Work 57 (2017) 433–440 433

DOI:10.3233/WOR-172581
IOS Press

Work-related stress and role of personality

in a sample of Italian bus drivers
Margherita Bergomi, Alberto Modenese∗ , Enrica Ferretti, Angela Ferrari, Giuseppe Licitra,
Roberto Vivoli, Fabriziomaria Gobba and Gabriella Aggazzotti
Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia,
Modena, Italy

Received 26 October 2015

Accepted 15 November 2016

Abstract.
BACKGROUND: Several studies have shown that professional drivers are at risk of developing work-related stress. Stress
may be responsible for a variety of adverse effects and may also be associated with an increased number of accidents.
OBJECTIVE: Perform an integrated, objective and subjective evaluation of work-related stress in bus drivers, that also
considered the role of personality traits.
METHODS: Salivary ␣-amylase and cortisol were measured in 42 bus drivers. Subjective stress evaluation was performed
with the Perceived Stress Scale (PSS-10) and Driver Stress Inventory (DSI). To evaluate personality traits, we administered
the Eysenck Personality Questionnaire-Revised (EPQ-R) and the Impulsivity Inventory (IVE).
RESULTS: Salivary biomarkers showed no associations with PSS-10 and personality traits. Cortisol levels were positively
correlated with fatigue (r = 0.44) at the middle of the work-shift and with aggression (r = 0.51) at the end of a day off. At the
end of the work-shift, cortisol levels were negatively correlated with hazard monitoring (r = –0.37) and salivary ␣-amylase
was positively correlated with thrill-seeking (r = 0.36). Neuroticism (␤ = 0.44) and impulsiveness (␤ = 0.38) were predictors
of perceived stress by multiple regression.
CONCLUSIONS: An integrated method, considering both objective and subjective indicators, seems adequate to evaluate
work-related stress in professional drivers. Personality traits are relevant in determining perception of stress.

Keywords: Occupational stress, biological monitoring, personality trait, accident prevention

1. Introduction factors, including the role of the worker inside the

According to the 2004 European Agreement on
stress at work, “stress is a state, which is accompanied
by physical, psychological or social complaints or
dysfunctions and which results from individuals feel-
ing unable to bridge a gap with the requirements or
expectations placed on them” [1]. Preliminary anal-
ysis of work-related risk factors, such as high job
demands and low job control, and of context risk
∗ Address for correspondence: Alberto Modenese, MD, PhD,
Department of Biomedical, Metabolic and Neural Sciences,
University of Modena and Reggio Emilia, via Giuseppe Campi
287, 41125 Modena, Italy. Tel.: +39 0592055475; E-mail:
alberto.modenese@unimore.it.
organization and the relationships with co-workers
and supervisors, is needed for comprehensive evalua-
tion of work-related stress. Specific occupational risk
factors must also be considered with regards to driv-
ing among content factors, and in particular exposure
to noise, microclimate, vibration, and biomechan-
ical overload related to the adoption of prolonged
fixed postures. For drivers in public transport service,
there is a relevant risk of aggression from passengers,
which is another potential cause of distress [2, 3].
A large number of studies have reported that bus
drivers are exposed to significant mental and physical
effort. One of the main reasons is the large num-
bers of complex tasks these workers must carry out.

1051-9815/17/$35.00 © 2017 – IOS Press and the authors. All rights reserved
434 M. Bergomi et al. / Work stress and personality in Italian bus drivers
These working conditions require a high, continuous
level of attention from drivers, who are unable to con-
trol external factors, such as interference with other
vehicles, cyclists, pedestrians, and possible roadway
obstacles [4–10]. Long-term exposure to these factors
in susceptible subjects may induce a distress condi-
tion that can lead to dysregulation of various hormone
and neurotransmitter levels, such as cortisol and cat-
echolamine, as well as increased susceptibility for
negative cardiovascular and neuro-muscular effects
[11]. In particular, for bus drivers, Du et al. reported
that elevated 24-hour urine cortisol levels were asso-
ciated with poor relationships between workers and
their supervisors [12]. Various studies showed a rela-
tionship between exposure to heavy traffic and the
level of urinary catecholamine [13, 14]. Djindjic et
al. found an association between work-related stress
and dyslipidemia and increased blood pressure in bus
drivers [15].
It has should also be noted that elevated stress in
bus drivers, in addition to increasing the likelihood of
accidents, may also lead to a significant risk of injury
for transport users, other vehicle drivers, pedestrians,
and cyclists. It has been suggested that some person-
ality traits may be potential predictors of hazardous
driving behaviors [16]. Ruiz-Grosso et al. [17] have
shown that common mental disorders such as alcohol
abuse, major depressive episode, anxiety symptoms,
and burnout syndrome are higher in public transporta-
tion drivers than in the general population [17].
To consider these premises, the objective of this
study was to evaluate work-related stress in a sam-
ple of bus drivers using both subjective and objective
investigation methods, as well as to estimate the
impact of the individual personality traits on stress
in bus drivers.
2. Materials and methods
The data presented herein were derived from a col-
laboration between the university’s Department of
Public Health and a public transport company located
in a north Italian city during the period from Novem-
ber 2010 to October 2011. Forty-two bus drivers were
recruited on a voluntary basis, and a signed informed
consent form was obtained from all. All data was
managed in accordance with the Italian law for pri-
vacy protection (D. Lgs. n◦ 196 of 30 January 2003).
A multidisciplinary team of health professionals
collected the data using several instruments.
Perceived stress was evaluated with the 10-item
Perceived Stress Scale (PSS-10), a self-administered
questionnaire that measures the degree to which sit-
uations are appraised as stressful, referring to the last
year [18].
The Driver Stress Inventory (DSI) was used to
measure susceptibility to stress during driving. This
self-administered questionnaire is composed of 5
scales with different stressful aspects of driving:
aggression, dislike of driving, hazard monitoring,
proneness to fatigue, and thrill-seeking [19].
The third and fourth self-administered ques-
tionnaires used were the Eysenck Personality
Questionnaire - Revised (EPQ-R) and Eysenck’s
Impulsivity Inventory (IVE), which investigate per-
sonality traits such as extraversion, neuroticism,
psychoticism, impulsiveness, audacity, and empa-
thy. These questionnaires do not evaluate psychiatric
symptoms, but only specific behaviors and attitudes
that are common in the general population [20].
Two types of biochemical indicators were used
as objective measurements, salivary ␣-amylase and
salivary cortisol [21, 22]. Salivary samples were
collected with Salivette® at the beginning (WD1),
mid-way (WD2), and at the end of a work-shift
(WD3) and also on a day off at approximatively the
same hours (DO1, DO2, DO3) to reduce variabili-
ties in hormone secretion related to circadian rhythm
[23]. Salivary concentration was determined with
an immunoenzymatic method (IMMULITE 2000,
DPC, 2005-04-05) for cortisol; ␣-amylase salivary
concentration was estimated indirectly by measur-
ing enzymatic activity with a colorimetric method
(DiaMetra, Ed. 01/08).
Statistical analysis was performed using SPSS-
21.0 for Windows (SPSS Inc. Chicago, IL, USA).
Continuous variables were correlated with Pearson’s
coefficient (r). A multivariate regression model was
built to look for significant association between the
variables investigated with questionnaires and the
levels of biomarkers. Finally, a t-test analysis was
used to evaluate differences in salivary cortisol and
␣-amylase concentrations between work days and
days off.
3. Results
A total of 42 subjects (10% of the total number of
drivers employed in the company on 31 May 2011)
were recruited (37 men and 5 women), with a mean
age of 40 years (min = 27, max = 57, SD = 6) and with
 M. Bergomi et al. / Work stress and personality in Italian bus drivers 435

Table 1
Mean scores in the PSS-10, DSI, EPQ-R, and IVE questionnaires compared with similar studies
Questionnaire Scale Range Bus drivers score Values reported
in other studies
Min Max Mean ± SD Mean ± DS
PSS-10 Perceived Stress 0–40 0 28.0 12.76 ± 6.10 14.49 ± 5.25∗
DSI Aggression 0–100 17.5 95.0 43.33 ± 15.27 46.00 ± 13.40∗∗
Dislike of Driving 0–100 1.67 59.1 24.93 ± 15.15 37.60 ± 13.01∗∗
Hazard Monitoring 0–100 57.0 100 83.48 ± 8.75 65.40 ± 12.60∗∗
Fatigue Proneness 0–100 1.25 100 35.62 ± 23.52 45.10 ± 15.50∗∗
Thrill-seeking 0–100 1.25 88.7 25.54 ± 23.55 25.90 ± 16.40∗∗
EPQ-R Extraversion 0–12 0 11.0 8.24 ± 2.14 9.15 ± 2.34∗∗∗
Psychoticism 0–12 0 5.0 2.36 ± 1.23 8.20 ± 2.74 ∗∗∗
Neuroticism 0–12 0 9.0 2.67 ± 2.57 1.72 ± 2.07∗∗∗
IVE Impulsiveness 0–19 1.0 15.0 5.70 ± 3.33 3.80 ± 2.61∗∗∗
Audacity 0–16 0 14.0 7.10 ± 3.62 6.70 ± 4.32∗∗∗
Empathy 0–19 5.0 18.0 11.67 ± 3.43 11.78 ± 2.91∗∗∗
∗ Ge et al., [23]; ∗∗ Matthews et al., [24]; ∗∗∗ Łuczak & Tarnowski, [25].

a mean length of service of 10.5 years. The drivers
were distributed on different work-shifts, both during
the morning and the afternoon.
Table 1 shows the scores of the four questionnaires
collected (PSS-10, DSI, EPQ-R, and IVE) in addition
to scores reported by similar studies [23–25].
In total, 37 saliva samples were collected (33 from
men and 4 from women). To avoid possible variabil-
ity related to gender, we considered only the 33 male
samples in statistical analysis [26]. The mean val-
ues of the concentration of cortisol and ␣-amylase
in the salivary samples, collected at WD1, WD2,
and WD3 and at DO1, DO2, and DO3 are shown
in Tables 2 and 3. The values obtained were within
the reference range indicated by technical details
of test kits (respectively, IMMULITE 2000 and
Diametra).
A significant increase in salivary cortisol was
found between the levels at DO2 and WD2 (t = 2.228;
p = 0.033). Salivary ␣-amylase also increased
significantly, comparing the concentrations at DO1
and WD1 (t = 2.312; p = 0.027).
No significant associations were seen between
salivary ␣-amylase and salivary cortisol levels with
scores on the PSS-10. There was also no associ-
ation between these concentrations and the scores
obtained with the EPQ-R and IVE questionnaires.
However, we found a positive significant correlation
between some subscales of the DSI and cortisol lev-
els. In particular, correlations between WD2 cortisol
and fatigue (r = 0.444; p = 0.007) and between DO3
cortisol and aggression (r = 0.508; p = 0.003) were
seen. A negative correlation between WD3 cortisol
and hazard monitoring (r = – 0.369; p = 0.032) was
also found. Regarding salivary ␣-amylase, there was
a positive correlation between WD3 levels and thrill-
seeking (r = 0.361; p = 0.046).
Comparing the scores obtained with the differ-
ent scales, we found a positive correlation between
neuroticism (EPQ-R) and impulsiveness (IVE)

Table 2
Mean concentrations of salivary cortisol during work-shifts and day-off
SALIVARY Mean concentration SALIVARY Mean concentration
CORTISOL ± SD (ng/mL) CORTISOL ± SD (ng/mL)
Work-Day 1 (WD1) 5.29 ± 2.53 Day-Off (DO1) 6.20 ± 6.87
Work-Day 2 (WD2) 6.20 ± 5.33 Day-Off 2 (DO2) 4.09 ± 3.15
Work-Day 3 (WD3) 3.76 ± 2.65 Day-Off 3 (DO3) 4.36 ± 3.57

Table 3
Mean concentrations of salivary ␣-amylase during work-shifts and day-off
SALIVARY Mean concentration SALIVARY Mean concentration
␣-AMYLASE ± SD (U/mL) ␣-AMYLASE ± SD (U/mL)
Work-Day 1 (WD1) 72.29 ± 72.72 Day-Off (DO1) 54.47 ± 46.12
Work-Day 2 (WD2) 92.43 ± 82.93 Day-Off 2 (DO2) 90.42 ± 68.76
Work-Day 3 (WD3) 86.71 ± 57.70 Day-Off 3 (DO3) 71.41 ± 62.55
436 M. Bergomi et al. / Work stress and personality in Italian bus drivers
Fig. 1. Correlation between neuroticism (EPQ-R) and Perceived
Stress Scale (PSS-10).
(r = 0.358; p = 0.02), aggression (DSI) (r = 0.618;
p = 0.00), and dislike of driving (DSI) (r = 0.343;
p = 0.026). In addition, impulsiveness (IVE) and dis-
like of driving (DSI) were also positively correlated
(r = 0.398; p = 0.009).
Considering the scores of the PSS-10 and per-
sonality traits, we found positive correlations with
neuroticism (EPQ-R) (r = 0.609; p = 0.00) (Fig. 1),
impulsiveness (IVE) (r = 0.558; p = 0.00) (Fig. 2), and
aggression (DSI) (r = 0.473; p = 0.002) (Fig. 3).
Multivariate linear regression analysis was used
to identify the personality traits that correlated with
perception of stress, considering the PSS-10 score
as the dependent variable. The independent vari-
ables that had a positive correlation with PSS-10
at univariate analysis were neuroticism (EPQ-R),
impulsiveness (IVE), and aggression (DSI). Neuroti-
cism and impulsiveness positively correlated with
PSS-10, with ␤ values of 0.44 (p = 0.004) and 0.38
(p = 0.004), respectively.
Fig. 2. Correlation between impulsiveness (IVE) and Perceived
Stress Scale (PSS-10).
Fig. 3. Correlation between aggression (DSI) and Perceived Stress
Scale (PSS-10).
4. Discussion
According to the Italian national law on occupa-
tional safety and health from 2008, work-related stress
is included among the occupational risks that employ-
ers in Italy are mandated to assess. The evaluation is
very complex because it must consider both objective
and subjective factors. Unfortunately, after estimat-
ing risk, according to the recent scientific literature,
to date adequate biomarkers or other individual mea-
sures to objectively monitor the effects of work-related
stress, before the occurrence of medical or psycho-
logical disorders in workers, have not been identified.
Currently, subjective questionnaires are the only tools
available to investigate work-related stress individu-
ally, but, nonetheless present a variety of problems.
For example, they are not specific for the work activ-
ity we evaluated, they are susceptible to the action of
non-occupational stressors, and can produce a very
different output depending on the specific period of
administration. For instance, if a questionnaire is
administered in a moment of extreme work overload
due to an impending delivery of a large quantity of
goods or during a considerable organizational change
inside the company, the score will be higher.
Bus driving activity, especially in city traffic,
exposes drivers to numerous stressors: complex inter-
actions with other vehicles, frequent stops at traffic
lights, fixed times of travel, repetitive paths, inter-
ference with passengers, episodes of violence, etc.
Evaluation of work-related stress in bus drivers is of
high importance both to protect workers’ health and
to increase the safety of passengers. In fact, it is well
documented that distress and fatigue decrease alert-
ness and psychomotor performance, increasing the
risk of traffic accidents.
 M. Bergomi et al. / Work stress and personality in Italian bus drivers
We considered that there is a risk of residual stress
in the public driving sector that is related both to the
work itself and to contextual factors. For these rea-
sons, we tried to evaluate the individual components
and to identify personal correlates of susceptibility to
the consequences of stress. In this sample of Italian
bus drivers, a very specific questionnaire was admin-
istered that investigated signs of stress during driving,
namely the DSI. At the same time, a general ques-
tionnaire for stress monitoring that is applicable both
to occupational and non-occupational exposure, the
PSS-10, was used. Next, in order to identify individ-
ual correlates, we firstly employed widely used and
easily obtainable biomarkers, salivary cortisol and
␣-amylase, and also investigated the intrinsic char-
acteristics of personality using the EPQ-R and IVE
questionnaires.
The mean scores of perceived stress (PSS-10)
obtained in out cohort are comparable with data from
similar studies in samples of drivers in other coun-
tries and can be considered quite low [23, 27–29].
Regarding the scores of questionnaires investigating
personality traits (EPQ-R and IVE) and stress percep-
tion during driving (DSI), our data is also comparable
with similar studies. The only exceptions were the
following:
– a lower mean score for the subscale “dislike of
driving” and a higher mean score for the subscale
“hazard monitoring” of the DSI [24];
– a lower mean score for the subscale “psychoti-
cism” of the EPQ-R and a higher mean score for
the subscale “impulsiveness” in the IVE [25].
Considering biochemical markers as possible indi-
cators of stress, we observed an increase in salivary
levels of cortisol between Days-Off and Work-Days
in the second monitoring period (at the middle of the
DO/WD); for ␣-amylase, we observed an increase
between Day-Off and Work-Day in the third moni-
toring period (end of the shift). It should, however, be
noted that these indicators have a high individual vari-
ability and also vary according to a circadian rhythm
during the day. Regarding detection of these biomark-
ers in saliva, cortisol is secreted in the blood from the
adrenal glands and takes some time to be detected
in the saliva, while ␣-amylase is secreted directly in
saliva. It should also be recalled that, within certain
limits, neuroendocrine activation of the organism is
physiological during working activity and is also use-
ful, e.g. to increase the level of attention, which is
fundamental in a complicated task such as driving
[30–35]. We did not find any significant association
437
between the levels of these two biomarkers and per-
ceived stress, in contrast with a recent Taiwanese
study where elevated 24-hour urine cortisol levels
were associated with a high score in the Occupa-
tional Stress Index. This can probably be explained by
differences between the two types of questionnaires
administered: PSS-10 is a very short questionnaire,
useful for rapid detection of stress, while the OSI
is a complex, long questionnaire, specifically meant
to investigate many content and context risk factors
that may be associated with individual stress [36].
Nevertheless, we found a positive significant correla-
tion between cortisol at the middle of the work-shift
and fatigue and between cortisol at the end of the
work-shift and aggression. These associations seem
concordant with the clinical features of hypercorti-
solism, even if it should be pointed out that the levels
of salivary cortisol detected in our sample were within
the reference range for the general population.
Finally, in the present study we also compared the
scores obtained in the different scales of the ques-
tionnaires administered to drivers. At multivariate
analysis, we found that the personality traits neu-
roticism and impulsiveness best correlated with the
perception of stress. The scale “neuroticism” of the
EPQ-R questionnaire outlines a person who tends to
be overly worried, anxious, and emotional, while the
scale “impulsivity” of the IVE questionnaire outlines
the tendency to act in a risky way, without adequately
considering the consequences of one’s actions. These
results confirm the influence of individual personality
traits on vulnerability to stress in drivers [37–40].
4.1. Limitations of the study
It has to be underscored that the present study has
several limitations considering the type of study –
cross-sectional – and the methodology used, both
in selecting the sample and measuring the different
indicators considered.
Our sample size is small, probably because sub-
jects were recruited on a voluntary basis, without a
direct and immediate advantage from their participa-
tion in the research.
Regarding the subjective indicators selected, we
considered the possible biases related to a self-
reported investigation in a small sample of subjects.
In order to minimize these limitations, we admin-
istered several questionnaires and also performed
objective measurements. For subjective stress percep-
tion, both the PSS-10 and the DSI have limitations.
The PSS-10 is quite short and investigates stress
438 M. Bergomi et al. / Work stress and personality in Italian bus drivers
perception in a general manner: this questionnaire
is sensitive for detecting distress situations and is
widely used, but is not specifically meant to identify
work-related issues [18]. We tried to cover this gap
by using another subjective questionnaire, the DSI,
which is very specific for professional driving, but
data in the scientific literature is scanty [24].
Considering objective measurements, the two
biomarkers used in the present study, salivary cor-
tisol and ␣-amylase, are easily detectable and widely
employed [41–43], but the results of their association
with job stress are often conflicting, possibly due to
their high inter- and intra-variability in following cir-
cadian rhythms. We tried to avoid these limitations by
using standardized methods during the same periods
of the day off and working days. However, we believe
that further research is needed to confirm the lack
of association of these biomarkers with stress per-
ception and correlations with the various personality
traits considered.
5. Conclusion
In the present study, we performed a detailed
investigation of individual work-related stress in a
sample of Italian bus drivers, using both subjective
(questionnaires) and objective (salivary biochemi-
cal indicators) methods, thus providing an integrated
evaluation of this complex phenomenon.
Bus driving in city traffic, according to data in the
international literature, can be considerably stressful
for some individuals. Our data confirm the important
role that personality traits play as they are associated
with both activation of the neuro-endocrine response
(cortisol and salivary ␣-amylase) during driving and
with the drivers’ perception of stress.
Despite the limited size of our sample, which may
not be representative of the overall population of
urban bus drivers, the results of our study provide
useful considerations, especially when comparing
them with the recent scientific literature. In disagree-
ment with other studies, we found no significant
association between biochemical markers and scores
of the questionnaire specifically investigating “per-
ceived stress”. This finding is in agreement with the
statement that stress assessment in workers must con-
sider integrated measures, and thus it cannot be based
on a single indicator.
However, considering the limitations in the mea-
surement of salivary ␣-amylase and cortisol, as
well as the conflicting results in the literature,
further research is needed to better understand these
aspects.
Regarding the personality traits investigated
through specific questionnaires, we found that certain
personality characteristics have an interesting role in
the vulnerability of bus drivers to stress: in particu-
lar, “neurotic” and “impulsive” traits were associated
with higher stress perception. This result may be use-
ful for future research, in order to further investigate
this association and possibly implement measures to
prevent accidents in the professional driving sector,
for example by employing specific preventive actions
for workers with these types of behaviors that aim to
minimize their vulnerability to work-related stress.
In conclusion, our data affirms that adequate con-
sideration of individual factors, such as personality
traits, are useful within a global organizational inter-
vention focused on reducing stress in professional
drivers. Among the possible preventive strategies
to reduce work-related stress, organizational and
individual interventions, e.g. adequate rest intervals
between shifts, barriers between drivers and pas-
sengers, ergonomic seats, providing information to
workers about risks and specific individual training
for possible behaviors to adequately manage stressors
may be beneficial. Such actions are definitely useful
to improve the health of drivers, but also the safety of
passengers.
Acknowledgments
We wish to thank the public transportation com-
pany of our city for the availability and interest in
investigating the complex phenomenon of stress dur-
ing driving.
Conflict of interest
None to report.
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