European Journal of Public Health, Vol. 15, No. 2, 209214 q The Author 2005.

Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/cki079

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Total workload, work stress and perceived symptoms in Swedish male and female white-collar employees
Gunilla Krantz1, Leeni Berntsson2, Ulf Lundberg3
Background: The aim of this study was to analyse how paid work, unpaid household tasks, child care, work child care interactions and perceived work stress are associated with reported symptoms in male and female white-collar employees. Methods: A questionnaire was mailed to 1300 men and 1300 women belonging to the white-collar sector, with at least 35 hours of regular employment a week and a participant age of between 32 and 58 years. It contained items relating to total workload (hours spent on paid work, unpaid household tasks and childcare), subjective indices for work stress and symptoms. The response rate was 65% (743 women; 595 men). Gender difference in symptom prevalence was tested by analyses of variance. Odds ratios were used to estimate the bivariate associations between work-related variables and symptom prevalence. A multivariate analysis estimated the effect of paid and unpaid work interaction, work childcare interplay and possible synergy. Results: The frequency and severity of symptoms was higher in women than in men (P , 0.0001). Employed womens health was determined by the interaction between conditions at work and household duties (OR 2.09; 1.06 4.14), whereas men responded more selectively to long working hours, i.e. .50 h/week (OR 1.61; 1.02 2.54). However, childcare (,21 h/week) appeared to have a buffer effect on the risk of a high level of symptoms in men working long hours. Conclusion: Working life and private circumstances and the interplay between them need to be taken into account to curb stress-related ill health in both men and women. Keywords: gender, household work, ill-health, multiple roles, paid work, stress, total workload

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Work-related health problems have increased for both men and women in industrialised countries. Neck shoulder
1,2

pain, tiredness, headache, stomach problems, low back pain and sleeping problems are the most frequently-reported symptoms resulting in sickness absence.1,3,4 Work-related illnesses in Sweden increased by two-thirds for women and almost doubled for men between 1996 and 1998.1 Several models have been presented to explain the association between workload (paid and unpaid work), perceived stress and health complaints.5 7 Higher levels of job stress have been reported in well-educated younger male and female employees working excessive overtime, and in high-level managers and administrators.8,9 The pattern of major job stressors appears to vary by workload, employment grade, occupational level, age and gender. To identify important health status determinants in women, the multiple roles of women have been investigated.10 12 The multiple role conceptbeing a spouse, a mother and an employeesuggests that harmful effects in relation to health outcomes may be produced by role conict and role overload.10 On the other hand, there is evidence that the benets of assuming multiple roles could outweigh the possible harmful effects by providing improved social networks, nancial independence and greater self-esteem, with one role compensating for the negative aspects of others.11 There is supporting evidence for both models, but most studies indicate that women

benet from shouldering multiple roles.13 15 One study found that shouldering multiple roles was benecial for women without children and for women over 40 years of age with children, while for younger women working full-time and having small children was linked to role conict, overload and poorer health.15 Fokkema also found that part-time work and having older children are associated with better health.16 Recent research conrms that both employment and marriage have benecial effects on womens health.12 However, much less is known about work marriage childcare combinations and health in men. The high female participation in the work force and the persisting traditional gender role pattern with regard to home and family responsibilities thus seem to contribute to observed gender differences in work stress.8,17,18 However, a deeper understanding of the association between workload (paid and unpaid), perceived stress and reported symptoms in both men and women, undertaken in the same study, is important in order to avoid unnecessary medication and sick-leave among women in the rst case. The aim of this study was to analyse how paid work, unpaid household tasks, childcare and work childcare interactions, as well as perceived work stress, are associated with reported symptoms in male and female white-collar employees in comparable life situations.

Methods
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1 Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institute, Stockholm, Sweden 2 The Sahlgrenska Academy at Goteborg University, Faculty of Health and Caring Sciences, Institute of Nursing, Goteborg, Sweden 3 Department of Psychology and Centre for Health Equity Studies (CHESS), Stockholm University, Stockholm, Sweden Correspondence: Dr Gunilla Krantz, Centre for Health Equity Studies, CHESS, Stockholm University and Karolinska Institute, SE-106 91 Stockholm, Sweden, tel. +46 8 674 7360, fax, +46 8 16 2600, e-mail: gunilla.krantz@chess.su.se

Selection of subjects The selection of study participants was based on a previous study8 and was made according to the following criteria: belonging to the white-collar sector; at least 35 hours of regular employment a week and participant age between 32 and 58 years. In 2001, samples of men and women were selected randomly, by Statistics Sweden, from four occupational areas in the white-

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European Journal of Public Health Vol. 15, No. 2, 209214

collar sector: (1) technology and natural science (architects, engineers and technicians in chemistry, physics and construction), (2) education (university professors and lecturers, school principals and other faculty members, school teachers), (3) health care (physicians, nurses, dentists, psychologists) and (4) administrative work (company and personnel administrators, computer programmers and system operators). From these areas, women and men were matched for age, occupational level and children below the age of 18 living at home. Male and female participants were not selected from the same families, although this may have happened in single cases by chance. This resulted in a study cohort of 1025 men and 1025 women, with at least one child under 18 years of age living at home, and 275 men and 275 women without children at home. The following occupational levels were represented: (1) top managerial level, director, managing director, deputy executive; (2) upper middle managerial level, head of a large division with 11 50 employees; (3) lower middle managerial level, head of a small division with up to 10 employees; (4) semi-managerial level, e.g. foreman without formal personnel responsibilities; (5) no managerial duties. A questionnaire containing items relating to socio-economic factors, total workload (TWL) and subjective indices for work stress and symptoms was mailed to the study participants and completed anonymously. For this reason, a reminder was sent by mail to everyone after three weeks. Incomplete questionnaires were excluded. Fifty respondents did not full the criteria set for participation, as they were either on maternity leave, sick listed on a long-term basis, or studying. The statistical analyses were based on data from 743 women and 595 men (table 1), equivalent to a response rate of 65%. The TWL instrument Total workload encompasses paid and unpaid forms of productive activity, as described by Kahn.19 A persons TWL thus encompasses paid employment and overtime at work and unpaid work duties, such as household chores, childcare, care of elderly or sick relatives, work in voluntary organisations, unions and so on. A Swedish TWL instrument, which was developed and psychometrically evaluated by Mardberg and colleagues and was designed specically for measuring aspects of TWL in female and male white-collar employees, was used in this study.20 It contains scales for measuring paid job descriptors, personal control, workload and qualication in the different activities. Calculation of TWL and work stress Each individuals TWL was calculated by adding up selfreported data relating to the average number of hours a week devoted to (i) paid employment and overtime at work, (ii) household duties (mending, sewing, laundry, gardening), (iii) childcare (homework/teaching, care-taking, playing) and (iv) other unpaid duties (voluntary work in unions and organisations, care of sick or elderly relatives). The items making up the four indices related to work stress, i.e. the subjective TWL indices, were calculated using mean raw scores (scale 1 7) and were as follows:20 1. Perceived TWL: too much to do on and off the job, overall stress, demands 1.1. Stress from paid work: too much to do at work, stress, demands at work 1.2. Conict between demands: childcare and household chores contribute to TWL, conict between duties 2. Control over household work: inuence at home, control, opportunity to make own decisions

Table 1 Socio-demographic data for study participants Women n Number of participants Occupational level Top 743 % Men n 595 %

.................................................. . .................................................. . .................................................. . .................................................. . .................................................. . .................................................. . .................................................. . .................................................. .

No of children under 18 years of age 0 1 2 Total 742 595 Non-managerial 367 47 266 Semi-managerial 174 25 140 Lower middle 79 11 69 Upper middle 87 12 65 35 5 55 9 11 12

24 44

.................................................. . .................................................. . .................................................. . .................................................. . .................................................. . .................................................. .

Age of participants 32 34 35 39 40 44 45 49 50 58 Total Total 743 595 37 67 9 72 248 33 206 237 32 168 191 26 149 25 28 35 12

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.................................................. . .................................................. . .................................................. . .................................................. . .................................................. . .................................................. . .................................................. .

Family type 742 594 220 29 208 175 24 125 151 20 113 131 18 92 65 9 56 9 16

19 21 35

.................................................. . .................................................. . .................................................. . .................................................. .

Family type with children under 18 years Living without partner Living with partner Total 75 Total 743 595 Living with partner 603 81 531 Living without partner 140 19 64 11 89

.................................................. . .................................................. . .................................................. . .................................................. .

Educational level 552 446 477 86 435 14 11 3 97

.................................................. . .................................................. . .................................................. .

Total 743 595 University/college 697 94 516 Secondary education; 12 years 41 6 77 13 87

The indices Stress from paid work and Conict between demands are subscales of Perceived TWL.20 Consequently, these indices were correlated with Perceived TWL, 0.75 and 0.76 respectively. The correlation between Perceived TWL and Control over household work was low, 20.20. All the TWL variables and the subjective TWL indices were dichotomised at the higher quartile of the distribution. Calculation of symptom prevalence As an indicator of perceived health, the dependent variable was assessed by a number of symptoms that are commonly reported by women and men in population-based studies.21 23 This

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211

Table 2 Symptom frequency (weekly or every second week) and symptom severity (moderate and severe) for women (n 743) and men (n 595) Sympton Women Frequency n Stomach pain Headache 205 % 28 Severity n 92 % 12 Men Frequency n 149 % 25 Severity n 48 % 8

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
Sleep disturbances Dizziness 303 41 172 23 171 29 64 11

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
Low back pain 121 16 42 6 57 10 19 3

272

37

145

20

192

32

92

16

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
Loss of appetite

243

33 4

133

18 2

180

30 2

79 3

13

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
Shoulder and neck pain 370 50 210 28 176 30 77 13

32

11

12

procedure is in line with the ndings from a study where the most common physical and psychological symptoms could be interpreted as a single entity phenomenon mirroring general distress.24 The symptoms were stomach pain, headache, sleep disturbances, dizziness, low back pain, loss of appetite and shoulder and neck pain (Cronbach alfa 0.60). The frequency (never, every second week or every week) and severity (mild, moderate, severe) of the symptoms was reported. To calculate symptom prevalence, taking both frequency and severity into consideration, a variable was created in which the seven symptoms were taken together and dichotomised into those with a high level of symptoms, equal to suffering from at least two symptoms present every week or every second week of a moderate or severe character, as opposed to those with a low level of symptoms, characterised by no symptoms or only one symptom of any frequency and severity. Statistical analyses Men and women were compared throughout the study. Gender difference in symptom prevalence was tested by analyses of variance (ANOVA), xed model. Odds ratios were used to estimate the bivariate associations between TWL variables and subjective TWL indices in relation to a high level of symptoms. Men and women were treated in the same analysis through introducing an interaction term between gender and each workrelated variable. The bivariate analyses were further supplemented by multiple logistic regression analyses to adjust for age, cohabitation status, number of children living at home and occupational level, as the matching of participants was not completely successful, but as hardly any difference in the risk of a high level of symptoms was detected, they are not presented. To estimate the effect of combined exposure (i.e. paid and unpaid work interaction and work childcare interplay), a multivariate analysis was performed with a combined variable. To further test for effect modication, a synergy index (SI) was calculated as proposed by Rothman.25 The following algorithm was used to determine effect modication, where SI . 1 signies a synergistic effect and SI , 1 an antagonistic effect. SI [RR(AB) 2 1]/{[RR(Ab) 2 1]+[RR(aB) 2 1]}where RR risk ratio, Ab exposed to one of the factors, aB exposed to the other factor and AB exposed to both factors. Odds ratios were used as estimates of relative risks. The Statistical Package for the Social Sciences (SPSS) was used for all statistical purposes.26 Statistical signicance was determined at the 95% condence interval (CI) level. This project was approved by the Ethics Committee at Stockholm University.

Results
Socio-demographic data reveal that somewhat more men than women were in top level positions, while more women than men (19% women and 11% men) lived without a partner. Of these, 75 (53%) women and 11 (17%) men had at least one child younger than 18 years of age living at home (table 1). Women had a higher TWL than men and spent more time on household work and childcare but fewer hours in paid work than men did. Furthermore, women obtained higher scores on all the subjective TWL indices than men and a statistically signicant difference was obtained through analysis of variance, with P , 0.0001.27 Symptom frequency was higher in women than in men for all symptoms and, moreover, more women than men rated their symptoms as moderate or severe (table 2). A mean was calculated for each symptom by analysing the constructed variable that combines the frequency and severity of each symptom (table 3). It was found that suffering from a particular symptom every week or every second week, of moderate or severe character, was more common in the women than among the men, and gender differences were statistically signicant for ve of the seven symptoms (P , 0.05). The most prevalent and severe symptom in the women was shoulder and neck pain, followed by headache and sleep disturbances, while sleep disturbances, low back pain and shoulder and neck pain were the most prevalent and severe symptoms among the men. Analysing the combined variable, where all the symptoms were taken together, revealed that 30% of the women and 15% of the men suffered from two or more symptoms appearing every week or every second week, of moderate or severe character, with P , 0.0001 (table 3). Of the TWL variables, i.e. those variables reecting the actual time spent on the various activities, none was associated with an increased risk of a high level of symptoms among the women, while only being in paid work more than 50 hours a week was associated with this risk among the men (table 4). However, 17% of the women and 32% of the men worked more than 50 hours a week, equivalent to overtime of more than 10 hours a week. When analysing the subjective TWL indices, the strongest association was found for stress from paid work for both women and men, with OR 3.54 (2.53 4.96) and OR 4.29 (2.67 6.91), respectively. Furthermore, perceived total workload displayed a statistically signicant risk of suffering from a high level of symptoms for both women (OR 1.93; 1.18 3.13) and men (OR 3.13; 1.61 6.08), while conict between demands and control over household work did not. Conict between demands was further analysed specically for women with
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Table 3 Gender difference in symptom reporting, frequency and severity combined (mean values are given for each symptom) Women Mean Stomach pain Headache 0.13 Men Mean 0.08 F 6.27 P-value 0.012

.................................................. . .................................................. .
Sleep disturbances Dizziness 0.24 0.11 35.01 ,0.0001 0.065

.................................................. . .................................................. .
Low back pain 0.06 0.18 0.03 0.14 4.43 4.95 0.036 0.026

0.20

0.16

3.41

.................................................. .
Loss of appetite

.................................................. .
Shoulder and neck pain All symptoms

0.02 0.29

0.01 0.13

2.98

0.085

.................................................. .
0.30 0.16 37.42 Signicance tests were performed by ANOVA. Df 1/1292; n 743 women and 595 men.

46.68

,0.0001 ,0.0001

children younger than seven and 11 years, respectively, but no statistically signicant association with a high level of symptoms was found. Finally, the association between paid work and a high level of symptoms was investigated when there was a concurrent exposure to a high level of household responsibility, i.e. a double exposure situation (table 5). This resulted in an odds ratio of 2.09 (1.06 4.14) and a synergy index of 3.7 for women, adjusted for age, indicating a considerably higher risk of symptoms as compared to being exposed to only one of the factors. For men, the double exposure situation was not associated with an increased risk of a high level of symptoms (OR 1.69; 0.46 6.21), but only 16 men were in this situation. The work child care interplay (table 5) was not associated with an increased risk of a high level of symptoms (OR 0.78; 0.16 3.88) among women, while an increased risk was noted for men (OR 2.96; 1.02 8.57), with synergy also being indicated (SI 5.3), but few men were in this situation. However, in the case of those men spending more than 50 h/week in paid work,
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Table 4 Association between work-related factors and a high level of symptoms for women and men, presented as crude odds ratios (OR) and 95% CI (n 1338: 743 women and 595 men) Variable High level of symptoms Women n TWL variables % OR 95% CI Men n % OR 95% CI

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Subjective TWL indices Perceived TWL: . 21 h/week 116 28 0.95 0.591.54 71 16 1.04 0.502.15 , 21 h/week 282 29 1 267 15 1 Childcare: . 20 h/week 258 32 1.13 0.811.58 59 17 1.11 0.542.28 , 20 h/week 433 30 1 481 16 1 Household work: . 50 h/week 131 34 1.17 0.781.75 190 21 1.61 1.022.54 , 50 h/week 580 30 1 376 14 1 Paid work: . 82 h/week 202 30 0.98 0.681.39 129 18 1.18 0.701.98 , 82 h/week 514 31 1 437 16 1 Total workload:

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High 244 28 0.85 0.601.19 104 15 0.94 0.521.69 Low/moderate 459 31 1 444 16 1 Control of household work: High 143 33 1.40 0.902.16 69 22 1.80 0.933.49 Low/moderate 301 26 1 307 13 1 Conict between demands: High 247 48 3.54 2.534.96 131 34 4.29 2.676.91 Low/moderate 452 21 1 427 11 1 Stress from paid work: High 113 37 1.93 1.183.13 62 29 3.13 1.616.08 Low/moderate 234 24 1 268 12 1

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Table 5 Effect modication of the combined exposure to paid work and household work, and paid work and childcare with regard to a high level of symptoms for women and men, presented as age-adjusted odds ratios with 95% CI and SI (n 743 women and 595 men) Variable Women n Paid work and household work: OR 95% CI SI Men n OR 95% CI SI

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
Paid work and childcare: Paid, .50 h/week; household, .20 h/week 40 2.09 1.064.14 3.7 16 1.69 0.466.21 0.6 Paid, ,50 h/week; household, .20 h/week 221 0.96 0.661.39 48 1.39 0.583.34 Paid, .50 h/week; household, ,20 h/week 92 0.75 0.441.27 169 1.73 1.042.86 Paid, ,50 h/week; household, ,20 h/week 353 1 330 1

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
Paid, .50 h/week; childcare, .21 h/week 12 0.78 0.163.88 1.0 22 2.96 1.028.57 5.3 Paid, ,50 h/week; childcare, .21 h/week 102 1.48 0.852.62 51 0.91 0.322.59 Paid, .50 h/week; childcare, ,21 h/week 56 0.74 0.381.45 99 1.46 0.732.93 Paid, ,50 h/week; childcare, ,21 h/week 234 1 179 1

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who also devoted a restricted amount of time to childcare (, 21 h/week), a reduced risk of a high level of symptoms was noted, as the effect of paid work thus lost its statistical signicance (OR 1.46; 0.73 2.93).

Discussion
The main aim of this study was to investigate how conditions related to paid and unpaid work and the interplay between them were associated with ill-health, in terms of a high level of common symptoms, in highly-educated white-collar men and women, aged between 32 and 58. A considerable number of men and women were engaged in overtime and almost twice as many women as men were suffering from frequent and severe symptoms. Employed womens reported symptoms were determined by an interaction between conditions at work and at home, whereas men responded more selectively to work conditions. On the other hand, a limited amount of childcare was able to reduce the observed symptom reporting from excessive paid work in this group of highly educated men. In line with this, Ozer and colleagues found that, the more fathers participated in childcare relative to their wife, the lower the fathers distress.28 Furthermore, the perception of stress from paid work was associated with an increased risk of suffering from symptoms for both women and men, although considerably more pronounced for men, while conict between demands and control over household work were not. These ndings are in line with stress models emphasizing the individuals personal evaluation of the environmental demands in relation to the individuals resources for meeting those demands and a balance is a prerequisite for health.29,30 The possible conict between demands from paid work and family obligations as a reason for ill-health, especially among women,10 was not conrmed in our study even though the women devoting much time to both paid work and household work were at a high risk of symptom reporting. Rather, this study lends support to the benecial effects of multiple roles and a plausible explanation is that academics, as compared to blue collar workers, often have sufcient job exibility to reduce work family conict and heighten levels of job satisfaction, which will positively affect health outcome.31

Methodological considerations The study participants were matched for age, occupational level and children at home and all the participants were in paid work for at least 35 hours a week. This procedure resulted in fairly homogeneous groups of men and women, which was an advantage in terms of comparing the groups, but limited our results and made them applicable only to white-collar sector men and women. We are therefore unable to draw any conclusions relating to other sectors or to the total population. This also resulted in a restriction of range when it comes to actual working conditions, which possibly explains why only one of the variables (paid work .50 h/week for men) emerged as a statistically signicant factor associated with reported symptoms. As the dependent and the independent variables were based on self-reports from the same instrument, there is a risk of response bias in that the participants who reported a high level of symptoms might rate their working conditions as generally worse than those not suffering from symptoms. However, women suffered more from common symptoms than men, but for all the independent variables the risk of suffering from a high level of symptoms was higher for men, which speaks against such an effect. The TWL instrument used in this study was developed in Sweden and, when validated, it was found to be a reliable tool for the study of stress-related aspects of the TWL of male and female white-collar employees.20

Conclusion
This study lends support to the idea that men also would benet from a multiple role situation rather than concentrating mainly on the paid employment role. We found that when care-taking of the children was added to overtime working mens activities, the risk of symptom reporting decreased. Furthermore, men suffered a higher risk of symptom reporting than women when in a situation of excessive overtime work or when perceiving their work burden to be high or when feeling stressed by their paid work. Shouldering multiple roles draws the attention away from paid work and we believe men have something to gain by engaging more in their other roles, i.e. as fathers and husbands. However, more knowledge is needed on the interplay between work and home circumstances, especially on mens roles and health effects.

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European Journal of Public Health Vol. 15, No. 2, 209214

Acknowledgements
This project was supported by grants to Ulf Lundberg from the Bank of Sweden Tercentenary Foundation.

10 Arber S, Gilbert GN, Dale A. Paid employment and womens health: a benet or a source of role strain? Sociol Health Illness 1985;3:375 99. 11 Sorensen G, Verbrugge LM. Women, work and health. Annu Rev Public Health 1987;8:5 51. 12 Waldron I, Weiss CC, Hughes ME. Interacting effects on multiple roles on womens health. J Health Soc Behav 1998;39:216 36.

Key points
A deeper understanding of the association between workload (paid and unpaid), perceived stress and reported symptoms in both men and women, undertaken in the same study, is important in order to avoid unnecessary medication and sick-leave among women in the rst case. Employed womens reported symptoms were determined by an interaction between conditions at work and at home, whereas men responded more selectively to work conditions. The work home conict as a reason for ill-health, especially among women, was not conrmed in this study. Rather, it lends support to the benecial effects of multiple roles. A plausible explanation is that academics often have sufcient job exibility to reduce work family conict and heighten levels of job satisfaction, which positively affect health outcome. Working life and private circumstances and the interplay between them need to be taken into account to curb stress-related ill health in both men and women.

13 Hibbard JH, Pope CR. Effect of domestic and occupational roles on morbidity and mortality. Soc Sci Med 1991;32:805 11. 14 Hibbard JH, Pope CR. The quality of social roles as predictors of morbidity and mortality. Soc Sci Med 1993;36:217 25. 15 Arber S, Gilbert GN, Dale A. Paid employment and womens health: a benet or a source of role strain? Sociol Health Illness 1985;3:375 99. 16 Fokkema T. Combining a job and children: contrasting the health of married and divorced women in the Netherlands? Soc Sci Med 2002;5:741 52. 17 Lundberg U. Inuence of paid and unpaid work on psychophysiological stress responses in men and women. J Occup Health Psychol 1996;1:117 30. 18 Matthews S, Power C. Socio-economic gradients in psychological distress: a focus on women, social roles and work-home characteristics. Soc Sci Med 2002;4:799 810. 19 Kahn RL. The forms of womens work. In: Frankenhaeuser M, Lundberg U, Chesney MA, Editors. Women, work and health. Stress and opportunities. New York: Plenum Press, 1991:65 83. 20 Mardberg B, Lundberg U, Frankenhaeuser M. The total workload of parents employed in white collar jobs: construction of a questionnaire and a scoring system. Scand J Psychol 1991;32:233 9. 21 Tibblin G, Bengtsson C, Furunes B, Lapidus L. Symptoms by age and sex. Scand J Prim Health Care 1990;8:9 17. 22 Gijsbers van Wijk CMT, Kolk AM. Sex differences in physical symptoms: the contribution of a symptom perception theory. Soc Sci Med 1997;45:231 46. 23 Walters V, McDonough P, Strohschein L. The inuence of work, household structure, and social, personal and material resources on gender differences in health: an analysis of the 1994 Canadian National Population Health Survey. Soc Sci Med 2002;54:677 92. 24 Krantz G, Ostergren P-O. Womens health: do common symptoms in women mirror general distress or specic disease entities? Scand J Public Health 1999; 27:311 7. 25 Rothman KJ. Modern epidemiology. Boston: Little, Brown, 1986. 26 Norusis M. Statistical package for the social sciences. Professional statistics release 6.1 (SPSS 6.1). Chicago: SPSS, 1994. 27 Berntsson, L., Krantz, G., Lundberg, U. Total workload: the distribution of paid and unpaid work as related to age, occupational level and number of children among Swedish male and female white-collar workers. Work & Stress, submitted (2003). 28 Ozer EM, Barnbett RC, Brennan RT, Sperling J. Does childcare involvement increase or decrease distress among dual-earner couples? Womens Health 1998;4:285 311. 29 Frankenhaeuser M. A psychobiological framework for research on human stress and coping. In: Appley MH, Trumbull R, Editors. Dynamics of stress: physiological, psychological and social perspectives. New York: Plenum Press, 1986:101 16. 30 Lazarus RS, Folkman S. Stress, appraisal and coping. New York: Springer, 1984. 31 Bekker M, Gjerdinger D, McGovern P, Lundberg U. Multiple roles: Health protection or health risk? In: Kolk A, Bekker M, van Vliet K, Editors. Advances in Women and Health Research. Toward Gender-Sensitive Strategies. Tilburg: Tilburg University Press, 1999:103 21.

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Received 11 June 2003, accepted 17 December 2003