Health Impact of Psychosocial Hazards at Work: An Overview Health Impact of Psychosocial Hazards at Work: An Overview Stavroula Leka BA MSc PhD CPsychol FRSPH Aditya Jain BA(H) MSc MA FRSPH Institute of Work, Health & Organisations, University of Nottingham Design & Layout: Philippos Yiannikouris WHO Library Cataloguing-in-Publication Data Health impact of psychosocial hazards at work: an overview / Stavroula Leka, Aditya Jain 1.Occupational health. 2.Risk management. 3.Workplace. 4.Psychology, Social. 5.Stress. 6.Risk assessment. I.Leka, Stavroula. II.Jain, A. III:World Health Organization. ISBN 978 92 4 150027 2 (NLM classification: WA 400) © World Health Organization 2010 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). 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Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views expressed in this publication. Table of Contents Executive Summary 01 1. Introduction 04 1.1 Defining psychosocial hazards and risks 04 1.2 Exposure to psychosocial hazards – mechanisms 06 1.3 Establishing the basis to estimate the global burden of disease of psychosocial 09 risks 2. Methodology 11 2.1 Establishing appropriate risk measures and exposure variables 11 2.2 Estimating risk factor levels 24 2.3 Overview of methods 24 2.4 Criteria for identifying relevant studies 24 2.5 Search strategy for studies 25 2.6 Selection of studies 26 3. Estimating risk factor - disease relationship 30 3.1 Changing nature of work 30 3.1.1 Impact of new forms of organisation and employment on health 30 3.1.2 Changes in the working population 32 3.2 Psychosocial risks - impact on health and stress 33 3.2.1 Job content 34 3.2.2 Workload and work pace 37 3.2.3 Work schedule: shift work and long work hours 38 3.2.4 Control 43 3.2.5 Environment and equipment 47 3.2.6 Organisational culture and function 49 3.2.7 Interpersonal relationships at work 50 3.2.8 Role in organisation 53 3.2.9 Career development 55 3.2.10 Home-work interface 59 4. Assessment of causality: Impact of psychosocial hazards and work-related 63 stress on health 4.1 Psychological and social health 65 4.1.1 Burnout 66 4.1.2 Mental health – depression and other common mental disorders 68 4.1.3 Social and behavioural health 73 4.2 Physiological and physical health effects 75 4.2.1 Musculoskeletal disorders 76 4.2.2 Heart disease 81 4.2.3 Metabolic syndrome and diabetes 85 5. Extrapolation of health impact of psychosocial risks: Link with previous 87 global burden of disease estimates 5.1 Psychosocial risks and heart disease 87 5.2 Psychosocial hazards and lower back pain 87 5.3 Psychosocial hazards and noise 88 6. Conclusions 89 References 90 List of Tables Table 1: Psychosocial hazards 05 Table 2: Summary of questionnaires 12 Table 3: Summary of observational instruments 20 Table 4: Review studies used 26 List of Figures Figure 1: Psychosocial work environment 07 Figure 2: Risks for work-related stress 09 Figure 3: Causal paths for work-related MSDs 77 We thank the following individuals for peer reviewing this document: Akizumi Tsutsumi, University of Occupational and Environmental Health, Japan Annette Prüss-Ustün, WHO, Switzerland Arturo Juarez Garcia, UNAM, Mexico Benedict Twinomugisha, Uganda Network for Workplace Health Promotion Dingani Moyo, Midlands Occupational & Travel Health Centre, Zimbabwe Harvey (Yong) Zhou, China Jennifer Lee, WHO, Switzerland Jian Li, Fudan University, China Maarit Vartia, Finnish Institute of Occupational Health Maureen Dollard, University of South Australia Michael Ertel, Federal Institute for Occupational Safety & Health (BAuA), Germany Monica-Lucia Soto-Velasquez, University of Antioquia, Colombia Muchtaruddin Mansyur, Indonesia Norito Kawakami, Tokyo University Graduate School of Medicine, Japan Wendy Macdonald, La Trobe University, Australia Health Impact of Psychosocial Hazards at Work: An Overview Executive Summary The working environment and the nature of work itself are both important influences on health (Marmot & Wilkinson, 2006). In recent decades significant changes, closely linked to the organisation and management of work, have taken place in the world of work (EU-OSHA, 2007). These have resulted in emerging risks and new challenges in the field of occupational health and safety. Psychosocial risks at the workplace have been identified as significant emerging risks (EU-OSHA 2007; NIOSH, 2002). Linked to psychosocial risks, issues such as work-related stress and workplace violence are widely recognised as major challenges to occupational health and safety (EU-OSHA, 2007). Psychosocial hazards are defined by the International Labour Organization (ILO, 1986) in terms of the interactions among job content, work organisation and management, and other environmental and organisational conditions, on the one hand, and the employees' competencies and needs on the other. As such, they refer to those interactions that prove to have a hazardous influence over employees' health through their perceptions and experience (ILO, 1986). A simpler definition of psychosocial hazards might be those aspects of the design and management of work, and its social and organisational contexts that have the potential for causing psychological or physical harm (Cox & Griffiths, 2005). A number of models exist in Europe and elsewhere for the assessment of risks associated with psychosocial hazards (termed psychosocial risks) and their impacts on health and safety of employees and the healthiness of organisations (in terms of, among other things, productivity, quality of products and services and general organisational climate). Psychosocial risks go hand in hand with the experience of work-related stress. Work-related stress is the response people may have when presented with work demands and pressures that are not matched to their knowledge and abilities and which challenge their ability to cope (WHO, 2003). Longitudinal studies and systematic reviews have indicated that stress at work is associated with heart disease, depression, and musculoskeletal disorders (MSDs) and there is consistent evidence that high job demands, low control, and effort-reward imbalance are risk factors for mental and physical health problems (e.g. Johnson et al., 1996; Kivimäki et al., 2006; Melchoir et al., 2007; Rosengren et al., 2004; Stansfeld & Candy, 2006; Tennant, 2001), thereby leading to further strain on public spending for increased costs on healthcare. Despite the available evidence, the prevention and management of psychosocial risks has not been high on the policy making agenda. Consequently, the Commission for the Social Determinants of Health (2008) recommended that while occupational health and safety policies remain of critical importance, the evidence strongly suggests the need to expand the remit of occupational health and safety to include work-related stress and harmful behaviours (Commission on Social Determinants of Health, 2008). In a wider perspective, psychosocial risks are being increasingly acknowledged as major public health concerns in industrialised countries (Leka & Cox, 2008). However, due to processes of globalisation and changes in the nature of work, these risks are not limited to the developed world. For some decades, there has been growing concern about the causes and health consequences of psychosocial risks, particularly in industrialized countries and to a lesser extent and only recently in developing countries (Kortum, 2007). Along with existing difficulties in controlling other more well-known occupational risks, there is a lack of awareness of psychosocial risks (as well as work-related stress, workplace violence and harassment), and shortage of resources to deal with them (WHO, 2007a). Although some research has been conducted in developing countries, particularly in Latin America, there are still not enough in- depth studies to fully analyse both cultural differences and behaviours, which vary from one 1 Health Impact of Psychosocial Hazards at Work: An Overview