Management standards and burnout among surgeons in the United Kingdom.

BACKGROUND: Burnout arising from chronic work-related stress is endemic among surgeons in the UK. Identification of contributory and modifiable psychosocial work characteristics could inform risk reduction activities. AIMS: We aimed to assess the extent to which surgeons' psychosocial working conditions met aspirational Management Standards delineated by the UK Health and Safety Executive, draw comparisons with national general workforce benchmarks and explore associations with burnout. METHODS: Surgeons (N = 536) completed the Management Standards Indicator Tool and a single-item measure of burnout. Descriptive data were computed for each Standard, independent t-tests were used to examine differences between trainees and consultants, and hierarchical linear regression was applied to explore relations between psychosocial work environment quality and burnout. RESULTS: Psychosocial work environment quality fell short of each Management Standard. Trainee surgeons (n = 214) reported significantly poorer psychosocial working conditions than consultant surgeons (n = 322) on the control, peer support and change Standards. When compared with UK workforce benchmarks, trainees' psychosocial working conditions fell below the 10th percentile on four Standards and below the 50th percentile on the remainder. Consultant surgeons were below the 50th percentile on five of the seven Standards. Psychosocial working conditions accounted for 35% of the variance in burnout over that accounted for by socio- and occupational-demographic characteristics. CONCLUSIONS: Surgeons' psychosocial working conditions were poor in comparison with benchmark data and associated with burnout. These findings suggest that risk management activities based on the Management Standards approach involving modification of psychosocial working conditions would help to reduce burnout in this population.

Identification of Surgeon Burnout via a Single-Item Measure.

BACKGROUND: Burnout is endemic in surgeons in the UK and linked with poor patient safety and quality of care, mental health problems, and workforce sustainability. Mechanisms are required to facilitate the efficient identification of burnout in this population. Multi-item measures of burnout may be unsuitable for this purpose owing to assessment burden, expertise required for analysis, and cost. AIMS: To determine whether surgeons in the UK reporting burnout on the 22-item Maslach Burnout Inventory (MBI) can be reliably identified by a single-item measure of burnout. METHODS: Consultant (n = 333) and trainee (n = 217) surgeons completed the MBI and a single-item measure of burnout. We applied tests of discriminatory power to assess whether a report of high burnout on the single-item measure correctly classified MBI cases and non-cases. RESULTS: The single-item measure demonstrated high discriminatory power on the emotional exhaustion burnout domain: the area under the curve was excellent for consultants and trainees (0.86 and 0.80), indicating high sensitivity and specificity. On the depersonalisation domain, discrimination was acceptable for consultants (0.76) and poor for trainees (0.69). In contrast, discrimination was acceptable for trainees (0.71) and poor for consultants (0.62) on the personal accomplishment domain. CONCLUSIONS: A single-item measure of burnout is suitable for the efficient assessment of emotional exhaustion in consultant and trainee surgeons in the UK. Administered regularly, such a measure would facilitate the early identification of at-risk surgeons and swift intervention, as well as the monitoring of group-level temporal trends to inform resource allocation to coincide with peak periods.

Nurses' illness perceptions during presenteeism and absenteeism.

BACKGROUND: Presenteeism has been linked with lost productivity, impaired health and absence. Whilst much research has focused on types of diseases associated with presenteeism and absenteeism, there has been little investigation into the role of individuals' illness perceptions in these episodes. AIMS: To assess how illness perceptions vary between presenteeism and absenteeism episodes. METHODS: A cross-sectional questionnaire was distributed to ward-based nurses working with older adults. Data on illness perceptions during presenteeism and absenteeism episodes were collected. Data were analysed via the Paired-Samples t-test, Wilcoxon test and McNemar test. RESULTS: Two hundred and seventy cases were analysed (88% response rate). Compared with presenteeism, illnesses during absenteeism were thought to affect lives more (P < 0.001), to have more serious symptoms (P < 0.001), to be more concerning (P = 0.003), more likely to be treated (P = 0.009), more infectious (P < 0.001) and perceived as more legitimate reasons for absenteeism (P < 0.001). Treatment was considered more effective during absenteeism (P < 0.001), whilst workability was better during presenteeism (P < 0.001). Presenteeism was perceived as harmful and absenteeism beneficial for illness. Individuals attended work when presenteeism was expected to be less harmful (P < 0.001) and avoided work when absenteeism was expected to be more beneficial for illness (P < 0.001). CONCLUSIONS: Illness perceptions varied significantly between presenteeism and absenteeism episodes and should be included in models of illness behaviour. Findings also highlight that policy may influence illness behaviour and that nurses may attend work despite concerning levels of illness.

Stress Management Competency Framework in English policing.

BACKGROUND: The UK Health and Safety Executive's Stress Management Competency Framework and associated questionnaire, the Stress Management Competency Indicator Tool (SMCIT), address line managers' behaviours across four competency areas. The application in policing remains unexplored. AIMS: This study profiled English police officers' perception of their line managers' competencies in the framework areas. The odds of experiencing poor mental wellbeing and work attitudes associated with having a line manager with a development need on each competency area were tested. METHODS: Two hundred and sixty-three police officers completed a survey comprising the SMCIT and measures of psychological distress, resilience and work engagement. Bivariate correlations were calculated to identify patterns of relationships between variables. Binary logistic regression analyses tested the odds of psychological distress caseness, low resilience and low work engagement being associated with officers' perception of their line manager having a development need on the SMCIT criteria. RESULTS: Approximately half the participants reported their line manager had a development need on the 'Managing and Communicating Existing and Future Work', 'Managing the Individual Within the Team' and 'Reasoning and Managing Difficult Situations' competencies, and one quarter on the 'Respectful and Responsible: Managing Emotions and Having Integrity' competency. Officers' rating of their line manager having a development need on the four competency areas was associated with up to four-fold elevated odds of each undesirable state. CONCLUSIONS: The framework competency areas are relevant to English policing and offer a basis for stress reduction interventions targeted at line managers' behaviours.

Contribution of work ability and core self-evaluations to worker health.

BACKGROUND: Work ability (WA) concerns the capacity to manage job demands in relation to physical and psychological resources. Core self-evaluations (CSE) refer to a composite personality construct comprising self-esteem, locus of control, self-efficacy and emotional stability traits. Studies have shown the independent contribution of WA and CSE to work outcomes, yet none has explored their additive contribution, when applied together, to identify workers at risk of impaired health and performance-related outcomes. AIMS: The aim was to explore the contribution of WA and CSE to explaining variance in psychological distress and work engagement in a sample of UK manufacturing sector workers. METHODS: A self-report questionnaire containing validated measures of WA, CSE, psychological distress and work engagement was administered to employees in four UK manufacturing organizations. Bivariate correlations were calculated to identify patterns of relationships between the variables and hierarchical linear regression analyses performed to examine the incremental contribution of WA and CSE to the target variables. RESULTS: Analyses were conducted on data contributed by 311 workers (21% response rate). WA accounted for around one-quarter of the variance in psychological distress and around one-fifth of the variance in work engagement. The addition of CSE explained a further 10% (psychological distress) and 7% (work engagement) of the variance. CONCLUSIONS: These exploratory findings suggest that WA and CSE might be useful in the identification of workers at risk of poor psychological well-being and work effectiveness in UK manufacturing. Longitudinal sector-representative studies are required to establish the constructs' predictive power.

Leaveism in English and Welsh police forces: baseline reference values.

BACKGROUND: Leaveism is a recently coined term for alternative attendance behaviours to sickness absence and sickness presence. Initial studies suggest that leaveism might mask the true extent of sickness in organizations and represent a response to perceived job insecurity, the belief that sickness absence could harm promotion prospects, and low job gratification. AIMS: To generate baseline reference values for leaveism in English and Welsh police forces to facilitate benchmarking and risk-reduction activities. METHODS: Officers represented by the Police Federation of England and Wales contributed survey data on the incidence of three leaveism dimensions in the year to February 2016. We applied descriptive statistics to characterize leaveism and Pearson's χ2 tests to examine differences in incidence rates by socio- and occupational-demographic factors. RESULTS: Annual leave or rest days were used to take time off from work due to physical health complaints by 8499/14 451 (59%) of respondents and psychological health complaints by 5983/14 326 (42%) (dimension 1). Work was taken home that could not be completed in normal working hours by 7515/14 959 (50%) of respondents (dimension 2), and 5974/14 963 (40%) reported having worked while on annual leave in order to catch up with work (dimension 3). Incidence rates on dimensions 2 and 3 differed markedly by rank, with higher ranks reporting higher rates. CONCLUSIONS: These sector-wide findings suggest that leaveism is a cause for concern. Further research is required to identify sector-specific causes of leaveism with a view to informing interventions to tackle the problem.

Application of multiple behaviour change models to identify determinants of farmers' biosecurity attitudes and behaviours.

It has been recognised that few cattle farmers undertake biosecurity practices on their farms. Approaches that take into consideration individuals' preparedness for change, alongside beliefs thought to motivate the enactment of certain behaviours, may provide a framework for actuating tangible change. The aim of this study was to use a combination of behaviour change models to link beliefs with behaviour and identify possible key interventions to improve the uptake of biosecurity measures by dairy cattle farmers in Great Britain (GB). This is the first study to explore farmers' practices and attitudes in relation to the prevention of direct (animal to animal contact); indirect (via fomites); and other biosecurity measures using a multitheory approach. A cross-sectional study was carried out, with postal questionnaires sent to 2505 dairy cattle farmers. Questions were asked about the extent to which a host of biosecurity measures were used, the influence of various stakeholders (e.g. veterinarians, industry bodies) in informing biosecurity choices, and the perceived control farmers felt they had over biosecurity on their farms. Farmer attitudes towards biosecurity were also explored. Two behaviour change models, the Transtheoretical Model, and the Theory of Planned Behaviour, were utilised. A variety of analysis methods were used to interrogate the data, including multivariable logistic regression. A total of 908/2505 (36.2%) farmers responded, with 757 responses (30.2%) deemed eligible for inclusion. Farmers generally fell into one of two categories: those that reported not applying biosecurity measures with no intention of doing so in the future, and those that reported undertaking biosecurity measures for some time. Farmers felt that biosecurity improved cattle health and welfare, but also felt that disease was inevitable. More farmers agreed with statements relating to their ability to control, rather than prevent disease. Analysis suggested a difference between influencing beliefs and whether specific types of measure were more likely to be undertaken. For example, farmers' beliefs about other stakeholders appeared to play a role in influencing the utilisation of measures preventing direct contact (e.g. nose to nose contact), rather than indirect contact (e.g. fomite transmission). The use of a combination of behaviour change models has identified key variables to use for interventional approaches targeted towards the different type of biosecurity measure (preventing direct or indirect transmission) to improve the uptake of biosecurity on dairy cattle farms in GB. Other industry stakeholders should be aware of these variables when working with farmers to achieve optimal cattle herd health.

Working hours and common mental disorders in English police officers.

BACKGROUND: There is a paucity of evidence on working hours and their psychological correlates in police officers of the federated ranks in England. AIMS: An exploratory study to establish the extent to which a sample of English police officers worked long hours and the association between long working hours and common mental disorder (CMD). METHODS: Officers of the federated ranks (constable, sergeant, inspector) from two English county forces completed a questionnaire to report their typical weekly working hours and symptoms of CMD. We also collected socio- and occupational-demographic data. We defined long working hours as ≥49 h in a typical week in accordance with 48-h weekly limit specified in the 1993 European Directive on the Organisation of Working Time. We established associations between long working hours and self-reported CMDs using binary logistic regression to generate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for potential confounding variables. RESULTS: Twenty-seven per cent (n = 327/1226) of respondents reported long working hours. The ORs for psychological distress (OR 2.05, 95% CI 1.57-2.68), emotional exhaustion (OR 1.99, 95% CI 1.52-2.59), and depersonalization (OR 1.30, 95% CI 1.00-1.71) were significantly increased for long working hours after adjustment for socio- and occupational-demographic characteristics. CONCLUSIONS: More than one quarter of sampled police officers reported working long hours and were significantly more likely to report CMD. National and longitudinal research is required to confirm these findings, which suggest management of working hours may effectively promote psychological well-being.

Sun safety in construction: a U.K. intervention study.

BACKGROUND: Interventions to promote sun safety in the U.K. construction sector are warranted given the high incidence of skin cancer attributable to sun exposure relative to other occupational groups. AIMS: To evaluate change in sun safety knowledge and practices among construction workers in response to an educational intervention. METHODS: A baseline questionnaire was administered, followed by a bespoke sector-specific DVD-based intervention. At 12-month follow-up, participants completed a further questionnaire. RESULTS: Analyses were conducted on a sample of 120 workers (intervention group, n = 70; comparison group, n = 50). At follow-up, the proportion of intervention group participants that reported correct sun safety knowledge was not significantly greater than at baseline. However, the intervention group demonstrated significant positive change on 9 out of 10 behavioural measures, the greatest change being use of a shade/cover when working in the sun followed by regularly checking skin for moles or unusual changes. CONCLUSIONS: Exposure to this intervention was linked to some specific positive changes in construction workers' self-reported sun safety practices. These findings highlight the potential for educational interventions to contribute to tackling skin cancer in the UK construction sector. The findings support the development of bespoke educational interventions for other high-risk outdoor worker groups.

Sun safety knowledge and practice in UK postal delivery workers.

BACKGROUND: Postal delivery workers spend a large proportion of their work time outdoors, placing them at increased risk of skin cancer. To date, no studies have examined occupational sun safety knowledge and practice within this group in the UK. AIMS: To describe the occupational sun safety knowledge and practice of UK postal delivery workers and to investigate the association of demographic, personal and occupational factors with knowledge and practice in order to identify potential strategies for improving sun safety in this occupational group. METHODS: Postal delivery workers completed a questionnaire that collected data on occupational sun safety knowledge and practice in addition to demographic, personal and workplace characteristics. One-way analysis of variances were applied to assess differences in knowledge and practice by these characteristics. RESULTS: A total of 1153 postal delivery workers completed the questionnaire, a 60% response rate. Thirty-three per cent reported receiving sun safety training within the previous 12 months. The majority of respondents reported correct knowledge on three of the six domains and good practice on four of the six behavioural domains. However, only one-fifth of respondents reported wearing sunglasses and ensuring a plentiful intake of water. Knowledge and practice differed significantly according to demographic, personal and workplace characteristics. CONCLUSIONS: There is a need to raise the profile of occupational skin cancer in this occupational group and to increase the priority given to occupational sun safety policies alongside targeted and tailored interventions, the effect of which can be evaluated.

Psychosocial work environment and leisure-time physical activity: the Stormont study.

BACKGROUND: Research findings on the relationship between the psychosocial work environment and leisure-time physical activity (LTPA) are equivocal. This might partly be due to studies having focused on a restricted set of psychosocial dimensions, thereby failing to capture all relevant domains. AIMS: To examine cross-sectional associations between seven psychosocial work environment domains and LTPA in a large sample of UK civil servants and to profile LTPA and consider this in relation to UK government recommendations on physical activity. METHODS: In 2012 Northern Ireland Civil Service employees completed a questionnaire including measures of psychosocial working conditions (Management Standards Indicator Tool) and LTPA. We applied bivariate correlations and linear regression analyses to examine relations between psychosocial working conditions and LTPA. RESULTS: Of 26000 civil servants contacted, 5235 (20%) completed the questionnaire. 24% of men and 17% of women reported having undertaken 30min or more of physical activity on five or more days in the past week. In men, job control (-0.08) and peer support (-0.05) were weakly but significantly negatively correlated with LTPA, indicating that higher levels of exposure to these psychosocial hazards was associated with lower levels of LTPA. Job role (-0.05) was weakly but significantly negatively correlated with LTPA in women. These psychosocial work characteristics accounted for 1% or less of the variance in LTPA. CONCLUSIONS: Longitudinal research to examine cause-effect relations between psychosocial work characteristics and LTPA might identify opportunities for psychosocial job redesign to increase employees' physical activity during leisure time.

Health and safety implications of recruitment payments in migrant construction workers.

BACKGROUND: The Middle East construction sector is heavily reliant on a migrant workforce that predominantly originates from South Asia. It is common practice for migrant construction workers to pay a local labour recruiter the equivalent of one or more years' prospective overseas salary to secure employment, work and travel permits and transportation. The occupational health and safety implications of these financial arrangements remain unexplored. AIMS: To examine associations between payment to a labour recruiter, perceived general health and worksite accidents among migrant construction workers in the Middle East. METHODS: A questionnaire was completed by a convenience sample of predominantly Indian migrant construction workers drawn from a large construction project. The relationship between payment and risk of poor health and workplace accidents was assessed using multivariate logistic regression models (crude and adjusted for socio-demographic and occupational factors). RESULTS: There were 651 participants. The majority (58%) of migrant construction workers had paid a labour recruiter and ~40% had experienced a worksite accident. Between 3% (labourers) and 9% (foremen) perceived their health to be poor. Labourers and skilled workers who had paid a labour recruiter were significantly more likely to have experienced a worksite accident in the previous 12 months. Skilled workers, but not labourers and foremen, who had paid a labour recruiter were at increased risk of poor health. CONCLUSIONS: The mechanisms linking labour recruiter payments to adverse safety and health outcomes warrant investigation with a view to developing interventions to erode these links.

The impact of two workplace-based health risk appraisal interventions on employee lifestyle parameters, mental health and work ability: results of a randomized controlled trial.

Health risk appraisals (HRA) are a common type of workplace health promotion programme offered by American employers. In the United Kingdom, evidence of their effectiveness for promoting health behaviour change remains inconclusive. This randomized controlled trial examined the effects of two HRA interventions on lifestyle parameters, mental health and work ability in a UK context. A total of 180 employees were randomized into one of three groups: Group A (HRA augmented with health promotion and education activities), Group B (HRA only) and Group C (control, no intervention). After 12 months, changes in mean scoring in 10 lifestyle, mental health and work ability indices were compared, Groups A and B demonstrated non-significant improvements in 70% and 80%, respectively, compared with controls (40%). Odds ratios revealed that, compared with the control group, Group A was 29.2 (95% CI: 9.22-92.27) times more likely to report a perceived change in lifestyle behaviour; Group B 4.4 times (95% CI: 1.65-11.44). In conclusion, participation in the HRA was associated with a higher likelihood of perceived lifestyle behaviour change which was further increased in the augmented HRA group, thereby providing preliminary evidence that HRA and augmented HRA in particular may help UK employees make positive healthy lifestyle changes.

Occupational health professionals' knowledge, understanding and use of work ability.

BACKGROUND: The concept of work ability (WA) has a 30-year history in Finland, where it has been used extensively in occupational health (OH) research and practice. The extent to which WA has been integrated into UK OH practice is unclear. AIMS: (i) To compare knowledge, understanding and use of WA among OH nurses and physicians in the UK and Finland and (ii) to identify factors that influence the use of WA in Finnish OH practice. METHODS: An online questionnaire administered to OH practitioners in the UK and Finland. RESULTS: A total of 436 UK and 97 Finnish OH practitioners completed the questionnaire. Though familiarity with the term 'work ability' was similar among Finnish and UK respondents, substantial differences were found in understanding of the term. Ninety-five per cent (Finland) and 7% (UK) of respondents reported using the Work Ability Index (WAI), a validated measure of WA, in their practice. Finnish respondents indicated that they used the WAI results primarily for individual case management, understanding population health trends, health promotion and determining WA across age groups. UK respondents primarily attributed failure to use the WAI to lack of training. Primary factors influencing use of WA in Finland included it being considered common practice and an effect ive system by which to conduct individual assessments. CONCLUSIONS: There are large differences between Finland and the UK in the assessment of WA in OH practice. Differences may reflect contrasting OH legislative frameworks.

Overweight and obesity in UK firefighters.

BACKGROUND: Obesity among firefighters can present a hindrance to operational effectiveness. In North American studies, 80% of US firefighters are overweight or obese. No studies have explored obesity among firefighters in the UK, and it is unclear whether obesity is a problem among UK firefighters. AIMS: To establish the prevalence of obesity among a large sample of firefighters in the UK and to explore changes in body mass index (BMI) over a 3-year period. METHODS: The BMI and body composition of 735 male firefighters from a UK county fire and rescue service were assessed in 2008 and 2011. RESULTS: In 2008, 65% of the firefighters were either overweight (54%) or obese (11%). In 2011, slightly fewer firefighters were overweight (53%), but the proportion classified as obese increased significantly to 13%. Those classified as normal weight in 2008 were more likely to have gained weight by 2011 in comparison with those categorized as obese at baseline. A lower proportion of firefighters were classified as high risk for obesity based on their waist circumference in 2008. CONCLUSIONS: The proportion of firefighters who are either overweight or obese is lower in this UK sample than that found in US studies. Nevertheless, the proportion of UK firefighters classed as overweight was higher than that found in the general population samples from England. Given the negative implications of obesity for performance, there is a need for further investment in theory-based, sector-specific health promotion research and practice.

Psychosocial factors and economic recession: the Stormont Study.

BACKGROUND: Little research has explored changes in workers' psychosocial hazard exposures, work-related stress and stress-related absence associated with the onset of unprecedented severe economic recession. Knowledge of these could inform psychosocial risk management measures appropriate to austere economic times. AIMS: To examine civil servants' psychosocial hazard exposures, work-related stress and stress-related absence during a period of economic recession, relative to levels prior to the onset of this period. METHODS: Analyses compared the findings of two surveys of employees of the Northern Ireland Civil Service conducted in 2005 (n = 17,124), prior to the onset of recession, and in 2009 (n = 9913), during a period of economic recession. RESULTS: Psychosocial hazard exposures were significantly worse during the recession than prior to it. These results are considered in relation to UK government exposure targets. Work-related stress and absence ascribed to work-related stress were significantly greater during recession than prior to it. CONCLUSIONS: This study demonstrates adverse changes in psychosocial hazard exposures, work-related stress prevalence and stress-related sickness absence associated with the onset of an unprecedented economic recession. Its findings indicate the need for a concerted focus on psychosocial risk management activities during austere economic times as a means by which to promote worker health and minimize sickness absence.

Sun safety measures among construction workers in Britain.

BACKGROUND: Relative to other occupational groups in Britain, construction workers have a high incidence of skin cancer attributable to sun exposure. The importance of sun safety measures to minimize the risk of skin cancer is recognized in the literature; however, little is known about the factors associated with their use by construction workers. Knowledge in this area could help inform interventions to encourage sun safety behaviour within the sector. AIMS: To investigate socio-demographic and occupational characteristics associated with the use of sun safety measures among construction workers in Britain. METHODS: Data collection was by means of a self-administered questionnaire, which was sent to 360 construction workers. Information collected included socio-demographic and occupational characteristics and the use of sun safety measures. RESULTS: Participants worked outdoors for an average of 6.6 h/day. Three specific sun safety measures were used by the majority of respondents. Logistic regression analyses showed that certain socio-demographic and occupational factors were associated with the use of sun safety measures. In particular, receipt of sun safety training was positively associated with the wearing of long sleeved, loose fitting tops and trousers (OR, 1.69; 95% CI, 1.02-2.80) and sunglasses (OR, 1.85; 95% CI, 1.10-3.13). CONCLUSIONS: The results highlight the importance of employer-led sun safety interventions in the British construction industry. Interventions that take account of demographic and occupational characteristics are likely to have a positive impact in terms of improving workers' use of sun safety measures.

Overtime and psychological well-being among Chinese office workers.

BACKGROUND: Research on the relationship between overtime and psychological well-being, and workers' perceptions of the factors that determine overtime, has been conducted exclusively in the Western cultural context. AIMS: To examine whether existing theory and evidence can be applied to a non-Western cultural setting by investigating the constructs among a sample of office workers drawn from a Chinese branch of an international information and communication technology company. METHODS: Data were collected from 130 full-time employees on overtime hours worked, psychological well-being, and four variables identified by participants as being important determinants of overtime: job demands, intrinsic motivation, anticipated rewards, and overtime work culture. T-tests and multiple linear regression analyses were used to examine the relationship between variables. RESULTS: All study participants had worked overtime in the previous 6 months period; the mean weekly overtime rate was 14.2 h. High overtime employees demonstrated significantly lower levels of psychological well-being than those who worked low levels of overtime. In combination, the four reasons for working overtime predicted approximately one-fifth of the variance in overtime hours worked, suggesting that knowledge of these variables could be used by practitioners to predict the amount of overtime in which workers are likely to engage. CONCLUSIONS: The findings suggest that existing theory and evidence may apply beyond the individualist cultural context. The findings might usefully inform the organization of work in collectivist cultures and the implementation of multinational operations in these cultures.

Work-related stress case definitions and prevalence rates in national surveys.

BACKGROUND: There is concern about lack of consistency in the design of case definitions used to measure work-related stress in national workforce surveys and the implications of this for the reliability and validity of prevalence estimates as well as for developments in policy and practice on tackling work-related stress. AIMS: To examine associations between case definitions used for the measurement of work-related stress in nationally representative workforce surveys and the prevalence rates generated. METHODS: The study focused on 18 nationally representative workforce surveys conducted between 1995 and 2008 that involved British samples. The published report from each survey was scrutinized for evidence of the case definition used to measure work-related stress and the associated prevalence rate. RESULTS: Several types of case definition were identified that differed in terms of their theoretical basis, structure, and content. Each was associated with a unique range of prevalence rates. CONCLUSIONS: The results illustrate the challenge presented to the production of valid and reliable estimates of the scale of work-related stress by inconsistent case definition design. The imperative for theory-based consistency in the design of case definitions used for the measurement of work-related stress in national workforce surveys is highlighted.