Psychological Medicine, 1999, 29, 1411–1416. Printed in the United Kingdom  1999 Cambridge University Press Job strain and psychiatric morbidity M. CROPLEY, A. STEPTOE  K. JOEKES From the Department of Psychology, St George’s Hospital Medical School, University of London ABSTRACT Background. This study examined the association between job strain and psychiatric morbidity using interview-based assessments of mental health. We assessed the prevalence of neurotic disorder in high job strain (high demand, low control) and low job strain (low demand, high control) school teachers, and compared these rates with data from individuals with similar educational qualifications from the National Psychiatric Morbidity Survey of Great Britain Methods. One hundred and sixty primary and secondary school teachers were selected from a larger survey on the basis of high or low job strain, and were assessed for psychiatric morbidity using the Revised Clinical Interview Schedule (CIS-R). The prevalence of neurotic symptoms and a total psychiatric morbidity score were calculated. Results. After adjusting for age, gender and occupational grade, the prevalence of psychiatric morbidity was greater in high job strain than low job strain individuals. The prevalence of severe anxiety, worry and fatigue symptoms was significantly greater in the high job strain teachers. In comparison with the British psychiatric morbidity survey, the prevalence of neurotic disorders was greater in the high job strain, but not in low job strain teachers. Individuals in the low job strain group were more likely to report severe anxiety, irritability and fatigue in the week prior to interview, than comparably educated individuals in the national survey. Conclusion. Job strain is associated with psychiatric morbidity. The high levels of neurotic psychopathology among teachers is consistent with previous research that has found teaching to be a highly stressful occupation. INTRODUCTION It has long been recognized that work can influence mental well-being (Karasek & Theorell, 1990). Depression, anxiety and psychological distress have been shown to be elevated in individuals working in high strain (high demandlow control) jobs, compared with indi- viduals working in low strain (low demandhigh control) jobs (Lerner et al. 1994 ; Bourbonnais et al. 1996; Wall et al. 1996). In the Whitehall II cohort of British civil servants, elevated scores on the General Health Questionnaire were associated cross-sectionally with high job demands and low control (Stansfeld et al. 1995), and prospectively with high job demands (Stansfeld et al. 1997). One limitation of these  Address for correspondence : Dr Mark Cropley, Department of Psychology, University of Surrey, Guildford, Surrey GU2 5XH. studies is that psychiatric morbidity has been assessed by self-administered questionnaires. The problems associated with the use of these type of measures of assessing neurotic psy- chopathology are well documented. Rating scales cannot be used for diagnostic purposes and they typically provide only general in- formation about mental well-being. Interview methods have obvious advantages over ques- tionnaire measures (Barker et al. 1995) and are the preferred form of assessment for psychiatric disorder (Gelder et al. 1999). The present study has two aims. The first was to examine the association between work charac- teristics and psychiatric morbidity using an interview-based assessment. The prevalence of neurotic psychopathology was compared in individuals reporting high and low job strain. It was predicted that the prevalence of psychiatric morbidity would be greater in high job strain 1411