Date Published: April 24, 2019
Publisher: Public Library of Science
Author(s): Jan Olav Christensen, Morten Birkeland Nielsen, Live Bakke Finne, Stein Knardahl, Sergio A. Useche.
Chest pain (CP) is common, frightening, and often medically unexplained. Occupational psychological factors are associated with somatic pain. Personality may influence both perceived working conditions and somatic health, thereby confounding associations of work with health. Despite this, very few studies have investigated the interplay between work factors, personality and pain. The current study assessed relationships of a relatively novel work factor, human resource primacy (HRP), and a personality factor known to be relevant to health, dispositional optimism (Opt), with CP across two years (N = 6714). A series of structural equation models (SEMs) were fitted, modeling “substantive” and “confounded” relationships of psychological factors with CP. A “common latent factor” (CLF) was included to account for bias by unmeasured factors that may have influenced all variables (e.g. reporting bias) and the role of optimism as a possible confounder of the relationship between HRP and CP was investigated specifically. Independent effects of HRP and Opt on CP were observed. No effects of HRP/CP on Opt were observed. Opt appeared to confound the relationship between HRP and CP to some extent. However, best fit was observed for a “reciprocal” model with independent lagged effects from HRP/Opt to CP as well as from CP/Opt to HRP. Thus, results suggested a mutual causal dynamic between HRP and CP along with an influence of Opt on both HRP and CP—implying that working conditions influence the experience of chest pain while the chest pain also influences the experience of working conditions. Optimistic dispositions may influence the experience of both work and pain, but not to an extent that fully explains their relationship. Hence, the notion that associations of HRP with CP are mere artifacts of optimistic/pessimistic reporting was not supported. More likely, complex reciprocal relationships exist between these factors, in which mutual reinforcements occur and both vicious and virtuous cycles may result.
Being a well-known symptom of cardiovascular disease (CVD), chest pain (CP) can be extremely disturbing. Acute CP motivates many emergency distress calls and incurs significant economic and human costs by being common and requiring extensive investigation . However, it is not a specific symptom and most admitted patients are not diagnosed with CVD . The majority of cases that reach the healthcare system remain unexplained or are due to conditions that are less alarming than CVD, such as gastritis, gastro-oesophageal reflux, sprains, panic disorder, etc. . A recent population-representative US study reported that only 5.5% of emergency department visits for CP led to diagnoses that are considered life-threatening . However, even if medical examinations do not give cause for alarm the symptom often continues to be profoundly alarming to the sufferer . Nevertheless, due to the seriousness of CVD the clinical priority is typically exclusion of cardiac causes rather than positive management of risk factors and symptoms for persons presenting with CP .
The current results suggested that employee chest pain can be influenced by companies’ demonstrated concern for employee health and well-being. Employee dispositions toward optimistic thinking are also likely to influence CP, both independently of HRP and by influencing the perception of working conditions. The results also suggested that optimists tend to report high HRP with low CP, and that a general unmeasured third factor (CLF) influenced the report of all items. This supports a notion of confounding by personality and other unknown influences on subjective report. However, such influences did not seem to fully explain the associations between the psychological work factor and pain. The residual T2 association between HRP and CP was statistically significant in the “Opt confounding” model, but not in the “reciprocal” model, with HRP T1 included as predictor (see Table 4). The statistical tenability of the reciprocal model suggested that adding HRP as a predictor of CP improved prediction compared to the model in which Opt was the sole predictor. Thus, the results suggested that work, optimism, and chest pain are linked together in several ways, some of which should be amenable to modification.
In conclusion, although the current study should be replicated with other measures and methods, the results suggested prospective relationships of both human resource primacy and dispositional optimism with chest pain. The data did not rule out the possibility that individual and situational characteristics may bias reports of work and health and consequently the association between them. However, they suggested that a relationship exists beyond such bias and did not give reason to dismiss subjective reports of work and health by default. Instead, they suggest researchers should attempt to disentangle various sources of variance and covariance by systematically and explicitly taking them into account when specifying models to analyze self-reported data reflecting subjective constructs. HRP is a measure of employees’ appraisal of management emphasis on human resources and thus ultimately a subjective factor. Nonetheless, the current results, if replicated in further studies, should be valuable to organizational practitioners by demonstrating the significance of effectively expressing a sincere interest in employee health promotion. If this organizational imperative is effectively conveyed, the act of conveyance in itself could contribute to the improvement of health.