Occupational Medicine 2017;67:135–142

Advance Access publication 28 September 2016 doi:10.1093/occmed/kqw127

Subjective health complaints, work-related stress

and self-efficacy in Norwegian aircrew
M. L. Omholt1,2, T. H. Tveito3,4 and C. Ihlebæk1,5
1
Section of Public Health Science, Department of Landscape Architecture and Spatial Planning, University of Life Sciences,
NO-1432 Ås, Norway, 2Department of Public Health, Sport and Nutrition, University of Agder, NO-4604 Kristiansand,
Norway, 3Uni Research Health, PO Box 7810, NO-5020 Bergen, Norway, 4Faculty for Health Sciences, University College of
Southeast Norway, NO-3603 Kongsberg, Norway, 5Faculty of Health and Social Work Studies, Østfold University College,
NO-1757 Halden, Norway.
Correspondence to: C. Ihlebæk, Section of Public Health Science, Department of Landscape Architecture and Spatial Planning,
Norwegian University of Life Sciences, PO Box 5003, 1432 Ås, Norway. Tel: +47 6723 1264; fax: +47 6496 5301;
e-mail: camilla.ihlebak@nmbu.no

Background The European civilian aviation industry has undergone major changes in the last decade. Despite
this, there is little knowledge about work-related stress and subjective health complaints (SHCs)
affecting Norwegian aircrew.
Aims To investigate the relationships between work-related stress, self-efficacy and SHCs in commercial
aircrew in Norway and to explore differences between cockpit and cabin crew.
Methods Aircrew members from the three major airlines operating from Norway completed an ­electronically
distributed questionnaire. Linear regression analyses were used to investigate the association between
work-related stress, self-efficacy and SHCs.
Results There was a 21% response rate. Among the 843 study subjects, tiredness, sleep problems, bloating,
low back pain, headaches and neck pain were the most prevalent SHCs. Cabin crew reported sig-
nificantly higher numbers, prevalences and mean values for all SHCs compared with cockpit crew
(P < 0.05). In total, 20% reported high stress levels. High levels of work-related stress were signifi-
cantly associated with all SHC factors in both groups. Self-efficacy partly moderated the relationship
between stress and psychological complaints in both cockpit and cabin crew, and for musculoskeletal
complaints in cockpit crew. The model explained 23 and 32% of the variance in psychological com-
plaints for cockpit and cabin crew, respectively.
Conclusions Commercial aircrew in Norway reported high numbers of SHCs, and high levels of work-related
stress were associated with high numbers of SHC. More knowledge is needed on the physical, organ-
izational and psychosocial stressors affecting cockpit and cabin crew in order to create a healthier
work environment for these groups.
Key words Aviation; cabin crew; cockpit crew; self-efficacy; subjective health complaints; work-related stress.

Introduction lower morbidity and mortality rates than other populations

Aircrew members experience a number of occupational
risk factors related to their work environment, such as radi-
ation, poor air quality, time-zone shifts, noise, p
­ hysically
demanding and monotonous work and vibration [1–3],
and they have a higher prevalence of some specific diseases,
such as malignant melanoma, than the general population
[2,4]. However, all aircrew need to pass strict regulation
criteria and medical standards [5] and in general they have
[4,6]. In addition to the physical work, aircrew members’
health may be affected by various organizational and psy-
chosocial factors. Cabin crew in particular might experi-
ence a high psychosocial load due to dealing with passenger
service and safety [3,7]. The European civilian aviation
industry has undergone substantial changes in the last dec-
ade and increased competition, new company structures,
increased security demands and changes in legislation have
led to a more demanding work environment and higher job

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136  OCCUPATIONAL MEDICINE
i­nsecurity. The Norwegian civilian aviation industry has
been described in harsh terms as ‘a hostile place for people
to work’, due to long work shifts and stressful schedules
[8]. Such a work environment could lead to higher levels
of perceived stress, which in turn could be associated with
increased health complaints [9].
Health complaints such as musculoskeletal pain,
gastrointestinal complaints, fatigue and depression are
often non-specific, with no findings of significant pathol-
ogy, and have been termed subjective health complaints
(SHCs) [10]. Sustained activation of the central nerv-
ous system has been suggested as a mechanism through
which high levels of perceived stress influence SHCs
[11]. Bandura [12] introduced the concept of self-
efficacy to describe an individual’s judgement of their
ability to deal with stressful challenges through cogni-
tive processes. An individual’s self-belief in their ability
to deal with a specific situation or setting will influence
how they perceive demands [12]. Low self-efficacy
might therefore be a vulnerability factor in stressful situ-
ations, whereas high self-efficacy might buffer stressful
work environments, and self-efficacy might influence
the relationship between stressors and health outcomes
[13]. High levels of perceived work demands and stress
have been reported for aircrew [3] and associated with
higher risks of health complaints [3,14]. An especially
prevalent complaint reported by aircrew is tiredness or
fatigue [15,16]. Studies have also shown that aircrew
report high levels of complaints concerning skin and
mucosal dryness, gastrointestinal problems, musculo-
skeletal complaints, headaches and earache [1,16–18],
and cabin crew have reported more health complaints
than cockpit crew [1,17]. Although the European civil-
ian aviation industry has undergone significant recent
changes, little is known about the level of SHCs in cock-
pit and cabin crew. The aim of our study was therefore
to investigate SHCs in commercial aircrew in Norway.
Furthermore, we wanted to explore possible differences
between cockpit and cabin crew and to investigate pos-
sible relationships between their perceived work-related
stress, self-efficacy and SHCs.
Methods
During spring 2013, a questionnaire was distributed elec-
tronically to unionized aircrew members employed in the
three major airlines operating from Norway. Invitations to
participate in the study and a link to the questionnaire
were distributed to personal e-mail addresses through the
eight major unions for aircrew members in the three airline
companies. The respondents answered anonymously. The
questionnaire included questions about gender, age, work-
related factors, perceived work-related stress, self-efficacy
and SHCs. The respondents were asked about their years
in aviation (<2, 2–5, 6–10, 11–20 or >20 years). They were
also asked about their occupational position (captain, first
officer, flight purser, air steward, air host); job titles were
dichotomized into cockpit and cabin crew. In addition, the
respondents were asked to indicate whether they worked
on domestic, Scandinavian, European or intercontinental
flights or a combination of these. For the purpose of the
study, a new variable was constructed: if working only on
domestic and/or Scandinavian flights, respondents were
categorized as working on Scandinavian flights; if also
working on European flights, respondents were catego-
rized as working on European flights and if also working
on intercontinental flights, they were categorized as work-
ing on intercontinental flights.
Perceived work-related stress was measured by a vali-
dated single question from the QPS-Nordic questionnaire
[19] with regard to the respondent’s work situation: ‘Stress
means a situation in which a person feels tension, uneasi-
ness, nervousness or anxiety, or is unable to sleep at nights
due to disturbing thoughts all the time. Do you currently
experience this type of stress?’ The response was rated on
a five-point scale (1 = never/very rarely, 2 = quite rarely,
3  =  sometimes, 4  =  quite often, 5  =  very often/always).
The variable was categorized into 1  =  low stress (never/
very rarely and quite rarely/sometimes) and 2 = high stress
(quite often and very often/always). Self-efficacy was meas-
ured by the General Self-Efficacy Scale (GSE) [20]. The
scale has been translated and validated for Norwegian pop-
ulations [21].The GSE is a 10-item psychometric scale that
measures optimistic self-belief in the ability to cope with
difficult demands in life and is rated on a four-point scale
ranging from 1 (totally wrong) to 4 (totally right). In order
to make the measurement more situation-dependent, the
respondents were asked to rate each item with regard to
their work. A sum score was constructed, and Cronbach’s
alpha was calculated for the sum score (α = 0.85). SHCs
were measured using the Subjective Health Complaints
Inventory, which consists of 29 common health complaints
[22]. The respondents were asked to grade the intensity of
each complaint in the previous month on a four-point scale
(0 = not at all, 1 = a little, 2 = some, 3 = severe). The com-
plaints are usually divided into five factors (sum scores)
[22]: musculoskeletal complaints (headache, migraine,
neck pain, shoulder pain, pain in arms, pain in upper back,
low back pain and leg pain) (α = 0.79); psychological (or
pseudoneurological) complaints (extra heartbeats, heat
flushes, sleep problems, tiredness, dizziness, anxiety and
sadness/depression) (α = 0.78); gastrointestinal complaints
(heartburn, stomach discomfort, ulcer/non-ulcer dyspep-
sia, stomach pain, gas discomfort, diarrhoea and consti-
pation) (α = 0.74); allergic complaints (asthma, breathing
difficulties, eczema, allergies and chest pain) (α  =  0.49);
and flu (cold, flu and cough). For the purpose of our study,
the flu factor was not reported upon due to seasonal fluc-
tuations of this factor.
All statistics were processed using SPSS version 23.0.
The prevalence of both single items and the four SHC
factors were calculated (no complaints/complaints). Sum
 M. L. OMHOLT ET AL.: WORK-RELATED STRESS AND SHCS IN NORWEGIAN AIRCREW  137

scores for the four SHC factors were also calculated and
a score for the number of complaints was constructed
(0–29). Group differences between cockpit and cabin crew
and between male and female cabin crew were tested with
independent t-tests (continuous data) or chi-squared tests
(categorical data). Separate linear regression analyses were
performed for each of the four SHC factors, using the sum
score of musculoskeletal pain, psychological complaints,
gastrointestinal complaints and allergic complaints as
dependent variable. Working on Scandinavian, European
and/or intercontinental flights, work-related stress and self-
efficacy were entered as predictors.To investigate a possible
moderation effect of self-efficacy, an interaction variable of
work-related stress and self-efficacy was also included in
the models. In order to minimize collinearity, a centred
variable for self-efficacy was used to calculate the interac-
tion variable. Only variables that showed significant associ-
ation with the SHC factors were included as independent
variables in the regression models. Age, gender and airline
company were included as potential confounders. Before
the analyses were performed, dummy variables for the
nominal variables—age, airline and operating flights—were
constructed. Separate analyses were performed for cockpit
crew and cabin crew. Informed consent was obtained elec-
tronically from each respondent. The project was approved
by the Regional Committees for Medical and Health
Research Ethics in Norway (2013/404).
Results
The questionnaire was sent to 4044 aircrew members
with 843 respondents completing and returning it giving
a response rate of ~21% (cockpit crew 28%, cabin crew
17%). The distribution of cockpit and cabin crew in
the total sample was nearly equal, but there were only
18 female cockpit crew members (4% of the total) and
107 male cabin crew (25%) (Table  1). Most respond-
ents were in the age group 41–50, and the cockpit crew
members were significantly older than the cabin crew
(Table  1). Most respondents in the total sample had
worked in aviation for >10 years and cockpit crew gener-
ally had longer working experience in aviation than cabin
crew. Almost all aircrew members reported they were
permanently employed. The majority of the respondents
operated on European flights and a higher proportion of
cockpit crew than cabin crew operated on Scandinavian
flights, while a higher proportion of cabin crew operated
on intercontinental flights (Table 1).
Only 20% of the study population reported high lev-
els of stress in their current work situation. However,
more cabin crew perceived the levels of stress as high
than cockpit crew. There were no significant differ-
ences in self-efficacy between cockpit and cabin crew
(Table  1). Aircrew members who reported low levels
of stress had significantly higher levels of self-efficacy
[mean (SD) 32.9 (3.7)] than those who reported high
stress levels [31.7 (2.7)] (P < 0.001). The most preva-
lent single complaints reported by cockpit crew were
tiredness, sleep problems, bloating, low back pain
and headache, and the most prevalent severe com-
plaints were tiredness, sleep problems and low back
pain (Figure 1a). The most prevalent single complaints
reported by cabin crew were tiredness, bloating, sleep
problems, headaches and neck pain, with tiredness,

Table 1.  Gender, age, work-related factors, work-related stress and work-related self-efficacy in cockpit and cabin crew

Total, n = 843 Cockpit crew, n = 416 Cabin crew, n = 427 P value

Female (%) 40 4 75 <0.001

Age (%)
 <30 years 16 6 26 <0.001
 31–40 29 23 34
 41–50 37 46 28
 >50 19 25 13
Permanent position (%) 99 100 97 <0.01
Years in aviation (%)
 ≤5 years 17 6 28 <0.001
 6–10 years 18 15 21
 11–19 years 35 38 32
 ≥20 years 31 42 19
Operating flights (%)
  Scandinavian flights 17 27 7 <0.001
  European flights 72 67 78
  Intercontinental flights 11 6 15
Work-related stress (%)
 Low 80 85 75 <0.001
 High 20 15 25
Self-efficacy, mean (SD) 32.7 (3.8) 32.7 (3.6) 32.7 (3.9) NS

Differences between occupational groups tested with chi-squared test (categorical data) and independent t-test (continuous data). NS, non-significant.
138  OCCUPATIONAL MEDICINE
Figure 1.  Prevalence of SHCs (%) in (a) cockpit crew (n = 416) and (b) cabin crew (n = 427).
sleep problems and shoulder pain as the most severe
(Figure 1b). Cabin crew had significantly higher preva-
lences of all SHCs (P  <  0.05), except for sleep prob-
lems, low back pain, diarrhoea, heartburn, allergies,
eczema and asthma.
Compared with cockpit crew, cabin crew reported
higher numbers, higher prevalences and higher mean val-
ues on sum scores for all SHC factors, thus indicating that
the severity of their complaints was higher (see Table 2).
There were no significant differences between male
and female cabin crew members in terms of numbers,
prevalence or mean values on any of the SHC factors
(Table 3).
In the multiple regression models on each of the
four SHC factors, perceived high levels of work-related
stress were significantly associated with high sum scores
on all factors for both cockpit and cabin crew (Tables 4
and 5). For cockpit crew, self-efficacy partly moderated
the relationship between work-related stress and muscu-
loskeletal and psychological complaints. For cabin crew, a
moderating effect was found only for psychological com-
plaints. For gastrointestinal and allergic complaints, no
 M. L. OMHOLT ET AL.: WORK-RELATED STRESS AND SHCS IN NORWEGIAN AIRCREW  139

Table 2.  Number of complaints (0–29), prevalence (score >0) and sum scores [mean (SD)] of the four SHCs factors

Total, n = 843 Cockpit crew, n = 416 Cabin crew, n = 427 P value

Number of complaints, mean (SD) 9.2 (5.3) 7.6 (4.6) 10.7 (5.5) <0.001
Prevalence (score >0), %
  Musculoskeletal pain 84 78 90 <0.001
  Psychological complaints 89 85 92 <0.01
  Gastrointestinal complaints 81 74 88 <0.001
  Allergic complaints 39 35 43 <0.05
Sum scores, mean (SD)
  Musculoskeletal pain 4.7 (4.4) 3.4 (3.4) 6.0 (4.8) <0.001
  Psychological complaints 4.1 (3.3) 3.2 (2.6) 5.0 (3.7) <0.001
  Gastrointestinal complaints 3.2 (3.0) 2.6 (2.7) 3.8 (3.2) <0.001
  Allergic complaints 0.8 (1.4) 0.7 (1.2) 1.0 (1.6) <0.01

Differences between occupational groups were tested with chi-squared test (categorical data) and independent t-test (continuous data).

Table 3.  Number of complaints (0–29), prevalence (score >0) and sum scores [mean (SD)] of the four SHCs factors for male and
female cabin crew

Cabin crew, n = 427 Men, n = 107 Women, n = 320 P value

Number of complaints, mean (SD) 10.7 (5.5) 10.6 (5.5) 10.8 (5.5) NS
Prevalence (score >0), %
  Musculoskeletal pain 90 87 91 NS
  Psychological complaints 92 92 93 NS
  Gastrointestinal complaints 88 87 88 NS
  Allergic complaints 43 46 43 NS
Sum scores, mean (SD)
  Musculoskeletal pain 6.0 (4.8) 5.5 (4.3) 6.2 (4.9) NS
  Psychological complaints 5.0 (3.7) 4.6 (3.3) 5.1 (3.8) NS
  Gastrointestinal complaints 3.8 (3.2) 3.5 (3.0) 3.9 (3.3) NS
  Allergic complaints 1.0 (1.6) 1.1 (1.5) 1.0 (1.6) NS

Differences between groups were tested with chi-square test (categorical data) and independent t-test (continuous data). NS, non-significant.

Table 4.  Regression modelsa for cockpit crew (n = 416)

Musculoskeletal Psychological Gastrointestinal Allergic

β P value β P value β P value β P value

Operating flightsb
  European flights 0.315 <0.001 0.154 NS 0.149 NS 0.013 NS
  Intercontinental flights 0.029 NS −0.055 NS 0.032 NS −0.022 NS
Work-related stress (low/high) 0.165 <0.01 0.404 <0.001 0.190 <0.001 0.190 <0.001
Self-efficacy (sum score 0–40) 0.485 <0.01 0.111 NS 0.157 NS −0.041 NS
Work-related stress × self-efficacy −0.607 <0.001 −0.293 <0.05 −0.278 NS −0.081 NS
Adjusted R2 0.12 0.23 0.06 0.06

The sum score of musculoskeletal pain, psychological complaints, gastrointestinal complaints and allergic complaints was used as a dependent variable in four separate
analyses. Standardized β values, P value and adjusted R2 given. NS, non-significant.
a
All models adjusted for gender, age and airline.
b
Reference category: Scandinavian flights.

moderating effects of self-efficacy were found. Working
on European flights was significantly associated with
higher scores on the musculoskeletal factor for cockpit
crew (Table  4). For cabin crew, working on European
flights was significantly associated with a lower score on
the allergy factor (see Table 5).
The model explained little of the variance in the SHC
factors for both cockpit and cabin crew, except for the
psychological factor, for which the model explained 23%
of the variance for cockpit crew and 32% for cabin crew
(Tables 4 and 5).
Discussion
Tiredness, sleep problems, bloating, low back pain,
headaches and neck pain were the most prevalent SHCs
140  OCCUPATIONAL MEDICINE
Table 5.  Regression modelsa for cabin crew (n = 427)
Musculoskeletal Psychological
β P value β P value
Operating flightsb
  European flights 0.097 NS −0.166
  Intercontinental flights 0.067 NS −0.058
Work-related stress (low/high) 0.275 <0.001 0.487
Self-efficacy (sum score 0–40) 0.269 NS 0.151
Work-related stress × self-efficacy −0.257 NS −0.256
Adjusted R2 0.11 0.32
The sum score of musculoskeletal pain, psychological complaints, gastrointestinal complaints and allergic complaints was used as a dependent variable in four separate
analyses. Standardized β values, P value and adjusted R2 given. NS, non-significant.
a
All models adjusted for gender, age and airline.
b
Reference category: Scandinavian flights.
among Norwegian cockpit and cabin crew. Cabin crew
reported significantly higher prevalence and mean val-
ues for all SHC factors compared to cockpit crew. In
total, 20% of the study population reported that they
had experienced work-related stress often or always, and
of this percentage significantly more were cabin crew
than cockpit crew. A model consisting of length of flight,
work-related stress and self-efficacy explained 23% of
the variance in psychological complaints for cockpit
crew, and 32% for cabin crew. The model explained little
of the variance in musculoskeletal, gastrointestinal and
allergic factors, but high work-related stress was signifi-
cantly associated with all SHC factors in both groups.
Self-efficacy partly moderated the relationship between
work-related stress and psychological complaints in both
cockpit and cabin crew, and for musculoskeletal com-
plaints in cockpit crew.
The study had several weaknesses that should be
taken into account before discussing the results. One
weakness was the low response rate, and as we had no
data on how many aircrew were actually reached and
invited and no information on the non-responders, we
cannot rule out possible selection bias. Our prevalence
values might therefore not exactly represent the gen-
eral population of Norwegian aircrew members since an
over-representation of healthy subjects in health surveys
has been reported [23]. However, selection bias is less
severe for the interpretation of group differences and
associations as long as the groups are comparable [24].
Furthermore, the number of respondents in our study
was relatively high, which strengthened the associa-
tions found between groups and between variables. All
respondents were fully anonymized, which could have
prevented reporting bias. A further weakness was that we
had no information on lifestyle variables that might have
affected the SHCs. Furthermore, we had no information
on the frequency or duration of flights or on work sched-
ules and had to rely on the information aircrew mem-
bers gave on whether they currently worked on domestic,
Gastrointestinal Allergic
β P value β P value
NS 0.034 NS −0.219 <0.05
NS 0.051 NS −0.120 NS
<0.001 0.301 <0.001 0.144 <0.01
NS 0.145 NS 0.097 NS
<0.05 −0.246 NS −0.092 NS
0.11 0.03
Scandinavian, European and/or intercontinental flights.
Lastly, the cross-sectional design of the study meant we
were limited in terms of drawing any conclusions about
any causal relationships.
The number and level of SHCs reported by the
Norwegian commercial aircrew members were surpris-
ingly high. In a study of SHCs in the general Norwegian
working population, Indregard et  al. [25] found the
mean number of complaints was 4.9, whereas aircrew
members in our study reported almost twice as many.
The most prevalent single health complaints among air-
crew members in our study were tiredness, sleep prob-
lems, bloating, low back pain, headaches and neck pain.
All of these complaints are also common in the general
population, although with a lower prevalence [25]. One
exception is bloating, which was reported by <20% of
the general population [25], whereas almost 60% of the
cockpit crew and 80% of the cabin crew reported this
complaint in our study. An increased risk of gastrointes-
tinal complaints in aircrew members has been reported
previously and has been linked to irregular sleep and
meals [26]. Furthermore, according to Boyle’s law, the
low atmospheric pressure at high altitudes could cause
intestinal gas expansion which may explain complaints
like bloating and stomach pain [27]. Cockpit crew
reported about the same degree of psychological com-
plaints that is reported for the general working popula-
tion, whereas cabin crew reported a higher degree [28].
Tiredness, sleep disruption and fatigue are known to
be common in both cabin crew [1] and cockpit crew
[18]. Both short-haul and long-haul flights have been
reported as being associated with the risk of fatigue
or tiredness [15,16]. In a study of Norwegian aircrew,
Haugli et  al. [17] found that long-haul aircrews had
more problems with tiredness and fatigue than short-
haul aircrews. However, the results of our study showed
that operating European or intercontinental flights was
not associated with psychological complaints among
cockpit or cabin crew.
 M. L. OMHOLT ET AL.: WORK-RELATED STRESS AND SHCS IN NORWEGIAN AIRCREW  141
In this study, cabin crew reported a significantly
higher prevalence and severity of most SHCs compared
with cockpit crew, as also previously reported [17,18].
This difference might be explained by gender differ-
ences, as almost all cockpit crew were male and cabin
crew were mainly female and women have been found to
report more SHCs than men [25]. However, we did not
find any significant differences between male and female
cabin crew for any of the SHC factors. This is in accord-
ance with a study by Haugli et al. [17], who found that
the health differences between cockpit crew and cabin
crew were larger than the differences between male and
female cabin crew, thus indicating that occupational dif-
ferences were more important. The difference could be
associated with more frequent and comprehensive health
tests and the higher socio-economical status of cockpit
crew, as well as with differing work environments and
psychosocial factors [17]. Cabin crew also experienced
physically demanding and monotonous work, a high
work pace during flights in order to ensure safety and
passenger service, and aggression and sexual harassment
from passengers [3,6]. These factors might lead to high
levels of stress and in our study more cabin crew reported
high levels of work-related stress.
We found that high levels of work-related stress were
significantly associated with high scores on all SHC
factors for both cockpit and cabin crew. High levels of
stress and work demands have been reported as asso-
ciated with health complaints in commercial pilots
[14,16] and cabin crew [29]. However, we did not find
any differences in the level of self-efficacy between cock-
pit and cabin crew, although both groups scored in the
upper range compared with other populations [30]. It
has been suggested that high levels of self-efficacy are
associated with lower levels of perceived stress [12], and
this was also found in our study. However, both cock-
pit and cabin crew reported higher levels of SHCs com-
pared with the general working population in Norway
[25,28]. Furthermore, in the regression models, self-effi-
cacy only moderated the association between perceived
work-related stress and psychological complaints for all
aircrew, and between work-related stress and musculo-
skeletal complaints for the cockpit crew. One could ques-
tion whether the self-efficacy measure used in the study
was really situation-specific, as we used the generic ver-
sion of the questionnaire and indicated to the respond-
ents that they should answer in relation to their working
situation, which might have influenced the results. The
tested model explained little of the variance for mus-
culoskeletal, gastrointestinal and allergic complaints,
thus indicating that other factors than flight length, job-
related stress and self-efficacy might be more important
for explaining the high levels of these complaints.
To summarize, Norwegian commercial aircrew
reported high levels of SHCs, and high reported levels of
work-related stress were significantly associated with the
level of musculoskeletal, psychological, gastrointestinal
and allergic complaints. The results indicate that more
research is needed on how physical, organizational and
psychosocial stressors affect SHCs in cockpit and cabin
crew. Furthermore, more knowledge of specific psycho-
social stressors, and how they affect cockpit and cabin
crew differently, is necessary in order to create a more
healthy work environment for these occupational groups.
Key points
•• Norwegian commercial aircrew reported high ­levels
and prevalence of subjective health ­ complaints,
and cabin crew reported more c­omplaints than
cockpit crew.
•• High levels of work-related stress were ­significantly
associated with the level of musculoskeletal,
psychological, gastrointestinal and allergic
­
complaints.
•• More knowledge is needed on how psychosocial
stressors affect cockpit and cabin crew differently.
Acknowledgements
The authors thank Parat, Norske SAS-Flygeres Forening,
SAS Norge Kabinforening, Norsk Kabinforening, Norwegian
Kabinforening, SAS Norge Pilotforening, Norwegian
Pilotforening, Widerøes Flyverforening and Widerøes
Kabinforening for the distribution of the questionnaire. We are
also grateful to all cabin and cockpit crew members who par-
ticipated in the study.
Conflicts of interest
None declared.
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