The present study investigated the association between visual display terminal (VDT) work and sick building syndrome (SBS) and the role of psychosocial factors in the relationship. Subjects were 2,161 Japanese office workers who responded to a cross-sectional anonymous self-administered questionnaire survey. Questions included were derived from the Miljömedicin 040, a validated questionnaire on SBS symptoms. After exclusion of data with missing information, data for 1,881 subjects were used for analysis. Multivariate logistic regression was used to estimate the odds ratio for SBS with adjustment for potential confounding factors, including psychosocial work stress. In multivariate analysis, the odds ratio for SBS was significantly elevated for men engaged in VDT work for 4 or more hours a day (OR=2.5, 95%CI: 1.0, 5.9) compared with less than 1 hour a day, showing a significant trend association (P for trend=0.04). In women, although the odds ratio for SBS with VDT use of 4 or more hours a day was somewhat elevated with adjustment for non-psychosocial factors (OR=1.5, 95%CI: 0.5, 4.3), the increase was greatly attenuated after adjustment for psychosocial work distress (OR=1.1). In conclusion, our study suggests that extended hours of VDT use might be related to increased SBS symptoms. Moreover, psychosocial distress related to VDT work might mediate the relationship between VDT use and SBS symptoms in women.