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Chronic Strain, Daily Work Stress, and Pain Among Workers with Rheumatoid Arthritis: Does Job Stress Make a Bad Day Worse? University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln Bureau of Sociological Research - Faculty Publications Bureau of Sociological Research (BOSR) October 2004 Chronic strain, daily work stress, and pain among workers with rheumatoid arthritis: Does job stress make a bad day worse? Judith Fifield University of Connecticut Health Center, MC-2918, Farmington, CT Julia McQuillan University of Nebraska - Lincoln, [email protected] Stephen Armeli Psychology Department, 41 Park Row, Pace University, New York, NY Howard Tennen University of Connecticut Health Center, MC-6325, Farmington, CT Susan Reisine University of Connecticut Health Center, MC-3910, Farmington, CT See next page for additional authors Follow this and additional works at: https://digitalcommons.unl.edu/bosrfacpub Part of the Sociology Commons Fifield, Judith; McQuillan, Julia; Armeli, Stephen; ennen,T Howard; Reisine, Susan; and Affleck, Glenn, "Chronic strain, daily work stress, and pain among workers with rheumatoid arthritis: Does job stress make a bad day worse?" (2004). Bureau of Sociological Research - Faculty Publications. 14. https://digitalcommons.unl.edu/bosrfacpub/14 This Article is brought to you for free and open access by the Bureau of Sociological Research (BOSR) at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Bureau of Sociological Research - Faculty Publications by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. Authors Judith Fifield, Julia McQuillan, Stephen Armeli, Howard Tennen, Susan Reisine, and Glenn Affleck This article is available at DigitalCommons@University of Nebraska - Lincoln: https://digitalcommons.unl.edu/ bosrfacpub/14 Published in Work & Stress 18:4 (October 2004), pp. 275–291; doi 10.1080/02678370412331324996 Copyright © 2004 Taylor & Francis Ltd. Used by permission. http://www.tandf.co.uk/journals/ Chronic strain, daily work stress, and pain among workers with rheumatoid arthritis: Does job stress make a bad day worse? Judith Fifield,1 Julia McQuillan,2 Stephen Armeli,3 Howard Tennen,4 Susan Reisine,5 and Glenn Affleck 4 1 University of Connecticut Health Center, MC-2918, Farmington, CT 06030, USA 2 University of Nebraska–Lincoln, 706 Oldfather Hall, Lincoln, NE 68588, USA 3 Psychology Department, 41 Park Row, Pace University, New York, NY 10038, USA 4 University of Connecticut Health Center, MC-6325, Farmington, CT 06030, USA 5 University of Connecticut Health Center, MC-3910, Farmington, CT 06030, USA Corresponding author: J. Fifield, email [email protected] Abstract The structure of the job and the daily experience of work are challenges for workers with rheuma- toid arthritis. Yet little is known about how these two factors interact to put workers with chronic pain at risk for worse pain on a given day. This exploratory 20 workday diary study of 27 workers with rheumatoid arthritis used hierarchical linear modeling to examine how the structure of the job and neuroticism moderate the relationship between daily undesirable work events (daily stressors), and pain reports within a day. On days with more undesirable work events compared to days with fewer events, individuals with jobs associated with job “strain” (high demand/low control) reported greater midday pain, irrespective of neuroticism and negative mood, than workers with other com- binations of demand and control. These findings demonstrate the utility of analyzing fluctuating within-person relationships among pain, mood, and daily work stressors within the context of the structure of the job, and helps to explain why daily work stressors result in worse health outcomes for some but not all workers with RA. Keywords: job strain, work stress, pain, rheumatoid arthritis 1. Introduction Remaining active in paid work is important for people with Rheumatoid Arthritis (RA). Workers with RA report lower levels of emotional distress than non-workers (Fifield, Re- isine, & Grady, 1991; Fifield, Reisine, Pfieffer, & Affleck, 1989), and workers who have been out of work and distressed find that their distress declines on return to work (White, Wrig- ley, LaGory, Fine, Maisiak, & Straaton, 1995). Also, they often use their continued ability to work as a source of comfort (Affleck, Tennen, Pfeiffer, & Fifield, 1987). Although paid work may be beneficial, the workplace can also be a source of unique challenges for many individuals with RA, demonstrated by the high rates of work disability (Albers et al., 1999; Allaire, Anderson, & Meenan, 1996; Reisine, McQuillan, & Fifield, 1995; Yelin, Nevitt, & Epstein, 1980). 275 276 FIFIELD ET AL. IN WORK & STREss 18 (2004) This study brings together two contrasting explanations for the unique negative effects of paid work for individuals with RA. The first explanation focuses on situational or acute stress associated with the undesirable events that occur on a daily basis in the changing ex- perience of work. A growing body of evidence indicates that such stressful daily circum- stances are associated with daily mood (Affleck, Tennen, Urrows, & Higgins, 1990; Armeli, Tennen, Affleck, & Kranzler, 2000; Bolger, DeLongis, Kessler, & Schilling, 1989), and ill- ness symptoms (DeLongis, Folkman, & Lazarus, 1988; Repetti, 1993; Stone, Reed, & Neale, 1987). Studies show an association between minor stressful events and the course of RA as well, including symptoms such as pain (Affleck et al., 1990, 1994; Crosby, 1988; Parker et al., 1988), emotional well-being (Zautra, Burleson, Matt, Roth, & Burrows, 1994), daily mood (Affleck et al., 1990) and indicators of disease activity (Mason, Anderson, Meenan, Weaver, & Haralson, 1990; Smith & Zautra, 2002). Few studies have examined the role of work events at the daily (cf. Affleck, Tennen, Urrows, & Higgins, 1992) or weekly level (cf. Potter, Smith, Strobel, & Zantra, 2002) in an arthritis population, although there is grow- ing evidence in the general population that changes in daily mood are linked to daily work events (Barling & Kryl, 1990; Bolger et al., 1989; Peeters, Buunk, & Schaufeli, 1995; Reicherts & Pihet, 2000; Repetti, 1993; Stewart & Barling, 1996; van Eck, Nicolson, & Berkhof, 1998). In contrast, a second model focuses on the strain associated with more stable characteris- tics of the job such as high psychological demands and low levels of control (Karasek, 1979; Karasek & Theorell, 1990). While the model of daily work stress posits that health outcomes such as pain and mood are linked to the momentary, undesirable events that happen in the course of a day at work, Karasek’s job strain model posits that the structure of the job creates chronic conditions within which workers interact. The model has been widely tested, and despite mixed results from the proposed interaction of demands and control, new variations of the model focusing exclusively on control (Bosma et al., 1997) and a new operationaliza- tion of control (Wall, Jackson, Mullarkey, & Parker, 1996), the job strain model is considered to be a primary model of chronic work stress with implications for both physical and mental health outcomes (Marmot, Theorell, & Siegrist, 2002; Schnall, Schwarz, Landsbergis, Warren, & Pickering, 1998; Schwartz, Pickering, & Landsbergis, 1996; Soderfeldt et al., 1997) includ- ing musculoskeletal pain among workers (Nahit, Pritchaard, Cherry, Silman, & Macfarlane, 2001; Pope, Silman, Cherry, Pritchaard, & Macfarland, 2001). The present, exploratory study investigates a multilevel (MLM) model of work stress that combines the chronic “strain” (high demand, low control) associated with the struc- ture of work, the acute stress associated with undesirable daily work events, and neurot- icism (Costa & McCrae, 1985), a personality characteristic of the individual. This multi- level stress/strain model is based on the notion that the chronic strain associated with jobs that are demanding and lacking in control may make exposed workers more vulnerable to the daily stressors they experience, resulting in higher levels of pain within that day. They may be more vulnerable or reactive to daily work stressors, either because their coping ca- pacity is diminished from the chronic “strain” of their work or because their job lacks ac- cess to coping resources such as control in their work (Pearlin & Schooler, 1978). The model also recognizes that individuals vary in their reactivity to undesirable daily events, based on personality characteristics such as neuroticism that may moderate the stressor-health outcome relationship (Affleck et al., 1992, 1994; Bolger & Schilling, 1991; Bolger & Zuck- erman, 1995; David et al., 1997; Persson & Sahlberg, 2002). Despite evidence that chronic stress associated with conditions such as neighborhood environment exacerbates the ef- fects of daily stressors (Caspi, Bolger, & Eckenrode, 1987; Lepore, Evans, & Palsane, 1991), multilevel models of work stress are rare (Grebner et al., 2004; Sonnentag, 2000), but may CHRONIC STRAIN, WORK STRESS, & PAIN IN WORKERS WITH RHEUMATOID ARTHRITIS 277 explain why undesirable work events result in worse health outcomes on a day-to-day ba- sis for some but not all workers with RA. The current study was undertaken to address this gap by exploring linkages among the relatively stable control and demand characteristics of the job associated with job strain, personality characteristics of the individual (neuroticism), undesirable daily work events, and pain and mood reports recorded on a daily basis in work event diaries. In particular,
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