Gender inequalities of psychosomatic complaints at work vary by occupational groups of white- and blue-collar and level of skill: A cross sectional study

Julia Grasshoff; Batoul Safieddine; Stefanie Sperlich; Johannes Beller

doi:10.1371/journal.pone.0303811

Peer Review History

Original SubmissionDecember 27, 2023
9 Feb 2024 Decision Letter - Rocco Franco, Editor PONE-D-23-38613Gender differences of psychosomatic complaints at work vary by occupational groups of white- and blue-collar and level of skill: A cross sectional studyPLOS ONE Dear Dr. Grasshoff, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Mar 25 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear Authors, The paper is very interesting and highlights gender inequalities that can be avoided. Technically the paper is simple and at the same time correct. The authors are aware of the limitations of this type of study and have controlled for them. I would like to make a few comments. When you do a sex-stratified analysis, you have to study the differences. If these differences are avoidable, then we would talk about "inequalities". Then we can talk about gender instead of sex. I think this terminology (e.g., in the title) should be better revised throughout the text. As a small comment, in Table 3 (which puts Table 1) the Chi-squared column should be removed. This is a suggestion, as I do not think it adds anything. If the authors decide to leave this column, I have nothing to say. Reviewer #2: This descriptive study assesses the extent of gender differences in psychosomatic complaints at work by different occupational subgroups in a study of employees in Germany. The strength of this paper is its examination of gender differences separately by occupational subgroup. However, the main weakness of the paper in its current form is the lack of discussion around the different contexts in these occupational subgroups. My main comment is that this study needs much more engagement with previous literature to motivate the examination of these gender differences by occupational subgroup. The paper currently focuses on how they differ in terms of gender composition, but there are other important differences between these subgroups. White collar and blue collar jobs have differences in physical job demands while low-skill and high-skill jobs presumably have large differences in terms of their psychosocial demands. These job characteristics could differentially impact men and women and should be discussed in both the intro to motivate the analyses and in the discussion to interpret the findings. Can the authors provide citation(s) for how other studies have operationalized psychosomatic complaints? And some more background about why these complaints are likely to be affected by work? I have several questions about the treatment of several analysis variables: How was skill dichotomized into high vs low skill? Why were working hours categorized as “up to 10 hours worked per week”, “11-20 hours worked per week”, “21-30 hours worked per week”, and “30 or more hours worked per week”? Very few participants work 10 or fewer hours per week so it is unclear why this needs its own category. Would it be possible to divide the over 30 hours per week into multiple categories to identify those working long hours? Previous literature examining the effects of working hours on adverse outcomes has found more than full-time work to be a risk factor, yet the current categorization does not allow the authors to examine this. It would be clearer to refer to the “Child status” variable instead as “parental status” The statistical analyses need some sort of correction for multiple testing. The analyses presented in Table 3 represent 28 comparisons (7 symptoms x 4 occupational subgroups), so it is not surprising that several are statistically significant. Throughout the results section, the interpretations of the odds ratios are incorrect and overstate the findings. For example, the interpretation of an odds ratio of 2.08 as “women were 2.08 times more likely to report headaches as compared to men” should be “women had 2.08 times the odds of reporting headaches as compared to men” ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: José Fernández-Sáez Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0303811.r001
Revision 1
8 Apr 2024 Author Response Comments of the Reviewers (also uploaded as a file where changes are highlighted in colour): Reviewer 1 Comment 1 Reviewer 1: When you do a sex-stratified analysis, you have to study the differences. If these differences are avoidable, then we would talk about "inequalities". Then we can talk about gender instead of sex. I think this terminology (e.g., in the title) should be better revised throughout the text. Answer 1 R 1: Thank you for your review of our manuscript and referring to a more precise wording. We changed the word “differences” to “inequalities” in the title and the manuscript as gender differences may be avoidable under other working conditions. We only kept the word “differences” when directly referring to numerical mean differences in the result section. Comment 2 Reviewer 1: As a small comment, in Table 3 (which puts Table 1) the Chi-squared column should be removed. This is a suggestion, as I do not think it adds anything. If the authors decide to leave this column, I have nothing to say. Answer 2 R 1: Thank you for pointing out how to make the manuscript more compact. We deleted the column as we agree that it does not add additional information. Reviewer 2 Comment 1 Reviewer 2: My main comment is that this study needs much more engagement with previous literature to motivate the examination of these gender differences by occupational subgroup. The paper currently focuses on how they differ in terms of gender composition, but there are other important differences between these subgroups. White collar and blue collar jobs have differences in physical job demands while low-skill and high-skill jobs presumably have large differences in terms of their psychosocial demands. These job characteristics could differentially impact men and women and should be discussed in both the intro to motivate the analyses and in the discussion to interpret the findings. Answer 1 R 2: Thank you for your review of our manuscript and pointing out the chance to include a wider range of perspective on the stresses that white- and blue-collar jobs. We additionally extended the following paragraph with additional literature as Doef (1999) Artazcoz (2016) and Ganster (2018) in the introduction: “Regarding stresses, in blue-collar jobs, workers are more exposed to physical strains as chemicals and heavy weights [3, 17], while white-collar jobs rather lead to psychosocial and emotional demands which significantly lead to exhaustion and reduced well-being [3]. In addition to work intensity, emotional demands are the strongest predictor for impaired occupational health and burnout [18]. It is yet to be researched if these stresses differ in impairment on different genders. Overall, for all genders, conditions as longer and asocial working hours (especially more than fulltime), emotional demands, demands for hiding emotions, high demands and low control, discrimination, low job promotion, low predictability, low meaning of work low social support have been found to have a strong negative effect on psychosomatic complaints when comparing workers with more or less of these stresses with each other [3, 17, 19, 20, 21, 22, 23].” Additionally, we did so in the discussion: “Also, stresses differ between blue- and white-collar jobs as more physical stresses in blue-collar jobs [3, 17] and psychosocial and emotional stresses in white-collar [3]. It remains unclear if and why these inequalities in stresses and their connection of inequalities in psychosomatic complaints appear more in white-collar high-skilled jobs than in other occupational subgroups. There might be certain stresses, tasks and resources that predominantly influence psychosomatic complaints that women are more exposed to or react to more.” Comment 2 Reviewer 2: Can the authors provide citation(s) for how other studies have operationalized psychosomatic complaints? And some more background about why these complaints are likely to be affected by work? Answer 2 R 2: Thank you for pointing out to be more precise in the citation of our literature. To get a fuller impression of recent studies, we added the following paragraph in the introduction (changes highlighted in green): “Previous research shows that women report more psychosomatic complaints at work than men as physical and emotional fatigue, sadness, irritability and muscle, heart, and stomach pain [1-5]. Papers used different styles of operationalisation as yes/no questions and sum scores of questionnaires, but the general trend was found again and again.” Additionally, the paragraph for the introduction we presented in Comment 1 includes more information and literature where different working conditions were analysed in connection with complaints indicating that certain work(-ing conditions) leads to more or less complaints. Comment 3 Reviewer 2: How was skill dichotomized into high vs low skill? Answer 2 R 2: The coding system of ISCO88 made job descriptions for a range of jobs and rated their skill requirements according to the work task that acquired the highest skill to do it (an additional information that was added in the manuscript as well). Occupations were grouped into several supergroups regarding skill and specialisation. To give a better insight which occupations were put where we adjusted the following paragraph in the methods section: “The sample divided into the occupational groups “white-collar high-skilled” (including legislators, senior officials, managers, professionals, technicians and associate professionals), “white-collar low-skilled” (including clerks, service workers, shop and market sales workers), “blue-collar high-skilled” (including skilled agricultural and fishery workers and craft and related trades workers) and “blue-collar low-skilled” (including plant and machine operators, assemblers and elementary occupations).” Thus, skill wasn’t dichotomised per se but rated together with skill specialisation which resulted in the four occupational groups. Comment 4 Reviewer 2: Why were working hours categorized as “up to 10 hours worked per week”, “11-20 hours worked per week”, “21-30 hours worked per week”, and “30 or more hours worked per week”? Very few participants work 10 or fewer hours per week so it is unclear why this needs its own category. Would it be possible to divide the over 30 hours per week into multiple categories to identify those working long hours? Previous literature examining the effects of working hours on adverse outcomes has found more than full-time work to be a risk factor, yet the current categorization does not allow the authors to examine this. Answer 4 R 2: Thank you for pointing out the impact of working hours on stress. We added literature to these findings (e.g, Eurofound, 2017) and changed the subgroups into 5-hour-steps between 20 hours and 45+ hours to make the possible extra burden of working over 30 or 40 hours/ week better measurable. In the results section and discussion, we included the results of the regression analysis that our data validated the effect that longer working hours led to more complaints although the effect of collar remains when controlling for it. Comment 5 Reviewer 2: It would be clearer to refer to the “Child status” variable instead as “parental status”. Answer 5 R2: To clarify the wording, we changed the words in the text as suggested. Comment 6 Reviewer 2: The statistical analyses need some sort of correction for multiple testing. The analyses presented in Table 3 represent 28 comparisons (7 symptoms x 4 occupational subgroups), so it is not surprising that several are statistically significant. Answer 6 R2: To improve the quality of the analysis, we added a Bonferroni correction using a stricter α-level in the analysis. Using the formular αcorrected= αchosen a priori / n with n= 7x4= 28 comparisons. This resulted in αcorrected= 0.05 / 28 = 0.002. 0.002 was used as a stricter cut-off for significance. Some values did not meet the significance anymore, the overall trend and statement that white-collar high-skilled female workers are dominantly under complaint inequalities remained. Comment 7 Reviewer 2: Throughout the results section, the interpretations of the odds ratios are incorrect and overstate the findings. For example, the interpretation of an odds ratio of 2.08 as “women were 2.08 times more likely to report headaches as compared to men” should be “women had 2.08 times the odds of reporting headaches as compared to men.” Answer 7 R2: Thank you for pointing out this error of interpretation. We adjusted the wording in the result section as suggested. Attachments Attachment Submitted filename: Rebuttal_letter_Response_to_Reviewers.docx https://doi.org/10.1371/journal.pone.0303811.r002
1 May 2024 Decision Letter - Rocco Franco, Editor Gender inequalities of psychosomatic complaints at work vary by occupational groups of white- and blue-collar and level of skill: A cross sectional study PONE-D-23-38613R1 Dear Dr. Grasshoff, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. 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Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors have clarified all my comments. I think this paper can be published in its current state. Has improved a lot. I have nothing else to say Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0303811.r003
Formally Accepted
10 May 2024 Acceptance Letter - Rocco Franco, Editor PONE-D-23-38613R1 PLOS ONE Dear Dr. Grasshoff, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Rocco Franco Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0303811.r004

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