1、 - 1 - 外文翻译 原文 The Relationship between Job Stress and Mental Health at Work Material Source:Industrial Health 1997, 35, 29-35 Author:Jun Shigemi, Yoshio Mino, Toshihide Tsuda, Akira Babazono and Hideyasu Aoyama Selyel defined stress as the state manifested by a specific syndrome which consists of a
2、ll the nonspecifically induced changes within a biologic system. Using an experimental study, he proved that stress induces a common pathological change which he called “general adaptation syndrome.“ He did not specify the character of stress. Stress which was comfortable to the individual and essen
3、tial for development and growth was called eustress, while stress which was unpleasant or harmful to the individual was called distress. Holmes and his collaborator weighted and scored stressful life events. They proved that severe health impairment is likely to occur if people have severe stressful
4、 life events and if the life events score exceeded 300 points in the previous year. Nevertheless, it was reported that there was only a weak relationship between the strength of stress and the incidence of psychiatric or somatic diseases. Knowing these facts, researchers attempted to identify other
5、stress factors which affected psychiatric or somatic diseases. Lazarus and his collaborators reported that the daily hassles of living having continuous and chronic characteristics are a significant stress. These “daily hassles“ appeared to be better predictors of health outcomes than life events. R
6、ecently, the causal relationship between job stress and psychiatric illness or cardiovascular disease was studied. The job-demand-control-support model suggests that psychological strain and subsequent somatic diseases resulted from the interaction of three types of job characteristics: job demand,
7、job decision latitude, and work related social support. In Japan, causal relationship between job stress and mental health has been drawing the attention of researchers who are currently studying job stress. Therefore, the study of job stress is important to develop strategies for the prevention of
8、stress related diseases and for health promotion. However, the relationship between job stress and problematic mental health state has not been - 2 - established in Japan. We hypothesized that adverse effects of subjective job stress on mental health state is great, and we estimated that some types
9、of prevalence odds ratios between job stress and mental health would be more than two. The purpose of this study is to clarify the relationship between job stress and problematic mental health state quantitatively using prevalence odds ratios. A cross-sectional study was performed using a self-admin
10、istered questionnaire given to the employees of an electric company in Okayama city, Japan. All subjects were workers producing minute electric parts. We selected this company because of its different work places, which allowed us to examine the characteristics of workers more precisely. Among 782 w
11、orkers, 763 responded to the questionnaire satisfactorily. The response rate was 97.6%. The questionnaire consisted of demographic questions such as gender, age, marital status, and employment section as well as questions taken from the Japanese version of the 30-item General Health Questionnaire (G
12、HQ) , and a questionnaire about subjective job stress developed by Uehata et al. We added questions about satisfaction with family life and physical health states. We used the 30 item Japanese version of the GHQ as a measure of the mental health state. A cut-off score of 718 points using GHQ method
13、was considered reasonable in Kitamuras study on the validity of the 30-item GHQ. Therefore, we defined response showing a GHQ score of 8 points or more as representing individuals with problematic mental health states, and responses showing 7 points or less as representing individuals without any me
14、ntal health problems. We treated the items of physical health status and satisfaction with family life as categorical data. We weighted two points on individuals who answered “very healthy“ or “healthy,“ weighted one points on individuals who answered “ordinary“ and weighted zero points on individua
15、ls who answered “not healthy so much“ or “not healthy.“ We weighted two points on individuals whose answers were “dissatisfied very much“ or “dissatisfied“ and weighted one point on individuals whose responses indicated neither satisfied nor dissatisfied, and zero points on individuals whose answers
16、 were “very satisfied“ or “satisfied.“ We employed a multiple logistic regression model controlling for potential confounding factors: gender, age, marital status, satisfaction with family life, and physical health state. In the logistic regression model, we used all items of subjective job stress i
17、n spite of the high value of the alpha coefficient, because we thought that the interrelationship between subjective job stress and problematic mental health state - 3 - should be analyzed with respect to every item of subjective job stress. Adjusted odds ratio and 95% confidence intervals for the o
18、dds ratios of each level of subjective job stress to mental health state were calculated. Although we thought that sex was a potential confounding factor, sex was not a significant variable in the multiple logistic regression analysis. Crude data analysis between subjective job stress and GHQ score
19、showed same tendency by each sex. In the correlation matrix coefficients of the logistic regression model, marital status showed a strong negative correlation (more than 0.5 in absolute value) to the subgroups with age range of 30-39 years and 40-49 years. Then, we excluded the variable regarding ma
20、rital status from the multiple logistic regression model because of its multicollinearity. In our study, the proportion of individuals with problematic mental health state was 37.8% in the total subjects, 41.7% in males and 34.3% in females. Iwata reported on the prevalence of depressive symptoms in
21、 a Japanese tax office using the Japanese version of the Center for Epidemiologic Studies Depression Scale. He found that 15.2% of males and 10.6% of females had high levels of depressive symptoms. Our study measured problematic mental health states by use of the GHQ. We could detect the cases from
22、the GHQ more than cases of depressive symptoms and then our concept of problematic mental health state was broader than Iwatas depressive symptoms. Therefore, our prevalence was higher than depressive symptom. This study investigated the relationship between subjective job stress and problematic men
23、tal health state. Therefore, we used multiple logistic regression to estimate quantitative measures of subjective job stress and problematic mental health state, adjusted by potential confounding factors of gender, age, satisfaction with family life and physical health state. Our results showed that
24、 the items related to subjective job stress because of “too much trouble at work,“ “too much responsibility,“ “poor relationship with superiors,“ “are not allowed to make mistakes“ and “cannot keep up with new technology“ were related to mental health state. Consequently, it is suggested that subjec
25、tive job stress can be harmful to a workers mental health state and cause “distress,“ which was caused by an injury from the nonspecific response of a living body to negative stimuli, according to Selye. We recognized that interpersonal conflict between the worker and his superiors might be an impor
26、tant risk factor for mental health in our cross-sectional - 4 - study. In the model of National Institute for Occupational Safety and Health, this type of interpersonal conflict is involved in job stressors. Therefore, cooperative relationships with superiors and colleagues as job support might be i
27、mportant in maintaining healthy mental state. Our study suggests that “Cannot keep up with new technology“ is another risk factor for mental health, especially in male workers. In Japanese industries such as electrical factories, workers are placed in highly automated circumstances. Therefore, work
28、related to highly developed technology might be a source of job stress. Our quantitative estimation of job stress might have under or over-estimated the magnitude of job stress because job stress may be affected by familial stress. Therefore, we hypothesized multiplicative interaction between subjec
29、tive job stress and feeling of dissatisfaction with family life, and analyzed the logistic regression using an interaction model. Adjusted odds ratio with interaction between subjective job stress and mental health showed the quantitative measure of multiplicative terms between job stress and famili
30、al stress and those interaction terms. But the positive multiplicative interaction model was not significant. From another point of view, there was a space to analyze the additive interaction model. The purpose of this study is to clarify the relationship between subjective job stress and mental hea
31、lth. From the result of the multiple logistic regression analysis controlling confounding factors, some kinds of subjective recognition of job stress were shown to possibly be related to problematic mental health state because of the more than double degrees of prevalence odds ratio. Accordingly, ou
32、r prevalence odds ratios with values above double would have more than 50% of attributable proportion in the causal inference between subjective job stress and problematic mental health state. Therefore, further studies to clarify causal relationship between job stress and mental health are required
33、 to prove it. - 5 - 译文 工作中的工作压力和心理健康之间的关系 资料来源：产业健康， 1997 年， 35 期， 29-35 页 作者： Jun Shigemi, Yoshio Mino, Toshihide Tsuda, Akira Babazono and Hideyasu Aoyama 赛亚将压力定义为一个特定的综合征，包括引起生物体系内的非特异性的变化。他使用的实验研究，证明了一个共同的病理应激诱导的变化，他称为“一般适应症候群”。他没有具体说明压力特征。压力令个人舒适和对发展和成长是必要的叫所谓的良性压力，同时压力令人不快的或有害于个人被称为困扰。 霍姆斯和他的合
34、作者合作，并获得了生活压力的事件。他们证明了如果人们有严重应激性生活事件和生活事件，并得分超过了去年 300 点，严重的健康损害就有可能发生。然而，据报道，压力强度和精神 或躯体疾病的发病率只有一点微弱的关系。了解这些事实，研究人员试图找出影响精神压力或躯体疾病的其他因素。 拉撒路和他的合作者报告说，有持续和长期特点的生活日常琐事是一个重大压力。这些“日常琐事“似乎是比生活事件的健康结果有更好的预测。最近，工作压力和精神疾病或心血管疾病的因果关系进行了研究。工作需求控制支持模型表明，心理压力和随后的躯体疾病是从三种类型的工作特性相互作用的结果：工作需求，工作的决定纬度，与工作相关的社会支持。在
35、日本，工作压力与心理健康的因果关系已经受到了目前正在研究工作压力的研究人员的关注。因 此，工作压力的研究对开发与压力有关的疾病预防和健康促进策略是很重要的。然而，工作压力与心理健康状况的关系在日本还尚未成立。我们假设，主观心理健康状况的对工作压力不利影响非常大，我们估计，工作压力和心理健康之间的某些类型的普遍比率将超过两倍。本研究的目的是澄清工作压力与心理健康状况在定量的普遍比率的关系。 一个代表性的研究是采用自填家公司因为其不同的工作场所，它使我们能够更准确地审查员工的特点。 782 名工人，有 763 令人满意地回答了问卷。回应率为 97.6。问卷包括人口问题，如性别，年龄，婚姻状况，就业
36、部分以 及从采取 30 项日本版的一般健康问卷（ GHQ），和发展于 Uehata 等其他人的主观工作压力问卷。我们增加了关于家庭生活和身体健康状况满意度的问题。 我们使用 30 项日本版的 GHQ 衡量心理健康状态。用 GHQ 的方法在对这 30个项目 GHQ 效度研究上得到 718 分的得分在北村的研究被认为是合理的。因此，我们定义 GHQ 反应显示的得分是 8 分以上的人代表有问题的个人心理健康状况和反应显示 7 分或更少的人代表个人没有任何心理健康问题。 - 6 - 我们将身体健康状况及家庭生活满意度的项目作为明确的数据。我们加两分在个人的回答是“非常健康的”或 “健康”，加一分在个人
37、回答“普通”和加权零分在个人回答 “不是很健康”或“不健康。”我们加两分在个人回答是 “很不满”或“不满意”，加一分在他们的回答表明即不满意也不满意 ,加零分在个人的答案是“非常满意”或“满意”。我们采用了多因素的逻辑回归模型来控制潜在的混杂因素：性别，年龄，婚姻状况，家庭生活满意度，和身体健康状况。 在逻辑回归模型，我们使用所有项目的主观的工作压力尽管高价值的系数，因为我们认为，工作压力和主观心理健康状况的相互关系应涉及每一个主观项目工作压力的分析。为每一个主观工作压力和心理健康状态水平进行了计算调整后的可能性和可能性的可信区间是 95%。 虽然我们认为，性别是一个可能的干扰因素，但性别不在
38、多变量逻辑回归分析显著。原始数据分析在主观工作压力与 GHQ 评分之间的表明各性别相同的趋势。 在相关的逻辑回归模型系数矩阵，婚姻状况表现出强烈的负相关关系（绝对值超过 0.5）在年龄 30-39 岁和 40-49 岁范围内的群体 。然后，因为它的多重共线性我们就从多变量的逻辑回归模型中排除了可变化的婚姻状况。 在我们的研究，个人的心理健康状况有问题的比例为 37.8，在总的被试者中， 41.7的男性和 34.3的女性。岩田利用日本版的病学研究中心忧郁量表报告在日本税务机关的抑郁症状。他发现， 15.2的男性和 10.6的女性有抑郁症状的高水平。我们的研究是使用 GHQ 来衡量心理健康状态。我
39、们可以检测 GHQ 的案子比忧郁症状的病例多，然后我们的心理健康问题的概念比岩田的忧郁症状更为广泛。因此，我们的抑郁症状发生率明显高。 本研究探讨主观工 作压力和有问题的心理健康状况之间的关系。因此，我们使用多元逻辑回归定量地估计主观工作压力和有问题的心理健康状况，由性别，年龄，家庭生活的满意度和身体健康状况这些潜在混杂因素进行调整。结果显示 , 主观工作压力涉及因“太多的工作不顺心的时候 ,”“太多的责任 ,”“可怜与上司的关系”、“不允许犯错误”和“不能跟上新技术”和心理健康状态有关。因此，有人建议，主观的工作压力会损害工人的心理健康状况并引起困扰，这是非特异性反应导致伤害引起了一个人身体
40、的负面刺激，根据赛亚。 我们认识到，在我们的代表性研究中员工和他的上司人 际冲突可能是心理健康的一个重要危险因素。在国家职业安全与卫生研究所的模型中，这种类型的人际冲突涉及工作压力。因此，与上级和同事的合作关系，工作中的支援可能对保持健康的精神状态十分重要。我们的研究表明，“不能跟上新技术” ,是人的心理健康的另一种危险因素。尤其是在男性工人，在日本产业如电子工厂 ,- 7 - 工人被放置在高度自动化的情况。因此，工作有关的高度发达的技术可能是工作压力的来源。 我们对工作压力的定量估计可能低于或高于了工作压力的大小，因为工作压力可能受家庭压力的影响。因此，我们假设主观工作压力和家庭生活的不满情
41、绪 是相乘交互作用，并分析了逻辑回归中的互动模式。调整后的可能比值与主观工作压力和心理健康的互动比表明，定量测量的乘法作用在工作压力和家庭压力和两者交互作用之间。但是，正面的乘法交互模型不显着。从另一个角度来看，有空间来分析添加的交互模型。 本研究的目的是澄清主观的工作压力和心理健康的关系。从多因素逻辑回归控制混杂因素分析结果来看，不同类型的工作压力的主观认识被证明与有问题的心理健康状况有一定的相关因为普遍几率超过两倍程度。因此，我们的患病几率高于两倍，在主观工作压力和有问题的心理健康状况之间的因果比例应占超过 50。因此，进一步研究，以澄清工作压力和心理健康之间的因果关系，必须证明这一点。
