Longitudinal Associations of Work Stress with Changes in Quality of Life among Patients after Acute Coronary Syndrome: A Hospital-Based Study

Abstract

(1) Background: Targeting a sample of Chinese employees in this study, the correlation of work stress with changes in quality of life (QoL) was explored subsequent to acute coronary syndrome (ACS). (2) Methods: Patients suffering from the first ACS episode, with regular paid work before ACS, were eligible for this one-year longitudinal study. Effort–reward imbalance (ERI), together with job strain (JS) models, were employed to evaluate work stress before discharge, and QoL prior to discharge (baseline), as well as at 1, 6, and 12 months following discharge, were measured using the 8-Items Short Form (SF-8), in addition to the Seattle Angina Questionnaire (SAQ). Moreover, generalized estimating equations were used to determine the relationship of work stress to longitudinal QoL variations. (3) Results: After adjusting for covariates, high work stress at the baseline measured by JS was associated with the slow recovery of both mental health (p < 0.01) and physical health (p < 0.05) in SF-8, while ERI-measured work stress was related to slower improvement in SF-8 physical health (p < 0.001), SAQ-angina stability (AS) (p < 0.05), SF-8 mental health (p < 0.001), and SAQ-angina frequency (AF) (p < 0.05). After mutual adjustment for JS and ERI, high work stress as assessed by JS displayed no correlation with any QoL alteration (all p > 0.05), whereas ERI-determined work stress at a high level still presented a relationship to slow improvement in SF-8 physical health, SAQ-AS, SF-8 mental health, and SAQ-AF (all p < 0.05). (4) Conclusion: Work stress was associated with slow recovery of QoL in patients with ACS across one year. For ACS patients, ERI was a stronger predictor of QoL variations than JS.

Work stress and changes in heart rate variability among employees after first acute coronary syndrome: a hospital-based longitudinal cohort study

“…It is of interest to observe that work stress in terms of ERI, but not of JS, was predictive in the current study. A similar finding was apparent in two earlier investigations of Chinese participants ( 39 , 62 ). One explanation points to the relevant role of status-related and financial rewards emphasized in the former model, that may have received a prominent role in the context of rapid and far-reaching changes of working and employment conditions in China ( 63 , 64 ).…”

Association between the stress–hyperglycemia ratio and all‐cause mortality in community‐dwelling populations: An analysis of the National Health and Nutrition Examination Survey (NHANES) 1999–2014

“… 21 In addition, biological mechanisms responsible for burnout are linked to sustained hyperactivation of the HPA axis. 20 In the early stages, this adaptive response prepares for the “struggle” and has a potent anti‐inflammatory effect, preventing disease behaviors and reducing infection risk. 21 Over time, this response manifests as psychological exhaustion and predisposes to various pro‐inflammatory diseases like metabolic syndrome, chronic pain, or CVD, along with a sickness behavior including psychomotor retardation, fatigue, or depression.…”

“…Stress‐induced inflammation may be adaptive, but chronic inflammation (a sustained stress situation) can contribute to processes like atherosclerosis, ultimately leading to the onset of CVD 21 . In addition, biological mechanisms responsible for burnout are linked to sustained hyperactivation of the HPA axis 20 . In the early stages, this adaptive response prepares for the “struggle” and has a potent anti‐inflammatory effect, preventing disease behaviors and reducing infection risk 21 .…”

“…In the community‐dwelling population, the SHR may indicate that the individual is in a state of stress (such as work stress, 20 , 21 life stress, 22 emotional stress, 18 psychological stress 23 ) due to environmental exposure, which could significantly affect the subject's prognosis. 24 , 25 However, no studies have investigated the association between SHR and all‐cause mortality in the community‐dwelling population.…”

“…18 Previous studies have shown that not only the psychological factor is one of the important factors affecting glucose metabolism 19 but also depression, general emotional stress, anxiety, sleep problems, anger, and hostility are associated with an increased risk of developing type 2 diabetes. 18 In the community-dwelling population, the SHR may indicate that the individual is in a state of stress (such as work stress, 20,21 life stress, 22 emotional stress, 18 psychological stress 23 ) due to environmental exposure, which could significantly affect the subject's prognosis. 24,25 However, no studies have investigated the association between SHR and all-cause mortality in the communitydwelling population.…”