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Psychosocial risk factors, job characteristics and self-reported health in the Paris Military Hospital Group (PMHG): a cross-sectional study

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      To investigate the associations between psychosocial risk factors and self-reported health, taking into account other occupational risk factors.


      Cross-sectional survey using a self-administered questionnaire.


      The three military hospitals in Paris, France.


      Surveys were distributed to 3173 employees (1807 military and 1336 civilian), a total of 1728 employees completed surveys. Missing data prohibited the use of 26 surveys.

      Primary and secondary outcome measures

      The authors used Karasek's model in order to identify psychosocial factors (psychological demands, decisional latitude, social support) in the workplace. The health indicator studied was self-reported health. Adjustments were made for covariates: age, gender, civil or military status, work injury, ergonomic score, physical and chemical exposures, and occupational profile. Occupational profile was defined by professional category, department, work schedule, supervisor status and service-related length in the hospital.


      Job strain (defined as high psychological demands and low decisional latitude) (adjusted OR 2.1, 95% CI 1.5 to 2.8, p<0.001) and iso-strain (job strain with low social support) were significantly associated with moderate or poor self-reported health. Among covariates, occupational profile (p<0.001) and an unsatisfactory ergonomic score (adjusted OR 2.3 95% CI 1.6 to 3.2, p<0.001) were also significantly associated with moderate or poor self-reported health.


      The results support findings linking moderate or poor self-reported health to psychosocial risk factors. The results of this study suggest that workplace interventions that aim to reduce exposure to psychological demands as well as to increase decisional latitude and social support could help improve self-reported health.

      Article summary

      Article focus
      • Health professionals reported frequently distress at work due to work overloads and the constant confrontation with illness.

      • We wanted to investigate the associations between psychosocial risk factors and self-reported health in a military hospital group.

      Key messages
      • Job strain and iso-strain were found to be associated with poor self-reported health.

      • Self-reported health is a unique indication that succeeds in estimating the multidimensional nature of health. It is a relevant synthetic indicator of actual health status.

      Strengths and limitations of this study
      • One of the strong points is that this study simultaneously explore psychosocial risk factors and occupational risk factors.

      • The nature of the studied population and different response rates between civilian and military staff limit the generalisation of the results to healthcare workers in non-military settings.

      Related collections

      Most cited references 35

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      Self-rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population.

      The validity of various self-reported health assessments in predicting physician contracts and all-cause mortality was investigated in a prospective study in Finland. The follow-up periods were one year for the use of physician services and ten years ten months for the mortality. The study cohort comprised 1340 men and 1500 women, 35-63 years of age at the beginning of the study. The initial health assessments were derived from postal questionnaires in 1980 (response rate 77.5%). The survey was repeated one year later to verify the stability of the respondents' perceived health status. The data on the physician contacts and mortality were registered independently. The stability of perceived health status was relatively good and the perceived health was inversely associated with the number of physician contacts per year. A consistent inverse association, standardized by age, sex and social status, was observed between perceived health status and perceived physical fitness and mortality, while the predictive value of self-reported chronic diseases was low. The results suggest that the subjective health assessments are valid health status indicator in middle-aged populations, and they can be used in cohort studies and population health monitoring.
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        Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study.

        To determine the association between adverse psychosocial characteristics at work and risk of coronary heart disease among male and female civil servants. Prospective cohort study (Whitehall II study). At the baseline examination (1985-8) and twice during follow up a self report questionnaire provided information on psychosocial factors of the work environment and coronary heart disease. Independent assessments of the work environment were obtained from personnel managers at baseline. Mean length of follow up was 5.3 years. London based office staff in 20 civil service departments. 10,308 civil servants aged 35-55 were examined-6895 men (67%) and 3413 women (33%). New cases of angina (Rose questionnaire), severe pain across the chest, diagnosed ischaemic heart disease, and any coronary event. Men and women with low job control, either self reported or independently assessed, had a higher risk of newly reported coronary heart disease during follow up. Job control assessed on two occasions three years apart, although intercorrelated, had cumulative effects on newly reported disease. Subjects with low job control on both occasions had an odds ratio for any subsequent coronary event of 1.93 (95% confidence interval 1.34 to 2.77) compared with subjects with high job control at both occasions. This association could not be explained by employment grade, negative affectivity, or classic coronary risk factors. Job demands and social support at work were not related to the risk of coronary heart disease. Low control in the work environment is associated with an increased risk of future coronary heart disease among men and women employed in government offices. The cumulative effect of low job control assessed on two occasions indicates that giving employees more variety in tasks and a stronger say in decisions about work may decrease the risk of coronary heart disease.
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          Predicting mortality and healthcare utilization with a single question.

          We compared single- and multi-item measures of general self-rated health (GSRH) to predict mortality and clinical events a large population of veteran patients. We analyzed prospective cohort data collected from 21,732 patients as part of the Veterans Affairs Ambulatory Care Quality Improvement Project (ACQUIP), a randomized controlled trial investigating quality-of-care interventions. We created an age-adjusted, logistic regression model for each predictor and outcome combination, and estimated the odds of events by response category of the GSRH question and compared the discriminative ability of the predictors by developing receiver operator characteristic curves and comparing the associated area under the curve (AUC)/c-statistic for the single- and multi-item measures. All patients were sent a baseline assessment that included a multi-item measure of general health, the 36-item Medical Outcomes Study Short Form (SF-36), and an inventory of comorbid conditions. We compared the predictive and discriminative ability of the GSRH to the SF-36 physical component score (PCS), the mental component score (MCS), and the Seattle index of comorbidity (SIC). The GSRH is an item included in the SF-36, with the wording: "In general, would you say your health is: Excellent, Very Good, Good, Fair, Poor?" The GSRH, PCS, and SIC had comparable AUC for predicting mortality (AUC 0.74, 0.73, and 0.73, respectively); hospitalization (AUC 0.63, 0.64, and 0.60, respectively); and high outpatient use (AUC 0.61, 0.61, and 0.60, respectively). The MCS had statistically poorer discriminatory performance for mortality and hospitalization than any other other predictors (p<.001). The GSRH response categories can be used to stratify patients with varying risks for adverse outcomes. Patients reporting "poor" health are at significantly greater odds of dying or requiring health care resources compared with their peers. The GSRH, collectable at the point of care, is comparable with longer instruments.

            Author and article information

            [1 ]HIA Bégin, Centre de Médecine de Prévention des Armées, Saint-Mandé, France
            [2 ]Centre d'Epidémiologie et de Santé Publique des Armées, HIA Bégin, Saint-Mandé, France
            [3 ]Département de Psychiatrie, HIA Percy, Clamart, France
            [4 ]Direction Centrale du Service de Santé des Armées, Vincennes, France
            Author notes
            [Correspondence to ] Dr Jean-François Ferrand; ferrand.jeff@
            BMJ Open
            BMJ Open
            BMJ Open
            BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )
            31 July 2012
            : 2
            : 4
            22855624 4400733 bmjopen-2012-000999 10.1136/bmjopen-2012-000999
            Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

            This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

            Occupational and Environmental Medicine



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