The relations between work demands and health complaints in lorry drivers

In this study, data of a questionnaire study among 439 lorry drivers were fitted to a model in which work demands and the worker's decision latitude are related to musculoskeletal complaints and general psychosomatic complaints. Structural analysis with LISREL was used to investigate the hypothesized relations. Two modifications resulted in a ² of overall fit equal to 77.35 with 47 degrees of freedom. The quality of model fit was considered to be satisfactory when the sample size was taken into account. The values of the Adjusted Goodness of Fit Index (0.948) and the Root Mean Square Residuals (0.029) indicated the same. The standardized solution of LISREL showed that work demands with respect to task contents were significantly related to musculoskeletal complaints as well as to general psychosomatic complaints (0.75 and 0.34 respectively, both P < 0.001). This conceptual variable was indicated by physical activities that the drivers had to perform. The relations between work-related psychosocial factors and musculoskeletal complaints were weak. Another significant effect on general psychosomatic complaints was found for work demands with respect to terms of employment (0.30, P < 0.001). This conceptual variable was indicated by variables concerning working hours and pressure of the work. It is recommended that in future occupational epidemiology, both physical and psychosocial aspects of the working situation be related to health effects, rather than solely a single exposure variable.     

Job demands, job resources, and work engagement of Japanese employees: a prospective cohort study

Purpose

Research on the prospective association of job demands and job resources with work engagement is still limited in Asian countries, such as Japan. The purpose of the present study was to investigate the prospective association of job demands (i.e., psychological demands and extrinsic effort) and job resources (i.e., decision latitude, supervisor support, co-worker support, and extrinsic reward), based on the job demands-control (JD-C) [or demand-control-support (DCS)] model and the effort-reward imbalance (ERI) model, with work engagement among Japanese employees.

Methods

The participants included 423 males and 672 females from five branches of a manufacturing company in Japan. Self-administered questionnaires, including the Job Content Questionnaire (JCQ), the Effort-Reward Imbalance Questionnaire (ERIQ), the nine-item Utrecht Work Engagement Scale (UWES-9), and demographic characteristics, were administered at baseline (August 2009). At one-year follow-up (August 2010), the UWES-9 was used again to assess work engagement. Hierarchical multiple regression analyses were conducted.

Results

After adjusting for demographic characteristics and work engagement at baseline, higher psychological demands and decision latitude were positively and significantly associated with greater work engagement at follow-up (β = 0.054, p = 0.020 for psychological demands and β = 0.061, p = 0.020 for decision latitude).

Conclusions

Having higher psychological demands and decision latitude may enhance work engagement among Japanese employees.     

The relationship between psychosocial work characteristics and fatigue and psychological distress

OBJECTIVES: To examine the associations between psychosocial work characteristics and fatigue in employees in the Maastricht Cohort Study. A second objective was to compare the relationships for fatigue versus psychological distress with these psychosocial work characteristics. METHODS: The design was cross-sectional and included 11,020 employees who responded to the self-administered baseline questionnaire of the Maastricht Cohort Study. Fatigue was measured with the Checklist Individual Strength, a 20-item self-report instrument. Psychological distress was measured with the 12-item version of the General Health Questionnaire. Psychosocial work characteristics comprised: psychological demands, decision latitude, and social support at work as measured by the Job Content Questionnaire, as well as emotional demands at work, physical demands at work, job insecurity, and conflict with supervisor/co-worker, which were assessed with items from existing Dutch questionnaires. RESULTS: Low decision latitude and low social support at work were associated with fatigue in both men and women. Associations were also found between emotional demands at work, job insecurity, physical demands and conflict with supervisor and fatigue in men; and high psychological demands and fatigue in women. As regards psychological distress, there was no association with low decision latitude, but strong associations with emotional demands and conflict with supervisor in both genders. CONCLUSIONS: The study provides strong support for associations between psychosocial work characteristics and fatigue in men and women, even after adjustment for psychological distress. Moreover, it suggests some differential effects of psychosocial work characteristics on fatigue and psychological distress.     

Psychosocial work environment and cardiovascular risk factors in an occupational cohort in France

STUDY OBJECTIVE: Concordant results have been reported in several studies for the effects of job stress on cardiovascular disease, but the potential mechanisms of these effects have seldom been explored. The aim of this study was therefore to examine, in women and men, the cross sectional relations between psychosocial work variables (psychological demands, decision latitude, and social support) and cardiovascular risk factors (hypertension, hyperlipidaemia, diabetes, overweight, smoking, and alcohol consumption). PARTICIPANTS: The original cohort comprised 20,625 volunteers (men aged from 40 to 50 and women from 35 to 50) employed by the French Company Electricite De France-Gaz De France and followed up yearly since 1989. The study was restricted to the 13,226 volunteers in the cohort who were still working and answered a self administered questionnaire on psychosocial work factors in 1995. DESIGN: Data were based on replies to this questionnaire. Three psychosocial work environment exposure scores were used to assess psychological demands, decision latitude, and social support at work respectively. The main outcome measures were the prevalence of hypertension, hyperlipidaemia, and diabetes within the previous 12 months, overweight, smoking, and alcohol consumption. MAIN RESULTS: Psychosocial work factors were significantly associated with hypertension, hyperlipidaemia, overweight, smoking, and alcohol consumption, but not with diabetes. In men, low decision latitude was associated with hypertension, high decision latitude and high social support with overweight, low decision latitude with alcohol consumption. Moreover, the risk of hyperlipidaemia increased in men exposed to both high psychological demands and low social support. In women, low decision latitude was related to hyperlipidaemia, high psychological demands with overweight, high psychological demands and high decision latitude with smoking, and low social support with alcohol consumption. CONCLUSIONS: These cross sectional results underline the potential effects of psychosocial work characteristics on cardiovascular risk factors and the differences between the effects of job stress in men and women, and confirm the direct mechanisms (through physiological variables) and indirect mechanisms (through behavioural risk factors) potentially involved in the relation between psychosocial work characteristics and cardiovascular disease.

 

     

The impact of decision latitude, psychological load and social support at work on musculoskeletal symptoms

The study was based on questionnaires and the subjects consistedof 755 male and female employees in different occupations. Theaim was to explore the relationship between the combined effectsof perceived decision latitude (control), psychological loadand social support at work on work-related neck, shoulder andlow-back symptoms. Prevalence rate ratios, stratified for ageand sex, were calculated for different combinations in the 3-dimensionalmodel where the theoretically lowest strain group (i.e. lowpsychological load, high decision latitude and high social support)was used as a reference category. Persons who perceived theirpsychological work-load as high and their decision latitudeas low reported more musculoskeletal symptoms than persons withlow psychological load and high decision latitude. The additionof social support at work is a significant dimension in moderatingdecision latitude; without support from supervisors and fellowworkers it was not sufficient to reduce the impact of psychologicalload on musculoskeletal symptoms. The use of the 3-dimensionalmodel provided a good picture of what structural characteristicsof working life could constitute an increased risk for the occurrenceof musculoskeletal symptoms.     

Psychosocial job factors and the one-year evolution of back-related functional limitations

OBJECTIVES: This 1-year prospective study aimed at assessing the association between some psychosocial job characteristics and back-related functional limitations. METHODS: The participants were 849 workers who sought medical consultation for nonspecific back pain in primary care settings of the Quebec City area. Information on job decision latitude, psychological demands, and social support at work was collected during a telephone interview conducted after the medical consultation. Back-related functional limitations were measured at baseline and 1 year later with the Roland-Morris Disability Questionnaire. The analyses were stratified by gender. Social support at work and the type of back pain were considered potential effect modifiers. Several potential confounders were also considered in the multiple regression analyses that were conducted to isolate the effect of the job psychological demands and decision latitude on the 1-year level of back-related functional limitations. RESULTS: A modest difference in the 1-year Roland-Morris average scores was found only among the women and only for the association between job decision latitude with back-related functional limitations, according to the level of social support at work. This difference was of limited clinical significance. Analyses by type of back pain showed, however, a clinically significant association between the combination of high psychological demands and low decision latitude and back-related functional limitations only for subjects with persistent pain. CONCLUSIONS: Job psychological demands and decision latitude have little influence on the 1-year evolution of back-related functional limitations for one-time and recurrent back-pain problems. However, our results suggest that this association could be important for workers with persistent pain.     

Associations between positive changes in perceived work characteristics and changes in fatigue

Little is known about the natural course of fatigue among employees. An adequate understanding of its development and risk factors is important to prevent chronic health complaints and absenteeism. This longitudinal study investigated associations between positive changes in perceived work characteristics (ie, a decrease in job demands, an increase in decision latitude, and an increase in social support) and changes in fatigue by performing hierarchical regression analyses. The work characteristics of the demand-control-support model were selected as predictors. The outcome measures emotional exhaustion and psychologic distress were investigated as secondary outcomes. The results showed that, compared with a stable work situation, positive changes in perceived social support, decision latitude, and psychologic job demands went together with a decrease in fatigue. Similar results were found for the secondary outcomes emotional exhaustion and psychologic distress.     

Psychosocial work environment and mental health--a meta-analytic review

OBJECTIVES: To clarify the associations between psychosocial work stressors and mental ill health, a meta-analysis of psychosocial work stressors and common mental disorders was undertaken using longitudinal studies identified through a systematic literature review. METHODS: The review used a standardized search strategy and strict inclusion and quality criteria in seven databases in 1994-2005. Papers were identified from 24,939 citations covering social determinants of health, 50 relevant papers were identified, 38 fulfilled inclusion criteria, and 11 were suitable for a meta-analysis. The Comprehensive Meta-analysis Programme was used for decision authority, decision latitude, psychological demands, and work social support, components of the job-strain and iso-strain models, and the combination of effort and reward that makes up the effort-reward imbalance model and job insecurity. Cochran's Q statistic assessed the heterogeneity of the results, and the I2 statistic determined any inconsistency between studies. RESULTS: Job strain, low decision latitude, low social support, high psychological demands, effort-reward imbalance, and high job insecurity predicted common mental disorders despite the heterogeneity for psychological demands and social support among men. The strongest effects were found for job strain and effort-reward imbalance. CONCLUSIONS: This meta-analysis provides robust consistent evidence that (combinations of) high demands and low decision latitude and (combinations of) high efforts and low rewards are prospective risk factors for common mental disorders and suggests that the psychosocial work environment is important for mental health. The associations are not merely explained by response bias. The impact of work stressors on common mental disorders differs for women and men.     

Work Organization and Health Among Immigrant Women: Latina Manual Workers in North Carolina

Objectives. We sought to describe work organization attributes for employed immigrant Latinas and determine associations of work organization with physical health, mental health, and health-related quality of life.Methods. We conducted a cross-sectional survey with 319 employed Latinas in western North Carolina (2009–2011). Measures included job demands (heavy load, awkward posture, psychological demand), decision latitude (skill variety, job control), support (supervisor control, safety climate), musculoskeletal symptoms, mental health (depressive symptoms), and mental (MCS) and physical component score (PCS) health-related quality of life.Results. Three fifths reported musculoskeletal symptoms. Mean scores for depression, MCS, and PCS were 6.2 (SE = 0.2), 38.3 (SE = 0.5), and 42.8 (SE = 0.3), respectively. Greater job demands (heavy load, awkward posture, greater psychological demand) were associated with more musculoskeletal and depressive symptoms and worse MCS. Less decision latitude (lower skill variety, job control) was associated with more musculoskeletal and depressive symptoms. Greater support (supervisor’s power and safety climate) was associated with fewer depressive symptoms and better MCS.Conclusions. Work organization should be considered to improve occupational health of vulnerable women workers. Additional research should delineate the links between work organization and health among vulnerable workers.Immigrant and low-income workers constitute a vulnerable population that is at significant risk for occupational injury and illness. These workers often have the most demanding jobs in the most dangerous industry sectors (e.g., agriculture, construction).1-5 When they work in less hazardous sectors, such as manufacturing, they generally work in industries such as poultry and meat processing, which have substantial hazards and few protections.6-7 These manufacturing hazards include exposure to toxicants (e.g., cleaners, solvents), exposure to biological materials (e.g., feces, dander), repetitive motion injuries, slips and falls, and lacerations and amputation from sharp tools and machinery.Although addressing conventional risk factors (e.g., chemical and mechanical exposures) remains important for improving the health of immigrant and low-income workers, greater attention is being given to how work organization affects their health and safety.5,8 The National Institute for Occupational Safety and Health (NIOSH)9 defines “work organization” as the processes and organizational practices that influence job design. Work organization domains include the timing of when work is performed, such as shifts and hours worked, seasonality, and flexibility; the physical and psychological demands of work; the control or decision latitude workers have, including variation in effort and choice in performing work; and style of supervision and support, including supervisor support and control and work safety climate.10,11Work organization has most often been considered in its effects on job satisfaction and health of white-collar workers. Although work organization is believed to be particularly influential in the health and safety of vulnerable workers, little research has examined work organization and health outcomes for vulnerable populations such as immigrant workers.5,8,12 Even less research has focused on work organization among immigrant women. For example, recent analyses of work organization and health among US immigrant workers in agriculture13-15 and construction16-18 have shown that, among agricultural workers, job demands are associated with poorer physical health13; high worker control is associated with better mental health14; and poor safety climate is associated with greater musculoskeletal discomfort.15 Among construction workers, poor work safety climate is associated with poor work safety behavior.16 However, participants in these studies have been almost exclusively male.Recent analyses of work organization and health among immigrant poultry processing workers have included a substantial number of women.19-22 These analyses showed that management practices, such as poor safety commitment, and job design, such as authority, variety, psychological workload, frequent awkward posture, and repetitive movement, are associated with risk of recent musculoskeletal problems, respiratory problems, and self-reported injury or illness.19-21 In a similar way, organizational hazards, including low job control and high psychological demand, are associated with increased risk for epicondylitis, rotator cuff syndrome, and back pain.22 However, these analyses have not focused on women or on gender differences. A qualitative analysis of female immigrant household domestic workers in Spain reported that such work organization factors as job control affect health.23,24The job demand–control–support model10,11 provides a framework for examining the association of work organization and health among women immigrant manual workers. This model posits that jobs with greater physical and psychological demand or stressors will result in poorer health. However, jobs with greater control or decision latitude can result in better health and can offset the effects of demand leading to poor health. Finally, support of peers and supervisors, including perceived safety climate25 (how workers perceive supervisors’ valuing safety over production) reduces occupational injury and buffers the effects of job demands.The place of work organization in the health of immigrant women is particularly important. These women have major family, child care, and domestic responsibilities that they need to integrate into their work responsibilities.12,26 Immigrant women are also extremely vulnerable to workplace physical and sexual harassment, as they often do not speak English, do not know their rights, and may lack proper work documents.27-29This analysis had 2 goals. The first was to delineate work organization attributes of full-time employed immigrant Latinas with manual occupations. The work organization attributes included indicators of job demands, decision latitude, and support. The second goal was to determine the associations of work organization attributes with health characteristics of these women, including physical health, mental health, and health-related quality of life. We tested 3 hypotheses: (1) greater job demands will be associated with poorer physical health, mental health, and health-related quality of life; (2) greater decision latitude will be associated with better physical health, mental health, and health-related quality of life; and (3) greater job support (higher perceived supervisor control, better job safety climate) will be associated with better physical health, mental health, and health-related quality of life.     

Psychosocial factors at work and self reported health: comparative results of cross sectional and prospective analyses of the French GAZEL cohort

Background: Psychosocial factors at work have been found to be significant contributors to health, especially cardiovascular health.

Aims: To explore the relation between psychosocial factors at work and self reported health, using cross sectional and prospective analyses for a large occupational cohort of men and women.

Methods: Psychosocial factors at work were evaluated using the Karasek questionnaire, designed to measure psychological demands, decision latitude, social support, and physical demands. Self reported health was used as health outcome. Covariates included chronic diseases, and sociodemographic, occupational, and behavioural factors. The cross sectional and prospective analyses concerned respectively 11 447 and 7664 workers. Men and women were analysed separately.

Results: Cross sectional analysis revealed significant associations between psychological demands, decision latitude, social support, and physical demands, and self reported health for both men and women. Prospective analysis showed that high psychological demands for both genders, low decision authority for men, and low social support and high physical demands for women were predictive of poor self reported health. These results were independent of potential confounding variables.

Conclusions: Results highlight the predictive effects of psychosocial factors at work on self reported health in a one year follow up study. They also underline the need for longitudinal study design and separate analyses for men and women in the field of psychosocial factors at work.

     

Factors contributing to job satisfaction following rehabilitation for musculoskeletal impairments

The study investigates whether changing jobs is related to work-related well-being of people with musculoskeletal impairments. In order to assess this relationship subjects who began new jobs after rehabilitation (N=52) were compared with subjects who returned to their former employment (N=63). Work-related well-being was measured by means of the scales job satisfaction and need to recover after work. After controlling for individual characteristics (gender, age, working hours per week, and pain complaints) and job characteristics (job demands and decision latitude), job satisfaction could be predicted by job change. Recovery need after work was predicted by pain complaints, job demands, and decision latitude, but not by job change.     

Psychosocial work environment and mental health: Job-strain and effort-reward imbalance models in a context of major organizational changes

This study explored the association between the two job-stress models, job-strain and effort-reward imbalance, and mental health outcomes in a working population exposed to major organizational changes. The cross-sectional study was based on 680 subjects, 504 men and 176 women. Psychosocial factors at work included: psychological demands, decision latitude, social support, effort, reward, and overcommitment. Mental health outcomes were depressive symptoms (CES-D) and psychiatric disorders (GHQ-12). Job strain, low decision latitude, effort-reward imbalance, and low reward (especially job instability) were found to be associated with depressive symptoms and/or psychiatric disorders among men. Overcommitment at work was a risk factor for both men and women. Social support at work played a role to reduce depressive symptoms for women. These findings emphasize the deleterious effects of psychosocial work environment on mental health during major organizational changes.     

Mental health problems among university students and the impact of structural conditions

Aim

Mental health among university students represents an important and growing public health concern. International research has shown a high prevalence of depression and anxiety among university students. The aim of this study was to determine the prevalence of depression as well as anxiety among German university students and to assess gender differences and discrepancies between fields of study as well as class years. Additionally, an important public health issue—the impact of structural conditions at the university on depression and anxiety—was addressed.

Subject and methods

A Web-based survey was conducted at two German universities, employing data from 1,707 students. Anxiety and depressive disorders were assessed with the 4-item Patient Health Questionnaire (PHQ-4), and structural conditions at the universities were also determined.

Results

During the 2 weeks prior to the survey, 14.2 % of the students showed depressive and 16.3 % anxiety symptoms; symptoms of both disorders were experienced by 8.4 %. Gender differences and differences correlated with study year and field were found, but the effect size showed that these were not empirically relevant. Structural conditions, such as study demands, time latitude, social support by students, qualification potential and decision latitude, proved to be significant predictors for depression and accounted for 18 % of the total variance. Demands, time latitude and social support by students were proven to be significant predictors for anxiety, contributing to 16 % of the total variance.

Conclusions

These findings highlight the need to address mental health problems among university students and to initiate interventions. Furthermore, the findings implicate that study demands placed on students should be adjusted, and study resources, especially time latitude and social support by other students, should be promoted.

     

Psychometric properties of the French version of the Karasek Job Content Questionnaire: a study of the scales of decision latitude, psychological demands, social support, and physical demands in the GAZEL cohort

OBJECTIVES: The objective of this study was to explore the psychometric properties of the French version of the Karasek Job Content Questionnaire (JCQ) for the recommended scales of psychological demands, decision latitude, social support, and physical demands. Internal consistency, factorial validity, and convergent validity were examined in a large occupational cohort of men and women. METHODS: This study was based on the GAZEL cohort composed of workers aged 40-50 years for men and 35-50 years for women employed by the French national electric and gas company Electricité De France-Gaz De France (EDF-GDF) in 1989. This cohort has been followed up since 1989 by means of yearly self-administered questionnaires and by the collection of data provided by the company. RESULTS: The study population included the 11,447 GAZEL subjects, 8,277 men and 3,170 women, who were working and who answered the French version of the JCQ in 1997. Cronbach's alpha coefficients higher than 0.65 supported the internal consistency of the JCQ scales and subscales. The results of exploratory factor analysis were consistent with the expected dimensions. Physical demands, supervisor support, and co-worker support were clearly found. However, for decision latitude, 'repetitive work' and 'learn new things' displayed low factor loadings. For psychological demands, low factor loadings were observed for 'conflicting demands', 'wait on others', and 'no excessive work'. Confirmatory factor analysis supported the instrument construct in six latent factors: psychological demands, skill discretion, decision authority, supervisor support, co-worker support, and physical demands, although the items mentioned earlier displayed low standardized factor loadings. The associations between the JCQ scales and gender, age, educational level, occupational grade, and job satisfaction were explored using analysis of variance and chi-square test, and supported the convergent validity. CONCLUSION: Although our results of factor analysis could invite the revision of the two scales of decision latitude and psychological demands, this study provided evidence of the validity of the French version of the four JCQ scales of psychological demands, decision latitude, social support, and physical demands among a large population consisting of French working men and women.     

Job strain, social support at work, and incidence of myocardial infarction

OBJECTIVES: The combination of high psychological job demands and low decision latitude (high job strain) has been associated with an increased risk of coronary heart disease. It has been proposed that this may also be the case for low social support at work. The aim of this study was to analyse the relations between these psychosocial factors and incidence of myocardial infarction. METHODS: Associations between psychosocial work characteristics and incidence of myocardial infarction was investigated through a population based case-control study. The study base comprised employed men and women in five Swedish counties during the years 1976-84. Cases of first myocardial infarction were identified from hospital discharge registers and death records from outside hospital, controls were selected through a random sample, and psychosocial work environment was assessed through a job exposure matrix on the basis of the occupation in the 1970 and 1975 censuses. RESULTS: An increased incidence of myocardial infarction was found for men and women in occupations characterised by low decision latitude. For men this increase was seen primarily in combination with high psychological demands (high job strain) and low social support at work. Younger men (30-54 years of age) in occupations with both high job strain and low social support at work had a relative risk of 1.79 (95% confidence interval (95% CI) 1.22 to 2.65) compared with subjects in low strain and high social support jobs after controlling for age, county of residence, and socioeconomic group. CONCLUSIONS: Our results indicate that jobs characterised by low decision latitude, high job strain, or low social support at work may be associated with an increased risk of acute myocardial infarction. If these associations are causal they may be of substantial importance from the point of view of workers' health.

 

     

Can high psychological job demands,low decision latitude,and high job strain predict disability pensions? A 12-year follow-up of middle-aged Swedish workers

Objectives

The aim of this study was to investigate whether job strain, psychological demands, and decision latitude are independent determinants of disability pension rates over a 12-year follow-up period.

Methods

We studied 3,181 men and 3,359 women, all middle-aged and working at least 30 h per week, recruited from the general population of Malmö, Sweden, in 1992. The participation rate was 41 %. Baseline data include sociodemographics, the Job Content Questionnaire, lifestyle, and health-related variables. Disability pension information was obtained through record linkage from the National Health Insurance Register.

Results

Nearly 20 % of the women and 15 % of the men were granted a disability pension during the follow-up period. The highest quartile of psychological job demands and the lowest quartile of decision latitude were associated with disability pensions when controlling for age, socioeconomic position, and health risk behaviours. In the final model, with adjustment also for health indicators and stress from outside the workplace, the hazard ratios for high strain jobs (i.e. high psychological demands in combination with low decision latitude) were 1.5 in men (95 % CI, 1.04–2.0) and 1.7 in women (95 % CI, 1.3–2.2). Stratifying for health at baseline showed that high strain tended to affect healthy but not unhealthy men, while this pattern was reversed in women.

Conclusions

High psychological demands, low decision latitude, and job strain were all confirmed as independent risk factors for subsequent disability pensions. In order to increase chances of individuals remaining in the work force, interventions against these adverse psychosocial factors appear worthwhile.

     

Study of the validity of a job-exposure matrix for psychosocial work factors: results from the national French SUMER survey

Objective  To construct and evaluate the validity of a job-exposure matrix (JEM) for psychosocial work factors defined by Karasek’s model using national representative data of the French working population. Methods  National sample of 24,486 men and women who filled in the Job Content Questionnaire (JCQ) by Karasek measuring the scores of psychological demands, decision latitude, and social support (individual scores) in 2003 (response rate 96.5%). Median values of the three scores in the total sample of men and women were used to define high demands, low latitude, and low support (individual binary exposures). Job title was defined by both occupation and economic activity that were coded using detailed national classifications (PCS and NAF/NACE). Two JEM measures were calculated from the individual scores of demands, latitude and support for each job title: JEM scores (mean of the individual score) and JEM binary exposures (JEM score dichotomized at the median). Results  The analysis of the variance of the individual scores of demands, latitude, and support explained by occupations and economic activities, of the correlation and agreement between individual measures and JEM measures, and of the sensitivity and specificity of JEM exposures, as well as the study of the associations with self-reported health showed a low validity of JEM measures for psychological demands and social support, and a relatively higher validity for decision latitude compared with individual measures. Conclusion  Job-exposure matrix measure for decision latitude might be used as a complementary exposure assessment. Further research is needed to evaluate the validity of JEM for psychosocial work factors.     

The incorporation of different demand concepts in the job demand-control model: effects on health care professionals

This paper reports a study of 212 health care professionals that focuses on job characteristics as predictors of employee health. By means of covariance structure modelling (LISREL 8) we tested the interactive assumptions of the Karasek (1979) Job Demand-Control (JD-C) Model [Karasek, R.A., Jr., 1979. Job demands, job decision latitude, and mental strain: implications for job redesign. Administrative Science Quarterly, 24, 285-307.] using three different concepts of job demands (i.e. psychological job demands, physical demands and emotional demands) in combination with a more focused measure of decision latitude (i.e. job autonomy) to predict employee health (i.e. job satisfaction, job involvement, emotional exhaustion and psychosomatic health complaints). Controlling for gender and age, the results partly support the JD-C hypotheses by finding three out of twelve assumed interaction effects. More specifically, different outcome variables are predicted by different combinations of job autonomy with the three kinds of job demands, respectively. In conclusion, although we refute the central hypotheses of the JD-C model to a large extent, the current (interactive) findings are quite illuminating and will be discussed in the context of their theoretical and practical implications. Researchers as well as practitioners have to broaden their perspective on 'job demands' in health care work and need to focus on different kinds of job demands to capture the complexity of this work setting.     

Cross-cultural validity of the demand-control questionnaire: Swedish and Brazilian workers

OBJECTIVE

To evaluate the cross-cultural validity of the Demand-Control Questionnaire, comparing the original Swedish questionnaire with the Brazilian version.

METHODS

We compared data from 362 Swedish and 399 Brazilian health workers. Confirmatory and exploratory factor analyses were performed to test structural validity, using the robust weighted least squares mean and variance-adjusted (WLSMV) estimator. Construct validity, using hypotheses testing, was evaluated through the inspection of the mean score distribution of the scale dimensions according to sociodemographic and social support at work variables.

RESULTS

The confirmatory and exploratory factor analyses supported the instrument in three dimensions (for Swedish and Brazilians): psychological demands, skill discretion and decision authority. The best-fit model was achieved by including an error correlation between work fast and work intensely (psychological demands) and removing the item repetitive work (skill discretion). Hypotheses testing showed that workers with university degree had higher scores on skill discretion and decision authority and those with high levels of Social Support at Work had lower scores on psychological demands and higher scores on decision authority.

CONCLUSIONS

The results supported the equivalent dimensional structures across the two culturally different work contexts. Skill discretion and decision authority formed two distinct dimensions and the item repetitive work should be removed.     

Effectiveness of a participative intervention on psychosocial work factors to prevent mental health problems in a hospital setting

Objectives

To assess the effectiveness of a workplace intervention aimed at reducing adverse psychosocial work factors (psychological demands, decision latitude, social support, and effort‐reward imbalance) and mental health problems among care providers.

Methods

A quasi‐experimental design with a control group was used. Pre‐intervention (71% response rate), and one‐year post‐intervention measures (69% response rate) were collected by telephone interviews.

Results

One year after the intervention, there was a reduction of several adverse psychosocial factors in the experimental group, whereas no such reduction was found in the control group. However, there was a significant deterioration of decision latitude and social support from supervisors in both experimental and control groups. There was also a significant reduction in sleeping problems and work related burnout in the experimental hospital, whereas only sleeping problems decreased in the control group while both client related and personal burnout increased in this hospital. The comparison between the experimental and control groups, after adjusting for pre‐intervention measures, showed a significant difference in the means of all psychosocial factors except decision latitude. All other factors were better in the experimental group.

Conclusion

Results suggest positive effects of the intervention, even though only 12 months have passed since the beginning of the intervention. Follow up at 36 months is necessary to evaluate whether observed effects are maintained over time. In light of these results, we believe that continuing the participative process in the experimental hospital will foster the achievement of a more important reduction of adverse psychosocial factors at work. It is expected that the intensity of the intervention will be directly related to its beneficial effects. Long term effects will however depend on the willingness of management and of staff to appropriate the process of identifying what contributes to adverse psychosocial factors at work and to adopt means to reduce them.