The prospective impact of psychosocial variables on rates of illness and injury in professional employees.

From a prospective study of health changes in air traffic controllers, it was determined that high scores on self-report measures of work-related life change distress, other life changes outside the work setting, the type A behavior pattern, and dissatisfaction with management were positively related to future rates of injuries and physician-diagnosed acute illness episodes. Depending on the risk factor involved, high scorers on these psychosocial risk predictors incurred from 80% to 252% more future accidental injuries and from 38% to 69% more future total morbidity over a 27-month follow-up period than the men in the low scoring groups. Moreover, coworker-rated amicability, probably an indication of the amount of social support available to an individual, was significantly protective against these outcome variables, with the rarely or never chosen group experiencing 60% more total morbidity and 174% more injuries than the often chosen group. A multiple-regression equation revealed that stress, amicability, type A, and satisfaction with management had an additive effect on the outcome variables. Work- and non-work-related life change distress subscales were similar in their ability to predict later morbidity. Prediction was stronger for 27-month follow-up than for only the first 9-month period. The findings, if replicated, raise the possibility of screening programs to identify employees at high risk of future illness and injury.

Life change stress, psychiatric symptoms, and natural killer cell activity.

Previous research has linked stress with adverse health change; however, the immunologic mechanisms mediating these changes remain poorly understood. To test whether "stress" was associated with alterations in cell-mediated immunity, we examined the correlations of self-reported life change stress (LCS) and psychiatric symptoms with natural killer cell activity (NKCA) among 114 healthy undergraduate volunteers. Although the bivariate correlation between LCS and NKCA was not significant, subjects reporting few psychologic symptoms in the face of large amounts of LCS ("good copers") had significantly higher NKCA than those experiencing high levels of both symptoms and LCS ("poor copers"). Furthermore, self-reported psychiatric symptoms were found to inversely correlate with NKCA, suggesting that symptoms such as anxiety and depression may negatively affect immunity.

Short-term symptom change in outpatient psychiatric disorders.

Changes in symptomatology (Hopkins Symptom Checklist scales) during a three- to four-week period were observed in a group of subjects (symptomatic volunteers) who had specific psychiatric disorders (Research Diagnostic Criteria [RDC]) and who were not currently receiving or awaiting treatment. Four of the depressive disorder categories and two of the anxiety disorder categories showed a significant drop in the primary symptomatology. There was a differential effect of diagnosis on the amount of this "spontaneous" symptom reduction; for the HSCL scales depression and panic-phobic anxiety, the RDC disorders with the highest initial levels of those symptoms (major depressive disorder; panic anxiety disorder, combined panic-phobic anxiety disorder) showed the least reduction in that symptomatology.

Life changes. Do people really remember?

The question, "How well do people remember life changes?" was approached in a longitudinal study of nearly 400 healthy men in a responsible profession. Three scales for assessing life changes were administered by questionnaire at two examinations nine months apart. The subjects were asked to report life change events occurring during a specific six-month period--that which immediately preceded the first examination. For all three life change scales there was substantial forgetting over the interval between reports, with a second report yielding total scores 34% to 46% less than those from the first report for the same period. The amount of change over time varied greatly across persons. These findings raise serious questions about the validity of retrospective studies of life change and illness when the period being reported is greater than six months in the past. They do not, however, jeopardize the potential of the method for prospective studies.

Prevalence of depression over a 12-month period in a nonpatient population.

A nonpatient population of air traffic controllers, all of whom remained employed during the observation period, was examined monthly for one year for level of depression using the Zung Self-Rating Depression Scale. The average monthly prevalence of depression was 9.1%, with 7.0% at the symptom level, 1.9% at a level comparable to outpatients, and 0.2% with moderately severe levels. These figures were generally similar to those for other reported population groups, although exact comparisons were difficult because of the preselection for health in this population. Two patterns of depression were observed. One was characterized by an acute, episodic symptomatology returning to nonsymptomatic levels for most of the year, similar to Research Diagnostic Criteria (RDC) category "episodic minor depressive disorder." The other showed a chronic, fluctuating course with significant depressive symptomatology over half the year, similar to RDC category "chronic and intermittent minor depressive disorder."

The assessment of life change stress: a comparative and methodological inquiry.

A comprehensive life events questionnaire was administered to 416 men. Total life change scores were computed from published normative weights and from individuals' own ratings of events that occurred. The results showed that the rank order of life events was highly correlated between our sample and the original normative groups. However, in the population of men we studied, there were significant differences between the total life event scores derived by summing the published normative weights and the total adjustment or distress reported by those men who experienced the events. Other results indicated that life event scores based on normative weights reflect more on the number of life events that are experienced, whereas life change scores based on individuals' ratings may better reflect on the potential impact of life change. Finally, the psychometric properties of several life change inventories are poor.

Health change in air traffic controllers: a prospective study. I. Background and description.

The background, rationale, and design of a 3-year prospective study of health change in 416 air traffic controllers is described. This study was designed to assess the relevant variables that might predict future physical and psychological health change. This report describes the major variables that were assessed in all participants, which included endocrine, cardiovascular, and behavioral differences in response to work, the occurrence of significant life events, work attitude and morale, availability and usefulness of psychosocial supports, and job commitment and performance. Future reports will describe the contribution, both individually and interactively, of these various factors to the risk for future illness. A major hypothesis to be tested by this study is that health change among air traffic controllers can be predicted by differential responsivity to work.

Plasma cortisol and growth hormone responses to intravenous characterization.

Plasma cortisol and growth hormone (HGH) responses to venous catheterization were studied in 29 volunteer subjects. Repeat characterizations were performed in 18 individuals. Mean plasma cortisol levels were significantly elevated during the first hour of the initial catheterization experience. Morning and afternoon levels of cortisol were not distinguishable during the first catheterization, but PM levels were significantly lower than AM levels during the second catheterization experience. Growth hormone responses were much more variable than cortisol and were distributed logarithmically. Growth hormone responses tended to parallel cortisol responses during the first catheterization experience. Individuals who listed more symptoms in response to venipuncture and catheterization after finishing their first catheterization had significantly higher cortisol and growth hormone levels during this experience. These data suggest a definite endocrine adaptation to catheterization by the second or third hour of the experience.