Occupational Class and Exposure to Job Stressors among Employed Men and Women in Japan

Protection of gender health and fight against gender violence during the COVID-19 pandemic: the experience of our street clinic in a disadvantaged suburb of Rome Metropolitan City

OBJECT

In this study, we evaluated health, social inequalities and risk to gender violence of women living in a disadvantaged degraded suburb of Rome Metropolitan City, during COVID-19 pandemic.

METHODS

The study included 779 women referring to primary care services of Medicina Solidale Institute for gynecological/breast examinations (209), medical and support aid for the children (383) and COVID-19 test execution (187).

RESULTS

The data show that most women (68%) were unemployed or had an irregular job. The request of support varied depending on the ethnicity: while healthcare support was requested mostly by African female community, the COVID-19 test, mandatory for public transportation and work, was a need of the east-european community. Both these communities referred to Medical Solidale primary care service for the healthcare and food/clothing support for their children. It is interesting to note that the requests from the Italian women community was elevated in terms of personal healthcare, support for the children and COVID-19 test execution. The access to the national health system (NHS) resulted a complex administrative procedure despite the original social-ethnic communities. The vast majority of women lacked awareness of their crucial role for supporting the family entity, while inadequacy was commonly reported.

CONCLUSIONS

This study confirms a critical condition for women living in disadvantaged neighborhoods, whose vulnerability is further worsened by the limited access to primary care assistance with serious consequences for health and quality of life. Prevention and treatment, especially for the most vulnerable subjects, should be a priority for the public health system.

Who Gains Mental Health Benefits from Work Autonomy? The Roles of Gender and Occupational Class

In recent years, improving work autonomy as an important priority in the UK labour market has been shown to enhance employee mental health and well-being. However, previous theories and empirical studies have paid little attention to the intersectional inequalities in the mental health benefits of work autonomy, preventing us from gaining a comprehensive understanding of the mental consequences of work autonomy. By integrating literature from occupational psychology, gender and social class, this study develops theoretical hypotheses regarding whether and how the mental health benefits of work autonomy vary alongside the intersectional axes of gender and occupational class and tests these hypotheses using long-term panel data in the UK (2010-2021). Overall, we find that those from higher occupational class and male employees acquire significantly more mental health benefits from high work autonomy compared with those from lower occupational class and female employees. Moreover, further analyses show significant intersectional inequalities of gender and occupational class. While male employees from all occupational classes gain significant mental health benefits from work autonomy, only female employees from higher (but not lower) occupational classes benefit from work autonomy. These findings contribute to the literature in the sociology of work by demonstrating the intersectional inequalities in mental health consequences of work autonomy, especially for women in the lower occupational class, highlighting the need for a more gender- and occupation-sensitive design in future labour market policies.

The quantity and quality of scientific evidence about the health of working women in occupational health of Japan: A scoping review

OBJECTIVE

We aim to investigate the quantity and quality of scientific evidence dealing with comprehensive health issues of working women in occupational health.

METHODS

This scoping review of original articles that investigated comprehensive health issues of working women aged 19-64 years in Japan was published in PubMed (1967-2022) and Igaku Chuo Zasshi (or Ichu-shi, 1982-2022). Using identical broad search terms, we first identified 17 122 English and 6154 Japanese articles. We excluded those with clinically relevant topics, or ethnicity other than Japanese and included 853 English and 855 Japanese articles for review and classified them into nine research areas considered to be critical factors for women in the workforce and five study design groups to investigate the quality of the evidence accumulated.

RESULTS

Among 853 English-language articles in PubMed, "Mental health" was the most frequent area studied, followed by "Work-related disease" and "Lifestyle-related disease." Among 855 Japanese-language articles from Ichu-shi, "Mental health" was the most frequently studied area followed by "Work and balance," and "Work-related disease." "Infertility, pregnancy, and childbirth" and "Menstruation, menopause, and genital disease" were well studied in Ichu-shi but scarcely published in PubMed. "Harassment and discrimination" were sparsely reported in both databases. As for research designs, many articles in both PubMed and Ichu-shi employed descriptive or cross-sectional study designs. However, a few studies employed cohort/longitudinal or interventional studies.

CONCLUSION

The results underscored the need for higher-quality study designs with more scientific evidence on working women's health in the field of occupational health.

The Association Between Fathers' Self-assessment of Their Own Parenting and Mothers' Recognition of Paternal Support: A Municipal-Based Cross-Sectional Study

Background

Discrepancies between parents’ reports of paternal parenting have been gaining attention, but epidemiological evidence is scarce in Asia. This study aimed to clarify agreement/discrepancy between paternal and maternal recognition of paternal parenting and the association between actual paternal parenting time and background factors.

Methods

Data from couples whose children attended 4-month child health check-ups in Fukushima City were analyzed (N = 509). Based on paternal recognition of paternal parenting (PRPP) and maternal recognition of paternal support (MRPS), couples were classified into four groups. Each group’s paternal household work and parenting time were analyzed. Univariable and multivariable analysis were performed to investigate the association between agreement/discrepancy and background factors of children and parents.

Results

Frequency of positive agreement (PRPP+ and MRPS+) was 83.9%, whereas negative agreement (PRPP− and MRPS−) was 2.6%. As for discrepancy, PRPP+ and MRPS− was 8.4% and PRPP− and MRPS+ was 5.1%. Fathers’ total median parenting time was 2 (weekdays) and 6 (weekends) hours, and showed significant differences among the four groups. Multivariable analysis revealed that compared to positive agreement, maternal mental health condition and pregnancy intention were significantly associated with the discrepancy PRPP+ and MRPS−, paternal mental health condition and marital satisfaction with the discrepancy PRPP− and MRPS+, and maternal mental health condition with negative agreement.

Conclusions

We identified differences in parenting time and mental health characteristics among couples depending on agreement/discrepancy in recognition of paternal parenting. Assessing both parents’ profiles is necessary in clinical practice to promote paternal participation in childcare.

A cross-sectional study of the association between effort-reward imbalance and psychologic distress among Japanese dietitians

OBJECTIVES

This study aims to clarify dietitians' effort-reward imbalance (ERI) and examine its association with psychologic distress.

METHODS

A cross-sectional survey was conducted. A total of 3593 questionnaires were distributed to dietitians in about 110 organizations and 1890 responses were received (response rate 52.6%). Hence, a total of 1743 valid questionnaires were used in the analysis. Effort-reward (ER) ratio was measured by a subscale of the ERI Questionnaire, and psychologic distress was measured by the Kessler Psychological Distress Scale (K6). The association between the ER ratio and psychologic distress was analyzed by multiple logistic regression analysis with covariates.

RESULTS

The mean ER ratio was 0.83 (SD = 0.53) and ERI (ER ratio >1) prevalence was 26.3%. The mean K6 score was 7.1 (5.3), and psychologic distress (K6 score ≥5) prevalence was 62.4%. The increased psychologic distress was associated with a higher ER ratio, less support from supervisors and coworkers, and lower age and household income. ERI was significantly associated with psychologic distress, even after being adjusted for covariates.

CONCLUSIONS

Dietitians experience high stress, as shown by their high ER ratio and K6 scores. Their ERI was greatly associated with psychologic distress.

Father-child bonding among Japanese fathers of infants: A municipal-based study at the time of the 4-month child health checkup

We aimed to clarify the factor structure of a bonding measure among Japanese fathers with infants and the factors associated with the subscales. Among fathers of children attending the 4-month health checkup, the Japanese version of the Mother-to-Infant Bonding Scale had a two-factor structure comprising "anger" and "lack of affection." Anger was associated with fathers' work demands and poor mental condition, and lack of affection with fathers' older age, poor mental condition, and interpersonal problems at home. Paternal parenting support needs to account for not only the fathers themselves, but also interpersonal communication at home and in the work environment.

Health and Social Inequalities in Women Living in Disadvantaged Conditions: A Focus on Gynecologic and Obstetric Health and Intimate Partner Violence

Purpose: Gynecologic and obstetric health and intimate partner violence are particularly influenced by social determinants of health, such as poverty, low education, and poor nutritional status, and by ethnic and racial factors. In this study, we evaluated health and social inequalities of women living in disadvantaged neighborhoods in the city of Rome, Italy.

Methods: The study included 128 women living in socioeconomically disadvantaged neighborhoods. For each woman, a medical record was compiled and a gynecologic examination with screening for cervical cancer was performed. Family network, risk factors for gender-based violence, and psychological abuse were also evaluated.

Results: The largest part of the sample, although had adequate schooling, was unemployed or had a low-status job; this was at the basis of intimate partner violence in about one-third of our sample. Nearly 35% of our sample was composed of pregnant women; about half of them were not assisted by the public health system for routine obstetric examinations. Common findings at gynecologic examination for nonpregnant women were infections (n=18, 19.9%), pregnancy planning (n=13, 13.7%), menopause management (n=12, 12.6%), ovarian fibromas (n=6, 6.3%), and post-partum assistance (n=3, 3.2%). Screening for cervical cancer was executed in 62 women; 9 (14.5%) had low- or high-grade squamous intraepithelial lesion or cervical carcinoma.

Conclusions: Health and social inequalities are frequent in women living in disadvantaged conditions, with serious consequences for health and quality of life of women and of their children. Prevention and treatment, especially for the most vulnerable subjects, should be a priority for the public health system.

The influence of operating room nurses' job stress on burnout and organizational commitment: The moderating effect of over-commitment

AIMS

To determine job stress among Chinese operating room nurses, test the mediating effect of burnout and verify the moderating effect of over-commitment between job stress and mental health.

DESIGN

A descriptive, cross-sectional study.

METHODS

A multistage sampling method was adopted. First, a random sampling method was used to select 30 tertiary hospitals in Beijing, after which 509 operating room nurses were selected by convenience sampling from March-June 2017. Self-administered questionnaires were used to evaluate job stress, burnout, and organizational commitment among participants. Multiple-group path analysis was used to test the mediating effect and the moderating effect.

RESULTS

Of all nurses, 70.3% were in a state of job stress, which had negative effects on organizational commitment mediated by emotional exhaustion and depersonalization. The result of multiple-group path analysis showed that the path coefficients are different between the low and high groups of over-commitment. When facing job stress, operating room nurses with low over-commitment were more likely to have emotional exhaustion (β = 0.750 vs. 0.602), while those with high over-commitment were more likely to have low organizational commitment (β = -0.641 vs. -0.594).

CONCLUSION

The job stress of operating room nurses in China was high. Burnout played a mediating role between job stress and organizational commitment. Over-commitment played a moderating role in the relationship among job stress, burnout, and organizational commitment.

IMPACT

This study analysed the relationship among operating room nurses' job stress, burnout, and organizational commitment. The findings provided confirmatory support on the mediated effect of burnout between job stress and organizational commitment and the moderation effect of over-commitment. Different measures are needed to reduce job stress, as for easing burnout and improving organizational commitment among different groups of nurses.

Psychological distress and associated factors among Japanese nursery school and kindergarten teachers: a cross-sectional study

The understaffing of nursery schools and kindergartens and the increasing workload of childcare workers are becoming significant issues in Japan. In this study, a cross-sectional survey was conducted to investigate the stress experienced by childcare workers and its antecedents. We distributed 2,640 questionnaires to childcare workers in Miyagi prefecture, obtaining a response rate of 51.9% (n=1,370). Finally, 1,210 valid questionnaires were used in the analysis. As a stress indicator, psychological distress was measured with the Kessler Screening Scale for Psychological Distress (K6). The mean K6 score was 7.0 (SD=5.4), and the prevalence of psychological distress (K6 score ≥5) was 60.0%. Considering work-related factors, the mean scores were as follows: supervisor support 11.8 (2.6), coworker support 12.1 (2.0), work engagement 3.2 (1.2), and effort-reward ratio 0.93 (0.53). A multivariate logistic regression analysis with adjustment for possible confounders revealed that increased psychological distress was associated with higher effort-reward ratio, lower support from supervisors and coworkers, lower work engagement, and insufficient sleep. These results suggest that elevated psychological distress is strongly associated with effort-reward imbalance, while high work engagement in childcare workers helped to reduce their distress.

Effects of a work-related stress model based mental health promotion program on job stress, stress reactions and coping profiles of women workers: a control groups study

BACKGROUND

Work-related stress and its detrimental effects on human health have rapidly increased during the past several years. It causes many different stress reactions, related diseases and unhealthy behavior among workers, but especially women workers. Thus, the aim of this study was to examine the effects of the work-related stress model based Workplace Mental Health Promotion Programme on the job stress, social support, reactions, salivary immunoglobulin A and Cortisol levels, work absenteeism, job performance and coping profiles of women workers.

METHODS

This study had a "pre-test post-test non-equivalent control groups" design and included 70 women workers (35 in each study group) selected by randomized sampling from two factories. The programme was delivered as an intervention including 12 weeks of follow-up. Reminder messages, videos, and WhatsApp texts were used at the follow-up stage. The research measurements were; the assessment form, the Brief Job Stress Questionnaire, the Brief Coping Profile Scale, salivary ELISA kits, and a self-reported check-list.

RESULTS

There were no differences in sociodemographic characteristics, general health or working conditions between the Intervention and control groups(p > .05). Three months after the intervention, there was a significant decrease in job stress(p ≤ .001), physical and mental reactions' scores(p ≤ .001) and work absenteeism(p < .05), and there was an increase in job performance(p < .05), social support(p ≤ .001) among the intervention group. The programme showed positive effects on coping profiles(p < .05). After the intervention salivary-cortisol and IgA levels showed a statistically significant decrease(p < .05). A majority of effect sizes were very large (ηp2 > .14).

CONCLUSIONS

Work-ProMentH was found to be effective and useful in job stress management and promotion of effective coping profiles. It enables its users to holistically assess worker stress and to plan and examine intervention programmes via a systematic approach. There is a need for more empirical studies that may support the data of the present study, but it is thought that the intervention can be maintained for the long-term. We recommend that occupational health professionals at workplaces should consider using this model-based cost-effective intervention, which seems easy and practical to apply in real-life situations.

TRIAL REGISTRATION

ISRCTN registration ID: ISRCTN14333710 (2020/10/03, retrospective registration).

Occupational disparities in bladder cancer survival: A population-based cancer registry study in Japan

Background

Little is known about occupational disparities in bladder cancer survival.

Methods

Using data from a population‐based cancer registry (1970‐2016), we identified 3593 patients with incident bladder cancer diagnosed during 1970‐2011 who completed occupational information. The patients were followed for 5 years (median follow‐up time 5.0 years). Their longest‐held occupations at incident bladder cancer diagnosis were classified according to a national standardized classification. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall death were estimated by Cox proportional hazard model, adjusted for age, sex, and year of diagnosis. Clerical workers served as the reference group.

Results

Overall prognosis was fair in this population (5‐year overall survival, 61.9%). Compared with patients in clerical jobs, survival was poorer for those in professional and managerial jobs (mortality HR 1.36; 95% CI 1.09‐1.69), sales and service jobs (HR 1.25, 95% CI 1.01‐1.56), construction jobs (HR 1.83, 95% CI 1.40‐2.38), and manufacturing jobs (HR 1.32, 95% CI 1.05‐1.66), as well as those not actively employed (HR 1.27, 95% CI 1.02‐1.58). A similar pattern was observed in the subgroup analyses restricted to male patients as well as additional analyses adjusted for potential prognostic variables (eg, stage) with multiple imputation.

Conclusion

We documented occupational disparities in bladder cancer survival in Japan. However, the pattern of disparity did not favor highest occupational groups.

Long working hours and depressive symptoms: moderating effects of gender, socioeconomic status, and job resources

PURPOSE

Systematic reviews and meta-analyses have found inconsistent associations between working hours and depressive symptoms. The purpose of this study was to investigate the possible moderators of this association, using data from a large-scale cross-sectional survey.

METHODS

A total of 16,136 Japanese employees (men 83.5%; women 16.5%) responded to a self-administered questionnaire inquiring about overtime working hours during the previous month and depressive symptoms (Center for Epidemiologic Studies Depression scale), as well as moderating factors including gender, age, marital status, socioeconomic status, commuting time, sleeping hours per day, job control and worksite social support (Job Content Questionnaire), neuroticism (Eysenck's Personality Questionnaire Revised), and social desirability (Social Desirability Scale) (response rate, 85%). We conducted sequential regression analyses to investigate the main effects and interaction effects of all moderating variables.

RESULTS

The association between overtime working hours and depressive symptoms was significantly moderated by gender (interaction effect: β = 0.03), age (β = - 0.02), manager (β = 0.03), sleeping hours (β = - 0.02), job control (β = - 0.03), and neuroticism (β = 0.02). Among workers engaged in 80 + hours of overtime, higher depressive symptoms were reported by women, younger employees, non-managers, employees with low job control, low worksite social support, and high neuroticism. A significant main effect of long overtime working hours on depressive symptoms was also observed even after controlling for all independent variables (β = 0.02).

CONCLUSIONS

Long overtime working hours is associated with depressive symptoms. We also found significant heterogeneity in the association according to employee characteristics, which may explain the inconsistent findings in previous literature.

Mental health of working-age populations in Japan who provide nursing care for a person at home: A cross-sectional analysis

OBJECTIVES

This study investigated potential associations between having a person in need of nursing care at home and psychological distress amongst the Japanese working population, using a nationally representative sample.

METHODS

We extracted data from the 2013 Comprehensive Survey of Living Conditions conducted by the Ministry of Health, Labour and Welfare of Japan. The original survey was conducted amongst 295,367 households in 5,530 randomly selected municipalities. We analyzed participants aged 25-65 years who headed a household. The original questionnaire included questions about the specific qualifications required to receive long-term care insurance benefits, about psychological distress (measured using the K6 scale), and other covariates. If a family contained a member in need of nursing care at home, the person who headed that household was recognized as the participant who had a person in need of nursing care at home. Multiple logistic regression analysis was conducted to investigate the association between having a person in need of nursing care at home and psychological distress.

RESULTS

A total of 36,193 men and 2,765 women were included in the analysis, 2.9% of whom had a person in need of nursing care at home. Statistical analysis revealed an association between having a care-requiring older relative at home and psychological distress (odds ratio: 1.40, 95% confidence interval: 1.01-1.93).

CONCLUSIONS

Having a person in need of nursing care at home appears to be positively correlated with worsening mental health of working populations in Japan.

Gender-dependent associations between occupational status and untreated caries in Japanese adults

The aim of this study was to examine whether the presence of untreated caries is different across occupational status among Japanese adults. This was a cross-sectional survey of 1,342 individuals (990 males and 352 females) aged 40-64 yr who underwent medical and dental checkups at a healthcare center in 2011. Oral examination was performed by a dentist and the presence of untreated caries was defined as having at least one untreated decayed tooth. Data regarding current occupational status were obtained using a self-administered questionnaire; the participants were classified into five groups: professionals and managers, clerical and related workers, service and salespersons, agricultural, forestry, and fishery workers, and homemakers and unemployed. Gender-specific odds ratios (ORs) and 95% confidence intervals (CIs) of occupational status for the presence of untreated caries were estimated using logistic regression. After adjusting for potential confounders, female professionals and managers (OR=3.51, 95% CI=1.04-11.87) and service and salespersons (OR=5.29, 95% CI=1.39-20.11) had greater risks of the presence of untreated caries than female homemakers and unemployed. However, this tendency was not observed among males. In conclusion, there was a significant difference in risk of the presence of untreated caries by occupational status among females.

Leadership position and physician visits - results of a nationally representative longitudinal study in Germany

Background

So far, studies within the occupational field have largely concentrated on working conditions and job stressors and staff members’ or subordinate health. Only a few have focused on managers in this context, but studies are missing that explicitly look at the relation between leadership position and health care use (HCU). Thus, the purpose of this study was to examine the potential effects of a change in leadership position on HCU in women and men longitudinally.

Methods

Data were drawn from a nationally representative longitudinal study in Germany (German Socio-Economic Panel, GSOEP). Data from 2009 and 2013 were used. Leadership position was divided into (i) top management, (ii) middle management, (iii) lower management, and (iv) a highly qualified specialist position. The number of physician visits in the preceding 3 months were used to quantify HCU (n = 2140 observations in regression analysis; 69% male).

Results

Adjusting for various potential confounders (e.g., age, self-rated health, chronic conditions, and personality factors), Poisson FE regression analysis revealed that changes from a highly qualified specialist position to the top management were associated with a decrease in the number of physician visits in men (β = .47, p < .05), but not in women. Gender differences (gender x leadership position) were significant.

Conclusions

Findings of this study emphasize the impact of leadership positions on the number of physician visits in men. Further study is required to elucidate the underlying mechanisms.

Occupational class and risk of renal cell cancer

OBJECTIVES

We sought to examine the association between occupational class linked to job stress and the risk of renal cell cancer. To identify potential mediators, we additionally examined whether any observed associations persisted even after controlling for the contribution of stress-related factors (eg, smoking, hypertension, and obesity).

METHODS

Using nationwide inpatient records (1984 to 2016) from the Rosai Hospital group in Japan, we identified 3316 cases of renal cell cancer (excluding upper tract urothelial cancer) and 168 418 controls. We classified patients' occupational class (blue-collar workers, service workers, professionals, and managers) and cross-classified it by industry type (blue-collar, service, and white-collar) based on a standardized national classification. Unconditional logistic regression with multiple imputation was used for the analyses.

RESULTS

A significantly elevated risk of renal cell cancer was found among men in higher occupational class (eg, professionals and managers). The elevated odds in male managers across all industries persisted even after controlling for smoking and alcohol consumption, with the association being more pronounced in blue-collar industries (OR, 1.61; 95% CI, 1.34-1.93). The association appeared to be mainly mediated by hypertension.

CONCLUSION

Occupational class is associated with the risk of renal cell cancer in men, particularly through modifiable risk factors.

Interaction effect of job insecurity and role ambiguity on psychological distress in Japanese employees: a cross-sectional study

Purpose

We examined the interaction effect of job insecurity (JI) and role ambiguity (RA) on psychological distress in Japanese employees.

Methods

Overall, 2184 male and 805 female employees from two factories of a manufacturing company in Japan completed a self-administered questionnaire comprising the scales measuring JI (Job Content Questionnaire), RA (National Institute for Occupational Safety and Health Generic Job Stress Questionnaire), psychological distress (K6 scale), and potential confounders (i.e., age, education, family size, occupational class, and work shift). Taking psychological distress as a dependent variable, hierarchical multiple regression analyses were conducted by gender and employment status (i.e., permanent and non-permanent employees). An interaction term of JI × RA was included in the model.

Results

After adjusting for potential confounders, the main effects of JI and RA on psychological distress were significant regardless of gender or employment status. Furthermore, the significant interaction effect of JI × RA on psychological distress was observed among permanent male employees (β = 0.053, p = 0.010). Post hoc simple slope analyses showed that the simple slope of JI was greater at higher levels of RA (i.e., one standard deviation [SD] above the mean) (β = 0.300, p < 0.001) compared to lower levels of RA (i.e., one SD below the mean) (β = 0.212, p < 0.001). On the other hand, the interaction effect of JI × RA was not significant among permanent or non-permanent female employees.

Conclusions

The present study suggests that higher levels of RA strengthen the association of JI with psychological distress, at least among Japanese permanent male employees.

The Mediating Role of Sleep Quality on Well-Being Among Japanese Working Family Caregivers

The purpose of this study was to investigate whether the well-being of caregivers is mediated by the association between behavioral and psychological symptoms in elderly relatives and the quality of sleep experienced by caregivers using a mediational model. The participants were 105 working family caregivers in Japan. We assessed well-being based on the Kessler Scale 10, self-rated health, and satisfaction in daily life. Our results showed that the well-being in working family caregivers was impacted by the severity of behavioral and psychological symptoms in elderly relatives. Well-being in working family caregivers was also affected by quality of sleep. Maintaining good quality of sleep in working family caregivers is important for reducing caregiver burden and psychological distress, and for improving the balance between work and family life.

The impact of work-related physical assaults on mental health among Japanese employees with different socioeconomic status: The Japan Work Stress and Health Cohort Study (JSTRESS)

Background

Work-related physical assaults or violence has severely impacted on the safety of the work environment and employees’ mental health. The aim of the present study was to investigate the prevalence of physical assaults, the effect of socioeconomic status (SES) on it and depression associated with it in employees working at large companies.

Methods

A total of 22,770 Japanese employees responded to a self-administered questionnaire including SES (educational status and occupational status), violence victimization, worksite social support and depression (response rate, 85%). The 12-month prevalence of physical assaults and depression was examined using a single question and the Center for Epidemiologic Studies Depression scale, respectively.

Results

The prevalence of physical assaults was 1.8% both in males and females. Although the risk of exposure to physical assaults was 2–3 times higher in the blue-collar group than in the manager group, the association of exposure to physical assaults with depression was stronger in the manager and white-collar worker group (Prevalence ratio [PR]=2.1 in males; 1.8 in females) than in the blue-collar worker group (PR=1.7 in males; 1.5 in females) after adjusting demographic and occupational covariates. A similar pattern was observed for education in males; the association was stronger than in the lower education group (PR=2.1 and 1.8).

Conclusions

Low SES is a risk factor of exposure to physical assaults, however, the association of physical assaults with depression was significantly greater among company employees of higher SES than those of lower SES.

•

1.8% of Japanese employees experience physical assaults during working time.

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Employees with low SES are at high risk for exposure to physical assaults.

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The impact of violence on depression is greater among employees with high SES.

Does an advantageous occupational position make women happier in contemporary Japan? Findings from the Japanese Study of Health, Occupation, and Psychosocial Factors Related Equity (J-HOPE)

Occupational position is one of the determinants of psychological health, but this association may differ for men and women depending on the social context. In contemporary Japanese society, occupational gender segregation persists despite increased numbers of women participating in the labour market, which may contribute to gender specific patterns in the prevalence of poor psychological health. The present study examined gender specific associations between occupational position and psychological health in Japan, and the potential mediating effects of job control and effort–reward imbalance in these associations. We used data obtained from 7123 men and 2222 women, aged between 18 and 65 years, who participated in an occupational cohort study, the Japanese Study of Health, Occupation, and Psychosocial Factors Related Equity (J-HOPE), between 2011 and 2012. We used logistic regression to examine the association between occupational position and poor psychological health, adjusted for age, working hours, household income and education, as well as psychosocial work characteristics (job control and effort–reward imbalance). The prevalence of poor psychological health increased from manual/service occupations (23%) to professionals/managers (38%) among women, while it did not vary by occupational position among men. In women, the significant association between occupational position and psychological health was not explained by job control, but was attenuated by effort–reward imbalance. Our findings suggest that Japanese women in more advantaged occupational positions are likely to be at a greater risk for poor psychological health due to higher levels of effort–reward imbalance at work.

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In Japan, occupational position was associated with women's psychological health.

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Women in higher positions were at greater risk for poorer psychological health.

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The association was largely explained by high level of their effort-reward imbalance.

Communication, support and psychosocial work environment affecting psychological distress among working women aged 20 to 39 years in Japan

When compared with their older counterparts, younger women are more likely to have depressive symptoms because they more often experience interrupted work history and a heavy childrearing burden. The purposes of the present study were 1) to investigate the possible association of psychosocial work environment with psychological distress and 2) to examine the way by which communication and support in the workplace affect to psychological distress among young women. We studied 198 women aged 20 to 39 yr in a cross-sectional study. The Kessler Scale-10 (K10 Scale) was used to examine psychological distress. In employees who experienced interpersonal conflict, those who had little or no conversations with their supervisor and/or co-workers had a significantly increased risk of psychological distress (OR, 4.2), and those who received little or no support from their supervisor and/or co-workers had a significantly increased risk of psychological distress (OR, 3.8) compared to those who had more frequent communication and received more support. Harmonious communication in the workplace can help prevent psychological distress among employees, which in turn may enable them to be satisfied with their work.

Work Content and Serious Mental Illness among Middle-Aged Men: Results from a 6-Year Longitudinal Study in Japan

Objective

The present study aimed to determine prospective associations between work content after a working life of more than 20 years and serious mental illness among Japanese men aged 50 to 59 years, using a nationwide population-based survey.

Methods

Data were extracted from a national longitudinal survey of middle-aged and elderly persons previously conducted by the Ministry of Health, Labour and Welfare in Japan. We analyzed data across 10 work content categories for Japanese men who had been working in the same job type or industry for over 20 years. As part pf the survey, participants completed the Kessler (K)6 scale each year to determine their level of psychological distress (with scores ≥13 indicating serious mental illness). Cox discrete time proposal hazard regression analysis was used to examine potential associations between work content and serious mental illness from 2005 to 2010. Further adjustments were made for other sociodemographic characteristics and lifestyle factors.

Results

The current study involved a total of 11,942 participants with a mean (± standard deviation [SD]) of follow-up was 3.4 (± 2.0) years, during which time 892 participants (7.5%) had been classified as having a new-onset serious mental illness. Men who had worked in service jobs and in manufacturing jobs at baseline were more likely to develop serious mental illness than those in managerial jobs (hazard ratio 1.37, 1.30, 95% confidence intervals 1.04–1.80, 1.02–1.65) after adjustment for confounding variables.

Conclusion

These findings suggest that Japanese men aged 50 to 59 years who have worked in service and manufacturing jobs after a working life of over 20 years have an increased risk of serious mental illness during follow-up. Identifying the most at-risk work content category after a working life of over 20 years would be an essential part of providing more effective interventions for psychological distress among Japanese men in this age group.

Mortality risks in relation to occupational category and position among the Japanese working population: the Jichi Medical School (JMS) cohort study

OBJECTIVES

A well-known demographic finding in modern society is the inverse association between socioeconomic status and mortality. The purpose of the study was to examine socioeconomic indicators, such as occupational category (white-collar vs blue -collar) and occupational position (managerial vs non-managerial) as determinants of all -cause, cardiovascular disease (CVD) and cancer mortality in a Japanese working population.

DESIGN

This is a prospective study.

PARTICIPANTS

Data of a baseline survey were collected between 1992 and 1995, and ultimately 6929 Japanese workers aged 65 years and younger (3333 men and 3596 women) from 12 rural communities across Japan were followed until the end of 2005.

MAIN OUTCOME MEASURES

The HRs of death and 95% CIs from all causes were calculated using the Cox proportional hazard model.

RESULTS

Men in blue-collar jobs showed an increased all-cause mortality risk compared with those in white-collar jobs (HR 1.64, 95% CI 1.10 to 2.45). Stratified by occupational category, non-managerial women in blue-collar jobs showed a decreased CVD mortality risk compared with managerial women (HR 0.15, 95% CI 0.03 to 0.81), after adjusting for confounding factors. However, non-managerial women in white-collar jobs showed an increased mortality risk compared with managerial women, although this was not significant (HR 2.34, 95% CI 0.25 to 21.87).

CONCLUSIONS

Socioeconomic disparity according to occupational category was related to the risk of all-cause mortality among Japanese men. There is a potential interaction of occupational category and position in CVD mortality among Japanese women.

Psychosocial mechanisms of psychological health disparity in Japanese workers

Recent epidemiologic research has shown that people with higher socioeconomic status (SES) (e.g., educational attainment) have better psychological health than those with lower SES. However, the psychosocial mechanisms of underlying this relationship remain unclear. To fill this gap, the current study examines the mediating effects of job demands and job resources in the relationship between educational attainment and psychological distress. The hypothesized model was tested using large data sets from two different studies: a cross-sectional study of 9,652 Japanese employees from 12 workplaces (Study 1), and a longitudinal study of 1,957 Japanese employees (Study 2). Structural equation modeling revealed that (1) educational attainment was positively related to psychological distress through job demands, (2) educational attainment was negatively related to psychological distress through job resources, and (3) educational attainment was not directly related to psychological distress. These results suggest that educational attainment has an indirect effect, rather than a direct one, on psychological distress among workers; educational attainment had both a positive and a negative relationship to psychological distress through job demands and job resources, respectively.

A new theory-based social classification in Japan and its validation using historically collected information

Studies of health inequalities in Japan have increased since the millennium. However, there remains a lack of an accepted theory-based classification to measure occupation-related social position for Japan. This study attempts to derive such a classification based on the National Statistics Socio-economic Classification in the UK. Using routinely collected data from the nationally representative Comprehensive Survey of the Living Conditions of People on Health and Welfare, the Japanese Socioeconomic Classification was derived using two variables - occupational group and employment status. Validation analyses were conducted using household income, home ownership, self-rated good or poor health, and Kessler 6 psychological distress (n ≈ 36,000). After adjustment for age, marital status, and area (prefecture), one step lower social class was associated with mean 16% (p < 0.001) lower income, and a risk ratio of 0.93 (p < 0.001) for home ownership. The probability of good health showed a trend in men and women (risk ratio 0.94 and 0.93, respectively, for one step lower social class, p < 0.001). The trend for poor health was significant in women (odds ratio 1.12, p < 0.001) but not in men. Kessler 6 psychological distress showed significant trends in men (risk ratio 1.03, p = 0.044) and in women (1.05, p = 0.004). We propose the Japanese Socioeconomic Classification, derived from basic occupational and employment status information, as a meaningful, theory-based and standard classification system suitable for monitoring occupation-related health inequalities in Japan.

Chronic stress modulates neural and cardiovascular responses during reversal learning

Animal studies have revealed that chronic stress shifts cognitive strategies from the flexible goal-directed action to the simple and rigid habit action. In addition, stress-induced atrophy in the prefrontal cortex and dorsomedial striatum which are involved in the goal-directed action and hypertrophy of the dorsolateral striatum which is critical for the habit action were parallel with the effects of chronic stress on behaviors. The present study tested whether these previous findings in animal studies are compatible in humans by analyzing effects of chronic stress on neural and cardiovascular responses, which are likely important for performing appropriate actions. Twenty healthy men exposed to low or high chronic job stress performed a stochastic reversal learning task, which required cognitive flexibility and the goal-directed action. Regional cerebral blood flow was evaluated during the task using (15)O-water positron emission tomography, and cardiovascular parameters such as blood pressure and heart rate were also measured. During the reversal learning task, whereas participants with low chronic job stress exhibited activity in the anterior caudate, as well as orbitofrontal cortex, ventrolateral prefrontal cortex, insula, and midbrain, which might be related to the goal-directed action, participants with high chronic job stress exhibited no activity in such brain regions. Furthermore, participants with high chronic job stress exhibited less reactivity in diastolic blood pressure, which might be mediated by anterior cingulate cortical activity. These findings, in line with previous studies, suggested that chronic job stress correlates with less activity in brain regions related to the goal-directed action, and insensitive physiological responses in humans.

Impact of occupational stress on stroke across occupational classes and genders

The aims of the present study were to analyze the association between incident stroke, occupational class and stress and to examine whether the association is found in both men and women in a prospective study of Japanese male and female workers. A total of 3190 male and 3363 female Japanese community-dwelling workers aged 65 or under with no history of cardiovascular disease were followed. Occupational stress was evaluated using a demand-control questionnaire. The impact on stroke was examined in stratified analyses of occupational classes. We identified 147 incident strokes (91 in men and 56 in women) during the 11-year follow-up period. Men with high strain jobs (combination of high job demand and low job control) were nearly three times more likely to suffer from a stroke than men with low strain jobs (combination of low job demand and high job control). Among male workers in low occupational classes (blue-collar and non-managerial work), job strain was associated with a higher risk of stroke. In contrast, there was no association between job strain and incident stroke among male workers in high occupational classes (white-collar and managerial work). No statistically significant differences were found for stroke incidence among the job characteristic categories in all the female participants. However, significant, over five-fold excess risks were found among white-collar and managerial female workers exposed to high job strain, compared with their counterparts with low strain jobs. Our study of Japanese workers provided supportive evidence for vulnerability to occupational stress among lower occupational class workers in males but not in females.

[Buffering effect of social support in the workplace on job strain and depressive symptoms]

OBJECTIVE

The present study examined the buffering effect of social support in the workplace on job strain and depressive symptoms by conducting a cross-sectional survey using a self-report.

METHODS

The subjects were 712 employees (male, over 40 yr old) who worked at a precision machine factory. The questionnaire determined the subjects, ages, types of occupation, scores of depressive symptoms, job strain (job demand and job control), and social support (supervisor support and coworker support). Job strain and social support were evaluated by the Job Content Questionnaire (JCQ). The Center for Epidemiologic Studies Depression Scale (CES-D) score was measured and depressive symptoms were defined as a CES-D score > or = 16 point. Job strain and social support were calculated and divided into low-score groups (LG) and high-score groups (HG), respectively, by the median value. The mean values of CES-D in the LG and HG of job strain or social support were compared by the t-test. The hierarchical multiple regression was analyzed with the CES-D score as the dependent variable and by the characteristics of the participants, job strain and social support, and the cross-product interaction term of job strain and social support as independent variables. The effect of the degree of social support in the LG and HG of job strain on the CES-D score was evaluated by analysis of covariance adjusted for age.

RESULTS

The results showed that 23.2% of the workers had depressive symptoms, and that, the CES-D scores in the job demand group were significantly higher in HG than in LG. The CES-D scores in the job control, supervisor support, and coworker support groups were significantly higher in LG than in HG. The hierarchical multiple regression analysis showed that job demand, job control, supervisor support, and coworker support had significant main effects on the CES-D score. Furthermore, it was shown that there was a significant interaction in the CES-D score between job control and supervisor support, and that, the CES-D score in the supervisor support group was significantly higher in LG than that in HG only when job control was low.

CONCLUSIONS

These results suggest that supervisor support may have the effect of buffering depressive symptoms related to low job control.

Hypertension and occupation among seniors

BACKGROUND

Little is known about statistical associations between occupation and hypertension for persons more than age 65.

METHODS

We analyzed cross-sectional data from the 2004 Health and Retirement Survey. We drew 12 gender-specific sub-samples (age 65+; age 70+; age 75+) who reported at least 1 year or 10 years tenure in the same occupation. For 65+ with at least 1 year tenure, n = 3645 men and n = 3644 women. Hypertension was self-reported based on physician diagnosis. Logistic regressions controlled for demographic variables and risk factors.

RESULTS

After adjusting for control variables, including education, race, income, smoking, drinking, body mass, and number of comorbidities, the following occupations were significantly (P < 0.05) more likely than managers to report hypertension in at least two of the six sub-samples for women: professionals, salespeople, private household cleaning service workers, and personal service workers. Statistically significant occupations in at least two of the six sub-samples for men included: salespersons, personal service workers, mechanics, construction trades, precisions production workers, and operators.

CONCLUSION

Current and especially pre-retirement occupations were risk factors for hypertension among seniors.

Socioeconomic indicators and cardiovascular disease incidence among Japanese community residents: the Jichi Medical School Cohort Study

BACKGROUND

There has been little research in inequalities in risk of cardiovascular disease incidence by social class in Asia.

PURPOSE

The purpose of this study was to examine the association between socioeconomic indicators and risk of stroke and coronary heart disease in Japan.

METHOD

Data from the Jichi Medical School Study, a population-based prospective cohort study of approximately 11,000 Japanese men and women, were used. The average follow-up period was 11.7 years. Age- and area-adjusted hazard ratios with 95% confidence intervals (CIs) for education level/occupation were calculated using Cox proportional hazard regression analysis.

RESULTS

Compared to those who completed education at age 14 or younger, the age and area-adjusted hazard ratios of intraparenchymal hemorrhage incidence for men who completed education at age 15-17 and at age 18 or older were 0.42 (95% CI, 0.21-0.84) and 0.34 (95% CI, 0.14-0.84), respectively. The age- and area-adjusted hazard ratios of intraparenchymal hemorrhage and subarachnoid hemorrhage incidence for female white-collar workers compared to female blue-collar workers were 0.28 (95% CI, 0.08-0.98) and 3.23 (95% CI, 1.29, 8.01), respectively. No associations were found between education level and risk of coronary heart disease among both men and women.

CONCLUSION

These results suggest the pattern of social inequalities in health in Japan might be different from that in Western countries.

Occupation and plasma fibrinogen in Japanese male and female workers: the Jichi Medical School Cohort study

This study explored the association between socioeconomic indices and plasma fibrinogen levels in Japanese male and female workers. Occupational category (white-collar vs. blue-collar) and position (manager vs. non-manager) were examined as relevant socioeconomic indices. The study population was a total of 1677 male and 1747 female workers aged 65 and younger taken from the Jichi Medical School Cohort study, a multicenter study designed to explore cardiovascular risk factors in the Japanese population. The association between socioeconomic indices and plasma fibrinogen levels was examined after taking into account several variables such as age, educational attainment, job strain, alcohol consumption, and smoking status and (for women) menopause status. Male white-collar workers had significantly lower fibrinogen levels than blue-collar workers. However, no significant association was found between occupational position and plasma fibrinogen for men. Occupational category interacted with occupational position for women. Among white-collar women, those in non-managerial positions showed higher levels of fibrinogen than those in managerial positions; among blue-collar women, there was no such difference. The association of occupational category and position on fibrinogen levels varied as a function of gender, implying that gender-specific socioeconomic differences could exist in cardiovascular risks in Japanese workers.

Application of item response theory to achieve cross-cultural comparability of occupational stress measurement

Our objective was to examine cross-cultural comparability of standard scales of the Effort-Reward Imbalance occupational stress scales by item response theory (IRT) analyses. Data were from 20,256 Japanese employees, 1464 Dutch nurses and nurses' aides, 2128 representative employees from post-communist countries, 963 Swedish representative employees, 421 Chinese female employees, 10,175 employees of the French national gas and electric company and 734 Spanish railroad employees, sanitary personnel and telephone operators. The IRT likelihood ratio model was used for differential item functioning (DIF) and differential test functioning (DTF) analyses. Despite the existence of DIF, most comparisons did not show discernible differences in the relations between Effort-Reward total score and level of the underlying trait across cultural groups. In the case that DTF was suspected, excluding an item with significant DIF improved the comparability. The full cross-cultural comparability of Effort-Reward Imbalance scores can be achieved with the help of IRT analysis.

Reliability and validity of the Japanese version of the Organizational Justice Questionnaire

OBJECTIVES

Previous European studies reporting low procedural justice and low interactional justice were associated with increased health problems have used a modified version of the Moorman's Organizational Justice Questionnaire (OJQ, Elovainio et al., 2002) to assess organizational justice. We translated the modified OJQ into the Japanese language and examined the internal consistency reliability, and factor-based and construct validity of this measure. A back-translation procedure confirmed that the translation was appropriate, pending a minor revision.

METHODS

A total of 185 men and 58 women at a manufacturing factory in Japan were surveyed using a mailed questionnaire including the OJQ and other job stressors.

RESULTS

Cronbach alpha coefficients of the two OJQ subscales were high (0.85-0.94) for both sexes. The hypothesized two factors (i.e., procedural justice and interactional justice) were extracted by the factor analysis for men; for women, procedural justice was further split into two separate dimensions supporting a three- rather than two-factor structure. Convergent validity was supported by expected correlations of the OJQ with job control, supervisor support, effort-reward imbalance, and job future ambiguity in particular among the men.

CONCLUSION

The present study shows that the Japanese version of the OJQ has acceptable levels of reliability and validity at least for male employees.

Association between job stressors and heavy drinking: age differences in male Japanese workers

The objective of the present study is to investigate the association between various occupational stressors and heavy drinking among male Japanese workers in different age groups. Using the Generic Job Stress Questionnaire, 13 occupational stressors and 2 workplace support indicators were assessed. The questionnaire survey was conducted of 25,104 workers, and the present study analyzed the data from 17,501 male workers. Heavy drinking was defined as weekly alcohol consumption of >275 g, and a total of 1,131 men (6.5%) were classified as heavy drinkers. After adjusting for shift work, occupational class, marital status and smoking, heavy drinking was related to "support from supervisor" for the 18-29 and 50-72 yr-old groups. For the 30-39 yr-old group, heavy drinking was related to "intragroup conflict", "job control" and "cognitive demands." For the 40-49 yr-old group, heavy drinking was related to "physical environment", "quantitative workload" and "underutilization of abilities." The present study clarified that certain occupational stressors relate to heavy drinking, and that this association varies among different age groups.

Relations of occupational stress to occupational class in Japanese civil servants--analysis by two occupational stress models

The aim of the present study was to identify relations between occupational stress and occupational class in Japanese civil servants, using two occupational stress models-the Effort-Reward Imbalance (ERI) Model and the Job Demand-Control (JDC) Model. The subjects were employees of three local public organizations. We distributed self-administered questionnaires and assessed occupational stress by ERI and JDC. We used seven occupational categories based on the Standard Occupational Classification for Japan. The data of 6,423 male and 1,606 female subjects were analyzed by logistic regression analysis to obtain odds ratios (OR) for relations between occupational stress and occupational class. In JDC, male clerical workers, transport/communication workers and protective service workers showed a significantly higher OR of being in the high occupational stress group, compared to managers. In ERI, male professionals/technicians, transport/communication workers, clerical workers and protective service workers showed a significantly higher prevalence OR, compared to managers, the two models giving different results. In ERI, female production workers/laborers and clerical workers had a significantly lower prevalence OR, compared to managers. The results of this study showed that occupational stress differed by occupational class and the two occupational stress models gave different results for occupational classes with high occupational stress.

Associations of health behaviors on depressive symptoms among employed men in Japan

The associations between health behaviors and depressive symptoms have been demonstrated in many studies. However, job strain has also been associated with health behaviors. The aim of this study was to analyze whether health behaviors such as physical activity, sleeping, smoking and alcohol intake are associated with depressive symptoms after adjusting for job strain. Workers were recruited from nine companies and factories located in east and central areas of Japan. The Center for Epidemiologic Studies Depression (CES-D) Scale was used to assess depressive symptoms. Psychological demand and control (decision-latitude) at work were measured with the Job Content Questionnaire. Multiple logistic regression analysis was used to determine the independent contribution of each health behavior to depressive symptoms. Among the total participants, 3,748 (22.7%) had depressive symptoms, which was defined as scoring 16 or higher on the CES-D scale. Using the multiple logistic regression analysis, depressive symptoms were significantly associated with physical activity less than once a week (adjusted relative risk [ARR] = 1.18, 95% confidence interval [CI], 1.14 to 1.25) and daily hours of sleep of 6 h or less (ARR, 1.25; 95% CI, 1.14 to 1.35). Smoking and frequency of alcohol intake were not significantly associated with depressive symptoms. This study suggests some health behaviors such as physical activity or daily hours of sleep are associated with depressive symptoms after adjusting for job strain.

Job strain, worksite support, and nutrient intake among employed Japanese men and women

BACKGROUND

The association of job strain (as defined by the job demands/control model) and worksite support with nutrient intake is not clear.

METHODS

A questionnaire survey was conducted of 25,104 workers employed in nine companies in Japan. Job strain and worksite support were assessed using the Job Content Questionnaire. Daily intake of 17 nutrients was measured using a dietary history questionnaire. Data from 15,295 men and 2,853 women were analyzed, controlling for age, education, marital status, occupation, and study site.

RESULTS

Among men, job strain was positively associated with average daily intakes of fat, vitamin E, cholesterol, poly- and mono-unsaturated fatty acids (p for trend<0.05), and worksite support was positively associated with average daily intakes of total energy, crude fiber, retinol, carotene, vitamins A, C, and E, cholesterol, and saturated fatty acid (p for trend<0.05). Among women, worksite support was positively associated with average daily intakes of total energy, protein, vitamin E, and polyunsaturated fatty acid (p for trend<0.05). However these differences were generally small.

CONCLUSIONS

The present study showed that job strain and worksite support were only weakly and inconsistently associated with nutritional intakes. It does not seem that changes in nutritional intakes explain the association between job strain or worksite support and coronary heart disease.

Psychosocial work characteristics and sickness absence in Japanese employees

OBJECTIVES

This study was undertaken to examine the association between sickness absence in Japanese employees and job demand/control and occupational class as psychosocial work characteristics.

METHODS

The study was cross-sectional in design with data collected from 20,464 male and 3,617 female employees, whose mean age was 40.9 years (SD +/- 9.1 years) and 36.9 years (SD +/- 10.8 years), respectively. The participants were asked to write the total number of sick leaves they had taken during the past year, and a comparison was made between the group with more than 6 days of sickness absence and the group with 0-6 days as a reference group. Job demands, job control, and worksite support from supervisors and colleagues were analyzed by the Job Content Questionnaire, and likewise by the Generic Job Stress Questionnaire of the National Institute for Occupational Safety and Health.

RESULTS

Both low job control and low support at the worksite were associated with a high frequency of sickness absence. But there was no clear relationship between job demands and sickness absence. The lowest sickness absence rate was found in male managers and the highest in male and female laborers.

CONCLUSION

This is the first report of a large-scale survey of Japanese employees to show a high frequency of sickness absence associated with increased work stress and a socioeconomically low occupational class.

Five-year stability of job characteristics scale scores among a Japanese working population

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 Jich 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.