Key Studies: Workplace stress, status and the Whitehall Studies

This material was in the first draft of “Stress: A Student’s Guide to IB Health Psychology.” It was removed from the final edition in favour of studies about teenagers. The information is here instead as extra optional content for extended and/or interested students.

Executive Stress Syndrome Hypothesis

In the 1950s and 1960s, psychologists thought that high-ranking individuals had higher stress. This was called “the executive stress syndrome” (Sapolsky, 2005). But studies like Sapolsky’s baboon research helped discredit the executive stress syndrome hypothesis and showed that lower status is linked with higher stress. However, the current consensus is that status is only linked with stress when it affects the number of stressors you are exposed to. Even then, it’s not that simple – behavioural, personality and social factors can affect our individual responses to the same stressors.

Human vs Animal Studies

Does the same apply to humans? Human studies on status and stress are more difficult to conduct than animal studies. First of all, there are many variables that make it difficult to isolate and define a human’s social status. This is because we belong to many different social groups and have many opportunities to have a high (or low) rank. A person could have a minimum wage job with three bosses, but also be the captain of a sports team. A high school kid might feel like an outsider with few friends at school but have thousands of followers on social media. Monkeys don’t have these same opportunities – their rank in their troop’s hierarchy is the only rank they know.

Another reason why humans are different to animals is that our status is not always directly related to acquiring the bare essentials for life, like having enough food to eat (Sapolsky, 2012). This is especially true in modern societies. For example, Jeff Bezos can easily acquire 2,500 calories to eat for the day and a bed to sleep in, but so can his lowest paid employee. In monkey troops, status has a more direct effect on seriously stressful situations like access to food and surviving predators by staying with the group. Therefore, the relationship between status and stress is different in human populations compared to animal populations. That being said, with carefully designed studies we can still study how status affects stress in humans.

Read more:

• How stress can kill: The HPA Axis & Cardiovascular Disease (CVD)
• Key Study: Social status and stress in Olive Baboons (Sapolsky, 1990)
• Key study: Subjective social status and stress in teenagers (Rahal et al. 2019)

The Whitehall Study I (Marmot et al. 1978)

One classic study that looks at social status and stress in humans is known as the Whitehall Study (Marmot et al., 1978). This was a longitudinal study that analyzed data over a ten-year period. The participants were 17,530 male British civil servants working in London. They were between 40-64 years old. After filling out a questionnaire, the men were categorized into one of five ranks based on their status. From highest to lowest, the ranks were:

1. Administrative
2. Professional
3. Executive
4. Clerical
5. Other

The researchers gathered data on the men’s physical health and habits. This included things like their blood pressure, cholesterol levels, weight, height, smoking and exercise habits. Over the ten-year period, they also gathered data on the men who died at this time and how many died of coronary heart disease (CHD) (a type of cardiovascular disease).

Coronary heart disease (a.k.a. coronary artery disease) is a type of CVD. CHD/CAD develops when the artery walls around your heart become blocked because of build-up of plaque and they cannot deliver enough oxygen-rich blood to the heart. This can lead to heart attacks. CHD is the leading cause of death in many countries (nih.gov).

The results showed that 462 of the men died in the ten-year period because of CHD – this is almost half of the total number of deaths during the study (1,086). More importantly, the rate of death by CHD was consistent with the men’s rank. Administrators had the lowest rates of CHD, followed by professionals and executives, then the clericals and finally the “other” category had the highest rates of death by CHD. In other words, the lower the rank the higher the chance of dying from CHD. For the rest of the participants, the men in the lowest rank (“other”) had 3.6 times the rate of CHD compared to men in the highest rank, administrative. This is consistent with more modern studies that show work stress increases your risk of CHD by up to 50% (Kivimaki et al., 2006). One conclusion from the Whitehall study is that your rank in the office could affect affect your stress levels and this might have dire consequences for your physical health.

This was a landmark study because it showed how social rank has a direct link with stress and physical health in a human population.However, just as with the monkeys, it’s not as easy as saying status = stress. There are multiple variables that can mediate (explain) or moderate (influence) the relationship between status and stress.

The Whitehall Study II (Marmot et al. 2005)

A second longitudinal study was started in 1985 and is still going on today, over 30 years later. Not surprisingly, it’s called the Whitehall II study and has followed over 10,000 London civil service workers who were aged between 35-55 when the study began. An important difference to the first study is that this one also includes women. Data is gathered every 2 to 3 years using questionnaires on a range of factors, including physical health (e.g. blood pressure and CHD symptoms and diagnosis), mental health and exercise behaviours. One finding was that just like in the first study, the lower your employment grade, the more at-risk you were of developing CHD. This was true for men and women.

The study also gathered detailed information about work characteristics, including four specific factors that were not related to the rank of their jobs. They analyzed the data to see if there were links between these factors and health. You can see these in the table below along with their definitions and the results from the study:

Work Characteristic	Definition	Result
Job demands	The extent to which someone feels overworked.	Regardless of rank, people with high job demands had higher rates of CHD.
Effort reward imbalance	When someone feels like the rewards for their work do not match their efforts (e.g. they feel underpaid).	Men and women who had effort reward imbalance had an increased risk of CHD.
Work social support	The extent to which someone feels supported at work, including support from colleagues and superiors.	Increasing levels of social support at work were protective for risk of fatal CHD and decreasing levels of social support at work increased risk of CHD.
Decision latitude	The extent to which someone has control over their work and the autonomy to make their own decisions.	Low decision latitude (less control) was associated with increased rates of angina (chest pain), which is a symptom of CHD.

 Because most of the participants are now retired and entering their 70s and 80s, the Whitehall study has changed from being based on workplace stress and health to being “…now a study on ageing, with the 30-year-old follow-up allowing research on multimorbidity, functional decline, frailty, disability, and dementia” (ucl.ac.uk).

From the Whitehall studies we can conclude that your rank at work might be linked with your physical and psychological health. This is consistent with the findings from animal studies. In addition, characteristics of your working life including job demands, control, effort-to-work ratio and social support could be risk factors for developing health problems like coronary heart disease.

Checking in:	Can you use the Whitehall studies to give a socio-cultural explanation for one or more health problems?
Critical thinking extension:	Areas of Uncertainty – Why? A good psychologist can summarize links between variables like social status and behaviour like stress. But they can also explain why those links exist. One aspect of critical thinking is being able to find the holes in your own arguments. The above lesson was designed to give you an idea of how human studies supporting findings from animal studies. However, the question of “why” was deliberately left vague. Can you think of any reasons why rank in your job could increase rates of CHD? Hint: Use the four factors in the table above to begin with. Similarly, can you hypothesize why those factors might be linked with CHD?
If you’re interested…	There’s a great documentary called Stress: Portrait of a Killer. This includes interviews with Sapolsky and footage of his field work as well as interviews with Marmot and a summary of the Whitehall studies.