Job stress rumination and sleep quality in employees of rescue 1122

Chapter I

Introduction

The aim of the current study is to evaluate the stress rumination and sleep quality in

employees of rescue 1122. The stress is the psychological issue which have different stages

and effects differently on an individual. On the other hand, sleep clock set by the average

sleeping duration of a person. The healthy sleep duration effects healthfully and vice versa.

The stress evaluation and sleep duration is the major components to know the rescue

employees.

1.1 Job stress rumination

Despite its frequent use, no agreed upon definition of job stress currently exists.

Nonetheless, Kahn and Bossier have identified three areas of consensus. First, job stress

results from the influence of external stimuli (stressor). Second, it involves the personal

evaluation of external stimuli (appraisal). And third, job stress negatively impacts mental,

emotional, physical, and/or behavioural functioning (strain). In short, job stress is a dynamic

process in which subjective cognitive appraisals of job-related stressors produce negative

health and/or behavioural strain outcomes.

From this general definition, scholars have developed four perspectives for

understanding job stress. First, originating from medicine, the response-based view classifies

job stress as a strain outcome in the form of either a cognitive (dissatisfaction), physiological

(illness), and/or behavioural (absenteeism) response. Second, the stimulus-based view applies

an engineering analogy to job stress. Its chief concern is identifying stressors (e.g., caseloads

or layoffs) capable of weakening one’s internal means of resistance, rather than the outcome

associated with these stresses. Third, derived from organizational psychology, the
 interactional view emphasizes the interplay between two distinct stressors. For example,

stress arises when social workers managing high caseloads are delegated little, to no control,

over assigned job duties.

The fourth perspective is the transactional view. Emerged from cognitive psychology,

job stress is construed as a reciprocal person-environment relationship involving subjective

judgments of the work milieu that influence the presence or absence of strain outcomes. Only

the transactional view encompasses Kahn and Byosiere’s three definitional elements (external

stressor, cognitive appraisal, and mental/physical/behavioural outcome); and as such, is the

perspective currently favoured by most stress researchers.

https://www.naswnyc.org/page/157/Job-Stress-Definition-Historical-Origins-and-

Intervention-Strategies.htm

Work-related stress

 Work-related stress is the response people may have when presented with work demands

and pressures that are not matched to their knowledge and abilities and which challenge

their ability to cope.

 Stress occurs in a wide range of work circumstances but is often made worse when

employees feel they have little support from supervisors and colleagues, as well as little

control over work processes.

 There is often confusion between pressure or challenge and stress and sometimes it is used

to excuse bad management practice.

Pressure at the workplace is unavoidable due to the demands of the contemporary work

environment. Pressure perceived as acceptable by an individual, may even keep workers

alert, motivated, able to work and learn, depending on the available resources and personal

characteristics. However, when that pressure becomes excessive or otherwise

unmanageable it leads to stress. Stress can damage an employees' health and the business

performance.

Work-related stress can be caused by poor work organisation (the way we design

jobs and work systems, and the way we manage them), by poor work design (for example,

lack of control over work processes), poor management, unsatisfactory working

conditions, and lack of support from colleagues and supervisors.

Research findings show that the most stressful type of work is that which values

excessive demands and pressures that are not matched to workers’ knowledge and

abilities, where there is little opportunity to exercise any choice or control, and where

there is little support from others.

Employees are less likely to experience work-related stress when - demands and

pressures of work are matched to their knowledge and abilities - control can be exercised

over their work and the way they do it - support is received from supervisors and

colleagues - participation in decisions that concern their jobs is provided.

Stress-related hazards at work: Stress related hazards at work can be divided

into work content and work context.

Work contents includes - job content (monotony, under-stimulation, meaningless

of tasks, lack of variety, etc) - work load and work pace (too much or too little to do, work

under time pressure, etc.) - working hours (strict or inflexible, long and unsocial,

unpredictable, badly designed shift systems) - Participation and control (lack of

participation in decision-making, lack of control over work processes, pace, hours,

methods, and the work environment)

Work context includes - career development, status and pay (job insecurity, lack

of promotion opportunities, under- or over-promotion, work of 'low social value', piece

rate payment schemes, unclear or unfair performance evaluation systems, being over- or
under-skilled for a job) - role in the organization (unclear role, conflicting roles) -

interpersonal relationships (inadequate, inconsiderate or unsupportive supervision, poor

relationships with colleagues, bullying/harassment and violence, isolated or solitary work,

etc) -organizational culture (poor communication, poor leadership, lack of behavioural

rule, lack of clarity about organizational objectives, structures and strategies) - work-life

balance (conflicting demands of work and home, lack of support for domestic problems at

work, lack of support for work problems at home, lack of organizational rules and policies

to support work-life balance)

Scientific evidence-base of risk factors, prevention and cost Work-related stress

is still an evasive concept to many, although the topic is covered in hundreds of papers

published every year. The seminar will focus on the main evidence of risk factors

extracted from existing research, as concerns in particular work-related stress

interventions and related costs. The presentation will provide an overview of the vast

amount of knowledge we already have.

https://www.who.int/occupational_health/topics/stressatwp/en/

1.2 Sleep Quality

Sleep quality is defined as one’s satisfaction of the sleep experience, integrating

aspects of sleep initiation, sleep maintenance, sleep quantity, and refreshment upon

awakening.

Sleep quality is a vital construct to clinicians and researchers due to the high

prevalence of disturbed sleep and insomnia, and the clear relevance of sleep quality to

optimal health and functioning. Yet, despite its common usage, “sleep quality” is a term

without a clear definition (Krystal & Edinger, 2008). In fact, sleep quality is likely to

have different meanings from one person to the next. For someone with problems

initiating sleep, the sleep onset period may be the strongest determinant of sleep quality.
 In contrast, the relative difficulty of going to sleep may be of trivial importance

to someone whose sleep is restless and rife with frequent awakenings.

https://link.springer.com/referenceworkentry/10.1007%2F978-1-4419-1005-9_849

The National Sleep Foundation (NSF) recently released the key indicators of good

sleep quality, as established by a panel of experts. Given the precipitous increase in the

use of sleep technology devices, the key findings are timely and relevant. This information

complements the data these devices provide, helping millions of consumers interpret

their sleep patterns. The report comes as the first step in NSF’s effort to spearhead

defining the key indicators of good sleep quality. The key determinants of quality sleep

are included in a report published in Sleep Health. They include:

 Sleeping more time while in bed (at least 85 percent of the total time)

 Falling asleep in 30 minutes or less

 Waking up no more than once per night; and

 Being awake for 20 minutes or less after initially falling asleep.

Multiple rounds of consensus voting on the determinants led to the key findings,

which have since been endorsed by the American Association of Anatomists, American

Academy of Neurology, American Physiological Society, Gerontological Society of America,

Human Anatomy and Physiology Society, Society for Research on Biological Rhythms,

Society for Research of Human Development, and Society for Women’s Health Research.

Max Hirshkowitz, PhD, DABSM, Chairman of the Board of Directors of the NSF

stated, “Millions of Americans are sleep technology users. These devices provide a glimpse

into one’s sleep universe, which is otherwise unknown. The National Sleep Foundation’s

guidelines on sleep duration, and now quality, make sense of it all—providing consumers

with the resources needed to understand their sleep. These efforts help to make sleep science
and technology more accessible to the general public that is eager to learn more about its

health in bold new ways.”

Notably, NSF's recent Sleep Health Index® revealed that as many as 27 percent of

people take longer than 30 minutes, on average, to fall asleep. With wider use of sleep

technology and the context provided by NSF’s guidelines, consumers can better gauge and

even improve their sleep. Furthermore, NSF's recommendations are instrumental to the

continued development of such consumer technologies. The report also highlights areas

where research is needed to identify and further delineate additional indicators of good sleep

quality across age groups.

“In the past, we defined sleep by its negative outcomes including sleep dissatisfaction,

which were useful for identifying underlying pathology. Clearly this is not the whole story.

With this initiative, we are now on a better course towards defining sleep health,” noted

Maurice Ohayon, MD, DSc, PhD, Director of the Stanford Sleep Epidemiology Research

Center.

https://www.sleepfoundation.org/press-release/what-good-quality-sleep

When it comes to setting sleep goals, most people focus on the number of hours they

spend in bed. While that is a good benchmark to start, in order to get the most out of your

shut-eye you need to focus on the restfulness of your sleep as well. Discover how to

maximize both aspects of sleep to wake up feel rejuvenated.

Sleep Quantity

Most adults should aim for the recommended seven to nine hours of shut-eye per

night, But in fact, for young adults between the ages of 18 and 25, some may need as little as

6 hours of sleep per night, while others require up to 10 or even 11 hours to full restore their
energy. Because each person is different, you need to be the judge of whether you feel alert

after 8 hours of sleep, or if you’d benefit from an hour or two more or less.

Measuring Sleep Quality

Unlike sleep quantity, sleep quality refers to how well you sleep. For adults, good

quality sleep means that you typically fall asleep in 30 minutes or less, sleep soundly through

the night with no more than one awakening, and drift back to sleep within 20 minutes if you

do wake up. On the flip side, bad sleep quality is the kind that leaves you staring at the

ceiling or counting sheep. It may be characterized by trouble falling asleep and staying

asleep, restlessness, and early awakenings.

The Perfect Formula to measure sleep quality

In order to feel your best, you should focus on sleep quantity and quality. Just like

skimping on the amount of sleep you get makes it hard to function, poor sleep quality can

also leave you feeling exhausted the next day and even impact your frame of mind. Good

quality sleep, on the other hand, may improve your mood more than quantity because

uninterrupted sleep allows you to get the optimal amount of restorative sleep.

Of course, sleep quality can be more difficult to measure than sleep quantity. If you

have concerns, talk with your doctor. A physician may recommend lifestyle changes (more

exercise, say, or limiting how much alcohol you drink in the evening) that can help improve

your odds of a restful night.

https://www.sleep.org/articles/sleep-quantity-different-sleep-quality/

1.3 Rescue 1122

Rescue 1122 is an emergency service that serves Punjab Province in Pakistan. The

service is accessed by calling 1122 from any phone. It was established under the 2006 Punjab
Emergency Service Act to provide management of emergencies such as fire, rescue

and emergency medical services. The Punjab Emergency Council and District Emergency

Boards have been constituted to ensure management and prevention of emergencies and to

recommend measures for mitigation of hazards endangering public safety. Dr Rizwan Naseer

is the current Director General of Rescue 1122 Pakistan.

After the success of the Lahore Pilot Project launched in 2004, Rescue 1122 is

operational in all Districts of Punjab with a population of over 110 million and providing

technical assistance to other Provinces of Pakistan. Rescue 1122 includes Emergency

Ambulance, Rescue & Fire services and a Community Safety program.

The District Emergency Officer is responsible for the day-to-day operational

management and administration of the Service in the Districts in close coordination with the

District Administration. The office of the Director General is mainly responsible for the

overall monitoring to ensure uniformity and quality, training, planning, research and

development through the Provincial Monitoring Cell. The management is currently working

to improve its services. In March 2013, Emergency Rescue Service Rawalpindi received 14

new fully equipped ambulances.

Presently, Rescue 1122 is representing a model of integrated emergency services in

the world. It offers emergency, fire, rescue, disaster management, water rescue, and animal

rescue and community safety services under one umbrella.

https://en.wikipedia.org/wiki/Rescue_1122

The Punjab Emergency Service (Rescue 1122) is the leading emergency humanitarian

service of Pakistan with infrastructure in all 36 districts of Punjab and is providing technical

assistance to other provinces. Rescue 1122 has rescued millions victims of emergencies

through its Emergency Ambulance, Rescue & Fire services and Community Emergency
Response Teams while maintaining its average response time of 7 minutes and standards in

all districts of Punjab province with an estimated population of over 100 million.

The Punjab Emergency Service Act was promulgated in 2006 to provide legal cover

to the Emergency Services Reforms initiated in 2004 from Lahore. Start of Rescue 1122 was

necessitated after failure of repeated attempts to revitalize and modernize the old

organizations mandated for emergency management. Now as a result of the performance of

Rescue 1122 during emergencies and disasters in recent years, it has also been notified as the

Disaster Response Force by the Provincial Disaster Management Authority (PDMA) &

Government of the Punjab.

The District Emergency Officer is responsible for the day to day operational

management and administration of the Service in the Districts under the supervision of

District Coordination Officer who is also the Chairman of the District Emergency Board. The

Board has become an effective organization for improving inter-departmental coordination

and prevention of emergencies based on review of emergency data. The Director General

who is the Chief Executive Officer of the organization is mainly responsible for overall

operations, monitoring to ensure uniformity & quality amongst districts, recruitment &

training, research, planning and development.

Rescue 1122 is not just providing the emergency victims with the basic right to timely

emergency care but believes in “saving lives and changing minds”. This is vividly reflected

in the mission statement of the Service which is “development of safer communities through

establishment of an effective system for emergency preparedness, response and prevention”.

http://www.rescue.gov.pk/Introduction.aspx

Rescue workers are required to respond to a variety of emergency situations involving

human suffering, danger, and death. For example, their occupational work includes providing
emergency medical assistance to injured people and rescuing humans from accidents, fires,

floods, or other natural or human-made disasters. Consequently, rescue workers are regularly

confronted with traumatic events (e.g., Regehr et al., 2002; Marmar, 2006). That is, they are

confronted (directly or witnessing) with actual or threatened death, serious injury, sexual

violence, and/or serious aversive details of those events. These situations go along with

physical, psychological, and emotional stress. Subsequently, rescue workers are at higher risk

for experiencing strong negative emotions (e.g., fear, worry), and disturbed sleep or

concentration (e.g., Van Der Ploeg and Kleber, 2003; Benedek et al., 2007; Halpern et al.,

2009; Donnelly et al., 2016), which in turn promotes the development of physical and mental

health problems. Indeed, the more often rescue workers are confronted with traumatic events

on duty, the higher is their risk of clinically significant and often comorbid depressive and

post-traumatic symptoms as well as physical complaints (Teegen and Yasui, 2000; Fullerton

et al., 2004; Benedek et al., 2007; Berger et al., 2012; Donnelly, 2012; Razik et al.,

2013; Fjeldheim et al., 2014; Wild et al., 2016; Skeffington et al., 2017). In addition to their

duty-related trauma exposure, rescue workers’ individual vulnerability for mental health

problems may further be increased by non work-related traumatic events in private life,

particularly experiences of childhood maltreatment (Maunder et al., 2012; for reviews,

see Hamilton et al., 2015; Li et al., 2016).

Besides the experience of traumatic events, the burden of rescue workers is further

complicated by their workload, resulting from adverse working conditions such as shiftwork

and its known negative consequences on physical and mental health (for a review see, Frank

and Ovens, 2002). Further factors are chronic workplace stress such as false alarms, time

pressure and tensed relationships with colleagues and managers due to increased stress in an

already high-stress profession (Clohessy and Ehlers, 1999; Teegen and Yasui, 2000; Van Der

Ploeg and Kleber, 2003; Aasa et al., 2005; Heringshausen et al., 2010). From a more general
point of view, the economic situation also impacts on worker’s health in non-profit

organizations such as the rescue service. In detail, studies have shown that major

macroeconomic distortions (such as the economic crisis) have a negative impact on health

care services due to decreased private and public funding, resulting in increased workload,

job insecurity, reduction of wages, and fear of becoming unemployed (Giorgi et al.,

2015; Mucci et al., 2016). Indeed, the economic recession has been linked to the development

of mental illness due to increased work-related stress (reviewed in Mucci et al., 2016). In this

regard, the economic recession could contribute to an increased stress load together with

already unfavourable working conditions and the experience of traumatic events in rescue

workers. Interestingly, accumulated stress has been associated with chronic low-grade

inflammation which in turn represents an underlying biological mechanism in the

development of mental disorders such as depression and PTSD (Berk et al., 2013; Gola et al.,

2013; Boeck et al., 2016). In sum, several factors might lead to the perception of increased

work-related stress in rescue workers, which accelerates the development of post-traumatic,

depressive, and somatic symptoms (Beaton et al., 1997; Boudreaux et al., 1997; Aasa et al.,

2005; Bennett et al., 2005; Sterud et al., 2008; Wild et al., 2016). These mental and physical

health problems can in turn cause sickness-related absence from work, earlier retirement and

even complete withdraw from the job (Hammer et al., 1986; Dirkzwager, 2004; Chapman et

al., 2009; Razik et al., 2013).

Given the work-related stressors and constant exposure to potential traumatic events

on duty, the ability to deal with negative emotions seems to constitute a crucial component in

the daily duties of rescue workers to stay healthy and carry out their work properly. Emotion

regulation is defined as all processes by which individuals influence which emotions they

have, when they have them, and how they experience and express them (Gross, 1998, 2015).

While several emotion regulation strategies have been associated with personal well-being,
physical and mental health (“adaptive” strategies), others have been proposed to boost the

vulnerability to develop mental problems (“maladaptive” strategies; for reviews see, Aldao

and Nolen-Hoeksema, 2010; Aldao et al., 2010). To the first category belongs the attempt to

change a stressful or negative situation and its consequences (problem solving); generating

positive interpretations or perspectives on a negative situation in order to reduce negative

emotions (reappraisal); and the ability to accept emotions, thoughts, and perceptions without

evaluating them (acceptance; Gross, 1998; Aldao et al., 2010). In contrast, typical

maladaptive emotion regulation strategies are the tendency to repetitively focus on the

experience of negative emotions and its causes and consequences (rumination); the

suppression of the emotional expression and experience of negative emotions (suppression);

and the avoidance of thoughts, emotions, sensations and memories related to the negative

event (avoidance; Foa and Kozak, 1986; Wenzlaff and Wegner, 2000; Gross and John,

2003; Garnefski and Kraaij, 2006; Nolen-Hoeksema et al., 2008).

These strategies are commonly studied in the context of psychopathology in healthy

and clinical populations, where research identified moderate to large effect sizes. In detail,

studies have shown that the use of adaptive emotion regulation strategies (particularly

reappraisal and problem solving) is linked to enhanced resilience against negative emotional

stress and mental diseases (Aldao and Nolen-Hoeksema, 2010; Aldao et al., 2010; Webb et

al., 2012). In addition, reappraisal and acceptance were found to promote post-traumatic

growth (Prati and Pietrantoni, 2009). On the contrary, the use of maladaptive strategies was

consistently associated with increased negative emotional stress and elevated risk for mental

health problems (Aldao and Nolen-Hoeksema, 2010; Aldao et al., 2010; Webb et al., 2012).

Research on maladaptive emotion regulation in trauma-exposed individuals such as

rescue workers yielded relatively consistent results. Previous research found rumination,

suppression, and avoidance to be associated with more severe post-traumatic and depressive
symptoms (e.g., Beaton et al., 1999; Clohessy and Ehlers, 1999; Kirby et al., 2011; Razik et

al., 2013; Shepherd and Wild, 2014; Wild et al., 2016). More important, longitudinal studies

indicated that rumination represents a prospective risk factor for the development of PTSD

and depression (Wild et al., 2016). Furthermore, the extent to which rescue workers

suppressed their emotional arousal during an experimental emotion regulation paradigm was

predictive for subsequent intrusions (Shepherd and Wild, 2014). These findings suggest a

central role of rumination and suppression in the development of trauma-related mental

disorders instead of being an epiphenomenon or a consequence of the respective disorders

(e.g., Michael et al., 2007; Kleim et al., 2012).

Regarding adaptive emotion regulation strategies, research obtained mixed results.

Some studies report reappraisal to be linked to less severe post-traumatic symptoms

(Shepherd and Wild, 2014), whereas others found no relationship with rescue workers’

mental health (Beaton et al., 1999; Clohessy and Ehlers, 1999). Moreover, to our knowledge,

no study has investigated the emotion regulation strategies acceptance and problem solving in

rescue workers. Finally, no study so far investigated the association of emotion regulation

with perceived work-related stress. Given that the perception of chronic work-related stress

represents a central risk factor for the development of health impairments (e.g., Aasa et al.,

2005), it is of great interest to investigate whether and to what extent emotion regulation

strategies are associated with perceived work-related stress in rescue workers.

In sum, past research has shown associations between several emotion regulation strategies

and perceived work-related stress and stress-related symptoms in healthy and clinical

populations. However, little is known about whether and how rescue workers use specific

emotion regulation strategies in their daily duties and how this relates to their physical and

mental health. Therefore, the first aim of this cross-sectional study was to examine to what

extent rescue workers use the six commonly studied emotion regulation strategies acceptance,
reappraisal, problem solving, avoidance, suppression, and rumination. Our second aim was to

investigate the relationship between these strategies and the rescue workers’ perceived work-

related stress and mental health. In detail, we hypothesized that adaptive emotion regulation

strategies (i.e., acceptance, problem solving, reappraisal) are linked to reduced work-related

stress and fewer post-traumatic, depressive, and somatic symptoms. On the contrary, we

expected that maladaptive emotion regulation strategies (i.e., rumination, suppression,

avoidance) are associated with the opposite effects. Independent of emotion regulation, we

expected general workload and recent private or work-related stressful events to elevate the

perception of work-related stress. Further, we expected the number of potentially traumatic

life events and increased work-related stress to predict more severe post-traumatic,

depressive, and somatic symptoms. Therefore, we controlled for these potential covariates

and were especially interested in incremental effects of emotion regulation strategies beyond

these factors.

(https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02744/full) this link you have to

read I will be very helpful for the further thesis.

 Literature Review

The aims of this study were to (a) examine the association between occupational

stress and insomnia and short sleep in Japanese workers and (b) demonstrate the difference

between 2 occupational stress models-Effort Reward Imbalance and the Demand Control

Model. All data were obtained via self-administrated questionnaires and annual health

checkups. Insomnia was evaluated by the Athens Insomnia Scale, and short sleep was defined

as less than 6 hours sleep per day. Employees at local governments and a transit company

who had annual health checkups during the period from April 2003 to March 2004. After

excluding participants without complete data, data from 6,997 men and 1,773 women were

analyzed. N/A. In men, high occupational stresses were significantly associated with

insomnia, especially a high level of Effort Reward Imbalance (defined as the presence of high

effort and low reward), had a remarkably higher odds ratio. In women, high occupational

stresses were significantly associated with insomnia as well. High occupational stresses were

significantly associated with short sleep in men. However, in women, only Effort Reward

Imbalance showed a significant association with short sleep. This study suggested that

occupational stress is a possible risk factor for insomnia and short sleep.

https://www.researchgate.net/publication/7298983_Relationships_of_Occupational_Stre

ss_to_Insomnia_and_Short_Sleep_in_Japanese_Workers
 Rescue workers are exposed to enduring emotional distress, as they are confronted

with (potentially) traumatic mission events and chronic work-related stress. Thus, regulating

negative emotions seems to be crucial to withstand the work-related strain. This cross-

sectional study investigated the influence of six emotion regulation strategies (i.e.,

rumination, suppression, avoidance, reappraisal, acceptance, and problem solving) on

perceived work-related stress and stress-related depressive, post-traumatic, and somatic

symptoms in a representative sample of 102 German rescue workers. Multiple regression

analyses identified rumination and suppression to be associated with more work-related stress

and stress-related symptoms. Acceptance was linked to fewer symptoms and, rather

unexpectedly, avoidance was linked to less work-related stress. No effects were observed for

reappraisal and problem solving. Our findings confirm the dysfunctional role of rumination

and suppression for the mental and physical health of high-risk populations and advance the

debate on the context-specific efficacy of emotion regulation strategies.

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02744/full

Sleep disorder is a disease that causes reduction in quality of life and work efficiency

of workers. This study was performed to investigate the relationship between job-related

stress factor and sleep disorder among wageworkers in Korea. Methods This study was based

on analysis of the 3rd Korean working conditions survey. We analyzed 35,902 workers

whose employment status is wageworker. We classified the job-related stress factor into 12

sections.

Logistic regression was performed to estimate the relationship between job-related

stress factor and sleep disorder and Odds ratio and 95 % CI were calculated using the SPSS

version 23.0 program. Many categories of Job-related stress factor were correlated with sleep

disorder (8 of 12 for women, 10 of 12 for men). The results of the regression analysis,

corrected for general and occupational characteristics, indicated that sleep disorder was
significantly correlated with the following categories of job-related stress: discrimination

experience (OR 3.37, 95 % CI = 2.49 ~ 4.56 in women, OR 1.96, 95 % CI = 1.53 ~ 2.51 in

men), direct customer confrontation (OR 2.72, 95 % CI = 1.91 ~ 3.86 in women, OR 1.99, 95

% CI = 1.45 ~ 2.72 in men), emotional stress (OR 2.01, 95 % CI = 1.30 ~ 3.09 in men), work

dissatisfaction (detailed) (OR 1.99, 95 % CI = 1.36 ~ 2.93 in men), work dissatisfaction

(overall) (OR 2.30, 95 % CI = 1.66 ~ 3.20 in women, OR 2.40, 95 % CI = 1.88 ~ 3.08 in

men), expression of opinion difficulty (OR 0.66, 95 % CI = 0.48 ~ 0.92 in women, OR 0.57,

95 % CI = 0.45 ~ 0.73 in men). A number of studies have reported that stress affects sleep

disorder. In this study, many factors suspected to increase the risk of sleep disorder were

added to previously known job stress factors. In particular, this study found a strong

correlation between work-associated sleep disorder and relational and organizational job

stress factors. Sleep disorder may lead to large decreases in workers’ quality of life and work

efficiency. Awareness and interventions are therefore required to reduce workplace stress;

additional research of this topic is also required.

https://www.researchgate.net/publication/308044951_The_association_of_relational_an

d_organizational_job_stress_factors_with_sleep_disorder_Analysis_of_the_3rd_Korean

_working_conditions_survey_2011

Work-related stressors are associated with low sleep quality. However, few studies

have reported an association between role stressors and sleep quality. Aims: To elucidate the

association between role stressors (including role conflict and ambiguity) and sleep quality.

Methods: Cross-sectional study of daytime workers whose sleep quality was assessed using

the Pittsburgh Sleep Quality Index (PSQI). Work-related stressors, including role stressors,

were assessed using the Generic Job Stress Questionnaire (GJSQ). The association between

sleep quality and work-related stressors was investigated by logistic regression analysis.

Results: A total of 243 participants completed questionnaires were received (response rate
71%); 86 participants reported poor sleep quality, based on a global PSQI score ≥6.

Multivariable logistic regression analysis revealed that higher role ambiguity was associated

with global PSQI scores ≥6, and that role conflict was significantly associated with sleep

problems, including sleep disturbance and daytime dysfunction. Conclusions: These results

suggest that high role stress is associated with low sleep quality, and that this association

should be considered an important determinant of the health of workers.

https://www.researchgate.net/publication/323583625_Association_between_work_role_stress

ors_and_sleep_quality

All participants were employees of two German Red Cross emergency medical

service stations. During occupational health seminars, 318 rescue workers were introduced to

the study’s aims and procedure and received an individual link for participation in an online

survey designed to assess stress and symptom burden and to examine possible resilience and

vulnerability factors. Of 115 rescue workers participating in the survey, full data was

available from 103 participants. Data of one participant had to be excluded due to an

invariant response pattern, leaving N = 102 participants (32.1% of the regional working

population) as the final sample, including 66 men and 36 women. The survey was presented

in LimeSurvey (LimeSurvey GmbH, 2017) and took about 1 h to complete. All subjects gave

written informed consent in accordance with the Declaration of Helsinki. The protocol was

approved by the Ulm University Ethics Committee. There was no compensation for

participation. On request, participants received individual feedback on their results.

In terms of formation, the sample comprised 30 (29.4%) emergency medical

technician intermediates (EMT-I/85, Ger.: Rettungssanitäter), 61 (59.8%) EMT paramedics

(EMT-P; Ger.: Notfallsanitäter) as well as 10 EMT-P trainees (9.8%) and one member of the

rescue coordination center (1.0%). The study sample was representative for the total number

of employees in both rescue stations (see Supplementary Table 1). Population and sample had
a similar age distribution, with the population slightly older than the sample. This is possibly

the result of a slight under-representation of medical student volunteers in the sample.

To assess rescue workers’ perceived stress due to the particular operational and

organizational work factors of the emergency medical service we developed a specific

questionnaire. On seven items, participants reported their stress experience due to alarms,

shift work, interruptions of meals, sweating caused by heavy work clothing, or the loud sound

of the emergency alarm. Participants could add another stressful work factor as free text.

Responses were recorded on a four-point Likert scale, anchored at 1 (not bothering) and 4

(very bothering), or as 0 if the work factor was not experienced. Responses were aggregated

to a sum score ranging from 0 to 32, showing a satisfactory internal consistency (Cronbach’s

α = 0.81). A principal component factor analysis and Velicer’s revised minimum average

partial test confirmed the scale as unidimensional. Questionnaire development and

dimensionality analysis are detailed in the Supplementary Material.

Stress-related depressive symptoms were measured with the German Patient Health

Questionnaire scale for depression (PHQ-9; Löwe et al., 2002). Participants reported on a

four-point Likert scale ranging from 0 (not at all) to 3 (almost every day) how much they felt

bothered by nine depressive symptoms (e.g., “tiredness or feeling of no energy”) during the

past 2 weeks. The sum score of all items (ranging from 0 to 27) was used for subsequent

statistical analyses (Cronbach’s α = 0.83). Somatic symptoms were measured with the

German Patient Health Questionnaire scales for physical symptoms (PHQ-15; Löwe et al.,

2002), including 13 items assessing how much participants felt bothered by physical-somatic

symptoms during the last 4 weeks (e.g., stomach aches or back pain) and two additional items

of the previously described PHQ-9 covering sleep disturbances within the last 2 weeks.

Responsses are recorded on a three-point Likert scale ranging from 0 (not at all) to 2
(very strong) and aggregated to a sum score ranging from 0 to 28 for statistical analyses

(Cronbach’s α = 0.84). The item for menstrual pain was excluded to avoid a systematic

gender bias. Post-traumatic symptoms were measured with the German version of the PTSD

Checklist for DSM-5 (PCL-5; Ehring et al., 2014). With regard to their worst lifetime event,

participants indicated on 20 items how much they were bothered by symptoms of the four

PTSD symptom clusters intrusions, hyperarousal, avoidance, and negative alterations in

mood or cognition during the last month. Responses were recorded on a five-point Likert

scale ranging from 1 (not at all) to 5 (very strong) and aggregated to a sum score (ranging

from 0 to 80) used for subsequent analyses (Cronbach’s α = 0.91).

For a better descriptive overview, we applied the questionnaires’ cutoffs to examine

whether participants met the screening criteria for a potential diagnosis. In the PHQ-9, the

cutoff for moderate depressive symptoms is reached when at least five of the nine items were

answered with “on more than half of the days.” The PHQ-15 cutoff for mild somatic

symptoms is reached when at least 3 out of 14 items were answered with “bothered a lot” and

a sum score of at least six points is reached. The PCL-5 cutoff for a suspected PTSD

diagnosis is reached when a sum score of at least 33 points is reached. According to

screening cutoffs, n = 4 (3.9%) participants fulfilled criteria for a PTSD, n = 10 (9.8%)

showed moderate levels of depressive symptoms, and n = 16 (15.7%) showed moderate

levels of somatic symptoms.

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02744/full