KSOEM
Articles
- Page Path
- HOME > Ann Occup Environ Med > Volume 27; 2015 > Article
- Research Article The effect of organisational system on self-rated depression in a panel of male municipal firefighters
- Se-Jin An, Yun Kyung Chung, Bong Hyun Kim, Kyeong Min Kwak, Jun-Seok Son, Jung-wan Koo, Young-Su Ju, Young-Jun Kwon
-
Annals of Occupational and Environmental Medicine 2015;27:1.
DOI: https://doi.org/10.1186/s40557-014-0044-x
Published online: January 14, 2015
Department of occupational and environmental medicine, Hallym university sacred heart hospital, Anyang City, Republic of Korea
Department of occupational and environmental medicine, Changwon Samsung Hospital, Sungkyunkwan College of Medicine, Changwon City, Republic of Korea
Department of occupational and environmental medicine, Seoul St. Mary hospital, Catholic university of Medicine, Seoul City, Republic of Korea JFIF d d Ducky d qhttp://ns.adobe.com/xap/1.0/ |er˭|I|-fGK.rΛp8XV1%K6mvG+tc+qE &ǸC_Nm:l=_/m5^[dߌڇ.c<%:)tQ$Ow~-aY;UJ >=F)2[nk؆?훐 M=l6[4(O.]2#-H^n#->&mp5~Fӛ+|| S,xag% qkEUzUgæBhߕP(7]kFnq?֖Cpru Z6*rEڊtS|*tI*E}7R<,nUU֫^I7Q*mSly%rdȓd8hE<9oHhMfNSRj[i7D[Rj݊+kდq{"$$H?p \̅S?㭻;t~ R߁ )^/>Qj`yt[w ԛ;² ~+ ߔ_ YW~|o] ?x^ᯛ `ʼn;g)T@vWn]>&4l p+$D̢1l|ȨF%-} .9[}w~
ԠLM9hСablfe&QoW !s ?wjLK?s7yO>(=C~_nyǜu? v 3vyo oI@qV-jeES^[9WoSܝh"l2C1a͔CiJ@3:Pճw= /7ovuk+\V;lDgն <[A+r X~d;m!_s8ݖ;;.0llUC+?i#_crʙ1~C.\q u l8Hܶ2m`ܻM3Tov|Bs rɵ"oLS-
DКw=Tv@f '6|YlD͓Y%-#Ѯo%:&!3o%\J<02;K87>^vgƓ# ;ݝmz^Y6=PS39U%~
&f#
}o!muH; ʲŇ˷yvP+&.7e[3'vR4Yj̗IZ`e˽3o[WU{
m[sUbۋZǾۆl6~9'V*.\S2<Sd*zY[aŶ`]C$n.v^Ʌ
dng>ەZ,Mmϑ :n6nϦezW qUJ4! ۇ4R! =>>F n|Q[{pRO 17ƕ~._I ''00k=b՛o}Osðc2'o\3}ݭQ^ 2 . R1yKȣtAݿ-u ܾw!`?1Whn|gzU o[ECWwjUIן)^h#1ɭ!/Z
np;o;ΗŻkXs."6E`Z1
עӐ9Kl8qd q} 2Stt;#j>;խabONŗ=fwP1j)l6J̶|gV 2`y/0E˛6+ԫ1?
6}KW c\KoKͨ2ۅFws*TԞLיuDx .kCzWXhy۶gLu|%TnupǺl-S* P RaLnT+c+*xl.v!.U=|; !_L̎뱚U=4hm:ٯ"y)$:>%(n}X'p[ȴ
^˒4kƓmzDx
\
'Nq amP7nyN݅=
• Received: May 30, 2014 • Accepted: October 14, 2014
© An et al.; licensee BioMed Central. 2015
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Abstract
-
Objectives The present study evaluated the effects of job stress, including organisational system to self-rated depression through a panel study of male municipal firefighters in the Republic of Korea.
-
Methods A panel of 186 municipal firefighters reported self-rated depressive symptoms according to the Beck Depression Inventory (BDI). The effects of job stress were evaluated using the Korea Occupational Stress Scale, taken one year earlier and classified by the median value. Panel members were classified into Depression or Control groups according to BDI scores, with a cut-off level of ‘over mild depression’ in a follow-up survey.
-
Results The Depression group included 17 (9.1%) workers. Firefighters who scored high on occupational system had an 8.3 times greater risk of being assigned to the Depression group than those who had not (adjusted odds ratio [OR] = 8.03, 95% confidence interval (CI) = [1.73–37.22]). In contrast, job stress from a ‘difficult physical environment’ revealed negative risks related to being classified in the Depression group (AOR = 0.20, 95% CI = [0.04–0.92]).
-
Conclusions Although the healthy worker effect may be involved, job stress based on perceptions of organisational system was a strong risk factor for depression. A comprehensive approach should be considered that encompasses social issues when assessing or mental health in high-risk groups, as well as the practical issue of physiochemical hazards.
Introduction
Firefighters perform a dangerous job that is an object of occupational medicine: they have long working hours [1] and are exposed to poor physiochemical surroundings. Other than risks during actual firefighting, job stress and adverse psychological health effects are also present [2]. In fact, epidemiological research has reported that firefighters display increased depression, post-traumatic stress disorder (PTSD), and lower quality of life that lead to mental pathology than do members of the general population [3]. In particular, research on adverse psychological effects found in fire officers has mostly focused on PTSD, but depression in general is the most frequently occurring mental disorder; research on the mental status of firefighters revealed a comorbidity of PTSD and depression, overlapping by as much as 16% [4]. Work stress or post-traumatic stress disorder resulting from having to meet the many demands of citizens can lead to extreme consequences such as suicide among firefighters, which attracts social attention. Besides physiochemical threats, other related elements reported to cause adverse psychological effects include conflicts in organisational system. However, there were a few limitations in previous studies resulting from the weaknesses inherent in cross-sectional studies, namely the lack of explanation of the causal relationship between exposed risks and health outcomes, and the inability to compare the influence of various subtypes of job stress such as organisational system and physical environment on depression. Therefore, this study aimed to examine the influence of job stress experienced one year ago to determine its effect on depression using a panel study design, a type of longitudinal study that can be used to analyse causal relationships.
Material and methods
Two hundred and sixty firefighters were selected from 22 municipal fire stations including 5 police stands, 5 special rescue teams, and 5 inspection divisions in Seoul. The baseline survey was administered to 248 municipal firefighters. The 12 firefighters excluded from the baseline survey were 7 women, 2 patients under medical or psychiatric care, and 3 firefighter conscripts. After 12 months, the follow-up survey was administered to 210 firefighters; 38 did not respond to the follow-up survey due to transfer or migration. Twenty-four firefighters could not respond to the depression scale; therefore, 186 firefighters remained as the final study group. Informed consent regarding confidentiality for all subjects before enrolment.
Through the initial and follow-up surveys, interviewer-assisted self-report questionnaires addressing socioeconomic and job-related characteristics, self-rated depression, and job stress were administered. The initial survey measured self-rated depression and job stress at 2005. The follow-up survey retested self-rated depression at 2006. Questionnaires were assigned to 248 subjects in total 2 yrs; 210 subjects responded to both the initial and follow-up surveys (response rate: 84.7%). Trained interviewers reviewed the questionnaires and checked for non-response. Socioeconomic characteristics collected were age, education, salary, and marital status. Job-related characteristics included working rank, type of occupation, shift work, and duration of work. Working rank was classified as one of 5 independent ranks according to the number of subordinates: firefighter, senior fire sergeant, fire sergeant, fire lieutenant, and above fire captain. Type of occupation included administrative, firefighting, rescue, and emergency. The type of occupational is fixed in principle. The type of shift was classified as no shift, 3 types of shift per day, 2 types of shift per day, and 1 shift of 24 h per day.
Self-rated depression was measured using the validated Korean version of the Beck Depression Inventory (BDI) at both the initial and follow-up surveys [5]. The Center for Epidemiologic Studies Depression Scale (CES-D) was completed during the initial survey. According to Beck’s criteria [6], a BDI under 10 was classified as ‘normal’. Through both the initial and follow-up surveys, the assignment to the 4 groups was performed as follows (Figure 1): normal-continuation (n = 152), depression to normal (n = 17), normal to depression (n = 9), and depression-continuation (n = 8). The operational definition established that the Depression group (n = 17) included the former 2 groups and the Control group (n = 169) included the latter 2 groups.
The self-report questionnaire for occupational stress was administered during the initial study. The short form of the Korea Occupational Stress Scale (KOSS) is composed of the following eight subscales: difficult physical environment, high job demand, insufficient job control, inadequate social support, job insecurity, organisational system, lack of reward, and discomfort in the occupational climate [7].
Organisational system was measured with 7 statements, as follows: ‘The organisational policy of my company is fair and reasonable’ ,. ‘My company provides me with sufficient organisational support’ ,. ‘Departments cooperate with each other without conflict’ ,. ‘All employees cooperate in harmony for the company’ ,. ‘I have opportunities and channels to talk about my ideas’ ,. ‘I expect my career development and promotion to progress as I have planned’ ,. and ‘My current status is appropriate for my education and career’.
The median score of the study subjects on each subscale was used as the cut-off to classify the high and low job stress groups.
Classification as ‘normal’ or ‘not significantly changed’ after 12 months was analysed by McNemar’s test. Between the Depression and Control groups, socioeconomic and job-related characteristics were comparatively analysed with chi-square and t-tests. Crude and adjusted odds ratios using covariates of age, rank, and shift work were calculated with 95% confidence intervals using multiple logistic regression.
Results
The point prevalence of self-rated depression was 13.4% at the initial survey and 9.1% at the follow-up survey. The difference of classification into ‘normal’ or ‘self-rated depression’ was significantly different through the 12 months of follow-up (p < 0.05, McNemar’s test) (Figure 1). The socioeconomic characteristics of subjects in the Depression group were compared with the Control group. The majority of study subjects were married (87.6%) high school graduates (55%) in their 30s (41.9%) or 40s (42.5%), with monthly salaries starting at 2,000 US Dollar (40.8%). No statistically significant differences were shown between the Depression group and the Control group. Additionally, none of the job-related characteristics, including working class, job content, and shift work presented significant differences (Table 1).
Table 1
General characteristics of subjects
The involvement of job stress in classification into the Depression group was analysed through logistic regression (Table 2). The risk of being classified in the Depression group was 8 times higher for those in the high occupational system stress group than for those in the low stress group regardless of subjects’ age, rank, and type of shift work (COR = 8.34, 95% CI [1.82–38.21]; AOR = 8.03, 95% CI [1.73–37.22]). In contrast, subjects in the high difficult physical environment stress group showed a 0.2 times lower risk of being classified in the Depression group (COR = 0.19, 95% CI [0.04–0.86]; AOR = 0.20, 95% CI [0.04–0.92]).
Table 2
The logistic regression of korean occupational job stress scales on self-rated depression
Discussion
The results of the study indicate that male firefighters who organisational system were 8 times more likely to become depressed than those who did not. This result was consistently observed even after adjusting for age and job position. This is similar to other previous studies reporting a relationship between organisational justice and depression. A cohort study conducted with civil servants in England showed that adverse change system increased psychiatric risks [8], as well as the risk of poor self-rated health [9]. In addition, previous studies were conducted to examine the connection between job stress and depression in firefighters. As a result, a subscale of job stress related to role conflict (OR = 1.8) and lower self-esteem (OR = 5.8) was presented as a risk factor. In particular, firefighters working for 24 hours showed work stress factors similar to procedural injustice such as inter-group conflict (OR = 1.7) and role ambiguity (OR = 1.6) as risk factors for depression.
This study, however, found that the difficult physical environment of firefighters had a negative association on depression (OR = 0.20, 95% CI [0.04–0.92]). The public workers such as rescue workers [10] and police officers [11] are reported that they are relatively resilient to mental health problems as they have been trained to cope with critical incidents since the beginning of their employment. Notably, this can also be seen as a result of the healthy worker effect, which can introduce a bias. Firefighters are selectively placed because they are physically and mentally healthier than the general population. Moreover, it is generally known that firefighters experience extremely strong social bonding, referred to as a ‘brotherhood’; this shows that the basic organisational culture of firefighters is likely to attenuate the influence of job stress on depression [12].
On the other hands, it has been reported that subjectively perceived incidents are classically more influential than objective incidents or situations as the pathologic mechanism of depression [13]; a lack of coping skills for responding to this is known to be an important mechanism [14]. The results of this study, that organisational system felt by individuals acts as a stronger risk factor for depression than frequently experienced job stress caused by a difficult physical environment, contrast with the results of existing studies on the pathogenesis of depression.
However, while the mental prescription for physical incidents can be filled by superficial contemplation, an invisible injustice at organisational system is a problem that is difficult to actively address and resolve.
A qualitative study in Korea indicated that in organisational systems, firefighters’ complaints include low allowances, bottlenecked promotions, and a rigid corporate culture [2]. Using the same job stress questionnaire used in this study, research conducted by KOSS found that organisational system, as a job stress factor of firefighters, was significantly higher than that found in the general population [15].
KOSS was validated in Korea and then applied to various types of occupations, presenting reference values for Korean workers [7] and a discussion to understand items through correlation analysis among the subscales. And organisational system in KOSS is also referred to as organisational culture, showing a lack of reward and strong correlation (r = 0.67) with other KOSS subscales [16]. A previous study [17] noted effect-reward imbalance as a predictor of poor mental health. Moreover, the ‘lack of reward’ could have detrimental effects on self-esteem. A Japanese study similar to this one investigated risk factors of depression in firefighters and reported that low self-esteem was five times more relevant to depression among them. Meanwhile, relational injustice is a component of organisational injustice that most previous studies have dealt with [18,19]. Studies on the absence of sickness [20] or self-rated health [9] have focused mostly on relational injustice. This study differs from the existing research in that it focused on procedural injustice. In the Korean municipal worker environment, organisational system is realistically close to procedural injustice. In fact, the internal congestion of promotions for municipal workers is attracting attention from society. A survey [21] showing that promotion was influenced by personal connections internally supports the assumption that unfairness is widespread in the decision-making process of the municipal employment hierarchy. This study found that such a situation might act as a severe stressor for staff in the organisation, and, if chronic, could cause depression after a year. In contrast, research that examined the relevance to depression using the same KOSS survey of all workers in Korea unexpectedly showed that organisational system did not have a great influence on depression [16,18,22]. However, this study discovered the adverse effects of organisational system on mental health, similar to previous research findings on firefighters, instead of the above study targeting all workers in Korea. In particular, unlike the aforementioned studies, the strength of this study lies in its longitudinal design and clear temporal relationships, as well as in the maintenance of internal consistency by restricting subjects to a certain panel of firefighters.
Injustice at organisational system also differs according to type of health effects. Stansfeld reported that organisational injustice is a major factor in short-term absence due to illness in women and long-term absence in men [23].
In our study, female firefighters were excluded from the final study group. The duties of female firefighters were mostly administrative jobs, different from those of male firefighters. Furthermore, subjects who presented as depressed in the initial survey were excluded to avoid confounding results caused by medication, and because this could be an interruption of the natural course of the study.
There are several known risk factors for depression including young age, being unmarried, and low socioeconomic status [24]. In our results, a univariate analysis of the above known risk factors according to depression revealed that they did not show any statistically significant association with depression. The point prevalence of depression in our study was 13.4% at the initial survey and 9.1% at the follow up survey. In the general population of Korea, the point prevalence of depression is 5%, 2.5% for lifetime prevalence according to an interview-based survey [25]. Using CES-D, the same self-rating scale used in the present study, the point prevalence for males in the general population was found to be 6.5% [26]. A similar study of depression in firefighters in Taiwan found a point prevalence for depression of 5.4%, and 10.5% for PTSD. In the same study, current PTSD status was shown to be a significant predictor for current major depression (OR = 1.157) [27]. Among firefighters present at the World Trade Center incident (also called 9/11), the point prevalence of combined PTSD and depression was 16.1%, which is higher than the prevalence of depression alone (5.9%). Because of limitations in the self-rated scale, the prevalence of depression in our results could not be adequately discriminated from depression co-morbid with other mental disorders. However, the healthy worker effect likely attenuated symptoms, so the actual prevalence could be understated due to the effect of bias toward the null. Besides, the size of depression group is slightly small and might be limitation of our study design. Because of panel study, the size and spectrum of participant was small and narrow and the depression group as well.
Notabley, this study was designed as a longitudinal panel study design which have a strength that it could be catch-up the level and trend of change of variance in single panel at the dynamic view point among other longitudinal studies. The dynamic changes of variance and status should be plausible evidences of the policy and management in a homogeneous panel. In case of this study, there is additional study about the depression-recovered group who would be also important group in practical view point of job-fitness. The risk factor and natural course of mild self-rated depression of firefighter should be noticed for management of public health. On the other hands, panel study design has a limitation to show exact causal relationship than the other longitudinal study design. A longitudinal study with incident case at the follow-up survey would be most appropriate to evaluated the causal relationships rather than cross-sectional study.
In terms of keep validity of panel study, the attrition rate should be worried for overestimation of variance of retention group. In our study, the follow-up loss due to job circulation was 38 subjects (13%) out of the final panel. Subgroup analysis of the 38 lost follow-up participants and high group in physical environment was conducted to assess the internal consistency of the panel. Because the distribution of socioeconomic status was not different statistically from that of the final subjects, the original characteristics of the panel were maintained.
Furthermore, panel studies are vulnerable to the weaknesses of instruments, which could be memorized by the subjects in the panel and therefore present biased results in the final analysis. Therefore, the questionnaires were varied to prevent subjects from learning the pattern of answers. For instance, the 2 types of self-rated scales for depression (the BDI and CES-D) were administered but only the BDI was used at the time of the follow-up survey. However, the validity of the self-rated scales of the BDI was used to measure symptoms of depression, not clinical diagnosis. Comparing BDI scales was suggested to be valid, and there should be little discordance between the questionnaire and actual clinical diagnosis [28]. A survey of 120 psychiatrists found that 70.89% of them suggest the BDI, with their suggestion confirmed by clinical practices [29].
Conclusions
Despite several limitations, this study has attempted to identify a effect of job stress to self-rated depression in municipal firefighters through a longitudinal panel study design. Based on our results, it is reasonable to propose that the development of male municipal firefighters should focus on not only job stress resulting from a difficult physical environment, but also organisational system. A comprehensive approach should be considered that incorporates social and academic issues in assessments of psychosocial risk or mental health in high-risk groups in addition to the practical issue of physiochemical hazards.
We thank Hyoung-Ryoul Kim MD.Ph.D. and Yong-kyu Kim MD Ph.D. for review of an early version of this paper. An earlier version was presented as the thesis for the board of M.PH at the Catholic Graduate School of Public Health in 2006. An earlier version was presented at the 29th International Congress of Occupational Health in 2009.
-
Competing interests
The authors declare that they have no competing interests.
-
Authors’ contributions
YC and JK conceived and designed this study. SA, BK, KK, JS, YJ and YK contributed to the design and the literature review of this study. YC contributed to the data collection and data analysis. SA drafted this manuscript. All authors (particularly YJ and YK) revised this manuscript critically. All authors read and approved the final manuscript.
NOTES
- 1. Lee D. An Empirical Study on the Relations of job Stressor and Morale of the Police Officer. 2004, Dankook University: Graduate school of public administration.
- 2. Guidotti TL. Human factors in firefighting: ergonomic-, cardiopulmonary-. and psychogenic stress-related issures. Int Arch Pccup Environ Health 1992;64:1–12. 10.1007/BF00625945.
- 3. Kang BS. Work Related Disease and Health Management of Fire Officer. 2006, Hoseo University: Graduated school of management.
- 4. Chiu S, Niles JK, Webber MP, Zeig-Owens R, Gustave J, Lee R, Rizzotto L, Kelly KJ, Cohen HW, Prezant DJ. Evaluating risk factors and possible mediation effects in posttraumatic depression and posttraumatic stress disorder comorbidity. Public Health Rep 2011;126:201–209. 21387950.ArticlePubMedPMCPDF
- 5. Hahn HM, Yum TH, Shin YW, Kim KH, Yoon DJ, Chung KJ. A standardization study of beck depression inventory in Korea. J Korean Neuropsychiatr Ass 1986;25:487–502.
- 6. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571. 10.1001/archpsyc.1961.01710120031004. 13688369.ArticlePubMed
- 7. Chang S, Koh S, Kang D, Kim S, Kang M, Lee C, Chung J, Cho J, Son M, Chae C, Kim J, Kim J, Kim H, Roh S, Park J, Woo J, Kim S, Kim J, Ha M, Park J, Rhee K, Kim H, Kong J, Kim I, Kim J, Park J, Huyun S, Son D. Developing an occupational stress scale for Korean employees. Korean J Occup Environ Med 2005;17:297–317.
- 8. Ferrie JE, Head J, Shipley MJ, Vahtera J, Marmot MG, Kivimaki M. Injustice at work and incidence of psychiatric morbidity: the Whitehall II study. Occup Environ Med 2006;63:443–450. 10.1136/oem.2005.022269. 16698805.ArticlePubMedPMC
- 9. Kivimaki M, Ferrie JE, Head J, Shipley MJ, Vahtera J, Marmot MG. Organisational justice and change in justice as predictors of employee health: the Whitehall II study. J Epidemiol Community Health 2004;58:931–937. 10.1136/jech.2003.019026. 15483310.ArticlePubMedPMC
- 10. Police officers: a high-risk group for the development of mental health disturbances? A cohort study.. BMJ.
- 11. Lalic H, Bukmir L, Ferhatovic M. Examining psychic consequences in firefighters exposed to stress. Coll Antropol 2007;31:451–455. 17847922.PubMed
- 12. Carey MG, Al-Zaiti SS, Dean GE, Sessanna L, Finnell DS. Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters. J Occup Environ Med 2011;53:928–933. 10.1097/JOM.0b013e318225898f. 21785370.ArticlePubMedPMC
- 13. Tennant C. Life events, stress and depression: a review of recent findings. Aust N Z J Psychiatry 2002;36:173–182. 10.1046/j.1440-1614.2002.01007.x. 11982537.ArticlePubMedPDF
- 14. Sargeant JK, Bruce ML, Florio LP, Weissman MM. Factors associated with 1-year outcome of major depression in the community. Arch Gen Psychiatry 1990;47:519–526. 10.1001/archpsyc.1990.01810180019004. 2350204.ArticlePubMed
- 15. Kim TW, Kim KS, Ahn YS. Relationship between job stress and depressive symptoms among field firefighters. Korean J Occup Environ Med 2010;22:378–387.ArticlePDF
- 16. Cho JJ, Kim JY, Chang SJ, Fiedler N, Koh SB, Crabtree BF, Kang DM, Kim YK, Choi YH. Occupational stress and depression in Korean employees. Int Arch Occup Environ Health 2010;82:47–57. 10.1007/s00420-008-0306-4. 18301911.ArticlePDF
- 17. Kivimaki M, Vahtera J, Elovainio M, Virtanen M, Siegrist J. Effort-reward imbalance, procedural injustice and relational injustice as psychosocial predictors of health: complementary or redundant models? Occup Environ Med 2007;64:659–665. 10.1136/oem.2006.031310. 17259167.ArticlePubMedPMC
- 18. Colquitt JA, Conlon DE, Wesson MJ, Porter CO, Ng KY. Justice at the millennium: a meta-analytic review of 25 years of organizational justice research. J Appl Psychol 2001;86:425–445. 10.1037/0021-9010.86.3.425. 11419803.ArticlePubMed
- 19. Elovainio M, Kivimaki M, Vahtera J. Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health 2002;92:105–108. 10.2105/AJPH.92.1.105. 11772771.ArticlePubMedPMC
- 20. Elovainio M, Van den Bos K, Linna A, Kivimaki M, Ala-Mursula L, Pentti J, Vahtera J. Combined effects of uncertainty and organizational justice on employee health: testing the uncertainty management model of fairness judgments among Finnish public sector employees. Soc Sci Med 2005;61:2501–2512. 10.1016/j.socscimed.2005.04.046. 15990210.ArticlePubMed
- 21. Lee M, Jeong PH. With emphasis on the perceptions of local public officials; an exploratory study on the misuse of personnel management power by local governors. Korean corrupation studies review 2006;11:119–141.
- 22. Park SG, Min KB, Chang SJ, Kim HC, Min JY. Job stress and depressive symptoms among Korean employees: the effects of culture on work. Int Arch Occup Environ Health 2009;82:397–405. 10.1007/s00420-008-0347-8. 18622624.ArticlePubMedPDF
- 23. Stansfeld SA, Fuhrer R, Head J, Ferrie J, Shipley M. Work and psychiatric disorder in the Whitehall II study. J Psychosom Res 1997;43:73–81. 10.1016/S0022-3999(97)00001-9. 9263933.ArticlePubMed
- 24. Hardeveld F, Spijker J, De Graaf R, Nolen WA, Beekman AT. Prevalence and predictors of recurrence of major depressive disorder in the adult population. Acta Psychiatr Scand 2010;122:184–191. 10.1111/j.1600-0447.2009.01519.x. 20003092.ArticlePubMed
- 25. Ministry of Health and Welfare. The Epidemiological Survey of Psychiatric Illnesses in Korea. 2006, Seoul: Ministry of Health and Welfare.
- 26. Cho MJ, Nam JJ, Suh GH. Prevalence of symptoms of depression in a nationwide sample of Korean adults. Psychiatry Res 1998;81:341–352. 10.1016/S0165-1781(98)00122-X. 9925185.ArticlePubMed
- 27. Chen YS, Chen MC, Chou FH, Sun FC, Chen PC, Tsai KY, Chao SS. The relationship between quality of life and posttraumatic stress disorder or major depression for firefighters in Kaohsiung, Taiwan. Qual Life Res 2007;16:1289–1297. 10.1007/s11136-007-9248-7. 17668289.ArticlePubMedPDF
- 28. Lee YH, Song JY. A Study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. Korean J Clin Psychol 1991;10:98–113.
- 29. Lee EJ, Kim JB, Shin IH, Lim KH, Lee SH, Cho GA, Sung HM, Jung SW, Zmimmerman M, Lee Y. Current use of depression rating scales in mental health setting. Psychiatry Investig 2010;7:170–176. 10.4306/pi.2010.7.3.170. 20927305.ArticlePubMedPMC
REFERENCES
Figure & Data
REFERENCES
Citations
Citations to this article as recorded by 
-
A comprehensive review of heavy metals (Pb
2+
, Cd
2+
, Ni
2+
) removal from wastewater using low-cost adsorbents and possible revalorisation of spent adsorbents in blood
Y.B. Nthwane, B.G. Fouda-Mbanga, M. Thwala, K. Pillay
Environmental Technology.2025; 46(3): 414. CrossRef - Marketing of Freshwater and Marine Fish Species in Alexandria City, Egypt: Human Health Risk of Specific Metals
Khaled A. Osman, Hala H. Elsayed Mohamed, Maher S. Salama
Biological Trace Element Research.2025;[Epub] CrossRef - A qualitative investigation of the occupational perceptions of firefighters with or without post-traumatic stress disorder symptoms
Gökhan Topçu, Gulbahar Bastug, Aysun Ergül-Topçu, Erguvan Tugba Ozel-Kizil
Psychology, Health & Medicine.2025; : 1. CrossRef - Environmental impact assessment of cement plants and estimation of pollutant load on environment in India
Madhab Chandra Jena, Sarat Kumar Mishra, Himanshu Sekhar Moharana
International Journal of System Assurance Engineering and Management.2025; 16(7): 2343. CrossRef - The global prevalence of musculoskeletal disorders among firefighters: a systematic review and meta-analysis
Amir Hossein Khoshakhlagh, Saeid Yazdanirad, Saleh Al Sulaie, Abdollah Mohammadian-Hafshejani, Robin Marc Orr
International Journal of Occupational Safety and Ergonomics.2024; 30(1): 272. CrossRef - Enhancement of the catalytic performance of Co-ZIF/WO3 heterostructures for selective catalytic reduction of NOx
Hassan Alamgholiloo, Esrafil Asgari, Amir Sheikhmohammadi, Naser Ghasemian, Bayram Hashemzadeh, Heshmatollah Nourmoradi
Scientific Reports.2024;[Epub] CrossRef - OCCUPATIONAL BURNOUT AMONG UNIFORMED SERVICES CAUSES AND WAYS TO COUNTERACT IT ON THE EXAMPLE OF FIREFIGHTERS
Bogdan Waldemar Stefanowski
Zeszyty Naukowe SGSP.2023; 85: 153. CrossRef - Relationship Between Work-Family Conflict and Depressive Symptoms Among Male Firefighters in China
Yebo Yu, Fan Yang, Mingqi Fu, Farooq Ahmed, Muhammad Shahid, Jing Guo
Journal of Occupational & Environmental Medicine.2023; 65(4): 337. CrossRef - The allostatic load model: a framework to understand the cumulative multi-system impact of work-related psychosocial stress exposure among firefighters
Somkene Igboanugo, John G. Mielke
Health Psychology and Behavioral Medicine.2023;[Epub] CrossRef - Work as an Understudied Driver of Racial Inequities in Breastfeeding
Margaret Whitley, Ashley Banks
NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy.2022; 32(3): 189. CrossRef - Efficacy and expenses of succimer vs. d-penicillamine plus garlic in the treatment of lead poisoning: a retrospective cross-sectional study
Maryam Vahabzadeh, Mahdi Balali-mood, Ali Banagozar Mohammadi, Mohammad Moshiri
DARU Journal of Pharmaceutical Sciences.2021; 29(2): 477. CrossRef - Health outcomes of psychosocial stress within firefighters: A systematic review of the research landscape
Somkene Igboanugo, Philip L Bigelow, John G Mielke
Journal of Occupational Health.2021;[Epub] CrossRef - Association between Shift Work and Neurocognitive Function among Firefighters in South Korea: A Prospective before–after Study
Kyeongmin Kwak, Bong-Kyu Kim, Tae-Won Jang, Chang Sun Sim, Yeon-Soon Ahn, Kyeong-Sook Choi, Kyoung Sook Jeong
International Journal of Environmental Research and Public Health.2020; 17(13): 4647. CrossRef - Association between organizational justice and depressive symptoms among securities company workers
HyunSuk Lee, KangHyun Um, YoungSu Ju, Sukkoun Lee, Min Choi, Domyung Paek, Seong-Sik Cho
Annals of Occupational and Environmental Medicine.2019;[Epub] CrossRef - Prevalence and associated factors of post-traumatic stress disorder among emergency responders of Addis Ababa Fire and Emergency Control and Prevention Service Authority, Ethiopia: institution-based, cross-sectional study
Yodit Habtamu Bezabh, Solomon Mekonnen Abebe, Tolesa Fanta, Agitu Tadese, Mikiyas Tulu
BMJ Open.2018; 8(7): e020705. CrossRef - Exposure assessment of particulate matter and blood chromium levels in people living near a cement plant
Sung Ho Hwang, Jae Bum Park, Kyung Jong Lee
Environmental Geochemistry and Health.2018; 40(4): 1237. CrossRef - Relationship between Occupational Stress, 5-HT2A Receptor Polymorphisms and Mental Health in Petroleum Workers in the Xinjiang Arid Desert: A Cross-Sectional Study
Ting Jiang, Hua Ge, Jian Sun, Rong Li, Rui Han, Jiwen Liu
International Journal of Environmental Research and Public Health.2017; 14(4): 402. CrossRef - The relationship between serum vitamin D levels and sleep quality in fixed day indoor field workers in the electronics manufacturing industry in Korea
Young Saeng Jung, Chang Ho Chae, Young Ouk Kim, Jun Seok Son, Chan Woo Kim, Hyoung Ouk Park, Jun Ho Lee, Young Hoo Shin, Ho Sung Kwak
Annals of Occupational and Environmental Medicine.2017;[Epub] CrossRef - Environmental health centers for asbestos and their health impact surveys and activities
Dong-Mug Kang, Jong-Eun Kim, Yong-Jin Lee, Hyun-Hee Lee, Chang-yeol Lee, Seong-Jae Moon, Min-Sung Kang
Annals of Occupational and Environmental Medicine.2016;[Epub] CrossRef - Factors associated with suicide ideation among subway drivers in Korea
Junsu Byun, Hyoung-Ryoul Kim, Hye-Eun Lee, Se-Eun Kim, Jongin Lee
Annals of Occupational and Environmental Medicine.2016;[Epub] CrossRef - Employment and occupation effects on late-life depressive symptoms among older Koreans: a cross-sectional population survey
Hyun Park, Young Hwangbo, Yong-Jin Lee, Eun-Chul Jang, Wook Han
Annals of Occupational and Environmental Medicine.2016;[Epub] CrossRef - Psychophysiological relationships between a multi-component self-report measure of mood, stress and behavioural signs and symptoms, and physiological stress responses during a simulated firefighting deployment
Alexander Wolkow, Brad Aisbett, Sally A Ferguson, John Reynolds, Luana C Main
International Journal of Psychophysiology.2016; 110: 109. CrossRef - The impact of sleep restriction while performing simulated physical firefighting work on cortisol and heart rate responses
Alexander Wolkow, Brad Aisbett, John Reynolds, Sally A. Ferguson, Luana C. Main
International Archives of Occupational and Environmental Health.2016; 89(3): 461. CrossRef - The Effects of Human Touch on Turnover Intention of Airport Ground Handling Employees
Min-Hoo Lee, Yung-Kil Lee, Ki-Woong Kim, Youn-Chul Choi, Sung-Sik Park
Journal of the Korean Society for Aviation and Aeronautics.2016; 24(2): 31. CrossRef - Emphysema prevalence related air pollution caused by a cement plant
Hyun Seung Lee, Chul Gab Lee, Dong Hun Kim, Han Soo Song, Min Soo Jung, Jae Yoon Kim, Choong Hee Park, Seung Chul Ahn, Seung Do Yu
Annals of Occupational and Environmental Medicine.2016;[Epub] CrossRef - Relationships between inflammatory cytokine and cortisol responses in firefighters exposed to simulated wildfire suppression work and sleep restriction
Alexander Wolkow, Brad Aisbett, John Reynolds, Sally A. Ferguson, Luana C. Main
Physiological Reports.2015; 3(11): e12604. CrossRef
Cite
XML DownloadThe effect of organisational system on self-rated depression in a panel of male municipal firefighters
Figure 1
The flowchart of study design and assignment of subjects.
Figure 1
The effect of organisational system on self-rated depression in a panel of male municipal firefighters
| General characteristics | Total | Depression | Control | P-value * | ||||
|---|---|---|---|---|---|---|---|---|
| (N = 186) | (N = 17) | (N = 169) | ||||||
| Age | 0.287 | |||||||
| 29 | 3 | (1.7)† | 0 | 0 | 4 | 2.4 | ||
| 30-39 | 78 | 41.9 | 4 | 23.5 | 74 | 43.8 | ||
| 40-49 | 79 | 42.5 | 11 | 64.7 | 68 | 40.2 | ||
| 50- | 25 | 13.4 | 2 | 11.8 | 23 | 13.6 | ||
| Subtotal | 186 | 100 | 17 | 100 | 169 | 100 | ||
| Education | 0.740 | |||||||
| -Middle school | 4 | 2.2 | 0 | 0 | 4 | 2.5 | ||
| High school | 99 | 55 | 9 | 52.9 | 90 | 55.2 | ||
| 2-year university | 36 | 20 | 5 | 29.4 | 31 | 19 | ||
| 4 –years college- | 41 | 22.8 | 3 | 17.6 | 38 | 23.3 | ||
| Subtotal | 180 | 100 | 17 | 100 | 163 | 100 | ||
| Salary in a month | 0.418 | |||||||
| <$2000 | 9 | 5 | 0 | 0 | 9 | 5.5 | ||
| $2000-2999 | 73 | 40.8 | 7 | 43.8 | 66 | 40.5 | ||
| $3000-3999 | 69 | 38.5 | 5 | 31.3 | 64 | 39.3 | ||
| $4000- | 28 | 15.6 | 4 | 25 | 24 | 14.7 | ||
| Subtotal | 179 | 100 | 16 | 100 | 163 | 100 | ||
| Marriage | 0.815 | |||||||
| Married | 162 | 87.6 | 15 | 88.2 | 147 | 87.5 | ||
| Single | 17 | 9.2 | 2 | 11.8 | 15 | 8.9 | ||
| Divorced or seperated | 6 | 3.2 | 0 | 0 | 6 | 3.6 | ||
| Subtotal | 185 | 100 | 17 | 100 | 168 | 100 | ||
| Working class | 0.268 | |||||||
| Firefighter | 26 | (14.1)† | 2 | 11.8 | 24 | 14.3 | ||
| Vice director | 85 | 45.9 | 5 | 29.4 | 80 | 47.6 | ||
| Director | 59 | 31.9 | 8 | 47.1 | 51 | 30.4 | ||
| Chief director | 6 | 3.2 | 0 | 0 | 6 | 3.6 | ||
| Above president | 9 | 4.9 | 2 | 11.8 | 7 | 4.2 | ||
| Subtotal | 185 | 100 | 17 | 100 | 168 | 100 | ||
| Job content | 0.721 | |||||||
| Administrative | 49 | 26.8 | 5 | 29.4 | 44 | 26.5 | ||
| Firefighting | 81 | 44.3 | 6 | 35.3 | 75 | 45.2 | ||
| Rescue (accident) | 31 | 16.9 | 3 | 17.6 | 28 | 16.9 | ||
| Emergency (health) | 22 | 12 | 3 | 17.6 | 19 | 11.4 | ||
| Subtotal | 183 | 100 | 17 | 100 | 166 | 100 | ||
| Shiftwork | 0.545 | |||||||
| None | 38 | 20.7 | 2 | 13.3 | 36 | 21.3 | ||
| 3 shift | 6 | 3.3 | 1 | 6.7 | 5 | 3 | ||
| 2 shift | 44 | 23.9 | 5 | 33.3 | 39 | 23.1 | ||
| 1 shift for 24 hrs | 96 | 52.2 | 7 | 46.7 | 89 | 52.7 | ||
| Subtotal | 184 | 100 | 15 | 100 | 169 | 100 | ||
| Sub-items in job stress † | Crude | 95% CI | Adjusted | 95% CI | |||
|---|---|---|---|---|---|---|---|
| Odd ratio | Odd ratio * | ||||||
| Total score | |||||||
| Low group | 1.00 | 1.00 | |||||
| High group | 2.44 | 0.80 | −7.48 | 2.50 | 0.80 | −7.78 | |
| Physical environment | |||||||
| Low group | 1.00 | 1.00 | |||||
| High group | 0.19 | 0.04 | −0.86 | 0.20 | 0.04 | −0.92 | |
| Job demand | |||||||
| Low group | 1.00 | 1.00 | |||||
| High group | 2.19 | 0.77 | −6.21 | 2.24 | 0.78 | −6.41 | |
| Job control | |||||||
| Low group | 1.00 | 1.00 | |||||
| High group | 0.97 | 0.33 | −2.80 | 0.92 | 0.32 | −2.70 | |
| Lack of social support | |||||||
| Low group | 1.00 | 1.00 | |||||
| High group | 0.86 | 0.30 | −2.44 | 0.80 | 0.28 | −2.32 | |
| Job instability | |||||||
| Low group | 1.00 | 1.00 | |||||
| High group | 1.14 | 0.23 | −5.77 | 1.14 | 0.23 | −5.77 | |
| Organisational system | |||||||
| Low group | 1.00 | 1.00 | |||||
| High group | 8.34 | 1.82 | −38.21 | 8.03 | 1.73 | −37.22 | |
| Lack of reward | |||||||
| Low group | 1.00 | 1.00 | |||||
| High group | 1.58 | 0.56 | −4.46 | 1.58 | 0.55 | −4.49 | |
| Organizational climate | |||||||
| Low group | 1.00 | 1.00 | |||||
| High group | 0.75 | 0.27 | −2.14 | 0.65 | 0.22 | −1.91 | |
Table 1
General characteristics of subjects
*Chi-square test (P < 0.05).
†N(%).
Table 2
The logistic regression of korean occupational job stress scales on self-rated depression
*Odd ratio was adjusted by age, job class, and shiftwork.
