Lack of job autonomy can have deadly effect

Low self-esteem, high stress harm heart health

Health promotion professionals have long been aware of the links between stress and illness, and that a job in which an employee feels helpless or controlled by others can be a major contributor to high stress levels.

But now, a study in the March 1998 issue of the American Journal of Public Health has shown that such feelings can have deadly consequences.1 The study, authored by Tores Theorell, MD, PhD, and colleagues at the Swedish National Institute for Psychosocial Factors and Health in Stockholm, found that people who have little or no decision-making ability at work and who report a high degree of job stress are at increased risk of suffering an early heart attack. They further found that many heart attacks occur within just a few years of a negative job change, such as a demotion or a decrease in career status.

The study involved 1,047 men who had a first heart attack between the ages of 45 and 64, and who had worked full-time during the five preceding years. The researchers found that the most vulnerable age group was those 45 to 54 years of age. Factors such as decreased job status, a lowered level of decision making or an inability to voice an opinion on the job within the previous five years significantly increased their risk for an early heart attack.

The findings of this study "absolutely" make sense to Howard Eisenberg, MD, who heads the Stowe, VT-based wellness consulting firm, Syntrek Inc. "Stress is more about how we interpret our relationship with our environment than it is about the external environment itself," he explains. "If we feel what we do has meaning, if the environment in which we operate is meaningful and fair, then we have a much higher level of comfort and satisfaction. When feel we are in the role of the victim, we have higher levels of stress."

That feeling of low self-esteem or lack of control in turn physiologically affects the heart, Eisenberg says. "We know that when we experience a stress reaction we see increased production of the adreno-cortico [steroid] hormones - as a natural part of the stress reaction," he explains. "These hormones cause the heart to beat more quickly, the arteries to constrict and narrow, so our blood pressure goes up, causing in turn a thickening of the blood which makes it more likely to clot or plug up. Sometimes, stress can cause heart arrhythmia." Stress can also lower the effectiveness of our immunological system so we are more vulnerable to illness, says Eisenberg. In fact, it can upset the immune system's balance to the point that it attacks healthy tissues, a phenomenon referred to as autoimmune disease.

Be an optimist

Unfortunately, some jobs will always carry an inordinate amount of stress. What's more, not every autocratic manager can be convinced to give employees a greater say in the business process. However, Eisenberg asserts that not even employees who are trapped in such a situation must inevitably succumb to the negative effects of stress. Optimism, he says, can get us through almost anything.

"Optimists have more faith in their ability to control their environment; they see opportunities where others see just another problem," he explains. "They are physically healthier and more successful in their careers."

But what about those Type-A personalities we hear so much about? Shouldn't "control freaks" be immune to stress problems? Not necessarily, says Eisenberg. "Control freaks have an extraordinarily high need to have control, because they are basically more insecure than the rest of us," he says. "They are not natural optimists."

A serene attitude can be one of the most effective coping mechanisms an employee can use, Eisenberg advises. He personally uses what he calls "the secular version" of the famous serenity prayer composed by philosopher Reinhold Niebuhr: "Give us the serenity to accept what cannot be changed, the courage to change what should be changed, and the wisdom to know the difference."

In a situation where the environment is oppressive, Eisenberg suggests, don't smash your head against a brick wall. Look at other areas in your life where you can make a difference - and not necessarily at work. At the workplace, look for opportunities in other parts of the company. If you must, seek employment elsewhere. (See the related story, p. 66, for more suggestions on minimizing the effects of a stressful job.)

[Editor's Note: For more information on stress and health, see: From Stress to Strength: How to Lighten Your Load and Save Your Life, by Dr. Robert Eliot, Bantam Books, New York, NY, 1994. You can contact Dr. Howard Eisenberg at: Syntrek Inc., P.O. Box 1078, Montpelier, VT 05601. Telephone: (802) 253-8691. E-mail:]


1. Theorell T, Tsutsumi A, Hallquist J, Reuterwall C, Hogstedt C, Fredlund P, Emlund N, Johnson J, and the SHEEP Study Group. Decision latitude, job strain, and myocardial infarction: A study of working men in stockholm. Am J Public Health 1998; 88:382-388.