ill-health and social support and that the relationship between employment and
social support is reciprocal over time (i.e. employment influences social support,
and social support influences employment).Conclusion
The results from this study provide support for the relationship between stress
(unemployment) and health and suggest that this relationship is mediated by social
support. Therefore, ill-health was greatest in those subjects who were both unemployed
and who reported low social support. In addition, the results suggest that although social
support may act as a mediating factor, it is itself related to employment status, with
individuals gaining social support from work colleagues.PERSONALITY
Early research exploring the role of personality as a moderator of the stress–illness link
focused on type A behaviour. For example, Friedman and Rosenman (1959) initially
defined type A behaviour in terms of excessive competitiveness, impatience, hostility
and vigorous speech. Using a semi-structured interview, three types of type A
behaviour were identified. Type A1 reflected vigour, energy, alertness, confidence, loud
speaking, rapid speaking, tense clipped speech, impatience, hostility, interrupting, fre-
quent use of the word ‘never’ and frequent use of the word ‘absolutely’. Type A2 was
defined as being similar to type A1, but not as extreme, and type B was regarded as
relaxed, showing no interruptions and quieter (e.g. Rosenman 1978). The Jenkins activ-
ity survey was developed in 1971 to further define type A behaviour. Support for a
relationship between type A behaviour and coronary heart disease using the Jenkins
activity survey has been reported by a number of studies (Rosenman et al. 1975;
Jenkins et al. 1979; Haynes et al. 1980). However, research has also reported no rela-
tionship between type A behaviour and CHD. For example, Johnston et al. (1987) used
Bortner’s (1969) questionnaire to predict heart attacks in 5936 men aged 40–59 years,
who were randomly selected from British general practice lists. All subjects were exam-
ined at the start of the study for the presence of heart disease and completed the
Bortner questionnaire. They were then followed up for morbidity and mortality from
heart attack and for sudden cardiac death for an average of 6.2 years. The results
showed that non-manual workers had higher type A scores than manual workers and
that type A score decreased with age. However, at follow-up the results showed no
relationship between type A behaviour and heart disease. More recently, however, much
research has focused on hostility and aspects of anger expression as the most important
personality types to be linked to stress and illness. Hostility has most frequently been
measured using the Cook Medley Hostility scale (Cook and Medley 1954) which asks
people to rate statements such as ‘I have often met people who were supposed to be
experts who were no better than I’, ‘It is safer to trust nobody’, and ‘My way of doing
thing I apt to be misunderstood by others’. Agreement with such statements is an
indication of high hostility. Hostility has also been classified according to cynical hostility276 HEALTH PSYCHOLOGY