Emotional demands and confrontation in person-contact roles linked to heightened type 2 diabetes risk

The emotional demands and confrontation inherent in person-contact roles, involving direct face-to-face or voice-to-voice interaction with external parties, are linked to a heightened risk of type 2 diabetes, suggests research published online in Occupational & Environmental Medicine.

And inadequate social support from managers and colleagues at work seems to amplify the magnitude of these associations, the findings indicate.

Job strain, job insecurity, workplace violence and bullying, and effort–reward imbalance have all been linked to a heightened risk of developing type 2 diabetes.

But the potential impact of person-contact roles, which include those requiring interactions with patients, customers, clients, passengers, and students, on this risk isn’t known, explain the researchers.

To explore this further, they extracted information from the Swedish Work, Illness, and labor-market Participation (SWIP) cohort which consists of around 5.4 million 16 to 65-year-olds, registered in Sweden in 2005.

They confined their study to those aged 30–60 with information on the job they held in 2005, and no history of any type of diagnosed diabetes, or a prescription for antidiabetic drugs in or before 2005. In all, around 3 million people were included in the study.

They assessed three dimensions of person-contact roles—general contact with people, emotional demands as a result of dealing with people with serious health or other problems, and confrontation—and the degree of workplace social support using job exposure matrices, based on the Swedish Work Environment Surveys (1997–2013).

For the general contact with people dimension, the researchers calculated the proportion of survey respondents answering “roughly three-quarters of the time” or “almost all the time.” For emotional demands and confrontation, they calculated the proportion of those answering “a few days a week” or “every day.”

They included 20 job roles in sectors with the highest level of exposure to each of the three dimensions. These include health care, education, service industries, hospitality, social work, law, security, and transport.

Between 2006 and 2020, 216,640 people (60% men) developed type 2 diabetes. They tended to be older, more likely to be born outside Sweden, and to have a lower level of education and low job control than those who didn’t develop the condition.

In both women and men, high levels of exposure to all three dimensions were associated with an increased risk of type 2 diabetes. But in women, the heightened risk associated with general contact with people disappeared after accounting for the level of job control.

High levels of exposure to emotional demands and confrontation were, respectively, associated with 20% and 15% heightened risks of type 2 diabetes in men, and 24% and 20% heightened risks, respectively, in women.

The associations between these two dimensions and type 2 diabetes were stronger among those with low levels of workplace social support than they were among those with high levels, with the highest risk (47% greater) in women whose roles entailed high emotional demands, but who had low social support at work.

The findings support the notion that working in people-contact roles is stressful and that this can ultimately affect workers’ metabolic health, say the researchers.

They acknowledge various limitations to their findings. For example, they used job exposure matrices which can’t capture variations in individual experiences or feelings or work environment within a given occupation. And information on people’s entire job history and potentially influential lifestyle behaviors wasn’t available either.

Nevertheless, they explain, “With regard to having contact with people at work, there are expectations for emotional management where workers are required to express or hide emotions according to societal, occupational and organizational norms. It is especially stressful when the displayed emotion and the genuinely felt emotion are not aligned.”

They continue, “Workers in human service occupations, such as health care professionals and social workers, take responsibility for the fundamental human needs of clients and witness human suffering, and in most cases, there is no reciprocity in relations with clients and patients.

“These are potential stressors that can result in compassion fatigue, burnout, and mental health problems among workers in such occupations.”

The biological mechanisms underlying the associations found may involve chronic stress that affects the neuroendocrine system, leading to excessive cortisol production, increased insulin resistance, and decreased insulin secretion and sensitivity, they suggest.

And these biochemical reactions may be made worse by a lack of social support in the workplace, they add.

The emotional demands and confrontation inherent in person-contact roles, involving direct face-to-face or voice-to-voice interaction with external parties, are linked to a heightened risk of type 2 diabetes, suggests research published online in Occupational & Environmental Medicine.

And inadequate social support from managers and colleagues at work seems to amplify the magnitude of these associations, the findings indicate.

Job strain, job insecurity, workplace violence and bullying, and effort–reward imbalance have all been linked to a heightened risk of developing type 2 diabetes.

But the potential impact of person-contact roles, which include those requiring interactions with patients, customers, clients, passengers, and students, on this risk isn’t known, explain the researchers.

To explore this further, they extracted information from the Swedish Work, Illness, and labor-market Participation (SWIP) cohort which consists of around 5.4 million 16 to 65-year-olds, registered in Sweden in 2005.

They confined their study to those aged 30–60 with information on the job they held in 2005, and no history of any type of diagnosed diabetes, or a prescription for antidiabetic drugs in or before 2005. In all, around 3 million people were included in the study.

They assessed three dimensions of person-contact roles—general contact with people, emotional demands as a result of dealing with people with serious health or other problems, and confrontation—and the degree of workplace social support using job exposure matrices, based on the Swedish Work Environment Surveys (1997–2013).

For the general contact with people dimension, the researchers calculated the proportion of survey respondents answering “roughly three-quarters of the time” or “almost all the time.” For emotional demands and confrontation, they calculated the proportion of those answering “a few days a week” or “every day.”

They included 20 job roles in sectors with the highest level of exposure to each of the three dimensions. These include health care, education, service industries, hospitality, social work, law, security, and transport.

Between 2006 and 2020, 216,640 people (60% men) developed type 2 diabetes. They tended to be older, more likely to be born outside Sweden, and to have a lower level of education and low job control than those who didn’t develop the condition.

In both women and men, high levels of exposure to all three dimensions were associated with an increased risk of type 2 diabetes. But in women, the heightened risk associated with general contact with people disappeared after accounting for the level of job control.

High levels of exposure to emotional demands and confrontation were, respectively, associated with 20% and 15% heightened risks of type 2 diabetes in men, and 24% and 20% heightened risks, respectively, in women.

The associations between these two dimensions and type 2 diabetes were stronger among those with low levels of workplace social support than they were among those with high levels, with the highest risk (47% greater) in women whose roles entailed high emotional demands, but who had low social support at work.

The findings support the notion that working in people-contact roles is stressful and that this can ultimately affect workers’ metabolic health, say the researchers.

They acknowledge various limitations to their findings. For example, they used job exposure matrices which can’t capture variations in individual experiences or feelings or work environment within a given occupation. And information on people’s entire job history and potentially influential lifestyle behaviors wasn’t available either.

Nevertheless, they explain, “With regard to having contact with people at work, there are expectations for emotional management where workers are required to express or hide emotions according to societal, occupational and organizational norms. It is especially stressful when the displayed emotion and the genuinely felt emotion are not aligned.”

They continue, “Workers in human service occupations, such as health care professionals and social workers, take responsibility for the fundamental human needs of clients and witness human suffering, and in most cases, there is no reciprocity in relations with clients and patients.

“These are potential stressors that can result in compassion fatigue, burnout, and mental health problems among workers in such occupations.”

The biological mechanisms underlying the associations found may involve chronic stress that affects the neuroendocrine system, leading to excessive cortisol production, increased insulin resistance, and decreased insulin secretion and sensitivity, they suggest.

And these biochemical reactions may be made worse by a lack of social support in the workplace, they add.