Work as a diagnosis
How different work schedules affect health
Oleg Lischuk, N+1
The relationship with working time for many of us is a difficult and painful issue. Is it wise to be a workaholic? Does working at night harm your health? Maybe it's better to be a freelancer? Or is the traditional working week healthier? We tell you how modern science answers these and other questions.
I am a workaholic, I work almost constantly, even at meals and on a picnic I am busy with work correspondence
The term "workaholism" was first coined in 1971 by Wayne Oates, professor of psychiatry and behavioral sciences at the University of Louisville and author of 57 books, most of which are devoted to the relationship between psychiatry and religion. By this he wanted to emphasize that work can cause real addiction akin to alcoholism.
Despite the fact that the concept itself has been around for half a century, there is still no clear clinical definition and diagnostic criteria for workaholism, which makes it very difficult to systematically study its impact on health. Nevertheless, a certain amount of research on this topic has been conducted. As a rule, their authors define workaholism, or work addiction, as excessive (in time and/or volume) and compulsive work that negatively affects personal life and social ties.
Workaholism has all the characteristic features of addiction:
- increasing tolerance (i.e. the need to increase the "dose" of work);
- withdrawal syndrome (deterioration of physical and mental condition during abstinence);
- an uncontrollable craving for another "dose".
The most obvious relationship between workaholism and burnout at work is best described (the latter includes emotional overwork, depersonalization, low professional achievements and satisfaction from work). This correlation was shown most convincingly in a large Dutch study involving 2115 trainee doctors, and there are other publications on this topic.
At the same time, the degree of burnout of a workaholic at work largely depends on the type of activity – so, it is most pronounced among managers in the "white collar" environment. However, regardless of work responsibilities, such manifestations of burnout as emotional overwork and depersonalization are most pronounced.
Several early papers indicated that the relationship between workaholism and burnout at work may vary significantly in different countries, but a fairly large (more than 2.2 thousand participants) US-Chinese study did not find significant evidence for this hypothesis.
Among other negative health effects, the link between workaholism, excessive smartphone use and sleep disorders, in particular daytime sleepiness and poor sleep at night, is quite convincingly shown. In addition, a correlation was found between dependence on work and addiction to smoking, work injuries, depression and other psychological disorders.
A study involving almost a thousand employees of a large consulting company conducted by the University of Bergen showed the indirect effect of workaholism on health. The experimenters examined 40 unfavorable working conditions and occupational stress factors, such as requirements for employees, performance control, social support, remuneration, and the like. It turned out that the negative health consequences in three cases (the relationship between work requirements and anxiety, social dysfunction, emotional exhaustion) were completely, and in another 12 – partially mediated by workaholism.
Due to the popularity of the topic, the number of studies on work dependence is growing day by day, so its harm to health is clearly not limited to the data provided. But now we can confidently say that working effectively does not mean spending all the available time at work and giving your best until you completely lose your strength.
I work mostly at night, the day is a time for me to sleep off
Night shift work has long been in the field of view of researchers. Its negative effects on health are mainly associated with the discrepancy between the lighting regime and the normal circadian rhythm (physiological response to the change of day and night). This affects various cyclic processes in the body, primarily related to the production of hormones (sexual, stress, metabolic and others). As a result, the risk of diseases with a dishormonal nature increases.
For these reasons, night work affects the health of women more strongly, who are characterized by pronounced physiological cyclicity. Changes in the production of melatonin in the epiphysis under the influence of artificial lighting disrupts the levels of sex hormones, which increases the likelihood of menstrual disorders, decreased fertility, miscarriage, early menopause, endometriosis and breast cancer.
In men, hormonal shifts increase the risk of prostate cancer. Regardless of gender, malignant tumors of the colon and rectum are more common.
The rhythm of glucocorticoid production is disrupted (they provide a response to stress, affect metabolism, the work of the sympathetic nervous system and immunity) and thyroid-stimulating hormone (regulates the metabolism of almost all substances in the body, including other hormones). As a result, the risk of developing type 2 diabetes mellitus, hypertensive crises and non-Hodgkin's lymphoma increases.
In addition, activity at an unusual time of day increases the likelihood of work injuries, mistakes at work, reduced ability to work, and also negatively affects social and family life.
Unfortunately, researchers practically do not take into account possible differences in the influence of night shifts on people of different chronotypes – "larks" and "owls". Perhaps the latter tolerate work better in the dark, but scientific confirmation of this is not enough yet.
I have a rolling schedule: I work at night, then in the afternoon, then in the morning
Shift work affects health in many ways similar to night work, since it also leads to a failure of circadian rhythms. However, constant changes in working hours lead the body to even greater "bewilderment", which has its negative consequences.
The most complete information on the impact of shift work on health is presented in the consensus of the International Working Time Society (WTS). It was published in 2019 and is based on meta-analyses, systematic reviews and large single studies conducted over the past 10 years.
It contains the following postulates:
- There is solid evidence of the relationship between shift work and such negative health consequences as cardiovascular diseases, gastrointestinal and metabolic disorders (for example, type 2 diabetes mellitus, non-alcoholic fatty liver disease).
- Less clear evidence points to the association of shift work with cancer, mental and reproductive disorders.
- The extent to which the negative effects of shift work on health are caused (directly or indirectly) by circadian rhythm disorders, sleep restrictions and social disunity is not fully clear.
- It is necessary to have a clearer understanding of the mechanisms of the development of negative health consequences and adequate countermeasures in real life.
- Men and women may react differently to shift work, and the risk of developing specific negative health effects may depend on gender.
- Laboratory data should be considered in the context of knowledge about the "real world" obtained during field research.
In addition, as in the case of night work, periodic work at night increases the risk of occupational injuries, reduced ability to work and mistakes at work. The latter is of particular importance for medical workers, who are often on duty in shifts, because it poses a threat to patients. The same applies to emergency workers, on whom the safety of other people depends.
But the impact of freelancing on health is perhaps the least studied. It is shown that the uneven workload characteristic of this type of employment has a significant effect on the emotional state. More hours worked contributes to greater peace of mind, and vice versa. However, urgent orders involving work in an emergency mode often cause stress and negatively affect the quality and duration of sleep.
Given the increasing popularity of freelancing associated with both social trends and the covid pandemic, we should expect more research on this topic.
Sick days are not for me, even with a fever I go to work
The evolution of working conditions and the difficult situation on the labor market in recent decades has led to talk about the spread of a new phenomenon – presenteeism. It is understood as going to work with various diseases – from colds to exacerbations of chronic somatic and mental conditions.
Due to the relative novelty of the problem, the studies devoted to it are still devoid of a stable methodology. Most often they are devoted to the economic consequences of presenteeism and generally agree that it is more expensive to go to work sick than to take a sick leave.
Most often, people go to work with allergies and hypertension. The most unprofitable for the company in terms of one employee are such "presenteeistic" diagnoses as chronic back and neck pain, mental illness, anxiety syndrome, depression and severe headache (including migraine); for the company as a whole – allergies and headaches.
Those who work despite feeling unwell, firstly, are more irritated and simply less productive, and secondly, they risk that it will be harder and longer to get sick, possibly with complications. If we are talking about infections, the sick person becomes a source of infection for other employees.
In any case, it should be understood that staying at home and being treated is more profitable and rational for both the employee and the employer. If episodes of temporary disability occur too often, you should take a more thorough look at your health and, perhaps, think about changing the type of employment (for example, switch to remote work).
5/2 from 9 to 17 – perfect?
The schedules and types of employment listed above, although very common, cover a smaller part of the working population. Most of us still work in the daytime five days a week for an average of eight hours a day, which adds up to a 40-hour work week. There is no good and unambiguous answer to the question whether such a schedule is ideal. But it can be noted that in developed countries this parameter tends to decrease – for example, the average number of weekly working hours in Germany is 25.6 hours, in the Netherlands – 27, in France – 30.
The British analytical center New Economics Foundation recommends switching to a 21-hour work week to combat problems such as unemployment, greenhouse gas emissions, insufficient well-being of life, established social inequality, recycling, insufficient attention to family and lack of free time in general.
Researchers also question the expediency of a five-day working week. Experiments in several cities have shown that four working days of 10 hours (which in total gives the same 40-hour week) significantly increase the satisfaction and quality of life of workers.
Interestingly, hunter-gatherers with a primitive lifestyle, who may seem like tireless workers in the struggle for survival, are actually far from the standards of the industrial and post-industrial economy. For example, in one of the villages of African bushmen, there are no more than 2.5 working days in a week lasting about six hours. There is something to think about.
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