Intra-individual patterns of hormonal and affective adaptation to work demands: an n = 2 study of junior doctors

This paper examines the detailed pattern of hormonal and affective response to natural variations in work demands, in relation to a taxonomy of adaptive response based on Frankenhaeuser's (1986) psychobiological analysis of coping modes and Hockey's (1993) regulatory control model. Two junior doctors were monitored every day over a 7-week period of work on a cardio-thoracic surgery ward. Measurements were made for each morning and afternoon work period of self-rated workload, effort and affective state, and the level of urinary catecholamines and cortisol. The de-trended data were analysed separately for the two individuals, using multivariate methods. Following reduction of work variables by principal components analysis, canonical correlation analyses were carried out for each individual. These revealed differences in the patterns of adaptation to two distinctive work contexts (enabling and demanding work) across the two doctors, as identified through loadings on two significant pairs of canonical variates. As expected, enabling work (high medical demands, with high personal resources) was associated with active coping in both subjects (low fatigue, high effort/adrenaline and low cortisol). However, demanding work (high general demands) was associated with marked differences between them in the pattern of loadings. One subject showed the strain pattern normally associated with effortful engagement in difficult tasks (high anxiety and fatigue, high effort/adrenaline), though without the anticipated reduction in cortisol. The response pattern of the other individual was indicative of passive coping (high anxiety and cortisol, with no effort/adrenaline component). The findings are interpreted in terms of the role of personal coping styles on the adaptive response to work demands. The use of canonical correlation methods with intra-individual data sets, although relatively unusual, appears to provide potentially valuable evidence on the nature of individual differences in the process of psychobiological response to stress underlying work-health relationships.