Top

BMC Public Health

Published in:

Open Access 01-12-2021 | Research article

The relative importance of work-related and non-work-related stressors and perceived social support on global perceived stress in a cross-sectional population-based sample

Authors: Jes Bak Sørensen, Mathias Lasgaard, Morten Vejs Willert, Finn Breinholt Larsen

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

High levels of perceived stress have a negative bearing on health and well-being, and stress is a major public health issue. According to the Stress Process Model, stressors are socially patterned and combine to produce strain. Despite this, most studies on stress have focused on work-related stressors leaving non-work determinants under-investigated. The aim of the present study was to determine the relative importance of work-related and non-work-related stressors and perceived social support for the overall perceived stress level.

Methods

Self-reported data were drawn from the 2017 population-based health survey “How are you?” conducted in the Central Denmark Region (N = 32,417). Data were linked with data drawn from national administrative registers. Work- and non-work-related stressors assessed included major life events, chronic stressors and daily hassles. Perceived social support was assessed using a single question. Overall perceived stress was assessed by the 10-item Perceived Stress Scale. We conducted dominance analyses based on a multiple linear regression model to determine the most important explanatory variables of overall perceived stress. Analyses were weighted and adjusted.

Results

Work- and non-work-related stressors along with perceived social support explained 42.5% of the total variance (R²) in overall perceived stress. The most important explanatory variables were disease, perceived social support and work situation. The stratified analyses produced slightly varying results (“dominance profiles”) of perceived stress between subgroups. Work situation was the most important explanatory variable in the employed group. However, adding non-work-related explanatory variables to the analysis tripled the explained variance.

Conclusions

The overall level of perceived stress can be statistically explained by a combination of work- and non-work-related stressors and perceived social support both at population level and in subgroups. The most important explanatory variables of overall perceived stress are disease, perceived social support and work situation. Results indicate that public health strategies aiming to reduce stress should take a comprehensive approach and address a variety of stressor domains rather than focus on a single domain.

Trial registration

The study was approved by the Danish Data Protection Agency (r. no. 2012-58-0006) and registered in the Central Denmark Region (r. no. 1-16-02-593-16).

Available only for authorised users

O’Connor DB, Thayer JF, Vedhara K. Stress and health: a review of psychobiological processes. Annu Rev Psychol. 2020;72:663–88.

van der Molen HF, Nieuwenhuijsen K, Frings-Dresen MHW, de Groene G. Work-related psychosocial risk factors for stress-related mental disorders: an updated systematic review and meta-analysis. BMJ Open. 2020;10(7):e034849. https://doi.org/10.1136/bmjopen-2019-034849.CrossRefPubMedPubMedCentral

Beauregard N, Marchand A, Blanc M-E. What do we know about the non-work determinants of workers’ mental health? A systematic review of longitudinal studies. BMC Public Health. 2011;11(1):439. https://doi.org/10.1186/1471-2458-11-439.CrossRefPubMedPubMedCentral

Limonic L, Lennon MC. Work and unemployment as stressors. In: Wright ER, Scheid TL, editors. A handbook for the study of mental health: social contexts, theories, and systems. 3rd ed. Cambridge: Cambridge University Press; 2017. p. 224–38. https://doi.org/10.1017/9781316471289.015.CrossRef

Dewe P, Cooper C. Work and stress: a research overview. London: Routledge; 2020. https://doi.org/10.4324/9780429331015.CrossRef

Karasek R, Theorell T. Healthy work: stress, productivity and the reconstruction of working life. New York: Basic Books; 1990.

Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol. 1996;1(1):27–41. https://doi.org/10.1037/1076-8998.1.1.27.CrossRefPubMed

Marchand A, Durand P, Haines V 3rd, Harvey S. The multilevel determinants of workers’ mental health: results from the SALVEO study. Soc Psychiatry Psychiatr Epidemiol. 2015;50(3):445–59. https://doi.org/10.1007/s00127-014-0932-y.CrossRefPubMed

Lazarus RS, Folkman S. Stress, appraisal, and coping: springer publishing company; 1984.

10.

Pearlin LI, Menaghan EG, Lieberman MA, Mullan JT. The stress process. J Health Soc Behav. 1981;22(4):337–56. https://doi.org/10.2307/2136676.CrossRefPubMed

11.

Maehlisen MH, Pasgaard AA, Mortensen RN, Vardinghus-Nielsen H, Torp-Pedersen C, Boggild H. Perceived stress as a risk factor of unemployment: a register-based cohort study. BMC Public Health. 2018;18(1):728. https://doi.org/10.1186/s12889-018-5618-z.CrossRefPubMedPubMedCentral

12.

Liu RT, Alloy LB. Stress generation in depression: a systematic review of the empirical literature and recommendations for future study. Clin Psychol Rev. 2010;30(5):582–93. https://doi.org/10.1016/j.cpr.2010.04.010.CrossRefPubMedPubMedCentral

13.

Bonde JPE. Psychosocial factors at work and risk of depression: a systematic review of the epidemiological evidence. Occup Environ Med. 2008;65(7):438–45. https://doi.org/10.1136/oem.2007.038430.CrossRefPubMed

14.

Kendler KS, Karkowski LM, Prescott CA. Stressful life events and major depression: risk period, long-term contextual threat and diagnostic specificity. J Nerv Ment Dis. 1998;186(11):661–9. https://doi.org/10.1097/00005053-199811000-00001.CrossRefPubMed

15.

Assari S, Lankarani MM. Stressful life events and risk of depression 25 years later: race and gender differences. Front Public Health. 2016;4:49.PubMedPubMedCentral

16.

Niedhammer I, Malard L, Chastang J-F. Occupational factors and subsequent major depressive and generalized anxiety disorders in the prospective French national SIP study. BMC Public Health. 2015;15(1):200. https://doi.org/10.1186/s12889-015-1559-y.CrossRefPubMedPubMedCentral

17.

Spencer RL, Hutchison KE. Alcohol, aging, and the stress response. Alcohol Res Health. 1999;23(4):272–83.PubMedPubMedCentral

18.

Keyes KM, Hatzenbuehler ML, Grant BF, Hasin DS. Stress and alcohol: epidemiologic evidence. Alcohol Res. 2012;34(4):391–400.PubMedPubMedCentral

19.

Steptoe A, Kivimäki M. Stress and cardiovascular disease: an update on current knowledge. Annu Rev Public Health. 2013;34(1):337–54. https://doi.org/10.1146/annurev-publhealth-031912-114452.CrossRefPubMed

20.

Sara JD, Prasad M, Eleid MF, Zhang M, Widmer RJ, Lerman A. Association between work-related stress and coronary heart disease: a review of prospective studies through the job strain, effort-reward balance, and organizational justice models. J Am Heart Assoc. 2018;7(9):e008073.CrossRef

21.

Kelly SJ, Ismail M. Stress and type 2 diabetes: a review of how stress contributes to the development of type 2 diabetes. Annu Rev Public Health. 2015;36(1):441–62. https://doi.org/10.1146/annurev-publhealth-031914-122921.CrossRefPubMed

22.

Harris M, Oldmeadow C, Hure A, Luu J, Loxton D, Attia J. Stress increases the risk of type 2 diabetes onset in women: a 12-year longitudinal study using causal modelling. PLoS One. 2017;12(2):e0172126. https://doi.org/10.1371/journal.pone.0172126.CrossRefPubMedPubMedCentral

23.

Kou W-c, Bratzke LC, Oakley LD, Kuo F, Wang H, Brown RL. The association between psychological stress and metabolic syndrome: a systematic review and meta-analysis. Obes Rev. 2019;20(11):1651–64.

24.

Prior A, Fenger-Grøn M, Larsen KK, Larsen FB, Robinson KM, Nielsen MG, Christensen KS, Mercer SW, Vestergaard M. The association between perceived stress and mortality among people with multimorbidity: a prospective population-based cohort study. Am J Epidemiol. 2016;184(3):199–210. https://doi.org/10.1093/aje/kwv324.CrossRefPubMed

25.

Aneshensel CS. Sociological inquiry into mental health: the legacy of Leonard I. Pearlin. J Health Soc Behav. 2015;56(2):166–78. https://doi.org/10.1177/0022146515583992.CrossRefPubMed

26.

Pearlin LI. The sociological study of stress. J Health Soc Behav. 1989;30(3):241–56. https://doi.org/10.2307/2136956.CrossRefPubMed

27.

Wheaton B, Montazer S. Stressors, stress, and distress. In: Scheid TL, Brown TN, editors. A handbook for the study of mental health: social contexts, theories, and systems. 2nd ed. Cambridge: Cambridge University Press; 2009. p. 171–99. https://doi.org/10.1017/CBO9780511984945.013.CrossRef

28.

Brown LL, Mitchell UA, Ailshire JA. Disentangling the stress process: race/ethnic differences in the exposure and appraisal of chronic stressors among older adults. J Gerontol B. 2018;75(3):650–60.CrossRef

29.

Wheaton B, Young M, Montazer S, Stuart-Lahman K. Social stress in the twenty-first century. Handbook of the sociology of mental health. In: Handbooks of sociology and social research. 2nd ed. New York: Springer Science + Business Media; 2013. p. 299–323.

30.

Pearlin LI, Schieman S, Fazio EM, Meersman SC. Stress, health, and the life course: some conceptual perspectives. J Health Soc Behav. 2005;46(2):205–19. https://doi.org/10.1177/002214650504600206.CrossRefPubMed

31.

Scott SB, Jackson BR, Bergeman CS. What contributes to perceived stress in later life? A recursive partitioning approach. Psychol Aging. 2011;26(4):830–43. https://doi.org/10.1037/a0023180.CrossRefPubMedPubMedCentral

32.

Scott SB, Whitehead BR, Bergeman CS, Pitzer L. Combinations of stressors in midlife: examining role and domain stressors using regression trees and random forests. J Gerontol B Psychol Sci Soc Sci. 2013;68(3):464–75. https://doi.org/10.1093/geronb/gbs166.CrossRefPubMedPubMedCentral

33.

Glanz K, Schwartz MD. Stress, coping, and health behavior. In: Health behavior and health education: theory, research, and practice. 4th ed. San Francisco: Jossey-Bass; 2008. p. 211–36.

34.

Brown RL, Ciciurkaite G. Understanding the connection between social support and mental health. In: Wright ER, Scheid TL, editors. A handbook for the study of mental health: social contexts, theories, and systems. 3rd ed. Cambridge: Cambridge University Press; 2017. p. 207–23. https://doi.org/10.1017/9781316471289.014.CrossRef

35.

Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310–57. https://doi.org/10.1037/0033-2909.98.2.310.CrossRefPubMed

36.

Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145–61. https://doi.org/10.1177/0022146510395592.CrossRefPubMed

37.

Statistics Denmark. FOLK1 - Population 2017. Available from: https://www.statistikbanken.dk/statbank5a/default.asp?w=1920. Accessed 22 Sept 2020.

38.

Pedersen CB. The Danish civil registration system. Scand J Public Health. 2011;39(7 Suppl):22–5. https://doi.org/10.1177/1403494810387965.CrossRefPubMed

39.

Christensen AI, Lau CJ, Kristensen PL, Johnsen SB, Wingstrand A, Friis K, et al. The Danish National Health Survey: Study design, response rate and respondent characteristics in 2010, 2013 and 2017. Scand J Public Health. 2020:1403494820966534. https://doi.org/10.1177/1403494820966534.

40.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96. https://doi.org/10.2307/2136404.CrossRefPubMed

41.

Lazarus RS. Psychological stress and the coping process. New York: McGraw-Hill; 1966.

42.

Lazarus RS. Psychological stress and coping in adaption and illness. In: Lipowski ZJ, Lipsitt DR, Whybrow PC, editors. Psychosomatic medicine: current trends and clinical applications. New York: Oxford Univ. Press; 1977. p. 14–26.

43.

Pedersen AB, Baggesen LM, Ehrenstein V, Pedersen L, Lasgaard M, Mikkelsen EM. Perceived stress and risk of any osteoporotic fracture. Osteoporos Int. 2016;27(6):2035–45. https://doi.org/10.1007/s00198-016-3490-1.CrossRefPubMed

44.

Christiansen J, Larsen FB, Lasgaard M. Do stress, health behavior, and sleep mediate the association between loneliness and adverse health conditions among older people? Soc Sci Med. 2016;152:80–6. https://doi.org/10.1016/j.socscimed.2016.01.020.CrossRefPubMed

45.

Lee EH. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res (Korean Soc Nurs Sci). 2012;6(4):121–7. https://doi.org/10.1016/j.anr.2012.08.004.CrossRef

46.

Nielsen MG, Ornbol E, Vestergaard M, Bech P, Larsen FB, Lasgaard M, et al. The construct validity of the perceived stress scale. J Psychosom Res. 2016;84:22–30. https://doi.org/10.1016/j.jpsychores.2016.03.009.CrossRefPubMed

47.

Stubbs B, Vancampfort D, Veronese N, Schofield P, Lin PY, Tseng PT, Solmi M, Thompson T, Carvalho AF, Koyanagi A. Multimorbidity and perceived stress: a population-based cross-sectional study among older adults across six low- and middle-income countries. Maturitas. 2018;107:84–91. https://doi.org/10.1016/j.maturitas.2017.10.007.CrossRefPubMed

48.

Graff S, Prior A, Fenger-Gron M, Christensen B, Glumer C, Larsen FB, et al. Does perceived stress increase the risk of atrial fibrillation? A population-based cohort study in Denmark. Am Heart J. 2017;188:26–34. https://doi.org/10.1016/j.ahj.2017.03.002.CrossRefPubMed

49.

Gawlik KS, Melnyk BM, Tan A. Associations between stress and cardiovascular disease risk factors among million hearts priority populations. Am J Health Promot. 2019;33(7):1063–6. https://doi.org/10.1177/0890117119847619.CrossRefPubMed

50.

Norbeck JS. Modification of life event questionnaires for use with female respondents. Res Nurs Health. 1984;7(1):61–71. https://doi.org/10.1002/nur.4770070110.CrossRefPubMed

51.

Sondergaard C, Olsen J, Friis-Hasche E, Dirdal M, Thrane N, Sorensen HT. Psychosocial distress during pregnancy and the risk of infantile colic: a follow-up study. Acta Paediatr. 2003;92(7):811–6. https://doi.org/10.1080/08035250310003857.CrossRefPubMed

52.

Tegethoff M, Greene N, Olsen J, Meyer AH, Meinlschmidt G. Maternal psychosocial stress during pregnancy and placenta weight: evidence from a national cohort study. PLoS One. 2010;5(12):e14478.CrossRef

53.

Tegethoff M, Greene N, Olsen J, Schaffner E, Meinlschmidt G. Stress during pregnancy and offspring pediatric disease: a national cohort study. Environ Health Perspect. 2011;119(11):1647–52. https://doi.org/10.1289/ehp.1003253.CrossRefPubMedPubMedCentral

54.

Kristensen TS, Hannerz H, Høgh A, Borg V. The Copenhagen Psychosocial Questionnaire--a tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health. 2005;31(6):438–49. https://doi.org/10.5271/sjweh.948.CrossRefPubMed

55.

Munch-Hansen T, Wieclaw J, Agerbo E, Westergaard-Nielsen N, Bonde JP. Global measure of satisfaction with psychosocial work conditions versus measures of specific aspects of psychosocial work conditions in explaining sickness absence. BMC Public Health. 2008;8(1):270. https://doi.org/10.1186/1471-2458-8-270.CrossRefPubMedPubMedCentral

56.

Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14. https://doi.org/10.1016/0277-9536(91)90150-B.CrossRefPubMed

57.

Eurostat. International Standard Classification of Education (ISCED) 2018 [updated 28-08-2018]. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php/International_Standard_Classification_of_Education_(ISCED). Accessed 22 Sept 2020.

58.

Hjollund NH, Larsen FB, Andersen JH. Register-based follow-up of social benefits and other transfer payments: accuracy and degree of completeness in a Danish interdepartmental administrative database compared with a population-based survey. Scand J Public Health. 2007;35(5):497–502. https://doi.org/10.1080/14034940701271882.CrossRefPubMed

59.

Azen R, Budescu D. The dominance analysis approach for comparing predictors in multiple regression. Psychol Methods. 2003;8(2):129–48. https://doi.org/10.1037/1082-989X.8.2.129.CrossRefPubMed

60.

Budescu D. Dominance analysis: a new approach to the problem of relative importance of predictors in multiple regression. Psychol Bull. 1993;114(3):542–51. https://doi.org/10.1037/0033-2909.114.3.542.CrossRef

61.

Luchman J. Determining subgroup difference importance with complex survey designs: an application of weighted dominance analysis. Surv Pract. 2015;8(5):1–10. https://doi.org/10.29115/SP-2015-0022.CrossRef

62.

Sun J-W, Bai H-Y, Li J-H, Lin P-Z, Zhang H-H, Cao F-L. Predictors of occupational burnout among nurses: a dominance analysis of job stressors. J Clin Nurs. 2017;26(23–24):4286–92. https://doi.org/10.1111/jocn.13754.CrossRefPubMed

63.

Särndal C-E, Lundström S. Estimation in survey with nonresponse; 2005. https://doi.org/10.1002/0470011351.CrossRef

64.

Hawthorne G, Hawthorne G, Elliott P. Imputing cross-sectional missing data: comparison of common techniques. Aust N Z J Psychiatry. 2005;39(7):583–90. https://doi.org/10.1080/j.1440-1614.2005.01630.x.CrossRefPubMed

65.

Larsen FB, Pedersen MH, Friis K, Glumer C, Lasgaard M. A latent class analysis of multimorbidity and the relationship to socio-demographic factors and health-related quality of life. A national population-based study of 162,283 Danish adults. PLoS One. 2017;12(1):e0169426.CrossRef

66.

Luchman JN. DOMIN: Stata module to conduct dominance analysis. Statistical Software Components S457629, Boston College Department of Economics, revised 19 Feb 2021. 2013. https://ideas.repec.org/c/boc/bocode/s457629.html.

67.

Evans D, Mallet L, Flahault A, Cothereau C, Velázquez S, Capron L, et al. The importance of both workplace and private life factors in psychological distress: a large cross-sectional survey of French railway company employees. Soc Psychiatry Psych Epidemiol. 2012;48:1211–24.CrossRef

68.

Hasselberg K, Jonsdottir IH, Ellbin S, Skagert K. Self-reported stressors among patients with exhaustion disorder: an exploratory study of patient records. BMC Psychiatry. 2014;14(1):66. https://doi.org/10.1186/1471-244X-14-66.CrossRefPubMedPubMedCentral

69.

Nilsen C, Andel R, Fritzell J, Kåreholt I. Work-related stress in midlife and all-cause mortality: can sense of coherence modify this association? Eur J Pub Health. 2016;26(6):1055–61. https://doi.org/10.1093/eurpub/ckw086.CrossRef

70.

Pandey A, Quick JC, Rossi AM, Nelson DL, Martin W. 11 stress and the workplace: 10 years of science, 1997–2007. In: The handbook of stress science: biology, psychology, and health; 2010. p. 137.

71.

DePasquale N, Polenick CA, Davis KD, Moen P, Hammer LB, Almeida DM. The psychosocial implications of managing work and family caregiving roles: gender differences among information technology professionals. J Fam Issues. 2017;38(11):1495–519. https://doi.org/10.1177/0192513X15584680.CrossRefPubMed

72.

Garrido MM, Hash-Converse JM, Leventhal H, Leventhal EA. Stress and chronic disease management. In: The handbook of stress science: biology, psychology, and health; 2011. p. 487–500.

73.

Madsen IE, Jorgensen AF, Borritz M, Nielsen ML, Rugulies R. Is the association between high strain work and depressive symptoms modified by private life social support: a cohort study of 1,074 Danish employees? BMC Public Health. 2014;14(1):698. https://doi.org/10.1186/1471-2458-14-698.CrossRefPubMedPubMedCentral

74.

Kim HJ, Hur W-M, Moon T-W, Jun J-K. Is all support equal? The moderating effects of supervisor, coworker, and organizational support on the link between emotional labor and job performance. BRQ Bus Res Q. 2017;20(2):124–36. https://doi.org/10.1016/j.brq.2016.11.002.CrossRef

75.

Almeida DM, Davis KD. Workplace flexibility and daily stress processes in hotel employees and their children. Ann Am Acad Pol Soc Sci. 2011;638(1):123–40. https://doi.org/10.1177/0002716211415608.CrossRefPubMedPubMedCentral

76.

Yu TC, Zhou H, Suh K, Arcona S. Assessing the importance of predictors in unplanned hospital readmissions for chronic obstructive pulmonary disease. Clinicoecon Outcomes Res. 2015;7:37–51. https://doi.org/10.2147/CEOR.S74181.CrossRefPubMedPubMedCentral

77.

Shmueli G. To explain or to predict? Stat Sci. 2010;25(3):289–310.

Title: The relative importance of work-related and non-work-related stressors and perceived social support on global perceived stress in a cross-sectional population-based sample
Authors: Jes Bak Sørensen
Mathias Lasgaard
Morten Vejs Willert
Finn Breinholt Larsen
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-10594-2

2024 ASCO Annual Meeting

Springer Medicine

The relative importance of work-related and non-work-related stressors and perceived social support on global perceived stress in a cross-sectional population-based sample

Abstract

Background

Methods

Results

Conclusions

Trial registration

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2021

Factors hindering health care delivery in nomadic communities: a cross-sectional study in Timbuktu, Mali

Association between supportive attitude and adoptive practice of control strategy against COVID-19 amosng college students in China: a cross-sectional study

Weight-related behaviors and weight loss maintenance: a cross-sectional study in Cyprus

Trends in socioeconomic inequalities in smoking in Turkey from 2008 to 2016

Arts engagement supports social connectedness in adulthood: findings from the HEartS Survey

The role of contraception in preventing HIV-positive births: global estimates and projections