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1.
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.  相似文献   

2.
Objectives To test the validity and reliability of selected scales, namely, decision latitude, psychological job demand, social support, job insecurity, and macro-level decision latitude from the Korean version of the job content questionnaire (K-JCQ), as part of a psychosocial epidemiological study among university hospital workers. Methods K-JCQ was developed by translation and back translation complying with the JCQ usage policy, and its psychometric properties were explored among 338 workers (290 females and 48 males) in a university hospital in Korea. Internal consistency was examined using Cronbach’s alpha correlation coefficients. Factorial validity was tested using exploratory factor analysis. Pearson’s correlation coefficients were used for test–retest reliability among a subset of 157 workers who responded to a repeat survey. Criterion-related validity was assessed by investigating the effects of the scales on job satisfaction and self-identity through work in multiple regression models. Results Cronbach’s alpha for all selected scales was higher than 0.6, except for job insecurity (0.53) and macro-level decision authority (0.52), indicating appropriate internal consistency. Correlation coefficients between test and retest scales of decision latitude, psychological job demand, and social support were 0.60, 0.41, and 0.35, respectively. Exploratory factor analysis found three- and four-factor models, i.e., with and without macro-level decision latitude, respectively, closely corresponding to the theoretical constructs. High levels of decision latitude and social support, and low levels of psychological job demand and job insecurity were significantly associated with high level of job satisfaction. Higher self-identity through work was positively related to decision latitude and social support. Conclusions These findings suggest that K-JCQ is valid and reliable for assessing psychosocial job stress among Korean workers. Macro-level decision latitude showed a separate factorial structure and was strongly associated with task-level decision latitude.  相似文献   

3.
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.  相似文献   

4.
OBJECTIVE: The aim of this study was to determine the reliability and construct validity of the three dimensions of the Job Content Questionnaire (JCQ): demand, control and job support among hospital nursing staff. METHODS: The minimun reduced version of the JCQ was used, which include three dimensions: psychological demands (9 items), job control (9 items) and job support (11 items). Validity was assessed in a random sample of 330 nursing staff from two general hospitals in the province of Alicante (Spain). The reliability of the questionnaire was evaluated after re-interviewing a subsample of 50 nurses 15 days after the first interview. Construct validity was evaluated by calculating correlations between the three dimensions of the JCQ obtained after factorial analysis with the burnout scale and six dimensions of the 36-item short-form health survey (SF-36) questionnaire. RESULTS: Factorial analysis revealed that the version of the JCQ validated in this study had the same factorial structure as the original questionnaire. The intraclass correlation between the first and second interview was high for each of the three dimensions (between 0.83 and 0.87). Cronbach's alpha was also high (between 0.74 and 0.88). A moderate but significant correlation was found between the three JCQ dimensions and the burnout scale: (-0,27 for job support, 0.31 for psychological demands and -0.12 for job control). A moderate correlation was also found for some SF-36 dimensions. CONCLUSION: The factorial structure of the JCQ was similar to that proposed by the author in the context of Spanish culture. The reliability and internal consistency of each of the three dimensions was high while construct validity was moderate.  相似文献   

5.

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.  相似文献   

6.
AIM: This paper examined the psychometric properties of the Swedish Demand-Control-Support Questionnaire (DCSQ), which is a shorter and modified version of Karasek's Job Content Questionnaire (JCQ). METHODS: The study encompassed 5,227 workers born in 1953-57 from the population-based Hordaland Health Study. DCSQ, a 17-item questionnaire, covers psychological demands, decision latitude, and social support in the workplace. The workers were manually classified according to the Standard Classification of Occupations. The main statistical methods were principal component analyses, and estimation of internal consistency and the subscales' shared variance by Cronbach's coefficient a and Pearson's correlation coefficients, respectively. RESULTS: The study gave support to the tri-dimensional factor structure of DCSQ. Decision latitude tended to split into skill discretion and decision authority in skill-level homogeneous samples. The specificity of the item loadings was satisfactory except for "conflicting demands". The inter-correlation of the three main subscales was weak. The internal consistency of the subscales was generally satisfactory. CONCLUSIONS: The psychometric properties of DCSQ are satisfactory. Being shorter and easier to use than the more comprehensive JCQ, DCSQ represents an important alternative, particularly if respondent burden and data-collection costs need to be minimized.  相似文献   

7.
目的了解高星级酒店员工工作压力现状,以便为采取有效措施降低或消除酒店员工工作压力提供科学依据。方法用中文版工作内容量表(JCQ),对大连市高星级酒店员工145人进行问卷调查,应用SPSS11.0统计软件建立数据库,采用日本工作压力判定图测量方法得出数据。结果工作内容问卷分析结果表明,高星级酒店男女员工的工作量分别为32.02和32.12;工作自主程度分别为60.48和60.47;上司支持分别为11.40和11.43;同事支持分别为11.317和11.324。男性员工在“工作量-工作自主程度”上的健康风险度为122,女性员工的健康风险度为98。结论大连市高星级酒店的工作压力对男性员工健康影响较大。  相似文献   

8.
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.  相似文献   

9.
Psychosocial work environment and mental health--a meta-analytic review   总被引:1,自引:0,他引:1  
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.  相似文献   

10.
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.

 

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11.
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.  相似文献   

12.
[目的]探讨人们不同行为方式、应对方式对职业紧张的影响.[方法]用工作内容问卷(JCQ)、A型行为量表和应对方式问卷对431名在职乘警和乘务员进行调查与测试.[结果]男性工作要求评分高于女性.不同文化程度组间工作自主程度及工作要求评分不同.文化程度高者,工作自主与工作要求评分均高.具有A型行为的职业人群中,对工作主要表现为高要求/高自主的紧张型;具有B型行为者则主要表现为低要求/低自主型;对事业有抱负者工作要求与工作自主评分高,具有泛A行为以及行为特征高者,工作自主与社会支持的评分也高;积极应对评分高者,工作自主及社会支持的评分均高于积极应对评分低者;行为特征与应对方式对工作自主及社会支持的评分,有负交互作用.[结论]不同行为方式和应对方式,对个体感受到的职业紧张程度有一定影响.  相似文献   

13.
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.

 

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14.
This paper explores the associations, for working women and men, of high strain jobs with self-rated health in the 1994/95 Canadian National Population Health Survey (NPHS). NPHS data were obtained on men (n = 4230) and women (n = 4043), aged 18-64 who answered an abbreviated version oF the job content questionnaire (JCQ). Using the upper and lower tertiles of psychological demands and decision latitude as cut points we classified workers into high strain and other jobs. Self-rated health was the outcome. We used polytomous logistic regression analyses and controlled for potential personal and home confounders; two risk parameters were estimated: for the odds of reporting poor/fair and good health both vs. very good/excellent health. High strain work was reported by 11% of women and 9% of men. After adjusting for potential confounders, high job strain was consistently associated with worse self-rated health in both models for each gender.  相似文献   

15.
Psychosocial risk factors have been considered as characteristics of the work environment rather than an individual issue, but their presence in the workplace is usually measured by self-reported questionnaires, based on worker attitudes. The objective of the study was to compare a self-reported measure of psychological job demands in a bus driver sample with selected indicators of bus company activity, as external 'objective' indicators, in order to assess its external validity. The final sample included 713 drivers in 41 routes. Self-reported measures of psychosocial work risk factors were obtained by the Job Content Questionnaire (JCQ). Four external indicators were available for each route: passengers, break times, bus incidents, and regulating actions. Spearman's correlation coefficient was estimated to assess the validity. Correlation coefficients showed that self-reported psychological demands were statistically significant correlated (p<0.05) with two external indicators: bus incidents (rho=0.397), and regulating actions (rho=0.475). Self-reported psychosocial risk factors have been compared with independent external indicators of the psychosocial work environment, trying to avoid any subject's perception. According to our results, psychological demands measured by the JCQ seem to reflect the actual psychosocial work environment. Other studies are necessary to confirm these results and to assess job control and job social support. This would be another step in improving our knowledge of the quality of measurement of psychosocial risk factors.  相似文献   

16.
BACKGROUND: The job characteristics scale of job strain, which combines high job demands and low decision latitude based on Karasek's model, has been applied to studies on health care and cardiovascular disease. However, little is known about the long-term stability of this scale with exposure of workers to job. We investigated the 5-year intraindividual variation in job characteristics scores among healthy community workers. METHODS: Subjects of the study were 458 community dwelling persons forming part of the Jichi Medical School Cohort Study at Yamato (currently, Minami-Uonuma city), Niigata prefecture. The Japanese version of the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (WHO-MONICA) Psychosocial Study Questionnaire was implemented twice (from 1992 through 1995, and in 1999) to measure job demands and decision latitude levels. Intraclass correlation coefficients were computed to evaluate stability of scores of the questionnaire. RESULTS: Intraclass correlation coefficient of the decision latitude scores was 0.629 (95% confidence interval: 0.564-0.686) and that of the job demands scores was 0.551 (0.476-0.617). Subgroup analyses by age, sex, education level, years since first employment, number of co-workers, and job category and status at baseline revealed similar results. In contrast, subjects who experienced position changes within the same enterprise or changed jobs showed lower correlation coefficients of both decision latitude and job demands scores compared to those who experienced no change in job contents. CONCLUSION: The Japanese version of the WHO-MONICA Psychosocial Study Questionnaire showed statistically significant long-term stability and could be to some extent responsive to change in job strain levels.  相似文献   

17.
A study was designed to test the association between job demandsand job decision latitude and coronary heart disease (CHD) riskand psychological strain among working men and women in theFRG. The data are from the 1984 FRG national health survey.The sample used for this research was composed of 795 persons:476 working men and 319 working women. Following the work ofKarasek, the results indicate that psychological strain wasrelated to high job demands and low job decision latitude. However,an association between CHD risk and high job demands and lowjob decision latitude was not supported by the findings. Correlationalanalyses revealed moderate correlations between psychologicalstrain and CHD risk. Multiple regression analyses indicatedthat low decision latitude may be a stressor that grows moresevere in the presence of high job demands in terms of negativehealth outcomes. Significant differences between men and womenwere also found.  相似文献   

18.
This study investigated the cross-sectional association of job demands (i.e., psychological demands) and job resources (i.e., decision latitude, supervisor support, co-worker support, and extrinsic reward) with job performance. A total of 1,198 workers (458 males and 740 females) from a manufacturing company in Japan completed a self-administered questionnaire that included the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire, World Health Organization Health and Work Performance Questionnaire, and demographic survey. Hierarchical multiple regression analyses were conducted. After adjusting for demographic characteristics, decision latitude (β=0.107, p=0.001) and extrinsic reward (β=0.158, p<0.001) were positively and significantly associated with job performance while supervisor support (β=−0.102, p=0.002) was negatively and significantly associated with job performance. On the other hand, psychological demands or co-worker support was not significantly associated with job performance. These findings suggest that higher decision latitude and extrinsic reward enhance job performance among Japanese employees.  相似文献   

19.
职业紧张对心理健康的影响   总被引:13,自引:2,他引:11  
目的探讨工作需求和工作控制水平对心理健康的影响以及工作需求与控制间的交互作用效应.方法采用修订的工作需求-控制量表和职业紧张反应测量工具对93名男性铁路货运编组站调度员进行测试,应用单应变量多因素方差分析、非参数统计方法--Kruskal-Wallis H法和Modian法、逐步回归分析对数据进行统计分析.结果非参数统计结果表明,决定自由度各组间心理卫生评分差异有显著性(平均秩次55.57,47.95,48.42,33.50,P<0.05),工作时间需求各组间心理卫生评分(37.45,40.01,58.35)、抑郁症评分(36.45,42.25,53.61)、每日紧张感评分(33.00,44.96,56.12)、工作满意感评分(53.18,46.91,32.43)的差异均有显著性(P<0.05).方差分析结果表明,工作时间需求和决定自由度对身心抱怨(R2=0.24)、焦虑症(R2=0.26)和白天疲劳(R2=0.28)三个应变量存在着有明显意义的交互作用(P<0.05).逐步回归分析表明,工作时间需求和工作负荷需求对应变量的决定系数(R2)大多大于0.05,且工作时间需求的决定系数(R2)大于工作负荷需求.工作时间需求和决定自由度的乘积变量进入了身心抱怨、焦虑和白天疲劳评分的预测方程,且乘积变量的决定系数(R2)几乎均在0.05以上.结论工作时间需求和决定自由度对部分心理性紧张反应存在着明显的影响,时间需求越大,心理性紧张反应越大,工作时间需求的作用大于决定自由度,二者对部分紧张反应结局变量有交互作用效应.  相似文献   

20.
Poor working conditions may be an important source of stress and may therefore contribute to the development of depressive and anxiety disorders. Social support may act as a buffer and protect against the development of depression or anxiety in the face of poor working conditions. With longitudinal data from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), the effect of working conditions and social support on the incidence of depressive and anxiety disorders was examined among 2646 working men and women, aged 18 through 65 years. Three dimensions of self reported working conditions were assessed: psychological demands, decision latitude and job security. Social support was assessed through validated scales for daily emotional support. About 10.5% of working women and 4.6% among working men developed an incident depressive and/or anxiety disorder over 2 years. Psychological demands predicted the incidence of depressive and anxiety disorders in both men and women (RR per score increase=2.29, 95% CI: 1.44-3.63), whereas decision latitude and job security did not. Social support protected against the incidence of depressive and anxiety disorders. This effect was stronger for men compared to women. Social support did not buffer the unfavorable mental effect of working conditions. Women were more likely to report low levels of decision latitude, whereas men reported higher psychological demands. Working conditions did not explain sex differences in the incidence of depressive and anxiety disorders.  相似文献   

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