Occupational Medicine 2012;62:196202

Advance Access publication on 6 March 2012 doi:10.1093/occmed/kqs020

Exposure to psychosocial work factors in 31

European countries
I. Niedhammer1,2,3,4, H. Sultan-Taeb5, J.-F. Chastang1,2,3, G. Vermeylen4 and A. Parent-Thirion4
1

Correspondence to: I. Niedhammer, INSERM U1018, Team 11, Batiment 15/16, Hopital Paul Brousse, 16 avenue Paul Vaillant
Couturier, F-94807 Villejuif Cedex, France. e-mail: isabelle.niedhammer@inserm.fr
...................................................................................................................................................................................

Background Although psychosocial work factors are recognized as major occupational risk factors, little information is available regarding the prevalence of exposure to these factors and the differences in exposure
between countries.
...................................................................................................................................................................................

Aims

To explore the differences in various psychosocial work exposures between 31 European countries.

...................................................................................................................................................................................

Methods

The study was based on a sample of 14 881 male and 14 799 female workers from the 2005 European
Working Conditions Survey. Eighteen psychosocial work factors were studied: low decision latitude
(skill discretion and decision authority), high psychological demands, job strain, low social support,
iso-strain, physical violence, sexual harassment, bullying, discrimination, workfamily imbalance,
long working hours, high effort, job insecurity, low job promotion, low reward and effortreward imbalance. Covariates were age, number of workers in household, occupation, economic activity, selfemployed/employee, public/private sector and part/full time work. Statistical analysis was performed
using multilevel logistic regression analysis.

...................................................................................................................................................................................

Results

Significant differences in all psychosocial work factors were observed between countries. The rank of
the countries varied according to the exposure considered. However, some countries, especially Denmark, Netherlands and Norway, displayed a significantly lower prevalence of exposure to four factors
or more, while some Southern and Eastern countries, especially Czech Republic, Greece, Lithuania
and Turkey, had a higher prevalence.

...................................................................................................................................................................................

Conclusions Differences in psychosocial work exposures were found between countries. This study is the first to
compare a large set of psychosocial work exposures between 31 European countries. These findings
may be useful to guide prevention policies at European level.
...................................................................................................................................................................................

Key words

European countries; job stress; occupational exposures; psychosocial work factors.

...................................................................................................................................................................................

Introduction
Psychosocial work factors have been recognized as occupational risk factors for cardiovascular diseases [1], mental disorders [2] and various health outcomes, such as
self-reported health, quality of life, sickness absence,
etc. Psychosocial work factors are also important because
of their potential high prevalence in working populations,
suggesting that their role in the burden of diseases may be
substantial. Although there is a substantial literature
concerning their aetiological effects on health outcomes,
information remains sparse about the prevalence of exposure to these factors at national and European level and
about the difference in exposure between countries.

Some countries have set up surveys to evaluate the

prevalence of exposure to psychosocial work factors in
their working population, such as Denmark [3], Finland
[4], France [5], Sweden [6], etc. but until now, no information has been available on the prevalence of exposure
to these factors at European level that would allow comparisons between countries using national representative
samples. A few studies provided information on comparison of exposure to psychosocial work factors, such as job
strain, as defined by Karasek, between a number of European countries, but these studies were not all based on
national random samples, making generalization of the
results difficult [7]. An exception may be the studies using

The Author 2012. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
All rights reserved. For Permissions, please email: journals.permissions@oup.com

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INSERM, U1018, CESP Centre for research in Epidemiology and Population Health, Epidemiology of Occupational and Social
Determinants of Health Team, Villejuif, France, 2Univ Paris-Sud, UMRS 1018, Villejuif, France, 3Universite de Versailles
St-Quentin, UMRS 1018, Villejuif, France, 4European Foundation for the Improvement of Living and Working Conditions, Dublin,
Ireland, 5Universite de Bourgogne, Laboratoire dEconomie et Gestion (UMR CNRS 5118), Dijon, France.

I. NIEDHAMMER ET AL.: EXPOSURE TO PSYCHOSOCIAL WORK FACTORS 197

Methods
The fourth European Working Conditions Survey
(EWCS) was carried out by the European Foundation
for the improvement of living and working conditions
(Eurofound) in 2005 [22]. This periodical survey aims
at providing information on working conditions in countries in Europe and may be considered as a major source
of harmonized and comparable data (the same questionnaire is used in all countries). The survey covered 25
European Union countries plus four acceding and candidate countries and two members of the European Free
Trade Association, making a total of 31 countries. The
sample is representative of people in employment (employees and self-employed, according to the Eurostat definition). In each country, the EWCS sample followed
a multistage, stratified and clustered design with a random
walk procedure for the selection of the respondents (except for Belgium, Netherlands, Sweden and Switzerland,

where the selection of the respondents was made using a

phone register). All interviews were conducted face-to-face
in the respondents own household. Details on sampling
design may be found elsewhere [22]. The target number
of interviews was 1000 in all countries except Cyprus,
Estonia, Luxembourg, Malta and Slovenia, in which it
was 600. The sample included 29 680 workers, 14 881
men and 14 799 women, with a cooperation rate, often
reported as a response rate, i.e. proportion of completed
interviews to all eligible units contacted, of 66% [22].
A set of 18 psychosocial work factors were studied, following well-known models and concepts (see item selection in the Appendix, available as Supplementary data at
Occupational Medicine Online). Three measures for
Karaseks dimensions were constructed: psychological
demands (five items), decision latitude (four items for
skill discretion and seven items for decision authority,
each sub-dimension being weighted in the total scale of
decision latitude) and social support (four items). The
scores were dichotomized at the median of the total sample to define low and high levels of exposure following the
recommendations of the original instrument [11]. Job
strain was defined by the combination of high demands
and low latitude and iso-strain by the combination of high
demands, low latitude and low support. Four factors were
related to workplace violence: physical violence (three
items), sexual harassment (one item), bullying (one item)
and discriminations (seven items). Exposure to physical
violence and discrimination was defined by exposure to
at least one situation. Other factors included workfamily
imbalance (one item) and long working hours ($48
h/week, one item). The measures for effortreward imbalance model were effort (six items), job insecurity (one
item) and job promotion (three items). Reward, following
the effortreward imbalance model, was constructed using a weighted sum of the sub-dimensions of job insecurity, job promotion and social support (used as a proxy for
esteem). Finally, a measure for effortreward imbalance
was constructed using a weighted ratio between effort and
reward and exposure to imbalance between high effort
and low reward was defined by a ratio over 1, following
the recommendations of the original instrument [12].
Several covariates were included: age, number of workers in the household, occupation coded using the first
level of the International Standard Classification of Occupations (ISCO), economic activity of the company coded
using the first level of the European classification of economic activities (NACE), self-employed/employee status,
public/private sector and part/full time work. These variables were taken into account in the multivariate analysis
in order to control for potential distribution differences
between countries.
All statistical analyses were performed for each gender
separately using SAS statistical software. The differences
in covariates between men and women were tested using
the chi-square test. The prevalence of exposure to the 18

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the European Social Survey (ESS) data, but only a very

limited number of exposures were studied namely job
insecurity and workfamily imbalance [810].
There is therefore a gap in the knowledge of the prevalence of exposure to various psychosocial work factors
across European countries. The limitations of previous
studies can be overcome by examining all countries in
Europe and by using harmonized and national representative data, exploring various types of exposures following
theoretical models and concepts that have displayed an
etiological role on health outcomes [1,2].
These models and concepts include: the job strain
model, developed by Karasek [11], composed of three
main dimensions, psychological demands, decision latitude (two sub-scales, skill discretion and decision authority) and social support at work; the effortreward
imbalance model, developed by Siegrist [12], including
effort at work and reward in terms of esteem, job promotion and job security; various forms of workplace violence,
including physical violence [13], sexual harassment [14],
bullying [15], discrimination towards gender, age, ethnicity, disability or sexual orientation [16]; long working
hours [17] that may be defined by the European Working
Time Directive specifying the maximum 48 h week; job
insecurity [18] and workfamily imbalance or conflict
between working and private life [19].
The evaluation of the prevalence of exposure to psychosocial work factors may be crucial in guiding prevention policies at European level. It may also provide data
for the estimation of attributable fractions [20] and the
costs of diseases related to these exposures [21].
The objectives of this study were to construct various
measures of exposure to psychosocial work factors, to
evaluate the prevalence of exposure for Europe as a whole
and to make a comparison between countries.

198 OCCUPATIONAL MEDICINE

the three levels of data to be taken into account, the

29 680 workers being clustered within 338 regions that
were themselves clustered within 31 countries. Odds ratios (ORs) and confidence intervals (CIs) were calculated
for each country using the geometric mean as a reference
value. Countries that displayed significant ORs . 1 were
interpreted as countries where the prevalence of exposure
was significantly higher than the mean, and those with
significant ORs , 1 as countries where the prevalence
was significantly lower than the mean.

Results
Cronbach alphas were 0.62, 0.78, 0.58, 0.76 and 0.67,
respectively, for psychological demands, decision latitude, skill discretion, decision authority and social support. Significant differences were observed between
genders for age, occupation, economic activities, selfemployed/employee status, public/private sector and
part/full time work (Table 1). Men were more likely to

Table 1. Description of the sample

Age (years)
,30
3039
4049
5059
60 or more
Occupations (ISCO)
Managers
Professionals
Technicians/associate professionals
Clerical support workers
Service and sales workers
Skilled agricultural, forestry and fishery workers
Craft and related trades workers
Plant and machine operators and assemblers
Elementary occupations and armed forces occupations
Economic activities (NACE)
Agriculture, hunting, forestry and fishing
Mining, quarrying, manufacturing, electricity, gas and water supply
Construction
Wholesale and retail trade
Hotels and restaurants
Transport, storage and communication
Financial intermediation
Real estate, renting and business activities
Public administration and defence
Education
Health and social work
Other service activities
Self-employment
Public sector
Part time work
P: P-value for chi-square test between men and women. ***P , 0.001.

Men (n 5 14 881)
n (%)

Women (n 5 14 799)
n (%)

2992
3854
3876
3068
1057

(20)
(26)
(26)
(21)
(7)

2875
3927
4096
3119
745

(19)
(27)
(28)
(21)
(5)

1405
1679
1650
1089
1317
754
3184
1682
2040

(9)
(11)
(11)
(7)
(9)
(5)
(21)
(11)
(14)

782
2377
2619
2633
2340
344
780
482
2350

(5)
(16)
(18)
(18)
(16)
(2)
(5)
(3)
(16)

1070
3401
1721
1930
476
1239
461
1033
1035
707
545
1079
3010
3138
1252

(7)
(23)
(12)
(13)
(3)
(8)
(3)
(7)
(7)
(5)
(4)
(7)
(20)
(21)
(8)

542
1991
242
2249
719
548
503
953
950
2071
2331
1544
1578
5165
3655

(4)
(14)
(2)
(15)
(5)
(4)
(3)
(6)
(6)
(14)
(16)
(10)
(11)
(35)
(25)

***

***

***

***
***
***

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psychosocial work factors was calculated for each gender

separately using unweighted and weighted data. The
prevalence of exposure using weighted data was calculated to provide an estimate that was representative for
the whole European working population of the 31 countries. These weights were calculated using a calibration on
margins for the following calibration variables: number of
workers in the household, gender, age, occupation, economic activity, region and country size. All these variables
were used as covariates except region, which was used as
a level variable in the multilevel analysis. Unweighted data
were used for subsequent analyses. The differences in the
prevalence of exposure to the 18 psychosocial work factors were tested between men and women using the chisquare test. The differences between countries were
tested for the 18 psychosocial work factors and for the
covariates for men and women separately using the chisquare test. In order to adjust for covariates, multilevel
logistic regression analysis was used to study the differences in the prevalence of exposure to psychosocial work
factors between countries. Multilevel analysis allowed

I. NIEDHAMMER ET AL.: EXPOSURE TO PSYCHOSOCIAL WORK FACTORS 199

between genders for the prevalence of job insecurity and

low reward.
The differences between countries were found to be
significant for the prevalence of exposure to all 18 psychosocial work factors and for all covariates for both genders
using the chi-square test (not shown). Using multilevel
logistic regression analysis, significant differences were
confirmed in the prevalence of exposure to psychosocial
work factors between countries (P , 0.05 for discrimination and P , 0.01 or P , 0.001 for the other factors),
except for sexual harassment among men. Table 3 (available as Supplementary data at Occupational Medicine
Online) summarizes the significant associations between
country and exposure for men and women separately.
Three different groups of countries may be distinguished.
In the first group, four factors or more (i.e. 1/3 of factors
or more, among 12 factors taken into account and six factors were omitted because they were in fact combinations
of other factors) were observed with a significantly lower
prevalence of exposure: Denmark, Netherlands, Norway
for both genders and Austria, Finland, Ireland, Latvia,
Slovakia, Spain and UK for women. The second group
is countries with a significantly higher prevalence of exposure to four factors or more: Czech Republic, Greece,
Lithuania, Turkey for both genders and Bulgaria and

Table 2. Prevalence of exposure to psychosocial work factors in Europe

Men

Job strain model

Low skill discretionb
Low decision authorityb
Low decision latitudeb
High psychological demandsb
Job strain
Low social supportb
Iso-strain
Workplace violence
Physical violence
Sexual harassment
Bullying
Discrimination
Other exposures
Workfamily imbalance
$48 h/week
Effort-reward imbalance model
High effortb
Job insecurity
Low job promotionb
Low rewardb
Effort-reward imbalance
a

Women

No. exposed

% exposed

% exposed
(weighted)a

No. exposed

% exposed

% exposed
(weighted)a

7030
6997
6846
7713
3669
6770
2084

48
47
47
52
25
48
15

51
48
48
53
27
56
18

7208
8303
7732
6818
3686
6568
2084

49
57
53
46
25
46
15

52
55
55
46
26
54
17

*
***
***
***
NS
**
NS

1074
141
802
745

7
1
5
5

7
1
4
4

1134
486
1103
935

8
3
7
6

8
3
6
6

NS
***
***
***

3421
3825

23
27

25
28

2729
1764

18
12

18
13

***
***

8183
2308
6195
6706
1612

55
16
42
49
12

57
14
41
53
13

6610
2203
6613
6834
1152

45
16
45
51
8

46
14
45
53
11

***
NS
***
NS
***

Prevalence of exposure using weighted data.

Scores dichotomized using the median in the total sample.

P: P-value for chi-square test between men and women (using unweighted data). *P , 0.05, **P , 0.01, ***P , 0.001.

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work as managers and blue-collar workers, whereas

women were more likely to work as professionals, technicians/associate professionals, clerks and service workers.
Men were more likely to work in the agriculture,
manufacturing, construction and transport sectors and
women in the wholesale/retail trade, hotels/restaurants,
education and health/social work sectors. Men were
more likely to be self-employed workers and women were
more likely to work in the public sector and have a part
time job.
There were very small differences between the prevalence calculated using unweighted and weighted data
(Table 2). Women were more likely to be exposed to
low skill discretion, low decision authority and low decision latitude, whereas men were more likely to be exposed
to high psychological demands and low support. No difference was observed between men and women for the
prevalence of job strain and iso-strain. The prevalence
of physical violence was not different between men and
women, but women were more likely to be exposed to sexual harassment, bullying and discrimination. The prevalence of exposure to long working hours, high effort,
effortreward imbalance and workfamily imbalance
was higher for men, but women were more likely to be
exposed to low job promotion. No difference was observed

200 OCCUPATIONAL MEDICINE

Poland for women. The third group is composed of the

remaining countries that did not display a substantial
number of significantly lower or higher prevalence of exposure. Sweden may be difficult to categorize as this country
had both a substantial number of high prevalences of
exposures for women and a low prevalences for men.

Discussion

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Strong differences in psychosocial work factors were observed between the 31 European countries. Some countries had a lower prevalence of exposure to four factors or
more, especially Denmark, Netherlands and Norway.
Other countries had a higher prevalence of exposure, especially Czech Republic, Greece, Lithuania and Turkey.
The strengths of this study include the high response
rate and the adjustment for covariates. We also used multilevel models that allowed the hierarchical structure of
the data to be taken into account. The sample studied
was large and allowed the separate study of men and
women, which has been shown to be crucial in occupational epidemiology [23]. It also covered a large number
of countries making comparisons possible using harmonized data. Such an analysis has never been done before
for psychosocial work factors across European countries.
The limitations of the study included measures of exposure using theoretical models and concepts, which were
not based on validated instruments and may lead to imprecision. However, additional analyses on Karaseks
dimensions supported expected psychometric properties.
Furthermore, other studies demonstrated the validity
of using proxies, for example Karaseks Job Content
Questionnaire-like dimensions [24]. Reporting bias cannot be entirely excluded as exposures were based on selfreporting. However, self-reported data may be the most
convenient way to measure psychosocial work factors in
such a large-scale survey. Other approaches, such as
jobexposure matrices, have been developed at national
level, but they also have limitations[5]. The choice of
the threshold to define long working hours ($48 h/week)
may be considered arbitrary but was related to the Working Time Directive (93/104/EC and 2003/88/EC). Using
other thresholds provided similar results confirming the
robustness of our findings. Macroeconomic and prevention policy-related factors, such as institutional framework, laws and regulations, unemployment and growth
rates were not taken into account. Finally, although considerable effort was made in translation and back translation of the questionnaire, it is possible that words and
formulations might be perceived differently between
countries. Differences between countries in awareness
and risk communication might also contribute to the differences observed.
Strong gender differences in psychosocial work factors
were observed in our study. Women were more likely to

report low skill discretion, low decision authority, low decision latitude, workplace violence and low job promotion, but men were more likely to report high
psychological demands, low support, long working hours,
high effort, effortreward imbalance and workfamily imbalance. Some other studies found either a higher prevalence of exposure to high psychological demands among
women (with a very modest difference) [7] or no significant difference between genders [11,25]. The strong difference in decision latitude between genders has already
been reported by others, women being more likely to report low latitude [7,25], as well as low skill discretion and
low decision authority [11,25]. After adjustment for covariates, the prevalence of job strain was higher for
women confirming previous results [7,25,26]. Men were
more likely to report low levels of support. Some other
studies have shown no gender difference [11]. The prevalence of bullying and discrimination was higher among
women. Other studies showed either no difference or
small differences between genders for bullying [27]. Sexual harassment was significantly more prevalent among
women, which is completely expected [14]. The prevalence of job insecurity was not different between genders,
although some studies reported a higher prevalence
among men [18]. The prevalence of effortreward imbalance was found to be higher among men than women, but
the difference was small; other studies reported a slightly
higher prevalence in women [28]. Finally, long working
hours and workfamily imbalance, especially time-based
conflict, were more prevalent in men, in agreement with
other studies [10,29].
Erlinghagen et al. [8] using the ESS data showed significant differences in job insecurity between 17 countries
in Europe and reported that France, Greece, Poland,
Czech Republic and Germany had the highest prevalence
and Austria, Norway, Ireland, Denmark and UK had the
lowest. Their results are consistent with ours, except for
some countries such as France. Gallie and Russell [9],
also based on the ESS, compared work-life conflict between seven European countries and showed gender differences between countries. The Nordic countries
displayed the lowest prevalence for men, whereas the
prevalence was higher in France, Denmark and Sweden
for women. However, Steiber found little evidence for
country effects in a comparative study of workfamily
conflict between 23 countries using the ESS data [10].
These studies using the ESS did not take any covariates
into account, which may explain partly the discordance
with our results.
A few other studies were not based on national representative samples, but on samples from restricted geographical areas and/or specific administrations and
companies, making the generalization of the results difficult. One study based on a multicentre survey showed
differences in psychological demands, decision latitude
and job strain between eight centres across six countries:

I. NIEDHAMMER ET AL.: EXPOSURE TO PSYCHOSOCIAL WORK FACTORS 201

Key points
Strong differences in exposure to psychosocial
work factors were found between 31 European
countries.
In general, Nordic countries had lower prevalences, whereas some Southern and Eastern countries
had higher prevalences.
This study may provide useful information to
develop prevention policies at European level.

Funding
French Agence Nationale de Securite Sanitaire, de lAlimentation, de lEnvironnement et du Travail (ANSES, previously
called AFSSET, EST-2009/1/43) and Conseil Regional de
Bourgogne (Projet Integre Recherche Innovation 2010).

Conflicts of interest
None declared.

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the development of prevention policies in order to improve psychosocial working conditions at European level.
Further studies may be needed to better understand the
differences in psychosocial work exposures between
countries and a forthcoming study will help in this matter
in taking contextual differences between countries into
account in terms of macroeconomics and prevention
policy-related factors.

202 OCCUPATIONAL MEDICINE

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