Tomoyuki KAWADA^(1)
(1)Department of Public Health. Gunma University School of Medicine - Maebashi. Japan

	[Hygiene, Public Health & Preventive Medicine]	[Occupational Health]

INTRODUCTION

Subjective complaint among Japanese industrial workers has been surveyed by a questionnaire or by interview. Questionnaire survey reflects relative evaluation of each subject against his/her desirable health level. Short questionnaire survey is frequently conducted for the opportunity of annual health examination, though its utilization seems to be not effective. Namely, medical check-up according to the law is precisely evaluated, but assessment of subjective complaint is sometimes unfinished. The author previously applied stress checklist to workers of a Railroad Company and evaluation by self-administered questionnaire is useful for promoting mental health support in the company ⁽¹⁾.

The author previously conducted mental health survey to know the association between subjectively evaluated health status and job. The type of work was divided into three as clerk, manufacturer, and sales. Among them, sales workers were marked as requiring mental health support ⁽²⁾. Afterward, stress level of manager was relatively lower than the other job categories ⁽³⁾. To reconfirm this association, the authors planned to conduct surveys using subjective complaints for the mental health management of workers in different job categories. Degree of subjective complaint is not only evaluated by the number of subjective complaints, but the number can easily be quantified and also related to the degree of subjective complaint to some extent.

MATERIAL & METHODS

The original subjective complaint questionnaire, consisted of 96 items (see Appendix), was distributed to 233 male and 106 female employees of a company in 1998 when they attended annual health examination. All subjects responded.

The ages of the male subjects ranged from 22 to 59, the average being 41.0 years, and the standard deviation 9.61. The ages of the female subjects ranged from 19 to 58, the average being 29.6 years, and the standard deviation 7.01. Score of subjective complaint was the check number of them. Job categories were classified into manufacturer, clerk, researcher, and manager in male workers. Female manager was not existed and job in female was classified into three categories.

The Student-Newman-Keuls multiple comparison were conducted. A software program for statistical analysis, SPSS for Windows (Ver. 9.0J) was used.

RESULTS

The distribution of the total number of complaints was shown in Fig. 1. About half of the subjects made within five complaints. Percentage of no complaints in male was significantly higher than that in female (24.0% vs 5.7%, p<0.01)Fig. 1.

The items in which the percentage of complaints exceeded 20 % only in female are continuous shoulder or neck stiffness and severe menorrhalgia. Headache, eye strain, dizziness, shoulder or neck stiffness, lumbar or back pain were sometimes complained over 20% both in male and female subjects. Among them, about half of the subjects complained of eye strain, though the VDT workers are under 3% of the target subjects. Related to this figure, 48.3% of the female and 28.5% of male complained of headache (Appendix).

There was a significant difference in the mean value of age among four types of male job by analysis of variance (p<.001) (Table 1). Age of manager was significantly higher and that of researcher was significantly lower than that of the other group, respectively (p<.05). In contrast, there was no significant difference in the mean value of age among three types of female job.

Table 1. Mean value of age divided by job

		Male		Female
Job	No	Mean+-SD (Range)	No	Mean+-SD (Range)
Manufacturer	76	41.5 +- 9.48 (22～57)	49	28.6 +- 7.91 (19～58)
Clerk	44	43.1 +- 9.40 (25～57)	21	31.1 +- 6.26 (23～48)
Researcher	68	33.8 +- 7.11 (22～53)	36	29.9 +- 6.05 (22～47)
Manager	45	48.8 +- 4.78 (40～59)
Total	233	41.0 +- 9.61 (22～59)	106	29.6 +- 7.01 (19～58)

There was a significant differences in the mean value of age among four groups of men´s job (p<0.001). Student-Newman-Keuls multiple comparison was applied, and the mean value of age of manager or researcher was significantly different than that of the other groups (p<.05).

Principal axis factoring analysis was conducted on 16 items. Factor loading over .40 was tentatively selected. Some items were different for men and for women, and six factors were extracted, respectively. In men, Factor 1 consisted of seven items, which related to depression and fatigue, accounting for 14.1% of the total variation. Factor 2 consisted of two items, which related to coping, accounting for 6.1% of the total variation. Factor 4 consisted of three items, which related to physical complaint, accounting for 4.5% of the total variation. Factor 3, 5 and 6 consisted of one item each, which related to worry, sleep induction, and stiff shoulder and neck, respectively. These three factors explained 5.8%, 4.3%, and 3.3% of the total variation (Table 2). Cronbach coefficient alpha for Factor 1, 2, and 4 were .76, .63 and .36, respectively. In women, Factor 1 consisted of two items, which related to depression, accounting for 9.2% of the total variation. Factor 2 consisted of three items, which related to worry, accounting for 9.1% of the total variation. Factor 3 consisted of three items, which related to fatigue, accounting for 8.1% of the total variation. Factor 4 consisted of two items, which related to shoulder, neck, and back pain, accounting for 7.3% of the total variation. Factor 5 and 6 consisted of one item each, which related to personal relationship and irregular menstruation, respectively. These two factors explained 5.3%, and 3.9% of the total variation (Table 2). Cronbach coefficient alpha for Factors 1 to 4 were .64, .59, .67 and .52, respectively.

Table 2. Varimax rotated principal axis factor analysis of the questionnaire. Yes response rate of each item higher than 5 % was selected.

Item	F1	F2	F3	F4	F5	F6	Comm.
Male
Var 2	.16	-.03	-.05	.52*	.02	.02	.30
Var 5	.07	-.03	.49	.38*	.01	.03	.16
Var 7	-.03	.08	.08	.27*	.03	.13	.10
Var29	.01	.09	.04	.18	.31	-.07	.14
Var35	.08	.14	.06	.19	.01	.55*	.37
Var44	.56*	.14	.08	.08	.25	.08	.41
Var45	.20	-.02	.08	-.11	.62*	.12	.46
Var46	.45*	-.03	.02	-.03	.05	.34	.32
Var47	.41*	.18	-.08	.20	.08	.04	.56
Var48	.58*	.18	.06	.04	.25	.03	.44
Var49	.25	.13	.76*	.15	.19	.07	.72
Var50	.53*	.08	.45	.04	-.08	.12
Var51	.57*	.22	.29	.07	.08	.09	.48
Var52	.31	.53*	.28	-.14	.01	.07	.48
Var53	.56*	.15	.17	.21	-.06	-.10	.42
Var54	.30	.70*	.03	.08	.12	.14	.61
% of exp.	14.08	6.14	5.79	4.49	4.25	3.29
Female
Var 2	.30	.30	.12	.21	.12	.04	.25
Var24	-.04	.00	.01	.02	.05	.33	.11
Var29	.04	-.04	.06	.06	-.22	-.05	.06
Var30	.00	.80*	.18	.08	.10	-.02	.69
Var35	.08	.02	-.07	.72*	-.15	.14	.57
Var36	.03	.17	.14	.56*	.19	.09	.41
Var44	.00	.20	.49*	.33	-.11	-.01	.41
Var45	.87*	.09	.13	.14	-.02	.01	.80
Var46	.30	.17	.11	-.04	.02	-.12	.15
Var48	.26	.33	.60*	-.04	-.05	.00	.54
Var49	.29	.42*	.17	.08	-.14	-.12	.33
Var50	.29	.02	.23	.36	.72*	-.15	.80
Var51	.44*	.29	.68*	-.04	.37	-.07	.89
Var53	.18	.48*	.10	.08	.12	.11	.31
Var56	-.02	.00	-.01	.12	-.07	.59*	.37
Var57	.24	.08	-.21	.01	.06	.26	.18
% of exp.	9.15	9.09	8.14	7.33	5.27	3.89

Factor loadings of 0.4 or higher by rounding are marked.

F1-6:Factor 1-6, Comm: Communality, exp.: explanation

Mean value in the number of subjective complaints divided by job was compared by the analysis of covariance controlling for age, which resulted significant in male (p<.05) (Table 3). Though not significant, the mean value for manufacturer was higher than that for manager (p=.062). In contrast, the mean value in the number of subjective complaints among three types of work was not different in female.

Table 3. Mean value in the number of subjective complaints divided by job

Job	Number	Mean +- SD	Mean (95%CI)
Male			(adjusted for age at 41.0)
Manufacturer	76	7.6 +- 7.70	7.5 (6.1～8.9)
Clerk	44	5.5 +- 4.91	5.2 (3.5～7.1)
Researcher	68	4.8 +- 6.00	5.6 (4.1～7.3)
Manager	45	5.2 +- 5.29	4.3 (2.4～6.3)
Total	233	5.9 +- 6.38
Female			(adjusted for age at 29.6)
Manufacturer	49	8.0 +- 6.19	8.2 (6.5～9.8)
Clerk	21	6.9 +- 4.79	6.6 (4.1～9.2)
Researcher	36	6.3 +- 6.08	6.2 (4.3～8.2)
Total	106	7.2 +- 5.90

There was a significant differences in mean values of subjective complaints among four groups of male job by analysis of covariance controlling for age (p<.05). Student-Newman-Keuls multiple comparison was applied, and the mean value of manufacturer was higher than that of manager (p=.062).

DISCUSSION

In this paper, the author used a new problem-check list of subjective complaints. By using non-scaled items for Japanese, the author intended to know the characteristics of questionnaire and also planed to clarify its application to workers. Namely, subjective complaint was compared among different jobs. Male manufacturer complained symptoms relatively frequently than manager, which result was in concordance with our previous work ⁽³⁾. Haratani et al. ⁽⁴⁾ reported better psychological health level as the job position increased. From the demand-control-support model ⁽⁵⁾, the authors speculate that the control factor seems to be effective for disappearing symptoms and then makes the subjects mentally better.

Consoli et al. ⁽⁶⁾ made a short, acceptable and reliable instrument for self-assessment of perceived stress for workers. Fig. 2 Stress global score was correlated with socio-professional status: unskilled and skilled workers such as technicians exhibited significantly lower scores (lower stress) than clerical workers or engineers. Namely, the blue collars and technicians were under less stressful situation than white collars and engineers. In contrast, Ohta et al. ⁽⁷⁾ reported that blue-collar workers have much more physical complains and show depressive state than others fig. 3

Though the criteria of blue collar are sometimes difficult, stress may be partly derived from poor knowledge of coping.

CONCLUSIONS

Though not significant, the mean value in the number of subjective complaints of manufacturer was larger than that of manager (p=.062). In contrast, there was no significant difference in the mean value of subjective complaints among three job categories in female. Considering the result of our past survey, manager seems to be less stressful because of the freedom of conducting work.

APPENDIX

Subjective complaint questionnaire

Please check on each item if you have symptom.

This appendix also includes yes response rate of each item in male and female, respectively

< 1> < 0.38, 1.72> I have always headache

< 2> < 8.75,15.52> I have always eyestrain

< 3> < 3.04, 0.86> I have always tinnitus

< 4> < 0 , 2.59> I have always dizziness

< 5> < 7.6 , 1.72> I have always rhinitis and nasal discharge

< 6> < 0.38, 0 > I have always nasal bleeding

< 7> < 6.08, 0 > I have always cough and sputum

< 8> < 0.38, 0 > I have always bloody sputum

< 9> < 0 , 0 > I have always hoarseness

<10> < 0 , 0 > I have always dyspnea

<11> < 2.28, 0.86> I have disagreeable sensation on chest at rest

<12> < 4.56, 1.72> I have disagreeable sensation on chest at exercise

<13> < 1.9 , 1.72> I have disagreeable sensation on chest at sleep

<14> < 0 , 0 > I have always arrhythmia or severe palpitation

<15> < 1.14, 1.72> I have always palpitation or shortness of breath by mild exercise

<16> < 0.38, 1.72> I have always edematous on face or foot

<17> < 0.38, 0 > I have always dysphagia

<18> < 0 , 0.86> I have always nausea

<19> < 0 , 4.31> I have always heart-burning or epigastral discomfort

<20> < 0.38, 0.86> I have always epigastralgia

<21> < 0 , 0 > I have always sub-umbilical pain

<22> < 0 , 0 > I have always flank pain

<23> < 1.14, 0 > I have always diarrhea

<24> < 2.28,13.79> I have always constipation

<25> < 0 , 0 > I have always thin stool

<26> < 0 , 0 > I have always bloody stool

<27> < 0 , 0 > I have always tarry stool

<28> < 3.04, 2.59> I am always thirsty

<29> < 6.46, 5.17> I am always sweating

<30> < 4.56,10.34> I am sensitive to the cold

<31> < 0.38, 0 > I have always appetite-loss

<32> < 0.76, 0.86> I have emaciation in the past 1 year

<33> < 2.28, 0.86> I am obese in the past 1 year

<34> < 2.28, 3.45> I have always joint or muscle pain

<35> <12.55,33.62> I have always shoulder stiffness or neck stiffness

<36> < 4.56,11.21> I have always lumbar or back pain

<37> < 0.76, 0 > I have always numbness on hands or feet

<38> < 0 , 0 > I have always tremor on hands or feet

<39> < 0 , 0 > I have always miction pain

<40> < 0 , 0 > I have always hematuria

<41> < 0.76, 0 > I have always incomplete miction

<42> < 1.90, 0.86> I have always pollakisuria

<43> < 3.04, 2.59> I have always skin itching

<44> <16.35,18.10> I have always fatigue

<45> <10.65,14.66> I have always difficult of sleep induction

<46> < 9.89,11.21> I am always awake in the midnight frequently

<47> < 6.08, 4.31> I am awake early in the morning and cannot go to sleep anymore

<48> <11.79,10.34> I lose of patience or eagerness

<49> <15.97,17.24> I am worry

<50> < 7.22, 6.03> I have problems of human relationship in the workplace

<51> <10.65, 8.62> I am depressed

<52> < 6.84, 0 > I have no people to consult with when embarrassing

<53> <24.33,33.62> I am difficult to go to work in the morning

<54> < 9.89, 2.59> I cannot enjoy everyday life

<55> < 0.76, 0.86> I have something to consult with

<56> < － ,18.10> I have irregular menstruation

<57> < － ,21.55> I have severe menorrhalgia

<58> < － , 2.59> I have uterine hemorrhage

<59> < － , 2.59> I have problems on menopause symptom

<60> <28.52,48.28> I have sometimes headache

<61> <45.25,50.00> I have sometimes eye strain

<62> <13.69,16.38> I have sometimes tinnitus

<63> <22.81,34.48> I have sometimes dizziness

<64> <17.49,18.10> I have sometimes rhinitis and nasal discharge

<65> < 5.32, 5.17> I have sometimes nasal bleeding

<66> <18.25, 4.31> I have sometimes cough and sputum

<67> < 2.28, 0 > I have sometimes bloody sputum

<68> < 5.32, 2.59> I have sometimes hoarseness

<69> < 5.70, 8.62> I have sometimes dyspnea

<70> < 7.98, 5.17> I have sometimes arrhythmia or severe palpitation

<71> <10.65,11.21> I have sometimes palpitation or shortness of breath by mild exercise

<72> < 6.08,12.07> I have sometimes edematous on face or foot

<73> < 3.04, 0.86> I have sometimes dysphagia

<74> < 7.22, 7.76> I have sometimes nausea

<75> <19.77,18.97> I have sometimes heart-burning or epigastral discomfort

<76> < 7.98, 7.76> I have sometimes epigastralgia

<77> < 1.90, 8.62> I have sometimes sub-umbilical pain

<78> < 3.42, 2.59> I have sometimes flank pain

<79> <18.25,19.83> I have sometimes diarrhea

<80> < 8.75,18.97> I have sometimes constipation

<81> < 2.28, 1.72> I have sometimes thin stool

<82> < 1.14, 2.59> I have sometimes bloody stool

<83> < 0.76, 0 > I have sometimes tarry stool

<84> <13.31, 6.03> I am sometimes thirsty

<85> < 7.98, 3.45> I am sometimes sweating

<86> < 6.84, 6.03> I have sometimes appetite-loss

<87> <14.07, 9.48> I have sometimes joint or muscle pain

<88> <26.24,30.17> I have sometimes shoulder stiffness or neck stiffness

<89> <20.15,24.14> I have sometimes lumbar or back pain

<90> < 3.80, 4.31> I have sometimes numbness on hands or feet

<91> < 2.28, 2.59> I have sometimes tremor on hands or feet

<92> < 0.38, 0 > I have sometimes miction pain

<93> < 0.76, 0 > I have sometimes hematuria

<94> < 4.56, 0.86> I have sometimes incomplete miction

<95> < 4.94, 3.45> I have sometimes pollakisuria

<96> <12.93,13.79> I have sometimes skin itching

BIBLIOGRAPHY

Kawada T, Kato K, Iijima T. Psychometric properties of stress check list for self and its relationship to health satisfaction and psychological traits (extroversion - introversion). J Occup Health 1997; 39: 223-7.
Kawada T, Suzuki S. Subjective symptoms and personality by the job -analysis of scale score of the Todai Health Index applied to employee in a dairy product company - Minzoku Eisei 1995; 61: 25-32 (in Japanese).
Kawada T. Psychometric properties of a stress questionnaire and its use in the workplace. Psychological Reports 1999; 85: 131-7.
Haratani T. Factors affecting mental health of manager in a company. Roudou no Kagaku 1993; 48: 336-9 (in Japanese).
Johnson JV, Hall EM. Job strain, work place social support, and cardiovascular disease: A cross-sectional study of a random sample of the Swedish working population. Am J Pub Health 1988; 78: 1336-42.
Consoli SM, Taine P, Szabason F, Lacour C, Metra PC. Development and validation of a perceived stress questionnaire recommended as a follow-up indicator in occupational medicine. Encephale 1997; 23: 184-93 (in French).
Ohta A, Takeuchi K, Sasazawa Y, Suzuki S. Differences in lifestyle and perceived health in different occupations in a community. J Occup Health 1998; 40: 325-33.

Discussion Board

Any Comment to this presentation?

[ABSTRACT] [INTRODUCTION] [MATERIAL & METHODS] [RESULTS] [IMAGES] [DISCUSSION] [CONCLUSIONS] [APPENDIX] [BIBLIOGRAPHY] [Discussion Board]

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	[Hygiene, Public Health & Preventive Medicine]	[Occupational Health]

Tomoyuki KAWADA
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Last update: 4/01/00