Workplace stress and prescription of antidepressant medications: a prospective study on a sample of Italian workers

  • Angelo d’ErricoEmail author
  • Mario Cardano
  • Tania Landriscina
  • Chiara Marinacci
  • Sherri Pasian
  • Alessio Petrelli
  • Giuseppe Costa
Original Article



The main aim of this study was to examine prospectively the relationship between antidepressant prescriptions (ADP), as a proxy of depressive symptoms, and work-related stress, measured according to the demand–control model.


A cohort of 2,046 union workers who participated in a survey on working conditions and health in 1999–2000 was followed up to 2005, through the Regional Drug Prescription Register, for an ADP. The relative risks associated with demand, control and job strain were estimated using Poisson regression, adjusting for age, sex and other workplace factors (shift work, overtime, loud noise and psychological violence).


In final multivariable models, high demand significantly increased the risk of depressive symptoms among blue collars (RR = 1.82), whereas among white collars, it was significantly protective (RR = 0.38). No significant relationship was found for job control or strain in either occupational class.


The direct association observed elsewhere among blue collars between depressive symptoms and demand was confirmed, but not for job control or job strain. It cannot be ruled out that the association with demand was at least in part determined by reverse causation, due to exposure over-reporting among subjects with subclinical depressive symptoms at baseline. The protective effect of demand among white collars is not consistent with the literature and may be attributable to the particular characteristics of this sample, which included mainly workers employed in public administrative positions.


Depressive symptoms Antidepressants Demand–control Work Stress Epidemiology 



This research was supported by the Grant number 35-12561/2004 from the Piedmont Region.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Alonso J, Angermeyer MC, Bernert S et al (2004) Disability and quality of life impact of mental disorders in Europe: results from the European study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 420:38–46Google Scholar
  2. Bonde JP (2008) Psychosocial factors at work and risk of depression: a systematic review of the epidemiological evidence. Occup Environ Med 65:438–445CrossRefGoogle Scholar
  3. Carayon P (1993) A longitudinal test of Karasek’s job strain model among office workers. Work Stress 7:299–314CrossRefGoogle Scholar
  4. Carroll BJ, Cassidy F, Naftolowitz D, Tatham NE, Wilson WH, Iranmanesh A, Liu PY, Veldhuis JD (2007) Pathophysiology of hypercortisolism in depression. Acta Psychiatr Scand Suppl 433:90–103CrossRefGoogle Scholar
  5. Chida Y, Steptoe A (2009) Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biol Psychol 80:265–278CrossRefGoogle Scholar
  6. Choi BK, Clays E, De Bacquer D, Karasek R (2008) Socioeconomic status, job strain and common mental disorders—an ecological (occupational) approach. Scand J Work Environ Health Suppl 6:22–32Google Scholar
  7. Dannon PN, Lowengrub K, Iancu I, Kotler M (2004) Paroxetine in panic disorder: clinical management and long-term follow-up. Expert Rev Neurother 4:191–198CrossRefGoogle Scholar
  8. Davidson JR, Meltzer-Brody SE (1999) The underrecognition and undertreatment of depression: what is the breadth and depth of the problem? J Clin Psychiatry 60(7):4–9Google Scholar
  9. de Lange AH, Taris TW, Kompier MA, Houtman IL, Bongers PM (2003) “The very best of the millennium”: longitudinal research and the demand-control-(support) model. J Occup Health Psychol 8:282–305CrossRefGoogle Scholar
  10. de Lange AH, Taris TW, Kompier MAJ, Houtman ILD, Bongers PM (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
  11. de Lange AH, Taris TW, Kompier MA, Houtman IL, Bongers PM (2005) Different mechanisms to explain the reversed effects of mental health on work characteristics. Scand J Work Environ Health 31:3–14Google Scholar
  12. Demyttenaere K, Bruffaerts R, Posada-Villa J et al (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291:2581–2590CrossRefGoogle Scholar
  13. Deuschle M, Schweiger U, Weber B, Gotthardt U, Körner A, Schmider J, Standhardt H, Lammers CH, Heuser I (1997) Diurnal activity and pulsatility of the hypothalamus-pituitary-adrenal system in male depressed patients and healthy controls. J Clin Endocrinol Metab 82:234–238CrossRefGoogle Scholar
  14. Eriksen W, Tambs K, Knardahl S (2006) Work factors and psychological distress in nurses’ aides: a prospective cohort study. BMC Public Health 6:290CrossRefGoogle Scholar
  15. Everson SA, Maty SC, Lynch JW, Kaplan GA (2002) Epidemiologic evidence for the relation between socioeconomic status and depression, obesity, and diabetes. J Psychosom Res 53:891–895CrossRefGoogle Scholar
  16. Evolahti A, Hultcrantz M, Collins A (2006) Women’s work stress and cortisol levels: a longitudinal study of the association between the psychosocial work environment and serum cortisol. J Psychosom Res 61:645–652CrossRefGoogle Scholar
  17. Grosch JW, Caruso CC, Rosa RR, Sauter SL (2006) Long hours of work in the U.S.: associations with demographic and organizational characteristics, psychosocial working conditions, and health. Am J Ind Med 49:943–952CrossRefGoogle Scholar
  18. Hansen RA, Gaynes BN, Gartlehner G, Moore CG, Tiwari R, Lohr KN (2008) Efficacy and tolerability of second-generation antidepressants in social anxiety disorder. Int Clin Psychopharmacol 23:170–179CrossRefGoogle Scholar
  19. Harrington JM (1994a) Working long hours and health. BMJ 308:1581–1582Google Scholar
  20. Harrington JM (1994b) Shift work and health—a critical review of the literature on working hours. Ann Acad Med Singapore 23:699–705Google Scholar
  21. Henderson M, Glozier N, Holland Elliott K (2005) Long term sickness absence. BMJ 330:802–803CrossRefGoogle Scholar
  22. Herman JP, Cullinan WE (1997) Neurocircuitry of stress: central control of the hypothalamo-pituitary-adrenocortical axis. Trends Neurosci 20:78–84CrossRefGoogle Scholar
  23. Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, Paulus MP, Kunovac JL, Leon AC, Mueller TI, Rice JA, Keller MB (1998) Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord 50:97–108CrossRefGoogle Scholar
  24. Karasek RA (1985) Job content questionnaire and user’s guide. University of Southern California, Los AngelesGoogle Scholar
  25. Karpansalo M, Kauhanen J, Lakka TA, Manninen P, Kaplan GA, Salonen JT (2005) Depression and early retirement: prospective population based study in middle aged men. J Epidemiol Community Health 59:70–74CrossRefGoogle Scholar
  26. Kawakami N, Haratani T, Araki S (1992) Effects of perceived job stress on depressive symptoms in blue collar workers of an electrical factory in Japan. Scand J Work Environ Health 18:195–200Google Scholar
  27. Kessler RC (1997) The effects of stressful life events on depression. Annu Rev Psychol 48:191–214CrossRefGoogle Scholar
  28. Kivimaki M, Elovainio M, Vathera J, Ferrie JE (2003) Organizational justice and health of employees: prospective cohort study. Occup Environ Med 60:27–34CrossRefGoogle Scholar
  29. Kristensen TS, Borg V, Hannerz H (2002) Socioeconomic status and psychosocial work environment: results from a Danish national study. Scand J Public Health Suppl 59:41–48Google Scholar
  30. Landsbergis PA, Schnall PL, Warren K, Pickering TG, Schwarz JE (1994) Association between ambulatory blood pressure and alternative formulations of job strain. Scand J Work Environ Health 20:349–363Google Scholar
  31. Leskela U, Rytsala H, Komulainen E, Melartin T, Sokero P, Lestela-Mielonen P, Isometsa E (2006) The influence of adversity and perceived social support on the outcome of major depressive disorder in subjects with different levels of depressive symptoms. Psychol Med 36:779–788CrossRefGoogle Scholar
  32. Marchand A, Demers A, Durand P (2005) Does work really cause distress? The contribution of occupational structure, work organization to the experience of psychological distress. Soc Sci Med 61:1–14CrossRefGoogle Scholar
  33. Marradi A (1981) Factor analysis as an aid in the formation and refinement of empirically useful concepts. In: Borgatta EF, Jackson DJ (eds) Factor analysis and measurement in sociological research: a multi-dimensional perspective. Sage, London, pp 11–49Google Scholar
  34. McEwen BS (1998) Protective damaging effects of stress mediators. N Engl J Med 338:171–179CrossRefGoogle Scholar
  35. McEwen BS (2008) Central effects of stress hormones in health disease: understanding the protective, damaging effects of stress, stress mediators. Eur J Pharmacol 583:174–185CrossRefGoogle Scholar
  36. Mills LB, Huebner ES (1998) A prospective study of personality characteristics, occupational stressors, and burnout among school psychology practitioners. J Sch Psychol 36:103–120CrossRefGoogle Scholar
  37. Netterstrom B, Conrad N, Bech P, Fink P, Olsen O, Rugulies R, Stansfeld S (2008) The relation between work-related psychosocial factors and the development of depression. Epidemiol Rev 30:118–132CrossRefGoogle Scholar
  38. Paterniti S, Niedhammer I, Lang T, Consoli SM (2002) Psychosocial factors at work, personality traits and depressive symptoms. Longitudinal results from the GAZEL study. Br J Psychiatry 181:111–117CrossRefGoogle Scholar
  39. Pearlin LI, Schieman S, Fazio EM, Meersman SC (2005) Stress, health, and the life course: some conceptual perspectives. J Health Soc Behav 46:205–219CrossRefGoogle Scholar
  40. Rugulies R (2002) Depression as a predictor for coronary heart disease. A review and meta-analysis. Am J Prev Med 23:51–61CrossRefGoogle Scholar
  41. Rugulies R, Bultmann 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 163:877–887CrossRefGoogle Scholar
  42. Savoie I, Morettin D, Green CJ, Kazanjian A (2004) Systematic review of the role of gender as a health determinant of hospitalization for depression. Int J Technol Assess Health Care 20:115–127CrossRefGoogle Scholar
  43. Schrijvers CT, van de Mheen HD, Stronks K, Mackenbach JP (1998) Socioeconomic inequalities in health in the working population: the contribution of working conditions. Int J Epidemiol 27:1011–1018CrossRefGoogle Scholar
  44. Shear MK, Maser JD (1994) Standardized assessment for panic disorder research. A conference report. Arch Gen Psychiatry 51:346–354Google Scholar
  45. Shields M (2006) Stress and depression in the employed population. Health Rep 17:11–29Google Scholar
  46. Spurgeon A, Harrington JM, Cooper CL (1997) Health and safety problems associated with long working hours: a review of the current position. Occup Environ Med 54:367–375CrossRefGoogle Scholar
  47. Stansfeld SA (1992) Noise, noise sensitivity and psychiatric disorders: epidemiological and psychophysiological studies. Psycol Med Suppl 22:1–44CrossRefGoogle Scholar
  48. Stansfeld SA, Candy B (2006) Psychosocial work environment and mental health—a meta-analytic review. Scand J Work Environ Health 32:443–462Google Scholar
  49. Stansfeld SA, Fuhrer R, Shipley MJ, Marmot MG (1999) Work characteristics predict psychiatric disorder: prospective results from the Whitehall II study. Occup Environ Med 56:302–307CrossRefGoogle Scholar
  50. Steptoe A, Cropley M, Griffith J, Kirschbaum C (2000) Job strain and anger expression predict early morning elevations in salivary cortisol. Psychosom Med 62:286–292Google Scholar
  51. Suadicani P, Hein HO, Gyntelberg F (2001) Socioeconomic status and ischaemic heart disease mortality in middle-aged men: importance of the duration of follow-up. The Copenhagen male study. Int J Epidemiol 30:248–255CrossRefGoogle Scholar
  52. Summerfeldt LJ, Antony MM (2002) Structured and semistructured diagnostic interviews. In: Antony MM, Barlow DH (eds) Handbook of assessment, treatment planning, and outcome evaluation: empirically supported strategies for psychological disorders. Guilford Press, New York, pp 3–37Google Scholar
  53. Tylee A, Jones R (2005) Managing depression in primary care. BMJ 330:800–801CrossRefGoogle Scholar
  54. Tylee A, Gastpar M, Lépine JP, Mendlewicz J (1999) DEPRES II (depression research in European society II): a patient survey of the symptoms, disability, current management of depression in the community. DEPRES steering committee. Int Clin Psychopharmacol 14:139–151Google Scholar
  55. Van der Doef M, Maes S (1999) The job demand-control(-support) model, psychological well-being: a review of 20 years of empirical research. Work Stress 13:87–114CrossRefGoogle Scholar
  56. van Oort FV, van Lenthe FJ, Mackenbach JP (2005) Material, psychosocial, and behavioural factors in the explanation of educational inequalities in mortality in The Netherlands. J Epidemiol Community Health 59:214–220CrossRefGoogle Scholar
  57. Virtanen M, Honkonen T, Kivimaki M, Ahola K, Vahtera J, Aromaa A, Lonnqvist J (2007) Work stress, mental health and antidepressant medication findings from the health 2000 study. J Affect Disord 98:189–197CrossRefGoogle Scholar
  58. Wang J (2004) Perceived work stress and major depressive episodes in a population of employed Canadians over 18 years old. J Nerv Ment Dis 192:160–163CrossRefGoogle Scholar
  59. WHO (2008) The global burden of disease 2004 update. WHO Press, GenevaGoogle Scholar
  60. WHO Collaborating Centre for Drug Statistics Methodology (2004) Guidelines for ATC classification and DDD assignment. WHO Collaborating Centre for Drug Statistics, OsloGoogle Scholar
  61. Wulsin LR, Singal BM (2003) Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosom Med 65:201–210CrossRefGoogle Scholar
  62. Ylipaavalniemi J, Kivimaki M, Elovainio M, Virtanen M, Keltikangas-Jarvinen L, Vahtera J (2005) Psychosocial work characteristics and incidence of newly diagnosed depression: a prospective cohort study of three different models. Soc Sci Med 61:111–122CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Angelo d’Errico
    • 1
    Email author
  • Mario Cardano
    • 2
  • Tania Landriscina
    • 1
  • Chiara Marinacci
    • 1
  • Sherri Pasian
    • 3
  • Alessio Petrelli
    • 1
  • Giuseppe Costa
    • 4
  1. 1.Epidemiology Unit ASL TO3—Piedmont RegionGrugliascoItaly
  2. 2.Department of Social SciencesUniversity of TurinTurinItaly
  3. 3.Center for Psychiatric Research—Piedmont RegionTurinItaly
  4. 4.Department of Public HealthUniversity of TurinOrbassanoItaly

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