Analysis of the Relationship between Physical and Psychosocial Risk Factors and Work

Stress and Fatigue amongst Firefighters

Abstract
This research was conducted on firefighters who are involved in risky activities and experience
work stress and fatigue. The purpose of the study is to determine the nature of work fatigue
and stress by examining the physical and psychosocial risk factors. It was conducted on 80
firefighters and administrative staff using a cross-sectional research design with observations;
the completion of questionnaires; testing of the amylase enzyme activation in saliva with a
Cocoro meter (Nipro Cocoro); measurement of reaction time with the Sleep 2 Peak smartphone
application (S2P); and measurement of vital body signs such as temperature, pulse and blood
pressure. Physical risk factors (force, awkward posture and manual handling), psychosocial
risk factors (effort, appreciation, over commitment, stress in job roles, emotional burden, social
support and non-employment) and organizational work factors (shifts and the status of
workers) are independent factors in the research into stress and work fatigue. The results of the
study show that a significant relationship between risk factors on the neck had an effect on
fatigue (CI 95% 1.75 to 16.16; OR 5.32); psychosocial factors, namely emotional burden (95%
CI 1.04 to 5.78; OR 1.56); stress in jobs roles (95% CI 1.23 to 4.76; OR 1.52); and social
support from the family (95% CI 1.27 to 5.43; OR 2.51) to stress and organizational work
factors consisted of type of work (CI 95% 0.05 to 0.55; OR 0.16), shift system (CI 95% 0.06
to 0.54; OR 0.18) and the status of workers had a relationship with the stress experienced by
firefighters.
Keywords: firefighters; work-related risk factors; work-related stress; fatigue

Introduction
Firefighters have jobs that pose diverse challenges and stressors (Baker, 2013). Based on the
results of a job-rated study by the American Psychological Association (2017), firefighters
ranked second out of the ten most stressful jobs, with a percentage of 72.43% (CareerCast,
2018). The work-related hazards faced by firefighters include chemical, physical and
psychosocial ones, which are related to the content and context of their work, including their
roles in the organization, job satisfaction, interpersonal relationships, household problems, and
workload related to work schedules or formats (Cox, Griffiths & Rial-Gonzalez., 2000; Baker,
2013).
According to research by Sharifah et al. (2012) related to the shift schedules of firefighters'
work in Malaysia, officers who worked 24-hour shifts had a higher incidence rate compared to
officers who worked 12-hour shifts. This was influenced by their workload, during which they
were required to be more awake, think fast, and react responsively when emergency events
occurred throughout the day. Malek, Mearns and Flin (2010) revealed that work schedules
experienced by firefighters with the format of 24 hours of work followed by 24 hours off (4
working days, 3 rest days), or 48 hours of work followed by 24 hours off (5 working days, 2
rest days), resulted in a very high risk of work fatigue and stress.
Work-related fatigue and stress are amongst the factors causing accidents at work. According
to ILO data (2013), as many as two million workers are victims every year of work accidents
caused by fatigue. These results involved 18,828 workers out of a population of 58,118,
meaning about 32.8% of workers experienced fatigue while working. Based on other studies,
about 40% of fatal accidents in all industrial sectors occur in the workplace due to the fatigue
experienced by workers (Vondráčková, Voštová and Nývlt, 2017). Several factors, such as
work, individual characteristics, and the psychosocial and physical environment, have a
relationship with stress and can cause fatigue in individuals, which affects their safety when
carrying out their work (Safe Work Australia, 2013).
Therefore, this study aims to establish the physical and psychosocial risk factors in work stress
and fatigue amongst firefighters, and to analyze the relationship between these factors and the
work stress and fatigue of firefighters in City X in 2018.

Methods
The design of this research study is cross sectional, being research that was only conducted
once (Newman, 2007). The study made subjective measurements using a questionnaire,
comprising the Swedish Occupational Fatigue Inventory (SOFI) and the Fatigue Assessment
Scale (FAS), as well as Effort Reward Imbalance, COPSOQ, NIOSH Generic Job Stress and
NIOSH Quality of Work Life (QWL) questionnaires. In addition, objective measurements were
made, including measurement of Salivary Amylase Activation (SAA) using a Cocoro meter
tool (Nipro Cocoro); testing of reaction time duration with the Sleep 2 Peak (S2P) smart phone
application; and heart rate and body temperature measurements. Secondary data were also
employed in the form of company operational data and other related literature.
Alpha-amylase is one of the major salivary enzymes in humans and is secreted from the
salivary glands in response to sympathetic stimulation. Salivary amylase is a biochemical
indicator that is useful for evaluating sympathetic activity from the sympathetic nervous
adrenomedullary (SAM) system.
Amylase activation in the salivary glands not only acts as a measure of norepinephrine levels,
but is also faster and more sensitive in responding to psychological stress than cortisol. This
shows that the activation of the amylase enzyme in saliva can be used as an index of
psychological stress levels. Research by Shetty et al. (2011) showed that amylase activity
decreases when the subject feels eustress (is comfortable) and rises in distress conditions
(uncomfortable ones). This shows that changes in alpha amylase enzyme activity can
distinguish between eustress and distress conditions.
SAA measurement uses the Cocoro meter (Nipro Corporation Japan) measuring instrument. A
Cocoro meter (Nipro Cocoro) is used to measure the level of alpha amylase in saliva, which
can measure both psychological and psychosocial stress levels with an accuracy of about 94%
if performed for under one minute. The unit used was kU / l. Use of this method was made by
inserting a strip (on which saliva could be placed) into the mouth for 10-30 seconds. The strip
was then inserted into the reader, namely the Cocoro meter. The results can be seen in a few
minutes, and the Cocoro meter will display the amylase levels in the saliva. There are four
classifications, namely:
a. Not stress: 0-30 kU / l
b. Mild stress: 31 - 45 kU / l
c. Moderate stress: 46 - 60 kU / l
d. Hard stress: ≥ 61 kU / l
Testing was done by involving the function of perception, and interpretation and reaction of
the motor by measuring the reaction time using a smartphone application called Sleep 2 Peak
(S2P). Reaction time is the period of time from being excited to a moment of consciousness;
carrying out the activity of prolonging the reaction time is an indication of a slowdown in the
physiological and muscle processes. Sleep 2 Peak is a smartphone application that uses the
Psychomotor Vigilance Test (PVT) principle.
The advantage of this PVP is that it has a high sensitivity and validity for losing one's sleep
time. Several related studies have revealed that PVP applications can be a measurement of RT
(Reaction Timer) if a person experiences chronic sleep deprivation. PVP applications have
been released up to the fourth generation and can be installed on an iPod (Ios 7.1); version 1.2
of Sleep 2 Peak was installed, which was released on October 28, 2013. This application was
designed to be able to assess the level of fatigue by observing changes in people’s alertness by
examining adequacy of sleep, prolonged activity and circadian rhythms (Brunet et al., 2017).
This study made observations and measurements at the beginning and the end of the work shifts
of officers who had a 1-1 working format; that is, one day working and one day off. The results
obtained were used to determine fluctuations and comparisons experienced by officers at the
beginning and the end of the shifts during the 24 hour period. The results of the study are
presented in a descriptive form to order to develop a description of the physical, psychosocial
and work organization risk factors, and the correlation between the independent and dependent
factors in the study, namely stress and work fatigue amongst firefighters.

Results
The results of the measurement of stress and fatigue in the respondents is shown in Table 1.
Table 1. Measurement Results of Fatigue and Stress in the Research Respondents

Type of Work Stress Fatigue

(Salivary Activation Amilase Index (Reaction Times by Sleep 2 Peak
by Cocoro Meter) App)

No Stress Stress No Fatigue Fatigue

n % n % N % n %
Administration 4 17.4 19 82.6 10 43.5 13 56.5
Firefighter 32 56.1 25 43.9 31 54.4 26 45.6

It was found that as many as 82.6% of the administrative personnel and 43.9% of clamber
officers were in the stress category, based on measurements of the amylase index in saliva.
56.5% of administrative staff and 45.6% of clamber were in the fatigue category, based on the
results of the reaction time measurement with the Sleep 2 Peak (S2P) application.
 Table 2. Measurement Results of SAA and S2P on Research Respondents

Variable Mean Median SD Minimal Maximal 95% CI

Stress Index 31.61 27.0 23.51 2-157 26.38-36.84
Before
Work
Stress Index 36.11 34.50 25.10 3-200 30.53-41.69
After Work
S2P 347.36 351.50 62.62 197-467 333.43-361.30
Before
Work
S2P 346.56 347.00 54.79 205-455 334.37-358.76
After Work

Based on Table 2, the results of the first measurement of salivary enzyme activation with the
Cocoro meter, or before work, showed an average of 31.61 kU/l, with a median of 27.0 kU/l
and a standard deviation of 23.51. In the second measurement, or after work, the results showed
an average of 36.11, with a median of 34.50 and standard deviation of 25.10.
The results of the first reaction time measurement with the S2P application, or before work,
showed an average of 347.36 m/s2, with a median of 351.50 m/s2 and a standard deviation of
62.62. The results of the measurement of reaction time in the second measurement, or after
work, had an average of 346.56 m/s2, with a median of 347.00 m / s2 and a standard deviation
of 54.79.
Graph 1 shows the SAA measurement results for the firefighters.

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Graph 1. SAA measurement results for firefighters while on duty in normal conditions
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Graph 2. S2P measurement results for firefighters while on duty in normal conditions
This research uses sub-unit samples for measurement, comprising firefighters involved or in
condition after extinguishing fires that day.

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Graph 3. SAA measurement results for firefighters after the work condition (involve of fire
extinguisher brigade)

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Graph 4. S2P measurement results for firefighters after the work condition (involve of fire
extinguisher brigade)
 RISK FACTORS Fatigue OR CI 95% Stress Index OR CI 95%
Not Yes Not Yes
n % N % N % n %
INDIVIDUAL FACTORS
AGE < 32,25 th 34 57,6 25 42,4 1,00 32 62,7 19 37,3 1,00
≥ 32,25 th 7 33,3 14 66,7 2,72 0,96-7,72 4 13,8 25 86,2 10,53 3,18-34,89***

EDUCATIONAL Senior High 33 52,4 30 47,6 1,00 32 50,8 31 49,2 1,00

LEVEL School/
Diploma
S1/S2/S3 8 47,1 9 52,9 1,24 0,42-3,62 4 23,5 13 76,5 3,35 0,97-
11,42

MARITAL STATUS Single 26 68,4 12 31,6 1,00 26 68,4 12 31,6 1,00

Married 15 35,7 27 64,3 3,9 1,54- 10 23,8 32 76,2 6,93 2,59-

9,89** 18,58***

NUMBER 0 31 62,0 19 38 1,00 32 64,0 18 36,0 1,00

OF ≥1 10 33,3 20 66,7 3,26 1,26-8,44* 4 13,3 26 86,7 11,56 3,48-
CHILDREN 38,39***
BMI Normal 23 44,2 29 55,8 1,00 23 44,2 29 55,8 1,00
Underweight 4 66,7 2 33,3 2,3 0,39-1,36 4 66,7 2 33,3 2,3 0,39-
1,36
Overweight 10 62,5 6 37,5 1,0 0,91-11,02 10 62,5 6 37,5 1,0 0,91-
11,02
Obese 4 66,7 2 33,3 1,7 0,21-13,22 4 66,7 2 33,3 1,7 0,21-
13,22
SMOKING STATUS Non-Smoker 18 64,3 10 35,7 1,00 15 53,6 13 46,4 1,00
Smoker 22 43,1 29 56,9 2,37 0,92-6,14 20 39,2 31 60,8 1,79 0,71-
4,54
Light Smoker 10 55,6 4 44,4 1,00 7 50,0 7 50,0 1,00
Heavy to 12 38,8 21 61,9 1,82 0,26-5,05 14 37,8 23 62,2 1,64 0,48-
Moderate 5,68
Smoker
LENGTH < 39 month 27 67,5 13 32,5 1,00 23 57,5 17 42,5 1,00
OF ≥ 39 month 14 35 26 65 3,86 1,53-9,75* 13 32,5 27 67,5 2,81 1,13-
SERVICE 6,99**
TYPE OF Administrative 10 43,5 13 56,5 1,00 4 17,4 19 82,6 1,00
WORK Firefighter 31 54,4 26 45,6 0,65 0,24-1,71 32 56,1 25 43,9 0,16 0,05-
0,55**
 WORK Permanent 11 42,3 15 57,7 1,00 5 19,2 21 80,8 1,00
STATUS Employee
Contracted 30 55,6 24 44,4 0,59 0,23-1,51 31 57,4 23 42,6 0,18 0,06-
Employee 0,54**
Shift Work Non-Shift 10 43,5 13 56,5 1,00 4 17,4 19 82,6 1,00
Shift (1-1) 31 54,4 26 45,6 0,65 0,24-1,71 32 56,1 25 43,9 0,16 0,05-
0,55***

PHYSICAL FACTORS
Fatigue OR CI 95% Stress OR CI 95%
RISK FACTORS Not Yes Not Stress
n % n % n % n %
Risk Factor in Low 31 63,3 18 36,7 1,00 26 53,1 23 46,9 1,00
Back High 15 48,4 16 51,6 1,83 0,74-4,58 13 41,9 18 58,1 1,61 0,97-3,46

Risk Factor in Low 35 62,5 21 37,5 1,00 1,00 36 64,3 20 35,7 1,00
Shoulder High 11 45,8 13 54,2 1,97 0,75-5,19 10 41,7 14 58,3 1,59 0,23-7,51
Risk Factor in Low 41 61,2 26 38,8 1,00 35 52,2 32 47,8 1,00
Wrist High 5 38,5 8 61,5 2,52 0,74-8,55 4 30,3 9 69,7 3,05 0,11-6,44
Risk Factor in Low 22 81,5 5 18,5 1,00 15 55,6 12 44,4 1,00
Neck High 24 45,3 29 54,7 5,32 1,75- 26 49,1 27 50,9 1,29 0,51-5,29
16,16**

PSYCHOSOCIAL FACTORS
Fatigue OR CI 95% STRESS OR CI 95%
RISK FACTORS Not Yes Not Yes
n % n % n % n %
Effort Low 21 61,8 13 38,2 1,00 18 52,9 16 47,1 1,00
High 20 43,5 26 56,5 2,1 0,85-5,20 20 43,5 26 56,5 1,16 0,47-2,82

Reward High 25 70,6 9 29,4 1,00 20 58,8 14 41,2 1,00

Low 16 34,8 30 65,2 2,21 0,25-9,47 16 34,8 30 65,2 1,89 0,89-5,38

Over Low 24 53,3 21 46,7 1,00 24 53,3 21 46,7 1,00

Committment High 17 48,6 18 51,4 1,21 0,50-2,93 15 42,9 20 57,1 1,17 0,48-2,84
Role Stress Low 24 52,2 22 47,8 1,00 26 56,5 20 43,5 1,00
High 15 44,1 19 55,9 2,72 1,23-4,76* 16 47,1 18 52,9 1,52 1,23-4,76*
Emotional Low 30 56,6 23 43,4 1,00 27 50,9 26 49,1 1,00
Demands High 11 40,7 16 59,3 1,89 0,74-4,86 10 37,0 17 63,0 1,64 0,63-4,23
Social Support High 30 54,5 25 45,5 1,00 29 52,7 26 47,3 1,00
from Supervisor Low 10 40,0 15 60,0 1,67 0,59-3,96 10 40,0 15 60,0 1,35 0,52-3,51
Social Support High 28 50,9 27 49,1 1,00 32 58,2 23 41,8 1,00
from Work Low 11 44,0 14 56,0 1,42 0,89-6,96 12 48,0 13 52,0 1,42 0,89-6,96
Partners
Social Support High 24 53,3 21 46,7 1,00 27 57,4 20 42,6 1,00
from Family Low 15 42,9 20 57,1 1,02 0,32-4,95 16 48,5 17 51,5 1,02 0,32-4,95
Non-Work Low 26 59,1 18 40,9 1,00 25 56,8 19 43,2 1,00
Factors High 13 36,1 23 63,9 2,56 1,03-6,33* 17 47,2 19 52,8 1,17 1,03-6,33*
Work Not Stress 23 64,9 14 35,1 1,00 24 64,9 13 36,1 1,00
Stress
Stress 13 30,2 30 69,8 3,27 1,25-8,51* 12 27,9 31 72,1 4,77 1,85-
12,31**
Sleep Debt None 21 61,8 13 38,2 1,00 2 100 0 0 1,00
24H (0 hour)
Yes 33 42,3 45 57,7 1,12 0,89-3,45 34 43,6 44 56,4 2,29 1,78-
(>1 hour) 2,95*
Discussion
Relationship between Individual Characteristics Factors and Fatigue and Stress
The individual characteristic factors in this study were age, education level, marital status,
number of children, BMI, smoking status, length of service and commuting time. Based on the
results of the analysis, respondents within the age group of > 32.25 years experienced more
work stress and fatigue. In the table of research results, groups with an age of > 32.25
experienced fatigue by 69%, based on the measurement results using the SOFI fatigue
questionnaires. The results of the S2P and SAA measurement also showed similar results, with
the age group of > 32.25 years having a higher stress percentage of 86.2%, compared to those
<32.25 years old. The results of the analysis showed a 95% CI value of 3.18 to 34.89, and an
OR value of 10.53. This means that older age increases the risk of stress by 10.53 times
compared to younger age.
Broadly speaking, the results of the study are in accordance with the results of several previous
studies, such as research on Sao Paulo firefighters and military personnel with an average age
of 37.9 years, and a variation of 5.4 years. In this study, older respondents experienced higher
fatigue compared to the group below the average age (Oliveira et al., 2015). Another study by
Dembe et al. (2005) on workers in various industrial sectors included individual characteristics,
one of which was the age factor, which was found to be one of the contributors to work-related
fatigue and stress.
The physical composition of the body changes with age. Body mass will shrink and total body
fat will be twice that of the whole. This causes strength, endurance and muscle volume
reduction, so fatigue takes place more and more quickly (WHO, 1996). Therefore, it can be
said that age is directly proportional to fatigue.
The results of the analysis show that the levels of fatigue and stress had a higher percentage in
the married group. The results of the assessment of fatigue with S2P show that married
respondents had an average reaction time that was longer than those who were not married.
This means that groups that already have a higher level of fatigue than those who are not
married. The results of the data analysis show that the percentage of respondents who were
married and experienced fatigue by 68%, there was a significant relationship between marital
status and the occurrence of fatigue. This was indicated by the 95% CI value of 1.15 to 9.91
and the OR value of 1.36, meaning that married people experience a 1.36 times higher risk of
experiencing defeat than those who are not married.
The assessment of stress levels using the Cocoro meter showed that the percentage of
respondents who experienced stress was higher in the married group of 76.2%. The results of
the analysis show that there was a significant relationship between marital status and stress
level, indicated by a 95% CI value of 2.59 to 18.58 and an OR value of 6.93. This means that
married respondents had a 6.93 times higher risk of experiencing fatigue than those who were
not married.
This is consistent with several previous studies, which have shown that those who are married
have a higher level of stress. This is because they have responsibility for their families (Smith
et al., 2017). In addition, marital status brings a person into a new stage of life, that gives them
a new role identity. Based on role identity theory, multiple role identities can give people some
hopes, meanings and values that are inherent in them (Stryker, 1968, cited in Davis, 2011). The
existence of children is also a family factor which can explain the dual role that a person has
and which can affect stress and fatigue.
In this study, the number of children living in the family is one of the variables that was taken
into account as a factor causing stress and fatigue. The respondents were divided into two
groups, namely those who had or did not have children. Based on the results of the analysis,
the level of fatigue was higher in the group with children in the household, with a percentage
of 76.7%. Assessment of fatigue with the S2P application also showed the percentage of fatigue
was higher in the group with children. The results of the analysis show that there was a
significant relationship between the number of children and fatigue, as exemplified by the 95%
CI value of 1.54 to 9.89 and the OR value of 3.9. This means that the group with children had
a 3.9 times higher risk than those without children.
The results of the measurement of stress levels show that the group with children had a higher
percentage of stress level by 86.7%. The results of the analysis show a significant relationship
between the number of children and the occurrence of stress, with a 95% CI value of 2.59 to
18.58 and an OR value of 6.93. This means that the group with children had a 6.93 times higher
risk of experiencing stress than the group without children.
These results are consistent with the research of Davis et al. (2011) on 473 firefighters, who
found that work-family conflict and fatherhood were factors in the work-related stress
relationship faced by firefighters. Fire. This is consistent with the results of this study, in which
the group with children had higher levels of stress and fatigue than the group without children.
Based on the research data, the characteristics of the research respondents based on gender
show that 95% were men, can be considered that it correlated with several studies above before.
In the table of research results, groups that had a service period of > 39 months experienced
fatigue by 67.5% based on the measurement results using the SOFI fatigue questionnaire. The
S2P measurement results also show that those with a service period of > 39 months had a higher
percentage of stress, at 65%, compared to those with a service period of <39 months. The
results of the analysis showed 95% CI values of 1.53 to 9.75 and OR values of 3.86. This means
that a length of service of > 39 months increased the risk of fatigue by 3.86 times compared to
one of <39 months.
Measurement of stress levels with the Cocoro meter show a higher percentage of stress with a
service period of > 39 months, at 67.5%. The statistical test results show a significant
relationship between service period and stress, which is demonstrated by CI 95% 1.13 to 6.99
with an OR value of 2.81. This means that the group with a service period of > 39 months had
a 2.81 times higher risk of stress compared to the <39 month group.
This result is in accordance with those of Tang's (2016) study of industrial workers in Taiwan,
in which the period of service affected the duration and pressure experienced by a person.
Therefore, the longer the working period, the greater the accumulation of pressure. According
to Davis (2015), Emergency Medical Services (EMS) workers, including firefighters, nurses
and ambulance workers, have stressful pressure from increased work. The results of the
analysis showed a positive relationship between service period and the level of stress
experienced by EMS officers. It can be interpreted that the longer the period of service, the
greater the stress experienced.
The results of the analysis in this study show that there was no significant relationship between
the length of commuting time and the occurrence of fatigue. This was indicated by a 95% CI
value of 0.84 to 5.44. Measurement of stress levels show that respondents with a commute time
of ≥ 45 minutes experienced more stress, at 61.5%. It was shown that there was no significant
relationship between the length of commuting time and the occurrence of stress in the study
respondents, indicated by a 95% CI value of 0.69 to 4.09.
The results of this study, in accordance with previous research by Morrow (2010), show no
relationship between commuter time and fatigue. According to the average commuting time
globally, the ideal time is 30-45 minutes, as this has little impact on the time available for rest
and sleep, which can affect worker fatigue.
Relationship between Work Organization Factors and Fatigue and Stress
The work organization factors in this study are type of work, work status and shift system. The
results of the analysis based on SOFI fatigue measurements show that there was a significant
relationship between the type of work and fatigue. This was evidenced by a 95% CI value of
0.10 to 0.79 with an OR value of 0.29. This means that the interpreter group has 0.29 times
better protection than the administrative staff. The measurement of fatigue with the S2P
application also gave the same results, in which the level of fatigue was more prevalent in the
administrative staff group.
Previous studies conducted by Davis (2015) and Smith (2017) have reached different results,
where working as a clerk had a high level of fatigue and stress. This is because the job is subject
to a high traumatic level, so it can give workers a bad memory. This is clearly the main stress
source for firefighters. In addition, high role conflict is one of the factors that causes high
extinguishing stress levels.
Relationship between Physical Factors and Fatigue
The results of the analysis found a significant relationship between risk factors in the neck with
the occurrence of fatigue. This was evidenced by the CI 95% of 1.75 to 16.16, with an OR
value of 5.32. This means that high risk groups have a 5.32 times higher risk of experiencing
fatigue compared to the low risk groups.
These results correlate with Davis's previous (2015) research regarding the physical risk factors
affecting firefighters. The study stated that such factors have a significant relationship with the
occurrence of fatigue and increase the risk of accidents at work. Taking into account body
posture, duration of time and physical ability, physical risk factors have a significant
relationship with the occurrence of fatigue. In addition, research by Haghighi et al. (2015) and
Hobman (2010) found that physical risk factors such as force have a positive relationship with
the occurrence of fatigue. This is often associated with effort, as well as Manual Load Handling
(PBM) activities with heavy loads, in which muscles and tendons are exerted to strong forces
in relation to heavy loads. Research by Widanarko and Modjo (2017) showed that physical risk
factors, such as sitting posture and lifting heavy weights (> 20 kg), and psychosocial risk
factors, for example work stress, had a significant relationship with the symptoms of acute
fatigue experienced by workers.
Relationship between Psychosocial Factors and Fatigue and Stress
Based on the results of the study, high risk groups had a higher percentage of error, which was
52.2%, compared to low risk groups. The measurement results using S2P also show a higher
percentage of fatigue experienced by high business groups. However, there was no significant
relationship between business variables and fatigue, as shown by a 95% CI value of 0.68 to
4.17, while the results of stress measurement with the Cocoro meter show the stress
experienced by many high-risk business groups. No relationship was found between effort and
stress.
Overcommittment factors, a group with high risk had a higher percentage of the occurrence of
fatigue, equal to 54.3%, based on the assessment of the SOFI fatigue questionnaire. According
to the results of the measurements with the S2P application, the high risk group also had a
higher percentage of fatigue, at 51.4%. With regard to the measurement of stress with the
Cocoro meter, the high risk overcommittment group had a greater percentage of experiencing
stress compared to the group with low risk, at 57.1%. The results of the analysis found no
significant relationship between overcommittment and the occurrence of stress.
The results of the measurement of fatigue with S2P also show that the percentage of fatigue is
more common in groups with low social support. The results of the analysis show that there
was no significant relationship between social support from superiors and co-workers,
indicated by a 95% CI value of 0.81 to 3.31.
The results of the measurement of fatigue with S2P also show that the groups with the influence
of high non-occupational factors have a high percentage of occurrence of fatigue, at 63.9%.
The results of the analysis show a significant relationship between non-work factors and
fatigue. This was indicated by a 95% CI value of 1.03 to 6.33 with an OR value of 2.56. This
means that the high non-occupational effect increases the risk of fatigue by 2.56 times,
compared to those who have the influence of low non-work.
Stress measurement with the Cocoro meter shows a higher percentage of stress experienced by
groups that are influenced by high non-employment factors, at 52.8%. The results of the
analysis show a significant relationship between the influence of non-work and stress. This is
indicated by a 95% CI value of 1.03 to 6.33 with an OR value of 1.17, and means that high
non-work effects can increase stress by 1.17 times.
This result is consistent with the research of Davis et al. (2011) on 473 firefighters, that other
factors outside of work (non-work), one being work-family conflict, affect the work-related
stress faced by firefighters. Based on Cox et al.’s (2000) theory, the home-work interface is a
psychosocial factor which can affect a person's psychological condition.
Relationship between Sleep Debt and Fatigue and Stress
Sleep debt is defined as the amount of sleep that a person has not had in the last 24 or 48 hours.
According to the results of the study, a person with a 24-hour sleep debt has a higher percentage
of fatigue, at 57.7%, compared to those who do not have such a debt. Measuring 24-hour sleep
debt to stress also shows that someone who has sleep debt has a higher stress percentage, of
56.4%. The results of the analysis show a significant relationship between sleep debt and the
occurrence of stress. This is demonstrated by the 95% C1 value of 1.78 to 2.95, with a value
of OR of 2.29. This means that someone who has had sleep debt in the last 24 hours has a 2.95
times higher risk of experiencing stress than those without sleep debt.
Conclusion
Based on the research, several conclusions can be drawn. The indication of the level of fatigue
obtained through the measurement of reaction time with the PVT system using the Sleep 2
Peak smartphone application is that as many as 45.6% of clamber officers are categorized as
tired and 56.5% of administrative personnel. From the description of stress obtained through
direct measurement using the Cocoro meter, 56.1% of clamber officers can be categorized as
stressed and 82.6% of administrative personnel. This can be caused by several issues related to
job characteristics, and the different habits, such as expenses, demands, and habits outside
working hours, of clerks and administrative staff.
The results of the study show a significant relationship between psychosocial factors, namely
emotional burden (CI 95% 1.04 to 5.78; OR 1.56), role stress (95% CI 1.23 to 4.76; OR 1.52)
and social support from family (95% CI 1.27 to 5.43; OR 2.51) and stress; risk factors for the
neck had an effect on fatigue (CI 95% 1.75 to 16.16; OR 5.32), as well as organizational work
factors consisting of type of work (CI 95% 0.05 to 0.55; OR 0.16), shift system (CI 95% 0.06
to 0.54; OR 0.18) and worker status.
Suggestions
Suggestions for consideration regarding stress and fatigue include the provision of
recommendations and considerations to the local City Government related to the distribution
of working hours in the shift system for clerks. Based on the Decree of the Minister of
Manpower and Transmigration of the Republic of Indonesia Number 233 / MEN / 2003 Article
2 concerning the division of work time in the shift system for services which have a pattern of
continuous working hours or in other circumstances based on an agreement between workers
and employers. In addition, the accumulative working hours of each shift should not exceed 40
hours per week (Article 77 paragraph 2 of Law No. 13/2003).
The procurement of fitness and health equipment that is intended to be used for spending free
time or resting in every UPT and service office should be facilitated. There should be improved
training related to fatigue and stress, such as fatigue and stress awareness or fatigue and stress
(FASTRESS) management planning. Fatigue control should be conducted in engineering,
especially real time detection of fatigue. The use of EEG detection technology could also be
made. There should also be provision of a periodic medical check-up program for all
administrative staff and clamber officers to record the history and type of illness suffered by
each worker.
Moreover, as regards suggestions on an institutional or fire service level, workes have power
to manage stress and fatigue; workers should perform good stress management by paying
attention to issues such as sleep adequacy, by making sleep a priority, scheduling sleep time
according to sleep hours, and reducing the habit of playing on mobile phones, laptops and other
devices. Increased physical activity should be carried out during work time so that staff can
maintain a fit condition for when there is an emergency which requires considerable energy.

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