Active job, healthy job? Occupational stress and depression among hospital physicians in Taiwan

This study assessed the levels and association of occupational stress and depression rate among physicians, and to compare physicians' occupational stress with that of Taiwanese employees in other occupations. The subjects were physicians employed at 14 participating regional hospitals in the Around Taiwan Health Care Alliance. Self-administered questionnaires capturing data on demographics, occupational characteristics, occupational stress measured using Job Content Questionnaire (C-JCQ), and health status measured using Taiwanese Depression Questionnaire (TDQ) were sent to eligible physicians. Results revealed that the depression rate (13.3%) was higher than that found in the general population (3.7%) of Taiwan. The mean scores of the JCQ dimensions "work demands" and "job control" were both much higher than those in most occupations in Taiwan. Higher depression scores were found in subjects with higher work demands, 8-10 d of being on duty per month, and more frequent alcohol consumption, while lower depression scores were found in subjects working in the east Taiwan area, with higher job control and with greater workplace social support. On the other hand, gender, smoking, and working hour were not independently correlated with depression, but the interaction of gender and job control also had an independent effect on depression. This study suggests that job stress plays an important role in depression in physicians; it is necessary to pay attention to physicians at high risk of depression, as well as their work environments, for early detection and intervention.     

Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

Background

Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention.

Methods

All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health.

Results

One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress.

Conclusion

Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.     

某医院护理人员工作能力与职业紧张相关性分析

[目的]探讨影响护理人员工作能力的职业紧张和职业心理卫生因素,为提高护理人员的工作能力提供科学依据. [方法]采取职业紧张测量问卷和工作能力指数调查表对某医院545名护理人员进行调查,对获得的数据进行相关与逐步回归分析. [结果]与护理人员的工作能力指数呈正相关的因素是职业心理卫生(P＜0.01);与工作能力指数呈负相关的因素是物理环境、缺乏社会支持、缺乏提升机会、缺乏参与机会、工作前景、工作危险、工作冲突、工作负荷(P＜0.01).引入逐步回归方程的3个因素是职业心理卫生、物理环境和缺乏社会支持. [结论]影响护理人员工作能力的职业因素是多方面的,主要是职业心理卫生、缺乏社会支持和物理环境.     

Perceived job stress and mental health in precision machine workers of Japan: a 2 year cohort study

OBJECTIVES: To determine whether perceived job stress affects mental health in occupational settings. METHODS: A 2 year cohort study was conducted. Initially, a survey including the general health questionnaire (GHQ) and a questionnaire about perceived job stress was carried out. Of 462 workers who initially showed a GHQ score of < or = 7,310 were successfully followed up for 2 years. The 2 year risks of developing mental ill health (a GHQ score > or = 8) were assessed relative to perceived job stress. To control for potential confounding factors, multiple logistic regression analyses were conducted. RESULTS: The overall 2 year risk for developing mental ill health was high at 57.7%. Workers who reported aspects of perceived job stress showed a greater 2 year risk than those without stress. Multiple logistic regression analyses showed that some components of perceived job stress were associated with a higher 2 year risk, among which "not allowed to make mistakes" showed the largest adjusted odds ratio (OR) (95% confidence interval (95% CI) of 2.37 (1.32 to 4.29). "Poor relationship with superior" had a significant effect on mental health only in women, with an adjusted OR (95% CI) of 3.79 (1.65 to 8.73). CONCLUSIONS: Certain specific items of perceived job stress seem to be associated with mental ill health in workers. These could broadly be described as job strain, or job demand items. The type of job stress that predicts mental health may be dependent on the characteristics of the workplace investigated.     

某地社康医院医护人员的职业紧张与工作能力的关系

目的通过探讨影响医务人员工作能力的职业紧张因素,为提高医务人员的工作能力提供科学依据。方法用职业紧张测量问卷和工作能力指数调查表对深圳市龙岗区社康医院276名医务人员进行调查,对获得的数据进行相关分析和逐步回归分析。结果医护人员的工作能力优、良、中、差的分布比例分别为43.5%、41.3%、14.5%、0.7%。与医务人员的工作能力指数呈负相关的因素是物理环境、缺乏社会支持、缺乏提升机会、缺乏参与机会、工作前景、工作危险、工作冲突、工作负荷(P<0.01)。引入逐步回归方程的4个因素是工作负荷、缺乏社会支持、工作危险和缺乏参与机会。结论多种职业紧张因素可降低社康医院医护人员的工作能力,该区各医疗机构应尽量降低医护人员的职业紧张程度。     

The impact of work and organizational characteristics on the health status, job dissatisfaction and turnover intentions of workers in an information service industry]

Based on the conceptual model of "healthy work organization", we conducted a questionnaire survey of 612 Japanese workers in an information service industry company to investigate the effect of work stressors and organizational characteristics on workers' health status, job dissatisfaction and turnover intentions from July to August 2001. The response rate was 96.2%. For the statistical analysis, data on 488 computer technical support staff were used. To grasp the occupational stressors, we used a focus group to clarify work stressors and organizational characteristics. After factor analysis, we identified seven factors composed of 29 items and created seven scales of work and organizational characteristics. As scales of "organizational characteristics", "insufficient evaluation system", "undeveloped management system", and "career and future ambiguity" were used. The remaining scales, "poor coworker support", "poor supervisor support", "insufficient office amenities" and "high job demands and control", were used as scales of "work and workplace characteristics". The results of multiple regression analysis showed significant relevance of organizational characteristics to health status, job dissatisfaction and turnover intentions of workers. They supported "healthy work organizations" as useful conceptual tools for the study of organizational health.     

Prevalence and determinants of workplace violence of health care workers in a psychiatric hospital in Taiwan

Workplace violence, a possible cause of job stress, has recently become an important concern in occupational health. This study determined the prevalence of workplace violence and its risk factors for employees at a psychiatric hospital in Taiwan. A questionnaire developed by ILO/ICN/WHO/PSI was first translated and validated. It was then used to survey the prevalence of workplace violence in the last 12 months experienced by all nursing aides, nurses, and clerks at the hospital. Multiple logistic regression models were constructed to discover the determinants of violence. A total of 222 out of 231 surveyed workers completed a valid questionnaire. The one-year prevalence rates of physical violence (PV), verbal abuse, bullying/mobbing, sexual harassment, and racial harassment were 35.1, 50.9, 15.8, 9.5, and 4.5%, respectively. The prevalence of PV at this hospital was higher than that reported by other countries for the health sector. A high anxiety level was associated with the occurrence of PV. These results need to be corroborated by future investigation. A training program may be required for high risk groups to reduce workplace violence.     

Job insecurity and its association with health among employees in the Taiwanese general population

As employers respond to intensive global competition through the deregulation of labor, job insecurity has become a widespread problem. It has been shown to have significant health impacts in a growing number of workers, but less is known about its social distribution, the mechanisms through which it may act, and the moderating effects of gender, socioeconomic position, and company size. Utilizing data from a national survey of a representative sample of paid employees in Taiwan, we examined the prevalence of job insecurity and its associations with psychosocial work characteristics and health status. A total of 8705 men and 5986 women aged between 25 and 65 years old were studied. Information on perceived job insecurity, industrial and occupational types, psychosocial work characteristics as assessed by the Job Strain model, and various measures of health status were obtained by a self-administered questionnaire. The overall prevalence of job insecurity was high (50%). Job insecurity was more prevalent among employees with lower education attainment, in blue-collar and construction workers, those employed in smaller companies, and in older women. Insecure employees also reported lower job control, higher job demands, and poor workplace social support, as compared with those who held secure positions. Regression analyses showed that job insecurity was strongly associated with poor health, even with adjustment of age, job control, job demands, and work place social support. The deleterious effects of job insecurity appeared to be stronger in men than women, in women who held managerial or professional jobs than women in other employment grades, and in those working in larger companies than smaller ones. The findings of this study suggest that perceived job insecurity is an important source of stress, and it is accompanied with adverse psychosocial work conditions and poor health. High-risk groups were identified for further investigation.     

Application of Karasek's demand/control model a Canadian occupational setting including shift workers during a period of reorganization and downsizing

PURPOSE: To apply Karasek's Job Content Model to an analysis of the relationships between job type and perceived stress and stress behaviors in a large company during a period of reorganization and downsizing. DESIGN: Cross-sectional mail-out, mail-back survey. SETTING: A large Canadian telephone/telecommunications company. SUBJECTS: Stratified random sample (stratified by job category) of 2200 out of 13,000 employees with a response rate of 48.8%. MEASURES: Responses to 25 of Karasek's core questions were utilized to define four job types: low-demand and high control = "relaxed"; high demand and high control = "active"; low demand and low control = "passive", and high demand and low control = "high strain." These job types were compared against self-reported stress levels, perceived general level of health, absenteeism, alcohol use, exercise level, and use of medications and drugs. Similar analyses were performed to assess the influence of shift work. RESULTS: Employees with "passive" or "high strain" job types reported higher levels of stress (trend test p < .0001); poorer health (trend test P = .006); and higher levels of absenteeism (trend test p < .0001). More shift workers reported themselves in poor or fair health (chi-square p = .018) and reported high levels of stress at home (chi-square p = .002) than nonshift workers. The relationships between job type and levels of stress, health and absenteeism, however, held for nonshift workers as well. CONCLUSIONS: Job types with high demand and low control were associated with increased stress, increased absenteeism, and poorer self-concept of health. The demand/control model of Karasek and Theorell was validated in this setting with respect to stress and some stress-associated attitudes and behaviors.     

Occupational health nursing education for the 21st century

Occupational health nurses are the largest group of occupational health professionals, and are critical to the delivery of quality health care services to the nation's work force. Educational preparation of occupational health nurses has advanced in recent years, and the need for occupational health nurses with advanced degrees is expected to increase. Occupational health nurses use licensure, continuing education, certification, supervisor and peer assessment of job performance, formal education, and practice to maintain their professional competence and protect the public's health. New strategies must be developed to prepare nurses to promote a safe and healthful work force. Funding for programs to prepare occupational health nurses will be essential for meeting this demand. Continuing education programs for occupational health nurses must be developed that demonstrate effectiveness in developing occupational health nurses' skills while minimizing their time away from the workplace.     

Stress, burnout and job satisfaction in rural psychiatric nurses: a Victorian study

OBJECTIVE: To measure the level of stress, burnout and job satisfaction in rural psychiatric nurses in Victoria, Australia. METHOD: This present study presents the findings of a research study undertaken with rural psychiatric nurses (n = 136) in two rural mental health services in Victoria. The study designed to measure their level of stress, burnout and job satisfaction using the Maslach Burnout Inventory (MBI), the Nursing Stress Scale (NSS) and Job Satisfaction Scale (JSS). RESULTS: The findings indicated that a low number rural psychiatric nurses suffered from 'high' level of burnout and the majority of nurses reported 'low level' of emotional exhaustion and depersonalisation scores. On the personal accomplishment subscale, only 11% recorded a 'high' score and 87% recorded 'low' score. On the Nursing Stress Scale, the 'workload' was the highest perceived stressor followed by 'inadequate preparation'. CONCLUSIONS: Paradoxically, the majority of rural psychiatric nurses stated that they were satisfied with their job, particularly with current situation at work, aspects of support and the level of involvement in decision making.     

Effect of work and organizational characteristics on workers in call centers: longitudinal study in an information service company]

To investigate the effect of work and organizational characteristics on workers' health status, with job dissatisfaction and intentions to leave as "organizational health", we conducted a longitudinal study using a questionnaire survey in call centers of an information service company from July to August in 2001 and 2002. The response rates were 96.2% and 92.0%, respectively. For the statistical analysis, the completed data of 296 technical support staff, which was more than 80% of the data, was used. We identified seven subscales composed of 29 items of work and organizational characteristics as scales of "organizational characteristics" and "work and workplace characteristics". The results of hierarchical multiple regression analysis showed quantitative and qualitative job-overload influenced psychological health status and poor supervisor support influenced all outcome variables. Moreover, "organizational characteristics" influenced cumulative fatigue and job dissatisfaction, showing an indirect effect with poor supervisor support and coworker support. This study suggests that measures of work and organizational characteristics are useful interventions for "organizational health".     

Burnout and occupational stress in nurses

BACKGROUND: In the last few years there has been a growing interest in the psychosocial work environment of health care workers, since they are both at high risk of burnout, role conflict and job dissatifaction. Burnout, as a type of prolonged response to chronic job-related stress, has a special significance in health care settings, where staff experience both psychological--emotional and physical stress. OBJECTIVES: The present study investigated the interrelationship between burnout, occupational stress and personality characteristics in a sample of 120 nurses employed in the Infectious Diseases Department and the Department of Medical Oncology of two major hospitals in Messina, Italy. METHODS: Three questionnaire surveys were administered: The Maslach Burnout Inventory (MBI) to estimate the job stress level, Occupational Stress Inventory to measure occupational stress and the Comrey Personality Scale to identify major personality characteristics. RESULTS: The results showed a significant statistical diference regarding the burnout levels in the two groups under study, with a higher burnout level in the Medical Oncology staff with respect to the Infectious Diseases Staff. The latter group also showed a higher occupational stress compared to the second group, with a significant statistical difference regarding "stress sources", coping strategies" and psychological health". Concerning the CPS results, some personality characteristics, as predictors for burnout syndrome, were found in the Medical Oncology staff. CONCLUSIONS: The study results underline the importance of the role ofpsychosocial work environment and the interrelationships between burnout, occupational stress and psychosomatic health in health care workers. In addition, in order to reduce a burnout risk, the Authors suggest improving the psychosocial work environment as a preventive measure.     

武汉市三甲医院护士抑郁症状及其与职业紧张的关系

[目的]探讨武汉市三甲综合医院护士抑郁症状的检出率及其与职业紧张的关系。[方法]随机抽取武汉市3家三甲综合医院384名护士自填完成一般情况问卷、工作内容问卷和中文版Zung氏抑郁自评量表。[结果]样本自评抑郁症状的检出率（95%可信区间）为54.7%（49.7%,59.7%）。轮班制岗位类别、合同制聘用、工作要求高、自主程度低和社会支持低是护士抑郁的危险因素,其比值比（OR）分别为1.44、2.53、3.39、2.78和2.23（P〈0.05）。[结论]不良的职业、社会、经济因素和职业紧张可能增加护士抑郁症状的发生风险。     

An investigation of the relationship between psychological health and workload among managers

BACKGROUND: Anecdotally, many workers complain of stress at work. However, the relationship between work and stress needs clarification to allow risk assessment and risk management of this hazard in the workplace. OBJECTIVES: To examine relationships between working hours, perceived work stressors, and psychological health in a group of managers. METHODS: Managers at two factories were invited to participate in an anonymous cross-sectional survey. All were asked to complete a work diary for a period of 1 week and a questionnaire comprising the 30-item General Health Questionnaire, an anxiety and depression scale, and questions identifying perceived workplace stressors. RESULTS: Over 60% of managers were above the threshold of caseness on at least one measure of psychological health. No statistically significant relationship was demonstrated between actual hours of work and psychological health. A relationship was demonstrated between some perceived workplace stressors and actual hours worked, and between some perceived workplace stressors and psychological health. CONCLUSIONS: A large proportion of managers in a typical production environment appeared at risk of developing psychological illness. Hours of work were not directly related to psychological health, but were significantly associated with individual perception of some work stressors which, in turn, were associated with measures of psychological health. Perceived workload appeared more important in determining psychological health than actual workload.     

Stress at work and mental health status among female hospital workers.

Relations between working conditions and mental health status of female hospital workers were studied in a sample of 1505 women: 43% were nurses, 32% auxiliaries, and 7% ancillary staff; 13% were other qualified health care staff, mainly head nurses; 5% had occupations other than direct health care; 63% worked on the morning, 20% on the afternoon, and 17% on the night shift. Data were collected at the annual routine medical visit by the occupational health practitioner, using self administered questionnaires and clinical assessments. Five health indicators were considered: a high score to the general health questionnaire (GHQ); fatigue; sleep impairment; use of antidepressants, sleeping pills, or sedatives; and diagnosis of psychiatric morbidity at clinical assessment. Four indices of stress at work were defined: job stress, mental load, insufficiency in internal training and discussion, and strain caused by schedule. The analysis was conducted by multiple logistic regression, controlling for type of occupation, shift, number of years of work in hospital, daily travel time to work, age, marital status, number of children, and wish to move house. Sleep impairment was mostly linked to shift and strain due to schedule. For all other indicators of mental health impairment and especially high GHQ scores, the adjusted odds ratios increased significantly with the levels of job stress, mental load, and strain due to schedule. This evidence of association between work involving an excessive cumulation of stress factors and mental wellbeing should be considered in interventions aimed at improving the working conditions of hospital workers.     

Stress at work and mental health status among female hospital workers

Relations between working conditions and mental health status of female hospital workers were studied in a sample of 1505 women: 43% were nurses, 32% auxiliaries, and 7% ancillary staff; 13% were other qualified health care staff, mainly head nurses; 5% had occupations other than direct health care; 63% worked on the morning, 20% on the afternoon, and 17% on the night shift. Data were collected at the annual routine medical visit by the occupational health practitioner, using self administered questionnaires and clinical assessments. Five health indicators were considered: a high score to the general health questionnaire (GHQ); fatigue; sleep impairment; use of antidepressants, sleeping pills, or sedatives; and diagnosis of psychiatric morbidity at clinical assessment. Four indices of stress at work were defined: job stress, mental load, insufficiency in internal training and discussion, and strain caused by schedule. The analysis was conducted by multiple logistic regression, controlling for type of occupation, shift, number of years of work in hospital, daily travel time to work, age, marital status, number of children, and wish to move house. Sleep impairment was mostly linked to shift and strain due to schedule. For all other indicators of mental health impairment and especially high GHQ scores, the adjusted odds ratios increased significantly with the levels of job stress, mental load, and strain due to schedule. This evidence of association between work involving an excessive cumulation of stress factors and mental wellbeing should be considered in interventions aimed at improving the working conditions of hospital workers.     

Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men

Both subjective and objective measures of lower social position have been shown to be associated with poorer health. A psychosocial, as opposed to material, aetiology of health inequalities predicts that subjective social status should be a stronger determinant of health than objective social position. In a workplace based prospective study of 5232 Scottish men recruited in the early 1970s and followed up for 25 years we examined the association between objective and subjective indices of social position, perceived psychological stress, cardiovascular disease risk factors and subsequent health. Lower social position, whether indexed by more objective or more subjective measures, was consistently associated with an adverse profile of established disease risk factors. Perceived stress showed the opposite association. The main subjective social position measure used was based on individual perceptions of workplace status (as well as their actual occupation, men were asked whether they saw themselves as "employees", "foremen", or "managers"). Compared to foremen, employees had a small and imprecisely estimated increased risk of all cause mortality, whereas managers had a more marked decreased risk. The strongest predictors of increased mortality were father's manual as opposed to non-manual occupation; lack of car access and shorter stature, (an indicator of material deprivation in childhood). In the fully adjusted analyses, perceived work-place status was only weakly associated with mortality. In this population it appears that objective material circumstances, particularly in early life, are a more important determinant of health than perceptions of relative status. Conversely, higher perceived stress was not associated with poorer health, presumably because, in this population, higher stress was not associated with material disadvantage. Together these findings suggest that, rather than targeting perceptions of disadvantage and associated negative emotions, interventions to reduce health inequalities should aim to reduce objective material disadvantage, particularly that experienced in early life.     

某钢铁厂工人职业应激状况调查

目的 调查某钢铁厂工人职业应激因素和应激结局水平及其影响因素,并探讨职业应激和心理健康作为企业健康促进效果评价指标的可行性.方法 使用整群抽样方法对某钢铁厂1039名工人进行横断面调查,问卷内容主要包括职业应激因素、技术利用水平、工作控制水平、心理健康状况和睡眠障碍等.结果 有54.5%的工人报告"工作不允许出错",47.6%的工人报告"工作责任太大".男性工作应激因素评分高于女性,差异有统计学意义(P<0.01).不同文化程度组问心理健康、技术利用程度、工作控制水平和睡眠障碍评分差异均有统计学意义(P<0.01或P<0.05),高文化程度组技术利用程度、工作控制水平评分高于低文化程度组,文化程度越低,心理健康状态越差.不同年龄组间技术利用程度、工作控制水平和睡眠障碍评分差异有统计学意义(P<0.01),高年龄组技术利用程度和工作控制水平评分高于低年龄组.不同工龄组间技术利用程度评分差异有统计学意义(P<0.05).工龄31-40年组心理状态最差,工龄21-30年组工作需要技术最多,睡眠障碍倾向最大.不同工种组间技术利用程度评分差异有统计学意义(P＜0.01),桁车工组工作应激因素最多,仪表工组工作需要技术最多,管理人员工作控制水平最高.职业应激因素评分与睡眠障碍评分呈明显的正相关(r=0.37,P<0.01),工作控制水平评分与心理健康评分呈明显的负相关(r=0.19,P<0.01).结论 钢铁厂工人工作中职业应激因素与健康结局有关,应将心理健康指标纳入企业健康促进效果评估体系.