Understanding the nature and impact of occupational stress on Australian rural aged care workers.

This study explored the nature and impact of occupational stress on direct-care workers employed by aged care providers in rural Australia. The Job demands-Resources (JD-R) model of occupational stress provided the theoretical framework to guide this qualitative investigation. A series of four FGs were conducted with direct-care workers (n = 23), who reported their job demands, job resources and personal resources. Direct-care workers identified six themes related to job demands: time pressure, physical demands, hindrance demands, an inadequate mix of staff, insufficient training to deal with complex conditions and work schedule demands. Four themes related to job resources were identified: collaboration with colleagues, equipment, opportunities for development and work schedule control. Disposition and self-care were identified as necessary personal resources for aged care workers. While the generic JD-R questionnaire captures many relevant workplace characteristics, further investigations with this work group should also consider the inclusion of items related to shift work, disposition and self-care.

Assessing the utility of a virtual-reality neuropsychological test battery, 'CONVIRT', in detecting alcohol-induced cognitive impairment.

New technologies such as virtual reality (VR) and eye-tracking software have paved the way for more sophisticated and ecologically valid measures of cognitive function. Testing the sensitivity and reliability of such measurements in response to acute alcohol intoxication provides a first step in establishing how these measures may operate in relation to cognitive impairments observed post-concussion. Healthy young adults (N = 54, M = 20.65, SD = 2.06, 30 females) completed the CONVIRT test battery (manual simple and choice reaction-time and saccade reaction-time) at three breath alcohol concentration (BrAC) levels: 0.00%T1, 0.05%T2, 0.08%T3. Participants consumed alcoholic beverages at 30-min intervals, with BrAC monitored at 15-min intervals using a breathalyser. All three CONVIRT measures were sensitive to changes in cognitive performance induced by alcohol at BrAC levels at or exceeding 0.05%. A composite measure was also sensitive to alcohol intoxication (Cohen's d = .85 at BrAC = 0.05%; d = 1.20 at BrAC = 0.08%). Strong test-retest reliability was observed (all r < .80), with no gender differences noted. CONVIRT measures were reliable and detected dose-dependent changes in alcohol-induced cognitive impairment. Potentially, the ecologically valid measures may assist in better quantifying the effects of conditions such as concussion, on cognitive performance.

Empathy and job resources buffer the effect of higher job demands on increased salivary alpha amylase awakening responses in direct-care workers.

The job demands-resources (JD-R) model has rarely been used in conjunction with physiological indicators of stress and ill-health. This study explored the associations between the JD-R model and physiological indicators of the stress response, while considering potential moderators of this relationship. Across 2 timepoints (summer-winter) direct-care workers completed questionnaires assessing job demands, job resources, empathy and self-efficacy, and provided morning saliva samples to assess physiological indices of stress and ill-health. Changes in job resources and empathy were positively correlated with changes in the cortisol awakening response (CAR). Further, changes in both job resources and empathy independently buffered the impact of higher job demands on increased salivary alpha amylase awakening response (sAA-AR) concentrations. These findings suggest that despite increased job demands, the sAA-AR decreased for direct-care workers that had perceived high job resources or who reported higher empathy. Potentially, job resources and empathy may act as a protective factor against the development of poor health associated with workplace stress.

Development of a new virtual reality test of cognition: assessing the test-retest reliability, convergent and ecological validity of CONVIRT.

BACKGROUND: Technological advances provide an opportunity to refine tools that assess central nervous system performance. This study aimed to assess the test-retest reliability and convergent and ecological validity of a newly developed, virtual-reality, concussion assessment tool, 'CONVIRT', which uses eye-tracking technology to assess visual processing speed, and manual reaction time (pushing a button on a riding crop) to assess attention and decision-making. CONVIRT was developed for horse jockeys, as of all sportspersons, they are most at risk of concussion. METHODS: Participants (N = 165), were assessed with CONVIRT, which uses virtual reality to give the user the experience of riding a horse during a horserace. Participants were also assessed with standard Cogstate computer-based concussion measures in-between two completions of the CONVIRT battery. The physiological arousal induced by the test batteries were assessed via measures of heart rate and heart rate variability (LF/HF ratio). RESULTS: Satisfactory test-retest reliability and convergent validity with Cogstate attention and decision-making subtests and divergent validity in visual processing speed measures were observed. CONVIRT also increased heart rate and LF/HF ratio, which may better approximate participant arousal levels in their workplace. CONCLUSIONS: CONVIRT may be a reliable and valid tool to assess elements of cognition and CNS disruption. The increased ecological validity may also mean better informed 'return-to-play' decisions and stronger industry acceptance due to the real-world meaningfulness of the assessment. However, before this can be achieved, the sensitivity of the CONVIRT battery needs to be demonstrated.

Trait mindfulness and the Effort-Reward Imbalance workplace stress model: Higher trait mindfulness is associated with increased salivary immunoglobulin A.

Individuals who are high in trait mindfulness are less stressed at work, better adjusted, and healthier than individuals who are low in this trait (Allen et al., 2015; Irving et al., 2009; Lomas et al., 2017) [1-3]. To date, trait mindfulness has not been considered within current, empirically supported, workplace stress models. Therefore, the present study explored if trait mindfulness, when used in conjunction with the Effort-Reward Imbalance model (Siegrist, 1996) (ERI [4]) better explains the links between workplace stress and non-adaptive physiological arousal. Across 2 timepoints (Summer-Winter) direct-care workers completed job stress (ERI), trait mindfulness, and health questionnaires and provided morning saliva samples to assess physiological indices of stress and ill-health. Compared across timepoints, changes in ERI and overcommitment were not associated with changes in the cortisol awakening response, salivary alpha amylase awakening response or secretory immunoglobulin A (sIgA). However, higher trait mindfulness was associated with increased sIgA. Potentially, trait mindfulness may act as a protective factor against ensuing ill-health and further, may be useful in better understanding the underlying mechanisms of the workplace stress-ill-health relationship.

An online mindfulness-based program is effective in improving affect, over-commitment, optimism and mucosal immunity.

Previous studies have demonstrated mindfulness-based programs are effective in reducing workplace stress; however, few have investigated the effectiveness of online mindfulness-based programs. Physiological measures are also underutilised when examining the efficacy of these programs. Therefore, we assessed the efficacy of an online mindfulness-based program on both short-term and more enduring aspects of psychological and physiological measures of stress and ill-health. Participants (N = 22) completed an 8-week online mindfulness-based program. Immediately before and after a mindfulness session, participants completed questionnaires to assess the short-term effects on mood and state anxiety and provided saliva samples to assess salivary alpha amylase (sAA) concentrations. Additionally, pre and post the 8-week intervention, participants completed questionnaires assessing workplace stress, over-commitment, work engagement, dispositional mindfulness and personal resources. Saliva samples were collected to measure the cortisol awakening response, sAA awakening response and secretory immunoglobulin A (sIgA). Our findings demonstrate that online mindfulness-based programs induce short-term improvements in fatigue and anxiety in employees. Additionally, we also report a decrease in over-commitment and increases in optimism and mucosal immunity (sIgA) following the program.

Do workplace-based mindfulness meditation programs improve physiological indices of stress? A systematic review and meta-analysis.

OBJECTIVE: Mindfulness-based interventions (MBI) have been related with improved job satisfaction, wellbeing, health, and reduced workplace stress with employees. However, until now, synthesis of the evidence of the effect of MBIs on physiological indices associated with stress and ill-health has been lacking. Therefore the current systematic review aimed to synthesise the literature from employee samples to provide guidance for future investigations in terms of which physiological indicators and biological systems may be most impacted by MBIs. METHODS: Electronic databases were searched. Studies that conducted a mindfulness-based program with an employee sample, which targeted workplace stress or work engagement, and measured a physiological outcome were selected for inclusion. Studies using either a between-group or within-group design were included. Nine papers were found to meet the inclusion criteria for our systematic review and meta-analysis of the literature. RESULTS: MBIs were found to be effective in reducing cortisol production, as indicated by lowered high and low diurnal cortisol slopes. However, no changes were found for cortisol awakening response or concentrations for single a.m. and p.m. time-points. MBIs also improved autonomic balance, assessed by heart rate variability coherence measures, but not blood pressure. Sympathetic nervous system reactivity as measured by salivary alpha amylase was also reduced following MBI. While aspects of immune function were also improved following MBIs, specifically, increased antibody response to a viral vaccine and reduced C-reactive protein concentrations, each of these outcomes were only assessed in a single study. CONCLUSION: Taken together, the findings suggest that MBIs are a promising avenue for intervention for improving physiological indices of stress. Our findings suggest that changes in daytime cortisol secretion and HRV coherence may be particularly influenced by MBIs. Future studies should aim to assess multiple physiological indices to confirm the current findings and further improve current understanding of which biological systems (and indices within these systems) show responses indicative of reduced stress due to MBI.

Investigating the JD-R occupational stress model with Australian direct-care workers: A focus group approach.

This study aimed to explore the use of a contemporary workplace stress model, the Job Demands-Resources model, with direct-care workers using a qualitative approach. The JD-R model has successfully been used to predict health outcomes across different occupations using quantitative methods. However, the use of the generic questionnaire developed for this model may not always be appropriate. Direct-care workers (n = 19) attended two focus groups and reported on their job demands, job resources and personal resources. Six themes relating to demands across the two groups: funding insecurity, time pressure, hindrance demands, poor systems, emotional engagement and dealing with client crises were identified. Participants identified clinical supervision, social support and progressive workplace resources as job resources. Finally, the personal resources identified by participants were professional behaviours, disposition and self-care. The JD-R model and its standard questionnaire captures some of these aspects of direct-care work, but many were not assessed. As such, future investigations with direct-care workers should ensure items related to poor systems, progressive workplace resources, disposition and professional behaviours are included. Alternatively, a qualitative approach should be used as a first step in the development of valid questionnaires when investigating workplace stress with this group to ensure their experience is accurately quantified.

A systematic review and meta-analysis of the effort-reward imbalance model of workplace stress with indicators of immune function.

OBJECTIVE: Despite considerable research into associations between the effort reward imbalance (ERI) model and various health outcomes over the past 20years, the underlying mechanisms responsible for the association remain unclear. Recently, ERI investigations have examined associations with immune sub-systems (e.g., leukocytes, cytokines and immunoglobulins). Synthesis of the amalgamated research evidence will aid clarity to this field of enquiry. We conducted a meta-analysis and reviewed the associations of ERI and over-commitment (OC) in the workplace with immunity. METHOD: Electronic databases were searched with the phrase 'effort reward imbalance' which initially yielded 319 studies leading to 57 full text studies being screened. Seven studies that met inclusion criteria were combined using mixed and random effects models. RESULTS: Greater ERI was associated with lower immunity (r=-0.09, CI -0.14, -0.05, p<0.001). Sub-group analyses revealed the effect with mucosal immunity was stronger (r=-0.33, CI -0.47 to -0.18) than trends between both cytokine (r=-0.04, CI -0.07, -0.01) and leukocyte sub-groups (r=-0.02 CI -0.04, 0.01) respectively (k=7, N=9952). Over-commitment was also associated with lower immunity (r=-0.05, CI -0.09, 0.01, p=0.014); subgroup (leukocytes, cytokines, mucosal immunity) associations, however, were homogenous (Q=1.83, df=2, p=0.400, k=6, N=2358). CONCLUSIONS: Greater ERI and OC were both associated with lower immunity. The association between mucosal immunity and ERI was stronger than the cytokine and leukocyte sub-groups. OC moderated the relationship between ERI and immunity.