Applied Ergonomics 44 (2013) 748e755

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Applied Ergonomics
journal homepage: www.elsevier.com/locate/apergo

Psychosocial work environment and mental health among

construction workers
J.S. Boschman a, *, H.F. van der Molen a, b, J.K. Sluiter a,1, M.H.W. Frings-Dresen a,1
a
b

Academic Medical Center, University of Amsterdam, Coronel Institute of Occupational Health, PO Box 22660, 1100 DE Amsterdam, The Netherlands
Arbouw, Dutch Health & Safety Institute in the Construction Industry, Harderwijk, The Netherlands

a r t i c l e i n f o

a b s t r a c t

Article history:
Received 6 January 2012
Accepted 11 January 2013

We assessed psychosocial work environment, the prevalence of mental health complaints and the
association between these two among bricklayers and construction supervisors. For this cross-sectional
study a total of 1500 bricklayers and supervisors were selected. Psychosocial work characteristics were
measured using the Dutch Questionnaire on the Experience and Evaluation of Work and compared to the
general Dutch working population. Mental health effects were measured with scales to assess fatigue
during work, need for recovery after work, symptoms of distress, depression and post-traumatic stress
disorder. The prevalence of self-reported mental health complaints was determined using the cut-off
values. Associations between psychosocial work characteristics and self-reported mental health complaints were analysed using logistic regression.
Total response rate was 43%. Compared to the general working population, bricklayers experienced
statistically signicant worse job control, learning opportunities and future perspectives; supervisors
experienced statistically signicant higher psychological demands and need for recovery. Prevalence of
self-reported mental health effects among bricklayers and supervisors, respectively, were as follows:
high need for recovery after work (14%; 25%), distress (5%, 7%), depression (18%, 20%) and post-traumatic
stress disorder (11%, 7%). Among both occupations, high work speed and quantity were associated with
symptoms of depression. Further, among construction supervisors, low participation in decision making
and low social support of the direct supervisor was associated with symptoms of depression.
The ndings in the present study indicate psychosocial risk factors for bricklayers and supervisors. In
each occupation a considerable proportion of workers was positively screened for symptoms of common
mental disorders.
2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Keywords:
Construction industry
Work environment
Psychosocial factors
Common mental disorders

1. Introduction
The physically demanding nature of the construction trade and
the resulting health effects have been extensively studied
(Holmstrm et al., 1995; Schneider, 2001). However, the world of
work has changed over the years and has led to several new or
increasingly prevalent psychosocial risks, such as new forms of
employment and an intensication of work (European Agency on
Safety and Health at Work, 2007). The construction industry has
become more stressful in recent years (Campbell, 2006). Therefore,
the inuence of psychosocial risk factors should be considered
when dealing with construction workers (Alavinia et al., 2007,

* Corresponding author. Tel.: 31 20 566 5337; fax: 31 20 697 7161.

E-mail address: j.s.boschman@amc.nl (J.S. Boschman).
1
JKS and MF-D were the co-principal investigators on this project.

2009; Holmstrm et al., 1992a; Holmstrm et al., 1992b). Several

theories have been developed which link psychosocial risk factors
at work to consequences for the mental health of workers. The jobdemand-control theory of Karasek is one of them (Karasek, 1979).
The extended model of job demands, control, and support states
that high demands, low control and low social support have the
most negative effects on employee wellbeing (van der Doef and
Maes, 1999). The central job demand in the model is a high quantitative workload. However, in the construction industry other job
demands may be important predictors as well, besides doing too
much work in too little time and working long hours (Beswick et al.,
2007). Also commuting, having responsibility for the safety of
others at work, engaging in dangerous job, the transient nature of
the job and the hire and re culture are reported in the literature
as stressors (Beswick et al., 2007). Furthermore, the nancial crisis
of 2008 had a great impact on employment in the construction
industry worldwide. The International Labour Organization (ILO)

0003-6870/$ e see front matter 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.
http://dx.doi.org/10.1016/j.apergo.2013.01.004

J.S. Boschman et al. / Applied Ergonomics 44 (2013) 748e755

calculated that at least 5 million construction workers had lost their

jobs during 2008, and the recession continues (International
Labour Ofce (ILO), 2009). Consequences of the recession include
job insecurity and minimal job opportunities.
Some of the before mentioned psychosocial risk factors and
their effects on construction workers have been studied (Alavinia
et al., 2007; Holmstrm et al., 1992a; Holmstrm et al., 1992b).
The construction industry, however, consists of many different jobs,
each with its own specic demands and requirements. Examining
the psychosocial risk factors for all construction workers ignores
the diversity of experiences within the industry. When studying the
psychosocial work environment among construction workers, it is
important to consider the situation for a specic job or trade
(Cremers, 2004). The nature and specic characteristics of the
psychosocial work environment among construction occupations
remain unknown.
Adverse psychosocial work environments may lead to stressrelated disorders (Nieuwenhuijsen et al., 2010) or depression
(Bonde, 2008) and could affect musculoskeletal health as well
(Eatough et al., 2012). Although the relationship between adverse
psychosocial work environments and musculoskeletal disorders
has been studied among construction workers, studies focussing on
mental health problems in this population are rare. Available evidence on the size and scope of the problem seems conicting. In the
Netherlands for example, the incidence of occupational mental
health disorders reported by the occupational physician has
increased in the construction industry from 11.2% in 2007 to 16.1%
in 2010 (Netherlands Center for Occupational Diseases (NCvB),
2011). The industry had the second-highest incidence in 2010,
after healthcare and social services. On the other hand, Stocks et al.
(2010) found a lower incidence (4%) of mental illness among construction workers in the UK compared to all other employment
sectors (as reported by clinical specialists from 2004 to 2008).
Compared to other diseases or conditions, mental illness had the
lowest incidence among construction workers. However, differences exist among the various construction occupations; Stattin
and Jrvholm (2005) found considerable variation in the risk for
disability pension due to psychiatric disorders among different
occupations within the construction industry.
Aside from the individual burden of common mental health
disorders, work functioning in the construction industry may be
critically reduced when the workers suffer from mental illness. This
may lead to a higher risk of accidents and injuries on the job
(Beseler and Stallones, 2010; Kim et al., 2009). Bentley et al. (2006)
studied the key risk factors for slips, trips and falls. They found that
such accidents are partially caused by time pressures and the need
to divide attention between concurrent visual tasks, such as
inspecting work progress and walking on difcult terrain. Among
the other key risk factors were fatigue and poor risk perception. In
other words, construction workers need psychological and mental
capacities to remain concentrated and alert and to manage the
variety of on-site hazards throughout the work day. These capacities are likely to be impaired when the worker suffers from mental
health complaints.
A detailed assessment of both the psychosocial work environment and the prevalence of common mental health disorders in the
construction industry allows for a more comprehensive understanding of the size and scope of psychosocial risk factors and
mental health effects among construction occupations. Increased
insight into the psychosocial and mental health risk factors of
construction work can contribute substantially to selecting the
most relevant interventions or actions for the workers.
The construction industry consists of over 80 different jobs. A
high proportion (about 55e70%) of the workforce is made up of
workers with manual skills (such as bricklayers, carpenters,

749

electricians etc). The remaining workforce (30e45%) is in managerial roles, including managers and supervisors (Grootenboer and
van der Schaaf, 2012; National Guidance Research Forum, 2012).
In this cross-sectional study, we aimed to get insight into the psychosocial work environment of two very distinct construction professions adequately, the occupation of bricklayer as an example of a
manual occupation and the construction supervisor as an example
of a managerial occupation. The bricklayer has a repetitive job with
high physical demands, whereas the construction supervisor is
responsible for site management and has a job with particular high
mental demands. In the present study we focused on psychosocial
job characteristics which are known risk factors for work-related
depression and stress: high work speed and work quantity, high
mental demands, low social support, little job control, and having
experienced or witnessed a serious accident (de Roos and Sluiter,
2004; Nieuwenhuijsen et al., 2010). Furthermore, we were interested in the specic stressor lack of future perspective, which
might play a role among construction workers, particularly since the
economic recession caused many construction workers to loose
their jobs or nd themselves in uncertain circumstances
(International Labour Ofce (ILO), 2009). The stressor lack of job
variety is often mentioned for occupations involving monotonous
work, which might play a role among the bricklayers specically
(Beereboom, 2005). Therefore, we decided to include job variety as a
psychosocial work characteristic of interest.
The objectives of the present study are to assess the following:
i) the magnitude of psychosocial work characteristics;
ii) the prevalence of self reported mental health effects (fatigue
during work, need for recovery after work, distress, depression and post-traumatic stress disorder (PTSD);
iii) the psychosocial factors that are associated with mental
health in the different occupations.
2. Methods
2.1. Sample and sample size
A priori, the prevalence of self-reported symptoms was estimated at a maximum of 30% and in order to obtain the prevalence of
symptoms with 5% precision, a sample size of 318 was calculated. In
a pilot questionnaire survey, a 40% response rate in a population of
bricklayers and supervisors was achieved (Boschman et al., 2011b).
In total, 750 bricklayers and 750 construction supervisors were
randomly selected from a Dutch registry comprised of all employed
Dutch construction workers. The random selection was performed
by the independent data manager of the registry, frequently
assisting in selecting samples for research purposes. Among the
bricklayers were both those working in the construction of new
buildings as in renovation. Among the construction supervisors
were those working in ground, road and water construction and in
commercial and industrial building. Furthermore, the selection was
not restricted based on the type of construction supervisor (main or
assisting supervisor).
There was an overall response rate of 39% among the bricklayers
(n 262) and 46% among the construction supervisors (n 310).
All respondents were active in their current occupation during the
past twelve months. A more detailed description of the characteristics of the respondents is presented in Table 1.
2.2. Procedure
The survey was conducted from December 2009 to January
2010. All participants received a sealed envelope at their home

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J.S. Boschman et al. / Applied Ergonomics 44 (2013) 748e755

Table 1
Characteristics of respondents.
Bricklayers

Construction supervisors

Male/female

100% male (n 258)

Age (years)

Mean (range, SD)

47 (18e63, 11)
29 (2e47, 12)

99.7% male (n 304)

0.3% female (n 1)
Mean (range, SD)
50 (25e65, 10)
30 (0e48, 12)

24 (1e47, 13)

16 (1e42, 10)

13 (1e42.0, 10)

17 (1e46, 12)

39 (5e55, 6)

47 (5e70, SD 8)

Years employed in
construction
Years employed in
present occupation
Years employed at
present company
Working hours per week

address containing a postcard with the invitation to participate, a

questionnaire survey and a lottery ticket. In the collective labour
agreement of the workers is recorded that research is performed
under the authority of Arbouw, The Health and Safety Institute for
the Dutch Construction Industry. The workers are reminded in
writing of this agreement and informed about the aims of the
present research. Workers can choose whether or not to participate
voluntarily. The workers are aware of the fact that by lling in and
returning the questionnaire, they give the researchers written
consent to use their information anonymously for research
purposes.
The questionnaire comprised the following parts: personal (age)
and job characteristics (years employed in construction, in present
occupation, at present company and working hours per week
according to their contract and overtime included) and psychosocial work characteristics, mental health effects and safety issues
and accidents. Completing the questionnaire took approximately
25 min. The participants were asked to fully complete and return
the questionnaire within two weeks. One reminder containing a
postcard was sent to all participants after one week. The response
rate was corrected for undeliverable post and for workers not
employed as bricklayers or supervisors.
2.3. Psychosocial work characteristics
Psychosocial work characteristics were measured using scales
from the Dutch Questionnaire on the Experience and Evaluation of
Work (QEEW) (van Veldhoven, 1996). Emotional demand was
measured using a self-formulated question. The QEEW questionnaire has been validated in the general working population and
in specic occupational groups (de Croon et al., 2004; Sluiter et al.,
1999). All items on psychosocial work characteristics were scored
on a 4-point scale (0 never, 1 sometimes, 2 often, 3 always).
Scale scores were calculated by adding the scores from the
respective items (total score). According to the instructions for use
of the QEEW, we corrected for missing items by replacing a missing
item with value 0 (only when at least two-thirds of the items of
the scale was answered) and recoded items such that high scores
always had a negative interpretation. All scale scores were transformed into scales ranging from 0 to 100 to allow a comparison
with reference data by using the following formula: scale
score (total score/(3  number of answered items))  100. Higher
scores on the scales reect worse psychosocial work characteristics.
2.3.1. Job demands
Job demands were measured using two scales that measured
work speed and quantity (eleven items), mental demands (seven
items) and by one question regarding emotional demands. Examples of work speed and quantity items (Cronbachs alpha: 0.84) are
as follows: Do you have to work very fast? and Do you have to
work extra hard to complete something? Exceeding the cut-off

value for the work speed and quantity-scale (a total score of

57.57) indicates an increased risk for serious psychological fatigue
as reported by Broersen et al. (2004). In their study including
employees treated for mental health complaints, the specicity of
detecting an increased need for recovery was found to be 79% and
sensitivity 72%. The scale measuring mental demands (Cronbachs
alpha: 0.91) included the following questions among others: Does
your work demand a lot of concentration? and Do you have to
work with a lot of precision?
Emotional demands of working as a construction worker were
measured by asking whether the respondent had witnessed or
experienced a serious accident at the construction site in the past year.
2.3.2. Job control
Job control was measured with three scales. The scale measuring independence in work consists of eleven items (Cronbachs
alpha: 0.91) and included the following questions among others:
Can you decide on your own the order in which you carry out your
work? and Can you interrupt your work for a short time if you
nd it necessary to do so? A lack of participation in decision
making (Cronbachs alpha: 0.89) was measured with a scale consisting of eight items including questions such as Do you have a lot
to say over what is going on in your work place? and Do you have
an inuence on the distribution of work among you and your colleagues? Opportunities for recovery (Cronbachs alpha: 0.67) (van
Veldhoven and Sluiter, 2009) were measured with nine items
including Can you interrupt your work if you nd it necessary to
do so?.
2.3.3. Social support
Social support was measured with nine questions concerning
the relationship with colleagues and nine questions concerning the
direct supervisor. Examples of the items on the scale for relationships with colleagues (Cronbachs alpha: 0.84) include Is your
relationship with your colleagues good? and Are you colleagues
friendly to you? The scale for relationship with direct supervisor
(Cronbachs alpha: 0.91) consists of items such as Do you have
conicts with your superior? and Can you count on your superior
when you come across difculties in your work?.
2.3.4. Job variety
Job variety was measured with two scales: a scale consisting of
six items on variety in work (Cronbachs alpha: 0.81) and a scale
consisting of four items on opportunities to learn (Cronbachs alpha
0.82). Examples of the scale on variety in work include: In your
work, do you repeatedly have to do the same things? and Does
your work sufciently require all your skills and capacities?.
Examples of the scale on opportunities to learn incluce: Does your
job offer you opportunities for personal growth and development?
and Does your work offer you the possibility of independent
thought and action?.
2.3.5. Future perspective
Uncertainty about the future was measured with four questions
(Cronbachs alpha: 0.95) on future perspectives. Examples of the
items on the scale include: Do you need more certainty that you
will keep your current job in the next year? and Do you need
more certainty that your current department/company will still be
in existence in one years time?.
2.4. Mental health
2.4.1. Short term effects of the work day
Mental health was measured with questions on both the short
term effects of the work day and the more prolonged health effects.

J.S. Boschman et al. / Applied Ergonomics 44 (2013) 748e755

Short term effects were operationalized by measuring fatigue

during work and need for recovery after work (van Veldhoven,
1996; van Veldhoven et al., 2002). The fatigue during work scale
(Cronbachs alpha: 0.95) is based on the concept that fatigue at
work is believed to result from mental and/or physical efforts
which have become burdensome to such an extent that the individual is no longer able to adequately meet the demands that the
job requires on mental functioning (Meijman and Schaufeli, 1996).
Fatigue during work is a major symptom in a variety of psychological and psychiatric disorders, diagnosed in occupational
healthcare as chronic job stress and burnout. Fatigue during work
was measured with a 16-item scale containing statements, which
are scored on a 5-point Likert scale indicating the respondents
level of agreement with the statement (1 3 points, 2 2 points, 3
and 4 1 point and 5 0 points). Items include concentration
problems or taking risks that are too high.
Furthermore, we have chosen need for recovery after work, as
this concept is believed to be a measure which bridges the stage
between normal work-related effort and serious long term work
related fatigue syndromes, such as burnout (Sluiter et al., 2003; van
Veldhoven and Broersen, 2003). The need for recovery scale
(Cronbachs alpha: 0.78) has been found to be an adequate measure
for early symptoms of fatigue at work, for use in both health surveillance and scientic research (van Veldhoven and Broersen,
2003).
Examples of the 11-item need for recovery after work scale
include I nd it difcult to relax at the end of a working day and
In general, I only start to feel relaxed on the second non-working
day. The items are answered with either a yes or no. The answers
were scored with 0 points as the answer indicated no need for
recovery after work and scored with 1 point as the answer indicated need for recovery after work.
Scale scores for fatigue during work and need for recovery after
work were calculated by adding the scores from the respective
items (total score). According to the instructions for use of the
QEEW, we corrected for missing items by replacing a missing item
with value 0 (only when at least two-thirds of the items of the
scale was answered) and recoded items such that high scores
always had a negative interpretation. The scale score of fatigue
during work was transformed into a scale ranging from 0 to 100 to
allow a comparison with reference data by using the following
formula: scale score (total score/(3  number of answered
items))  100. The scale score of need for recovery after work was
transformed into a scale ranging from 0 to 100 by using the following formula: scale score (total score/(number of answered
items))  100. Workers exceeding the cut-off value for the need for
recovery-scale (a total score of 54.54) are likely to have an
increased risk for psychological complaints (Broersen et al., 2004).
2.4.2. Distress, depression, PTSD
Three scales considered common mental health disorders by
measuring self-reported symptoms indicative for distress, depression and PTSD. Distress was measured with the distress screener
(Cronbachs alpha: 0.83) developed by Braam et al. (2009). The
distress screener was found to be a valid tool for early identication
of distress in workers (Braam et al., 2009). The questions include
During the past week, did you suffer from worry?, During the
past week, did you suffer from listlessness? and During the past
week, did you feel tense? The items are answered on a 3-point
scale, no (0), sometimes (1) or regularly or often (2), indicating
the respondents level of agreement with the question. A total score
was constructed by summing up the answers on the three items.
The cut-off point that discriminates between screened positive
and screened negative was set a score of 4 or higher. A positive
score means that the person involved is scored as distressed

751

according to the distress screener (Braam et al., 2009). The cut-off

point was set by using the four-dimensional symptom questionnaire (4DSQ) distress score as reference standard. This instrument is a self-report questionnaire and frequently applied by Dutch
occupational physicians among employees on sick leave.
Symptoms indicative for depression were detected with at least
one positive answer on the two-item depression screener. With this
instrument symptoms indicative for depression are detected with a
negative predictive value of 99%, indicating that the screening
instrument only rarely misclassies a depressed person as being
mentally healthy (Whooley et al., 1997). The questions include
During the past month, have you often been bothered by feeling
down, depressed, or hopeless? and During the past month, have
you often been bothered by little interest or pleasure in doing
things?
The Dutch version of the Impact of Event Scale (IES) (Brom and
Kleber, 1985) was used to detect workers with symptoms of PTSD
(Cronbachs alpha: 0.94) and the cut-off value of 26 was used to
distinguish the workers with possible PTSD (Horowitz et al., 1979;
van der Ploeg et al., 2004). The scale contains 15 items, such as Any
reminders brought back feelings about it. The items were scored
on a 4-point scale (0 never, 1 rarely, 3 sometimes,
5 frequently) and a total score was constructed by summing up
the answers on all items.
2.5. Analysis
Questionnaires were eligible for analysis when: 1) at least twothirds of the items of the QEEW scales were answered; 2) no items
were missing on the distress screener or depression screener; 3)
three or less items were missing on the IES.
To gain an understanding of the magnitude of psychosocial load,
need for recovery after work and fatigue during work, the scores of
the bricklayers and supervisors were compared to the general
Dutch employed population from 2003 to 2007 in the Netherlands
(SKB Questionnaire Services, 2010) by means of a one sample t-test.
The reference data used in the present study for the aforementioned scales are based on results of 58114 up to 68536
workers (depending on the scale) in the Netherlands. These large
scale reference les are managed by SKB Questionnaire Services.
They closely guard the quality and representativeness of the data
and update the data regularly. Workers from industries, commercial and non-commercial services, healthcare and public welfare
are represented in the reference datasets.
The prevalence of the self-reported psychological complaints
regarding distress, depression and symptoms of PTSD were calculated using the cut-off values of the instruments. Condence
intervals (CI) were calculated by using the Wald method.
The associations between psychosocial job characteristics and
self-reported psychological complaints were analysed using univariate logistic regression. As the relation between job characteristics and presence of symptoms of mental health complaints was
not linear for all job characteristics, we have chosen to describe the
relation between psychosocial work characteristics and mental
health complaints using a categorical job characteristic variable
instead of the continuous job characteristic outcome. In absence of
reference values for low and high psychosocial workload, a categorization based on three categories with an equal number of
persons was chosen. The highest tertile indicated the highest (most
adverse) psychosocial load. The association was calculated by
comparing the highest tertile to the lowest tertile. For work speed
and quantity, the cut-off value was used to discriminate between
adverse and nonadverse work speed and quantity. Only job characteristics which are known risk factors for work-related depression and stress were analysed (high work speed and work quantity,

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J.S. Boschman et al. / Applied Ergonomics 44 (2013) 748e755

high mental demands, low social support, little job control, and
having experienced or witnessed a serious accident) (de Roos and
Sluiter, 2004; Nieuwenhuijsen et al., 2010). For PTSD, only the
association between the emotional demand of experiencing or
witnessing an accident and PTSD was determined. Statistical signicance was set at an alpha level of 0.05. We corrected for multiple
analyses by using the Bonferroni correction. The IBM SPSS Statistics
19.0 software was used for analysing the data.
3. Results

need for recovery after work scale was exceeded by 13.6% (35/257)
of the bricklayers. On the IES 10.9% (28/258) of the bricklayers
exceeded the cut-off value. Of the bricklayers, 4.7% (12/255) were
classied as distressed and 17.6% (44/250) scored positive on the
depression screener.
Among the supervisors there was a higher need for recovery
than among the reference population. A total of 24.6% (74/301) of
the supervisors exceeded the cut-off value on the need for recovery
after work scale. The prevalence of PTSD, symptoms of distress and
symptoms of depression were 6.9% (21/304), 6.8% (20/295) and
19.6% (59/300), respectively.

3.1. Psychosocial work characteristics

In Table 2 scores on psychosocial work characteristics are presented as well as the comparison of the score to the general Dutch
working population. Compared with the general Dutch working
population, the bricklayers experienced a lack in job control,
learning opportunities and future perspectives. On the other hand,
the bricklayers appraised their relationship with colleagues better
than the general population. With regard to work speed and
quantity, 17% of the bricklayers exceeded the cut-off value. Of the
bricklayers 4.3% (n 11) reported that they had experienced or
witnessed a serious accident on the construction site in the six
months prior to the questionnaire survey.
Construction supervisors experienced higher job demands than
the general Dutch working population. This data corresponded to
the information on number of hours worked per week; on average,
the construction supervisors worked 47.4 h per week, with a
maximum of up to 70 h. Of the supervisors 83% reported that they
worked longer than they were supposed to according to their
contract. On the other hand, the construction supervisors reported
better job control and job variety compared to the reference population. The supervisors did not appraise their relationship with
colleagues statistically signicant different from the general
working population. Of the supervisors 5.1% (n 15) reported that
they had experienced or witnessed a serious accident on the construction site in the six months prior to the questionnaire survey.
3.2. Mental health
The data on mental health effects are presented in Tables 3 and
4. Both the need for recovery after work and the amount of fatigue
during work were for the bricklayers not statistically different from
the general Dutch working population. The cut-off value for the

3.3. Associations between psychosocial work characteristics and

mental health
The odds ratios (ORs) between high versus low psychosocial
load and depression, distress and PTSD are presented in Table 5. In
bricklayers, high work speed and quantity was associated with
symptoms of depression (OR 4.1, 1.2e14.3). For supervisors, high
work speed and quantity (OR 2.8, 1.0e7.7), low participation in
decision making (OR 5.5, 1.7e17.9) and low social support from the
direct supervisor 7.5 (1.9e30.0) were associated with symptoms of
depression. None of the psychosocial variables were associated
with distress in bricklayers. In supervisors a high workload (OR 5.6,
1.1e28.1), was associated with distress. In both occupations, having
experienced or witnessed an accident at the construction site lately
was not signicantly associated with symptoms of depression,
distress or PTSD.
4. Discussion
4.1. Findings
The psychosocial work environment of bricklayers and construction supervisors differed on the following aspects compared to
the general working population: the bricklayers experienced worse
job control, learning opportunities and future perspective. Among
the construction supervisors it was found that their mental
demands are higher compared to the general working population.
Among both occupations, high job demands are associated with
symptoms of depression. Low participation in decision making and
low social support from the direct supervisor are additional psychosocial risk factors for symptoms of depression among
supervisors.

Table 2
Psychosocial work demands among bricklayers and construction supervisors compared to the general Dutch working population (2003e2007).

Job demands
Work speed and quantity
Mental demands
Job control
Task autonomy
Participation in decision making
Recovery opportunities
Social support
Relationship with colleagues
Relationship with direct supervisor
Job variety
Variety in work
Opportunities to learn
Future perspective
Future perspective
a

Reference populationa

Bricklayers

Mean (SD)

Mean (SD)

42.8 (14.7)
72.3 (17.4)

Bricklayers compared to
reference population

Supervisors

42.8 (14.1)
62.1 (17.6)

n.s. (t 0.075, p 0.940)

Better (9.30, p < 0.000)

49.6 (13.0)
75.5 (15.6)

Worse (t 9.14, p < 0.000)

Worse (t 3.60, p < 0.000)

41.8 (18.4)
46.6 (19.8)
n.a.

49.4 (18.0)
49.1 (20.4)
39.5 (14.9)

Worse (t 7.56, p < 0.000)

Worse (t 2.43, p 0.016)
n.a.

34.2 (17.0)
32.1 (19.6)
45.7 (15.0)

Better (t 7.03, p < 0.000)

Better (12.36, p < 0.000)
n.a.

21.3 (13.2)
21.4 (16.2)

18.2 (14.0)
21.5 (18.7)

Better (t 3.49, p 0.001)

n.s. (t 0.09, p 0.932)

23.4 (13.8)
22.5 (18.0)

n.s. (t 2.72, p 0.007)

n.s. (t 1.05, p 0.294)

37.6 (19.9)
48.7 (22.2)

39.9 (17.1)
52.6 (21.2)

n.s. (t 2.18, p 0.031)

Worse (t 3.47, p 0.001)

25.7 (13.9)
34.8 (19.0)

Better (t 14.94, p < 0.000)

Better (t 12.25, p < 0.000)

32.6 (34.8)

48.6 (33.5)

Worse (t 7.97, p < 0.000)

29.1 (29.2)

n.s. (t 1.71, p 0.089)

Mean (SD)

Supervisors compared to
reference population

data provided by SKB Questionnaire Services; better: score is signicantly lower (p < 0.002) than reference population; worse: score is signicantly higher (p < 0.002) than
reference population; n.s.: not signicantly different (p > 0.002) from reference population; n.a.: not applicable, no reference value available.

J.S. Boschman et al. / Applied Ergonomics 44 (2013) 748e755

753

Table 3
Need for recovery and fatigue during work among bricklayers and construction supervisors compared with the general Dutch working population (2003e2007).
Mental health effects

Reference populationa

Bricklayers

Short term effects

Mean (SD)

Mean (SD)

Need for recovery

Fatigue during work

26.8 (28.9)
22.8 (16.0)

21.7 (27.3)
20.3 (16.9)

Bricklayers compared with

reference population
n.s. (t 2.22, p 0.027)
n.s. (t 2.40, p 0.017)

Supervisors
Mean (SD)
31.0 (30.4)
23.8 (14.1)

Supervisors compared with

reference population
Higher (t 3.33, p 0.001)
n.s. (t 1.18, p 0.239)

a
data provided by SKB Questionnaire Services; n.s.: not signicantly different (p > 0.002) from reference population; less: score is signicantly lower (p < 0.002) than
reference population; higher: score is signicantly higher (p < 0.002) than reference population.

Our results on the psychosocial work environment of bricklayers

are in line with the psychosocial factors discussed in the literature
(van der Molen, 2004), but allow a more comprehensive understanding of the psychosocial effects among bricklayers by comparing them with the general Dutch working population. Although
the demanding psychosocial nature of the occupation of construction supervisor is described in the literature in more detail
than that of the bricklayer (Boschman et al., 2011a; Strobel and von
Krause, 1997), information on the magnitude of psychosocial factors is lacking. The results of our study provide insight into the
psychosocial risks for construction supervisors.
The need for recovery after work is a sign of occupationally
induced fatigue and a predictor of adverse health effects (Sluiter
et al., 1999). In this study, it was found that the need for recovery
after work was signicantly higher among the supervisors. The
results indicate an increased risk for mental health complaints due
to occupationally induced fatigue among this population of construction workers and monitoring and tackling these problems
seems relevant.
We found in the present study population that a higher proportion of respondents was screened positive for symptoms of
depression than for distress or PTSD. This compares to the ndings
of Brenner and Ahern (2000), who found that depression was the
most common diagnosis among construction workers in the UK.
However, the one-year prevalence of depression among the general
population in the Netherlands is estimated to be approximately 6%
(National Institute for Public Health and Environment (RIVM),
2011), the point prevalence among the working population in the
Netherlands ranging from 2.2 to 7.4% have been reported (LaitinenKrispijn and Bijl, 2002). A plausible explanation for the relatively
high number of workers reporting symptoms of depression would
be a nonresponse bias, which is discussed in more detail in the
limitations section. However, several factors might have actually
inuenced the mental well-being among the construction workers
during the period of time the present study was conducted. The
economic recession profoundly impacted the construction industry. Many workers lost their jobs, leading also to job uncertainty
among those workers who avoided unemployment, which could
lead to an increase in depressive symptoms (Burgard et al., 2012).
The proportion of workers with PTSD is known to be high
among construction workers (Stocks et al., 2010). It is known that
accidents are a major hazard in the construction industry and can
affect the mental health of other workers (Hu et al., 2000).
Although we did not nd a signicant association between experiencing or witnessing an accident and current symptoms of PTSD,
symptoms of depression and distress among bricklayers who
Table 4
Prevalence of mental health effects among bricklayers and construction supervisors.
Long-lasting
effects

PTSD
Distress
Depression

Bricklayers

Construction supervisors

% (95% CI)

Relative
frequency

% (95% CI)

Relative
frequency

10.8 (7.1e14.7)
4.7 (2.1e7.3)
17.6 (12.9e22.3)

28/258
12/255
44/250

6.9 (4.1e9.8)
6.8 (3.9e9.7)
19.6 (15.2e24.2)

21/304
20/295
59/300

experienced or witnessed an accident were nearly three to ve

times higher than those who didnt. Results need to be interpreted
with caution given the wide condence intervals, and of course,
construction workers can also be exposed to other life events which
can result in PTSD.
4.2. Limitations
Certain limitations must be taken into account in the present
study. The cross-sectional design does not allow for causative
statements on the relationship between an adverse psychosocial
work environment for bricklayers and supervisors and their mental
health effects. However, we have chosen a priori to only associate
psychosocial work-related risk factors and symptoms of mental
health effects for which evidence is available in the literature (de
Roos and Sluiter, 2004; Nieuwenhuijsen et al., 2010) or the uncertainty about the future, currently a relevant topic for the workers in
the industry. By doing so, we can now provide not only the magnitude of psychosocial characteristics for bricklayers and supervisors but also give an indication of the extent to which plausible
psychosocial risk factors affect the mental well-being of workers in
these two occupations. Although this information cannot be
regarded as evidence for a causal relationship between psychosocial risk factors and adverse mental health effects, it can be used in
designing and selecting logical interventions aimed at improving
the mental well-being of construction workers by addressing the
specic psychosocial risk factors in their occupation.
Furthermore, the data were derived from voluntarily completed
and returned questionnaires. Therefore, selective participation may
have inuenced the results of our study. In this respect, it must be
noted that the mean age of the respondents was fairly high (47
years among the bricklayers and 50 years among the supervisors).
The mean age of the bricklayers who responded was not signicantly different from the age of the general population of Dutch
bricklayers, but the construction supervisors who responded were
signicantly older than the general population of Dutch construction supervisors (6.2 years, p 0.000). Whether a bias results
from this fact, remains unknown. We might have overestimated the
psychosocial workload and the prevalence of adverse short-term
health effects of work, such as the need for recovery after work
among the supervisors (Sluiter et al., 2003). On the other hand,
Hoonakker and van Duivenbooden (2010) did not nd more complaints about psychological demands among older construction
workers than among their younger colleagues. Furthermore, we
only used self-reported measures to measure both psychosocial
work characteristics and symptoms of mental health complaints.
This might have led to bias and possibly an ination of the associations, as persons suffering from symptoms of mental health
complaints might judge their psychosocial work environment more
negatively anyhow. In a longitudinal study design this would be a
lesser problem than in our cross-sectional design.
The average response rate of 43% was low, but comparable to
results of a pilot study among this population (Boschman et al.,
2011b). This low rate may have led to reporting bias, resulting in
an ination of the association between adverse psychosocial factors
and the symptoms of mental health effects, as indicated by Kolstad

754

J.S. Boschman et al. / Applied Ergonomics 44 (2013) 748e755

Table 5
The association between high versus low psychosocial load and symptoms of depression, distress, and PTSD. Statistically signicant associations are in bold (p < 0.001).

Job demands
High work speed and quantity
Bricklayers
Construction supervisors
High mental demands
Bricklayers
Construction supervisors
Job control
Low task autonomy
Bricklayers
Construction supervisors
Low participation in decision making
Bricklayers
Construction supervisors

Depression OR (99.9% CI)

Distress OR (99.9% CI)

PTSD OR (99.9% CI)

4.1 (1.2e14.3) (n 249)

2.8 (1.0e7.7) (n 298)

3.7 (0.5e27.8) (n 254)

5.6 (1.1e28.1) (n 294)

n.t.
n.t.

1.2 (0.3e4.8) (n 249)

1.6 (0.4e6.5) (n 299)

2.1 (0.2e27.9) (n 254)

7.0 (0.2e220.5) (n 294)

n.t.
n.t.

1.8 (0.4e8.1) (n 249)

2.9 (0.9e9.4) (n 299)

2.6 (0.1e90.1) (n 254)

1.4 (0.3e7.3) (n 294)

n.t.
n.t.

1.0 (0.2e3.8) (n 246)

5.5 (1.7e17.9) (n 298)

1.1 (0.1e17.3) (n 251)

3.6 (0.6e21.9) (n 293)

n.t.
n.t.

Social support
Low social support colleagues
Bricklayers
Construction supervisors
Low social support direct supervisor
Bricklayers
Construction supervisors

2.7 (0.8e9.5) (n 250)

3.4 (0.9e12.5) (n 299)

1.7 (0.2e13.5) (n 255)

3.1 (0.3e29.3) (n 294)

n.t.
n.t.

3.9 (0.9e16.1) (n 248)

7.5 (1.9e30.0) (n 297)

12.6 (0.4e420.4) (n 253)

2.8 (0.5e17.3) (n 292)

n.t.
n.t.

Negative future perspective

Bricklayers
Construction supervisors

3.2 (0.5e20.4) (n 249)

3.0 (0.9e9.5) (n 299)

N (n 253)
3.0 (0.6e15.9) (n 294)

Traumatic event on construction site

Bricklayers
Construction supervisors

2.8 (0.3e23.7) (n 246)

1.7 (0.2e12.5) (n 288)

5.1 (0.3e82.7) (n 251)

1.0 (0.0e31.6) (n 289)

0.9 (0.0e29.5) (n 254)

1.0 (0.0e32.2) (n 294)

n number of cases included in analysis; n.t. not tested; N no estimation of OR and condence interval possible.

et al. (2011). On the other hand, Kaerlev et al. (2011) found no

indications that low participation distorts associations between
psychosocial factors and mental health effects. Based on the literature it is not possible to give a sound indication of the nonresponse
effect, but the results of our study must be generalised with
caution.
We decided a priori to gather information about psychosocial
risk factors by univariate analyses. The risk factors obtained by that
approach, indicate where potentially effective interventions could
be aimed at. If we aimed at constructing a multivariate model, we
should have included more participants, as the number of parameters in a multivariate model is generally believed to not exceed
5%e10% of the minimum number of persons in one of the groups
(with or without the event) to prevent over tting of the data
(Twisk, 2007). Because in our study the outcome events are
rather sparse, the resulting coefcients in a multivariate analysis for
individual variables may represent spurious associations, or the
effects may be estimated with low precision. It would be of value
when subsequent studies focus on a longitudinal study design with
a multivariate analysis to build a prediction model.
4.3. Implications
In the present study we gain insight into the psychosocial work
environment of Dutch bricklayers and supervisors. This information provides a better understanding of the size and scope of psychosocial risk factors and adds to the available knowledge on the
(mainly physical) risk factors confronting construction workers. In
addition to the psychosocial work environment, we assessed
mental health effects to provide further knowledge on the health
impact of construction work. Information on the characteristics and
health effects of specic construction occupations is essential to
optimise occupational healthcare for construction workers.
Previous research indicates that the psychosocial work environment among construction workers is worth considering.

Alavinia et al. (2009) found that lack of job control, lack of support
and dissatisfaction with work were signicantly related to sick
leave. Holmstrm et al. (1992a,b) found that psychosocial factors
such as quantitative work demands, were signicantly associated
with low back pain. We found that, although bricklayers and construction supervisors both work in the construction industry, the
psychosocial work environment for bricklayers and supervisors
differs greatly when compared to the general working population.
While bricklayers experience lack of learning opportunities, job
control and future perspectives, supervisors experience high psychological demands. Monitoring job-specic aspects of the psychosocial work environment might therefore be a proper strategy
to improve working conditions for constructions workers. In a
longitudinal study design the effects on mental health of such a
strategy, based on signalling psychosocial risk factors and consecutive preventive actions, could be evaluated.
The construction supervisor is believed to be at risk for stressrelated disorders and other mental health problems (Beswick
et al., 2007; Boschman et al., 2011a; Strobel and von Krause,
1997), but based on the ndings in the present study, there is a
need to monitor the mental health of both bricklayers and construction supervisors. Moreover, workers with symptoms indicative of mental health disorders should be offered interventions to
improve their mental well-being in an early stage. When screening for common mental health disorders in construction workers,
it seems preferable not to differentiate between occupations.
However, when assessing job-specic psychosocial risk factors, the
type of construction occupation should be taken into account.

Authors contributions
JB is responsible for data collection, statistical analysis and
drafted the manuscript. All authors conceived and designed the
study, read and corrected draft versions of the manuscript and

J.S. Boschman et al. / Applied Ergonomics 44 (2013) 748e755

approved the nal manuscript. HM, JS and MF-D obtained funding

for this study. JS and MF-D were the co-principal investigators.
Acknowledgements
This study is partly granted by Arbouw, Dutch Health & Safety
Institute in the Construction Industry.
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