Gignac MA, Sutton D, Badley EM. Arthritis symptoms, the work environment, and the future: measuring perceived job strain among employed persons with arthritis. Arthritis Rheum. 2007 Jun 15;57(5):738-47. [Pub Med ID 17530672]

Objective

To develop a measure of job strain related to differing aspects of working with arthritis and to examine the demographic, illness, work context, and psychosocial variables associated with it.

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Methods

Study participants were 292 employed individuals with osteoarthritis (N=105), inflammatory arthritis (N=151), or both (N=36). Participants were from wave 3 of a 4-wave longitudinal study examining coping and adaptation efforts used to remain employed. Participants completed an interview-administered structured questionnaire, including a Chronic Illness Job Strain Scale (CIJSS) and questions on demographic (e.g., age, sex), illness and disability (e.g., disease type, pain, activity limitations), work context (e.g., job type, job control), and psychosocial variables (e.g., arthritis-work spillover, co-worker/managerial support, job perceptions). Principal component analysis and multiple linear regression were used to analyze the data.

Results

A single factor solution emerged for the CIJSS. The scale had an internal reliability of 0.95. Greater job strain was reported for future uncertainty, balancing multiple roles, and difficulties accepting the disease than for current workplace conditions. Participants with inflammatory arthritis, more frequent severe pain, greater workplace activity limitations, fewer hours of work, less coworker support, and greater arthritis-work spillover reported greater job strain.

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Conclusion

The findings underscore the diverse areas that contribute to perceptions of job strain and suggest that existing models of job strain do not adequately capture the stress experienced by individuals working with chronic illnesses or the factors associated with job strain. Measures similar to the CIJSS can enhance the tools researchers and clinicians have available to examine the impact of arthritis in individuals’ lives.

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List of Tables and Figures (in the publication)

• Table 1. Sample characteristics.
• Table 2. Chronic illness job strain scale items assessing the degree of perceived stress.
• Table 3. Chronic illness job strain scale inter-item correlations and scale internal consistency.
• Table 4. Multivariate unstandardized and standardized regression coefficients for explanatory variables by chronic illness job strain.
• No figures for this paper.

Selected Tables from the Publication (with interpretation)

Multivariate unstandardized (b) and standardized (B) regression coefficients for explanatory variables by chronic illness job strain.i

		Variables	R2 changeii	b	ß	P
Demographic variables			0.00
	Age			-0.13	-0.09	0.08
	Sexiii			0.88	0.03	0.59
Illness related variables			0.44
	Diagnosisiv
		OA		-4.14	-0.15	0.01
		Both OA and IA		-5.27	-0.11	0.02
	Joints affected			-5.38	-0.08	0.12
	Fatigue			1.29	0.12	0.06
	Severe pain			2.02	0.17	0.00
Workplace activity limitations			0.13
Work context variables			0.03
	Job fieldv
		Health, science, art, sport		-1.70	-0.06	0.23
		Sales and service		1.52	0.04	0.38
		Trades and transportation		1.00	0.02	0.69
	Average hours of work per week			-0.15	-0.10	0.05
	Control over work schedule			-0.56	-0.05	0.25
	Drug benefitsvi			5.52	0.16	0.10
	Extended health benefitsvi			-4.32	-0.13	0.16
Psychological scales			0.12
	Job perceptions			-0.00	-0.00	0.98
	Arthritis-work spillover			1.07	0.39	0.00
	Manager-supervisor support			-0.11	-0.03	0.53
	Coworker support			-0.47	-0.18	0.00
Total R2			0.72

Table 4 shows the results of the multivariate analysis which differs in several ways from previous work on job strain with healthy adults. Similar to workplace studies, work hours were related to overall perceptions of stress. In this study, however, participants working fewer hours reported greater job strain compared to participants working more hours. This may be because arthritis limited the ability of some participants to work the hours they wanted. Other work context factors such as job type, control over the work schedule, job perceptions, and perceptions of managerial support were not significantly associated with job strain. Sex and age were also not related to perceived stress. Instead, arthritis-type pain and workplace activity limitations were the largest contributors to understanding the variance in job strain. A trend also existed for fatigue associated with greater strain. Psychosocial perceptions were also important, with those perceiving they had less support from co-workers and those perceiving difficulties balancing arthritis and work reporting greater job strain. These findings suggest that factors associated with job strain among those with chronic illness are largely different from those of healthy adults.

Supplementary Tables (with interpretation)

Supplementary Table 1: Chronic Illness Job Strain Scale (CIJSS) by age and sex at T3.

	Male					Female
Age group	N	Mean	Std Dev	Min	Max	N	Mean	Std Dev	Min	Max
Below 40	8	31.750	19.352	15	68	17	28.118	10.682	15	55
40-49	19	30.842	13.434	15	58	50	37.960	14.168	15	69
50-59	23	33.130	14.467	15	60	106	34.731	14.278	15	64
60+	18	32.833	13.334	16	57	51	27.180	10.185	15	53

Supplementary Table 1 shows the mean and standard deviation of the CIJSS by age and sex. Men’s scores seem to be quite consistent across the age groups; however, the women’s scores on the CIJSS seem to increase at age 40 and then decline significantly once over the age of 60 years.

Supplementary Table 2: Chronic Illness Job Strain Scale (CIJSS) by age at T3.

Age group	N	Mean	Std Dev	Min	Max
Below 40	25	29.280	13.722	15	68
40-49	69	36.000	14.236	15	69
50-59	129	34.441	14.268	15	64
60+	69	28.677	11.283	15	57

Supplementary Table 2 shows the mean and standard deviation of the CIJSS by age. Overall scores seem to increase at age 40, and then decline significantly at age 60 years or over. Thus, job strain seems to be the worst between ages 40-60 years, which may be when job and family demands are at their highest.

Supplementary Table 3: Chronic Illness Job Strain Scale (CIJSS) by age and working status at T3.

	Full-time					Part-time
Age group	N	Mean	Std Dev	Min	Max	N	Mean	Std Dev	Min	Max
Below 40	21	30.000	14.286	15	68	4	25.500	11.091	18	42
40-49	61	36.197	14.641	15	69	8	34.500	11.339	15	53
50-59	105	33.913	13.876	15	64	24	36.708	15.958	16	61
60+	42	31.073	12.705	15	57	27	25.037	7.542	15	41

Supplementary Table 3 shows the mean and standard deviation scores of the CIJSS by age and working status (i.e., either full or part-time employment). The sample size is quite small for the part-time employment group, so these results must be interpreted with caution. The scores for the full-time group seem to peak in the 40-49 age group, and then steadily decrease. Job strain seems to be the worst at this stage of life. In the part-time employment group, the scores seem to peak in the 40-60 age group, again, not very different from those who work full-time. It is difficult to get a clear picture, without considering other factors such as disease severity and pain, which may be the cause of part-time hours.

Supplementary Table 4: Chronic Illness Job Strain Scale (CIJSS) by diagnosis of arthritis at T3.

Diagnosis	N	Mean	Std Dev	Min	Max
IA	105	33.848	13.204	15	62
OA	151	32.074	13.920	15	68
Both	36	34.417	15.206	15	69

Supplementary Table 4 demonstrates the relationship between job strain and diagnosis of arthritis (osteoarthritis versus inflammatory, or both). The means are quite similar, as the level of pain and fatigue are likely more influential on job strain than the actual type of musculoskeletal disease. N.B. We have to be careful with interpretation as diagnosis was significant after controlling for pain and fatigue in the multivariate analysis.

Supplementary Table 5: Chronic Illness Job Strain Scale (CIJSS) by Arthritis Pain at T3.

Pain in past month	N	Mean	Std Dev	Min	Max
No days	85	23.702	8.149	15	52
A few days	81	31.225	12.262	15	61
Some days	64	38.302	12.539	15	69
Most days	42	41.548	14.641	15	68
All days	20	44.650	14.489	20	64

Supplementary Table 5 examines the level of job strain by number of reported days of arthritis pain. This is clearly a strong linear relationship, with job strain increasing with the number of reported days of pain.

Supplementary Table 6: Chronic Illness Job Strain Scale (CIJSS) by arthritis fatigue at T3.

Fatigue in past month	N	Mean	Std Dev	Min	Max
No days	65	22.703	8.801	15	54
A few days	48	26.333	10.031	15	54
Some days	76	33.297	11.832	15	62
Most days	62	40.226	12.634	20	69
All days	40	45.800	13.107	18	68

Supplementary Table 6 and Figure 1 demonstrate the linear relationship between job strain and arthritis fatigue; that is, as fatigue increases, so does level of job strain.

Figure 1: Mean scores on the CIJSS by number of days fatigue and pain were reported.

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