Psychosocial work environment and health in U.S. metropolitan areas: a test of the demand-control and demand-control-support models.

The authors use confirmatory factor analysis to investigate the psychosocial dimensions of work environments relevant to health outcomes, in a representative sample of five U.S. metropolitan areas. Through an aggregated inference system, scales from Schwartz and associates' job scoring system and from the Dictionary of Occupational Titles (DOT) were employed to examine two alternative models: the demand-control model of Karasek and Theorell and Johnson's demand-control-support model. Confirmatory factor analysis was used to test the two models. The two multidimensional models yielded better fits than an unstructured model. After allowing for the measurement error variance due to the method of assessment (Schwartz and associates' system or DOT), both models yielded acceptable goodness-of-fit indices, but the fit of the demand-control-support model was significantly better. Overall these results indicate that the dimensions of Control (substantive complexity of work, skill discretion, decision authority), Demands (physical exertion, physical demands and hazards), and Social Support (coworker and supervisor social supports) provide an acceptable account of the psychosocial dimensions of work associated with health outcomes.