title: Psychosocial working conditions and the utilization of health care services.
abstract: BACKGROUND
  While there is considerable theoretical and empirical evidence on how job stress affects physical and mental health, few studies have examined the association between job related stress and health care utilization. Using data from the Canadian National Population Health Survey from 2000 to 2008, this paper examines the association between stressful working conditions, as measured by the job strain model, and the utilization of health care services.
  
  
  METHODS
  A zero inflated negative binomial regression is used to examine the excess health care utilization due to job strain. Separate regressions are estimated for both males and females since studies have shown gender differences in health care utilization.
  
  
  RESULTS
  Estimates for the whole population show that high or medium job strain has a positive and statistically significant association with the number of visits to both a general practitioner (GP) and a specialist (SP). On average, the number of GP visits is up to 26% more (IRR = 1.26, 95% CI = 1.19-1.31) for individuals with high strain jobs compared to those in the low job strain category. Similarly, SP visits are up to 27% more (IRR = 1.27, 95% CI = 1.14-142) for the high strain category. Results are quantitatively similar for males and females, save for medium strain. In general, findings are robust to the inclusion of workplace social support, health status, provincial and occupational-fixed effects.
  
  
  CONCLUSIONS
  Job strain may be positively associated with the utilization of health care services. This suggests that improving psychosocial working conditions and educating workers on stress-coping mechanisms could be beneficial for the physical and mental health of workers.
authors.affiliation: Department of Economics, Concordia University, 1455 de Maisonneuve Blvd, West, Montréal, Quebec, H3G 1M8, Canada. s_azagba@live.concordia.ca
authors.forename: Sunday
authors.initials: S
authors.lastname: Azagba
authors.forename: Mesbah F
authors.initials: MF
authors.lastname: Sharaf
mesh_terms: D000328:Adult; D002170:Canada; D004651:Employment / Q000523:psychology*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D012044:Regression Analysis; D013315:Stress, Psychological / Q000628:therapy