Work-related stress assessment in a population of Italian workers. The Stress Questionnaire

Science of the Total Environment 502 (2015) 673–679

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Science of the Total Environment

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Work-related stress assessment in a population of Italian workers. TheStress Questionnaire

Nicola Mucci a,b, Gabriele Giorgi c, Vincenzo Cupelli a, Pier Agostino Gioffrè d, Maria Valeria Rosati d,Francesco Tomei d, Gianfranco Tomei e,⁎, Edgar Breso-Esteve f, Giulio Arcangeli a

a Chair of Occupational Medicine, Health Services Research Unit, Department of Clinical and Experimental Medicine, University of Florence, 1/23 Largo Piero Palagi, Florence, Italyb Institute of Occupational Medicine, Catholic University of Sacred Heart, 1 Largo Francesco Vito, 00168 Rome, Italyc Department of Psychology, European University, 190 Via degli Aldobrandeschi, 00163 Rome, Italyd University of Rome “Sapienza”, Department of Anatomy, Histology, Legal Medicine and Orthopedics, Unit of Occupational Medicine, Rome, Italye University of Rome “Sapienza”, Department of Psychiatric and Psychological Science, Rome, Italyf Department of Developmental, Educational, Social and Methodological Psychology — Vocal Social Psychology, Jaume University, 0 Av. de Vicent Sos Baynat, 12071 Castellón de la Plana, Spain

H I G H L I G H T S

• Work-related stress is an issue explicitly considered in the European legislation.• We found only little scientific evidences to support check-lists of stress at work.• Consequently, we developed a process to help the management of work-related stress.• We show information about reliability and validity of the psychosocial risk scale.

⁎ Corresponding author at: Via Monte delle Gioie 13Tel.: +39 0649912540; fax: +39 0686203178.

E-mail address: [email protected] (G. Tomei).

http://dx.doi.org/10.1016/j.scitotenv.2014.09.0690048-9697/© 2014 Published by Elsevier B.V.

a b s t r a c t

Article history:Received 15 May 2014Received in revised form 19 September 2014Accepted 21 September 2014Available online xxxx

Editor: E. Capri

Keywords:Stress QuestionnairePsychosocial risk scaleWork-related stress assessmentItalian workers

The present study shows detailed information about the reliability and validity of the psychosocial risk scale in-cluded in the Stress Questionnaire (SQ) developed by our research group. The primary purpose of this work is totest the factor structure of the psychosocial risk scale through a first-order confirmatory factor analysis (CFA)using a large pooled dataset obtained from a population of 2026 employees of 15 Italian medium–largecompanies.Data were collected by a team of researchers who examined demographic variables, work-related stress, work-place bullying, mental health and other constructs. In addition to these substantive issues, the survey was de-signed to better understand response bias.After the evaluation of the results we conclude that the psychosocial risk scale reported a satisfactory reliabilityand validity. In addition, it allowed a careful measurement of work related stress, considering both leader's andfollower's perspectives.

© 2014 Published by Elsevier B.V.

1. Introduction

In October 2004, the European social partners signed a FrameworkAgreement on work-related stress in order to provide employers andworkers with a framework to identify, prevent and manage problemsof work-related stress. According to the Agreement, stress is defined

, Zip Code: 00199 Rome, Italy.

as: “a state, which is accompanied by physical, psychological or so-cial complaints or dysfunctions and which results from individualsfeeling unable to bridge a gap with the requirements or expectationsplaced on them”. Moreover, “… stress is not a disease but prolongedexposure to it may reduce effectiveness at work and may cause ill-health.”

The concept of work-related stress is included in a book by Kahnet al. (1964), who first examined its characteristics. Work-related stressmay be considered as the product of the dynamic interaction betweenthe person and the social and organizational context in which he orshe works, constituting the result of a (not equal) relationship betweenthe stresses imposed by the task/role and the operator's ability to cope

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with these (Costa, 2009; Cox et al., 2000; Karasek and Theorell, 1990;Siegrist et al., 1997; Giorgi et al., 2014). According to Sonnentag andFrese (2003), in modern industrial systems work-related stress is asource of problems both for the health of workers and the organizationsdue to the consequential costs. European and American studies in liter-ature have shown that health costs were higher among those who hadhigh levels of stress. Moreover, an alarming percentage of lost workingdayswas related to occupational stress andwork-related stress involvesvery high costs, both for the society and the companies, estimated in theorder of hundreds of billions of dollars per year worldwide (Béjean andSultan-Taïeb, 2005; Culpepper, 2010; Eurofound, 2010; Goetzel et al.,1998; Sultan-Taïeb et al., 2013).

Stress-related diseases nowadays are explicitly considered in thelegislation of many European countries. In Italy, with the MinisterialDecree of 27 April 2004, stress and the resulting biological damagehave been recognized. Moreover, in the current legislation, the stresshas been included specifically as an element to be included in the riskassessment by the company's physician. In Italy, a methodology toquantify psychosocial work-related risk factors was proposed andsuggested to organizations in 2010 by the government institutionINAIL-ISPESL, and is an adaptation of the “Management Standards”method developed by the UK HSE Indicator Tool (Natali et al., 2010).Although given the nature and complexity of the issue, it has not beenpossible to date to have an established and shared method to quantifythis risk in various working environments (Arcangeli and Mucci, 2009;Mucci et al., in press).

In Italy, in the last six years the interest in issues related to work-related stress has significantly increased. The reasons for this phenome-non are due, first, to the promulgation of the new main law for theprotection of health and safety in the workplace (Legislative Decreeno. 81/2008 and subsequent amendments) which include an obligationto assess the risks related towork-related stress for all employers and inall areas of employment.

Severalmeasures have beenused for the assessment ofwork-relatedstress experiences in the employees, including check-lists based on ob-jective data (such as absenteeism, productivity, etc.), as well as simplequestions (yes/no) on the organizational environment answered bythe key people of the organizations (Pasquarella, 2012). Nonetheless,Giorgi (2013) found only little scientific evidence to supportthe validity and the reliability of a range of check-lists of stress atwork, pointing out the opportunity of measuring the subjective stressthrough validated questionnaires. In particular, the check-lists maybe – intentionally or not – biased and distorted since these are drawnfrom a limited number of safety factors of each company (e.g. the em-ployer, the company's physician and the safety and health technicalexperts).

Work-related stress, and more general stress, is a subjectivephenomenon and, consequently, the involvement of a large part ofthe employees in its assessment appears as an outstanding issue(Barling et al., 2005; Giorgi, 2010). In this context, several strategieshave been used to assess employees' subjective experience of work-related stress, mainly through questionnaires: the OccupationalStress Indicator (Cooper et al., 1988), the PressureManagement Indi-cator (Williams and Cooper, 1998), the Job Content Questionnaire(Karasek et al., 1998), the Health and Safety Executive's Manage-ment Standards (Edwards et al., 2008), the Effort-Reward Imbalance(ERI) (Siegrist et al., 1997), the Copenhagen Psychosocial Question-naire (COPSOQ) (Kristensen et al., 2005) and the HSE IndicatorTool (HSE, 2004). However, a considerable limitation of the ques-tionnaires may be the overconfidence of self-reports (Spector,1994). Nevertheless, several studies have also tested the predictivepower and validity of self-assessment methods in work contexts(Podsakoff et al., 2003; Stock et al., 2005), and nowadays, there aremany surveys that have overcome weakness pointed out bySpector (1994) as Schwarz (1999) predicted in 1999 and lately wasdescribed in a meta-analysis carried out by Berry et al. (2012).

The exclusive use of self-report data might be troublesome for severalreasons. For example, employees might have a proclivity to reportinformation in a more favorable way – for themselves and/or forcompanies – than to reality. This phenomenon is commonly known associal desirability bias or impression management (Donaldson andGrant-Vallone, 2002). However, despite the measures of self-reportingto measure job stress improving greatly in recent years, they are not ex-empt from criticism. It is precisely for this reason that the combinationof different methods for quantitative assessment needs to be adequateto avoid significant biases. Consequently, Giorgi (2013) developed a pro-cess to help employers and employees manage the issue of work-relatedstress, consisting of a stocktaking of several self-reports called the StressQuestionnaire (SQ).

A total of 87-itempooled into a questionnaire based on the review ofwork-related stress literature and existing questionnaires mentionedabove were written by some of the authors of this paper (Giorgi,Arcangeli, Cupelli and Mucci). The development of the questionnairewas based on twomain criteria: a) itemshad to be related to the specificcontext; and b) items should be restricted to assessing specificallywork-related stressors and no other kind of psychological stressors.

Subsequently, a total of ten experts (organizational psychologistand occupational physicians) evaluated items by establishingwhether they assessed the intended stress dimensions and if theywere appropriate to the working context as well as the socio culturallevel of responders.

The method used by the judges is based on the assumption that ifdifferent evaluators use the same categories for the classification ofthe test results, the final decisionmay be considered as evidence in sup-port of the reliability of the results.

All judges worked independently, without consulting each otherabout the suitability of the items. Nevertheless, the final judgementshave shown high agreement on the validity of the items.

The majority of items were accepted and some were removed onlybecause they had poor evaluations or were duplications of otheritems. Next, an Exploratory Factor Analysis (EFA) approach was usedto extract factors that better represented the five different stressareas: psychosocial risks, stress of the task, stress of thephysical context,stress of the psychological context, and stress of the socioeconomic con-text (Giorgi, 2012, 2013). Items were removed if the factor loadingswere too low or ambiguous, being convergent in more than one factor.

In conclusion, the final version of the SQ is a 69-itemmeasure whichallows an assessment of several factors of stress as well as those whichhave been identified by the literature, and appears to have high facevalidity (Giorgi, 2013).

The development of the questionnaire followed themain scientif-ic standards (Rattray and Jones, 2007). The importance of stating thenumber of factors expected in a prototypic measure was empha-sized. Issues of reliability and validity were explored also usingitem analysis. A complete account of the theoretical and empiricaldevelopment of the SQ is available in a recently published test(Giorgi et al., 2013).

The SQ includes a positive impression scale which measures theproclivity to answer in a way that will be viewed positively by others.This phenomenon could take the formof over-reporting (higher stress),of under-reporting (lower stress) or of undesirable perceptions. Thisproclivitymight produce bias in the analysis of self-reported data, espe-cially if the data were extracted from questionnaires, and consequentlyinterfere with the interpretation of stress scores. Biases and distortionswere analyzed and discussed in the literature on personality and detec-tion of individual differences. In this context, some studies have ex-plored some critical issues in organizational diagnosis. For instance,the European Agency for Safety and Health at Work (EU-OSHA)observed – among other aspects – that workers may try to hide theirdifficulties in coping with this high level of stress, which is seen by therespondents as a reaction to the fear of losing their job (EU-OSHA,2007, EU-OSHA, 2013a, 2013b).

Table 1Demographics of the total sample (n = 2026).

No. %

1. GenderMale 1.068 52.7Female 958 47.3

2. Type of companyPrivate 12 80Public 3 20

3. Job seniority (years)0–7 1.326 65.5N7 700 34.5

4. Job statusManagers/middle managers 280 13.8White-collars 1.357 66.9Blue collars 389 19.3

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The present study shows detailed information about the reliabilityand validity of the psychosocial risk scale included in the SQ. Moreover,it improves existing psychometric studies by providing additional anal-yses such as correlations with related constructs (negative behaviors atwork and mental health problems) and comparisons of stress meanscores across participants.

For a better evaluation, work-related stress must also be framed in acultural perspective that highlights the processes of integration and dif-ferentiation compared to other countries in and outside Europe (Giorgi,2010). A simple adaptation of foreign evaluation scales, even when thisprovides useful and benchmarked scientific information, may present arisk of underestimating peculiar factors to each national cultural reality(e.g. support of his superiors, job role, relationships with colleagues).Therefore, the development of a new test, with items tailored to theItalian characteristics of work, will be an important tool for research inthis field. In addition, it was decided to develop a new psychometric in-strument because the existing inventory tools do not seem appropriateto the contemporary occupational realities. Even the ManagementStandards Indicator Tool, which has good validity and reliability incontext, consists of items designed ten years ago (Toderi et al., 2013).

Finally, this study contributes to the updating of knowledge in thefield in two ways: by including a positive impression of scale, andassessing the determinants of work-related stress in a large sample ofItalian employees.

Severalmethodswill be used to test the validity of the scale. To checkthe validity of the construct, a confirmatory factor analysis (CFA) and therelationships between the determinants will be examined. Convergentvalidity of the scale will be determined on the basis of correlations withtheoretically related self-report instruments (bullying and mentalhealth). One hypothesis is that the psychosocial risk scale would be posi-tively correlatedwith theGeneralHealth questionnaire 12 (GHQ-12,De laRevilla Ahumada et al., 2004; Fraccaroli et al., 1991) and theNegative ActsQuestionnaire (revised) (Giorgi et al., 2011).

Finally, the validation of the psychosocial risk scale will be per-formed through the exploration of the differences, according to mainsocio-demographic and occupational variables.

1.1. The Stress Questionnaire (SQ)

The StressQuestionnaire (SQ) assesses several psychosocialworkingvariables related towork-related stress. Thefirst versions of the SQwerebased on Karasek's (1979) demand, control and support model and theHealth and Safety Executive's Management Standards work-relatedstress (Edwards et al., 2008). Based on a review of the literatureconcerning work-related stress, the SQ was further developed addingemerging stress determinants such as the fear of crisis and non-employability (Giorgi, 2013). Furthermore, the critical issues experi-enced in the job taskwere considered aswell as in the physical and psy-chological context.

Giorgi (2013) have pointed out that one of the most important as-pects of the questionnaire is the psychosocial risk scale; it is based onfivemain psychosocial risks whichmight lead to stress-related negativeoutcomes. The scale consists of 25 items and 5 subscales: job demand,job control, role, supervisors support, and colleagues support. Researchshowed that high job demands and low job control (i.e., how muchdiscretion people have in their work), lack of colleague and supervisorsupport (i.e., the encouragement, the sponsorship and the resourcesprovided by colleagues and the supervisor), role ambiguity and roleconflict (i.e., whether people understand their role within the organiza-tion without having conflicting or ambiguous roles) may play a crucialrole in work-related stress (Gilboa et al., 2008). Indeed, all the factorsmentioned above are usually known as job stressors in the differentmodels that have been proposed to explain the relationship betweenworking conditions and the negative consequences of stress.

The scale is easily intelligible by occupational physicians and quicklyadministered; the results can be readily included in the preparation of

the risk assessment document provided by the Italian Legislative Decreeno. 81/2008 mentioned before, and subsequent amendments. In fact inItaly, the main operational guidelines on this issue also recommendperforming a subjective assessment of work-related stress (Mucciet al., 2012, in press).

1.2. Aim

Taking into account the lack of reliable, comprehensive ability toassess job stress in the Italian context, the main objective of the presentstudy is to test the factor structure of the psychosocial risk scale througha first-order CFA using a large pooled dataset obtained from a popula-tion of employees of 15 Italian medium–large companies. On the basisof previous research regarding work-related stress (Giorgi et al., 2012;Giorgi, 2013; Mucci et al., 2014), a further hypothesis is that the SQwould show positive correlations with measures on subjective healthand workplace bullying. In addition, the SQ should report negative cor-relations with the positive impression scale.

The differences in the psychosocial risk scale according to socio-demographic and occupational variables were also investigated.

2. Methods

2.1. Participants

Data were collected by a team of researchers who examined demo-graphic variables, work-related stress, workplace bullying, mentalhealth and other constructs. In addition to these substantive issues,the survey was designed to register or evaluate potential response bias.

The sample consisted of 2026 employees (of which 52.7% weremales) from 15 Italian companies (12 private industries and 3 publicadministrations).

The response rate range, in all organizations, was from 65.4% to93.0%. Regarding job seniority, 65.5% of the respondents had workedfor up to 7 years in their current company. In addition, 13.8%wereman-agers/middle managers, 66.9% were white-collar workers and 19.3% ofthe respondents were blue-collar workers (see Table 1).

2.2. Questionnaire

The surveywas carried out for the analysis of the issues listed below.Demographic aspects were detected by some questions, in which

information was requested regarding gender, job position, and jobseniority of responders.

Psychological well-being was assessed with the General HealthQuestionnaire (GHQ-12) in the 12-item Italian version (Fraccaroliet al., 1991). This scale measures subjective mental health by askingwhether the respondent has recently experienced a symptom or behav-ior of psychiatric disturbance. As physical health is not investigated inthe scale, it is also considered a measure of psychological well-being

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or subjective mental health. The questionnaire gives a total rangingfrom 0 to 36, in which a higher score indicates a greater degree ofpsychological distress.

Work-related stress was measured with the Stress Questionnaire(SQ), which assesses five stress-related factors on a Likert scale rangingfrom 1 (absolutely agree) to 5 (absolutely disagree): a) role conflict,which measures the perception of lack of awareness in their roles andresponsibilities (5 items: e.g., “I have a clear idea aboutwhat is expectedof me at work”); b) colleagues' support or collaboration and supportamong employees (5 items: e.g., “I get the support I need from col-leagues”, “Forme it's difficult to assess whether my colleagues are com-petent”); c) supervisors' support or the extent to which employeesexperience support and understanding from their supervisors/leaders(5 items: e.g., “My supervisor energizes me at work”, “My supervisoris neither competent nor self-confident”); d) job demands, which refersto quantitative, demanding aspects of the job (6 items: e.g., “I haveunrealistic deadlines”, “I'm under pressure at work”); and e) job controlor job resources that pertain to the task (5 items: e.g., “I can plan mywork”, “I'm fully autonomous in choosing my working tools”). Thefactorial structure of this questionnaire has been supported in previousstudies (Giorgi et al., 2012).

Furthermore, with particular reference to the Italian culture, Giorgiet al. (in press) showed a possible trend by some workers to improveor worsen the image of themselves or of the company in which theyare employed; in short, there may be cases in which the analysis ofthe questionnaires could provide a distorted picture in activities oforganizational diagnosis. A positive impression scale was added to theSQ in order to verify whether workers might give socially desirable re-sponses in organizational diagnosis (Table 2). The scale is an integralpart of the questionnaire and has been recognized as valid, reliable(Giorgi, 2013) and useful for the diagnosis of stress (Giorgi et al., inpress).

Workplace bullyingwas assessed by the shortened Italian version ofthe Negative Acts Questionnaire Revised (NAQ-R) (NAQ-R: Einarsenet al., 2009) validated by Giorgi et al. (2011). This questionnaire mea-sures the frequency of 17 specific negative acts (bullying behaviors) atwork (response categories were 1: never, 2: now and then, 3: monthly,4: weekly, and 5: daily) within the last six months. Items are dividedinto personal bullying (12 items described as exposure to behaviorssuch as gossip, insulting remarks, excessive teasing, and persistent criti-cism) and work-related bullying (5 items, such as unreasonable dead-lines, unmanageable workloads, excessive monitoring, and experiencingcrucial information being withheld). The questionnaire provides a totalscore (ranging from 17 to 85) in which a higher score means greaterexposure to negative acts (bullying behaviors).

2.3. Analyses

In order to examine the dimensionality of the psychosocial riskscales, a confirmatory approach using AMOS 19.0 was conducted. CFAallows models to be driven both statistically and theoretically, whichtraditional procedures like EFA are unable to do. Maximum likelihoodestimation was applied.

Based on theoretical notions and previous empirical studies, the fiveunderlying factors of stress were expected to exist. However, a one-

Table 2The positive impression scale (Likert scale1–5) added to the SQ.

The positive impression scale

I'm never in a bad moodI've never had a stressful day at workI've never had a bad dayI've never complained at my workplace

dimensional measurement model was also tested for comparativepurposes.

2.3.1. Fit indicesMaximum likelihood estimation methods were used and the input

for each analysis was the covariance matrix of the items. Thegoodness-of-fit of themodels was evaluated using absolute and relativeindices. The absolute goodness-of-fit indices calculated (Jöreskog andSörbom, 1986) were: a) the χ2 goodness-of-fit statistic; b) the RootMean Square Error of Approximation (RMSEA); c) the Goodness ofFit Index (GFI); and d) the Adjusted Goodness of Fit Index (AGFI). Theχ2-test is a test of the difference between the observed covariance ma-trix and the one predicted by the specified model. Non-significantvalues indicate that the hypothesized model fits the data. However,this index is sensitive to sample size so that the probability of rejectinga hypothesized model increases as the sample size increases. To over-come this problem, the computation of relative goodness-of-fit indicesis strongly recommended (Bentler, 1990; Schweizer, 2010). The errorof approximation refers to the lack of fit of the model to the populationcovariance matrix, and RMSEA is a measure of the discrepancy per de-gree of freedom for the model. Values smaller than .08 are indicativeof an acceptable fit and values greater than 0.1 should lead to model re-jection (Cudeck and Browne, 1993). The GFI is a measure of the relativeamount of variance accounted for by the model, whereas the AGFI alsotakes model parsimony into account. Since the distribution of the GFIand the AGFI is unknown, no statistical test or critical value is available(Jöreskog and Sörbom, 1986). The relative goodness-of-fit indexcomputed was the Comparative Fit Index (CFI). The CFI is a populationmeasure of model misspecification that is particularly recommendedfor model comparison purposes (Goffin, 1993); as a rule of thumb,values greater than .90 are considered as indicating a good fit (Hoyle,1995).

3. Results

3.1. Validity and reliability

In order to verify the proposed dimensions of the psychosocial riskscale, the research was based on a confirmatory approach with twomeasurement models. These were a one-dimension model with allitems measuring the same latent variable, and a five-dimension modelwith items loading only on each stress factor. The statistical analysisshowed that an overall stress measure (one dimension) doesn't fitwell to the data, whereas the five dimension model is related with ac-ceptable descriptive fit measures and fits the data better (see Table 3).Moreover, the standardized factor loadings for the five-factor modelwere all statistically significant (p b .001) and ranged from .40 to .76.

Convergent validity can be assessed by comparing scores on the newscale with an established measure of similar constructs such as mentalhealth. There was a moderate positive correlation with mental healthindicating that the more a person is stressed, the more the person isprone to reporting mental health problems. In addition, stress factorscorrelated positively with bullying at work as expected. Stress factorswere also negatively correlated with the positive impression scalewith similar values around .20.

Finally, the item-total correlations within each subscale of SQ wereall above .40, indicating acceptable relationships between items andtheir scales. Alpha reliabilities of the stress factors were satisfactory.

Table 3Confirmatory factor analysis for the psychosocial risk scale (n = 2026).

χ2 df GFI CFI RMSEA AGFI IFI

One-factor 5871 275 .75 .61 .10 .71 .61Five-factors 1633 265 .93 .91 .05 .92 .91

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Cronbach's alpha for the 25 items in the psychosocial risk scale was .87,indicating a good internal consistency (see Table 4).

In addition, thefive dimensions of stress are as expected,moderatelyinter-correlated, with r ranging from .21 to .48 (p b .001).

3.2. Additional psychometric analyses

Another aspect of the validity is the capacity of themeasure to differ-entiate scores among respondents. Consequently, we hypothesized dif-ferences in scores from different groups of respondents (Spector, 1992).To analyze whether stress factors differed across participant workgroups, job seniority and gender, several ANOVA and T tests were per-formed on the total score on each factor. As far as the gender differenceis concerned, women (M= 2.49; SD= .77) scored significantly higherthan men (M = 2.38; SD=. 69) on the factor job control [T (1975) =3.2; p b .001]. No differences were found for the other factors.

Regarding the job seniority, working for more than 7 years (M =2.46; SD = .96) seemed to be a factor that increased the perceptionof lower support by the supervisor [T (1956) = 2.7; p b .05] whencompared to those working for 7 years or less (M = 2.58; SD = .93).However, this patternwas oppositewhen scores of job control were an-alyzed. Respondents in their present job for 8 years ormore (M= 2.39;SD = .71) reported better job control [T (1956) = 2.8; p b .05]than those who took up their current job within the last 7 years(M= 2.49; SD = .74).

Regarding the job position, the managers reported lower stressthan those in lower-skilled jobs and manual workers for job control[(F (2, 1842) = 31.4; p b .001], supervisor support [F (2, 1842) = 4.4;p b .05], colleague support [F (2, 1842) = 6.9; p b .05] and role[F (2, 1842)= 3.8; p b .05]. Conversely, themanagers reported a higherjob demand [F (2, 1842) = 8.8; p b .001].

4. Discussion

The literature shows that the usability of measuring and assessmenttools for stress and for the identification of a prospective causal or co-causal role in occupational diseases is often complex (see Table 5). Fur-thermore, because of the time required for administration and process-ing, their application in some clinical settings may be difficult. This isespecially true for protocols that require the evaluation of large samples,where it is essential to have fast and practical tools. Nowadays, the trendin the personnel assessment at work places is approaching amore com-plex way that helps to evaluate the experience of the employee. In thecase of stress, themajor benefit of this approach is the ability to focus at-tention only on those who actually perceive stress (and, consequently,detect it). Moreover, this approach allows an understanding of whatthe key stressors are for each individual and for theworking populationas a whole. In such a context, our research group has developed a newmethodological tool, specially calibrated for theworkers and readily ad-ministered in all workplaces. This tool allows the operator to analyze

Table 4Means, standard deviations, alpha and correlations among variables.

Variable M SD Alpha 1 2 3

1 Job demand 2.66 .73 .73 – .30⁎⁎ .32⁎⁎

2 Job control 2.43 .73 .75 – .37⁎⁎

3 Supervisors support 2.55 .94 .80 –

4 Colleagues support 2.38 .73 .765 Role 2.04 .68 .756 Mental health 10.5 5.1 .857 Bullying 24.2 7.1 .868 Positive impression scale 3.5 .69 .749 Gender 1.47 .50 –

10 Seniority 1.66 .48 –

11 Job position 2.05 .57 –

⁎ Correlation is significant at the 0.01 level.⁎⁎ Correlation is significant at the 0.05 level.

individual responses to stressful events in a simple and quick way,even on large samples and on heterogeneous working populations. Ad-ditionally, this survey has been tested on a large and heterogeneoussample of Italian employees and the scales and items selection for thissurvey has been performed considering the specificity of the Italianwork-context in order to ensure their suitability. We consider thatissue as a strength of the current survey because it enhances themotiva-tion of the questionnaire subjects to answer properly and that in turnimproves the questionnaire validity.

Results of this study showed that the 25-item psychosocial risk scaleis a statistically valid measure of stress. CFA confirmed that five factorsunderlie the construct. The confirmatory factor analysis showed that afive-factor structure of the scale produces a better fit than a one-factorstructure. The findings and the validity tests explored suggest that thescale behaves as expected because it was related to similar constructs,and significantly related to hypothesized effects of stress. Indeed, thefive dimensions have also been found to be positively correlated withthe general health andworkplace bullying (Giorgi, 2013). It is notewor-thy that the positive impression scale correlated with the stress factors.In addition, although the correlations of the positive impression scalewith stress factors were not more than moderate, the use of this scaleconfirms its worth for work related stress assessment with the subjec-tive method.

Finally, the characteristics of the psychosocial risk scale make itappropriate for organizational settings, because the factors also allowcomparisons between non-homogeneous groups of employees.

In general, the differences in the psychosocial risks subscales,according to socio-demographic and occupational variables, tended tobe consistent with previous findings in this area.

The finding that women report similar psychosocial working condi-tions compared to men except for job control agree with recent studieson organizations in Italy (Giorgi, 2009, 2012; Toderi et al., 2013;Arcangeli et al., 2014). For instance, although European data show thatwomen tend to report bullying and harassment at work, in Italy nosignificant difference with men has been found (Giorgi et al., 2011).

The finding that employees with low job seniority have less controlthan employees with a high seniority might be related to the superiorexperience of senior workers which help them to better control thejob. Therefore, the difference on the job control subscale may also beexpected. On the other hand, higher seniority is also linked to lowersupervisor support. If we consider that many jobs in Italy have a stronghierarchy and centralized decision making, we may infer that, after acertain period of tolerance, workers might develop some conflicts ordisagreements with their supervisors (Giorgi et al., 2013).

The finding that managers are generally less stressed than non-managers was also consistent with previous reported findings(e.g., Batinic et al., 2010). Several studies have shown that high levelemployment is positively related with good health (Andersen, 2009).In view of the Jahoda's (1981) latent deprivation theory, being amanagerprovides a number of latent beneficial functions such as time structure,

4 5 6 7 8 9 10 11

.34⁎⁎ .21⁎⁎ .37⁎⁎ .41⁎⁎ − .22⁎⁎ − .03 .02 − .09⁎⁎

.37⁎⁎ .48⁎⁎ .32⁎⁎ .38⁎⁎ − .18⁎⁎ .07⁎⁎ − .07⁎⁎ .18⁎⁎

.43⁎⁎ .44⁎⁎ .34⁎⁎ .41⁎⁎ − .20⁎⁎ − .02 .06⁎ .07⁎⁎

– .36⁎⁎ .33⁎⁎ .48⁎⁎ − .19⁎⁎ .00 .00 .09⁎⁎

– .34⁎⁎ .36⁎⁎ − .20⁎⁎ .01 − .03 .06⁎⁎

– .50⁎⁎ − .35⁎⁎ .06⁎⁎ .05⁎⁎ − .02– − .22⁎⁎ − .02 − .02 .06⁎

– − .02 − .01 − .08⁎

– .02 − .13⁎⁎

– − .15⁎⁎

–

Table 5Reference table.

Authors Title Journal Study design

Béjean S, Sultan-Taïeb H. Modeling the economic burden ofdiseases imputable to stress at work.

The European Journal ofHealth Economics

The study evaluated the costs of work-related stress in France.Cardiovascular diseases, depression, musculoskeletal diseases andback pain that may result from exposure to stress are identified andthe proportions of cases attributable to the risk factor are calculatedfrom epidemiological studies.

Goetzel RZ, Anderson DR,Whitmer RW, Ozminkowski RJ,Dunn RL, Wasserman J.

The relationship betweenmodifiable health risks and healthcare expenditures. An analysis ofthe multi-employer HERO healthrisk and cost database.

Journal of Occupational andEnvironmental Medicine

This investigation estimates the impact of ten modifiable healthrisk behaviors and measures and their impact on health careexpenditures, controlling for other measured risk anddemographic factors.

European Agency for Safety andHealth at Work (EU-OSHA)

Diverse cultures at work: ensuringsafety and health throughleadership and participation.

Publications Office of theEuropean Union

This report describes the state of the art in addressing culturaldiversity in the workplace, focusing on cross-cultural aspects andmulticultural aspects in occupational safety and health

European Agency for Safety andHealth at Work (EU-OSHA)

Mental health promotion in theworkplace— A good practice report

Publications Office of theEuropean Union

This describes the state of the mental health and ill-health in theworkplace and its causes and consequences and summarizes howmental health promotion initiatives in general can and do addressthis issue.

Bentler P. Fit indexes, Lagrange multipliers,constraint changes and incompletedata in structural models

Multivariate behavioralresearch

The study evaluated certain aspects of model modification andevaluation, with an emphasis on some points of view that expandupon or may differ from Kaplan. The usefulness of BentlerBonettindexes is reiterated.

Schreuder KJ1, Roelen CA, KoopmansPC, Groothoff JW.

Job demands and healthcomplaints in white and bluecollar workers.

Work This survey studied job demands and health complaints inworking white and blue collar employees

Culpepper L The social and economic burdenof shift-work disorder.

The Journal of family practice The purpose of the article is to examine Shift-work disorder andits symptoms.

Myrtek M, Fichter A, Strittmatter M,Brügner G.

Stress and strain of blue andwhite collar workers during workand leisure time: results ofpsycho-physiological andbehavioral monitoring.

Applied Ergonomics This study investigated behavior, psychological parameters and thelevel of subjective stress and objective strain of blue and white collarduring work and leisure time.

Donaldson SI, Grant-Vallone EJ. Understanding self-report bias inorganizational behavior research

Journal of Business andPsychology

This paper outlines a conceptual framework for understandingfactors that influence the motivation of an employee to bias his orher responses to questions posed by organizational researchers.

Rattray J, Jones MC. Essential elements ofquestionnaire design anddevelopment.

Journal of ClinicalNursing

The aims of the paper were to raise awareness of the issues inquestionnaire development and subsequent psychometricevaluation, and to provide strategies to enable nurse researchersto design and develop their own measure and evaluate thequality of existing nursing measures.

678 N. Mucci et al. / Science of the Total Environment 502 (2015) 673–679

social contact, collective purpose, identity/status, and activity. Conse-quently,managersmayhave access tomore resources such social supportor job control.

However, this study shows that managers perceived higher job de-mands than blue collarworkers. This finding is also in linewith previoussurvey studies that showed howwhite-collar employees reportedmorejob demands at work than blue-collar employees (e.g. Myrtek et al.,1999; Schreuder et al., 2008; vonBonsdorff et al., 2012). However, it isnoteworthy that they didn't just report a greater demand, but alsogreater control. Perceiving high job demands and high job control, ac-cording to Karasek et al. (1998), is typical of active jobs andmight stim-ulate a positive stress (eustress) and constructive coping strategiesamong managers.

Limitations of the present study are related to its cross-sectionalstructure, which does not allow the establishment of causality in the re-lationships among the possible measured consequences and work-related stress. A future study should focus on the discriminant validityof the instrument and should test the association of the scalewith objec-tive data (absenteeism, sicknesses etc.), as well as with physiologicalparameters (e.g. blood pressure, level of cortisol).

However, we conclude that the psychosocial risk scale reported asatisfactory reliability and validity. In addition, it allows a careful mea-surement of work-related stress, taking into account both leader's andfollower's perspectives.

Sources of funding

This study was supported by internal funding.

Declaration of interest

The authors report no conflicts of interest. The authors alone are re-sponsible for the content and for writing this paper. No disclosing finan-cial, commercial or other relationships are relevant to the study. Nocompeting financial interests exist.

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