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The European Journal of Public Health Advance Access published online on July 21, 2005
The European Journal of Public Health, doi:10.1093/eurpub/cki028
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received June 6, 2003
Accepted May 25, 2004

Article

Gender and regional differences in perceived job stress across Europe

P. de Smet 1*, S. Sans 2, M. Dramaix 1, C. Boulenguez 3, G. de Backer 4, M. Ferrario 5, G. Cesana 6, I. Houtman 7, S. O. Isacsson 8, F. Kittel 1, P. O. Ostergren 8, I. Peres 2, E. Pelfrene 4, M. Romon 3, A. Rosengren 9, L. Wilhelmsen 9, and M. Kornitzer 1

1 School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
2 Programma CRONICAT Institute of Health Studies, Barcelona, Spain
3 Laboratoire de Médecine du Travail, Faculté de Médecine, Université de Lille 2, Lille, France
4 Vakgroep Maatschapelijke Gezondheidkunde, Faculteit Geneeskunde, Universiteit Gent, Gent, Belgium
5 Dipartimento di Scienze Cliniche e Biologiche, Universita degli studi dell'Insubria, Ospedale di Circolo - Fondazione Macchi, Varese, Italy
6 Centro Studi Patologia Cronico-degenerativa Negli Ambienti di Lavoro, Universita Degli Shidi di Milano BICOCCA, Monza, Italy
7 TNO Work & Employment, AS Hoofddorp, The Netherlands
8 Department of Community Health, Malmö University Hospital, Lunds Universitet, Malmö, Sweden
9 Section of Preventive Cardiology, Göteborg University, Göteborg, Sweden

* To whom correspondence should be addressed.
P. de Smet, E-mail: pdesmet{at}ulb.ac.be


  Abstract

Background: Over the last 20 years stress at work has been found to be predictive of several conditions such as coronary heart disease, high blood pressure and non-specific sick leave. The Karasek demand/control/strain concept has been the most widely used in prospective epidemiological studies. Objectives: To describe distribution in Karasek's demand/control (DC) dimensions as well as prevalence of strain in samples from different parts of Europe grouped into three regions (South, Middle, Sweden), adjusting for occupation. To describe gender differences in Karasek's DC dimensions along with strain prevalence and assess the regional stability of those differences in different occupational groups. Design: The Job stress, Absenteeism and Coronary heart disease in Europe (JACE) study, a Concerted Action (Biomed I) of the European Union, is a multicentre prospective cohort epidemiological study: 38,019 subjects at work aged 35-59 years were surveyed at baseline. Standardised techniques were used for occupation coding (International Standardised Classification of Occupations) and for the DC model (Karasek scale): five items for the psychological demand and nine items for the control or decision latitude dimensions, respectively. Results: A total of 34,972 subjects had a complete data set. There were important regional differences in the Karasek scales and in prevalence of strain even after adjustment for occupational class. Mean demand and control were higher in the Swedish centres when compared to two centres in Milano and Barcelona (Southern region) and values observed in four centres (Ghent, Brussels, Lille and Hoofddorp) in Middle Europe were closer to those observed in the Southern cities than to those obtained in the Swedish cities. Clerks (ISCO 4) and, more specifically, office clerks (ISCO 41) exhibited the smallest regional variation. In a multivariate model, the factor ‘region’ explained a small fraction of total variance. In the two Southern centres as well as in the four Middle European centres, men perceived marginally less job-demand as compared to women whereas the reverse was observed in the two Swedish centres. Differences were larger for control: men appeared to perceive more control at work than did women. In a multivariate model, gender explained a small fraction whereas occupational level explained a large fraction of the variance. Conclusions: In this standardised multicentre European study Karasek's DC model showed large gender and occupational differences whereas geographic region explained a small fraction of the total DC variance, notwithstanding large differences in labour market and working conditions as pointed out by the European Commission as recently as 2000.

Keywords: gender; job stress; occupation; regional differences.
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