Social Psychiatry and Psychiatric Epidemiology

, Volume 48, Issue 8, pp 1211–1224 | Cite as

The importance of both workplace and private life factors in psychological distress: a large cross-sectional survey of French railway company employees

  • David Evans
  • Luc MalletEmail author
  • Antoine Flahault
  • Catherine Cothereau
  • Sébastien Velazquez
  • Loïc Capron
  • Michel Lejoyeux
Original Paper



The psychological well-being of employees is a priority in occupational health. This study aimed to estimate the prevalence of psychological distress among employees of a large French company, to calculate the associations between distress and stressors in the workplace and private life domains, and to explore confounding across stressor domains.


8,058 employees of the French national railways company completed a nation-wide survey in 2006 (94.3 % participation). Psychological distress was measured by the 12-item General Health Questionnaire and 21 potential stressors and socio-demographic factors by a self-administered questionnaire. Stressors were summarized in scores for work pressure, workplace conflict, and personal life domains. Risk ratios (RRs) between psychological distress and stressors were calculated using robust-variance Poisson regression.


The prevalence of psychological distress was 32.8 % (95 % CI 31.8–33.9 %), higher among women (48.9 %, 95 % CI 46.5–51.7 %) than men (30.1 %, 95 % CI 29.0–31.2 %). Each stressor domain was associated with distress in the final model containing likely confounders and all three domains (RR highest vs. lowest level—work pressure: men 1.55, 95 % CI 1.42–1.70, women 1.42, 95 % CI 1.23–1.63; work conflict: men 2.63, 95 % CI 2.38–2.91, women 1.98, 95 % CI 1.70–2.30; life concerns: men 2.04, 95 % CI 1.86–2.23, women 1.53, 95 % CI 1.32–1.78). The mutually adjusted RRs for the stressor domains were smaller than the unadjusted RRs.


Almost one-third of all employees and one-half of female employees experienced psychological distress. All three stressor domains were associated with psychological distress and adjustment reduced the association size, suggesting possible over-estimation if one or more domains are omitted from the survey.


Psychological distress Mental health Workplace stressors Private life stressors 



We thank Drs Fayada, Izar, Mille, Richardot, and Severyns (Medical Department, SNCF) for their contribution to the design of the study; Dr Falissard (Université Paris Sud—Paris11) for his technical advice and critical review of the methodology; and the participants and clinic staff in the study sites.

Conflict of interest

The SNCF funded the study as part of the company’s occupational medicine program. A working group of medical department employees and consultants from academia developed the study design. The academic authors independently analyzed the data, drafted the paper, and had responsibility for the decision to publish.

Ethical approval

The study was approved by the Commission nationale informatique et libertés in France (approval No. 1129168).

Supplementary material

127_2012_605_MOESM1_ESM.pdf (702 kb)
Supplementary material 1 (PDF 702 kb)


  1. 1.
    Chevalier A, Bonenfant S, Picot MC, Chastang JF, Luce D (1996) Occupational factors of anxiety and depressive disorders in the French National Electricity and Gas Company. J Occup Environ Med 38:1098–1107PubMedCrossRefGoogle Scholar
  2. 2.
    Bultmann U, Kant I, Van den Brandt PA, Kasl SV (2002) Psychosocial work characteristics as risk factors for the onset of fatigue and psychological distress: prospective results from the Maastricht Cohort Study. Psychol Med 32:333–345PubMedCrossRefGoogle Scholar
  3. 3.
    Calnan M, Wainwright D, Forsythe M, Wall B, Almond S (2001) Mental health and stress in the workplace: the case of general practice in the UK. Soc Sci Med 52:499–507PubMedCrossRefGoogle Scholar
  4. 4.
    Arial M, Gonik V, Wild P, Danuser B (2010) Association of work related chronic stressors and psychiatric symptoms in a Swiss sample of police officers; a cross sectional questionnaire study. Int Arch Occup Environ Health 83:323–331PubMedCrossRefGoogle Scholar
  5. 5.
    Kopp MS, Thege BK, Balog P, Stauder A, Salavecz G, Rózsa S et al (2010) Measures of stress in epidemiological research. J Psychosom Res 69:211–225PubMedCrossRefGoogle Scholar
  6. 6.
    Netterstrøm B, Conrad N, Bech P, Fink P, Olsen O, Rugulies R et al (2008) The relation between work-related psychosocial factors and the development of depression. Epidemiol Rev 30:118–132PubMedCrossRefGoogle Scholar
  7. 7.
    Stansfeld S, Candy B (2006) Psychosocial work environment and mental health—a meta-analytic review. Scand J Work Environ Health 32:443–462PubMedCrossRefGoogle Scholar
  8. 8.
    Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B (1998) The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol 3:322–355PubMedCrossRefGoogle Scholar
  9. 9.
    Siegrist J (1996) Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1:27–41PubMedCrossRefGoogle Scholar
  10. 10.
    Wilhelm K, Kovess V, Rios-Seidel C, Finch A (2004) Work and mental health. Soc Psychiatry Psychiatr Epidemiol 39:866–873PubMedCrossRefGoogle Scholar
  11. 11.
    Romanov K, Appelberg K, Honkasalo ML, Koskenvuo M (1996) Recent interpersonal conflict at work and psychiatric morbidity: a prospective study of 15,530 employees aged 24–64. J Psychosom Res 40:169–176PubMedCrossRefGoogle Scholar
  12. 12.
    Dragano N, He Y, Moebus S, Jöckel K-H, Erbel R, Siegrist J (2008) Two models of job stress and depressive symptoms. Results from a population-based study. Soc Psychiatry Psychiatr Epidemiol 43:72–78PubMedCrossRefGoogle Scholar
  13. 13.
    Niedhammer I, David S, Degioanni S (2006) Association between workplace bullying and depressive symptoms in the French working population. J Psychosom Res 61:251–259PubMedCrossRefGoogle Scholar
  14. 14.
    Eriksen W, Tambs K, Knardahl S (2006) Work factors and psychological distress in nurses’ aides: a prospective cohort study. BMC Public Health 6:290PubMedCrossRefGoogle Scholar
  15. 15.
    Kessler RC (1997) The effects of stressful life events on depression. Annu Rev Psychol 48:191–214PubMedCrossRefGoogle Scholar
  16. 16.
    Nolfe G, Petrella C, Zontini G, Uttieri S, Nolfe G (2010) Association between bullying at work and mental disorders: gender differences in the Italian people. Soc Psychiatry Psychiatr Epidemiol 45:1037–1041PubMedCrossRefGoogle Scholar
  17. 17.
    Merecz D, Drabek M, Mościcka A (2009) Aggression at the workplace—psychological consequences of abusive encounter with coworkers and clients. Int J Occup Med Environ Health 22:243–260PubMedCrossRefGoogle Scholar
  18. 18.
    Kanner AD, Coyne JC, Schaefer C, Lazarus RS (1981) Comparison of two modes of stress measurement: daily hassles and uplifts versus major life events. J Behav Med 4:1–39PubMedCrossRefGoogle Scholar
  19. 19.
    McIntyre K, Korn J, Matsu H (2008) Sweating the small stuff: how different types of hassles result in the experience of stress. Stress Health 24:383–392CrossRefGoogle Scholar
  20. 20.
    Charbotel B, Croidieu S, Vohito M, Guerin A-C, Renaud L, Jaussaud J et al (2009) Working conditions in call-centers, the impact on employee health: a transversal study. Part II. Int Arch Occup Environ Health 82:747–756PubMedCrossRefGoogle Scholar
  21. 21.
    Amiel-Lebigre F, Kovess V, Labarte S, Chevalier A (1998) Symptom distress and frequency of life events. Soc Psychiatry Psychiatr Epidemiol 33:263–268PubMedCrossRefGoogle Scholar
  22. 22.
    Silva LS, Barreto SM (2010) Adverse psychosocial working conditions and minor psychiatric disorders among bank workers. BMC Public Health 10:686PubMedCrossRefGoogle Scholar
  23. 23.
    Bouteyre E, Maurel M, Bernaud J (2007) Daily hassles and depressive symptoms among first year psychology students in France: the role of coping and social support. Stress Health 23:93–99CrossRefGoogle Scholar
  24. 24.
    Clark C, Pike C, McManus S, Harris J, Bebbington P, Brugha T, et al (2012) The contribution of work and non-work stressors to common mental disorders in the 2007 Adult Psychiatric Morbidity Survey. Psychol Med 42(4):829–842Google Scholar
  25. 25.
    Malinauskiene V, Leisyte P, Malinauskas R (2009) Psychosocial job characteristics, social support, and sense of coherence as determinants of mental health among nurses. Medicina (Kaunas) 45:910–917Google Scholar
  26. 26.
    Marchand A, Demers A, Durand P (2005) Do occupation and work conditions really matter? A longitudinal analysis of psychological distress experiences among Canadian workers. Sociol Health Illn 27:602–627PubMedCrossRefGoogle Scholar
  27. 27.
    Smith PM, Frank JW, Mustard CA, Bondy SJ (2008) Examining the relationships between job control and health status: a path analysis approach. J Epidemiol Community Health 62:54–61PubMedCrossRefGoogle Scholar
  28. 28.
    Wang J, Smailes E, Sareen J, Schmitz N, Fick G, Patten S (2012) Three job-related stress models and depression: a population-based study. Soc Psychiatry Psychiatr Epidemiol 47:185–193PubMedCrossRefGoogle Scholar
  29. 29.
    Wang JL (2006) Perceived work stress, imbalance between work and family/personal lives, and mental disorders. Soc Psychiatry Psychiatr Epidemiol 41:541–548PubMedCrossRefGoogle Scholar
  30. 30.
    Weinberg A, Creed F (2000) Stress and psychiatric disorder in healthcare professionals and hospital staff. Lancet 355:533–537PubMedCrossRefGoogle Scholar
  31. 31.
    Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O et al (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27:191–197PubMedCrossRefGoogle Scholar
  32. 32.
    Bridger R, Brasher K, Dew A, Sparshott K, Kilminster S (2010) Job strain related to cognitive failure in naval personnel. Ergonomics 53:739–747PubMedCrossRefGoogle Scholar
  33. 33.
    Karasek R (1985) Job content questionnaire and user’s guide. Department of Industrial and System Engineering, University of Southern CaliforniaGoogle Scholar
  34. 34.
    Amiel-Lebigre F, Pelc I, Lagorce A (1984) Existential events and depression—a comparative study of several types of depression. Ann Med Psychol 142:937–958Google Scholar
  35. 35.
    Loehlin JC (2004) Latent variable models: an introduction to factor, path, and structural equation analysis. Lawrence Erlbaum Associates, New JerseyGoogle Scholar
  36. 36.
    Rothman K, Greenland S, Lash T (2008) Modern epidemiology. Lipincott Williams &Wilkins, PhiladelphiaGoogle Scholar
  37. 37.
    McNutt L-A, Wu C, Xue X, Hafner JP (2003) Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol 157:940–943PubMedCrossRefGoogle Scholar
  38. 38.
    Kaufman JS (2010) Toward a more disproportionate epidemiology. Epidemiology 21:1–2PubMedCrossRefGoogle Scholar
  39. 39.
    Zou GY (2004) A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 159:702–706PubMedCrossRefGoogle Scholar
  40. 40.
    Greenland S (2004) Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case–control studies. Am J Epidemiol 160:301–305PubMedCrossRefGoogle Scholar
  41. 41.
    Gimeno D, Elovainio M, Jokela M, De Vogli R, Marmot M, Kivimaki M (2009) Association between passive jobs and low levels of leisure-time physical activity: the Whitehall II cohort study. Occup Environ Med 66:772–776PubMedCrossRefGoogle Scholar
  42. 42.
    Lohela M, Bjorklund C, Vingard E, Hagberg J, Jensen I (2009) Does a change in psychosocial work factors lead to a change in employee health? J Occup Environ Med 51:195–203PubMedCrossRefGoogle Scholar
  43. 43.
    Wacholder S (1986) Binomial regression in GLIM—estimating risk ratios and risk differences. Am J Epidemiol 123:174–184PubMedGoogle Scholar
  44. 44.
    Desquilbet L, Mariotti F (2010) Dose-response analyses using restricted cubic spline functions in public health research. Stat Med 29:1037–1057Google Scholar
  45. 45.
    Sim J, Reid N (1999) Statistical inference by confidence intervals: issues of interpretation and utilization. Phys Ther 79:186–195PubMedGoogle Scholar
  46. 46.
    Evans S, Huxley P, Gately C, Webber M, Mears A, Pajak S et al (2006) Mental health, burnout and job satisfaction among mental health social workers in England and Wales. Br J Psychiatry 188:75–80PubMedCrossRefGoogle Scholar
  47. 47.
    Brown J, Fielding J, Grover J (1999) Distinguishing traumatic, vicarious and routine operational stressor exposure and attendant adverse consequences in a sample of police officers. Work Stress 13:312–325CrossRefGoogle Scholar
  48. 48.
    Babazono A, Mino Y, Nagano J, Tsuda T, Araki T (2005) A prospective study on the influences of workplace stress on mental health. J Occup Health 47:490–495PubMedCrossRefGoogle Scholar
  49. 49.
    Lopes CS, Araya R, Werneck GL, Chor D, Faerstein E (2010) Job strain and other work conditions: relationships with psychological distress among civil servants in Rio de Janeiro, Brazil. Soc Psychiatry Psychiatr Epidemiol 45:345–354PubMedCrossRefGoogle Scholar
  50. 50.
    Stansfeld SA, Fuhrer R, Shipley MJ, Marmot MG (1999) Work characteristics predict psychiatric disorder: prospective results from the Whitehall II study. Occup Environ Med 56:302–307PubMedCrossRefGoogle Scholar
  51. 51.
    Emslie C, Fuhrer R, Hunt K, Macintyre S, Shipley M, Stansfeld S (2002) Gender differences in mental health: evidence from three organisations. Soc Sci Med 54:621–624PubMedCrossRefGoogle Scholar
  52. 52.
    Stansfeld SA, Fuhrer R, Head J, Ferrie J, Shipley M (1997) Work and psychiatric disorder in the Whitehall II Study. J Psychosom Res 43:73–81PubMedCrossRefGoogle Scholar
  53. 53.
    Haoka T, Sasahara S, Tomotsune Y, Yoshino S, Maeno T, Matsuzaki I (2010) The effect of stress-related factors on mental health status among resident doctors in Japan. Med Educ 44:826–834PubMedCrossRefGoogle Scholar
  54. 54.
    Jenkins R (1985) Sex differences in minor psychiatric morbidity: a survey of a homogeneous population. Soc Sci Med 20:887–899PubMedCrossRefGoogle Scholar
  55. 55.
    Choi B, Östergren P-O, Canivet C, Moghadassi M, Lindeberg S, Karasek R et al (2011) Synergistic interaction effect between job control and social support at work on general psychological distress. Int Arch Occup Environ Health 84:77–89PubMedCrossRefGoogle Scholar
  56. 56.
    Laaksonen M, Rahkonen O, Martikainen P, Lahelma E (2006) Associations of psychosocial working conditions with self-rated general health and mental health among municipal employees. Int Arch Occup Environ Health 79:205–212PubMedCrossRefGoogle Scholar
  57. 57.
    De Raeve L, Jansen NWH, van den Brandt PA, Vasse R, Kant IJ (2009) Interpersonal conflicts at work as a predictor of self-reported health outcomes and occupational mobility. Occup Environ Med 66:16–22PubMedCrossRefGoogle Scholar
  58. 58.
    Lahelma E, Lallukka T, Laaksonen M, Saastamoinen P, Rahkonen O (2012) Workplace bullying and common mental disorders: a follow-up study. J Epidemiol Community Health 66:e3Google Scholar
  59. 59.
    Vartia MAL (2001) Consequences of workplace bullying with respect to the well-being of its targets and the observers of bullying. Scand J Work Environ Health 27:63–69PubMedCrossRefGoogle Scholar
  60. 60.
    Quine L (1999) Workplace bullying in NHS community trust: staff questionnaire survey. BMJ 318:228–232PubMedCrossRefGoogle Scholar
  61. 61.
    Niedhammer I, David S, Degioanni S, Drummond A, Philip P, Acquarone D et al (2009) Workplace bullying and sleep disturbances: findings from a large scale cross-sectional survey in the French working population. Sleep 32:1211–1219PubMedGoogle Scholar
  62. 62.
    Niedhammer I, Chastang J-F, David S (2008) Importance of psychosocial work factors on general health outcomes in the national French SUMER survey. Occup Med (Lond) 58:15–24CrossRefGoogle Scholar
  63. 63.
    Evers W, Tomic W, Brouwers A (2002) Aggressive behaviour and burnout among staff of homes for the elderly. Int J Ment Health Nurs 11:2–9PubMedCrossRefGoogle Scholar
  64. 64.
    Ferrie JE, Shipley MJ, Marmot MG, Stansfeld S, Davey Smith G (1998) The health effects of major organisational change and job insecurity. Soc Sci Med 46:243–254PubMedCrossRefGoogle Scholar
  65. 65.
    Westerlund H, Ferrie J, Hagberg J, Jeding K, Oxenstierna G, Theorell T (2004) Workplace expansion, long-term sickness absence, and hospital admission. Lancet 363:1193–1197PubMedCrossRefGoogle Scholar
  66. 66.
    Vahtera J, Kivimaki M, Pentti J, Linna A, Virtanen M, Virtanen P et al (2004) Organisational downsizing, sickness absence, and mortality: 10-town prospective cohort study. BMJ 328:555PubMedCrossRefGoogle Scholar
  67. 67.
    Wang J, Schmitz N, Dewa C, Stansfeld S (2009) Changes in perceived job strain and the risk of major depression: results from a population-based longitudinal study. Am J Epidemiol 169:1085–1091PubMedCrossRefGoogle Scholar
  68. 68.
    Ferrie JE, Shipley MJ, Stansfeld SA, Smith GD, Marmot M (2003) Future uncertainty and socioeconomic inequalities in health: the Whitehall II study. Soc Sci Med 57:637–646PubMedCrossRefGoogle Scholar
  69. 69.
    Laaksonen E, Martikainen P, Lallukka T, Lahelma E, Ferrie J, Rahkonen O et al (2009) Economic difficulties and common mental disorders among Finnish and British white-collar employees: the contribution of social and behavioural factors. J Epidemiol Community Health 63:439–446PubMedCrossRefGoogle Scholar
  70. 70.
    Laaksonen E, Martikainen P, Lahelma E, Lallukka T, Rahkonen O, Head J et al (2007) Socioeconomic circumstances and common mental disorders among Finnish and British public sector employees: evidence from the Helsinki Health Study and the Whitehall II Study. Int J Epidemiol 36:776–786PubMedCrossRefGoogle Scholar
  71. 71.
    Clougherty JE, Souza K, Cullen MR (2010) Work and its role in shaping the social gradient in health. Ann N Y Acad Sci 1186:102–124PubMedCrossRefGoogle Scholar
  72. 72.
    Bridger R, Brasher K, Dew A, Kilminster S (2008) Occupational stress and strain in the Royal Navy 2007. Occup Med Oxford 58:534–539CrossRefGoogle Scholar
  73. 73.
    Escribà-Agüir V, Tenías-Burillo JM (2004) Psychological well-being among hospital personnel: the role of family demands and psychosocial work environment. Int Arch Occup Environ Health 77:401–408PubMedCrossRefGoogle Scholar
  74. 74.
    Marchand A, Blanc M-E (2010) The contribution of work and non-work factors to the onset of psychological distress: an eight-year prospective study of a representative sample of employees in Canada. J Occup Health 52:176–185PubMedCrossRefGoogle Scholar
  75. 75.
    Chen W-Q, Wong T-W, Yu T-S (2009) Influence of occupational stress on mental health among Chinese off-shore oil workers. Scand J Public Health 37:766–773PubMedCrossRefGoogle Scholar
  76. 76.
    Stansfeld SA, North FM, White I, Marmot MG (1995) Work characteristics and psychiatric disorder in civil servants in London. J Epidemiol Community Health 49:48–53PubMedCrossRefGoogle Scholar
  77. 77.
    Sutinen R, Kivimäki M, Elovainio M, Virtanen M (2002) Organizational fairness and psychological distress in hospital physicians. Scand J Public Health 30:209–215PubMedCrossRefGoogle Scholar
  78. 78.
    Kivimäki M, Elovainio M, Vahtera J, Ferrie JE (2003) Organisational justice and health of employees: prospective cohort study. Occup Environ Med 60:27–33 (discussion 33–34)PubMedCrossRefGoogle Scholar
  79. 79.
    Elovainio M, Kivimäki M, Vahtera J (2002) Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health 92:105–108PubMedCrossRefGoogle Scholar
  80. 80.
    De Lange A, Taris T, Kompier M, Houtman I, Bongers P (2004) The relationships between work characteristics and mental health: examining normal, reversed and reciprocal relationships in a 4-wave study. Work Stress 18:149–166CrossRefGoogle Scholar
  81. 81.
    Ford DE, Kamerow DB (1989) Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 262:1479–1484PubMedCrossRefGoogle Scholar
  82. 82.
    Strine TW, Chapman DP (2005) Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Med 6:23–27PubMedCrossRefGoogle Scholar
  83. 83.
    Rugulies R, Bültmann U, Aust B, Burr H (2006) Psychosocial work environment and incidence of severe depressive symptoms: prospective findings from a 5-year follow-up of the Danish work environment cohort study. Am J Epidemiol 163:877–887PubMedCrossRefGoogle Scholar
  84. 84.
    Melchior M, Caspl A, Milne BJ, Danese A, Poulton R, Moffitt TE (2007) Work stress precipitates depression and anxiety in young, working women and men. Psychol Med 37:1119–1129PubMedCrossRefGoogle Scholar
  85. 85.
    Melchior M, Niedhammer I, Berkman LF, Goldberg M (2003) Do psychosocial work factors and social relations exert independent effects on sickness absence? A six year prospective study of the GAZEL cohort. J Epidemiol Community Health 57:285–293PubMedCrossRefGoogle Scholar
  86. 86.
    Söderfeldt B, Söderfeldt M, Jones K, O’Campo P, Muntaner C, Ohlson CG et al (1997) Does organization matter? A multilevel analysis of the demand-control model applied to human services. Soc Sci Med 44:527–534PubMedCrossRefGoogle Scholar
  87. 87.
    Van Yperen NW, Snijders TA (2000) A multilevel analysis of the demands-control model: is stress at work determined by factors at the group level or the individual level? J Occup Health Psychol 5:182–190PubMedCrossRefGoogle Scholar
  88. 88.
    Van Veldhoven M, de Jonge J, Broersen S, Kompier M, Meijman T (2002) Specific relationships between psychosocial job conditions and job-related stress: a three-level analytic approach. Work Stress 16:207–228CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • David Evans
    • 1
    • 2
    • 3
  • Luc Mallet
    • 1
    • 4
    • 5
    • 6
    Email author
  • Antoine Flahault
    • 1
    • 2
    • 3
  • Catherine Cothereau
    • 1
  • Sébastien Velazquez
    • 1
  • Loïc Capron
    • 1
  • Michel Lejoyeux
    • 1
  1. 1.Medical DepartmentSociété Nationale des Chemins de Fer Français (SNCF)ParisFrance
  2. 2.EHESP School of Public HealthRennes, ParisFrance
  3. 3.Inserm UMR-S 707ParisFrance
  4. 4.Centre de Recherche de l’Institut du Cerveau et de la Moelle épiniere, UMR-S975Université Pierre et Marie Curie-Paris 6ParisFrance
  5. 5.Inserm, U 975ParisFrance
  6. 6.Centre d’Investigation Clinique, CHU Pitié-SalpêtrièreParisFrance

Personalised recommendations