptions accounted for 12% of the variance.

Table 4. Multivariate unstandardized (b) and standardized (β) regression coefficients for explanatory variables by chronic illness job strain*
 R2 changebβP
  • *

    OA = osteoarthritis; IA = inflammatory arthritis.

  • R2 change values identify the unique contribution to the variance of each block of variables. Total adjusted R2 = 0.69.

  • Reference category: male sex.

  • §

    Reference category: IA.

  • Reference category: business, finance, administration.

  • #

    Reference category: yes.

Demographic variables0.00   
 Age −0.13−0.090.08
 Sex 0.880.030.59
Illness-related variables0.44   
 Diagnosis§    
  OA −4.14−0.150.01
  Both OA and IA −5.27−0.110.02
 Joints affected −5.38−0.080.12
 Fatigue 1.290.120.06
 Severe pain 2.020.170.00
Workplace activity limitations0.130.910.300.00
Work context variables0.03   
 Job field    
  Health, science, art, sport −1.70−0.060.23
  Sales and service 1.520.040.38
  Trades and transportation 1.000.020.69
 Average hours of work per week −0.15−0.100.05
 Control over work schedule −0.56−0.050.25
 Drug benefits# 5.520.160.10
 Extended health benefits# −4.32−0.130.16
Psychological scales0.12   
 Job perceptions −0.00−0.000.98
 Arthritis-work spillover 1.070.390.00
 Manager/supervisor support −0.11−0.030.53
 Coworker support −0.47−0.180.00
Total R20.72   

DISCUSSION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. PARTICIPANTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES
  10. APPENDIX A

Previous research has documented important implications of perceiving work as stressful. However, studies have not examined the role that working with a chronic illness can have in contributing to job strain, the sources of strain encountered by individuals with arthritis who are employed, or factors associated with job strain. This study created a measure of chronic illness job strain and examined perceived stress among employed individuals with arthritis, as well as the relationship of job strain with illness, workplace, and psychosocial variables.

Responses to questions on the CIJSS suggest that strain associated with working with arthritis is multidimensional. Of note is that participants often reported less strain related to current work conditions such as job scheduling, workplace relationships, and job demands, and greater perceived stress associated with future uncertainty, balancing multiple roles, and difficulties psychologically accepting the impact of the disease. These findings are noteworthy because previous research in both the workplace and arthritis fields has focused largely on current work or illness conditions. For example, the job-control model, which is among the most frequently tested models of job stress in the employment literature, emphasizes current work demands, job control, and workplace support (1, 6). This research finds that additional areas of strain are important and have been overlooked. These findings highlight the need to enhance the conceptual models used to understand work stress and suggest new avenues of focus for workplace intervention efforts among individuals with arthritis.

To address issues of content validity, the CIJSS measure drew on the “expert” responses of persons working with arthritis, as well as a review of the arthritis and employment literatures. Preliminary psychometric work has found that a single construct, labeled job strain, was identified and that the measure exhibited good internal consistency. Some evidence for the construct validity of the measure was also found. Specifically, perceptions of strain were significantly associated with illness, work context, and psychosocial variables that have been previously identified as potential job stressors, contributing to giving up employment. Although the measure was administered to individuals with IA and OA, the concepts assessed in the CIJSS are broadly applicable to a range of chronic physical diseases, including other types of arthritis, low back pain, cardiovascular disease, diabetes, and migraine. The potential to compare perceptions of job strain across a range of conditions and at different disease stages is important given the prevalence of chronic illness in the population. Current workplace studies have not examined the unique sources of job strain that may confront individuals with chronic physical illness. At the same time, additional research is needed using the CIJSS with a range of disease cohorts to examine the stability, sensitivity, and predictive validity of the measure.

The results of the multivariate analysis differ in several ways from previous work on job strain with healthy adults. Similar to workplace studies, work hours were related to overall perceptions of stress. In this study, however, participants working fewer hours reported greater job strain. This may be because arthritis limited the ability of some participants to work the hours they wanted. For example, in other studies persons with arthritis sometimes reported that they were unable to work full time because of their disease (13). Other work context factors such as job type, control over the work schedule, job perceptions, and perceptions of managerial support were not significantly associated with job strain. Sex and age were also not related to perceived stress. Instead, pain and workplace activity limitations were the largest contributors to understanding the variance in job strain. A trend also existed for fatigue associated with greater strain. This finding suggests that factors associated with job strain among those with chronic illness are largely different from those of healthy adults. Consequently, a reliance on existing models of job strain that focus on current job factors and that omit illness-related variables and items related to unique areas of stress among those with arthritis is likely to underestimate the degree of workplace strain that persons with arthritis experience. Again, given the prevalence of musculoskeletal disorders and other chronic illnesses, greater attention to chronic illness job strain and the factors associated with it is warranted.

Psychosocial perceptions such as a perceived absence of coworker support and arthritis-work spillover were also related to strain. These findings underscore the importance not only of individuals' disease symptoms and the environment within which they work, but also of individuals' interpretations and the meaning they give to their experiences. Specifically, a lack of perceived coworker support was related to overall strain, despite the fact that difficulty with coworkers was not cited as one of the most stressful aspects of work. The reason may be that, although relationships were often not currently strained, respondents were concerned about the sustainability of employment in an environment where coworkers were perceived as not being supportive. Other workplace research has also found that coworkers play an important role in contributing to stress in the workplace (49, 50). Additional research on the role of supervisors and coworkers as a source of job strain is needed. The fact that arthritis-work spillover was related to strain is not surprising given that balancing multiple roles was endorsed by respondents as among the most stressful aspects of working with arthritis. Future research needs to devote more attention to the intersection of the different roles that persons with arthritis assume and to more general issues of role strain in addition to job strain.

There are limitations to this study that need to be addressed in future research. Although our recruitment strategy enabled us to generalize beyond a clinical sample and was comparable with other samples in terms of age, marital status, education, income, and occupation, the sample was purposive. The extent of job strain experienced by individuals with arthritis and other conditions needs to be replicated in diverse groups, particularly with greater numbers of men. Moreover, as noted, the stability, sensitivity, and predictive validity of the CIJSS needs to be examined in longitudinal research. Finally, although much of the variance in job strain was accounted for by the variables examined here, additional research examining work context variables would be beneficial.

Its limitations acknowledged, this study extends existing research by enhancing the tools available to researchers and clinicians that can help to more fully understand the impact of arthritis on the lives of persons living with the disease. The findings underscore the diverse areas that contribute to perceptions of stress and the need to recognize the importance of the appraisals individuals make of their working lives.

AUTHOR CONTRIBUTIONS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. PARTICIPANTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES
  10. APPENDIX A

Dr. Gignac had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study design. Gignac, Sutton, Badley.

Acquisition of data. Gignac.

Analysis and interpretation of data. Gignac, Sutton, Badley.

Manuscript preparation. Gignac, Sutton, Badley.

Statistical analysis. Gignac, Sutton.

Acknowledgements

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. PARTICIPANTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES
  10. APPENDIX A

We thank Jennifer Boyle, Novlette Fraser, Cristina Mattison, and the interviewers and coders who provided so much assistance to this research.

REFERENCES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. PARTICIPANTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES
  10. APPENDIX A

APPENDIX A

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. PARTICIPANTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES
  10. APPENDIX A
Table  . CHRONIC ILLNESS JOB STRAIN SCALE (CIJSS) QUESTIONS
There are a number of factors that may make [having arthritis] and being employed stressful. We are interested in learning to what extent, if at all, the following make [having arthritis] and working stressful for you:Not at all stressfulA little stressfulSomewhat stressfulQuite a bit stressfulExtremely stressful
  • *

    Items 2 and 14 yielded low factor loadings and were not used to derive total CIJSS scores.

1. To what extent do the symptoms of your [arthritis] (e.g., pain, fatigue, etc.) make employment stressful?12345
2. To what extent does thinking about [arthritis] as an ongoing chronic illness that won't go away make employment stressful?*12345
3. To what extent is uncertainty about how you will feel at work from day to day stressful?12345
4. To what extent does the scheduling of your job combined with your [arthritis] make employment stressful?12345
5. To what extent do the demands of your job combined with your [arthritis] make employment stressful?12345
6. To what extent are thoughts about the impact of [arthritis] on your finances now or in the future stressful?12345
7. To what extent are managing absences from work related to [arthritis] stressful?12345
8. To what extent is lack of information and/or resources about how to manage [arthritis] and employment stressful?12345
9. To what extent are thoughts about the impact of [arthritis] on your ability to remain employed stressful?12345
10. To what extent does the impact of [arthritis] on your ability to use your skills and training make employment stressful (i.e., not being able to use your training)?12345
11. To what extent are thoughts about the impact of your [arthritis] on your future career plans stressful?12345
12. Considering your [arthritis], to what extent is your current relationship with your employer or concerns about your future relationship with your employer stressful?12345
13. Considering your [arthritis], to what extent is your current relationship with your coworkers or concerns about your future relationship with your coworkers stressful?12345
14. To what extent is/was the decision to tell or not to tell your employer about your [arthritis] stressful?*12345
15. To what extent does the “invisibility” of your [arthritis] make employment stressful (by that I mean that people can't tell from one day to the next how you feel)?12345
16. To what extent is balancing your health, your work, and your personal life stressful?12345
17. To what extent have you experienced stress in trying to accept the changes that have occurred in your life as a result of your [arthritis] (e.g., changes in circumstances, in your sense of identity, etc.)?12345