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The Journal of Health Science: October 2005, Vol. 7, No. 4. p379~p392
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390
The Journal of Health Science: October 2005, Vol. 7, No. 4. p379~p392
�� !"#$7 � 4 �
physicians: the use of overlapping question-
naire design. Soci Sci Med, 45, 1615-1629.
Arnetz, B. (1997). Physicians’ view of their work
environment and organization. Psychother
Psychosom, 66, 155-162.
Bosma, H., Marmot, G., Hemingway, H., et al. (1997).
Low job control and risk of coronary heart dis-
ease in Whitehall II study. BMJ, 314, 558-565.
Caplan, D., Cobb, S., French, JRP, Jr., et al. (1975).
Job Demands and Worker Health. Cincinnati,
OH: Natl. Inst. Occup. Saf. Health. Publ. No.
75-168.
Cheng, T. A., & William, P. (1986). The design and
development of a screening questionnaire
(CHQ) for use in community studies of mental
disorders in Taiwan. Psychological Medicine,
16, 415-422.
Cheng, Y., Kawachi, I., Coakley, E., et al. (2000).
Association between psychosocial work char-
acteristics and health functioning in American
women: prospective study. BMJ, 320(27),
1432-1437.
Cheng, Y., Chen, C. W., Chen, C. J., et al. (2005).
Job insecurity and its association with health
among employees in the Taiwanese general
population. Social Science and Medicine, 61
(1), 41-52.
Cottington, M., Mattews, A., Talbott, E., & Kuller, H.
(1986). Occupational stress, suppressed anger and
hypertension. Psychosom Med, 48(5), 249-260.
Diamond, L. (1982). The role of anger and hostility
in essential hypertension and coronary heart
disease. Psychol Bull, 92, 410-433.
Frank, E. (2004). Physician health and patient care.
JAMA, 209(5), 637.
Goldberg, D. P. (1979). A scaled version of the
General Health Questionnaire. Psychological
Medicine, 9(2), 139-145.
Goldberg, D. P., Gater, R., Sartorius, N., et al.
(1997). The validity of the two versions of the
GHQ in the WHO study of mental illness in
general health care. Psychological medicine,
27(2), 191-197.
Goldberg, P., Gueguen, A., Schmaus, A., Nakache,
J. P., & Goldberg, M. (2001). Longitudinal
study of associations between perceived health
status and self reported diseases in the French
Gazel cohort. Journal of Epidemiology and
Community Health, 55(4), 233-238.
Hallqvist, J., Diderichsen, F., Theorell, T., et al.
(1998). Is the effect of job strain on Myocar-
dial infraction risk due to interaction between
high psychosocial demands and low decision
latitude? Results from Stockholm heart epide-
miology program (SHEEP). Social Science and
Medicine, 46(10), 1405-1415.
Howie, G., Hopton, L., Heaney, J., & Porter, M.
(1992). Attitudes to medical care, the organi-
zation of work, and stress among general
practitioners. Br J Gen Pract, 42(2), 181-185.
Hughes, H., Brandeberg, N., Baldwin, C. Jr., et al.
(1992). Prevalence of substance use among US
physicians. JAMA, 267, 2333-2339.
Johnson, V., & Hall, M. (1988). Job strain, work
place social support, and cardiovascular
disease: a cross-sectional study of a random
sample of the Swedish working population.
Am J. of Public Health, 78, 1336-1342.
Johnson, V., Hall, M., & Theorell, T. (1989). Com-
bined effects of job strain and social isolation
on cardiovascular disease morbidity and mor-
tality in a random sample of the Swedish male
working population. Scan J Work Environ
Health, 15(2), 271-279.
Kaplan, G. A., Goldberg, D. E., Everson, S. A., Cohen,
R. D., Salonen, R., Tuomilehto, J., & Salonen, J.
�� !"#$%&'(�)*+,-
�� !"#$7 � 4 � 391
(1996). Perceived health status and morbidity and
mortality: Evidence from the kuopio ischaemic
heart disease risk factor study. International Jour-
nal of Epidemiology, 25(2), 259-265.
Karasek, A. (1979). Job demands, job decision
latitude, and mental strain: Implications for
job redesign. Adm Sci Q, 24(2), 285-308.
Karasek, A. (1990). Lower health risk with in-
creased job control among white collar
workers. J Organ. Behav, 11(2), 171-185.
Karasek, A., & Theorell T. (1990). Healthy work:
stress, productivity, and the reconstruction of
working life. New York, NY: Basic Books.
Karasek, A., & Theorell, T., Schwartz, E., et al.
(1988). Job characteristics in relation to the
prevalence of myocardial infarction in the US
health examination survey (HES) and the health
and nutrition examination survey (HANES).
Am J Public Health, 78, 910-918.
Liukkonen, V., Virtanen, P., & Kivimaki, M. (2004).
Social capital in working life and the health of
employees. Social science and medicine, 59,
2447-2458.
Marmot, G., Bosma, H., Hemingway, H, et al.
(1997). Contribution of job control and other
risk factors to social variations in coronary
heart disease incidence. Lancet, 350, 235-239.
Miilunpalo, S., Vuori, I., Oja, P., Pasanen, M., &
Urponen, H. (1997). Self-rated health status as
a health measure: The predictive value of self-
reported health status on the use of physician
services and on mortality in the working-age
population. Journal of Clinical Epidemiology,
50(5), 517-528.
Moller, L., Kristensen, T. S., & Hollnagel, H.
(1996). Self rated health as a predictor of coro-
nary heart disease in Copenhagen, Denmark.
Journal of Epidemiology and Community
Health, 50(4), 423-428.
Schnall, L., Landsbergis, A., & Baker, D. (1994).
Job strain and Cardiovascular Disease. Annual
Review of Public Health, 15(3), 381-411.
Siegrist, J. (1996). Adverse health effects of high-
effort/low-reward conditions. Journal of Occu-
pational Health and Psychology, 1(1), 27-41.
Siegrist, J., Starkea, D., Chandolab, T., et al. (2004).
The measurement of effort-reward imbalance
at work: European comparisons. Social Sci-
ence & Medicine, 58(8), 1483-1499.
Theorell, T. (2000). Working conditions and health.
Social Epidemiology. L. F. Berkman and I.
Kawachi. New York, NY: Oxford University Press.
Theorell, T., & Karasek, A. (1996). Current issues relat-
ing to psychosocial job strain and cardiovascular
disease research. J Occup Health Psychol, 1(1), 9-
26.
Theorell, T., deFaire, U., Johnson, J., et al. (1991).
Job strain and ambulatory blood pressure profiles.
Scand. J Work Environ Health, 17(3), 380-385.
Theorell, T., Hamsten, A., deFaire, U., et al. (1987).
Psychosocial work conditions before myocar-
dial infarction in young men. Int J Cardiol, 15
(1), 33-46.
Theorell, T., Tsutsumi, A., Hallqvist, J., et al. (1998).
Decision latitude, job strain, and myocardial
infarction: a study of working men in Stockholm.
Am J Public Health, 88(3), 382-388.
William, E., Konrad, T., Linzer, M., et al. (2002)
Physician, Practice, and Patient Characteristics
Related to Primary Care Physician Physical and
Mental Health: Results from the Physician
Worklife Study. Health Service Research, 37,
119-141.
392
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�� !"#$7 � 4 �
Elucidating the Relationships between Physician Job
Strains and Health
Duan-Rung Chen Cheng-Ta Chung
Abstract
Physician health has been largely ignored. This study assessed the principal factors associated with
physician health in a cardiologist sample group. Job Demand Control model was applied to assess the
psychosocial environment in which physicians work. Mental health was measured using the Chinese
Health Questionnaire. Self-reported health status was also examined. A total of 131 cardiologists
responded to questionnaires. Multiple logistic regression results demonstrated that physician self-
reported health status was associated to stressors related to hospital management and the health care
environment. Job strain was significantly associated with minor psychiatric distress. Employment in a
medical center and/or as managerial staff was a health risk factor for cardiovascular disease. Preliminary
results indicate that more objective physiological indictors assessing health are needed.
Key words: Physicians, job strain, health status
1Associate Professor, Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan
University.2
Director, Chia-I Veterans Genera Hospital.
Received: Mar. 18, 2005 Revised: Aug. 30, 2005 Accepted: Oct. 12, 2005
Address Correspondence to: Duan-Rung Chen Rm. 307, No. 19, Hsu-Chow Road, Taipei 100, Taiwan (R.O.C.)