RESEARCH ARTICLE

Workaholism and Potential Outcomes in Well-Being and Health in a Cross-Occupational Sample

Cecilie Schou Andreassen1,2*, Jrn Hetland1, Helge Molde1 & Stle Pallesen1,3
1 2

Faculty of Psychology, University of Bergen, Bergen, Norway The Bergen Clinics Foundation, Bergen, Norway 3 Norwegian Competence Center for Sleep Disorders, Bergen, Norway

Abstract This study examined workaholism components (work involvement, drive, enjoyment of work) and potential outcomes in terms of psychological well-being and health. A sample of 661 Norwegian cross-occupational employees from six different organizations completed an online questionnaire measuring workaholism, job satisfaction, life satisfaction, insomnia and subjective health complaints. A short version of the Norwegian-translated Workaholism Battery showed signicant relationships with reports of psychological well-being and subjective health. Enjoyment of work was positively associated with job and life satisfaction and negatively associated with symptoms of poor health. Work involvement and drive were the strongest predictors of job dissatisfaction. Both were positively related to symptoms of poor health. Drive was, in addition, negatively associated with life satisfaction. The results showed that it is important to discriminate between different workaholic features when investigating associations between workaholism and potential outcomes, which were related in predictable ways to outcomes in terms of psychological well-being and health. Copyright 2010 John Wiley & Sons, Ltd.
Received 3 February 2010; Accepted 25 October 2010; Revised 29 September 2010 Keywords workaholism; WorkBAT; psychological well-being; health *Correspondence Cecilie Schou Andreassen, Faculty of Psychology, University of Bergen, Christies gate 12, N-5015 Bergen, Norway. Email: cecilie.andreassen@psych.uib.no Published online 5 December 2010 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/smi.1366

Workaholism is dened in many different ways, but most denitions include notions of overindulgence with work, long working hours, working more than what is demanded/expected, prioritizing work over most other activities and enjoyment of work. Only in recent years have researchers begun to clear up conicting conclusions about workaholism by differentiating between different workaholics features and sub-dimensions (Andreassen, Hetland, & Pallesen, 2010; Andreassen, Ursin, & Eriksen, 2007). As workaholism is associated with a high work-related effort some view workaholism in positive terms (Scott, Moore, & Miceli, 1997) whereas others emphasize its potential negative aspects (Oates, 1971; Robinson, 1998). Consequently, the existing literature and recent empirical ndings give reason to differentiate between enthusiastic and non-enthusiastic workaholics (Andreassen et al., 2010). Non-enthusiastic workaholics are characterized by high levels of work involvement (e.g. spend time efciently at work and when off work), high levels of drive (e.g. feel driven to work due to internal pressure) and low levels of enjoyment of work
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(e.g. seldom nd anything enjoyable about work), whereas enthusiastic workaholics, typically have high scores on all three workaholism components as measured by the frequently used Workaholism Battery (WorkBAT) developed by Spence and Robbins (1992). It has been argued that workaholism is related to job satisfaction and general life satisfaction (Bonebright, Clay, & Ankenmann, 2000; McMillan, Brady, ODriscoll, & Marsh, 2002; Schaufeli, Taris, & van Rhenen, 2008), which commonly are considered to be reciprocally linked (Rain, Lane, & Steiner, 1991). Enjoyment of work has been reported to be positively associated with job satisfaction (Spence & Robbins, 1992). Drive and work involvement, however, have recently been empirically linked to low degrees of both job and life satisfaction as well as to low work engagement (Andreassen et al., 2007; Bonebright et al., 2000; Schaufeli et al., 2008). Ng et al. (2007) recently argued that workaholism, in general, has both direct and indirect costs in terms of poorer physical and mental health because workaholics do not prioritize protective behaviour such as leisure and exercise. McMillan and ODriscoll (2004),
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however, did not nd differences in psychological, physical and general health between workaholics and nonworkaholics. Still, recent studies have shown that when experiencing strain in their jobs, individuals who score high on drive typically report increases in subjective somatic and psychological symptoms, whereas this response pattern has not been found in individuals who score high on enjoyment of work (e.g. enthusiastic workaholic characteristics) (Andreassen et al., 2007). Still, very few empirical studies have investigated the associations between the different workaholism features and different health parameters. There are, to date, not enough data to create normative standards for WorkBAT scores. Because of this, we will, in the present paper, refer to the different workaholic features rather than workaholic types. The present study aims to extend our understanding of potential outcomes of workaholism by examining how its different dimensions are related to job satisfaction, life satisfaction and health parameters such as subjective health complaints (SHCs) and insomnia. On the basis of previous research and theories, our hypotheses are as follows: (1) enjoyment of work will be positively related to both satisfaction measures, whereas work involvement and drive will be negatively related to job and life satisfaction; (2) work involvement and drive will be positively related to insomnia and SHCs. Enjoyment of work will be negatively related to insomnia and SHCs.

Norwegian version was based on a standardized translation-back-translation procedure. All items were answered on a ve-point scale ranging from 1 (strongly agree) to 5 (strongly disagree). The questionnaire measures three dimensions of workaholism: work involvement (e.g. I spend my free time on projects and other activities) (three items; = 0.57), reecting the need to spend time efciently both at work and when off work, blurred boundaries between work and private life, as well as the inability to relax; drive (e.g. I seem to have an inner compulsion to work hard) (four items; = 0.83) reects internal pressure/motivation for work and the frequency of thinking about work; enjoyment of work (e.g. sometimes I enjoy my work so much I have a hard time stopping) (seven items; = 0.85) assesses satisfaction from work. Results based on the full 25-item original WorkBAT are also reported in the tables in order to provide opportunity for comparisons between the shortened and the full scale. Job satisfaction scale Job satisfaction was measured by the Job satisfaction scaleshort version (Brayeld & Rothe, 1951), which is composed of ve items about satisfaction at work. The items are answered on a ve-point scale ranging from 1 (strongly disagree) to 5 (strongly agree) (e.g. I really experience joy in my work) and are summed up to produce an overall score for job satisfaction ( = 0.80). High scores indicate high levels of job satisfaction. Multidimensional Students Life Satisfaction Scale (MSLSS) General life satisfaction was measured using the MSLSS (Huebner, 2001), which is composed of nine items concerned with different aspects of life and how satised one is with them ( = 0.91). The items are answered on a four-point scale ranging from 1 (never) to 4 (almost always) (e.g. I have what I want in life). High scores indicate high levels of life satisfaction. Bergen Insomnia Scale (BIS) Insomnia was measured using the BIS (Pallesen et al., 2008), which is composed of six items related to both nocturnal and daytime symptoms of insomnia. Each item is answered on an eight-point scale ranging from 0 (zero days per week) to 7 (every day per week) (e.g. during the last month, how many days per week have you been dissatised with your sleep?). A composite score was calculated based on all items (sum of six items; = 0.84). High scores indicate poor sleep, while low scores indicate good sleep. SHCs SHCs were measured using three subscales of the Subjective Health Complaints Inventory (Eriksen, Ihlebk, & Ursin, 1999). The inventory measures somatic and psychological SHCs experienced during
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Method
Participants and procedure In all, 661 (54% females) out of 1300 Norwegian crossoccupational employees completed a Web-based questionnaire (response rate 51%) during fall 2007/spring 2008. Their age ranged from 16 to 72 years [M (mean) = 42.6, SD (standard deviation) = 10.5]. The sample was recruited from six companies from various sectors: pharmaceutical industry (n = 127), health care (n = 96), media (n = 172), HR (Human resources) consultancy rms (n = 80) and two university faculties (n = 186). Most of the participants were married/living with a partner (67%), living with children (53%), university educated (87%), worked full time (88%) and were managers or had management responsibilities (53%). Almost 40% worked 46 h or more per week. The Regional Committee for Medical and Health Research Ethics, Health Region West in Norway approved the study. Measures WorkBAT By conducting explorative structural equation modelling (SEM) we previously (See Andreassen et al., 2010) found support for a revised and shorter 14-item Norwegian version of WorkBAT (Spence & Robbins, 1992), which we used to measure workaholism. The SEM results came from the same data set as used here. The
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Workaholism

the last 30 days. The severity of the complaints is reported on a four-point scale ranging from 0 (zero) to 3 (severe) (e.g. headaches, shoulder pain, tiredness, anxiety). The three subscales were: musculoskeletal complaints (eight items; = 0.78), pseudoneurological complaints (tiredness, sleeplessness, depression, anxiety, hot ushes, palpitations, dizziness; seven items; = 0.77) and gastrointestinal complaints (seven items; = 0.71). In addition, an overall score was computed (sum score of all 22 items; = 0.86), which was used in the subsequent analyses. Number of working hours per week This was assessed as the response to a question pertaining to the number of hours worked in total, including extraordinary paid and unpaid work, per week. The responses were given on an 11-point scale ranging from 1 (less than 37.5 h per week) to 11 (80 h or more per week).

Regression analyses We controlled for the cluster design effect by using the survey data command in STATA (StataCorp) (UCLA: Academic Technology Series, Statistical Consulting Group, 2010). All independent and dependent variables were standardized using z-transformation (Bring, 1994). A series of hierarchical multiple regression analyses (see Table II) were conducted where individual demographic variables were entered at step 1. Workrelated variables were entered at step 2. Work hours were excluded from the regressions as it may be regarded as an alternative manifestation of workaholism. The three shortened workaholism components were entered at step 3. The three full-scale versions of WorkBAT were entered in separate analyses, analogue to step 3. No violations of assumptions in terms of normality, multicollinearity, linearity and homoscedasticity were found. Workaholism and job and life satisfaction For job satisfaction, all three workaholism components were signicant at step 3, explaining 37% of the total variance. Employees with high scores on enjoyment of work, and low scores on work involvement and drive indicated higher levels of job satisfaction. For life satisfaction, drive and enjoyment of work were signicantly related to life satisfaction at step 3. The workaholism components explained 16% of the total variance. The employees who reported high scores on enjoyment of work and low scores on drive indicated higher levels of life satisfaction.

Results
Correlations Work involvement correlated positively with the health symptoms but negatively with job satisfaction (see Table I). Drive correlated positively with insomnia and SHCs but negatively with job and life satisfaction. Enjoyment of work correlated positively with job and life satisfaction and negatively with insomnia and SHCs. All three workaholism components correlated positively with hours worked per week.

Table I. Correlations and descriptive statistics (n = 661) 1 1 2 3 4 5 6 7 8 9 10 11 F-Work Involv F-Drive F-Enjoyment S-Work Involv S-Drive S-Enjoyment Job satisfaction Life satisfaction Insomnia SHC Work hours 0.30** 0.14** 0.72** 0.31** 0.14** 0.11** 0.11** 0.08* 0.07 0.23** 23.12 4.82 1039 0.63 8 2 3 4 5 6 7 8 9 10 11

0.03 0.26** 0.91** 0.01 0.33** 0.27** 0.30** 0.31** 0.21** 21.82 5.84 735 0.82 7

0.09* 0.07 0.97** 0.52** 0.35** 0.13** 0.12** 0.21** 33.89 6.37 1250 0.77 10

0.24** 0.08* 0.10** 0.02 0.09* 0.09* 0.21** 10.73 2.41 315 0.57 3

0.05 0.26** 0.20** 0.23** 0.23** 0.19** 12.32 3.82 420 0.83 4

0.52** 0.37** 0.14** 0.14** 0.21** 22.46 5.03 735 0.85 7

0.56** 0.34** 0.29** 0.11** 4.00 0.67 1.25 0.80 5

0.34** 0.33** 0.02 3.02 0.53 1.444 0.91 9

0.55** 0.01 12.79 9.58 042 0.84 6

0.00 8.87 7.38 049 0.86 22

3.26 1.60 111 1

M SD Range Items

Note: * p < 0.05; ** p < 0.01. Subjective health complaints. Number of hours worked in total, including extraordinary paid and unpaid work, per week. F: full WorkBAT subscale; S: shortened WorkBAT subscale.
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Table II. Standardized hierarchical multiple regression analyses based on short and full versions of WorkBAT subscales (n = 661) Job satisfaction R 0.08 0.04 0.03 0.28*** 0.04 0.04 0.03 0.02 0.25*** 0.05 0.05 0.00 0.07** 0.03 0.07* 0.41 0.06 0.08 0.07 0.05* 0.07 0.03 0.03 0.04 0.02 0.03 0.02 0.03 0.03 0.02 0.03 0.06 0.04 0.02 0.07 0.07** 0.05** 0.02 0.22*** 0.37*** 0.02 0.02 0.02 0.01 0.04 0.03 0.03 0.02 0.07** 0.05** 0.03 0.05 0.27*** 0.36*** 0.02 0.02 0.01 0.02 0.03 0.04 0.02 0.04 0.05 0.21*** 0.04 0.08* 0.04 0.04 0.03 0.03 0.02 0.04 0.04 0.03 0.02 0.03 0.04 0.04 0.06 0.11*** 0.10 0.05 0.01 0.08** 0.02 0.05 0.21*** 0.16** 0.06* 0.02 0.10* 0.05* 0.06 0.32*** 0.56*** 0.04 0.05 0.21*** 0.04 0.10* 0.26 0.04 0.04 0.04 0.02 0.05 0.03 0.04 0.02 0.02 0.03 0.02 0.04 0.23 0.04 0.06 0.11*** 0.11* 0.04 0.01 0.06** 0.02 0.02 0.30*** 0.14** 0.03 0.04 0.04 0.02 0.04 0.02 0.04 0.01 0.02 0.04 0.01 0.03 0.03 0.02 0.02 0.02 0.06* 0.01 0.08*** 0.00 0.02 0.01 0.02 0.09 0.11 0.08 0.20*** 0.07 0.08 0.07 0.00 0.03 0.05** 0.07* 0.03 0.25*** 0.13** 0.06 0.02 0.04 0.04 0.05 0.03 0.02 0.01 0.02 0.02 0.02 0.03 0.09 0.19*** 0.07 0.08 0.08 0.00 0.03 0.03 0.07* 0.00 0.33*** 0.11* 0.05 0.02 0.04 0.04 0.05 0.03 0.02 0.02 0.02 0.02 0.03 0.03 0.04 0.05 0.03 0.04 0.03 0.09 0.06 0.08 0.11** 0.06 0.04 0.03 0.03 0.02 0.04 0.09 0.04 0.02 0.22*** 0.09 0.08 0.02 0.02 0.03 0.06* 0.06* 0.07 0.03 0.04 0.04 0.05 0.03 0.03 0.02 0.02 0.13 0.04 0.04 0.02 0.04 0.10* 0.04 0.10* 0.11** 0.04 0.03 0.03 0.02 0.00 0.20*** 0.08* 0.07 0.06 0.02 0.03 0.04 0.06 0.03 R R 0.02 SE SE SE SE SE SE Life satisfaction Insomnia Subjective health complaints SE 0.05 R

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Variable

SE

0.03 0.05 0.15* 0.06

0.05 0.05 0.04 0.06

0.04 0.03 0.12* 0.06 0.01

0.05 0.05 0.03 0.06 0.04

0.01 0.02 0.04 0.11***

0.03 0.02 0.02 0.02

Step 1 Age Gender Marital Children Step 2 Age Gender Marital Children Position Sector Pharmacy HR Health care University Step 3 Age Gender Marital Children Position Sector Pharmacy HR Health care University Work Invol Drive Enjoyment

0.06 0.09* 0.07 0.05* 0.06

0.04 0.03 0.04 0.02 0.03

0.05 0.03 0.11** 0.06* 0.07 0.26*** 0.58***

0.02 0.03 0.03 0.02 0.03 0.04 0.04

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* p < 0.05; ** p < 0.01; *** p < 0.001. SE = Standard errors Gender (1: male; 2: female). Marital status (1: partner; 2: no partner). Living with children (1: no; 2: yes). Position (1: follower; 2: leader/leadership responsibility). The TV sector represents the reference group. Using full WorkBAT scales.

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Workaholism and health For insomnia and SHCs, drive and enjoyment of work were signicant independent variables at step 3. The workaholism components explained 7% of the total variance (see Table II). The employees who reported high scores on drive and low scores on enjoyment of work indicated higher levels of health problems.

Discussion
In general, the workaholism components correlated signicantly with job satisfaction, life satisfaction and self-reported health as expected. A series of regressions showed that the workaholism components uniquely explained between 7% and 37% of the variance in the outcome variables. We expected work involvement to correlate negatively with job and life satisfaction and positively with health problems. This hypothesis was only partly conrmed. Work involvement correlated negatively with job satisfaction and positively with insomnia and SHCs. In the regression analyses, however, work involvement was only signicantly associated with job satisfaction. Hence, our results stand in contrast to one previous study in which a negative correlation between work involvement and life satisfaction was reported (Bonebright et al., 2000). This discrepancy can not be explained by low statistical power in the present study as it represents one of the largest sample sizes that have been used in the study of workaholism and health variables. As work involvement reects aspects of not being able to relax from work, the negative relationship between work involvement and job satisfaction seems reasonable. It is worth noticing that work involvement was unrelated to insomnia and SHCs in the regression analyses. Secondly, we expected drive to correlate negatively with job and life satisfaction. These expectations were conrmed, replicating results obtained in previous research (Bonebright et al., 2000; Burke, 2001; Schaufeli et al., 2008). The internal pressure to work, feelings of guilt when not working, etc., may suppress feelings of joy and satisfaction. Drive was also hypothesized to be positively related to symptoms of poor health, and the results also supported this hypothesis. We argue that individuals who score high on drive pursue perfection or do not cope well with challenges at work or fail to reach self-imposed goals. Subsequently, this may lead to sustained activation and inability to recover, which can be manifested in terms of insomnia and subjective sleep complaints (Kristenson, Eriksen, Sluiter, Starke, & Ursin, 2004; Ursin & Eriksen, 2004). We nally hypothesized that enjoyment of work would correlate positively with job and life satisfaction and negatively with symptoms of poor health. Without
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contradictions and in line with previous studies (Andreassen et al., 2007; Bonebright et al., 2000; McMillan et al., 2002), this hypothesis was conrmed. An individual who scores high on work enjoyment typically spends a large proportion of life on enjoyable work tasks, thus it seems logical that he or she will report satisfaction with work and life in general. In sum, our ndings show that specically enjoyment of work and drive have opposite relationships with different health outcomes, which are ndings in accordance with previous research and postulations (Andreassen et al., 2007; McMillan et al., 2002; Ng et al., 2007; Schaufeli et al., 2008; Taris, Schaufeli, & Verhoeven, 2005). Specically, it seems that enjoyment of work co-varies with good health and high levels of satisfaction. Drive, on the other hand, shows an inverse pattern of relationship with the same constructs. Some cautionary comments concerning the ndings are warranted. As we previously have stated (Andreassen et al., 2010), further efforts are recommended to investigate the structure of WorkBAT and other workaholism instruments. In addition, further efforts aiming at validating the workaholism concept and its operationalizations are needed. For example, the enjoyment of work component seems to overlap with items in the job satisfaction scale. This may inate their empirical association, although it is maintained that enjoyment of work and job satisfaction are regarded as two distinct constructs (McMillan et al., 2002). Another methodological issue concerns that items reecting job satisfaction, life satisfaction and enjoyment of work exclusively are composed of positive-phrased items. Hence, they may all be related to positive affectivity, which also articially can increase the magnitude of their associations. Furthermore, the shortened work involvement subscale had a somewhat low alpha value (0.57). It should be noted that this subscale also in its original form has proven to have low reliability across studies and should thus be used with caution. Most of the participants in our sample were active workers. Thus, the relationship between workaholism and health may therefore be obscured by the fact that workers on long-term sick leave, etc. were not included in the sample. It should be noted that we can not draw any conclusions about causality in the present study as our design was crosssectional. Another limitation is that all data in the present study were based on self-report, which may inuence our ndings due to the common method bias (Podsakoff, MacKenzie, Lee, & Podsakoff, 2003). Despite the limitation inherent in the present study, we believe that our results show that it is important to discriminate between different workaholic features when investigating associations between workaholism and potential outcomes. Only a limited number of studies have employed such an approach. Most previous research has predominately used narrow US samples. In contrast, the present study draws on data
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from a broad cross-occupational European sample from six different organizations and sectors. Although longitudinal data, collateral reports and objective behavioural data are difcult to obtain, future research on workaholism with such qualities should denitely be encouraged and emphasized.

Acknowledgments
The authors would like to thank the employees and management of the organizations for their collaboration. We would also like to thank Trude Remme and Arne Magnus Morken for technical assistance.

REFERENCES
Andreassen, C.S., Hetland, J., & Pallesen, S. (2010). The relationship between workaholism, basic needs satisfaction at work, and personality. European Journal of Personality, 24, 317. Andreassen, C.S., Ursin, H., & Eriksen, H.R. (2007). The relationship between strong motivation to work, workaholism, and health. Psychology & Health, 22(5), 615629. Bonebright, C.A., Clay, D.L., & Ankenmann, R.D. (2000). The relationship of workaholism with worklife conict, life satisfaction, and purpose in life. Journal of Counseling Psychology, 47(4), 469477. Brayeld, A.H., & Rothe, H.F. (1951). An index of job satisfaction. Journal of Applied Psychology, 35, 307311. Bring, J. (1994). How to standardize regression coeffecients. American Statistician, 48(3), 209213. Burke, R.J. (2001). Workaholism components, job satisfaction, and career progress. Journal of Applied Social Psychology, 31, 23392356. Eriksen, H.R., Ihlebk, C., & Ursin, H. (1999). A scoring system for subjective health complaints (SHC). Scandinavian Journal of Public Health, 27, 6372. Huebner, S. (2001). Manual for the Multidimensional Students Life Satisfaction Scale. Retrieved from South Carolina University, College of Liberal Arts Psychol-

ogy web site http://www.cla.sc.edu/PSYC/facdocs/ hueblifesat.html Kristenson, M., Eriksen, H.R., Sluiter, J.K., Starke, D., & Ursin, H. (2004). Psychobiological mechanisms of socioeconomic differences in health. Social Science & Medicine, 58, 15111522. McMillan, L.H.W., & ODriscoll, M.P. (2004). Workaholism and health: Implications for organizations. Journal of Organizational Change Management, 17(5), 509519. McMillan, L.H.W., Brady, E.C., ODriscoll, M.P., & Marsh, N.V. (2002). A multifaceted validation study of Spence and Robbins (1992). Workaholism Battery. Journal of Occupational and Organizational Psychology, 75, 357368. Ng, T.W.H., Sorensen, K.L., & Feldman, D.C. (2007). Dimensions, antecedents, and consequences of workaholism: A conceptual integration and extension. Journal of Organizational Behavior, 28, 111136. Oates, W. (1971). Confessions of a workaholic: The facts about work addiction. New York: World. Pallesen, S., Bjorvatn, B., Nordhus, I.H., Sivertsen, B., Hjrnevik, M., & Morin, C.M. (2008). A new scale for measuring insomnia: The Bergen Insomnia Scale. Perceptual and Motor Skills, 107, 691706. Podsakoff, P.M., MacKenzie, S.B., Lee, J., & Podsakoff, N.P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88, 879903.

Rain, J.S., Lane, I.M., & Steiner, D.D. (1991). A current look at the job satisfaction/life satisfaction relationship: Review and future considerations. Human Relations, 44, 287307. Robinson, B.E. (1998). Chained to the desk: A guidebook for workaholics, their partners and children and the clinicians who treat them. New York: New York University Press. Schaufeli, W.B., Taris, T.W., & van Rhenen, W. (2008). Workaholism, burnout, and work engagement: Three of a kind or three different kinds of employee well being? Applied Psychology, 57(2), 173203. Scott, K.S., Moore, K.S., & Miceli, M.P. (1997). An exploration of the meaning and consequences of workaholism. Human Relations, 50, 287314. Spence, J. T, & Robbins, A.S. (1992). Workaholism: Denition, measurement, and preliminary results. Journal of Personality Assessment, 58, 160178. Taris, T.W., Schaufeli, W.B., & Verhoeven, L.C. (2005). Workaholism in the Netherlands: Measurement and implications for job strain and worknonwork conict. Applied Psychology, 54(1), 3760. UCLA: Academic Technology Services, Statistical Consulting Group. (2010). Analyzing correlated (clustered) data. Retrieved from http://www.ats.ucla.edu/stat/ stata/library/cpsu.htm Ursin, H., & Eriksen, H.R. (2004). The cognitive activation theory of stress. Psychoneuroendocrinology, 29, 567592.

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