The impact of allergic rhinitis on the management of asthma in a working population.

BACKGROUND: Currently, little data is available about the management of asthma in the working population. The aim of this study was to describe asthma control and severity among workers according to current or previous allergic rhinitis comorbidity. METHODS: A network of occupational physicians participated in this pilot study on a voluntary basis. They included a random sample of salaried workers during their systematic occupational medical check-up. All subjects completed a self-administered questionnaire based on the European Community Respiratory Health Survey screening questionnaire, and if they reported any respiratory symptoms including allergic rhinitis, the physician filled in a medical questionnaire. Current asthma control and severity were evaluated according to 2006 Global Initiative for Asthma guidelines. RESULTS: A total of 110 occupational physicians from two French regions participated. Out of the 6906 employees screened, 3102 identified respiratory symptoms and completed the medical questionnaire and performed spirometry. Overall, 374 were identified as current asthmatics, including 271 (72.5%) with allergic rhinitis. Among current asthmatics with current allergic rhinitis (n = 95), 68.8% had partially controlled asthma or uncontrolled asthma, including 51.6% who received insufficient anti-asthmatic treatment. Partly or no control asthma was not associated with current rhinitis (OR = 1.4; 95% CI: 0.8-2.7). Current asthmatics with current or previous allergic rhinitis had a significantly lower risk of emergency department visits than current asthmatics without allergic rhinitis (respectively 11.6, 17.1 and 29.1%; P = 0.002). CONCLUSIONS: Most current asthmatics both with and without allergic rhinitis had uncontrolled asthma, with inappropriate treatment. Future intervention strategies need to be developed for effective control and prevention of asthma in the workplace.

EV@LUTIL: An open access database on occupational exposures to asbestos and man-made mineral fibres.

OBJECTIVES: The aim of Evalutil is to document occupational exposure to asbestos and man-made mineral fibers. METHODS: These databases provide grouped descriptive and metrological data from observed situations of occupational exposure, collected through the analysis of scientific articles and technical reports by industrial hygienists. RESULTS: Over 5,000 measurements were collected. We describe the occupations, economic activities, fiber-containing products, and operations on them that have been documented most often. Graphical measurement syntheses of these data show that the situations presented for asbestos and RCF, except mineral wools, report fiber concentrations mainly above historical occupational exposure limits. CONCLUSION: Free access to these data in French and in English on the Internet (https://ssl2.isped.u-bordeaux2.fr/eva_003/) helps public health and prevention professionals to identify and characterize occupational exposures to fibers. Extended recently to nanoscale particles, Evalutil continues to contribute to the improvement of knowledge about exposure to inhaled particles and the health risks associated with them.

French firefighter mortality: analysis over a 30-year period.

OBJECTIVE: To explore mortality of French professional male firefighters. METHODS: Standardized mortality ratios (SMR) were calculated for 10,829 professional male firefighters employed in 1979 and compared with the French male population between 1979-2008. Firefighters were identified from 89 French administrative departments (93% of population). RESULTS: One thousand six hundred forty two deaths were identified, representing significantly lower all-cause mortality than in the general population (SMR = 0.81; 95%CI: 0.77-0.85). SMR increased with age and was not different from 1 for firefighters >70 years. No significant excess of mortality was observed for any specific cause, but a greater number of deaths than expected were found for various digestive neoplasms (rectum/anus, pancreas, buccal-pharynx, stomach, liver, and larynx). CONCLUSION: We observed lower all and leading-cause mortality likely due to the healthy worker effect in this cohort, with diseases of the respiratory system considerably lower (SMR = 0.57). Non-significant excesses for digestive neoplasms are notable, but should not be over-interpreted at this stage.

An extensive epidemiological investigation of a kidney cancer cluster in a chemical plant: what have we learned?

OBJECTIVES: In 2003, a cluster of renal cell carcinoma (RCC) cases was reported among men working at a French chemical plant using a proprietary process to produce vitamin A. The 10 index cases yielded a standardised incidence ratio of 13.1 for 1994-2002. Nine of these 10 cases were diagnosed by a plant-specific abdominal ultrasonography screening programme that targeted exposure to an intermediate chemical, 4-chloro-1,1-dimethoxy-3-methyl-2-butene, commonly named 'chloracetal C5', suspected as the cause by some experts. Epidemiological investigations sought to examine the relations between occupational exposures and RCC. METHODS: A retrospective cohort mortality study and a nested case--control study were conducted. The cohort study included all workers who had been employed at the plant for at least 6 months between 1960 and 2003. The case--control study included an extensive search within the region for other kidney cancer cases among the cohort members. Industrial hygienists assessed occupational exposure. RESULTS: From 1968 to 2006, no significant excess mortality was observed for all causes of death or for all cancers. We found excess mortality for kidney cancer only among women. The nested case--control study showed a dose--response relation for cumulative exposure to chloracetal C5: the OR rose from 2.5 in the low-exposure category to 10.5 in the high-exposure group. Adjustment for screening attenuated this relation. CONCLUSIONS: The results of the case--control study were consistent with the positive results of in vivo genotoxic tests and suggest that chloracetal C5 can have a causal role in RCC.

Pleural mesothelioma and occupational coexposure to asbestos, mineral wool, and silica.

RATIONALE: Occupational coexposure to asbestos and other fibers or particles could modify the carcinogenicity of asbestos with regard to pleural mesothelioma. OBJECTIVES: To estimate associations between pleural mesothelioma and occupational mineral wool and silica exposure and to study the impact of occupational coexposure on the risk of pleural mesothelioma. METHODS: A total of 1,199 male cases and 2,379 control subjects were included in a French pooled case-control study. Complete job histories were collected, and occupational exposure to asbestos, mineral wool (MW), and silica were assessed by three French job exposure matrices. Unconditional logistic regression models adjusted for age, birth date, and occupational asbestos exposure were used to estimate odds ratios (OR) and 95% confidence intervals (CIs). MEASUREMENTS AND MAIN RESULTS: A significant association between mesothelioma and MW exposure was observed after adjustment for occupational asbestos exposure. OR for subjects exposed to less than 0.01 fibers·ml(-1)·yr(-1) was 1.6 (95% CI, 1.2-2.1) and increased to 2.5 (95% CI, 1.8-3.4) for subjects exposed to more than 0.32 fibers·ml(-1)·yr(-1). All ORs for silica exposure were around the null. Coexposure to either asbestos and MW or asbestos and silica seemed to increase the risk of pleural mesothelioma. ORs were 17.6 (95% CI, 11.8-26.2) and 9.8 (95% CI, 4.2-23.2) for subjects exposed to both asbestos and MW and for subjects exposed to both asbestos and silica, respectively, compared with 4.3 (95% CI, 1.9-9.8) for occupational asbestos exposure alone. CONCLUSIONS: Our results are in favor of an increased risk of pleural mesothelioma for subjects exposed to both asbestos and MW or asbestos and silica.

Psychotropic drug use in a cohort of workers 4 years after an industrial disaster in France.

Two years after the 2001 Toulouse industrial disaster, a longitudinal study was set up to evaluate the impact of the disaster. The current substudy examines the medium-term impact (5 years) the incident had on the mental health of 3,004 participants. As part of the monitoring, data relating to the psychotropic drug use of 2,494 participants were collected from administrative databases 4 years after the disaster. Use of psychotropics was higher among women for anxiolytics (10.4% for men and 15.0% for women), hypnotics (10.5% and 17.0%), and antidepressants (7.6% and 11.2%). Exposure to the disaster, especially proximity to the exposure, was significantly associated with the use of antidepressants in men, OR = 3.22, 95% CI[1.57, 6.61]. This was also the case for other exposure factors (saw dead or injury, injured, home damage, death or injury loved one, psychological disorders, exposure toxic fumes): range of OR 1.75 to 2.52 in men, 1.48 to 1.62 in women. In conclusion, this study highlights the medium-term psychological impact of an industrial disaster on psychotropic drug use and the potential for using medical records data as a means for tracking postdisaster mental health.

[Difficulties of a longitudinal epidemiological follow-up study in French occupational medicine]. / Les difficultés d'un suivi epidémiologique longitudinal dans les services de santé au travail.

INTRODUCTION: This study was designed to describe the difficulties of epidemiological follow-up of employees by occupational health services. METHODS: This study was based on two transverse studies conducted by the Pays de la Loire musculoskeletal disorders (MSD) surveillance network. Eighty-three occupational health physicians included 3,710 employees between 2002 and 2005 and had to review them between 2007 and 2009. Thirteen of these physicians changed jobs and 7 changed geographical sector in the same occupational health service. RESULTS: Another 94 physicians were contacted and 85 agreed to participate in the network. The follow-up rate was 43%: 1,044 employees were reviewed by the physician who saw them on inclusion and 567 employees were reviewed by another physician of the network. The other employees were distributed as follows: 25% were lost to follow-up and their occupational status remained unknown; 23% were still employed with an identified occupational health physician but had not attended a medical visit during the follow-up study; 5% had left the occupational health surveillance system. Only 23 employees refused to participate in the follow-up and 105 employees had a physician who refused to participate. DISCUSSION: There is therefore a considerable mobility of occupational health physicians, which interfered with follow-up despite their good mobilization and a high percentage of employee are lost to follow-up after having left their jobs. More appropriate systems must be set up to follow populations of employees, such as new collaborations with general practitioners.

Employment and occupational outcomes of workers with musculoskeletal pain in a French region.

OBJECTIVES: To study the employment and occupational outcomes of workers who were diagnosed with upper limb musculoskeletal disorders (UL-MSDs) or had complained of upper limb musculoskeletal pain a few years before compared with workers who had no upper limb pain. METHODS: In 2002-2005, an epidemiological surveillance system was set up. Occupational physicians examined 3710 randomly selected workers. It focused on six UL-MSDs: rotator cuff syndrome, lateral epicondylitis, flexor-extensor peritendinitis of the hands and fingers, de Quervain's disease, carpal tunnel syndrome and ulnar tunnel syndrome. Three groups were constituted: a 'UL-MSD' group (workers with a clinically diagnosed UL-MSD at baseline, 13% of the cohort); a 'PAIN' group (workers with pain in the previous 7 days at baseline and without any clinically diagnosed form, 38%); and a 'HEALTHY' group (workers with no disorder or upper limb pain in the previous 7 days, 49%). They completed a questionnaire between 2007 and 2009. RESULTS: A total of 2332 responded. Fewer subjects were still in work in the 'UL-MSD' group (79.3%) than in the 'PAIN' (85.9%) and 'HEALTHY' (90.4%) groups, the difference remaining significant after adjusting for gender, age, occupational category, type of company and comorbidities. Of the subjects still in work, 24% had changed their work station in the same company in the 'PAIN' group compared with 19% in the 'HEALTHY' group and 21% in the 'UL-MSD' group. CONCLUSIONS: This study showed the impact of musculoskeletal pain on employment outcome and the difficulty of keeping workers with musculoskeletal problems at work.

Characterization of a French series of female cases of mesothelioma.

BACKGROUND: More than 80% of mesothelioma cases in men are attributable to occupational asbestos exposure compared to only 40% in women. The objective of the study was to characterize a series of female pleural mesotheliomas according to known and suspected risk factors. METHODS: From the exhaustive recording of 318 female mesothelioma cases in the French National Mesothelioma Surveillance Program between 1998 and 2009, multiple correspondence analysis and hybrid clustering were performed to characterize these cases according to expert assessed occupational and non-occupational exposure to asbestos and man-made vitreous fibers, X-ray exposure, and history of cancer and non-malignant respiratory diseases. RESULTS: Four clusters were identified: (1) occupational exposure to asbestos and man-made vitreous fibers (7.9% of subjects); (2) radiation exposure during radiotherapy (12.9%); (3) increased asbestos exposure (19.8%); and (4) "non-exposure" characteristics (59.4%). CONCLUSION: These results will allow hypotheses to be generated about associations between mesothelioma and non-occupational asbestos exposure, X-ray exposure and history of respiratory disease.

Compensation of pleural mesothelioma in France: data from the French National Mesothelioma Surveillance Programme.

BACKGROUND: The aim of this study was to determine the rates of compensation awarded to patients presenting with pleural mesothelioma and factors linked to such compensation in France. METHODS: The study population consisted of 2,407 patients presenting with pleural mesothelioma, recorded by the National Mesothelioma Surveillance Programme between January 1, 1999 and December 31, 2009. Analysis of claims for recognition as "occupational disease" (OD) and claims for compensation by the Compensation Fund for Asbestos Victims (FIVA) were analyzed. RESULTS: Approximately 30% of subjects presenting with pleural mesothelioma, affiliated to the General National Health Insurance fund, neither sought recognition as an OD nor claimed for FIVA compensation. Gender, age at diagnosis, type of health insurance, and socio-professional category influence the likelihood of patients presenting with mesothelioma seeking compensation for this disease. CONCLUSIONS: Results show an under-compensation of pleural mesothelioma as OD and by the FIVA in France.

Temporal patterns of occupational asbestos exposure and risk of pleural mesothelioma.

Asbestos is the primary cause of pleural mesothelioma (PM). The objective of this study was to elucidate the importance of different temporal patterns of occupational asbestos exposure on the risk of PM using case-control data in male subjects. Cases were selected from a French case-control study conducted in 1987-1993 and the French National Mesothelioma Surveillance Program in 1998-2006. Population controls were frequency matched to cases by year of birth. Occupational asbestos exposure was evaluated with a job-exposure matrix. The dose-response relationships were estimated using restricted cubic spline functions in logistic regression models. A total of 2,466 ever-asbestos-exposed males (1,041 cases and 1,425 controls) were used. After adjustment for intensity and total duration of occupational asbestos exposure, the risk of PM was lower for subjects first exposed after the age of 20 yrs and continued to increase until 30 yrs after cessation of exposure. The effect of total duration of exposure decreased when age at first exposure and time since last exposure increased. These results, based on a large population-based case-control study, underline the need to take into account the temporal pattern of exposure on risk assessment.

Heavy manual work, exposure to vibration and Dupuytren's disease? Results of a surveillance program for musculoskeletal disorders.

INTRODUCTION: This study aimed to determine the prevalence of Dupuytren's disease in men and its relationship with work exposure, particularly heavy manual work with and without significant use of vibrating tools, using data from a surveillance program for musculoskeletal disorders. METHOD: This cross-sectional study was conducted in France between 2002 and 2005. Dupuytren's disease was diagnosed clinically by one of 83 occupational physicians. Exposure in relation to work status and occupational risk factors was assessed with a self-administered questionnaire, and categorised according to vibration exposure (defined as use of vibrating tools for ≥2 h/day), heavy manual work without vibration exposure (defined as use of hand tools for ≥2 h/day (use of vibrating tools for ≥2 h/day excluded) and Borg scale ≥15/20) and no such exposure. Bivariate and multivariate associations using logistic models were recorded in men and in those with >10 years in the same job. RESULTS: Of 2161 men, 1.3% (n=27) had Dupuytren's disease (mean age 47.1±6.7 years). Heavy manual work without vibration exposure was significantly associated with the condition (adjusted OR (aOR) 3.9; 95% CI 1.3 to 11.5) adjusted on age and diabetes), as was use of vibrating tools (aOR 5.1; 2.1 to 12.2). These associations remained significant among subjects with >10 years in the same job, with increases in aOR of 6.1 (1.5 to 25.0) and 10.7 (3.4 to 34.6), respectively. CONCLUSION: Despite the limited number of cases, occupational exposure, including both vibration exposure and heavy manual work without significant vibration exposure, was associated with Dupuytren's disease.

Comparison of risk factors for shoulder pain and rotator cuff syndrome in the working population.

BACKGROUND: To compare risk factors for shoulder pain without and with rotator cuff syndrome (RCS). METHODS: A total of 3,710 workers of a French region were randomly included in the cross-sectional study between 2002 and 2005. Personal and occupational risk factors were assessed during a physical examination and by a self-administered questionnaire. Multinomial logistic modeling was used for the following outcomes: no shoulder pain and no RCS (reference), shoulder pain without RCS (called "shoulder pain") and RCS, separately for men and women. RESULTS: The prevalence rates of "shoulder pain" for men and women were 28.0% and 31.1%, respectively, and the prevalence rates of RCS were 6.6% and 8.5%, respectively. In men, "shoulder pain" and RCS were associated with age, high-perceived physical exertion, and arm abduction. Automatic work pace and low supervisor support were associated with "shoulder pain," and high psychological demand and low skill discretion with RCS. In women, "shoulder pain" and RCS were associated with age, repetitiveness of tasks, and low supervisor support. High perceived physical exertion and exposure to cold temperatures were associated with "shoulder pain." CONCLUSIONS: Age was more strongly associated with RCS than with shoulder pain without RCS for both genders. Biomechanical and psychosocial factors were associated with "shoulder pain" and RCS and differed between genders.

Prediction model of Parkinson's disease based on antiparkinsonian drug claims.

Drug claims databases are increasingly available and provide opportunities to investigate epidemiologic questions. The authors used computerized drug claims databases from a social security system in 5 French districts to predict the probability that a person had Parkinson's disease (PD) based on patterns of antiparkinsonian drug (APD) use. Clinical information for a population-based sample of persons using APDs in 2007 was collected. The authors built a prediction model using demographic variables and APDs as predictors and investigated the additional predictive benefit of including information on dose and regularity of use. Among 1,114 APD users, 320 (29%) had PD and 794 (71%) had another diagnosis as determined by study neurologists. A logistic model including information on cumulative APD dose and regularity of use showed good performance (c statistic = 0.953, sensitivity = 92.5%, specificity = 86.4%). Predicted PD prevalence (among persons aged ≥18 years) was 6.66/1,000; correcting this estimate using sensitivity/specificity led to a similar figure (6.04/1,000). These data demonstrate that drug claims databases can be used to estimate the probability that a person is being treated for PD and that information on APD dose and regularity of use improves models' performances. Similar approaches could be developed for other conditions.

The relation between type of farming and prevalence of Parkinson's disease among agricultural workers in five French districts.

Retrospective assessment of pesticide exposure is complex; however, patterns of pesticide use strongly depend on farming type, which is easier to assess than pesticide exposure. Our aim was to estimate Parkinson's disease (PD) prevalence in five French districts in 2007 among affiliates of Mutualité Sociale Agricole (MSA) and to investigate the relation between PD prevalence and farming type. We identified PD cases from administrative files as persons who used levodopa and/or benefited from free health care for PD. Densities of 16 farming types were defined at the canton of residence level (1988 French agricultural census). We used logistic regression to study the relation between PD prevalence and density of farming types and a semi-Bayes approach to deal with correlated exposures. We identified 1,659 PD cases, yielding an age- and sex-standardized PD prevalence of 3.01/1,000. Prevalence increased with age and was higher in men than women. We found a higher PD prevalence among affiliates living in cantons characterized by a higher density of farms specialized in fruits and permanent crops (multivariable semi-Bayes model: OR(4+5 vs 1+2+3 quintiles) = 1.21, 95% CI = 1.08-1.36; test for trend, P = 0.035). In France, farms specialized in fruits and permanent crops rank first in terms of insecticide use per hectare. Our findings are consistent with studies reporting an association between PD and insecticide use and show that workers in farms specialized in fruits or permanent crops may be an occupational group at higher PD risk.

Matgéné: a program to develop job-exposure matrices in the general population in France.

OBJECTIVES: Matgéné is a program to develop job-exposure matrices (JEMs) adapted to the general population in France for the period since 1950. The aim is to create retrospective exposure assessment tools for estimating the prevalence of occupational exposure to various agents that can then be correlated to health-related parameters. METHODS: JEMs were drawn up by a team of six industrial hygienists who based their assessments on available occupational measurement, economic and statistical data, and several thousand job descriptions from epidemiological studies performed in France since 1984. Each JEM is specific to one agent, assessing exposure for a set of homogeneous combinations (occupation × activity × period) according to two occupational classifications (ISCO 1968 and PCS 1994) and one economic activities classification (NAF 2000). The cells of the JEM carry an estimate of the probability and level of exposure. Level is estimated by the duration and intensity of exposure-linked tasks or by description of the tasks when exposure measurement data are lacking for the agent in question. The JEMs were applied to a representative sample of the French population in 2007, and prevalence for each exposure was estimated in various population groups. All documents and data are available on a dedicated website. RESULTS: By the end of 2010, 18 JEMs have been developed and eight are under development, concerning a variety of chemical agents: organic and mineral dust, mineral fibers, and solvents. By implementation in the French population, exposure prevalences were calculated at different dates and for complete careers, and attributable risk fractions were estimated for certain pathologies. Some of these results were validated by comparison with those of other programs. DISCUSSION: Initial Matgéné JEMs results are in agreement with the French and international literature, thus validating the methodology. Exposure estimates precision, however, vary between agents and according to the amount of exposure measurement data available. These JEMs are important epidemiological tools, and improving their quality will require investment in occupational health data harvesting, especially in the case of low-level exposures.

Breast cancer risk by occupation and industry: analysis of the CECILE study, a population-based case-control study in France.

BACKGROUND: It has been suggested that certain occupational exposures may play a role in breast cancer etiology. The recognition of high-risk occupations may give clues about potential mammary carcinogens in the work place. METHODS: We conducted a population-based case-control study in France including 1,230 breast cancer cases and 1,315 population controls with detailed information on lifetime work history. Odds ratios for women ever employed in an occupation or industry were adjusted for well-established risk factors for breast cancer. RESULTS: Adjusted odds ratios were marginally increased in some white-collar occupations, as well as in textile workers (2.4; 95% CI [0.9-6.0]), rubber and plastics product makers (1.8; 95% CI [0.9-3.5]), and in women employed for more than 10 years as nurses (1.4; 95% CI [0.9-2.1]) and as tailors/dressmakers (1.5; 95% CI [0.9-2.6]). The incidence of breast cancer was increased among women employed in the manufacture of chemicals, of non-metallic mineral products, and decreased among women in agriculture. CONCLUSIONS: These findings suggest a possible role of occupational exposures in breast cancer, including night-shift work, solvents and endocrine disrupting chemicals and require further studies with detailed assessment of occupational exposures.

Attributable risk in men in two French case-control studies on mesothelioma and asbestos.

Pleural mesothelioma is a primary tumor of the pleura that is mainly due to asbestos exposure. To study the relationship between mesothelioma and occupational asbestos exposure in France, two case-control studies (A and B) were conducted. A substantial difference in the attributable risk in the population (AR(p)) was observed among men: 44.5% (95% CI: [32.6-56.4]) in study A and 83.2% (95% CI: [76.8-89.6]) in study B. As different exposure assessment expert methods were used, the main objective of this work was to re-estimate the AR(p) men in two case-control studies according to a common standardized exposure assessment by using a Job Exposure Matrix (JEM) and to assess the role of subjects' selection. The initial observed AR(p) difference was maintained: 36.3% (95% CI: [24.3-50.3]) in study A and 69.7% (95% CI: [51.7-83.2]) in study B. Further investigations highlighted the potential selection bias introduced in both studies, especially among controls. The AR(p) could be underestimated in study A and overestimated in study B. After weighting subjects according to distribution of socio-economic status in the general population for controls and according to distribution of socio-economic status of cases registered by the French National Mesothelioma Surveillance Program, re-estimated AR(p) values were 52.4% in study A and 70.2% in study B. These results provide additional information to describe the relationship between pleural mesothelioma and occupational asbestos exposure, but also confirm the importance of subjects' recruitment in case control studies, particularly control selection.

Possible effect of environmental exposure to asbestos on geographical variation in mesothelioma rates.

BACKGROUND: In population-based mesothelioma studies in industrialised countries, the incidence of mesothelioma without any identified asbestos exposure (IAE) is usually higher among women, while male incidence is mainly attributed to IAE. Through a comparison of the spatial distribution of male and female rates, and IAE and no IAE incidence, this study investigated whether mesotheliomas without IAE are in fact induced by non-recognised asbestos exposure, mostly from environmental sources. METHODS: We calculated mesothelioma mortality (SMR) and incidence (SIR) ratios by district in France, pooling 30 and 10 years of data, respectively. Using correlation coefficients, we compared geographical patterns of male and female mesothelioma ratios, and IAE and no IAE mesothelioma ratios. RESULTS: The raw numbers of male and female mesothelioma cases were equivalent. Mesothelioma SMR (0.76) and SIR (0.80) geographical correlations between men and women were strongly positive. SIR correlation between occupationally IAE and no IAE cases was also positive (0.69). Correlation between occupationally IAE and no IAE cases was positive among women but not among men. CONCLUSIONS: Data analyses of mesothelioma mortality and incidence showed that female cases occur in the same geographical areas as male cases. Female mesotheliomas with no IAE occur in the same geographical areas as exposed cases, suggesting asbestos has a major influence on female mesothelioma, likely through environmental exposure.

Working conditions and depressive symptoms in the 2003 decennial health survey: the role of the occupational category.

INTRODUCTION: The aim of this study is to describe the associations between depressive symptoms and some working conditions according to broad occupational categories in France. METHODS: These data came from the decennial health survey conducted in 2003 in France by the National Institute for Statistics and Economics Studies (6,082 men, 5,521 women). The data collected included: depressive symptoms (Center for Epidemiological Studies-Depression Scale), psychosocial factors at work and potential confounding factors. RESULTS: Associations between psychosocial work factors and depressive symptoms varied, according to occupational category and sex. Time pressure was significantly associated with depressive symptoms in the less advantaged occupational categories. The lack of job control was associated with depressive symptoms only in managers and associate professionals and technicians. Only low social support was systematically associated with depressive symptoms, regardless of occupational category. CONCLUSION: These results should be taken into account to adapt strategies of mental health disorders prevention at work, for a better efficacy.