Study of the validity of a job-exposure matrix for psychosocial work factors: results from the national French SUMER survey

  • Isabelle Niedhammer
  • Jean-François Chastang
  • David Levy
  • Simone David
  • Stéphanie Degioanni
  • Töres Theorell
Original Article



To construct and evaluate the validity of a job-exposure matrix (JEM) for psychosocial work factors defined by Karasek’s model using national representative data of the French working population.


National sample of 24,486 men and women who filled in the Job Content Questionnaire (JCQ) by Karasek measuring the scores of psychological demands, decision latitude, and social support (individual scores) in 2003 (response rate 96.5%). Median values of the three scores in the total sample of men and women were used to define high demands, low latitude, and low support (individual binary exposures). Job title was defined by both occupation and economic activity that were coded using detailed national classifications (PCS and NAF/NACE). Two JEM measures were calculated from the individual scores of demands, latitude and support for each job title: JEM scores (mean of the individual score) and JEM binary exposures (JEM score dichotomized at the median).


The analysis of the variance of the individual scores of demands, latitude, and support explained by occupations and economic activities, of the correlation and agreement between individual measures and JEM measures, and of the sensitivity and specificity of JEM exposures, as well as the study of the associations with self-reported health showed a low validity of JEM measures for psychological demands and social support, and a relatively higher validity for decision latitude compared with individual measures.


Job-exposure matrix measure for decision latitude might be used as a complementary exposure assessment. Further research is needed to evaluate the validity of JEM for psychosocial work factors.


Psychosocial work factors Job stress Occupation Economic activity Job-exposure matrix 



The authors thank the members of the DARES (French Ministry of Labour), especially Nicole Guignon for their help and advice. The authors also thank all the 1,792 occupational physicians and ‘médecins inspecteurs régionaux du travail’, all the employees who participated to the SUMER survey and made this study possible, and Maryvonne Auxenfants-Prigent for her linguistic help. This study was supported by the DARES of the French Ministry of Labour.


  1. Alterman T, Shekelle RB, Vernon SW, Burau KD (1994) Decision latitude, psychologic demand, job strain, and coronary heart disease in the Western Electric Study. Am J Epidemiol 139:620–627PubMedGoogle Scholar
  2. Amick BC III, McDonough P, Chang H, Rogers WH, Pieper CF, Duncan G (2002) Relationship between all-cause mortality and cumulative working life course psychosocial and physical exposures in the United States labor market from 1968 to 1992. Psychosom Med 64:370–381PubMedGoogle Scholar
  3. Ardilly P (1994) Les techniques de sondage. Editions Technip, ParisGoogle Scholar
  4. Belkic KL, Landsbergis PA, Schnall PL, Baker D (2004) Is job strain a major source of cardiovascular disease risk? Scand J Work Environ Health 30:85–128PubMedGoogle Scholar
  5. Bouyer J, Hemon D (1993) Studying the performance of a job exposure matrix. Int J Epidemiol 22(Suppl 2):S65–S71PubMedGoogle Scholar
  6. Cohidon C, Niedhammer I, Wild P, Gueguen A, Bonenfant S, Chouaniere D (2004) Exposure to job-stress factors in a national survey in France. Scand J Work Environ Health 30:379–389PubMedGoogle Scholar
  7. Deville JC, Särndal FF (1992) Calibration estimation in survey sampling. J Am Stat Assoc 87:375–382CrossRefGoogle Scholar
  8. Eurostat (2002) NACE: Statistical Classification of Economic Activities in the European Community, Rev. 1.1. LuxembourgGoogle Scholar
  9. Fermanian J (1984) Measurement of agreement between 2 judges: qualitative cases. Rev Epidemiol Sante Publique 32:140–147PubMedGoogle Scholar
  10. Fredlund P, Hallqvist J, Diderichsen F (2000) Psychosocial job exposure matrix: an update of a classification system for work-related psychosocial exposures (in Swedish), vol 11. Arbetslivsinstitutet, StockholmGoogle Scholar
  11. Hammar N, Alfredsson L, Theorell T (1994) Job characteristics and the incidence of myocardial infarction. Int J Epidemiol 23:277–284PubMedCrossRefGoogle Scholar
  12. Hasselhorn HM, Theorell T, Hammar N, Alfredsson L, Westerholm P, the Wolf Study Group. Occupational health care team ratings and self reports of demands and decision latitude. 2004. Stress Research Reports, vol 314. National Institute for Psychosocial Factors and Health, Stockholm, SwedenGoogle Scholar
  13. Hémon D, Goldberg M (1993) Retrospective evaluation of occupational exposures in epidemiology: a European concerted action 1990–1992. Int J Epidemiol 22:(suppl 2)Google Scholar
  14. Héran-Le Roy O, Niedhammer I, Sandret N, Leclerc A (1999) Manual materials handling and related occupational hazards: a national survey in France. Int J Ind Ergon 24:365–377CrossRefGoogle Scholar
  15. INSEE (2003a) Nomenclature des professions et catégories socio-professionnelles 2003. INSEE, Nomenclatures et codes, ParisGoogle Scholar
  16. INSEE (2003b) Nomenclatures d’activités et de produits françaises - Edition 2003. INSEE, Nomemclatures et codes, ParisGoogle Scholar
  17. International Labour Office (1990) International standard classification of occupations (ISCO-88). International Labour Office, GenevaGoogle Scholar
  18. Johnson J, Stewart W, Fredlund P, Hall E, Theorell T (1990) Psychosocial job exposure matrix: an occupationally aggregated attribution system for work environment exposure characteristics, vol 221. National Institute for Psychosocial Factors and Health, Department of Stress Research, WHO Psychosocial CentreGoogle Scholar
  19. Johnson JV, Stewart WF (1993) Measuring work organization exposure over the life course with a job- exposure matrix. Scand J Work Environ Health 19:21–28PubMedGoogle Scholar
  20. Johnson JV, Hall EM, Theorell T (1989) Combined effects of job strain and social isolation on cardiovascular disease morbidity and mortality in a random sample of the Swedish male working population. Scand J Work Environ Health 15:271–279PubMedGoogle Scholar
  21. Johnson JV, Stewart W, Hall EM, Fredlund P, Theorell T (1996) Long-term psychosocial work environment and cardiovascular mortality among Swedish men. Am J Public Health 86:324–331PubMedGoogle Scholar
  22. Karasek R (1985) Job content questionnaire and user’s guide. Department of Industrial and Systems Engineering, University of Southern California, Los AngelesGoogle Scholar
  23. Karasek R, Theorell T (1990) Healthy work: stress, productivity, and the reconstruction of working life. Basic Books, New YorkGoogle Scholar
  24. Karasek RA (1979) Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Q 24:285–308CrossRefGoogle Scholar
  25. Kasl SV (1996) The influence of the work environment on cardiovascular health: a historical, conceptual, and methodological perspective. J Occup Health Psychol 1:42–56PubMedCrossRefGoogle Scholar
  26. Kauppinen T, Toikkanen J, Pukkala E (1998) From cross-tabulations to multipurpose exposure information systems: a new job-exposure matrix. Am J Ind Med 33:409–417PubMedCrossRefGoogle Scholar
  27. Kristensen TS (1995) The demand–control–support model: methodological challenges for future research. Stress Med 11:17–26CrossRefGoogle Scholar
  28. Kristensen TS (1996) Job stress and cardiovascular disease: a theoretic critical review. J Occup Health Psychol 1:246–260PubMedCrossRefGoogle Scholar
  29. Landsbergis P, Theorell T, Schwartz J, Greiner BA, Krause N (2000) Measurement of psychosocial workplace exposure variables. Occup Med 15:163–188PubMedGoogle Scholar
  30. Netterstrom B, Kristensen TS. Self-reported job strain increases the risk of ischaemic heart disease: a 14-year cohort study of employed Danish men. 2005. In: Fourth international conference on work environment and cardiovascular diseases, Newport Beach, March 9–11, 2005Google Scholar
  31. Niedhammer I (2002) Psychometric properties of the French version of the Karasek Job Content Questionnaire: a study of the scales of decision latitude, psychological demands, social support, and physical demands in the GAZEL cohort. Int Arch Occup Environ Health 75:129–144PubMedCrossRefGoogle Scholar
  32. Niedhammer I, Chastang JF, 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
  33. Niedhammer I, Chastang JF, Gendrey L, David S, Degioanni S (2006) Propriétés psychométriques de la version française des échelles de la demande psychologique, de la latitude décisionnelle et du soutien social du “Job Content Questionnaire” de Karasek: résultats de l’enquête nationale SUMER. Santé Publique 18:413–427PubMedGoogle Scholar
  34. Niedhammer I, Chea M (2003) Psychosocial factors at work and self reported health: comparative results of cross sectional and prospective analyses of the French GAZEL cohort. Occup Environ Med 60:509–515PubMedCrossRefGoogle Scholar
  35. Niedhammer I, Saurel-Cubizolles MJ, Piciotti M, Bonenfant S (2000) How is sex considered in recent epidemiological publications on occupational risks? Occup Environ Med 57:521–527PubMedCrossRefGoogle Scholar
  36. Niedhammer I, Tek ML, Starke D, Siegrist J (2004) Effort-reward imbalance model and self-reported health: cross-sectional and prospective findings from the GAZEL cohort. Soc Sci Med 58:1531–1541PubMedCrossRefGoogle Scholar
  37. Reed DM, LaCroix AZ, Karasek RA, Miller D, MacLean CA (1989) Occupational strain and the incidence of coronary heart disease. Am J Epidemiol 129:495–502PubMedGoogle Scholar
  38. Schnall PL, Landsbergis PA, Baker D (1994) Job strain and cardiovascular disease. Annu Rev Public Health 15:381–411PubMedCrossRefGoogle Scholar
  39. Schwartz JE, Pieper CF, Karasek RA (1988) A procedure for linking psychosocial job characteristics data to health surveys. Am J Public Health 78:904–909PubMedGoogle Scholar
  40. Stansfeld S, Candy B (2006) Psychosocial work environment and mental health: a meta-analytic review. Scand J Work Environ Health 32:443–462PubMedGoogle Scholar
  41. Steenland K, Fine L, Belkic K, Landsbergis P, Schnall P, Baker D, Theorell T, Siegrist J, Peter R, Karasek R, Marmot M, Brisson C, Tuchsen F (2000) Research findings linking workplace factors to CVD outcomes. Occup Med 15:7–68PubMedGoogle Scholar
  42. Steenland K, Johnson J, Nowlin S (1997) A follow-up study of job strain and heart disease among males in the NHANES1 population. Am J Ind Med 31:256–260PubMedCrossRefGoogle Scholar
  43. Theorell T, Hasselhorn HM (2005) On cross-sectional questionnaire studies of relationships between psychosocial conditions at work and health: are they reliable? Int Arch Occup Environ Health 78:517–522PubMedCrossRefGoogle Scholar
  44. Theorell T, Karasek RA (1996) Current issues relating to psychosocial job strain and cardiovascular disease research. J Occup Health Psychol 1:9–26PubMedCrossRefGoogle Scholar
  45. Theorell T, Tsutsumi A, Hallquist J, Reuterwall C, Hogstedt C, Fredlund P, Emlund N, Johnson JV (1998) Decision latitude, job strain, and myocardial infarction: a study of working men in Stockholm. The SHEEP Study Group. Stockholm Heart epidemiology Program. Am J Public Health 88:382–388PubMedCrossRefGoogle Scholar
  46. van der Doef M, Maes S (1999) The job demand–control(–support) model and psychological well-being: a review of 20 years of empirical research. Work Stress 13:87–114CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Isabelle Niedhammer
    • 1
    • 2
  • Jean-François Chastang
    • 2
  • David Levy
    • 3
  • Simone David
    • 2
  • Stéphanie Degioanni
    • 2
  • Töres Theorell
    • 4
  1. 1.UCD School of Public Health and Population Science, Woodview HouseUniversity College DublinBelfield, Dublin 4Ireland
  2. 2.INSERM, U687-IFR69Saint-MauriceFrance
  3. 3.INSEERennesFrance
  4. 4.Karolinska Institute and National Institute for Psychosocial Factors and HealthStockholmSweden

Personalised recommendations