de Smet P, Sans S, Dramaix M, Boulenguez C, de Backer G, Ferrario M, Cesana G, Houtman I, Isacsson S O, Kittel F, Ostergren P O, Peres I, Pelfrene E, Romon M, Rosengren A, Wilhelmsen L, Kornitzer M
School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
Eur J Public Health. 2005 Oct;15(5):536-45. doi: 10.1093/eurpub/cki028. Epub 2005 Jul 21.
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.
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.
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.
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.
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.
在过去20年中，人们发现工作压力可预测多种疾病，如冠心病、高血压和非特异性病假。Karasek需求/控制/紧张概念在前瞻性流行病学研究中应用最为广泛。
描述Karasek需求/控制（DC）维度在分为三个地区（南部、中部、瑞典）的欧洲不同地区样本中的分布情况以及紧张的患病率，并对职业进行调整。描述Karasek DC维度中的性别差异以及紧张患病率，并评估不同职业群体中这些差异的区域稳定性。
欧洲工作压力、旷工与冠心病（JACE）研究是欧盟的一项协同行动（生物医学I），是一项多中心前瞻性队列流行病学研究：在基线时对38019名年龄在35 - 59岁的在职受试者进行了调查。采用标准化技术进行职业编码（国际标准职业分类）和DC模型（Karasek量表）：心理需求维度有5个项目，控制或决策自由度维度分别有9个项目。
共有34972名受试者拥有完整数据集。即使对职业类别进行了调整，Karasek量表和紧张患病率仍存在重要的区域差异。与米兰和巴塞罗那的两个中心（南部地区）相比，瑞典中心的平均需求和控制水平更高，而中欧四个中心（根特、布鲁塞尔、里尔和霍夫多普）的观察值更接近南部城市的观察值，而非瑞典城市的观察值。办事员（国际标准职业分类4），更具体地说是办公室职员（国际标准职业分类41）表现出最小的区域差异。在多变量模型中，“地区”因素解释的总方差比例较小。在两个南部中心以及四个中欧中心，男性感受到的工作需求略低于女性，而在两个瑞典中心则观察到相反的情况。控制方面的差异更大：男性似乎比女性感受到更多的工作控制。在多变量模型中，性别解释的方差比例较小，而职业水平解释的方差比例较大。
在这项标准化的欧洲多中心研究中，Karasek的DC模型显示出较大的性别和职业差异，而地理区域解释的DC总方差比例较小，尽管欧盟委员会最近在2000年指出劳动力市场和工作条件存在很大差异。
