Occupational differences in associations between Korean Occupational Stress Scale subscales and depression: a systematic review and meta-analysis

Occupational stress is a major determinant of depression among workers. The Korean Occupational Stress Scale (KOSS) is widely used to assess psychosocial stressors in Korean workplaces through multiple subscales; however, its association to depression across different occupational groups has not been systematically evaluated. This review examined associations between KOSS subscales and depression, focusing on occupational differences in subscale association. PubMed and KoreaMed were searched through March 2024. Nine studies met the inclusion criteria. Study quality was assessed using the Joanna Briggs Institute checklist. Random-effects meta-analyses were conducted to estimate pooled odds ratios (ORs), and between-study heterogeneity was evaluated using Cochran’s Q test and the I 2 statistic. Occupational group–specific patterns were synthesized qualitatively based on the statistical significance of individual KOSS subscales. Meta-analyses demonstrated significant associations between depression and most KOSS subscales, excluding the physical environment subscale, with substantial heterogeneity across studies. In qualitative synthesis, the pattern of significant subscales differed by occupational group, KOSS version, and analytic approach, indicating variability in subscale association across work settings. Several KOSS subscales, including insufficient job control, are associated with depression; however, their association varies by occupation and measurement context. These findings suggest that KOSS may not fully capture key psychosocial stressors in certain occupational groups. Future revisions should incorporate occupation-specific items and clearer interpretive criteria to improve its applicability in occupational mental health research and practice.