Partner Relations and Work Stress Modulating Health Issues

Two hundred and twelve participants, 135 male and 77 female, derived from several different occupations, responded to questionnaires based upon several self-report instruments including the Subjective Stress Experience Questionnaire (psychological and somatic), the Stress and Energy Scale, the Hospital Anxiety and Depression (HAD) Scale, the Job Stress Survey (JSS), Partnership Relations Quality (PRQ) Test, and the Positive and Negative Affect Scale (PANAS). It was found that self-reported high levels of work stress (the JSS “High work stress” group) induced more anxiety, stress (SE), psychological and somatic subjective stress, and negative affect than selfreported low levels of work stress (the JSS “Low work stress” group), with intermediate levels of work stress (the JSS “Medium work stress” group) in between. Self-reported high levels of partnership relations quality (the “High PRQ” group) was associated with less depression, anxiety, stress (SE) and negative affect than self-reported low levels of partnership relations quality (the “High PRQ” group), with intermediate levels (the “Medium PRQ” group) in between. Regression analysis indicated that depressive, anxiety, stress (SE), psychological stress and somatic stress were each significantly predicted by work stress (JSS), whereas partnership relations quality was counter-predictive for depression, anxiety, stress (SE) and psychological stress. Female participants expressed higher levels of stress and energy (SE), anxiety and psychological stress (SSE) than the male participants. The present findings tentatively suggest the health-promoting advantages of positive partnership, and/or familial, relations in counteracting the illhealth accruing from various types of general stress (SE, psychological and somatic) and the particular stresses of work occupation. *Corresponding author: Ann-Christine Andersson Arntén, Swedish Police, Department of National Operations, Assessment Functions, 10226 Stockholm, Sweden, Tel: +46-722027660; E-mail: ann.christine.andersson.arnten@psy.gu.se; acarnten@gmail.com Received: April 15, 2018; Accepted: April 30, 2018; Published: May 07, 2018 Citation: Ann-Christine AA, Jansson B, Archer T (2018) Partner Relations and Work Stress Modulating Health Issues. Clin Exp Psychol 4: 191. doi: 10.4172/24712701.1000191 Copyright: © 2018 Ann-Christine AA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Introduction
A currently-held belief is that marriage promotes health and that single individuals are at greater risk for illheath than married/ common-law couples. This belief is supported by research showing that marital/partnership relations, under some conditions, may generate positive health effects for both men and women [1,2]. On the other hand, Whisman and Bruce [3] found that co-habiting partnership dissatisfaction was associated with almost 70% of disorders assessed by the Ontario Health Survey Mental Health Supplement (including those connected with anxiety and depression). Concomitant studies focussed on work-related stress present a similar association of stress in the work environment implicated in physical and psychological health issues [4][5][6][7][8][9][10][11].
Involvement in a partner relationship (PR) has been found to exert a strong influence upon how individuals experience the global aspects of life satisfaction [12]. Maslow [13] postulated that each human being possesses the need for 'loving' and 'to be loved' . The capacity to develop a loving relationship, characterised by intimity and respect, remains a basic prerequisite for individual satisfaction, according to Maslow [14]. This contention is supported by Forrester [15] who indicates that what most strongly predicts individual life satisfaction is involvement in a PR based upon love. Thus, individuals involved in a well-functioning partner relationship report higher levels of life satisfaction and lower levels of neuroticism [16]. Nevertheless, it must be considered too that not only partnership but the quality of the relationship is important. Accordingly, PR quality may function as buffer against stressful events [17], through (i) protecting against risks associated with social isolation [18,19]; (ii) exerting an indirect influence on health via increased socioeconomic resources [20]; (iii) optimising healthrelated behaviours that thereby reduce health-destructive behaviours [21,22]. Conversely, negative PR and/or marital distress, with physical and psychological influences, may affect both physiological and psychobiological stress reactions [17,23,24]. For example, Barnett et al. [25] found an association between marital quality and stress markers whereby individuals with marital problems estimated higher stress levels and markers whereby individuals with marital problems estimated higher stress levels and diastolic blood pressure over the 24-hour period with salivary cortisol levels showing a lower, flatter curve, indicating that both genders reporting marital conflict reported too higher stress throughout the day. Further, a link between problem-afflicted marriages and reduced immune functioning has been reported [26]. Other studies point to increases in psychophysiological and endocrine measures of stress, as well as changes in immune function, associated with marital conflict [27,28]. These reactions are generally more intensive and of longer duration in women [28]. In cases where conflict is long-lasting can even resting levels of psychophysiological measures be influenced [29,30]. Other studies highlight the association between problems in PR and increased risk for cardiovascular disorders [31], as well as other physiological risk factors such as blood pressure, high-density lipoprotein cholesterol levels, and body mass index [32]. Quality of PR is linked also to prognosis for myocardial infraction [31] and survival among patients with congestive heart problems [33]. PR quality is implicated too as an eventual protective factor in atherosclerosis [32], by optimising social and material resources. Finally, Troxel et al. [17] responses to the 10 negatively-charged adjectives were summated to provide a total NA-result for NA affect, and similarly the responses to the positively-adjectives were summated to provide a total PA-result for PA affect. The PANAS instrument has been validated through studies analyzing conditions associated with general aspects of psychopathology [41], as well as a multitude of other expressions of affect [42].
The participants' mean for PA was 3.70 (SD=0.55), indicating a somewhat higher value compared to the norm group (N=6557, M=3.35, SD=0.98. The participants' mean for NA was 1.93 (SD=0.59), indicating a somewhat lower value than that of the norm group (M=2.09, SD=1.00).

Hospital anxiety and depression (HAD):
The instrument is derived to measure depressive and anxiety symptoms [43,44]. It consists of 14 statements to which participants respond by marking one of either three or four response alternatives. For example, "I can sit still and feel relaxed" with response alternatives: Definitely, Generally, Seldom, Never, or, "I look forward with gladness towards this and that" with response alternatives: As much as before, Less than before, Hardly ever. Half of the statements were constructed to illustrate depressive symptoms whereas the other half to illustrate anxiety-related symptoms. Participants´ responses thereby provided two results, one pertaining to depressive symptoms, the other to symptoms of anxiety.

Subjective stress experience (SSE):
The instrument is derived from a diagnostic manual designed to assess different reactions to stress [45]. Participants were required to estimate the extent to which different statements concurred with how they felt on an ordinary working day. The first part of the instrument consisted of 23 statements wherein participants were required to respond to the extent to which they experienced, for example, "Nausea or abdominal pain" or "Overreaction to inconsequential inner stimuli/easily frightened", or, "Muscle tension", or, "Sleep problems caused by worry". The test contained statements concerning symptoms implicating autonomic activation, mood changes, tension as well as other non-specific symptoms associated with stress responses. Participants' estimations were carried out using a Visual Analogue Scale (VAS) whereby they marked a cross on a 10cm line (1 at one end and 10 at the other) whereby 1= "do not agree at all 2 and 10=agree completely". The results of the test provided a total estimation for somatic stress (SSSOM) and one for psychological stress (SSPSYK).
Partner relationship questionnaire: The questionnaire consists of 45 questions regarding individuals' partner relationships that are designed to provide a comprehensive outline of these relationships, including sexual relations. The questionnaire contains two types of scales, multiple choice alternatives and an estimation scale from 1-10. Examples of questions are, as follows: "How often do you and your partner discuss current events?" with response alternatives provided in those cases as multiple choice alternatives that vary from "Never or Almost never", "Seldom", "Sometimes", "Often", to "Very often", and "How often does petting and stroking occur between you and your partner?", with multiple choice response alternatives that vary from "Never", "Seldom", "Less than once a week", "More than once a week" to "Everyday" [46]. Examples of questions applying an estimation scale from 1 -10 are, as follows: "How much enjoyment do you get out of sexual intercourse?" whereby 1 represents "No enjoyment at all" to 10 "Very intensive enjoyment".
The estimation of "Intern partner relation" which relates to the couples experience of partnership relation quality (PRQ), was obtained from 11 of the questions from the questionnaire. Other aspects of the questionnaire were left outside the scope of the present study.
found that women reporting high PR quality showed a lower risk for development of metabolic syndrome.
Research concerning the psychological consequences of PR problems appears limited although there are findings pertaining to the psychobiological consequences of problems arising in PR. For example, qualitatively worse PRs are associated with a greater incidence of depressive symptoms, increased worry, etc. [34], as well as increased anxiety [32]. Concomitantly, PR defined by high levels of partner support are associated with low levels of psychological distress [35,36]. Fincham and Bradbury [37] found that high levels of depressive symptoms were contra-related to PR satisfaction while selfconfidence was positively related to PR satisfaction over both genders. After controlling for work-related stress, Blom et al. [38] showed that PR stress was linked to lower social integration, degree of experienced support, degree of belongingness and degree of actual support whereas, after controlling for PR stress, work-related stress did not exert the same influence. It has been shown that marital satisfaction was highest when both spouses experienced high work self-direction [39].
Taking into account the likelihood that poor quality of PRs is implicated in a long-lasting, elevated risk for distress underlying a wide variety of psychosomatic disorder profiles. The purpose of present study was to determine the effect of PRQ and JSS in health and in conditions of poor health. Here, health was measured by positive affect, energy, LOT and poor health by depression, anxiety, stress, psychological and somatic subjective stress experience and negative affect.

Participants
One two hundred and twelve participants (135 male and 77 female participants) equally divided between eight different occupational categories, including physiotherapists, police, sales personnel, construction foremen, teachers, administrative personnel, IT-personal and executive middle management, took part. The mean age of the whole population of participants was 39.05 years (SD=8.93), with male participants aged 36.66 years (SD=6.95) and female participants aged 43.25 years (SD=10.40). A greater proportion of female participants (21.8%) were found to be smokers compared with the male participants (13.2%), whereas a greater proportion of male participants (27.2%) reported that they never experience aches and pain compared with female participants (9.0%). A greater proportion of male participants (43.4%) also reported that they never experience sleeping problems compared with female participants (34.6%).

Design
The study consisted of independent variables: "Work Stress (JSS divided in to: ABI, BSI and ASI)", "Partnership Relations Quality (PRQ)", and "Gender", and the dependent variables "Subjective Stress Experience; psychological and somatic", "Stress and Energy", "Anxiety" and "Depression", and "Positive and Negative affect".

Instruments
Positive affect and negative affect scale (PANAS): The PANASinstrument provides a self-estimation of "affect", both positive and negative. It consists of 10 adjectives for the NA dimension and 10 adjectives for the PA dimension. The test manual [40] postulates that the adjectives describe feelings (Affect) and mood level. Participants were instructed to estimate how they felt during the last few days. The response alternatives were presented on a five-grade scale that extended from where 1=not at all to 5=very much. For each participant the

Stress and energy (SE):
The SE-instrument is a self-estimation scale that assesses individuals' experience of their own stress and energy [47]. The test is divided into two sub-scales that express each participant's level of mood in the two dimensions: "experienced stress" and "experienced energy". Response alternatives are ordered within six-graded scales that extend from 0=not at all to 5=very much. The instrument has been validated through studies concerning occupational burdens and pressures [48]. The SE-scale has been constructed from the earlier used checklist, Mood Adjective Check-List [49], which was modified by Kjellberg and Bohlin [47] and Sjöberg et al. [50]. Kjellberg and Iwanowski [48] reduced the list to 12 adjectives in the two dimensions, stress and energy, which provides the latest version applied here. Cronbach's testing indicated Alpha=0.7644.
The participants' mean for Energy was 3.25 (SD=0.83), indicating a somewhat higher value compared to the norm group (N=4508, M=2.93, SD=1.94; Karlsson and Archer, unpublished data). The participants' mean for Stress was 1.83 (SD=1.14), indicating a somewhat lower value than that of the norm group (M=2.09, SD=1.94).

Job stress survey (JSS):
The JSS instrument presents a general measure of stress at work. In the test, participants are questioned about the level of seriousness of certain stressors according to how individuals perceive them and how often these stressors have been experienced during the last six months [51]. Through the expediency of assessing the level of seriousness of the stressors as well as their frequency a distinction is made between condition and characteristic under measurement. The participants first estimate the level of seriousness of certain stressors on a 9-graded scale. Following this, they were instructed to assess on a scale from 0 to 9+ how often each incident had occurred during the last six months. The result was tabulated on nine different scales: three of these being index scales, three grading scales and three frequency scales. These scales were separated into three different stress sources: work stress (ASI), work burden (ABI) and lack of organisational support (BSI).

Life orientation test (LOT):
The LOT-instrument is a selfestimation instrument that assesses an individual's degree of dispositional optimism. The instrument is based on a general model, regarding self-regulated behaviour that indicates that optimism exerts meaningful behavioural consequences based on the model [52]. It was constructed originally to study the extent to which the personality trait optimism was associated with the ability to develop suitable 'coping strategies' in connection with severe psychological and physical handicaps (e.g. tinnitus). Since the test has been shown to be successful for predicting success-rate in physically demanding and stressful sports [53], it was considered both sufficient and necessary for inclusion in the present study. The instrument consists of 12 statements from which each participant is instructed to assess the extent to which each of these statements fits in with him/her as an individual. The response alternatives are presented on a five-graded scale extending from 0="strongly disagree" to 4="strongly agree". LOT is a suitable scientific instrument with an estimated internal consistency of 0.76 (Cronbach's alpha) and a Health and background questionnaire: The questionnaire is used to assemble background data regarding health and health-related information about the participants. It consists of questions regarding gender, age, education, smoking habit, exercise, aches and pains, sleep problems, time spent watching TV, and amount of activity associated with occupation. Examples of questions include: "How often have you experienced sleep problems during the past year?" Response alternatives in this case provided for a choice between five different options including: "Constantly", "2-3 times a week", "Once a week", "Once a month", or "Never". Each participant was instructed to mark the alternative that was most appropriate for himself/herself.

Procedure
Fifteen places of work, both private and public, were contacted with regard to participation of employees in an investigation upon aspects of health. Permission to carry out the study was sought through Heads of personnel, union representatives and persons in positions of responsibility who adjudged whether or not the material could compromise the integrity of the personnel. Places of work choosing not to allow the investigation provided the following reasons: "This compromises personal integrity", "We don't have the time", and "Our policy is not to take part in any investigations". Eight places of work, representing both private and public sectors, accepted to allow the study. Nevertheless, the private sector was somewhat over-represented (68%).
Employees at each respective place of work were informed first by their respective Heads about the study and then asked whether or not they wished to participate. All participation was on a volunteer basis and took place at the usual work place during working hours. Most of the participants were tested in groups of maximally five persons although some were tested singly. Prior to testing, participants were ensured total anonymity as well as the fact that each set of responses was unidentifiable among all the other sets of responses.
In order to avoid the possible effects of ordering of each instrument, the order in which each instrument/questionnaire occurred was randomly distributed in each envelop. Each participant picked an envelop randomly out of the box containing them. The maximum amount of time allocated for subjects to complete all the questionnaires was 30 minutes. At the start of testing, participants were informed about the purpose and background of the study and that it was above all on a volunteer basis. It was emphasis that all details of work place and personal identity were to be omitted since total anonymity was essential. On completion of all the instruments, each participant was instructed to replace all the questionnaire in the envelope. All the envelopes were collected and stored until the employees from each of the places of work had completed the tests.

Effect of work stress
In order to analyse whether or not different degrees of work stress (JSS) affected the self-reported measures of health/illhealth, the individual scores on this variable were assigned to three groups on the basis of subjects' own responses to the questionnaire:-Group 1 ("Low work stress") reported low levels of stress on the JSS instrument, Group 2 ("Medium work stress") reported intermediate levels and Group 3 ("High work stress") reported high levels. Pillai's MANOVA (3 × 2 factorial design) with work stress (JSS) and Gender as independent variables and with stress, energy, anxiety, depression, psychological and somatic subjective stress experience, positive and negative affect and LOT as dependent variables indicated significant main effects for One-way ANOVA with work stress (JSS) as independent variable and with stress, energy, anxiety, depression, psychological subjective stress experience och somatic subjective stress experience, dispositional optimism (LOT), Negative and Positive affect as dependent variables indicated signifikant effekts for the following variables:

Effect of partnership relation quality (PRQ)
In order to analyse whether or not the different degree of work stress (JSS) affected the self-reported measures of health/illhealth, the individual scores on this variable were assigned to three groups on the basis of subjects' own responding:-Group 1 ("Low PRQ") reported low levels of PRQ, Group 2 ("Medium PRQ") reported intermediate levels and

Effect of gender
One-way ANOVA with Gender as independent variable and with stress, energy, anxiety, depression, psychological subjective stress experience and somatic subjective stress experience, dispositional optimism (LOT), Negative and Positive affect as dependent variables indicated significant effects for the following variables: No significant Gender effects were obtained for depression, somatic subjective stress experience, positive and negative affect or dispositional optimism (LOT) ( Table 2).

Regression Analysis
Linear regression analysis was performed, applying the hierarchic method, to examine the extent to which anxiety and depression (HAD), stress and energy (SE), psychological subjective stress experience (SSPSYK) and somatic subjective stress experience (SSSOM), may be predicted from (i) work stress (JSS) and (ii) partnership relation quality (PRQ).  F(3,172)=8.76 p<0.001, Adjusted R2=0.08] were each predicted significantly from JSS whereas PRQ was counter-predictive for each of these five estimates of illhealth. Table 3 presents the Standardiserad β (Standardized weights) and Standard Error for Beta (SEB) values for the linear regression analysis with depression, anxiety, energy, stress, psychological subjective stress experience and somatic subjective stress experience, respectively, as dependent variables, and (i) JSS and (ii) PRQ as independent (Predictor) variables.
Finally, each of the three work stress factors: work stress (ASI), work burden (ABI) and lack of organisational support (BSI), as well as PRQ were assigned to be independent variables with depression as dependent variable in an hierarchic regression analysis. The analysis was found to produce a significant effect: (F(5,168)=11.32, p<0.001, adj. R2=0.17) whereby lack of organisational support (BSI) was shown to be significantly predictive of Depression [β=0.508, p<0.01] and PRQ was significantly counterpredictive [-0.328, p<0.01]. Work stress (ASI) and work burden (ABI) were not significantly predictive of depression (Table 4).

Discussion
The present findings may be summarised as follows: (1) Selfreported high levels of work stress (the JSS "High work stress" group) induced more anxiety, stress (SE), psychological and somatic subjective stress, and negative affect than self-reported low levels of work stress (the JSS "Low work stress" group), with intermediate levels of work stress (the JSS "Medium work stress" group) in between. (2) Selfreported high levels of partnership relations quality (the "High PRQ" group) was associated with less depression, anxiety, stress (SE) and negative affect than self-reported low levels of partnership relations quality (the "High PRQ" group), with intermediate levels (the "Medium PRQ" group) in between. (3) The female participants expressed more anxiety, stress (SE), energy (SE) and psychological subjective stress experience that the male participants. (4) Regression analysis indicated that depression, anxiety, stress (SE), psychological stress and somatic stress were each significantly predicted by work stress (JSS), whereas partnership relations quality was counter-predictive for depression, anxiety, stress (SE) and psychological stress.
Work-related stress is often encountered as an important factor that induces illhealth in adult as the place of work [11]. Several studies have shown that unpleasant workplace conditions have a negative influence upon employees physical and mental health [54,55]. The accumulated effects of high levels of chronic workplace stress, lack of recovery time, high performance requirement and psychobiological concomitants lead to serious loss of energy, exhaustion and breakdown [56]. The evidence from the present study indicates that partnership relation quality exerts a positive influence upon health and thereby ought to mediate the recovery process from sources of stress. Thus, partnership  Table 2: Means (± SD) for anxiety and depression (HAD), stress and energy (SE), psykisk och somatisk subjektiv stresserfarenhet (SSE), dispositional optimism (LOT), and positive and negative affect (PANAS). by each of the three groups presenting partnership relation quality (PRQ).   relation quality seems to counteract the potentially unpleasant workplace conditions and to reduce negative effects upon health due to experienced work-related stress. Regression analysis indicated that work-related stress predicted an increased risk for depression, anxiety, general stress experience and subjective somatic stress symptoms whereas high quality partnership relations predicted a reduced risk for these symptoms, thereby reinforcing the notion that good partnership conditions may counteract the negative effects of stress generated at the workplace.

Predicting variables Standardised Beta (β) SEB
Kiecolt-Glaser and Newton [28] have shown that emotional support from a partner is related to low risk for cardiovascular and other types of mortality. Levels of blood pressure are partcularly sensitive to the supportive or non-supportive relations between partners [27,57,58]. It is hypothesised that oxytocin may be the primary physiological mediator in the health-producing effects of emotional support, particularly when linked to warm and intimate caressing [59,60]. Light et al. [2] found that a higher frequency of embracing and massage from the partner was associated with a higher baseline of oxytocin levels. They found too that frequency of embracing correlated with partner-support and women reporting more frequent partner embraces showed lower baseline levels of blood pressure as well as lower heart rates during stressful conditions. A profile of more frequent partner-embracing was associated with higher baseline levels of oxytocin and lower cardiovascular response. Women presenting higher oxytocin activity showed a more effective and goal-oriented, time-limited stress response but no reduction in the peak stress response [2]. Thus, high quality partnership relations may contribute positive influences to health, and on the the other side of the coin, unhappy relations may be potential psychosocial stressors with accompanying risks for illhealth [1].
The presence of 'cross-over' effects between family-and-work and work-and-family have been investigated. Barnet et al. [25] found that partnership-related difficulties influenced biological functioning during the course of the work-day. The analysis of subjective stress indicated too that men and women expressing high levels of marital difficulty reported higher degrees of stress both during working and leisure hours which implies that dissatisfaction in partnership relations may underlie the distress contributing to elevated levels of depression and anxiety. Barnet et al. [25] showed similar results whereby poor marital quality, among middle-aged couples with long relationships, could induce chronic stress, leading to resignation and withdrawal. DeLongis et al. [61] found spousal strain interacted with spousal support to predict 'next-day' negative affect. Work-place-to-family crossover effects [62] whereby stressors from one partner's work to the other have been examined [63]. Thus, Westman and Etizion [64] found crossover effects of burnout transfered from army career officers to their wives and vice versa, whereas Demerouti et al. [56] observed crossover effects between the workplace and family among couples where both parents had occupations. Shulz et al. [65] showed the relationship between work and family whereby the negative arousal of workdays was associated more aggressive marital behaviour among women and less aggressive, but more withdrawn, marital behaviour among men. Furthermore, daily fluctuations in the workday rhythym predicted women's marital behaviour. The investigation showed too that several of these workdaymarital behaviour relationships varied as a function of the degree of marital satisfaction [65] and signal positive health prognosis [66].

Conclusion
Taken together, the present findings point towards a broad perspective, incorporating type and quality of partnership relations, for eventual treatment regimes directed at problems arising from work-related stress. Fruzzetti and Linehan [67] imply the importance and relevance of couple-related factors in assessments of individual psychopathology, and vice versa, both in disorder neurodevelopment but also in the context of relapse and recovery from distress [68]. Arkowitz-Westen and Fruzzetti [69] showed that validatory behavior predicted higher levels of satisfaction among couples in a cross-section of clinic and community populations [70].

Recommendations
The concensus of these and other findings suggest the attainment of longterm and lateral health benefits for individuals afflicted by occupational stress requires a proper understanding of partnership relations in order to reinforce the positive intervention achieved through coping strategies, cognitive and behaviour therapies.

Limitations
The study sample would have benefitted from a larger sample size in order to obtain greater predictive validity.