At-risk and intervention thresholds of occupational stress using a visual analogue scaleReportar como inadecuado

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The visual analogue scale VAS is widely used in clinical practice by occupational physicians to assess perceived stress in workers. However, a single cut-off black-or-white decision inadequately discriminates between workers with and without stress. We explored an innovative statistical approach to distinguish an at-risk population among stressed workers, and to establish a threshold over which an action is urgently required, via the use of two cut-offs.


Participants were recruited during annual work medical examinations by a random sample of workers from five occupational health centres. We previously proposed a single cut-off of VAS stress in comparison with the Perceived Stress Scale PSS14. Similar methodology was used in the current study, along with a gray zone approach. The lower limit of the gray zone supports sensitivity -at-risk- threshold; interpreted as requiring closer surveillance and the upper limit supports specificity i.e. -intervention- threshold–emergency action required.


We included 500 workers 49.6% males, aged 40±11 years, with a PSS14 score of 3.8±1.4 and a VAS score of 4.0±2.4. Using a receiver operating characteristic curve and the PSS cut-off score of 7.2, the optimal VAS threshold was 6.8 sensitivity = 0.89, specificity = 0.87. The lower and upper thresholds of the gray zone were 5 and 8.2, respectively.


We identified two clinically relevant cut-offs on the VAS of stress: a first cut-off of 5.0 for an at-risk population, and a second cut-off of 8.2 over which an action is urgently required. Future investigations into the relationships between this upper threshold and deleterious events are required.

Autor: Frédéric Dutheil , Bruno Pereira, Farès Moustafa, Geraldine Naughton, François-Xavier Lesage, Céline Lambert



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