SHORT COMMUNICATION

Psychometric Properties of the Work Well Index: A Short

Questionnaire for Work-Related Stress
Daniel Mauss1,2*, Jian Li3 & Peter Angerer3
1
Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
2
Occupational Health Services, Allianz SE, Munich, Germany
3
Institute of Occupational and Social Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany

Abstract
The aim of this study was to test the psychometric properties of a short questionnaire for work-related stress
entitled Work Well index (WWi) and its interaction with different variables of self-reported health. An online
survey was conducted in a sample of 1,218 employees (51% female) in four countries of an international insurance
company. Internal consistency reliability, factorial validity, convergent validity and criterion validity of the 10-item
WWi were analyzed. Good internal consistency reliability of the WWi was obtained (Cronbach’s α coefficient = 0.85).
Confirmatory factor analysis showed a satisfactory model fit of the data (AGFI = 0.92). The WWi was highly corre-
lated to conceptually close constructs such as demand–control, effort–reward imbalance and workplace social capital
(p < 0.001). Moreover, the 10-item WWi was significantly (p < 0.001) associated with elevated risk of self-rated
health, absenteeism, presenteeism and depression (odds ratio 1.63, 1.36, 2.08, 2.95, respectively). We conclude that
this short questionnaire is a reliable and valid instrument measuring psychosocial stress at work. Copyright © 2016
John Wiley & Sons, Ltd.

Received 17 May 2015; Revised 13 December 2015; Accepted 31 December 2015

Keywords
effort–reward imbalance; job demand–control; psychosocial risk assessment; work stress; WWi

*Correspondence
Daniel Mauss, Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University,
Ludolf-Krehl-Str. 7-11, D-68167 Mannheim, Germany.
E-mail: dmousetrap@googlemail.com

Published online 24 February 2016 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/smi.2670

Introduction validated models to be associated with the major

Work-related stress is common and has significant
consequences on employee productivity and economic
profit of companies. The World Health Organization
has declared work-related stress as one of the biggest
challenges of the twenty-first century (Houtman,
Jettinghoff, & Cedillo, 2007). The associations between
work stress and diseases like depression (Theorell et al.,
2015), cardiovascular disease (Backé, Seidler, Latza,
Rossnagel, & Schumann, 2012) and musculoskeletal
disorder (Lundberg, 2015) have been extensively inves-
tigated during the past decades. Additionally, reduction
of work-related stress can improve work ability, well-being
and productivity of employees (Schulte & Vainio, 2010).
Different concepts and instruments have been
developed to demonstrate the root causes of work-
related stress (Tabanelli et al., 2008). Much evidence
has shown that the job demand–control model (JDC)
(Karasek et al., 1998), the effort–reward imbalance Model
(ERI) (Siegrist et al., 2004) and the concept of so-
cial capital (Kouvonen et al., 2006) are the best
stress-related diseases.
The JDC takes work demands (e.g. workload and
time pressure) and control (e.g. decision latitude and
skill discretion) into consideration. A mismatch of high
demands and low control indicate high strain. An addi-
tional dimension of social support, lack of help and
cooperation from supervisors and coworkers, extends
the model with socially isolated jobs.
The ERI is based on a fundamental principle of
interpersonal behaviour called social reciprocity. This
element is characterized by a balance of efforts spent at
work (e.g. workload, time pressure and interruptions)
and rewards received (e.g. career prospects, job security,
esteem and salary) with an imbalance of high efforts and
low rewards indicating the most perceived stress.
The concept of social capital has been introduced to
the new version of the Copenhagen Psychosocial Ques-
tionnaire (COPSOQ) and is mainly reflected by the
components of trust and justice at work (Pejtersen,
Kristensen, Borg, & Bjorner, 2010).

80 Stress and Health 33: 80–85 (2017) © 2016 John Wiley & Sons, Ltd.
D. Mauss, J. Li and P. Angerer
According to national requirements, every employer
is responsible for a regular psychosocial risk assessment
of job functions in most European countries with a wide
range of instruments in use (Tabanelli et al., 2008). While
established stress constructs focus on specific stressors
only, comprehensive questionnaires such as COPSOQ
or others include up to 90 items upsetting employers
and participants because of the time-consuming and
burdensome procedure. Reliable and valid question-
naires with a very limited number of items are needed
for indicative investigation of work-related stressors. As
many companies conduct regular employee surveys, a
set of items focusing on work-related stress could be in-
cluded to these questionnaires. These established surveys
are usually well accepted by all stakeholders and could
therefore help to implement a psychosocial risk assess-
ment. Furthermore, it would be helpful to have an easy
to measure short index for corporate stress management.
Already existing indices like the Occupational Stress Index
(Belkić, 2003) are still too long and inconvenient.
The aim of this cross-sectional study in employees of
an international insurance company was to investigate
the psychometric properties of a new 10-items stress
index, termed Work Well index (WWi) reflecting psy-
chosocial working conditions. Firstly, we analyzed the
internal consistency reliability and the factorial struc-
ture of this index. Secondly, we examined convergent
validity by examining the correlations of this index to
established constructs of work-related stress. Finally,
criterion validity was determined by associations of the
index with self-rated health, absenteeism, presenteeism
and depression.
Methods
Study sample
A voluntary questionnaire was offered to 2,421 em-
ployees (50.1% female, 40.2 years) in four countries
(USA, Romania, Germany and Switzerland) of an inter-
national insurance company. In total, 1,218 employees
(response rate 50.3%) completed the online question-
naire either in English (n = 483, USA and Romania) or
German (n = 735, Germany and Switzerland). Response
rates differed between countries (USA 43.3%, Germany
51.4%, Romania 54.8% and Switzerland 56.9%).
Procedure
The data collection was conducted by corporate
human resources in December 2014 during working
hours. Participation was anonymous. Answering all
items was compulsory, beside socio-demographics,
including age (≤34, 35–49, ≥50 years), gender, country,
job position (senior manager, manager and employee)
and working years for the employer (<5, 5–9, ≥10 years).
Participants with missing values in socio-demographics
were not excluded from our current analyses. Informed
consent was given by each participant. The study was
approved by the corporate data protection officer and
Stress and Health 33: 80–85 (2017) © 2016 John Wiley & Sons, Ltd.
Work Well Index Validation
by the Ethical Committee of the Bavarian State Chamber
of Physicians, Munich.
Measures
Work Well index
According to the scientific literature of work stress re-
search, we defined five dimensions of psychosocial work
characteristics with each dimension reflecting two com-
ponents, such as demand/effort (work pace and work-
load), control (skill discretion and decision authority),
support (coworker support and supervisor support),
reward (material reward and non-material reward) and
social capital (trust and justice) (see Appendix). According
to the required length of the WWi, we picked one item for
each component. Two occupational health scientists con-
ducted the selection process independently; a third scien-
tist evaluated these two selections followed by a group
discussion to finalize the 10-item WWi. Eight WWi items
were part of the annual corporate employee engagement
survey. Item responses were scored on a five-point Likert
scale (1 = strongly disagree, 5 = strongly agree). Scale totals
were determined by summing up all values with a scale
range of 10–50 and higher values indicating lower work-
related stress levels.
Demand–control–support questionnaire
The 17-item demand–control–support questionnaire
(DCSQ) was used in our survey, including the subscales
demand (five items), control (six items) and support
(six items) (Chungkham, Ingre, Karasek, Westerlund,
& Theorell, 2013). A four-point Likert scale was used
with higher values indicating higher demands, higher
control and higher social support at work (Cronbach’s
α 0.72, 0.77 and 0.84, respectively).
Effort–reward imbalance questionnaire
Effort–reward imbalance was measured by the validated
short-form questionnaire (Siegrist, Wege, Pühlhofer, &
Wahrendorf, 2009), including the subscales effort (three
items, Cronbach’s α 0.74) and reward (seven items,
Cronbach’s α 0.78) using four-point Likert scales. Sum
scores for each subscale were calculated with higher values
indicating higher effort and higher reward.
Social capital
Social capital at work was assessed by the subscales
trust (two items, Cronbach’s α 0.74) and justice (two
items, Cronbach’s α 0.70) from the COPSOQ (Pejtersen
et al., 2010). Five-point Likert scales were used summing
up all items. Higher values indicated higher social capital
at work.
Outcomes of health functioning
Four self-reported health outcomes were ex-
plored. Self-rated health was assessed by one item
(Idler & Benyamini, 1997) using a five-point Likert scale
(1 = very good, 5 = very poor). Depression was measured
81
Work Well Index Validation D. Mauss, J. Li and P. Angerer

using the two-item Patient Health Questionnaire Table I. Characteristics of study subjects (N = 1,218)
(Kroenke et al., 2003) with a four-point Likert scale
(0 = not at all, 3 = nearly every day). Sum scores ≥3 indi- Variables N %
cated a high risk for depression (Cronbach’s α 0.77). For Country Switzerland 537 44.09
the number of days employees had been sick at work Germany 198 16.26
(presenteeism) (Leineweber, Westerlund, Hagberg, United States 449 36.86
Svedberg, & Alexanderson, 2012) or sick at home Romania 34 2.79
(absenteeism) during the past 12 months, one item Age (years) ≤34 388 31.86
was asked each (0–3, 4–10, >10 days). 35–49 513 42.12
≥50 266 21.84
Missing 51 4.18
Statistical analysis Gender Men 539 44.25
As a core aspect of scale reliability, internal consistency Women 621 50.99
was assessed by examining Cronbach’s α coefficient Missing 58 4.76
and item-total correlation of the WWi. Cronbach’s α Job position Senior manager 59 4.84
values >0.7 and item-total correlations >0.3 were con- Manager 179 14.70
sidered to be acceptable. Factorial validity was tested by Employee 956 78.49
confirmatory factor analysis. Being driven by our assump- Missing 24 1.97
tion, the five first-order factorial solution representing de- Working years for employer <5 472 38.76
mand, control, support, reward and social capital were 5–9 287 23.56
applied. Several established indicators were used to assess ≥10 434 35.63
Missing 25 2.05
goodness-of-fit including the goodness-of-fit index (GFI),
adjusted goodness-of-fit index (AGFI) and comparative
fit index (CFI), each with values exceeding 0.90 suggesting
an acceptable fit to the data. Root mean square error of Table II. Scores of established work stress constructs, the Work
Well index and its five dimensions, and health outcomes by survey
approximation (RMSEA) values between 0.05 and 0.08
language
suggested a reasonable fit to the data, values >0.10 were
not acceptable.
German (N = 735) English (N = 483)
Bivariate correlations between WWi and subscales of
established work stress constructs were examined with Work stress Range Mean ± SD Mean ± SD
values >0.4 indicating satisfying results for convergent
Demand (5–20) 12.79 ± 2.42 13.31 ± 2.40
validity. To assess criterion validity, logistic regression
Control (6–24) 16.70 ± 2.94 17.31 ± 2.76
modelling was applied to test the associations of WWi
Support (6–24) 18.81 ± 2.84 18.27 ± 2.76
with four different outcomes, adjusting for age, gender,
Effort (3v12) 8.65 ± 1.84 8.56 ± 1.86
job position, country and working years. The results Reward (7–28) 19.00 ± 3.06 19.16 ± 3.51
are shown as odds ratios with 95% confidence inter- Social capital (4–20) 14.97 ± 2.69 15.13 ± 2.96
vals. A p-value of <0.05 was considered as statistically WWi (10–50) 34.43 ± 6.02 35.55 ± 6.83
significant. We used SAS 9.4 for all analyses. WWi-demand (2–10) 5.58 ± 2.05 5.76 ± 2.02
WWi-control (2–10) 7.21 ± 1.63 7.40 ± 1.62
Results WWi-support (2–10) 7.86 ± 1.46 7.86 ± 1.51
WWi-reward (2–10) 6.25 ± 1.67 6.83 ± 1.78
Study population
WWi-social capital (2–10) 6.95 ± 1.50 7.22 ± 1.74
Characteristics of the study sample are shown in Table I,
including sample sizes, age, gender, job position, working Health outcomes % %
years and country. Missing data ranged between 1.97% Absenteeism (days) 0–3 67.89 81.58
(job position) and 4.76% (gender). All health outcomes 4–10 22.31 16.77
are presented in Table II, including missings for absen- >10 7.76 1.24
teeism and presenteeism as well as mean values with Missing 2.04 0.41
standard deviations for all explored subscales of work Presenteeism (days) 0–3 64.63 73.08
stress constructs like DCSQ, ERI and social capital. 4–10 28.98 23.19
>10 4.63 2.90
Internal consistency Missing 1.76 0.83
Cronbach’s α was 0.85 indicating satisfactory internal Self-rated health Good 77.96 80.54
consistency of WWi (English sample 0.88, German Fair 18.23 16.77
Poor 3.81 2.69
sample 0.82). These values remained stable if one item
Depression No 85.31 85.92
was deleted. Item-total correlations resulted in values
Yes 14.69 14.08
between 0.41 and 0.62 for all 10 WWi items indicating
considerable consistency. WWi: Work Well index.

82 Stress and Health 33: 80–85 (2017) © 2016 John Wiley & Sons, Ltd.
D. Mauss, J. Li and P. Angerer
Factorial validity
Figure 1 illustrates the confirmatory factor analysis.
The theoretical construct reached an acceptable
goodness-of-fit (GFI= 0.95, AGFI= 0.92, RMSEA=
0.08, CFI= 0.94). All values were slightly better in the
English-speaking sample.
Convergent validity
Work Well index (WWi) was significantly (p < 0.0001)
correlated with the subscales of established constructs
of work stress: demand ( 0.51), effort ( 0.43), control
(0.45), support (0.60), reward (0.74) and social capital
(0.64). In addition, significant differences of WWi were
determined by position (analysis of variance, p < 0.05):
employees 34.74 ± 6.39 versus managers 35.81 ± 6.06
versus senior managers 36.66 ± 4.42; and by sample
language (t-test, p < 0.01): German 34.44 ± 6.02 versus
English 35.55 ± 6.83; indicating good discriminant
Figure 1 Confirmatory factor analysis of the Work Well index (N = 1,218)
Stress and Health 33: 80–85 (2017) © 2016 John Wiley & Sons, Ltd.
Work Well Index Validation
validity. No significant WWi differences were found
regarding age, gender and working years.
Criterion validity
In logistic regression analysis, significantly (p < 0.001)
elevated odds ratios were observed ranging from 1.36
to 2.95 for every standard deviation decrease of WWi
(Table III). These results slightly differed between
survey languages.
Discussion
The present study provides evidence to validate a novel
short questionnaire for psychosocial work conditions.
The results indicate satisfactory psychometric prop-
erties of this 10-item Work Well index. The index
showed high correlation with established scales measur-
ing psychosocial loads at work, obvious difference by oc-
cupational position and significant associations with
several health-related outcomes.
83
Work Well Index Validation D. Mauss, J. Li and P. Angerer

Table III. Associations of the Work Well index with productivity and health indicators for all participants (N = 1,218) and for those
answering in German (N = 735) or English (N = 483)

Productivity indicators

Absenteeism (ordinal logistic Presenteeism (ordinal logistic

regression, OR and 95% CI) regression, OR and 95% CI)

All 1.36 (1.19, 1.56) *** 2.08 (1.81, 2.40) ***

WWi German Decrease per SD 1.35 (1.15, 1.60) *** 1.79 (1.51, 2.13) ***
English 1.40 (1.10, 1.77) ** 2.68 (2.10, 3.42) ***

Health indicators

Poor self-rated health (ordinal Depression (logistic regression,

logistic regression, OR and 95% CI) OR and 95% CI)

All 1.63 (1.40, 1.88) *** 2.95 (2.42, 3.59) ***

WWi German Decrease per SD 1.69 (1.40, 2.05) *** 3.34 (2.54, 4.38) ***
English 1.58 (1.25, 2.00) *** 2.83 (2.09, 3.83) ***

**p < 0.01,

***p < 0.001.
Adjustment for age, gender, job position, working years, and country.
WWi: Work Well index; SD: standard deviation; OR: odds ratio; CI: confidence interval.

A major merit of this study is that we present
information on reliability and validity of a short
questionnaire, which, due to its phrasing and limited
number of items, can be part of an employee survey.
Our results are in line with the European standards
for stress assessment tools mentioned in the EN ISO
10075-3:2004, including validity, objectivity, reliabil-
ity, sensitivity, diagnostic broadness, generalization,
usability and grading of commodities (German Institute
for Standardization, 2004).
Our findings demonstrate that large organizations
may benefit from such an index. Key performance indi-
cators (KPI), in this case for stress, are well accepted by
managers and meet the needs of industrial companies.
Viewed as an organizational issue rather than an indi-
vidual fault, psychosocial risks and stress measured by
key performance indicators can be just as manageable
as any other corporate challenge or other workplace
health and safety risk. Furthermore, a short-form index
leads to shorter administration time and better compli-
ance of employers and employees for participation.
Another strength of this study is the generalizability
of results due to a cross-cultural study sample with
balanced gender quota and position-related health
outcomes. Separate analyses for both sample languages
also confirm our findings that similar results of reliabil-
ity and validity were replicated across countries.
Regarding confirmatory factor analysis, the factorial
structure of the index was consistently confirmed
across both languages (AGFI ≥ 0.90, data not shown).
All statistical analysis demonstrated a good fit of the
data. Concerning the criterion validity, our overall re-
sults are in line with previous studies exploring the
association of work-related stress with multiple health
outcomes such as depression (Theorell et al., 2015).
Further, occupational position was linked to perceived
work stress measured by the WWi, which has been
explored earlier in different studies (Clougherty, Souza,
& Cullen, 2010).
Different organizations such as the World Health
Organization, International Labor Organization and
British Health and Safety Executive have defined a bundle
of topics that should be considered for a healthy work-
place reducing psychosocial risks. Of these topics, the
WWi explores five dimensions that are especially impor-
tant as they represent established risk factors for major
diseases. Accordingly, the World Health Organization
mentioned ERI and JDC as the most relevant models to
assess work-related stress (Burton, 2010). Both models
built the scientific background of our validation study.
Nevertheless, the WWi covering five dimensions with 10
items is more of an indicative measurement tool for
psychosocial loads at the workplace than a holistic psy-
chosocial risk assessment. Therefore, it can be used to
identify groups of employees and areas within a company,
respectively, that are jeopardized by work stress, followed
by an in-depth evaluation.
Several limitations need to be mentioned. Because of
the cross-sectional design, the predictive validity and
factorial stability of WWi over time could not be
examined. Future studies should investigate the pre-
dictive validity and the stability (test–retest reliability)
of this index. In addition, bias of common method
variance cannot be ruled out because of self-reported
nature of all variables. However, the aim of a psycho-
social risk assessment is not to measure the impact of
stress on people but to estimate risks and to identify
possible root causes for interventions improving working
conditions. Further, results may have been biased due to
the fact that Romanians could not answer the survey in

84 Stress and Health 33: 80–85 (2017) © 2016 John Wiley & Sons, Ltd.
D. Mauss, J. Li and P. Angerer
their native language. Nevertheless, only 3% of the study
sample were Romanians.
In conclusion, this study demonstrates good reliability
and validity of the 10-item Work Well index to date. It
can be used as indicative measurement assessing psycho-
social work-related stress. Our findings indicate that
stress can be detrimental to employee health and produc-
tivity. The Work Well index could be implemented in
employee surveys and help to manage work-related stress
by providing an easy assessable key performance indica-
tor in the context of corporate health management.
REFERENCES
Backé, E.-M., Seidler, A., Latza, U., Rossnagel, K., &
Schumann, B. (2012). The role of psychosocial stress
at work for the development of cardiovascular
diseases: A systematic review. International Archives
of Occupational and Environmental Health, 85(1), 67–79.
Belkić, K. (2003). The occupational stress index: an ap-
proach derived from cognitive ergonomics and brain
research for clinical practice. Cambridge (United
Kingdom). Cambridge International Science Pub.
Burton, J. (2010). WHO healthy workplace framework
and model: Background and supporting literature
and practices.
Chungkham, H. S., Ingre, M., Karasek, R., Westerlund, H.,
& Theorell, T. (2013). Factor structure and longitudinal
measurement invariance of the demand control support
model: An evidence from the Swedish Longitudinal
Occupational Survey of Health (slosh). PLoS ONE,
8(8), e70541.
Clougherty, J. E., Souza, K., & Cullen, M. R. (2010).
Work and its role in shaping the social gradient in
health. Annals of the New York Academy of Sciences,
1186(1), 102–124.
German Institute for Standardization (2004). ISO
10075-3:2004: Ergonomic principles related to
mental workload – Part 3: Principles and require-
ments concerning methods for measuring and
assessing mental workload. Berlin: Beuth Verlag.
Supporting information
Additional supporting information may be found in the online version at the publisher’s web site.
Stress and Health 33: 80–85 (2017) © 2016 John Wiley & Sons, Ltd.
Conflict of interest
Daniel Mauss is chief company physician of Allianz SE
and holds stock of this company. WWi is a registered
trademark of Allianz.
Acknowledgments
We gratefully acknowledge Claire Henault and Lars
Heemann from Allianz for her support in conducting
the survey.
Houtman, I., Jettinghoff, K., & Cedillo, L. (2007).
Protecting Workers’ Health Series No. 6 Raising
awareness of stress at work in developing countries.
Idler, E. L., & Benyamini, Y. (1997). Self-rated health
and mortality: A review of twenty-seven community
studies. Journal of Health and Social Behavior,
38(1), 21–37.
Karasek, R., Brisson, C., Kawakami, N., Houtman, I.,
Bongers, P., & Amick, B. (1998). The Job Content
Questionnaire (JCQ): An instrument for interna-
tionally comparative assessments of psychosocial
job characteristics. Journal of Occupational Health
Psychology, 3(4), 322–355.
Kouvonen, A., Kivimäki, M., Vahtera, J., Oksanen, T.,
Elovainio, M., Cox, T., … Wilkinson, R. G. (2006).
Psychometric evaluation of a short measure of social
capital at work. BMC Public Health, 6, 251.
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2003).
The Patient Health Questionnaire-2: Validity of a
two-item depression screener. Medical Care, 41(11),
1284–1292.
Leineweber, C., Westerlund, H., Hagberg, J., Sved-
berg, P., & Alexanderson, K. (2012). Sickness
presenteeism is more than an alternative to sick-
ness absence: Results from the population-based
SLOSH study. International Archives of Occupa-
tional and Environmental Health, 85(8), 905–914.
Lundberg, U. (2015). Work conditions and back pain
problems. Stress and Health, 31(1), 1–4.
Work Well Index Validation
Pejtersen, J. H., Kristensen, T. S., Borg, V., & Bjorner, J.
B. (2010). The second version of the Copenhagen
Psychosocial Questionnaire. Scandinavian Journal of
Public Health, 38(3 Suppl), 8–24.
Schulte, P., & Vainio, H. (2010). Well-being at work–
overview and perspective. Scandinavian Journal of
Work, Environment & Health, 36(5),
422–429.
Siegrist, J., Starke, D., Chandola, T., Godin, I.,
Marmot, M., Niedhammer, I., & Peter, R.
(2004). The measurement of effort-reward imbal-
ance at work: European comparisons. Social
Science & Medicine (1982), 58(8), 1483–1499.
Siegrist, J., Wege, N., Pühlhofer, F., & Wahrendorf, M.
(2009). A short generic measure of work stress in
the era of globalization: Effort-reward imbalance.
International Archives of Occupational and Environ-
mental Health, 82(8), 1005–1013.
Tabanelli, M. C., Depolo, M., Cooke, R. M. T.,
Sarchielli, G., Bonfiglioli, R., Mattioli, S., &
Violante, F. S. (2008). Available instruments for
measurement of psychosocial factors in the work
environment. International Archives of Occupational
and Environmental Health, 82(1), 1–12.
Theorell, T., Hammarström, A., Aronsson, G.,
Träskman Bendz, L., Grape, T., Hogstedt, C., … Hall,
C. (2015). A systematic review including meta-analysis
of work environment and depressive symptoms.
BMC Public Health, 15(1), 738.
85