We reserve the right to edit letters. The article on stress in general practice ('All stressed up and nowhere to go', features, pages 2829, 15 June) made interesting reading. However, readers could be misled into thinking that work in general practice is more stressful than it actually is.

The researchers used the general health questionnaire (GHQ) as a measure of stress among health service staff.

GHQ-12 asks about the level of mental strain respondents have experienced during the previous month. Yet this approach cannot be seen as tantamount to studying work related stress, as the GHQ-12 does not link the person's mental well-being to specific sources of stress.

It may be possible that the practice staff surveyed had experienced stressful events outside their workplace.

Alternatively, literature shows certain types of personalities are attracted to specific kinds of occupations.

1Could it not be that those attracted to working in general practice have different personalities and different 'stress thresholds' when compared with those working within the acute sector?

A better analysis of stress in general practice would be to examine the severity and the frequency of sources of stress. Chronic situations, such as excessive paperwork, may, for example, have a different impact on staff than acute but less frequent events such as violence against staff. A questionnaire such as the job stress survey may be better for rigorously examining levels of work-related stress in primary care.

2To make analyses of stress more meaningful, it would also be better to distinguish between occupational stress (unique to one's job) and organisational stress (related to organisational policies, procedures or climates). I was disappointed by the article's assumption of a linear and causal relationship between the sources of stress uncovered through interviews and the abnormally high GHQ-12 scores that the researchers obtained.

Ample evidence shows that other variables (for example, perceived control over events, coping styles and strategies, and so on) can also have an impact on the stress levels individual employees may encounter.

Although stress in general practice tends to attract a great deal of attention, it is a shame that research in this area cannot go beyond the use of 'blunt' tools such as the GHQ.

Glenn Williams Research officer Parkside Health trust

REFERENCES

1 Tokar DM, Fischer AR, Subich L Personality and vocational behavior: A selective review of the literature 1993-1997.J of Vocational Behavior , 1998; 53, No. 2, 115-153.

2 Spielberger CD, Vagg P. Research Manual for the Job Stress Survey . Psychological Assessment Resources. Florida, US: 1999.