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pati.ertt aamplcs t1ete most s:imllar to -011c anotlH!r and most d.ts-

.sim:ilar froru. t:.be three patitmt_ group:J acrcss All 1line scales. 

For comparison purpo:?oes the scale !.cores '•hich correspond~d 

tc1 a complete lac.k of Sj"r:<}'teoaa on any z:tven scele arc listed 

iu the seventh rot.r of Tsble 127. I.m.ediately bf!low this row 

is the symptomatic C'.Ut--off score dt.!signated by thts s.tudy -t~H:U'!l. 

'fhe symptomatic cut-off scorE:. waa established as being 

greatE'r than or equal to one dtt..ndard de.vL:.tion .&.bo.ve the urban 

coti.m.u.td.ty sample, r.lr two stan:i.1rd deviations above thoe :Jrba.n · 

ccu\Uiuntty leaders ~ltt'lple, ·o~~hich~:Ver W"lU greater. The cut-off 

s~ore was rounded off to the next h.i&hc.at .l.z:..;;.eg•~-r when it was 

below 50; ('.u,:··off sc.ores above 50 were rounded down to the next 

full int".ger. This procedurl..! waa followed because the ~core 

of 50, iu &.n.d of itself, wa~ the mean ot peychiat::ic inpatie11ts 

on each 9C&le in the original 3tar.dardl.zati~..:m study. A9 can 

be ~;e.cn. the nyu~ptU4lltic cut·-cff rJcores C:!lt;:'!b!ished for th~ 

air tr.:ffic conti.:ollcra were- almcst ident·icr . .t to and som.eti.lltc.a 

higher than th.;..~. scon~s of fo~~t!r it'.patients. '!'he c,.corea used 

tc .cata.blish ·dgnificant>-syu.pr:ometoJ.ogy nh<o ;..:ere eqta.'ll to ot· 

grE-ater than the. QY•.:!:t:age accn~r:; of prc-treatw.ent outpat:f..zut:8. 

Finally, ·and pcrh:.tp!::.i most dramaticallJ, \V"!.th the (>...XC.eption of 

sabjec.t;f.v€' distreso, and pe:rhapr:~ t.;oege-<".!trnPr r!lc:e, the cui..-off 

scct:es alsn wcr<a equivalent to the mean sc:.}n;~~• ;1chieved by 

paychiutr.ic iQpaticnt.s. Com;£tquently, \-Then -m. t'f!J:u: .. ..:-t th.:1t an 

air traffic controlle:r h:id si~,nific,'lnt S)"'illpto:r.otology in .'itt 

area, it is usually equivalent to ~n.ying thut. the cont.roll(:r 

was at lr.ast ae Sytllptomstic. <1FJ outpati(;nt::9 and input1Ewts 

receiving or ~"J.bout to recpi·.:e treatment. 

Thus the sym.ptOaUltic c;ut:-off &core.a hall both stu.tistical 

und cl:f.tlical. meaning in that they w•.:re equivn.lent to the mean· 

fm.· inpatients a;.1d r.;utpMtienta, "'·ere. r.Jr!e full otandani deviatlon or reore above the scorea of an llrt,lin co::trl'.untty :lamplet 

and r~?preaented t& levt~l of aylT>.ptomatology fouud in persons 

invol.ved with p~ychiatric treatJll.<l!nt. 

In addition to the cv&J.vation of psychiu~r:r.c at~::P:ua ty 

m .. "'r,~1s of ~he stru..::.ture:d clinJc'll in.teJ:view conductto:<d. nt 

'3osi~('Kl Univer~1i.ty, we w"l'"e. ir.t~reatnt: i.n ol.H:.-'.dn.lllR. more 

frc.c:uent r.:ati-'Uat:ca of -~he p~jnhological fuuct.ir:-niug of 

the suhj ~eta. Aiter the int:.nke ,·!vaJ.uat:icrHl ac Benton Ut"tiver·~i.ty. it b4Ca!"te clear tl'"-lt tha rr.;(')l!t comtriOn p~ycholog1c.1.l 

pr01llas ,mre erut:iety .and. deprension. Cr>n·ii~~ut·ntly, wu 

S1?'8:t'che.d thf:! !iter t::.turr: for se1 f-·report inventor:l.ea thut 

uoulcl h..:: .!:len>~ to admiuiater • dillopl~ to Bl':nrc!, and c.li11:i>..:ally 

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relevant. 

With the valuable assistance of James Barrett, li.D., a 

psychiatric epidemiologist, oUr research led to the work and 

instruments of William Zung, M.D. Zung had develo~ed a special 

scale for the assessment of clinically significant depression, 

a·nd a scale for the assess~ent of clinical.i..y signifiCant 

anxiety'(Zung, 1965; Zung, 1971). In both instanc~a Zung 

used clinical diagntJstic criteria to ~elecr. the self-report 

items in such a way that a high score on his scales would 

re.present a higher intensity of either anxiety or c!epre.'Jsion .. 

Both ~~atruments were reported to be reliable and valid for 

the quan~tative assessment of clinically significant ~nxiety 

and depression (Zung, 1965, 1967a, 1967b, 1969, 197la, 197lb). 

In addition, both the Self-rating Anxiety Scale (SAS) 

and the ~elf-rating Depression Scale (SDS) were self-report 

measures with established degrees of subject acceptability 

and were practical to use as repeated measures. They were 

short. only twenty 1t~s, and easy to score. Finally, and 

of particular relevance for our selection of these instruments, they both had received wide use in various patient 

groups and in normals, mak!ng available considerable validation data as well aa a large number of comparison groups to 

aid us in the interpretation of results. 

We decided to use tht2:se instruments, but we needed to 

decide on the optimum frequency of self-report. The length 

of time between interval e::aminations averaged nine months, 

and the P~S evaluation at each examination was made on the 

basis of the previous month's symptomatic behavior. Hence, 

between PSS evaluations we would have no knowledge llf a man's 

general psychiatric status for eight of every niae months. 

Although there were reasons why more frequent or less 

frequent self-reports might be useful, we felt that a monthly 

report of the two prominent syndromes of depression and 

anxiety symptomatology would be most useful. Therefore, aftar 

the secO\ld exa.m:!.nation v'initc to Boston University, we began 

to incl.,de the SAS and tha SDA as part of the 1110nthly self-

•~pott package mailed to each subject at the end of each 

r40n~h to be filled out and retur~ed with information relating 

to tfiat particular month. 

Ove< 90% of the men cooperated by completing the 

SAS and ~DA each month along with rncir M>:>nthly Real th 

rte.ViEw (sea Se.ction IliC). The S#,S and SDS continued to 

be oent each month ur.til an ATC becrulle ineligible for the 

study by virtue of ~romotion, transfer, or dischtrge froG 

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the agency. 

Table 128 displays the foi'1!1 of the SDS a•J we used it on a 

monthly basis. Table 129 displays the SAS aa we used it. The 

directions were slightly different from those originally used 

by Zung be::ause a nurse or other person was not available (as 

Zung would hav~ it) to apl.J.in how to answer the questiQns. At 

the top of each form we noted the month for whic~ the SAS or 

the SDS was co be completed. Both instruments have positively 

worded items and negatively worded items so that a response 

tendency to say "yes" or "no'' would not lead to an artifically 

inflated or deflated score. 

The first month's returns were carefully scrutinized to 

ascertain whectoer at not the air traffic controllers un-:teratood 

the directions. Any responses which suggested a misunder«tanding 

of directions or unusual response tendencies were follo~ed up by 

a call to the controller to determine and correct the difficulty. 

Examination of the next month's form~ showed that all such difficulties had been resolved. 

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TABLE 128 

SeJfwRatlng Oepr~ssion Scale 

401 

PLEASE CHECK THE APPROPRIA7E ANSWER FOR THE HONTH OF: 

DIRECTIONS: Please read each question very carefully. Although s~ QUestions may 

be difficult to answer, please give your best answer by making a check in the 

appropriate answer column. Also, please note that the answers change meaning 

depending on th:'e question. For example, "none" doe~ not always mean no dlfflcul ty. 

1. I feel down-hearted and blue 

2. Horning Is when I feel the best 

3. I have crying spells or feel 

like It 

~. have trouble sleeping at night 

5. eat as mu~h as I use to 

6. stl't I enjoy sex 

7· notice that I am losing weight 

8. have troub!e with constipatl<'n 

9. Hy heart beats faster than usual 

10. I get tl red for no reason 

11. Hy ~lnd Is as clear as It used 

to be 

12. find It easy to do the t:hlogs 

use to do 

13. am restless and can• t keep still 

14. teel hopeful about the future 

15. am more Irritable thin usual 

!S. find Jt easy to rJlake decisions 

17. fesl that I em useful and 

needed 

18 .• Hy life lo prottY full 

19. I roe! that others would be 

better off If I were dead 

20. I still enjoy the thing! I used 

to do 

NONE 

OR A 1.1 TTLE ~F TH~ T1 ME SOHE OF 

THE TIHE 

GOOO PART 

OF THE TIME 

MOST OR ALL 

OF THE TIME 

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Self-Ratin.; An:d~tv_Sc.-lt: 

PLEASE CHECK THE APPROPRIATE ANSWER FOR THl MC,TH OF: 

t. I f~e I more. . .,~ rvous and anx JI):.JS 

than· usua I 

2. ft:~l afraid for no reason at all 

3. get up~et easily or feel panicky 

4. feel I ik~ I'm. hi I ing apart c111d 

going to pieces 

s. I feel that everything is all right 

and nothing bad will happen 

6. My arms anci legs shake and tremble 

7, I am bothered by headaches, 

neck and back pains 

8. feel weak and get tired easily 

9. feel calm and c~n ~It still easily 

10. can feel my heart beating fa!t 

I I. am bothered by d I ZZ'f spe II s 

12. nave fainting spe11s or f~;f".l like It 

13. can breathe In and out ea~ily 

1~. get feelings of nt .o~o~neSS and tingling 

In my fingers, toes 

IS. I a.n bothered by stomach aches or in .. digestion 

16. I have to empty my bladder often 

17. Mv hands ere usua 11'1' dry and warm 

18. Hy tace gets hot and b I ush.ed 

19. I f•ll asleep easily lmd 9!!! t a good 

nl9ht 1 S rt:'.!H 

zc. I h4ve night m.:-.res 

:lONE 

OR A L1 nLE 

OF THE TIME 

SOME OF GOOD PART 

:!:!'F TIME OF THE TIM~ 

MOST OR ALL 

OF THE Tl ME 

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Indexing Psychological Health Change By L~vels of Severitv 

403 

Two tasks were accomplished to index the levels of severity for 

psychological h2alth change. First, Severity levels were establish~d for eilch criterion symptom scale of the PSS, SDS and SAS. 

Second, sev~~~cy level~ were established for psycholgical health 

change across symptoms and over time. 

Several indices of severity were investigated fo::.· the PSS 

criterion scales. Results indicated that a dichoto~ous, 

asymptOmatic verses symptomatic. classification was mos.t appropriate. 

The final determination of psychiatric status and severity was 

made two ways. Susceptibility to psychistric problems wa& defined 

by three groupir.gs. 

1) Incidence cases were defined as those oen who on 

any of the five PSS criterion scales Were classified 

symptomatic after, but not at, intake. 

2) Prevalence casea were defined as those men who had 

any of the five PSS criterion scales classified 

symptomatic at intake. 

3) As}~ptomatic controls ~ere defined as those men 

whc never had a symptomatic PSS,criter~on score in 

five evaluations. 

?he second ove::all psychiatric status asb:esscent classified men 

into four groups according to the extent of psychiatric problems. 

1) Asymptomatic controls never had a symptomatic 

PSS criterion scale in five evaluations. 

2) AcutP. cases had only a single s~ptomatic criterion 

score at only one evaluation of the five. 

3} Intemittent cases had one or- more symptomatic cr" teria· 

at 2 or 3 of fl.ve •••aluations. 

4) Chronic cases had on~ or more symptomatic criteria at 

4 or S of five ev•lu3tions. 

s~v~rity for the monthly evaluation of depression and anxiety 

also was cvuluated two ways. 

For a given rn.ont.h, the severtty was classified according to the 

lev~l of aym:ptor.tatology refV~cted by a acor"!. 

1) Lev~l 0 was eotablished at .a range indicative 

of "" or insignificant symptom.atology. 

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2) Level 1 reflected definite depression or an"iety 

at the symptom level. 

3) Level 2 was established at a syndrome level equivalent to outpatients with a diagnosis of depression 

or anxiety. 

4) Level 3 was established as the highest level, repr~­

senting a severe depressive or anxiety neurosis 

r.eeding clinical treatment. 

Men were classified into four groups representing their characte~istic payohiatric morbidity over their time in the study using 

annualized rates of Level 1, 2 or 3 ePisodes. A minimum of one 

interval between examinations with at least five returned questionnaires was needed to- make these classifications-. The four 

groups were: 

1) Asymptomatic controls had an average annual 

rete of episodes of leas than .s per year. 

2) Acute cases had an average annualized rate 

of episodes between .6 and 2.9 per year, 

3) Intermittent cases had an average annualized 

rate ofepisodes between 3 and 8.9 per year. 

4) Chronic cases had an average annualized rate 

of episoces uf 9 or more per. year. 

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2. Indexing Psychological Heal~h Change By Severity 

Elimination of Levels of Severity for_Scores on Specific PSS Scales 

Two issues in classifying th~ oev~ricy of psychological health 

problems nad to be considered. First, we had to consider the use 

of severity levels for each of the symptom scales; and second, we 

had to consider the usc of severity levels to classify overall 

psy·chia.tric health or illness. The first task was to consider the 

use of· severity levelo on the individual symptom scales. 

Table 130 displays the two major methods that w~ examined 

for claosifying Psychiatric Status Schedule severity on a given 

criterion scale. The first method produceJ ordinal categories 

so that a "Level 0' 1 on a criterion scale represented an asymptomatic assessment. £ven though symptoms mEy have been present, t~ey 

would not be sufficient to exce'ed the cut-off score established 

for significant symptomatology, As previously mentioned, these 

ct,t-off scores were established by comparison with a number of 

clinical groups (see Table 12~). A Level 1 psychiatric symptom 

"'as established as one- in which the PSS scar!:! was above the cutoff criterion but less than one standard deviation above the 

psychiatric inpatient group. Hence a Level 1 psychiatric health 

llutcome was derived from signifJ.cant but clinically mild symptomatology, A Level 2 psychiatric health change was established 

as one in which the PSS criterion score was greater than one 

standard deviation above the psychiatric inpatient average. 

Finally a Level J health change required a PSS criterion score 

of more than one standard deviation above the psychiatric inpatient average ~nd in additio~ required hospitalization for 

the psychological condition. 

This method of establishing levels of symptomatology 

attempted to include the absolute level of symptomatology 

involved in the dysfunctional status. However, we conducted 

a large number of analyses that compared individuals classified at the various levels on each of the PSS criterion 

scales and focnd that there was very little difference between 

the tnree symptomatic groups on measure• of personality, attitudes toward work, life ch.an,ge, laboratory or personal history 

variables. Ihia rcther ourpriaing finding suggested that the 

concept of leval vas not a·uaeful one since there were few, if 

any, distinguishing characterie.tic:a between people at the three 

upper leve.ls. \ole date-nnir.ed, therefore. that it was most feasible ainply to classify individuals. aa asymptomatic or symptomatic. 

Our eventual method of clusification according to the 

l'sychiatric Status Schedule criterion ae4le8 waa, therefore·• 

dichotolllOU8, If an individual ocorecl above th~ out-off for a 

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Method 

Method 2: 

TAJJLE 130 

Methods Fer Classifying PSS 

SeveritY On Criterion Scales 

Level of symptomatology 

A. Level 0- asymptomatic, below cut-off score for significant 

symptomatology 

R. l.•ve 1 1 - above cut-off score but less than one standard 

deviation above psychiatric Inpatient average 

C. Level 2 - more th.lln one standard deviatiort above psychiatric 

Inpatient averaqe 

D. Level 3- Level 2 plus hospltallzatlcn 

Asymptomatic vs symptomatic 

A. Level 0 - equal to or less than cut-off score 

B. Leve 1 - ~bove cut-off score 

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eriterion ~cale, he w~~ classified as symptomatic. If an individual scored at or below the cut-off level, he was ;.:.or,sidered 

asymptomatic. This method had the obvious drawback t.hat Sl)me 

individuals could score exceedingly close to the cut-off on 

one or more c=iterion scales without being considerea symptomatic. This was a probl~~ common to categorical measuremenc 

of any kind. 

We investigated the problem of cut-off score boundaries by 

examining the actual symptoms that contri?uted co the classification of our subjects as symptt;~matic on a given seal.::. Convernely, we examined the specific symptoms for individuals 

scoring at or just a few points below the criterion cut-off 

score. We found that the combinations of symptoms that actually 

Qccurred to symptomatic individuals were clinically ~ignificant, 

i.e., the symptoms resulting in a classification of symptomatic for an individual w~re reflected by clinically diagn9sable 

conditions. 

On the other hand, those scoring just below the criterion 

cut-off tended to have somewhat unrelated symptoms that reflec·-

ted either a pre~clinical state or a non-diagnossble series of 

scattered symptoms. 

T~roughout this report we have used only a c~assification 

of symptooatic or asymptomati~ to describe or group subjects on 

specific -Psychiatric Status Schedule criterion ecales- Clinical 

psychiatric diagnoeeb were not made in this stcdy, nor wera 

levels of severity assigned to scores on the specific PSS scales. 

Levels of Severi~y for Ove~all PSS Asses~roent 

We netded then to conPider establishing severity levels 

to categorize the men's overall psychiatric status. Table -131 

displays a number of methods that were possible for classifying 

an individual'! over~ll psychiatric status in a pnrticulac examination by levels of severity. 

Methods 2, 3 and 4 were usable only if classification by 

levels were used on the individual scales. We investigated 

the predictive differenc"s between the groups using all five 

methods. We found that there were very few differences berween 

the groups distinguished by level (os in the investigation of 

the usefulness of levels of severity for classifying individual• 

on the individual scales), whereaa the numbt--r of scales on which 

the individual was classified symptoreatic seemed to be the more 

powerful discriminator b~tween persons. 

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408 TABLE 131 

Methods For Classifying. Levels Of 

O·.'erall Psychiatric Status 

At A Given Examination 

Method 1: Number of Symptomatic Criterion Scales 

A .. None 

8. One 

c. Two 

D. Three or more of eight 

• 

Method 2: Number and Level of Symptomatic Criterion Scales 

A. Nona 

B. One kvel 1, all others normal 

C~ Mult1pla ievel l's. no 1ev~1 2 1 5 or 3 1 s 

0. At least one level 2 

E. At least one level 3 

M?thod 3: Number and level of 5ymptow~tic Critericn Scales 

A. None 

B. One level 1; all others normal 

C. One level 2 or 3; all others ncrm•l 

Method 4: Nu~ber and level of Sym~tomatic Criterion Scales 

Method 5 

A. None 

B. One I eve I i; a I~ others norma 1 

C. One level 2 or 3: all others normal 

0. Two at:. ant level, 1-3, all others nor~ I 

E. Three or more at any level, 1-3 

Number of Syr.,ptomatic Crl terlon Scales 

A. None 

B. One 

c. Two or more 

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We decided, therefore, to use Method 5, with three categories for the number of symptomati~ ~riterion scales at a 

given examination to classify an i,tdividual' s overall level 

of psychiatric status. These three categories were: 1) none 

of the criterion scales were symptomatic; 2) a single criterion 

scale was symptomatic; or 3) two or more scales were at symptomatic levels. Individuals with no S)~ptomatic criterion 

scales were co~sidered asymptomatic with respect to their overall psychiatric status at a given examination. Individuals 

with only one criterion scale at a symptomatic level were considered to have a mild psychiatric disorder, and individuals 

with two or more symptomatic scales were considered to have a 

ruGderate psychiatric disorder. 

Severe psychiatric disorders characterized by hospitalizations, suicide attempts, or psychC"-sis were very infrequent 

as one would expect. Theae few cases ate discussed -:.tith the 

deRcriptive findings. 

Psychiatri~ Status Schedule: Classification of Severity OVer Time 

Pinally, we investigated a number of methods for classifying 

an individual's psychiatric statu;J a~ross examinations; that is; 

an individual's psychiatric status over his entire period of 

enrollment in the stuOy. We finally were satisfied with four 

different classifications, the first two of wqich app:ied t~ single 

criterion scales, the second two of which applied to an individual's 

overall psychiatric status. 

Table 132 displays the final m~thods we used for classHying 

psychiatric status across the examinations. With re~pect to 

individual criterion scales such as subjective distress or alcohol abuse, we determined that ~o major issues were of paramount 

importance to the purposes of this contract. First, one. would 

want to know the variables •hat could predictively distinguish 

between people who first developed the!r problem during the study, 

and those who r.emained asymptomatic. Secondly, one would want 

to know what the significant predictors were for people with 

varying frequc~cies of occurrence for a given problem. 

Tb~ problem of determining the significant predictors of the 

first onset of psyr.~iatric problems was one which had not been 

developed prrticularly well in the literature in the area. Consequently, we de.viS~d a method labeled a "sliding interval" onset analysis. 

The pril:ary purpose of this design was to discover the predictors of the first onset of a psychiatric diffic~lty. Cases 

were defined as men with the first occurrenr.e of a problem after 

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410 TABLE 132 

MPthods For Classifying 

PStchiatric Status Across 

Exam1nat1cns 

Criterion Scales 

I. First occurrence of a oroblem- sliding interval onset ona1ysis 

A. Cases- men with the first occurrence of a problem after intake 

1. Exclude men with problem at intake 

2. Exclude men with unremitting problems 

B. Controls - men who never had any problem 

1. Sample in same proportion from each round as t-hose who \'Jere 

cases 

C. Pr~dictors - selected from examination preceding onset examination, 

e.g. 1 when cases we·re asymptomatic 

A. Categories 

1. Never 

2. Once only 

J. Twice or more 

B. Exclude drop-outs-true frequency unknown 

c. Predictors - intake and background variables 

Overall S.tatus 

1. Susceptlbi lity to psychiatric problems 

A. Incidence Cases - anyone who had any PSS symptomatic scvre 

after in.take, but not at intake, including drop-outs 

B. Prevalence cases - anyone .,.,ho had any PSS symptomatic score 

at intake, Including drop-outs 

c. Ccntrols - those who never had a symPtomatic score. exclude 

drop-outs 

2. Extent of psychiatric prohlems - exc)ude drop-o4t~ 

A. Mild- a single occur;ence of a single symptomat:c scor'e 

B. ~loderate- one or more symptomeitlc criteria at two or three 

exam! nat ions 

C. Severe- one or mor_e sym_ptomatic crl teria at four or five 

examinations 

0. Controls- those who never had a symptomatic criterion scoro 

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intake. Men with either problems at intake or unremitting problems were excluded from the case group. Both of these exclusions were necessary so that we would avoid predicting psychiatric problems from pre-existing psychiatric problems. Contr~ls 

were defined as :!J.,m who never had any symptomatic psychiatric 

criterion scale throughout the entire period oi enrollment in 

the study. Because predictors could vary fro~ ~ound to round 

due to historical events ar.d ulaturation of indi'liduals, the predictor data on the controls was takeri' from :;pecific rounds of 

oexaminations to match th~! cases with predictor d-.,ta from specific rounds. iredictor data were selected from an ~xamination 

pr~ced1ng the onset examinntion; that is, from a t~e when the 

ATC Was asymptomatic. Our design compared predictor data from 

cases before they became asymptotnatic with predictor data from 

those who never developed a problem on a particular criterion 

scale. Therefore, for each sliding interval onset analysis, 

individuals were simply classified as having developed a problem 

or not. There was no further differentiation in the level of 

their difficulty. 

The second method for classifying status across examinations 

on a given scale was to categorize individuals in terms of the 

frequen~y with which they exp~rienced a problem. We established 

these categories e.s: (1) never having had the problem over the 

course of the study; (2) having had a problem on a particular 

criterion scale only once; and (3) having had a particular problem ~~o or more times out of the five examinations. For these 

analyses, men who dropped out and did not have complete Psy~hiatric Status Schedule examinations were excluded from the analysis 

since the true frequency for which they may have had problems 

was not determinable. Precictors for this type of analysis 

were dra~ from intake, personality and background data looking 

forward over the course of this study to determine if there were 

significant differences between people w~o experien~ed particular 

problems at different rates. 

Trere uere also two methods for classifying an individual's 

overall t-tJyc.hiatric status across all examinations. The first 

method was concerned with the problem of determining the characteristics of individuals who were s~sceptible to psychiatric 

probl~s. This method classified individuals according to three 

criteria. Firat. incidence casea were defined as those men who 

he.t... any l:SS symptomatic criterion score after 1ntakeg buc who 

did not have any PSS symptomatic scores ~take. Men who lat~r 

dropped out, but who had developed a probl~ prior to oropplng 

ou' were considered as incidence cases, assuming they also did 

~ot have a prohiem at intake. Secondly, prevalence casea were 

defined as those men •Aho had any PSS symptomatic criterion score 

at intake. Prevalence case• could include drop-out•• since even 

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drop-outs had intake evaluations. Prevalenc.! cases t·emained 

classified as prevalence Cd&es even if new or diff.erent problems developed a!ter intake. Third, control cases were defined 

as those who never had a PSS ~ymptomatic crite~ion score. For 

the control group, drop-outs had to be excluded since the presence or absence of symptomatic scores could not be dete~ined 

after they left the study. 

Since any probl~ was sufficient to result in either a 

prevalence ~r incidence classification, the compari~on of cases 

Rnd controls result~d in a study of susceptibil1ty to p•ychiatric 

problems. Intake psychoJ .... gical characteristics, sociodemogr~plt1C 

t.hat:'acteristic:.s, personality, physiological responsivity to work~ 

and other data were used to differentiate between asymptomatic 

controls, prevalence cases and incidence ~-$es. 

The second ov~rall psychiatric status assessment was made 

according to the extent of psychiatric problems. For this classification scheme drop-outs had to b2 exc~uded since they would not 

have full data on wnich ~o classify their status. Four groups 

were defined for t~ese analyses. Acute ~ases were those who had 

a single occurrence of a single symptomatic criterion score on 

thP. PSS. Intermittent cases wer~ defined as those men who hsd 

one Or more symptomatic criteria ..:.:t two or three of the five 

examinations. Chronic cases were defined as those men who had 

one or more symptomatic criteria at four or five \.'Ut of the 

five elQID.inations. Controls were defined as those ~,., never had 

a PSS sy'lflptomatic criterion score. 

pared by their intake p•y~hological 

background data, thr.u responsivity 

health symptoms. 

Again, these 

test.s. their 

to work, ·and 

Levels of Monthly D•pression And Anxiety 

~~~ups were comsociodemographic 

their physical 

Table 133 displays the criteria by which we established 

levels of monthly d£preas1on and anxiety episodes. Level 0 was 

established at a range indicative of no or insignificart symptomatology. Although a person could have a number of symptoma and br" 

classified at Level 0, one would not conaider him to have had a 

significant problem. 

r~vela 1, 2, 3 were establishP.d to discriminate between peopl~ uith symptoms of varying intensity and medical significance. Level 1 represented deH.'Iite sympt0111s of depression (or 

anxiety), Scores in this range reflected significant depression 

or anxiety at the symptom level, but one would not necessarily 

expect peroona •coring at this level to obtain treatment. 

Having established theu levels for the scores obtained in 

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~a 

;~· ·f,-

ll .. '" .. 1i 

i!iii &1. 

;A. .... w. 
• 

TADLE 133 413 

Levels Of HonthiT Depression 

and Anx ett 

Standard 

Score Range 

~ ~ll!2!!. Anxiety 

0 

2 

25-49 

50-59 

60-69 

]()+ 

25-44 

45-54 

ss-64 

Descriptive Meaning for 

Depression (Anxl~ 

No or Insignificant sympton~tology 

Definite symotoms of depression (anxiety). 

Scores In this range should reflect the 

presence of significant depression (anxiety) 

at the symptom level, but below that 

which would ordlnari ly result !n referral 

for t rea tmen t. 

Depressive (anxiety) syo>ptcmatolcgy 

present at a level which miQht be seen 

in actual patients who present with 

depression (anxiety} as the main problem. 

Level 2 represents the syodrO'Jle level 

of an out-patient group wl th a diagnosis 

of depressive (anxiety) n~urosis. 

Depressive (anxiety) symptomatology 

present to a markad G~gree. dominatinq 

the clinical picture. This range should 

be equivalent to that seen In patients 

either hospitalized for depres>ion (anxiety) 

cr experiencing c severe depressive 

(anxiety) neurosis. 

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• 

) 
414 

any given month, we considered how many monthly responses we 

should require to assign a level for a given ioterval. Table 

134 displays the monthly respor.sts rates during the second 

interval of the &~udy. The monthly ~UP.Stionnait~s were not 

sent until a man completed hi~ second examinativn at Boston 

University. Not only had 24 men become ineligible between 

the first and second examlnations, but an additional 20 w~Le 

becoming in~ligiblc at the time of their second evaluation. 

Consequently, 4!J individual:.:~ were r..ot :;e:L&t any monthly questionnai!'e& during titc second interval as can be seen in the 

f~rst row of table 134. 

Table 134 was organized in ascending order of the number of que~tionnaices returned because it is only on rhe basis 

of returneci questionnaires th~t d1egncistic assessmenLs would 

be aadc. Cl~arly the more quP.stionnaires a man returned, the 

higher his average response rate. In fact, the overall response 

rate during this interval was 9~.6%. However, response rates 

for pPople who returned few questionnaires were ouch lower. 

Since it was :l'ossible 'hat the re'fponse rates 'Mere .1 function of th~ number of ~uestionnaires men were sent between 

their second and third evaluat:f.ons, \ole needed to determine a 

t'easonable respo•.lD.;.. tate and to es:-:abJ.ish a minimum number of 

rctt:rn'!'d questionl"'!.aircs for an individual to be giv"!n a valid 

assessme-nt fo.r the interval. 

There was a major change in Lhe response rate between 

t~ose who returned four or f~w~r questionnaires and those wh~ 

returned five or mol!:'e. If an indivic~ual ,.eturned four or fewer 

questionnaices, the responae ruta ~as at le•st 66%. Furthermore, 

five quentionnaires rep~esented at least half of the average 

interval length of 9 mouths. In addition, there were very f.ew 

people who were on the borderline level of five returned questionnaires. Consequently, for the purpose of classifying individuals 

according to their depression and anxiety between examinations, 

we established a minimum standard of at least five returned 

questionnaires. In all cases, returning five or more questiontutirea meant that an individual returned at leas·t two ont of 

the thr~e sent to him during an intPrval. 

FGr the great majority of men who returned aix or more 

questionnaires, the response rate was much higher. We f&-~ 

confident that our minimum criterion of five queationn~ires 

per ilttet:V~ pr'>vided a reliab" e and valid tiata bas1. on which 

to evalu~te a man 1 a episodic ~perienc~ of Uepreasion and 

anxiety. · 

Finally, we had to consider h~~ to classify the levels of '-·.• 

) 

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Number of 

Questionnaires 

Return?.d 

N/A<• 

0** 

1 

2 

3 

4 

5 

6 

7 

8+ 

Totals 

TABLE 134 

Response Rates During 

SP.:cond lntery_al For Monthly 

OP.pr~ssion And AnxiP-ty Questionnaires 

Num~er of Total Number of Total Number of 

Individuals Questionnaires Questionnaires 

Returned Sent 

(44) N/A 0 

2 0 0 

3 3 26 

5 10 36 

4 12 32 

3 12 29 

5 25 36 

27 162 178 

58 406 424 

262 24l2 2420 

372 3069 3211 

+(44) lnel iglble 

416 Tot<! at intake 

415 

Average 

Re.sponse 

Rate 

N/A 

0 

II. 5~ 

27.8% 

37-H 

41.4% 

69.4% 

91.0% 

95.8% 

29.6% 

95.6% 

* lne11gib1e because of changed status bv the time quastionnatres were sent 

out 

** T"ese 2 subjects exercised their right to refuse to complete these qu~stlonnalres even though they remained as study participants. 

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416 

depression and anxiety episodes over tim~. Having established 

levels for class~fying the monthly self-reports, we needed to 

establish the characteristic psychia~ric morbidity of our subjects 

during the interval between examinations. Table 135 displays 

our definitions and criteria for levels of annualized rates of 

depression and anxiety episodes. An episod~ was defined as a 

month in which a controller had a Level 1 or above s~ore. If 

a man had,at least one interval in which he returned a minimum 

of five questionnaires, then he tfas classified into one of four 

groups based on this average rate of episodes calculated across 

all intervals for which the minimum criterion of five questionnaires was met. 

An individual was classified as asymptomatic if his average 

annual rate of episodes was less than 1 month per year. An 

1n4ividual was classified as having acute episodes if his average 

annualized rate was greater than 1 month but less than 3 months 

per year. Intermittent classifications were made if the average 

annual rate was greater than 3 months but lens than 9 months per 

year. An individual was classified as having chronic anxiety 

or depression if the average annualiz~d ra:·tc of ep13odes was 

equal to or greater than 9 months per year. 

.. These classifications of chronicity were based purely on 

numbers of episodes without consideration of the levels of severity. We did examine the combined influence of both the level 

of severity and the number of episodes. These results are shown 

in Table 136. 

Table 136 displays the number of months out o£ 36 that 

individuals were asymptomatic, acute, intermittent, or chronic 

at each of the def~ed levels of depression or anxiety. For 

exuople, those subjects classified aaymptoc~tic had no Level 1, 

Level 2, or Level ;, episodes over the thret! intervals in the 

study. The s•D ~f months do not total 36 ~xactly because of 

roundL..g error ir~ the annualization calculations for each intt!rval. 

Clr·•rly the ovcr:Ul cl~as!.ficlltion based on n=ber of 

epis(tdF.Is waa ~asociated &lao With ae.verity of episodes. P"\r 

exaaaple the chr('ln!c group had a~ven times the ann:.~al rate ... ! 

Level 2 d~pressive episodes aa the intel.'IIIJ.ttent group, and the 

!.nteruaittent grou;> had t,;,ico th& annual rnte of Level 2 

•Pisodco as the acutc group. lin the otheJ: hsnd, the Level 3 

epiaodai ot dep-.::-ession were experit~.l.r-ed about eq·ually by the 

three r.linical grou~s. 

The same pictvre held t::,la for ar;:tietv. The chro:1lc 

group (ao expected bt drfinition) ~Ad the highest annual rate 

• 

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rABLE 135 417 

Levels Of Rates Of 

lsodes From 

Examinations 

Episodes: defined as Level o_r above for a s i ven month. 

Annualized rate: defined as the average number of months per year an 

indiviJwal experienced episodes of depression or anxiety 

calculated for ea~h between- examination interval. 

Subjects: 

levels: 

an Individual received an Interval annualized rate only If 

he returned at least five monthly questionnaires In an Interval. 

Asymptomat!£- average annualized rate of episodes less than one 

montl1 per year 

Acute- average annualized rate of episodes equal to or jreater. 

~one morth but less than three months per year 

lntermftte~t ·average annualized rate of episodes equal to or 

greater than three months but less than nine months per year 

Chronic- average annualized rate of episodes equal to or greater 

than nine months per year 

NOTE: The average annualized rates were rounded off according to th~ following 

algorhythym: 

Actua 1 ave:~age 

o.oo-o.55 

0.56-2.95 

2.96-8.95 

8.96-12.00 

Ro~nded to 

o.o-o.5 

0.6-2.9 

3.0-8.9 

9.0-12.0 

~crlptlve label 

Less th6n one month per year 

Gr=ater than one but less ths~ 3 

mc.nths per year 

Greater than 3 but less than 9 

mnths per year 

Gr~ater than or equal to 9 months 

per year. 

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\..~,~~(~~~.: 
.. 

Over a 11 leve I 

Classification of 

A'1erage rlnnual Rate level 0 

Asymptomatlc1 35. lit 

Acute 2 32.06 

lntermi ttent3 20.33 

Chronic 4 4.82 

TABLE 136 

Overa11 Annualized Rates* 

0! Depression And Anxiety Episodes As 

A function Of The level of Episodes 

R~tes of levels of Episodes 

Depression Anxiety 

leve I I lcve_!__l level 3 lev~l 0 leve I I 

HIA II/A N/A 35- 16 Nlt.. 

2.30 -53 .22 32.44 2.39 

13.84 .sa .JJ 1].63 16.11 

2).4(. 6.67 .43 4-37 26.99 

level 2 leve I 3 

li/A N/A 

.43 • I I 

.]6 .25 

3-99 .oo 

*Based on the sum of three inter'i~:sof ca1culablt: annualized rates to yield figures representing the 

number of 1uonths o~t of 36 that an individual had episodes of the particular level; total N with 3 

intervals • 271; N/A•not ap~lica~Je by definition 

Depression, N•l78; Anxiety, N-187 

2 

Depression_ N•66; Anxiety, N•57 

3 

Oepres~ion~ N=l8; Anxiety, Na18 

4 

Depression. N•9; Anxiety, N-9 

.. .... 

~ 

.... 

co 
• 

of Lev~l 1 anxiety episodes. In addition, they hnd more than 

four times the rate of Level 2 anxiety episodes com~ared to 

the intermittents who themselves had three times the anxiety 

episode rate of the acute group. The results for Level J 

ailX.Lety episodes were not clear. For some reason the chronic. 

anxiety group had no Level 3 episodes of aaxiety. The intermittent anxiety group experienced Level 3 episodes at a rate 

of l in 12 years. The acure group experienced a Level 3 

anxiety episode at a rate of only one in approximately 30 

years. Thus Level 3 anxiety episodes werp_ extremely rare 

on the whole and were not particularly associated with the 

overall level classificatiOn based on the average annual 

rates. 

These results indicated generally that subjects classif419 

ied as chronic according to their average annual rate of episodes 

had not only more episodes but also more severe episodes than 

those classified as intermittent or acute. This finding was 

true for both anxiety ·and depression. As a consequence of 

this linding we were able to simplify our overall classification 

of levels to that based simply on the annual average rate. 

Before making this decision we checked to see how well 

the annualized rate in each interval was correlated with the 

overall annual rate across all intervals. We also checked 

how well the rates calculated- for ea·:.h o.t; the three intervals 

correlated with one another, and finally we examined whether 

or not the number of intervals influenced the average annual 

rate that was calculated. 

Table 137 displays theae final checks. Ae can be seen 

in Part ·A.of this t~ble, the annual rate calculated for any 

given interval was very highly related to the· average annualized rate across all intervals. The correlation's were above 

.9 and approximately equal. 

Part 8 of Table 137 shows that the annual rates calculated for each interval were highly correlated with one another 

for both depression and anxiet7. That ia, the assessment of an a.no•1ual rate of epiaodes during one interval wa• quite comparable to the annual rate calculated tor another interval. 

These cnrrelationa, however, were not aa high as the correlations-between the intervale and the overall annualization 

rates, which augges_tad that a given interval could not be 

used to represent the entire experience of d@pression and 

. onxiety epioodes. On the olher hand, the overall ~verage annualized rate well represented the experience of anxiety and depreos!on episodes by individual contrcllers. 

• 

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421 

Part C of Table 137 displays the correlations between the 

number of valid intervals and the rates calculated for them. 

There were no significant relationships between the number of · 

valid intervals and the annual rates either over all intervals 

or for any given interval. Consequently we were assured that 

the number of intervals did not influence the annual rates. 

After making these various checks, we were confident about 

using our overal: level classification based on the average 

annual rate for depression and ~nxiety episodes. In the remainder of this study the classification of individuals based on 

monthly psychiatric morbidity is reported in two ways--first, 

in terms of the overall average annualized rates of episodes, 

and, secondly, in terms of 'the asym?tomatic, acute, intermittent, 

and chronic groupings. 

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• 

SUMMARY 

Prevalence and Incidence of Psychological 

Health Change 

Over the three y~ars in the study, 32.5% of the controllers 

remained symptom free in our five criterion areas of psychiatric 

status. About one quarter (23.8~) of the ~en had some significant' symptom.;,;tol~gy at intake and an additional 28.1% manifested significaul problems after, but not ai:, intake. A few 

mon (15.6%) were asymptomatic up to the point they dropped out 

I?ut their later status w~.s not known. 

The prevalence of sign~ficant symptomatology was 12.7% for impulse 

control disturbances, 7.6% for mate role problems, 7.5% for alcohol 

abuse, 6.01. for subjective ·iistress, and 4.1% for work role distt,arbances. 

Alcohol usc and abuse _were in•Jestigated further. Using a stanCarY protocol, 4Z-61% of tbe controllers were classified as 

heavy drinkers com~a=ed to 28-31% of a national sample of men, 

depending on the age group but controlling for race artd socioeconomic status. On the other hand, we found that 7.5% were 

classified as alcohol abusers Using behavioral and psychiatric 

criteria and less than 1% were alcoholics using strict physiological ~ritefia. Other data indicated that most drinking was 

used as a copir~ mechanism by the men. 

In terms of the overall extent and severity of psychiatric problems for three years, 2.9% of the men were hospitali~ed for 

psychi.:ttric reasons, 127. ;,ad chronic problems, 22.4% had interoittent problems, 14.95 had an acute problem, 32.5% ne,er had 

a criterion problem-in five evaluations, and- 15.4i~ had no problem 

by the time they became ineligible for further evaluat~on. 

Evaluations of the average monthly Qorbidity due to depression 

revealed that 4. 2% had chronic depression (nine or more monl'l:s 

with an episode of depression in a year), 6.8% had intermittent 

depression (3-8.9 months in a year with an episqde), 22% had acute 

depression (.6-2.9 months in a year with an episode) and 66.8% 

had no, or very infrequent depressive episodes. 

The monthly morbidity of anxiety was quite similar with 2.8% 

experiencing chronic anxiety, 6.8% having intermittent anxiety, 

20.5% having acute anxiety epi~odes and 69.9~ having very infrequent or no anxiety episodes over ~wo and a half years. 

• 

• 

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423 

The monthly morbidity rate of depression was not significantly 

different from that of other non-patient groups while the monthly 

morbidity of anxiety·was less than that of general non-patient pcpulations. 

) 

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3. 

425 

Prevalence of Significant Psychiatric Symptomatology and 

~rbidity of Depression and Anxiety 

Table 138 dis~lays our findings of significant psychiatric 

B}~ptomatology in the PSS examinations at Boston University over 

the three years of contrOller participation. These findings relate to the individual symptom criterion scales. At intake, 6% 

of ,the controllers were experiencing significant subjective distress, representing primarily depreesion and at~iety. By the 

end of the study, 12.5% had experienced significant subjective 

dis~ress proLlems at least once in the three years. The prevalence figure of 6% at intake was samewtat below the pre~alence 

figurr. of 9.9% in an urban community sample, calculated from 

data ?rovid~d by Or. Jean Endicott of the Evaluation Section, 

New York State Department of Mental Hygiene and originally 

collected. by Dr. Bruce Oohrenwend (see Table 127). Thus the 

controllers experienced 39% less aisnificant subjective diutress 

than did the urb&n community sample. However, as 58% of the 

community sample were women, the data are not fully comparable. 

~o better comparisons were found. 

impulse control disorUers as assessed by the PSS primarily 

reflect the inability to control anger, drug abus.e, and antisocial behaviors. As seen in Table 138 the aJ.r traftic control.-

lers experienced a relatively high ?rop~rtion of tmpuls~ control di"Jturbances compared to the urban community 9411'-Vle noted 

above. I.n fact, the controllers had four times the prevalence 

of impulse control disturbances compared to this group. By 

the end of the study, almost one-third of the controllers had 

manifested some prc:,l(...a with impulse control. This result was 

confirmed by our-fincilngs on the Califo~n1a Psychological Inv¥-ntory (see Section IIIB3). In ~hat section we noted that controllers scored very low on theiz:· responsibility and socialization scales of the CPI, whiah reflect dimer.aions of .tmpulse. 

control problems. 

The work role disturbance scale of the PSS asseseea whether 

or not the psYchiatric status of an individual interferes significantly with his job performance according to a number of 

criteria. For this dimension of pa}'chiatric dysfunction, the 

controllers had a prevalence of 4.1% compared to 2.1% of the 

urbe.n community sample. The high rate of work-related di<turbances waa understandable in light of the high level of impC~lse 

cont=ol disturbances experienced by the contrullers, since one 

would have to have other psychiatric problema before one cocld 

find disruptive functioning in the occupAtional role. 

The mate role scale of the PSS aasessea ,hether or not 

there is dy•function in the mate ~elatior.ship of the individual 

in terme of activities, sexual functiouina, coDDUnication pat-

• 

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) 
426 

Tota I Percent 

TABLE 138 

Pre'lalence Of s:snl flcant. 

Psychiatric Srmetomatolcgy 

By PSS Examination 

Percent ATCs Percent of 

Symptomatic Urban Cormwnl ty 

Number Asymptomat I<. at Sample Symptomatic 

of at Intake at First 

ATCs Intake iPrevalence~ Evaluation 

416 94.0% 6.0% 9.9% 

416 87.3% 12.7% ). 1% 

416 95.9% 4.1% 2.1% 

)842 92.4~ 7.6% 6.1% 

416 92.5% 7.5% 2.)t 

111.0.1:·3 for complete comparl son data. 

384 of 416 were married or had a cohaDI tat ion mate. 

Percent ATCs Who 

Had or Developedthe Problem 

at Lea$t Once 

In Three Years 

12.5% 

)0.)% 

2).8% 

21.6% 

19.0% 

) 
427 

terns with the mate or social patterns ~f the couple. The prevalence for controllers with this problem was 7.6% compared with 

6.1~ for the urban community sample, e~sentially the same rate. 

Approximately one in five controllers had a disturbance in mate 

rol~ functioning at some time over the three years of the study. 

Finally, the symptom criterion of al~ohol abuse was evaluated and the controllets experienced a prevalence Of 7.5% at intake, compared with a prevalence of 2.3% among the urban community sample. One needs to exercise restraint in interpreting this 

comparison because of the sex differences in alcohol use and 

abuse, and the majority of women in the commCJity sample. In 

addl.tion, it is quite likely that ttte urban sample was underrep~>rting thei~ use of alcohol. 

Since alcohol abuse waa mentioned very frequently by the 

air traffic controllers and by the facility administrators as 

a problem area, we undertook a particularly intense and detailed 

examination of alcohol use and abuse problems among air traffic 

controllers. These results are presented separately fOllowing 

the other findings, but generally, the 7.5% prevalence of alcohol 

abuse problems among the controllers at intake is similar to Northeastern USA prevalence of persons defined as problem drinkers and 

alcoholics (Chafetz, 1974), but is low•r than prevalence figures 

for a nimilar occupational group (Cahalan, Gisin, Grirdner~ Smith, 

1972). Hence although the prevalence of alcohol abuse was higher 

than that of the. urban community sample, it was comparable to, 

or even slightly lower than, a more appropriate comparison group. 

Table 139 displays the frequency of occurrence of significant psychiatric symptomatology for those men who were studied 

all five ttmes by PSS examination at Boston University. These 

results differ from the preceding in that any ~n who did not 

have all five evaluations was not included and hence the total 

percentage of men experiencing a problem is slightly, but llOt 

greatly, different.. 

The frequency of occurrence of significant psychiatric 

symptomatology was notable primarily becuuse of the r~latively 

low rates of occurrence of problema two or more times during 

the three years. The single exception to this observation was 

impulse control disturbances, which occurred in approximately 

15% of the m~.c. tw:> or uore times. 

Tab~e 140 eddre•a"s the final overall psychiatric atat•Js 

accorded each man a~ a r2sult of his examinations at Boston 

University. Tha table diopleys the results using our two methods 

for C:!!acribing a man' a overall ps~·ct:.iatric st&tua. Part A of 

) 
428 

Symptom 

Crl ter I on 

Subjective Distress 

Impulse Control 

Work Role 

Hate Role 

Alcohol Abuse 

1 

TABLE 139 

£c~uency Of Occurrence 

Ot'Signiflcant Psychlatrl~ 

Symptomatolo~,y In Tl•?se Studied 

All 5 Times By PSS F.xamlnatlon 

Total % Exeerlenclns 

Number 1 of ATCs ~ Once 

307 8?.9% 7.2% 

307 74.3% 11. 1% 

3052 80.3% 14.4% 

271 3 30.1% 11 .4% 

307 81.1% 9.4% 

Twice or Hore 

4.9% 

11,.n 

5.2% 

8.5% 

9.1.~ 

Only those evaluated all S times are Included, lncludl.1g men who were 

disqualified from the study. 

2 

3 

Two men had not worked due to physical Illness for an entire 

Interval between examinations. 

113 men changed their mate (not Just spouoe) status at different 

examinotlons and therefore did not have 5 evaluations. 

• 

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• 

) 

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I 
TAIILE 140 429 

Overall ?~ychlatric Scatus 

A. Zusceptlblll ty to Psychiatric Problems In Three Years 

Any Any Total Who 

No Proh l ems- flo Problems New P rob I ems Had or Developed 

Income; fete* Problems at ln!ake After Intake A Pt?blem 

Number of 

ATCs 65 135 99 117 2~6 

%of 416 15.6% 32.5% 23..8% 28. 1% 51 .9% 

B. Extent of Psychiatric Problems In Three Years 

No Problems- Uo InterIncome; Jete* Problems ~ ml ttent Chronic 

Number of 

ATCs 65 135. 65 99 52 

% of 416 15.6 32.$ 15.6 23.8 12.5 

No Problems- No Inter- Psychiatric 

Number of 

I ncofl'lle: I e te* Problem• ~ mit tent Chronic Hospltallzutlon 

ATCs 64 135 62 93 50 12 

% of 416 15.4 32.5 14.9 22.4 12.0 ?..9 

• These subjects had no problems before dropping out and their later status 

was not fully assessed. 

.. 
430 

Table 140 displays the prevalence of problems according to 

suscePtibility categories discussed earlier. Sixty-five men 

were classified as having no problems, but this was a resul~ 

of their having incomplete data. We classified them separately 

since we felt it was unjustified to consider them the same as 

those who had no problems at all. ' 

OVer the three years in the study 32.5% of the men, or 

135 individuals, had no problems on an>· of the five PSS symptom 

cr-iterion scales. They were co::tpletely asymptomatic. Ninetynine men, or 23.8%, had one or more significant problems at 

intak<o. 

One hundred aud seventeen men, or 28.1%, devQloped at least 

one problem after intake into the study. This group of men did 

not have any problems at intake, but developed them late~. 

Finally, Table 140 shows that 216 men either had a pl'f>blem 

at intake or develo?ed a problem subs2quent to intake. Slightly 

over half of the men initially enrolled in the study manifested 

some psychiatric problem either at intake or during the three 

years. Thus, the susceptibility of air traffic controllers to 

psychiatric problems was quite high when one considers that by 

the end of the study, half of the men had at least some psychiatric problem or psychological dysfunction. Unfortunately, thera 

is no comparison group to help interpret whether this figure 

is part!cularly high relative to any other occupational groups. 

However, the magnitude of this value certainly suggests a high 

prevalence of psychological difficulty.· 

Part B of Table 140 displays the results of our assessment of the extent uf psychiatric problems in three years as 

opposed to the susceptibility to different problema. Part B 

of the table is split into two parts, the first including 

psychiatric hospitalizations in the general statistics, the 

second displaying honpitalizations separately. 

Again, s1xty•f1ve men had no problem5 by the time they 

dropped out of the study, but since they did not have full 

assessments, it was impossible to desrdbe accurftely the 

extent of psychiatric problems they may have had throughout 

tha three years. Consequently, their data w~s considered 

incompl~te. The group with no problema is exactly the Dame 

group ao in Part A of Table 140. Sixty-five men, or 15.6%, 

had an acute psychiatric problem, which by def~•ition meant 

that they had only one significant evaluation of one psychiatric problea over the entire three years. Another 99 men 

had one or more problema At cwo or three paych1ntr1c evaluations. These men were defined aa having intemittenc 

) 

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431 

psychiatric problems, and they comprised 23.8% of the original 

group of 416 men enrolled in the study. Men who had one or 

more problems at four or five of the evaluations were defined 

as h.lJving chronic problems. Ther~ were 52 such men or 12.5% 

of the original study gr~. 

The second half of Table 140, Part ·s, groups those men 

who had psychiatric hospitalization into a special category. 

Three men who were hospitalized for psychiatric. r~asons had 

been defined as having acute problems. Six had intermittent 

p~oblems, and two had chtonic prorlems according to our assessments. Thus a total of 12 men were hospitalized for psychiatric reasons, or 2.9% of the original group. SincP. these special 

cases would s~emingly indicate partic~larly significant psychiatric difficulty, we examined their data somewhat more closely 

across other variabl~s. 

T&ble 141 displays the reported diagnosis, the assessment of ,aychopathology at intake or later in the study, the 

extent of psychiatric problems, the burnout category and the 

FAA award category for these men~ The reportecl diagnoses 

were obtained either from the medical records of the hospital 

or were l-eported directly by the subject on ei.ther a Monthly 

Heat~h Review or during a psychiatric examination. Five of 

the twelve men had been hospitalized twice dudng ~he study. 

The reported diagnoses were all psychoneuroses or alcoholism. Alcoholism •=counted for 33% of the psychiatric hospitalizations. The remaining diagnoses were basically anxiety or 

depressive neuroses. 

With the ex~eption of ono. man, the hos~italized subjects 

were found to have had at least one psychiatric problem on 

the Psychiatric Status Schedule evaluation. The single man 

who did not manifest problems on the Psychiatric Status Schedule 

also was found to have no prnblem& in terms of the extent of 

psychiatric problems. He was not classifiable according to ~ 

our burnout category because of incomplete data, and he iell 

in the high average category for FAA ...,arda for performance. 

This man would seem to be somewhat of an Qn~maly since we had 

no data substantiating his difficulties sufficient to require 

hospitalization. 

Eleven of the 12 men were found to have some psychiatric 

difficulty on their Psychiatric Status Schedule evaluations. 

In addition, our Lurnout classification of men (which used 

>rod< role pathology as one of four indices) had defined t\10 .. 

men as caseS of definite burnout, 7 men as preclinical, and 

• 

• 

• 

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4:.12 

2 

Anxiety ~leurosls• 

Depressive Neurosis 

Psyehoneuros i s,'c 

AlcoholIsm 

Alcohol ism 

Alcoholism 

A•xlety Neurosis• 

AnxietY Neurosis 

ter Disorder 

I Ism 

Neurosis* 

ros Is* 

1 

TABLE 141 

Psychiatric Hospitalizations 

1 N • 12 Hen 

Extent of 

Problem at Psychiatric 

lnt·ake or Prob I ems on Burnout 

Later PSS Exams Category 

None None N/A 

Later lntermi ttent Prec II n I ca I 

Later Acute Preclinical 

Later lnterml ttent Definite 

Later Chronic Preclinical 

Later Acute Preclinical 

Intake Intermittent N/A 

Later Acute Prec II n I ca I 

Intake lnter;nlttent Mixed 

Intake Chronic Preclinical 

Later IntermIttent Definite 

Later Intermittent Preclinical 

From medica I record or reported by subject 

2 

FAA 

Award 

Catesoa 

High Average 

Low Average 

High Average 

N/A 

Low 

High 

Low 

Low 

~ow 

Low 

High 

High Average 

S of the 12 were hospitalized twice. These are marked with an asterisk (*). 

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one man as a mixed case of positive and negative aigns. Hence, 

75% of these men were classified as being pre-~l~nical or 

definiee cases of burnout (See Section lllE for a more complete description of the meaning and significance of these 

burnout outcomes). ' 

433 

We also had collected data on a number of different awards 

men received from the FAA for their occupational performance 

(see Section !liE). Table 141 shows that five of the twelve 

hospitalized men were in the very lowest category of FAA 

performance awardo. On the other hand, another five men fell 

in the highest category of FAA awards for performance. And 

fin4lly, one man received a low average number of awards. 

One man could not return for the fifth evaluation during 

which this information was collected and therefore could 

not be classified in terms of FAA performance. These data 

are important to note because they certainly sujsest that 

psychiatric hospitalizations were not related to performance 

in terms of the awards th~ FAA would make for such performAnce. Because of the nature of the data, we were not able 

to determine whether the a~ards were made before or after 

psychiatric hospitalization, but regardless of that fact, it 

is important for t:vo reasons: If me1;. received iheir performance award before hospitalization, then clearly their performance was not particularly ass·ociated with later hospitalization. 

On the other hand, if awards were made after psychiatric hospitalization, then the significance of their psychiatric problem did not necessarily interfere with th~r performance on 

the job. Hence, although our descriptive results have indicated 

that certain particular problems such as impulse control disturbances were quite prevslent among controllers, and that psychiatric problems as a whole uere experienced by approximataly 

50% of the men over three years, psychiatric difficulties may 

not necessarily affect or be related to work performance of 

air traffic controllers. Findings presented later in this 

report on the predictive association between certain variables 

Ruch aa the amount of work done, the amount of time spent working, 

and other of the job measures provided additional support. for 

this ougges t icn. · 

As ~revioasly d~sc~ibed, we also evaluated the monthly 

morbidity of depreosion and anxiety. Table 142 displays the 

prevalence of montluy depression by interval and by the overall 

averase annual levels as previously define.d. During the intervals beewcen examinations, only 3.1% to 5. 9% of the men experienced chroni~ depressi~n; 2.6-7.0% experienced intermittent 

problems; and 7.9-11.8% experienced acuta problems during the 

intervllls. Dur:utg any given interval 76.3% to 80.3% of the 

men experience~ no significant depreoaivft symptomatology. 

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TA.BLE 142 

~2lence Of Monthll 

Oee_ression 8•; 

Interval And Over a II A'1era9e 

Annual Level 

Ov:!ra II Averagt= 

Interval 2 lnterva I l lrterval 4 Annual Leve I* 

Level _ N ___ %_ _N ___ %_ _N ___ % _N _1_ 

Asymptom~tic 271 76-3 245 80.3 218 79-0 235 66.8 

42 11.8 24 7·9 34 8.2 79 22.2 • 

Intermittent 25 7.0 18 5-9 II 2.6 24 6.8 

17 4.8 18 5-9 13 3· I IS 4.2 

355 ~OS 276 353 

) 

on the average annualized rate over the three intervals for the 

353men who had one or more lnter,al rates 

i. 

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With respect to the overall average annual level of ~he 

depressive episodes experien~ed by men over the three years, 

66.8% were asymptomatic the entire time, 22.27. had acute 

episodes, 6.8% had intermittent episod~a, and 4.2% had 

chronic difficulties. If one considers the intermittent and 

chronic groups to have the mor~ severe episodes of depr~ssion, 

as was shown in Table 136 then approximately 11% of the men 

experienced significant depressive episodes at a level certainly suggesting a need for treatment. This 11% fi~ure is 

very .similar to that found in psychiatric epidemiolocical 

studies of depressive disorders in the general population 

(Barrett, Hurst, DiScala, Rose, 1978). 

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Table 143 displays our results on the extent of monthly 

anxiety by intervals and according to the overall average annual 

ll!vel. It can be seen that 3.9 - 4.8% of the men experienced 

chronic anxiety during the three intervals between Examinations 

2-5. In addition, 5.n to 6.9% of t<te men experienced intermittent anxiety episodes, and 6.9% to 13% of the men experienced. 

acu~e episodes of significant anxiety. Seventy-six percent to 

83.3% of the men experienced no anxiety at all during thase 

intervals between examinations. 

Considering the overall extent of monthly anxiety over 

the three years, we found that 2.8% experienced chronic anxiety 

episodes, 6.8% experienc~ci intem.ittent episodes. 20.5% experienced acute episodes, and the temaining 69.9~ were asymptomAtic 

over the entire period of the study. 

The extent of anxiety and depressicn on a monthly basis 

was very similar, and in fact, it was quite common for men with 

depressiv~ problems also to have anxiety problems. The important point is that the more severe int~rmittent and chronic 

levels were experienced by only 9.6% of the men with respect 

to anxiety and 11.0% with ~espect to depression. As previously 

noted, these figures are very similar to those found for other 

populations of non-psychiatric patients. 

Psychological problems, including some psychiatric syndromes, were quite prevalent among the men in the study. Slightly 

more than half h:td at least one psychiatr~c difficulty. The 

mo3t prevalent psychiatric difficulty was impulse control 

disturbance• which reflected a relatively high·number of men 

who had an inab:lli ty to control overt ange:!'. anti-social impulses, 

and illicit drug use. Alcohol use was q1.~1te high. but alcphol 

abuse vas about the same as in comparable groups of subje,ts. 

A1~ioty and depresaion were experienced at levels equal to or 

less than that experienced in s~neral populations of non-patientw. 

The experience of psychiatric pro~lems was not particularly 

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TABLE 143 

Prevalence Of Monthly 

Anxiet~ Bt Interval An.d 

Overall Average Annual Level 

Over a i I Average Interval 2 Interval l Interval 4 Annual Level* l:ml N -'- !L _% __ L _%_ _N_ .i._ 

AsymptomatIc 270 76.0 254 83.3 227 82.2 ?46 69.9 

Acute 46 13.0 21 6.!) 19 6.9 73 20.5 

lnterml ttent 

! 

22 6.2 18 5.9 19 6.9 24 6.8 

Chronic IZ 4.8 12 ~·2 11 4.0 10 2.8 

Totals 355 305 276 353 

• 

88sed on the average annualized rate over the three intervals for the 

353 ""'"who had one or more Interval rates. 

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related to FAA performance criteria, ~ut on the other hand, 

these problems in turn affected the men's work role performance. Psychiatric problems in mate rvle relationships were 

experienced at approximately the same rate as amo~g the urban 

community group, and therefore, we would conclude that mate 

role difficulties were not more frequent among air traffic 

controllers than among others. Finally, since alcohol usP. 

a~d abuse were problem areas of great concern to both the air 

traffic controllers and management, we made an especially 

detailed evaluation of this problem area which is present~d 

in the next section. 

437 

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4. Al~ohol Abuse 

Information for, the assessment of alcohol use and abuse, 

drinking behavior and consumption patterns was collected by 

use of the 16-item alcohol abuse scale of the Psychiatric 

Status Schedule, by an eight-item scale generated by factor 1

analysis which assessed the ATCs' use of alcohol as a coping 

mechanism, and by a set of questions r~lative to frequency, 

amount, v~riability and volume of alcoholic beverage consumption. 

Problems with Alcohol Revealed By The PSS 

the symptoms reported most frequently were the following: 

they keep drinking at times even though they feel they should 

stop; they admit to becoming regularly intoxicated; they report periods in ~o~"hich they cannot recall what occur ... :ed the 

night before, and while alone, they have three or more drinks. 

The symptoms reported least often were those associated with 

physiological functioning and generally indicative of the 

symptom cluster labeled "alcoholism. 11 The distribution and 

ranking of symptoms indicated that the type of problem experi-

"nced by the ATCs was generally a psychological dependence 

cather than physiological addiction. 

the relationships between ether psychiatric difficulties 

alcohol abuse are displayed in Table 144. From 69% to 

of the sample experienced neither psychiatric problems 

alcohol problems at a given evaluation. In two-thirds of 

cases in which problems related to alcohol did occur. 

: appeared in conjunction with other psychiatric. difficulties 

es impulse control, mate role imp~irment and work role 

'rment. These findings indicated that difficulties with 

ol were assOciated with difficulties in other areas as 

• Coping bJ Drinking Factor of tne ATC Questionnaire 

alcohol usage as a means of ur.winding fzom work-rel~ted 

t· and the effectiveness of drinking as a means of coping 

~k-related difficulties. High scores were indic~tiv~ 

.ively frequent usage of al~oh~l as a means of copir.g 

·ess or tension. This scale revealed that drinking as 

)f unwir.ding after work was a fa!~ly r~gular occurrence 

:ollers. Approximately 504 wE._·~ inclined to drink as 

means ci" •mwir-ding on 15 ol 20 working ·dEJye. Sixty to 70% 

that wh~n they did drink. it was effe~tive in helping 

.em to unwind and relax. The results shown ir~ Table 145 

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2 

3 

~ 

5 

No 

Pre~ I em 

H(%) 

305 03. 3) 

273(69.6) 

251 (71.9) 

. 216(69.0) 

280(72.2). 

TABLE 144 

Overlap Between Psychiatric Problems And 

Alcohol Abuse Ar Each PSS f.Ja I .~at ior. 

Psychiatric Psychiatric Problem without Problem and 

Al coho! Abuse . A I coho I Abuse N(%) N (t) 

80(19.2) 20( 4.8) 

95(22.8) 17( 4. I) 

61(17.5) 21(6.0) 

65(15.6) 21(6.7)· 

7~(!8.3) 23( 5.9) 

. ·-·-·---.~. -·--

...... 

Alcohol Abuse 

Or, I y 

N (%) 

11(2.6) 

7 ( I. 8) 

16( 4.6) 

II( 3.5) 

9 ( 2. J) 

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!ABLE 145 

Correlation Matrix: Exam One Through Five 

For Coping By Drinking Scale 
441 

also indicated that the ATCs exhibited a high degree of stability 

in their use of drinking to cope. 

Categorizing the aen into low, moderately low, and moderately 

~igh and high users of alcohol for coping purposes and then cross-

· tabulating the classifications at the different examinations resulted in the finding that between 57% and 60% of the c~ntrollers 

remained in the same category from exam to exam. About 10% of the 

men consistently relied on hea~ alcohol usage every day of the 

month to cope with tension from the job. 

Alcohol Use As Revealed By Quantity-Frequency-Variability Measures 

I 

Frequency of drinking: 

A special interview questionnaire about alcohol use was devised 

for the fourth and fitth examination visits. A systematic evaluation of the frequency, amount, variability and kind of alcohol 

usage was cond-ucted. The different types of alcoholic beverages 

were combined by using pure ethanol equivalents. the frequency of 

drinking represents the number of times that the individual drank 

iu the course of a week, month or ye11r. Table 1••6 indic.ates that 

about 36% of the controllers drank nearly e'rery Jay and another 

20% drank three or four times a week. Cumulatively, about 56% 

drank at least three or more t~es a week; only 7% did not drink 

at all (abstainers). 

Quantity of Alcohol Cons~ed: 

Data on the amount of alcohol consumed is presented in Table 

147 in terms of the number of ounces consumed per week. About 

31% drank betwe~n 1 and 7 ounces; 21% drank betwe~n 8 and 14; 

and the remaining 41% drank 15 or mere ounces per week. The 

mean consumption for ExaminAtion 4 was 16 ounces per week, while 

for Examination 5 it was 14 ounces. The correlation between 

reported alcohol conaumptiQn at Examinations 4 and 5 was .64. 

Quanti tv-Frequency-Variability: 

Table 148 indicates th~t approximately half of the ~rca 

were heavy drinker& (botween 47% a.~d 54%) while about a third 

were liaht or infrequent drinkers, or abstainers (32% to 39%), 

Drinking Occasions: 

The controllers were asked if th~y drank more on their daya 

off or their workdays after work, or if it did not make a difference. Host controllers indicated thkt their drinking practtcea ~ere the &Rme for workdays after '~rk and days off. 

) 
442 

TABLE 146 

Frequency Of Drinking Alcoholic Bever'lges Amo.ng ATC Study Sample 

Fre9uehcy , Exam·' 4 Exam 5 

N(t,)"" N(%) 

l. 

2. 

3. 

4. 

Two times a day 2 (. 7) l (. 7) 

Nearly every day 107(35.2) 107(35.2) 

H times a week 62(20.4) 58(19.1) 

1-3 times a week 74(24.3) 78 (25. 9) 

2-3 times • month 17( 5.6) 20( 6.6) 

About once ~ month 15( 4.9) II ( 3 .6) 

Less than once a month/ 

at least once a year 4 ( I • 3) 7 ( 2. 3) 

Never 23( 7.6) 21( 6.9) 

are adjusted to Include those ATCs present at both ~xam 4 and 

5 and Include only journeyman controll•rs. (N-304). 

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Total 

TAB!.E 147 

Quantity Of Alcohol Consumed By ATC Study Sample 

1n Ounces Per Week, As Reported In Round~ 4 And 5 

Consurr.e:tion: Exams 4 and 5 

Ethanol Eguivalent 

Ounces Pe~k Exaon 4* Exam 5* 

N(%) N(%) 

0 23( 7 .4) 26(6. 7) 

1-7 92(29.8) 131( 6.7) 

8-14 67(21. 7) 83(21.4) 

15-21 37(12.0) 56(14.5) 

22-28 34(11.0) 36(9.3) 

29-35 '21(6.8) ·2S( 6.5) 

Over 35 35(11.3) 30( 7.8) 

Mean 16.37 14.20 

S.D. 16.45 14.2 

N 309 38J 

Range 0-140 0-120 

All men who were eva I uated were lncl uded. 

443 

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TA.BLE 148 

Quantity-Frequency-varlabil ity Classification 

Exam 4-' Exam 5'" 

N t N t 

164 54.1 144 47 .. 5 

Drinker 42 . 13.9 40 13.2 

70 23.1 91 30.0 

t Crlnker 4 1.3 7 2.3 

21 7.6 21 6.9 

Totals 304 100.0 304 99.9 

are adjusted to Include those ATCs present at exam four and five 

ude only journeyman controlle.rs. . 

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Type of Bev~rage: 

For those controllers \rho drank, the beverages ID"Jst frequently cons11med were hard liquor and beer, while wine represented the least frequent beverag~. 

Comparison of Controllers to National Survey SampleS on QuantityFrequency-Variability 

The special alcohol que.stionnaire gi'\t..!n at the fourth and 

fifth examinations enabled us to compare the cor,trollLrs to 

adult males of similar demographic characteristics. National 

s~rvey data using the same questionnaire was available for comparis,n. 

Compared to the national survey ~esults, ATCs were heavy 

dririkers about four times more often than those in the national 

surVey. Both samples had similar prevalences of light and moderate drinkers. Controllers were also 4 times less -likely to fall 

within the abstainer group {Table 149). ----

Age was a posRible influence on the difference between 

national and ATC drinking prevalences. Table 150 indicates 

less drinking aR age increases £or the- nat:tonal survey as well 

as for controllers. In t:erms of heavy drinking, the national 

survey results were unaffected by age ~thile heavy drinking 

tenae<i to decrease with 8.~ among controllers. Overall, controllers had a higher percentage of drinkere and heavy drinkers. 

Medical Diagnoses of Alcoholism 

We declined to make poychiatric diagnoses_ in order to avoid 

t~e pejorative implications and the unreliability associated 

with these diagnoses. However, in the medtcal sphere, the internist 

for the study rendered diagnoses based on medical history, physical 

examination, serology, urology, radiology, monthly self-reporte, 

and hospital records. Diagnoses rendered on the basis of thes~ 

data were considered more reliable and subject to specific physical 

findings and symptoms. Thus, diagnoses of alcoholism made by 

the internist represented physiological addiction with substantive 

physical findings present. 

The internist diagnosed alcoholism for one man at intake and 

three men after intake. Thus, the tothl number of men receiving 

diagnoses of alcoholism on physiological grounds was four, or 0.97%. 

These men had findings of liver disease, tremors, peripheral neuropathy, blackouts, and other physiological symptoms ?f addiction to 

alcohol in association with a history of heavy, prolonged intake of 

alr.oholic beverages. All four were hospitalized at leaat once 

• 

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A ComparisOn Of Quantity-Frequency-Variability Clas~~~icoittO~. Between A Hdtlonal Survey Sample And The ATC Sample At Exam four And Five 

Nat iona I Surve:x: Exam Four* 

!!. ! N % 

Heavy Drir.kers 324 12 168 5~-~ 

~derat~ Drinkers 354 13 ~2 13.6 

Lignt Drinkers 766 28 72 n.3 

Infrequent Drinkers "04 IS " 1.3 

Abstainers a93 ..B._ 2L ..1.:.!! 

Tote I 309 

... 

*All men who ~reevaluated w..re Included for these ~oparlsons. 

' ' 

.......... ----- ·"'------ .. 

~-, ' 

t ( 

, .. 

· .. , ·-- ,: ·' ~ '· 

'-

Exam 5* 

!! ! 

185 ~7.8 

49 12.7 

118 20.5 

9 23.0 

~u_ 

387 

... 

... 

"' 
A Comparison Of Drinkers And Non-Drinkers In A National Survey Sample And The ATC Study 

Sample At Exams Four And Five Analyzed By Age And Contro111ng For Socioeccnom.i_r Status I 

Percent Drinkers Percent Heav~ Drink~rs 

.f.TCs Fourth ATCs Fifth ATCs Fourth 

All! Cate92ries Nf!t tonal Saml!le Exam Exam National Sample Exam 

21-29 a~ 94 96 28 61 

30-39 86 92 91 JO 52 •,·; 

~0-19 79 90 88 31 56 

r--- .. ·-....:..- ....... __...,.,..,.,, '•·-~-N-'• P">'<~'' 

'-

f.,. ,._~ 

ATCs Fifth 

Exam 

56 

48 

42 

,.. 

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448 

because of their condition. 

The incidence of alcoholism according to this s tl'ingent 

criterion was about 0.25% per year, a figure nearly identical 

to the prevalence at intake of 0.244 (l/416). Hence, a strict 

physiologically based diagnosis of alcoholism was quite rare. 

In· summary, slightly over 50% of the air traffic controllers were heavy drinkers. At intake into the study, 7.5% had 

~lcohol abuse problems according to psychiatric and behavioral 

Criteria. Nina teen percent experienced an alcohol abuse prob-

~em at· some point during the three years. According to physiological ~riteria, less than 1% suffered from alcoholism during 

the three years. Alcoholism was newly diagnosed at a rate of 

about 0.25% per year, a figure nearly identical to the yrevalence 

of physiological alcoholism at intake (0.24%). 

It is important to recognize that we examined alcohol-related 

bel,avior from a variety" of perspectives. U'2 did not wish to 

enter the highly controversial issue surrounding the diagnosis 

and definition of alcoholisn and ther~fore used several definitional aspects of "alcoholism." From all perspectives, the controllers drank a great deal but relatively few had ph)"Siological 

as consequences. 

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SUlt:ARY 

JOB OUTCOMES 

Certain job outcomes were measured and analyzed as an adjunct 

to the health outcomes: burnout, promolion. medical disqualification, amount of work performed and special recognition. 

~efinite burnout was defined as a decline dur1ng the course of 

the study in two or more of four variables: work satisfaction, 

competence ratings of peers, bounceback/burnout and work role 

pathology. Partial burnout was defined as a decline in ~ne of 

these variables. 

Using the definition decided upon, 35 men were found to have 

developed definite burnout after intake into the study. Fortynine uen were promoted to supervisor; 11 men received medical 

discharges fct' psychiatric reasons, and 12 men r·~ceived medical 

discharges for physical probleMs. 

The men who were promoted received more award~, on the average, 

thari others, and the men who were disq~allfied for psychiatric 

r~asons had, on the average, fewer awards than those disqualified 

for physical health reasons, and all other men. 

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450 

E. Job Outcomes 

In addition to the health outcomes ir. the previous sections, 

we measured and analyzed certain job _outcomes that we considered 

important adjuncts to our health change data c..'r that were of particular importance to the F~-A. 

These job outcomes were: 

l. Burnout 

2. Promotio!l 

3. Medical disqualifica.don 

4. Amount of w~rk perf.ormed 

5. Special recognition awnrds 

The definition, method of measurement, and frequency of occurrence of these outcomes among the study population are repo.rted in 

this section. 

Methods of Neasurement 

l) Burnout 

The phenomenon of burnout has been of great inte4est both to 

the controllers and to the FAA. However, no accepted definition 

of burnout exists; and its ~portauce, if it is an actual phenomenon, has been a matter of controvers). After considerable discussion with participating controllers, the members of the research 

team decided upon a definition of burnout that might capture the 

meaning of the term to controllers. We defined burnout as the 

occurrence in individuals of a significant negative change, over 

the three years of the study, in two ~r more of the foll~ing 

four variables~- Work satisfaction, bounceback-burnout factor on 

the ATC Questionnaire, numbet' of times chosen for competence by 

_ peera on the so~iometric questionnaire, and the presence of significant work role pathology on the Psychiatric Status Schedule. 

·we designated individuals who showed a significant decline in 

on two or more of these variables as a definite case of 

l!••rnout, and those who declined one of four variables as a case 

burnout. In order to make this :letermination, we calthe average of the sr.ores for each of these variables 

Rounds l and 2 aLd again on Rour.ds 4 and 5. We then examined 

differences 1n these two averaee scores, subtracting the averof Rounds l and 2 from that of Rounds 4 and 5. For the burnoutfactor, the compet2nce ratings and work satisfaction, 

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451 

those individuals who had the largest de~l~.!. ~s (in the lowest: onequarter to one-third of the distrlbutton) we:t"':'e designated as l1ovln"" 

had a significanc change in the particui~~ factor. F~r the work 

role pathology, i·dividuals who developed work role pathology afcer 

not having it at intake were designated as having significant change 

in this var1.3ble. We also eliminated f-rom all groups individuals 

who were consistently low from intake onwara on two or mo~e of the 

· four factor&. We wished t? disc~iminate between. men who developed 

burnou~ during the time they were in the study and those who were 

already manifesting burnout at intake into the study. 

J:n general there W·!re t.hree selection criteria for determining 

cases of burnout, potential burnout, and comparison groups. 

l. lndivid~ls had to have completed all five rounds of 

ex:Minations at B.U. They could not have dropped, have been p.;omoted, or have b~en disqualified. This was necessary because we 

were measuring ·change and had to have the data for all times for 

the ne.cessary calculation. (M-adical drop-outs are cC"vered .in a 

separate job outcome variable). 

2. Men had to experience significant decline in scores of 

two .Jr more of the four variabled to be labeled a case of b·:rnout. 

3. If individuals showed scores in thP. lowest quartile at 

Roun~s l and 2 on two or more of the four defining variables, th~y 

were excluded from the analysis (17 cases were found). 

These criteria yielded the fcllowing groupit.g of meu: 

97 men-- comparison group, no signifi~ant 

fall on any of ~he variables 

115 men -- partial burnout cases, fall in only 

one of the crit~rion Z!.ctot·s 

35 men-- burnout case~, Iall iq two or.more 

of the criterion factore 

246 men able to be classified. 

The bounceback-burnout factor consisted of scores on four 

questions in the Air Traffi~ Controller Questionnai~e. As described in a previous section ~hese were found to intercorr&late 

highly enough to form a single scale. Hen who scored high on 

burnout and hence low ~n bounceback on this bipolar dimension 

answered the following questions as indicated: 

• 

• 

• 
1~ "In the past six mont.hs it has been becocaing more 

difficult for me to bounceback to peak performance· 

when I've been away from the boards" 

(Answex: Posl.tively) 

2~ "In the past six months, it's been harder to shift 

between peak and slow periods .. " 

(Answer: Positively) 

3. "How often do you find yourself worrying about 

your awn burnout?" 

(Hi«h burnout answers: very often or constantly) 

4. "At the present. time, how_ close to burnout do you 

feel?" 

(Answex: extx..,.ely close or •tery close) 

A second defining criterion for burnout was the score on work 

satisfaction taken fxom the Job Description lnaGX (Smith). This 

scale is answered by the individual indicating his agreuent from 

"ccxnpletely true" to "completely false" for a lic;t of 19 adverbs 

describing work such aR gooG, fascinating, routine. satisfying, 

etc. 

The third score used was-the number of .c~petence ratings au 

individual received fr~ co-workers on the first two roun1s campared to the fourth and fifth round. Individuals wa1e scoxed in 

the direction of burnout when there was a major decline in the 

number of men who rated them as amcng ti~ most competent. 

The fourth critexion was work role pathology on tbe PSS for 

which individuals received a positiva (burned out) score if they 

were found by the interviewer to have significant interference in 

their ability to work becaupe of p$ychological problems. 

Table 151 lists the number of cases of buxnout over the 

course of the study in terms l)f the combinationa of the four 

variables used to define the conr.ept. Of 35 cases of burnout, 

Z9 showed a cOlllbination of t>.•c of t:1e four factors declining 

seriously, S men showed changes on three of the four, and one 

man showed all four variables changing in a negative direction. 

By analysis of this ~able, one can deduce that 24 men had negative changt'.s in bounceback-burnout along with something else 

and 23 meA he<! negative char.ges in work satisfaction along with 

one or more other faCtors, wnue 16 bad significant declines in 

competi.!Dce ra::ings by co-workers and ll. l:uld significant increases 

in work ... ole pathology. Thus one may conclude that our definition of burnout was h:i.ghly weighted by an individual's own estimation of his <'bHities and sa!:1sfaction. Those individuals who 

J 
453 

TABLE 151 

Combinations Of Significant Declines Over The Course ~f the Study 

Of The Four Variables Used To Define A Case Cf Burnout 

{Two or More Required For Definition) 

Number of Men Frequency 

Satisfaction + 

Rating 3 8.5% 

Satisfaction + 

9 25.7% 

5 1~.3% 

Rating + 

-burnout 9 25.7% 

2.9% 

-burnout + 

Pathology 2 5.7% 

Satisfaction + 

Role Pathology 3 4-4% 

Satit.faction + 

Rating + 

Role Pathology 2 5.7% 

Variables 2.9% 

Total 35 100.0 % 

• 

• 

I 

L 

• 

• 

) 
454 

were defined as "burnout 11 were very likely to have received that 

rating because they had shown a significant decrease over the three 

years in their own estimation of their work satisfaction and ability 

to bounceback. 

Promotions and Medical Qualiflcatio~ 

The ATCs reported any of these changes to the study teams as 

they occurred. The reports by the ATCs were then confirmed at the 

end of the study by FAA records. Table 152 summarizes these 

· change~. 

Amount of Work Performed 

A description of the rationale and procedure for mea~uring 

'this job outcome is contained in Section liiB. Briefly, amount 

, :of work performed by the ATCs was measured durins on··the-job 

studies. This objective workload measure was standardized across 

and sectors and an average workload was derived for 

who hai participated in field studies at least two 

By refetence to ~hese average workload measures, cate-

.Ror>es of low, medium, and high workload change over the three 

in average workload were established. 

and Award~ 

ATGs receivetf various awards and recognitions from the FAA 

their. job performance. Tnese included: Outstanding Per-

~c>rm.ance Award, Point with Prine, Qunlity Step-increase, Award 

, Yearly-in-grade, Sugge3tion Award, Special Act Award 

\.lotrc>ut>l, and Special Aci,ievement Awe~.rd. The ATCs were aske_U at 

how many of these awards and recognitions ha~ been reduring the e;ree years 0~ the study. 

In order to have another dimension of job performance, a 

awards index ~as created in a w.'ly that would reflect difitt ATC performance. Of the eight awards, Suggestion 

, Special Act Awards (grt.:'up) and N-1ard for Valor were 

lu•u•at:eu from the total awaris score as these were considered 

events and not accurately ~eflective of individual 

performance. The remaining five awards were 

weighted to ref:ect their ditfering prestige 

tt.o quality of ATC job performance. 

For example, a yearly in-grade promotion was clearly iess 

in defjning job performance than a Point with Pride 

Based on Nunnally's (1967) suggestion that variables in 

com~inations should be weighted by the ll1verse of their 

deviations, the followi1:1g weights were attached: 

) 

' i 

•.. j 

.. ..,r .. -. 
455 

TABLE 152 

Administrat:ve Job Changes 

Absolute Relative 

~· frequency Frequency 

No Change 283 68.0% 

! 

Hedical Discharge-Psychiatric II 2.6% 

Hedlcal Discharge-Physical 12 2.9% 

to Supervisor ~9 11.8% 

DSS 10 2.5% ) 

to ATC work elsewhere 27 ' 6.5% l 

I 

24 5.8% l 

' ; 

~ 

j 

I 

' 

represents th~:; ATCs who disco~tlnu~d participating variaty of oe.rsona I reasons. 

' 
• 

456 

in-gra~e • 0.7; b) Quality step-increase • 1.5; 

c) Outst.mding perfotV'.a.nce award • l. 8; d) Special Achievement Award • 2.6; and (~) Point with Pride • 3.6. Thus the 

tl)tal award was equal t:o the SULl of the products of the number 

each type of award •md the wei&hts for each type respecA review of the frequency of each of these recognitions .· awards fallows. 

Yearly In-G ~ade Increase 

There was consid,erable variation in the number of tim~s the 

received this increase, with 27 of the men reporting that 

received none. Less than 5% cf the respondents received 

or more such_ increases. The high incidence rate of this 

of recognition :;ustifies its lower weight in the total 

index. 

Quality Step Incr~ase 

incidence ra~e for this ?erformance measure is preSented 

As can be seen, 199 men did not receive a quality 

increase while 3 controllers reported receiving fi•re such 

during the course of the study. This distribut~on of 

indicated that this was a measure which could be used ·to 

J:f~~:~:~!:~e. between ATCs. It was interesting to note that 188 ., a QUE•lity Step Increase w'rlle 128 men received an 

itstar1ding Performance Award. It is likely thes~ two were interbut not ~erfectly, and the lower incidence rate for the 

supports its higher weightin& in the total performance 

index. · 

Outstanding Performance Award 

The incidence rates for this and other awards are presentf!C. 

Table 153. As can be seen, 259 ATCs (62%) did not receive an 

tat:a~~u1g Per~Qrmance Award during the three years they were 

whereas one of the controllers received four such 

The fact that 128 ATCs received this award at least 

during <he course cf the study, while 2:i9 did not, indicates 

this award is probably reflective of higher performance as 

If all of the men in the study had received such an 

if none had, it wo:.~ld be a meaningless measure of p«!rSpeclal Achievement Award 

• 

• 

•• 

; ~ 

I 

) 
.., 

0 

... 

8. 

,.. 

-g 

.. .. 

... 

G 

a 

,.. 

• .... 

• "" .. 

"' c 

~ 

~ 

Q 

No of1 

Awards 

-

0 

I 

2 

3 

4 

5 

6 

7 

8 

9 

No 

Response 

' 

I 

Yearly InGrade Jr,crease 

I lien % 

27 6.5% 

146 35-1% 

130 31.3% 

58 13-~% 

10 2.4% 

II 2.6% 

2 0-~~ 

z o.5t 

-

I 0.2% 

2~ 7.0% 

, ___ _ _______ ,. 

~"-

!_, 

&;;;:.;_ .. -;.·---~·:,;; .. 

Quality 

Step Increase 

I Ke:- Q, tr nco1 ~ 

1~9 47.8% 

141 33-~t 

4?. 10.1% 

I 0.2% 

I 0.2% 

3 o. 7% 

-

29 7.0% 

OutstandJnq 

Performance 

Award 

I Ken t 

I 25~ 72.3% 

~0 21.6% 

30 7.2% 

7 I. 7t 

I ~-2% 

. 29 7.0% 

Special 

Achievement 

Award 

# Ken % 

324 77-~% 

56 13-5% 

3 0.7% 

2 O.S% 

I 0.2% 

I 0.2% 

29 7-0%' 

Poir.t with 

Pride 

I Hen % 

364 87-5% 

15 3-6% 

5 1.2t 

3 0.7% 

--

29 7 •. o ~ 

.• ---..... ,.. .... ><.~ ....... J.• •. _,~~- .-.. p·~ ... -~ .. ··~-- ... ·-~ ... -~--·-·~·-·--~-- ... -

..... 

! 

Suggestion 

AwarJ 

I Hen t -

351 84.4% 

19 4.6% 

6 1.4% 

4 1.0% 

2 0.5% 

3 0.7% 

I 0.2% 

I G.2% 

29 7-0% 

Special 

Act 

Award 

I Hen % - -

351 34.4% 

15 3.6% 

II 2.6% 

5 1.2% 

I 0.2% 

3 0.7% 

I o.n 

Awaf'd 

For 

Va1or 

# Men % 

38!' 92.8% 

I 0.2% 

--

I 

29 7.c<l29 7-~~~ 

~ 

"' ... 
,,~ ........ while one of the men received eight awards. The incidence 

distribution supports the higher weight assigned this award 

the total awards index. 

, e) Point with Pride Award 

This award was given quite infrequently as 364 of the ATCs 

not received one during the cours~ ~f the study. On the 

hand, it was interesting to note that 3 ATCs reported refive awards iuring the three years of the study. 

Total Awards Index 

Since this measure was a weighted linear combination of t':Jselected award categories, examination of the score distriwas skewed positively, reflecting the fact that a large 

of ATCs received only a few (or no) awards. 

In order t~ provide some evidence for the validity of this 

the relationship between selected job changes and this 

awards lndex was examined. It was ex}>ected that those 

who were promoted would have higher scores on the awards 

while those medically disqualified would have lower scores. 

shown in Table 154, the mean awards index for those J..TCs ~OIDOt:ed was significantly higher (p <•01), and the mean awards 

tbose ATCs "'edically discharged for psychological 

was significantly lower (p < 05). There was no differbetwe•n the mean award ind~x scores for those ATCs medically 

for physical reasons and those ATCs who remained in 

t 

l 

l 

l 

) 
I 

1 

' ! 

~ . 

421 

Part C o£ Table 137 displays the correlations between the 

number of valid intervals and the rates calculated for them. 

There were no significant relationships between the number of · 

valid intervals and the annual rates either over all intervals 

or for any given interval. Consequently we were assured that 

the number of intervals did not influence the annual rates. 

After making these various checks, we were confident about 

using our overal~ level classification based on the average 

annual rate for depression and •nxiety episodes. In the remainder of this study the elassifieatioll of individuals based on 

monthly psychiatric morb!.dity is reported in two ways--first, 

in terms of the overall average annualized rates of episodes, 

and. secondly, in terms of -the asym!Jtomatic, acute, intermi.ttent, 

and chronic groupings. 

i 

\ 

' l 

l 

I 

I 

i 

I 
422 

• 

SUMMARY 

Prevalence and Incidence of Psychological 

Health Change 

Over the three y~ars in the study, 32.5% of the controllers 

remained symptom free in our five criterion areas of psychiatric 

status. About one quarter (23.8%) of the ~en had some significan~ symptomutol~gy at intake and an additional 28.1% manifested significanL problems after, but not a,, intake. A few 

men (15.6%) were asymptomatic up to the point they dropped out 

f?ut their later statu!J WC)_s not known. 

The prevalence of sign~ficant symptomatology was 12.7% for impulse 

control disturbances, 7.6% for mate role problems, 7.5% for alcohol 

abuse, 6.01. for subjective ·iistress, and 4.1% for work role distt,.~rbances. 

Alcohol usc and abuse _were in·1estigated furthe·r. Using a stan-

~arU protocol, 42-61% of the controllers were classified as 

heavy drinkers com~a~ed to 28-31% of a national sample of men, 

depending on the age group but controlling for race ar,d socioeconomic status. On the other hand, we found that 7.5~ were 

classified as alcohol abusers Using behavioral and psychiatric 

criteria and less than 1% were alcoholics using strict physiological ~rite~ia. Other data indicated that most drinking was 

used as a coping mechanism by the men. 

In terms of the overall extent and severity of psychiatric problems for three years, 2.9% of the men were hospitalized for 

psychiatric reasons •. 127. ;,ad chronic problems, 22. 47. harl intercit tent problems, 14.95 had an acute problem, 32.57. never had 

a criterion problem in five evaluatiotls, and· 15.4% had no problem 

by the time they became ineligible for further evaluatLon. 

Evaluations of the average monthly uorbidity due to depression 

revealed that 4. 2% had chronic depression (nine or more monl!l!s 

with an episode of depression in a year), 6.8% had intermittent 

depression (3-8.9 months in a year with an episode), 22% had acute 

depression (.6-2.9 months in a year with an episode) and 66.8% 

had no, or very infrequent depressive episodes. 

The monthly morbidity of anxiety was quite similar with 2.8% 

experiencing chronic anxiety, 6.6% huving intermittent anxiety, 

20.5% having acute anxiety epi~o·odes and 69.94 having very infrequent or no anxiety episodes over two and a half years. 

• 

• 

•• 

J 
423 

The monthly morbidity rate of depression was not significantly 

different from that of _other non-patient groups while the monthly 

morbidity of anxiety·was Jess than that of general non-patient 

pcpulations. 

) 
3. 

425 

Prevalence of Significant Psychiatric Symptomatology and 

Morbidity of Depression and Anxiety 

Table 138 dis~lays our findings of significant psycniatric 

s~'1D.ptomatology in the PSS examinations at Boston University over 

the three years of contrOller participation. These findings relate to the individual symptom criterion scales. At intake, 6% 

of .the controllers were experiencing significant subjective distress, representing primarily depression and at~iety. By the 

. end of the study, 12.5% had experienced significant •~bjective 

dis~ress proLlems at least once in the three years. The prevalence figure of 6% at intake was somewr.at below the pre~alence 

figure of 9.9% in an urban community sample, calculated from 

data ?rovidcd by Dr. Jean Endicott of the Evaluation Section, 

Hew York State Department of Mental Hygiene and origi~1ally 

collected. by Dr. Bruce Dohrenwend (see Table 127). Thus the 

controllers experienced 39% less oignificant subjective diJtress 

than did the urbzm community sample. However, as 58% of the 

community sample were women, the data are not fully comparable. 

No better comparisons were found. 

Impulse control disorders as assessed by the PSS primarily 

reflect the inability to control anger, drug abus_e, and antisocial behaviors. As seen in Table 138 the a:l.r traftic contro:&.-

lers experienced a relatively high ~rop~rtion of impuls& control d1'3turbances compared to the urban community tuurvle noted 

above. I.n fact, the controllers had four times the pt·evalence 

of impulse control disturbances compared to this group. By 

the end of the s::udy, almost one-third of the controllers had 

manifested some pre:) l t.wl with impulse control. This result was 

confirmed by our findings on the California Psychological InvP.ntory (see Section IIIB3). In ~hat section we noted that controllers scored very low on their respons.ibility and socialization scales of the CPI, which reflect dimerAions of tmpulse 

control problems. 

The work role disturbance scale of the PSS assesses whether 

or not the psYchiatric status of an individual interferes significantly with his job performance according to a number of 

criteria. For this dimension of p&}'Chiatric dysfunctlon, the 

controllers had a prevalence of 4.1% compared to 2.·1% of the 

urb"n community sample. The high rate of work-related di&turbances was understandable in light of the high level of impe~loe 

control disturbances experienced by the contr~llera, since one 

would have to have other psychiatric problema before one cocld 

find disruptive functioning in the occupfttional role. 

The mate role scale of the PSS aaseesea uhether or ttot 

th~re is dysfunction in the mate ~elatior.•hip of the individual 

in terme of activities, sexual funct:iouing, coonunication pat-

• 

• 

• 

) 
Total 

Number 

of 

ATCs 

416 

416 

416 

)842 

416 

Percent 

TABLE 130 

Pre•1a lence Of S ignl flcanl 

Psychiatric Symetomatolcgy 

ey PSS Examination 

Percent ATCs Percent of 

Symptomatic Urban Community 

AsymptomatIc.. at Sample Symptomatic 

at Intake at Fl rst 

Intake ~Prevalence! Evaluation 

94.0% 6.0% 9.9% 

87.)% 12.7% ). 1% 

95.9% 4.1% 2.n 

92.4; 7.6% 6.1% 

92.5% 7.5% 2 .)% 

T~ble 111.0.1~3 for complete comparison data. 

of 416 were married or had a cohaol tat ion mate. 

Percent ATCs Who 

Had or Developed· 

the Problem 

at Lea!lt Once 

t n Three Years 

12.5% 

)0.3% 

23.8% 

21.6% 

19.0% 

) 

. .. 
427 

terns with the mate or social patterns ~f the couple. The prevalence for controllers with th"is problem was 7.6% compared with 

6.1% for the urban community sample. etisentially the same rate. 

Approx~tely one in five controllers had a disturbance in mate 

rol~ functioning at some time over the three years of the study. 

Finally, the symptom criterion of al~ohol abuse was evaluated and the controllets experiericed a prevalence of 7.5% at intake, compared with a prevalence of 2.3% among the urban community sample. One needs to exercise restraint in interpreting this 

comparison because of the sex differences in alcohol use and 

abuse, and the majority of women in the commUJity sample. In 

add1.tion, it is quite likely that the urban sample was underrep~rting thei~ use of alcohol. 

Since alcohol abuse was mentioned very frequently by the 

air traffic controllers and by the facility administrators as 

a problem area, we undertook a particularly intense and detailed 

examination of alcohol use and abuse problems amoog air traffic 

controllers. These results are presented separately fOllowing 

the other findings, but generally, the 7.5% prevalence of alcohol 

abuse problems among the controllers at intake is similar to Northeastern USA prevale~ce of persons defined as problem drinkers and 

alcoholics (Chafetz, 1974), but is low•r than prevalence figures 

for a oimilar occupational group (Cahalan, Gisin, Gcirdner·, Smith, 

1972). Hence although the prevalence of alcohol abuse was higher 

than that of the. urban community sample, it was comparable to, 

or even slightly lower than, a more appropriate comparison group. 

Table 139 displays the frequency of occurrence of significant psychiatric symptomatology for those men who were studied 

all five ttmes by PSS examination at Boston University. These 

results differ from the preee~lng in that any ~n who did not 

have all five evaluations was not included and hence the total 

percentage of men experiencing a problem is slightly. but .. not 

greatly, different.. 

The frequency o£ occurrence of significant psychiatric 

symptomatology was notable primarily becuuse of the relatively 

lov rates of occurrence of problems two or more ttmea during 

the three years. The single exception to this observation waa 

impulse control disturbances, which occurred in approximately 

15% of the mec. t>10 or uore times. 

Tsb \e 140 adoireH&es the final overall psychiatric stat•1s 

accorded each man aft a result of his examinations at Boston 

University. The table diopleys the results using our two methods 

for <:~scribing a man's overall psyct:.iatric statua. Part A of 

) 

). ' - lul-•"•;.o...,~....,:..O..'C..""" .: 
428 

Symptom 

CriteriOn 

Subjecti vc Dis tress 

Impulse Control 

Work Role 

Hate Role 

Alcohol Abuse 

I 

TABLE 139 

~uency Of Occurrence 

Ot'Signiflcant Psychiatric 

Symptomatolof,y In Tr~se St•Jdled 

All 5 Times By PSS f:xamlnatlon 

Total % Exeerlenc:ins 

Number 1 of ATCs ~ 9.!!.£!. 

307 87.9% 7.2% 

307 74.3% 11. 1% 

3052 80.3% 14.4% 

2713 30.1% 11 .4% 

307 81.1% 9.4% 

Twice or Hore 

4.9% 

"'·n 

5.2% 

8.5% 

9 .I.,., 

Only those evaluated all 5 times are Included, lncludl.1g men who were 

disquall fled from the study. 

2 

3 

Two men had not worked due to physical Illness for an entire 

Interval between examinations. 

113 man changed their mate (not Just spouoft) status at different 

examlnnlons and therefore did not have 5 evaluations. 

• 

' ' 

) 

~--·'"""'·~ 

• 

• 
TABLE 140 429 

Overall ?•ychlatric Status 

A. Su•ceptlblllty to Psych I atrl c Problems In Three Years 

Any Any Total Who 

No Proh I ems- llo Problems New Prob I ems Had or Developed 

lncom(!lete* Problems at I n~ake After Intake A Pr">blem 

Number of 

ATC5 65 135 99 117 2~6 

% of 416 15.6% 32.5% 23.8% 28. 1% 51.9% 

s. Extent of Psychiatric Problems In Three Year5 j 

I 

l. ' ! • 

No Problems- llo Inter- ' 

Income: tete* Problems Acut~ mlttent Chronic l 

Number of l) 

ATCs 65 135. 65 99 52 I 

% of 416 15.6 32.5 15.6 23.8 12.5 l 

1 

No Problems- No Inter- Psychiatric 

·-i 

I nco~ tete* Prob I em• ~ mit tent Chronic Hospl tallzotlon i 

Number of l 

ATCs 64 135 62 93 50 12 

15.4 32.5 14.9 22.4 12.0 '-·9 I I , 

had no prob I ems before dropping out and their later status I 

I 

asses!led. 

.. 
430 

Table 140 displays the prevalence of problems according to 

susceptibility categories discussed earlier. Sixty-five men 

were classified as having no problems, but this was a result 

of their having incomplete data. We classified them separately 

since we felt it was unjustified to consider them the same as 

those who had no problems at all. 

Over the three years in the study 32.5% of the men, or 

135 individuals, had no problems on an>· of the five PSS symptom 

criterion scales. They were co~pletely asymptomatic. Ninetynine men, or 23.8%, had one or more significant problems at 

intaluo. 

One hundred and seventeen men, or 28.1%, dev~loPed at least 

one probtem after intake into the study. This group of men did 

not have any problems at intake, but developed them late~. 

Finally, Table 140 shows that 216 men either had a problem 

at intake or developed a problem subs~quent to intake. Slightly 

over half of the men initially enrolled in the study manifested 

some psychiatric problem either at intake or during the three 

years. Thus, the susceptibility of air traffic controllers to 

psychiatric problems was quite high when one considers that by 

the end of the study, half of the men had at least some psychiatric problem or psychological dysfunction. Unfortunately, there 

is no comparison group to help interpret whether this figure 

is part!cularly high relative to any other occupational groups. 

However, the magnitude of this value certainly suggests a high 

prevalence of psychological difficulty.· 

Part B of Table 140 displays the results of our assessment of the extent of psychiatric problema in three years as 

opposed to the susceptibility to different problema. Part B 

of the table is split into two parts, the first including 

psychiatric hospitalizations in the general statistics, the 

second displaying hoopitalizations separately. 

Again, oixty-five men had no problems by the time they 

dropped out of the study, but since they did not have full 

uoeasments, it was impossible to deao.cibe accurlttely the 

extent of psychiatric problema they may have had throughout 

tba three years. Consequently, their data wws considered 

incomplete. The group with no problems is exactly the DUe 

aroup aa in Part A of Table 140. Sixty-five men, or 15.6%, 

had an acute psychiatric problem, which by def~>ition meant 

that they had only one significant waluation of one poychiatric probl"" over the et>t1re thre .. years. Another 99 men 

had one or more problema At cwo or three paychintric evaluations. These men ~<ere defined ao having intemitten< 

) 
• 

431 

psychiatric problems, and they comprised 23.8% of the original 

group of 416 men enrolled in the study. Men who had one or 

more problems at four or five of the evaluations were defined 

as having chronic problems. There were 52 such men or 12.5% 

of the original study gr~. 

The second half of Table 140, Part B, groups those men 

who had psychiatric hospitalization into a special category. 

Three men who were hospitalized for psychiatric r~asons had 

been defined as having acute problema. Six had intermittent 

p~oblems, and two had chtonic pro~lems according to our assessments. Thus a total of 12 men were hospitalized for psychiatric reasons, or 2.9% of the original group. SincP. these special 

cases would •~emingly indicate partic~larly significant psychiatric difficulty, we examined their data somewhat more closely 

across other variabl~s. 

T&ble 141 displays the repurted diagnosis, the assessment of ,sychopathology at intake or later in the study, the 

extent of psychiatric problems, the burnout category and the 

FAA award category for these men. The reporterl diagnoses 

were obt~ined either from the medical records of the hospital 

or were reported directly by the subject on ei.ther a Monthly 

Heal~h Review or during H psychiatric examination. Five of 

the twelve men had been hospitalized twice dut"ing the study. 

The reported diagnoses were all psychoneuroses or alcoholism. Alcoholism a~counted for 33% of the psychiatric hospitalizations. The IPJnaining diagnDses were basically anxiety or 

depressive neuroses. 

With the exception of on~ man, the hos~italized subjects 

were found to have had at least one psychiatric problem on 

the Psychiatric Statud Schedule evaluation. The single man 

who did not. manifest problems on the Psychiatric Status Schedule 

also was found to have no problems in terms of the extent of 

psychiatric problems. He was not classifiable according to ~ 

our burnout category because of inc·omplete data, and he i'eil 

in the high average category for FAA ""'arda for performance. 

This man would seem to be somewhat of an Qn~maly since we had 

no data substantiating his difficulties sufficient to require 

hospitalization. 

Eleven of the 12 men were found to have some psychiatric 

difficulty on their Psychiatric Status Schedule evaluations. 

In addition, our Lurnout classification of men (which used 

wo"k role pathology ao one of four indices) had defined two .. 

men as caseS of definite burnout, 7 men as p!'eclinical, and 

• 

• 

) 

' L 
4J2 

TABLE 141 

Psychiatric Hospl tallzatlons 

N • 12 Hen 

Extent of 

Problem at Psychiatric FAA 

Reoorted 2 Intake or Problems on Burnout Award 

Dlagno~ Later PSS Exams Category CateQO!:Y 

Anxiety tleurosis• None None N/A High Average 

Depressive Neurosis Later lnterml ttent Preclinical Low Averaqe 

Psychoneurosis 1'r Later Acute Preclinical High Average 

Aleoholl sm Later lnterml ttent Deflnl te N/A ,. AI coho I ism Later Chronic Prec II n I cal Low 

ism Later Acute Preclinical High 

ety Neurosis• Intake Intermittent N/A Low 

Neurosis Later Acute Preclinical Low 

r Disorder Intake lnter.111 ttent Mixed ~ow 

Ism Intake Chronic Preclinical Low 

Neurosis* Later Intermittent Definite High 

I s• Later Intermittent Preclinical High Average 

medical record or reported by subject 

of the 12 were hospitalized twice. These are marked with an asterisk (*). 

. .• 

' ."+-' 
one man as a mixed case of positive and negative :}igns. Hence, 

75% of these men were classified as being pre-~l~nical or 

definiee cases of burnout (See Section IIIE for a more complete description of the meaning and significance of these 

burnout outcomes). ' 

433 

We also had collected data on a number of different awards 

men received from the FAA for their occupational performance 

(see Section IIIE). Table 141 shows that five of the twelve 

hospitalized men were in the very lowest category of FAA 

performance awardo. On the other hand, another five men fell 

in the highest category of FAA awards for performance. And 

fin;lly, one man received a low average number of awards. 

One man could not return for the fifth evaluation during 

whith this information was collected and therefore could 

nat be classified in terms of FAA performance. These data 

are ~portant to note because they certainly s~asest that 

psychiatric hospitalizations were not related to performance 

in terms of the awards th~ FAA would make for such performAnce. Because of the nature of the data, we were not able 

to dete~ine whether the a~ards were made before or after 

psychiatric hospitalization, but rega~dless of that fact, it 

is important for two reasons: If met,;, received iheir performance award before hospitalization, then clearly their performance was not particularly associated with later hospitalization. 

On the other hand, if awards were made after psychiatric hospitalization, then the significance of their psychiatric problem did not necessarily interfere with tn~F performance on 

the job. Hence, although our descriptive results have indicated 

that certain particular problems such as impulse control disturbances were quite prevalent among controllers, and that psychiatric problems as a whole uere experienced by approximately 

50% of the men over three years, psychiatric difficulties may 

not necessarily affect or be related to work performance of 

air traffic controllers. Findiags pre~ented later in this 

report on the predictive association between certain variables 

Auch aa the amount of work done, the amount of time spent working, 

and other of the job measures provided additional suppo~t. for 

this suggestion. · 

As previodsly d~sc~ibed, ~ also evaluated the monthly 

moroidity of depre9sion and anxiety, Table 142 displays the 

prevalence of monthly depression by interval and by the overall 

averase annual levels as previously define.d. During the intervals between examinations, only 3.1% to 5. 9% of the men experienced chronic depresai~n; 2.6-7.0% experienced intermittent 

probl.,.s; and 7. 9-ll. 8% expar1en<:ed acute problems during the 

intervals. Dur~g any given interval 76.3% to 80.3% of the 

men experinncert ao oignificant depressive symptomatology. 

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TABLE 142 

~~lence Of Month!~ 

Interval 

Oeeress ion 8~, 

And Over a II A•1eraqe 

Annual Level 

Ov:Jra II Averagt= 

Interval 2 Interval l lrterval 4 Annual Level* 

Level _N ___ %_ _ N _ _L _H ___ % _ll ...L 

Asympt~t i.e 271 76.3 245 80.3 218 79.0 235 66.8 

Aoute 42 II. 8 24 7.9 34 8.2 79 22.2 • 

Intermittent 25 7.0 18 5.9 II 2.6 24 6.8 

Chronic 17 4.8 18 5.9 13 3. I 15 4.2 

355 }05 276 35 3 

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on the average annualized rate over the three intervals for the 

one or more inter\al rates 

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With respect to the overall average annual level of ~he 

depressive episodes experien~ed by men over the three years, 

66.8% were asymptomatic the entire time, 22.2% had acute 

episodes, 6.8% had intermittent episod~s, and 4.2% had 

435 

chronic difficulties. If one considers the intermittent and 

chronic groups to have the mor~ severe episodes of depr~ssion, 

as was shown in Table 136 then approximately 11% of the men 

experienced significant depressive episodes at a level certainly suggesting a need for treatment. This 11~ fi~u<e is 

very .similar to that found in psychiatric epidemiological 

studies of depressive disorders in the general population 

(Barrett, llurst, DiScala, Rose, 1978). I 

Table 143 displays our results on the extent of monthly 

anxiety by intervals and according to the overall average annual 

level. It can be seen that 3.9 - 4.8% of the men experienced 

chronic anxiety during the three intervals between Examinations 

2-5. In addition, 5.9% to 6.9% of tote men experienced intermittent anxiety episodes, and 6.9% to 13% of the men experienced. 

acute episodes of significant anxiety. Seventy-six percent to 

83.3% of the men experienced no anxiety at all during thase 

intervals between examinations. 

Considering the overall extent of monthly anxiety over 

the three years, we found that 2.8% experienced chronic anxiety 

episodes, 6. 8% experiencP.~ intem.ittent episodes. 20.5% experienced acute episodes, and the temaining 69.9~ were asymptomAtic 

over the entire period of the study. 

The extent of anxiety and depression on a monthly basis 

was very atmilar, and in fact, it was quite common for men with 

depresaiv~ problema also to have anxiety problems. The important point is that the more severe int~rmittent and chronic 

levels were experienced by only 9.6% of the men with respect 

to anxiety and 11.0% with ~espect to depression. As previously 

noted, these figures are very similar to those found for other 

populations of non-psychiatric patients. 

Psychological problems, includins some psychiatric syndromes, were quite prevalent among the men in the study. Slightly 

more than half had at least one psychiatrlc difficulty. The 

mo3t prevalent psychiatric difficulty was impulse control 

diaturbancea which reflected a relatively high·number of men 

who had an inability to control overt ange:c, anti-social impulses, 

and illicit drug use. Alcohol use was q~>ite Hgh, but alcphol 

abuse vas about the same as in comparable groups of aubje~ts. 

Anxiety and depression ..,ore experienced at levels equal to or 

leas thAn that experienced in s~neral population& of non-patientw. 

The experience of psychiatric pro'>lema was not particularly 

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TABLE 143 

Prevalence Of Monthly_ 

Anxiet~ B!: Interval And 

Overall Average Annual Level 

Over a i I Average 

Interval 2 Interval l Interval 4 Annual level* 

.b!!!!!. .!L. 1._- _N_ _% __ !L _%_ _N_ .L_ 

AsymptomatIc 270 76.0 254 83.3 227 82.2 ?46 69.9 

Acute 46 13.0 21 6.9 19 6.9 73 20.5 

In term! ttent 22 6.2 18 5-9 19 6.9 24 6.8 

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th'ron i c 'Z 4.8 12 l·2 11 4.0 10 2.8 

Totals 355 305 276 353 

* lased on the average annualized rate over the three intervals for the ' l ) 

, 353 ""'n who had one or more Interval rates. 

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related to FAA performance criteria, ~ut on the other hand, 

these problems iu turn affected the men's work rol~ performance. Psychiatric problems in mate rvle relationships were 

experienced at approximately the same rate as amor.g the urban 

community group, and therefore, we would conclude that mate 

role difficulties were not more frequent among air traffic 

controllers than among others. Finally, since alcohol usP. 

a~d abuse were problem areas of great concern to both the air 

traffic controllers and management, we made an especially 

detailed evaluation of Lhis problem area which is present~d 

in the next section. 

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4. fu_oho 1 Abuse 

Information for the assessment of alcohol use and abuse, 

drinking behavior and consumption patterns was collected by 

use of the 16-item alcohol abuse scale of the Psychiatric 

Status Schedulet by an eight-item scale generated by factor 1

analysis which assessed the ATCs' use of alcohol as a coping 

mechanism, and by a set of questions r~lative to frequency, 

amount, variability and volume of alcoholic beverage consumption. 

Problems with Alcohol Revealed By The PSS 

. The symptoms reported most frequently were the followi~1g: 

they keep drinking at times even though they feel they should 

stop; they admit to becoming regularly intoxicated; they report periods in "'hich they cannot recall what occur:..:ed the 

night before, and while alone, they have three or more drinks. 

The symptoms reported least often were those associated with 

physiological functioning and generally indicative of the 

symptom cluster labeled "alcoholism. 11 The distribution and 

ranking of symptoms indicated that the type of problem experi-

~nced by the ATCs was generally a psychological dependence 

:·ather than physiological addiction. 

The relationahips between ether psychiatric difficulties 

alcohol abuse are displayed in Table 144. From 69% to · ·,__ of the sample experienced neither psychiatric problems 

alcohol problems at a given evaluation. In two-thirds.of 

cases in which problems related to alcohol did occur, 

appeared in conjunction with other psychiatric difficulties 

ts impulse control, mate cole imp~irment and work role 

orment. These findings indicated that difficulties with 

ol were associated with difficulties in other areas as 

:..1.Y_!Jrinking 

·' Coping by Drinking Factor of tne ATC Questionnaire 

a,.._·: alcohol usage as a means of unwinding f:-om work-reli.ted 

and the effectiveness of drinking as a means of coping 

k-~elated difficulties. High scores were indic .. tive 

.!vely frequent usage of al~oh~l as a means of copir.g 

'; ·ess or tension. This scale revealed that drinking as 

a -:-,f unwir.ding after \.fOrk waA a fai.rly regular occurrence 

foe ·ollers. Approximately 50% w£._'4:! inclined to drink as 

a means ·'' •mwirding on 15 ol 20 working ·d<1ye. Sixty to 70% 

found th<:!':. wh~n they did drink, it was effective in helping 

· .em to unvi.nd and relax. The results shown 11~ Table 145 

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2 

3 

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5 

Ho 

Problem 

H(%) 

305(7).3) 

273(69.6) 

251(71.9) 

216(69.0) 

280(72.2) 

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TABLE 144 

Overlap Between Psychiatric Problems And 

A I coho 1 Abuse At Each PSS E..ta I .:at ior. 

Psychiatric Psychiatric 

Problem withou-t Problem and 

Alcohol Abuse A l coho I Abuse 

N(%) N (~) 

80(19.2) 20( 4.8) 

95(22.8) 17( 4.1) 

61(17.5) 21 ( 6.0) 

65{15.6) 21(6.7)· 

7f.(!8.3) 23( 5.9) 

......_ 

Alcohol Abuse 

Or. I y 

N(%) 

II ( 2. 6) 

7 ( 1. 8) 

16( 4.6) 

11 ( 3 .5) 

9 ( 2. J) 

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E<am I 

Exam 2 

£xam 4 

TABLE 145 

Correlation Matrix: Exam One Through Five 

For Cop;ng By Drinking Scale 

E~am I E~am 2 E~am 3 

.80 

.77 .84 

.71 .78 .S4 

• 71 .76 • 79 

Exam 4 

.91 

I correlation coefficients are significant bey>nd the .001 level. 

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also indicated that the ATCs exhibited a high degree of stabilityin their use of drinking to cope. 

Ca~egorizing the Qen into low, moderately low, and moderately 

~igh and high users of alcohol for coping purposes and then cross- · tabulating the classifications at the different examinations resulted in the finding that between 57% and 60% of the c~ntrollers 

remained in the same category from exam to exam. About 10% of the 

men consistently relied on heayy Alcohol usage every day of the 

month to cope with tension from the job. 

Alcohol Use As Revealed By Quantity-Frequency-Variability Measures .., 

Frequency of drinking: 

A speCial interview questionnaire about alcohol use was devised 

for the fourth and fifth examination visits.' A systematic evaluation of the frequency, amount, variability and kind of alcohol 

usage was conducted. The different types of alcoholic beverages 

were combined by using pure ethanol equivalents. The frequency of 

drinking represents the number of times that the individual drank 

iu the course of a week, month or ye'lr. Table l•t6 indic.ates that 

about 36% of the controllers drank nearly e,tery Jay and another 

20% drank three or four times a week. Cumulativaly, about 56% 

drank at least three or more tLnes a week; only 7% did not drink 

at all (abstainera), 

quantity of Alcohol Cons~ed: 

Data on the amount of alcohol consumed is presented in Table 

147 in terms of the number of ounces consumed per week. About 

31% drank betwe•n l and 7 ounces; 21% drank betwe•n 8 and 14; 

and the remaining 41% drank 15 or more ounces per week. The 

mean consumption for ExaminAtion 4 was 16 ounces pe.r weeic., while 

for Examination S it was 14 ounces. The correlation between 

reported alcohol consumptiQn at Examinations 4 and 5 was .64. 

Quanti tv-Frequency-Variability: 

Table 148 indicates th~t approximately half of the ~TCa 

were heavy drinkers (botween 47% a.~d 54%) while about a third 

were li&ht or infrequent drinkers, or abstainers (32% to 39%). 

Drinking Occasions: 

The controller• were aaked if they drank more on their daya 

off or their workdays after work, or if it did not make a difference. Host controller• indicated that their drinking practice• 

were the •~• for workdays after '~rk and days off. 

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TAllLE 146 

Freqc•ency Of Drinking Alcoholic Bevenges Amo~g ATC Study Sample 

Frequency , Exam·.\ 4 Exam 5 

N(f,}"" N(~) 

I. Two times a day 2 (. 7) l (. 7) 

2. Nearly ev~ry day 107(35.2) 107(35.2) 

3· 3-4 times a week 62(20.4) 58(19.1) 

4. 1-3 times a week 74(24.3) 78(25.9) 

2-3 times " month 17( 5.6) 20( 6.6) 

About once ~ month I<' -' 4.9) 11(3.6) 

Less than once a month/ 

at 1 east once a year 4( 1.3) 7 ( 2. 3) 

Never 23( 7.6) 21(6.9) 

*Figures are adjusted to Include those ATCs present at both "xam 4 and 

'exam 5 and Include only journeyman controllers. (N-304). 

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Total 

TABLE 147 

Quantity Of Alcohol Consumed By ATC Study Sample 

'" Ounces Per Week, As Reported In Round~ 4 And 5 

Consum2tion: Exams 4 and 5 

Ethanol Eguiva1ent 

Ounces Per \Jeek Exai11 4* Exam 5* 

N(%) N(%) 

0 23( 7.4) 26(6. 7i 

1-7 92(29.8) 131( 6.7) 

8-14 67(21. 7) 83(21.4) 

15-21 37(12.0) 56(14.5) 

22-28 34(11.0) 36(9.3) 

29-35 21 ( 6.8) ·25( 6.5) 

Over 35 35(11.3) 30( 7.8) 

He an 16.37 14.20 

S.D. 16.45 14.2 

N 309 38"/ 

Range 0-140 0-120 

men who were evaluated were included. 

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••• TADLE 141J 

guantf~y Frequency-varlabil lty ClassiFication 

Ex•01n •.. £.><a"' •• N N • 

,6. s,._, , .. 4;,:.s 

<z 13.9 40 13.2 

70 23.' 9. 30.0 

• .., 7 2.3 

--'-"- 7.6 ...3.!.. ~--

Totals 304 100.0 304 99.9 

adjusted to Include those ATCs present at exam four and five 

only journeyman controlle.rs. 

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Type of Beverage: 

For those controllers liTho drank, the beverages mst frequently consnmed were hard liquor and beer, while wine represented the least frequent beverae~. 

445 

Comparison of Controllers to Natio~al Survey SampleS on QuantityFreqUency-Variability 

The special alcohol questionnaire gi~~n at the fourth and 

fifth examinations enabled us to corupare the coratroll<.rs to 

adult males of similar demographic characteristics. National 

s~rvey data using the same questionnaire was available for comparlslln. 

Compared to the national survey ~esults, ATCs were heavy 

dririkers about four tiL'les mo·re often than those iD. the national 

surVey. Both samples had similar prevalences of light and moderate drinkers. Controllers were also 4 times less ·likely to fall 

within the abstainer group (Table 149). ----

Age was a pos~ible influence on the difference between 

'i'lll&t.10llaJ. and ATC drinking prevalences. Table 150 indicates 

drinking at' age increases ~or the nati-onal survey as well 

for controllers. In ~erms of heavy drinking, the national 

r~•f'•ey results were unaffected by age while heavy drinking 

~J~oed to decrease with 8~ among controllers. Overall, controlhad a higher percentage of drinker• and heavy drinkers. 

We declined to make poychiatric diagnoses_ in order to avoid 

pejorative implications and the unreliability associated 

these diagnoses. However, in the med:f.cal sphere, the internist 

study rendered diagnost:s bas.ed on medical history, physical 

~nati•>n, serology, urology, radiology, monthly self-report~, 

, hospital records. Diagnoses rendered on the basis of thee~ 

were considered more reliable and subject to specific physical 

and symptoms. Thus, diagnoses of alcoholism made by 

U11:ern1st represented physiological addiction with substantive 

findings present. 

internist diagnosed alcoholism for one man at intake and 

men after intake. Thus, the total number of men receiving 

of alcoholism on physiological grounds was four, or. 0.97%. 

men had finding& of liver disease, tremors, peripheral neuroblackouts, and other physiological symptoms of addiction to 

in association with a histor.y of heavy, prolonged intake of 

beverages. All four were hospitalized at leaat once 

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National Surve~ Exam Four* 

N ! N % 

Heavy Drir.kers 324 12 168 54.4 

~derat~ Drinkers 354 13 42 13.6 

Lignt Drinkers 766 28 72 l3.3 

Infrequent Drinkers lt04 15 4 1.3 

Abstainers as3. _E_ 2l.. ..l.:i 

Tote I 309 

... 

*All men who were evaluated w..re Included for t~ese ~oparlsons. 

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~~-·: .. 

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...... •·. 

Exam 5* 

!! ! 

185 47.8 

49 12.7 

118 20.5 

9 23.0 

..1L u_ 

387 
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A eompartson Of Drinkers And Non-Drinkers In A Natlonal Survey Sample And The ATC Study 

Sample At Exams four And Five Analyzed By Age And Contrail ing For Socioeconomk Status I 

Percent Drinker$ Percent Heavy Drinkers 

ATCs Fourth ATCs Fifth ATCs Fourth 

Age Categories N,ational Samele Exam Exam National Samele Exam 

21-29 84 94 96 28 61 

30-39 86 92 91 :lO 52 

"0-19 79 90 88 31 56 

1 

ATCs Fifth 

Exam 

56 

48 

42 

All ATCs from the fourth (N•309) and fifth (H-387i were Included. The data for the national sample was drawn 

from results for white males, high school to college level education, In the same Income bracket as ATCs. 

.... ---·. --.....;...- --~~<" ... _,~-~ ~-- --~-.... ~~-. -~>< ~--

~-- ....... 

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because of their condition. 

The incidence of alcoholism according to this stt'ingent 

criterion was about 0.25% per year, a figure nearly identical 

to the prevalence at intake of 0.24% (1/416). Hence, a strict 

physiologically based diagnosis of alcoholism was quite rare. 

In· summary, slightly over SO% of the air traffic controllers were heavy drinkers. At intake into the study, 7.5% had 

~!cobol abuse problems according to psychiatric and behavioral 

Criteria. Ninateen percent experienced an alcohol abuse prob-

~em at· some point during the three years. According to physiological ~riteria, less than 1% suffered from alcoholism during 

the three years. Alcoholism was newly diagnosed at a rate of 

about 0.25% per year, a figure nearly identical to the yrevalence 

of physiological alcoholism at intake (0.24%). 

It is important to recognize that we examined alcohol-related 

behavior from a variety' of perspectives. Ue did not wish to 

enter the highly controversial issue surrounding the diagnosis 

and definition of alcohol!&~ and ther~fore used several definitional aspects of 11 alcohol1sm. 11 From all perspectives, the controllers drank a great deal but relatively few had physiological 

disorders as consequences. 

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SUltlARY 

JOB OUTCOMES 

Certain job outcomes were measured and analy-zed as an adj1.1.nct 

to the health outcomes: burnout, promoLion. medical disqualification. ~ount of work performed and special recognition. 

Definite burnout was defined as a decline during the course of 

the study in two or more of four variables: work satisfaction, 

competence ratings of peers, bounceback/burnout and work role 

pathology. Partial burnout was defined as a decline in ~ne of 

these variables. 

Using the definition decided upon, 35 men were found to have 

developed definite burnout after intake into the study. Fortynine uen were promoted to supervisor; 11 men received medical 

discharges fct' psychiatric t:easons, and 12 men r•;oceived medical 

discharges for physical probl~s. 

The men who were promoted received more awardR, on the average, 

-thari others, and the men who were disqcalified for psychiatric 

-- rt:.asons had, on the average, fewer awards than those disqualified 

for physical health reasons, and all other men. 

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E. Job Outcc~ 

In addition to the health outcomes ir. the previous sections, 

we measured and analyzed certain job .outcomes that we considered 

important adjuncts to our health change data t.~r that were of particular importance to the Fl-A. 

These job outcomes were: 

1. Burnout 

2. Promotion 

3. Medical disqualif ico.tion 

4. Amount of vnk perf.ormed 

5. Special recognition aw~rds 

The definition, method of measurement, and frequency of occurrence of these outcomes among the study population are repo~ted in 

this section. 

Methods of Heasurement 

l) Burnout 

The phenomenon of burnout has been of great inte4est both to 

the controllers and to the FAA. Hcwever, no accepted definition· 

of burnout e~ists; and its ~portauce, if it is an actual phenomenon, has been a matter of controvers). After considerable discussion with participating controllers, the members of the research 

team o:lecided upon a definition of burnout that might capture the 

meaning of the term to controllers. We defined burnout as the 

occurrence in individuals of a significant negative change, over 

the three years of the study, in two nr more of the follo~ing 

four variables:. Work satisfaction, bounceback-burnout factor on 

the ATC Questionnaire, numbet· of times chosen for competence by 

peeri on the so~iometric questionnaire, and the presence of significant work role pathology on the Psychiatric Status Schedule. 

We designated individuals who showed a significant decline in 

scores on two or more of these variables as a definite case of 

burnout, and those who declined one of four variables as a case 

of partial burnout. In order to make this 1etermination, we calculated the av~rage of the sr.ores for each of these variables 

on Rounds l and 2 ar.d again on Rour.ds 4 and 5. We then examined 

the differences in these ~wo averaee scores, subtracting the average of Rounds l and Z from that of Rounds 4 and 5. For the burnoutbounceback factor, the compet2nce ratings and work satisfaction, 

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those indi•liduals who had the largest de,..l~.!'. ~s (in the lowesL onequarter to one-third of the distr1but.1.on) wer:e designated as ltc..vin .... 

had a significanc change in the particui~~ factor. F0r the work 

role pathology, i dividuals who developed work role pathology afcer 

not having it at intake were designated as having sig~ificant change 

in this vartable. We also eliminated from all groups individuals 

who were consistently low from intake onwara on two or mo~e of the 

' four factorb. We wished t? discriminate between men who developed 

burnou~ during the time they were in the study and those who were 

already manifesting burnout at intake into the study. 

J:n general there w-!re three selection criteria for determining 

cases of burnout, potential burnout, and comparison groups. 

1. Individ~als had to have completed all five rounds of 

examinations at B. U. They could not have dropped, have been p.:omoted, or have b~en disqualified. This was necessary because we 

were measuring ·change and had to have the data for all times for 

the ne.cessary calculation. (M-adical drop-o_uts are cc-ver-2cl .in a 

separate job outcome variable). 

2. Men had to experience significant decline in scores of 

two Jr more of the four variabled to be labeled a case of b·:rn-· 

out. 

3. If individuals showed scores in thP. lowest quartile at 

Roun~s 1 and 2 on two or more of the four defining variables, th•y 

were excluded from the analysis (17 cases were found). 

These criteria yielded the fcllowing groupit.g of meu: 

97 men -- comparison group, no signifi~ant 

fall on any of ~he variables 

115 men -- partial burnout cases, fall in only 

one of the critt!rion .f!lctot·s 

35 men-- burnout case~, 1all 1~ two or.more 

of the criterion factor.e 

246 men sble to be classified. 

The bounceback-burnout factor consisted of scores on four 

questions in the Air Traffi~ Controller Questionnaire. As described in a previous section ~hese were found to intercorrclate 

highly enough to form a single scale. Men who scored high on 

burnout and hence low ~n bounceback on this bipolar dimension 

answered the following questions as indicated: 

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1. "L'1. the past six mont.hs it has been becoming more 

difficult for me to bou.~ceback to peak performance· 

when I've been away from the boards 11 

(Answex: Posl.tively) 

2. "In the past six months, it's been harder to shift 

between. peak and slov periods." 

(Answer: Positively) 

3. "How often do you find yourself worrying about 

your own burnout ?n 

(Hiflh burnout answers: very often or constantly) 

4. "At the present time, how close to burnout do you 

feel? 11 

(Answer: extremely close or ·tery close) 

A second defining criterion for burnout was the score on work 

satisfaction taken from the Job Description lna~ (Smith). This 

scale is answered by the individual indicating his agreeaent from 11CCIIlpletely true" to "completely false .. for a. lio;t of 19 adverbs 

describing work such a~ gooG, fasc~ting, routine, sacisiying, 

etc. 

The third score used was·the number of _c~petence ratings an 

individual received fr..)t!l co-workers on the first twt) rounds compared to the fourth and fifth round. lndividuals wa•e scored in 

the direction of burnout when there was a major decline in the 

number of men who rated them as amcng ti.e most compecent. 

The four~h criterion wss work role pa~hology on the PSS for 

which individuals received a positiva (burned out) score if they 

were found by the interviewer to have significant interference in 

their ability to work becaufe of p$ycbological problems. 

Table 151 lists the number of cases of burnout over tbe 

course of the study in terms of the combinatloo.s of the four 

'.variables used to define the conr.ept.. Of 35 cues of burnout, 

29 showed a c=bination of ewe of ~:1e fot:r factors declining 

seriously, 5 men showed changes on three of the four, and one 

man shuwed all four variables changing in a negative direction. 

· By analysis of this :able~ one can deduce that 24 men had nega-

. tive changt>.s in bounceback-burnout along with something else 

23 meJl bac! negative cbar.ges in work satisfaction along wieh 

or more other factors, ~hile 16 bad significant declines in 

ra::inga by co-workers and H >,ad significant increases 

... ole pathology. Thus oc~e may conclude that our def1.ni-

"f burnout was highly weighted by an individual's own estiof his "bHities and sa!:isfaction. Those individuals who 

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TABLE 151 453 

Combinations Of Significant Oecl ines Over The Course ~f the Study 

Of The Four Variab1es Used To Define A Case Gf B~rnout 

{Two or More Required For Definition) 

• 

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454 

''w•re defined as 11 burnout" were very likely to have received that 

:_tatinz because they had shown a significant decrease over the three 

'Years in their own estimation of their work satisfaction and ability 

to bounceback. 

Promotions and Medical Qualiflcatio~ 

The ATCs reported any of these changes to the study teams as 

occurred. The reports by the ATCs were then confirmed at the 

of the study by FAA records. Table 152 summarizes these 

Amount of Work Performed 

A description of the rationale and procedure for mea~uring 

job outcome is contained·in Section IIIB. Brieflr, amount 

work perfonned by the ATCs was measured during on,.the-job 

,' •tudies. This objective workload measure was standardized across 

·:;facilities and sectors and an average workload was derived for 

all ATCs who haJ participated in field studies at least two 

~-times. By refetence to ~hese average workload measures, cate-

&ories of low, medium, and high workload change over the three 

years in average workload were established. 

~pecial Reco~niticns and Award3 

AT~s receive~ various awards and recognitions from the FAA 

their. job performanct. Tnese included: Outstanding Per-

, .. formance Award, Point with Prirle, Qunlity Step-increase, Award 

: :··.for Valor, Yearly-in-grade, Suggeation Award, Special Act Award 

· ·(group), and Special Aci•ievement Awca.rd. The ATCs were asked at 

RoUnd 5 how many of these awards and recognitions hae been re-

'c•'~e,iVed during the t~ree years of the study. 

In order to have another dimension of job performance, a 

total awards index was created in a w.•y that would reflect dif-

'ferences i11 ATC performance. Of the eigh:: awards, Suggestion 

'Awards, Special Act Awards (gr~..•up) and A~'lard for Valor were 

eliMinated from the total awaris score as these wera considered 

.specialized events and not accurately ~eflective of individual 

day-to-day job performance. The remaining five awards were 

differ"""ially weighted to reCect their dil'fering prestige 

indices of tt.e quality of ATC job performance. 

For example, a yearly in-grade promotion was clearly iess 

'imror.tant in deflning job performance than a Point with Pride 

'awa=d. Based on Nunnally's (1967) suggestion that variables in 

lin!ar coml--inations should be weighted by the inverse of their 

Standard deviations, the followiug weights were attached: 

) 

\ ..... 

•. , 
455 

TABLE 152 

Administrat:ve Job Changes 

Absolute Relative 

i!!.!!!.S Frequency Frequency 

283 68.0% 

Discharge-Psychiatric II 2.6% 

Discharge-Physical 12 2.9% ' i 

on to Supervisor ~9 11.8% 

to 055 10 2.5% ) 

fer to ATC work elsewhere 27 6.5% ! 

' I 

24 5.8% l ·' i 

• ' I 

I 

• 

represents t~~:; ATCs who disco~tinu~d participating 

variety of oe.rsonal reasons. 

' 
• 

456 

a) Yearly in-grace • 0.7; b) Quality step-increase • 1.5; 

c) Outst .. nding perfonr.a.nce award • 1. 8; d) Special Achievement Award • 2.6; and (~~~ Point with Pride • 3.6. Thus the 

t9tal award was equal t:o the SULI of the products of the number 

of each type of award 1md the weishts for each type respectively. A review of the frequency of each of these recognitions 

~nd awards follows. • I 

a) Yearly In-G:ade Increase 

There was consid,arable variation in the number of tim~s the 

.\TCs received this increase, with 27 of the men reporting that 

they received none. Less than 5% cf the respondents received 

four or more such increases. The high incidence rate of this 

type of recognition ~ustifies its lower weight in the total 

awards index. 

b) Quality Step Incr~ase 

The incidence ra~e for this yerformance measure is presented 

. in Table 153. As can be seen, 199 men did not receive a quality 

increase while 3 controllers reportt~ receiving fi~Je such 

inc'r.eas••s during the course of ·the study. This distribut~on of 

indicated that this was a measure which could be used ·to 

··~~f=:~~~;::~e. between AICs. It was interesting to note that 188 ~i a QUE•lity Step Increase w'rlle 128 men received an 

,::.Oo•tsta1odlLng Performance Award. i:t is likel;• thes,. two were interbut not ~erfec(ly, and the lower incidence rate for the 

'·'•"••r supports its higher weighting in the total performance 

index. · 

Outstanding Performance Award 

incidence rates for this and other awards are presentf~ 

153. As can be seen, 259 ATCs (62%) did not receive an 

;~ltstairu!JLng Pcr::p~ance Award during the three years they were 

study, w·:\ereas one of the controllers received four suc:.h 

The fact that 128 ATCs received this award at least 

during the course cf the study, while 259 did not, indicates 

this award is probably reflective of higher performance as 

If all of the men in the study had received such an 

if none had, it wo:~ld be a meaningless measure of p11r-

,rmsnce. 

d) Speclal Achievement Award 

This awar.i >:as glv~n to approximately 16% (63 ATCs) of·· 

reapondents. Three hundred and twenty-four ATCs reported 

receiving any such award during the three years of the 

• 

• 

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) 

. -I 
-g 

,_ 

!. 

>-

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u 

~ 

,_ 

m 

,.. • 

• .... 

l! 

u 

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~ 

~ 

Q 

No of1 

Awards 

-

0 

1 

2 

3 

4 

5 

6 

7 

8 

9 

No 

Response 

' 

t 

Yearly In· 

Grade lr.crease 

I lien % 

27 6.5% 

146 35.1% 

130 31.3% 

58 13.~% 

10 2.4% 

II 2.6% 

2 0.5~ 

2 o.st 

-

I 0.2% 

29 7.0% 

---: -~ --·- .. -

k<" 

>;'.: 

(.:.~~<-"~ ..... _:, 

. 

Quality 

Step Increase 

I Ke.- "" ..- ·-·· ... 

199 ~7.8% 

141 33.9% 

47 10.1% 

1 0.2% 

I 0.2% 

l 0.7% 

-

29 7.0% 

Outs tand i nq 

Performance 

Award 

I Hen % 

259 72.3% 

90 21.6% 

30 7.2% 

7 I. 7t 

I r.n 

. 29 7.0% 

Special 

Achievement 

Award 

# Hen % 

32~ 77.9% 

56 13.5%. 

3 0. 7% 

2 O.S% 

I 0.2% 

I 0.2% 

29 7.0% 

·------........ ;;~ ....... J- •'••-' 

..... 

Polr:t with 

Pride 

# Hen % 

364 87.5% 

15 3.6% 

5 1.2t 

3 0.7% 

29 7 .. 0 ·' 

-

Suggestion 

AwarJ 

I Men % 

351 84.4% 

19 4.6% 

6 1.4% 

4 1.0% 

2 o.5% 

3 0.7% 

I 0.2% 

I G.Z% 

29 7 •. 0% 

Spec.i a I 

Act 

Award 

I Hen % 

351 34.4% 

15 3.6% 

II 2.6% 

5 1.2% 

I 0.2% 

3 0.7% 

Award 

For 

Valor 

II Men % 

JBf 92.8% 

I 0.2% 

. 

I 0.2% . 

--

I 

29 7.C1.129 7-~~r 

~ 

"' ... 
458 

study, while one of the men received eight awards. The incidence 

rate distribution supports the higher weight assigned this award 

in the total awards index. 

, e) Point with Pride Award 

1 This award was given quite infrequently as 364 of the ATCs 

had not received one during the cours~ ~f the study, On the 

·other hand, it was interesting to note that 3 ATCs reported re- . cciving five awards :luring the three years of the study. 

'f) Total Awards Index 

1 Since this measure was a weighted linear combination of t~J 

.five selected award categories, examinatiGn of the score distri-

:ou<><>n was skewed positively, reflecting the fact that a large 

number of ATCs received only a few (or no) awards. 

In order t~ provide some evidence for the validity of this 

the relationship between selected job changes and this 

awards 1ndex was examined. It was ex?ected that those 

who were promoted would have higher scores on the awards 

while those medically disqualified would have lower scores. 

shown in Table 154, the mean awards index for thos"' J..TCs ~moot:ed was significantly higher (p <·01), and the mean awards 

for those ATCs medically discharged for psychological 

reaSOilS was significantly l<l'•er (p < 05). There was no differbetweP.n the mean award index scores for those ATCs medically 

for physical reasons and those ATCs who remained in 

I 

t 

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• 

• 

459 

TABLE 154 

Mean Tolal Award Scores by Admln1strative Status 

N Mean 

282 38.25 

45 50.24 ,; • 

Disqua lif led-Psychologies 1 5 21.40 

Disqualified-Physically 9 35.67 

···.· 

) 

, 

I 

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I __,.-;.~ ., . "--"• .. ,A.ro 
IV. Evidence For The Validity of Self-Reported Data 

' 

important part of the data in the ATC l!CS was collected 

t••esms of questionnaires answered directly by the study subin any research project utilizing subject r~sponses 

',q•J••ot!.o~•na.ires•, therP. was some question about the truthfulresponses. We were concerned that some of the 

•tio1tr~1ire responses might be biased by subjects who ~ght 

to influence the findings toward changes in management 

or in their own job situation, 

It was critical, therefore, that we determine the accuracy 

responses to our questionnaires~ Reported in this seca number of cheCks that were made to ascertain the 

of varioas self-reports. 

j 

; 

\ 

\ 

) 
SUMMARY 

Validity of Self-Report Job Scales 

ATCs' scores on "faking good,'' ''faking bad" and "random 

:;~'re<•pons••" scales included in· the California Psychological ~*ln••e<lto•r7 were correlated with scores on job attitude scales 

a check on the validity of self-reported job attitudes. 

generally low correlations indicated that the men were 

honestly and without strong bias to the job attitude 

tionnaires. 

461 

; 

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l 

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) 

--~ 

·, ·-.-~ . . ~ 

-~.:;-:.::'t~ 
462 

A. Validity of Self-Report Job Scales 

Alehoush it is difficult to detect directly whether or not 

questionnaire responses are "faked11 (answered to effect a desired 

conclusion) or ans~ered hapha~ardly, an indirect metns to determine 11 fakingu is to include "faking" scales in the questionnaires 

or inventvries. 

Such "faking" scales are included in the California Psychological lnv•ntory (CPI). As this inventory was administered to 

our ATC subjects during their second exam~nation at Boston University Medical Center, we were able to a~sess indirectli whethet· 

or not an&wera on job attitude scales were honest by correlating 

the variabl~s involved with the three response irregularity scales 

of the CPt. 

One of the CPI scales, the ".sense of well-be:!.n~ scale~ is 

generally used as a measure of "faking bad" (Megargee, 1972), although clone examination of the evidence would seem to indicate 

that this scale has excess meaning in terms ~f measuring the 

. self-reported "well-being" of the respondent. · 

A second SC"ale, the "good impression., scale, has been used 

to assess 11 faking good" or ·social desirability. Again, close 

examination of the literature, particularly the adjectives characterizins high and l.ow scoring men (Megargee, 1972), see.ns to 

indicate excess meaning for this s-.:ale in terms of k:Lndnt'!'Ssunkindness and satisfaction-dissatisfaction. 

The third scale, "communality," has been used to identify 

those respondento who answered in. a random fashion. Although 

meager, the existing evidence (Megargeet 1972) does seem to 

support this meaning of the acale. 

The correlations between these CPI scales and eight me·asures 

of job attitude are displayed in Table 155. A high correlation between a person's score on the faking scales and other 

scales is evidence that the person was falsifying hls answers 

on the second scale. The generally low or non-significant 

cor;elationa indicate that the ATCs responded ~onestly to 

queationo: concerning their job eatisfactions and their supervisors. 

The low "communality" co~relations indicated that the NtCs did 

no_t respond in a random fashion to the job '-:...titude qu1!Btions. 

Although there were some statistically significant ccrrelations which mi&ht be taken to indicate some degree of faking 

in responses to the job attitude questionnaires, the low magnitude of the correlations reassured us that if there were some 

. fakt responses, thAy did not represent any strong binNes. For 

• 

• 

) 

I 

! 
463 

TABLE 155 

Correlations B~tween Job Attitude Scales 

and Seiected CPI Scales 

Round 2 (N • 392) 

Scales CPI Sea 1 es 

Sense of Good 

Well-Being I n1pres s I on 

Satisfaction • 19 .23 

.34 .26 

Satisfaction • 12 .08 

.2£ .22 

• 19 • 17 

Structure .04 .04 

• 14 • 11 

erance of Freedom • 13 .08 

·For 11•392, correlations of .10 and .13 are slgnlflc>nt at the 5\ 

:and 1% re•pect levels re<pectlvei.Y 

l 

I 

I 

I 

' l : 

' ' · Conmun3ll ty l 

u .06 l 

• 13 j 

, 

• ' .01 ' ' ' i -.01 1 

i 

• .0); ! 

.03 · . .05 

.06 

.. 
example, the highest correlati_on (. 34) only indicates 11. 5%. 

of shared co-v!lri.atiou between these two variables. Furthermore, th~ excess meaning attached to the first two CPI scales 

would lead to the expectation of a positive rel~tionship between the two CPI variables and measures of job satisfaction. 

That id, the "well being" emphasis of the first CPI scale 

and the 11 happ1ness-unhappiness" excess meaning of the second 

CPI scale. would lead to the expectatio" of a positive relationship with job satiafactlon as this empirical relationshio has 

been found previously (Ka\·anagh and Halpern, 1977). If the . 

correlations between the CPI scales afld the industrial scales 

were larger, ln the .60 to .80 range, we could conclude that 

the ATCs Were biasing their answe~s. However, the results in 

Table 155 suggest that the ATCa were thoughtful and honest 

in their responses to the job attitude questionnaires. 

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465 

SUMMARY 

Ext~rnal and Internal Validatqrs vS. MHR 

The accuracy of the self-reports on the Monthly Health Rev1£w 

were checked by both external infor.ut-.tion and internal comparisons 

of information report~d. 

Telephone interv.1.ew by the stcdy's physician with selected hTCs 

resulted in confirmation of the MHR diagnosis of ~~ of 58 illnebs 

events. 

Comparisons of reported gastrointestinal symptoms with actual 

serum pepsinogen 1 levels delllonstrated that reports of contin~·ing 

gastrointestinal problems were mu~h more frequent, as exp~cted, 

among those with high pepsinogen 1 levels. 

Internal analysis of data on upper respiratory infection (~I) 

showed that: 

1) With an increase in number of URI symp~~ms reported, 

use of medical care increased, and proportion of 

episodes involving four or more days lost from w~rk 

increased sharply; 

2) the !:lame sympto;ns reported a~ isolat.ed evLnts .,..t!re 

less often attended by a physician 1nd r~;:~ult.eJ in 

fewer days down; 

3) reports of symptoms followed known seasonal varia·tiorts. 

Genernlly, the· MHR self-reports were affirmed as accurate in all 

of these checks. 

• 

• 

) 

.. ~· 

··-- ';· •• ;: _j 
46u 

8. External and Internal Validators vs. MHR 

Two general approaches to checking the accuracy of selfrepc~:trted illness info~ation on the Honth!y Health Review 

(MHR) were utilized: external and internal criteria. 

The external validactons involved l) telephone int~:rviews 

by the study's physician to ATCs reporting respiratory symptoms to assess the accuracy of the diagnoses made on the basis 

of MHR info~tion; and 2) compariRon of reported gastrointestinal 

symptoms with actual serum pepsinogen levels co ascertain whether 

or not expected relationships were actually observed. 

Internal validation of the ~!R was assessed by analysis 

of reported symptoms to ascertain whether or not their frequency 

followe~ known seasonal variations in prevalence of specific illness conditions (e.g. upper respiratory infections in winter), 

and to check whether reports of symptoms as "episodes," "isolated 

events,'' and ''continuing problems" reflected clinical medical 

expectations with regard to level of medical care involved, to 

days of restricted activity, and to known cluster~ o~ symptoms 

for the illnesses diagnosed. 

Results of the telephone interviews confirmed that diagnoses 

based on the }ffiR information alone were identical to the diagnosis 

rendered by the physician on the basis of the telephone interviews in_43 of 58 events. Among the IS remaining events, all 

but 2 were diagnosed wittin the sam€ group of illness cond1.tions 

as the HHR diagnosis. Of the remaining 2 diagnoses, 1 was Considered an isolated symptom by the physician, but an episod~ of 

common ~old on the basis of ~IR scoring; the other was considered 

to be too non-specific to be diagnosed by the physician while it 

was categorized as an upper respiratory infection on the ~a&is 

of the I!IIR symptcms. 

The comparison of reported gastrointestinal symptoms with 

,:,~::~~~e:•;:erum pepsinogen I levels demonstrated that, as would be ~· those with the lowest serum pepsinogen I levels did 

t having symptoms such as nausea and/or vomiting as a 

problem; and again as would be expect.ed, those with 

highest pepsinogen levels reported having auoh symptoms ac 

average rate of 37.5 symptomatic months per 10·0 person-years. 

of stomach pain, abdominal cramps or heat'tburn were also 

common as continuing problP.ms in persons with high pepainoI levels, as w.ould be expected. 

Analysis of 1Z5 URI episodes !n the months from February 

April, 1975 showP.d that ao the number of reported symp-

.. 

; 
467 

toms in the URI cluster increased, the number of events uti·lizing doctors' care also increased. and the proportion of 

episodes involving 4 or more days lost from work increased 

sharply. Another indication of the validity of the MHR reports 

was that the same symptoms reported as isolated events occurred 

much less frequently, were less often attended by a physician, 

and resulted in fewer days lost from usual activities. Again, 

the ebb and flow of symptoms reported followed known seasonal 

variation. 

Analysis of the clustering of individual respiratory 

symptoms showed that the ATCs related the symptoms to the three 

alternative choices of chronicity: illness episode, isolated 

symptom or cou.:inuing problf!m. The symptoms checked as illness episodes were in fact reported far more frequently in fall 

.1nd winter than in spring and summer. "sn~ezing, stuffy or 

runny nose," for exanple, was checked most frequently as part 

of an illness episode. but far less frequently as an isolated 

symptom, and only rarely as a chronic problem. On the other 

hand, frequent dry cough, productive cough, ac.d. 11 aches or 

pains in muscles or joints other than back" were reported as 

chronic problems by almost as ma~~· ATCs as those reporting 

t~ as acute episodes. 

0thf~ reports of symptoms with the expected chronicity 

- e.~. reports of diarrhea, stomach pain/abdominal cramps, 

b~ck pains, headaches, sleep problems, heartburn. excess 

fatigue, and o:-:hers primarily as isolated -events - also 

tended to affi~ the accuracy of the MHR rep~rts. 

An extended discussion of the methods of validation 

summarized briefly above, a~d mor~ ietailed results cf the 

analyses performed to assess the accuracy of the MHR reports 

is available in a ps.per prepared for publication, "Use of 

a Monthly Heald, Review to Ascertain illnesses and Injuries 

in the Air Traffic Controller Health Change Study." 
468 

SuMMARY 

Validity of Self-Reported Marital Satisfaction: 

Relationship with Mate-Rola Function as Evaluated 

by PSS Interviewer 

Self-reported marital satisfaction, checked against the diagnoses 

of mate role problems made by a trained lnterviewer during the 

psychological examinations, appeared tr be accurate and honest, 

a• was also self-reported compatibili'.y between mates on family 

goals. 

• 

• 

• 
469 

C. V~lidity of Self-Reported Marital Satisfaction: Relationship 

with Mate-Role Function as Evaluated by PSS Interviewer 

As discussed in Section IIIB, the Air Traffic Controller 

Biog:aptical Questionnaire (ATC BQ) contained a self-reported 

measu.:e of the ATC 's marital satisfaction. In order to examine 

ti".~ accuracy of this self-reported data, the relationship between mate role dysfunction on the basis of the PSS interview 

and self··reported marital satisfaction were examined. Correspondence between diagnosed mate role problems, as jeeermined 

by a trained interviewer, and a self-reported measure of marital satisfaction would provide some evidence that the ATCs 

re_Jponded hc'['I~Gtly. 

Analysis revealed Etrong and st&tistically significant 

differe"nct!s in degree of ruarital satisfaction between ATCs 

diagnosed as asymptomatic and those diagnosed as sympto~atic 

in mate role dysfunction on the PSS (p < .0001). ATCs diagnosed in the PSS interview as having mate role problems had 

a mean of 3.519 on the marital satisfaction item, whereas 

those judged to have no problems by the interviewer had a 

mean of 1.655 on a re"tponse scale ranging from 1~ "very happy 

and ::;.atisfied," to 5, "very unhappy .::tnd dissatisfied."- The 

mean of the symptomatic ArCs was midway between *'neutralJ or 

very mixed teelings" and "somewhat unhappy and dissatisfied. 11 

In addition to the self-report of marital satisfaction, 

the ATC BQ also contained 3 meadure of the ATC's perception 

of how well he and his wife agreed on family goals (see 

Section IIIB.). Examinat1ons of the relationship between 

the total goals compatibility score for the self-report and 

the mate role status as evaluated in ~he PSS interview provided 

strong evidence that the ATCs' perceptions of the compatibility 

in their marriages, as self-reported, were accurate. Those 

ATCs diagnosed as asymptomati~ perceived much greater compatibility between themselves a~ their spouses than did those 

diagnosed as symptomatic (P < .0003). This result provides 

additional evidence for the validity of the self-reported 

data. 

.. 
!&70 

Stw.MARY 

Technological and Management Changes R~flected in 

Job Attitude Questionnaire Results 

Self-reported individual satisfaction of ATCs and group morale 

showed an expected positive change at the Islip facility as a 

result of a change in management policy. 

At the same time, introduction cf new technological equipment, 

for radar control at all facilities. resulted, aa expected, 1-n 

a negative change in work satisfaction. 

The lack of any changes in coworker or pay satisfaction at this 

time tended to affirm the honesty of the responses on the other 

scales. 

Together, the reflPction of events in the responses to the 

attitude scales provided evidence of the h0nesty of the responses. 

~ J 

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471 

D. Techno!ogical and Management Change Reflected in Job Attitude 

Re~ults "': 

In late 1974, the study team received a request from the new 

facility head at Islip to evaluate the imp3ct of hin new managerial philosophy and policies. Coincidentally, the new technology 

for controlling aircraft was implemented in all of the facilities 

in the study. This technological change in the radar equipment 

was made to simplify the ATC's job, and thus to improve the quality of job performance. However, it was the etudy team•s observatinn, while talking to the men, that they really did not like 

this technological change. 

Thus. there were two significant changes that we wished to 

investigate. One of the troat common findings in tl-.i! literature 

on organizational change is that employee attitud(·s are usually 

affected by any change (cf. French and Bell, 1973; Ruse, 1975; 

Thomas and Benr.is, 1972). In this case, we expected the technological change to have a negative effect on the at,:itudes of 

the ~TCs toward their work, while the change in management policy 

at Islip was expected to l~ad to positive attitude changes in 

general. 

Act'..lal occurrence of the hypothesized attitudinal changes 

would constitute evidence for the validity of the respon~~s on 

attitude 'lues!';tonnaires. That is, if the ATCs were responding 

honestly to the job attitude questionnaires, these "naturalu 

changes iu their wc~k environment should ~ave been manifested 

in attitudinal changes. 

Since job attitudes were collected continuously during the 

time when the changes were made, it was possible for us to test 

our hypotheses. The facility chief change occurred in December, 

1974, approximately the same time as the technological change. 

Using attitud1nal data collect~d during October and November 

1974 aa a pre-measure and that collected during January and 

February 1975 ae a past-~asure, we were able to assess attitudinal changes. 

For the analysis. we ~~ntraated the attitudinal changes at 

lalip with those at the ot~er <ac111ties. Aa expected, the 

ATCs' satisfaction with their work itoctf decr·eued significantly 

at Islip. Fu~tt.ermore, work aa~tsfsction decreased aignificantly 

in the other !acU.ities, and the ne~ativ-:1 change at Ialtp wae 

the same a a the ch"nge in nll othor tacilitiel. lu; discussed in 

Section II!BS. thin sp~ci!ic n•peet of job sati•faction is concetned ~ith th~ actu4l work the Arc do&s. The negative change 

in satisfaction with thia aapect 1.., p.>rt •• due to· the techno• 

logical c~ans• introduced into the AfC'a job. Since this change 

• 

• 
in all facilities, it provides strong evidence that 

were responding honestly on this attitude Scale. 

The ~ignificant positive changes in both individual satisfactic>n and group morale at Islip were as expected. These 

variables did not show any change for the other facilities. 

two scales measure overall or general satisfaction in 

of individual and group factora on the job. Thus. a 

in management philosophy or policy "ould be expected 

affect these overall measures. 

Finally, the lack of any changes in co-worker or pay datisalso provides indirect evidence that the ATCs were 

opo'nCl;Lng honestly to these scales. One would not expect 

a technological or management policy change to affect 

ATCa' attitudes toward their co-workers or their pay. 

In a~ry, the pattern of changes in attitudes coincidental 

important chanJes in their work environme~t provided strong 

that our study group responded honestly to the selfmeosures of their atcitudes. 

.. 

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SUMMARY 

Relation of Hypochond~iasis, Hysteria, Depression and 

Anxiety to the Freguency of Diagnosed Physical Health Changes 

473 

To test whether <.;!.' not a psychological propensity to complain 

gight generate self-reports of symptoms and ultimate diagnoses of 

illness conditions, hypochondriasis, hysteria, depression and 

anxiety scales were administered and scores were correlated with 

Dumber and level of illnesses reported during the interval follnwing. 

ATC scores were lower than the a·rerage of the norm group in all 

except hysteria, in which higher than average scores were attribtlted to a tendency to deny personal problems. There was no 

evidenc6 that men with greater psychological propensity to complain had e higher frequency of any level of physical health 

ch5nges. 
474 

E. 

• 

Relation of Hypochondriasis, Hysteria, Depression and Anxiety 

to the Frequency of Diagnosed Physical Health Changes 

When the diaenosis of physical health changes is based in 

whole or in part on self-report, one must consider the possibility 

that illness reporting, and hence, the probability of rendering 

dia~noses will be influenced by ~uch personality characteristics 

as tendencies toward hypochondriasis, hysteria, depression and 

anxiety, all of which could generate a propens1ty to complain 

about minor ph}•sical symptoms. 

In order to examine this possibility in the ATC HCS, the 

·hypochondriasis and hysteria scales from the MMPI, and brief but 

validated depression and anxiety scales from the same test, were 

·administered at the third round of examinations. The scores 

obtained were compared with population norms established for the 

~I and correlated with the frequency of physical hP>al.th 4J..a.gnoaes 

at Level 0, Level 1, Level 2, gnd Level 3 :!oring the interval 

which followed the third round of examinations. This analysis 

was thus a prospective determinatio~ of the relationship between 

these psychological tendencies and the frequency of diagnoses 

made by the study physician on the basis of the health surveillance procedures utilized in the study. 

Results 

For the 295 ATCs having complete data for interval 3, the 

mean, the maximum and the minimum numb~r of health changes at 

each level is liuted below: 

Level of Health Chanse Mean Maximum Minimum 

Level 0 0;5 6 0 

Level 1 1.5 9 0 

Level 2 0.2 3 0 

Level 3 0.04 1 0 

It ia correct to tnfer that the majority of men had Eero 

heall:h changes at each bv 11 indicat~d. A fairly·good distribution 

0 and Level 1 health changeo occurred, but tor Level 2 

Level l, the dietribution was extremely truncated. 

The mean &corea fr.r e:ach of the: psychological scalea on the 

130 inotrumenz admin&tercd at Round 3 are ahovn below in 

metric with 50 equal to the tU:an of Minnt~Bota normal 

c::J .LO equal to th• otandurd deviation of rair d1otr1h,.tion. 

• 

• 

• 
475 

s~·ale Mean Maximum Minimum 

Hypochondriasis 47.8 72 39 

Hysterl.a 57.1 80 36 

Depress ior! (030) 48.6 82 37 

B~ndig Anxiet;: 44.7 80 34 

Hysteria Subscales: 

Admission of s~ptoms 47.8 74 38 

Denial of problen•s 60.1 81 34 

The table reveals thar. this sample of ATCs had a lesser 

tendency toward hypochondria~is than the standardizing group of 

"Minnesota nomal adults." Del't"ession score was also somewhat 

lower than the normative sample of college students free of psychological disorders. The Bendig Anxie~:' scale -- a short foTlll of 

th& Taylor Manifest Anxiety Scale -- had a considerably lower 

mean than the original standardizing sampl~. On the hysteria 

scale, however, the ATCs scored higher than the MJ.nnesota normals. 

When the hysteria scale was broken down into ita two components, 

however, it became apparent that this elevation in mean score 

came co~pletely from the tendency of ATCs to deny personal and 

interpersonal probl~ (~is scale being one standard deviation 

above the normative mean). On the other hand, the tendency to 

admit physical symptoma, as measured by the "admission" scale 

coincided with the finding for the hypochondriasis scale that 

ATCa were slightly below average adults. 

The correlations between the six psychological scales and 

frequency of diagnosed hualth changeo at Levels 0, 1, 2, 

3 can be oummarized simply, The 24 corr~lations in this matoll ranged betwe~n +.08 and -.10. Fourteen of these small 

correlation• Wftre in the negative direction and 

poaitin diraction. Und•r the h~pot:besil that psyc-hoproblema waul~ ~eneraca greater n~ers of diagnooed 

!lfi11Clll health changes, one would exp~:t the great majority 

corr~lationa to be positive and to be of much ireater 

The evidence from these data analyaer vas clear and conArea wore not hypochond~iacal, anxiouo or deprea~ad 

1raatoor degrees than tht. avarase population, The only al.etl•1r personality which could have been considar&d 

l 

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476 

"hysterical" in nature were somewhat higher ~requencies of 

d~nial of problems. Although the r"nge of p•ychological 

scores was considerable for this sample of ATCs, there was 

no tendency for men With greater psychological propensi.ties 

to complain to have a higher frequency of any level of 

physical health change as diagnosed by the study physician. 

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SU!1MARY 

felatiOliBhip of Subjective D!stress in th~ P~ychiatric 

Interview to Prior Depression and A~~iety 

47i 

Monts-aly Relf-reports of anxiety and deptessior\ were checkf·d against 

the a~sessments of a~iety and depression by the professional 

~sychologists administer1ng the PSS (SubJective Distress Scale). 

Cross t:!bu_l a tiona of interviewer and self assc:ssments show~d that 

the interviewer's poRitivc findings of am;:'.ety and depression 

were largely substantiated by the earlier self-reports. but there 

were in addition a large number of self-repvrts of symptoms that 

were nc.t matched by int~r~ iew~rs' assessments of sigt,i ficant 

symptomatology. This surfeit of se!..f-reporcs muy have reflected 

less eigni~i~ant, or tranaienL sycptoms, o~ general over-repo~t~ng. 

• 

• 

• 
478 

F. Relatlonsftio of Subjective Distress in the Psychiatric 

Interview To Prior Depression and Anxiety 

The monthly assessments of depression and anxiety were 

self-report, pencil-and-paper instruments. On the other hand, 

the psychiatric interviews were conducted in a structured, 

clinical format which allowed professional judgment in ascertaining symptomatology. We checked the validit; of the 

monthly self-reports by comparing them with the im~ressions 

of the professional interviewer. As the Subjective Distress 

criterion scale of the psychiatric interview (PSS) primarily 

assessed significant symptoms of depressio11 and anxiety, it 

was chosen as the most appropriate PSS scale for comparis~n 

with the self-reports. 

Table 156 shows that men assessed by the professional 

interviewer as having significant S'lbjective distress had 

previously reported rates of depress1vn nine times higher 

than those found in asymptomatic persons during th~it psychiatric interview. The cross-tabulation results dhown in the 

lower half of this table indicate that only 2 of 17 men who 

were symptomatic in the interviews had self-reported rates 

of depression categorized as asymptomatic. On the other hand, 

66 of 81 men whc were symptomatic by self-report were asymptomatic by interview. 

157 shows the same comparisons for monthly anxiety. 

'Essenti.al.ly the same results were found for anxiety as for 

An appropr~ate·conclusion from the validity check might 

that men who were having problems with anxiety and depresby assessment of the PSS interviewer had self-reoorted 

problems previously. However, an additiOnal group. of men 

that they were having these problems, but appeared 

having significant symptom~tology by the time of the 

"''"'"'''''u These :~en may have been overreporting less signiS)~ptoms, or their symptoms may have ~een transient. 

"Y check did establish that the positive findings 

PSS interviewer were substantiated by the previous 

ol.f-repor ..• 
• 

TABLE 156 

Anr.ualized Rate Of Monthly Depression Between The Second 

And Third Examinations At Boston University For 

479 

ATCs With And Without Subjective Distress At Their Third Examinations 

Total 

Avai I able 

Subjects 

347 

Subjective 

0 is tress 

Asymptomatic 

330 

Subjective 

Distress 

Symptomatic 

17 

. 76 ...:2]_ 4.50 

I. 0 1.60 2.70 

t • 9.37 p ~.0001 

Monthly Depression 

Symptomatic 

Asymptomatic (Acute to Chronic) 

Totals 

As ymp tonlfi.EJ.E.. 

Sympto!'1at ic 

Totals 

264(observed) 

(253)(ex~ected) 

2 

13) 

26G 

66 

(77) 

15 

( 4) 

81 

x2 • ;8. 34 p < . oooo 1 

330 

17 

347 

• 

• 

• 

l: ... '-._;;; 
480 TAJ!LE 157 

Annualized Rate Of Monthly Anxiety Between The Second And 

Third Examinations At Boston University For ATCs 

With And Without Subjective Distress At Their Third Examinations 

Total Subjective ::'••bject T ve Avai I able Distress Distress 

Subjects Asympt1Jcmat i c Symptomatic 

347 330 17 

.78 

--~2~.0~'--------------~2.~0~0-------------~ 

t - 4.26 p.O: .0001 

Monthly Depression 

SymptomatIc 

Asymptomatic (Acute to Chronic) 

262 

(252) 

3 

( 13) 

2 

68 

(78) 

'" ( 4) 

82 

x2 a 30.82 p<.OOOul 

Tota Is 

330 

17 

·' ... 
SL'liHARY 

Liver Function Tests as an Index of the ValiditY 

of Alcohol Abuse and Drinking Assessme!lts 

481 

Three tests sensitive to liver damage were performed during 

the physical examinations and provided a means of checking the 

validity of the alcohol use and abuse assessments. 

Two of the liver function tests discriminated the heavy drinkers 

and the alcohol abusers from the o~~~rs, with the strongest 

assoc.t "ltion between alcohol abuseJ:s and liver damase. The PSS 

assessments of alcohol abuse were confirmed by the Liver Test 

data. 
482 

• 

G. Liver Functi.Jn Tests As Ati".Index Of The Validity 

Of Alcohol Abuse And Drinkin~~ Asseusments 

Three liver function tests were perfo~ed as part of the 

serolugy studies conducted at each evaluation at Boston University - serum glutamic oxalacetic transaminase, setum glut£m1c 

pyruvic transaminase and alkaline phosphatase. These tests are 

sensitive to liver rlamage and the values generated become elevated 

as t~e liver becomes impaired. The testaJ therefore, provide~ 

a mear.s of checking on damage to the liver that might be associated with alcohol use and abuse. 

Table 158 displays the result~ of comparisons of the liver 

function tests of those who were asymptomatic on the Psychiatric 

Status Schedule evaluation of alcohol abuse with those who were 

symptomatic according to our criteria. Two of the liver tests 

were significantly elevated among those classified as s~·mptomatic 

alcohol abusers according to behavioral and psychiatric cr.iteria. 

There was al&o greac~r vatiabtlity in the liver function tests 

~ng those classified as symptomatic. 

Table 159 displays the ethanol consumption r•er week among 

those who had abnormal liver function tests and t~\ose who dld 

not at the enu of th~ study. As expected, ethanol intake was 

significantly higher among those who we~e abnormal on two Of 

the three tests. 

It was interesting to note that the relationship between 

alcohol abuse and abnormal liver functioning was stronger than 

that between ethanol intake and liver functioning (this -comparison can be made by comparing the absolute magnitude of the 

t•tests). 

-In aum, two of the liver flmction ·tests were cleat·ly elevated 

among those having alcohol abuse problems defined in psyc~iatric 

and behavioral terms. In addition, men with abnormal liver function as determined either by SCOT or alkaline phosph~tase, tnde-

.pendently reported hlgher volumes of ethanol consumption to the 

·study interviewers. Hence, a completely different and bli~'ld 

the psychiatric interviever&) source of data confirmed the 

of our iote1view data And the significance of our cla:asiof alcohol ahuae. 

• 

• 

• 

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Serum Glutamic 

TABLE 158 

Alcohol Abuse Effects On Liver 

Function Tests At Intake 

Alcohol Abuse Status 

At Intake Examination 

Asympto- Symptomat ic matic 

(N•)83) (!I~) I)• _t_ 

Me .an 4).83 58. I) 4.27 

Oxalacetlc Transaminase:':~~ (S.D.) (1).67) (44.98) 

Serum Glutamic He an 2).85 26.58 1. 04 

Pyruvic Transaminase** (S.D.)(I2.64) (26.15) 

Alkaline Phosphatase** Mean 60.70 82.68 ).29 

(S.D. )(20.4)) (28.81) 

• 

---L.. 

.0001 

N.S. 

.002 

The results of two men were excluded because the laboratory-assay 

was inva1 id . 

•• 

Normal llmi ts: SGOT, 0-45 

SGPT, 0-41 

Alk.Phos., 

International ••nits/liter 

fnternatlonal units/ !fter 

33-110 units/liter 

483 
484 

TABLE 159 

Ethanol Consumption Differences Between 

Men With And Without Abnormal Liver 

Function Tests At Theft Flnal Examinations 

Serum G I utaml c 

;;Oxalacetic Transaminase 

Abnormal Serum Glutamh! 

Oxalacet ic Transaminase '~ 

·· (N•9) 

Serum Glutamic · .. Pyruvic Transamfn•se 

(N•339) 

Abnormal Serum Glutamic 

. Pyruvic Transamfnas__,,,* 

(N•44) 

13.92 (14.05) 

H.56 (17.21) 

1}.74 (14.15) 

17.75 (14.46) 

Normal Alktline Phosphatase 13.76 (13.08) (N•)64) 

Alkaline Pho•phatase••• 21.77 (25.72) 

,, 

Normo I llmlu: 0-45 fnternatlonal ~.11 ts/11 ter 

•• 

Norma I limits: 0-41 International unlts/llt,•r *"' Normal limIts: 33-110 units/liter 

t • 1.76 p • N.S. 

t • 2. 44 p <. 02 

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SL1!!1ARY 

Legal Problems as Validation of Impulse 

Control Symptomatology Classifications 

To <heck the possibility that our finding of a high rate ot lmpulse 

control symptomatology might have been due to an unrealistic cutoff score on the PSS Impulse Control scale, we checked for l~gal problems indicated in the life change inventories completed at 

each ~~amination at Roston University Medical Center. 

We found that men with impulse control disturba;1ces at i.ntake had 

significantly m3re leeat problems before and after intak~ than 

other~, and that these problems did not particularly distress 

thom. The>e findings confirued the validity of the classification 

system for impulse control disorder!. 

• 

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486 

Legal Problems As Validation Of Impulse Control Symptomatology Classifications 

high rate of impulse control disorders among 

controllers, and we wondered if this high 

have been generdted by a cut-off score that was 

Therefore, we undertook several checks on the 

)~r·opril•t••n•••• of our impulse control criterion cut-off 

One check involved an investigation of the relationbetween legal life events and our impulse control 

ifications. 

and theory, men with impulse control prob~ 

higher probab!lity of having legal probbecause their antisocial behavior would be likely to 

attention from law enforcement officials, or be the 

of legal action• against such individuals. The ROLE 

events inventory contai.ned a number of legal life 

such as being jailed, sued, forecloRcd and so on. 

events were subs~ued by the Holmes and Rahe ~HR) 

lhe Paykel, P"usoff and llhlerihu~h (PUP) list; th~ 

listed all of these and ~everal others. Since 9ubjects 

th~ kOLZ at intake and Rubsequent examinations, it 

!":•~::~:.o~'~.~detenutne if the theory WE9 corr'=!:ct. lf our 

t.t the theory. \ole c.ould be much more conf idcnt 

of higher rate• of im:>'Jlse cont::ol disorders 

If we were misclassifying subjectR 1 then we yould 

the expected association with legal problems. 

shows that men with impulse cor,crol disturb-

(prevalence cas.sl had lignificantiy higher 

scoreB than either as~~tomatic :ontrols or 

after intake. Since the co:relation between 

and the number of events was .90 or above (see 

and Ro1e, 1978), we c~ulci safely conclude that 

have impulse control disorders had the expected 

of legal probleQa prior to intake. 

in Table 160 aleo auggeat that legal problems 

impulse control disorders since the incidence 

different from the asymptcmstic c&aes. 

shows that men with ~pu!se control disturbhad significantly higher legal lif~ •vent 

interval between intake and ~he SI"!Ccnd eV-".luaacores were derived from tht!ir reports at the 

' looking backvarda ovu this time opan). 

our data showed that oux· case assignm~nts 

ditorder.a did diffcuntiate th.,se men who .. 

' 
487 

TABLE 160 

Legal Life Ev~nts~ 

Validity Index Of lmpuise Control 

Symptomatology: Comparis,on Of_ 

Asymptomatic Co~trols, Prevalence Cases And Incidence Cases 

Life Event Score Asymptomatic Prevalence Incidence 

For 6 Honths Prior Controls* Cases 1

' Cases* 

To Intake !!.:.!1.!.. N•SO !!:1.!.. F _L 

Holmes and Rahe He an 2.33 5.38 I. 39 J.so .04 

L~gal Life Changes (S.D.) (7.50) (13.39) (3. 69) 

P•ykel, Prusoff & Mean 2.4D 4.04 I. 38 3.04 .os 

Uhlenhuth Legal (S. 0.) (5.64) (3.49) (3.46) 

L1 fe Changes 

ROLE legal Mean 6.52 13.55 4.27 2. 51 .09 

Ll fe Change (S.D.) (18.79) (35.39) (11.68) 

Distress 

• 

Asymptomat!~ controls were ATCs who never had ~~y significant symptomatology 

In the S criterion areas of the Psychiatric Status Schedule examination. 

Four controls did not complete the I ifr. chanc;e assessment and were ·excluded 

from this analysts. Prevalence cases had significant lmpul1e control symp· 

tomatology at Intake. One such case did not co~plete the life change assess· 

ment and was excluded f ro.n th 1 s ana I ys Is. Inc 1 dence cases devc loped s l gn I f• 

!cant Impulse control symptomatology after Intake and did not have It at 

Intake. 

i. 

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488 

Rahe 

Changes 

and 

TABLE 161 

Legal Life Events As A 

Val 1dfty lndeK 0!· Impulse Control 

Symptomatology: later Events As A 

Fu~ctlon Of Intake Status 

As~metomat fc:'r S~mptomatfcl't 

11•341 N•51 

He an I. 64 6.67 (S. 0.) (7.35) (18.62) 

He an I. 91 4.90 (S. 0.) (5.27) (10.)5) 

Mean 9.84) 28.24 

(S. 0.) (28.26) (57.71) 

.!. .e. 

).50 .00il9 

3.2) .002 

).65 .0006 

tic • No Impulse control disturbance assessed fn Fsychlatrlc StatJs e examination at Intake. 

tic • Impulse control disturbance above criterion level en Psychiatric Schedule e)(ami-nat fun at Intake. 

• 

• 

• • 

' I 
had and would have more legal problems than m~n without this 

disorder. 

489 

In summary these data ,upported our impulse control disorde: clasa!fi~at!ons and reassured us that the high rate of 

i~pulse control disorders wa3 not an artifact of our criterion 

cut-off scores. 

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490 

S!Jr1MARY 

Predictorn of :lild .1nd Hoderate :tcalth Change 

Av~rage annualized illness rates were co~puted and were relatP.d 

to psychological variables measured before onset of the illnesses. 

The following factors were fou.nd to be related to total morbidity; 

l) The group with the most illness had the most 

work-related anxiety, t\S measured by th:~ ATC 

questionnaire; 

2) Tho high illness group had the lowest ability 

to discharge tension effectively and reported 

that ATC work ".-:ost 11 them u lot in terms of 

interference with other asp~cts of their liv~s; 

3) !hose in the high illness group were least often 

chosen by their peers tor a~icability or as ideal 

team members; 

4) The high illness group had the lowest group 

morale as ~neasured by the :<avanagh scale, the 

least satisfac~ion with management, and consistently rated their supervisors as having in-

·adequate consideration for. others; 

5i The high illness group was more job-involved, 

more Type A, os measured by the Jenkins Activity 

Survey, and ~ore dQminant, more sociable and ~ore 

accepting of the . .-<~selves as measured by -the CFI; 

6) The high illness groc.p had "igrificantly more 

life changes that were distressing, and this 

proved to be one of the strongest predictors of 

total morbidity; 

7) The high illness group a-".owed significantly luwer cortisol 

•ecretion and significaatly less variability~lood 

pressure at field studies. ----

Discriminant function analyses, using the variables that were significant in univariate stuaies 1 indicated that the predictor variables were best for discriminating between individuals in the 

hi&,he.st and the loweost illness groups, but not of great value in 

discriMinating individuals in the middle groups of health change. 

!he variables that predicted low vs. high rates were: Amount of 

distressing life change, systolic residual range (range beyond that 

e:,pected from ti,e level of blood pr.:~sun~), total cortisol secretion, and Type A personaLity. 

Uuing theoe four variables, 76.7% of the individuals in the high 

I 

,II 
• 

491 

group an~ 79.1% in the low grou~ were predicted. Predictors were 

determined separately for eac!-1 of the four diagnostic categories 

in which mi!c! and coder ate illness was me:-·::. frequent. 

• 

• 
492 

V. PR[D!CTIVE FINDINGS 

1. Predictors of ~1ild and-Moderate Phvsical Health Changes 

Mild and moderate health changes were defined for purposes of 

this study as those illnesses and injuries scored at severity levels 

1 and 2. The frequ(·ncy of these events was treatt..::! as a continuous 

score adjusted for the amount of time each respondent was in the 

study and the percentage of Monthly Health Reviews returned. The 

derivation of the basic statistic, the average annualized compressed 

illnens rate, was described earlier (Section III C). The present 

section describes the psych0logical, biographical and field predictors of average am,ual illness rates for all causes of morbidity and 

then separately for nine major categories of medical diagnoses. 

Average annualized illness rates were computed for all f~ur 

intervals of the study and these were related to psychological variables measured at Round l. Because a larger array of psychological 

variables were available for Round 2, tnese were also entered into 

the analyses but in order to avoid the problems of citcularity caused 

b~ the presence of interval one illness events in the .overall averages, ne-.· indexes of morbidi':y were calculated bR.sed on the average 

for intervals 2~ 3, and 4. For these indexes, all Round 1 and Round 

2 psychological data were truly predictive inasmuch as the data on 

the p~edictor variables were collected before the beginning of interv&l 2. The average illness rates for this shorter time period 

also eliminated from consideration a number of men who participated 

in the study only through interval 1, i.e., to the second round of 

examinations. To the extent that there were unreliabilities in psychological data and in meJical data at the beginning of the study 

which were eliminated after both participants and ·staff l)ecaro.e more 

familiar with the routine, the average rates for intervals 2 through 

4 may also be more reliable expressions of respondents' particular 

morbidity patterns. 

Jotal Average Morbidity 

The total of average annualized morbidity for all d1.agnostic 

cat.:!gories includL1b injuries represents the best single overall 

i"dex of physical health change available to the study. It is 

heavily weighted by the most common diagnostic categories such as 

acute respiratory disorders which comprise 45% of all illness episodes. The total index is aldo administratively importaGt because 

it represents also short term absenteeism from work due to ill~ess, 

and t""---f~l;Qrs which predict the total 1ndex will also predict 

the short terc absenteeism. 

ATCs were divided into four groups on the basis of their a_vera~e 

annualized Jllness r.nte. Only men who had at least one adequate!y 

reported ira.terval of observation were included in the analyses·. The 

low illness group averaged les8 than one ~inor illness ~pisode or 

j 

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493 

injury per year, the high illneSB group averaged five or more· illness episodes or inj•1ries of any kind per year and the two intermediate groups had correspondingly less illness. The exact delimitations of the groupings and the nu~her of men in each category for 

the analyses based on all four intervals and those based on the 

three intervals after thP. first are shown in the small table below: 

AVERAGE NUMBER OF ILLNESS EPISODES 

Tutal Less Than 1.0 - 2.5 2.6 - 4.5 5.0 or More 

Sample One Per Year Per Year Per Year Per Year 

Analyses 

tor intervals 1-4 378 58 129 131 60 

Intervals 

2-4 only 344 n 103 112 57 

The one-way analyses of variance grouped men in th~ four categories above and ~alculated mean scores on the {-vssible psychosocial 

predictors. Fifty-two such predictors were used from Round 1 of 

examinations and 57 from Round 2. Utilizing th.e P • .05 level of 

statistical significance, 7 of 52 Round 1 predictorS and 18 of the 

57 Round 2 predictors were signifi~antly different across groupings 

by degree of :U.lness averaged for all four illnesses of observation. 

When t;,.:; outcome variable o.•qs the av<!rage illness rates for the 

three intervals excluding the fir3t, 3 variable'3 from Round 1 were 

found significant, wherea:-. 15 Round 2 predictors were significantly 

associated with illness rates in the three ensuing inttrvale. To 

eliminate the possible effect of controllers' first interval illness on their psyl.. .• ol:)gical responses during the Round 2 examinations, 

Round 2 variables are ~~scussed only as possible predictors of illnesses occurring after the second examination, i.e., the av~rage 

rates based on.intervals 2-4. The reason why Round 1 variables were 

so much weaker a~ predictors of total illness rates is not clear. 

We suspect that the greater length of the interview and questionnaire procedures at the intake examination may have led to fatigue 

and carelessness in subjects' responses and that this may h~ve weakened the validity of the psychological variable•. We also believ~ 

that reporting of illnesses became more r~liable as the study progressed and that the procedures for assigning diagnoses became more 

methodical after the first few months. For these several reasons 

the analysis of prediC'.tors of mild and moderate it"lnesses will concern mainly the illness averages gen~rated by the last three intervals of observation and the psychological data gathered at Round 2. 

• 

• 

• " 
494 

.Psychological and Job-Related Predictors of Total MorbiditY 

There was a consistent tendency for variables reflecting psychological dist~ess and anxiety to be predictive of future physical 

illnesses as diagnosed by the study physician. Scores on the workrelated anxiety factor generated by the Air Traffic Cantrelle~ 

Questionnaire were associated with future illness in that the most 

healthy group had the lowest mean and the group with 5 or more 4 11-

ne~ses per year had the highest mean of the four.~roups considered 

(P • .004). This high illness group also had the lowest abi!ity to 

discharge tension effectively (P • .003) and reported that ATC work 

"cost" them a lot subjectively in terms of expead!ture of efforts, 

countering of inconveniences and ct·eating a drain on their emotional 

resources (P • .02). 

Nominations by the controllers of those among their peers whom 

they found to be most amicable and those whom th~y would wish to work 

w:i.th on thei:- ideal team also were associated with future illness 

rates. Men in the highest illness categories tt~.•ere least often ch011en 

for amicability or as ideal team ~mbers (P • .001 and P • .005), 

Ratings of technical competence as an ATC were not associated with 

future illness risks. 

Three variables dealing with an ATC's satisfaction with the 

work situation Were associated with future illness. Group morale as 

measured by the Kavanagh ScaiP. was lowest both at Round 1 (P .03) 

and at Round 2 (but only marginally significant at P • ,09) in men 

who had highest illness ~ates for interv"ls 2-4. This high illness 

gro'Jp also had least satisfaction with manctgemen~ .. (P • .01) and consistently rated their supervi.sors as showing less than adequate 

amounts of co~;.sideration for other$. Although many of the 344 tDftn 

included in these specific data analyses had the same limited number 

of supervisors, the men who perceived supervisors as more considerate 

remained physically healthier than those who perceived tt'J-:-,m as having less conslderation forth~ employees (P • .02). 

Several long-standing personality traits were strongly predictive of future 11lneas. Both the Jenkin£ Activity Survey, a test 

for the coronary-prone behavior pattern, and the California Psychological Inventory, a multidimensional· personality measure, had predictive qualities. Men who were most Type b -- that is, those who 

had fewer of the competitive, hurried, achieve~nt-oriented traits 

of coronary proneness -- were the most healthy of the study population. 

Tho high illness group was significantly more Type A (P • .02). This 

tendency cama mostly from the greater job i~volvem~tt which waa characteristic of the higher illness groups (P • .02) and secondarily 

from the greater haste, impatience and irritabllity which high illness peroono tended to show (P • .02). On the CPl, high illneoa 

persona were significantly more dominant (P • ,04) -- a finding consistent with their tendency to be more Type a. They were also more·· 
sociable (P • .03) a4~ more a~cepting of themselves (less selfcritical and less pr~ne to guilt) (P • .02). 

495 

Among the strongest predictors of total morbidity was the amount 

of life strese and lifE! change encount.ered in the period immediately 

preceding the beginni~g of intervals 2-4. This study used thr~e different methods for scoring life change. These variously reflected 

either effort for. adjust~ent and/or amount of distress associated 

with the changes in one's life c:irc:umst.ance. All of these variables 

were strongly related in that the two groups have illness rates above 

the sample median, had substantially more life changes than the 

healthier groups. The Holmes-Rahe Scale was significant at P • .009, 

the Paykel Scale was significant at P • .002 and the self ratings of 

distress associated with life change, developed specifically fo~ this 

study, were significant at P • .0001. 

Biographical Prerf:'.ctors of Tota' Morbidity 

Several of the biographic items revealed by the ATCs on the 

Biographica! Questionnaire that was completed at the intake examination were faun"- .:o be associated with total average annual rate of 

illness. However, emou~ tbE:se, only tvo associations were considered su~ficiently significant to report. 

The amount oi education compl~ted was associated with the illness rates, though not in linear fashion. College graduates had the 

lowest rates, high sd1ool and grade school graduates had intermediate 

valtJ.es, and men with some college education short of a college degree 

had the highest average illness rates among these different groups 

(P • .004). 

Men who lost a parent before age 18 because of sep.'lration or 

divorce had higher illness rates than those ~no lived :n a twoparent huusehold or those who lost a pare~t by death. 

None of the biographical variables predicted total illness 

with the clarity or st.;.tistical strength of the stronger psychological or field predictors. 

Biologio.al Field Predictors of Total Morbidity 

Two of the major predictors of increased moderate and mild 

health change observed in the study were related to the mea~~rement 

of aerum cortisol and blood pr~~sure in the field studies. In order 

to obtain a more stable estimate of individuals' physiological responses to air trJ.ffic work. we selected men \thO had tht"ee or taOre 

field studies, and averaged their responses over all studies to obtain a characteristic value for cortisol and blood pressure response. 

In doing this, we were unable to use thege chhracteristic levels of 

cortisol or blood pressure response as prPdi.ctors of health change, 

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because they were actually measu~ed concu~rently with the health 

changes observed during the course of the study. However, to~e were 

able to separate individuals' values from their first blood presnure 

or cortisol examination. Th~se values obtained during this first 

study could be uoed as a predictor variable, as it preceded interval two. 

We totaled each man's cortisol values collected every twenty 

minutes for ·five hours. We then averaged the three or more studies 

to obtain an average total cortisol for the 227 men who were studied 

this frequently. We then divided these men into terciles 9£ high, 

middle and low values, The high group did not get below 13 ug/100 

ml wh:1.le the individuals who vere in the low group in the morning 

went below JO .g/100 ml. Similar differences were observed in the 

afternoon. 'l'hese groups are shown in Figure Y. Because each of the 

three G:oups, high, middle 3nd l~'W, were actually composed after 

thr~e or more ~tudies, the results are very stable and very significantly di:ferent. 

We were su:-prisl~d to observe that individuals in the lowe~r: 

cortlscl grou.p had significantly more health change during the course 

of :he st~~dy as is sho-'11 in Table 162. These differences are highly 

significant ii:ld whether one measur£=f:. total cortisol for the day or 

the maxiruum coztisol on position, those men with the lowest values 

had significantly more health change (p <,003 and p <.003 respectiV•!ly), 

B~cause of the rather surprising finding that individuals who 

had low or perhaps suppressed levels of cortisol at work had a 

g~eater amount of moderate or minor illness, we decided to investigate wLc::ther_ C•r not the first cortisol values obtained during the 

first field st:udv would be predictive of the average annualized 

health change in the sace w._y that the values obtained for the average tctul cor,_isol were correlated with i.ncreased health change. 

lhesP. data ~:ce presented in Table 163, and it is clear from this 

cable tb~c the in1iv1duals in the lowest level of annualized health 

change, i.e., those with less than 1.0 illness episodes per year, 

• 

ha1 a total cortisol in the first field study of 1205 u g/100 ml compared to those in the highest illness category, "hose with 5 episodes 

per year, who had ., total cortisol of 1102 ~g/100 ml. Thts difference 

is aignif!-~.tlnt at- thP. .02 level. Therefore, the lowet:ed secretion 

of·~~ obs.erved in the fir!!!_ field study is j?rediet":tve of individuals who show~d more frequent health change, the 3ame result 

that was observed when the cortisol for all visits was averaged. 

It is of note that the first field study was perfOrmed, ~n the average, 3.9 mC'nths before the start of the second interval, at which 

time we began averaging the cortisol data as explained earlier in 

this section. Only 12% of the sample had the firet field study after 

examination at B.U. and the beginning of the second 

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•98 TABLE 162 

Differences In Rate Of Physical Health 

Change As A Function Of Cortisol Le~ 

At Work Among ATCs 

AVEPAGE TOTAL CORTI~OL FOR HEN 

With i 3 FIELD STUDIES 

LOW MIDDLE F p 

AVERAGE TOTAL MEAN 3.80. 

2. 72 

2.75 

1. 63 

~ 

2.75 

1.84 

6.24 <.D03 

ANNUAL RATE STD 

hAXIMUM CORTISOL ON P051TION 

AVoRAGE TOTAL MEAN 

ANNUAL P.ATE STD 

bQ!L 

3.91 

2.62 

MIDDLE 

2. 79 

1. 91 

HIGH 

2.59 

1 .56 

F 

9.36 <.0003 

1 1 .. 

-~ 

i 

! 
< 1.0/yr 

? 5.0/yr 

• 

499 

TABLE 163 

Tot•l Cortisol At Work As A Predictor Of 

Aver~g~ Annualized Health Change 

!!. 

(47) 

(68) 

(68) 

(44) 

F • 

p • 

Average Total 

Cortisol 

(All Visits) 

Mean~ S.D.(ug/100ml) 

1231 :. 137 

1219 ~ 134 

1186 ~ 99 

1145 + 120 

4.63 

.004 

Total Cortisol 

Fir~·~ield 

Study 

Mean ~S.D. (ug/1 OOml) 

1205 ~ 200 

1203 ~ 210 

1158 ~ 176 

1102 ~ 122 

3.38 

.02 

(Performed on the average 

of 3.9 months before start • 

of second interval) 

• 

• 

• • 
;oo 

We were interested in how useful the initial visit values were 

in classifying indi·Jiduals compared to the .... lassification C\~Jtained 

by averaging the total cortisol across all visits. These da•a are 

presented in Table 164. It iR clear that there was a high!.y significant relationship between classification of individuals on their 

initial visit and the classifi~ation obtained by averagifig all three 

visits. Part of this relations~ip was due to the fdct that the 

average across all visits contained the initial visit, but nevertheless it was apparent that individuals who were high in the first 

visit tended to :emain high while individuals who ~ere lo~ on the 

first visit tended to remail• low, and individuals in the middle 

tended to be high, middle or low suose~uently. The relationship 

was highly significant with a chi square of 88.99, p <.00001, and 

the correlation between visit one and the total average was .71. 

It was possible to classify men by the first visit, and the reliability of this classification was enhsnced at the higher and lower 

range of cortisol. 

We were interested in trying to clarify the rela~ionship between lower cortisol secretion and higher illness rates. We compared individuals' maximum cortisol while working on position during 

a day when their workload was very heavy ana a day when it was very 

light. We selected men who experieuced maximum differences in workload, the workload one day being in the highest quartile of the distribution for all men and another day oeing in th~ lowest quartile. 

These data ar~ presented 1.n Table 165. It is clear from thi~ table 

that the maximum cortisol on position, controlling for time of day, 

was oignificantly higher during the high workload day for all men 

and lower on the low workl~ad day. However, the 90 men who =ould 

be selected in terms of having experienced these extremes of workload showed relatively small differences in maxi~um ~ortisol secretion between high workload and low workload. This can be explained 

by a look at the distribution of. differences among these 90 individuals. Thirty-four individuals showed relatively little change and 

23 individuals showed 11 significant decrease itt corti:~ol when worklo~d 

increased. These individuals might be labeled a" "inverse responders." 

We ••ere interested in seeing whether individuals who showed th1.s inverse response - cortisol falling when workloa~ was increased - had 

a different incidence of mild ta moderate health change. Again, thia 

waa not a predictiv~ finding but a correlational one as it was done 

concurrently with the measurement of health change. Nevertheless, 

we did find a significant relationship bet~een inver•• responders 

and incrf \sed health change. Table 166 compares men whose maxitnum 

cortisol on poaition incr~dse:i, did not change or decreased vhen 

worklo.:1d increas.ed. Those individuals who were inverse responders 

had an annualized health change of 4.22 episodes compared tp 2.76 

.. 
I~ITIAL 

VISIT 

HIGH 

HIGH 

TABLE 164 

Prediction Of Avera e Total Cortisol 

3 to 5 Visits By First Visit 

AVERAGE CORTISOL ALL VISITS 

HIGH MIDDLE LOW 

50 25 ~ 

(26) (27) (26) 

HIOOLC: 25 32 25 

(27) (28) (27) 

LOW I 20 ~7 

{23) {23) (23) 

COLUMN TOTAL 76 77 76 

Chi Square 88.99 

df • ~. p < .00001 

CORRELATION VISIT I X TOTAL AVERAGE • 

501 

RAW 

~ 

79 

82 

68 

229 

.71 

l 

I 

t 

I 
502 

NORMALIZED 

MAXIMUM 

CORTISOL 

. ON POSITION 

• 

TAllLE 165 

Comparison Of Individuals• 

Maximum Cortisol While Working On Position 

When Workload Is Heavy Versus Liqht 

HIGH WORKLOAD LO\,' WORKLOAD 

125.5 118.3 

ONE WAY ANOVA F • 4.52 p < .05 

REPEATED MEASURES (08,1) 

Individuals tall Into 3 Groups 

Wnen Calct1lating Differences Between 

Maximum Cortisol On High Hinus Low '..lorkda"s 

n INCREASES ) 15 Jlj' 

NO CHANGE -I 0 to 15 33 

DECREASES <-10 23 'INVE~SE RESPONDERS' 

• 

• 

• 

I 

I I 

L_j 
TABLE 166 

Comparison Of Hen Who~e Maximum Cortisol 

On Position Increases, Does Not Change, 

Or Decreases \./hen Workload lncreas~s 

In Terms Of Total Annualized Healtr Chang~ 

ANNUALIZED HEALTH CHANGE EPIS0DES 

POPULATION VALUE 3.20 + 1.95 n • 90 

MAXIMUM CORTISOL INCREASES 2.76 + 1.61 n • 34 

MAXIMUM CORTI SOL !!Q. CHANGE 2.94 + 1.97 n • 33 

11AXIMUM CORTISOL DECREASES 4.22 + 2.07 n • 23 

• Inverse responders 1 

503 

one-way a nova F • 4.65 p c.: .012 

(87,2) 

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504 

for thos~ whose cortisol increased and 2. 94 

sol did not change when workload increased. 

significant at the .012 level. 

for those whose cortiThis difference was 

In summarizing the relationship between cortisol secretion and 

annualized health change, three findings were made. The first was 

that during t~,e st1.ody, individuals who showed lower cortisol levals 

at to,·ork experiE:.nced more health change, a concurrent relationship. 

Second, we found that individu.:.ls whose first. field study revealed 

lower levels of cortisol at work also showed in the subsequent two 

to three years au increased level of illness. Third, those individuals whose cortisol decreased when traffic increased, so-called 

"inverse responders, 11 3.lso showed an increased level of annualized 

health change. 

The significance of these findings are not yet clear. !he relationship appears to be a stable finding and has prompted u. to 

begin to inveotigate more carefully what characteristics might describe indivi~"~tls who do show this inverse response or diminished 

cortisol resp'1nsiv1ty at work that seems to carry with it an increased risk for developing health change. Since in some ways this 

finding fs replicated in te<::"ms of" Llood pressure re'ipons ivity, the 

potential implications are all the more interestin3 and must be 

pursued. 

The other major physiological response ·<r~hich correlated with 

and to some extent possibly predicted health change was the systolic 

residual range at work. The systolic residual range was H variable 

representing the variabilitv of systolic blood pressure at work when 

one controlled for initial levels. Because variability or range is 

correlated with average level, we regressed each individual's averaRe level from the range to obtain a systolic residual range for 

~lood pressure while working. 

The results of our study of blood pressure response may be 

viewecl as parallel with the cortisol respon&e. Those individuals 

who showed diminished systolic variability (diminished systolic 

residual range) had an increas~d amount of mild to moderate illness. 

These data are ohown in Table 167. The average systolic residual 

range for all visits for these who showed the lowest amount of 

health change (less than one episode per year) was 2.0 ± 6.6 mm Hg 

aa contrasted witlt those in the highest category of heal~.h change, 

those with > 5 episode3 per year, who showed a systolic residual 

range of 1.32 + 4.2. This difference was significant at the .03 

level. We alsO attem~ted to clarify whPther or not the average systolic residual range durillli the first field study was predictive t)£ 

the subsequent health change. The values were clearly in the right 

direction with individuals at the loweot level of health change 

showing a residual range of 3.13 ~ Hg wh<le individuals in the 
• 

505 

TABLE 167 

Systolic Residual Range At Work As A Predictor 

Of Average Annualized Health Change 

Average Annual I zed 

Health Change Category 

..!!. 

~ 1 .0/yr (56) 

1.0-2.5/yr (72) 

2.6-4.9/yr (86) 

> 5.0/yr , 

F • 

p • 

Average Systolic 

Res 'dua I Range 

All VIsits 

Mean:!:. S.D.(nm Hg) 

2.01 :!:. 6.6 

-0.11 :!:. 4.9 

-0.15:!:. 6.9 

-1.32 :!:. 4.2 

2.95 

.0328 

Average Systol i~ 

Residual Range 

First Field Study 

Mean :!:. (nm Hg) 

3.13:!:. 13.3 

~...1.2:!:. 10.5 

-1.14:!:.11.5 

0.53 :!:. 12.52 

1.88 

. 132 N. S. 

(perFormed on the average 

of 4.4 months before 

start of second Interval) 

• 
highest level of lu~alth change showed a residual range of 0. 53·: 

Howevert as is evident from the table, the standard deviation was 

considerably higher for the first field study for each of these 

categories compared to the average data, _reflecting the lack of 

stability ~rom one study alone. Consequently these difference~ were 

not statistically significant, p • .132. Viewed from another perspective, the first blood pressure study did not correlate as highly 

with the average data obtained on three or more visits (r • • 51) ·as 

the first cortisol value· correlated with that obtained on th_ree or 

more visits. ~evertheless, these data were provocative in that individuals who did show throughout the course of the study a reduced 

variability in blood pressure independent of level were experiencing an increased amount of health change. As noted previously, this 

Qbservation was parallel from a physiological perspective with the 

f~ct that individuals who showed lower cortisol response to work 

also had increased health change. 

It was interesting that among the 10 individuals who had the 

highest amount of. health change, i.e. two standard deviations from 

the mean~ or more than 7 episodes per year, 7 had total cortisol 

values and systolic residual range below the mean. Seven of these 

10 ·men therefore would be considered hyporeS!ponde.rs in both ph-rsiological systems. 

Health Hist~ry and Health Habits as Predictors of Total Morbidity 

As" noted in a previous section, all inciividuals had a very 

careful review of their medical history along with their physical 

examination at their intake examination into the- study. One of the 

reasons for collecting history of past illnesses· as well as a .record 

of current physical health was to be able to ascertain whether or 

not individuals who experienced increased levels of health change 

during the course of the study had come into the study with more 

previous illness. One might ~rgue that individuals who had more 

health change duri.1g the three years of surveillance simply came 

into the study less well to begin with, with more chronic illnesses, 

etc. Therefore it was necessary to collect, as well as we could, 

information about their health status at intake. 

In addition to dividing intake diagnoses into various physical 

systems, we also totaled all intake diagnoses to b~ st~died as a 

potential predictor of the individual's average annualized health 

change. These data are pres~nted in Table 168. There was no relationship between the total intake diagnoses and the annualized 

health change, f • 0.56, N.S. Fa~ two categories of health change, 

allergies and GU complaints, there was a signLficant relationship 

between intake diagnoses and the subsequent number of illness episodes in these two specific c~tegories. However, as allergies only 

accounted for 6% of the total annualized health change and GU 3%, 
TABLE 168 

Total Intake Diagnoses As A Potential 

Predictor Of Average Annualized Peal th Change 

Average Annualized 

Health Change 

Cate9or:z: Mea11 ,. S.D. In take 

Number of Men 

~ I .0/yr (72) 4. 35 ::. 2. 56 

I. 0-2. 4/yr (I 03) 4.56 :!:. 1.88 

2.6-4.9/yr ( 112) 4.73 :_2.25 

> 5.0/yr (57) 4.75 !. 2. 07 ~ 

F • 0. ~6 N.S. 

• 

• 

507 

Diagnoses 

• • 
508 

the relationship between intake and subsequent d1agnos~s within these 

two categories did not significantly affect the total. Nonetheless, 

this specific relationship was important in studying potential predictors of illness episodes in these two systems. 

Health habits were also investigateU as potential predictors. 

In the first round of examinations we asked individuals the number 

of cigarettes, cigars and pipes of tobacco they smoked, the amount 

of coffee they dr~nk, the amount of medications they took, etc. 

Th~se health habits did not significantly predict the annualized 

health rates, and therefore did not influence the variour psychosocial and work-related predictors of mild to moderate illness. 

Discriminant Function Analyses o~ Significant Predictors of Total 

Morbidity 

In an effort to examine the overall predlrtive utility"of the 

psychosocial and the c?rtisol and blood pressure predictors, discriminant function. analyses were performed using the ten variables 

that were significant when studied in a univariate fashion. We 

found that we were best able to d~scriminate ~etween individuals in 

the highest ~nd lowest groups and that our. predictors were not of 

great value in discriminating ind!viduals in the middle groups _of 

health change. The variable·s that differentiated between men with 

high and low annu.:&l rate of mild or Ulder&te physical health change 

are shown in Table 169. These could be summarized as follows: 

The individuals who showed greater emounts of physical health change, 

i.e., thOS(· with five or more episodes .J. ;ear, had approximat~ly 

three times the amount of life change events in the period of time 

before the illnesses occurred, were more Type A in their personality, 

were chosen leas often by their peers in terms of their amicability 

(ease to work with), rated themselves as having morA anxiety at work, 

scored high-::i on the self-acceptance scale of the CPI, rated them• 

selves as having more subjective coats relating to controlling 

traffi~. st~wed more job involvement on the Jenkins Activity Scale, 

part of the Type A personality complex, and showed lowered systolic 

r~sidual range at work and lowered total cortisol at work and maximum cortisol on position. 

Of the ten variables which individually discriminated between 

those with low and high rates of annuali<ed heAlth change, only 

four were foUnd by stepwise dioctiminant function analysis significantly to predict low vs. high rates. These data are shown in Tabl~ 

170. The major va~iable that discriminated between the tuo groups 

w.ss the amount of life change distress,. laheled as life change distress rating, followed by the two physiological measures at work, 

systolic residual range a·ad total cortisol. and the fourth Variahle 

that cuntributed to the significant discrimination b~tween these 

groups • .., ... the increase-! Type A personality among tl,oae with high 

-· 

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-------~ 
TABLE 169 

Variables That Differenti3te Between Hen 

With High And lv" Annual Rate Of Hild And Hoderate 

Physical Health Change 

(10 SIGNIFICANT UNIVARIATE) 

VARIABLE 

< I ~ per yr. 

l.lfe Change Distress 

Type A Personality 

Amicability Choices (peer) 

Anxiety Factor 

Self Acceptance Seale (CPI) Subj~etlve Costs 

Job Involvement (JAS) 

Average systol ie BP residual 

range at work 

Average total cortisol at 

work 

Average maximum cortisol 

on position 

N 

125.7 

-6.28 

2.30 

46.42 

56.65 

49.56 

-7.49 

I .86 

1222.19 

123.30 

43 

VALUE 

5--.;;ryr. 

359.8 

-.po 

l. 51 

53.33 

6!.60 

54.]2 

-3.d5 

-I .33 

1142.45 

ll4. 30 

43 

F 

20.15 

12.19 

9.92 

9.61 

8.02 

6.96 

5.27 

7.00 

8.39 

6.80 

509 

.0001 

.001 

.OJ 

.OJ 

.01 

.OJ 

.05 

.OJ 

.OJ 

.as 

' 

, 

1 

1 

I 

' 

I j . ; 

·; 

~~ 

.iJ 
< 1/vr 

• 

T.\BLE 170 

Stepwise Discriminant Functio'l Ana1y_s...l2_ 

To Predict Low Versus ti,.ish Annual Illness Rate 

VARIABLE 

Life change distress 

Average systolic BP 

residual range at work 

Average total cortisol 

at work 

Type A personality 

PREDICTED 

< 1/yr 5+/yr 

9 

F _£_ 

20.15 .0001 

9.79 .01 

8.27 .01 

7.17 .01 

Total %Correct 

43 79.1% 

5+/yr 10 43 76.7% 

TOTAL 86 

• 

• 

• • 
511 

rates of annualized ~llness. Using these four variables we were 

able to predict correctly '6. 7% of the individuals in the high group 

and 79.1% of individuals in the low group. 

Predictors of Average Annualized Health Change Rate~ For the 

Three Most Frequent Diagnostic Categories 

In addition to determining the predictors of total average 

annualized mild and moderate health changes, we also analyzed the 

predictors of these health changes l:ly diagnostic catego~:y within 

~he total. Nine Major. sub-categories were identified and analyzed: 

Respiratory, Acute Gastrointestinal, Chronic Gastrointestinal, NonSpecific Viral, Skin Diseases, Oanes, Muscles and Joints, Allergies, 

Genitourinary and Injuries. Preliminary efforts to d~cerMine predictors showed that for those dJ.agnostic categol.·ies with s:nall 

numbers of affected persons, such as chronic G.I., Skin, GU und 

Bones, Muscles anr' Joints. it was difficult to establish valid 

relationships. Therefore, the discussion is confined to the four 

categories in which average annualized mild and moderate health 

changes were most frequent~ Respiratory, Acute Gastrointestinal, 

Non-Specific Viral and Injuries. 

Respiratory Illness 

As ccmpared with men who had more respiratory problems, the 

cen most free of respiratory problems were older and morf~ experienced (P a .002 and p • .005 respectively), did not have psychological problems that interfered with their work role performance 

(measured by PSS, Round 2 vs, ··respira~.:.a:y illness in intervals 

2-4, p • .03), were most likely to have higher tverage blood pressures on busy work days than on quieter days (systolic increases, 

p • .05, diastolic increase, p • .01), secreted-significantly more 

serum cortisol at work {p • .02), served in the armed forces the 

modal 4 years found for all subjects in this study (p • .003), had 

wives who wer~ employed full time (p • .04), went out with their 

wives less frequently than three times a week (p • .003), were leas 

satisfied with their marital situation (p • .003), and were more 

alienated from social values (measured by Srole Anomie scale, p • .05). 

The high respiratory illness· gr~ was, by comparison, more 

job involved (p • .02), had considerably higher anxiety concerning 

their work (p • .02), had greater marital resource support (p • .03), 

had lower cortisol and blood pressure reactivitt at work (p • .02), 

were younger and had less experience with the FAA (p • .002 and 

.005 tespectively) had some college ~t did not graduate (p • .05), 

had wives who uere homemakers (p • .04), were more likely to go out 

frequent!y with their wives (p • .003), had either neutral or happy 

feelings about their marital situation (p • .003) and were not alienated from social values (p • .05). •• 
m 

Acute Gastrointestinal Illness 

Men •ho te~ded to have the highest levels of acute G. I. disease 

showed a complete atsence of clinical degrees of subjective distress . .....-

and work role disorder, freedom f~om clinically significant alcOhol 

abuse, greater social alienation (anomie sr::.ale, p • .02), gre&.ter 

expressed discrepancies between their own and t:hei: wive:a' goals 

lor their marriage (p • . 001), lower socio-econ·::>m;ic status in 

childhood than their wives (p • .02) and perceptions of their 

parents as very different. from one another in personality and values 

(p •.• 02). 

In addition concurrent associations were revealed between increased risk for a~~te G.I. episodes and less cortisol reaponsivity 

(p • .04) and ~ blood pressure responsiv:l.ty on the job. 

Non-opeclfic V<.ral Disease (NSV) 

The strongest predictors of NSV were the sociometric ratings 

at Round 2. ATCs who were free of NSV in the ensuing 2-21 year~ 

were frequently selected by their ~o-workers as being amicable 

(p • .007), competent (p • .007.) and as ideal •eam membero (p • 

.004). 

The second strongest predictors were the lif~ change scores 

preceding the intervals at risk. Men' with freq·uent NSV had the 

highest life change scores by two methods of measurement {HolmesRahe and Paykel, Uhlenhuth and Prusoff, p • .03) and somewhat lower 

scous by the third method (self-ratings of life. change distress 

preceding a period at risk, p • .06). 

Additional predictors of higher rates of NSV.were: low interviewer judgments from the intake round on coping vith training respo·nsibilities (p • • 02) and overall coping acore (p • .04), more 

anx.iety about potential air traffic incidents (p • .02) and workrelated anxiety (ATC Questionnaire, p • .0007), feelings that the 

supervisor gave inadequate structuring to the job situation and had 

little consideration of others (p • .0007 and p • .005 respectively), 

feelings of higher subjective coots associated with ATC work (p • 

.04), lese ability to discharge tensions pr9mptly (p • .02), higher 

job involvezent (p • .02), greater hard-driving characteristic 

(Jenkins Activity Survey, p • .004), less social confor.ity (commu- nal~ty scale, p • .OJ), longer residence in the same county (more 

than 20 years), substantial upward mobility. 

All in atl, the pictur~ of the NSV-prone man is that of a person with leas than an average amount of este~m from his peers, but 

noMtheleao highly Job involved, hard-driving, c0111petitive and pet"-

haps somewhat non-conforming. These men at high risk fo~ NSV tind 

•.. 

I 

r 

l 
• 

5!3 

that their job takes a lot of enE!rgy und resilience from th~m, often 

arouses anxiety, nnd leaves theQ less able to discharge tensions and 

cope with difficulties. There appears to be a large psychosocial 

component in vulnerability to non-specific viral disease. 

Injuries 

There were more predi~tors of injuries than of any other category of health change in the study. Sixteen psychosocial predictors 

were associated with injuries at the p • .05 level or better. 

Men who incurred the mogt mild or moderate 1n1urtes were chosen 

less often both for 11 ideal" team members (in peer noctinationa, p • .06 

and p • .002 fpr Ro~.:.nd 1 and Round 2 data, respectively) and for 

amicability {p • .05 and p • .01 for Rounds 1 and 2, respectively), 

were by far the strongest Type A in thei~ behavior {p • .0001), had 

greater life change distrePa (Paykel, p • .OJ; self-ratings of dis·· 

tress, p • .004; Holmes-Rahe, p • .008), had a much highe~ frequency 

of work role disorders (Psychiatric Status Schedule Round 2, p • .008), 

greater ar~iety concerning the possibility of traffic incidents 

(p • .05) and other work-related anxiety, less satisfaction with 

management (p • .OS), more difficulty in discharging their tensions 

(p • .02 for both Round 1 and Round 2 data), and !ower blood pressure 

responsivity at ~rk (!ower maximum blood 9ressure during the fir3t 

3 co 5 days they were measured in the job both for systolic, p • .01 

and diastolic, p • .04). 

In addition, men witb high injury rates reported that they got 

along with their parents somewhat worse or much worse than _other 

teenagers {p • .05), and they were least satisfied with their marriages {p • .03). 

A:a:ong those men (99%) who had served in the Armed Forces, the 

64% who were non-commiss:toned officers had substantially more i"ljuries than those who remained at the enlisted ma~ level (p • .02). 

The fact that the injury ca~egory had the largest number of 

~sycho~ocial predictors of all categories may be due to the clearly 

overriding involvement of behavior and paycholoRical factors in the 

causation of injury, but also may be influ•nced by the fact that 

large nu=bers of men generated moderate and high numbers of injuries, 

thus leading to the kind of distribution of values which allows more 

powerful tests of the role of psychosocial predictors. These findings have important implication• because they may lead to interventions to reduce the fecond moat ·:onmon cause of lost time from work 

and need for medical attention. 

/ 

• 

• 

' 

1 

l 

l 

• 
514 

SUMMARY 

Predictors of Hypertension 

Pred.'.ctors were soughr.. primarily for the de•!E>lopment of hypertension during the course of the study, that is, predictors of 

the 36 new cases of hypertension that developed by ~he study's 

own criteria for determination of the disease. Some additional 

analyses involved intake cases of hypertension. 

The following rt?:lationships were found: 

1) Co~pared to thos~ who stayed normotensive, body 

weight at intake was significantly higher in intake 

cases 0£ hypertension but not 1~ new cases developing during the study; however, body weight increased 

slightly ov,er the course of the £; tudy for those who 

developed hypertension during this time; 

2) Compared with those who remained nomot'ensive, intake cas'!s were older, but new cases were no·t olde·r; 

3) Compared with those who remained normotensive, 

systolic and diastol!c blood pr~ssure measured at 

the intake interview was elevated both in thosP. who 

had hypertension at intake and in those who devel~ped 

it during the course of the study, syStolic and 

diastolic blood pressure meas"Jred at work were tlignificantly higher in those wt.o developed hypertension, 

and were as high during the first fi•ld study as in 

those who already were diagnosed hypertensive at intake; measurements made at ~ork on high workload and 

low workload days showed that the 36 new cases of 

hypertension had significantly greater elevations 

of systolic blood pressure on the high workload day 

compared with those diagnosed hypertensive at intake 

and with normot.ensives; 

4) The major change that occurred to cau~e the diagnosis 

of hypertension among the 36 new cases was a rise in 

diastolic pressure, while systolic pressure remained 

at the sace level or, in some cases, was reduced; 

5) Coping with difficulties by use of alcohol was more 

prevalent among future hypertensives, as was ability 

to cope on heavy days (rated by a psy,hologist interviewer); 

6) lndividuale who became hypertensive had significantly 

lower marital resources, significantly less distressing life ch,Jnge events, and '11.-::re more Type B (,less 

hard-driving) personalities. 

. .. 

\ 

1 

: . J 

l.] 
515 

Discriminant function analysis showed that the most important 

variable discriminating betNeen those who remained normotensive 

and those who developed hypertension vas the systolic average 

at work, anc! other V«riables contributing to discriDlination were 

Type B behavior, diastolic average at work, interview rating of 

coping on heavy days, decreased marital support and decreased 

life change distress. 
516 

2. Predictors of Hypertension 

In an earlier secti.on describing the natp!"e C"f physical health 

findings, we re~iewed the prevalence 3nd incidenr.e •)f hypertension 

in our populati~n. These values varied significantly depending on 

th~ criteria thar were employed, i.e., whether they were the HANES, 

Framingham, our Dl·-n research criteria, or the FAA criteria. For 

predictive purposes, we used the most rigorous research criteria 

f~r defining hypertension that could be employed. We called men 

'hypertensive at intake or subsequently only if their blood prescure 

readings in ~o successive visits were above the criterion level, 

systolic pressure of 140 or more or diastolic pressure of 90 or more. 

The tabulation of participants according to the research criteria is 

displayed in Table 171. Most of the predictors to be discussed were 

studied in an attempt to discriminate between the men who remained 

normot~nsive and c:,~se who developed hypertension after intake into 

the study. Howeve1·, other predictors that differentiated between 

normotensive and prt.:.valence cases (intake cases) are also discu~Jsed. 

Perhaps the t.~.rst approach that might reasonably be taken iP. a 

search for predictors of future hypertension would be to examine the 

relationship between hypertension in our men and var.iables known to 

predict hypertension in the general population. These include body 

weight, chronological age, and blood pressure while visiting the 

pr.ysician at the first examination. It is well known that pt!ople 

who develop hypertension tend to have incre~sed blood pressure on 

previous physical examination. Body weight and age are also known 

to be predictive of development of. hyp~rtension. The values at the 

intake examination for weight, age and first blood pressure measures 

for the three groups of men (normotensive, prevalence cases and nP.w 

cases) are g-iven in Table 172. 

Body weight at intake was significantly higher in those with 

hypertension at intake but was not significantly higher in those 

devf!loping new cases of hypertension compared to the normotensive:~. 

Similarly, those who had hypertension .lt intake were older, but 

those developing new ~==~s of hypertension were not older compared 

with- the normotPnsi·res. The systolic and diastolic blood presaurl!s 

(from the second rea.~ing during the first, intake exam) ahow~d a 

different distribution among three groups. Compared with normotensives, systolic blood pressure was elevated not only in those individuals who had hypertension at int:JJ.ke but .also in !.:hose who developed hypertension later. Similarly, in compariSon with those who 

remained normotensive. diastolic blood prP.ssure at the first examination was elevated for those who had hypertensicn at intake and 

those who later developed the condition. 

We compared the three groups of mFn - nor~ctens!ves, hypertensives at intake and new cases - with respect to their .blood presaure 

• 

• 

• 
TABLE 171 

Prevalence And Incidence Of Hypertension 

Among Participants In ATC HCS By The Study Criteria 

NormotensIve Hen 2~5 

Prevalence Cases 

(Intake And Second Round) 135 

New Cases During Study 

Hust Meet Criteria Over 36 

2 Successive VIsits 

(3 Year Incidence) 

Total Participants ~16 

--~----

517 

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518 

TABLE 172 

Ph~slcal Measures On 3 Groues ATCs At In take Ex-3m 

· Hypertensive Variable Normotensive At lnta~e 

(n•24s) (n•I3S) 

WEIGHT mea" 179.5 194.4 S.d. 24.9 26.6 

ACE mean 35.6 37.4 S.d. 5.0 4.8 

2nd SITTING mean 125.5 139.0 SYSTOLIC BP s. d. 9.1 9.3 

2nd SITTING mean 83. I 96.5 ~IASTOLIC BP s.d. 7.5 6.7 

Of 

New Cases Of 

Hp'!ertens i11n 

n•36) 

181.8 

22.4 

35.9 

5.6 

132. I 

9.2 

86.0 

5.4 

F 

15. I 0 .0001 

5.98 .003 

81.62 .0001 

131.0 .0001 

i 

. ' 

lJ 

; 

i 

l 

I 

t 
• 

• 

519 

on '...he initial and final examinat:ion. We did this in ('rder to clari·· 

ty whether or not it was a change in 3ystolic or diastolic blood 

pressure, or both, that resulted in the classification as a case of 

hypertension. These data are preser.ted in Table 17J. This table 

also giveS body weight and shows a s:light increase in body weight 

from intake tu final exam for new cases. However. the most interesting finding was that there was not a significant increase in systolic 

blood pressure. Tbe systolic blood pressure actually fell in the 

normotensive group approximately 4.2 mm Hg and even showed a very 

small, but nonsignificant fall in the new cases of hypertension. 

This fall in systolic blood pressure perhaps reflects ~ return to 

usual pressure after the increased arousal attendant upon coming to 

B.U. for the first time. This tnitial arousal phenomenon was one 

reason why we estabJ~shed the crlterion that elevateC ~lood pressures 

must be evident on both their initial and second r01md- "examinations 

for classification as a prevalence case and on any two successive 

exams after intake for classification as a new case. 

The major cnange that occurred to cause our population to be 

clas~ified h;·J:ertensive was the change in diastolic blood pressure. 

There was a slight increase of approximacely 2 mm Hg in the normotensive and 0.5 mm Hg of diastolic blood pressure in those hypertensive. at intake. while there was a relatively la.rge increase in 

diastolic blood pressure from 86.0 at intake to 93.9 mm Hg at final 

exam, a change of almost 8 mm Hg, in the m:!n w-ho developed hypertension. tt.ia evident from these duta that individuals who developed 

hypertension in this study were P.Xperiencing an increase in diastolic 

blood pressure above criterion value rather than increased systolic 

blood pressure. 

We found 9 variables, listed in Table 174, that were significantly different between the group ~vho developed hypertension and 

the group that remained normotensive. Si~ce w~ requi:ed all individuals to have values for all variables when we perforrnr~ discriminant analyses, the.re was sli~ht attrition of the number of men cornpared, leaving 28 of 36 net~· cases and 183 of 245 normote~!3ivcs. AA 

noted. systolic Llood pressure at the f:frst physical exal!l was signi·· 

ficantly higher in individuals who lat;:er developed hype!'tenbion. 

We also found, as is discussed later in thts section, ~hat systolic 

ci:Cd diastolic blood r·:essutl! at wor!c: were significantly higher it· 

cases who develOped hypertension comyared to those who reoaincd 

norrnotensivf:!. Another univariate predictor Q_f new cases wa8 coping 

by drinking, which was more prevalent in future hy,•ertr)nsives. This 

score was taken from the Air Traffic Cot'_troller Qt:.t'!Stt:mnaire in 

which individuals responded to auch items as "g.,ing drinking ·with 

other controllers after work to unwind,'' etc. .\nether variable 

that discrl.JT1inated bet~:-een hypertcnsi\1'(' and nonuocer:slve cases was 

an interview rating by a psychologist of the ATC'a effort and -;uccess in copinl\ on heavy days. Those individuals Who developed 

• 

• • 
S20 

TABLE 173 

Cotnpar-lson Of Ph' •deal Findings On 

Initial And Final Exam!nations 

(3 Years Apart) On Three Groups 

Nonnotens i ve 

Hypertensive New Cases Of 

At Intake Hypertension 

INTAKE 

FINAL 

SYSTOLIC BP (SITTING) 

INTAKE 

FINAL 

DIASTOLIC BP (SITTING) 

INTAKE 

FINAL 

179.5 

180.0 

125.5 

121 • 3 

83. I 

85.4 

194.4 

192.9 

139.0 

136.1 

96.5 

97.0 

181 .8 

184.7 

132. I 

131.8 

~ 9 

. 

-.' 
• 

TAJILE 174 

Vari~bles That Predi~t New Cases Of 

Hypertension Compared To Those \tlho Stay Noi-motensive 

VARIABLE HEAN VALUE 

Norma ten~ Develop H. T. F 

125.4 132.3 12.88 

126.4 138.8 25.69 

84.6 91.8 21.76 

48.4 52.4 4.69 

3.75 4.46 5.19 

49.4 45 .. 4 4.12 

change distress :i.75.8 134.2' 7.29 1

A1 persona) ity -Z.6 -6.6 4.93 

driving factor -.31 -6.1 11.50 

N 183 28 

• 

• 

521 

• • 

.0001 

.0001 

.0001 

.05 

.05 

.05 

.01 

.05 

.001 
522 

hypertension were rated by the interviewer as higher in this coping 

characteristic. This implies that better capers are more susceptible 

to b_'_ood pressure increases or that the inct'eased effort to cope, 

despite its aJtpa.:ent success, may force up diastolic blood pressure. 

We also found that individuals who became hypertensive had significantly lower marital resources and significantly less distressing 

life change events. New cases of hypertension were found to have 

more Type B and less Type A personality. In addition, individuals 

who developed hypertension were also found to be less hard-driving, 

consistent with their more Type B pPrsonality. 

In order to assess how ~ell psychological variables could predict future cases of hyp~rten~ion. we performed a discriminant analysis that utilized only psychological variables Hnd found that they 

were able to predict correctly 67.9% of new cases as shown in Table 

175. The most important psychological facto~ was the less harddriving, mere Type B personality. 

As noted earlier, one of the most important predictors of new 

cases of hypertension was the blood pressure responses of men while 

actually controlling traffic. Table 176 shows the mean blood ~ressure responses at work during the first field study. We compared 

normotensive individuals, those hypertensive at intake, those who 

had a diagnosis of hypertension after nine months· in the study, i.e., 

beginning with the second examination, and those who were found to 

be hyperten~ive at 18 months or later. It can be seen from this 

table that cumpared to normotensive~ those individuals who developed 

hypertension either earlier or later in the study had significantly 

elevated blood pressur.e responses during their first field study. 

As a matter of fact it is P-Vident from this table that those who 

developed hypertersion later had blood pressure responses as elevated during th~ir first field study (before the diagnosis was made) 

as those who were diagnosed hypertensive at in::ake. Furtt~_more, 

as there was no difference between those who developed hypertension 

later in the study and those who developed Jt earlier, proximity of 

the diagnosis was not a crucial variable. This f~rther supports the 

power of the first field study for prediction of hypertension. 

In order to clarify the nature of the relationship between increased blood pressure responses at work and the lat"r diagnosis of 

hypertension, we made another comparison of normotensives with those 

w~o were hypertensive at intake and those who later developed hypert~nsion. W~ selected 257 men whose workload on one day while they 

were studied was significantly greater than that on another study 

day. Only 257 men met this criterion of two study days differing 

significantly in magnitude of workload. Of this number, 149-were 

normocensives, 84 were hypertensive at intake and 24 were new cases 

of hypertension. Table 177 compares the average systolic blood 

pressure on the high wot'k day with the average systolic blood pres• 

.. 
I. 

2. 

3. 

4. 

5. 

TI\BLE 175 

Stepwise Discriminant Function Using 

Only Psychological Predictors 

VARIABLE 

Hard driving on JAS 

Coping by drinking 

life chan3e distress 

Interview cc..,.;ing heavy days 

Marital support 

Using These 6 Predictors Yields: 

523 

F .e. 

II. 51 .oo: 

4. 84 .05 

4.67 .05 

5.50 .025 

6.26 .025 

67.9% correct prediction of H:T. cases (~ensltivlty) 72.1% correct prediction of normotensives (Specificity) 
Mean p;p ResPOnses At Work During First fie.ld Study 

N "' 

Hypertensive ~ 

Hyoertensive Hypertensive Normotensive At Intake After 9 mas. After 18 mos. F n • 194 ...e.... n • 86 n • 16 n • 15 11111 Hg 

AVERAGE SYSTOLIC 126.7 136.6 135.8 138.8 19.86 KAXIHUN SYSTOLIC 146.8 .0001 158.1 157.2 159.0 12.32 AVERA~E DIASTOLIC 84.3 .0001 90.7 92.7 89.4 19.12 HAXIHUX DIASTOLIC 97.9 .0001 104.6 105.5 103.5 12.88· .0001 

' 

• 

• _, 

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• 
High 

day 

ling for 

on Low day 

TABL.:: 177 

·comparison Of Normotenslves, Those With 

Hypertension At Intake, And New Cases OF 

Hypertension In Terms Of Blood Pressure 

Responses To High Vorsua Low Workload 

Normotens I ves Intake HT New HT 

84 

127.4 137.7 139.1 

124.9 134.6 127 .s 

2.5 3. I 11.6 

-2.46 2.15 7.76 

525 

Total 

-

257 

~ ·.~ 

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4 

I. 

I 

t 

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I 
on the low work day for the~e groups. All three groups showed 

increase in systolic blood pressore on the high day compared to 

'the low day, but the biggest differences were observed for the new 

· cases of hypertension, who averaged ll. 6 tnn1 hg dif terence between 

--these two days. Because one might argue that the value on the high 

could also be a function of the value of the low day since low 

and high day were correlated, we calculated differences in the 

day minus low day, controlling for (he low by regression analy-

: sis. This removed the influence of initial blood pressure, i.e., 

blood pressure on the low day, from the value observed on the high 

day. When this adjustment was made, it was still apparent that the 

new cases of hypertension showed significant elevations of blood 

··pressure on the high day compared to the low day, a·"eraglng 7.6 mm 

·I~ compared to only 2.5 for those who had hypertension at intake and 

r2.46 for the normotensives, a highly signJ.ficant difference. These 

data suggest that men who were becoming hypertensive not o_nly showed 

·'elevated blood pressures during work, but also a highly significant 

increase in systolic blood pressure when they worked a heavier day 

compared to when they worked a lighter day. 

We wanted to evaluate the predictive power of the biological 

variables by themselves in discriminating new cases of hypertenston 

from those who remained normotensive. These data are presented in 

Table 178. This table lists the average systolic blood pressure at 

work, as well as the first blood pressu~e on physical exam. It can 

be seen from this table that the average systolic blood pressure at 

work was the most significant discriminator of normotensive and'new 

cases of hypertension, with F value of 25.69, and only a small amount 

of variance w~s accounted for by ciiastolic blood pressure at work 

and by the first blood prc3sure on physical exam at B.U. The average systolic blood pressure at work represents the mean systoli~ 

blood pressure for those men with three or more study days and 

actually represents a value that was concurrent but net predictive 

because it was collected during the entire course of the study. In 

many instances one or more field studies included ln this average 

were performed after the diagnosis of hypertension had been ~de. 

From this point of view the average of the field studies is merely 

correlated with hypertension. However, as was seen in Table 177, 

individuals who developed hypertension also had significantly elevated blood pressure responses duri11g their first field study, and 

use of this data was predictive. The average blood pressures are 

used to illustrate the associative nature of a stable measure and 

are presented as a more stable reflection of the first field study 

pre~sures. which were predictive. Using theae three biological measures, we could 1.dentify 73.2% of the new cases of hypertension and 

71.4% of those who r~~ained normotensive. 

From the persp~ctiYE! of blood pressurtt responses at work. the 

men who developed bypertE!nsion were. d.ifferent in three ways. The 

I.J 
~ 

2 

3 

• 

TABLE 178 

Stepwise Discriminant Function Using Only 

Biological Variables 

VARIABLE F 

Average Systolic BP at Work 25.69 

Average Diastolic BP at work 5.49 

1st BP at physical exam 4. 17 

Using these 3 predicto,.. yields: 

527 

e. 

.0001 

.025 

.os 

73.2% correct prediction of H.T. cases (sensitivity) 

71.4% correct prediction of normotensiv5 (specificity) 

• 

• 

• • 
528 

first way was the increased average blood pressure during the first 

field study, the second was that their averag~ systolic blood pressure for all times at work was significantly higher, and the third 

way was that they had significantly increased blood pressure response 

to increasing workload compared to those who remained ~ormot~nsive. 

The fin&l analysis was to evaluate how accurately we could predict new cases of hypertension using all the variables at our disposal, i.e., psychological variables, initial blood pressure, and 

blood pressure at work. These data are provided in Tnble 179. Six 

variables contributed to the discrimination between individuals who 

remained no~tensive and those who developed hypertension. These 

sir. predictors yielded an as·. 7% correct prediction of new cases of 

hypertension and an 82.0% correct prediction of normotensives. The 

most important variable in discriminating between thase two groups 

of men remained the systolic average at work, and other'variables 

which added to a correct prediction were Type B behavior, diastolic 

average at work, interview rating of coping on heavy days, deCreased 

marital support, and decreased life change events. · 

The final table, 180, compared the various predictors from the 

point of view of implementing a screening procedure. We addressed 

ourselves to the_question of how would one predict new cases -of 

hypertension taking into consideration the cost and difficulty in 

making these predictions. It was apparent that the easiest thing to 

do would be to evaluate a man's blooq pressure at physical ex~ination. /~ this w&s a significant predictor, we examined how well 

this variable by itself could discriminate between new cases of hypertension and those who remained normoten&ive. Using the ~ systolic blood pressure measured in the physician~s office,- we found 

that this variable value correccly predicted 64% of new cases and 

64% of normotensives. However, it did falsely cla•sify 66 as new 

cases of hypertension, and although it predicted 18 out of 28 caaes 

who did develop hypertension correctly, it missed 10 casest i.e •• 

false negatives. We therefore examined he·" much we could increase 

our predictive power by studying men in the field. W~ added the 

field measures of average systolic at work and average diastolic at 

work to the predictive equation. We had a significant increase in 

accuracy in predicting both new cases s.s well as those who rema·ined 

normotensive. Finally we added the psychological predictors to the 

field predictors and we •Kain improved our predictive power. Using 

the entire array of variables that we ·collected in the study, we 

correctly predicted 24 of 28 cases (85.7%) who developed hypertension and 150 out of 183 who did not. 

We also examined data collected in the b1ographic3l•queationnaire filled out by the participants for any association between 

background data and the develo-ment of hypertenaion. Similar to the 

marital satisfaction questionnaire we found that in the data colleeted 
TABI.E 179 529 

Stepwise Discriminant Fun~tlon Using 

All Possible Predictors To Predict New Cases Of Hypertension 

(Significant Univariate) 

~I ABLE F p 

Systolic Av~rage at Work 25.69 .0001 

Hard Driving on JAS 9-55 .005 

01asto1 ic Average at work 5.90 .025 

Interview Rating Coping 

Heavy Days 5.03 .025 

Marital Support 5:55 .025 

Life Change Distress . 7. 29 • 01 

Using these 6 predictors yields:. 

85.7% correct prediction of H.T. cases (sensitivity) 

82.0% correct prediction of normotenslves (specificity) i 

t 

l 

j 

! . 

! 

' l 
530 

• 

TABLE 180 

Improvement Of Prediction Of N~w Cas~s Of 

Hyperten.sion By Field Studies And Psychological Variables 

I st S~stollc BP Measured In Physician•s Office 

Normotensive 

New Hypertension 

Normotensive 

New Hypertension 

Normotensive 

New Hypertension 

PREDICTED 

Norm New Hypertension 

lJJTI 66 

10 ill] 

Total 

Adding Field BP Measures 

~REDICTED 

Norm New Hypertension 

DID 49 

8 ill] 

Total 

Adding Ps~chological Predictors 

PREDICTED 

Norm New Hypertension 

33 

ill] 

Total 

183 

28 

211 

Total 

183 

28 

211 

Total 

183 

28 

Tot a I 211 

% 

Correct 

63.9 

64.3 

% 

Correct 

73.2 

71.4 

% 

Correct 

82.0 

85.7 

• 

• 

• • 
531 

in the biographical questionnaire, men who were more happy with their 

marital relationship were more likely to remain normotensive whereas 

those who were only moderately happy were more likely to become hypertensive. Both intake cases of hypertension and new c~:;es after 

intake were associated with growing up in an above average neighborhood. Growing up in better economic circumstances than one's wife 

was alsa associated with increosed risk for hypertension, as was 

hRving parents with somewhat diffe~ent social background and educa- tJ?n than oneself. 

In summary, as noted earlier, air traffic controllers did have 

an elevated incidence and prevalence of hypertension in our study 

compared to other studies. Furthermore, we were able to pcedict 

significa~tly those individuals who developed hypertension and this 

related to several psychological factors as well as to increased 

blood p~essure responsivity at work. We also found that men who 

develop~d hypertension had increased blood pressure responses to 

workload - lower blood pressure on a low day of workload and increased blood pressure on a high workload day. One might conclude 

that when individual~ are predisposed to develop hypertension, for 

whatever combination of genetic and biological factors, their increased blood pressure responses to increased work sigaificantly 

contribute to the development of the disease along with such cha~­

marital acteristics as a more Type 8 personality, le6s life change an4 less support. 
512 

SUMMARY 

Predictors of Other Serious Illnesses and In1urie~ 

Comparison of tho~e who incurred serious illnesses or injuries 

with a "clean control group" who were free of serious illnesses, 

injuries and hypertension and who had less than the median level 

of mild and moderate health changes, produced the following differences: 

l) Those who experienced severe injuries were more likely 

to have ~rown up in moderately large cities and suburbs, 

and were more likely to have moved residence frequently 

in childhood; 

2) Men with serious injuries more often reported that they 

had occasionally ~anted to quit high school, and men 

with serious illnesses had considered quitting high 

school even more frequently, · 

3) ~len who later developed serious illnesses or 'injuries were 

selected significantly less often ~y peers as ideal team 

members; :nen who incurred serious injuries had the fewest 

number of peer selections for competen~e. those who developed serious illnesses had an inte~ediate number of 

peer selections, and the ;'clean controls" had the greatest number of selections for competence; 

4) Men who later d~veloped serious illnesses and injuries 

had higher levels of work satisfaction and social resources for coping with problems; 

5} H~n wno later developed serious illnesses had less experier..ce with the agency for their 2ge; l!len with serious 

1njur1.es had the lowest average experience with the 

agency; 

6) The ATC 's report o! pay satisfaction declined in the 

round before they incurred a serious injury or il~ness; 

7) Diastolic blood pressures at work were highest for 

the "clean control group. a !nt:erm.edia.t'.! for the injuries 

group, and lowe.st: for those with Ott,er Ser'iOU8 illnesseS • 

j 

l • ' I 

~ 

l 

I 

j 
• 

53~ 

3. Predictors of Other Serious Illnesses and Injuries 

Illnesses and injuries serious enough to be rated as Level 3 

were relatively infrequent in the .\TC study. Of all the men w:!.th 

adequate amounts of predictive data to percit analysis, only 18 

developed o~te or more injuries at L-3, and 23 developed severe (L-3) 

illnesses. Psychosocial prelictors from Round 1 were utilized, and 

in addition a "&liding interval -:1nalysis" _(see Section II) was conducted for those psychological and work-related variables gathered 

at each round. !he hijgr~phical questionnaire and field data were 

also exa.min£!d for their preciictive possibilit:'.es. In all of thP.se 

analyses, comparison uas made with a "clean contcol group, 11 To be 

. eligible for incluelon in this group, men had eo be free of all 

Level ) injuries and illn~sses, to be free of hypertension by the 

A'fC study criteria both at intaic.e and subsequently, and also to have 

less than the median level of average ar.nualized mild and moderate 

health changes. These criteria were fulfilled by 167 men, who comprised the ''clean control group." 

!indings 

Analyses of the Ciographical questionnaire completed at intake 

into the study revealed that the .17 men who later experienced s..a:vere 

injuries were more likely to have spent their childhoods in mode::-

ately large cities and in suburbs of large metropolitan areas. They 

did not com~ from small towns or rural areac (p • .002). Mobility 

of residenc~ during childhood was a marker of' men who later developed 

L-3 illnesses. Such men were core likely than cGntrols to have moved 

residence four or more times prtor to reaching age 13 (p • .006). 

Men who later qualified for the 11Clta:an cont::rol group" more often 

reported that they had never seriously considered quitting high 

scho~l during their adolescence. Those men who developed L-3 injuries more often reported occasioually wanting to quit whereas 

those with L-3 illnesses seriously considered this still m~re frequently (p • .02). 

Six psychosocial predictors from the first examinations were 

significantly distinctive ucross the illness, injury and control 

groups. Men who later developed L-3 injuries and illnesses were 

selected significantly less often than ~ontrols .n th~ peer selections for ideal controlling team (p • .04). In addition, the ••-

lections for coi:Qpe.t'1ncy as a controller were eignificantly different, 

with men who later had a~~idental injuries sc~rin6 by far thP. lowest, 

men with L-3 illnesses scoring at an intermediate level, and the 

clean control group being picked far more frequently (p •· .02). 

Two other variables went "in th<e wrong direc.:ion" in tenus of 

the hypothesis Griginally h~ld for them. Men who later dev.:!loped 

serious illneases and injuries had higher levels of work satisfactJ.on and su~ial resources for coping with problems than the clo;a.n 

• 

• 

•, 

• 
534 

control group at Round 1 (p • .01 and p • .005 respectively).- It 

is difficult to see how increased work satisfaction or greater availability of social coping resources could prove a risk factor for each 

of these kinds of serious conditions. One might, however9 eutertain 

the notion ~hat there may be a subjective distortion of perception 

about these variables among men who are about to de~elop serious 

problems. 

The remaining two significant variables at the intake examination dealt with the relation of age to experience. They both tell 

the same story. Men who later developed L-3 illnesses were older 

relative to the amount of experience they had than was the clean 

control group (p • .02). Another way of saying this was that they 

had less experience with the agency for their age than the clean 

con·.:.rol group ( p "" • 006). These findings were interesting inasmuch 

as age was not signif~ntly associated with risk of serious health 

changes (p ~ .30), but years of experience considered alone approached 

a significant difference among the three groups (p • .07), but for 

this table it was the men with serious injuries who had the lowest 

average experience. T.he equivocal nature .of these latter two statistics leads us to accept the more si5nificant and more consistent 

findings first reported. The Unplication for the agency, if these 

findings are replicated on larger samples of people with serious 

problems (such as those receiving medical discharges from the agency) 

would be to reconsider the advisability of hiring men into the ~gency 

at ages beyond those which arr: averag·e for incoming ATCs, but the 

benefits of this action would need to be reconciled with costs in 

terms of other results. 

The sliding interval analyses identify the time at which an L-3 

illness or injury occurred and then move to the immediately prior 

round of examinations to gather predictive data. Of course thiS 

method of analysis can be done only for those psychosocial variables 

which are gathered at each round of exaoinations.· This analysis 

yielded one replication Ot Round 1 findings and one new finding. 

ATCs' choices among their peers for competence were associated with 

later serious health change: The clean control group had the most 

frequent selections (mean • 3.45), whereas the L-3 injury and L-3 

illness group were picked significantly less often (means • 1.35 and 

2.00 respectively for a probability of .023). Another finding was 

that ATCs' reports of pay satisfaction declined in the round before 

they incurred a seriC'IIJS i~i:.1ry or illness and no such decline was 

apparent in the clean control group. This resulted in the sliding 

interval analyses showing both health change groups to have significantly lower pay satisfaction than the healthy controls (p • .02). 

A number of bi0logical variables gathered in the field were 

also significantly associated with the presence of serious health 

changes. There are some problems in t!le interpretation of these 
• 

535 

findings. howeve-..·. as they are. b<rsed on anywhere from 3 to 10 Jays 

of on-the-job study, some of which may !1ave taken place after the 

L-3 event occurred. Nevertheless it is possible that the L-3 event 

~3Y not have affected the behavior or the blood pressure of these ~ 

men, and so these findings will be reported but with the above note 

of caution. 

The amount of behavior arousal and motor activity at work was 

significantly different among the three groups (p ~ .01) with men 

who developed other illness having by far the least amount of motor 

arousal and those who incurred injuries being the most active per 

period of.observation. This finding needs further examination before 

being judged to be with or without circularity. 

D~astolic blood pressures at work were highest for the clean 

control group, intermediate for the accident group and lowest for 

those with other illnesses. This was true for t~o measures of diastolic blood pressure, the average of all readings for three to five 

work days of study (p • . 04) and the -avera~e maximum peak of diastolic 

pressure reached on ea~h of the three to five days of study (p • .02). 

These findi~gs were consistent with those reported elsewhere for 

average annualized mild and moderate health changes. In those analyses also, the group with the most frequent illness or injury outcomPs 

had the lowest levels of blood pres.gure rea<:tivity. 

Desp.ite the fact that a number of varia",les from the biographical questionnaire, psychosocial predictors, and field predictors 

were significantly associated with the presence of serious health 

changes, it must be remembered that a very large number of variables 

existed in each of theqe data pools and only a small minority of 

these achieved statistical significance. TI1e basic question regarding these findings is whether or not the predictors of this small 

group of severe health changes are the snme as those for mild and 

moderate illnesses and for ~ypertension. 

• 

• 

,.I 

!
536 

SUM!!ARY 

Predictive and Concurrent Risk Factor~ For 

Psychological Ilealth Change 

We found that a great variety of medical, on-the-job, and psychological variables differentiated bet~een peopl~ with psychiatric 

problems and thoee without such problems. The clearest distinction could be made between men without any problems over three 

years, those who had problems at intake, and those vho develop~ 

problems only after -intake. There was a slight association 

between total health change rates and psychiatric health change, 

but this ~ssociation was accounted for by a large num~er of 

other significant ~ifferences between these groups. In general, 

only three to five· variables out of the large number that were 

significantly different between the various psychological heDlth 

change outcome groups accounted for the oajority of significant 

differences between these groups. 

It was v~ry difficult to distinguish between new cases with different extents of psychiatric problems and between cases with 

varying frequ~~~ies of monthly depression and anxiety. On the 

other hand, the predictive accuracy for new nine month onset 

cases versus asympt~atic controls for the fi\·e primary psychiatric 

areas was quite good. The classification results wers sufficiently 

sensitive and sp~cific that programs coulJ be i~plemented to identify subjects at risk for these five psychiatric problems, and 

for people who might develop new problems across several areas. 

On the other hand, the specificity and sensitivity of predictive 

resuits for closely related groups, ,,·h-• Were distinguished only 

by their rate or extent of problems was not sufficiently good to 

suggest programs for implementation of risk identification and 

1nti!rvent1on. 

Finally, we found that those who had psychiatric problems according to our overall susceptibility index were disqualified at much 

higher rates from the FAA for both medical and psychiatric reasons 

than wet·e asymptomatic subjects. There also was a tendency for 

subjects with a heightened susceptibility and a greater extent of 

~sychiatric problems to have fewer FAA performance awards. ADymptomatic subjects tended to have the highest number of these 

awards. 
537 

predictive and concurrent risk factors for psychological 

change presented in this section were assessed by questioninterview and physiological responses on the job. Although 

number of variables were tested for their predictive abilpurposes of clarity and simplicity only significant findreported. We used considerabl~ caution in our statistical 

since the large number of variables wo~1ld make it possible 

a large numb~r of significant differences purely by 

To control for this factor we used rigorous statistical 

for significance, and in almost all cases, subjected all 

""'••e• showing a significant relationship to a pat·ticular cutfurther analyses which would control for the overlap and 

relationship between predictor variables. 

Most of the predictive findings reported in this section are 

assessments made at intake into the study. However, on 

~,ca••u•n, predictive variables were assessed at the second evaluapersonS with problems preceding chat evaluation were 

from the analyses. For example, this procedure was re-

~hen analyzing the monthly dep~ession and anxiety morbidsince the depression and anxiet7 questionnaires were not sent 

until after the second evaluations. 

In other analyses, concurrent measures were used. These con-

·. current measures primarily were derived from our field studies and 

represented the average work, blood pressure, cOrtisol, or other 

assessment of an individual over the three years in the study. As 

these measurements were relatively unstable over time, concurrent 

aesessments were necessary to arriv~ at the mo:Jt stable charact.eristics oi the men and then to associate them with changes in psychological functioning. We have made an effort to distinguish clearly 

between predictive and concurrent findings in tables and text. 

Finally, although a large number of psychiatric outcom~s were 

discussed and evaluated for descriptive purposes in Section IIID, 

these outco•es were not all significantly associated With other 

factors and are not all, theretore. discussed below. Rather, we 

concentrated on five major assessments of psychological functioning: 

subjective distress, tmpulse control disordars, alcohol abuse, mate 

role an<l work role. 

One outcome discU63ed in this section is susceptibility to 

psychiatric problems, defined by an assessment of abnormality on 

any of the five criterion scales of the Psychiatric Status Schedule. 

Comparisons of susceptibility were made among three groups: those 

having no psychiatric problems over the three years, those with 

' ! 

i 

' I 
• 

at intake, and those who ;eveloped problems after intake. 

Another overall assessment was the extent of psychiatri~ probdefined by quantity and frequency of problems. Four groups 

compared: men who had no problems on any of the criter:i.on 

across the three years of the study; mild new cases with one 

rit:er·ion scale abnormal at only one of five examinations; moderate 

with one or more criterion scales abno~l at rwo or thre~ 

five examinations; and, chronic cases with one or more criterion 

abnormal at four or five examinatiova. 

Predictors of the onset of pgychiatric problems were deterby a procedure that was called "sliding int~rval" analysee, 

Which men who Geveloped a problem during the study were compared 

a number of variables wlth ::.en w; .. ,o never de-.7 elopeC a problcrn -

case and control procedure, with the special feature that the 

the predictor variables WF.S taken fro1ll. an examination immepreceding onset vi the symptoms, and the data for the comgroup was taken from matching time periods. 

The monthly self-reports of depression and anxiety were used 

define the following comparison groups for predictive analyses: 

controls, acute cases, intermittent cases_ and chronic 

Asymptomatic controls were uaen who had an average r·ate of 

monthly episodes per ·y·!ar, and chronic cases had 9 or moru 

episodes per year. As was discussed in Section III 0, all 

of the men could be classified in this fashion. These 

and definitions are repeated in the tables for 

a summary is prese"tted of the relationship between 

health change and other outcome~ in this study iocludmoderate health chsnges, FAA ~erformance awards, and 

outcomes of varying kind·s. 

• 

• 

i 

l 
539 

Su:~ceptibilitv to Psvchiatr-ic Problems 

The three groups delineated above - an asymp·tomatic group, 

cases and lncidenc_P. cases - were compared on a number 

predictor variables. Men who had no problems, hut who did not 

all five evaluations (N "" 65 for most analysE~s) were excluded 

we did not know their later psychiatric status. As is 

in the tables following • some subjects had incomplete 

and therefore, the number of subjects in each of these groups 

reduced. The reductions in each area are indicated on each 

number of measures of on-the-job behavior responsivity were 

and used as concurrent risk factors for psychiatric health 

Table 181 displays the relationship betwet~n on-the-job 

response and overall psychiatric susceptibility status. 

remained asymptomatic throughout the study tended to have 

l"e><tr£lll<ely low behavioral responses at work, whereas men who developproblem~ over the course of the study tended to have higher levels 

behavioral response on the job. KEn who came into the study with 

psychiatric problems had behavioral responses at about the levels , expected by chance. 

The !'elationship between the average normalized cortisol on 

job and the overall psychiatric susceptibility is displayed 

in Table 182. The lowest le~~l of cortisol expressed either in 

terms of total corti~ol output or maximum cortisol output, on position, was found among men who never developed any psychiatric po::oblems in the study. The highest levels of cortJ.sol output were 

associated with having p~ychiatric problems at intake into the 

Those men who developed psychiatric problems during the 

had cortisol output in between these two gro.ups. Hence, 

cortisol responsivity was associated with the presence rather than 

the development of psychiatric problein.s. 

A large number of bloOd pressure measures were d~vised to 

assess cardiovascular responsivity at work. Table 183 displays 

the relationship of the average systolic blood pcessure at work 

to overall psychiatric status susceptibility. Men who remained 

asymptomatic throughout 'he study tended to have either. very low 

average: systolic blood pressure or very high syatolic blood pressure at work, whereas men who developed psychiatric problems tended to have an average level of aystolic blood pressure ~nd were 

very much less likely to have very low or very high ave1::-.age systolic blood pressures. Men who came ~nto the study with psychiatric problems tended to have much higher than expected raLes of 

high averAge systolic pressure at work, and were under-re'presente<l 

in the very low average systolic blood pressure at work categories • 

. ., 

,-.,1 

I ,..; 

·' ·l 
Extremely low behavioral response 

(less than -1 s.d,), controlling 

for total time worked 

Average J!. I. s.d.) behavioral 

response, controlling for total 

time worked 

Extremely high behavioral response 

(greater thJn +I s.d.), controlling 

for total time work~d 

Ratio of Observed to Expected Numbers of 

Subjects in Each Psychiatric Susceptibility Group 

Asymptomatic Prevalence Incidence 

Cases Cases ~ 

II. 321 1.00 I :::ill 

·.89 1.04 I . 12 

.96 .93 1. 12 

X

2

-9.64 df • 4 p < .05 

• 

Total 

N 

73 

190 

54 

Ken w/o Dsychlatric problems but who were not evaluated all 5 times (N=65) arod men with J. ss than 3 on 

tha-job r"esults for behavior (N=34) were excluded from this analysis .. The psychiatric groups were 

reduced a• follows: Asymptomatic (135 remained 135), Prevalence cases (reduced from 99 to 84) and 

Incidence cases (reduced from 117 to 98). 

** 

A ratio of 1.00 means that the number of men observed In a category was exactly equal to that expected by chance • 

......., .......... , -w .......... """""""""''"'""'"'-'"' e;'n(·..:-·om··"-J· ________ _.._~~-...,-.. _ ·-·- ,""~~--- "'---..... ~- ·- ·-·-- -------·-. 

s_c_,·.~ .. ~). 
-~·--·-

: •.... 

TABLE 132 

The Relationship of Average Normalized 

· Cortisol On-The-Job To Overall 

Psychiatric Susceptibi llty Status* 

Asymptoma- Prevaience Incidence 

.!l£..Group :::C::.a::;se"'s'--- Cases F _p__ 

Average Normalized Total Mean 1179.1 1231. 1 1198.9 3.20 < .05 

Cortisol Output s.o. 121.8 119.2 133.2 

N** 95 60 64 

Average On-Position He an 117-9 126.3 119.5 6.32 ~.003 

Maximum Cortisol S.D. 14.4 15.5 15.0 

Output in 20 minutes N•':** 101 61 65 

* Overall Psychiatric Susceptibility Status groups were defined as: 

Asymptoe~tlc- all 5 PSS criterion scales were asymptomatic at all 5 evaluations (11=135) 

Prevd)ence cases-~ of the 5 PSS criterion scales were symptomatic at intake (N=99) 

lncident3 cases -any of the 5 PSS criterion scales were symPtomatic after intake but 

not at Intake (d•ll7) 

.. 

!·l<>n who had no .problems but who did not have all 5 PSS evaluations (N=65) und men who did not 

have tne specified cortisol assessment (N~I32) for three or more field studies were excluded. 

*** lien who had no problems but who did not have all 5 PSS evaluations (N=65) and men 1·1ho did not 

have the specified cortisol assessment (N•124) for three or more field studies were excluded. 

• 

• _, 

V> 

~ 

... 

• 

• 
542 

TABLE 183 

The Relationship Of Average Systolic 

Blood Pressure At Work To Overall Psvchiatric Status 

Susceptibility Groups* 

Ratio of Observed to Expected 

Numbers of Subjects in Each 

Psychiatric Suscept:bility Group** 

Prevalence Incidence Asymetomatic Cases Cases 

low av~rag.e systolic I. 44 .so .]7 than-1s.d.) c?t work 

.88 1.04 1. 1S 

average systolic 1. 18 1. 30 .so r than +l.s.d.) 

2 

X •13.44 dfa4 p< .01 

Total 

!:!.__ 

41 

193 

39 

with no psychiatric problems but who were not evaluate<·i all 5 times 

) and men with less than 3 on-the-job blood pressure studies (N•I4S) 

excluded from this analysis. The psychiatric groups were reduced as 

lows: Asymptomatic (135 reduced to 122), Prevalences cases (99 reduced 

67) and Incidence cases ( 117 reduced to 84). 

that the numbef·of men observed in _a category was 

expec:ed by chance. 
543 

Hence, men who were susceptible to psychiatric problems over 

the course of the study tended to have higher than expected levels 

of behavioral response, slightly higher than average cortisql outfUt c.n the job, average levels of systolic blood pressure at w·ark 

and less than expected low and high blood pcessure levels at work, 

whereas men who came into the study with psychiatric problems had 

average behavioral responses to work, much higher than average 

cortisol outputs, and more average systolic blood pressures at work. 

Men who remained free of psychiatric problems over the course of 

the study tended to have extr~ely low behavioral responses at work, 

low cortisol output, and either high or low, but not average, systolic blood pressure responses at work. 

The ATCs were •lso administered a large number of psychological tests at intake and at their second evaluations. Table 184 

displays differences o.n the Job Descr;.ption Index, the ATC Questionnaire and by age and experience levels. Men who developed problems 

were significantly younger and had sis~ificantly less experience 

than men who remained as~ptomatic or who had problems at intake. 

In fact, thane who developed new problems d,uing the course of the 

study had a low~t age than their experience would suggest, whereas 

men who remained asymptomatic were older than their experience 

would indicate. 

Hen who came into the atudy with problems had significantly 

lower satisfaction with work and with their co-worke.rs. Moderate 

levels of satisfaction with work and co-worker~ were expressed by 

those who developed new problems, and the greatest satisfaction Was 

expressed by those who remained asymptomatic over the course of the 

study. Men who tended to avoid work in order to cope with the pressures of the job tended already to have problems at lhe beginning 

of the study. Also, as indicated in Table 134 it was interesting 

to find that the more an ATC was invested in his identity as a controller, the more lik~ly he was to develop problems over the cours~ 

of the study. Those men uho ~ad leRs of a need t~ be super controlle·rs tended to remain asymptomatic. Men whC) came into the study 

with psy~hiatric problems felt that their job cost them a lot in 

many area• of their lives. Those who remained symptom free felt 

that the job had cost them relatively less in terms of their person~! 

lives. 

Table 185 diaplays differences on the ATC Questionnaire and on 

our interview ratings of coping, burnoct, and investment. Hen who 

came into the study with psychiatric problems used physical ac•ivities as a coping mechanism significantly !ess often than asymptomatic 

controls or men wno developed new psychiatric problema. The use of 

alcoholic belll!rages as a copi.ng mechanism \148 significantly higher 

among men who came into the study with psychiatric problems than 

either asymptomatic controls or the incidence cases. Both those who 

I

I 

I' ' 
544 TABLE 184 

Intake Differences Between Overall Psychiatric 

Susceptibi I ity Status Groups: Age, Experience 

And Job Related Characteristics* 

es 

p- Asymptomatic 

Group 

(N•l35) 

Mean 36.60 

(S.D.) (4.85) 

Mean 11.16 

(S.D.) (4.68) 

Mean .40 

(S.D.) (2.73) 

Mean 52.07 

(S.D.) (8.83) 

Mean 52.69 

(S.D.) (~.69) 

Mean 48.85 

(S.D.) (9.12) 

Mean 48.81 

(S.D.) (10.32) 

Me~n 48.05 

(S.D.) (8.65) 

P"ieva- Inc ilence dence 

Case$ Cases 

(N•99) (N•117) F _e_ 

36.80 .003 

(5. 16) 

II. 79 

(4.57) 

.02 

(2. 74) 

45.52 

(10.82) 

47.76 

(9.96) 

52.03 

(10.15) 

49.02 

(lo. 76) 

53.97 

(10.71) 

34.68 

(5.27) 

6.14 

10.05 3.91 .02 

(4. 74) 

-.46 3.35 .04 

(2.39) 

50.55 13.'1D 

(9. 97) 

48.02 10.10 

(10.46) 

49.57 3.27 

(9.39) 

51.89 

(9. 79) 

3.27 

.0001 

.0002 

.04 

.04 

50.97 10.52 .0001 

(9.74) 

tomatlc - no PSS criterion scale abnormal In 5 evaluations; 

lence- any criterfon scale symptomatfc at intake; and Incidence 

any crlterlor. scale symptomatic after Intake but not· at Intake. Men 

were asymptomatic but who were not evaluated a11 5 times were ex-

(N•65), since their later status could not be det•rmlned. Group 

varied slightly due to missing or not applicable data for •orne 

• 

• 

• 

I 

\ 

l 
545 TABLE 185 

Intake 01 fferences Between Overall Ps~chlatrlc 

Susceptibi I ity Status Groups: Coping And Interview Assessmf"'.nts* 

fnta:O:e Varl ables 

ATCQ•ATC Quest ion- Asympto- Preva ... locinai re, Interview- matic lence de nee 

Global rating from Group Cases Cases 

l(low) to 7(hi2h) (N•I35) (N•99) (N•177) F _£_ 

ATCQ Coping by Physical Hel·n 52.61 47.20 50.14 8.82 .0004 

Activities Factor (S.L) (9. 02) (9.85) (9.97) 

ATCQ Coping by Drinking Mean 47.18 54.14 50.64 14.80 .0001 

Factor (S.D.) (7.97) (11.06) (9.82) 

ATCQ Ha r i ta I Coping Hean 52.55 47.06 48.30 9.53 .0003 

Resources Fac tnr (S.D.) (li.l3) (10.80) ( 10. 15) 

Interview: Coping wl th Mean 4.16 3.20 ).75 10.73 .0001 

Difficult Days at Work (S.D.) (I. 57) ( l. 55) (I. 54) 

Interview: Coping wl th He an 3.80 3.25 3.61 4.02 .C2 

Trainees and Training (S.D.) (I. 37) (I. 49) (I .53) 

Interview: Overall Mean 4.04 3.21 ).69 10.85 .0001 

Coping (S.D.) {! .34) ( 1.25) (I. 40) 

Interview: Glob6l Mean I. 96 ).00 2. II 18.33 .0001 

Burnout (S.D.) (1.08) (I. 79) (I. 24) 

Interview: Investment Mean 5.17 4.22 4.91 8.27 .0006 

In ATC IdentIty (S.D.) (I. 59) (2. 14) (I .67) 

* Asymptomatic - no PSS criterion scale abnormal In 5 evaluations; Prevalence -~criterion scale symptomatic at Intake; and Incidence -any criterion 

scafe symptomatic after Intake but not at Intake. 

Hen who were asymptomatic but who wore not evaluated all 5 times wer$ excluded (N•65), since their true status CoUld not be determined. Group 

sizes varied slightly duo to missing or not appl !cable data for some 

subjects. 

. .. 

I 

l 

' t 

·l ' 

l 

! 

i· 

l 

~ 

I 

I . 

! 

' 
546 

had problems coming inta the stUdy and those who developed problems 

over the course of the study rated themselves as having much lower 

marital coping resources than those who remained symptom-free over 

the course of the study. By self-report measures, therefore, coping 

mechanisms were primarily different between those who already had 

psychiatric problems and those who remained sympto~-free. Those 

who devel0ped new psychiatric problems tended to score between those 

two groups. 

Our special interview to assess coping, burnout, and investment 

also significantly discriminated between groups. Those men who came 

into the study with psychia,ric problems were given coping ratings 

significantly lower than the asymptomatic group a~d the incidence 

cases. Coping was rated as highest among those men who remained 

asymptomatic throughout the study. It is important to remember 

that these are predi~.tive results. The lntervie;.:co.s at that ti.Dle 

had no idea ho\1 men would change in their psychiatric status over 

the course of the study. 

Two other ratings are of particular interest. Burnout was 

rated higi";est amongst those who had p~;ychiatric problems at intake 

and lowest amongst those who continued asymptomatic throughout the 

study. Investment in the air traffic controller identity was rated 

lowest amongst those who had problems at intake, and highest amongst 

those who remained 4Symptomatic throughout the study. This result 

contrasted.with the self-reported difference in inVestment (see 

Table 184) where the asymptomatic cases scored lowe&t on investment, and new cases of psychiatric problems were higher. 

Other psychological intake differences between the overall 

psychiatric susceptibility grou"' are shown in Tables 186-188. 

The sense of anomie and alienation was highest amongst men who had 

problems coming into the studv, and lowest amongst those who remAined symptom-free. Psyc~lophysio!ogical anxiety symptoms, life 

changes, and ethanol consumption per week were highest amongst 

t~ose who came into the study with psychiatric proble~s. Men who 

were more Type B tended to have no psychiatric probl~s at all 

over the course of the study. 

These m3ny significant differences between men who had nv 

problems, me~ who had problems co~ing into the study, and men who 

developed problems over the course of the study were subjected to 

multi-variate discriminant analyses in order to find the most significant and pa~simoniou~ set of predictors. Table 189 displayu 

the five variables which contributed to the maximum discrimination 

betwe2n these groups. Once these five variables were taken into 

ac~ount, none of the other si~nificant differences report~d thus 

far contributed to a significantly greater differentiatio.n between 

groups. As seen in Table 189, the CPI sense of well being and 

I 

' 
• 

• 

TABT.E 186 54 7 

Intake Differences Between ~vera! I Psychiatric 

Susceptibi I ity Status Groups: Psychologici:d Characttristics. 

L; fe Changes, And Ethane I C0nsurr.pt ion;': -: 

Srole's ~nomie 

:(High scores • 

less anomie) 

Asymptomatic 

Cases 

(N•I35) 

Mean 13.71 

(S.D.) (1.94) 

ATCQ Poychophys i o- Mean 

logical Anxiety (S.D.) 

Factor 

47.82 

(8.74) 

ATCQ Bounceback 

(High)- Burnout 

O.ow) Factor 

ATCQ Tension 

D ischuge Rate 

Factor 

Mean 

(S.D.) 

Mean 

(S.D.) 

52.29 

(8. 58) 

52.72 

(8.96) 

Pay~e 1 , Uh ·, enhuth, Mean 28.24 

· And Prusoff LCU (S.D.) (23.08) 

Total For 6 Months 

prior to Intake 

Review of Life 

Events Distress 

Tc;ta l for 6 

rronths ~lrlor to 

Intake 

E~hanol Consu"Jpt I on per week In 

absolute ounces 

• 

Mean 171.80 

(S.D.) (79.71) 

Mean 7. 75 

(S.D.) (!3.30) 

Prevd1 en('.e 

Cas~s 

(N•99) 

12.81 

(2. 22) 

53.47 

(11.16) 

47.30 

( 1 1 . 81) 

47.78 

(11.17) 

36.56 

(24. 07) 

Incidence 

Cases 

(Nmll7) 

13.20 

(2. 01) 

so. 39 

(9.20) 

50.69 

(9.49) 

48.53 

19.79) 

36.00 

(27.25) 

206.55 241.22 

(192.971 (240.54) 

14.24 

(12.13) 

8.44 

(8. ~3) 

F 

5.72 

9.54 

7.16 

8.56 

4.21 

6.45 

8.57 

_e._ 

.004 

.0002 

.0015 

.0005 

.02 

.0005 

Asymptomatic ... no PSS crltedvn scale abnormal tn 5 evaluations; Prevalence-~ criterion scale symptomattc ~~;and lncfdence- any 

criterion scale symptomatic after intake but not at intake . 

• 

were asymptomatic but who were not evaluated all 5 t!mes woe.·e 

excluded (N•65), since .their true status could not b<l determined Group 

sizes varied slightly due to missing or not applicable data for ~ome 

subjects. 

• 

• 

• 

i 
----------------------~ 

54R 

TABLE 187 

Ca 1 i forn ia Psycholosical Inventory (CPI) Differences 

Be tween Ove ra I I Psychiatric SusceptibilitY Status Groups":': 

Asympto- Preva- Inc!-

matic lence dence 

Cases Cases Cases 

i st i *'" (N=I34)'' (N=94) (N•III)* F _J_ 

Status Mean 52.61 49.42 50.51 3.61 .03 

(S. 0.) (8.55) (8.78) (10.25) 

Mean 53.24 49.28 52.23 4.60 • 02 

(S.D.) (9.80) (10.36) (9.52) 

He an 52.31 43. 15 47.60 25.01 .0001 

(S.D.) (8. 21) (10.93) (10.24) 

Mean 44.40 38.57 39.46 II. 61 .0001 

(S.D.) (9.53) (10.34) (10.49) 

Mean 50.62 42 .I 0 44.22 29.52 .0001 

(S.D.) (7.55) (10.52) (8.80) 

Mean so. 39 42.67 45.51 23.99 .0001 

(S. 0.) (8. 36) (8.52) (8. 79) 

Mean 50.28 44.55 46.83 11.32 .0001 

(S.D.) (8. 15) (9. 71) (9.84) 

Impress ion Mean 47.78 40.27 43.56 14.85 .0001 

(S.D.) (10.05) (9. 77) (9.08) 

sy•tpt<>mattic- no PSS criterion scale abnormal in 5 evaluat-ions; Preva-

- ~criterion scale symptomatic at intake; and Incidence - any 

iterlon scale symptomatic after intake but not at intake. Men who 

asymptomatic but who were not evaluated all 5 times were excl,Jded 

s:-nce their tr 1Ie status could not be determined. F.Jeven others 

out bE:~fore completing the CPI and I asymptomatic subject antheCPI invalid!\'• 

for interpretive descriptions of these characteristics. 

j 

>' ·.'; 

' ' 1 

l 

L 

>':! . . ·t· <'.I ·-

" Iii 

·il :'I 
• 

TABLE 188 549 

California_ P:;ycholoi!it.:al Inventory (CPI) And Jenkins Activity Survez: 

Overal (JAS) Differences Between I Pslchi~tric Susceetfbil itl Status Groups,·: 

Asympto- Preva- lncimat ic CPI lence de nee or JAS Cases Cuses Characteristic** t.ases (N•I34)* (N=94) •> (N=IIl)•> F -L 

Corr.muna I i ty He an 55.88 52.32 52.16 8.50 .0005 (S. 0.) (6.62) (8.23) (9. 14) 

Achievement Mean 54.33 45.79 49.32 24.12 Conformity .OOvl (S. 0.) (8. 89) (9. 73) (9.49) 

Efficiency 

lntellectu~ I Mean 51.48 45.98 47.50 9.90 .0002 (S.D.) (8. 91 ,I (9. 99) (10.59) 

Flexibility Mean 47.73 51. 13 50.23 3.09 .05 (S.D.) (10.98) (9.86) (11.64) 

Fern in i ty Mean 47.39 50.59 48.10 4.26 .02 (S.D.) (8.39) (8.20) (8.39) 

Persona 

JAS Type 

1 i 

A 

ty 

He an -4.54 -2.76 -I.~ I 3.79 .03 (S. 0.) (3. 26) (9. I 0) (9. 60) 

JAS Speed And Mean -5. I~ -4.01 lnpatience (~. 0.) -.03 14.50 .0001 (8.27) Factor (8.89) (9.67) 

JAS liard Driving Mean -I. 62 -2.00 1.03 3.80 Factor .03 (S.D.) (8. 56) (8. 88) (9. 18) 

• 

Asymptomatic - no PSS criterion scale abnormal in 5 evaluatfons; Prevalence - ~ criterion scale symptomatic at in~; and Incidence - any 

criterion scale symptomatic after intake but not at intake. Men who were 

asymptomatic but who were not eva I uated"a 1 1 5 times were exc 1 uaed (N=65) 

since their true status could not be determined. Eleven others dropped 

out before completing the CPI and JAS and 1 asymptomatic subject answered the CPI invalid and was excluded. 

See Table 

Chapter for interpretive descriptions of CPI characteristics and 

for interpretive descriptions ot JAS character~tics. 

------------~----

--.. ----. 

• 

i:, 

• 

,, 

:I: 

iii 

' 

,I 

• • 
Satisfaction 

consumption per 

luLe ounces 

'!"ABLE 189 

Asymptomatic 

Controls 

Prevalence 

Cases 

Incidence 

Cases 

Inventory High•highest of three groups 

Medium a middle of three groups 

Low • Lowest of three groups 

High Low Medium 

High Low( tie) Low(tie) 

Rate Factor High Low Medium 

High Low Medium 

week Low High Medium 

tic controls for this analysis (N•104 of 135) were defined as never 

had any significant symptomatology on any PSS criterion sc~le. Prevc•"es (N~79 of 99) were defined as men having any of the 5 PSS criscales abnormal at intake. lncidenc11 cases (N•88 of 117} were defined 

men having any of the 5 PS3Criterion scales abnormal after intake but not 

intake. Men without 5 PSS evaluations \rlho were asymptomatic (N-65) were 

uded because their later status could not be determined. The reduced group 

were due to missing data on any of the predictor variables. 

.. 

I 

i· 

I 

' I 

', 

f 

I, 

I

:, 

' I'' 
551 

responsibility scales were differentiating traits between the groups. 

Men who had a high sense of well being and a high responsibility 

score tendeJ. to remain Sytl'ptom-free throughout the study. Those 

who scored low on the well being or responsibility scales tended to 

have problems or develop problems. Men with high rates of tension 

discharge tended to r~ain symptom-free whereas men who had low 

tension discharge rate either had or· developed pcychiatric problems. 

Work satisfaction ~as greatest among thos~ who remained symptomfree and lowest among thos~ who had problems at intake. Finally, 

ethanol consumption per week was highest among those ~~th psychiatric problems at intake and lowest among those who remained symptomft'ee. 

These variables were combined in the discriminant functions 

for. predicting the overall psychiatric susc~ptibilit;• status of men 

during the study. Table 190 displays the classification accvr"'tcy 

of these discriminant functions. As can be seen, the specificity 

of these classifications was 70.2%, which represents the percentage 

of controls who were correctly identified. The sensitivity of the 

discriminant functions to pick up cases was 57.0% for those who had 

problems at intake and 47.7% for those wSo later developed problems. 

the overall pe4centage correct of the classification functions was 

59.0%. One-fourth to one-third of the men were incorrectly classified as fals~ negatives or false positives. 

The discriminant and Classification results were good, though 

not excellent. They indicated that it pould be possible to identify with a high degree of statistical significance those men who 

re~ined symptom-free in a three-ye~r period of time, but that the 

identification of men with problems or who developed problems was 

more difficult. The greatest amount of misclassification occurred 

between those who had problems and those predicted to develop problems. From a star.dpcint of implementing programs this would be ~~ 

min1~al significance since individuals predicted either to have 

problems or to have a .high likelihood of developing prcblems could 

be defined as the at-risk group, who might then profit from counseling or other intervention services. 

The results presented were the strongest of a larger group 

from a conceptual, methodological and statistical standpo·".nt. A 

number of other statistically significant results were found but 

because of the level of measurement (categorical} and/or the number of results that could have- occurred by chance in tl-• .!se areas, 

they are presented separat~~y. Suhsequent studies mRJ be able to 

integr.ate the results reported on th.e pages following with the results reported above, but at the time of this report, we are not 

convinced of their overall ~ignificance and mean!ng. However, 

since they may prove to be illumicating or of particular significance in their own right, they are presented next. 
552 

TABLE 190 

Classification Accuracy Of The 

Host Parsimonious And Significant Discriminants 

• 

Retween Over.::: II Ps)chiatric Status Susceptibility Gi="oups* "'; 

Spec if is_i n. -- % of 

controls correctly 

identified 

Sensitivity--% of 

cases correctly 

j Ot:.io!i fj ed 

Asymptomatic Prevalence Incidence 

Controls Cases Cases 

70.2% 

57.0% 47.7% 

Classification Matrix 

Predicted Group 

Asymptrnnatic ~revalence lncidence 

Actua I 

Groups 

Asymptomatic 

Pre~talence 

ll 

14 

26 

Overall Percent Correct • 73+45+42/271 • 59.0% 

Percent False Po•itives • 31/104 a 29.8% 

Percent False Negatives • 14+26/167 • 24.0% 

• 

7 

.!!.2. 

20 

24 

20 

Total 

104 

79 

88 

271 

• 

Asymptomatic (H•104 of 135) defined as never hav.!ng had any significant symptomatology on any PSS criterion scale. Prevalence cases (N•J9 o' 99) were 

def(ned as men having any of the 5 PSS criterion scales abnormal at intake. 

Incidence cases (N-88 of 117) were defined as inen having any of the 5 PSScriterion scales abnormal after intake but not at Intake. Hen without 5 PSS 

evaluations who were asymptomatic (N~S) were excluded because their later 

status could not be determined. The re~uced group sizes were due to missing 

data on an~ of the predictor variables. 

• 

• 

,; 

:r 

I 

!: 
553 

T~ble 191 displays the rel4tionship between mild and moderate 

health change rates and overall psychiatric susceptibility status. 

Men who developed psychiatric problems over the course of the study 

had higher rates of respiratory illness than men who had problems 

at intake, but only marginally higher respiratory illness rates 

th3n asymptomatic men. There were no significant differences in 

other categories of mild and tOOderate illness between those with 

and those without psychiatric susceptibility~ On the other hand, 

when we summed across all the illness categories, the men who developed psychiatric problems over the course of the study had significantly higher average mean illness rates of mild and moderate 

health changes than men who remained asymptomatic, or who had problems coming into the study~ 

In general, therefore, we found only a slight association between mild and moderate health change and susceptibility to psychiatric problems. This association was due primarily, if not solely, 

to an increased rate of respiratory problems among those who developed new psychiatric proLlems during the study compared to those 

who ha.d such problems coming into the study.~ 

An important implication of this finding was that a general 

complaint, or malaise, syndrome was ruled out of our results. If 

such a syndrome was predominant or even a general factor, we would 

have had considerable overlap in our medical and psychiatric outcomes. Since we did not, we could rule out this possible factor. 

We also were interested in the posSibility that a man's general medical history might account for his later psychiatric status. 

Out of nearly one hundred possible items we assessed in their medical history prior to intake, only six were significant at the .05 

level. By chance we could have expected at least five signiffcant 

items. Therefore the following results are offered for the sake o! 

completeness in describing our results. 

Table 192 displays the significant differences between the 

overall psychiatric susceptibility groups on certain facets of medical hiscory prior to intdke. Men who later developed problems in 

the study had a history of frequent night sweats, prostate trouble, 

and close contact with tuberculosis. Men who had psychiatric probl~ms coming into the study reported previous history of pain in 

the cheat or with breathing; operations on -the head, neck, or face; 

and allergic reactions to penicillin. Some of these findings make 

intuitive sense; we are not sure of the overall meaning of the 

others. 

In summary, we can say that a man's prior hi~tory of physical 

illness had little, if any, effect upon his psychiatric status 

during the study. 

' \ 
• 

TABLE 191 

Hi ld To Moderate Health Chanae Rates 

As A Function Of Overall Psychiatric 

Susceptibility Status* 

Average Number of Months Per Year 

Ourins Which Illness/Disorder Was Exeer i enced*l~ 

Asymp- Preva .. lncitomatic lence dence 

Controls Cases Cases F _£_ 

Mean 1. 64 1. 42 1.84 4.23 .02 

(S.D.) .99 1.08 ."98 

Mean .52 .}6 • 51 1. 97 N.S . (S.D.) • 67 .55 .63 

He an .42 .43 .53 1.10 N.S. 

s (S.D.) .58 .65 .69 

Mean . 14 . 14 .16 .06 N.S. 

(S.D.) .35 -35 .36 

Mean . 15 .12 .2D 1.2~ N.S • 

(S.D.) .36 .33 .40 

Hean • 22 • 15 .20 .• 70 ~.s . (S.D.) .41 .36 .40 

Mean .30 • 25 .36 .89 N.S • 

(s.o.i .S2 .53 .63 

Mean • 53 .52 .64 .96 N.S • 

(S.D.) .66 .75 .80 

Mean .14 • 11 .06 2.44 • 10 

(S. 0. ) .35 .31 .23 

Ave rage Mean 2.44 2.~4 2.73 3.66 .03 i 

Rate (S.D. ) .88 • 98 .95 I 

I 

I 
Significant I ter.,s from 

Health History Prior to Intake 

Frequent night sw•ats 

Pain in chest or witi• breathing 

Close contact with tuberculosis 

il.D. told ATC had prostate tro•,bl" 

Had operation on head/neck/face 

Allergic to penicillin 

Ratio of Observed to Expected Positive 

Responses for _Overall Psychiatric Susceptibility 2 Asymrtomatic** Prevalence** Incidence** ~ 

.so 

.25 

1.38 

.27 

1.26 

.43 

1.00 

2.33 

017 

1. 33 

1.17 

2.20 

1. 56 

.]:; 

1. 29 

1. 50 

-55 

.83 

6.05 

7.62 

6.19 

11. 15 

7.96 

9-09 

£....._ 

<.os 

<.03 

<.os 

<.005 

<.02 

~02 

*Overall Psychiatric Susceptibility groups were defined as (I) Asymptomatic if all 5 PSS criterion scales 

were nonr.al throughout the study; (2) .Prevalence c::ases if !!!1. of the PSS criterion sc~Jes were "iymptomatic 

at intake; or (3} Incidence cases if any of the PSS criterion scales were symptomatic after intake. Hen 

with no proble11;s but Nho did not have ali 5 evaluations (N=65) were excluded. 

** Some subjects 

analyses to: 

• ' 

had incomplete medical histories and therefore the number of subjects was reduced for these 

Asympton~tic (135 down to 130), Prevalence (99 down to 97) and Incidence (117 down to 115) 
557 

2. Sociodemographic Relationships to Psychological Health Change. 

In their intake evaluation for the study the controllers were 

ad::ain:f.stered a biographical questionnaire that assessed many areas 

of each man's functioning in the past as well as in the present. 

In this section, we present a description of the sociodemographical 

variables which were significantly related to psychological health 

change up to but not including the final evaluation in the study. 

A very large number of findings could have bee_n generated from the 

more than 500 analyses conducted in this area. However, only the 

statistically significant and more interesting findings will be 

described in general terms in order to help present a more global 

image of those who had or developed psychiatric problems. 

We used a number of indices of social mobility. One was defined as the difterence in socioeconomic level of one's home neighborhood between childhood and the p-resent. We .. founu that those 

with the least social mobility tended to develop more psychological 

health changes. Those whose ?resent home neighborhooU was in a 

better socioeconomic area than the home neighborhood of childhood 

had fewer psychological problems Cevelop over the course of the 

study. 

We'asked about the sibling composition of men's parental families. We found that men who were the only child had the feWeSt· 

psychological health changes with 72% having no problems over the 

course of che study. Of those with one or more siblings, 50-55% 

had no problems over the c·:>ursc of the study. 

W~ inquired about th~ educational lEvel of both the controller 

and his parents. Thirty-~ix percent of those ATC$ who had far ~ore 

education than their fathers had an impulse control problem at some 

time during the first four roun&a, whereas only 17% of those whose 

fath{~rs had equal or more education were so affected. More generally only 40% of those controllers with far higher levels of education 

than t~eir fathers remained fr~e oC psychological health problems 

over the first four evaluations, whereas 504 of those with lesser 

differences in education between the father and the I.!Ontrollers, 

and 67% of those whose fathers had equal or greater education remained free of psychological difficulties over the first four 

rounds. 

The educational level of the controller himself was significantly 

related to impuloe control problems. Those who completed high school· 

and had some vocational training had the f~west such problems. 

Those few who did not graduate from high school or who did graduate 

from college had somewhat more impulse control problems. Over all 

areas of psychological fu~lctioning, the two m.~jority groups having 

middle levels of schooling - high school sraduotes with vocational 

.I 
• 

558 

training and high school graduaees with some college - had th~ 

lowest percentage of psychological probl~?ms over the first four 

rounds a 

A special set of five questions on the biographical questionnaire asked the controller to compare his parents with regard to 

five areas which might have gE=112rated a cc·.tflict of values or expectations in the study subject. The controllers were asked to 

indicate how similar or different their parents were in terms of 

social background, ~ducation, religious emphasis, their goals for 

child rearing, and their personality. A composite score was calculated across thes~ areas. 

The 25% of men who reported the greateat differenc~s between 

their parents had substantially higher frequencies of,impulse control problems. This was true both for men with and without such 

problems at intake. Overall this parental discrepancy variaLle 

showed a strong predictive relationsh ~·. Only 34% of those men 

who reported their parents as being very different from one another 

showed no psychological abnormalities over the first four roundd, 

of those with more similar parents were free from 

difficulties. 

asked about their relationsttip with their parents 

teenage years. Those who reported worse than av~rage 

developed psychological problems significantly more 

often t&an those who said their relationship with their parents 

was average or better than average. 

Our sociodemographic background variables included an assessment of the si:;.e of the ~ity in which a man was· reared and certain 

other habits and characteristics. It was found that men who were 

born in large cities had fewer problems with subjective distress 

(anxiety and depression) than t_hose tnen who were born in small 

towns or suburbs. However. those men born in large cities also had 

more work role difficulties than tho~e born in small towns or 

suburbs. 

SubJects also were asked how oft·.!n t!tey had seriously considered quitting high school. Those whrJ had never considered quitting 

had significantly fewer impulse control problems and less susceptibility to any psy'ch1.atric problems over the first four evaluation~•. Men who said they never seriously considered quitting high 

school developed one or more psychOlogical difficulties only 28% 

of the time-.• whereas tbose who had occasionally or frequently 

constdered qui.tting .school later developed one or more psychiatric 

problems 42% of the tlme. 

• 

• 

• 
559 

The few men who had never married had more impulse control and 

alcohol problems. In addition, they had a much greater frequency 

o~ having thrP.e or more problem areas over the first few rounds, 

than did those men who were married one or more times. Men who 

were married only once compared ·to those who were married more than 

once were not significantly different from one another. 

We also assessed the difference between controllers and their 

wives in socioeconomic level (SES) during their childhood. Men 

with a higher background than their wives had half the incidence of 

new problems (14%) than did men with equal or lower SES backgrounds 

than their wives (34-38%). 

A general marital satiSfaction question was asked; "All things 

considered, how happy and sqtisfied have you been this year in your 

relationdhip with yC'Iur wife? 11 Only about 16% of the married men 

ga~_:-e neutral or unhappy ans"'·~rs. These individ"als with lower marital satisfAction experienced ~ix times as much subjective distress 

at intake and developed seven times as many new problems over the 

course of the study. These particular men who were unhappy in their 

marriages had significantly r.'.Ot ... impulse control disorders, more 

alcohol abuse, ar.C of course, also far more mate role disturbanc~s. 

This single questiun was highly related to t::he later development 

of psychological heali, changes. 

We considered all of these f1.ndings to be particularly intetesting since the characteristics assessed with respect to background 

and c11rrent life situation should be quite stable. However, all of 

these variables were categorical or ordinal in nature. In addition 

more th~n one hundred background variables were examined for these 

same outcome groups and many of the differences obs~rved could have 

been due to change. Further analyses may be able to determine their 

overall significance in the prediction of men who develop psychia- tric: problem.J. 
560 

3. Extent of Psychiatric Probl"ems 

All of the preceding types of analyses were repeated for men 

differentiated according to extent of their psychiatric problens 

ov~r the course of the study. The asymptomatic control group remained the same as for the analyses on susceptibility to psychia· 

tric problems. Three case groups wete labeled as mild n_~ cases, 

moderate new cases, and chronic new cases. Men who had problems 

at intake and men who had incomplete evaluations were excluded fr.om 

thes~. analyses. All of the same predictive variables (medical history, field study, and psychological variables) were subjected to 

these analyses. 

A fewer number of variables disc~iminated among the groups of 

men who had differe~t levels and freqaencies of psychiatric problems for the first time. Table 193 displays significant intake 

predictor differences between these group; Men who became chronic 

new cases of psychiatric pr~ble~s had the highest tension discharge 

rate 1 the highest level of coping by drinking, the lowest satisfaction with their co-workers, the highest life change by eii:!1er of 

two methods, the highest marital coping resources, and were the 

youngest and least experienced co:ttrolle:rs. Mild and :nodetat.:e ,.., :!W 

cases had the lol..·est tension discharge rate, the next highest le ·rels 

of drinking to cope, mvderately low Satisfaction with their co-F<..rkers, 

and moderately high levels of life change. They also tended to b~ 

younger and less experienced than asymptomatic controls ~nd reported 

the lowest levels of marital coping resources. 

Table 1~4 displaya significant personality correldtes associated with extent of psychiatric p~oblems. There were a large number of significant differences on these persona~ity variables. 

Here again it is cl2ar that the least adjusted and most hurried and 

impatient Type A individuals developed the most severe psychiatric 

problems. 

Again, the large number of significant intake predictors and 

personality cha.racteris~icr; were subjected to discriminant analysis to find the most significant and parsimonious set of discrimiM.tors between the extent of psychiB eric problem groups.. Table 

!95 displays th~ results of the discriminant analyses. The coping 

by drinking factor, life change exf~rience in the six months prior 

to intake, the CPI responsibility scale, the JAS speed and impatience 

factors, and the marital coping resources factur were the primary 

discriminants between groups. No othe~· ·.;Q::iah..i..:..,. contributed to 

a further differentiation between these groups once these five 

variables were tak .n into account. The pattern of results on each 

of these variables is displayed in Table 195. These variables were 

then placed into discriminant fur.ctions for predi~ting and diHel·-

entiating between the Krcupa. 

. ~· 

. ''· 
• 

TABLE 193 

Signi. icanc Intake Predictors 

Of The 

Extent Of Psych1atric Prcblems 

Among Air Traffic Controllers* 

Contrast Amons As·,~ptC'.,atic Control,, (N ~ 135) And 

New Cases Of Mild (N•52), Moderate 1~!•54) And 

• 

561 

Chronic (N•11) Disorders Over Thr~e ¥ears, Excluding 

Prevalence Cases At Intake (N•99) And lnco,plete Cases (N•65)** 

Asympto- Mild floderate Chronic 

mat ic New ~~ew New 

Controls ~ Ca;es ~ases F-rat io 

Predictive Mean Mean Mean Mean between £.of 

Intake Variable (~) (~) (~) (S.D.) grour: F-rilti..> 

--- Tensfon Discharge 52.72 49.02 47.09 53.27 5.56 . 002 Rat~ Factor · (8.96) (9.83) (9. 1:5) (10.43) 

Coping by Drinking '•7. 18 ~8.65 51.76 54.54 5.03 .003 

Factor (7.79) (~.42) (10.91) (8.69) 

Satisf~ction with 52.69 47.49 48.79 46.82 5.12 .003 

Co-Workers (8.69) (10.65) (10.46) (i0.30) 

11P!.IP11 LIfe Cnange 28.24 36.20 31.68 55.91 4.31 .003. 

Units (23.08) (30. 12) (21.07) 03. 20) 

11 ROLE11 life 171. )I 2;;3.96 204.28 357.50 4.31 .006 

Change Distress ( 140.1•9) (310.09) (145.51) (219.13) 

Age 37.13 34.62 34.96 30.50 8.49 .0001 

(4. 61) (4. SO) (5.57) (4.09) 

~xpcrlence 11.56 9-93 10.09 7.00 4.20 .007 

(4. 61) (4.42) (4. 99) (3.33) 

Marl ta I Coping 52.52 47.33 48.48 55.57 4.91 .003 

Resources (8.20) (9. 27) (11. 22) (7. 23) 

(Asymptomatic, 

11•107, 79%) 

(IIi ld, N•43, 83%) 

(Moderate, N•46, 

CS%) (Chronic, 

ll•7. 64%) 

• 

• • 

,, 

•.1; 

·i 

!i 

} 

,, 

. il 

'I ul r, 

ll 
TABLE 193 cont'd. 

Footnotes 

t of psychiatric problems was evaluated usi-ng the Psychiatric Status 

Subjective Distress, Impulse Control Disturbances, Work Role Dis-

' Mate Role Disturbances and Alcohol Abuse were used ~s the criterion 

IC controls: Uever had a symptomatic criterion scale 

I criterion scale abnormal at only I of 5 examinations 

1 +criterion scales abnormal at 2 or 3 of 5 examinations 

1 + criterion scales abnormal at ~ or 5 of 5 e~aminations 

Asymptomatic up to time of dropping out - later status 

• 

• 

) 
TABLE 194 563 

Si9nificant Pers,onal it:t Correlates 

Of The 

Extent Of Psichiatr~ Problems Amon2 

Air Traffic Controllera 

Among Asymptomatic Controls (N•I34) And New Cases Of Hi ld te (N=50), And Chronic (:I• II) Disorders Over Three 

luding Prevalence Ca~es At Intake (N•99) And lncomplet~ On PSS, 7 On CPI And JAS)*'' 

Asympto- IIi I d Moderat- Chronic - matic New New N;!W 

Mean 

Controls Cases ~ Cases F-ratio 

(~) Mean Mean Mean between e. of (S.D.) (~) Ts. o.) groups F-rat io 

f .. Acceptance 58.61) 58.24 62.16 52.73 3.71 .02 (8.54) (11.07) (d. 72) (12.88) 

52.31 49.04 47.66 40.82 7.90 (8. 21) .0002 (10.29) (9.77) (10.66) ) q4,4o 40.08 39.72 35.46 5.64 .002 (9.53) (10.13) (10.29) (13.03) 

50.62 44.96 44.40 40.00 13.74 .0001 

f (7.55) (8. 94) (8. I 0) (10.77) I 

48.06 43.78 41.82 9.68 i 50.39 

(8.36) .0001 (7. 91) (8. ~3) (9. 47) 

50.28 47.34 47.50 41.46 4.53 (8. 15) .005 (9.02) (9.84) (12.49) 

47.28 45.34 42.64 39.64 4.40 .006 (10.05) (9.20) (9.08) (7.14) 

55.88 51.96 53.04 49.09 5.31 (6.62) .002 (10.08) (6. 77) (13.47) 

54.33 50.82 49.26 42.82 8.50 (8. 89) .0001 (7.46) \9. 86) (13.57) 

Intellectual 51.48 47.98 47.98 42.82 4.40 .006 (8. 91) (11.18) (9.20) (13.42) 

Type A score -4.54 -3.7Q .52 .44 4.65 .004 (8.21) (8.(.7) (10.42) (7.89) .. -5. 14 -3.Jg J. 18 .6J II. 72 .0001 (8. 27) (8.17) (10.12) (9. 59) 

1 . i 

''· '"'\~j '' ~: 

·•',' ' ' .. .. 
TABLE 194 cant'd. 

Footnotes 

t of psyc~iatric problems was evaluated using the Psychiatric 

Schedule. Subjective Distress, Impulse Control Disturbance, Work 

Role Oisturbanc~, and Alcohol Abuse were used as 

c controls: Never had a symptomatic criterion scale 

t criterion scale abnormal at only I of 5 examinations 

cases: I +criterion scal.es abnormal at 2 or 3 of 5 examinations 

I +criterion scales abnormal at 4 or 5 examinations 

cases: Asymptomatic up :o time of dropping out - later status 

~Villuatoed Seven other subjects also did not complete the California 

logical Inventory (CPI) or Jenkin$ Activity Survey (JAS)·. 

) 

·~ 

l ' 

i ._; 

I 

1 
ibi I i ty 

TABLE 195 

The Most Significant And Parsimonious 

Discriminators Of The Extent Of Psychiatric 

Problems Among Air Traffic Controllers* 

565 

Asymptomatic Mild Moderate Chronic 

and Prusoff 

Controls Cases f!!!!. f!!!!. 

Inventory Hlgh•Highest of four groups 

Med. High•Next to highest group 

Med. Low-Next to lowest group 

Low-Lowest of four gr=o;u~p~•---------------

Low Med. High Med. High 

Low 

Low Med. Med. Low High 

:li gh 

High 14ed. Low Hed. High 

Low 

and I npa t i enc'! Factor Low Hed. High M~d. Hi9•~ 

Low 

Hed. High low Med.Low nigh 

II Extent of Psychiatric Problems was defined using the 5 criterion 

scales from the PSS e~aluations. The asympt~natic controls were men 

had a symptomatic crlte~lon scale (116 of 135 possible .nen for this 

s). The mild cases had I criterion scale abnormal at only I of 5 exam-

(45 of 52 possible men). The ~derate cases had I or more criterlun 

abnormal at 2 or 3 of 5 examinations (46 of 54 possible men). Chronic 

had 1 or more abnormal scales at 4 or 5 of 5 examinations (7 of II pasmen). Reduced group sites were due to missing or not applicable data 

• 

• 

• 

) 

l 

! 

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Table 196 displays the claSsification accuracy of these disfunctions. The specificity of these d.iscriminant func59.5%, representing the percent of controls correctiy 

ont>r:Lea. Sensitivity was 37.8% for mild ~ases, 41.3% for moderate 

28.~% for chronic cases of psychiatric difficulties. 

percent exactly correct over 4 categories was 50.0%. 

high perce~tage of false positives (40.5%) was ob-

• but a much lower rate of false negatives occurred (2'•· 5%). 

classification matrix indicates that the· prtmary difficulty of 

classification analyses was diatinguishir~ between the maount 

psychiatric difficulties as opposed to the simple asymptomatic 

case distinction. These results were not good enough to 

that one could implement a system of predicting the extent 

psychiatric problems, whereas previous. results indicated that 

would be much more feasible to implement a program distinguishamong men with a susceptibility to psychiatric pro~lems. 

) / 

•.. 

.• 
l'ABLE 196 

Classification Accuracy Of The 

Host Parsimonious And Sfgnificant Oiscrim(nants 

Between Overall Extent Of Psychiatric 

Prc.,J,Iem Grou?s* 

Asymptomatic Mild Moderate 

Controls Cases Ca~~s 

of 59St 

of 37.8% 41.3% 

y 

Classification Hatrix 

As:tmetomatic Hild Moderate 

Asymetomatic 69 Jli'"" 20 

!!ill. 12 .!l 7 

Hoderate II II .!1 

Chronic 2 2 

Percent Correct • 69+17+19 +2/214 • 50.0% 

False Positives • 14+20+13/116. 40.5% 

False Negatives • 12+11+1/98- 24.5% 

C.hron i c 

Cases 

28.6% 

Chronic 

I J 

9 

5 

2 

567 

Totals 

-m;-

45 

46 

7 

m 

II Extent of Psychiatric Probl~m• was defined using the 5 errsymptom scales from the PSS evaluations. The asymptomatic controls 

who never had a symptomatic criterion scale (116 of 135 possible 

this a~alysls). The mild cues .had I criterion scale abnunnal at 

I of 5 examlna.tlons (45 of 52 possible men). The moderate cases had 

more criterion ~cales abnormal at 2 or 3 of 5 examinations (46 of 54 

ble men). Chronic cases had 1 or more obnormal scales at 4 or S of 

Ions (7 of II possible men). Reduced group sizes were due to 

applicabla ~ata for some men. 

) 

~ 

I 

i 

I 

: 

( 
Onset of Specific Psychiatr1c Problems 

We were also interested in the possibility Of distinguishing 

bel:ween men who had developed specific kinrls of problems for the 

t time during the study, and men who did not.: drNelop any psychic problems. Separate analyses were performed for subjective 

tress, impulse control d:i.sorders, work role disorders, mate role 

dii!Or·ders, and alcohol abuse ~s ev3luated in the Psychiatric Status 

Schedule examination. As described elsewhere for the "sliding 

interval" type of analysis, predictors were derived from the examinations preceding the development of ptoblems in each of these 

Predictor variable data. for the asymptomatic controls were 

from certain examinations to match the number who became 

·'~Dpl:ou~tic for the first time at a particular ex~ination. Table 

the final set of the most parsimonious and significant 

completely asymptomatic controls and 

onset cases in these five psychiatric symptom areas. 

who developed subjective distress for the first time had 

lower work satisfaction, co-worket· satisfaction, and 

rates than asymptocatic controls. They also had 

higher invesrment in their ATC identities and signit110&rttl.y higher distress from life changes preceding the develo~-

their problems for the first time. 

the other hand, those who developed impulse (."_ontrol diswere most distinguished fro~ the asymptomatic control~ by 

levels of investment in the ATC identity, high levels sub1,e~ti·vp cost that controller work exacts from other areas of 

, and high levels of drinking to cope. 

who developed work role diuorders had significantly 

satisfaCtion but significantly higher subjective costs, 

distress, and drinking to cope, scores than did their 

IB~Dpto"'otjlc controls. 

Those who developed mate role problems were significantly 

from the asymptomatic controls in that they had lower 

llt:1sl'ac:tl.on with their co-~workers, lower tension discharge rates, 

use of physical activiti•s to cope, and higher life change 

assessed with the Paykel, Uhlenhuth, and Prusoff Inventory. 

Those who developed alcohol abuse had significantly higher 

of drinkins to cope, more life chsnge units and higher shift 

coats compared to their asymptomatic contr~ls. 

It is important to rem.emb~r that all of these assessments 

IC<•mced at the ttme that these onset cases were asymptomatic. 

even though it is possible tha~ the7 may have been preat that time, it is also possible that a0111e of the controls 

• 

• 

• 

) 

I L_ 
TABLE 197 

The Most Parsimonious And 

~ignificant Intake Oiscriminator5 

Between Co~o:oletely Asymptomatic Controls(14•131-135) 

And New, 9-Honth. Onset Cases In Five 

Psychiatric Symetcm Areas: ·Convnon And ;>istinctive 

Contrasts* 

Subjective Impulse Work 

Distress Control Role 

569 

Mate 

Role 

(N•25L_ (N•68) (N•72) (N•SI) 

Low Low 

Low Low 

Rate Low Low 

High High 

--- High High 

Distress High High 

High High 

Low 

Hlgh 

psychiatric ~roblems In each of the five criterion areas was 

first occurrence of significant symptomatology after Intake 

those wl th:!!!!l. significant symptoiOatology at Intake. Asymps were sampled proportionately and randomly from examlnato the proportion found symptomatic at an examination. 

refers to the onset cases In comparison to controls. The 

lous set of predictors were derived from the complete set of 

I variate dlscrfmlnt.f'itS between groups using 11 s 1mul tanr.ous 

lv•rlate discriminant analysis. 

\ 

Alcohol 

Abuse 

(11•44) 

) 

High 

High 

High I 

I 

·-
sampled at the eame t~e were pre-clinical as well. By 

the results in Table 197 indicate that part1cular psychare predicted by some distinctive variables as 

some common characteristics. 

variables were then all placed into respective discrimitoo,ctlorts for classifying the subjects as either cases or 

in each of these five areas of psychiatric dysfunctions. 

displays the classification accuracy of the discriminant 

specificity of the discriminant functions was quite good, 

from 70.4% for impulse control disorders to 84.3% for 

distress disorders. The sensitivity of the discriminant 

also was quite good, ranging from 64.0% for subjective 

to 72.7% for alcohol abuse cases. The overall percent 

range from a low of 60.5% for impulse control disorders to 

of 81.1~ for subjective distress disorders • 

. nus relatively sophisticated methodology indicated that it 

·only possible but perhaps feasibJ.e to distinguish men who 

particular problems over a oet period of time from those 

not develop those problems. The results for svecificity 

for particular kinds of problems are much better 

they were for the over3ll psychiatric variables of susceptibility 

extent of problems. 

! 

\ 

l 

I 

l l 

I 

! 

I 

) 
Subjective Impulse 

Distress Control(N=68 

(N=25 cases vs cases vs 135 

134 controls) controls) 

SPECIFICITY 

Actual t Correct--A~yrnptomatic 84.3 70.4 

SENS IT !V lTV 

,'\ctual % Correct-.. Hew Onset 64.0 67.6 

Overall % Correct--Total 81.1 69.5 

% False As)'!"~tcmatlc of 36.0 32.0 

Symptomatic 

% False New Onset of Asymptomatic 16.0 30.0 

~ •--••A~<..O-.,_,~·--··-~-

.... 

Work Hate 

Role (N~ Role (N=51 

72vsl34 cases vs 131 

controls) controls 

71.6 78.6 

68.1 70.6 

70.4 76.4 

32.0 29.0 

28.0 21.0 

• 

• 

Alcohol 

Abuse N=44 

cases vs 132 

controls) 

79.5 

/2.7 

77.8 

27.0 

20.0 

-• 

"' .... 

.... 

• 

• 

• 
5. ~nthly Depression Morbidity 

In addition to evaluation of psychiatric status at Boston 

University, we evaluated self-reported depressive and anxiety epi.-

sodes on a monthly basis after the second examinations at Boston 

University. l1en were grouped :Into asymptomatic controls, acute 

cases, intermittent cases, or chronic cases according to their 

frequency of depressive or anxiety episodes. These groups were 

then contrasted in terms of their health history. field measures, 

and psychological measures at Boston University as well as on the 

job. 

Table 199 displays significant health history, workload, 

blood pressure, and mild to moderate health change differences 

among the monthly depression morbidity groups. The use of tranqUilizers in the six months prior to intake was significantly 

different among the depression morbidity groups. Men who became 

chronic cases of monthly depression had significantly higher use 

of tranquilizers prior to coming into the study, in spite of the 

fact that men who had subjective distress difficulties on the 

PSS evaluations at intake were excluded to prevent circularity in 

these findings. In addition, men who were acute or chronic cases 

of depression on a monthly basis used significantly mvre sleeping 

pills prior to intake than did those who were intermittent or 

asycptomatic cases. 

Th~ remaining variables on Table 199 are average assessments 

of field measures over three or more field studies. The results 

showed that asymptomatic controls had a significantly lower average 

timeload on the job than men who were-acute, intermittent or 

chronic cases. The case groups did not differ among themselves on this particular variable. 

The average psychological response to work was highest among 

those who became chronic cases, next highest among those who were 

intermittent cas~s, and lowest among those who were acute cases of 

depressive disorders. This result indicated that those who were 

chronic caces of depressive diPorders on a monthly basis tended to 

feel that their workload on the job was much higher than it was 

rated ~ccording to our objective measur~s. On the other hand, 

those men who experienceQ only a few depressive episodes rated 

their job difficulty less than the objective diff~ that we 

assessed. 

The average systolic range at wo~k, r.ontrolling for average 

systolic blood pressure at work, over three or more field studies 

also differentiated betweeo.n .. the case groups but not between the 

case and control groups. Chronic cases of depression and intermittent cases of depressioo had significantly higher average 

systolic range at work than did men who were acute cases. The 

) 
-573 

TABLE 199 

Sls_nificant Health ~istory, Workload, Blood Pressure 

Reseonse To Work And Hi Jd~To-Hodera.te Health Change 

Differences Among Monthly Depression Morbi~tty Groups* 

Asympto- Intermatic Acut'! mi ttent Chr<'nic 

Controls Cases Cases Cases 

Nal69 N•42 N•l8 N~5 Heai1 Mean Mean Mean 

(S.D.) (S.D.) (S. 0.) (S.D.) F _P_ 

of tranquilizers in 

months prior to intake .02 .09 .06 .60 9.19 .0001 

• 1-monthly, 2•bi- (. 16) (. 43) (. 24) (l. 35) , 3-weekly, 4-daily) 

of sleeping pills In 

months prior to intake .04 . 16 .oo .20 4.10 .02 !•monthly, 2=bi- (. 22) (.53) (. 00) (.63) . \. 3-weekly, 4•daily) 

Time load over ) 

or more field 13.85 14.58 14.78 14.79 3.36 .0~ res (Timeload • total (2.06) (1.74) (2. 32) (2. 15) on position +maxiconsecutfve time on 

tion) 

; 

,. 

100.17 98.86 102.54 103.24 3.61 .02 (5.09) (6.03) (4.40) (4.32) 

I 

.Systolic Rang£ at 

rolling for l .02 -1.32 3-79 .72 3.06 .03 I systoiic 6.?. ar (5.]2) (5.33) (9. 37) (4.06) 

J over three or more 

studies ' Annua 1i zed Rate 

Hild-to-Moder·ate l Inj ies (only for those 

at least I lnterna 1 .48 .58 .94 • 73 2.91 .03 5 returned Monthly ( .69) I (. 70) ( .87) (.9) l I th Reviews)-Number of , on the averag~, in ! 

an Injury was sustained out nf 12 

I; 
TABLE 199 cont'd. 

Footnotes 

with Subjective Distress diffi:ulties on the PSS evaluation at intake 

excluded (N•20). Classifications of monthly depression were based on 

rage annua I rate of depre_ss ion episodes between the second and fifth 

ions at B.U. The predictive c;1aracteristics were assessed at the 

examination which preceded the monthly questionnaire evaluations. 

opt:orrtatic controls were defined as havi~g an average annual rate of less 

mqnthly episode per year; acute cases had a rate of 1·2.9 monthly 

per year; intermittent cases had a rate of 3-8.9 monthly episodes 

; chronic cases had 9+ monthly· episodes per year. A total of 234 men 

included in these analyses after excluding those without health hisor three or more field studies. 

.. 

J 
5i5 

asymptomatic controls had almost exactly the average systolic-range 

at work of the total study group. 

Finally, the average annualized rate of mild to moderate injuries was significantly higher for the intermittent and chronic 

groups than for the 3symptomatic and acute groups. Men with inter1 mittcnt and chronic depressive episodes had the highest rates of 

injuries, whereas the asymptomatic controls had the lowest rate of 

injuries. 

Table 200 displays the job specific and ltfe change differences among the monthly depression morbidity groups. The chronic 

cases were notable by scoring very low on the assertive good contrpller factor on the ATC Questionnaire, scor.ing very high on the 

psychophysiological anxiety reaction factor, scoring very high on 

the subjective cost fa(!tor, scoring very high on the burnout factor, 

by having very low social coping resource scores and by having an 

. extremely high life change distress total for the six months prior 

to intake. The results on all of these scales were almost linear 

~and monotonically inc~easing from low levels for chronic& to high 

·levels for controls. 

More general job-related attitudes and dispositional variables 

assessed by means of the Job Description Inventory, the 

Kav~~g;h Life Attitude Profile, and the Jenkins Activity Survey. 

201). Chronic cases scored very low on work satisfaction, 

~··wc·rker satisfaction, and group satisfaction. They were very 

o1s:so'"'''ried with FAA management policy, but on the other hand 

satisfied with FAA training policy. They tended to score in 

Type A speed and impatience direction on the JAS. On the 

hand, the asymptomatic controls in particular scored relatively 

on JDI work satisfaction and co-worker satisfaction scales, 

the KLAP group satisfactioa index. They were also relatively 

•••·f·•~~ with managerial and J:raining policies. They scored in 

Type B direction on the JAS speed and impatience factor • 

• 

Table 202 displays differences among the monthly depresoion 

""''u••Y groups on the California Psychological Inventory scales. 

were obviously a large number of hig~ly ~~~~ificant differbetween these groups with the chroi.l:f.c casee of depression 

~·~inR most abnormal on all scales. An~ as expeCted, tbe 

controls scored more nearly normal according to the 

not1D8.tive statistics. From an overall s;~:\ndpoint, one would 

that those who were a&ympto~tic in depression over the course 

the study were most similar to normal ct.Clparison groups, and 

groups were devian~. 

All of the preceding significant differences among the monthly 

~e11ai.on groups were subjected to a multi-variate discriminant 

' l 

I 

I 

', ~ 

) 
TABLE 200 

Job-SEeclflc And Life Chan2e Differences 

Amon2 Month!~ Oe~resslon Horbldlt~ Groues• 

istics Asympto- · u~rmatic .- .* f· ·cent Chronic 

Control-. . e~ es Cases 

N•230 '.,.,, ij;"ff 

, Jenkins and .~se Mean .,co.-. ""'~" He:in 

(S.D.) (S.~.) (S.D.) (S. 0.) F _L 

Good Controller Factor 47.85 46.34 48.79 38.82 3.75 .02 

(8.93) (10.68) (8.28) (7. 87) 

47.08 ~9.33 51.33 54.64 5.04 .003 

(7. 73) (8.88)(10.69) (7.09) 

Subjective Costs Fa'"or 48.44 51.43 52.28 55.2i' 4.38 .006 

(9.50) (':'. 03) (11. 04) (8.01) 

50. 17 46.69 47.33 4!.82 5.54 .002 

(8. 72) (9. 61) (9.98) (5.95) 

50.12 45.73 ~5. II 45.46 5.39 .002 

(9.69) (9. 18) (8.23) (9. 17) 

Distress 196.96 242.88 2~4.67 536.46 8.53 .0001 

(188.37) (244.58)261.36)(436.97) 

with Subjective Distress difficulties on the PSS ev&luatlon at Intake 

excluded (N-20). Classifications o'f monthly de~resslon were based on 

averao1e annual rate of depression episodes between the se .. ond and fifth 

Ions at B.~. The predictive characteristics were assessed &t the 

examination which pr~ceded the monthly questionnaire evaluations. 

f'IP!:Oirultlc control$ were defined as having an average annual rata of less 

monthly eplsodft per year; acute cases h.>d a rate of 1-2.9 I!Onthly 

per year; Intermittent cases had a rate of 3-8.9 monthly •plsodes 

year; chronic cases had 9 + monthly ,.plsodes per year. A C~lll of 333 

were Included In 'hese analyses. 

• 

• 

' '! 

',i 

!II 

• 

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·.: 

) 
577 TABLE 201 

General Job-R..,Iated Attlt.,d!nal And Dls~s!tlonal 

Drf,erences Amon9 MonthiX Deeression Morbiditl Groues* 

lve Char~cterlstlcs Asympto- Intermatic /\cute mi ttent Chronic 

Description lnven- Controls Cases Cases Cases 

Life N-230 i~ ;;;nr ~ 

Mean Mean i1ea'i1 Heail 

(S.D.) (s. D.) (~) <l.:.P.J F _J!_ 

48.44 46.30 43.50 37.82 6 .II .0007 

(9.ll) (10.05) (8.00) (12.99) 

Co-Worker ' Sat Is! .. c t I on 53.40 50.19 45.28 39.82 9.75 .0001 

(10.23) (10.54) (9.96) (11.9~; 

Group Satisfaction 53.72 52.12 53.83 45.55 3.n .02 

(9.13) (8.s:;J (8.81) (8. 31) 

FAA 49.94 46.34 49.39 46.73 3. 18 .03 

(9. 14) (9.5q (7.30) (6.84) 

FAA 48.41 51.28 47.39 54.00 2.70 .05 

(9.89) (9.90) (9.40) (7. 13) 

And lnpatlence -3.58 -l .27 2.16 l. 70 3-90 .or 

(8 .81) (9.44) (9.24) (ll.44) 

with Subjective D,lstress difficulties on the PSS e.aluatlon at Intake 

uded (N•20). Classifications of monthly depression were based on 

tveroge annual rate of depression episodes between the second and fifth 

ons at B.U. The predictive characteristics were assessed at the 

examinations which preceded the monthly questionnaire evaluations. 

lc controls were defined 'S having an average annual rate of less 

monthly episode ~·r year; acute cases had a rate of 1-2.9 monthly 

per year; Intermittent cases had a ra~e of 3-8.g monthly episodes 

; chronic cases had 9+ monthly episodes per year. A total of 3:13 

Included In these analyses. 

.. 

\ 

. 

' ' l l ~ 

! 

f 

\ 

) 
TABLE 202 

California Psycholo2!cal Inventory Differ~nces 

Among Monthly D~pression Morbidity Groups* 

Asympto- Inter- matlc A..:ute mi ttent Chron !c Controls Cases Cases Cases N•230 N•74 N•l8 N•ll 

Mean Mean Mean Mean (S.D.) (S.D.) (S. 0.) (5. 0.) f' -L - 57.35 53.01 51.61 46.73 5.88 .001 (!1.08) (12.30) (11.88) (14.75) 

52.64 48.76 Sl. II 47.18 4.59 .004 (8.26) (9.39) (9. 51) (13.46) 

53.85 49.46 48.11 49.00 6.07 .001 (8. 65) (10.46)(10.43) (12.20) 

1 Presence 53.90 55.8h 57.33 51.46 5.25 .002 ) (9.38) (10.44) (10.83) (14.29) 

of Well-Being 51.96 46.32 48.78 37.91 14.71 .0001 (9. 46) (9.03) (10. 49) (11.59) 

43.18 39. 14 36.56 36.73 5.72 .002 (9. 93) (10.40) (9. 70) (11.15) I 

' izat!on 48.47 45.03 43.83 44.09 4.48 .00!' ' (8.64) (9.03) (8.)3) (11.63) 

49.78 44.70 46.78 42.82 ].4] .0002 (8.64) (8.18) (6.36) (11.00) 

49.87 46.27 47. II 43.55 4.76 .004 

r (8. 72) (8.47) (8.45) (10.83) 

46.99 I 41. 19 44.89 39.36 7.81 ' Impress !on 

.0002 I 

' (10.00) (9.21,) (10.20) (11,1,8) 

55.48 53.22 52.22 49.09 4.43 .005 (6.60) (8.33) (6.03) (10.74) 

t-Conform! ty 53.88 46.89 48.61 44.]3 IS. 1·9 .0001 (8.25) (9. 72) {9.41) (11.53) 

lectual Eff!c!en~y 50.79 45.84 47.44 44.18 6.6!i .0004 (9. 17) (9.11)(10.)3) (12. i'6) 

Jic.,J Hlnd~dnes1 55.47 52.11 53.67 51.91 3. I:! .03 (8.46) (8. 94) (8.51) (14.05) 

.... 
• 

TABLE 202 cont'd. 579 

Foot"lotes 

Cases with Subjective Distress difficu1ties on the PSS evaluatioo at intake 

.Ore excluded (N•20). Classifications of monthly depression were based on , ~he average annual rate of depression episodes between the second and fifth 

~xaminations at B.U. The predictive characteristics were assessed at the 

second examination which preced,Jd the monthly questionnaire e~,·aluations. Asymptomatic controls were defL1e:! as having an average annual rate of less 

than I monthly episode per year, acute cases had a rate of 1-2.9 monthly 

episodes per year; Intermittent cases had a rate of 3··8.9 monthly episodes 

per year; chronic cases had 9+ monthly episodes per year. A total of 333 

men were included in these analyses. 

• 

• 

J 

l 

' ' r:.; 

• 
Table 203 displays the most parsimonious and significant 

auaan,ts among these groups. Only three variables accounted 

majority of differe~c~s between the monthly depression 

These variables wern the CPI sense o~ well-being, the ROLE 

distress total i:or- the six months prior to intake, and 

eo-worker satisfaction scales. The asymptomatic co~trols 

highest on the CPI sense of well being and JDI co-w~r.ker 

scales, and lowest on the ROLE l~fe change distress 

whereas tl',e chronic cases scored in exactly the opposite 

or, these three scales. 

T~e discriminant functions derived from these analyses were 

tc classify subjects pcedictively. Table 204 displays 

accuracy of the d.t.scriminant (unctions. the 

was 57.2% for tha asymptomatic controls. Sensitivity, 

the percent of cas.as correctly iden-;:f.fied, was 36.5% 

acute cases, 38.94 for intermittent cases, and 45.4% for chronic 

The overall percent of ~orrect classifications was 51.2%. 

hlgh false positive rate of 42.8: was found and a relatively 

of 21.4% was found for fal~e negatives. As in previous 

the major difficulty in making accurate classificdtions 

in differentiating among the case grcups a8 can be seen 

classificatiou matrix of Table 204. The spP.cifidty and scn-

•••:•v><Y of these analyses would not be sufficient for tmplementation 

a risk identification program. Further work would need to be 

on dt:o.veloping the discriminant furlctions or one might need to 

revt:.t't to a simple case ver&us cou-c.rol comparison to i.'11pro.re the 

predic.:tive classifications 9'1fficiently for an implE!ment~J.tion program .• 

\ 

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l 

) 

·I 
1ABLE 203 

The Host Parsimonious And SigniFicant 

Dfseriminants Among Monthly Depression Groups~" 

Asymptomatic Acute lnterml ttent Chronic 

Controls Cases Cases Cases 

N•229 N•74 ~ .!!:!.!. 

High Hed. lled.High Loo4 

Low 

Low Hed. lled.High High 

Low 

High Hed. Hed.Low Low 

High 

581 

with Subjective Distress difficulties on the PSS evaluation were 

(N•20). ClassiFications of monthly depersslon were based on 

annual rate of depression episodes between the second and 

!nations at B.U. The predictive characteristics wera assethe second examination which preceded the monthly questionevaluations. Asymptomatic controls were defined as having an 

annual rate of less than I monthly episode per year; acute 

had a rate of 1-2.9 monthly episodes per year; inter~ltt•-t 

had •• rate of 3-8.9 ITK'nthly episodes per year; chror.!c c, .es had 

y episodes per year. A total of 332 men were Included In 

analyses. 

-----------··----.·------·-······-··--··-------

i 

I 

.! 

ci '

r 

) 

l_j 
• 

TABLE 204 

Classification Accuracy Of The Most 

Parsimonious And S:gnificant Discriminants 

Among M~nthly Depression Groups* 

.\symptomatic 

roiltrols 

Acute Intermittent Chronic 

~ 

57.2% 

Aslm~toma tic 

~ 

lnterml ttent 

Chronic 

Percent Correct 

False Positives Fats~ Negatives 

36.5% 38.9% 

Classification Matrix 

~~~~~~-· PrP.dicted Groups Asymptomatic Acute :ntermittent 

Controls ~s !'~. 

.!l!. 33 44 

17 .rr 19 

5 2 ...1 

0 2 4 

• 51.2% 

• 42.8% 

• 21.4% 

45.4% 

Chronic 

~ 

21 

II 

4 

2. 

Tot a I s* ~ 

229 

74 

18 

II 

332 

th Subjective Distress difficulties on the PSS evaluation were 

(N•2D). Classifications of monthly depression were based on 

annual rate of depression episodes between the second and 

!nations at B.U. The oredlctlve characteriHics were assessed 

second ~xamlnatlon which preceded the monthly questionnaire eval-

• Asymptomatic controls were deftn~d a~ having an average annual 

less than J monthly episode per yea~; acute cases had a rate of 

y epi-sodes per year; Intermittent cases had a rate of 3-8.9 

episodes Per year; chronic cases had 9+ oonthly episodes per 

A total of 332it1en '.ttere !nc1ud*"d In these analyses. 

• 

) 

I 

l · .. 

' 

• 

'i 

I 

I 

ii 
583 

Monthly Anxiety !lorbidity 

Table 205 displays the significant workload, paychological 

response to work and mild to moderate health change differences 

I"Aong the monthly anxiety morbidity groups. The asymptomatic controls had a significantly lower averag~ normalized workload over 

thr~e or more field studies compared to any of .the cas~ groups. 

The highest levels of normalized workload were achieved by the 

acute and chronic cases. It is not kP.own whether the higher level 

of workload resulted in the higher rates of depression, or if the 

men who were depressed worked more in order to avoid focusing on 

their depressed feelings, since the overage normali~ed workload was 

computed over the course of the study and is only an associated and 

predictive characteristic. 

chronic cases also had a significantly higher average. 

:P•:~choloogllCaol response to work indicating that they perceived their 

•ot·K!c>aa as higher than the actual objective workload that we meaAcute cases estimated their workload at levels significantly 

than what we assessed with our objective difficulty measures. 

controls scored exactly at the average. 

Table 206 displays job specific and life change differences 

the monthly anxiety morbidity groups. On the ATC Questionchronic cases scored significantly higher on the psychophysio-

~081C!l! anxiety reaction factor, significantly lo~er on the tension 

rate factor, significantly highEr on subjective ..:ost, 

lower on bounceback-burnout factor, significantly 

on the marital coping rP.sources !~ctor, and moderately low 

social coping resource factor. They also scored extremely 

on the ROLE life change distreoa total for the dx months prior 

intake. The asymptomatic controls scored in P.xactly the opposite 

as the chronic cases, and the acute and intermittent cases 

between these two groups. ~eae res~lts were all predictive 

as opposed to the priot t:,ble of results which were con207 displays general joh-related and dispositional 

lif:fereoc:es among the monthly anxiety morbidity groups. The JDI 

14t1sfaction, co-worker satisfaction, and pay aatisf'action 

were Bignificantly lower among the chronic cases of anxiety 

the ~symptomatic controls. The chronic cases also were 

icantl.y less satisfied with individual job related characteraoJ were significantly less satisfied with group related 

ch•or<tcterist1cs, both as assesaod by the Kavanagh Life Attitude 

The intermittent and chronic cases also scored signifithan the other groups on the satisfaction with FAA 

and promotional policy scales. Finally • there w.la a 

:encle•1cy for intermittent and chronic caoeo to score high on the 

' ,. 

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. 

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584 

TABLE:205 

Significant Workload, Psyc~~loglcal Response to Work, 

And Mild·To·HoJerate Health Change Differences 

Among Monthly Anxiety Morbidity Groups* 

Character· 

or more 

rage P•ychologlcal Responses to work over 3 or 

field studies ("' 100• 

subjective difficulty 

higher than actual 

lve difficulty; 

subjective dlfflty less thtin actual 

lve difficulty; 

10, Mea" • 100 

Asymptomatlc 

Controls 

N-ll7 

Mean 

~) 

~96.01 

(22.32) 

100.26 

( 5.07) 

Acllte 

Cases 

N•60 

'fieai1 

(S.D.) 

504.67 

(25.30) 

98.62 

(5.96) 

Inter· 

mit tent 

Cases 

N-18 

He an 

!S.D.! 

500.83 

(20.43) 

100.95 

(5.34) 

Chronic 

Cases 

N•fi 

~) """" 

50S. 13 

(22.22) 

104.77 

(4.51) 

F P. 

2.60 .05 

3.91 .01 

with ~ubjectlve Distress difficulties on the PSS evaluation were ex-

(H•20), Classifications of monthly an~.ety were based on the average 

I rate of anxiety episodes b•tween the second and fifth examinations 

.u. The predictive characte• I sties were assessed at the second examlwhlch preceded the monthly questionnaire evaluations. Asymptomatic 

..,,,tr<>ls ""re defined as having an average annual rate of less· than I moAthly 

per year; ac~te eases had • rate of 1-2.9 nonthly episodes per year; 

ttent cases had a rate ot 3-fi.9 mont~ly eplso~es per year; chronic 

had 9+ monthly episodes per year. A total of 303 men .,.re Included 

these analyses after excluding those without three or more field studies. 

) 
• 

585 

TABLE 206 

Job-Seeclfic And Life Chan9e Differences 

,.\-,tOng Monthi:t Anxiet;t Morbiditl: Groues* 

Asympto- InterATC Qu!stionnaire matic Acute mi ttent Chronic 

Review of Life Events Controls Cases Cases Cases 

Jenkins, and Rose Mean 

N•241 N=b4 ·~ N=lr Mean Mean Mean (S.D.) (S.D.) (S.D.) (S.D.) • F -L 116.67 

(7.44) 50.71 53.80 54.50 9.92 .0001 (9.65) (8. 71) (7.60) 

50.87 47.31 41.60 llJ.75 8.92 (9. 15) .0001 ( 10.41) (8.23) (7 .JI) 

48.47 51.84 53.45 56.50 5.09 (9.12) .003 (10.23) (7.93) (7.76) 

Bounceback (High)- 50. 12 47.5? 44.10 41.00 5.79 .001 (Low) Factor (8.91) (9-37) (8.58) (4.90) 

49.53 50.07 43.88 44.25 2.64 (9.46) .05 (9.08)(12.56) (8.23) 

49.54 

(9.33) 47.63 43.30 46.88 3.09 .OJ (10.98) (7. 72) (9.72) 

195.66 278.53 274.75 388.88 4.41 (200.76) .005 (231.32)(298.53) (448.51) 

with Subjective Distress difficulties on the PSS evaluation at Intake 

excluded (N•20). Classifications of monthly anxiet;y were based on the 

annual rate of anxiety episodes between the •er.ond and fifth examlat B.U. The predictive characteristics were 1.ssessed at the second 

ion which preceded the monthly quesUonnalre evaluatlo~s. Asymptotrol• were defined as having an average annual rate of less than 

ly episode per year; acute cases had a r•le of 1-2.9 monthly episodes 

; Intermittent cases had a rate of J-8.9 monthly episodes per year; lc cases had 9+ monthly episodes per year. A total of 333 men were ncJuO<tO In these analyses. 

• 

" 

• 

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t 

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I, 

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586 

TABLE 207 

General Job-Related And Dispositional 

Differences Among Monthly Anxiety Morbidity Groups* 

Asympto- Intermatic Acute :nlttent Chronic 

Controls Cases Cases Cases 

N•241 N•64 N•20 N•8 

Mean Hean ;:;;an Mean ~) (S.D.) (S.D.) .!.!.:.Qj 

47.92 47.95 41.60 39.75 

(9.38) (9.62) (8. 39) (13.34) 

Co-Worker Sat is- 53.03 50.88 43.75 42.13 

fact ion (10.26) (10.66) (I I .22) (12.04) 

Pay Satisfaction 49.42 49.50 47.80 40.00 

(9.45) (9.98) (10.04) (8.21) 

Individual Satls- 52.74 51. ~7 42.25 43.63 

fact ion (8.76) (9 .01) (7.89) (6. I 2) 

Group Satlsfact ion 53.47 53.66) 4~.05 47.86 

(8.90) (9. 2 I) (7 .37) (12.04) 

sfactlon wl th FAA 49.60 48.63 43.53 47.63 

Pol Icy (9. 52) (8.30) (6.84) (6. I 6) 

49.60 48.33 43.45 46.38 

(9.37) ( 10. 12) (6.89) (5. 37l 

Speed and In- -3.59 -I. 30 4.98 -I .JS 

patience Factor (8.80) (9.29) (8.38) (12.76) 

F __L_ 

4.54 .005 

7.55 .0002 

2.67 .05 

4.36 .005 

2.48 .05 

2.84 .04 

3.02 .03 

6.25 .0006 

with Subjective Distress difficulties on the PSS evaluation at Intake 

exc I uded (N•20) • Classifications of monthly anxiety were based on the 

annual r&te of anxiety episodes between the second and fifth examlnae.u. The pr~dictlve characteristics were assessed at the second 

on which pr~c•ded the monthly questionnaire evaluations. Asympto· 

controls were deflned as havtng an aver&ge annual rate of less than I 

ly episode per year; acute cases had a rate of 1-2.9 monthly episodes 

Intermittent cases had a rate of 3-8.9 monthly epi5odes per year; 

had 9+ monthly eploodes per year. A total of 333 men were 

In these analyses. 

.. 

I 

h 

I' 

,, 

ii! 

,,, 

I 

I. 

I 

I 

I 

I 

I 

I 

r 

I 
~87 

JAS Speed and Impatience factor especially as contrasted with the 

asymptomatic coritrol subjects. 

Table 208 displays the California Psychological Inventory 

differences a~ong the monthly anxiety morbidity groups. The results 

were very similar to those for the monthly depression morbidity 

groups inasmuch as the case groups deviated considerably from the 

norms, whereas the asyLipcomatic controls were much more similar to 

the original normative groups on which the CPI scoring was devised. 

Finally, we once again submitted the variables which were 

significantly different between the morbidity gLoups to a multivariate discriminant analysis. Table 209 displays the most parsimonious and significant discriminants among these groups. Only 

three variables accounted for all the significant diffe~enc~s 

between the monthly anxiety morbidity groups. The ATC Questionnaire psychophysiological anxiety reaction factor, the ATC Questionnaire tension discharge rate factoL and the ROLE life change 

distress total account~d for all of the significant dtfferences 

between these groups. Table 209 also indicates the relative standing of anxiety groups on these three variables. 

The discriminant functions using these three variables were 

then applied in the classification analysis. Table 210 displays 

the results of the classification analysis. 

The results of the cl£ssification analysis were not particularly 

good. The specJ.ficity was onl~, 53.1%. Sensitivity was ca1.:-u1ated 

at ~5.4% for acute cases, 56.2% for inte~ittent cases, and 28.6% 

for chronic cases. The overall percent correct was 45.4%,. a very 

low figure. And conversely. the percentages of false pos1.t1ves 

and false negatives were very high at 46.9% and 37.3% respectively. 

Although statistically signif.icant, these results were not 

Sufficiently good to suggest that an accurate risk identification 

program could be implemented for persons with varying degrees of 

anxiety episodes. Again, further analyses and refinements of our 

methodolo~y might result in a program of implementable risk identification procedu-·es. 

I 
588 

TABJ.E 208 

California Psychological Inventory Differences 

Among Monthly Anxiety Morbidity Groups* 

Asympto- Intermatic Acute mi ttent Chronic 

Psychological Controls Cases Cases Cases 

N•241 N•64 N•20 N•8 

Mean He an lie an Hean 

~.) (S.D.) (S.D.) (S.D.) F ....J!.._ 

57.00 52.86 53.65 45.38 4.61 .004 

(11.03) (12.61) (14.18) (12.92) 

Capacity for Status S2.51 49.11 48.35 48.75 3.72 .02 (~. 61) (8.36) (10.40) (13.86) 

Sociability 53.55 49-44 48.80 50.50 4.43 .005 

(9.03) (10.31) (9.00) (10.46) 

Social Presenc;:e 59.85 55.50 55.70 52.00 5. 13 .003 

(9.84) (9.55) (11.34) (10.50) ) 

Sense of Well-Being 51.99 46.78 42.00 38.75 16.61 .0001 

(8.47) (9.34)(10.64) (11.44) 

, 

Res pons i b i U ty 42.75 40.Cj 37.30' 3~.75 3.94 .009 

(I O. 13) (10.13)(11.09) (7.32) 

I Socialization 48.24 45.92 ~0.80 46.63 5.21 .002 

(8.29) (9.49) (10.59) (9.02) 

I Self-Control 49.13 46.66 40.90 44.5'l 6.99 .0003 

(8.31) (8.08)( II. 78) (9.58) 

I Tolerance 4S.90 46.64 43.35 44.13 6.21 .. 0007 l . 

(8 .44) (8.84) (11.03) (7.75) 

46.18 44.34 40.80 H.IJ 3. II .03 I 

(I 0. II) (9 63) (11.42) (10.09) 

Convnuna I I ty ss.4a 52.98 51.70 50.25 4.36. .006 

<6.m (7.41) (7. 41) (9.74) 

I Achievement-Conform! ty 53.35 48.78 44.20 45.75 10.90 .0001 

(8.60) (9.49) (10.50) (9.91) 

I lntellectua I 50.71 '46.30 43.75 44.13 7.24 .0003 

Efficiency (9.24) (8.61) (II. 71) (10.76) .. I Psychological Minded- 55.43 53.38 52.05 50.00 3·35 .02 

ness (8.69) (8. 35) (8. 58) (1~.50) 

I Feminity 47.20 50.03 51.65 48.50 3.57 .02 

(8. I 0) (9.06) (5.46) (7. 39) 
589 

TABLE 208 cont'd. 

Footnot"s 

with Subjective Distress Difficulties on t1e PSS evaluation at 

were excluded (N-20). Classifications of monthly anxiety were 

the a~erage annual rate of anxiety episoi~s between 'he second 

examinations at B.U. The predictive cha"acteristics were 

at the second examination which preceded the monthly que;tlonuations. Asymptomatic eontrojs were defined a!t having an 

ann~al rate of !ess than l monthly episode per year; acute 

had a rate of 1-2.9 monthly e~lsodes per year; Intermittent cases 

rate of 3-8.9 ~nthly episod~s per ye>r; chronic cas~s hau 9+ 

episodes per year. A total of 333 men were included in these 

i 

f 

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1. 
590 

TABLE 209 

The Host Parsimonious And Stgnificant 

Discriminants Among Monthly Anxiety Groups* 

Asymptomatic 

Controls N-'mAcute Cases 

N•64 

Inter· 

mittent 

Cases 

N•20 

Chronl c 

Cases 

N•B 

Questlcnnalre: Low Med Low Hed High High 

lological 

ety React I on Factor 

Q.ues t i anna i re: High Med ltlgh Low Med Low 

on Discharge 

Factor 

Low Med High tied Low High 

with Subjective Distress difficulties on the PSS evaluation were 

(N•20). Classifications of monthly anxiety were based on the 

annual rate of anxiety episodes between the second and flftl. exons at a.u. The predictive Characteristics were asSessed at the 

examinations whi ... h preceded the mon!hly questionnalre evaluatlons. 

IYmJ>t<><natfc controls were defined as having an averaqe annual rate of 

I monthly eplsodt per year; acute cases had a rate of 1-2.9 

eplsodu per year; Intermittent cases had a rate of 3-8.9 monthly 

per year; chronic cases had 9+ monthly episodes per year. A 

of 333 men were included In these analyses. 

• 

• 

• • 

) 
591 

TABLE 210 

Classification AccuraCy Of The Most Parsimonious 

And Significant Discriminants Among Monthly Anxiety Groups* 

Specificity --% oi controls 

correctly Identified 

Sensitivity --% of cases 

correctly identiffed 

Asymptomatic Acute 

Controls Cases 

53.1% 

15.4% 

Classification Hatrlx 

Preulcted Gr1JuE;3 

Asyn>pto- Intermatlc Acute mit tent 

~rols Cases Cases 

~svmetomat 1 c .J..Q!!. 38 31 

Aeute 24 8 • 15 

I nterml t·cent 3 0 2. 

Chronic 3 

Per~ant Correct • 45.4% 

False Posl tlve • 46.~% 

False Negative • 37.3% 

• 

Inter• 

ml ttent Chronic 

Cases Cases 

56.2% 28.6% 

Chronic 

Cases Totals** 

23 196 

5 52 

h 16 

1. _]_ 

271 

C1ses with Subjective Distress difficulties on the PSS ~valuation were 

'exclucl;:d (N•20). Cldsslflcatlons of monthly anxiety were based o.l the 

1verage annual rate of anxiety episodes between the second and fifth 

exam:natlons ~t B.U. The predfctrve characteristics were 8Ssessed at 

the second examtration whfch preceded the oonthly QU.t:.1tronnalre evaluations. Asymptomatic controls were def!ned as having an ~v!!r'age a~nual 

r•t~ of less than I monthly episode per year; acute cases had a rate of 

1-2.g monthly episodes per year: Intermittent cases had a .~te of 3-8.9 

montnly episodes per year; chronic cases hau 9+ monthly episodes per..year. 

reduced number of subjects Is due to the fact that all subjects mu:;t 

all variables to permit discriminant and classification analyses. 

I; 

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:,. 

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'" I' II: 

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592 

7. Psychiatric Status vs Other Outcomes 

Psychiatric Qutcomes could be considered one of the softer 

areas in the study from the standpoint that one might questio~ 

whether they make a difference to the Agency. Therefore, we inveatigated whether the psychiatric status classifications of in1ividuals were relatud to other outcomes. Table 211 displays comparative statistics on psychiatric status assessed in the study 

and medical disqualiflcati~ns from the FAA during the thre~ year• 

of the study. The top half of this table s~ows that only one in 

135 asymptomatic controls were medically disqualified, whereas 

9.1% of prevalence cases and 8.5% of incidence cases were so disqualified by the Federal Aviation Administration. The lower half 

of Table 211 shows that this a~sociation between psychiatric status 

in the study and being medically disqualified by the FAA was 

statistically significant. Of the 20 men who were medically disqualified by the FAA, 19 men had an abnormal psychiatric status 

aa assessed by the study team. One person who was an asymptomatic 

control wns disqualifled f'r reasons not kno~~ to the-study team. 

It is important to note that of these twenty cases, half were disqualified by the FAA for psychiatric reasons and half for medical 

reasons, indicating that psychiatric status was a risk factor for 

both medical and psychological disorders aa assessed by FAA federal 

air surgeons. 

table 212 displays the ,.elationship of FAA performance awards 

to other outcomes including the psychiatric outcomes aaaessed in 

the study, We f<'Und that the highest award group had somewhat 

fewer psychiatric proble~ at intake or later, and that men with 

chronic problems had the fewest awards. The asymptomatic group 

received more awards in general. However, tlaera was no significant 

association between the monthly morbidity of depression or anxiety 

and FAA performance awards. And finally, aa indicated in other 

sections of this report, there was no relationship be~een mild 

and moderate health changes or hypertension and FAA perfo=manca 

awards. 

) 

I 

I • 

t 
Psychf•trfc StAtus And Hedlca1 Dlssu~llffcatlons From The FAA 

Percent Medically Disqualified 

Ho Psychiatric 

Problems Prior Asympto- PrevaTo Dropping matlc lence lncld~nce 

Group From Study• Controls• Cases• .;:;C=.•s::.e::.s=-*----

KYmher and percent 3/65 • 4.6% 1/135. 0.7% 9/99- 9.1% 10/117. 8.5% 

Cross-tabulation Of Psychiatric Status In Study And Hedlcal 

Olsquollflcat!on By FAA 

Psychiatric Status In Stud~ 

Asympto- Prevamatlc lence Incidence 

Cant roll Cases Cases 

Hedfcally Olsguall- YES I Observed 9 10 

fled By FAA7 (8) Expected (6) (6) 

HO 134 90 107 

(127) <.w (.!..!.!) 

Column Totals 135 99 117 

,.z • 10.92 df. :.. < .01 

Pow 

Jotals 

20 

331 

351 

not evaluated all 5 

Asymptomatic- these men had no abnormalities on the 5 PSS criterion scales at all of their 

psychiatric evaluations. Preval~nce CQSCS - these men had one or more symptomatic criterion scales on the PSS at Intake. 

inclcence cases - these men had one or more symptomatic criterion scales on the PSS after 

liiiaka but not at Intake. --

• ·--·-----·- . ·' 

...... • - ·--=~ ..•• -.- =---:- --=--::-o-~ 

' 

"' w "' 

• 

• 
594 

TABLE 212 

Relationship Of FAA Performance 

Awards To Other Outcomes 

lblllty to ?sychlatric 

Re Ia t I onsh I p To Performance .~wards 

Highest award group had fewest 

psychiatric problems at Intake or 

later (p.C:.JO) 

O~pression Morbidity 

Morbidity 

Hea I th 

Chronic problem go·oup had fewest 

awards, No problem group more 

awards (p <:. 20) 

No significant relationships (p> .SO) 

No significant relationships (p ~.so) 

No significant relationship (p».SO) 

No Significant relationship (p >'.so) 

-. 

) 

i -

: 

I 

I 

. ·~ ' 

u 

.. ) ··•. ,, 

.. 
SuMMARY 

Predictors of Work-~elated Changes 

Analysis of relationships between predictor variables and workrelated changes produced the following asaociations: 

595 

1) Individuals who 3ater developed burnout showed, at intake 

or Round 2, more vigor, friendliness and elation (measured 

by Profile of Mood States), less anxiety regarding work, 

better tension discharge rate, less coping by drinking 

and more coping by physical activity, less anxiety with 

training, and more assertiveness; 

2) By the end of the study, men who developed burnout had 

more subjective distress than othere; 

3) Individuals who developed burnout dta not show any differences in average amount of work done or time spent on 

position on the days they were monitorea, nor did they 

show any deteriorat!on in physical health; 

4) Men who were promoted were generally more satisfied with 

FAA policies, had more personal job morale, were generally 

more hard-driving, dominant and job-involved, had more 

life change just before being promoted, had more peer noMinations for competence, were slightly older and had sli&, .. tly 

more exp~rience than those not promoted. At the same time, 

those who were promoted rated themselves as more burned 

out on the bounceback-burnout question in the ATC Questionnaire; 

~) Men who were medically disqualified during the course of 

the study were chOsen much less often th~n others as ideal 

team memb~rs or as among the most competent, were not as 

invested in the job, had fewer marital resources, scored 

lower on feelings of well-being, reaponaibility, tolerance· 

and i ellectual efficiency, the last being the most import lt predictor emerging from a discriminant function 

aatalysis; 

6) Analysis of PSS scores ahowed that psychiatric symptomatology either at intake or later was highly related to 

eventual medical disoualification; 

7) Differences in the amount of work perforaed were in general not predictable; however, total time on position and 

time Ypent consecutively en position was related to age, 

the older men spending leas time on position; those who 

spent less time or. position aloo had higher rates of impulse control disorders and showed more coping by drinking; 

8) Men t-'ho received zoore awardw were cho•en IDQre frequently 

aa ideal team members, ae amicable and competeat; they 

; 

! 

I 

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i 

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) 

!

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• 

received high ratings for coping on heavy days, copirig With training and overall coping; 

9) FAA performance awards were generally unrelated to other 

outcomes. 

• 

• 

·~· 

• 

) 
597 

After study of the four criterion variables defining burnout 

all live rounds of examinations, three groups of men w~re selfor comparison. The burnout group was made up of those ~howsignificant decline on at least two cf the fo~r criterion varidescribed ia Section III E. The rartial burnout group comthose who had one of four variables reaching criterion values. 

comparison group shvwed no decline on any of th2se variables. 

excluded from all three groups men who were showing significant 

at the beginning of the study as we were primarily interin studying predictors of developing burnout. 

We were primarily intere~ted in whether or not we could disbetween those who developed burnout and t.hose who did not, 

collected in our first rwo rounds of examinations. Payvariables which did discriminate between these two groups 

listed in Table 213. This table shows that those individuals 

later developed burnout scored significantly highet· at intake 

the second round of examinations on a number of positive facor variable•. They had more vigor, friendliness and elation 

Profile of Mood States (POMS). They showed less anxiety 

work on Round 1. They had a higher tensio~ discharge ratH 

1. They coped by drinking less often than the comparison 

(Round 1), coped by rhysical activity more often (Round 2), 

less anxiety with training on Round 2. They also showed 

iveness on Round 2, a measure of their interest in doing 

~s a controller. Therefore, one would conclude that 

who later developed burnout showed more psychological 

early in t 1.le study than the comparison group. Th~y did not 

as dissatisfied, as alienated or as h~ving more anxiety, 

were committed, and from their own estimation as well 

estimation of others, (they did not have significP.ntly lowec 

.nominations in the beginning), were functioning as well or 

tnan others. 

were concerned that some of the differences observed were 

our definition of burnout. That is, men who showed signideclines or: various factors later in the study. scored higher 

on other factors because they were relat~d to our definitherefore reviewed the scores of the four variables used 

· tne burnout, i.e., bounceback-burnout factor, competence nomiwork satisfaction and work role pathology. The men who 

burnout scored significantl;• higher than the compaor.ly on thP bounceback-burnout factor on Round 1 or 2, 

different on the other three, "This suggested that the 

obse:-v.ed in :he burnout group early in th'! sturly were 

cs of t:he <lcfir..1 t1.ons but rt.>f lee ted true differences 

o:•en .!u corr .. rlflri~~u to t:huse who t·~o.1ned unchanged 

t•uz ~!"JU'''•f:! vf tn~ study, 

.. 

I 

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TABLE ~13 

Cnm~arlson Burnout 

Group (N•96) ..J!!:2_up (N•35) 

Mean :.s.o. 

• 

51 .s !:. 8.60 57.7!:. 9. II 

48.5!:. 8.55 53.9!:. IC.60 

48.6!:. 7.98 54. I !:. 9.22 

Faetor-Rnd 51.6 !:. 8. 78 48.5 !:. 7.SO 

48. I !:_10.3 52.4 !:. 9.38 J 

51.3!:_8.94 48.9 !:. 10.01 

with Tralnlng-Rnd 2 53.7 !:. 8.45 50.7!:. 10.03 

lve Faetor-Rnd 2 45.3 !:. 9.27 49.8 !:. 9.02 

leal Actlvlty-Rnd 2 47.3:!:. 9.20 51.3 !:. 8,87 
• 

• 

599 

ThP men who developed burnout showed on Round 5 an increased 

incidence of subjective distress compared to the oth~r two groups. 

This was impressive as none of these 35 men showed problems in subjective distress on the PSS on Round 1, as presented in Table 214. 

It was apparent that although they started out feeling good abO'Jt 

themselves and scoring low on psychulogical distress in the beg~nning, dur.ing the course of the study and by Round 5 they were sho-.·-

ing increased psycholog~~cal problems compared to the control group. 

These observations suggested that some individuals (3/35) who developed b1trnout began to have behavior and psychological problems that 

were not present earlier. 

It is notable that the individuals who did develop burnout did 

not show auy differences in average amount of work done or time 

spent on position during the times they were physiologically monitored over the course of the study. Furthermore, they showed no 

differences in any of the physiological measures taken at work i.e., 

cort~sol and blood pressure, nor did they show a higher incidence 

of hypertension or a higher incidence of mild to moderate health 

change, From these data it was opparent that their physical health, 

at leRot ov~r the relatively short period of time that they were 

stud1,_c!, W.:l3 not undergoing a rapid deteriora.tion, b:~t their bumout stntus was associated with increased incidence of psychological 

problems, which perhaps if followed over a longer period of time, 

could result in a disruption of their work and place them at risk 

for future medical disqualification. 

In some w~ys the men who developed burnout showed some of the 

characteristics observed ±n the mean at intake of those who were 

later promoted, and this is discussed 1n detail in the next section 

on promotions. 

• 

• 
TABLE 214 

Appearance Of Subjective Distress In Cases 

Of Burnout In The Fifth Round Of Examinations 

Round 1 Exam Round 5 Exam 

0.053 + .224 0.020 + .141 

(n=i 3) (n,:5) 

0.073 + .261 0.010 + .102 

(n;;-7) ( n=i ) 

0.052 + .223 

( n;;-6) 

0.009 + .093 

(n;j) 

0.000 + .ooo 0.086 + .284 

(n;;Q) (n.:)) 

F • 2.73 F • 4.49 

p • .09 p • .012 

• 

·-

,,·•I ,, 
601 

2. Promotion 

As nJted in Section III E. on Job Outcomes, 4~ ATCs received 

promotions to supervisor during the course of the study. We reviewed the psychological and other data collected during the first and 

second visits for factors that would .differentiate between men who 

were promoted in subsequent visits anQ those remaining journeyman 

controllers for all three years of the study. 

Fifteen variables were found signilicantly to discriminate 

between those who ~ere promoted and the comparison group (see Table 

215}. The comparison group consisted of men who were in the study 

for the entire 5 rounds and were not Qedically disqualified or dici 

not drop out for personal reasons. One q·1alification that should 

be added is that of the 49 promotions, 7 took place prior to the 

second round of examination&. Round 2 data were not truly predictive but were associated with their being promoted. In a similar 

vein individuals might have learned that they were beir.c considered 

seriously for promotion by the second visit. We were unsure how 

many men fell into this category, but realized that the situation 

did in some way reduce the predictive significance of some of the 

variables that were collect·ed in the seCond round. Data collect£>d 

in the first round were not affected. 

In general, the men who were p=omoted were more satisfied with 

FAA policies, had higher amounts of ?ersonal Job morale and were 

generally more hard-driving and more job-in'!Ol ved than those Who 

were not promoted. The individuals who were promo.ted were also 

characterized by increased amounts of life change in the pP.riod of 

time prior to being promoted as well as by high scores on the dominance scale of th~ CPl. Th~y were slightly older than those not 

promoted (37.8 vs. 35.9 years) and had slightly more years of experience (13.2 vs. 10.8 years). 

'r<·ro variables that diacriminatei between these two groups deserve special mention. These are the increased frequency of peer 

r.ompetence nominations collected in Round 1 among th~•e who were 

promoted as contrasted with the com~arison group. Those who were 

promoted received on Round 1 an averag~ of 2.67 nominations by their 

peers contrasted with only 1.84 nominations for the comparison 

group. This difference is highly significant, F • 16.22, p <.0001, 

At the same time that the men who ware later promoted were receiving 

more competence nominat~ons from their peers, they also were rating 

them•elves as more burned ot·.t ou the bouncetack-burnout factor also 

collected on P~und 1. Tne men whb were promoted scored lower on the 

bounceback-burnout factor, ind.icating they thought themnelves le&s 

able :o bounceback and more likely to burnout. Their average score 

was 46.3 compared to 51.1, also highly signHicant, F " 9. 76, 

p < .005. 

,,;, 

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602 

TABLE 215 

Variables That Differentiate Between Hen Who Were Promoted 

And Others Remainin In The Stud For All 5 Rounds Of Examinations 

Come;arf son Grou2 Promoted F 

~ ...!!.. 

:I 1.84 2.67 16.22 .0001 .I 

35.90 37.80 5.46 .025 

rs of Experience 10.80 13.20 10.75 .oos 

49.20 52.50 4.38 .os 

rnout 

- Rod I 51 .10 46.)0 9.76 .005 

- Rod I 49.00 54.10 10.22 .005 

Life • Change-Rod 2 97.50 145.70 14.58 .001 

- Rod 2 s .. 40 58.90 29.75 .0001 

52.88 57.20 8.78 .005 I FAA 'i 

,, I - Rod 2 48.24 56.65 31.49 .0001 

faction with FAA I 

icn Polley - Rod 2 i 47.91 57.26 38.14 .0001 

L l fe Change - Rod 2 ,29.00 40.02 7.25 .OJ 

lnance Scale CPJ - Rod 2 55.57 62.11 12.87 .001 

-5.25 -2.04 7.28 .OJ 

-1.49 2.21 7.21 .OJ 

Number of men 245 46 

.. 
603 

Since both the bounceback-burnout factor and the pep-r nominations remained as significant discriminators between the two groups 

in the stepwise discriminan~ function analysis, some discussion of 

the presence of these tuo seemingly disparate factors is relevant. 

The r.·en who were later promc.ted did describe themselves early 

in the study as more burned out at the same time that they were 

showing more satisfaction with management and higher morale and 

were receiving significantly more peer nominations for competence. 

Therefore, one might conclude that these individuals viewed themselves as less able than they had been in the past, less abl~ 

bounceback, and more concerned about burnout. This occurred at the 

same time they were receiving a relatively high frequency of peer 

nominations for competence ~y team-mates. This finding, along with 

the finding that men who developed burnol't scored h~&h on many positive areas when they first entered the study, suggest& that individuals who do feel more concerned with or more ce"rtain that they will 

burnout, may also be among the more competent individuals. 

Further, it suggests that competent controllers can and do 

experience concerns about burnout, and as a m&tter of fact, ATCs 

with such concerns were core frequently represented among individuals 

who were promoted than agong individuals who were not ?romoted. One 

might therefore speculate that burnout is not a characteris;ic of 

individuals who are poor controllers, but may relate to the co~cern 

that one will not be as good as one has been and wili fall in the 

es.timation of one's peers. As answers to the four questions cotltprising the burnout factor (bounceback-burnout) repree.ented self estimations, we might conclude that developing lower scores, having 

more burnout concerns, may function as self-fulfilling prophecy. 

What is of note fro~ this analysis of the promotion data is that 

these individuals did rate themselves as having more concern about 

burncut while they were still receivin~ high peer nominations for 

competence. 

The eight variables that accounted for the most significant 

differences between the group who were promoted and the group not 

promoted, are noted in Table 216. The most important variable that 

remained was satisfaction with promotion policy of the FAA as measured 

at Round 2. For a few men, this finding may in some way have reflected 

either a recent promotion (9/49) or knowledge of a p<>e&ible pen~ing 

proJnOtion. However, the bQunc~back-burnout factor t't".:O.iued as strong 

a discriminant variable as did competence no.!li.-::tation by peers. Life 

change was greater in individuals who were promoted, as were selfmorale and dominance as measured on the CPI. The increaoed level 

of experience with the FAA remains a significant predictor although 

it was tha weakest discriminator on the list with F • 4.12 when the 

other variables were taken into consideration. The combination of 

these eight variables in the stepwise discriminant function analysis 
604 

• 

TABLE 216 

Stepwise Discriminant Function Ana1ysls Of 

Men Pro~ted Versus Those Remaining In Study 

Variable F 

Satisfaction with promotion 

policy of FAA 38.14 

Bounceback-burnout factor 16.90 

Peer competence nominations 15.40 

Ll fe change (Holmes & Rahe) 15.30 

Self Horale 11.50 

Dominance CPI Scale ].33 

Ll fe Change (P & U) 4.25 

Experience 4.12 

Predicted correctly 37/46 

Predicted correctly 203/24~ 

80.4% promote~. 

82.9% not promoted. 

• 

• 

' 

1!. 

.0001 

.0001 ' • 

.0001 

.0001 

.001 

.01 

.05 

.05 

:! 

. ' ,': 

I 

l 
correctly predicted 80.4% of those promoted and 82.9% of those 

not promoted. 

605 

In summaryt men who were promoted were characterized by higher 

satisfaction with FAA management policy, mor.e peer nominations fo~ competence, more concern (before they were promoted) with the 

specter of burnout, higher self-morale, and higher dominarce scores. 

.. 

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i 

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6C6 

3. Medical Disqualifications 

The~e were 23 men who were medi<ally disqualified during the 

course of the study. Eleven of t:hese disquP.lifiCatJ.ons were for 

psychiatric reasons and 12 were attributed to various ph:•sical problems. EJght of these men were medically disqualified in the fi<st 

interval, i.e., betwP.en intake exaMination and the s~cond examination. Fifteen of the 23 men, however, were present at both the 

intake exam and the s~cond round, and information on their responses 

to various questionnaires given in these rounds was therefore available. 

~e exPJn!~ed the responses of these 15 men to see what variables 

V''.~ht d!fferentiate them fro111 the individuals who remained in the 

study. We elected to compare individuals who were medi<ally disqualified both for psyct.iatric and medical reasons with those who 

remained in the s~udy but were not promoted. Thus the comparison 

group was made up of those wh~ remained in the study for the entire 

ti.m.e, were not promoted, ~·ere not disqualified and did not drop out 

for ~ersonal r~•sons. 

Table 217 lists the variables Chat significan•ly discriminated 

medically ·disqualifed men from ATC• w~o remained in the .;tudy (by 

one-way li-·.talyses of variance). The men wt.~., were medical.ly disqualified were chosen much less often by their peers· as ide11l team choices 

or ar among th~ ~at ·competent. They also were given a lower investment score by the psychvlogists in the Round 1 interview. On 

Round 1 they also ·rated themselves as having lus<J marital resources 

and st:.ored lower on four &•.:ales of the California P3ycholozical 

Inventor:;- (CPI). They were lo,.er on feelings of well being, res-

~onsibility, tolerance, and intellectual efficiency. · 

Step~rise discriminaLt fu~ction analysis of these eight predictors yielded four that contributed significantly and independently 

to predict those who were medically disqualified and those who were 

not, as shown in Table '18. The most importune predictor was the 

CPI intellectual efficiency score, Zollowed by the investment score, 

ideal team choices and marital resources. By this analysis, we 

correctly predic•ed ll out of 15 men who were disq•~lified or 73.3%, 

snd 188 of 245 or 76% of those remaining and not disqualifi~d. 

Although these variables did significantly discriminate and 

predict men who were medically disqualified, a more striking predictJ.on came from analyst• of the data collected on the Psychiatric 

Stat113 Schedule (PSS) comparing men who were med1cally disqualified 

and those who remained in the study. Table 219 shows the difference 

in the intake prevalence and later incidence of psychiatric problems bet>•een the group who were disqualified and the comparison 

gr~up. This analysis yielded 135 men who were asymptomatic on the 

----------·---·---·---·---·--··---·---·------·-

! ' 

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TABLE 217 

Variables That Predict Medical Olsquailfications 

(Univariate) 

Comparlstln Group Oisgua1iflcation (mean) 

F 

Team Choices 1.96 1. 13 6. 73 

Categories 1.83 1.07 5.02 

4.98 3-53 9.41 

4S.92 44.07 4.98 

48.83 40.87 9.16 

lb11ity Scale 

41.72 34.53 7.24 

Scale 

47.97 41 .4: 7.52 

Efficiency 

48.93 40.53 I 0. 31 

n • 245 IS 

• 

• 

607 

.1!. 

.01 

.025 • • 

.oos 

.os 

.005 

.01 

.01 

.oos 
608 

TABLE 218 

~t~pwlse Discriminant Funct.lon Analyses of Predictors 

• of'Medical Dl•qullliflcatlons 

Variable .E. .1!. 

lnt~llectual Efficiency Scnle CPI 10.)1 .005 

Investment score tn lntervlew·Rnd 8.04. .005 

Ideal Team Choices 5.74 .025 

Marl ta I resources 4.47 .025 

·Cor·rec:tly predicted 11/15 or 73.3% of tl10se medically disqualified. 

;CorTe,ctlv predicted leS/245 or 76.7% ~f those remaining· not disqu•lifled.' 

... 

J 

/ 

' 
f 

/ 

loi.J~~·"'-"· 

Gro•1p: 

Numter and ~ercent 

Prevalence 

Cases* 

lncld.ence 

Cases* 

3/65 • 4.6% 1/135. o.n 

~s-tab"lation Of Psyehlutric Status In Study A~d Medical 

Disqualification By FAA 

9/99 • 9.1% 10/117•8.5% 

Psychiatric Status In Study 

Asymptomarie Prevaience 

Controls Incidence Rcw Cases Cases Totals Kedically Disguallfi- ill I Observed 9 10 20 fie~ By FAA? (8) E~peeted (6) (6) 

.!!2. 13~ 90 107 ( 127) 331 (93) (!.!.!.l Colunn Totals - 135 99 117 351 

x

2 

• 10.92 df. 2 poC .01 

'~ychiatrk Problems ?rior To Dropnfng Fr,.. :itudy - these men· (N•65) were not evaluated all 5 

tinx:s and therefore could have developed problems we did not know about. 

Asy~.yto~atfc ... Th.:!.e men had no abr.ormalitfes on the S PSS criterion scales at ali of their ;'syciliatrlc evaluations. 

Prevalence cases - these men had one or more syn;>tornatic criterion scales on the PSS at ~· 

lneld~,ce eases- these men had on~ or more symptomatic crl~erion scales on the PSS after Intake b~t not at !ntaka. 

- .__ ... __ ---..... __ ,.., ......... ,# ................ . 

. '--~-' 

.. 

.,. 

:2 
• 

610 

PSS throughout the course of the study; 99 individuals who had one 

or more nymptomatic criterion scales on the PSS at intake, referri!d 

to as prevalence cases; and 117 men free of PSS pathology at intake 

who ~ad one or more symptomatic criterion scales on the PSS after 

intake, defined as incidence cases. Twenty out of the total of 23 

disqualified men were able to be identified by their psychiatric 

status category. Of these 20 men who were medically disqualified, 

19 werP. either classified by PSS as a prevalence or an incidence 

case. Therefore, as indicated in the table, 9 men who were medically disqualified were preval·~nce ..:ases, or 9.1% of all pre\·alence 

.cases weJ.e eventually medically disqual~.fied, and 10 cases to~Jt of 

lli incidence cases were medically disqualified or 8.5% of the 

total incidenco! cases. This contra~t:ed with the observation that 

among the 135 rated as a.~ymptomattc on the PSS, only one individual 

. w .. medically disqualified dur·ing the course of the entire study. 

One may conclude that having difficulties on the P3S either at intake or later in the: study wan predictive of, or correlated Wii:h, 

medical disqualification from the FAA. Also as not~d earlier, the 

increased incidence ~nd prevalence of psychiatric difficulties was 

apparent both for men who were disqualified for somatic illnesses 

•nd those who were disqualified for psychiatric reasnns. These 

data strongly support tho conclusion t.i1at mental health changes· 

:.observed in the controllers had a significant relationship with . career longevity. 

• 

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611 

4. Amount of Work Performed 

In JSenera1, we were unable to predict differences in the 

amount of work perfo~ed ~uring field work obsP.rvationl. The 

major work variable, ~'ma·awork," was a composite qcore 'tased on 

the total number of planes normalized for facility, se·!tor and 

position, normalized peak numbered planes and no~ali~ed range 

of numbn~ of planes. Men who did rOOre WOl k versus less work, 

using ttin summary measure as the outcome variable, differed 

sign1Hcantly on only a very fe!W of our psychological or interview variables. We did not study this set of psychological predictor variables in te~a of the differences in variou3 aspects 

of work assessed separately, eag., peak planes, ~wish to do this 

in the future. 

We did find that men showing the high~st amount of ganwork, 

(greater than one standard deviation abova the mean, N • 57), also 

showed significantly more active behavior at work compared to the oth~r•, F • 17.02, p < .0001. This suggests that those who do 

more work also show more signs of behavioral arousal associated 

with the increased workload. 

There were, however, s~veral significaut corr~lates of the 

total amount of time and the longest consecutive time that individuals spent on position, suronarized as the variable "t1meload." 

Those in the lowest l/6th of the group (One standard deviation 

below the mean, N • 40) were signi.ficantly older, 38.8 years, compared with those spending average etme on position, 35.6 years, 

·or more time on position, 35.4 years. This relationship still 

held wh~n experience was eontrolled (age with experience controlled). 

Those with less timeload also had significantly higher rates of 

impulse diso·:ders, F • 6.53, p <.0043. They also showed more 

coping by drinking, F • 4.35, p <•014. These findings suggest the 

possibility that the vadable "t:lllleload" 1D4Y be an early identifier 

of that subgroup of older men who are beginning to experience 

emotional problems and ~eterioration of ATC skills. 

.. 

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5. Special Recognition& &..'ld A•Jards 

main groups of psychological fa£tors predicted the men who 

awards during the course of the study. These are listed .in 

220. The first related to the sociometric evaluatio~s or 

nominaeions. The men who received more awards were consistchosP~ more frequently for an ideal team, for amicability and 

camp,et,.n,ce compared w~th those receiving few or no awards. In 

1~1~••r way, the interview ratings, made in terms of ability to 

Round 1 significantly differentiated among men receiving 

some awards. The men receiving more awards received high 

coping on heavy days, coping with training, and overall 

compared with those who received zero awards. One 

racr,or discrtminating among th~ men was the amount of physical 

engaged in on Round 1, greater physical activity being 

in individuals who receiv~d ~re awards. 

were relatively few· relationships. however, between FAA 

1o~•nc:e awards and other outcomes. There was so~ tendency for 

who received the most awards to have fewer psychiatric 

intake, but this was not linear through the ranks of 

receiving fewer or zero awards. Similarly, the group of those 

aa severe in the extent of psychiatric problems had fewest 

while those with no problem had more awards. There was no 

ufica1nt relationship between awards and the average monthly 

anxiety and depressi~n. the development and prevalence 

~,erlterLalcorL, or the av~ra&a annualized illness rate. 

results suggeat that the men receiving more.awards were 

for their great~r competence and were r~arded as more 

choices by the c~ntrollers as weLl as rP.cogn!zed by the 

Similarly, theoe individuals were judged by int~rviewers 

better able to cope Wlith life !Jroblems. aowever, these men 

consistently describe themselves as morP. satisfied with 

or •how more bounceback, or scor~ differently on th~ CalifPaychologicaJL Inventory or a variety of other_ :::~c'llP.s during 

flrat or second rounds of exam.e, no::' did these men differ in 

of work they did in the course of Held Hudies, the 

of time they IFent on position, or 13 their cortisol 

pressure r.'esponees to work. 
• 

TABL£ 220 

Variables That Differentiate Among Men With 

low, Hiddle And liigil Freguenc~· Of Receivins: Awards 

-Total Awards Categoty 

(Mean) 

0 l-4 ..i:!L 9+ F _L 

1.56 1. 83 2.23 2.21 4.45 .005 

illty Choices 1.56 1. 89 2.14 2.33 3.58 .014 

1.42 1. 79 2.11 2. 17 3.53 .015 

46.12 50.04 51.03 51.49 2.62 .05 

3. lO 3.82 3.92 4.08 3.12 .025 

with Training 2.95 3.59 3.91 3.96 4.59 .004 

I Coping 3.00 3. 73 3.92 3.96 4.61 .004 

41 245 95 22 

• 

613 

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614 

SlJM!(ARY 

Concordanct?: of Di-fferent Categories of Outcomes 

In order to dete~ine whether or ~t men who had or.e health outcome 

were more likely to have another, they were divided into two groupR 

by extent and frequency of illness or injury and all groups were 

cross-tabulated for indications of association. 

It was dc~ermined that there were no significant associations between any of the major categories of health outcomes. 

•.. 

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615 

0. Concordance of Different Categories of Outcomes 

We were quite interested in whether or not individuals who 

had one type of health outcome were any mare or less likely to 

have other types of health outcomes. Since the health outc~mcs 

were derived from procedures and on metrics of conRiderable diversity, we dichotomized the men on each health outcome index and 

then cross-tabulated the group~ngs. 

Men with severe, Level 3 injuries were divided into those who 

had none (N•399) and those who had one or ""'re (N•l7). M~n with 

Gevere, Level 3 medical illnesses were similarly grouped into 

those who had none (N•394) and those who had one or mo=e (N•~2). 

Men who received all S Psychiatric Status Schedule examinations 

(N•35l) were divided into two groups also. One group (N•l51) had 

no problems at all (tha aRymptomatic control) or had only one 

symptomatic criterion _scale at one exaination (those with acute 

problems). The second group (N•200) had moderate or chronic problems (one or more problems at two or more examinations). Hen who 

hed at least one scorable health change interval of five Monthly 

Health Review evaluations (N•37S) were divided into two groups, 

one below and one Rbove the median rate of 2.5 mild-to-moderate 

health changes per year \low rate, N•216; high rate, N•l62). All 

combinations of these groupings were cro~6-tabulated and evaluated 

for significant associations using the chi-square statistic. 

Table 221 displays the final results of these analyses. There 

were no significant associations between any of the health outcomes. That is, men with 0ne type of ptoblem were no more o~ less 

likely to have other he~lth outcomes. If our health outcome measures were contamineted by complaint behavior or if the controllers 

had a predisposition to have several types of health changes when 

they had dny at all, we would h~ve found so~e associations. Since 

we did not find any significant associations on these global cate-

!JOrizations of our health outcomes, we concluded that there was 

no predisposition to respond with general illness - or injuryproneness. 

These overall results did not exclude the possibility that 

certain subtypes of outcomes would have significant as~ociations. 

For example, as was reported in Section VB., there was a higher 

rate of respiratory disorders among men who developed psychiatric 

problems, and more injuries among men with moderate and chronic 

psychiatric difficulties. Specific types of problems may have an 

association, but in general, we found no indications of general 

pronanesa to illness and injury. 
616 

TABLE .221 

Concordance of Different Categories 

Of II lness Outcomes 

I. Severe Injury versus Severe Other Medical Health Change 

X2 • 1.12, df • I ~.S.** 

2. Severe Other Medical Health Change versus Extent of Psychiatric Problems 

x2 •0.22, df• 111.s. 

3. Severe Other Medical Health Cnange versus Annual Mild-to-Moderate Ill ness Rate 

x2 • 0.00, df • I N.S. 

Severe lnj~ry versus Extent of P~ychiatric Problems 

x

2 

• 0.00, df • I N.S. 

Severe Injury versus Annual Mild-to-Moderate Illness kate 

x

2 

• 0.27, df • I N.S. 

Extent of Psychiatric Proplems versus Annual Mild-to-Moderate Ill ness Rate 

x

2 

• 0.05, df • I N.S. 

outcome variable was dichotomized for these analyses 

S. • Non-significant. 
VII. IMPLICATIONS FOR FAA PURPOSES 617 

A. Introduction 

In a study as large and comprehensive as the ATC HCS it is difficult to reduce the plethora of data and findings to conclusive 

fundamental implications for future consideration or action. _As 

there are complexities and perplexities in our developing understanding of the interactions between our subjects and their work, these 

irregularities manifest themselves in diverse specific findings that 

do not always have consistent implications. Actions that may ameliorate one kind of problem may not help. and may even exacerbate, 

another kin~ of problem. The implications communicated in this 

section, therefore, are of two kinds: sam£ specifi~ findings, it 

seemed to us, carried limited Unplications that would t~ve to be 

reconciled with other requirements and goals of the FAA; other 

findings were of a more general nature and had Lmplications that 

aight be more broadly applicable. 

Our goal• in this study were: I) to monitor our sample of air 

traffic controllers sufficiently over a three-year period to be able 

to d~term.ine the frequenc.y, type and severity of their physical and 

psychological health change&; 2) to establish whether or not we 

could which controllers would later develop proble:ms, by 

:::~~:~~:~~ their performance on a multitude of social, psychological, , physiological and workload m~sures; 3) to determine 

po•sible (given the fact that data on other groups is usually 

sufficjently comparable to be used) wh~ther they were at excess 

for any health changes by virtue of the nature of thei~ job or 

characteristics of the men who enter this occupation or thei~· 

or practices after they enter it. 

We attempted to reach these goals by the following major strat1) studying the relationship between years on 

the job (age-controlled) and various pathologies; 

2) studying the relationship of workload and 

worktime on position to such btological predictor variables as cardiovascular and endocrine measurements on the job and also to 

frequency and type of eventual hu.lth changes; 

3) comparing men vith d1ffed1111 rates of iilnesa 

on a large number of additional predictor 

variables including psychological, biographical 

and attitudinal meaaurea for which data was 

gathered at repeated BUMC examinations; 

L 

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618 

4) 

• 

comparing rates of illness and injury where 

possible to population norms, and also comparing predictor data where possible to popu- lation norms. 

Although population norms were not avatlable for comparisons of 

rates of many types of illnesses, we were fortunately able to make 

such comparisons in several important are~s. including prevalence 

of hypertension, psychological and psychiatric problems, including 

alr~hol abuse. Our most important findings in this study concerned 

the increased risk among ATCs of hypertension and certain peycPiatric 

problems, including alcohol abuse, and the associations of mild and 

moderate illness, and of burnout, with certain psychological, social, ·work, or physiological factors. 

Our findings in these areas suggest some possible courses of 

action that we think may be ameliorative or preventive. The impliCations of these findinga are organized as answers and c~ents to 

questions posed by the FAA .under the contract. Although the contract 

requires only that the data be organiz~d and reported in such a 

manner as to be nre.udily addressable" to these quest1.:ms, we have 

addreesed our findings ~!rectly to them, and present whatever 

ameliorative or preventive suggestions we have within these comments. 

Each oi the questions posed in tile contract is stated and 

followed by our co~ents on the meaning of our findings w~th respect to the particclar question. 

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B. Specific Questions Posed in t:te Contract 

1. W~at is the nature, derivation, extent, and significance 

of health chnnges ·among air traffic controllers? How do 

tltese ch3nges affect performance, career longevity? 

2. Do controllers experience stress? If so, what is the 

n~ture and extent of the stress? How much is related 

to tho job? llhat c:.uses it? To what job conditions, 

including social and psychological forces or factors 

does it relate? 

3. To what extent do lll&nagem.ent, supervision and manpower 

managaent policie!l, practices, programs or procedures 

contribute to healt't changes and especially to the 

degree of stress present in an air traffic job? E.g., 

does how work is assigned, work sclaedules, hours on 

duty, length of work periods, etc. relate to stress 

and if so, how? 

4. Are there predictive factors or ~easures that could 

s. 

be applied before employment of air traffic contro~lers 

which would indicate to management officials which 

candidates might be more prone toward deleterious 

health changes? 

Are there ways by which individuals can be identified 

who need counseling or help due to their increased 

potential risk for illness? Is this risk in~rea&ed 

~ecause of their particular personality, family problems o' because of the nature of the working environment that they are in? 

6. How do the streso levels in the air traffic occupation 

compare with othe~ occupations, e,g., pilots, business 

executives, etc.? Although the ~ata collected in this 

study may noc prov!de for direct comparison of Air 

Tl:affic Controllers with other individual.s in other 

occupation,, ar.tempts should be made to compare the reaulto that are obtatned with th~se from other inve•ti-

&atora studying other occupations. 

7·. Ia there a "barn-out" phen.owenon1 If so, what is it? 

a. Can the individuals who are more prone to early 

~hysi,al deterioration be identified? 

b. Can we identify ~~rk oituationa that are more prone 

to produce wideop~ead early phyoical deterioration than 

other work situatio_ns may be, so that eat'ly counselling ..... and other career possibilities can bo identified and 

considered. 

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1. What Is The Nature, Derivation, Extent and Significance 

of Health Changes Among Air Traffic Controllers? How Do 

These Health Changes Affect Performance, Career Longevity? 

Over the three years of surveillance for health changes, 4,300 

diagnoses of illnesses and injuries were rendered. One-third of these 

were considered trivial inasmuch as they involved isolated symptoms 

which did not cause loss of function or call for medical care (Level 

0). Nearly 60% were minor health changes involving a symptom complex, 

auch as an upper respiratory infection or minor injury, often entailing a day or two of reduced activity but not usually requiring mediattention. Another 6% of diagnose~ were ~re severe than this 

but they were less disabling and less dangerous in their implications 

than tha 2% of diagnoses (labeled Level 3) that constituted major ..,o11c••~ problems. 

The most common of the acute minor health changes were respiraailments (J6% of the total) and injuries (12.5% of the total), 

sprains were the most frequent type. No other major cateaccounted for more than 10% of the diagnose~. Among the chronic 

serious conditions, the most common was hypertension. This lppro••c~aed an epidemic ,ro~rtion among air traffic controllers, and 

in more detb~l following this summary of other m~4ical 

The next most freq1.11ent chronic, though usually not 

conditions were back pain (including low back pain), hemtrboicls, and hay fever. 

rates of acute minor health changes did not seem grossly ~f,•r•~t from those reported aoong men of these ages in the general 

apulaltlcln, where ?Opulation daea was availacyle. It should be noted, 

that general population data are usually dek"~ved froa ~rosso:t:LO•l&J. et\rveys, which are not as reliable aa the continued surthat provided the data on the ATCa. The aedian number of 

or moderate health changes among our A7C populaticn w~ 2.5 

y.,.r (after annualizing ou.r monthly data), Twenty P< ;.:cPnt of ..,. had virtually no health rhange during a yesr, but 16% had 

av•orage of S or 110re diagnosed 1Uneasea and injuriea annually. 

Excluding hypertension, other oerioua illneaaas acd aerioua 

occurred to about 10% of the zan over the three yea~• of 

Eishteen ""'" incurred aavera in.1ur1ea calling tor boa-

~:=~~~= and 11l0re t:hal' one month of restricted activity. 

ll Mn (incl<~ding two who al"o had serious injuries) 

d~a=l~;in~~~:.:o:~~ l.ife-threatening cond1tiona apre..t acroaa 

i It ia important to note that there vaa 

correlation between having hypertetULion, havins a 

(Laval 3) health chaaa• and haviog mora than the average 

of mild and IICJ<Iera~e Ulnessea • 

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621 

Neither medical disqualifications nor burnout was associated 

with frequency of mild and moderate health changes. Men with more 

mild and moderate health change, however, had a higher frequency 

of psychological health p~oblems. 

The serious {Level 3) injuries and illnesses affect performance 

and career longevity in that they are either life-threatening, such 

as hypertension, myocardial infarction, bleeding peptic ul-::er, or 

they cause periods of disability of a month cr more. There was one 

.death among participants during the study, and this resulted. from a 

Level 3 injury (automobile accident). 

The actUal causes of most of tr.e major kinds of health changes 

experienced by ATCs in this study are only partially understood by 

~P.dical science, and are under intensive investigation in many biological laboratories devoted to specific causal research. One of 

our major efforts was directed to the determination of predictors 

of specific types of health changes. The predictors may or may not 

be causal, but 1n any event, ~hey provide the foundatiou for future 

expertmental app~oaches to prevention of these health problems. 

Several categories of predictors of total morbidity (average 

· annual illness rates) among ATCs were identified. Men who had large 

numbers of life changes, •hich tbey identified as distressing, were 

at high risk of illness and injury. Similarly,. those who were the 

competitive, hurried behavior Type A, particularly if they were 

deeply in,•olved in their job, and those who were more sociable and 

hut less self-critical, also had more illness. A number 

factors related to the job situation were predictive of high 

rates. Those mea who had high frequencies of anxiety and 

ta>eionon the job, who feared the possible problema of air traffic 

~•••t~oll.ing, had more illness. Similarly, those with lCYest work 

morale, least satisfactiOn with management, and the greatest 

that their supervisors were not considerate of them, also 

more illness. These same hi&h illness men were least often 

by co-workers either ior their amicability or for their value 

ideal team members, at the examination preceding the intervals 

whic:.h illness ra.tea were averaged. 

Several psychosocial variables and job-related factors preLevel 3 eerioua injuries and illneesea. Peer aelectiou. aa 

a competent controller, or being most desired for the ideal 

oaldoa vent to those men who later incurred a serious injury 

illness. It wao interesting to note, but contrary to our expec~­

that mer. with later serious health changeo had higher work 

~~~::~;,i~~ at intake and report~d a greater amount of social 

Ia to help theoo cope with probl1!1118. In the examiaati.>o 

Mdialtol.y prior to their serious injury or illneao, howaver, their 

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oatisfac:tj,on with their pay dropped considerably. 

Among the many diagnostic categories of health changes that 

into tlte total morbidity experience, :ton-specific ·..riral diseases 

injuries had large numbers of social and psychological predictors. 

are dealt with in the respective sections of thi~ project 

. It will suffice to state here that a number of findings have. 

for preventive or therapeutic programs. 

Hypertension was the most common of all chronic diseases in oUr 

population. If our study groap is at all representative of 

a~ traffic controllers, this is an occupation with an extremely 

prevalence and incidence of this disease. Epidemiologic studies 

in the U.S. have used a variety of diagnostic 

• Our ATC HCS data wP.re collected in such a way that they 

be evaluated by several of these criteria. Co=pared to the 

for males irom the DUE"~ Hedlth and Nutrition Examination Survey 

- 1974 and to men in the Framingham Heart Study, ages 35-39, 

sample had 1.5 ta 1.6 times the prevalence of definite hyperof these other rwo comparison populations. This was true 

though our ATCs were younger on the averege than the two comparso that the excess risk of the ATCs was probably underway to compare prevalence of definite hypertension in 

is to use a comparison group of men with similar ir,.c:oDie 

a linear extrapolation to the age r,nge in our s~udy. 

done using the Western Collaborative Gro~p Study as the 

population, For thflir participants, with mean age 43.2 

the prevalence was 8.4% using the criterion of seated blood 

reading exceeding 160 sbp or 95 dbp. This was considerably 

tiwn observed by other epidemiologic studies. In contrast, 

prevalence in the ATC using these criteria was 19.5%, 

twice the WCGS rate, despite the fact that the WCGS group 

7 years older than the ATC group. 

is inadequate information on incidence of hypertension 

However, estimates have been offered by experts in the 

on their reviews of the medical literature (Stamler, 

Julius and Schorlt, l97l). Incidence was estimated 

the range of l% to 4% per year amen~ persons aged 

30 - 60 years, with lower incidence rates prevailing 

years. One could extrapclate froA these eatfmates that 

of new hypertension for males averaging 36 years of age 

ATCa), should be l% to 1~ per year. 

l.nother c0111parison of tha incidence of hyperte~sion in 

ve. men of comparable age and geographic regj.oa t we 

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623 

obtained access to the computer printouts from the Framingham lfeart 

Studya This was arranged through the courtesy of Dr. H. Emerson 

Thomas, Co-principal Investigator of the Framingham Heart Study, 

M&. Pat McNamara, Research Associate, and Dr. Bernard E. Kreger who 

serves as ex3l'lining physician, both for the Framingham Study and the 

ATC HCS. Careful review of the printouts revealed 362 men ages 30-

39 years vho were normotensive at intake into the Framingham Study. 

Their hypertensive status was followed for 3 biennial examinations, 

a petiod of six years. When the obServed changes in hypertensive 

status were converted to annu~lized rates, the incidence of borderline hyper~ension was 4.6% pe< year, of definite hypertension 0.4% 

per year, for a. total hypertension incidence of 5%. In comparison, 

using the same criteria and annualizing the three years of follow up 

in the ATC study, the comparable incidence rates were 18.4% borderline hypertension, 3.1% definite hypertension, for a total hypertension incidence of 21.5%, For each category this would represent 

a relative risk of 4 to l. However, the comparison is r.ot altogether 

defensible in that the Framingham incidence might be higher if Framinghsm ~en had been at risk of exceeding the 140/90 mm hg cut-off 

· five examinations rather than only at biennial exams. 

Our estimates are that air traffic controllers currently on the 

have 50% to 100% h;LghH prevalence of hytfertension than "the 

ove:raa:e man the same age in u.s. communities." ln adc!ition, ATCs 

even greater risk than other men of developing new hyperrisk may be more than 200% that of other men. 

d"veloped ita own criterill for dia.gnosta of hyperThese rest upon the preaence of elevated blood pressure~ 

two succ£o;91.ve v1e.dical examin&tions, usc:ally 9 months apart. By 

more stringent crit.erion, 36 new cases of hypertension were 

eca,vel,ed over an avera~e observation period of 2.25 years (as 

by the nature of the criterion above) for an average annualincidence of 5.7% per year. Our criteria for diagnoses have 

been ueed in other studies, thus pr4clud1ng exact comp~risons. 

would seem, however, that this is about 3 times the incidence 

described above as the estimate of expert epidemiotogists, but 

as the latter is based on blood pressure readings from a 

examination it ~~y represent a more lax criterion and the 

relative risk of 3 to l may underestimate ATCs true excessive 

of hypertension. 

The predictors of hypertension are discussed &t length in 

V. In &\.UIIID8ry, 86% of th•> new 36 hypertensive cases (by 

criteria) were correctl1 "predicted'' by a diacrb1inant funceqlutt:1.on incorporating office blood pressures, blood pressure 

while at worr, and psychological predictors. The best 

of the development of new hyperrens~on included the excess 

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of systolic c,nd diastolic blood pressure avera3es at work above t.he 

·resting pressures observed by the study physician. In ad~ition, 

l~w scores on the hard driving scale of the Jenkins Activity Survey, 

interviewer rating of ability to cope on heavy work. days, 

average coping resOurces from one's marriage and below average 

:am,>utltS of distress due to life chal-~ge were also significant preof new hypertension. It thus appears that theft!"is a defiof on-the-job blood pressure responsivity and psychocnaracten.st•lcs whtch are found in men who later develop 

Neither the presence of hypertension at intake into the study 

its development during the three years of follow up were assocwith increased drop-out from the study or with poor perfor&-

as a controller as rated by co-workers. Job-related outcomes 

just as good for -hypertensives as normotensive& and the preof a blood pressU~ abnortnality did not predispose to the conor later development of psychiatric difficulties. ·The main 

of hypert~nsion on career longevity is that the diagnosis ~f 

or the practice of taking anti-hypertensiv~ medications 

our,r.•ntlv grounds __ for disqualification from active duty as a 

It should be emphasized, however, thut the 

for hypertension differ from those of the HA.~ES, 

Study, or our own Health Change Study. The FAA hypercriteria calls for blood pressure to be measured while 

for repeated measurements to be taken with the lowest reading 

counted, and for an age adjustment factor allowing higher 

pressures in older ages. The FAA criteria thua yield a lower 

and prevalence of hypertension for this sample than do 

criteria used. 

The regulation that use of anti··hypertcnsive drugs provided 

for dismissal from active work as an ATC was formulated many 

when the usual first line anti-hypertensive drugs were ••••<aJcto•~ and -reser~ine, both of- which could. in susceptible 

cause drowsiness and slowing of response ~ate. The 

for treatment of hypertension has changed drastically 

15 years. Presently the most commonly used drUgs for 

oeno1cm are the diure.cics. The increase kid"ey output with 

of excreting socL~um, reducing total blood volume and thus 

preasur~. The diuretics have no central nervous 

and therefore do not cauoe drowsiness, slu~giahneas, 

rates. For persona whose blood presure cannot 

~~~::~~ controlled on diuretics a variety of st"ep9ed-care 

ej are commonly used. These involve combinations of 

more potent &nti-hypertensive drc.gs. A fell of these 

cause slowed reaponse rates or drowsiness in susceptible 

, but many of the more potent drugs do not have such 

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625 

effects. It is vitally important that the FAA reconsider its· 

criteria for medical dirqualification as they involve hypertension. 

We do not !ecommend that controllers with hypertension who are concerned about the possible progression of their disease be forced 

to remain as ATCs, but we feel that mandatory disqualification 

simply on the grounds ox the presence of hypertension or the taking 

of diuretics or other drugs having no side effects that might influence alertness or controlling ski1ls should not continue to be 

agency policy. 

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2. Do Controllers Experience Stress?. If So, What 

is That Nature And Extent Of The Stress? How 

Much Is Related To The Job? What Causes It? 

To What Job Conditions, Including Social And 

And Psychological Forces Or Factors Does It 

Relate? 

By the operational measures of stress used in this study, 

controllers differ in their experience of stress. Primarily 

physiological and behavioral measurements at work were used in 

this study to reflect stress on the job. Additionally, selfreports of job difficulty were used to some extent. Stress may 

· be inferred from other data gat~ered in the study, but its sources 

8re not dete~inable. Illness outcomes in themselves were not 

considered to be reflective of stress because the causes of specific 

illnesses, and illness in general, are multiple, and that part which 

may be due to stress on the job or elsewhere would be difficult, if 

not impossible, to isolate. The observations that we used to 

estimate stress were relatively direct and simple to quantify. They 

represent only a few of the many possible physiological, psychological 

or social responses or adaptations that individuals might make to 

stressful situations. 

For this study we hypothesized that stress would be reflected 

the differences in blood pressure! levels, in cortisol and growth 

hormone levels and in behavior among and within men while workin·g 

conditions of varying difficulties. Further reflection of 

might be obtR.incd, we thought, from the men'S own reports 

their perception of difficulties during a day's work. Although 

knew that these indicators of stress might not be sensitive to 

situations, we were interested in observing their relationships 

other phenomena.. 

scientific literature on stress that current 

~'"''age in the field was not enough advanced to identify the 

body mechanisms by which stress may be mediated. We also 

that transient or repeated physiological or psychological resto difficult situations had not yet been shown conclusively 

a causal relationship to the onset of illness in human 

Respecting the scientific frontier in this area, we can only 

that the relatior~hi?s that were found between our selected 

of stress and soge few outcomes may implicate work 

utcwL<V as having some ,,artial role, when combined vith other 

·~;:~~~~~;;,and psychologic&! factors, toward ultimate illness 

P• Specifically, the physiological measures at work did 

predict hypertension and mild and moder&tQ illness. 
• 

6?7 

The same physiological measures did not in general predict psycfiiatric illness or a!.cohol abuse although individual r_esponses to the 

stress of work did correlate with the devElopment of ~any of the 

psychiatric or psychological problems. 

• 

With respect to hypertension, those ATCs who had higher systolic 

and diastolic blood pressures during their first field study had a 

significantly increased rate of developing hypertension during the 

course of the study. Evidence for a role of stress in development of 

hypertension was most persuasive ln studies uf blood pressure variability within the same person. These studies showed that those 

who were developing hypertension during the course of the study were 

responding to heavy air traffic with blood pressur~ increas~s four 

to five times greater than the increases of those who remained normotensive. Only a minority of those who responded to increased traffic 

with higher blood pressure developed hypertension. In general, 

individuals who showed more variabi.lity were at greater risk for 

developing hypertension. This risk was clear for those who showed 

the increased blood pressure responses to work. 

Interestingly, those ATCs who responded to difficult days on 

the job with 1ow cortisol or l~ variability in blood pressure were 

more prone to have mild or moderate illnesses during the course of 

the study. We thing that there was a suppression of their physiological system, and this may have represe~ted their way of responding, to stress. 

The fact that ATCs who had more job involvement and who reported 

mere job difficulties, incluJing work dissatisfaction, wece at increased risk for developing psychological problecs was construed as 

a ~onsequence of job stress in vulnerable individuals. However, many 

individuals who were d1ssat1afield with their work, or with management policies, ... ~ those with more distrt.asing life change .. could 

also be satd to indicate stressful respo~ses, but often without negative health ohange. 

In summary, while we have little doubt that controllers experience stress, and that their ~rk itself and th~tr attitudes toward 

. their work and the unagement generates soce of this eJqierience of 

data sugg~st that individuals experience otreas in difand amounts, and. that experience of stress does not 

1r:11ply illness consequence•• altbough J.n the case .Jf 

hY11er·tens1o1o, the implication is quite forceful. The psychological 

distress were also forcefully r.el.ated to near-future 

probleas of clinical oeverity. 

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628 

3. To What Extent Do Managem~nt, Supervision 

And Manpower H~nagement Policies, Practices, 

Programs Or Procedures Cont~ibute To Health 

Changes t.nd Especially To The Degree of Stress 

Present In An Air Traffic Job? E.g.: How 

Work Is Assigned, Schedules, Hours On Duty, 

Length Of Work. etc.z Relate To Stress And 

If So, How? 

Our inquiries, by means of questionnaires, regarding the controllers' perspectf.ves, attitudes and satisfaction with vatious 

policies and programs brought varied responses. We attempted t~ 

determine whether or not the controllers who were more dissatisfied 

with policies, procedures, shifts, schedules, etc. were more likely 

to develop health changes during the cour~e of the study. 

We cc-ncluded that W'ork ~issatisfaction was an extremely important p•edictor of psychiatric problems. Similarly, dissatisfaction 

with co-workers and reduced ability to discharge tensions were also 

found to be highly prevalent among those who developed psychiatric 

problema. T11erefore, it can be ssid that individuals who p~rceive 

their wor~ or their co-workers as less satisfactory are at greater 

risk for developing psychiatric problr~, and possibly for eventual 

medf.cal disqualification on that score. Co-worker dissatisfaction 

was greater among the controllers than among a comparison group of 

workers in other 1ndu&tri's and occupations. The morale problems 

that dissatisfaction with co-workers creates would appear to bo of 

sufficient po~ential seriousness to warrant some study of possible 

amelior.at!ve or remedial action. 

Questions reg~rd!ng the controllers satisfaction with management and management policies elicited responses indicating diss~ticfaction a.ong a la~~e ~nough group to warrant a review of 

management policies and practices, and an attemp: to arrive at 

mutually satisfactory revisions where beneficial. 

It is worth noting that controll~rs who shoved greater involveunt in the job, for whom it was impor .:ant to be a "good controller." 

experienced an additional risk for developing psychiatric and psychological problema. In other wo1·ds, it ia not a:aong those who don't 

care, but amona thoae who c&re a great deal and are highly irVested, 

that the risk for future paycholoKical problema is aGre apparent. 

This findin1, togr<her with the reporting of incre•sed subjective 

coots f1oa air traffic control work auggerta that the agency might 

investigate ..ana by which individuals can discharge their tensions 

&t the end of tit& work day with greater efficiency acd benefit. The 

uae of alcohol to cope with difficulties and to discharge tension 

ineraaoad the risk for psychiatric problaaa. Thia finding, too, 

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629 

addresses the potential benefit of a search for alternative methods 

of discharging tension and unwinding from the rigors of work. In 

this regard, it is noteworthy that individuals who reported increased 

subjective costs associated with frequent ehift change were at 

greater risk for alcohol abuse. 

Respor~es to a questionnaire regarding eleep problems indicatPd 

that change of schedule (S!iifts) was most frequently thought to be 

the reason f~r sleep problems among the approximate one-third of 

controlle~s who had them on 4 or more tim~s during the month. Contr~llers also varied in the time of day or night during which they 

functioned best. These ~indings suggest that there may be reason to 

investigate the assigni~g of shifts on the basis of whether an indiVidual is better able to fUnction at one time or another, and perhaps 

study optimum shift scheduliag with consideration also of the physiological sl~ep problems associated, for some people, with shift changes. 

In sammary, management attention might be directed to the dissatisfactions that were reported with co-workers, with management 

policies, and with schedules. Additionally, more productive and 

health-promoting methods of dischargir,,; tension might be explored. 
630 

4. Are There Predictive Measures Or Factors 

Which Could Be Applied Before Emoloyment 

Of Air Traffic Controllers Which Would 

Indicate To Management Offici~ls WhLch 

Candidates Might Be More Prone To Deleterious -Health Changes? 

Our studies of the antecedent conditions of various disorders 

resulted in several finding~: flrst, those who scored very low on 

the sense of well-being, responsibility, socialization, selfcontrol, tolerance and intallectual efficiency scales of the California Psychological Inventory (CPI) were at much higher risk for 

psychiatric health change and had a much higher rate of medical 

disqualifications from the FAA for either psychiatric or medical 

conditions. Men who scored lower on the dominance, sociability and 

self-acceptance scale of the CPI had more injuries of a mild to 

moderate nature. While men who were especially young for their 

experience were at greater risk for psychiatric problems. older 

men with less experience had more mild, moderate and severe illness 

and injuries. 

The psychological predictors suggested that the California 

Psychological Inventory might be added to the screenlng battery 

currently used for pre-employment selection. Alternatively the 

correlations between the 16-Personality Factor {16-PF) and the CPI 

scales could be calculated for air traffic controllers, and if the 

correlations are sufficiently high, equivalent scores on the CPI 

might possibly be derived from the 16-PF scale scores. The present 

study administered the CPI at the second evaluations of 392 men and 

administered the 16-PF to 388 men at the final exit ~xaminatioos. 

Thus the data is available on a sufficiently large sample to ~ttempt 

to derive these specification equations so that the FAA may not need 

to add an additional battery to thosP. currently used, but could perhaps derive the predicted scores on the CPI from the 16-PF. 

The results on age and experience suggested that men hire~ at 

young an age might not have sufficient maturity and experience 

life stre!:>.ses to cope with the particular stresses and environof air traffic controlling, and that older men without a great 

of prior experience in air traffic control work might have 

Jrticular difficulty in adjusting to this work. In combination 

ith the psychological predi~tive r~sults for both psychiatric and 

~dical outcooes in this study, we would suggest that the selection 

r.ocedures might be modified to emp}~size selection of psychologic&lly 

iture individuuls. The minimum a&e for beginning training as 1 

,ntroller might be raised to age 25 and the maximum age' for begin-

·~8 training might be reduced to age 30. These suggestions from 

relatively limited data should bP. first bolstered by tne FAA's •.. 

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631 

own personnel and medical disquaLification dat~. to assure th8t our 

findings are typical for the whole systema 

Twu other ·sets of psyc:hologic-w.l findings may have· predictive 

value if in fact their use is feasible in pre-employment screening. 

&\ history of legal events (more prevalent histories of being arrested, 

sued, jailed and so forth) was asfJociated with thf.! expres~:~ion of 

impulse control disorders, psychiatric problems in genaral, and 

eventual disqualification. SimilarlY we found that exceptional 

alcohol use was highly related to the development of alcohol abuse 

problems as well as to all psychiatric problems. This was tn•e not 

only in terms of quantity of alcohol consumed to cope with the presaure of the job, but also with respect to age at which the individidual began to drin~. That is, men who reported that they began to 

drink at earlier ages tendeG to have more alcohol abuse problems 

and more psychiatric problems. Such data also might be included in 

the biographical history information requested prior to employment. 

A large number ~f other pre-employment data may be associated 

with deleterious health changes. ~owever, time and personnel constraints do not allow us to pursue this irivestigation. Adoption 

of any pre-employment screening must, of course. pass the test of 

appropriateness and adherence to statutory. ·requirements. It ls 

our overall impression that preventive and ameliorative se-cvices 

~fter employment might be a more appropriate way to reduct~ hE:alth 

changes among the air traffic contrcllers. 
6)2 

5. Arf" Ther:e Ways B;t ~oihic:h· Individuals Can Se 

Identified \Jl10 Need Coun·selinC fir Help Due 

Tn Their Increased Potential Risk for Illness? Is This Risk Increased Secaus~~ 

Theit· Pnrticular Personality, Family Problem:l 

Oc_Becau..!.~ Of The Nature Of The Work:.l!!.& 

Enviro~ent That TheY Are In? 

Our predictive studies of both m~dical and psychiatric health 

Chdnge indicated a number of risk factors for illr.ess. Although 

the results wer~ sometimes different, as one might ~xpect for the 

predictors of these two areas, there was also some commonality in 

findings and :lnstrumentation which could be us~d for risk detection 

procedures .. 

We found that individu.:ils who had a large amount of life change 

a~d distress du,~ to that life change were at risk for physical and 

psychiatric illness. Men who were more Type A on the Jenkins• 

Activity Survey also "''ere at gr.eater risk for both mediC'al (other 

·than hypertensio.n) a.nd psychiatric illness. Individuals who had a 

large number of psychophysiological anxiety symptoms at work, and 

who had difficulty discharging tension arising from wDrk were at 

risk for ~oth typec of heaJ,.th chan~e!". Those who coped by drinking 

were at particular risk fer psychiatric health change, as were men 

who had a larger number of legal problems or decreased marital 

coping resources. '•en who were highly dis'iatisfied with their 

work and their cowork~rs, and sometimes these men who were not 

ratPd very high by their peers were at incregsed risk for qealth 

change. Men who were highly invested in their job from a personal 

psychological st~ndpoint were at a particul~r risk for health 

change. A nUmber of dimensions from the California Psychological 

Inventory differentiated among those men with raedical health changes, 

. and also among those men with psychiatric health changes, although 

the particular dim~nsior.s were different for the two outcomea. 

Finally, men vho became h~pertensive were notable by havihg a high · ol job i~~olvement, a tendency to avoid h~rd-driving compe-

.titive behavior, fewer distressful life changes. and a high level 

of cardiovascular reactivity on the job. 

These results certainl; suggested that individual£ can be 

c1G<enl:u1ed who need counselL:tg or other h.elp due to their increAsed 

ial risk of illness. In some cases our predictive validities 

exceptionally good; in other cases not quite ~s good. In most 

one would be making errors in the directior1 of false 

rather than fa:se negatives, which is better fro~ the 

lt&ndJ>Oi.nt of preventive care. Those _who would be false positive» 

recPive ~he counseling and assistance which might be ameliotive, whereas men who were false negatives would fail to have 

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633 

their risk identified and thus woold not receive any special counseling or assistance. 

The instruments providing our predictive assessment are either 

published and commonly available, or available from the stuciy team. 

For example, the Califotnia Psychological Inventory and the Jenkins 

Activity Surv~y are published instruments available from their commercial producers. The Review of Life .~vents (ROLE) is available 

from the investigators, although it would need a number of chane:es 

to be useful on the job and to improve the ease of scoring. The 

Air Traffic Coutroller Questionnaire also is available from the 

invef'tigators and vould need some revisions for the greates_t ease 

of application and eventual utility. All of these instruments also 

have the advantage that they a~e celf-administered, and if given in 

a neutral setting with appropriate validiry chec~..s, could be an 

economic series on which to base an annu&l risk detection procedure. 

The work satisfaction variables of most significance in this 

study are commercially available in the Job Description Inventory 

of Dr. Patricia Smith. The Job Descrtption Inventory is simple to 

use, easy to score, and relativeiy inexpensive. It is selfadministered and could be quite valuable in screening for individt~ls 

at risk for either medical or psychiatric illness. 

The most prevalent and serious disease among these air traffic 

controll~rs was hypertension. Hypertenbion was p~edicted by intake 

systolic blood pressures end .from mear:ures of blood pressure reactivity while working on the job. Once the intake blood pressure was 

taken into account, neither age, ~periencet nor obesity contributed 

to the prediction, so they are less useful than intake blood pressure 

for identifying individuals At risk for hypertension. Men who were 

already overweight, however, had a much hi~her prevalence of hypertena1on. A special evaluation procedure •.!Ould be conceived for screening and counseling individuals at risk for developing hypertension. 

We could foresee the posDi~ili~· of as8e•sins hlood pressure 

and pulse ratea in the way th&t we did in the 5tudy while men were 

either worldng live traffic or working on a simulator. However. to 

change to a simulator condition ai~ht reqaire another study to establish comparability. Blood pressure me&aurementa while workin& live 

traffic could be made U8ing the same equipment that we u•ed, which 

1a c~ercially av&ilabl&. This eqaipment interfered very little, if 

at all. with the men while they were working. It was a non-intrusive 

procedure ~ad -cauaed no rliacomlort tQ any controller. Individuals 

who w•re found to be ,articularly r~sponsive might be apprised of 

thia fact and might be referred for relaxation training, or perhaps 

ether medienl procedures that might aaaiat them in retarding the 

development of hypertension. 

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Both of the medical and psyehiatric evaluations done in tOis 

were quite good at detecting problems after they had developed. 

measures. which we~e paper and pencil tests of 

kinds. were quite good at predicting who would deveh>p probThe particular factors which put men at risk were ones that 

not necessarily socially undesirable. and hence information 

be requested without causing an individual to feel that he 

disqualify himself. This is an important concept for any 

detection program. It is quite unlikely that the same quality 

assessment and honesty in evaluation could take plaCe in an 

~e1ryo~y work environment as took place in this study. where great 

•~>rt·anc~ was placed on maintaining the confidentiality of informagiven to us. Some type of outside risk screening procedures 

therefore be quite useful in conju~ction with the Federal 

JlOitlon Ad~inistration's current medical evaluation prograN. 

Risk detection as opposed to medical disqualification procedures 

be confidential and not part of a man's government personnel 

Rather, an individual going through such a program would be 

of his particular resalts and of the interventions that were 

Since most of the interventions would be in the nature of 

onoseJ.~"'8• relaxation training. bio-feedback training, aQd so forth. 

be relatively innocuous, but useful from the individual's 

If any part of a risk detection program were to become 

the medical surveill~nce and disqualification program, then 

only would the quality of answers and assessments.be compromised, 

any interventions might be seen as punishment or negative conWe did ~ot find that th~ ATC work environ3ent and the workload 

that ~nvironment were the most predictive factors for illness. 

we found that particular types of people with their own 

psychological and biological reactions ~re susceptible to 

when placed in the air traffic control environment. Since 

not have aay other environment in which to study these men 

group of men, we cannot say whether_ or not these 

ty or personal characteristics would predispose to illness 

settings. There were some elements of the work environindividuals to b~ more or less satisfied and more or 

responsive, which factors in tu~n were 

the results that we found would be moat german8 to 

ahing risk detection and evaluation programa of men already 

As noted in v~rious other sections o·f this report, 

.,:Lic:at:ic•ns for. screening prior to employment wEre less numerous 

aeneral1zable than our implications for men already employair traffic controlleraa It would be our strong recommendation 

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635 

that a semi-independent risk det~ction, prevention. and intervention 

program be set up fer air traffic controllers. The potential 

benefits both to the inji,viduals concerned and to the agency could 

be substanti3l. 

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636 

6. How Do The Stress Levets In The Air Traffic 

Occupation Compare With Other Occup~tions, 

e.g., Pilots, Business Executives, etc.? 

Although The Data Collected In This Study 

Hay ~~ot Provi,!fe For Direct Comparison Of 

Air Traffic Controllers W.ith Other Individual!! 

In Other Occupations, Attempts Should Be Made· 

To Compare The Result~ That Are Obtained With 

Those From Other Inv~~tigators Studying Other 

Occupations. 

As the measures used in this study to assess the amount of 

stress felt by the controllers were d~vised for this study, it is 

not possible to compare controllers' responses on these measures 

with those of men in other occupations. 

In our comments regarding Question 2, we indicated that it is 

the air traffic control work E!~ ~ that produces indicators 

stress, but rather, according to the measures we ~sed to refJ.ect 

The work appears to provoke the stressful responses i.n 

persons. Given this finding we cannot compare '-'str~ 

in the air traffic "occupe.tion" with those in other "occupaThe stress level, we believe, is not altogether dependP.nt 

the occupational activity and hazards. but is determined in part 

the psychological and physiological "interpreters" of the indiHoweVer, we can supply some comparisons between the particiin our study and persons in other occupations ~egarding meadefined as reflections of stress in another study, that of 

et al. in 1975. The Caplan gt·oup defined stress as "any 

ha1:acte1:istics of the job environment which pose a threat to the 

and strain as "any deviation from normal responses in 

person." Their measures of stress included: job future ambisocial support from supervisors, co-workers, friends, relaand family; and role conflict. 

These Caplan et al. measures were included in our Round 5 data 

'••'""''•on for comparison purposes, aa waa one of the Caplan et al. 

of strain, boredom. 

We compared the scores of our controllers not only with the 

Study's controllers but also with the atudy'a compari~n 

froa 21 other occupations. 

Our co::trollers were siu.ila:.:. to the Caplan group'" controllers 

the etresa measures, but showed significantly greater, boredom, 

high score reflecting the boredom of controllers in centers. 

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637 

The tower controllers in our study did not differ from the Capian group. 

When the means of the responses by the ATCs in our study were 

racked with the 21 other occupation groups in the Caplan study, the following coaparison em~rged: 

1) Job future ambiguity: ATC HCS controllers ranked fifth; 

indicating that they were relatively more certaln abour 

their future in their jobs than most ~ther occupational groups; 

2) Social support from supervisor: ATCs ranked 15th in 

terms of their perceptions of the amount of support provided by their supervisors. The only occupational 

groups reporting lower supervisory support were unskilled and semi-skilled blue collar employees; 

3) Social support from co-workers: ATCs ranked 17th in 

terms of perceptions of support provided by co-vorkers, 

the only occupational groups reporting less support 

were blue collar employees; 

4) Social support from friends, relatives and family: 

ATCs tied at rank 18. There wer2 only three other 

occupational groups reporting leas perceived support 

from their friendship and home social networks; 

S) Role conflict: ATCs tied for 2nd in terms of perception of a low amount of role conflict. The ATC 

HCS controllers, relative to the perso~ in these 

other occupation~t groups, were experiencing 

fairly low perceived amounts of role conflict. 

6) Boredom: ATCs ranked 15th in perception of boredom 

in their jobs. Our center controllers particularly 

saw their jobs as more boring, while the tower controllers were less bored. 

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638 

• 

7. Is there a "burn-out" phenomenon? If so, what is if? 

a. Can the individuals who are more prone 

to early physical deterioration be 

identifiod? 

b. Can we identify work situations t~at 

are more prone to produce widespread 

early physical deterioration than other 

work situations may be, so that early 

counselling and other career possibilities 

can be identified and considered? 

Our definition of burnout related to whether or not a man: 

1. Showed significantly increased work 

dissatisfaction as the study progressed; 

?. Was Selected significantly less often 

by his peers for his competehce; 

3. Developed work role pathology not previously 

present; 

4. Reported significant decrease in his 

ability to bounceback and increase in h1s 

concern about burnout during the course 

of the study. 

rndividuals who had no difficulties in these aress at intake but 

who experienced negative changes in two or more of these areas 

during the courSe of the study were considered cases of burnout. 

Thirty-five men, or approximately 1~% of the 234 men for whom 

we had 5 Rounds of data, showed clear siy,ns of burnout over the 

3 years of the study. 

The phenomenon of burnout relates more to psychological than 

to physical deterioration, as we have viewed it, and is, b~;· otJr 

measures, weighted heavily on individuals' estiAation of their 

own abilities and concerns about their abilities in the futu•e. 

These two subjective factors were combined with the more ohjective 

assessments of work role pathology by m~ans of the P&S interview 

and of competence by means of nominations from co-vOrkera. 

Our definition of burnout required that we follow men through.-

ou~ the study, and therefore, we were not- able to determine the 

relative risk of burnout c:tses for tnedical disqualification. However, the major characteristic of the burnout; case a waa __ their 

• 

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639 

development of psychiatric problems that were not present at intake. Inasmuch as the presence of psychiatric problems represented 

an increased risk for medical disqualification in the other studies 

that we made, it is possible that we would find an increased risk 

for medical disqualification _among burnout cae:es if we were able 

to continue to follow the men we designated as burned out at the 

end of the study. 

Individuals who developed burnout had average or above average 

abilities at the beginning of the study, were enthusiastic and 

vigorous as controllers, had high tension discharge rate, and 

showed less coping by drinking compared to the control group. The 

men who became burned out, therefore, were not from a poorer group 

of controllers and did not have lower peer ratings at intake compared ' to the control group. It was also noteworthy that those who 

became burned out by our definition did not show diminished amount 

of work performed during the days of physiological monitoring over 

· the course of the study nor did they spend less time working. 

It was interesting that the men ~ho w2re promoted (not the sam~ 

13 men who burned out in our study) also showed increased concern 

about burnout prior to their promotiong, although they w~re receiving 

high ratings from their peers on competence. Thus, developing burndoes not appear to be associated with doing a poor job as a 

coln<•roJc~<•<• while concern about developing burnoue is actually 

by those who are promoted and those who actually do burnout. 

There were not clear-cut psychological characteristics that 

liacr:lm:Ln••t,od men who burned out from those who did not, except 

their somewhat increased enthusiasm and vigor on the job, along 

increased psychological coping. 

We were impressed with the subjective nature of the burnout 

he•aa,enc•n and the relat~onship with developing psychiatric probSince burnout may represent a self-fulfilling prophecy, in 

the man with concerns about his fut.ure ability becomes therelea• able~ we believe that parsons manifesting such concerns, 

other evidence of early burnout, should b·e aftorded an opportufor counseling and career planning. Provision of counseling 

mAy also help to deal with this aubjective rhenomenon in 

that would not ~etnforce malingering. 

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Ostfeld, A.M.: The Common Headache Syndromes. Springfield, Ill.: 

C.C. Thomas, 19r,2, 

Owens, W.A., C~~pagna, J.A.: A Selected Bibliography on Biographical Data. Greensboro, NC: The Creativity Research Institute 

of the Richardson Foundatior., 19o5. 

Paffenbarger, R.S., Jr., Thorne, M.C., Wing, A.L.: Chronic disease 

in former college students. VII. Characteristics in youth 

predisposing to hypertension in la~er years. Am. J. Epirlem, 

So: 25-32, 1968. 

Palmore, E • Predicting longevity: A follow-up <'.ontrolliug for 

age, 9erontology. Winter, 1969, 

Paykel, E.S., Prusoff, B.A., Uhlenhuth, E.H.: Scaling of life 

events. Arch. Gen. Psycbiat. 25: 34G-347, 1971. 

Paykel, E.S., Uhlenhuth, r:.11 .• : Rating the magnitudP. of li.f;, stress. · Canad. Psvchiat. As8oc. J. 17: ss93-ssl00, 1972. 

Philipp; U., Reiche, D., Kinhner, J .H.: 'the use of subjective rating. Ergonomics. 14: 611-616, 1971. ~ 

\ 
648 

Qui~n, R.P., Staines, G.L., McCullough, M.R.: Job Satisfaction: 

Is There a Trend? Washington, DC: U.S. Department of Labor, 

Manpower Research Monograph No. 30, 1974. 

Rahe, R.H.: Epidem:l.ological stu,lies of life change and illness. 

Internac. J. oi Psychiat. Med. 8: 133-146, 1976. 

Rahe, R.H.: LHe change measurement as a predictor of illness. 

Proc. Royal S?C• Med, 61: 1124-1126, 1968. 

Rahe, R.H., Meyer, H., Smith, H., Kjaer, G., Holmes, T.B.: Social 

stress and illness onset. J. Psychosom. Res. 8: 35-44, 1964. 

Reinhardt, A.M.: Anomie, socioeconomic status and mental disturbance. Comm. Meat. ii"'o:.lth J. 8: 109-119, 1972. 

B.ei111anis, G.: Psychosoeial development, anotlie ard IIIDOd. J. Pers. 

Soc. Psychol. 29: 355-357, 1974. 

Reiser, M., Weiner, H., Singer, H.T.: Cardiovascular responses and 

their psychological correlates: 1. A study in healthy yo~~g 

adults and patients with peptic ulcer and hypertension. Psychosom. Med. 24: 477-49&, 1962. 

Ridley, C.A.: Exploring the impact of work setisfaction and work 

involvement on marital interaction when both partners are employed. J. Marr. and Fum. 35: 229-237, 1973. 

Riess, W.F., Werdegar, D., Sokolow, H.: 5lood pressure rearnnsea 

to daily life eventa. Trans. Assoc. Lifs. Ins. Med. Dir. America. 

51: 116-129, 1968. 

Rose, R.M., Poe, R.D. :..:Son, J.W.: PaychologicG! state and bady 

size as determinants of 17-QHCS excretion. ~· Int~. 121.: 

406-4!3, 1968. 

B.oaellll&ll, R.H., Friedman, H., Strauss, R., et al.: A pre·Uctive 

study of coronary heart disease: The V ·a tern Collabc•rative 

Group Study. ~ 189: 15··22, 1964. 

Rubin, R.T., Gunderson, E.K., Atthur, R.J.: Life stress snd illn2as 

patterns in the U.S. Navy, V. Prior life change and illness 

onset in a battleship's crew. J. Psychosom. Res. 15: 89-9~, 

1971. 

R.T., Gunde~eon, E.K., Arthur, R.J.: Prior life change end 

illnu1.1 Owaet in an &ttack cattl.er 's crew, II!. Arch. En~~· 

Health. lS: 753-757, 1969, 
• 

649 

Russek, H.I.: Role of heredity, diet and emotional stress in coronary heart disease. ~ 171: 503-508, 1959. 

S..'L~a, S.M.: Organizational role as a risk facto:< in coronary disease. Admin. Sci. Quar. 14: 325-337, 1969. 

S.M., House, J.: Job dissatisfaction as a possible risk 

(actor in coronary heart disease. J. Chronic Dis. 23: 861-

873, 1971. 

B., Bl!ding, A.: Problems and symptoms in army basic 

tr~inees with stress-induced hypertensive reactions. J. Psych~som. Res. 20: 51-59, 1976. -

C.A., House, R.J., Kerr, S.: Leader initiating structure: A reconciliation of discrepant research results and some 

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C.A., Stogdill, R.M.: Differences in the factor structure across three versions of the Ohio State L~ership Scales. P~nonnel P&Y£1!!!!. 2.8: 189-206, 1975. 

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R., Rutenfranz, J.: AttitudeR of air traffic c~~trollers 

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York State Psychiatric Institute, 1968b. 

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650 

Spitzer, R.L., Endicott, J., Fleiss, J.L.: Instruments and recording forms for evaluating psychiatric status and history: 

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,) 

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651 

Thomas, J.M., Bennis, W.G.: Management of Change and Conflict. 

Baltimore, MD! Penguin, 1972. 

Trites, O.K., Kurek,. A., Cobb, B.: Personality and achievement of 

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Weiner, H.: Psychobiology and Huwan Disease. New York: Elsevier, 

1977' 

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lleissenberg, P., Kavanagh, :1.J.: 'The independe:.ce of initiating 

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Personnel Psychol. 25: 119-130, 1972. 

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Arch. Gen. Psychiat. 32: 357-364, i975. 

Psychosoc.ial influences in gastro.intestinal function. 

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, W.W.K.: A self-rating depression scale. Arch. Gen. Psvchiat. 

63-70, 1965. 

Factors influencing the self-rating depression s~ale. 

Arch. Gen. Psy~. 16: 543, 1~67a. 

Depression in the normal aged. Psychosomatics 8: 

1967b. 

W.W.K.: A cross-cultural survey of symptoms in depression. 

Am. J. Psychiat. 126: 154-159, 19t9. 

A rating instrument for anxiety disorders. Pavcho371-379. 1971. 

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Zung, W.W.K.: A rating instrument for anxiety disorders.· Psychosom. Med. 12: 371-379, 1971a. 

Zung, W.W.K.: 

orders. 

1971b. 

The differentiation of anxiet~ and depressive disA biometric approach. Psychosomatics 12: 380-384, 

Zyzanski, S., Jenkins, C.D., Ryan, T.J., Flessa, A., Everist, M.: 

Psychological correlates of coronary angiographic findings. Arch. Int. Med. 136: 1234-1237, 1976. 

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EXHIBITS 

I. Copyrighted and Published Instruments 

A. California Psychological Inventory - available from Consulting Psychologists ~ress, Palo Alto, Calif., 94302; 

B. Jenkins Activity Survey - available from Psychological Corporation, attn. Dr. Richard Hanson, 757 Third Ave., N.Y., 

N.Y., 10017.' 

c. Sixteen Personality Factor Questionnaire - available from 

Institute for Personality and Ability Testing, 1602 

Coronado Dr., Champaign, Ill., 61820. 

D. Zung Self-Rating Depression Scale and Zung Self-Rating 

Anxiety Inventory - published in 

Zung, w.w.K.: A self-rating depression scale. 

!!A:!:r~ch'¥;' ..;Gepn:,:.-4P:.SY.r.;C:.!h"'i;,:;a~t"'-ryf' 12: 63-70, 1965, 

Zung, w.w.K.: A rating inotrument for &DAiety 

disorders. Psychosomatics, 12: 371-379, 1971. 

E. Psychiatric Status Schedule - availabl~ from Robert Spitzer, 

M.D., or Jean Endicott, Ph.D., Evaluation Unit, Biometrics · 

Research, New York Dept. of Mental Hygiene, New York State 

Psychiat'ric Institute, 722 West 168th St., N.Y., N.Y., 10032. 

F. Profile of MOod States - available from Educational and 

Industrial Testing Service, ~an Diego, Calif., 92107. 

G. Job Description Inventory- in Smith, P.C., Kendall, L.M. 

and Hulin, C.L.: Tha Mansurem2nt of Satisfaction iL Work 

and Retirement. Chicago, Rand McNally and Co., 1969. 

H. Kavanagh Life Attitude Profile- in Kavanagh, M.J., 

MacKinney, A.C., Wolins, L.: Satisfa,tion and morale of 

foremen as a function of middle manaf or's performance. 

J. Applied Parchol., 54: 145-156, 1970. 

I. Leader Behavior Description Questionnaire - Published as 

Manual for the Leader Behavior Descriptj~n question~ 

Form XII, Columbus, Ohio State University, Bureau of Business Research, 1963. 

J. MHPI Subacal&s (part ~! Minnesota Multiphasic Personalit) 

Inventory) - available from the Psychological Corporation, 

757 Third Ave., N.Y., N.Y., 10017. .. 
654 

II. Instruments Devised by ATC HCS 

A. Physical examination 

B. Medical questionnaire - labelled as "MED 210 - Review of 

Health History" 

C. Health checklist - labelled "Monthl/ Health Review" 

D. He<1dache questionnaire - labelled "ATC Headache Study" 

E. Sleep quest!onnaire - labelled "Trouble Sleeping?" 

F. Biographical questionnaire - labelled "ATC Biographical 

Questionnaire" 

G. ATC questionnaire - labelled :Fifth Round, PSY 102: ATC 

Questionnaire, Career Attitudes and Behavior" 

H. Sociometric questionnaire - labelled "PSY· 103 - Sociometric 

Questionnaire" 

I. Review of Life Experiences (ROLE) - labelled "PSY 131, 

Fifth Round" 

J. Satisfaction with FM Policy Questionnaire - labelled 

"Satisfaction with FM Policy Questionnaire" 

K. FM Awards Questionnaire - labelled "lM Awards Questionnaire" 

L. Subjective Difficulty Questionna!re - labelled "ATCS Subjective Difficulty Questionnaire" 

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APPENDIX I 

SUPPLEMLNTARY DATA AND TABLES 

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Appendix I - 1 

Specific ATC Variables 

item selection criteria and factor composition of ATC questionnaire 

Job-sped fi~ scal~s. 

The item composition of the ATC questionnaira was analyzed twice to reduce 

number and redundAncy of que•tlons. Th~ first item reduction analys;s wa.s 

~duct<•d on the results from a pilot study of 55 air traffic controil~rs at 

Oakland (Calif.) Air Route Traffic Control Center. The sec~nd item re~u~tion 

ysi$ was cond~cted on the results from the first testing ol' all 416 controllers 

health change study. In both analyses tJ,e same crit.,ria for Item 

used. 

retention were devised prior to any analyses to avoid 

to results. Items were retained if they met all of the followAt least 85% of the respondents answered a que~;tlon. 

Item standard deviations were no less than 0.80 units. 

Item response distributions were approximately normal with no 

worse than 80%-20% split between any two cf seven response 

categories. 

ltem-tofal correlations would exceed 0.30 after excluding the 

given Item from a tot&l score • 

. basis of these criteria, 147 Items were retained In the first Item reduction. 

the ATC questionnaire that was administered to the partlcithe ATC HCS during their Intake examinations. 

the administration of the questionnaire (147 Item version) to all 416 

another Item r~ductlon analysis was performed. The 

us to shorten the questionnaire to, 95 Items for repeated 

~ealth Chenye Study. 

the flr•t administration of ~he ATC qu<-stlonnalre to all 416 controlwe had neglected two important constructs -- anxiety 

t:·Ainhog on the job and an>elety due to having incidents (violations 

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Appendix 1 -2-

of legal separation standards)4 Two sets of six new ite~5 were developed to 

assess these additional constructs. However, since these two scales werP devei 

oped and implemented at the second evaluation, they were not inc1uded in our 

other psychometric work on the ATC Questionnaire. 

The above proce,Jures utilized rational, intuitive, and emrdrical methods 

for scale constrw:ticn. These methods have been found equi'.talent or superior to 

~ther methods such as fa~tor analysis In term• of pred!ctlve v-lidity (Haase and 

Compared to fa~tor analytic met~·.ds, this procedure yields 

greater content specificity and face validity. 

However, since factor analysis was liNely to yield fewer scales with ~ighter 

psychometric properties, we also conducted a corrm:m factorSanalysis wi:':h varimax 

lon (Nie, Bent, and Hull, 1970; Harrron, iJ60). Harrron's (1960) suggestion 

retaining and interpreting only those items with loading gre~ter than .35 was 

to determine the items comprising the factor sc~Jcs. lt,.!ms which h~d signione factor were retained in the factor on which 

lr loadin9 was highest. 

The next series of tables (Ap~endix Tables III.B.S.a.-l-11 display the 

ts of '-he common factors ana J ys is: the i tern loadings, i tern con t~~::nt, fac·, or 

, and the percentar,e of con1n0n variance accounted for. Some- items introd~.o,;ed 

a general question, such as :conslderfng an aver·age 

for you, Indicate how each of the following .•• ", were separate( by the 

items In oth~r scales. For example, ·1 dr!nklng b,.ha;ior that 

of a q~:.stlon asking al1nut methods of coping on ~~ol days may 

loaded onto a "drInk L·,g to cope" factor wh II e a sports actIvity under the 

question may have ber..:~me an Item In the "coping by physical artivlThe original questions are repeated In the following t?~les 

they are necessary to the understanding of th~ respense lt~m • 

. " -~ ...... --------~-~-:::_:-:.=-=-~=~=----· ... "'~·-·~c;,.;;_ • .;....;.. ... .-~~-- _ .......... ......i:Z'~.-:. 'mw~';!""~~v.,,...:~- .] 

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Appendix 1 -3-

ly, Appendix Table III.B.S.a.-12 displays the correlations between 

r scales and their most nearly related!!. prio.!J_ ~<:.,les. It ~"las 

factor scales were primarily conder.sations and minor rec.ombi-

.! priori scales. 

!' 
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Appendix 1-4 

Appendix Table I I I.B.S.a.-1 

Factor Name: Psychophysiological Anxiety Reactions 

• 14.3 

• 32.] 

High scores ~an a large number and frequent occurrences of anxiety 

symptoms before, during and after work. 

Item 

How long does it take to get back to your peak aft~r changing shifts? 

(1 • no tLn~ at all •.• ] • over a week) 

Even.though Air Traffk Control may be a very exciting and rewarding job, to what extent do you feel it has 11cost 11 you personally to b~ ~n ATC? 

(1 • much less than most .•. ; • much more than nost things) 

• 

~~fore going to work when weather and/or tr~fflc conditions were 

b-J, how often did ycu h~ve: 

a) Dlfflcultv getting to sleep rn~ staylr.g dSleep? 

(1 • never ••• ]~ nearly every time) 

b) Uptight, fldg~•y, and tense feeling 

(I • never .•• ] • ~arly every time) 

c) Loss of appetite? 

(1 ~never ••• ]~ nearly eve~y time) 

d) Urset stomach? 

(1 • never ••• ] • nearly every time) 

e) lll•hes that It was r.ot your shift? 

(1 "never ••• ] • nearly every time) 

fl Thoughts about cal I lng In slc.k but not actu.l ly doing It? 

(1 • never ••• ] • nearly every time) 

llhlle working difficult traffic In the lest six months how 

often have yo" f<>lt or e~perlenced aj A lot of perspiration? 

(I • never ••• ] • ~early every tlma) 

b) rour muscles tQnslng up? 

(1 • never ••• ] • nebrly every time) 

c; Feeling uncomfortably ~rm? 

(1 • nGver ••• ] • nearly every tlma) 

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Appendix l-5 

d) A dry mouth? 

(I • never ••• ] • nearly every time) 

e) Feeling "Put on the spot?" 

(I • never •.. ] • n"arly eve··y time) 

f) Tense and worried feelings? 

(I • never ..• ] nearly every time) 

g) Getting more irritable with other controllers? 

(I • never ••• ] • nearly every time) 

Now please indicate now often you have felt or experienced 

the following after you nave been relieved from a long period 

of heavy traffic. How often have you fP.it or experienced: 

a)The realization that ·;~our muscles "''~revery tense? 

(I • n~ver ••• ] • n~ariy every time) 

b) A backache 1 

(I • never ..• ] • ne~rly every time) 

c) Your heart beating very hard or fast? 

(I ~.never ••. 7 • nearly every time) 

d) A headache 1 

(I • never •.• ] • nearly •very time) 

e) A total lack of apf·~tite? (I • never ... ] • nea• ly every time) 

f) Feeling exhausted and In nee<;! Qf rest? 

(I • never ••• ] • nearly every t!me) 

Considering an average work day for you, lndlcace how accurately 

each of the following statements describe usual things you do to unwind at the end of the day. 

a) I prefer to be a lone to recuperate. 

(I • ~tremely Inaccurate ••• ] • extremely accurate) 

When you ~re having a poor day, such as described above, how 

work? often do you use each of the following ways to cope with 'tat 

o) Drink more coffee or other stimulants. ,, (I • never ••• 7 • ..arly always) 

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Appendix 1-6 

Appendix Table III.B.S.a.-2 

8. I Factor Name: ~oocl Controller 

• 18.J 

High scores mean a controller endorses answe1·s of a socially desirable (for controllers) nature, 

Items 

How is the quality of your work affected immediately after changing onto your 11 least 11 preferred shlft? 

(I • work quality ~~comes much worse •.• ]-work qu~lity becomes much better) 

Once you come bac~ from a week or more of annual leave, how long does it take you to 9et up to peak again? 

(1 • a month or more •. . ]:a day or less) 

Hy own standards of performance are higher than those in the FAA rules. 

(1 • completely false ••• ] • completely true) 

I am constantly reviewing my performance throughout a shift against my own set of standards. 

(1 ~ C:l'!lpletely false .•• ] • completely true) 

I try to get assigned to technically challenging sectors so that I won't 96t bored. 

(1 • completely false •.• ] • compl~tely true) 

Compared to other controllers, I keep my cool better in very difficult situations. 

(I • completely false ••• ] • completely true) 

People can easily tell from my words and actions how I really feel about them: 

(1 • Completely false ... ] • completely true) 

Compared to other cuntrollers, I can easily return to peak performance after e bad time on the boards. 

(I • completely false ... 7 • Completely tru,.) 

Con!lderlng a11 average wor~ d~y for you, ln<tlcate how acturate1y 

each of the following statemen<s describe u•ual things you do to unwind at the end of the day. 

a) I just do whatever's handv, 

(1 • never •• ,] • nearly every time) 

Overall, considering only those thing• which you do to unwind, 

which you rated abov.,, how helpful are ti'ey In ass1stlr•g you to unwind at the end of a day? 

(I • extremely •Jnheipful ... ] • extre..,)y ~ ... l.,ful) 

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Appendix 1-7 

Most controllers have days when they feel on tep of the 

world, I ike they could handle traffic of four sectors 

at once and master every situation thc.t arises (well, 

a I most). In an average working month of about 20 days how often do you feel really topnotch? 

(I • 0-2 days ••. ] • 13-20 days) 

GlvM those activities which you CJursue, how much overall 

gratification and reward do you r;et from these activities? 

(I • very ungratlfyinq and quite overextended •.• 7 • very gratifying anJ rewarding) 

• 

• 

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Appendix 1-8 

Appendix Table III.B.S.a.-3 

Fact•or ll<ome: Coping by [i· inking 

~ 3.8 

- 8.6 

High scores mean that an ATC depends on drl nk i ng a I coho II c beverages for relaxation and coping. 

I find I have to drink more to get the same rel'ef. 

(1 • completely false ••• ] • completely true) 

If I'm not able to drink, 

to unwind. find it ext·ernely difficult 

(I • completely false ••• ] • completely true) 

Considering an average work day for you, Indicate how 

accurately each of the following statements describes 

usual things you do to unwind at the end of the day. 

a) go out with the guys for a drink. 

(I • extremely Inaccurate ••• ] • extremely accurate) 

Given the twenty working da·fs in an average month, Indicate 

how many days (out of twenty) ~ou would usually do each 

of the following: 

a) I drink alone at home. 

(I • 0-2 days ••• ] • 18-20 days) 

b) I drink with a few friends. 

(I • 0-2 days •.• ] • 18·20 days) 

c) I don't drink. 

(I • 0-2 days ••• ] • 18-20 days) 

On the whole, how helpful is drinking in helping to unwind 

and relax at the end of a working day. 

(I • not helpful at all ... ] • the best thing) 

People often pursue other Interests outside their jobs, We 

would like to know If you have pursued any of the following 

activities in the last six month•. U•e the scale below 

for indicating how much time, on the average, you gt~e to the following activities. 

a) Dating, drinking, or partying. 

(I • 0-2 hours a week ••• ] • 18-20 hours a week) 

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• 6.] 

Appendix 1-9 

Appendix Table III.B.S.a.-4 

Factor Name: Social Coping Resources 

m-.an a high level of $Oclal coping resources. 

Items 

If you or your famll y were struck by a crIsIs or tragedy, 

how many ~ersons of the following categories could you 

really count on to he I? yo"1 For these purpose•., count a 

married couple or a family unit as "1". 

a) Among relatives. 

(1 • none ••• ] • 10 or more) 

b) Among friends. 

(1 • none ••• ] • TO or more) 

c) Among people at work. 

(T • none ••• ] • TO or more) 

How many people do you consider close friends who live 

within an hour's drive of your home? 

(I • none ••• ] • TO or more) 

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3.2 

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Appendix 1-10 

Appendix Table III.B.S.a.-5 

Factor Name: Work Avoidance on Bad Days 

scores mean a controller avo!ds work on difficult days. 

I terns 

When you are having a poor day, such as described above, 

how often do you use each of the following ways to cope with it at work? 

a) Try to get assigned to a sector with a light load 

(1 ~never ••• ]~ nearly always) 

b) Take longer brP.aks. 

(1 ~never ... ] • n~arly always) 

c) Take more breaks. 

(1 ~never .•• ] • n~arly aiways) 

d) Find a work partner that understands and can help out. 

(I ~never ••. 7 ~nearly ah-:ays) 

e) Find a friend or dlversiGn to take your mind off th<> problem. 

(1 ~ never ••• 7 ~nearly alwavs) 

• 

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Appendix 1-ll 

Appendix Table lll.a.s.a.-6 

• 1.9 

4.) 

Factor Name: Subjective Costs 

High scores mean a high level of subjective costs. 

--------------------~'~e~m~s---------------------------

ATe work may affect many Other areas in your life. Use the 

scale below for Indicating how each of the following areas have been affected for you. a) Fdendshlps. 

( 7 • ATe work has interfered tremendous !y !;; this area •.• 

1 • ATe work has helped tremerodously in this area) 

b) Social Life. 

( 7 • ATe work has interfered tremendously In this_acea ... I • ATe work has helped tremendously in this ar~a) 

c) Relationships with wife or girlfriend. 

( 7• ATe work has Interfered tremendously In this area •.• 

I• ATC work ~as helped tremendously In this area) 

ci) Family life and relations with children. 

( 7 • ATe work has Interfered tremendously In this area,. 

1• ATe work has helped tremendously In this area) 

e) Physical health. 

( 7• ATC work has Interfered tre~ndously in this area,, 

I • ATC work has helped tremendously In this area) 

f) Peace uf ml nd ., 

(7• ATe >tark has Interfered tremendously In this area,, 

1 • ATe wt•rk has halped tremendously In this area) 

''"' 
APpendiX l-12 

Appendi~ Table III.B.S·a.-7 

Factor Name: Bounceback-Burnout 

this factor mean high bounceback. Low scores 

mean high burnout and low bounceback 

In the past sl~ months It has been becoming more difficult for me to bounce back to peak performance when I've 

been away from the ~oards. ( 7 • comple•eiY false •.. I• completelY true) 

In the last sl~ months, I've been flndln9 It Mrder to 

shift between peak and slOW perlcds. ( 7 • com?letely false •.• I, • completelY true) 

H'W often do you find yourself worrying about your own 

11but·nout11 'l (I • never ••• i • constantlY) 

At the present time, hOW close to "burnout" do you feel? 

(7 • e~trei!I"IY close ... I • e><trc,.,IY distant) 

, .. ,,, 
• L6 

- 3.6 

Appendix l-13 

Appendix Table III.B.S.a.-8 

Factor Name: Investment 

• 

High scores mean a high le·1eJ of investm.:!nt in activities 

characteristic- of ••super-Controll ers" 

Items 

! greatly disli~e having to restrict aircraft prior to 

their entering my sec.to·r. 

(I • completely fals~ ••• 7 • completely true) 

When working a co,blned sectur well, I don't !ike to have 

anyone suggest decombinlng 't. 

(1 a completely false .•. ?- completely true) 

Even w;1en ~ 'm under IJ:'R pressure, I don• t feel f 'm doing 

a complete job unless I proviGe VFR advisories. 

(1 • completely false ••• ] • completely true) 

It Is extr_.,.,."'1mpoftant to ~-'te'···..-y and fill pilot 

requests even when their requests wfiJ cause me extra work. 

(I • completely false .•• ] • completely true) 

I try to do so~thlng extra in every shift so that I'll 

end each shift with a sense of accomplishment. 

(1 • cono/letely false •.• ] • complete;y true) 

I try to g~t assigned to technically challenging sectors 

so that I won't be bored. 

(1 • completely false ••• ?~ completely true) 

• 

i 

I 

• 

{ 

' I 

I 

I 

I 

• 

I

I.: 

" 

• 

!']·,; 

'·-~· 

:J 

·/. 

·f 

.j 

' 

:. 

' ~ . 

i 

.I 

.i 

. I 

i 

'j 

,, 

. ' ''! '· •'I 

1r. 
Loading 

. 51 

.;o 

. 36 

·55 

.64 

.56 

Appendix 1-14 

Appendix Ta~le III.B.S.a.-9 

• 2.J Factor Name: Tension Discharge Rate 

• S.J 

Each item was scor~d in rever~e such that a high score 

meant a high tension di~,:~~arge rate. 

I terns 

After I have left th~ bc>rds I c>ntinue thinking ~oout all 

mind. the possible co.1fl1cts and work them through again In m) 

(1 • completely fal$e •.• 7 • comrl•tely rrue) 

I s:ay in "high gear" and have tcouble r..,laxing once I leave work. 

(1 • completely false .•• 7 • complvtely true) 

Over the past few months, find it is becoming increas;ngly difficult to unwind at the end ~fa shift. 

(1 • com~letely false ... 7 • cor .. Hely true) 

When I get home after we>rk, ano so preoccupied with 

what happe.1ed on the job that I can': '" 1 k wl ~h my wl fe or frlendo. 

(1 • completely fals"'···7 • coo.lpletely true) 

Even when I'm awey from Air Traffic Cont•olllng I spena much of my tl~ thinking abcut ATC ~k. (1 • complete:y false ..• 7 • complet~ly true) 

In describing me, my friends •1oufd say that I eat, drink and think ATe. 

(I • completely false ••• 7 • completely true) 

I 

I 

i 

! 
1.3 

- 2.9 

• 

Appendix 1-15 

Appendix Table I II.B.S.a.-10 

Factor Name: Physical Activities 

High scores mean more use of physical activities for coping 

Items 

• 

Considering an average work day for you, indicate how accurately 

each of the following statements describes"sual things you do 

to ~nwind at the end of the day. 

a) I take a walk to relax. 

(1 • extremely inaccurate ... 7 • extremely accurate) 

b) do strenous exercise or some physical sport. 

(1 • extremely inaccurate ... ? • extre•nely accurate) 

c) start doing a hobby. 

(1 • extremely inaccurate ..• ] • extre~1y accurate) 

People often pursue other interests outside their jobs. 

We would like to know if you have pursued any of the 

following activities in the last six months. Use the scale 

below for indicatin9 how much time, on the average, you .give to the fo1 lowing activities. 

a) Ph)': i ca I sports, such as baseba II , baske tba I I , bowl i ng, hockey, fishing. 

(1 • 0-2 hours a week ..• 7 • 18·20 hours a week) 

• 
Loading 

• 78 

.62 

.6) 

·79 

Appendix 1-16 

Appendix Table III.B.S.a.-11 

1.2 Factor Name: Marital Coping Resources 

• 2.6 

High scores mean high marital resources. Unmarried men received no score. 

Items 

How much support do you feel your wlf~ provides you In coping with the pressures of your job? 

(I o she crlticizes·me tremendously ••• 7 • she supports me tremendously) 

How often do you talk with your wife about your feelings that are a consequence of your work? 

(I • 11!!Ver or extremely rarely .•• 7 • more than <VIce a d11y) 

How do you feel about your wife sharing her trials and tribu- lations of the day when you arrive home? 

with (I • me.) I hace lt ••• 7 • I really like her to share her problems 

How "nderstandlng Is your wife of your need to unwind at the end of a day's work? 

(I • complecely lacks such an understandlng ••• 7 • extremely understanding) 
Appendix 1-17 

Appendix Table III.B.S.a.-12 

Correlatlors Between Factors and 

the Host Neatly-Related!. priori Scales 

Co'felatfon 

·92 

.87 

.80 

ler .so 

.45 

-.38 

·97, 

Days .96 

·95 

• 79 

-.n 

·95 

.99 

Physical Activities .8R 

1.00 

ng Resources 1.00 

/ 

wl th Host N~rly-Related a priori Scsle(s) 

During Work Anxiety Symptoms 

After Work Anxiety Symptoms 

Before Work Anxiety Symptoms 

Investment 

Boun.:eback 

Burnout Concerns 

Drinking to Cope 

Tension Discharge Mechanisms on 

Bad Days 

Subjective Costs 

Bouncebaclt 

Burnout Concerns 

Investment 

Tension Discharge Rate 

Coping by' Physical Activities 

Harltal Coping Resources 

Social Co~lng Resources 

I 

I 

I 

I 

! 

J 

J 

t 

f 

f 
• 

• 

Appendix 1-18 

tll.a.s. Peer Nominations for Competence: Background 

General Valldi ty of Sociometric Ratings 

Using sociometric (peer) ratings to predict future performanr3 b""avlors 

has been successful in the evaluation of naval officers (Hollander, 1956a, 

In the selection of life Insurance salesmen (Mayfield, 1970; Weltz, 1958). 

predicting managerial success (Kr;,ut, 1975; Roadman, 1964). In fact, In 

• 

of ?rediction of managerial performance over time, Korman (1968) concluded •• 

s review ~f the literature by noting that peer ratings are better predictors of 

~erlfor~mar>ce than psychometric procedures, and better than n Jst tests (p. 319). 

extensive reviews on sociometric nomination studies (Lindzey and Byron, 1969; 

nand Zwany, 1976) reached the same conclusion as Korman. Thus, the ATC 

could be expected to have a strong relationship to actu&l ATC 

Peer nomination• also have demonstrated good Internal consistency •nd testrei labilities acrosr a variety of situations (Lewin and Zwany, 1976). 

more Importantly, high rellabllitles have been reported after relatively 

Interaction times with peers. HollandPr (1956b, 1957) found •·ncorrected 

t-half rei labilities of approximately .90 for peer nominations after only 

to five days of lnterilctlon. Furthermore, these. spilt-half rellabiiJtles 

change significantly over time, and the rei labilities across se•slons 

t-retr!st reliabll ity) were Just as high. In his later study, Hollan.:ler 

w~ek (of Interaction) -- and perhaps 

nomination score Is stabilized ••• 

• 11 Thus, p,·evlous studies indicated that sociometric nominations are 

lable and stable. 
Appendix l-L9 

specific indices, e.g., group cohesiveness and within-group status, 

the nominations, speclfk empirical evldenc" of relationof these variables to health change MS been somewhat meager. .Izard (1959) 

that peer namlnatl~ns of Naval Air Training Carlets were related to psychoe complaints. Trainees who received significantly lower peer evaluations 

significantly more psychosomatic complaints. This study Is highly 

tlve and unfortunately Is the only >tudy that examined the relationship 

n~inations to a health-related r.rlterion. After an extensive review 

, Korman (1968) concluded that peer nominations a~sess a person's ability 

adequately in a complex, dynamic environment. lr: this study, t:e 

predicted, or moderated, health changes 

env I ronmen t. 

of names on 'ists from which a man could be chosen 

ar·rec:< the frequency of being chosen. In fact one can calculate the expected 

being chosen If all choices were random. Each crew must be connumber of men Is dlffere~t In each crew. 

the number of men on crew A who can choose a member of that 

P1 be the n.,.,~er of men on each of the sister crews thoot can 

Let Tl, TZ, and TJ be the total numoar of name' on the 

crew A and the sister crews resp~tiYely. Then the probability of a 

A being chosen r•o4amly by men on crew A Is Pl/Tl. Similarly, the 

les of a man In each of the sister cr~ being chosen from hls.slster 

ore P2/T2 and P3/T3. Furthermore, each of these PI, P2, and P) men 

votes (3 choices for each of t~ree ~uestlons). Thus the total expected 

I 

:q 
Append 1X 1-20 

of choices of any one man by chance would be 9 (Pl/Tl + P2/T2 + P)/T3) 

questions. 

possible Influence of ranciomly expected scores, we computed all 

relevant figures for Logan Tower (N • 35). We found a non-significant 

between the rand~ly expected total number of times a man 

the total number of times a man was actually chosen by his 

In addition a non-significant correlation (r • .07) was found between 

of men w~ could choo,;e an ATC and the n<wnber of times the same ATC 

• Finally, If we adjusted the raw total number of times a given ATC 

by the ~xpected number of times he would be chosen at random, the 

tlon between the adjusted number of choices and the actual number of choices 

results clearly Indicated that an adjustment for expected choices was 

• We could use the uncorrected number of times a man was chosen by 

of interest for each qu~stlon. However, the question 

to whether or not t~e above results mav have been due to restricted 

deviation•, and/or ranges In the variables. Appendix Table I II. 

that this was not the case. The results in the table show a good 

reasonable varlublllty for these scores. 

~_eendlx Table lll.a.s.a.v.-1 

Statl<tics on Soclo..,etrk Total 

Choices ~t Looan Tower 

( N • 35) 

Number of Times 

Selected by Other 

ATC 

9.0 

9-26 

0.41 

Number Who 

Could Choose 

ATC 

10.5 

5.7 

7.14 

Expected Number 

of Cnolc~s for An 

ATC 

8.5 

0.9 

6.5 - 9.8 i 

I . I ;, ~,, 
• 

• 

Appendix l-2l 

check on the validity of using the uncorrected number of choices 

For the Logan Tower ATCs, the number of men w~o could choose a 

very hl~hly correlated with the number of men from which the given 

make hi• choices (r 2 .91). Thus, we could use the latter as an 

of the actual number who could choose an ATC In order to study ~11 416 

correlation ~etwe~n the estimated number of men who could choose an ATC 

times that ATC ~as cho>en by those men was .01 across all 416 

we were confident In usln,i the uncorrected number of times an 

for each ques:lon and forth~ total scorn. The theoretically 

adjustments for the ~robablllty <>f being chosen w~re not necessary. 

some possible sociometric varl11bles could be based on the number of 

choices of an ATC, the same probability of choice problem could have 

the ·•ame procedures and statistics to determine If adjustments 

the scores ba•ed on choices by team members. We found nn 

tloe rllndomly expected number of choices and the 

of choices made by tear-t members and, onc.e again, th!:re was a very 

!cant ,·elatlonshlp between the theoretically adjusted ~~Core and the 

of team "'ember selectl.ons of an ATC (r • .88). Consequently, 

any adJustments for·these kinds of scores either • 

.. else. Consequ~ntly th~se r~llabllltle5 

• For our SPRQ., test•ntest ellablllty was a more lo.portant 

It lndlcatos the st.,.blll ty ~f tl•e measure<! variable 

• 

• • 
Appendix 1-22 

The thrP.e main scores we derived from the SPRQ were ideal team choices, 

illty choices, and competence choices of a given ATC by his peers. 

lx Table III.B.S.a.v.-2 displays the test-retest reliability coefficients 

these three ~cores over two separat~ Intervals which averaged nine months 

re-test. 

team choices 

Ill ty cho lees 

omo·ett!nce cho l ces 

Appendix Table III.B.S.a.v.-2 

Test-Retest R~liabilltv Over """iT:::wo~is::uc:-c;:e:-s;;s f'V;;Tnw\l;aTs-

.:.1 !!n.>.:te:::,:r_,v~a.:.I_,__-_::;N.;. 3 77 

.n 

• 70 

76 

Interval 2 - N•3~ 

.69 

71 

79 

The resulto shown in the table above Indicate that the number of times an 

was chosen by his peers for three different characteristics was very stable 

~successive nine-month intervals. 

The eighteen monlh reliability coefficients (obtained by combining the two 

lne,·mc>nth Intervals) were .64, .63, and .]2 for Ideal, amicability and compechoices respectively. Even over this very long period of time, contro: lers' 

ces of one another remained relatively stable, f .rther Indicating the value 

these measures In the study. 

.. ... 
Appl!ndix 1-23 

Appendix Table 111.B.7.·1 

Peak Traffic Statistics Used To Obtain f:lgnnalbgd Wnrk!aad Measures 

NYARTCC 

4.383 

2.647 

ObservatIons 12998 

,, '·'I 

Arrival Transition En route Trans! t ion E~route Rooot ,, 

' 

H Low Low HI 

3.636 4.785 5. 114 4.099 5.027 4.472 2.236 2.527 2.599 2.533 3.010 2.683 '1 •li: 

547 390 185 525 696 2343 ,, 

'\ :I 

,., •·•11 

3.96~ 4.686 4.681 4. 15i 4.565 4. 326 2.416 2.457 2.690 2.452 3.283 2.647 2b11 1777 640 1690 1470 8190 :: ' 

I 

I 1-',~'1 

3.278 3.091 4.765 2.583 3.585 1.602 I. 814 2.538 • 1.621 2.053 1a 11 17 12 65 :.· 

!' 

'j'i 

4.~43 4. 745 5.177 3.!}84 5.247 4.513 ,, 

~i, 2.275 2.675 2. 718 2.094 3.499 2.'615 ,;,,~ 

808 443 220 564 364 2400 

3.982 4.70~ 4.861 4.107 4.780 2.366 ' 2.504 2.68~ 2.)98 3.251 . <i 

3984 2621 1062 2786 2542 ' 

'' ::; 

l· 

!cable In this facility 'i, 

;I: 

data -- co1um ~U111N1ry st3tf·stl cs were use_d- •• th• bett sstfmates; " ' ., ' :~ 

-as not a• .. ·allable rcw suma1ry •tathtlcs , .. re u&tJdi If both coluom . •.,. 

istlcs could not b<1 calculatea the overall facility statistics were used. !I 'r ,!I In the following way: lle~n 

'I St&ndard Deviation '.' i i- ~ Number of observations 

) 

.'f-

. f, 
Appendix 1-24 

Append1A Table 111.8.7.·2 

• 

Pe&k Trarflc Statistics Used to Obtain Nvrmallzed Workload Measures 

ty - BOSARICC 

<.630 

I. 836 

of Observu Ions 5333 

Arrlv•l Transition 

2.502 

• I. 715 

305 

2.~81 2.925 

I. 514 1.793 

54 92(1 

• • 

3.161 

• I. 8"!6 

:Ia 

2.850 

I. 792 

1344 

oppllcoblo In this foclllty 

En route 

1.560 

I. 387 

H 

1.912 

I. 755 

91 

• 

2.900 

I. 668 

30 

2.055 

I. 729 

146 

Transition 

2.38~ 

1.793 

177 

2.~93 

I. 805 

1968 

• 

2. 712 

I. 719 

156 

2.479 

I .SUI 

29:i5 

i!nroute 

1. 799 

2.013 

273 

2.~1.3 

I .9t0 

530 

• 

3.07~ 

1.989 

54 

2.906 

1.982 

865 

Row 

'L 

2.~77 

1.823 

1389 

2.654 

1.636 

3563 

4.188 

2. 198 

16 

# 

2.921 

1.812 

365 

• 

lont data-- column su~ry statistics woro used •• tho best ostlmote•; If 

'""""''"' w11 not a"nJiable row SUJP!ff>try tttatlttlcs want used;; If bntfl cnlumn 

statistics could not be calculated tho overo!l facility statlstlct were used. 

In the following woy: Hun 

Stondard O.•lotlon H~r of ~bsorvotlona 

• 

• 

' 

I 

I 

I 

I .-. 

1.; 

' ;, ( 

. ".;~·

.'

.
Appendix 1-25 

Appendix Table 111.9.7.-3 

Peak Traffic Statlttie'l Uc:ed to Qbtafp. Hormat I ted Workload Ucasures 

• N/A • • • • 

).23~ 

1.675 N/A • • ~.237 

• 1.669 

355 3S8 

].102 ).~62 ).085 1.7~7 N/A 2.1~~ I. 307 

]. 176 

2.167 

2681 65 71 17 

ltablo In thl•l fu!llty 

dolo •• e<>I<>M ~·....,.ry otatlstlcs were used .s tho belt ostlNtos; If 

was not ovall-blo row •~ry stotlstlcs waro utod; If both column stl<~ e<>-.ld not be clllculo<ftd tho overall hclllty statistics ..,.routed. 

In the following way: tlean 

Standard Oovlatlon 

NUIIIber of obsorvat lont 

' 

,, l 

l 

l 

' ' 

l ' 

' 
Appendix 1-26 

Appendix Table 111.8.7.-4 

lt'eak Trafflc Statistics !Jsed to Obtafn-Norma1Jzed Workload Measures 

LOGAN 

2.444 

1.757 

of Obse,vatlons 1310 

2.807 

2.142 N/A * N/A N/A 

238 

2.373 

I. 702 N/A • N/A N/A 

868 

• N/A • N/A Hili 

2.299 

1.427 N/A • N/A N/A 

197 

2.441 

1.761 N/A • N/A NiA 

lJ03 

applicable In this facility 

2.807 

2.142 

238 

2.378 

1.697 

875 

• 

2.299 

I . ~7.7 

197 

lclent data-- column summary statlltlcs we'e used •• the bast estimates; If 

suom&'Y was not available row summa'y statistics we'e used; If both column 

statistics could not ba colculatod the ove,all facility st•tistlcs wa'e used. 

reads In the following way: Hun 

Standa'd Deviation ~wmber of obse,vatlons 

. :-.. 

·<
• 

Appendix 1-27 

Appendix Table I II .8.7.-5 

• 

Peak Traffic Statistics Used To Obtain Nonnalized Workload-Heasur(.s "": 

BRADLEY 

1,622 

1.214 

r of Observations __5.QJJ__ 

• 

En route 

1.854 1.884 

I. 476 N/A • NIA • 1.451 

41 43 

•. 600 I. 580 

I. 199 NIA • N/A • 1.192 

402 414 

• N/A • N/A • • 

I. 745 I. 745 

I. 354 N/A • N/A • I. 354 

51 51 

1.6)6 1.273 

1.240 N/A • N/A .905 

494 II 

Not applicable In this feclllty 

cle.1t data ... _ colu~ sumnary statistics were used as the best estimates~ If 

sum\c1ry was not liYaflabJe rO¥J SUIMUJrY statistics were us~d; ff both column 

• 

row statistics could not be calculated the overall facility statistics were used. 

re•ds In the following woy: He•n 

Standard Deviation 

Number of observations 
Appendix l-28 

Apper.dlx Table 111.8.7.-6 

,P.,ak Traffic Statistics Used to Cbtafn Normalized workload Measures 

Facll i ty ---lWJJ.ONILS;uE:.JT'-----

I 782 

I. 382 

of Observations 377 

1.919 

I. 505 

14& 

I. 728 

1.289 

217 

• 

* 

1.805 

1.382 

365 

* 

* 

• 

• 

Not applicable In this facility 

N/A 

N/A 

N/A 

N/A 

N/A 

Enro:Jte liar;. 

Hi2h su .... ry 

1.900 

N/A * 1.505 

150 

1.705 

N/A * 1.292 

227 

N/A * 

N/A • 

N/A ,, 

•.. 

ent data -- column summary statistics wer~ used as the best estimates: !f 

'ummory was not avalleble row su~ry statistics were used; If bot~ column 

row statistics could not be calculated the overall facility statistics were •.s&<l. 

roods In the following way: MeaA 

Standard Oevlotlon 

Number of obtervatlons 
• 

Appendix 1-29 

Appendix Table Ill .8.7.-7 

~eak Trafftc Statistics Used To Obtajn Normalized Worklga( Measures 

OTIS 

2.070 

I .491 

Observations 328 

2.054 

1.5"·8 

Ill 

2.136 

1.479 

177 

• 

1.825 

1.3~4 

40 

2.070 

1.491 

328 

N/A 

N/A 

N/11 

N/A 

N/A 

licable in this facility 

En route 

N/A N/A N/A 

N/A N/A N/A 

N/A N/A N/A 

N/A N/A N/A 

N/A N/A N/A 

• 

2.054 

1.548 

Ill 

2.136 

1.479 

177 

* 

1.825 

1.394 

40 

data -~ column summary statistics ware used as the best estimates; If 

was not available row surrmary statistics were used;_ If both coiUfftft 

sties could not be calculated the overall facility statistics were used. 

In the following w~y: lleen 

Standard Oevlation 

Number of observat Jo:n 

• 

• . 'I 

··I 

' 

' 

{ ' 

' { ',!) 

f 

i 

, 

I 

I 

! 
Appendix 1-30 

Appendix Table 111.8.7.-8 

~eak Traffic Statistics Used To Obtarn Normal ize.d Workload Hea~ 

PROV I OENCE 

1.175 

1.171 

of Observations 63 

0. 778 

1.060 

18 

1.333 

1.187 

45 

• 

* 

I. 175 

I . 171 

65 

N/A 

N/A 

N/A 

N/A 

N/A 

Not applicable In this facll lty 

N/A 

N/A 

N/A 

N/A 

N/A 

En route Row 

H 

0.778 

N/A N/A 1.060 

18 

1.333 

N/A N/A 1.187 

45 

N/A N/A • 

N/A N/A • 

N/A N/A 

flcient data -- column su~ry statistics were us~d as the best asllmatc$; tf 

summary was not available row summary 1tatlstlcs were used; If both co'umn 

row statistics could not be celculated the overall facility statl•tlc: ~r• usod. 

reads In the following way! Mean 

Standard Deviation 

N-r of obsorvat Ions 
Appendl.x 1-31 

Appendix Table 111.8.].-9 

Conversion of Normal fzed Workload To Raw Planes For Fa!t;IIJtx h}(g I 

Raw PI anes 

Sum of Maximum Range in 

Norma I i zed Peak Traffic Peak Traffic Peak Traffic 

Workload Mean Mean Mean 

Range N2 (S.D.) (S.D.) {S.D.) 

11.39 3.44 3.33 J~J-m 18 (7. 4~) 

2).29 

(I. 10) 

4.29 !J.H) ).88 

4oz-42l 41 !Z·6~! (. ~Jl {I. OO! 

25-90 4. I 4. 10 

425-4 )6 58 (P4! 

2~.68 !J • O~! no 

(1.40) 

4.74 

432·442 72 (8.lJ! 

)1.2) 

p.ol) 

s.86 (I. i2l 4. 3 

4~0-462 "Z po.os) ( 1.1 ~! {r.~l) 

)).66 6.49 5.)0 

46l-4Z4 Ill (8.86i !'. 22! (1.72! 

39.55 6.96 s.4s 

4Z2·48Z ll2 ~~·6l! ).84 

(1.12) 

7.82 

p .6~) 

6.20 488-~12 212 (~·~2) 

49.74 

( l.l6! 

8.41 

(I .68) 

6.)3 2.!4-~26 10~ 't. ll) !J .IO! {I. ~6) 

§ .oo 9.)2 7. 14 

~2Z-~4o 81 po. 48! !' .41) !'. 75! 

sii.11 9-97 7. 77 

66 g2·l~l (1.4~! IJ.S!) 

0-97 10.]9 8.21 

67 (10.92! 

66.29 

(1.7(1! 

11. o8 (2 ·lll 11.15 

48 (ll·:!O) ( r. ZS! ~l.6!! 

]0.97 11.76 9.28 

Hormollzed workload Is the sum of normalized pe4k traffic, normallz~d maximum 

peak traffic, and normalized range In peak tcafflc. Normalized workload was 

lculated on 26)2 m.n·days Jf ob,ervation and pu~ ~ a seale where the meAn 

Is SOO and the standard deviation Is Sll. 

who ~re never on • 'IIIIOrking positft1n artt exciud•d. 
• 

AppendLt 1-32 Appendix Table 111.8.7.-lc 

Conversion of Normaliz~d Workload to Raw Planes for Facility Nashua 1 

Sum of 

Peak Traffic 

Mean 

Raw Planes 

Maximum 

Peak Traffic 

Me•n 

Range in 

workiQOd Is tho sum of normalized peak traffic, normtllled ~xlmum 

c, end normalized r·onge In pe•k traffic. Normollzed worklo.oJ was 

on 2632 mon-days of ~~servatlon and put on a scale whore tho mean 

tho •<andord deviation Is 50. 

working position ar~ exclud~d. 

• 

• 
Appendix 1-33 

Appendix Table 11!.8.7.-ll 

Conversion of Norn~lized Workload to Raw Plane' for Ftclllty !fRI 

Sum of 

Peak Traffic 

1'\ean 

Raw Plane~ 

Haxfmwn 

·Peak Traffic 

Hun 

Range in 

Peak TraTfl c 

1'\ean 

lzod workload Is the suo of norNIIzed peak traffic, norNllzed Nxl...,. 

ftc, and normalized range In peek traffic. NorNtlzed workload·,..• 

on 2632 mon•days of observation and put on a scale whore the .... and the standard deviation Is so. 

_were nevttr on a ...,rklng pos! tlon ere er.cluded. 

f 

i 

~ 

! 

i j 

i \ 

u 
~ppendi>: 1-34 

Appendix Table 111.8.7.-12 

Conversion of Normalized Workload to Raw Planes for F~cility Logan! 

Sum of 

Pe•k TraffIc 

11ean 

Raw Pianes 

ttaximum Range in 

Peak Traffic 

workload Is the >um of normall>ed peak traffic, nnrmallzed 

traffic, ond nor~dli•ed range In peak traffic. Normallze~­

calculated on 2632 man-days of :>bservatlon and p~t on a 

tho mean Is 500 and the llandard deviation lr SO. 

never on a working poolt!i>n are exduded. 
Appendix 1-JS 

Appendix Table I II .8.7.-13 

• 

of Normalized WOrkload to Raw Planes for The Smaller Facllfties 1 

Sum of 

Peak Traf;::lc 

Mean 

(5.99) 

27.67 

kaw PI anes 

Maximum 

Peak Traffic 

Mean 

Range In 

Peak Tr.1ffic 

-i1ean --

load Is the sum of norttw~ll zed peak traffl c. norma I i zed 

traffic, and nortnallzt!d range In peak traffic. Normalized 

.c•lculatcd on 2632 man .. days of observation and put on 1 

mo•n Is 500 ond tho •tandard deviation fs 50. 

lltfet •re Quonset, Otis, ar.d Prov,dence. 

never one working poSition are excluded. 

• 

• 

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Appendix Table 111.1.,.•1 

..!!L 

ruu Ui!2Y 

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lt&xl- Sxstollc At Work 

ALL "st13JECTS 

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Appendix 1 - 41 

J'\f]pendf;c Table 111.8.9.-6 

Corretatfons Amon~ On-Position CardJova$r.:ular ' 

Me.1Surcment.s of AIr Traffic Controllers 3t Work: First Studl 

N* • 349 • 353 

{I) (2) (3) (4) (5) (6) (7) (8) (9) (10) (II) (12) 

1.Average 1.00 

2.Range • 24 1.00 • 

3. H<ox I mum .89 .62 1.00 

St•ndard 

4.Devlatlon .30 .91 .62 1.00 

5 ,Average .ss .05 .;,a .II 1.0~ 

6.Ronge .12 .42 .2] .28 .o6 1.00 

7.Haxlmum .56 .23 .55 .23 .88 .47 1.00 

Standard 

8.Devlotlon .!9 .)0 .27 .)0 .13 .90 .49 1.00 

.28 .18 • )I .20 .17 .06 • 18 .13 1.00 

.09 .)7 .23 .23 .to .20 .18 .07 .30 1.00 

.26 .)0 .34 .26 .18 .14 .22 .14 .89 6'' • • 1.00 

.II .22 .18 . ~ 8 .14 .08 .15 .05 .. •O .92 .65 1.00 

*Excluded subJectl on antl·hypertonslve medications·. The •~h)£ctl who wero 

never on4Posftlon •r• al1o excluded. For some tubjects ~he r6qufslt• date• 

points r~r calculating a given v•rlable ~ra not avell1ble due to measurement 

difficulties. 

•• 

• 
Appendix 1-42 

Appendix Table JJJ.B.9.-7 

tsu:r:aiatiQu~ Among On .. PosltJon Cardiovascu13r 

Hca$1.1[~mf!DU gf Air Trifff~ Controllers at Work: Second Stud~ 

N* • )06-)18 

(I ) (2) (3) (4) (S) (6) (7) (8) (9) (10) (II) ( J 2) 

I. Average 1.00 . ' 

2. Range .42 J .00 ~· l 

). Maximum .92 . 71 1.00 

Standard 

4. Oevlat ion .45 .89 .68 1.00 

s. A•Jerage .so .19 .45 .18 1.00 

6. Range .24 .)7 .3) .19 .12 1.00 

7. Haxlm'um .53 .3) .s4 .26 .89 .so 1.00 ' 

Standa,.d 

8. Devlat Jon .21 .25 .26 .16 .09 -~' .4) I.CO 

.. 

Average .21 . 17 .22 .22 .29 -.01 .25 .01 1.00 

Rang& .I) .27 .20 .20 .12 .15 • 17 .07 .3~ 1.00 

Maximum .22 .24 .26 .25 .28 .06 .25 .04 .87 • 71 1.00 

:,Cclud••d subjects on .,ntl ... hypertensfve medications. The subjects ·~'ho were never \ 

tlon are also excluded. for some subje.cts the requisite da'l: .. polnU for 1

· 

culatlng a given variable were not available due to measurement dlfflcultfes. \ 

\ 

•.. 
I. 

2. 

J. 

• 

• 

Appendix 1-43 

Appendix Table l 11.8.9.-~ 

Correlatior"GAm:lng On-Position Cardiovascular 

Measurements o~ Air Traffic Controllers at Work: Thl rd Study 

N* • 258-268 

(I ) (2) (3) (4) (5) ( 6) (7) (8) (9) (I 0) (II) ( 12) 

.\verage I. 00 

Range .4] I. 00 

MaximuM .91 . 73 I. 00 

Standard 

Deviation .43 • 93 .70 I. 00 

Average .52 .18 .47 . ;a 1.00 

Range .15 . 32 .23 .25 .II 1.00 

Maximum .51 .29 .so .26 .87 .52 1.00 

.14 .28 .21 .28 .08 .90 .47 1.00 

.:;o .19 .33 .22 .27 -.10 .16 -.I 3 1.00 

.II .32 .24 .28 .06 .13 .09 .10 .20 1.00 

.29 . 31 .38 . 32 .24 .00 . 17 -.05 .88 .57 1.00 

subjects on antl-hypert~nsfve medications. The sub~ects who were 

on-position are al~o excluded. For some sUbjects the requisite datafor calcui.ating a given v•rl.able were not available due to measurement 

ties. · 

• 

' 

• • 
Appendix 1-44 

Appe~dlx Table 111.8.9.-9 

Correlations Among On-Position Cardiovascular 

Ke•suroments of Air Traffic Controllers at ~rk: Across Three Studies 

Average 

Range 

Haxlmum 

St.ndard 

Deviation 

Average 

Roose 

Maximum 

Stondard 

Deviation 

VIsit 

VI 

VIsit 

.58 

.08 

.48 

.00 

.60 

.2) 

.54 

.18 

.Sl 

.I) 

' 

.41 

.09 

2 

N• • 258-)11 

VIsit VIsit 2 

VI VI 

VIsit .sit 3 VIsit 

.4§ ) 

.2) .14 

.49 .4o 

.20 .II 

.46 .48 

.09 .IS 

·'' .)) 

.os .II 

.44 .41 

.06 .oa 

.)6 .)9 

.04 .I) 

\ 

*Excluded •ubjecu on ontf-hypertensfve ,..dlcatlons. The aubjocu who,..,. ,, never OR"'PCJiitfon are •ho excl&.lded. For aCMe subjec:s the .-eqt.~hlte dat•· . 

points for calculating • given Ylrlabfe were not •vallable due to .easur~nt 

difficulties. In addition, tho corralatlons could only be ulculated for 

subjocts having a partlcul•r ... sure for all three atudlea. •• 

;l

"
App-ix l-4S 

Appendix Table 111.8.9.-10 

Sorreiatlons Al'IDng Off .. Posltlon Ciirdfova_s.£!1..!..!! 

MeasuremenSJ of AIr Traffic Controll.ers It Work: Fl rst StuJy 

N* • )54 

(I) (Z) (3) m (5) (6) (7) (8) (g) (IO) (II) (12) 

I. Average 1.00 

z. ll<!ngo .19 1.00 

•• llexlmum .86 .65 1.00 

** Standard 

4. Oevlatlon 

s. Aver aye .51 .oz .40 1.00 

6. Range • I Z .46 .31 - -.01 1.00 

7. Mxtmum .so .26 .s1 .86 .46 1.00 

** Standard 

a. Oevlatlon 

9. Average .17 .09 .17 .lg -.02 .IS - 1.00 

10. Range .oo -39 .20 .01 .3) .17 • 18 1.00 

II. lllxl- .14 .23 .zz . I 7 .12 .10 .go -55 1.00 

** Standard 

lZ. ilevlatlon 

· *Excluillng sut.jecu on ant 1-hypertenslv. ""'dlcat Ions. The subje,ts who wre 

never off-pooltlon are also axcl~d •. For soae subjects the raqulolte data• 

rolnts for calculating • given v•rlab,ls ware not available due to •••urement 

difficult lao. 

calculated. 

l 

~ 

,

·---·- --
Appewliz 1-47 

Appendix Table 111.8.9.-12 

Correlations Anr:>n2;- Off-Position Cardiovascular 

He•surements of Air Traffic Controllers at \lork: Third Studx 

H* • 264•269 

(I) (2) (~I (4) (5) (6) <7! (8i (2) !JO) (II) ( 12j_ 

I. Average 1.00 

2. Range .)5 1.00 

3. Maximum .91 .68 1.00 

UStandard 

4.De•1atlon 

.42 .02 .35 1.00 

.19 .38 .29 .07 1.00 

),. llox1nKim .4) .19 .4) .87 .51 1.00 

** Stando~rtf 

Deviation 

.24 .15 .26 .16 .~4 

··~ 1.00 

.01 .22 .ro -.06 .)2 .09 .19 1.00 

.18 .22 .24 . .08 • 18 .I~ .88 .61 1.00 

subject' on antl.;hyp.~rtenslve !Mdlc.atlorts. The sub_fects ~were 

oflf-oos1tJon •re .also excluded. For some subjects tne t q•J!s:te datafor calculatin-g a given variable were not avafl1ble d·LJt '"o musuren~nt 

fflcul t los. 

•f

. \

1

' ' !. 
Appendix 1-48 

Appendix Table 111.8.9.-13 

Correlations Among Off-Position Cardlovascu~ 

Heesurements of Air Traffic Controilers at Work: Across Three Stcdl-s 

Average 

R.nge 

Hoxl,.... 

.. St•ndard 

llovletlon 

Average 

R.nge 

VIsit I 

VI 

VIsit 2 

.~8 

.02 

.32 

.51 

.08 

.43 

.so 

.06 

.37 

N* • l6~-310 

VIsit 

VI 

VIsit 

.u 

.04 

.30 

• ~I 

• 12 

.36 

.40 

.02 

.29 

3 

VIsit 2 

VI 

VIsit 3 

.43 

.02 

.30 

.~0 

.06 

.)1 

.46 

.I 5 

.43 

,.,..,.,...., subjects on antl-hypertonolve IMdlcatlons. The subjects who ""re 

-pooltlon are also exclueed. For 000. subjects the requlolt• datacalcul•tlng ~ givon variable were not av•ffeblo due to ~••ur~nt 

rrrcultles. In eddltlon, tM correlations could only be calculated for IUbj~:ts having • particular .... ure for all three s~udlas. 

\ 
• 

Appendix 1-49 

Appendix Table 111.8.9.-14 

to~relations Among Dally Cardiovascular Measurements of 

Air Traffic Controller' at 'Work: Fl rst Study 

N*•358-)60 

(I) (2) (3) (~) (5) (6) (7) (8) (9) (10) (II) (12) 

1.00 

.35 1.00 

. 86 ,7) 1.00 

.)6 .94 . 71 1.00 

.57 .os .~~ .II 1.00 

.25 .26 .28 .26 .IS I. 00 

.57 .2) .so .26 .86 .54 1.00 

.27 .26 .28 .28 .I) .9] .49 1.00 

.25 .22 .26 .22 .16 .06 .17 .08 1.00 

.07 .26 .19 .26 .13 -.01 .II -.01 •. 35 1.00 

.21 .27 .27 .27 .21 .06 .19 .07 .89 .68 1.00 

.os .18 .I) • 19 • 13 .OJ -13 .02 .40 .89 .68 1.00 

, •• ,,,.,_.son anti-hypertensive madlcetlons; some "'rreletlons are -besed on 

than others bec•use for some subj~ctl there were too few observations 

a me•sure. {e.g. There Is no range when only one ~asurement wes mQde). 

• 

• 

' 

• • 

L .. ~ 
Appe~dix l-50 

Appendix Table 111.8.9.-15 

Cocrc!atlons Aqpng poi h:...t.Ar.rUovasc:ular_~411asurc:men .. s <U. 

Air Traffjc Contro11trs at Wor~; ~;ynd Study 

N*•304·320 

(I) (2) (31 {4) {5) {6) {1) {8) (9) ( 10) {II) {12) 

1. Average 1.00 

2. 

). 

:.. 

Range .43 1.00 

Maximum .91 .73 1.00 

Standard 

Oevlat ion .47 -9S .n 1.00 

.so .16 .44 .IS 1.00 

Range .)2 .26 .JS .2S .II 1.00 

Maximum .s4 . 28 .52 .27 .87 .49 1.00 

.31 .28 . 35 .27 .09 .90 .44 1.00 

.2S • IS .24 .18 .32 .12 . ).1 .08 1.00 

.17 .23 .21 .26 • 13 -.04 .09 -.05 .4$ 1.00 

.25 .20 .27 .24 .29 .05 .26 .02 .86 .]7 1.00 

.II .19 .!6 .21 .I) .oo • 13 -.02 .47 .88 .74 1.00 

udfng subj~cts on antf•hypert•nslve medfcatlons; some correlations are based on 

subjects than others because for somm S!Jbjacts there were too few oDservat Ions 

calculate a r.easure. (e.g. There Is no range when on1y one measureme.nt '~IS made) • 

.. 

/ 

'- I 

'' 

'· 

I . 

·

•
AppendiX 1-51 

Append!• Table 111.8.9.-16 

Correlations Among OarJ~ Cardiovascular Measurements _gf_ 

~~ t Trgffl£ C2otroJiers at Work: Third Studx 

N* • 256·270 

(I) {2) (3) (4) (5). (6) (7) (8) (9) (I 0) (II) ( 12) 

L Average 1.00 

~- Range .46 1.00 

). Maximum -90 .76 1.00 

Standard 

4. Deviation .49 .95 . 75 1.00 

5. AveraQCJ .51 .I) .43 .14 1.00 

6. Range .2) .24 .28 .22 .17 1.00 

7. llil•lmum .51 .21 .48 .21 .88 .53 1.00 

Standard 

8. Oavlat I on .26 .24 .29 .25 .16 .90 .47 1.00 

.31 .26 .36 .25 .26 •.05 .16 .-.07 1.00 

.09 .I 5 .IS .13 .00 .09 -.01 .10 .19 I.OG 

.28 .28 .36 .27 .20 .02 .12 .00 .84 .62 1.00 

.04 . 13 .II .12 .01 .06 .oo .07 .21 .86 -~6 1.00 

udlng subjects on anti-hypertensive medications; tome correlati~ns are ~ased on 

subjects than others because for sane subjects there were too few observations 

colculate a measure. (e.g. There Js no re•nge when only one mea.surerNh1t was made). 
-------------------------... 

Averaqe 

Ringe 

Maximum 

Standard 

De vi at ion 

Average 

Range 

Maximum 

Correlations 

Air Traffic 

First 

VS 

Second 

Study 

.59 

-.02 

.41 

.03 

.61 

.00 

.46 

• 04 

.54 

.04 

.40 

.08 

. . 

Appendix l-52 

Appendix Table lii.B.9.·i7 

Amns Oa i 1 ~ Cardiovascular Measurements of 

Controllers at Work: Across Three Studies 

N* • 256-320 

First Sftcond 

vs vs 

Third Third 

Study Study 

.s1 .49 

• 14 .24 

.44 • 39 

.20 .25 

.47 .52 

.12 .04 

.)0 .)6 

.IS .09 

.41 .s1 

.10 .zs 

.)6 .44 

.07 • 19 

udlng '\ubjccts on antf-hypertenslve medications; so:11e correlations are 

on fewer tubj~cts than others becaus~ for some 1uGJ~ct1 there were 

few observ~tlons to calculate a measure. (e.g. There Is no range when 

• 

on4 measuremant was made). In addition, the correlations could only 

calcu14ted for subjects havJ~g a particular meaauro for all three studfea. 

• 

' 

• I 

• I» 

·ii: 

: ... 
APPENDIX II 

DIAGNOSTIC SUMMARIES SCORING ALGORITHMs 

··: 

·-
AIR TRAFFIC CONTROLLER STUDY 

II. A-l 

B.U.M.C. 

PHYSICAL EXAMINATION FORM 

Label 

VITAL SIGNS: 

HEIGHT: _____ fn. 

WEIGHT: ____ _Jb. 

PULSE: ___ • __ _,per mfn. 

RESP: _____ per mfn. 

BLOOD PRESSURE: 

1st 2nd 

observation observation RIGHT: Standing, __ .._ __ 

zfttfng __ ...._ __ _ 

supfr:e 

LEFT: standfng, __ ..._ __ _ 

Sitting __ ...._ __ _ 

supine 

___ _,_ __ 

BLACK.._ __ 

WHITE ___ _ 

OTHER (describe): ___ _ 

3rd 

cbservatfon 

-----

' ' 
• 

• 

. . 

II. A-2 

Place label her£ (VItalometer) 

FEV I (tenths of Liters) _____ _ 

FVC (tenths of L fters ) _____ _ 

EKG reading: 

Rate/min. ____ _ 

left ventricular hypertrophy-----

Ventricular extrasystoles (r.umber/mln. ). ____ _ 

Supraventricular extrasystoles (number/min.) ___ _ 

Other arr·hyt/rnh: 

Other abnormalities: 
II. A-3 

HAl A 01~TRJ8UTION: 

e:r::us 1 v£. . . . . . . . . . . • • .......... oz0411 

OECitEASEO ••••.••••••••••••••••• , .020421 

LOCATIO" 020/tJO: 

AASH: 

Size 020510: ~. 

DESCRIPTION: 

Hac.ul•r •••••••••••••••••••••••• 020521 ) 

Papul•r· .•.•..•••••••••.••...•. 020522 ) 

W•slcul•r ..•.•••••.•••••••• , , •• 020523 ) 

Ulc•r•tlve •••••••••••••••• , ., •• OZOSZ" } 

Sc:..llng ••• , •••.•• ,., ••••••• , ••• 020525 ) 

OTHER 020520: 

LOCATION 020530• 

SPECI,fC APOMALin: 

ACNE ••.••.•••....•••••••••••••••• 020611 

Loc•c lon OZOiiiO: 

CHE:M.Y ANGIOHA ••••• ,,, •••••• ,, ••••• (120621 

Loc•tlon OZC~ZG: 

S,IO!l AHGI~ •.•...••..••.••.•... OzOlJr"r---rLoutlon 020630: 

SPLtMT£1 HCHOAAHA41,,,,,,,,,,,,,,,,0206"1 

Louclon 020640~ 

P£T!CHIAE •• , •••••• , ••• , , ••••••••••• 0206S I 

Loculon 0206SO: 

ECCHYHOSES ••••••• , ••• , • , •••• , • , •••• OZU66 I 

Lout ion 020660: 

PUIII'tiiV. ........................ , ••• 0,0671 

Lou. t lonD206]0; 

PAL.HA« EltYTHEJitA •• ,, •••••• ,.,, •• , • , .020681 lilac 

lt ........... 0204'~2 ( ) Lt .... 02068) ( 

OTHU 0206,0: 

IIOL£5,, ••• ,.,, ••• ,.,,,., ••••• , ••••• 0207.11 

l.oc.lt ton 020720: 

WARn ............................. o20731 

Location 020730: 

StAAs ••••• _ •••••••••• , ••••••••••• •• 0201": 

Loe.t .on- 020]1,01 

5tkU 02071 D: 

H!M• AUt~JTY OJOII01. __________ _ 

·' 

.. 
GEH(RAL CONDITION: 

~HANf.[: 

NUTRITION L H~DRATIO~: Ooeu!: 

II. A-4 

.l'li Idly ........ ,,....... . .. CIOIII 

l'tot.ler•tely ...•.•...•...•..... 010112 

Lur$'11C! ly,., .. , .. , •.......... 01011] 

Thin ..•....••......••......... or orr~ t.tc.he-ct ic, .......... , ......... 010115 

Anh•rc•················· .. 010116 

Oehydr•tea., .•.. ,, ............ 010117 

ftOT STArED AGE: 

Appe•r• older .••.•..•••••••••.• Q:OIZI 

Appur~ youngttr ••••...••••••.•• O/tlf12 ILL: 

Acutely,, .•.. , ..•.•....•. , ...•. 0101)1 

Chronic•lly ..••.••..•..•• , .•.•. 0/0132 

llrf OIST"ESS: 

"'ld .........•....•.•..•••.•.. -010141 

Mode r• t• .. , . , ..............•.. . 0 I 0142 

Acute.,., ..••.• , ••.•••.•••••..• 01014) OTH(J; 010150 

SfATE or COHS(IOUSNESS: 

NOT AL!II.T: 

Orow\y ...•.. , . , ....•.•••....•. 010211 

Leth•rgic,, ..•.•...•.. , .•.•.•. 010112 

Obtundw •.•...••••..•.•..••... 01021) 

l.nrespons i \If\, •••• , • , • . . .•. 0 I 0214 O!SOII.i[NT£0: 

To penun ........ . 

To pl<l'-e ........ .. 

To time ......... .. 

OTH£111. 0102)C; 

rt:HPEAAAUH; 

..... or our . ... 010122 

. ..• 01022) 

DEPRESS£(). . . 0 I 0) II 

A~.I:/OlJS..... . .... , ..... C/0)21 

WITHOII..Aio'N ............. , ••••.••• OIO]JI 

AGGA[5SIV£ .•...••.••.. , . .. .010)~1 lJ~COOPERATIV£ ....... , .. , , , .• .010}51 

PA'iSIVf AGGRESSIVC •••.•.•...•. IJIOJ61 OTHER 010)70: 

OTHER 010"110: 

------------- ,,, •. ~,-------------------------------- -m,rRA fUR£: 

WAAA .••••••.••.••.•.•••••• , •.•• 02011.1 

CCLD •.•••••••••••••.••••••••.•. Q20121 

HYDRATION: 

0RY •••••••••••••••••••••••••••••• Q1\)211 

1101ST,~,., .................. , ... 020221 

OILY .•••••••.•..••••.•.••.••••••• 020211 

OlCAEASfD TUACOilt .• , .• , •.•.•• , •• , . 0202%1 

COLORATiON: 

P.t.:.£ ................ , ...... , . ., •. 021)11 

RUDDY,, •••.•••••• , ••• ,,, •• ,, ••..• 020}21 

CVAHOT I C., , • , •.• , , , , , •• , , • , •••••• 020)]1 

ICTERIC .••• , •• , .... , ............. 020)1tl 

HYP(Rll' IC11[NHO •• , •• , , .... , • , • , •• , OlOJSI 

HYPOr> IGMUtHD,, ....... , ...... , ••. 020)61 

FRECKLED., •• , ...... , .......... , •• 020)71 OTHER 020)]0: 

• 

• 

• 

01 lf(N[It.\L HEC )NL( JAIN( 

02 ~ N&( )N<( )AIN( 

OJ ~ N~( )N&. ( )AI .. ( 
II. A-5 

ill to 

AUDITORY TESTING; 

OECREASE9'ACUI TY: 

At ....... 040IJI ( ) Lr ...... ot.oll2 \ 

Conmenc .. 040120: 

BONE CONDUCTION> AIR; 

Rt ........ 0401]1 ( ) Lt. ..•.. 0101]2 

Ufl!iR LATERAl! ZES TO THE: 

Rt., .••• , .040111 ( ) Lt.., ... OhOJ42 

OTHER 040156: 

AURIClE: 

ABNORHALITY 040210: 

AUDITORY CAHAL: 

EXCESSIVE CERUHEN ............. , •• 040]1 J Booh 

R< ......... 040]11 ( ) Lt ..... 010]12 ( ) 

INfLMHATION ..................... 040]2] loth 

Rt ......... 010321 ( ) Lt ..... 040J22 

DISCHARGE, ....................... 040JJJ Both 

Rt ........ 040]]1 ( ) Lt ..... 010]]2 I 

T'fHPANIC "EHBRANES: 

NOT VI SUALIZEO: 

Rt. ........ 040411 Lt ..... o40412 INJECTED: 

Rt ......... 040421 Lt ..... 040422 SCARRED: 

Rt ......... 0404]1 Lt ..... 0404j2 PERFORATED: 

Rt ......... 040441 Lt. .... 040442 R£TRACTED: 

Rt ......... 01o0151 Lt .. , •• 040io52 BULGING: 

R t ......... 01046 I Lt ..... 040162 OTHER 040470: 

OTHER o4o51o: 

l!llt 

' LIDS: 

EXOPHTHALMOS . ..••.•.•.. , .•..••. OSO Ill lo { h 

Rt ...... o5orr 1 C J Lt ....... 050112 c 1 

XAHTHELASHA ....... , •• , ... ,., ..• 05012) Both 

Rt ...... 050121 ( )Lt ....... 050122 { 1 

PTOSIS.,.,., ................... 050IJJ Both 

Rt ...... OSOIJI ( 1Lt ....... OSOIJ2 ( ) 

LID LAC, ....................... 05014] Both 

Rt ...... osol41 c )Lt ....... 050142 c 1 

OTHER DSO I 50: 

........................... 05021 J Both 

...... 050211 C ll.t ....... 050212 C I 

,Cilii,JUNCTIVITIS .. , •• ,, ........ ,, •• 05022] loth 

..... csozz1 C )Lt ....... osozz2 c 1 0502]0: 

.. , ..................... ,OSQJIJ Both 

..... OSQJII ( )Lt ....... 050]12 ( ) 

........................... OSOJZJ Both 

.... 050]21 ( )Lt ....... 050322 ( ) OSOJJO: 

Qq ~ Nl'( )NL ( )AIM( 

05 EYES Ni'( )Ill( )t.IM( 

•.. 

i 

. 

j ' ' I ~ 

l l -~ 
II. A-6 

COANEA: 

ARCUS SENILIS •••••••••••••••••.•••••••••..• 050'tl) Borh ( 

Rt •••••••••••.• 050'111 ( ) U .•.•••••.•• 050~12 ( ) 

OPACiriEO •••••••.•.•••••••••••••••••••••••• 050'12) Borh ( 

Rr ••••••••••••• o:o~21 ( ) Lr ••••.•••••• 050'122 ( ) 

on,a OSC'>JO: 

IRIS: 

NEOVASCUI.ARI2ATION ••••••••••••••••••••••••• 05051) Both ( 

Rt ••..•••.••••• 050511 ( ) L[ ••••••••••• ~50512 ( ) 

OTHER OSOS<O: 

LENS: 

OPACIFIED •••••••••••••••••••••••••••••••••• 050613 Both ( 

Rt ••••••••••••• 050611 ( ) Lt ••••••••••. 050612 ( I 

R£110VED •••••••••••••••••••••••••••••••••••• 05062) Both ( 

Rt •.•••••••.••• ~50621 ( ) U ••••••..••. 050622 ( ) 

OrHER 050630: 

PUPILS: 

NOT EQUAL (Note forger ono) ••••••••••••• , •• 050711 Rt 

NOT RO'-'NO .•••. ••• , •••••••••••• , ••••••••• , • • 050721 Jlt 

NOT REACTIVE TO LICHT ...................... 0507)1 Rt 

NOT ACCOHCCATIVE ........................... 0501~ I Rt 

OTHER 050150: 

fUIIOOSCOPIC: 

DISC: 

PoiiOf' .................................... 050811 ~' 

Arraphy .................................. 050621 ~t 

Papillede.t~• .. .••..•..•..•.......•••..•... . OSOBJI ~t 

Pulso);tlon of RetiMI Vein ................. OS08itl Rt 

OTHER 050850. 

MTERIOLES: 

N•rrowlng, ••• ••••••••••.•.••.•.••.•.•.••.•• . OS0911 Rr ( 

Strlithtenlng ..... ................ , ... ,, .• • O:iC92f At ( 

AIY nicking ................................ 050931 Rt ( 

(oflpor ~lrl"9 .............................. 050941 Rt ( 

Tortuosity ................................. 050951 Rt ( 

or•EA 05096o: 

VEHULU: 

Tort\tOIIty •. ...•••.• , . , , , , .•••••••• ,, ..••. • 051011 Itt ( 

lnoorv~nt ......•......... , ...•..•..•.•.. . 051021 "' ( 

OTNEII 0510)0: 

tt.orloretlnJtls .......................... _ ... OSiffl It 

-.,rrhlgf'!ls: 

fl-.................................... 051121 It ( 

Dot ...................................... 051111 -t ' 

Soft ..................................... 0511~1 Rt ( 

!lord ..................................... ~511 51 Rt ( 

051160• 

fiELD$ 051)10: 

.--- -· 

) 

) 

) 

) OS0712 lt ( 

) 050722 Ll ( 

) OSOi'l2 Lt ( 

) 0501~2 lt ( 

) 0So812 Lt ( l 05Q~22 lt ( 

) O'o832 Lt ( 

) 0508lo2 Lt ( 

) 05~12 Lt ( ) 

I GS0922 lt ( I 

) 050312 Lt ( l 

I, 050942 L t ( ) 

I os~52 l< ( I 

l OSIOI~ Lt ( 

) 051022 Lt ( 

)051112Lt( 

) 051122 L1 I 

) 0511>2 Lt ( 

l 0511~2 Lt ( ) 

) 051152 Lt ( ) 

__ .--

' I 

' 
• 

II. A-7 

06 NOS( 1<11£( ..!!2ll.i. 

HOUTH & 

SEPTU. AS~MHETAICAL, •••• 060III 

01 SCH.W:E: 

Mt.lcus ••. •••• . 060211 Itt( 07 THROAT Ill ( ) 060212 Lt( ) 08 NECK Mlr( 

Pus •.••.••••• 060221 At ( ) 060222 Lt( ) 

- Olood ........ 0602)1 Rt( ) 0602)2 Lt( ) ~ THORAX oor ( OISTAUCTION ••• 0£0)11 Rt( ) 060)12 Lt( ) 

- OTHER 060410: 

IO BREASTS tU;( 

CARIES ...................... 070111 

OENnJAES .................... 010121 

E'ENTULOUS ••••••••••••••••• • 0101 )I 

CALCULUS .................... 0701~1 GIHGIVITI S .................. 010151 

OTHER 070160: 

TONGUE: 

AONCiliiALITY 070210: 

PALATE: 

IHFLAMHATION ................ 070311 

EOEH.l ....................... 070)21 

P£T£CHIAE ................... 070)]1 ~THER 070340: 

PHAR~NX: 

INFLAIOEO .................... 07~11 EDEHATOUS ................... 07~21 OTHER 070~)0: 

TONSILS: 

HY'EOTROPHIEO, •••••••••••••• C70SI I 

RED ......................... 070521 

EXUDATIVE ................... 0705)1 OTHER 070540: 

orid 67061 o: 

.!illi 

RIGID ..................... .. 0801 II THYROID: ( 

fNLAIU0£0.. • • • : ........... 080211 

NODULAR ....... , ........... 080221 

TENDER .............. , ..... 0802)1 

IAUI T ..................... 08024 I 

OTHU Dllo2$0: 

At 

Rt 

•• Rt 

) 

( 

( 

( 

( 

) 

) 

) 

080212 Lt 

080222 Lt 

0802)2 Lt 

080242 Lt 

J'i, elevued o&))IO: 01 <~t d~gr•es HtPATO·JUCULAR N£FLU~ ..•• 080411( ) CAROTID PULSU: 

HOT PALPA!L( ............. Oilo5fl Rt 

UN£~ WITH PREOOHI~C£.080521 Rt 

Uutr ..................... Oilo5JI Rt 

OTHU Ollo540: 

08oSt2 Lt l 

C30S22 Lt ( 

DlloS)2 Lt ( 

( 

( 

( 

( 

• 

• 

) Ill ( ) -( 

)Ill.( ) _, ) • 

)Ill.( ) Alii( ) 

)Ill.( 

) -~ l 

)Ill. ( ) Alii( 
THOIIAX: II. A-8 

INCRrASED A•P >IN<frfR • ., ••••• , ,, •••••• , ,0,.,11 I ( ASY~fTRY (Ooscrlb•J a,o210: 

OTHd O§O)JO: 

IRZASTS: 

HASSES DESCRIPTION 100120• ••••••••••••••••••••••••••••••••••• IQOI!I Rt ( ) 100112 Lt ( ) 

RETRACTED ------------------------------------------- NIPPLE •• , •••• , , •••• , •••••• , , , , •• • I 00211 Rt ( 

ENLARGED, •• , ••••••.••• , •••• ,, ...... ., ... ... 100311 Rt ( 

INCREASED PIGMENTAIJON., .................. 100411 ( ) 

GLA10UIJR HYPERTRO~•Y.,,., ............ ., .. .100511 ( ) 

LACIATING ........................ ......... 100611 ( ) 

TENOER ...................... ; .............. 100711 ( ) OTHER 100810: 

----------------------------------------

) IOC2U Lt ( 

) 100]12 •• ( 

•.. 

) 

) 

i 

I 

\ 

~ 

i 

I 

I 

I 

I 

I 

• I 

I 

! 

,, 

f 
H!AOT, 

AH't'THH: II. A-9 

Revular lrreiularlty •••••••••.•.••• IIOIIII 

lrr~tgulal lrregul.rlty .•••••••.•.•• fiOI211 

llg•lny ..••.•••.•..•......•..••... IIOI)II ~ N(( ) II. ( ) ... ( ) 

OccuiONII htr,uystolu, .••••. , ••• IIOiiill OTHER IIGISIO:. _____________ _ 

PALPATION: 

PHI: locall.nd,,,,JI02111 ( ) dlftuu.,.,lf0211Z ( ) 

Duration: Sustalned •.•. II02121 C ) lrlet .. ,lfOZilJ ( ) 

OTHER 1102120:==-""Tl;;;-r;r-r-,....,:::::::--,. 

A.plltude: hpplng .... !lozl)i ( ) HMve .... llozJJZ C OTHU 11021)0: 

Location: £plg•urlc .•.. aloza41 ( ) ~rauer,.I .•• II02il•Z 

11021110: c. lt of HSI. In thla ICS OTHER IMPULSES IIOIDQ (Describe): - ( ) 

ftAL.PAiL( HEART SOUNDS: 

$1 ••• 11>2]11 ( ) 52 ... 1102)21 ( ) S) ... II02])1 ( ) ·~···1102) .. ( ) THRILLS: Syuotlc ••• lfOZitll ( } Dlastallc ••• noz~tzl ( ) 

AUSCULTATION: 

OTHD. C~nt IIO.ZSIO: 110~:~~):0:':::::::::::::::::::::::::::::::::::::::::::::::: HEAAT SOUNDS I GALLOPS: 

Sl: Accentuated.,.lfO)III ( ) llluant •.• IIOJII.Z ( ) Spllt ••• JIDJII,i ( ) OTH£11: 11?)110: 

U: Ac~ent"• tell .•• Tl""loii"Jni-;2Ti-(r-T) -;o<ljr:,~,.::.;:;,,-,-. -.)njr>oCiJTi2"2M(-,)r--------

Spllt: f•t'•doxically •• IIOJI2J ( )) flxH, •• IJQ)I2.t, ( ) SU~ UP ...... , .......... IIQJI.ZS (( 

SU. S.ZP ................. 110)126 ) 

S) SZA'<'S2P gal;op ................. ................ fiO]I)I I/Q]I2] ( ) ( ) OTHU 11'!)120:,~------ -

COMMent on lo~•tlon 110)1]0: 

54 gallop ............. , •• IIOJI4.rr-,---------------

HUAHUIIlS: OTHER ~nt II OJI SO: 

on,~~·:•:'•:•~·=·~·I~I=0:3~1·~·~'::::::::::::::~::::::::::::::::: Syttallc •• IJ0)21 

(llf"s dlvlt(s) 

) •M l.ocetlon•----------

"'· 
• 

• 

LUNGS 

---u:J; IRA Tllli!: 

Cheyne· Stokes ••••••..•••••••.•••• 1.~0111 (( ) 

kusa..uJ ..••. .....•.......•...•.. •201 Zt ) 

loborfd •••••••••••••••••••••••••• 120131 ( I 

ShAllow •••••.•••••••••..••• , ••••• lZOJ,Il (( 

Prolon;rod upfrotory Phose ••••••• 12015! ) 0TH£R 120160:. _____________ _ 

• 

II. A-10 

PERCUss I Oil: 

OUI.L: 

Right onterfa.•: 

Ape,. I 20211 •••• 'l left int.Jr1or: 

Apex IZOZIJ •••• l~ I 

Hid ••••••••.••• 2 

a. Htd •••••••••••• 2 ............. J( 

llose ........... Jf l h\oofthoro •••••• 4( 

Heoithor········ 

• 

Right PCIIterfor: 

ltft PQsterfor: 

• 

"""" 120212 .. "'/ I Apex IZOZ14 •••• JJ 

f 

Htd •••••.•••••• 2 

Htd •••••••••••• 2 

',', 

a. ............. ] 

Heol 1 a. ............. ] thor1x ..... 4 

"-1thoru ..... 4 

FLAT: 

Right Interior: 

14'00 120221 left ••tertor: •••• 1( ) 

Al>ex 120223 .... J( ) 

Ntd ............ 2{ ) 

Htd ............ z{ ) 

a. ............. ] I e .............. J I 

Komfthorox ••••• 4 

"-1thorax ..... 4 Right posterior: 

Apox 120222 ••.• 1( ) left ~sterfor: Apex 120224 .... J( ) 

Hid ............ zf ) 

Htd •••••••••••• zf J ease ........... J ) 

Bi!se •••.•..••• ,J J 

Htoofthor•x ••••• 4( ) 

Heoitllorax ••••• 4( ) 

OTHER IZOZJO: 

· ~ntrllll: 

INCREASED 8REAiH SOUiiDS: 

Right onterlor: 

Apex Left anterfor:· IZOJIJ •••• J( l Apox 120313 •••• 1( l 

Hid .. , ....... .. l( 

Mid ........ ... zc !lose ........... l( 

Heofthortx Buo ........... J( ••••• 4( l 

Heoltfloru ...... 4( Right PQstertor: 

Apex 120312 left -PQst!tr1or: •••• 1( 

Apex !20314 .... 1( 

f 

Hid ............ 2( f 

Hid ............ 2( lltse ........... J( 

s .............. Jc H•fthorox ..... 4( 

Hooofthor•x ••••• 4( II(CREAS£0 BII£A TH SOUIIOS: 

Right •nterfor 

Apex 120J2J ••• If Left anterior: 

I 

Apex 120323 •••• 1( 

1 

Htd ............ z 

Hld ............ z{ 'a. ............. J 

a. ............. J Hoot thoro., ••••• 4 

Hooofthorex ..... 4 

ltft PCISterfor: l Ape, IZOJZ4 •••• J~ ) Hfd ............ l ) l Bose ........... Jf I -fthoru ..... 4 

i . 

lt!t anterior: 

I f Apex l20JJJ •••• J( 

f 

Mid ............ 2( 

Bou ........... J( 

Helsflfloru ••••• 4( 

I 

loft ~'<>stertor: 

l f 

A pox 1203.!4 .... 1 ( 

I Htd ............ zc 

a. ............. ]( Haolt~~or •••••••• , 
RALES 

Right tntertor: 

Apex 120341 •... 11 ) Hid ••••••.••••• 2 ) 

Bue ........... J J 

Heolthorax .•••. 4( ) Right posterior 

Apex 120342 •.• ·c J 

Hld •••••••••••• 2/ J 

Base ...•..••• •. 3 

Heolthorax ••.•• 4( Rl«li!CHI: 

Right anterior: 

Apex 120351 •••• 1( ) 

Hid ••••••••••• • 2( I 

Base ••.•.•.••• • 3( 

Heolthorax ••••. 4( Right posterior: 

Apex 120352 ••• 1( ) 

Hld •••••••••••• 2( / 

Base •••••••••.• J( 

Heolthorax •.••. 4( illf£EZ£S: 

Right anterior: 

Apex 120361 .••• 1/ 

Mid •••••••••••• 2 

Base ••.•••••••• J( 

Haolthorax ••••. 4( Right posterior: 

Apex 120362 ••.. 1( I 

Hid .••••••••• •• 2{ Bue •••....•..• J H~"'-fthori)C ••••. 4 FRICT!/ltj RUB: 

~1~ht enter1or: 

:~.!~?~~!::::lf 1 

Base •••.••••••• J 

Koolthorax ••••• 4( Right PGstvlor: 

Base •....••••• ,J 

II. A-ll 

left •nterfor: 

Apex 120343 ... I{ ) 

Hid ........ ... zc ) Bue .......... J( J 

Heolthorax •••• 4( ) left P<tsterfor: 

Apex 120.144 ... 1( ) 

Hid .......... • zc J 

B•se .......... J/ J 

HIM•thora• •••. 4 ) 

left •nterfor: 

~~.!~~~~:::1[/ J 

8ase .......... J( 

H•lthoru •••• 4( Left PG•terlor: 

:~:.!~?~:::lj I 

Base ....... ... 3 >' 

H•lthorax .... a( 

ltft tnterfor: 

Apex 120363 ••• 1( 

Hid .... ....... z/ Bue .......... 3 

Hem I thor ...... 4( 

Loft PGsttrfor: 

Ap .. 110364 ••• 1( ) 

Hid ........... 2/ ) 

Baso .......... J J 

HoMithoru .... 4 

left ilnterfOr: 

:rn~.!~?~~~:::lf I 

Bue .......... J I 

Koolthor••····•C I Apex 120372 Left posterior: •••• 1( 1 

Hid •••••....•• • z/ 

Koolthorox ..•.• 4 · 

01H£R 120380:._:-------------: 

~ ll04Jo, 

Apex 120374 ••• 11 ) Hld .•••••••••• 2 I 

8aso .......... J 

Heofthorax •••• 4( 

... 
Il. A-lZ 

Z 8 R CY~ ~ II£( )Ill( ) Alii( ) I] 

9 l CY~ BACK ME( ) Ill( ) Alii( ) 14 

Entire GEMIT/!1, ME( I tC.( ) Al'l( ) 15 .IIIOO'tEII: 

RETAACTED ..•..• 1 30111 ( 

DISTEIID£0 •.••.• 1 30211 ( RECTA!, M[( I tC.( ) Alii( ) 16 

EITR£MITI£S ME( I IC.( l All( )17 

I Z 3 4 5 6 I 8 9 0 

ro LIGHT PO!.PATIDM I 30llt I l ( I ( l I I ( l ( l I ) ( l I I I I 

CliMttltT lJOJIQ: 

to btEP PAl PAl ION 130321 ( WtllNT I 30JZQ: 

R£iiQUHil •••••••••••••• t Jll0(11 ( 

ctil!lt£HT 130410: 

GUAJII) lliil ..••.•..••••• nom , COOftENT 130510: 

t•,m PAtPA!ilt ..... :7:TlZ!m I 

C!Ht!NT 110610: 

sen ................. t :mm 1 

CIHt!Mf 130110: 

ASCtTES •.•••••••••••• lJOStl ( 

G!IGAJOIEGAU; 

l ( l I 

) I ) ( 

l ( l ( 

l ! l ( 

l ( ) ( 

l ( l ( I I 

I ( ) I )( 

l I l ( l ( 

I I ) ( ) ( 

) ( ) ( ) I 

) ( l ( l ( ) ( 

l ( l ( ) ( I( 

) ( ) ( ) ( l I ) 

.... ) ( )( j( )( 

l ( . ) ( l I ) ( 

LIVER: SPlE£N: P•1P'ble Pf.1pa~bl~o~ ••. . • ~.1~1~09~1~1 1 30921 ~(_!~O~th~e:r { Other' ~~~309~10~; 1 }0,2:0: ========== OTHtM 130930: 

BOWd SGUilibS: 

H!PERACTIY£ .•.••••• 111011 ~ IIIFREQUE•T ••.•.•••. }31021 

OISTAIIT ..•.•••••••• 131031 OTHER 1)1040: ___________________ _ 

MERiiiA: 

IJI81LICAL. ••.•••••• ll1111 l 

INCISIOML •..•.••.. 111121 t!HtENT 131120: ___________________ _ 

IIIGU I !tAL ; 

Rt: c-t R<duclb1o •••• l)llJI ( Honrtductblo 131132 ( llllJO: __________________ _ 

Ll: ,_, Roduclb1t .••. IJI141 ( MonrtductDte 131142 ( lll140: _________________ _ 

Ctller 131150: 

OtHER OTHER lllllJ!; 1lli21~0~:~=================== 

SCOLIOSIS ..••. 140311 ( ) OTHER 140410: ___________ _ 

.~ PHIIIIUS ..•• ISOIIl l PAAAPIHMOSIS •••• 1501!1 ( ) CllCIJOICIUD ..... tSOlll l I 

I«I'OSPAGIAs.J 50131 51\EGMA .......... 150141 ( l DISCHAI!GE ••••••• 150151 OTH!R 150160: ____________________ _ 

IISTICI.lS: 

MASS DTh~ ........ 150220: ISOZI! ___________________________ Rt ( 150212 Lt ( _ 

=~IO'ft.IM: 

NfD~·~L.E .. ISOltl •c ( ls<-!12: Lt t 

VM.It;Gw!I)(Ll.ISOl%1 At ( 150].22 Lt ( 

O!MlO ISOllO'----------------------------
!!.m&i OECREAS:O SPHINCTER TON£ ••••••• 160111 

TENOER•:ESS ••••••••••.•••.•.•••• 160211 HEMO~~HOIOS .................... 160311 

HE•.URRHO!OAL SKIN TAGS ......... 160411 

'~OS TATE: 

ENLARG£0 •••••• 160511 Rt ! 

TENDER ........ 160521 Rt ( 

NOOULAR •.••••• 160531 Rt ( 

160512 Lt ( 

160522 Lt ( 

160512 Lt ( 

• 

160513 Diffuse ( 

160523 DHfuso ( 

160533 Olffus& ( 

OTHER 160540: ____ ·-------------

ASkORMAL FECES ON GLOVE: 

GUAIAC POSIT!VE .......... 160611 ( ) 

OTHER 160610: 

OTHER 1607:0: ----------·---------

...... 170111 Rt ( 

L TO KNl£170121 Rt ( 

ANKLE. ..... 1/0131 Rt ( 

CLUBU!IIG: 

fiNGERS .... 110211 ( ) 

TOES ....... 170221 ( ) 

170112 Lt ( 

170122 Lt ( 

170132 lt ( 

17QI13 8oth ( 

170123 8oth ( 

1701 33 BOth l 

VAR!COS!T!ES.I70310 (Describe site): ___________ _ 

PULSES: (Carotid -- see NECK 

NONPALPABLE 

Rt Lt 

RADIAL 17041. ........... I ( ) 2( ) 

COI!Illen t I 7041 0: __ _ 

BRACHIAL 17o42 .......... I( 2( 

Co<ll!ent 170420: __ _ 

fE.~ORAL 17043 ........... I( 2( ). co .. nent 170430: __ _ 

DORSALIS PEDIS 17044 •••• 1( 2( 

c-ent 1 10440: __ _ 

POSTERIOR TIBIAL 17045 .. 1( 2( C"""'"'nt 17(1.\50: __ _ 

.OTHER 170460: 

SWELLING REDNESS 

Fll«iER wmr 17051. .... 1( 2~ ~ )l) 17052 ..... 1( 

t..saw 17053 ..... 1 ( 

SI()UI.OER 17054 ... 1 ( 

KIP 11055 ........ I ( 2( ) 

ANKLE 11057 ...... 1 2( I K~££17056 ...... 1l Z() 

:ms 17058 ....... 1 2( i 

OIHlR 170590: ___ _ 

~q :ll 3( J 4 ) 

3( ! 4( ) 3; 4( ) 

3( 4( ) 

3( ) 4( ) 

3( ) 4( ) 

WEAK 

Rt -- Lt 

3( ) 4( ) 

3( 4( 

3( 4( 

l( 4( 

3( 4( 

PAIN ON MOTION 

5! ) 6( ) 5 ) 6( ) 

5 ) 6( ) 

5( J 6( ) 

5( ) 6( ) 

5( ) 6( ) 

S( l 6~ l 

5( ) 6 ) 

BRUIT 

Rr--Lt 

5( ) 6( ) 

5( ) 6( 

5( ) 6( 

5( ) 6( 

5( ) 6( 

REOUCED MOTION 

H ! il ! ~q ~q ~~ ) ~ ) 

I( ) 8( I 

• 

• 

• 
ll. A-14 

18 LI'IIPH NOOES HI( I Ill.( ) Alii( ) 

Rt 

TEi<IJER ........ 180111 ( ) 

Lt 

180112 ! l 180122 

l' NEIJIOUIGICAI. EXAM liE( ) ICl( ) Alii( 

r«JMTEHD£R ••••• 180121~ ) 

FIXED .•....••• 180131 I 

l«lBlLE •••••••• 180141. ) 

180132 l 

180142 ( 

O~ER 1801~=---------------------

POSTERIOR CERVICAl: 

Rt 

TEIClER ........ 180211! l 

r«JNTEHOER ••••• 1BOZZ1 

FIXED ......... 180231 ) 

l«lBILE ........ 180241 ( ) 

Lt 

180212 ! ) 180222 ) 

180232 ( ) 

180242 ( ) 

OTHER 1802~'------------

SUPRACLAVICUlAR: 

Rt Lt 

TENOER •.•••••• 180311 ( ) 180312 ( ) 

OOIITWOER ••••• l80Jll! ) 1803l2 ( ) 

FIXEO ......... 180331 l 180332 ( ) 

l«l!!IL£ ........ 180341 ( 180342 { ) OTHER 1803~: _____________ _ 

AXILLARY: 

Rt 

HNOER •••••••• 180411! ) 

NOHTENOER ••••• 180421 ) 

FIXED ......... IW431( l 

l«l&ILE ••••••.• 180441( 

Lt 

180.CI2 ( ) 

180422 ( ) 

180.CJ2 ! l 

180442 ) OTHER 180450: ____________ _ 

INGUINAl.: 

At 

TENDER ........ 180511( ) 

r«JNTENDER ••••• 100521( ) 

FIX£0 ......... 180531( ) 

l«lBILE ••••...• 180541( ) 

Lt 

180512 ( ) 

180522 ( ) 

180532 ( ) 

180542 ( ) OTHU 180580: _______________ _ 

OTHER 180610: 

~lko',L E!MJH6T!ON· liJifA( STATUSfState o? Conic1ousrM!SS -- Se« GEHEAAI. section) 

l!IAPPROPR!ATE EXPRESSION ..... 19011t ( ) 

c-nt 190110· 

DISTURBED THOUGHT CQKTEHT •••• J90121 c-t 190120: ________________ _ 

INAPPROPRIATE 1«100 ........... 190131 

C~nt 1901~=-----------------

IMPAIREO ME&«lliY .............. I90141 c-nt 190140: ______________ _ 

IIIAPPAOPRIATE SPEECH ••••••••• 190151 C~t 190180: ________________ ~ 

OTHvt 1211160:_· -----------------

CRAHIAL NERVES (Descrlb« Abn..,..llty): 

OL£FACTOHY OPTIC ( 2 j ( 

.................. I ) ............. 190210 190220 ( ( ) );;:;;;~n:==== 

OCUl~TO*, TROCHI.£AR,ASOUC~NS (1,4,6) ........ 191)230 I 

TRW£1UNAL rAGII.L {]) ................... (5). .............. 190250 190240! )f~~~~~~~~~ ) 

Al"iTORY (8) ................. 190200 ) 

~ OSSOPIIAAYIIG£111. (9,10) ...... 1211270 1· 

S'IMAl AtC£SSQaY (11) ••••••.• 1902~ ( 

HfPOGLOSSAL (12) ......... " .. 190200 I ~ 

... 

"•-~ ... 
II. A-lS 

C£JIEB£lLAR FUNCTION .•••.•• ,., ••• ,, .•. 190310 ( lflTOR; 

ARMS 

l!ttt MUSCLE WEAKNESS 19041 .. 1( )2( ) C-.:nt i904IO; -- Hv~rRto~tA t904z ••••••.• lc 121 1 

c .... ent 190420:_ 

FLAtciO 19043 ........... 1( )2( l 

c-.nt 190430:_ 

IH~IRED GAIT 19044 ..•.. 1( 12( I 

C-nt 190440:_ 

LACK OF CDORDINAtloR 19045 I( 12( 1 

ec...ent 190450:_ 

OTHER 190460: ___ _ 

lEGS Rr-cr3( )4( ) 

3( )4( ) 

3( )4( ) 

3( )4( I 

l( 14( I 

SENSORY: Rt lt 

ARHS DECREASED Cooooent PAIN 190510. SENSE ______ 19051 .••••..••. _ 1( ~) 

OEtAEAsto TEHP£AAfuRt 5£~£ 19o5z ••. J( ) 2( ) Cootoant 190520: ______ _ 

DECREASED VIbRATORY SENSE 19053 ....• 1( ) 21 ) Cootoent 190530: _____ _ 

OTHER 1§6540: 

REFLEXES: A85tNT DECREASED ~Lt Rt ICIIEE 1!1061 ................. 1 ( lt 

Other 19U6JO: ) 2 ( ) 3( ) 4 ( ) 

AIIKLE 1906z ................ !( Other 190620: 2 ( ) 3( ) 4 ( I 

BICEI1s 19063 ............ , .. I ( Other 190630; 2 ( ) 3( ) 4 ( ) 

TRICEPS 19064 .............. 1( Other 190640: z ( ) J( ) 4 ( ) 

BAlliRskt 190ot. ............. J At (I 2 Lt (I C-..,t 1906!iQ: OTHU 190660:_----

0THER I 90710: ----- Cllltfllf 190610: ____ _ 

Rt Lt 

.J.i~S lcHn 

3( )4t ) 

l( )4( ) 

INCREASED 

Rt 

5( ) 

Lt 

6 ( ) 

5( ) 6 ( I 

5( ) 6 ( I 

5( ) G ( ) 

1 

I 

I 

. ·.~ 

1,·· 
• 

• 

rr. s-1 

liED 210: REVIEW OF HEALTH HISTORY 

SECOND ~OUHO 

~LEASE INDICATE IF ANY OF YOUR BLOOD RELATIVES HAS DEVELJPED ANY OF THE FOLLOWIN~ HEALTH CONDITIONS SINCE YOUR LAST REGULAR VISIT H£~£ TO THE ATC 

SINCE STUDY. YOUR INCLUDE LAST VISIT BOTH NEW HERE. EVEIHS AND PAST CONDITIONS THAT YOU LEARNW ABOUT 

PLEASE RELATIV£(S) WRIT£ HAD THE CONDITION. HUMBER OR NUMBERS (SEPARATED BY COitltAS) INDICATING WHICH 

WRITE '9' IF YOU D~~'T KNOW OR DON'T UNDERSTAND 

WRITE '0' IF HO BLOOD RELATIVE DEVELOPED THIS CONDITION (OR YOU 

DIU NOT LEARN AOOUT TN£ CONDITION) DURING 7HIS Tilt£ P~RIOD. IN ALL OTHER CASES, USE THE NUMBERS LISTED BELOW: 

0. HO RELATIVE HAD THI~ CONDITION I, FATHER 

2, MOTHER 

J, GRANOPARENT(S), UNCLE(S), OR AUNT(S) IF BLOOD RELATIVE 5. BROT~ER(S) OR SISYER(S) 

7. SON (S) OR DAUGHTER (S) 9. DON'T KNOW 

101 HEART ATTACK OR ANGINA? 

I 02 STROKE? --- IOJ HIGH 8LOOO PRESSURE? 

104 ASTHI'.A, HAYFEVER, HI"V"'ES"",-:.o:;;-n-EczeMA? 

lOS DIABET£~ ( SUGAR DISEASE ) 1 ---- 106 NERVOUS DISORDER? 

107 LIVER DISEASE (JA'"'UN"'O"I""'C"'ET') 7 

108 ANEMIA OR BLEEDING DISEAS"'E?;---- 109 KIDH~Y DISEASE? 

IIO CANCER OR LfUKEitiA1-

IIJ SUICIDE] 

1/2 PEPTIC UUER'rIIJ ~11PHYSEMA OR o''r'"H"'ER,.-,C"'HROHIC LU~~i; DISEASE? 

~HSWERS FOR THE FOLLOWING OR CONOIT,~NS. QUESTIONS, YOU ARE TO HAKE ---A CHOICE AHOHG POSSIBLE 

CIRCLE THE NtiKDER CO~ESPONOIHG TO YOUR ANSWER CHOICE: 

119 IN WHICH CATEGO~Y OF "SI10KII\'G HISTORY" 00 YQU Fl-:"1 

0. I CURRENTLY SIIOKf 

I. I NEVER S!1:l'tO ON -~ ~ECULAR BAS IS 

J, 2. I I STOPP[O IIWE STOPPcO SMOKING SKOKI~~ flEFORE Sll.fCE HV LAST MY LAST.VISIT VISIT HERE. (PHYSICAL EXAlt) H~RE. IF'!, 2 OR ]' SKIP TO QU£HIOH IJO. IF'O' GO TU QUbTiO~ 125 

A) PLfAS[ IHDICI!TF. HOW 11UCH TOBACCO OF EACH kiNIJ LISTED BELOW YOU liSE 

EACH DAY, 11AK£ ONE ANSWER FOR EACH KINO OF TOBACCO. 

CICAftETrES/OAY 

I. /tONE 

2. UF TO l/2 PACKS 

• 

• • 
II. B. 2 • 

3. HORE THAN l/2, UP TO I PACK 

4. HCRE THAN I, UP TO 2 PACKS 

S. HORE THAN 2, UP TO 3 PACKS 

6. HORE THAN 3 PACKS 

CIGARS/o.&Y 

7. NON< 

8. I TO 3 

9. 4 TO 5 

I O. HORE THAN 5 

PIPES/DAY 

II. NONE 

12. I TO 3 

13. 4 TO 5 

14. MORE THAN 5 

HOW OFTEN DO YOU EAT BREAKFAST (I.E., MORE THAN A BEVERAGE) AFTER 

ARISING FA~ YOU MAIN SLEEPING PERIOD, IRRESPECTIVE OF CLOCK TIH£7 

I. A~OST EVERY DAY 

2. ABOUT HALF THE TIHE 

), RARELY OR NEVER 

A50UT HOW MANY 'REGULAR HEALS' DO YOU EAT IN AN AVERAGE WEEk? 

14 OR LESS (INCLUDE 'BROWN BAG' LUNCHF.•) . 5. IS TO 19 

6. 20 OR 21 

]. MORE THAN 21 

IN ADDITION TO REGULAR HEALS, HOW OFTEN 00 YOU EAT BETWEEN HEALS? (I~CLUOE ALL SNACKS AT WORK, BUT DON'T COUNT TIMES WHEN YOU HAV~ ONLY BEVEP'IGES) 

8. RARELY 

9. ABOUT 3 TIMES A WEEK 

10. ALMOST EVERY DAY 

II. MORE THAN ONCE A DAY 

ON THF. AVERAGE WORKING DAY, HOW HUCH OF EACH 1F THE F?LLOWING DO 

YOU DRINK? (IN(LUOE THE FULL DAY. HOME AND ELSEWHER~ -WRITE IN NUMBERS PLEASE) 

CUPS OF CCFFEE CUPS 

BOITLES OR CANS (12 OZ.) OF COLA DRINKS~---

GLASSES OR CARTONS ( l/2 PI NT) OF K ILK ANO DA' PY OR INKS. __ _ 

IN THE AVERAGE 24 HR. DAY, HOW HANY HOURS OF SL.EEP DO WU GET? 

PLEASE W~ITE THE AHRAGE NUMBER TO THE NEAREST HOUR, FOR EACH SHIFT 

L'HED BELl'W. IF YOU NEVER WORK A CERTAIN SHirT, WRITE IN 'O', 

HOW MUCH aD YOU SLEEP ~EN YOU ARE ON DAY SHIFT (7•3)7 

HOW HUCH 00 YOU SLEEP WHEN YOU ARE ON A~TERNOON SHIFT (3·11)1 

HOW MUCH DO YOU SLEEP WHEN YOU ARE ON 1'11 ~~ (II ·7)1 
16C. 

• 

II. B) • 

PLEASE INDICATE HOW OFTEN (ON THE AVERAGE) YOU HAVE TAKEN EACH 

OF THE FOLLOWING PREPARATIONS OR MEDICINES SINCE YOUfi LAST ~ISIT 

HERE. USE THIS CODE TO HAKE AN AN5WER TO EACH liN£: 

0. NOT AT All 

I. ONCE A MONTH OR LESS 

2. A FEW TIMES A MONTH 

). WF.EKLY OR MORE OFTEN 

4. DAILY OR MORE OFTEN 

A) VITAAINS_,...--

·B) ANTACIDS (SUCH AS TUMS, HAALOX, A."'PHOJEL) ---

• 

C) HEADACHE AND PAIN RELIEVERS (SUCH AS ASPIRIN,BUFFERIN,APC,EXCEDRIN~~--

D) ENERGIZERS (TO KEEP YOU AWAKE OR ACTIVE, SUCH AS NO•OOZ . .L---

E) TRANQU ILLI ZERS --- F) SLEEPI~G PILLS __ _ G) OTHER NON·?RESCR!PTION PREPARATIONS (PILLS,CAPSULES,LIQUIDS},__ __ H) OTHER PRESCRIPTION HEOICINES __ _ 

... THROUGHOUT THIS I NTERV I E'J THE TERH "RECENTLY" APPL itS TD TlfE 

PERIOD Of' TIME SINCE YOUR LAST REGULAR VISIT HERE TO THE ATC STUDY** 

INDICATE WHICH OF THE FOLLOWING APPLY (APPLIES) TO YOU: 

3) YOU ARE ON WEIGHT REDUCING OIET 

4) YOU ARE ON ANOTHER SP[CIAL DIET 

5) NONE OF THE ABOVE 

INDICATE WHETHER YOU HAVE HAD ANY OF THE FOLLOWING RECENTLY (I.E., 

SINCE YOUR LAST VISIT HERE): 

I) DOUBLE VISION 

2) BLURRING EYESIGHT WHICH LASTED HCftE THAN A FEW HINUTES 

)) PAIN IN EITHER OR BOTH OF YOUR EYES 

4) TEMPORARY BLINDNESS IN EITHER EYE 

5) HALOES AROUND LIGHTS 

6) TEMPORARY LOSS OF VISION 

7) NONE OF THE ABOVE 

INDICATE WHICH OF THE FOLLOWING APPLY (APPLIES) TQ YOU: 

I) YOUR TEETH (OR DENTURES) ARE CAUSING YOU SIGNIFICANT TROUBLE, 

OR THEY ARE IH POOR CONDITION 

2) VOLIR t:EARING HAS DETERIORATED RECENTLY 

3) YOUr VOICE HAS CHANGED (OEtOME ROUGH, SCRATCHY OR HOARSE) 

RECENTLY OTHER THAN WHEN YOU HAD A COLD OR A HINOR THROAT 

INFECl'ON 

4) NONE Of THE ABOVE 

CIRCLE All OF THE FOLLOWING THAT APPLY TO YOU: 

1) YOU USUALLY HAVE A COUGH 

2) YOU BRING UP HAT£RIAL (SUCH AS SPUTUK, PHLEGM OR HUCUS) 

IIHEII COUGHING 

3) YOU SOHETIHES COUGii UP OLOOD 

4) NONE OF THE ABOVE 

• 

,, 
·---·.-,, .. 

II. 8- 4 -

PLEASE INDICATE WHIC~ PHRASES DESCRIBE YOUR CURRENT SITUATION (CIRCLE ALL THAT APPLY): 

I) YOU DO NOT HAVE SHORTNESS OF BREATH 

2) YOU GET SHORTNESS OF BREATH WHEN WALKING ON LEVEL GROUND 

3) YOU GET SHORTNESS OF SREATH WHEN CLIHBING A SINGLE FLIGHT OF STAIRS 4) YOU GET SHORTNESS 0~ BREATH WHEN SHOVELING SNOW 

5) YOU GET SHORTNESS OF BREATH WHI'H CAUSES YOU TO WAKE FROH SLEEPING 

6) YOU GET SHORTNESS OF BREATH WHEN LYIIIG QUIETLY 

* * * • * * * 

7) YOU GET OERIODS OF WHE~ZING OR WHISTLING IN YOUR CHEST 

INDICATE WHETHER YOU HAD ANY OF THE FOLLOWING CONDITIONS SINCE YOUR LAST VISIT (CIRCLE All THAT APPLY): 

I) FREQUENT NIGHT SWEATS THAT DRENCH YOUR BED CLOTHES 

2) HAY FEVER OR FREQUENT SNEEZINS SPELLS 3) PNEUHONIA 

4) FREQUENT BRONCHITIS 

5) PLEURISY (PAIN IN THE CHEST WHEN BREATHING) 6) BRONCHIAL ASTHK~ 7) EHPHYSEHA 

8) YOU HAVE BEEN TOLD THAT ',"OUR CHEST X-RAY liAS ABNORMAL 9) NONE OF THE ABOVE 

INDICATE WHETHER YOU HAVE HAD ANY OF THE FOLLOW!~~ RECENTLY: 

l) TUBERCULOSIS 

2) CLOSE CONTACT WITH PEOPLE WHO HAVE HAD TUBERCULOSIS 

(INCLUDING ANYONE IN YOUR FAMILY) 

3) .~ POSil'IVE TUBERCULOSIS SKIN TEST 4) NONE CF THE ABOVE 

YOU GH PAIN, CISCOHFORT, TICHTNESS OR PRESSURE IN YOUR CHUT 

0) NO 

I) 'iES 

I~ NO SKIP TO QUESTION 220 

INDICATE WHICH PHRASES DESCRIBE YOU~ PAIN OR DISCOHFORT (CIRCLE ALL THAT APPLY): 

I) OCCURS EVERY OAV 

2) OCCURS MORE THAN ONCE A WEEK 

3) OCCURS EVERY 2 OR 3 WEEK~ 4) OCCURS ONCE A MONTH 

Sl 

6) 

7) 

8) 

* • • • * • * • * 

IS LOCATED ON BOTH .SIDES 

IS LOCATED ON THE LEFT SlOE ONLY 

IS LOCATED ON THE RIGHT SfOE ONLY 

... 

IS LOCATED ON THE MIDDLE OF THE CHEST, * • • * ~ • • • * 

9) . NONE OF THE ABOVE UNDER THE BREASTBONE 

. ' 
--.:-~ 

II. B • S • 

216. INDICATE WHICH PHRASES DESCRIBE YOUR PAIN OR DISCOHFORl 

(CIRCLE ALL THAT APPLY IN EACH SECTION) 

I) IS MADE WORSE BY BREATHING DEEPLY 

2) IS MADE WORSE BY SWALLOWING 

• * * • * • * • • • 

3) COMES ON AFTER YOU EAT A LARGE HEAL 

4) COHES ON AFTER YOU BECOME ANGRY OR EXCITED 

S) COMES ON AFTER YOU 00 STRENUOUS WORK OR WAlK RAPIDlY 

6) COMES ON AFTER YOU TURN FROM SIDE TO SlOE, LEAN FORWARD OR LIE DOWN • • * * * • • * • • * 

7) IS USUAllY SO PAINFUL THAT YCU ARE IN GREAT DISTRESS • • * • * * • • • • • 

8) NONE OF THE ABOVE 

217. INDICATE WHICH PHRASES DESCRIBE FACTORS THAT REliEVE YOUR CHEST PAIN 

OR DISCOMFORT (CIRCLE ALL THAT APPlY IN EACH SECTION) 

I) RESTING RELIEVES IT IMMEDIATElY 

2) RESTING RELIEVES IT IN LESS THAN S MINUTES 

3) RESTING RELIEVES IT IN 5·15 MINUTES 

4) RESTING ~:tiEVES IT IN MORE THAN IS MINUTES 

5) RESTING DOES NOT RELIEVE TilE PAIN 

• • * * k • * * • * * • 

6) NITROGLYCERIN RELIEVES IT 

7) NITROGLYCERIN DOES NOT RELIEVE THE PAIN 

8) I DO NOT TAKE NITROGLYCERIN 

* • * • * * ~ * • * 9) ANTACIDS RELIEVE IT 

INDICATE WHETHER ANY OF THE FOLLOWING APPLY (APPLIES) TO YOUz 

I) YOU GET POUNDING, SKIPPING, THUMPING OR RACING OF YOUR HEART 

(PALPITATIONS AND/OR FlUTTERING) WHILE YOU ARE AT REST 

2) YOU FINO IT NECESSARY TO SLEEP PROPPED UP (WITH EXTRA PillOWS 

OR IN A CHAIR) TO liEU' YOU BREATHE EASILY 7) NONE OF THE ABOVE 

I

CIRCLE NDICATE ALL WHICH THAi OF APPLY THE FOLLOWING APPLY (APPLIES) TO VOU IN EACH SECTIOH IN EACH SECTION) · 

I) YOU GET SWELLING OF YOUR FEET OR ANKLES THAT DOES NOT DISAPPEAR OVERNIGHT 

2) YOU GET PAINS CONSISTENII.Y IN YOUR CALVES OR LOWER LEGS IIHEN YOU WALK ANY DISTANCE 

3) THE PAINS IN Y~R CALVES OR LOWER I.EGS IIAKE YOU STOP WALKING 

4) THE PAINS IN YOUR CALVES OR LOWER lEGS GO AWAY AFTER A SHORT RESr (S-10 MINUTES) 

* • * * " * * * * • • • 

5) YOU HllliE BULGING (VARICOSE) VONS IN YOUR LEGS 

6) YOUR FINGERS ARE EXCESSIVELY SENSITIVE TO COLD SO THAT THEY B~COHE VERY PAINFUL, COMPLETELY WHITE OR DARK BLUE, WHEN ONLY SliGHTLY Cill.O 

7) YOU HAD S~IN ULCERS ON fOUR ANKLES THAT TOOK MANY MONTHS TO HEAL 

8) NON. OF THE ABOVE 

- - 1 .. - . ~- -
• 

II. ! 6 

SINCE YOUR LAST VISIT HAV< YOU TAKEN MEDICINE: 

I) FOR YOUR HEART 

2) FOR HIGH BLOOD PRESSURE 

3) TO HELP ThlN Y~UR BLOOD ~) FOR TilE PURPOSE OF LOSING WArER 

5) NEVER FOR THE ABOVE Rf..\SONS 

INDICATE WHETHER A DOCTOR HAS RECENTLY TOLD YOU THAT YOU HAD: 

I) HEART HURHUR 

2) ENLARGED HEART 

3) HIGH BLOOD PRESSURE 

4) A HEART ATTACK 

5) RHEUMATIC FEVER 

6) MIGIHA OR ANGINA PECTORIS 

7) PHLEBITIS, OR THROI180PHLEBITIS OR "HILK LEG" 8) TROUBLE WITH YOUR CIRCULATION 

9) NONE OF THE ABOVE 

INDICATE WHETHER YOU HAVE HAD ANY OF THE FOLLOWING RECENTLY: 

I) A PERSISTENT SORE TONGUE 

2) BLEEDING GUHS THAT HAVE BEEN VERY TROUBLESOME 

3) A CHOKING FEELING OR A LUHP IN THE THROAT b~EN HOT EATING 4) TROUBLE SWALL~WING FOOD OR LIQUIDS 

5) FOOO OR LIQUIDS STICKING IN YOUR THROAT WHILE SWALLOWING 6) NONE OF THE ABOVE 

YOU GET AN UPSET STOMACH OR ABDOMINAL DISTRESS HORE THAN ONCE A WfEK 

0) NO 

I) YES 

IF NO SKIP TO QUESTION 332 

INDltATE WHICH PHRASES DESCRIB~ YOUR ABDOMINAL PAINS 

(CIRCLE All THAT APPLY IN EACH SECTION) 

I) OCCUR EVERY DAY 

2) OCCUR EVERY FEW DAYS 3) OCCUR EVERY WEEK OR TWO 4) OCCUR OCCASIONALLY 

•••••••• 5) ARE lOCJ,TEO ABOVE THE HAVEL 6) ARE LOCATED SELOW THE NAVEL 7) ARE LOCATED ON THE RIGHT SIDE 8) ARE LOCATED ON THE lEFT SIDE 9) ARE lOCATED THROUGHnUT THE ~OHACH • • • • * * • * * 10) THEY FEEL DUll II) THEY FEEL SHA~P 12) THEY FEEL CRAHPY 13) THEY GIVE OTHER KIND OF FEELING 

• • * ~ • • • * * • 14) 00 NOT HAVE PAIN 

-~- .... : 

• 

• 

i i 

1 

I 

I 

! 

' 

l 

• ' 

• • l 

ill. 
II. B 7 

231. INDICATE IIHICH PHRASES 'lESCRIBE YOUR A~DOHINAL PAINS DR DISTRESS 

(CIRCLE ALL THAT APPLY IN EftH SECTIOhJ 

I) THEY COHE ON AT THE TIME OF, OR DIRECTLY AiTER, EATING A IlEAL 

2) THEY COHE ON ONE OR 2 HOURS AFTER EATING 

)} THEY COHE ON AT NO PARTICULAR TII':E · 4) THEY KEEP YOU FROH GOING TO SLEEP 

5) THEY AWAKE YOU FROM SLEEP 

6) THEY COHE ON AFTER EATING FRI[~ OR F~TTY FOOD 

* • * • * • • * * • 

7) THEY ARE RELIEVED BY TAKING II ILK, SODA, 11»15 OR of!MI.OX 'ANTACIDS) 

8) THEY ARE RELIEVED BY EATING 

9) THEY ARE RELIEVED BY BOWEL KOVEHENT 

* • * * • • • * • * * 

10) NONE OF THE A60VE 

))2. INDICATE WHETHER ANY OF lY.E FOLLOWING APPLY (APPLIES) TO YOU: 

I) YOU HAVE ATTACKS OF NAUSEA OR VOMITING HORE T~AN ONCE A MONTH 

2) YOU KAVE VOMITED BL~OO OR MATERIAL THA1 LOOKED LiKf COFFEE GROUNDS 

3) YOUR SKIN OR EYES HAVE BEEN YELLOW OR YOU HAVE BEEN TOLD BY A 

DOCTOR THAT YOU HAD JAUNDICE OR HEPATITIS 

4) NONE OF THE ABOVE 

333. PLEAS£ INDICATE WHICH OF THE FOLLOWING YOU HAVE NORE THAN ONCE A ~ONTH: 

I) CONSTIPATION 

2) DIARRHEA 

3) RECTAl PAIN 

4) STRAINING ON EXPELLING BOWEL MOVEMENT 

5) A~V OTHER ABNORMALITY WITH YOUR BOWEL MOVEMENT 

6) HONE OF THE ABOVE 

INDICATE WHETHER ANV OF THE FDLLOW!NG HAVE BEEN TRUE FOR YOU RECENTLY: 

I) YOU USE A LAXATIVE fREQUENTLY 

2) YOU HAVE HAD BOWEL HOVE/lENTS THAT WERE AS BLACK AS COAL OR TAR 

3) YOU WERE TAKING IRON OR VITAMINS AT THE TIME OF THE BLAClt BOWEL HOVE/lENTS 

4) YOU WERE NOT TAK!MG IRON OR VITAMIN$ AT THE TIM£ OF THE BLACK BOWEL 

MOVEMENTS 

5) VOU HAVE HAD 81000 IN YOUR BOWEL MOVE/lENTS 

6) NONE OF THE ABOVE 

INDICATE WHETHER A DOCTOR ~S RECENTLY TOLD VOU THAT YOU HAO: 

I) AN ULGER (STOMACH OR DUODENAL) 

2) UALLSTONES OR GALL &LADDER DISEASE 

3) CIRRHOSIS, HEPATITIS OR SOME OTHER LIVER DISEASE 

4) INflAMED STOMACH (GASTRITIS) .. , 

5) NERVOUS STOHACH 

6) PANCREATITIS 

7) INTESTINAL D!~EASE (INCLUDING COLITIS, ENTERITIS, Oft ILEITIS) 

8) HEMORRHOIDS OR PILES 

') WORMS OR PARASITES 

10) DYSENTERY OR SERIOUS DIARRHEA 

II) NOM£ OF THE A&OV E 
II.· B8 • 

iNDICATE WHETHER YOU RECENTLY HAO ANY OF THE FOLLOWING X-RAYS: 

I) STOHACH 

2) GALLIILAODER 

J) INTESTINES (UPPER GASTROINTESTINAL SERIES, BARIUM ENEMA) 4) NONE OF THE ABOVE I 

INDICATE WHICH OF THE FOLLOWING APPLY TO YOU RECENTLY: 

I) YOU BROKE A BONE 

2) YOUR JOINTS ARE STIFF WHEN YOU WAKE UP 

J) THE DOCTOR TOLO YOU THAT YOU HAVE "ARTHRITIS" 4) NONE OF THE ABOVE 

DO YOU GET SEVERE BACK FAINS7 

0) NO 

I) YES 

IF NO SKIP Tij QUESTION 448 

HOW OFTEN DO YOU. GET THESE BACK PAINS? 

I) FREQUENTLY (EVERY DAY) 

2) OCCASIONALLY (SOME TIHE EACH WEEK) J) AFTER DOl HG HEAVY WORK 

4) RARELY 

DO THESE PAINS USUALLY START IN YOUR LOWER SPI~E AND PAS$ DOWN THE BACK OF EITHER OR BOTH LEGS? 

0) NO 

I) YES 

INDICATE WHETHER ANY OF THE FOLLOWING APPLY (APPLIES) TO YOU: 

I) THE DOCTOR TOLD YOU THAT YOU HAD A GOUT 

2) YOU RECENTLY HAO AN OPERATION ON YOUR BONES OR JOINTS 

3) YOU RECENTLY HAD REO, TENDER OR SWOLLEN JOINTS 4) NONE OF lHE ABOVE 

DO YOU GET PAINS IN YOUR lONES OR JOINTS? 

0) NO 

I) YES 

IF NO SKIP TO QUESTION 548 

INDICATE WHICH PHRA~ES DESCRIBE YOUR PAINS (CIRCLE ALL THAT APPLY) 

I) niEY ARE OFTEN SO SEVERE THAT THEY PREVENT YOU FROit HOVING SATISFACTORILT YOUR ARit OR LEG 

2) THEY INVOLYE HANY JOINTS 

* * * • • * * • * • 

3) WALKING INCREASES THE PAINS 

4) WALKING RELIEVES THE PAINS 

5) ASPIRIN, BUFFERIN, ANACIN OR OTHER MILO ltEOICATION R~IEVE THE PAIN * • * • • * • * * * 

6) NONE OF THE ABOVE 

'i 

J ' ~ 

I 

'/ 

i 

' 
'II. s- 9 -

548. INDICATE WHETHER YOU RECENTLY HAVE HAD 

I) BURNING OR PAl~ ON URINATION 

2) DIFFICULTY IN STARTING OR STOPPING URINATION 

4) 3) OLOCO IJNEXPECTfO LOSS OF URINE lii1EN YOU COUGH, SNEEZE, LAUGH, ETC. IN YOUR URINE 

5) DARK URINE 

6) PUS IN YOUR URINE 

7) N?NE OF THE ABOVE 

549. DO YOU USUALLY GET UP AT NIGHT TO URINATE? 

0) NO 

I) YES 

IF NO SKIP TO QUESTION 551' 

550. INDICATE WHICH PHRASES DESCRIBE YOUR PROBLEH (LIST All THAT APPLY): 

I) YOU USUALLY GET UP ONCE PER NIGHT 

2) YOU USUALLY GET UP 2 OR MORE TIMES PER NIGHT t • * * ~ * * * * * 

3) YOu HAVE BEEN GETTING UP FOR LESS THAN 6 MONTHS 

4) YOU HAVF. BEEN GETTING UP FOR ABOUT 6 MONTHS TO I YEAR 

5) YOU HAVE BEEN GETTING UP FOR MORE THAN I YEAR * * fr ·* • * * * 1r * 6) NONE OF THE ABOVE 

INDICATE WHETHER A DOCTOR RECENTLY TOLD YOU THAT YOU HAD: 

I) PROSTATE TROUBLE 

2) KIDNEY Qq BLADDER INFECTION THAT WAS VERY DIFFICULT TO 

CLEAR UP OR WHICH RECURRED FREQUENTLY 3) KIDNEY OR 1LAQOER STONES (GRAVEL) 4) VENEREAL DIS'EASE ("VO") 5) HERNIA 

6) PROTEIN (ALBUMIN) IN THE URINE 7) NONE OF THE. ABOVE 

INDICATE WHETHER ANY OF THE FOLLOWING HAVE HAPPENED TO YOU RECtNTLY: 

I) YOU HAD A BLADDER OR A kiDNEY OPERATION 

2) YOU HAD A KIDNEY X·RAY (INTRAVENOUS 0 YEL0GRAM) 

3) SOMETIMES YOU FEEL THAT YOU HAVE TO URINATE BUT 

FINO THAT YOU CANNOT PASS ANY URINE 

4) YOUR URINE OFTEN CIJHES OUT IN DRIBBLES, RATHER THAN IN A STRONG STREA."' 

5) NONE OF THE ABOVE 

INDICATE WHICH OF THE FOLLOWING APPLY (APPLIES TO YOU: 

I) YOU HAVE BEEN TOLD THAT YOU WERE AIIEMIC 

2) YOU HAVE BEEN TAKING IRON OR OTHER MEDICATION FOR ANEMIA 

YOU OFTEN GET MANY BlACK OR BLUE SPOTS WITHOUT APPARENT ~EASON YOU BLECO FOR VERY LO~ !IME WITHOUT STOPPING WHEN YOU INJURE 

YOURSELF OR WHEN YOI; NAVE SURGERY 0~ TOOTH EXTRACTION • • * • • * ~ ~ ft ~ 

NONE OF TilE ABOVE 

• 

• 

• 

I I , 

I I 

,. " ~.I ' 
n.s·lo. 

OR SINCE YOUR LAST VISIT HERE, HAVE YOU EXPERIENCED ENLARGED GLAND$ lYMPH NODES; 

I) IN YOUR NECK? 

2) IN YOUR ARMPIT? 

3) IN YOUR GROIN? 

4) ELSEWHERE IN YOUR BODY? 

5) NOT AT ALL 

HAVE ANY OF THC fOLLOWING HAPPENED RECENTLY?: 

I) YOU RECEIVED A BLOOD TRANSFUSION 

2) YOU HAD A RASH OR OTHER REACTION TO THE BLOOD TRANSFUSION 3) YOU HAD VITAHIN B·l2 INJECTIONS 4)· N~NE OF THE AGOVE 

INDICATE All THE PHRASES THAT APPLY TO YOU: 

I) YOUR SKIN HAS RECENnY BEC()I'jE DARKER (OTHER THAN SUNTAN) 

2) YOUR SKIN HAS RECENnY BECOHE LIGHTER OR HOR£ PALE 

3) YOUR S~IN HAS RECENTLY BECOME YELLOW 

4) YOUR SKIN HAS SHOWN SOH£ OTHER TYPE OF CHANGE IN COLOii S) THE TEXTURE OF YOUR SKIN HAS CHANGED 6) HO CHANCE AT All .·. 

INDICATE WHETHER OR NOT YOUR DOCTOR HAS RECENTLY TOLD YOU THAT YOU HAD: 

I) DIABETES (SUGAR DISEASE) 

2) OVERACTIV;: THYROID 

3) LOW HETABOLI SH OR UNDERACTIVE 

4) GOITER (ENLARGED THYROID) 

S) HIGH CHOLESTEROL 

6) NONE OF THE ABOVE 

THYROID 

l 

f ' 

! 

·I 

INDICATE WHETHER ANY ~F THE FOLLOWING HAS HAPPENEC SINCE YOUR lAST VISIT HERE 1 

I) YOU HAVE EXPERIEkCED EXTREME DISCOMFORT IN HOT WEATHER 

2) YOU HAVE !XPERIEilC£D EXTREME DISC()I'jFORT IN COLD WEATHER 

3) YOU HAVE NOTICED THAT YOUR EYES BULGED FOR~RD 4) YOU HAVE BEGUN TO DRINK MUCH MORE IIAl'ER OR L!QUICS THAN YCU USED TO S) YOUR HANDS SDHETIHES TREH8L£ OR SHAKE 

6) YOU HAVE HAD SUGAR IN YOUR URINE 7) NONE OF THE ABOVE 

PLEASE INDICATE WHETHER ANY OF THE FOLLOWING OCCURAED TO YOU RECENTLY: 

I) ANNOYING SKIN RASHES IIHICH lASTED FOR ONE MONTH OR LONGER 2) FREQUENT SKIN INFECTIONS OR SOILS 

l) HIVES, WELTS OR SWELLING OF YOUR SKIN 

4) A STUFFY NOSE, RASH, HIVES, ECZEM, OR THROAT Sllflli"'Q •·• TH.~T OCCURS ONLY AT CERTAIN SEASONS OF TH£ YEM 5) NONE OF THE MOVE 

l 

' .! 

t. 

~ 

( 

( 
II. B- II -

INDICATE WHETHER YOU HAVE RECENTLY NOTICED: 

I) NEW GROWTHS ON YOUR SKIN 

2) HOLES WHICH BECAME DARKER OR LARGER 

3) SORES THAT WILL NOT HEAL 

4) NOTHING AT ALL 

ARE YOU AllERGIC TO OR HAVE YOU RECENTLY DEVELOPED A RASN, ECZEMA, 1 

WHEEZING OR NASAL BLOCKADE FROH ANY OF THE FOLLOWING: 

I) DETERGENTS, SOAPS, SHAMPOOS, OR TOIL~TRIES 2) SEAFOODS, SPICES OR OTHER FOODS (CAUSING SKiN RASHES) 3) PENICILLIN 

4)' PHENOBARBITAL OR BARBITURATES 

5) CODEINE, MORPHINE, OR DEHEROL 

6) ASPIRIN, EMPIRIN, OR BUFFERIN 

7) UNKNOWN STIMULUS 

8) NO SU'H AlLERGIC REACTION 

HAVE YOU RECENTLY WORKEO NEAR OR OFTEN BEEN AROUND ANY OF THE FOLLOIIIHG: 

CHEMICALS, CLEANING ~IUIOS OR SOLVENTS 

INSECT OR PLANT SPRAYS 

AMMONIA, CHLORINE, OZONE OR NITROUS GASES 

PLASTIC OR RESIN FUMES 

LEAD OR METAL FUNES 

X-RAYS, RADIOACTIVITY OR ULTRAVIOLET RADIATION 

BERYLLIUM, ASBESTOS OR POLYURETHANES 

NONE OF THE ABOVE 

SINCE YOUR lAST VISIT HERE, HAVE YOU HAD VERY BAD HEADACHES MORE THAN ONCE A WEEK7 

NO SKIP TO QUESTION 679 

NOICATE w'HETHER ANY OF THE FOLLOWIPIG APPLY (APPLIES) TO YOU: 

YOU FEEL THESE HEADACHES HAVE BEEN GETTINr, WORSE 

YOU HAVE BEEN TOLD THAT YOU HAVE MIGRAINE HEAO~CHES YOU RELATE THE HEADACHES TO TENSION 

THE HEADACHES ARE RELIEVED BY: ASPIRIN, BUFFERIN, A!~CIN, EXCEORIN, DARVON,oR OTHER MILO HEADAC~E REMEDIES NONE OF THE AnOVE 

YOU OFTEN HAVE DIZZY SPELLS iHAT INTERFERE WITH YOUR WORK IN NORMAL DAY'S ACTIVITY? 

SKIP TO QUEST! O~j 685 

! . '., 

! ' 1 ' 

U.J 

' I 
• 

INDICATE WHETHER ANY OF THE FOLLOWING ARE ASSOCIATED WITH YOUR DIZZY SPELLS: I) l!GHTHEADEDNESS 

2) WHIRLING OR SPINNING SENSATIONS 

3) OBJECTS ROTATING OR MOVING ABOUT 

II. B- 12 -

4) DEAFNESS 

5) RINGING IN YOUR EARS, OR NOISES 6) NAUSEA OR VOMITING 

7) STAGGERING OR DIFFICULTY WALKING 8) ' HONE OF THE ABOVE 

INDICATE All THE PHRASES THAT APPlY TO YOU: 

I) THE DIZZINESS IS BROUGHT ON BY MOVI~ YOU~ HEAO 

2) THE DIZZINESS IS BROUGHT ON BY CHANGING POSITION, FOR EXAMPLE STANDING UP 

• * * ~ * • • w * • 

3) THE ATTACKS LAST A COUPLE CF MINUTES Oft lESS 4) THE ATTACKS LAST AN HOUR 

5) THE ATTACKS lAST A COUPLE OF HOURS Oft MORE • * • * ~ * • • • • 

6) OF YOU THE HAD DIZZINESS SOMETIMES FALlEN DOWN OR TO THE SlOE BECAUSE 

7) THE DIZZY SPElLS ARE HADE WORSE BY HOVING YOUR HEAD 

8) YOU HAD SOHETIHES EPISODES OF NUMBNESS OR UNUSUAL 

SCNSATIONS (BURINIHG, TINGLING, ETC.) SOMEWHERE IH YOUR 80DY * * * * * * • * • ~ 9) HC~E OF THE ABOVE 

0) NO 

I) YES 

• 

HAD ANY TEETH EXTRACTIONS 

INDICATE WHETHER YOU HAVE RECENTLY HAD AN OPERATION ON YOUft: 

STOHACH 

GAlLBLADDER 

APPEND!)( 

COLON iBOWEL) ANUS/RECTU>I 

OTHER PARTS OF YOUR ABDOMEN 

HONE OF THE ABOVE 

TE IIHETHER YOU RECEt:TLy lfAO AN OPEMTION 0:1 YOUR: 

TONS I LS/ADE~OI DS 

NECK, HEAD, OR FACE 

ARH; OR lEGS 

REPRODtiCT! VE SYSTfH INCLUc; I HG VASECTOHy 

ilTHE" 

HO~E OF PARTS OF THE BODY flOT AlREADY IIENTICN£0 THE ABOVE 

NO YOUR lAST VISIT HAVE YOU SEEN HOSPITALIZ£0 FOR ANY R£ASON7 

YES 

• 

j 

f ,, 

.I 

' • 

• 

• 

,, 
rr. c-1 

IIUMC-ATC HEALTH CHAHG£ STUDY 

MONTHLY HEALlH REVIEW 

OPEN 10 #, _______ _ 

SUMMARY OF IN~!~UCTiONS 

i!i!iS:i!ii55i:E:!55i55 

Check In ILLNESS EPISODES COLUMN 

I. All S'fiiiP~oms thu occurred together ~:J • slfllll•a II IMss. 

(see definitions over) 

2. If more then one Illness episode, check sy.pta.s In 

znd ' Jrd columns provided. 

Check In ISOLATED EVENTS COLUMN If sywoptcoa occurred by I tsalf Infrequently--~ was n.>t just a part of an lllnass eDisode. 

Chec~ In CONTINUING PROBLEMS COLUMN If syapta. ~urred at least 

half t~.e days this month--~ was not just part qf an Illness episode. 

Check In NOT THI~_!\!HTH COLUMN If S'fiiiPtOIII dldn' t occur. 

D£TAILEO INSTRUCTIONS SEE OTHER SIDE OF THIS PAGE. 

PLEASE DO NOT DETACH THIS SHEET. WE WILL DESTROY UPO~ RECEIPT, 

i' 
II. C-2 

This form of the MOnthly Health P.evlew has two parts - the first for ''ness 

episodes and ot~er symptoms and the second for Injuries. 

What is •n "IlLNESS EPISODE"? 

Host 11 i llnesses11 that people have are made up of 11 number of complaints or 

symptoms thet occur In .J duster. For ex•mple. -. ''cOld" m.ay start wl th 1 sore 

throat and progress to a f'twer, cough, and run~.y nose. The throat NY feel bett•r 

before the no'e beglns running, but neverthel~ss we consider 111 four of these s~ptoms as the tam. Illness episode. The 111ness episode ls considered over when 

alJ the symptoms have been gone for at least • day or two (except for certain types or-chr~nlc. recurrln9 condlt.ons). Doctors use the particular combinations of sympt~s as welt as the length of the Illness episode to help diagnose and classJfy 

diseases. Our new Konth1y Health Review Includes vertical columns for you to check 

off as ~ny as three Illness episodes. 

In addition, people sometimes have fsol•ted problems or complaints that oecur 

on scattered occasions but are not part of a larger picture of disease. Examples 

are oCcasional headache or heartburn. If you have had any of these, check them In 

the "I SOLA TED EVENTS" co I \JIM. 

finally. those s~ptOMs which are a chronic problem for yau, though not 

occurring as a separate Illness, and which were present during at least naif the 

days of the month. check In the "CONTINUING PftOBLEHS" col.-. The typical 

••cigarette couqh11 Is this k.lnd of symptCNa. 

How to Complete the Review Accur·ately .:ond Quickly 

Before checking off anything: 

I) Note the month entered at the top of the FonM. 

2) Look over tho whole Form to see the health problems listed. 

3) Recall as accuracely as possible what health events have occurred to 

you In the specified month. 

Then enter Information: 

~) Working vertically by columns, check off sympt~s which happened In 

eacJo. "Illness £pfsode' 1 , then those that were "lsol•ted fvents 11 , and flt:~afly, 11Continulng Problems11 • 

5) tf you have f'lad no such symptom, check the column marked 11Not This MonU111 • 

6) Note that. for each symptom, there should be a check mark In '""'" column. 

Also, ft Is possfblo for • symptom to be checked In more than one column, 

If the symptom Is part of more than one tllness, or If It Is' • contlnul~g 

problem thtlt flares up •s part of an acute 11 111nsss £p,sode11 • 

1) Be sure tc answer questlon-s about getting medical help and to enter numbers 

for days of disability r·esuhlng frOIR each Illness or Tnfury. 

If you hdve dny questlons, ••k the ATC Hed~c~• Technician when he c~s to your 

llty, or telephone us collect at 617·262-~022. 
• 

II. C-3 

•!f•C - t.1t Ill AI fit ~"AIOI(.l \1\lll'l ..... ,. 

MAlt• •nUtt POil. '>O<HOI Of ---------------

lf(A ,.,_,. 6-IIHllt. all ,.,_1.- ,,.,., llt .. ul 1»1....,., I.,.I,.IH C...tl"""'l"" Mill tfllh 

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...... ' -· ~-~· - ,.1...,,. ;---~~":~:·"·"·~·'"·co·•·-------~-c---r---~----+--------+-------< 

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ll llri~., jll~ .... \-· , ....... ~ ..... 

'~•'e:t'• ''*'" .,, <l'u"•• • 

J\ r~-·· .. ul.., ••• ~. ... ., u• I • '•• 

.U 1-..c;•n h•••-

,,--..,--,--,.--,.-,.--,-,-,-,,-""-,---"---:----+----e--;.------+---·------+------i 

" " ou •• ,. ...... _.,..... ..... •.w• 

tcio ..... ~, -111,... ., .. ,._... i " 

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I EVERYONE IIUUf APH0'11J.\TI ! : .. i f!M.411itll1 ( •• ,. o,t,l.~ •.•• )lllu' t 

t CO«.ItU,~II .. C<JI ._Who S: • lioll AU :1 , .................................. :~·-~~--~--·~,·--~·• ... ot;'_j!~ ... ot·~ ... >i->!'' 

: AU()(.UMtlt HOW I'IAHt Ot.'tS OlD : 1,:, ':!:, a 

:)1 THit l:i(P" 'rOU Flh.IHCJ. ~t\.Q.f : if 

i "'PA,_•? (ttUU "..t"'UI !I r-------- _____ ...__,___,_ _,_ +------;,;;, I ,_Oll HOW ~H.., 0"1 fHf:)( GA.VS DIDJ a 

! fUll t:AU$1 YOV (1.1 CUI' COWl Nt: '• 

}1 YDva \lti.IA\.. ~tlJViftllo IMC\.\1~: !i :_,: J)IIK. rt"' L,)lf HtC!Il ~"1 ·.;, :',,I .---- _( .. 111fl llifila(lll 

l )t OIU YOI.I C.U t.tl)lt.IIL HU,po ·,:,YU :,vat :,yet:,·, "'liS .,81 I, I, (U(..Jl'l<t ··~ <.t.IJfl:\ fOil 1'~11 ' ' 

t '""'u•:~ .. ~ t("H' n·)wiiJ : no\ no: no: no no " 1 • ' • ' ' :: ·--,.-. --·· -------~ 't ......... 4 ............................................................. - ........ ~ ............... ~ •• 

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II. C-t• 

INJI.IUU: rluu c:tlec:la 111 Jhet oc.:~o~rr•4 

lor a.Nh •v•,.t• 

--------

I' 

IS 

II 

II 

II 

,, 

.. 

.. 

twjor '"''• •c··•o••• or bruise• 

tnJurlcl to Jol,.tt, '"'-" .n ·.pr.alns, 

'ltr•l,., '">~ .. r•nd"ll,... 1 

Other In Juri •• to ,.,.. .,.. f•c•, •~h •• 

concuuiQn, l,.tur•llll •n. lou of tc4th. etc. 

Alt~u.-..r '- _,.y """' dl4 this lo-p 'I'OU fecl'"t below ''per''7 (enter,..,.....,., 

fc.• ......_ _.., ol thelll ,. • .,, "''d tl'lh C.twt• 

~-""'Y to'""' dc:-'1 oo. yo.,,. u~-...1 .-.ctlwltie"'l, 

lnclu41"t ''-lou,,._ -rlo.7 (cnt•r .,....,.rJ 

014 -,o.. 9CC --'11'.;1 h•l• (.IS._ fOr' Ot Cl fnlc) 

tor t,.h probl-f (CIAClt: AN~\.1(111) 

41 KAVI 'I'CIU JU:H lt01.PtfALilt:O Ol.lll~ ftCfS HOttiH 

(Cir..le Aftt-d 

m 

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,., 

.. .. m 

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4) O.,rl"f this _,h, "-ve yow M4 .,..,. I lr.,..u ot ..._. .. ~ pi'Oitl- ~ cower-.! '• eM• 

tevt- fo,...P (Ci~CLI A.liiWU) 

"" 110 

It tU, .._, II ttr 

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• II. D-1 

ATC HEADACHE S11JDy 

October 1976 

Headaches ar·e among the lllOst co....., health Coq>lafnts that Air Trofftc Controllers ,.._ port on their Monthly Health Review, In order to get a bt,tter understanding of the n1tura 

of those headoches, we will be enclosfn~ these added Items In several selected lmnths: 

A complete description of headaches helps doctors to classify thea and to derive fdeas 

regarding their causes. So would you Please consider each ft .. below and CHECK whether It 

Usuattx_, Occasfonally, or~ was true for the heodaches you had THIS PAST lilliiTH. 

Frequenc;y 

How many headaches dfd you have thfs last 1110t1th: '·J Total number of he•daches 

z. How II\Ony lasted for more than one hour? 

3. HO\t many were so ~evere they Mlde you 5top what you were dofng? 

__ --'· z. 

(IF YOU ANSWERED "0" FO~ "Z" OR "3", YOU ARE fiNISHED. PlEASE R£TUAN THIS PAGE WITH 

\'OUR MONTHLY HEALTH REVIEW. If YOU ANSWERI:O A POSITIVE Hli'18£R FOR •z• ~ "3", COIITIIIUE.) 

Please answer the question• for~ those heodaches which EIThER were so severa 11 to 11ke you stop what you were doing, OR Tasted ~!. than one hour TOi"1iath). 

__ 3. 

Check Check l:ow often EACH item below uas true for your hudaches thfs 1110nt1t. Pleue .. ke l for each numbered statement: 

Just before th~ headache: 

Usuall.l!: Occas fonaJ!.I!: !!!tt.•..!: 

4. Muscles of head or neck are tight __ 

5. Eyes become overl_;. senstt1vu to light 

6. Visfon blurs or fl1ck.ers --- 7. Cth•r: (write in): 

8. No symptoms precede tn; actua I 

headache 

Starting locatio~: 

9. Forehead 

10. Around or behind the _eyes 

11, Back of head or neck 

12. All over the hea.o 

13. £1ther -~of he•d (not both •fdes) 

Usual tHoo of occurr~: 

14. Gu~ing periods of intense conccn tra t f on 

15. During or after worry or emotion.:. 

al tension 

16. During the "let downq after a perlod of work 

17. Duri119 rest or relaxation 

18. Stdrts durfng sleep and wake! ~ UD 

19. Usuai iy only dfter eating or d?fnkfng too much 

ZO. Other (wr1to in):. _______ _ 

--

·-

-· 

·-

-· 

--

--

_ __ 4-. 

-.-5. ---6. 

--7. 

__ a. 

---..,9. 

__ ...,lo. 

lt. --~2. 

___ IJ. 

__ _,'4, 

__ _,·s. 

__ 

---..J6. _,/, 

__ _,8, 

--~9. 

---<'0. 

• 

• 

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ATC HEA!W:i!E STUOY 

II. D-2 

.!1!1 ot Ptin 

21. Steody pressure 

22. Oull study •crn. or paIn 

Usuolly 

23. Tight b.lnd of "he•~ f~ a Yhe" ~4. Throbbing or PGUndtng 25. Other (..,.lte In):, _____ _ 

During the Heodache 

26. NGUStl or VOMfLing 

27. "Buzzing• In the e1rs 

28. Feeling faint 

29. Re..tness or w.otertng of - tl)'e ---30. 8r~gi1t 119ht .. kes H loOf'Se 

Dur1tlon of Head•che 

31. less than 1 hour 

32. 1 to 3 hours 

JJ. 4 t11 8 hours 

34. 9 t 24 hours 

35. More than 1 dly 

Severt tv 

36. Aching. No real fnterferenc• 

with acttvltles 

37. Patn. Some Interference ~lth most acttvltfes 

38. Severe patn. ~~kes uo stop 

whatever I'm dotng 

What do YOU use to relieve headaches? 

--

Do not us~ tbts 

39. Rest 'or relaxation (,.., drug~l- 40. Hasuges of nock or held (no drugs) __ _ 41. Aspirin, Anacfn 

42. :.tronger pain rel foYer (unprescrfbed,4-__ 43. ~tronger medicine (prescription) 

44. fleeds a lledlcfne containing ergot 

45. A parent or close relattve has 

severe heodaches of the s ... type as •lr~. 

46. I first experienced heodlches of ~ t.r;>e I had 

this month before age 25 ye•rs. 

47, As a Child I was SUbJect to "motion SfCki14SS" 

THAHK YOU FOR •OUR ASSISTANCE 

Occostonallr 

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Page 2 

___ --~21. zz. 

--~23. 

--~24. _ _ _,zs. 

___ 26. 

__ _,n. __ _,za. __ _,29. __ _.:10. 

----31. 

__ _,32. 

__ ---;»· ...,34. __ _,35. 

36. 

___ 

--37. 

.--~38. 

Jt ~Yp: f~!fle. 

39. --.. 0. 

---'41. 

---'42. 

--.......;43. 

--_;44. 

__ _;45. 

___ 46. 

___ 47. 

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U. E-1 

TROUILE SL£EPINGl 

Ono of the..,., "-n proble,.. reportod by Air Trefflc Controllers In the , .... , Is trouble oleeplng. Wo wont to find out moro •bout this prool .. In 

0 

soerch for possible causes. 

If you hod !!2. sloop probl.,.. this peu 110n~11. ploese return tlllo for• blonk. 

1 f you !!.! have sleep praor ... plecae check the c;orrec:t ~Jc.rlptfon below:· ,..k• one check per It-. 

iO) (I) 

Not •t 1•3 

•II ....... Hovo 

~rouble 

trouble 

atey•ng 

f•llln •aloepl 

Aal .. p7 CJ CJ 

(I.e. If you w.ke up far too CJ Cl 

lOOn and un• t gee: beck to sloop.) 

up several cr .. , per CJ c::::I 

up after your uauel 

f•llng CJ c::::J tired 

the following ~lch you f .. r 

I' •• eaten or drunk 

to u•e the beth~ -are then 

night --

Idea• spinning through "'t •lr . .;; or proble.s 

Jn sleeping schedule, such •• in work shi fu 

enough cr .. for sleep not on tPis list 

TIHE OF OAY 

v •• 

: : 

H 

CJ 

td 

(2) Ul 4·7 a-" ....... da)l 

c::::r CJ c::::J c:J 

c::::I c::::J 

CJ CJ 

cause the p·robl._ 

No 

Fl 

§ 

CJ 

0 

t:=J 

(~) 

15•21 

da)'a 

CJ 

CJ 

c:J 

CJ 

~Ia feel fer botter·· .. re •lort, COMpetent, end heppy at ona tl .. of dey, 

lcoebly below thee le•:el ot other tloou. You hear •-• saying: "I'• • person'', <~nd another: 11 11• • night owl." ' 

(S) 

22·31 

oya 

CJ 

CJ 

CJ 

CJ 

e1c~ deacrfptlon, please che~ the one ••t of hours Which ~It flea 

. - - ZXIr-tz~~oon 12NOon·SPII SPH-1 OPH . 

time of day for,.. I f .. l MOre •n•r~etlc, CJ capaole. 

or Irritable. difficult tl.., of da1• I ort., feel tl recf, Q 

tl•s of d•y are about t"- , ... tor Me In terN. .------------, 

0 

0 

0 

D 

ube•t tiM" It J~;~st 11 lfUty t(l occur any tiMe 

------------------·--._ .. __ _ 

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II. F-1 

£f_ ~GRAPHICAL QUESTIONNAIRE 

The followinq questions ask about aspects of yourself, your family, and 

experiences that have not been covered elsewhere. 

Consider each question Ca·refu1Jy and select your answer from among those 

In some cases the question may not fit your situation exactly. 

instance, if a question asks about your parents, you may have to Interpret 

In tenns of guardians or step-parents. Please choose the one answer which 

most accurate for you, even if it does not fit perfectly, by circling the 

in front of your answer choice. Some answers will need to be written. 

While you were growing up, •1here did you live most of the time: 

{1) in a rural are~ t 

(Z) in a sma II town? 

(3) in a suburb of a large city? 

(4) in a City of le~s than 500,000 inhabitants? 

(5) in a city of over 500,000 inhabitants? 

unti) you were 13 years oid, how many times did your family 

not count moves known at the time to be temporary, e.q. for the 

7 or more 

reaching the age of thirteen, but before moving out on your own, 

times did your family rr.ove? 

• 

• 

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(4) While you were 9rowfng up, was the section of town fn which your family lived longest: 

1) one of the poorer ones 

Z) about average 

J) good but not the best 

4) one tlf the best 

5) not applicable, lived In rural area 

(5) What was the economic situation llf your family: 

1) not able to make ends meet 

Z) able to have the necessities only 

J) able to live comfortably 

4) well-to-do 

(6) How many brothers and sisters did (do) you. have: (Wrfte fn t~ actual number) 

o 1 der brother$ -

- o~der sisters 

- self 

_ yQunger brothers 

_ younger sisters 

(7) How often dfd you seriously consider quitting high school: 1) never 

Z) once or twice 

J) occasionally 

4) frequently 

(8) During your last year in high school, ~1hat was the average number of 

evenings a week that you went out socially wfth persons of the opposite sex: 

l) less than 1 

Z) 1 

J) z 

4) J 

5) 4 or more 

'i 
II. F -3-

(9) In hig~ school did you have: 

l) fewe~ f~iends than most othe~s 

2) about the same numbe~ of f~iends as othe~s 3) mo~e f~iends than most 

(10) Ou~fng you~ teen yea~s was your rate of physic4l growth compa~ed to other boys: 

1) much slcwe~ 

2) a little slowe~ 

3) about the same 

4) a little faster 

5} much faste~ 

(11) When did you have you~ fi~st alcoholic beverage (include bee~) outside you~ home: 

l) unde~ age H 

2) 14-16 

3) 17-20 

4) 21 o~ olde~ 

5) I neve~ d~,nk 

During you~ teens, 1~as your relationship with your parents: 

1) much wo~se than that of others 

2) somewhat wo~se than that of othe~s 3) about ave~age 

4) better than that of most 

5} much bette~ than that of most 

Whether or not you played o~ganized sports, how athletic and fit 

were you compared to most of you~ classmates? 

l) much less athletic and fit 

Z) less athletic dnd fit. 

3) about ave ~age 

4} mor-e athletic and fft 

5) much mo~e athletic and fit 

\, 
U. F -4-

(14) lr. which religious tradition did your parents raise you? 

1) no religion at all 

2) the Roman Catholic Church 

3) a Protestant religion 

4) the Jewish religion 

5) some other religion not listed 

6) an a~heist or agnostic tradition 

(15) Please check for each person listed the highest level of formal sr.hoolinq 

he or she was able to obtain. (Place one check in each vertica! column. 

If you have not lived with a wife during this past year, please cross out 

columns 18, 19, and 20.) 

1' , 16 17 18 19 20 

Myself My My MY MY wtre s MY W1fC 

~unt of School father mother wife father mother 

Ei ahth arade or less (I) 

Same high school but 

did not-araduate (2) 

High school graduate (3) 

Formal vocat;~nal 

tf'aining after 

hiah school (H 

Some college (5) 

Colleae araduate ( 6) 

Master's degree or 

hf_gher _(]J 

Not know11 (9) 

(21) Wh1Te you l'ere growing up, what was your father·'s primary occupatiM? 

Write in the answer. Lfst more than one, if appropriate. Please 

indicate the nature of the work, not the employer -- Wrfte "Repaired 

mach1 nes in a cannery." Do not wr 1 te "Worked for food pro.cessor. N 

If a fanner, fnd1cate size of farm and whether owner~ renter, or 

• 

• 

• 

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II. F -S-

(21) hired hand, For pr1prietor, Indicate nature of business and n1111ber of 

employees. 

(22) While you were growing u~. what was your mother's occupation? Write 

In the answer. List more than one If appropriate. 

In some families parents are very similar to one aoother, but in ot~er 

famflles the parents are "as different as night and day.• Please check 

how simflar your parents were to each other in eacli of tile follo;.,lng 

respects: 

Ver~ simflar A little different 23) Social background -~ Sharply different 

- - 24) Education 

- 25) Reltglous emphas 1s -

- - 26) Their goals for you 

- - 27) Personality 

- (28) Up until you were age 17, was either of your r.atural parents out -of 

your home for more than a year? 

0) No, l lived with both natural parents until 18 

1) No, my parents were together but I lived elsewhere (e.g, boarding 

school or In another home). 

2} Yes, a separation only occurred 

3} Yes, a divorce occurred 

4) Yes, father away in military or related service 

5) Yes, a parent died 

6} Yes. some other reason 

(29) If you ._nswer•d "yos" to question 20, how old were you the flnt tfnte 

a parent left you• home for a y•ar or '!lOre? Enter your age then: ___ _ ... 

I 

I 

i • 

., 

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II. F •6· 

(30) If you answered yes to question 28, which parent left? 

NOW WE ARE GOING TO ASK ABOUT YOUR CURRENT liYING·~ITUATION: 

(31) How many of ~he following kinds of persons are living In your present. 

household7 Write In the number residing with you 1n each category. 

- in-laws 

- relatives on your side 

- children (Include adoptions etc.) 

friends -

- other: (~pecify) 

(32) At the present time l live In a section of town ------- which fs: 

1 ) one ~f the poorer ones 

Z) about average 

3) good but not the best 

4) one of the best 

(33) 1 currently consider myself a member of: 

1) no religion at all 

2) the Roman Catholic Church 

3) a Protestant religion 

4) the Jewish religion 

5) some other religion not listed 

6) an atheist or agnostic tradition 

(34) On the average, l 9~ to church service: 

1) never 

2) once o, twice a year 

3) around on•e a month 

4) twice a month or so 

S) once a week or more 

I 

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I. 

f 
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II. F -7-

(35) For how .,.ny years have you lf•;ed in the county of your present address? 

Write ln the number of years. 

(36) For how many years did you serve in the •nmed forces? Write in the 

n,..ber at years ("9~"if you served for less than's year) •. If you never 

served, please skip to question 39. 

------· 

(37) If you dfd serve fn the armed forcas, what was tno highest rank you 

attained: 

I) never sorved 

2) private, corporal, seaman, airmaR, etc. 

• 

3) in the ranks of sergeant, petty officer, and so on 

4) lieutenant (jg., first, second), captain (AF or Army), lt. commander (Navy) 

5) major {AF, Army), commander (Navy) or above 

(38) While in the service were you an: 

I) ATC 

Z) pilot 

3) navigator 

4) other job related to aviation 

5) nooe o' these 

6) never s•rved 

(39) How many times have you been married? Write In the number: 

(40) At pres•nt I am: 

I) married {Please continue, startioq with Item 41) 

Z) separated leu than one year {Please continue, starting With Item 41) 

J) sep•rateJ on• year or more {Pl••se skip to Item 69) 

• 

•• 
........... --- ---------------·-·-

II. F ·8-

(40) 4) divorced (Please skip to !teo 69) 

5) widowed (Please skip to Item 69) 

6) engaged (Please skip to Item 69) · 

7) unattached and none of the above (Please ski~ to Item 69) 

(41) While your wife was growing up, what was the primary occupation of HCR 

FATHER? (Write in the answer. list more than one if appropriate. As 

for Item Zl, indicate the nature of the activity, not Just the general field.) 

(42) While your wife "as growing up, what was the ~rlmary occupation of HER 

MOTHER? (Write In the answer. List more than one if appropriate.) 

(43) Has Your wife In the past or presently pursued any of the following 

vocations or profession>? Please check as many as apply. 

I) Business person, •uch as proorletor or manager, supervisor, personnel 

director, or the like 

2) Professional person such as lawyer, certified accountant, registered 

engineer, physician, chemist or the like 

3) Professional person such as school teacher, social worker, artist, 

registered nurse, medical technolo~1•t (with college degree) 

4) Clerical & sales position, such as secretary, bookkeeper, office 

worker, salesperson. 

S) Skilled occupation such as medical technician (without college degree), 

craftsman, machine operator, factory worker, electrical or similar work 

6) S<rvice ~ositions such as hairdresser, waitre>s, or s1mil•r work 

7) Some other area: Please specify: 

8) None of the above 

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II. F .g. 

(44) At the present time, does your wife do work other ~han as a housewife? 

1) No 

2) Yes, voluntEer work outside the home. 

3) Yes, part time Job 

4) Yes, full time Job 

IF YOU ARE NOT PRESENTlY LIVING WITH YOUR WIFE, PLEASE SKIP TO ITEM 69. Ftmfly Decision Makinq 

In every family somebody has to decide such things as where the family 

will live and so on. Many couples talk things over first, but the final 

decision may really be made by one person. For each of the following Issues, 

please Indicate whether the decision is made (1) by the husband always, (2) by 

husband more than wife, (3) by husband and wife exactly the same, (4) by wife 

more than husband, or (5) by wife always. Please make one check tn·each 

horizontal row. 

Final decision (I) is made by: (2) (J) ( 4) (5) Husb. Husb. mo:--e Husb. & wffe Wffe ~r.ore Wife 

Issue ah;ays than wife the same What Job than Husb. always the husband should take 

- - - - - What car to get 

- - - - Whether or not to 

buy life insurance 

- - Wher·e to go on vacation 

- - - What house or 

apartment to take 

- - - - Whether or not wife 

should go to work or 

quft work 

What doctor to have 

when someone 1s s·tck - - - - - How much mo~ey tfie family 

can afford to spend on food 

- About 

are to 

how be the disciplined children - - -
• 

• 

II. F•lO· 

The e"llowfr•g Is a list of some possible family goals. Pleue rank the 

goals fran one to ten In tenns of how Important you feel each goal should be • 

for a family. Then rank each goal as you think your wife would. Th~ Nost 

Important goal should be ranked number I; the least Important shouod be 

ranked •umber 10. 

Cl-lu) (1·10) A family should provide: 

(54) A respected place In the COIMloJnfty 

(55) The means for healthy and happy children 

Your rank fng How you think 

your wife wouid 

r•hk th..., 

(56) C~panlonshlp for all members so 

that everyone feels comfortable and gets along 

(57) Personality development for 

chfldren 

(58) Satisfaction with the amount of affectfon shown one another 

(59) Economic security 

(60j Emotional se<urtty 

(61) Moral and reliQiaus unity 

(62) Interesting activities 

(63) A house and home where everyone feels 

they belong and other people cannot fnterfere 

--

Did you take your childr·en (either with or Without your wife) to an 

eating place, the movies, •ome entertainment, or recreation, or to visit 

friends --

(64) In the past week? 

(65) In the past month? 

_g_ No. 

Yes. Enter the n• "ber of times bflfore 

the "'/es". 

_Q_ Ho. 

_Yes. rnter the number of u .... $ before 

th1 •ve~··. 

• • 

• 
II. F-11-

(65a) __ _ 

Check here If this fs not applicable berause you have no chfldren 

(unaer age 18) living with or near you. 

Old you go out with your wife to an eat<ng place, the movies, to some 

entertainment or recreation, or to vfsft friends (You may Include events reporte~ above ff your wife was present.) --

(66) In the past wel!k? 

(67) In the past month! 

--l'_No. 

- Yes. 

_g_ No. 

_ves. 

Enter the number of times ~fore the "Yes." 

Enter nt•,nber of times befure 

the "Yes". 

(68) All things considered, how happy and sat;sffed have you been :;ofs reor 

In your relationship ~fth your wife? 

I) Very happy and satisfied 

2) Fairly happy and satf>ffed 

3) Neutral -- or very mixed feelings 

4) Som.what unhappy and dissatisfied 

5) Very unhappy and dissatisfied 

The last five it~ns deal with general issues about which everyone has some 

ofpinion. thesestatements: Please indicate the degree to which you agree or ufsagree ~fth each 

(69) These days a per•on doesn't really know whom he can count on. 

I) Strongly Agree 2) Agree 

3) Disagree 

4) Strongly Dfsagrae 

(70) Nowadays a person has to live pretty much for to~ay and let tomorroo. take care of Itself, 

1) Strongly Agree 2) Agree 

3) Disagree 

.;) Strongly Disagree 

(71) Host public officials (people In goverr;mer:t offices) are not really Interested In the problems of tne overage man. ., 

I) Strongly Agree 

2) Agree 
II, F ·12-

( 11) 3) Disagree 

4) Strongly Disagree 

{7l) 

In spite of what some PtopJe say, the Condition of the average a.n Is getting Worse, not better, 

I) Strongly Agree 2) Agree 3) Disagree 

4) Strongly Disagree 

(13) It fs hardly fafr to bring children ioto the world with the Nly things loo~ for U;e future, 

If Strongly Agree 2 Agree 3 Disagree 

4 Strongly Disagree 

THANK YOU FOR YOUR COOPERATIOII IN COMPLETING All THESE ITEMS, 

TO PLEASE THE PSYCHOLOGIST, TUR~ Ill THIS FO~, WITH YOUR "OPEN 10 IIUMB£R" ON IT, ' 

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II. G-1 

FIF'l'H IKlUND 

PSY 102: ATC QUESTIONNAIRE 

CAREER ATTITUDES ANC BEHAVIOR 

· Thia qoest:tonnaire a.aka oillOut ~rour ATC work. It you Mve PIU"...,.tl4!ntly lett 

; Air Traffic Controlling please a"awer t.he tollowin9 queationa in teraa of 

yov praaent occupc&tion. Pl.eaae consider eac queation eerefully before 

anawer1nq. Multiple choice answer• are prov: ~Utely ilhave u.ch 

que•t.ion. 

l 

Enjoy ver:y 

•ueh 

2 

£njoy quite 

• bit 

3 

Enjoy ~­

what' 

• Don't care 

either w.ay 

5 

Dialike Oialike 

.a.ewbat quite a bh. 

7 

Dial ike 

va·y 

.,ch 

1. Ho., do you reqarct the va.riety pcov1de4 by ahitt chanqea? 

l. work 

2. Work 

3. work 

•• work 

s. work 

6. WOrk 

7. Work 

••••••••••••••••••••••••••••••••••• 

qu.Uty 

cr..ur.ltty 

qUt..Uty 

quaUty 

qlM.lity 

qu.o.li<v 

quality 

beca.ea Much worse 

b6c~a ~~ately ~rae 

beca~Uta a081~At .orae 

1a not attect~Hl 

becanea a~t better 

becoat.ea ~M>dttrately better 

bec~o& •uch better 

2. How h tho qu.lity of your wac-k attect•d ia!Mdi4taly after cN.nging 

onto your 'l .. at~ prete~red shift? 

••••••••••••••••••••••••••••••••••• 

1. No ttae. At .u, ah~tt cha.nqe• 40n 1 t. •fhct •Y work quality 

2, M hour or two 

l. Several houra 

4. At l.a•t one full ahift 

S. TWo or .are whifta 

6, up to a weedc. 

1. ov•r • ve•k 

•••••••••••••••••••••••••••••••••• 

l 

Up to 

• \!Hft:~l!. 

• About 

a week 

6 7 

Up to ttu:•• Never qet 

w.uka fully relAXed 

Nov lOtlfl '-'uWl it t•ke rou tn re.d J·t ur.win4 or r•l•x orn:e ';'c:M.& have at.art.S 

.annu.l l._.vo? 

) 

) 

I 

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i· 

I 

i 

., 
A month 

or more 

2 

Up to 

three 

weeks 

l 

Up to 

two weeks 

II. G -2-

4 

About 11 

week 

s 

Up to 

a week 

• 

b 

A couple 

of days 

S. Once you come back from o week or more nf annual leave, how long does it t•ke you to get up to peak a;aJn? 

I. Huch les1 than most 

2. Quite • bit less 

), s~~t less t~n .a,t things 

~. About as much as anything I do 

S. Scmewh.t more tNn most things 6. Quite a bit mor• 

7 

A day 

o,· less 

7. Much mo;e than mott things 

6. Even thoug~ Air Traffic Control may be o very ••r.ltlng ond rewording 

job, to whot e•tent do you feel it hoo "cost" you por~onolly to be an ATC? 

*****tt**********tntt<*•**********'~*.t**************:t* 

ATe work may offoct monv other oreoo In vour life. U•e the scolo below 

for indicoting how each of the following areoo hove been offectee for vou. 

I. ATC work Ns 

2. ATC work Interfered tremendous!~· In thh .,.~• hoo 3. AT' WOt'k 4. ATC WOC"k 

hu Interfered moderately in this area Interfered siJyhtly In thi5 hos area s. not affected this are1. ;._rc work he$ 6. ATC work helped siJght:ly this '"•• hu ]. ATC 

friendships 

Socl•l life 

work ho• helped moderetely ttls •rea halped tremendously ~his are• 

Rel•tionshlps with wife or girlfriend 

FMtily life •nd rel•tions with children 

Opportunity for •dv•ncement 

Phys lea I Mr•l th 

Peace of Htind 

The next ••t of que•tlon• ••ks about your perceptions and feelings 

regording vorlou• upecu cf being •• ATC. If a question is not .. octlv 

approprl•[e for you respond In terma ~f the most p.r•flel sltu•tlon. 

For inst•~ce, some ~flcr towers do not have tectors but they do 

have •rriv•lldeplrtUre specl•llats, Use whltever your tower/center 

hU for i u controllers. Abo, In 10010 question•, sofety considerations 

would Influence vour answer. Pleo•e interpret each question as if ••fety ""'• IUured, 

• 

I 

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For these questions please use the scale given below for selecting 

your answer. First decide whether a •tatement is true of false for 

the you. st•tement Then select is. the number on tho 5Caio indicating~ true or faioo 

I 

COMpletely 

,.,,. 

3 ~ s 

SOMewhlt NeJ ther S~t 

fohe tr~o~e nor f•lte true 

6 

Hootiy 

true 

7 

COMpletely 

true 1~. my 1 greatly sector dislike having to reotrict aircrJft prior to Choir entering 

IS. When working • combined •ector welt, I don't llko to have onvone suggest decOMblnlng It 

"v own ltandardo of performance are higher than those In tho FAA rules 

I 011 cOftotantfy reviewing ov performance throughout e shltt ogelnu "'Y own set of st•ndo.-ds 

Evon when l'oa under IFN preuuro, I don't feet I '11 doing o COIIplete job unlesa t provide VFA •dvl&orJes 

It is e•treoely !mportant to 110 to try and flit pilot requests even when their requests wJ II c•use me extr.t work · 

I try to do something e•tr• in every shift so that 1'"11 ond eoch shift with 1 sense of •ccompllshment 

won't I try bet to get bored assigned to technically thai longing sectors so that 

difficult Coopored to other controllers, I keep '"Y coot bettor In very sltu•tlons 

I couldn't 0. 1 supervisor of ~ friends 

•bout People them con eully tell from my wordo ond oct lOfts how I •·eatty fool 

People who know me welt WOUld uy I lot • lot of things "got to 110" 

go If to It a wor• doc; not tor for tho FAA required physical I would rorely,ff over, 

I find I Mve to drink n.ore to gee the a-. re' fef 

If I'• not able to drink, I find It .. tr~fy difficult to unwind 

After I have loft tho boardt I continuo thinking •bout oft tho PQS5Ibla conftlctl •"d work c~ through •g•Jn In my alnd 

I l!ay In "high g .. , .. •nd hovo troubto •••••fng once I I•••• work 

unwind Ovor the u ~It law oontho, I find It fa bocooolng lncreootngty dlrf!cuft to the end of • lhf ft 

..... 

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' . • J . ~- • ·,..{v '- . :;J . . ' ,·.·. ~:>-~./4 

~-~~:-~;~:~-~~-j~---l~~ ;I 

) 
I 

Completely 

f•fse 

2 

Hostly 

f•lse 

II. G -4-

l, 5 

Ne I titer So.e .. ~ t 

true nor f•lse true 

6 

ltost ly 

true 

1 

Ca.pfetely 

trve 

32. I get so Involved with "Y wor!< :hot ot the end of o lhlft I often forgot things such as where I p•rked •Y car. things to shop for. and so on 

33. When 1 got honoo ofcer work, I M so pr-cupled with whet hopponod on the job that I can•t t•lk with my wife or frtends 

34. Even wnon I'" owoy from Air Trofflc Controlllng I spend -.ch of -v tiMe thinking about ATC work 

)5. In deocrlblng .,., my frlendo would •~Y that I eot, drink end think ATC 

36. Coopored to othor controlloro, I con •••lly return to pook porfonoonco after a bad tIme on the bcNrds 

J]. In the poot tlx MOntho It hot hoen boco•lng more difficult for .. to 

bouoco bock to peak perfornoon~e when I'•• boon -Y frooo the boerdo 

38. I• the lost sf• ~•tho, I've boon finding It horoer to thlft between peak and slow perfocfa 

l9. I a. rela~ed when giving on-the~ job ~raining 

4). get very lrrltoblo with t•·olneoo when glvl•g on-the-job training_ 

44. jcoperdfze .. never bothered "'Y rating. by thoughto that actions of~ trolnoe of •lne will 

4S. Whenever I hove o noor-ml;s, -v lelf confldonco It greotly thoken. 

46. Tho lost non-col!lsfon "polr" 1 hod S:IIJ bothero .. greatly. 

47. One of tho gra.teot ltross,. In ATt work ttemo froa tho olose-colls 1 hove hod • 

. 48. The effect of having on Incident "'•rs off me within > week or so. 

49. In the lou yoor, huw bOny "lncldontt" (rel)Ortoblo or Otherwho) hove you boon Involved ln7 Write In tn. act~l number, 

50. How many of these lncldento >till bother YO• greatly? Write In the octuol number 

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II. G -SThi, >ection o:' the quesUonnaire h• concerned with your reactions to 

v.arious situ.ulor.s th41t •··ise in Air Tro!lffic Control. 

Ple•s• indicate l>ow often in the past sl, months you have felt or experienced 

any of the follo,in., before going «> .or;. wi:•n you knew the weather and/or traffic condition~ -~re bad. Use the $~ale giv~~ b41ow: 

2 l 4 5 6 ~.ever, Rarely Occasion.1lly ltore th•n F•irly Vary {'IC(.aslona ~ · v often b<.t often les1 

than often 

~efore going :o work when weuh:or and/or traffic condl tlons were bod, t.ow oftet'l did ,·ou have: 

S2. Uptight, fidgety, and tense feelings? 

SJ. loss of appetite? 

S~. Upset stomach? 

SS. Wishes that It w.s not YOUr shift? 

56. Thoughts al:<o"t calling lro sick but not actually doing It? 

1 

lllearly 

every 

time 

While fe It or working exper difficult traffic In the last six months how often have you I enceU: 

57. A lot of perspiration? 

58. 'tour muscles tensing up? 

Feeling ~ncor~ortably warm? 

A dry mouth? 

Feeling "put on the spot" 

Tense and worried feelings? 

Cettlng more Irritable with other controllers7 

please lndlcoto how often you hav• felt or exp•rlenced the following yo~ have ~een relle~ed fro• a long period of he•vy traffle. often have you felt or ax~~rlenc•d: 

The re•llzatlon that your tnu•,cles 1o110re very tens .. 7 

A backac:,. 

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2 l ~ s 6 Never Rarely Occ~u I on a I I r Hor_e: than ~alrJy Very occasionally often but less often 

than often 

Considering an average work day for you, Indicate how accurately each 

of the fol luwlng sr:atements describe usual things you do to unwind at the end of the day. Use this scale: 

I. Extremely Inaccurate 

2. Moderately Inaccurate 

). Somewhat lnac~urate 

4. Neither accurate nor Inaccurate 

5. Sotn~~what olCCorate 

6. Modarately 4CCurate 

1. Extn~n.ely accurate 

take a w.Jik to rela,; 

do strenuous exercise or ~ phy~Jcal sport 

join a group for soCial conversation 

go for a drive after getting h~ 

5tart dof~g a hobby 

go out with the guys for a drink 

just do •~tever'• ~ndy 

II, considering ~ly those thlnts which y~ do to unwind, which rat~d above, ~ helpful are thev In •aslstlng you to unwind at end of • d.ay1 

USf TillS SCALf : 

!. ht•·t~mely u'lhelpful 

2. "od•.-~~tely unMipful 

). Solnewh•t unMipful 

lt. Neither helpful nor unhelpful 

s. Somewn.t h•lpful 

6. ltod~r.ataly h•lpful 

1. E•trem.ly helpful 

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Nearly 

every 

tl ... 

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Absolutely 

no 

l ~vbe 

not 

II. G •]· 

19. In your opinion, will •II controllers eventually 11 burn out11 ? 

Ne11er \ 

About •a o~ten u Anyone else 

~ 

Fairly 

oft on Very ' 

often 

How often do yo.u find yourself -.orr-ylng about your OlJIIn burnout? 

I 

btreltMtly 

close 

2 

Very 

close 

l 

Somewt..t 

close 

~ 

He I thor 

close nor dhtant 

At the preaent time, how close to 11burnout11 do you feel? 

I. -i • lfiOre likely 

llfe•s probleMs 2. 

). 

4. A~o ..,ch one •• thtl other 5. 

6. 

1 

Definitely 

••• 

1 

Constantly 

1. I a. ~re ll~ely to be e.otlonal, fly off the ~ndle, decide on the beals of feelings over facts 

) 

6·8 

do yo 

Plott controllf'rs f'wlve daya ~n they feet on top of the; tetrld, like th4'f' could 

handle traffic of fOur sectort at once end .. Iter •very sltuetlon t~t arltel 

~ (.,..II, eiMOU), In an evere9e worklrujJ ~BDnth of •bout 20 deys 00. often do feel r--ally topnotch? 

) 

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0-2 

days 

2 

J-5 

days 

II. G -8-

• 

5 6 1 

15-17 

d.Jys 

9-11 

days 

12-14 

days 

84. There are other days when a person feel• he juu can't "get It all togethor", 

when he re•lly feels below p~r. You may or ~y not be sl~k. you just 

feel 'that your controlling 1klll1 are really below your own average, Of 

the overage 20 working day1 in a month, how many are like this for you on 'the •vero~ge1 

When )Ou are n.vrn9 • poor U•y. such as described above, how often do 

you use ••ch of the following w.ya to cope with It at work? Use tfle following "•It~: 

l 4 

Oce4sion•fly ~re th•n 

occasion• ltv 

85. Try to get •sslgned to a sector with~ light lo.d 

Never 

86, T~ke longer hrc•k~ 

87. Take more bra4ks 

5 

Fairly 

often 

90. F f-'!d ' f-rleod.. or dlye-ul-ott to -UJ«t.. Y~?U:_r. •lnd __ of_f _.the probJ.• 

Very ' 

often 

Given the t-.nty working doys In •• overage month, lndlcoto how Many days (out of twenty) you would usually do ••ct. uf the following 

Use thh tcale: 

2 l ~ s ' 0-2 1 )·; 6-a '"" 12·1~ 15•17 18-zo dolys days ... .,. days d•ys days 91. days orink •lone at 

92. drink wl th a """"' few friends 

,,, dcut't ddnk 

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U. G -g. 

I 2 3 ~ 5 6 Not helpful A little Somewhat Moderately Qui tc1 Very ac all helpful helpful helpful helpful helpful 

On tf!e who 1e, how helpful Is drinking In helping to unwind and re'~• at the end of li working day? 

Peci)le ofLen pursue other Interests outside their jobs. We would liKe 

to know If you have pursued any of the following activities In the 

lou six ""'nth>. Use the scole below for Indicating how lftUCh time, on the 

give to the following •ctlvltles. 

0-2 hours 

2 3 ~ 

7 

Tho best 

thing 

s ~ 1 

l-5 hours 6·8 hours g-11 hours 12·1~ hours 15-17 hours • week a week 

• we•k o week 1 Week • week 

Another outside job 

Oatlng, drinking, or partying 

Hobbles. such •• stamp collecting, Cilrpentry, c,u ros:'"'l''' 

Physlca I sports, suches ~~e~ll, basketball, bow II ng, hoc: key, fishing 

Very ungratlfylng and quite overextended 

Quite ungratlfylng and somewhat overextended S~what unyratlfylng and overextended · _-He_:f th_er ·-9- _-:31-l~T.Y-1 ng not ungf•.fl-fy 1-ng · 

Somewhat gratifying and rewerdf~t Quite gratifying and rew.rdl··· -~·. ·. Very gratifyrng •nd rew.rdlft 

::-~-- ' 

Given those activities which you pur4ue. how much overat: 

tnct reward to you get frOAt the5e •ctfvltf.es? 

•••••••••••••••••••••••••••• 

NOT HARR;Eo, SKIP TO ~UESTION I 10• 

··········~··~·············· 

.. -,._ ·- -.· ---- _..;,_ ---

gratification 

f:Jpport tJo yoy feel your wife provfd~s you In coping with the 

''"""''"' of Y""r jobl 

I. She criticizes .. tre.cndously 

2. She criticizes me quite • bit 

J. She crltlclzes me somew~t 

~. She neither supports me nor criticizes Me 

S. She suf'IPOru me sm.ewMt 

6. She gives me moderate support 

1. She suppo,-t 1 rae tremendous I y 

18·20 

Hrs a 

week 

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t~::~hi£~ ---
II. G•IO• 

101. How often do you talk with you wife about your feelings that are a consequence of your work7 

I. Never or extremaly rarely 

2. Once a month or less 

3. A couple of times a month ~. Once a week at most 

S. A couple of days a week 

6. Once a day-at ~st 

1. Kore than once a day 

102. How do ycu feel about your wife sharing her trials and trfbulatlono of the day when you arrive h~~7 

I. ...,. it 

2. dislike It qUite a bit 

3. d lsi Ike lc somewhat 

4. don't fe61 elth~r way about It 

S. somewhat like her to 

6. most often like her to 

1. really I Ike her to share hc=r proble-as with me 

10). How understanding Is your wife of your need to unwind at the end of a day's work? 

I. Completely· lacks such ,an understanding 

2. Lacks such an understanding quite a bit 

]. Son~what lacks such an understanding 

~. Neither understandln9 nor misunderstanding 5. Somewhat understanding 

6. Quite understanding 

7. EKtremely understanding 

None 

2 

1·2 7 

] 

3·4 4 

S-6 s 

7-8 

6 

9·10 10 or more 

If you or your family wer• struck by a crisis or tragedy, how many 

persons of t~e following cat~gorles could you really count on to help you7 

for these purposes, count a married couple or a famf)y unit as "1 11 • 

104. Among re'latlves 

lOS. Among friends 

106. Among people at work 

107. How many people do rou consider close friends who live within an hour's 

drive of your non~7 (use the s~ale above) 

TillS IS THE END OF THIS QUESTIONNAIRE. THANK YOU FOR YOUR COOPERATION 
fiFTH ROUND II. H-1 

Psv IOJ-Sociomo!tri c Quds t iorma I r.: 

This particular questionnaire has only three questions. For each questf'i"' 

>~Ill glvo three ansc,•rs. The questions ask ab<.ut your choice or p;eforence 

your co-.,orkers when various conditions exist, We are having you wrf te 

numbers ra tiler than names to make It eas r er to 

corr~spond ln aoy way to your confidential code. 

not list a person more thon once In each question, Howevur, 

perso11 -In ttore than one question. Aho, do not use your.eH 

'-'•• your choJce of three other controllers. 

answer. These 

should have been given. list of names ana codes with this questionnaire. 

have not,· please obtain o I list from the receptlonlst-coordlna.tor. Tho 

st-coordlnotor will Indicate which ll•t, of names you will use. 

Include all members of your team and sister teams 

from islip or Nashua, your lfst wilt Include 

teams Jn your facility. 

left of each controller's name. This Is the 

Til£ THREE QU£STJONS AND THE ANSWER SPACES ARE TOGETHER ON TifF. 11EXT PAGE. 

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II. H-2 

fiFTH ROIIl!ID 

ANSWER SHEET 

for 

PSY103· Sociometric Questionnaire 

®EST IONS 

.. -.. ------.. ---------. ---.. -------------. --- I. If all assignments were changed to correspond with ~r preference•, which 

three ATCS's would you most like to work with! List In order of preference 

on the answer sheet as Indicated. 

--. .. ----.. ---.. -.. --- -------------------.. - II.Without consldedng t•chnlciol oblllty, with which thrwe ATtS'a do you find 

It easiest to work? List In crder as lndlcoted on the answer ah .. t. 

-------·-----·-- ... --------·--------- • Ill. Without considering how easy it Is to work with~.~ do you 

believe are the three best controllers f~ a technl~l standpoint? 

List In order aa indlt;ated on the answer sheet. 

~ --.. - .. .. .. ----------· -------- ~ -.. -----

ANSWER SPACES 

1. A. Top choice: N.,,... code:_ Is he presently on your tea•7(1-yet,o-no) __ _ 

B. Second chofca: N•m• code: h he p'rasently on your t~4ttl7(1-yea,o-no) - - c. Thlr~ cho7ce: Heme code:_ Is he presently on your teu.?(l-yes,O•no) ___ _ 

II. A. Eufest to work wl th: N•• code::::-~:'::'mr:::c"" Is he presently on your teu.f(l-yes,O-.·,u), ___ _ 

8. Second easiest to work with: Ntme code: 

h he presently on your teamHI•v•s,O•no), ___ _ 

C. Third e.aslost to work wl th: Namo code::..,.== 

Is he presently on your teamHI•yos,O•no) ___ _ 

llfA.Beat: Ntlmo code:. _____ Is he presently on your to.m?(l•yes,O-rtO) __ _ 

!I.Second best: N-. code:_ h he presently on your teMI?(I-yea,O•no)_ 

C. Thlrd belt; N~m~ c~d•~- Ia he preaently on your teM?(I-yot, Cl-nc:J)_ 

) 

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II. I-1 

PSY lll 

FIFTH R:lUND 

• 

This questl.onll4..1re inq\ures aboue tllinqs which sCiletillt.ea happan to 

~plo. Their rec~nt occurrence is thouqht to be related to an increased 

bec;(llfU.nq ill. 

Thl» particulAr lOVBn~ory ia concerned ~1~ tho actUAl occurence of 

ev11nta and. the diatru•• which t.hey caueod. you. The exact d•t&i:a of 

·~;~,~::~•:::~~ Are ot -n" ~poctance. W. are simply concerned with 9&the.rirl9 

_1 about the actual nlaber ot event• which happen4ld. to you and the 

diatreaa which you experienced. 

you -.&y r~a.u. durinq you.r previoua vtaita here, thia Ute cUft9e 

~Ueot.lorln<lil·o w.sa quite lolll)' and •.:.• tiaee t..:iioua if aany Ulinq• Md h.apponwi 

w., hc~ve revued thie proceduce cona.i4er&bly to eUaJ.n.ate f&tique. 

,.h.ial t.U.e, if an event did not occur to you aince you.~ l.n.at r-.qu.lar ... 

~ !.!!. !h.!. hat ! ~~ !! ~ aldpR«l ~..!!1.;.! !!!!. !.91: ~~· pha .. ··~· on the auver ah .. t. 

If •n event did occ\IZ' aince ·your laat ~ here,or in the la.et il ..ant.ha 

~ski~~ 

• Outresa R.ltinq 

f 

n.xt 

~ to ~ 

the 

!..!!.!.~· YES on a.U.ply 

W• .<tNUoter 

report 

asheet. 

Ite'OcM.n;;;-oy 

You co~n t.l»e 

~ 

any 

tr0111 01 to 99, dependinq on how Mriouaiy the ever:t trou.bled you. 

~ ~£!!!. ratiri.J• ~:::Juld refhct ~ ~ difJcMI.fort, upa&t, 5!!. ~ ._.!!!!.! ~ ~· 1'h• ecahl .below wiU reapr.ar at the top ot ea.cl\ 

show:s thAt in anothtar study motst ()*) .. ie oll.lve nllfterical ratinqe b.-

and. 20, 40 4lld 55, 4hd 95 and '19 to tl\u evenu in the tollowinq 

RelfttJIIlber, thia eJWo~C~pl_, L• only • COOt.Jh guide tOE you. Your own 

.. y take •ny value troc Ol to 99 accordinq to the d89ree of di•treaa 

th~ ~vent cau•ed for yuu. 

MODERATE UISTI::SS EXTREME DISTRESS 

2o ••••• Jo •••••• <to •••••• !)() •••••• 6o ••••• 7o ••• ao •••• i0 ••••••• 99 

ADDITIONAL PERSON 

MOV&s IN'l'O HOUSE 

' CHILD DIED 

• 

• 

• • 

) 

I L .. ~.: .......... . 
------------------------------· 

u. 1-2 

PSYIO~ 2 

DISTRESS SCALE 

LOW DISTRESS HODERATE DISTRESS EXTREME DISTRESS 

ul. .... 10 ..... 20 ..... Jo ..... 4o ..... so ..... 6o .... • 10 •.•• • eo ..... 90 ..... , 

YES: 01.) 

YES: 02.) 

YES:= C),) 

YES: 04.) 

YES:- 05.) 

YES:- 06,) 

YES:- 07.) 

YES:= 08.) 

YES: 09.) YES:- 10,) 

YES:- II.) 

YES:- 12.) 

YES:- IJ,) 

YES:= 14,) 

15. ) 

16.) 

YES: 17.) 

YES:- 18. I 

YES:= 19. I 

20.) 

2).) 

2~.) 

HAVE YOU CHANGED TO A DIFFERENT LINE OF WORK7 

HAVE YOU CHANGED YOUR PLACE OF WORK (DIFFERENT ADD~ESS)T 

HAS THERE BEEN A CHANGE IN YOUR RESPONSIBILITIES AT WORK (SUCH AS 

A LATERAL TRANSFER OR SHIFT TO A NEW WORK AREA OR NEW CO~LEAGUES, 

OR A PROKOTION OR DEKOTIONT 

HAVE YOU HAC TO START LEARNING ANY HAJOR HEW EQUIPHENTT 

HAVE YOU INCREA,£0 THE AVERAGE HUHDER OF HCURS THAT YCU WORK PER PAYT 

HAVE YOU DUREJ(S'Eti THE AVERAGE NUMBER OF HOURS THAT YOU WORK PER PAYT 

HAVE YOU HAD ANY TROU.LE WITH ANY OF YOUR SUPERVISDRST I~VE YOU HAD ANY TROUBLES WITH CO-WORKERS, OR PERSONNEL UNDER YOUR 

SUPERVISION! 

HAVE YOU RECEIVED ANY DISCIPLINARY ACTION OF RECPADT 

HAVE YOU BEEN PUT ON HEDICAL WAIVERS! 

HAVE YOU TAKEN GN A SECOND JOBl 

HAVI' Y~U GIVE~ UP A SECOND JOBT 

IF YOU HAVE A SECOND JOB, HAVE YOU HAD PROBLEMS THAT DISCOURAGED YDUT 

HAVE YOU TAKEN A VACATION? . 

IN SUHIIARY, HOW WELL WOULD YOU SIIY YOUR LIFE AT WORK HAS GONE FOl 

YOU RECENTLY? (CIRCLE A~SWER BELOW) 

1.) THE BEST EVER 

2.) ESPECIALLY WELL 

J,) GOOD 

4.) AVERAGE 

5.) POOR 

6.) REAlLY BAD 

7.) THE WORST EVER 

HAVE YOU STARTED TAkiNG ANY COURSES TO HELP YOU IN YOUR WORK OR TO 

PREPARE YOU FOR ANOTHER JGBT 

HAVE YOU BEGUN AN ON•THE•JOI TRAINING COURS[$1 

OlD YOU PASS THE ElAHINATION QUALIFYING YOU FDA JOUANEYHAN ATC STATUST 

HAVE YOU HUVEO TO A NEW PLACE OF RESIDENCE WITHIN THf SAKE CITY OR 

AREA Of THE STATEl 

HAVE YOU ~WED TO A NEW PLACE Of RESIDENCE FROM A DlfFERfhT AREA IN 

TilE SAKE STATE? 

HAVE YOU HOVEO TO A ~EU PLACE Of RESIDENCE FROH ~THER STATE? HAV~ YOU HAD ANY HI NOR TROUBLES WITH THE LAW, NOT LEADING TO A COURT 

APPEARANCE? (<OR EXAKPLE, LESSER TRAFFIC VIOLATif~S. TAX RETURNS, lTC.) 

HAVE YOU H.',' A VIOLATION UAOING TO ,\COURT Al'rEAIWICf ( INnUDING 

LOSING DRIVER'S LICENSE? 

HAVE YOU BE<N INVOLVED IN A LAW SUITT 

/ ; 

) 
I 

PSYIO~ ll. I-3 J 

DISTRESS SCALE 

LOW DISTRESS KOOERATE DISTRESS EXTAEM! DISTRESS 

Dl. •••• to ..... zo ..... )0 .•••• ~0 •.••• so ..... 60 •.••. 7D ••••• 80 ••••• ,o .•... " 

YES:_ ZS.) 

' YES: 26.) 

YES:= 27.) 

YfS:_ 28.) 

Y£5._ 2,.) 

)0.) 

YIS:_ )I.) 

YES:_ }2.) 

YES: )}.) 

YES :-: • ..J~ . ) 

. YES:_ JS.) 

)6.) 

}7.) 

HAVE YOU HAD ANY TROUBLE WITM TME lAW WHICH LED TO Y~ IEIMG 

HELD IN JAIL fD~ AWHILE! (fOR EXAMPLE, DRINKING TOO "VCH, DISTURIIHG 

THE PEACE, AWAITING BAIL) HAVE YOU I"(N THE VICTIM Of A CRIME! (E.G., ROIIERY, ASSAULT, ETC.) 

HAVE YOU HAD HOOERATE fiNANCIAL DlfFICULTitS, SUCH AS EXCESSIVE 

EXPENSES Oft TROUBLE rROH BILL COlLECTORS! 

HAVE YOU BEEN THREATENED WITH LEGAL ACTION (SUCH AS REPOSSISSION) 

OVER HOT PAYING YO~ KORTGAGE OR INSTALLAH£MT PAYMENTS! 

HAVE YOU BUN IN AN AUTO ACCIDF.HT (OR OIHE~ ACCIDENT) INVOLVING 

INJURY TO A PERSON OR PROPERTY D4HAGE OF OVER $200! 

HAVE YOU HAD MAJOR LOSSES IN TME STOCK MAAKtT OR 0Tij£A SECURITIES 

TRADING! 

HAVE YOU HAD MAJOR FINANCIAL DIFFICULTIES RESULTING IN EXTREMELY 

HEAVY DEBTS OA IANKRU~TCY! 

HAVE YOU HAD A 'US I NESS FA I LUIIET 

HAVf. YOU tUILT A HOllE Oft HADE MAJOR IIII'ROVEIIENTS ON YOUR HOIIEl 

HAVE YOU TAKEN ON ANY SUBSTANTI~.I. LOANS OR HADE MAJOR PURCHASES 

(fOR LESS THAN $10,0001 (FOR £rAIIPLE, A COLOR TV, CAR, FREEZER, ETC.) 

HAVE YOU TAKEN Oh A P:IP.t.HASE FOR MORE TMAN $10,000, SUCH AS A 

HOH[ OR REAL ESTATE! 

HAVE YOU HAD A SUUSTANTIAL IHPROVCHENT IN fiNANCES, SUCH ~S A 

MAJOR RAISE IN PAY, NEW SOURCES OF INCOME, Oft AN INHERITANCE! 

All. IN ALL, HOW WELL WOULD YOU SAY YOUR HOUSING, FINANCIAL AND 

LEGAL HATTERS HAVE GONE FOR VOU RECENTLY? (CIRCLE ANSWER BELOW) 

1.) THE lEST EVER 

2.) ESPECIALLY WELL 

].) GOOD ~.) AVERAGE 

S.) POOR 

6. ) REALLY lAO 

7.) TH£ WORST EYER 

)~.) HAVE YOU HAO AN ILLNESS OR INJURY TMAT ~EQUIREO MEOICAL ATTENTION 

DR THAT kEPT YOU FAOII \IOMIMG OR fUNCTI(INING NOftHALLYf 

(IF YOU ANSWER NO, SkiP TO QUESTION ~1.) 

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01 STR[SS SCAlf 

LOW GISTRESS IIODERAT£ DISTRESS EXTREME DISTRESS 

01. ...• :o ...•. 20 ..•.• JO •.••• ~0 ...•. SO ...•. 60 .••.• 70 ..•.. So •..•. 90 .••.• 99 

)9.) FOR THE .LLNESS OR INJURY T~AT OCCURRED SINCE YOUR LAST VISIT HERE, 

HOII LONC WERE YOU KLPT FROM IIOAK OR IIOIUIAI. ACTIVITY! 

(CIRCLE ANSWER IELOW) 

0.) NOT AT ALL 

I.) lESS THAN THREf DAYS 

z.) MORE THAN 3 DAYS IUT LESS TIWI A IIOIITH 

]. ) A IIOIITH OR MORE 

40.) WUE YOU HOSPITAL11Ul (CIRCLE ANSWER 1£LOW) 

0 • HO 

I • YES 

• 

YES: "·) 

YES:= 42.) 

HAVE YOU CHAIIGEO YOUR EATIHG HAIIT! IN TEAHS OF WHAT YOU EAT OA HOII J<UCHl HA~E YOU CHAWGED.YOUA SLEEPING HAIITS IN TEAKS OF SLEEPING A LOT MORE 

YES:_ 4J.) 

YES: 44.) 

YES:_ 45.) 

YES: 46.) 

Y(S:- 47.) 

YtS:- 48.) 

YES:- 49.) 

rES:= 50.) 

YES:_ 51.) 

YES: 52.) 

YES:= SJ. 

su 

Oft A LOT LfSSl 

HAS THERE BEEN A DEFINITE IIICREASE IN HOY MUCH TIH£ YOU 00 HEAVY 

PHYSICAL 'JO~K OR ExERC"SE! 

HAS THE•£ IEfN A DEFINITE DECREASE IN HOW ~H TINE YOU 00 HfAVV 

rHYSICAL ~RK OR EXERCISE! 

HAVE YOU FELT ON THE EDGE ~F A NERVOUS IREAKOOWNl 

HAVE YOU EXPERIENCE THE DEATH OF: 

A CLOSE FAt END OR SIGNIFICANT HLATIVE (E.G., fAVORITE .'WHT)l 

AN IMMEDIATE F~ILY HEH8ER (E.G., PARENT, SIBLING, FIANCE)! 

ONE OF YOUR 01111 CHILDREN! 

YOUR SPOUS£7 

ANY OTHER PERSON CLOSE TO YOU! 

HAVE YO~ EXPERIENCED A SEPARATION fROM A SIGNIFICANT PERSON (E.G., A 

CLOSE FRIEND ~YES AWAY, A DOCTOR 0~ COUNSELOR STOPS GIVING SERVICES, 

SOHEONE YOU DEPENDED ON LEAVES YOU)l 

HAVE YOU EXPE~IEOCED THE LOSS Of A PErl 

HAVE YOU [IPERIENCED THE LOSS Oft AOBBEAY Of SOME PERSONALLY H[ANINGfUL 

OBJECT (E.G., A WEOOIHC RING, JEWELRY, SENTIMENTAL OBJECT)T 

HAVE YOU liEN UNHAARIED FOR THE ENTIRE TIM£ SINCE YOU WERE LAST HERE! 

(CIRCLE ANSWER BELOW) 

0 • NO 

I • U.S 

If YES, PLEAS£ SKIP TO QUESTION 7J.) 

• 

• 

J 
u. l-j 

DISTAESS !CAL£ 

LOW DISTRE5S ftODERATE DISTRESS EXTREN£ DISTRESS 

01 ..... 10 .... . zo .... . ]0 ..... 40 ..... so ..... 60 ..... 70 ..... 80 ..... ,o ..... 99 

HAVE YOU IECOH£ HARRIED OR REMARRIED? 

HAVE YOU HAD AM INCREASE IN ARGUHENTS WITH YOUR WIFE? 

IIAVE AMY Of YOUR ARGUHENTS 1/ITH ilEA tEEN SERIOUS OR VIOLENT? 

HAVE YOU HAD TO IE SEPAAATlO FROK YOUR WIFE BECAUSE Of HAA•TAL 

PROILENS? 

HAVE YOU HAD TO If SEPAAATEO FROIO YOUR WIFE FOa REASONS t.'~ER 

THAN MARITAL PR~~LtMS? 

ARE YOU SERIOUSlY CONSIDERING OIV0'-:£1 

HAVE YOU FILED FOR DIVORCE OR HAD A DECREE GftANTED? 

HIIV£ YOU FOUND OUT THAT YOUR WIFE IS PRfGtWIT: 

ANO THIS IS A WANTED PREGNANCY? 

AND THIS IS AM UM\IANHD PREGNAHCY7 

HAS YOUR WIFE HAD A HISCARRIAGE, STILLBIRTH, OR AIO~!ION7 

HAVE YOU BEEN HAVING SEXUAL DIFFICULTIES? 

HAVE YOU BEGUU AM EXTRAMARITAL AFFAIR7 

HAS YOUR Wlft 8EGIJN AN EXTRAHA~ITAL AFFAIR (OR HAVE YOU 

DISCOVEREO eEASON TO SUSPECT ONE)7 

5 

"AVE YOU HAD A tiARKEQ IHPROVEHENT IN YOUR RELATIONSHIP Wll'H YOUR 1/IF£7 

HAVE YOU HAD LESS THAN YOUR USUAL NUHBfR OF ARGUMENtS WITH TOUR WIFE? 

HAVE YOU HAD A ~RITAL R(CONCILIATION? 

HAS YOUR WIFE BECUN \101\K OUTSIDE THE HOKE? 

HAS TOUR WIFE SiOPPEO WORK OUTSIU£ THE HOHE7 

HAVE YOU EVER HAD ANY CHILDREN (BY BIRrH OR ADOPTION)? 

(to•:LE AH~fR Bf.OW) 

0 • ..o 

I • rt:S 

(IF NO, PLEAS£ SkiP TO QUESTION 81.) 

HAVE YOU GAINED A NEW CHILD IY BIRTH 0~ AOOPTION7 

HAVE YOU KAO A CHILO ENLIST OR BE OIAFTED INTO THE ARMED FORCES? 

HAVE YOU HAO A CHILD LEAVE MOM£ FOR OTHER REASONS? (E.G.,COLLfGf, 

OR OTHER INSTITUTICNJ 

HAS ONE OF VOUR C"ILDREN HAD A SEVERE PERSONAL PROILE" (E.G., ~ANTED PRtGNANCY, MAJOR ARGUMENT WITH PARENT OR TROutt£ WITH 

TH( LAWif 

HAS A SON OR OAUGHTEH IECOHf fNGAGEO TO If HARRIED? 

HAS A SON OR OA~~HTER ~RIED WITH YOUR APP~OVALf 

HAS A $0,1 OR OAU!OitiU ..,_UIEO AGAINST VOUR IIISHES7 

' 

.. 

1 

! 

I 

l 

I 

I 

I 

) 

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PSYIQ4 U, l•b 

OISTR£SS StAl£ 

LOW DISTRESS MODERATE DISTRESS EXTREHE DISTRESS 

o 1. ••.• 10 ..... 20 ..... 30 ••••• 4o ..... so ..... 6o ..... 10 .... • ao ..... 90 ..... , 

81.) AT ANY TIHE IN T~E LAST 2 YEARS HAVE YOU IEEN INVOLVED IN A 

"DATING RELATIONSHIP" (CIRC•E ANSWER IHOW) 

0 • NO 

1 • '([$ 

(IF NO, PLEASE SKIP TO ClUlSTI.ON 87) 

YES: __ 82.) HAVE YOU STOPPED STEADY DATING (OF THREE MONTHS OR MORE) OR £ND£D 

YES: 8).) YES:=8~.) 

YES: 85.) 

YES:-- 86.) YES:= 8].) 

AN EST~~LISHED RELATIONSHIP? 

HAVE YOU BEGUN A SEPIOUS DATING R(LATIONSHIP OR IECONE ENGAGED? 

HAVE YOU HAD AN INCREASE IN ~ENTS OR DIFFICULTIES WITH A LONG TE~ STEADi OATf, WITN YOUR FIANCE, ~R A VERY 'LOSE fRIEND? 

HAVE YOU SRQI(ft, AN ENGA"HENTl 

IF YOU HAVE A 'oiRLfRIE~D, HAS SHE RECENTLY IECOIIE PREoNANTl 

HAS A NEW PE~SON OTHER TNAN AN INFANT HOVED INTO YOUR HOUSEHOLD 

(E.G., AN OLDSTER, RELATIVE, LODGER, OR CHILDREN RETUNIING fROH 

LIVING ELSEI/IIERE)l 

YES: __ 88.) HAS A HEHBER Of YOUR HOUSEHOLD (OTHU TI<AH YDUR SPOUSE OR CHILD) 

HOVEO OUT Of THE HOH£1 

YES: __ 83,) HAVE YOU HAD ANi PR08LEHS WITH YOUR IN•LAWS (WIFE'S PARENTS OR 

YOUR CHILOREN·IN•LAWS), fRIENDS, OR CLOSE RELATIVES WHO liVE IN 

THE HOH£7 

YES: __ 90.) HAVE YOU HAD ANY PROWLEHS WITH SUCH PEOPLE WHO LIVE OUTSIDE 

YOUR HOHU 

YES: __ 91.) HAVE YOU BEEN CONCERNED AIOUT THE PHYSICAL OR MENTAL HE~TH Of A 

HlHBER Of YOUR IHHEDIATE fAMILY (SPOUSE, CHILD, PARENT, SIBLING), 

A RELATIVE OUTSIDE Of THE IHHEDIATf fAHILY, OR AN INTt~TE f-lfNOT 

(If YOUR ANSWER IS "~O",PLEASE SKIP TO QUESTION 95) 

6 

WHAT ~AS THE INIENSITY Of THE PHYSICAL OR NENTAL HEALTH DifFICULTY OF: ___ 92.) A NEHBER Of YOUR IHHEDIATE f~ILY (S,OUSk, CHILD, PARfNT, SIILING)T 

9),) A RELATIVE OUTSIC[ Of THE IMMEDIATE fAHILYT 

::: 9~.) AN INTIHAIE fRIEND? 

O.) NO PROILEti 

1.) RfLAliYELY KILO 

2,) QUIT£ SERIOUS 

).) Lift THREATNING 

HAS THUf IE£N A HARKED INCREASE IN HOW fftlCIUl~TLY YOU ''Gt:T IOGfTHU" 

WITII RELATIVES OR FRIENDS·)-- •· 

HAS THERE BHN A HAAK(O DHREASf IN HOW fRlQUENTLY YOU '':ltT TOGfTHU" ~ITH RUATIVES OR FRIEND~7-- . HAS THEA£ BEEN A &A~AK UP OF \LOVE RELATIONSHIP OTHER THAN ON( 

YOU HAVE ALREADY REPORHD IN T>HS CIUESTIOHIIAIRU 

·1 

i 

j 

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II. 1-7 7 

DISTRESS SCALE 

LOW CISTRESS MODERATE DISTRESS EXTRE~E DISTRES; 

01 .•... !C ••••• 20 ..••. jQ ••••• 4Q ••.•• 50 ••..• 60 •.••. 70 ..... 80 ...•. 90 ••.•. 99 

YES:_ 98.) 

YES:_ 99.) 

1.00.) 

YES:_ 101.) 

YES:_ 102.) 

HAS THERE BEE• A HARKED IHPROVEHENT IN YOUR RELATIONSHIP WITH SOHEONE CLOSE TO YOU (EXCLUDING YOVR WiH)7 

HAS TH~RE BEEN A HAJOR CHANGE IN YOU' PERSONAL HA81TS7 (E.G., 

YOUR CHOICE Of FP.IENQS, STYLE Of ORES$, INTER~STS, ETC.) 

HAVE YOU HADE ANY RECENT HAJOR rtCISION RE~ROING YOUR fUTURE (fOR 

EXAMPLE, WHEN YOU WILL RETIRE FROH YOUR PRESENT WORK, PLIMS TO 

SUY A NEW HOUSE. HOVE TO ANOTHER PART OF THE COUNTRY, £TC,)7 

HAS THERE BEEN A NAJOR CHANGE IN YOUR kELIGIOUS OR POLITICAL 

CONVICTIONS? 

HAVt YOU EXPERIENCED ANY OUTSTANDING PERSONAL ACHIE~EK£MT7 

IQJ.) ALL IN ALL, HOW otLL WOULD YOU SAY YOUR 11.\RRIAGE, fAHILY, AND/OR 

PERSONAL Llf~ HAS GONE FOR YOU REtENTLY7 (CIRCLE ANSWER BELOW) 

1.) THE BEST EVER 

2.) ESPECIALLY WEll 

J.) GOOD 

4.) AHOW:E 

S.) POOR 

6.) REALLY BAD 

7.) T•E WORST EVER 

WE HAVE ASKED VOU I<AHY QUESTIOHS ABOuT THINGS THAT tiAVE HA??£NED TO 

YOU, AND NOW WE HAVE n.G QUESTIONS OF A DIFFERENT SORT. 

fiRST, HAS ANYTHING T~REATEIItO TO HAPPEN IIHICH COULD HI.VE CAUSED 

SON£ CHANGE IN YOUR l;~f-wHICH PASSED Wll~OUT HAPPENIN~7 

105.) SECOND, HAS ANYTHING FAILED TO HAPPEN WHICHiYOUi7iAD HOPED FOR AND 

EXPECTED (FOR EXAMPLE, ANTICIPAo!O PLEASURE, RECOGNITION, OR SUCCESS)? 

THIS INTERVIEW IS C~PLETED 

TI:ANK YOU FOR YOUI< COOPfRATION AND CAHOID AliSWE~S. 

• 

• 

) 
H. J-1 

Satl~factlon ~lth FAA.Polley 

Questionnaire 

l, The FAA Is more concerned with lm~rovlng hardware than 

with helping people do their job. 

4. The greatest problems I face In doing my job well are due 

to FAA policies and not the work itself. 

3. The facility's reluc:tanc:e to use overtime often seriously 

disrupts my personal life. 

4. The fac:lllty's reluctance tl) us10 ovf'.rtlme often result.s In d~ngerous understaffing. 

5. The FAA does not reward conslstentl1 good performan•:e. 

6. Job performance counts very II ttle ft;or promotlo:~. 

], O,e of thJJ problems of being promoted to super·•lsor Is that 

you become a "yes•man" for ~r~anagel\lllnt. 

8. You I0$8 the respect of your peers when you are promoted to 

supervl sor. · 

9. About the only reward for controlling well Is th•a recognition 

other controllers give yo!J, 

10. The only time management respor~ds to the qu.allty of my work 

Is when son•thlng sees wrong. 

11. Our facility chief would do a lot more for us If It were not 

for FAA policies handed down from W•shlngton. 

12. Hy facility chief putt the controllers' welfare too low on his 

ll»t of prlorltlet. 

13. Tho quality of canal<l••tes accepted lr.to tile training prqgram ~~ too low. 

14. In the last coupl~ of years, It h.as b&come too easy to become •• 

a fully rated _1-:.urneyman. 

I Jon't feel that training developmentcl cr.ntrollers with live 

traffic should ~ a part of my job. 

The FAA Is more ':oncerned with haloing llf>Ople do their job then 

Improving ~~rdwere. 

i 

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l 

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II. J -2-

17. The greatest difficulty I h&ve In doing my job well Is due 

to the nature of the work itS<tlf rather than FAA policies. 

18. The facility's use of overtime does not often disrupt my 

personal life. 

19. Tha faclllt·;'s reluctant use of overtime does not often 

result In dangerous understaffing. 

20. Consistently good performance Is pro~erly rewarded by the 

rAA. 

21. Our facility chief d•>es more for us becaur.e of policies set 

by the national FAA administration. 

22. The welfare of contn)llers Is high on thu priorities of my 

feel Jlty chief. 

23. I feel that training developmental contr•ollers with live 

traffic should be a required part of my job. 

2~. The quality of accepted training candidates Is appropriately 

high. 

I believe It Is just at difficult as ever to become a fullyr•te<l journeyman controll·er. 

I belt&ve excellent performance as a controlfer Is an Important consideration when promotions are made. 

All ATC does not lose the respect of fellow c:ontrollert ...,.n 

he It promoted. 

All ATC's at:tltude toward controllert beCOIINis much 100rse whe~ 

he Is promoted to supervisor. 

Exceptional contn)ller perfol'lll•nce results In recognition from 

supervise'" thu helps In getting pr·omoted. 

llonag-nt give appropriate recognition when thi••JS are golrg 

well. 

I . r 

) 

•. 

.' ·--~ -- ·.··'] .... : ......... • .. ;;< 
-------------------------- • 

n. K-1 

FAA Awards questionnaire 

We understand that the FAA has an awards and recognition 

program. The official names for these awards are: 

Cutstandlng Performance A~ard 

Quality Step lncreuot 

Point with Pride 

Award for Valor 

Yearly In-grade 

Suggestion Award 

Special Act Aw~rd (group) 

Special Achievement award 

Please Indicate the number of each of these awards you have 

received during the three years you have been In this study. 

I. Outstanding Performance Award 

2. Quality step-Increase 

). ~oint with Pride 

~. Award for Valor 

S. Yearly In-grade 

6. Suggestion Award 

1. Special Act Award (group) 

8. Special Achievement Award 

• 

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I 

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I 

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) 
II. L-1 

ATCS SUBJECTIVE DIFFICULTY QUESTIONNAIRE 

This short questionnaire Inquires about several aspects of your 

work today, Please respond solely In terms of only your own 

experience. Select the an•wer to each·questlon that most 

accurately reflects your response, Put an "X" In the appropriate box on the answer sheet. 

If anything unusual or stressing occurred t~at Is not Included on 

this questionnaire, write It In the space pro•lo'ed at the end of the answer sheet. 

I. Overall, how difficult do you feel your assignments have 

::.een today? 

I Very easy 

2 Hr4e~ately easy 

3 A little easy 

4 Neither easy nor difficult 

5 A I ltcle difficult 

6 Moderately difficult 

7 Very difficult 

2. Considering all of the tasks that composed your various 

as~ gnments , how good a job do you feet you have done today? 

I Best I've ever done 

2 Quite a bit better 

3 A little better than my average 4 About my average 

5 A little less good a job 

6 Quite below my average 

7 lolors t I 1 ve ever done 

How heavy has be~n today's traffic In terms of number of aircraft handled? 

I The highest I can recall 

2 Quite high 

3 Somewhat above average 4 Average 

S Somewhat below average 

6 Quite a bl t below average 

7 The lightest I've ever hed 

I 

J 

I 

) 

• 
II. L-2 

Wh~t kind of aircraft mix have you had? 

I Totally commercial 

2 Much more than usual proportion of commercial 

3 More than usual proportion of commercial 

4 About an average mix of commercial and military and general aviation 

5 More than usual proportion of mil itao·y and general aviation 

6 Much more than usual proportion of military and general aviation 

7 Totally mi II tary and general aviation 

How mucio did weather affect the ease of working traffic today? 

I Hade ex~remely easier 

2 Hade quite easier 

3 Hade somewhat easier 

4 Neither made easiernor difficult 

5 Hade somewhat difficult 

» Hade quite difficult 

7 Hade extremely difficult 

Compared to other times, what was the o~ality of help 

provided by your strip man and handoff man? 

I Terrific 

2 Much better than usual 

3 netter than usual 

4 Average 

5 Not quIte as good as nornoa I 

6 Quite a hit below par 

7 The worst they've ever done 

How many breakdowns or serious Impairments cf function 

(quality of return, fruiting, degradation, etc./ did 

tour radar and communications equipment have today? 

I The greatest number of faults ever 

2 Many more faults than nonnal 

3 More faults than normal 

4 Average n~mber of fau Its 

5 Fewer than average defects 

6 Hany fewer f.oults t~oan normal 

7 The fewest I've ever e~perlenced 

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II. L-3 

8. How many failures and impalr:uen.o of function did the 

conmunications equipm~nt c.n the clircr.!!f! hava today? 

I The greatest number of faults ever 

2 Hany more faults than normal 

3 Hore faults than normal 

4 Average number of faults 

5 Fewer than average defects 

6 Huch fewer than average defects 

7 The fewest faults I've ever experienced 

9. How did your supervisor contribute to your performance today? 

I Helped tremendous~y 

2 Helped quite a bit 

3 Helped somewhat 

4 Didn't help or hinder 

5 Hindered somewhat 

6 Hindered quite a bit 

7 Hindered me completely 

10. How many Interpersonal conflicts occurred for you today? 

(Such as those arising from FAM fl1ghts, administrative 

po!Jcy, and othec non-ATC action} 

I The most I've ever hdu 

2 Quite a bit more than usual number 

3 Hore than usual a.nount 

4 About usual amount 

5 Fewer than usual number 

6 Quite a bit few~r than usual number 

7 F.,.,.est I've ever· had 

II. How many potential truffle conflicts occurred today -· compared to "norm'-1' 1 times? 

I The most I've ever had 

2 Quite a bl t more than usual numbfJr 

3 Hore than usual number 

4 About usual number 

5 fewer than usual number 

6 Quite a bl t fe.,er than usud number 

7 fewest I've e•ter had 

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~ ·----- ---- ~ --~·"···· "----~·-- .. 

II. L-4 

How many changes from peak to slow control ling conditions 

occurred today compared to 11normal 11 times? 

I The most I've ever had 

2 Quite' a bit more than usual number 

3 Somewhat more than usual number 

4 About usual amount 

5 Fewer than usual number 

6 Quite a bit fewer than usual number 

7 Fewest I've ever had 

How many times did you feel you were about to "go down the pipe"? 

I The most I've ever had 

2 Quite a bit more than usual number 

3 Hore than usual amount t~ About usua I amount 

5 Fewer than usual number 

6 QuI te a b I t few,.r than usua I number 

7 F~est I've ever had 

How much did Your ~eneral mood prior to =omlng to work 

affect the difficulty of your jcb today? 

I Hy mood was terrible; made job m•Jch more difficult 

2 Hy mood was poor; made job moderately more difficult 

3 Hy mood was not as good as usuul; made job a little more difficult 4 Average mood and very little effect on the job 

S Better. than average mood; made job a II tt le easIer 

6 Huch better than average mood; made job moderately easier 

7 I was In the best mood ever; made job much easier 

If you gave training (formal or Informal) today, how much 

of a burden was lt7 Circle bo~ no. 4 If you did not give training today 

Lightened the job extremely 

2 Lightened the job quite a bit 

3 Lightened the job somewhat 

4 Was neither burdensome nor did It lighten the job S Somewhat burdensome 

6 Quite burdensome 

7 Extremely burdensome 

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16. Hew much 'did the requirc·ments of this srudy contribute r.o 

tn" d Iff I cuI ty of your j d> today? 

I Made my job very much easier 2 Made my job quite easy 3 Made my job somewhat easier 4 Neith~r made easier or difficult 5 Made my job somewhat difficult 6 Made nov job quite difficult 7 Made my job very difficult 

17. Overall, in your experience as an ATC at this facility, 

how difficult were your as>lgnments compared to ~~st other assignments that you might have had? 

Very easy 

2 Moderately easy 

3 A little eas1· 

4 Average-- neither easy nor difficult 

5 A little difficui t 

6 Moderately difficult 

7 Very difficult 

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15134 

APPENDIX II - 1 79-Hnv-n 

UOI - E'0.2 

~AGE I 

DJAGHOSTir: SU.-"ti".ARIES SCORING AI.GORITJU19 

--------------------------------------- TEXT LEVEL 1~DA HflHE 1-2 3-6 7-14 15-30 31+ STill UHDET DI-A 0' C#ll,, 

1 '·1 0 1 1 2 2 2 2 1 • 0 1 1 2 2 2 • 1 l • • • • • • • • OASJIIOn;TEJt1 ns 

1 9.2 1 1 1 2 2 ~ • 1 2 1 1 1 2 2 ., • l 3 • • • • • • • • STREP' tHRoAT 

1 34.0 1 l l 1 1 1 • 1 2 I I l I 1 1 3 • I I I 1 I 1 l • IKI'JIC£111A 1 

1 311.9 • • • • • • • • 2 • • • • • • • • l • , 2 2 2 2 • • A50'T1C I!I:NIHGHU l 4:5.0 • • • • • • • • 2 • 2 2 2 2 2 • • 3 • 2 2 2 2 2 • • IIMIC£\.LA I s2.o • • • • • • • • 2 I 1 l I t 1 • 3 l • • • • • • • • HEIIN:I zosru 

1 53.9 1 1 l 2 l • • • • l I ! . 2 2 2 3 1 • 1 l 1 2 2 2 • HEltP£S SIIIPLEX l 

l 54.0 1 1 1 • • • • l 2 l l 1 2 2 2 • l 3 I 1 1 2 2 2 • IMFECJIOU& ~PAJITIS 1 

l 70.0 • • • • • • • • 2 2 2 2 2 2 2 3 2 2 • 2 ·2 2 3 3 • IIIRAL CONJUNCTIVIJIS 2 1 78.9 • • • • • • • • 2 • l 1 2 2 2 • • ' 3 • • • • • • • • ' • .. lllltAL WoltTI 

1 79.1 0 1 1 l 1 1 • 0 2 0 l 1 1 1 1 • 0 3 • • • • • • • • 

----------;--··-·---·- ...--~-......:."""Y,....._'o;...'!.,.._(;o;~ ............... ,,~ .. -""'-,.,.,.~,. ......... ,_..,;-~_·;.;; ',_.,,~- -~-''•' .. ..._ ...... ,~-~ ;~ .... " ............ -, •• .t~ 

~....,.. ... __ ~_-.,_,;._' ... 
APPENDIX U - 2 

29-Hov-77 

DIAGNOSTIC SUKKARIES SCORING ALGORITHMS 

---------------------------------------

1'1111£~ 

TEXT 

LEII£L ICDA HONE 1-2 3-4 7·14 U•30 31+ IfiLL UHnET VIRAL INFECTION 

I ''·' I I I 2 2 2 • I 

2 I I I 2 2 2 • I 

3 • • • • • • • • W-At. IIM18 

I 99,9 I I I I I I • I 

2 I I I I I I • I 3 I I I I I I • I 

TlHtA·SCALP I MMD 

I uo.o 0 I I I ' I • 0 

2 0 I I I I I • 0 

3 •• 2 2 2 :t 2 ' • Tl11£A I''EOIS 

I uo.s 0 I I I I I • 0 

2 0 I I I I I • 0 

3 • 2 2 2 2 2 • • TINEA CRURIS ETC, 

I uo., 0 I I I I I • 0 

2 0 I I I I I • 0 3 • 2 2 2 2 2 • • PlTYRIAIII 11£atiCOLot 

I 111.0 0 I I I I I • 0 2 0 I l I I I • 0 

3 • 2 2 2 2 2 • • TltlClfOitOtii AS II 

I 131.0 0 I I I I • 0 

2 0 1 I I I I • 0 

3 • 2 2 2 2 2 • • KQl£8 

I 133.0 0 I I I I I • 0 

2 0 I I I I I • 0 3 •• 2 2 2 .2 2 • • -.1..t.w.r N£0PUSII 

I 162.1 • • • • • • • • 2 2 2 2 2 2 2 • 2 

3 2 2 2 2 3 3 • 2 • ""UGIMHT HEDf'LASII-SXiN 

I 173.3 • • • • • • • • 

2 2 2 2 2 2 2 • 2 

3 2 2 2 2 3 3 • 2 BEIIJM NEDf'LASII-BOH£ 

I 213.9 • • • • • • • • 

2 2 2 2 2 2 2 • 2 3 2 2 ~ 2 3 .3. • 2 

...... 

--------------·--- IS' ... ·. 

! . '~ .. -

-~--~;,.,.......~_ f 
2f•Nov-77 

rAGE l 

DIAGNOSTIC SUKHARIES SCORING ALGORITHMS 

--------------------------------------- TEXT 

LEVEL .ICDA "ONE 1-2 l-6 7-14 1S·JO 31+ I TILL UHDET 

LIPOM-3KIN 

1 214.1} * • • • • • • • 

2 2 2 ~ 2 2 2 • 2 

l 2 "2 2 2 3 3 • 2 BEMI~N HED~LASX-PREAST 1 217,0 • • • • • • • • 

2 2 2 2 2 2 2 • 2 

] 2 2 2 2 l 3 • 2 HASH~PSOTD~I T!iYRO.i.DlTJS 

1 245.1 • • . • • • • • 

2 2 2 2 2 2 2 • 2 

3 2 2 2 2 2 2 • 2 

DlAaETES H£Lt!i~l 

1 2zo., • • • • • • • • 

2 2 2 2 2 2 2 • 2 

3 ;; 3 3 3 3 3 • l HTP£i;i.:r'!~.!'!!tt, 

1 212.0 0 0 0 0 0 0 • 0 

2 0 0 0 0 0 0 • 0 

3 0 0 0 0 0 0 • 0 

GOIIT 

I 274.0 0 1 1 • • • • 0 

2 0 1 I 2 2 2 • 0 

] • • • 2 2 2 • • _ M£1!IA NOS 

! 28S.? 0 0 0 0 0 0 • 0 

2 0 0 0 0 0 0 • 0 

• 

·3 0 0 0 0 0 0 • 0 

ANXIETY 

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PAGE 6 DlAGHOST!C SUKKAR!ES SCO'JNG ALOOR!THHS 

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29-Nov-77 

PAGE 11 PIAOHOSTIC 5VHHARI£S S~ORIHO ALOORITHHS 

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PAGE 13 

DIAOHOSJIC SUHHARJES SCORIHG ALGOR1THKS 

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\1'01 - [02 APP~1llX II 

- .20 f'AGt 20 

~IAnNO$TIC SUMH~RIES SCORING ALGO~ITHHS 

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- 22 2V-Nc.ov-77 

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DIAGNOSTIC SUKhARJES SCORING ALGO~JTHHS 

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\'01 - EC2 APPENDIX II - 24 PAGE 24 

DIAGNOSTIC SUMMARIES SCORING ALGORITHKI 

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APPEIIDIX II - 27 

DIAGNOSTIC SOM"ARIES SCORING ALGORITH"S 

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29-Nov•77 

PAGE 27 

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DIAGNOSTIC SU~HARlES SCORING AtGORITH"S 

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