Sick building syndrome (SBS) may have more to do with the psychosocial work environment than with the physical attributes of the building, according to the results of a cross-sectional study reported in the March issue of Occupational and Environmental Medicine.

"Although guidelines exist for the investigation and management of SBS, systematic research has failed to identify consistent associations between particular physical properties of buildings and SBS," write A. F. Marmot from the Linton House in London, United Kingdom, and colleagues from the Whitehall II study. "There is increasing evidence that the psychosocial work environment is related to health and that the physical responses to work stress may resemble symptoms that have been attributed to the physical work environment. Work overload, lack of support at work, and conflict at work may exacerbate the effects of the physical work environment."

The investigators used cross-sectional data on the physical environment of a selection of 44 buildings to individual data from the Whitehall II study, an ongoing health survey of office-based civil servants. Ten symptoms of SBS and psychosocial work stress were evaluated with a self-report questionnaire administered to 4052 participants aged 42 to 62 years.

After adjustment for age, sex, and employment grade, no significant relationship was found between most aspects of the physical work environment and symptom prevalence. There was a nonsignificant trend toward a positive relationship between airborne bacteria, inhalable dust, dry bulb temperature, relative humidity, and having some control over the local physical environment. High job demands, low support, and other features of the psychosocial work environment had greater effects on symptom prevalence. Based on multivariate analysis, only psychosocial work characteristics and control over the physical environment were independently associated with symptoms.

"The physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms," the authors write. " 'Sick building syndrome' may be wrongly named."

Study limitations may include high quality of Whitehall buildings above the threshold for affecting symptoms; the potential for misclassification of the environmental characteristics for each building; self-reported nature of the psychosocial work characteristics and symptoms; and questionnaire and fieldwork data collected at different times of the year.

"These findings should not be interpreted as justification for assuming that the quality of the physical environment of the workplace is unimportant," the authors conclude. "The results imply that if SBS is reported in a building, management should consider causes beyond the physical design and operation of the workplace and should widen their investigation to include the organisation of work roles and the autonomy of the workforce.... SBS symptoms are more about the jobs people do, their psychosocial environment, and their ability to control conditions in their office than about the physical environment of the building or workstation where the job is performed."

Financial support for the Whitehall II study came from the UK Medical Research Council; the British Heart Foundation; Health and Safety Executive; the UK Department of Health; the National Heart, Lung, and Blood Institute and the National Institute on Aging of the US National Institutes of Health; the US Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality; and the John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health.