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Open Access Research article

Is a single item stress measure independently associated with subsequent severe injury: a prospective cohort study of 16,385 forest industry employees

Simo Salminen1, Anne Kouvonen234*, Aki Koskinen5, Matti Joensuu6 and Ari Väänänen6

Author Affiliations

1 Finnish Institute of Occupational Health, Occupational Safety and Ergonomics, Helsinki, Finland

2 UKCRC Centre of Excellence for Public Health (NI), Queen’s University, Belfast, UK

3 Department of Social Research, University of Helsinki, Helsinki, Finland

4 University of Social Sciences and Humanities, Faculty in Wroclaw, Wroclaw, Poland

5 Finnish Institute of Occupational Health, Creating solutions, Helsinki, Finland

6 Finnish Institute of Occupational Health, Centre for Expertise for Work Organizations, Helsinki, Finland

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BMC Public Health 2014, 14:543  doi:10.1186/1471-2458-14-543

Published: 2 June 2014



A previous review showed that high stress increases the risk of occupational injury by three- to five-fold. However, most of the prior studies have relied on short follow-ups. In this prospective cohort study we examined the effect of stress on recorded hospitalised injuries in an 8-year follow-up.


A total of 16,385 employees of a Finnish forest company responded to the questionnaire. Perceived stress was measured with a validated single-item measure, and analysed in relation recorded hospitalised injuries from 1986 to 2008. We used Cox proportional hazard regression models to examine the prospective associations between work stress, injuries and confounding factors.


Highly stressed participants were approximately 40% more likely to be hospitalised due to injury over the follow-up period than participants with low stress. This association remained significant after adjustment for age, gender, marital status, occupational status, educational level, and physical work environment.


High stress is associated with an increased risk of severe injury.

Stress; Injury; Forest industry; Finland; Cohort study; Hospitalisation