This study examined the impact of chronic industrial noise exposure on psychological distress symptoms, accident involvement and sickness absence among male and female workers. It also examined whether workers expressing high noise annoyance were more adversely affected by it. Subjects were blue-collar workers, 1,680 males and 688 females, who participated in the Cordis Study. Noise exposure levels were: low [< 75 dB(A)], moderate [75-84 dB(A)], and high [> or = 85 dB(A)]. For males, noise exposure level affected job dissatisfaction and post-work irritability, while for females it also intensified somatic complaints, anxiety and depression. All the distress symptoms were higher for females. Further analysis showed that the significant increase of symptoms with noise exposure level was only for workers reporting high annoyance. Higher noise exposure levels were associated with increased accidents and sickness absence for both sexes. Noise-annoyed males had a significantly higher percentage of accidents when exposed to moderate noise levels and a marked increase in sick leave at high noise levels. Finally, the nonauditory effects studied here were already prevalent at moderate noise exposure levels, especially among noise-annoyed workers. This indicates the importance of reducing even moderately high levels of industrial noise not usually considered harmful to hearing.