Vagal cardiac control throughout the day: the relative importance of effort–reward imbalance and within-day measurements of mood, demand and satisfaction

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Abstract

The effects of variables derived from a work stress theory (the effort–reward imbalance theory) on the power in the high frequency (HF_HRV) band of heart rate (0.14–0.40 Hz) throughout a work day, were determined using multilevel analysis. Explanatory variables were analysed at two levels: at the lowest level (within-day level), the effects of positive mood, negative mood, demand, satisfaction, demand-satisfaction ratio, and time of day were assessed. At the highest level (the subject level), the effects of sleep quality, effort, reward, effort–reward imbalance, need for control, type of work (profession), negative affectivity, gender and smoking on HF_HRV were assessed. Need for control has a negative effect on HF_HRV after controlling for time of day effects, i.e. subjects with a high need for control have a lower vagal control of the heart. In the long run, these subjects may be considered to be at increased health risk, because they have less of the health protective effects of vagal tone. The interaction between effort–reward imbalance and time of day has a positive effect on HF_HRV, i.e. the cardiac vagal control of subjects with a high effort–reward imbalance increases as the day progresses. It is discussed that this probably reflects reduced effort allocation, ensuing from disengagement from the work demands.

Introduction

The relation of psychosocial factors in work, either objectively assessed or measured by subjective judgements, with cardiovascular reactions and complaints has been amply demonstrated (Karasek, 1979, Hackman and Oldham, 1980, Cooper and Payne, 1991, Marmot, 1994, Siegrist, 1996a). However, less is known about the physiological mechanisms allegedly responsible for this relationship. A theory that may explain certain aspects of these mechanisms has been proposed by Siegrist (1996b). This theory, known as the effort–reward imbalance theory, suggests that a high effort, a low reward and a high need for control first lead to changes in physiological and psychological responses and eventually to the development of cardiovascular disease. However, sufficient evidence, especially for the relation with physiology, is still needed. The present paper will focus on this issue, by assessing the effects of effort–reward imbalance (ERI) — both as a trait and as a state — as well as need for control on vagal autonomic control (as is indicated by high frequency heart rate variability (HF_HRV)). Furthermore, the effects of within-day measurements of negative mood, positive mood, time of day and other potential determinants (sleep quality, negative affectivity, smoking, gender and profession) on HF_HRV are assessed.

The effort–reward imbalance theory is based on the premise that an imbalance between effort and reward leads to psychophysiological changes referred to as ‘emotional distress’ and an ‘activation of the autonomic nervous system’. Furthermore, the consequences of effort–reward imbalance are amplified by a high need for control (i.e. a strong tendency to engage in work activities). Thus, three major constructs are distinguished in the effort–reward imbalance theory that may codetermine psychological and physiological responses: the invested effort, reward received and an individual's need for control. Siegrist and Peter (1994) argue that the risk for cardiovascular disease is mainly due to a chronic activation of the autonomic nervous system, and that the risk increases if individuals respond to effort–reward imbalance with a high need for control (after controlling for traditional risk factors).

To date, effort, reward and need for control have been associated with a decreased task elicited blood pressure reactivity in the laboratory (Siegrist, 1996b), but not yet with cardiovascular dynamics throughout an actual working day. Hypotheses about the relation between effort, reward, need for control and cardiovascular changes have to be based on an extension of the theoretical framework. Increased mental effort induces a decrease in vagal tone (Aasman et al., 1987). Low vagal control of heart rate has been shown to be related to coronary artery disease (Martin et al., 1987) and increased mortality (Kleiger et al., 1987). In a recent consensus paper it is confirmed that HF_HRV clearly represents vagal influence: a low HF_HRV is associated with a low vagal cardiac control (Berntson et al., 1997). The meaning of the low frequency (LF) heart rate variability (<0.14 Hz) is more debated, most probably reflecting a mix of sympathetic and parasympathetic influences. According to Sloan et al., (1994) high LF/HF_HRV ratio is also associated with the relative dominance of sympathetic nervous system activity.

Putting these elements together, we expect subjects high on effort or on need for control (involving expenditure of mental effort) to have a lower vagal tone. The status of reward relative to autonomic drive is unclear; its effects will be tested as well. Imbalance of effort and reward may lead to either decrease or increase in vagal tone. The former response is expected in individuals, that perceive the environmental demands as a challenge, and still engage in work related activities. The latter response is expected in individuals that cope with the demands by disengagement from work related activities and/or switch to less effort demanding strategies. These responses are in line with the hypothesis that the motivational drive of individuals interacts with environmental demands, and co-determines the psychological and physiological responses (Hockey, 1997). In the effort–reward imbalance theory, need for control reflects the motivational aspects of an individual. Consequently, individuals with a high need for control as well as a high effort–reward imbalance are expected to have a lower parasympathetic drive than individuals with the opposite. The hypothesised interaction is tested in the present paper.

According to the effort–reward imbalance theory, effort, reward and need for control are stable trait-like constructs, implicitly assuming that these psychological characteristics are continuously and evenly present over longer periods of time. Expanding on the theoretical framework, it may also be argued that ongoing within-day assessments of these variables (referred to as ‘demand’, and ‘satisfaction’) also should affect heart rate variability throughout the work day. In line with the effort–reward imbalance theory, in which an imbalance ratio was expected to have a stronger predictive value, the ratio between demand and satisfaction (‘the actual demand–satisfaction ratio’) was also determined, anticipating an effect on heart rate variability. By testing all three variables (demand, satisfaction and the demand-satisfaction ratio) simultaneously, it was aimed to determine which of the effects was the strongest.

Other factors than the ones derived from the ERI theory have been shown to affect physiological functioning: the psychological trait of negative affectivity (Parkes, 1994), but also sleep quality, smoking, profession, gender (Grossman and Kollai, 1993, Egloff et al., 1995, Meijman, 1997, Shapiro et al., 1997), and negative and positive mood (Gellman et al., 1990, Schwartz et al., 1994, Shapiro et al., 1997) have been shown to have an effect on physiological changes throughout the day. The relative contribution of these factors to HF_HRV will be estimated as well.

Finally, some studies have also shown that time of day may interact with aspects of work (e.g. night shifts, long working hours) (Akerstedt, 1988, Akerstedt, 1991), thereby influencing performance but also physiological state (Campbell, 1992). Another study has shown time of day to affect heart rate variability (Malliani et al., 1991). Therefore, it is hypothesised that time of day will interact with the constructs for the effort–reward imbalance theory, and have an effect on heart rate variability. Specifically, it was explored whether subjects differing in ERI show another HF_HRV pattern over the day, and whether this is affected by need for control.

Section snippets

Subjects

From an initial sample of 104 subjects, 77 agreed to participate in the study. Four subjects were removed from the analysis of heart rate data, because they used anti-hypertensive medication, and another three were removed due to equipment failure. The final sample consisted of 70 workers from two different professions: health professionals (mean age=40.0, S.D.=4.6; 18 male, 15 female) and office clerks (mean age=33.1, S.D.=9.3; 21 male 16 female). The age and proportion of male subjects did

Descriptive statistics

Mean, Standard Error of Mean (S.E. Mean) and their quartile scores can be found in Table 2. Mean and S.E. Mean for within-day variables derived by aggregating the scores at each beep over subjects and days. The mean effort–reward Imbalance (ERI) ratio (0.50) shows that the present sample was not highly stressed. The average ERI score of a normal working population is 0.54 (derived from Hanson et al., 2000b). According to a criterion provided by the theory, only subjects with an ERI ratio lower

Discussion

Most importantly, we found that a higher need for control is associated with lower HF_HRV. According to the effort–reward imbalance theory, a high effort–reward imbalance is associated with vigorous striving and an increased ‘autonomic activation’, an effect supposedly enhanced by need for control. In the present study, we found support for one aspect of this hypothesis: a higher need for control is associated with more vagal withdrawal. As lower heart rate variability (indicating a lower vagal

Conclusions

The importance of ongoing psychophysiological measurements is now gaining recognition (Hockey, 1997). The relationships between patterns of work strain and their consequences for the individual are essentially dynamic, requiring dynamic assessments and analyses to reflect these processes. In the present study, the variance in ambulatory HF_HRV could partly be explained by variables at the beep (time of day) and the subject level (need for control) as well as by interaction of time of the day

Acknowledgements

This work was part of the requirements of the PhD study at the Research Institute Psychology and Health at Utrecht University. We thank professor Wilmar Schaufeli for his contribution to this manuscript.

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