Are reports of psychological stress higher in occupational studies? A systematic review across occupational and population based studies

PLoS One. 2013 Nov 4;8(11):e78693. doi: 10.1371/journal.pone.0078693. eCollection 2013.


Objectives: The general health questionnaire (GHQ) is commonly used to assess symptoms of common mental disorder (CMD). Prevalence estimates for CMD caseness from UK population studies are thought to be in the range of 14-17%, and the UK occupational studies of which we are aware indicate a higher prevalence. This review will synthesise the existing research using the GHQ from both population and occupational studies and will compare the weighted prevalence estimates between them.

Methods: We conducted a systematic review and meta-analysis to examine the prevalence of CMD, as assessed by the GHQ, in all UK occupational and population studies conducted from 1990 onwards.

Results: The search revealed 65 occupational papers which met the search criteria and 15 relevant papers for UK population studies. The weighted prevalence estimate for CMD across all occupational studies which used the same version and cut-off for the GHQ was 29.6% (95% confidence intervals (CIs) 27.3-31.9%) and for comparable population studies was significantly lower at 19.1% (95% CIs 17.3-20.8%). This difference was reduced after restricting the studies by response rate and sampling method (23.9% (95% CIs 20.5%-27.4%) vs. 19.2% (95 CIs 17.1%-21.3%)).

Conclusions: Counter intuitively, the prevalence of CMD is higher in occupational studies, compared to population studies (which include individuals not in employment), although this difference narrowed after accounting for measures of study quality, including response rate and sampling method. This finding is inconsistent with the healthy worker effect, which would presume lower levels of psychological symptoms in individuals in employment. One explanation is that the GHQ is sensitive to contextual factors, and it seems possible that symptoms of CMD are over reported when participants know that they have been recruited to a study on the basis that they belong to a specific occupational group, as in nearly all "stress" surveys.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Health Surveys / methods
  • Health Surveys / statistics & numerical data*
  • Humans
  • Occupational Health / statistics & numerical data*
  • Prevalence
  • Stress, Psychological / epidemiology*
  • Surveys and Questionnaires*
  • United Kingdom / epidemiology

Grants and funding

This study was funded by the UK Ministry of Defence (MoD). The author's work was independent of the funders and the paper was disclosed to the MoD at the point of submission. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.