title: Psychosocial job conditions, fear avoidance beliefs and expected return to work following acute coronary syndrome: a cross-sectional study of fear-avoidance as a potential mediator.
abstract: BACKGROUND
  Despite improvements in treatment, acute coronary syndrome remains a substantial cause for prolonged sick absences and premature retirement. Knowledge regarding what benefits return to work is limited, especially the effect of psychological processes and psychosocial work factors. The purposes of this cross-sectional study were two-fold: to examine associations between adverse psychosocial job conditions and fear-avoidance beliefs towards work, and to determine whether such beliefs mediated the relationship between work conditions and expected return to work in acute coronary syndrome survivors.
  
  
  METHODS
  Study inclusion criteria: acute myocardial infarction or unstable angina diagnosis, below 65 years of age, being a resident in the West county of Sweden and currently working. In all, 509 individuals (21.8 % women) accepted study participation and for whom all data of study interest were available for analysis. Psychosocial work variables; job demand-control and effort-reward imbalance, were assessed with standard questionnaire batteries. Linear regression models were used to investigate relationships between psychosocial factors and fear-avoidance, and to evaluate mediator effects for fear-avoidance. Both total sample and gender stratified analyses were calculated.
  
  
  RESULTS
  Fear-avoidance beliefs about work were associated to psychosocial job environments characterized by high strain (β 1.4; CI 1.2-1.6), active and passive work and high effort-reward imbalance (β 0.6; CI 0.5-0.7). Further, such beliefs also mediated the relationship between adverse work conditions and expected time for return to work. However, these results were only observed in total sample analyses or among or male participants. For women only high strain was linked to fear-avoidance, and these relationships became non-significant when entering chosen confounders.
  
  
  CONCLUSIONS
  This cross-sectional study showed that acute coronary syndrome survivors, who laboured under adverse psychosocial work conditions, held fear-avoidance beliefs towards their workplace. Furthermore, these beliefs mediated the relationships between - high strained or high effort-reward imbalanced work - and expected return to work. However, mentioned results were primarily found among men, which could results from few female study participants or gender differences in return to work mechanisms. Still, an earlier return to work might be promoted by interventions focusing on improved psychosocial work conditions and cognitive behavioural therapy targeting fear-avoidance beliefs.
authors.affiliation: Department of Occupational and Environmental Medicine, Institution of Medicine, Sahlgrenska Academy & University of Gothenburg, Box 414, 405 30, Gothenburg, Sweden. mia.soderberg@amm.gu.se.
authors.forename: Mia
authors.initials: M
authors.lastname: Söderberg
authors.affiliation: Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SU/Östra, Gothenburg, Sweden. annika.rosengren@gu.se.
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.affiliation: Department of Occupational and Environmental Medicine, Institution of Medicine, Sahlgrenska Academy & University of Gothenburg, Box 414, 405 30, Gothenburg, Sweden. sara.gustavsson@amm.gu.se.
authors.forename: Sara
authors.initials: S
authors.lastname: Gustavsson
authors.affiliation: Department of Occupational and Environmental Medicine, Institution of Medicine, Sahlgrenska Academy & University of Gothenburg, Box 414, 405 30, Gothenburg, Sweden. linus.schioler@amm.gu.se.
authors.forename: Linus
authors.initials: L
authors.lastname: Schiöler
authors.affiliation: Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden. annika.harenstam@psychology.su.se.|Department of Psychology, Stockholm University, Stockholm, Sweden. annika.harenstam@psychology.su.se.
authors.forename: Annika
authors.initials: A
authors.lastname: Härenstam
authors.affiliation: Department of Occupational and Environmental Medicine, Institution of Medicine, Sahlgrenska Academy & University of Gothenburg, Box 414, 405 30, Gothenburg, Sweden. kjell.toren@amm.gu.se.
authors.forename: Kjell
authors.initials: K
authors.lastname: Torén
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology*; D000328:Adult; D003430:Cross-Sectional Studies; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D062707:Return to Work / Q000523:psychology*; D012201:Reward; D012307:Risk Factors; D012737:Sex Factors; D012931:Social Environment; D011795:Surveys and Questionnaires; D013548:Sweden; D017132:Workplace / Q000523:psychology*