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Workplace intervention

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Workplace intervention

Occupational health psychology (OHP) "concerns the application of psychology to improving the quality of work life, and to protecting and promoting the safety, health and well-being of workers."[1] It emerged from two distinct applied psychology disciplines, health psychology and industrial and organizational (I/O) psychology, as well as occupational health.[2] OHP is concerned with psychosocial factors [3] in the work environment and the development, maintenance, and promotion of employee health and that of their families.[4] OHP has been informed by a number of other disciplines, including occupational sociology, industrial engineering, economics,[5] preventive medicine, public health and others.[4]

Occupational health psychology is concerned with a number of topics, such as accidents and safety, burnout, musculoskeletal disorders, occupational stress,[6][7] work schedules such as shiftwork, workplace violence, and work-family issues.[8] Examples of psychosocial factors in the workplace linked to negative health outcomes include decision latitude and psychological workload,[9] the balance between a worker's efforts and the rewards (e.g., pay, recognition, status, prospects for a promotion, etc.) received for work,[10] and the extent to which supervisors[11] and co-workers[12] are supportive. OHP is concerned with both mental and physical problems (e.g., accidental injury),[13] cardiovascular disease,[14] psychological distress, and burnout and depression.[15] OHP is also concerned with the relation of psychosocial working conditions to health behaviors (e.g., smoking, alcohol consumption),[16] impact of deteriorating economic conditions,[17] carryover of deleterious workplace experiences to the worker's home life,[18] the potential impact of preexisting mental health problems on psychosocial working conditions,[19] and unemployment risk.[20]

Historical overview

Origins

A number of events and individuals who contributed to the foundation of OHP.[21] For example, Marx's[22] theory of alienation of the industrial worker has been influential. Taylor's (1911) Principles of Scientific Management[23] and Mayo’s industrial psychology research in the late 1920s and early 1930s on workers at the Hawthorne Western Electric plant[24] helped to develop later research in OHP topics. Some have argued [25] that industrial psychologist Arthur Kornhauser’s commitment in the 1920's, to identifying organizational factors thought to improve the wellbeing of workers was instrumental to the development of the field.[26]

Developments after World War II

There were a number of developments which have had some impact on current research studies in occupational health psychology. These occurred after World War II and into the 1970s. The creation in 1948 of the Institute for Social Research (ISR) at the University of Michigan was an important stimulus to research on work and health because of the institute's interdisciplinary character. Many psychological and sociological studies of work were initiated by researchers at the ISR.[27][28][29] Research by Trist and Bamforth (1951) showed that the reduction in autonomy that accompanied organizational changes in English mining operations affected worker morale.[30] A study by Gardell (1971) that examined the impact of work organization on mental health in Swedish pulp and paper mill workers and engineers.[31]

Research into unemployment and the influence on mental health conducted at the University of Sheffield’s Institute of Work Psychology (IWP) has consistently yielded a considerable influence on the field of occupational health psychology.[26] In 1971 medical researchers documented the impact of unemployment on blood pressure in 1971[32] influenced the emergence of OHP in at least two respects. First, Kasl and Cobb's study showed that a work-related psychosocial stressor can affect a physical condition. Second, the study demonstrated that rigorous methods can be applied to research on the impact of psychosocial work factors on an aspect of health.

Emergence as a professional discipline

The term "occupational health psychology" appeared in print from 1985.[2][33] In 1990, Raymond, Wood, and Patrick described "occupational health psychology" as a specific professional discipline, stating that creating healthy workplaces should be a goal for psychology.[34] This paper has been credited as the first use of the term.[6][35][36] In 1990, the American Psychological Association (APA) and the National Institute for Occupational Safety and Health (NIOSH) jointly organized the first international Work, Stress, and Health conference in Washington, DC.

Development after 1990: academic societies and specialized journals

In 1996, the International Commission on Occupational Health created its scientific committee on Work Organisation and Psychosocial Factors (ICOH-WOPS). That same year, in the United States the Journal of Occupational Health Psychology was published by APA. In 1998, ICOH-WOPS organized its first international conference in Copenhagen.[37] The second conference was held in Okayama, Japan in 2005, after which ICOH-WOPS adopted a two- to three-year cycle for its conference schedule. In 1999, the European Academy of Occupational Health Psychology (EA-OHP) was established.[38] The EA-OHP initiated its own series of international conferences on the psychological aspects of work and health. In 2005, the Society for Occupational Health Psychology (SOHP) was founded in the United States.[39] Work & Stress, published by Taylor & Francis, became associated with the EA-OHP. In 2008, SOHP joined with APA and NIOSH in organizing the, by then, biennial Work, Stress, and Health conferences.[40] Also in 2008, the EA-OHP and the SOHP began to coordinate activities (e.g., conference schedules).[41][42]

Research methods

The main purpose of OHP research is to understand how working conditions affect worker health,[43] as well as to evaluate the effectiveness of interventions.[44] The research methods used are similar to those used in other branches of psychology.

Standard research designs

Self-report survey methodology is the most used approach in OHP research.[45] Cross-sectional designs are commonly used, case-control designs less often.[46] Longitudinal designs[47] including prospective cohort studies and experience sampling studies[48] can examine relationships over time.[49][50] Quasi-experimental designs[51][52] and, less commonly, experimental approaches[53] have been used.[54]

Quantitative methods

Statistical methods commonly used in other areas of psychology are also used in OHP-related research. Statistical methods used include structural equation modeling[55] and hierarchical linear modeling[56] (HLM; also known as multilevel modeling). HLM can better adjust for similarities between employees [56] and is especially well suited to evaluating the lagged impact of work stressors on health outcomes; in this research context HLM can help minimize censoring and is well-suited to experience sampling studies.[57] Meta-analyses have been used to aggregate data (modern approaches to meta-analyses rely on HLM), and draw conclusions across multiple studies.[49]

Qualitative research methods

Qualitative research methods include interviews,[58][59] focus groups,[60] and self-reported, written descriptions of stressful incidents at work.[61][62] First-hand observation of workers on the job has also been used,[63] as has participant observation.[64]

Avenues of OHP related research

Job stress and cardiovascular disease

A number of significant factors are related to increased risk for cardiovascular disease (CVD). These risk factors include smoking, obesity, low density lipoprotein (the "bad" cholesterol), lack of exercise, and blood pressure, among others. In a case-control study involving two large U.S. data sets, Murphy (1991) found that hazardous work situations, jobs that required vigilance and responsibility for others, and work that required attention to devices were related to increased risk for cardiovascular disability.[65] These included jobs in transportation (e.g., air traffic controllers, airline pilots, bus drivers, locomotive engineers, truck drivers), preschool teachers, and craftsmen. Among 30 studies involving men[66] and women,[67] most have found an association between workplace stressors and CVD.

Job strain and CVD

Job strain refers to the combination of low work-related decision latitude and high workload.[9] Fredikson, Sundin, and Frankenhaeuser (1985) found that reactions to psychological stressors include increased activity in the brain axes which play an important role in the regulation of blood pressure,[68][69] particularly ambulatory blood pressure. A meta-analysis and systematic review involving 29 samples linked job strain to elevated ambulatory blood pressure.[70] Belkić et al. (2000)[71] found that many of the 30 studies covered in their review revealed that decision latitude and psychological workload exerted independent effects on CVD; two studies found synergistic effects, consistent with the strictest version of the strain model.[72][73] A review of 17 longitudinal studies having reasonably high internal validity found that 8 showed a significant relation between job strain and CVD and 3 more showed a nonsignificant relation.[74] The findings, however, were clearer for men than for women, on whom data were more sparse.

Effort-reward imbalance and CVD

An alternative model of job stress is the Effort-reward imbalance model.[75] That model holds that high work-related effort coupled with low control over job-related intrinsic (e.g., recognition) and extrinsic (e.g., pay) rewards triggers high levels of activation in neurohormonal pathways that, cumulatively, are thought to exert adverse effects on cardiovascular health. At least five studies of men have linked effort-reward imbalance with CVD.[76]

Job loss

Research has also shown that job loss adversely affects cardiovascular health[32][77] as well as health in general.[78][79]

Burnout

There is evidence from a prospective study that job-related burnout, controlling for traditional risk factors such as smoking, blood pressure, etc., increases the risk of coronary heart disease over the course of the next three and a half years in workers who were initially disease-free.[80]

Adverse working conditions and economic insecurity linked to psychological distress and reduced job satisfaction

What is meant by psychological distress

A number of longitudinal studies have shown that adverse working conditions can contribute to the development of psychological distress. Psychological distress refers to negative affect, without the individuals necessarily meeting criteria for a psychiatric disorder.[81][82] Psychological distress is often expressed in affective (depressive), psychophysical or psychosomatic (e.g., headaches, stomachaches, etc.), and anxiety symptoms. The relation of adverse working conditions to psychological distress is thus an important avenue of research. Job satisfaction is also related to negative health outcomes.[83][84]

Working conditions and psychological distress

Parkes (1982)[85] studied the relation of working conditions to psychological distress in British student nurses. She found that in this "natural experiment," student nurses experienced higher levels of distress and lower levels of job satisfaction in medical wards than in surgical wards; compared to surgical wards, medical wards make greater affective demands on the nurses. In another study, Frese (1985)[86] showed that objective working conditions give rise to subjective stress and psychosomatic symptoms in blue collar German workers. In addition to the above studies, a number of other well-controlled longitudinal studies have implicated work stressors in the development of psychological distress and reduced job satisfaction.[87][88]

Economic insecurity and psychological distress

Some researchers in occupational health psychology are concerned with (a) understanding the impact of economic crises on individuals' physical and mental health and well-being and (b) calling attention to personal and organizational means for ameliorating the impact of the crisis.[17] Ongoing job insecurity, even in the absence of job loss, is related to higher levels of depressive symptoms, psychological distress, and worse overall health.[89]

Work and mental disorder

Alcohol abuse

Main article: Alcohol abuse

Another study based on cross-sectional ECA data found high rates of alcohol abuse and dependence in the construction and transportation industries as well as among waiters and waitresses, controlling for sociodemographic factors.[90] Within the transportation sector, heavy truck drivers and material movers were at especially high risk. A prospective study of ECA subjects who were followed one year after the initial interviews provided data on newly incident cases of alcohol abuse and dependence.[91] This study found that workers in jobs that combined low control with high physical demands were at increased risk of developing alcohol problems although the findings were confined to men.

Depression

Using data from the ECA study, Eaton, Anthony, Mandel, and Garrison (1990) found that members of three occupational groups, lawyers, secretaries, and special education teachers (but not other types of teachers) showed elevated rates of DSM-III major depression, adjusting for social demographic factors.[92] The ECA study involved representative samples of American adults from five U.S. geographical areas, providing relatively unbiased estimates of the risk of mental disorder by occupation; however, because the data were cross-sectional, no conclusions bearing on cause-and-effect relations are warranted. Evidence from a Canadian prospective study indicated that individuals in the highest quartile of occupational stress are at increased risk of experiencing an episode of major depression.[93] A meta-analysis that pooled the results of 11 well-designed longitudinal studies indicated that a number of facets of the psychosocial work environment (e.g., low decision latitude, high psychological workload, lack of social support at work, effort-reward imbalance, and job insecurity) increase the risk of common mental disorders such as depression.[49]

Personality disorders

Main article: Personality disorders § Occupational functioning

Depending on the diagnosis, severity and individual, and the job itself, personality disorders can be associated with difficulty coping with work or the workplace, potentially leading to problems with others by interfering with interpersonal relationships. Indirect effects also play a role; for example, impaired educational progress or complications outside of work, such as substance abuse and co-morbid mental disorders, can plague sufferers. However, personality disorders can also bring about above-average work abilities by increasing competitive drive or causing the sufferer to exploit his or her co-workers.[94][95]

Schizophrenia

Main article: Schizophrenia

In a case-control study, Link, Dohrenwend, and Skodol found that, compared to depressed and well control subjects, schizophrenic patients were more likely to have had jobs, prior to their first episode of the disorder, that exposed them to “noisesome” work characteristics (e.g., noise, humidity, heat, cold, etc.).[96] The jobs tended to be of higher status than other blue collar jobs, suggesting that downward drift in already-affected individuals does not account for the finding. One explanation involving a diathesis-stress model suggests that the job-related stressors helped precipitate the first episode in already-vulnerable individuals. There is some support for the finding from data collected in the Epidemiologic Catchment Area (ECA) study.[97]

Workplace interventions

Industrial organizations

OHP interventions often concern both the health of the individual and the health of the organization. Adkins (1999) described the development of one such intervention, an organizational health center (OHC) at a California industrial complex.[98] The OHC helped to improve both organizational and individual health as well as help workers manage job stress. Innovations included labor-management partnerships, suicide risk reduction, conflict mediation, and occupational mental health support. OHC practitioners also coordinated their services with previously underutilized local community services in the same city, thus reducing redundancy in service delivery.

Hugentobler, Israel, and Schurman (1992) detailed a different, multi-layered intervention in a mid-sized Michigan manufacturing plant.[99] The hub of the intervention was the Stress and Wellness Committee (SWC) which solicited ideas from workers on ways to improve both their well-being and productivity. Innovations the SWC developed included improvements that ensured two-way communication between workers and management and reduction in stress resulting from diminished conflict over issues of quantity versus quality. Both the interventions described by Adkins and Hugentobler et al. had a positive impact on productivity.

Occupational Safety & Health Organization's work on OHP-related interventions

Currently there are efforts under way at NIOSH to help reduce the incidence of preventable disorders (e.g., sleep apnea) among heavy-truck and tractor-trailer drivers and, concomitantly, the life-threatening accidents to which the disorders lead,[100] improve the health and safety of workers who are assigned to shift work or who work long hours,[101] and reduce the incidence of falls among iron workers.[102]

Military and first responders

The Mental Health Advisory Teams of the United States Army employ OHP-related interventions with combat troops.[103][104] OHP also has a role to play in interventions aimed at helping first responders.[105][106]

Modestly scaled interventions

Schmitt (2007) described three different modestly scaled OHP-related interventions that helped workers abstain from smoking, exercise more frequently, and shed weight.[107] Other OHP interventions include a campaign to improve the rates of hand washing, an effort to get workers to walk more often, and a drive to get employees to be more compliant with regard to taking prescribed medicines.[108] The interventions tended reduce organization health-care costs.[107][108]

Workplace incivility

Main article: Workplace incivility

Workplace incivility has been defined as "low-intensity deviant behavior with ambiguous intent to harm the target....Uncivil behaviors are characteristically rude and discourteous, displaying a lack of regard for others" (p. 457)[109] Incivility is distinct from violence. Examples of workplace incivility include insulting comments, denigration of the target's work, spreading false rumors, social isolation, etc. A summary of research conducted in Europe suggests that workplace incivility is common there.[110] In research on more than 1000 U. S. civil service workers, more than 70% of the sample experienced workplace incivility in the past five years. Compared to men, women were more exposed to incivility; incivility was associated with psychological distress and reduced job satisfaction.[110]

Workplace violence

Main article: Workplace violence

Homicide

OHP is also concerned with work-related violence. According to figures from the United States Bureau of Labor Statistics, in 1996 there were 927 work-associated homicides,[111] in a labor force that numbered approximately 132,616,000.[112] The rate works out to be about 7 homicides per million workers for the one year.

Assault

Workplace assault is much more prevalent than workplace homicide.[113] Assaultive behavior in the workplace often produces injury, psychological distress, and economic loss. One study of California workers found a rate of 72.9 non-fatal, officially documented assaults per 100,000 workers per year, with workers in the education, retail, and health care sectors subject to excess risk.[114] A Minnesota workers' compensation study found that women workers had a twofold higher risk than men, and health and social service workers, transit workers, and members of the education sector were at high risk compared to workers in other economic sectors.[115] A West Virginia workers' compensation study found that workers in the health care sector and, to a lesser extent, the education sector were at elevated risk for assault-related injury.[116] Another workers' compensation study found that excessively high rates of assault-related injury in schools, healthcare, and, to a lesser extent, banking.[117] In addition to the physical injury that results from being a victim of workplace violence, individuals who witness such violence without being directly victimized are at increased risk for experiencing adverse effects, as found in a study of Los Angeles teachers.[118]

Curbing or preventing workplace violence

Although the dimensions of the problem of workplace violence vary by economic sector, one sector, education, has had some limited success in introducing programmatic, psychologically-based efforts to reduce the level of violence.[119] OHP research suggests that there continue to be difficulties in successfully "screening out applicants [for jobs] who may be prone to engaging in aggressive behavior,"[120] suggesting that aggression-prevention training of existing employees may be an alternative to screening. Only a small number of studies evaluating the effectiveness of training programs to reduce workplace violence currently exist.[121]

Relationship to industrial and organizational psychology

Industrial and organizational psychology is a discipline within psychology, which also covers the psychological aspects of occupational health and wellbeing,[122][123][124] occupational stress,[124] work organization and psychosocial factors[8] and, more recently, occupational safety and health.[125]

See also

References

Further reading

  • Cohen, A., & Margolis, B. (1973). Initial psychological research related to the Occupational Safety and Health Act of 1970. American Psychologist, 28, 600-606.
  • de Lange, A. H., Taris, T.W., Kompier, M. A. J., Houtman, I. L. D., & Bongers, P. M. (2003). “The very best of the millennium”: Longitudinal research and the Demand-Control-(Support) Model. Journal of Occupational Health Psychology, 8, 282–305.
  • Everly, G. S., Jr. (1986). An introduction to occupational health psychology. In P. A. Keller & L. G. Ritt (Eds.), Innovations in clinical practice: A source book, Vol. 5 (pp. 331–338). Sarasota, FL: Professional Resource Exchange.
  • Frese, M. (1985). Stress at work and psychosomatic complaints: A causal interpretation. Journal of Applied Psychology, 70, 314-328.
  • Karasek, R. A. (1979). Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly, 24, 285-307.
  • Kasl, S. V. (1978). Epidemiological contributions to the study of work stress. In C. L. Cooper & R. L. Payne (Eds.), Stress at work (pp. 3–38). Chichester, UK: Wiley.
  • Kasl, S. V., & Cobb, S. (1970). Blood pressure changes in men undergoing job loss: A preliminary report. Psychosomatic Medicine, 32, 19-38.
  • Kelloway, E.K., Barling, J., & Hurrell, J.J., Jr. (Eds.) (2006). Handbook of workplace violence. Thousand Oaks, CA: Sage Publications.
  • Leka, S., & Houdmont, J. (Eds.)(2010). Occupational health psychology. Chichester, UK: Wiley-Blackwell.
  • Parkes, K. R. (1982). Occupational stress among student nurses: A natural experiment. Journal of Applied Psychology, 67, 784-796.
  • Quick, J.C., Murphy,L.R., & Hurrell, J.J., Jr. (Eds.) (1992). Work and well-being: Assessments and instruments for occupational mental health. Washington, DC: American Psychological Association.
  • Quick, J. C., & Tetrick, L. E. (Eds.). (2010). Handbook of occupational health psychology (2nd ed.). Washington, DC: American Psychological Association.
  • Raymond, J., Wood, D., & Patrick, W. (1990). Psychology training in work and health. American Psychologist, 45, 1159-1161.
  • Sauter, S.L., & Murphy, L.R. (Eds.) (1995). Organizational risk factors for job stress. Washington, DC: American Psychological Association.
  • Siegrist, J. (1996). Adverse health effects of high effort-low reward conditions at work. Journal of Occupational Health Psychology, 1, 27-43.
  • Zapf, D., Dormann, C., & Frese, M. (1996). Longitudinal studies in organizational stress research: A review of the literature with reference to methodological issues. Journal of Occupational Health Psychology, 1, 145-169.

External links

  • List of academic journals that publish OHP-related articles by Paul Spector

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