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Biomedical subjects

S A Stansfeld

Publications and source records attributed to S A Stansfeld.

At least 55 records · Page 3Linked to original sources
PubMed1995

Work characteristics and psychiatric disorder in civil servants in London.

STUDY OBJECTIVE: To describe the association between self reported and externally assessed work characteristics and psychiatric disorder. DESIGN: Analysis of questionnaire data collected from the first phase of the Whitehall II study, a cohort study of an employed population. SETTING: Twenty civil service departments in London. PARTICIPANTS: Altogether 6900 male and 3414 female civil servants aged 35-55 years. MAIN RESULTS: High levels of subjective social support at work, control at work, job variety, and skill use were associated with greater satisfaction and wellbeing and less psychiatric disorder measured by the 30 item general health questionnaire (GHQ). High levels of subjective work pace and conflicting demands were associated with less satisfaction and wellbeing and greater psychiatric disorder. The combined effects of work characteristics were similar to the effects of the work characteristics considered separately, except that for men there was a small interaction between psychological demands and control on the GHQ. There was little overall support for the two factor job strain model. In contrast, objective indices of work were generally not associated with the psychological indices. Findings in men and women were generally comparable and were not significantly influenced by employment grade. CONCLUSIONS: Negative affectivity and a tendency to report negatively about both work and the psychological indices may partly explain the difference in the findings between subjective and objective work characteristics. However, subjective work characteristics were still associated with psychiatric disorder after adjusting for negative affectivity. The potential confounding effects of employment grade did not explain the association between either subjective or objective work characteristics and the psychological indices. While modifications to the work environment may directly reduce certain adverse physical health effects, the influence of work place design and management on psychological wellbeing, satisfaction, and psychiatric disorder may be mediated through subjective perceptions of the work environment.

Adult↗
PubMed1995

Sickness absence in the Whitehall II study, London: the role of social support and material problems.

STUDY OBJECTIVE: To investigate the role of social supports, social networks, and chronic stressors: (i) as predictors of sickness absence; and (ii) as potential explanations for the socioeconomic gradient in sickness absence. DESIGN: A prospective cohort study (Whitehall II study) with sociodemographic factors, health and social support measured at baseline, and spells of sickness absence measured prospectively. SETTING: Twenty London based non-industrial departments of the British civil service. PARTICIPANTS: Participants were civil servants (n = 10,308), aged 35-55 years at baseline, of whom 67% (6895) were men and 33% (3413) were women. The overall response rate for Whitehall II was 73% (74% for men and 71% for women). The analysis is based on 41% of the sample who had data on reasons for sickness absence and were administered all social support questions. Only 4.3% of participants did not complete all necessary questions and were excluded. MEASUREMENTS AND MAIN RESULTS: High levels of confiding/emotional support from the "closest person" predicted higher levels of both short and long spells of sickness absence. After adjusting for baseline physical and psychological health the effects were increased, suggesting that high levels of confiding/emotional support may encourage illness behaviour rather than generate illness. Social network measures showed a consistent but less striking pattern. Increased levels of negative aspects of social support resulted in higher rates of sickness absence. Material problems strongly predicted sickness absence, but the effect was diminished once adjustment for the covariables was made, suggesting that health status may be functioning as an intervening variable between chronic stressors and sickness absence. In addition, social support may buffer the effects of chronic stressors. Social support did not contribute to explaining the gradient in sickness absence by employment grade beyond that explained by the baseline covariables. CONCLUSIONS: Sickness absence from work is a complex phenomenon, combining illness and coping behaviours. High levels of confiding/emotional support, although not entirely consistent across samples, may either encourage people to stay at home when they are ill or may be accompanied by more social obligations at home prolonging sickness absence. Negative aspects of close relationships may jeopardize health and hence increase sickness absence.

Administrative Personnel↗
PubMed1995

Occupational back pain--an unhelpful polemic.

In most industrialized countries, disability and work absence due to occupational back pain have risen steadily in recent decades. Conventional views of the causes of this slow epidemic tend to fall into one of the following three areas: (i) the clinical pathology view, which attributes the level of pain and disability to either the severity of the initial injury or to psychosomatic conditions; (ii) the biomechanical exposures view, which attributes the problem to hazardous and preventable conditions of work; and (iii) the perverse incentives view, which suggests that reporting and disability are influenced by a combination of work dissatisfaction and accessible disability benefits. This paper reviews, from an epidemiologic perspective, the specific methodological hurdles faced during investigations of the etiology of occupational back pain. It is argued that methodological issues have contributed to the perpetuation of the three distinct but incomplete views of the problem. New research directions are suggested and a broader interdisciplinary perspective is proposed to help resolve the existing polemic.

Back Pain↗
PubMed1993

Association between physical and psychological morbidity in the Whitehall II Study.

Mechanisms for the association between psychiatric disorder measured by the General Health Questionnaire and subjective and objective indices of physical illness are examined among 6900 male and 3414 female civil servants aged between 35 and 55 yr from the cross-sectional results of the Whitehall II Study. It was hypothesized that the association between physical illness and psychiatric disorder might be because psychiatric disorder was either secondary to the pain and disability of physical illness, or related to the somatic presentation of psychiatric disorder, or to common causes of both physical and psychiatric illness. Overall health status, and self-reported physical symptoms were strongly associated with psychiatric disorder. Angina in men and severe chest pain in men and women were significantly associated with psychiatric disorder, but electrocardiographic abnormalities were not. Established risk factors for physical illness: alcohol intake in women and men and smoking habit in men were related to psychiatric disorder. Fibrinogen was related to self reported physical symptoms but not psychiatric disorder. The association between psychiatric disorder and self-reported physical symptoms is most likely explained by somatisation and plaintive set. However, psychiatric disorder is likely to be secondary to the pain and disability of conditions such as angina.

Adult↗
PubMed1993

Road traffic noise, noise sensitivity and psychological disorder.

The relationship between traffic noise exposure and psychological morbidity was assessed using the population-based Caerphilly Collaborative Survey of 2398 men from Caerphilly, South Wales. The findings showed that traffic noise exposure levels were strongly associated with annoyance to noise. Noise-sensitive men were more likely to be highly annoyed by noise exposure than less noise-sensitive men. There was no direct association between noise exposure level and psychological morbidity but there were provocative interactions with noise sensitivity. The role of noise sensitivity is discussed as an indicator of vulnerability to environmental stressors and a measure of negative affectivity and over-reporting.

Cohort Studies↗
PubMed1993

Road traffic noise, noise sensitivity and psychological disorder.

The relationship between traffic noise exposure and psychological morbidity was assessed using the population-based Caerphilly Collaborative Survey of 2398 men from Caerphilly, South Wales, UK. The findings showed that annoyance to noise was strongly associated with traffic noise exposure levels. Men with noise sensitivity were more likely to be highly annoyed by noise exposure than men with less noise sensitivity. There was no direct association between noise exposure level and psychological morbidity until the results were stratified by noise sensitivity. This revealed a gradient of increasing psychological morbidity with increasing noise level in the lower two tertiles of noise sensitivity. No gradient was found in the highest tertile of noise sensitivity. The role of noise sensitivity is argued to be either an indicator of vulnerability to environmental stressors or a measure of overreporting.

Anxiety Disorders↗
PubMed1992

Social class and minor psychiatric disorder in British Civil Servants: a validated screening survey using the General Health Questionnaire.

Major psychiatric disorder is more common in people of lower rather than higher socioeconomic status. This is less clear for the commoner, so-called minor psychiatric disorders, but these are more affected by tendency to report symptoms. To examine this the distribution of minor psychiatric disorder by employment grade measured by the 30-item General Health Questionnaire is reported from the first cross-sectional phase of the Whitehall II Study of 10,314 London-based civil servants, men and women between 35 and 55 years. Validation of the GHQ in a random subsample stratified by grade and sex (N = 201) suggested that people in lower employment grades tend to under-report minor psychiatric disorder on the GHQ relative to those in higher employment grades. The prevalence of minor psychiatric disorder corrected by the coefficients from the validity study was greater in the lower employment grades than the higher employment grades particularly for men. This was echoed in grade differences in well-being measured by the Affect Balance Scale, and in symptoms and recurrent health problems. Overall, for women there were few clear-cut differences in minor psychiatric disorder by employment grade. The lack of social class gradient in women suggests that further exploration should examine women's role at work and their personal lives for the aetiology of minor psychiatric disorder.

Adult↗
PubMed1992

A population survey of ischaemic heart disease and minor psychiatric disorder in men.

Associations between ischaemic heart disease and psychiatric morbidity in hospital recruited samples may be confounded by differential referral of patients with co-morbidity. Associations of angina, past history of myocardial infarction, blood pressure, and electrocardiographic evidence of ischaemia with psychiatric disorder can best be examined in community samples as reported here in 2204 middle-aged men from the Caerphilly Collaborative Study. There was a strong association between past history of myocardial infarction, non-specific chest pain, Angina Grade II and psychiatric disorder measured by the 30-item General Health Questionnaire. Electrocardiographic evidence of ischaemia alone was not significantly associated with psychiatric disorder. It is suggested that non-specific chest pain is a symptom of psychiatric disorder; conversely in severe angina psychiatric disorder is secondary to the pain, restricted activity and threat to life which angina implies.

Chest Pain↗
PubMed1992

Noise, noise sensitivity and psychiatric disorder: epidemiological and psychophysiological studies.

Noise, a prototypical environmental stressor, has clear health effects in causing hearing loss but other health effects are less evident. Noise exposure may lead to minor emotional symptoms but the evidence of elevated levels of aircraft noise leading to psychiatric hospital admissions and psychiatric disorder in the community is contradictory. Despite this there are well documented associations between noise exposure and changes in performance, sleep disturbance and emotional reactions such as annoyance. Moreover, annoyance is associated with both environmental noise level and psychological and physical symptoms, psychiatric disorder and use of health services. It seems likely that existing psychiatric disorder contributes to high levels of annoyance. However, there is also the possibility that tendency to annoyance may be a risk factor for psychiatric morbidity. Although noise level explains a significant proportion of the variance in annoyance, the other major factor, confirmed in many studies, is subjective sensitivity to noise. Noise sensitivity is also related to psychiatric disorder. The evidence for noise sensitivity being a risk factor for psychiatric disorder would be greater if it were a stable personality characteristic, and preceded psychiatric morbidity. The stability of noise sensitivity and whether it is merely secondary to psychiatric disorder or is a risk factor for psychiatric disorder as well as annoyance is examined in two studies in this monograph: a six-year follow-up of a group of highly noise sensitive and low noise sensitive women; and a longitudinal study of depressed patients and matched control subjects examining changes in noise sensitivity with recovery from depression. A further dimension of noise effects concerns the impact of noise on the autonomic nervous system. Most physiological responses to noise habituate rapidly but in some people physiological responses persist. It is not clear whether this sub-sample is also subjectively sensitive to noise and whether failure to habituate to environmental noise may also represent a biological indicator of vulnerability to psychiatric disorder. In these studies noise sensitivity was found to be moderately stable and associated with current psychiatric disorder and a disposition to negative affectivity. Noise sensitivity levels did fall with recovery from depression but still remained high, suggesting an underlying high level of noise sensitivity. Noise sensitivity was related to higher tonic skin conductance and heart rate and greater defence/startle responses during noise exposure in the laboratory. Noise sensitive people attend more to noises, discriminate more between noises, find noises more threatening and out of their control, and react to, and adapt to noises more slowly than less noise sensitive people.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Attitudes to community psychiatry among urban and rural general practitioners.

General practitioners' requirements for community psychiatric services may differ according to the area in which they practise. A questionnaire survey of general practitioners' attitudes to community psychiatric services is reported from three contrasting areas: an inner city urban area, a new town and a rural area. General practitioners in all areas wanted more consultation with psychiatrists, and 53-68% wanted regular psychiatric outpatient clinics in their surgeries. There was enthusiasm for community psychiatric nurses and for help with psychotherapy. In the rural area general practitioners favoured surgery based psychiatric outpatient clinics and arranging emergency hospital admissions themselves; in urban areas domiciliary visits from psychiatrists to help with emergencies were favoured. These results appear to reflect the greater geographical distance between primary and hospital based secondary care in rural as opposed to urban areas. Overall, general practitioners wanted more support from community psychiatric services in carrying out their primary therapeutic role especially in rural areas far from hospital-based psychiatric services.

Attitude of Health Personnel↗
PubMed1992

Noise, noise sensitivity and psychiatric disorder: epidemiological and psychophysiological studies.

Noise, a prototypical environmental stressor, has clear health effects in causing hearing loss but other health effects are less evident. Noise exposure may lead to minor emotional symptoms but the evidence of elevated levels of aircraft noise leading to psychiatric hospital admissions and psychiatric disorder in the community is contradictory. Despite this there are well documented associations between noise exposure and changes in performance, sleep disturbance and emotional reactions such as annoyance. Moreover, annoyance is associated with both environmental noise level and psychological and physical symptoms, psychiatric disorder and use of health services. It seems likely that existing psychiatric disorder contributes to high levels of annoyance. However, there is also the possibility that tendency to annoyance may be a risk factor for psychiatric morbidity. Although noise level explains a significant proportion of the variance in annoyance, the other major factor, confirmed in many studies, is subjective sensitivity to noise. Noise sensitivity is also related to psychiatric disorder. The evidence for noise sensitivity being a risk factor for psychiatric disorder would be greater if it were a stable personality characteristic, and preceded psychiatric morbidity. The stability of noise sensitivity and whether it is merely secondary to psychiatric disorder or is a risk factor for psychiatric disorder as well as annoyance is examined in two studies in this monograph: a six-year follow-up of a group of highly noise sensitive and low noise sensitive women; and a longitudinal study of depressed patients and matched control subjects examining changes in noise sensitivity with recovery from depression. A further dimension of noise effects concerns the impact of noise on the autonomic nervous system. Most physiological responses to noise habituate rapidly but in some people physiological responses persist. It is not clear whether this sub-sample is also subjectively sensitive to noise and whether failure to habituate to environmental noise may also represent a biological indicator of vulnerability to psychiatric disorder. In these studies noise sensitivity was found to be moderately stable and associated with current psychiatric disorder and a disposition to negative affectivity. Noise sensitivity levels did fall with recovery from depression but still remained high, suggesting an underlying high level of noise sensitivity. Noise sensitivity was related to higher tonic skin conductance and heart rate and greater defence/startle responses during noise exposure in the laboratory. Noise sensitive people attend more to noises, discriminate more between noises, find noises more threatening and out of their control, and react to, and adapt to noises more slowly than less noise sensitive people.(ABSTRACT TRUNCATED AT 400 WORDS)

Acoustic Stimulation↗
PubMed1991

Social factors and minor psychiatric disorder in middle-aged men: a validation study and a population survey.

A cross-sectional survey of minor psychiatric disorder is reported in a representative community sample of 2204 men between the ages of 45 years and 64 years living in Caerphilly, South Wales. Minor psychiatric disorder was measured by the 30-item General Health Questionnaire and validated by the Clinical Interview Schedule in a consecutive sample of 97 men, weighted to provide one-third cases, two-thirds non-cases. A case threshold of 4/5 on the General Health Questionnaire was chosen on the basis of 'ROC' analysis. An overall estimated 'true' prevalence rate for minor psychiatric disorder of 22.0% was found, with 22.3% of men scoring 5 or more on the General Health Questionnaire. Rates of minor psychiatric disorder were higher in widowed and divorced men than in married men but were also, unexpectedly, lower in single as opposed to married men. There was no social-class gradient in minor psychiatric morbidity but a lower rate in Social Class III NM may be largely explained by lower unemployment rates. There were markedly higher rates of minor psychiatric morbidity in unemployed men and those who retired ill. Men with no available social contacts had higher rates of morbidity than men with some or high social contacts.

Cross-Sectional Studies↗
PubMed1988

The development of a computerized assessment for minor psychiatric disorder.

This paper describes the development, validation and use of a computerized assessment for minor psychiatric disorder based on the Clinical Interview Schedule (CIS; Goldberg et al. 1970). There was good agreement between the computerized assessment and the CIS administered by psychiatrists, both in assessing overall severity and in defining 'cases' of psychiatric disorder. Individual symptoms elicited by the computer and the CIS were compared, and the levels of agreement found were similar to those from inter-observer studies of standardized interviews. Subjects from a variety of non-psychiatric settings regarded the assessment as acceptable, accurate and easy to use. It is concluded that this computerized assessment of neurotic symptoms is valid and reliable. It eliminates observer bias, it is an efficient use of research resources and it may have clinical applications in primary care.

Adolescent↗
PubMed1985

Sensitivity to noise in a community sample: I. Measurement of psychiatric disorder and personality.

A sample of 77 women of high and low noise sensitivity, living in areas of high and low exposure to aircraft noise drawn from the 1977 West London Survey, were interviewed in the community in 1980. Women of high, intermediate and low noise sensitivity in 1980 were compared for measures of psychiatric disorder, personality and reactivity to the other sensory stimuli. In addition, the noise sensitivity measures defining the three groups in 1980 were compared with further measures of noise sensitivity. High noise sensitive women exhibited significantly more psychiatric symptoms, higher neuroticism scores, and greater reactivity to other sensory stimuli than intermediate and low noise sensitive women.

Adolescent↗
PubMed1985

Sensitivity to noise in a community sample: II. Measurement of psychophysiological indices.

A sample of 77 women of high and low noise sensitivity in 1977, living in areas of high and low exposure to aircraft noise, were interviewed in the community in 1980. High, intermediate and low noise sensitive women were compared, using measures of blood pressure, heart rate, skin conductance, hearing threshold, uncomfortable loudness level and magnitude estimation of six tones. These physiological measures did not clearly distinguish different noise sensitivity groups, except that highly noise sensitive women had a consistently slower heart rate. Noise sensitivity was not related to auditory threshold. In the high aircraft noise area there were significantly more skin conductance responses than in the low aircraft noise area irrespective of noise sensitivity. This may be the result of chronic exposure to high aircraft noise.

Adolescent↗
PubMed1984

Children who poison themselves. I. A clinical comparison with psychiatric controls.

Fifty schoolchildren, admitted as medical emergencies after poisoning themselves, were compared with 50 matched controls, resident in the same area of London, referred for psychiatric help for other reasons. The dependent measures were based upon systematically recorded clinical information in both groups. The self-poisoners showed more psychiatric symptoms and more disturbed family relationships than did the psychiatric group; they were more likely to meet criteria for depressive disorder and to come from families showing little warmth. This form of self-injury is not trivial or wholly culturally determined, and it warrants psychiatric intervention.

Adolescent↗