Hans-Martin Hasselhorn*, M.D. (1), Niklas Hammar, Ph.D. (2,3), Lars Alfredsson, Ph.D. (3), Peter Westerholm, Ph.D. (4), Töres Theorell, Ph.D., M.D. (1,5), and the WOLF-Study Group; (1) Div. of Psychosoc. Factors and Health, Karolinska Institutet (2) Dept. of Epid., Karolinska Hospital (3) Inst. of Environm. Med., Karolinska Institutet (4) National Inst. for Working Life (5) Nat. Inst. for Psychos. Factors and Health

Introduction: Job strain (high psychological job demands and low decision latitude) is associated with an increased risk for myocardial infarction (MI). In the WOLF study (Work Lipids and Fibrinogen) the relationship of job strain to hypertension, serum lipids and plasma fibrinogen is being studied as these factors are risk factors for MI.

Method: In this part of the WOLF study individual evaluation of psychological demands and decision latitude at the work place (self-administered questionnaire, 6 questions on "decision latitude" and 5 on "demand") as well as the responding external evaluation by the local occupational health unit (3 questions on "decision latitude", 2 on "demand") were related to blood pressure, serum lipids and plasma fibrinogen.

Results: Altogether 3807 workers (2275 men, 1532 women) were included in this evaluation. Externally rated decision latitude showed a highly significant positive correlation with the individual evaluation index (R2=.31 for men, .24 for women. p<.001. Linear regression, contr. f. age). External rating of psychological demands was not strongly but positively associated with the individual scores (p<.001). In general, higher correlations were found for men, younger and blue collar workers. Individual and external ratings mostly showed similar tendencies when the prevalence ratio (PR, contr. f. age, body mass index and smoking) was calculated for adverse blood lipids and fibrinogen particularly in men. Those with job strain did not have a consistently more adverse risk profile when compared with those with high decision latitude and low demands. Men with both high decision latitude and high job demands ("active") had an increased risk for an adverse ldl/hdl ratio (external evaluation: PR 1.5, 95%CI 1.1-1.9), and showed a tendency towards high fibrinogen and a high apolipoproteinB/A1 ratio. Similar tendencies were found in women. For men who were externally rated to be exposed to job strain but did not report this themselves, lower PRs for an adverse ldl/hdl ratio (.7 [.5-1.0]) and high blood pressure (.6 [.4-.9]) were found.

Conclusions: External evaluation of psychosocial working conditions correlates well with individual ratings when concerning decision latitude but less so demand. Our results do not support a strong association of high job strain with an adverse blood lipid profile or with high fibrinogen. The associations found were weak but were more pronounced when external rating was applied.

CORRESPONDING AUTHOR: H.-M. Hasselhorn, M.D., Div. of Psychosocial Factors and Health, Dept. of Publ. Health Sc., Karolinska Institutet, S-17177 Stockholm

Paul A. Landsbergis, EdD, MPH, Cornell University Medical College, Peter L. Schnall, MD, MPH, University of California, Irvine, Katherine Warren, Thomas G Pickering, MD, DPhil, Cornell University Medical College, and Joseph E Schwartz, PhD, State University of New York at Stony Brook

Some studies have suggested that the effect of job strain on CDV is greater among men who are older, have higher blood pressure, have lower social support, or have lower socioeconomic status (SES). We tested this hypothesis in a sample of 285 healthy male employees, aged 30-60 at initial recruitment, at 8 New York City work sites, 195 of whom were restudied 3 years after their initial participation. Mean systolic (SAmBP) and diastolic (DAmBP) ambulatory blood pressure at work, home and during sleep were computed from 24-hour recordings and diary entries specifying location. Multiple regression analysis was used to examine the cross-sectional and prospective associations of AmBP with job strain, controlling for age, body mass, race/ethnicity, smoking, alcohol consumption, education, and physical exertion on the job. Interaction terms were computed by multiplying job strain by age, hypertensive status at Time 1 (>85 mm Hg clinic DBP on 2 separate occasions), coworker and supervisor support, years of education, occupational status (scale of 1-99), occupational category (white-collar; clerical, technical or administrative; blue-collar) and personal and family income.

The association of job strain and AmBP at Time 1 was much stronger among older men. Compared to 30-40 year olds without job strain, 51-60 year olds with job strain had 18.7 mm Hg higher SAmBP, but 30-40 year olds with job strain had only 0.8 mm Hg higher SAmBP (interaction term: p=.02). The job strain-AmBP association at Time 1 was also much stronger among men with mild hypertension. Compared to controls without job strain, cases with job strain had 18.5 mm Hg higher SAmBP, but controls with job strain had only 0,4 mm Hg higher SAmBP (interaction term: p=.006). The job strain-AmBP association at Time 1 was also somewhat stronger among men with lower SES. For example, compared to men with a college degree without job strain, men with only a high school degree or less and with job strain had 7.2 mm Hg higher SAmBP, but college graduates with job strain had only 2.6 mm Hg higher SAmBP (interaction term: p=.08). No significant main effects of workplace social support nor any significant interactions between job strain and social support were observed. Similar interaction effects were observed for change in AmBP over 3 years.

CORRESPONDING AUTHOR: Paul Landsbergis, Division of Hypertension, Starr 416, Cornell University Medical College, 525 east 68 St., New York, NY 10021

Schnall Peter L, University of California, Irvine, Landsbergis Paul A, Warren Katherine, Pickering Thomas G, Schwartz Joseph E, Cornell University Medical College, NY.

Purpose: 'Job Strain' (defined as high demands and low control) has been previously associated with increased risk of cardiovascular disease (CVD) and, cross-sectionally, with hypertension and elevated ambulatory blood pressure (AmBP). Our longitudinal cohort study was designed to investigate the hypothesis that exposure to 'job strain' is causally related to increase in mean AmBP.

Methods: The sample consists of 285 healthy male employees, aged 30-60 at initial recruitment, at 8 New York City worksites, 195 of whom were restudied 3 years after (Time 2) and 195 of whom were restudied 6 years after (Time 3) their initial participation. Mean systolic (SAmBP) and diastolic (DAmBP) ambulatory blood pressure at work, home and during sleep were computed from 24-hour recordings and diary entries specifying location. The relationship of 'job strain' to AmBP was examined cross-sectionally at each round of data collection. A 'job strain' change variable was constructed with four categories: those defined as having no 'job strain' at either Time 1 or Time 2 (N=138), those reporting 'job strain' at both times (N=15), and two groups which changed 'job strain' status. We repeated this analysis comparing Times 1 and 3 and Times 2 and 3. Multiple regression analysis was used to examine the cross-sectional associations of AmBP with 'job strain', as well as to predict 3 year and 6-year change in AmBP with 'job strain' change, controlling for age, body mass, race/ethnicity, smoking status, alcohol consumption, education, sodium and physical exertion level of the job.

Results: Cross-sectional analyses at Time's 1, 2 & 3 showed consistent significant effects of 'job strain' on AmBP. With subjects reporting 'job strain' having work SAmBP/DAmBP which were 5-7/3-5 mm Hg higher than subjects without 'job strain'. Men facing chronic 'job strain', that is working in high strain jobs at both Time 1 and Time 2 had work SAmBP/DAmBP on average, 10-12/6-8 mm Hg higher than those with no 'job strain' at both times. In longitudinal analyses, subjects who changed from exposure to 'job strain' to no exposure thee or six years later had a decrease in SAmBP/DAmBP of about 5/3 mm Hg.

Conclusions: The previously reported cross-sectional association between 'job strain' and AmBP was replicated twice during follow-up periods. Repeated exposure to 'job strain' was associated with the highest levels of AmBP's, but not with any further increases in AmBP. However, changes in 'job strain' status predicted change in AmBP over three and six year periods. 'Job strain' emerges as a consistent and substantial risk factor for AmBP in men.

Mark Cropley, Ph.D., and Andrew Steptoe, D.Sc., St. George’s Hospital Medical School, University of London, UK.

It has been proposed that the impact of job strain (high demand / low control) on coronary heart disease and hypertension is mediated by heightened cardiovascular and neuroendocrine stress responsivity. However, studies using standardized mental stress testing have not shown differences in responsivity between low and high job strain groups. We tested the hypothesis that people experiencing high job strain would be especially responsive to uncontrollable stressors, but not to controllable behavioral demands. We also assessed ambulatory blood pressure and heart rate, predicting that high job strain individuals would show deficits in homeostatic regulation, leading to a failure to "unwind" after work.

Participants were 162 school teachers (60 men, 102 women), selected from a survey of 755 teachers as reporting high or low job strain. Blood pressure, heart rate, skin conductance and cortisol responses controllable (self-paced) and uncontrollable (externally-paced) computerised tasks were recorded under standardized conditions. Blood pressure and heart rate were monitored from 9.00 am – 10.30 pm on a working day and subsequent evening.

High and low job strain groups did not differ in demographic factors, body mass or resting cardiovascular activity. Blood pressure reactions to the uncontrollable task were significantly greater in high than low job strain groups. Physiological responses to the controllable task were not significantly different between job strain groups, even though the range of individual responses was similar for the two tasks. Systolic and diastolic blood pressure over the working day was similar in the two groups. However, blood pressure decreased in the evening to a greater extent in the low job strain participants. The maintenance of blood pressure levels from the day to evening in the high strain group was independent of age, body mass index, posture and resting blood pressure. Subjective ratings taken at the same time as blood pressure measures showed greater self-reported pressure and lower control in the teachers with high job strain.

These data highlight ways in which psychophysiological responses may mediate the impact of work experience on cardiovascular disease risk. People experiencing high job strain may be selectively responsive physiologically to experiences that are perceived as uncontrollable, and show failures to unwind after work that contribute to risk.

CORRESPONDING AUTHOR: Andrew Steptoe, D.Sc. Department of Psychology, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.

Andrew B. Littman, MD 1,2, L. Christine Oliver, MD 2,1, Nancy Asdigian, Ph.D. 3 , Penny Snell, 2, Ray Gaita, 2. Massachusetts General Hospital 1, Occupational Health Institute 2, Public Health Research Institute 3, Boston, MA

Among blue collar workers generally, stress has not been well studied. Risk factors for stress in this group and, in turn, the extent to which stress itself serves as a risk factor for other adverse health outcomes are not clear. The present study was carried out to examine baseline and follow-up health status and outcome in workers on a large highway construction project in the northeastern United States.

An integrated data system that includes both primary and secondary databases has been created to evaluate stress, cardiovascular and respiratory illness and disease, and accidents and injuries among laborers, tunnel workers, and operating engineers (OE) on this construction project. Primary data is obtained from baseline and annual follow-up union-based health surveys of these trades. Secondary databases are: workers' compensation (WC) claims from 1992 and union health and welfare fund (HWF) claims from 1994. Denominator data of hours worked (as person-years) is used to calculate rates for claims by type for WC and by ICD-9 code for HWF.

In the longitudinal health survey, in addition to a detailed health and exposure history, questionnaires were used to measure psychological stress: Kellner Symptom Questionnaire (KSQ), 96 item self-report scale measuring anxiety, hostility, depressive symptoms, total distress; and Karasek Job Content Questionnaire (KJCQ), evaluating psychological job demands and decision latitude, as well as job strain (decision latitude/psychological demand).

A total of 296 workers has been examined to date. (Laborers= 132, tunnel workers= 45, and OE's= 119. Most are white (87%) males (90%), married (60%) with mean age of 41 years and duration of work of 12 years. KJCQ subscales raw scores did not differentiate job trade or union local, while the use of job strain category did. KSQ raw scores did not differentiate job trade or union local, except for small but significant differences of hostility and total distress differentiating union locals. This difference was much more robust when evaluating the frequency of workers in different trades and locals with a level of total distress or hostility above a prior predetermined clinically relevant level (relative risks 2.5-3.0). Evaluating average KSQ scores by KJCQ job strain category was not useful except for mild mean elevations psychological symptoms in the high job strain group (low decision latitude/high psychological demand). All workers with different job stress levels measured by KJCQ job strain categories and evaluated for the frequency of those workers with significant levels of psychological symptomatology demonstrated dramatic differences somatic, depressive, and hostility symptoms. Finally, a pilot evaluation of workers with significant depressive symptoms appear to have elevated levels risk factors and prevalence of cardiovascular disease.

This preliminary data suggests that there are significant differences in the frequency of job strain and clinically significant psychological symptomatology in subgroups of workers not explained by job classification. Various hypotheses explaining these differences will be offered. For the workers in aggregate, the level of job strain is strongly related to the frequency of clinically relevant levels of psychological symptoms.

This research funded by: Center to Protect Workers' Rights/NIOSH

CORRESPONDING AUTHOR: Andrew B. Littman, MD, RSHB-090, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA

Chair: Irene Houtman, Dr., NIA TNO; Presenters: Pascal Paoli, European Foundation; Kaisa Kauppinnen, Finnish Institute of Occupational Health; Inger Eklund, Department of Labour and Educational Statistics, Working Environment; Anders Wikman, Arbejdslivsinstituttet; Irene Houtman, NIA TNO.

Aim of this symposium is to present both data from different European ‘monitors’or surveys, and methodological issues, particularly with respect to the area of occupational stress.

In this symposium data are presented on trends in occupational stress risks.

Pascal Paoli presents data from the European Foundation surveys, in which data are collected in all 15 European member states. He presents prevalences and trends in psychosocial risk and identifies risk groups.

Kaisa Kaupinnen pays attention to one specific risk group: women. She uses the same European Foundation Survey.

Inger Eklund presents data from the Swedish Working Environment Survey. In her presentation she particularly goes into the relation between psychosocial risks as determinants of musculoskeletal problems, like repetitive strain injuries.

Irene Houtman presents data from the Dutch Monitor on Stress and Physical Load, in which data from both employers and employees were collected on risks, health outcomes and prevention. Recently for a subgroup a one-year follow-up was performed.

Anders Wikman concludes with a discussion on the use of surveys to collect data about psychosocial issues.

For each presentation a separate abstract is included.

CORRESPONDING AUTHOR: Irene Houtman, NIA TON, PO Box 718, 2130 AS, Hoofddorp, The Netherlands

Pascal Paoli, European Foundation for the Improvement of Living and Working Conditions

The Foundation has been monitoring the conditions of work and particularly psychosocial conditions and their consequences for health in all 15 member States of the European Union. Each country sample was representative for the country and consisted of about 1000 employees.

The analysis of these data (and of national data sources on these issues) indicates that:

• Work intensity is increasing in all Member States, overall workers work faster and to tighter deadlines.
• Autonomy at work is also on the increase, but this increase is not sufficient to compensate for the increased intensity of work. This means that more workers are confronted with work situations under great strain.
• Jobs can be divided into 4 categories:
• passive jobs, which are characterised by low demands (low work intensity) and little control over the work environment (little influence on the pace of work and work organisation). Those jobs are mainly held by unskilled blue collar workers;
• low strain jobs, which are characterised by low demands and high control over the work environment (influence on the pace of work and work organisation). Administrative and service workers are most prominent in this category;
• active jobs, which are characterised by high demands (high work intensity) and high control over the work environment. Managerial and white collar professionals are most prominent in this category;
• high strain jobs, which are characterised by high demands and low control. Skilled blue collar workers are most prominent in this category.
• High strain jobs, which are most likely to create occupational stress, are to be found mainly:
• among skilled blue collar workers;
• in the transport sector, in catering and in metal manufacturing;
• among young workers;
• equally among male and female workers (In 1991 the proportion of male workers in high strain jobs was higher than that of female workers).
• High strain jobs, that is to say jobs with high intensity and low autonomy, lead to a higher number of health complaints from workers (stress, burn-out). Overall 28% of workers report stress and 20% report burn-out.
• The profiles described above confirm to a large extent the on-going tayloristic division of work in Europe.

These results are discussed in the light of policy developments in Europe and in particular in the light of the obligation for companies to carry out regular risk assessments. Models such as the job demand/job control model might provide a good basis for the identification of risk situations and groups at risk and the setting up of health prevention policies.

CORRESPONDING AUTHOR: Pascal Paoli, Wyattville Road, loughlingstown, Dublin, Ireland.

Kaisa Kauppinen, and Irja Kandolin, Finnish Institute of Occupational health

Around the EU, women are forming an ever growing proportion of the working population, and women’s employment rates continue to increase. Women’s foothold in the European labor market is different today than 10 or 20 years ago. The change has been dramatic, however, inequality of wages and lack of career opportunities for women are still big problems.

Gender segregation of work is strong and it extends both across and within occupations. Women’s jobs are characterized by elements of caring, nurturing, and supportive roles, while men monopolize the ‘heavy’ manual, technical and managerial tasks. Important national differences in these broad patterns exist. There is a risk for increased gender segregation in working life.

Altogether 17% of employed women and one-third of men hold supervisory positions. Women usually supervise small work units with 1-5 persons. Women’s roles refer to middle-management positions. There is a ‘glass ceiling’ which stops qualified women from advancing to higher organizational positions. The results showed that there was more communication, participation, team-work, an less immediate managerial control in female-supervised than in male-supervised workplaces.

A good 3% of the women had been subjected to sexual harassment over the past 12 months at the workplace, while 4% had been subjected to sexual discrimination and unfair treatment. Women in precarious employment were more often subjected to sexual harassment than those in permanent employment. The attacked persons reported health disorders, fatigue, headaches, and stress. Altogether, 29% of women and 27% of men felt stress was affected by work, another 20% felt overall fatigue, and 11% felt irritable.

This study was prepared by Kaisa Kauppinen and Irja Kandolin, and it was based on an analysis of the findings of the Second European Survey on Working Conditions conducted in 1996 by the European Foundation for the Improvement of Living and Working Conditions, Dublin, Ireland.

CORRESPONDING AUTHOR: Kaisa Kauppinen, PhD. Section Chief, Adjunct Professor, Finnish Institute of Occupational Health,

Inger Eklund, Department of labour and educational statistics, Working Environment

This paper presents the Swedish Working Environment Survey and how the results from the survey are used for describing how the risk of developing physical pain or repetitive strain injuries is linked to strain in the working environment .

Since 1989 SCB undertakes continuous surveys of the working conditions in Sweden by questioning 10,000 to 15,000 persons of the working population every other year. The Labour Force Survey is used as a foundation for the Working Environment Survey. The investigation is partly carried out by interviews, partly by questionnaires. In 1997 the questionnaire consisted of around 130 questions.

Forty four percent of the people that answered the questionnaire report that they cannot dismiss the job from their thoughts when they are off work at least one day a week and 17% have a hard time sleeping because thoughts about the work keep them awake. Thirty-one percent of the women and 39% men feel they have so much to do that they have to skip lunch, work late, or bring the work home, at least one day a week. It is three times more common to have pain in the upper part of the back or in the neck every day for women who work in a twisted posture at least ¼ of the working time and every week have so much to do that they have to skip lunch, work late or take work home with them, than for those who work less than ¼ of the time in twisted posture and less than every week must skip their lunch etc. For men it’s nearly four times more common. Also, three out of five women that work with their hands raised to the level of their shoulders and have so much to do so they must skip their lunch etc. report that they have pain in their shoulders or arms. The results show that there is a relation between the physical working environment - repetitive and/or heavy work, work in twisted posture and the influence in planning the work, the working pace and the amount of work.

The relationship found above is discussed in the light of other data available, e.g. by the fact that workplaces have become highly computerised. About 61% of the working population use such highly computerised equipment, and about 55% spend some time in front of a display monitor. During the last thirteen years, the Swedish amount of computerised work that needs a display monitor has increased greatly. The increase is from 16% to 54% for women, and from 17% to 57% for men. Also 17% women and 9% men have been exposed to violence or threat of violence at work in the last year, 8%, for both women and men, have been exposed to bullying from superiors or fellow workers, and 5% of women and 1% of men have been exposed to sexual harassment from other persons than superiors or fellow workers at their workplace during the last 12 months.

CORRESPONDING AUTHOR: Inger Eklund, department of Labour and Educational Statistics, Working Enviroment. PO Box 24 300, S-104 51 Stockholm, Sweden.

Anders Wikman, Arbejdslivsinstituttet

Surveying is very much about registering peoples imperfect efforts to draw a picture of themselves and their surroundings. It is also about dealing with imperfect communication systems to transfer descriptions and impressions between people who have partly different reference backgrounds and use partly different abstract terms. The difficulties can be expected to be of different extent in different situations though.

Consequently, questions can not be about anything. There are obvious limits to what can be brought up. The limits are furthermore reasonably different to different people. We can only ask about things that have an evident "substance". That means that we can only ask about conditions that people have observed clearly and memorised, or conditions they have given much thought to. The questions must furthermore be able to sufficiently transfer, i.e. communicate these conditions. We must be able to "understand" and "picture" what the respondent really means.

That also means that description questions are preferable before judgement questions, among other things, because it is easier to communicate with the first type of questions and they often have a more concise meaning. Most preferable are those description questions that refer to close everyday life experiences. Furthermore, when reactions and attitudes are registered "angles towards the problems" should be chosen that are most easily communicated even if they do not capture what is most preferable.

The use of questions in surveys might give the impression that one often chooses indicators by what is theoretically most interesting and disregard what is difficult to measure technically. It seems as if ...

the difficulties to measure what is of most interest to measure are underestimated,

but at the same time the value of measuring something else that is easier to measure is underestimated.

To succeed you have to use your fantasy to find out such aspects of the problems that are really measurable and at the same time interesting enough to help to illuminate the problems.

The scepticism one can feel towards many survey results, emanates from, among other things, the information difficulties we all knew that we are confronted with in our every day life. Our mind has to handle all the time a very large number of facts and impulses. The task our nervous system then has to deal with is both extensive and difficult. It is easy to assume that the nervous system does not solve this problem perfectly. It must among other things be influenced unproportionally much by the aspects that happen to be of interest for the moment or in the environment very near by.

Difficulties in these respects have been studied a lot, for example in many methodological studies. In some of the most interesting studies it has been possible to do direct validation comparisons, i.e. comparing survey results to other kinds of data that have been registered in another (and hopefully more correct) way.

CORRESPONDING AUTHOR: Anders Wikman, Arbejdslivsinstituttet, Stockholm

Irene L.D. Houtman, Frank Andries, Karin Bosch, NIA TNO

Due to recent changes in legislation on occupational health and safety, a national monitor on stress and physical load was developed in the Netherlands to monitor (1) risks and consequences of stress and physical load at work, (2) preventive actions in organizations to reduce these risks, and (3) organizational and environmental variables that facilitate preventive actions. In this presentation, we focus on the main (crossectional) relations between risk factors for work stress, emotional exhaustion and preventive action, and the development of this relation during a one yearfollow up in a subsample of companies and employees.

Information was gathered from employers and employees. The Monitor was administered to a nationally representative sample of organisations 1716 organisations in total. For the follow up, only a limited number of companies were available (n=), of which the response was rather low. In .. companies 200 employees made themselves known, and could be followed up at both the individual and organizational level for one year.

The information from the employees, aggregated at the organizational level was not found to be correlated with that from the employer from the same organizations. Although a considerable amount of employers do recognize risk factors for both physical load and stress as a problem they often seem to underestimate the problem when compared to employees (representatives). This is particularly the case for psychosocial risk factors. Also, the perception of outcome measures, especially the amount of employers considering emotional exhaustion as work-related, was less as compared to the employee representatives of the same organisation. Preventive measures on physical load are much more popular than measures against stress. More preventive action of all kinds is found to be associated with the employer to recognize either a risk factor as a problem and/or health outcome to be work-related, employee participation, larger organizations, more use of support at branch level, and employers considering the measures to be effective. For specific preventive measures, specific predictors emerged as well. Except for the measures directed at the prevention of work stress, information from employees did not significantly contribute to the intiation of preventive workplace measures. Crosssectionally, taking measures was often associated with more work stress risks, and more emotional exhaustion. After one year, taking measures was again found to be related to more complaints, even when taking into account the level of emotional exhaustion measured at the first year.

CORRESPONDING AUTHOR: Irene L.D. Houtman, PhD. NIA TNO, PO Box 718, 2130 Hoofddorp, The Netherlands

Wayne Corneil, ScD, Health Canada, Ottawa, Ontario, Canada

CORRESPONDING AUTHOR: Wayne Corneil, ScD, Health Canada, Tunney’s Pasture, Ottowa, Ontario K1A 0L3, Canada

Wilhelm Thiel, AUVA

CORRESPONDING AUTHOR: Wilhelm Thiel,Director General, Allgemeine Unfallversicherungsanstalt, Adalbert-Stifter-StraBe 65, A-1201, Vienna, Austria

Satoru Shima, MD, PhD, Tokyo Keizai University, Norio Kuroki, Toho University, MD, PhD, Minoru Arai, MD, PhD, Juntendo University and Rumii Kurabayashi, National Institute of Industrial Health

One of the most typical examples of workers' compensation and work stress in Japan is Karoshi, death due to overwork. "Karoshi" was first proposed in the early eighties, not as a medical term but as a social term. Since then many compensation claim have been seen as a possible Karoshi case, although very few cases have been certified as Karoshi. It is only recent that the Ministry of Labor has officially recognized the existence of Karoshi. Karoshi is now an established term in the field of worker's compensation. In spite of that that recognition long working hours are still widely seen in Japan.

Following Karoshi, very recently "Karojisatsu" has received a great deal of attention in public. Karojisatsu means suicidal attempt due to overwork. Karoshi cases are likely caused by cardiovascular diseases, whereas most Karojisatsu cases are likely caused by depression. Until now there have been 5 cases in the private sector and 10 cases in the public sector which were certified as Karojisatsu. In addition, there have been two cases in the private sector resulting in civil trials where the employers were found guilty of neglecting long working hours as a possible harmful factor related to employees' health.

Thus, workers' compensation and work stress is one of the major issues in the field of occupational health in Japan. Various countermeasures will be described.

CORRESPONDING AUTHOR: Satoru Shima, Department of Management, Tokyo Keizai University, 1-7-34 Minami-cho, Kokubunji, Tokyo, 185-8502 Japan

Meryl Stanton, Comcare Australia, Canberra, ACT 2601, Australia

Like most other developed nations, during the 1990s Australia has experienced a rise in reports of occupational stress, in both private sector and government employees.

This presentation will outline the approaches to occupational stress taken by the various States in the Australian federal system, concentrating on the initiatives of the jurisdiction covering Federal Government employees, Comcare Australia.

The Comcare scheme has been successful in significantly lowering workers’ compensation claims for occupational stress, in a high benefit scheme, without legislative change. The presentation will outline the initiatives taken to prevent stress claims, and to manage those that do occur.

CORRESPONDING AUTHOR: Meryl Stanton, Comcare Australia, P.O. Box 211, Canberra, ACT 2601, Australia

Terry Bogyo, Director Corporate Planning and Development Workers' Compensation Board of British Columbia

The "work-relatedness" of stress continues to be a controversial topic in most workers' compensation systems. The Workers' Compensation Board of British Columbia is no exception. After more than two years of study, thousands of submissions and nearly 60 days of public hearings, the Royal Commission on Workers' Compensation in British Columbia released its final report in January 1999. This 1300 page review and research piece includes a detailed analysis and recommendations for the consideration and adjudication of stress claims. This presentation will recap the Commission's findings and contrast the recommendations with current practice in BC, Canada, and other jurisdictions.

Donald Elisburg,Esq., Donald Elisburg Law Offices

This presentation will provide an update on how stress related mental claims are being dealt with under the many different systems of workplace disability compensation in the United States. This discussion will review the changing treatment of these claims in the 50 States and several Federal jurisdicitons, each one of which has a different approach to consideration of work-related claims stress. The US system varies wildly in the way in which these types of claims are considered, ranging from complete exclusion from the compensation system to virtually no specific restrictions on securing compensation. A specific issue will include the development of stress claims related to workplace violence as that becomes a more prevalent problem in the workplace. Since such stress related issues remains a current favorite for consideration by State Legislatures and Administrators, the criteria are ever changing. The discussion will follow up earlier reviews of the subject by the author.