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RESEARCH NOTE

Adverse psychosocial working conditions and subjective health in freelance media workers

MICHAEL ERTEL^ EBERHARD PECH^ PETER ULLSPERGER^OLAF VON DEM KNESEBECK^, & JOHANNES SIEGRIST^

^Federal Institute for Occupational Safety and Health, Subdivision ‘Mental Workload, Stress and Work Design’, Berlin, Germany; ^Center for Psychosocial Medicine, Institute of Medical Sociology, University of Hamburg, Eppendorf, Germany; and ^Department of Medical Sociology, University of Duesseldorf, Germany

AbstractIn recent years there has been a steady growth of non-standard work contracts in advanced societies. These contracts are characterized by increased flexibility of work arrangements and increased job instability, which holds particularly true for the media industry. This pilot study analyses associations of work stress with subjective health in a group of German freelancers {N = 290) working in the media industry. The measurement of work stress is based on the effort-reward imbalance model. Results of logistic regression analyses indicate significant effects of high effort in combination with low reward (money, esteem, promotion prospects, job security) on subjective health in men and women, with the effects being higher in men. Moreover, among, men a critical pattern of coping with work stress enhanced the reported effect. In conclusion, the preliminary evidence from this study indicates an elevated risk of poor subjective health among freelance workers who are exposed to adverse psychosocial work conditions.

Keywords: Effort-reward imbalance, flexibility, freelance media workers, subjective health, insecure work, reduced ability to relax

Introduction

Far-reaching changes in the nature of work and the labour market in highly developed economies are currently reshaping the agenda of worklife research (Rantanen, 1999). In particular, the steady growth of non-standard work contracts, increasing instability and flexibility and rapid technological change may have far-reaching effects on health and well­being (Ferrie, Marmot, Griffiths, & Ziglio, 1999; Goudswaard et ah, 2002). As a consequence of rapid technological change, new communication technologies contribute

Correspondence: Michael Ertel, Federal Institute for Occupational Safety and Health, Subdivision ‘Mental Workload, Stress, and Work Design’, Noeldnerstrasse 40/42, D-10317 Berlin, Germany. E-mail: Ertel.Michael@baua.bund.de

ISSN 0267-8373 print/ISSN 1464-5335 online i DOI: 10.1080/02678370500307289

2005 Taylor & Francis

.'■f-

294 M. Ertel et al.

to growing decentralization of work and organizational flexibility. Companies tend to substitute conventional employment by market transactions with freelance workers in order to handle unpredictability of work and to minimize their risks, which in turn shifts the risks to the working population. In particular, people on fixed-term contracts, contingent and temporary work and the self-employed may suffer from the consequences of increased flexibility and decentralization (Büssing & Glaser, 1998; Theorell, 1996).

The media industry belongs to the sectors that are most intensely hit by these developments. Work is no longer organized around traditional hierarchies. Instead, there is often a segmentation between a privileged core group and a periphery where partners form temporary networks of flexible specialization in order to achieve common goals. While there is open access to network organizations at the periphery, the inner core with the higher status, higher paid positions is more or less closed. Freelancers may contract with a firm for a particular service or a specific length of time. They may also work on behalf of different firms as they move from one project to the next one. However, the experience of insecurity is inherent in this type of activity (Baines, 2002). Thus, the workforce in the media sector is characterized hy interchangeable and fluent transitions between different types of contractual relationships, i.e. freelancers and employees with more stable positions. Moreover, irregular earnings force many freelancers to work long hours, to postpone vacations or even to disregard episodes of illness if demands with time constraints do exist. Few studies so far have analysed the associations between adverse psychosocial work conditions and health in freelancers.

In order to define these conditions more precisely in theoretical terms, the model of effort-reward imbalance (ERI) at work was applied to the present investigation (Siegrist, 1996). The focus of this model is on the notion of reciprocity in a work contract, a notion that is critical in freelancers due to its poor specification, in particular with regard to workload, work prospects and job security. Moreover, this model contains two components, an extrinsic component (experienced or expected demands and rewards, i.e. effort-reward), and an intrinsic component, the attitudes and motivations of the individual (work-related commitment). These extrinsic and intrinsic conditions of imbalance between effort and reward at work in the long run produce adverse effects on health and well-being because they elicit negative emotions and recurrent activation of the autonomic nervous system. The model has been successfully tested in a number of prospective and cross-sectional epidemiological investigations and in experimental studies (for a review see Siegrist, 2002).

In the present study the following hypotheses were tested. (1) Hypothesis 1: High work load in combination with low rewards (effort-reward imbalance) is associated with poor subjective health. (2) Hypothesis 2: A high level of work-related commitment is associated with poor subjective health. (3) Hypothesis 3\ The combined effect of these two conditions on subjective health exceeds the hypothesized separate effects.

Methods

Study design and participants

This questionnaire-based study was conducted in co-operation between the German Federal Institute for Occupational Safety and Health and the German union of media workers. To access freelancers, we contacted representatives of the union of media workers in the region of Munich, one of the centres of the media business in Germany. A self- administered survey instrument was developed in collaboration with members of the Union. It was based on a previously tested questionnaire (Ertel, Junghanns, & Ullsperger,

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1994; Ertel, Pech, & Ullsperger, 2000). The questionnaires were mailed to freelancers who were members of the tmion of media workers, mainly in the region of Munich. As expected in this professional group that is detached from traditional occupational settings and probably highly stressed, the response rate was low. No more than 'about 20% (N = 290) returned the questionnaire. Given the lack of comparable studies, we do not Imow whether, and to what extent, the sample is biased.

A total of 52% of the respondents were women, 43% of the freelancers were aged less than 40 years, 38% were between 40 and 49 years and 19% were over 50 years. Our sample included a diversity of occupations within the media industry (i.e. journalists, multimedia designers, public relation agents, marketing agents and others). Overall, participants were highly educated, but showed great variety with regard to working hours and income level.

Measures

Work stress

The measurement of the extrinsic component of the effort-reward imbalance model was based on the original questionnaire developed by Siegrist (1996). The scale ‘effort’ is measured by six Likert-scaled items, the scale ‘reward’ by 11 items. Cronbach’s a of the scales in this sample is .74 for ‘effort’ and .85 for ‘reward’, respectively. The wording of a few items had to be changed slightly in order to describe the freelancer’s specific work situation more appropriately (e.g. ‘overtime work’ was replaced by ‘worldng longer time than anticipated’ and ‘poor job security’ was replaced by ‘insecure occupational situation’).

In order to estimate the core theoretical notion of the model with regard to stress, the degree of imbalance between effort and reward, a ratio of the two scales was constructed following the standard procedure (Siegrist et al., 2004). The logarithmically transformed continuous ratio showed a normal distribution in this cohort. Based on the continuous ratio, tertiles were defined where scores in the upper tertile were considered to indicate high work stress, as opposed to the remaining group as reference.

The intrinsic model component, ‘overcommitment’, was not measured by the original scale developed by Siegrist (1996), but by a short scale based on a related construct, ‘reduced ability to relax’ (Richter, Rudolph, & Schmidt, 1996). The scale is composed of six Likert-scaled items (Richter, 1994) with a Cronbach’s a of .84. Again, the upper tertile of the score distribution was defined as indicating overcommitment (i.e. a score of 17 or more; range 6-24). A recent study shows strong correlations between ‘overcommitment’ and ‘reduced ability to relax’, indicating strong construct similarity (Rothweiler & Metz, 2003). Thus, scoring in the upper tertile of the scale ‘reduced ability to relax’ was considered a proxy measure of overcommitment, the intrinsic component of the effort- reward imbalance model.

Subjective health

Poor subjective health has been assessed in a number of investigations in the field of work stress and health (Karasek & Theorell, 1990; Niedhammer et al., 2004; Pikhart et al., 2001; Siegrist, 2002). This measure has been repeatedly found to predict ill health, morbidity and mortality (Idler & Benyamini, 1997). In the current study, respondents were categorized as exhibiting poor health if they simultaneously rated their health as ‘satisfactory’ or ‘poor’, as opposed to ‘very good’ or ‘good’ (1 item), and if they worried about future severe health

296 M. Enel et al.

problems (yes vs. no, 1 item). Some 37% of the freelancers were classified as suffering from poor health. This combined measure of subjective health was found to be particularly appropriate in the case of freelancers, whose future professional success is heavily dependent on continued good health. .

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The following covariates were included in this analysis; gender, age, education, income, marital status, body mass index (BMI), smoldng and regular physical activity.

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Statistical analysis

To analyse associations between psychosocial working conditions and subjective health, multiple logistic regressions were used. All analyses were performed using the software package (SPSS Version 10). First, crude odds ratios of either component of the model of effort-reward imbalance on subjective health were calculated (unadjusted). Odds ratios were adjusted for the covariates mentioned above (adjustment I and II). In the fully adjusted model (adjustment III), effects of the respective model components were taken into account. Second, distinct exposure groups were computed to estimate the combined effect of the two model components, again adjusted for all covariates. All analyses were performed separately for women and men.

Results

Associations between effort-reward imbalance and poor subjective health are shown in Table I. Poor health was significantly related to each one of the components, with stronger effects in men compared to women. Associations remained significant after controlling for age, BMI, smoking, physical activity, education, income and marital status (adjustments I and II). After additional adjustment for reduced ability to relax (adjustment III), the ratio of effort and reward remained significantly associated with poor subjective health in men (OR =2.53) and in women (OR = 1.66). However, the effects of the intrinsic component lost their significance both in men and women after adjustment for the ERI ratio. Thus, the first hypothesis found support from the current study (i.e. effort-reward imbalance was associated with poor subjective health). However, the second hypothesis (that a high level of work-related commitment would be associated with poor subjective health) was not supported by the data.

To explore the third hypothesis, i.e. the combined health effect of the extrinsic and intrinsic components of the model, a variable with four categories was computed: (1) scoring low on both extrinsic and intrinsic work stress (reference group); (2) high scores in both the extrinsic and intrinsic component (upper tertile, see Methods); (3) high extrinsic and low intrinsic scores; (4) low extrinsic and high intrinsic scores. Table II shows the respective findings in separate analyses for men and women. While no significant effects were found in women, in men, the odds ratio of suffering from poor subjective health was almost three times as high in the high-risk compared to the low-risk group (OR =2.92). This finding can be interpreted as preliminary support of the hypothesis with regard to men.

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Table I. Effort-reward imbalance, reduced ability to relax and poor self-rated health Odds Ratios (OR) and 95% confidence intervals (Cl).

Variable Adjustment OR 95% Cl

Effort-Reward Imbalance (ERI) Unadjusted:Men 5.65 2.55 12.53Women 3.19 1.56 6.52

Adjustment I:Men 2.58 1.64 4.06Women 1.85 1.24 2.74

Adjustment II:Men 2.82 1.67 4.77Women

Adjustment III:1.88 1.21 2.93

Men 2.53 1.41 4.53Women 1.66 1.00 2.73

Reduced ability to relax (RAR) Unadjusted:Men 2.32 1.09 4.92.Women

Adjustment I:2.61 1.29 5.28

Men 1.58 1.05 2.39Women

Adjustment II:1.82 1.21 2.73

Men 1.97 1.20 3.24Women 1.75 1.12 2.74

Adjustment III:Men 1.32 0.75 2.34Women 1.58 0.97 2.58

Adjustment I: Age, BMI, smoker, physical activity.Adjustment II: Adjustment I+education, income, marital status.Adjustment III: Adjustment Il-fmumal adjustment for ERI and reduced ability to relax.

Discussion

To our knowledge, this is one of the first studies testing the associations between adverse psychosocial work conditions and subjective health in a group of freelancers in the media sector. The findings demonstrate strong associations of effort-reward imbalance (extrinsic model component) with poor subjective health in men and, to a lesser extent, in women.

Table II. Combined components of Effort-Reward Imbalance (ERI),Reduced Ability to Relax (RAR) and poor self-rated health.

OR 95% Cl

MenERI high/RAR high 2.92 1.15 7.43ERI high/RAR low 2.05 0.59 ■■ 7.19ERI low/RAR high 0.53 0.20 1.44

WomenERI high/RAR high 1.92 0.85 4.33ERI high/RAR low 1.06 0.40 2.86ERI low/RAR high 0.98 0.40 2.37

Reference group: ERI low/RAR low.Adjusted for age, BMI, smoker, physical activity, education, income, marital stams.

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Moreover, among men, a combined effect of the extrinsic and intrinsic components of the model on health is observed that exceeds the effect size produced by the single components.

Several previous investigations have documented associations of effort-reward imbalance at work with self-rated health, both cross-sectionally (Pikhart et al., 2001) and prospectively (Niedhammer et al., 2004; Ostry et al., 2003). The study by Pildiart et al. (2001) is of particular interest in this context as it was conducted in a population exposed to severe threats to job stability and economic change (Central and Eastern European countries in early post-communist societies). Although the group of freelancers in the current study is working in a more privileged context, economic pressure and job instability are highly prevalent exposures.

Although associations between ERI and health were found for men and women, they were more consistent among men, particularly as far as the combined effect of the two components of the model is concerned. This observation is in line with several previous reports testing gender-specific health effects of effort-reward imbalance at work (Head, Stansfeld, & Siegrist, 2004; Peter et al., 2002). One interpretation points to the relevance of control and reward related to social status for dominant male gender-role orientation. However, relevant data are not available in the present smdy.

A number of limitations need to be addressed. First, the results are based on a critically low response rate (20%). This fact demonstrates the difficulty of reaching target groups in flexible work (‘dispersed’ workforce) for traditional survey research that is generally based on relatively stable occupational settings. Discussing the results with our partners from the tmion of media workers, we feel that our results are reliable. However, it is not Imown to what extent the findings can be generalized to freelancers working in this part of Germany and beyond. Second, given the cross-sectional design of the study and the self-reported measures of predicting and criterion variables, response bias may operate in invalidating the results to some degree. This restriction calls for a longitudinal research design and for inclusion of more objective health measures. Third, the effort-reward imbalance model was not used in total in its original form, as its intrinsic component ‘overcommitment’ was assessed by a proxy measure derived from a more recently developed scale ‘reduced ability to relax’. However, a strong correlation between the two measures (Rothweiler & Metz, 2003) indicates considerable overlap between the constructs.

Despite these limitations, this study adds to Imowledge concerning work-related stress and health as it was conducted on a flexible, poorly-regulated and increasing workforce that is of growing importance.

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ReferencesBaines, S. (2002). New technologies and old ways of working in the home of the self-employed teleworkers. New

Technology, Work and Employment, 17, 89-101.Büssing, A., & Glaser, J. (1998). Arbeitszeit und neue Organisations- und Beschäftigungsformen; Zum

Spannungsverhältnis von Flexibilität und Autonomie. [Working time and new forms of work organisation and employment: On the tension between flexibility and autonomy.] Mitteilungen aus der Arbeitsmarkt- und Berufsforschung, 5, 585-598.

Ertel, M., Jungharms, G., & Ullsperger, P. (1994). Gesundheit am Bildschirmarbeitsplatz (GESBI). [Health at the VDU workplace.] Bremerhaven: Wirtschaftsverl. NW (Schriftenreihe der Bundesanstalt für Arbeitsmedizin).

Ertel, M., Pech, E., & Ullsperger, P. (2000). Telework in perspective—new challenges to occupational health safety. In K. Issaksson, C. Hogstedt, C. Eriksson, & T. Theorell (Eds), Health effects of the new labour market (pp. 169-181). New York: Kluwer Academic/Plenum Publishers.

Ferrie, J. E., Marmot, M. G., Griffiths, J., & Ziglio, E. (1999). Labour market changes and job insecurity: A challenge for social welfare and health promotion. WHO Regional Publications European series. No. 81. Copenhagen: WHO, Regional Office for Europe.

--

Work stress and subjective health 299

Its of the iponents. nbalance pectively 01) is of ;o severe ntries in study is'

■e highly

en, they the two

previous : (Head, vance of ;ntation.

critically roups in ly based from the nown to lermany reported iting the and for

cdel was :nt’ was d ability k Metz,

id stress irce that

Goudswaard, A., Andre, J. C., Ekstedt, E., Huuhtanen, R, Kuhn, K., Peirens, K., Op de Beeck, R., & Brown, R. (2002). New forms of contractual relationships and the implications for occupational safety and health. European Agency for Safety and Health at Work. Luxembourg: Office for Official Publications of the European Communities.

Head, J., Stansfeld, S. A., & Siegrist, J. (2004). The psychosocial work environment and alcohol dependence: A prospective study. Occupation and Environmental Medicine, 61, 219—224.

Idler, E., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community smdies. Journal of Health and Social Behavior, 38, 21-37.

Karasek, R. A., & Theorell, T. (1990). Healthy viork. Stress, productivity, and the reconstruction of working life. New York: Basic Books.

Niedhammer, I., Teck, M. L., Starke, D., & Siegrist, J. (2004). Effort-Reward Imbalance Model and self-reported health: Cross-sectional and prospective results from the GAZEL Cohort. Social Science Gf Medicine, 58, 1531- 1541.

Ostry, A. S., Kelly, S., Demers, P. A., Mustard, C., & Hertzman, C. (2003). A comparison between the effort- reward imbalance and the demand control models. BMC Publications, 3, 10—21.

Peter, R., Siegrist, J., Hallqvist, J., Reuterwall, C., Theorell, T, & the SHEEP smdy Group (2002). Psychosocial work environment and myocardial infarction: Improving risk estimation by combining two complementary job stress models in the SHEEP Study, Journal of Epidemiology and Community Health, 56, 294-300.

Pikhart, H., Bobak, M., Siegrist, J., Pajak, A., Rywik, S., Kyshegyi, J., Gostautas, A., Skdova, Z., & Marmot, M. G. (2001). Psychosocial work characteristics and self rated health in four post-communist countries. Journal of Epidemiology and Community Health, 55, 624-630.

Rantanen, J. (1999). Research changes arising from changes in worklife. Scandinavian Journal of Work, Environment and Health, 25 (6), Special Issue, 473-483.

Richter, P. (1994). Job content and myocardial health risks—consequences for occupational prevention. In M. Vartiainen, & V. Teikari (Eds.), Change, learning and mental work in organizations (pp. 19-33). Helsinki: University pf Technology, Report No. 157.

Richter, P., Rudolph, M., & Schmidt, Ch. F. (1996). FABA: Fragebogen zur Erfassung belastungsrelevanter Anforderungsbew’ältigung. [FABA: Questionnaire to analyse stress-related coping] Frankfurt/M.: Swets Test Service.

Rothweiler, E., & Metz, U. (2003). Beziehungen zwischen Faktoren der Arbeits-Anforderungsbewältigung (FABA, Richter et al.) und den Konzepten Overcommitment (Siegrist) und Irritation (Mohr). [On the relation between coping factors (FABA, Richter et al.) and the concepts of overcommitment (Siegrist) and irritation (Mohr).] Wirtschaftspsychologie, 1, 150—152.

Siegrist, J. (1996). Adverse health effects of high effort—low reward conditions at work. Journal of Cccupational Health Psychology, 1, 27-43.

Siegrist, J. (2002). Effort-reward imbalance at work and health. In P. L. Perrewe, & D. C. Ganster (Eds), Historical and current perspectives on stress and health (pp. 261—291). Amsterdam: JAI.

Siegrist, J., Starke, D., Chandola, T, Godin, I., Marmot, M. G., Niedhammer, I., & Peter, R. (2004). The measurement of Effort-Reward Imbalance at work: European comparisons. Social Science & Medicine, 58i 1483-1499. :

Theorell, T. (1996). Flexibility at work in relation to employee health. In M. J. Schabracq, J. A. M. Wiimubst, & C. L. Cooper (Eds), Handbook of work and health psychology (pp. 147-160). Chichester: Wiley.

kers. New

:en: Zum ation and arkt- und

ilth at the ledizin). aal health arket (pp.

icurity: A No. 81.