ObjectiveStrategies and measures for fighting occupational stress in China are inadequate. This study aimed to determine the level of occupational stress in coal miners and to assess the associations between occupational stress and job burn-out, depression and hypertension. The results could provide clues for preventive measures and strategies to improve the psychological well-being of this population.DesignCross-sectional study.SettingXinjiang Coal Administration Bureau.ParticipantsFour coal mines were selected randomly (computer-generated random number-based selection process) from the 21 coal mines of Xinjiang, and all miners with >1 year of employment were screened for participation.Primary and secondary outcome measuresA general demographic questionnaire, the Self-rating Depression Scale, the Effort–Reward Imbalance (ERI) model and the Maslach Burn-out Inventory.ResultsA total of 1400 questionnaires were collected, including 1334 (95.3%) valid questionnaires. This survey indicated that 1107 (83.0%) participants with an ERI score >1 (high occupational stress) and 227 (12.8%) had ERI ≤1. Severe depression was found in 21.7% of the participants. Job burn-out was positively correlated with occupational stress, which was, in turn, associated with depression. Multivariable linear regression analysis showed that depression (β=0.006, p=0.012), sex (β=0.358, p<0.001) and occupational stress (β=0.702, p<0.001) were independently associated with job burn-out. Working years (β=−0.086, p=0.015) and job burn-out (β=0.022, p<0.001) were directly associated with depression.ConclusionThis study highlights that occupational stress may affect job burn-out, depression symptoms and hypertension. A higher degree of occupational stress was associated with poorer mental status and hypertension.