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Oral Session 5 – Stress

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J. S. C. Shiao1, Y. Tseng2, M. J. Yang3, Y. Cheng4, Y. L. Guo2.1Department of Nursing, Chung Hwa College of Medical Technology, Tainan, Taiwan; 2Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Department of Psychiatry, Kaohsiung Medical University, Kaohsiung, Taiwan; 4Department of Health Policy and Management, National Taiwan University, Taipei, Taiwan

Introduction: Job stress in nurses is known to be caused by heavy workload, shift work, emergencies, needlestick injuries, and infectious disease. A significant relationship has been found between job stress and depression, frustration, job dissatisfaction, and burnout in nurses.

Objective: To assess the association between job stress and nurses’ subjective perception of mental health.

Methods: Nurses working in five psychiatric hospitals and four general hospitals in Taiwan were recruited for a questionnaire survey. The job stress questionnaire was based on the conceptual framework of job stress model, Karasek’s demand–control model (JCQ), Siegrist’s effort–reward imbalance (ERI) model, and additional items including assault and shift work. The Taiwan Depression Questionnaire (TDQ) was also included.

Results: A total of 1030 questionnaires were completed (77% response rate). Among the nurses in the psychiatric institutions, 14.8% were in the effort–reward imbalance group and 16.7% had depressive syndrome. Shift working was associated with poorer mental health. Among the nurses in the general hospitals, 21.8% were in the effort–reward imbalance group and 24.0% had depressive syndrome. Shorter tenure and shift working were associated with effort–reward imbalance. In both types of hospitals, depressive syndrome was found more in the younger age, effort–reward imbalance, and high demand–low control groups.

Conclusion: Among nurses in psychiatric institutions and general hospitals, depression syndrome was rather common, and was associated with young age, effort–reward imbalance, and high demand–low control job content.


S. Radi1, T. Lang1, V. Lauwers-Cancès1, E. Diène1, G. Chatellier2, R. De Gaudemaris3.1Unité INSERM 558, Toulouse, France; 2Département d’Informatique Hospitalière, Hôpital G Pompidou, Paris, France; 3Service de Médecine et Santé au Travail, CHU, Grenoble, France

Introduction: The aim of our study was to examine the relationship between organisational risk factors (job strain, and passive and active jobs), social support at work, and the incidence of arterial hypertension in a working population.

Methods: A case–control study was nested in a cohort study. The 20 participating worksite physicians enrolled each of the incident hypertensive subjects (normotensive at baseline and hypertensive at 1 year follow up). Each case was matched for age and sex with two normotensive subjects attending the follow up screening immediately after the case. As a result, 203 cases and 406 controls were included (426 men and 183 women). The self administered Karasek questionnaire was used to measure job constraints. Subjects completed a self administered questionnaire on modifications of working organisation in the past years (restructuring, relocation, subcontracting, and downsizing).

Results: Relationships between organisational risk factors were stronger in women than in men. Odds ratios were 3.5 (95 % confidence interval 1.0 to 12.7) in women and 1.8 (0.8 to 3.9) in men for subjects exposed to a high psychological demand together with a low decision latitude (job strain); 4.0 (1.1 to 14.3) in women and 1.7 (0.8 to 3.7) in men for subjects exposed to a low decision latitude but having a low psychological demand (passive jobs); and 3.9 (1.1 to 13.9) in women and 1.4 (0.7 to 2.9) in men for subjects exposed to a high psychological demand but having a high decision latitude (active jobs). In both sexes, low social support at work was not related to hypertension and no interaction with organisational risk factors was observed. Previous organisational changes were not associated with hypertension.

Conclusions: A relationship between blood pressure levels and job constraints was observed, which was stronger in women than in men. Further research is needed to understand the direct and indirect mechanisms linking psychosocial factors at work and hypertension, as well as this difference between men and women at work.


J. Wieclaw1, E. Agerbo2, P. B. Mortensen2, J. P. Bonde1.1Aarhus University Hospital Dep. of Occupational Medicine, Denmark; 2Aarhus University National Centre for Register-based Research, Denmark

Introduction: Little is known about the role that occupation plays in developing depression and stress, and there are only a few epidemiological studies. There is evidence of gender differences in prevalence of mental disorders and there is still a gender segregated labour market.

Objective: To investigate the risk of depression and stress across occupations and to describe gender difference in the risk pattern.

Method: A population based nested case–control study was based on register data from The Danish Psychiatric Central Research Register and Statistics Denmark’s Integrated Database for Labour Market Research. A cohort of hospital inpatients and outpatients treated for depression (ICD10, F30–39) or stress related conditions (ICD10, F40–48) on a psychiatric ward during the period 1995 to 1998 (n =  28 971), was matched for age, date of birth, and sex with five controls each (n = 144 855, age 18–65 years) drawn from a 5% sample of the Danish population. The occupation held for 1 year before treatment was classified according to the two digit level of a Danish version of ISCO-88 (DISCO-88). Conditional logistic regression was used to compute the relative risks with 95% confidence interval, adjusted for socioeconomic factors.

Results: Among 27 occupations on the DISCO-88 two digit level, eight occupations among women and one among men had significantly elevated risk of depression and stress related conditions (relative risk (RR) range for women 1.20 to 1.58) compared to a reference group of clerical staff. In contrast, the risks were reduced in eight occupations in men (RR range 0.50 to 0.76) and only in one occupation in women. We found the highest risk in teaching (RR 1.58) and the health professions (RR 1.53). Only professionals caring for mentally and physically disabled had elevated risks in both women (RR 1.72; 95% confidence interval (CI) 1.38 to 2.16) and men (RR 2.09; 95% CI 1.38 to 3.15). Being unemployed or out of the labour market was also a significant risk factor in both sexes.

Conclusion: The risk of developing depression or stress disorder is related to occupation and there are gender differences in the risk pattern.


W. H. Chow1, B. T. Ji1, X. O. Shu2, M. Dosemeci1, G. Yang2, J. Coble1, M. Hauptmann1, J. Lubin1, N. Rothman1, W. Zheng2, A. Blair1, Y. T. Gao3.1National Cancer Institute, Bethesda, Maryland, U.S.A.; 2Vanderbilt University, Nashville, Tennessee, U.S.A.; 3Shanghai Cancer Institute, Shanghai, China

Introduction: Hypertension is an insidious condition that may predispose to coronary heart disease, stroke, and certain cancers. Occupational risk factors for hypertension have been suggested, but data are limited. We examined the relationships between occupation and hypertension in the Shanghai Women’s Health Study (SWHS).

Methods: The SWHS is a population based cohort study that enrolled 75 044 female residents of Shanghai, China, aged 40–70 years during 1997–2000. Prevalent cases (n = 17 840) were identified from self reports of physician diagnosed hypertension at baseline and measurements of blood pressure at 2 year follow up. Equal numbers of controls were frequency matched to cases by year of birth and age at diagnosis. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regressions, adjusted for education, income, body mass index, tobacco exposures, and other potential confounders.

Results: Preliminary analyses showed significant overall positive associations between hypertension and ever employed as teaching personnel, particularly nursery school (OR 1.2; 95% CI 1.02 to 1.5) and middle school teachers (OR 1.1; 95% CI 1.01 to 1.2), and as production/transportation related workers, including packaging/baling (OR 1.1; 95% CI 0.97 to 1.2) and warehouse workers (OR 1.1; 95% CI 1.00 to 1.2). Borderline significant positive associations also were observed with painters and service personnel, particularly nursery care workers, as well as several production jobs, including leather/fur, food/beverage, and tobacco. Many of these occupations showed increased risks with duration of employment and years since job began. There were no apparent trends in risks with estimated sitting time or energy expenditure on the job. Analyses of specific chemical exposures using job exposure matrices are underway. Analyses of work related stress are planned.

Conclusions: Occupation may be related to hypertension through work related stress and exposures to certain industrial agents, such as lead.

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