Industrial Health 2002, 40, 101112

Review Article

Work-related Reproductive, Musculoskeletal and

Mental Disorders among Working Women
History, Current Issues and Future
Research Directions
Reiko KISHI1*, Teruyo KITAHARA2, Ayumi MASUCHI3 and Setsuko KASAI1

1
Department of Public Health, Hokkaido University School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo,
Hokkaido 060-8638, Japan
2
Department of Preventive Medicine, Shiga University of Medical Science, Setatsukiwa-cho, Otsu 520-2192,
Japan
3
Department of Psychology, Hokkaido University School of Letters, Sapporo, Hokkaido 060-8638, Japan

Received December 17, 2001 and accepted January 12, 2002

Abstract: According to the recent changes of working environments and socio-economical conditions,
the proportion of working women are increasing in Japan. Characteristics of occupational workload
and stress of Japanese working women are consistent with those in many industrialized countries
except man-dominant culture. In this review we describe the history, current issues, and future research
directions on occupational health of working women, especially focused on reproductive health, work-
related musculo-skeletal disorders (WMSDs), and mental disorders. In the reproductive health survey,
traditionally main concern was about pregnancy outcomes, then fecundity studies, such as time to
pregnancy, became topics recently. Future research will be shifted to outcomes not only during
pregnancy but also disorders of hormonal balance and climacterium or health conditions after
menopause. WMSDs are reviewed on mainly gender difference and its causative factors. Historically,
mental health of working women in Japan has focused on the job stress of nurses. We compare results
with a lot of recent researches in Europe and U.S.A., where interaction between occupational stress
and family roles were studied. It is not easy to predict the prospective status of female workers in
Japan, but social, workplace and familial supports will enhance their health promotion.

Key words: Working women, Reproduction, Musculoskeletal, Mental disorders, Research directions

Introduction
According to a study by the Management and Coordination
Agency, the percentage of women in the whole hired labor
force in 2000 was 40.0%. The proportion of working women
according to age shows an M-shaped curve, with 2024 years
old and 3034 years old as peaks and 3034 as a trough.
*To whom correspondence should be addressed.
However, with the trend of high education and late marriage
among women in recent years, the proportion of working
women and 2529 years old is increasing, though many
women quit their jobs due to childbirth and childcare.
According to the Survey on Female Employees by the
Ministry of Labor, the number of working women who leave
their jobs due to childbirth or childcare is decreasing, and it
is expected that more women will continue to work after
they have children. After the amendment of the Law for
102
Equal Employment Opportunity of Men and Women in 1998,
women can work in occupations that were previously mostly
dominated by men. In addition, after the abolition of the
Womens Protection Rule from the Labor Standards Law,
women may work overtime and late at night. With this
relaxation of the regulations for women, women can work
in as the same style as men do.
However, there are still many obstacles for working
women: a) they have much greater household responsibility
than men; b) the system to support care of children and old
parents; and c) most working women are part-time or
temporary employees, which means that their insurance
system is insufficient and the wage gap between men and
women has not been narrowed.
In this society, where the social support system is
insufficient, and people have deep-rooted beliefs about gender
roles, it may be a big burden for working women to be
required to work like men do. For instance, since the abolition
of the Women Protection Rule, women working long hours
have suffered from serious problems. They may end in death
(karoshi) or suicide from overwork.
In this article, we will review important issues, i.e.,
womens reproductive health, work-related musculoskeletal
disorders (WMSDs), and mental health in Japan and
industrialized countries, and discuss future issues.
Working Women and Reproduction
Chemical exposure
Menstrual disorders: Menstrual disorders are one of the
symptoms most commonly reported. Menstrual cycle
parameters that are considered to be associated with labor
include the length and regularity of the cycle, the length
and volume of flow, dysmenorrhea and menstrual discomfort.
It has been reported that menstruation is affected by exposure
to chemicals and by occupation1). Occupational exposure
to synthetic hormones2, 3), organic solvents4) and carbon
Table 1. Effects of various factors on female reproduction
Indicators
Menstural disorders Menstrual cycle change
Dysmenorrhea
Infertility Prolonged time to pregnancy
Medically diagnosed infertility
Pregnancy outcome Abortion
Small size for gestational age
Climacterium Timing of climacterium
R KISHI et al.
disulfide5), and chemical exposure among hairdressers6) are
associated with menstrual cycle changes. Dysmenorrhea
occurs when increased prostaglandin production and release
by the endometrium during menstruation give rise to
increased abnormal uterine activity that produces ischemia
and cramping pelvic pain. It is sometimes followed by leg,
backache or digestive symptoms. Because diagnosis of
dysmenorrhea as a premenstrual syndrome requires making
an association with menstruation that has not yet occurred,
reports on its prevalence remain inconsistent7). Symptoms
relating to menstruation vary depending on age, the number
of childbirth deliveries, contraceptive devices and even
research methods. Relations between severe dysmenorrhea
and work in a reinforced plastic factory8), mercury9) and
toluene10) exposure have not been confirmed. It is well known
that dysmenorrhea is commonly found among hairdressers6).
Some studies reported the association between antineoplastic
agents/hairdressers and irregular menstrual cycle/irregular
menstrual bleeding11).
Infertility: Infertility indicators consist of the time to
pregnancy and fecundity ratio. Prolonged time to pregnancy
among working women exposed to mercury 12), nitrous
oxide13), formaldehyde14) and organic solvents4) has been
reported. Associations between the diagnosis of infertility
and exposure to organic solvents, dust, insecticides15), dyes
and metals16) have been reported.
Pregnancy outcome: Increased abortions in parents of
textile workers17), semiconductor workers exposed to ethylene
glycol18, 19) and workers exposed to organic solvents2022) have
been reported. The number of fetuses small for gestational
age was reported to increase among working women exposed
to organic solvents23) and hair dressers24).
Climacterium: Studies on the association between labor
and the climacteric period and symptoms are rarely found.
The climacteric period may possibly be associated with
smoking and carbon disulfide exposure25) (Table 1).
Factors with implied relations to indicators
Hormone substitute, organic solvents, carbon disulfide, hairdresser
Hairdresser
Mercury, nitrous oxide, formaldehyde, organic solvents
Organic solvents, dust, insecticide, dyes, metals
Fabrication worker, semiconductor worker, ethylene glycol, organic solvents
Organic solvents, hairdresser
Smoking, carbon disulfide
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REPRODUCTIVE, MUSCULOSKELETAL AND MENTAL DISORDERS AMONG WORKING WOMEN 103

Physical environment and work schedule
Menstrual disorders: An association between night work
and menstrual cycle disorders has been reported 26) .
Amenorrhea is recognized to be associated with those having
strenuous jobs like athletes27) and ballet dancers28). The
association between the length of the menstrual cycle and
occupations has never been discussed, but an association
with physical exercise and prolonged menstrual cycle among
college students was reported29). An irregular menstrual cycle
have been found among poultry slaughterers, which indicates
the association between irregular work schedules and low
temperature at work30). An association between serious
dysmenorrhea and shift work and irregular work in Japanese
hospitals has been reported as has an association between
low temperature/physical work and dysmenorrhea. Lower
temperature is related to greater prevalence of dysmenorrhea
and sick leave31).
Infertility: Women who do heavy physical work32) and
shift workers33) were reported to have prolonged time to
pregnancy. An association between a medical diagnosis of
infertility and exposure to dust, VDT work and noise has
been reported15).
Pregnancy outcome: The number of pre-term births was
reported to increase among women with long working hours,
long hours of working in a standing position, shift work
and job dissatisfaction34). The number of fetuses small for
gestational age was reported to increase among women
workers with heavy physical workloads35) and shift work36)
(Table 2).
Needs for further studies
Regarding the effects of labor on reproduction, more
studies have been conducted for women than for men. These
studies were mostly focused on pregnancy outcome.
However, because the rate of pregnant women is extremely
low, the small number of subjects was an obstacle to exposure
assessment. This obstacle has been overcome by targeting
women having a menstrual cycle, and indicators regarding
menstruation have been used in recent studies. Studies of
the influence on early pregnancy loss and the menstrual cycle,
using hormonal indicators and other biomarkers for exposure
assessment, will be useful in the future. Future studies should
also focus on further accumulation of exposure effects of
chemicals that have not yet been considered.
Most information on occupational stress concerns its
effects on men. That in women has been mostly obtained
from nurses, and further examination of its effects on women
in various occupations is needed.
Studies on differences in reactivity to stress in different
reproductive phases such as during pregnancy and the
climacterium, and after menopause, are also necessary. For
that purpose, a study using physiological indicators such as
hormone assessment is necessary.
In addition, the menstrual cycle, childcare and household
management should be included as burdens when the
assessment is done. Research combining shift work and
other working factors such as chemical exposure should also
be carried out (Table 3).
Work-related Musculoskeletal Disorders
(WMSDs) among Working Women
History of WMSDs among working women
Past studies and future problems of work-related
musculoskeletal disorders (WMSDs) among working
women, mainly upper limbs disorders (except those due to
local vibration) and occupational low back pain, are reviewed.
The history on WMSDs is old in Japan. Women with
low back pain often suffer from upper limb disorders caused
by their working style. Thus, these two conditions are

Table 2. Effects of physical environment and work style on female reproduction

Indicators Physical working environment factors and working style

with implied relations to indicator

Menstrual disorders Menstrual cycle changes
Amenorrhea
Dysmenorrhea
Metrorrhagia
Infertility Prolonged time to pregnancy
Medically diagnosed
Pregnancy outcome Pre-term birth
Small size for gestational age
Shift work, night work, irregular work schedules, poultry slaughterhouse (irregularity of
menstrual cycle), Exercise of college student (Prolonged menstrual cycle)
Athlete, ballet dancer
Shift work, irregular work schedules, physical work, cold temperature, psychological stress
Shift work , night work, irregular work schedules, cold temperature, psychological stress
Heavy physical work load, shift work
Dust, VDT, noise
Long working hours, long hours of working in a standing position, shift work, job dissatisfaction
Heavy physical workload, shift work
104 R KISHI et al.

Table 3. Research directions of reproductive health Table 4. List of the occupations for which WMSDs were reported at
Congress of Japan Society for Occupational Health since 1960s
I. Traditional research: (excepting occupations mainly composed of working men)
1. Mainly targeted on women
2. Pregnancy-outcome study Reported year Occupation
3. Exposure: chemical and physical agent
1960s keypunch operator
II. Recent research:
telephone operator
Fertility study (time to pregnancy)
typist
III. Future research:
1. Targeted on both women and men 1970s office worker (counting bills, turning over papers,
2. Exposure: Further accumulation of effects of chemical and duplicating by ball-point pen, writing)
physical exposure and/with psychosocial stress worker at the supermarket (checking, bagging)
3. Outcome: 1) Early pregnancy loss and menstrual cycle computer operator
characteristics worker operating a packing machine
2) During pregnancy line worker producing a stereo amplifiers
3) Climacterium, and after menopause film rolling worker
4. Use of hormonal and other biomarkers for exposure seamstress
assessment (related to reproduction and stress) line worker producing cigars
plywood-producing worker
ironing worker
nurse
nursery teacher
designated WMSDs in this review. Tenosynovitis,
worker at a home for handicapped children
paratendinitis and occupational cramps have been reported teacher of a class for the handicapped
among pianists, telegraphists, and stenographists in matron at nursing home
occupational health literature published since 1868. school lunch cook
Furthermore, research on tenosynovitis and joint 1980s flight attendant
inflammation among female peasants and blacksmiths was data-input worker
done even earlier37). After the mid-1950s, women entered VDT worker
the workforce more actively as mechanization and confectionery worker
technological innovation occurred and simple repetitive work sorting worker
shoemaker
increased.
barber, beautician
By the 1960s, many female workers suffered from worker growing fruit at orchard
WMSDs, especially occupational cervicoskeletal disorders. gold beating worker
Low back pain occurred often not only among men (forklift butcher
drivers, construction workers etc) but also women, for 1990s sign language interpreter
example, nursery school teachers, flight attendants, teachers clinical laboratory worker, pipetting worker
for handicapped children, etc. In Japan, surveys have been teacher for the handicapped
conducted about various occupations mainly composed of Nursing worker
working women. Table 4 shows a list of the occupations in home help worker
cash & carry wholesaler
which WMSDs were reported at the Congress of Japan
metal processing worker
Society for Occupational Health since the 1960s. packing worker in a canning factory

Gender differences in the incidence of WMSDs

It has been reported that the incidence of WMSDs is higher
among women than men 3840). Why is this? Does the
difference depend on gender by nature or is it acquired or
due to a difference of workloads between men and women?
We cannot find any studies in Japan that answer the question
clearly. Even in foreign studies, the factor of gender
difference in the incidence is not clear yet, but some studies
suggest that muscle fiber composition in the trapezius muscle
may be related to the gender difference41, 42). It has been
reported that the composition of type 1 fibers, related to
myofacial pain, in womens trapezius muscles is higher than
in men (Table 5).
Difference of causative factors between working women and
men
Important causative factors of WMSDs are physical,
mental, and social. We will discuss the possible gender

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REPRODUCTIVE, MUSCULOSKELETAL AND MENTAL DISORDERS AMONG WORKING WOMEN
Table 5. Morphological study explaining gender
difference of WMSDs incidence
Muscle biopsy from trapezius muscle
Relative frequency Female Male
Type I (fatigue resistant) 58% < 67%
Type IIA (fatigue resistant) 29% > 21%
Type IIB (fatigue sensitive) 8% > 2%
There were significant differences for all fiber types except
for type I fibers of the occipital, clavicular region and the
ascending portion. The difference in fiber size may be
important in the functional capacity of muscle and in the
development of neck-shoulder dysfunction.
(Lindman et al. 199141, 42))
difference, related studies, and future problems.
Physical aspect: Depending on anthropometrical
differences, that is, height, shoulder width, and lengths of
limbs and fingers, it is clear that the muscular load is different
even for same work43). Women will suffer from symptoms
if they use a work station designed for men. Physical strength
(grasping power, back power) is generally greater in men
than women. The Guidelines for prevention of occupational
low back pain (1994) states that the lifting power of women
is about 60% of that of men.
However, there are quite few studies both in Japan and
other countries, on how much the gender difference of
physical strength is related to the occurrence of WMSDs.
The number of working women will get increase in the near
future even in occupations mainly composed of men. Thus
there may be a high risk of WMSDs in work environment
that are not suitable for women. From the anthropometrical
and ergonomical viewpoints for working women, the
development of useful tools and assessment of reduction of
the physical work load are necessary.
Mental aspect: Patients with WMSDs often suffer from
not only muscular symptoms but also mental symptoms.
In Japanese studies on WMSDs, personal character and
psychological factors are often discussed and many
researchers have reported the results of CMI or YG tests at
the Congress of Japan Society for Occupational Health.
However, there are few Japanese studies showing that
personal character or psychological factor contribute and interpersonal relations. As for teachers, office workers,
clearly to WMSDs.
Some interesting studies have been reported by northern
European researchers. Some of them have reported that
mental load affects muscular blood flow or muscular
tension44) and that women may be more easily influenced
by mental load than men45). At the Symposium on Muscular
105
Disorders in Computer Users in Copenhagen (1999),
Lundberg emphasized that there were workers with
discomfort due to upper limb disorders even among those
using well-designed ergonomical work stations, and the
influence of psychological load on WMSDs should not be
neglected.
Women are considered to be more caring, more interested
in relationships, and to value communication with others
more highly than men40). Thus, the effect of psychological
load on the occurrence of WMSDs should be discussed more
for prevention of WMSDs among working women.
Social and familial aspects: Women have an important
role in household matters, nursing and caring even in recent
decades. Housework adds to be physical workload and
inhibits recovery from fatigue. Thus, the difference of the
social load contributes to the gender difference in the
incidence of WMSDs. In reports on WMSDs at the Congress
of Japan Society for Occupational Health, researchers pointed
out that they should consider the social and familial
characteristics of women for prevention of WMSDs. It is
difficult to find a casual relationship between work and
VMSDs among working women because housework is
sometimes a strong confounding factor in epidemiological
studies46).
Gender, Work and Mental Health
Japanese female workers stress and health disorders
Occupations in which high proportions of Japanese women
are employed include health services such as medical care,
nursing, care for the elderly and care of disabled persons.
The need for these services is expected to increase.
Traditionally, manufacturing and office work have employed
large numbers of women. Now, in the service and in
distribution industries, women are increasing. However, in
the areas of technology, management, transportation and
security, most employees are still men.
Sakai classified the mental stress factors of working
women by occupation47) (Fig. 1). Women predominate,
especially in the medical/health services area; for example,
nurses. There have many stress factors in addition to overtime
work and long time work, irregular work shift, time pressure,
sales persons, workers in manufacturing, services, and
agricultural and forestry industries, all of them suffered from
time-related stress such as overtime work, irregular work
shifts and time pressure.
The interesting thing is that interpersonal relation is a
serious factor of womens mental stress. It should also be
106 R KISHI et al.

Fig. 1. Mental stress factors of working women, classified by occupation

noted that many womens occupations also have work-related Table 6. Nurses and caregivers work conditions
ergonomic problems and sometimes environmental hazards, associated with their mental health

too, that were mentioned above. Focusing on physical Quantity of work

problems, a national survey in 1987 found that the complaint
rates of health disorders were 80% for men, and 88% for
women48). Women, especially complained about symptoms
such as back and shoulder pain, lumbago, eye strain, diarrhea,
constipation, stomachache, abdominal pain, failing eyesight,
headache and irregularity of menstruation.
It seems many of these complaints are caused by the nature
of womens occupations; for example, back and upper-limb
disorders caused by a job at a video display terminal (VDT)
workstation. It should be noted, however, that the prevalence
rates were higher for men than women49). Diseases for which
women had high prevalence rates were lumbago, work-
related back and upper-limb disorders, hyperthyroidism,
migraine, autonomic imbalance, irritable colon and so on.
First, these diseases reflect the workloads and work situations
of typical womens occupations. The survey reported that
stress syndromes such as migraine, autonomic imbalance
and irritable colon, were increasing among women.
Nurses occupational stress in Japan
Research on mental health of female workers in Japan
has focused on the occupational stress of nurses. Most of
studies found that stressors experienced in nursing are
associated with deteriorating mental health status. Stressors
include a quantitatively excessive workload, shift and night
work, interpersonal problems, poor physical environment,
low utilization of abilities, an insufficient educational system,
and difficulty in judgments at work. Table 6 lists work
long time of working (overwork), frequent overtime
work, heavy workload
Shift/night work
shift work, night work
Physical environment
unsuitable temperature and noise, exposure to toxic
chemicals, exposure to radiation
Job demands
difficult judgments in the job, perceived insufficiency
in giving care, need for proficiency at job
Low utilization of abilities
skill underutilization
Insufficient training system
having little opportunity to acquire new skills and
knowledge
Reward/social appraisal
low income, low social valuation, low work status
Interpersonal problems
conflict with supervisors, conflict with co-workers,
conflict with patients or their families
Others
a long commute
conditions that are associated with their mental health.
A study of 79 hospital nurses and 69 office workers with
less than three years of service, found that mental health
status was associated with the severity of the job (time of
working, a long commute and low income), social support
by colleagues and stress coping behavior49). There were no

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REPRODUCTIVE, MUSCULOSKELETAL AND MENTAL DISORDERS AMONG WORKING WOMEN
differences of mental health status between nurses and office
workers. A survey using data from 471 hospital nurses
revealed that the General Health Questionnaire (GHQ)-60
scores were associated with the working environment
(number of days off in the last month, difficult judgments
at work, being confronted with death of a patient), and
personal relationships in the hospital50). It also found
interactive effects of difficult judgment on the job scores
and personal relationships at workplace GHQ-60 scores.
In fair or good personal relationships, perceived difficulty
in judgment was not associated with GHQ scores. In contrast,
in poor personal relationships at work place, the association
is significant, suggesting that women reporting high difficulty
in judgment were more distressed than those with low
judgmental difficulty.
One of the most important issues in research on nurses
mental health is burnout, a syndrome particular to caregivers.
The relationship between stresses of person-helping
professionals and their burnout syndromes was
investigated51). The degree of burnout was measured by the
MBI (Maslach Burnout Inventory, Maslach & Jackson, 1981),
and three dimensions-emotional exhaustion,
depersonalization, reduced personal accomplishment-were
extracted. Their results showed that depersonalization was
related to conflict with a supervisor or co-worker, lack of
communication, insufficiency in giving care, and an
insufficient educational system, whereas emotional
exhaustion was related with insufficiency in giving care,
conflict with a supervisor, an insufficient educational system,
and an excessive workload. The association between work
conditions and burnout syndrome was shown using data from
231 female hospital nurses52). This study found that emotional
exhaustion was inversely related to years of working and
support from co-workers, and that the depersonalization score
was related to trouble with patients.
A few studies based on the job-strain model53) or job-stress
model (NOISH) revealed gender differences in job stress.
A survey found that there were gender differences in
perceived job stress of men and women, and that women
worked lower hours and had lower job control54). Women
are more adversely affected by low control and a poor
physical environment, while men are negatively affected
by a heavy quantitative workload.
Mental health research in Europe and the U.S.
Numerous researchers in the United Status have
investigated the effects of employment on womens
psychological well-being. Most of the research focused on
the impacts of womens family roles in explaining the effects
107
of employment, and found that some dimensions of family
demands such as the number of children and the responsibility
for housework were associated with the psychiatric symptoms
of employed women. However, these studies tended to
investigate the overall effects of paid work on womens well-
being, without taking into account job conditions experienced
by working women.
On the other hand, a number of studies based on Karaseks
job stress model 53) that examined the effects of work
conditions (job demands, job control, substantive complexity,
autonomy, etc.) on health have included only men, probably
because of the difficulty in obtaining appropriate data from
women who are often working in different types of jobs
from men. Recently, some studies in this area included data
from women in their analyses and investigated the effects
of work conditions on well-being of employed men and
women. Most of the studies revealed gender differences in
work conditions and the consequences of the conditions for
mental health.
The effects of four kinds of work conditions (job demands,
job deprivations and rewards, work environment, and work-
related social support) on the well-being of female and male
factory workers in similar jobs were examined55). The study
revealed that men worked longer hours, had slightly higher
substantive complexity and autonomy, slightly higher levels
of supervisor support, and were less distressed than women.
Among job demand measures, job strain increased distress
but working overtime did not. Those with more autonomy
were less distressed. The effects of job conditions on distress
did not significantly differ by gender. It was also indicated
that there was a negative impact of children on well-being
for women, suggesting that further research is needed to
investigate the relative impacts of work and non-work
influences on mental health and to study interactions between
them.
A study of 1,352 respondents in the United States found
gender differences in perceived substantive complexity as
women reported slightly less complexity in their jobs56). The
levels of substantive complexity that were reported by
employed men and women did not correlate with
psychological distress. In that analysis, gender and self-
esteem were the most important determinants of distress
and no direct effects of work conditions on distress were
evident, suggesting that the impact of work conditions on
distress is indirect and operates through self-esteem.
It was found that there was a significant gender difference
in perceived job control, with men reporting higher perceived
job control57). The study showed that women are more
vulnerable to job stress, as they were women are more
108
adversely affected by high job demands, high job
routinization and less adversely affected by hours of work
than men, in spite of the same levels of exposure to job
demands and job routinization. There was no gender
difference in the impact of complexity and hours of work.
It also indicated the three-way interaction of hours of work,
routinization, and gender. There was no significant difference
in the well-being of men and women in low-routinization
jobs, regardless of the hours of work. In contrast, there were
significant differences in the impact of high routinization,
as women in highly routine jobs who worked few or average
hours were significantly more distressed than men in similar
jobs. This means that women in highly routine jobs who
work part-time perceive high distress compared to men and
women in other jobs.
On the other hand, some studies based on the job-stress
model showed no gender difference in dimensions of job
appraisal and psychological well-being58).
Thus these studies reported contradictory findings about
gender differences in the process through which work
conditions have effects on well-being, but suggested
consistently that it is important to investigate the interactive
effects of work and family conditions on womens well-
being.
Studies on interaction between occupational stress and
family roles
Recent studies presented some evidence to suggest that
conditions at home and work interact. The hypothesis that
the degree of control at work moderates the effects of
demands in the family on womens well-being was tested59).
One study revealed that there was a significant interaction
between the number of children and job autonomy. With
high job autonomy, the number of children was not associated
with distress. On the other hand, in low-autonomy jobs the
association was significant, and women with two or more
children reported more distress than those with no children
and those with one child. However, responsibility for
housework did not interact with job conditions. In addition,
the finding that employed women had fewer symptoms of
distress than homemakers was consistent with previous
findings in this area.
The characteristics of daily work conditions and the
consequences of these work conditions for psychological
well-being of employed wives and full-time homemakers
were investigated and compared60). This study found that
full-time homemakers reported more autonomy, more
interruptions, greater physical effort, more routine, less time
pressure, and less responsibility for matters outside ones
R KISHI et al.
control than employed wives. Employed wives and
homemakers showed similar levels of depressive symptoms,
in spite of differences in their work conditions.
More recently, some longitudinal studies based on the
job stress model were carried out to investigate the causal
relationships between the characteristics of the work
environment and mental health among employed men and
women. For example, in the Whitehall II study, a cohort
study of 6895 men and 3413 women, it was reported that
high job demands predicted higher scores on the General
Health Questionnaire, which was used to measure psychiatric
disorders, at follow-up61). In the first phase of a cohort study
of 1,891 nurses, it showed that a combination of high job
demands and low decision latitude was associated with
psychological distress62).
Unfortunately, in these studies, work and family conditions
were not measured in detail. Further research should include
measures for characteristics of the work environment and
dimensions of family roles in the longitudinal design, in
order to understand the relationships of the conditions to
mental health.
Future Research Directions
Womens workload factors are classified into three types;
fundamental factors, direct factors and social problems (Fig.
2). The fundamental factors are biological matters. Women
are different from men in their maternal function, muscular
power, athletic ability and cardiopulmonary function.
The direct factors are as follows: An irregular work shift
may allow flexible time use; however, on the other hand, it
may be very difficult for women to work early in the morning.
As for ergonomic aspects, men also have the same problems.
However, when women go into a conventionally male-
dominated occupation, because the workplace is not designed
for women, not a few workloads will be imposed on them.
The situation is the same for the work environment, too.
There is a problem of mental health as well. Women feel
stress in interpersonal relations.
Household responsibility and role responsibility are
categorized as social problems. In Japan, women are still
silently required to devote themselves to household work.
This expectation sometimes causes stress due to role
responsibility in women. Both responsibilities are
substantially related.
The Japanese Diet decided to abolish the Womens
Protection Rule from the Labor Standards Law. From April
1999, women have been allowed to work overtime, on
holidays and late at night as men do. There has been serious
Industrial Health 2002, 40, 101112
REPRODUCTIVE, MUSCULOSKELETAL AND MENTAL DISORDERS AMONG WORKING WOMEN
Fig. 2. Structure of working womens workloads in Japan
Table 7. Research directions of female work
1. Research gender differences
2. Use of effective biological markers even in mental health study
3. Include burden of childcare and household management
4. Research on combined work and other factors
5. Research on quality of working life (QOWL) of female workers
6. Research on QOL of female workers families
concern about whether fatigue and work-related diseases
might therefore increase among women. The prevalence
rate for men remains relatively higher than that for women
at present. However, it is wondered if the complaint and
prevalence rates for women will continue to lower. There
is also fear that physically weak persons or those with health
problems may drop out. Even though the abolition certainly
has the merit of giving greater job opportunities to women
and helping to promote a gender equal society in the 21st
century, such concerns have not disappeared.
Finally future research directions of working women are
pointed out in Table 7. Further accumulation of effects of
chemical, physical exposure and psychological stress
including changes of working style is needed. In addition
to Table 3, where research directions of reproductive health
were listed comparing with traditional research, six points
would be added. More occupational health research should
be focused on gender difference. Using sensitive biological
markers such as immunological, biochemical or molecular
parameters detecting new health effects even in the study
of mental disorder is recommended. Parameters on the
burden of childcare and household managements in the job
stress models should be included to further study the
109
interaction between occupational stress and family roles.
Not only direct job-related work stress but also other factors
such as long commute, shortage of welfare facilities, working
culture, and work organization should be researched. Finally
more studies on both quality of working life of working
women and their families are needed, because they are
associated with each other.
Acknowledgements
We thank Ms. Hisae Sato for her assistance in editing the
manuscript.
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