Editorial: Cognitive science,occupational stress and organizational health

A number of studies have shown that musculoskeletal symptoms are related to the physical and psychosocial work environments. Workers with musculoskeletal symptoms are often advised to cope by such measures as changing working technique, using lifting equipment and discussing health and environmental problems with supervisors and colleagues. Intervention studies at the individual level, however, have shown that such advice has limited effects in reducing the prevalence of musculoskeletal symptoms. The hypothesis for this study was that negative social and organizational factors may prevent workers from implementing such coping strategies. All 103 motor vehicle mechanics surveyed in 12 different garages responded to a questionnaire on coping with musculoskeletal symptoms and the psychosocial work environment. Positive and significant relationships were shown between how mechanics coped with their musculoskeletal symptoms and such psychosocial factors as work demands, social support, control, manager's involvement in health and safety work, and whether the garages had regular meetings between management and workers. Achieving positive results from preventive work through back schools and other ergonomic interventions seems to require that an organization with positive attitudes towards health and safety work be created before such interventions are implemented.     

The relationship of work stressors, coping and social support to psychological symptoms among female secretarial employees

A conceptual framework is advanced that assumes that psychological symptoms emerge within multiple contexts, such as the workplace, and are influenced by the interplay of individual and situational risk and protective factors over time. This framework was utilized to examine the impact of work and work-family role stressors, coping, and work-related social support on psychological symptoms among 239 female, secretarial employees in the USA, using both cross-sectional and longitudinal structural equation models. Work stressors and avoidance coping were viewed as risk factors, and active coping and social support as protective factors. Work stressors contributed substantially to increased symptoms, primarily through a direct pathway in the cross-sectional model, but also indirectly to both Time 1 and Time 2 symptoms (4 months later) via pathways through active and avoidance coping. In both models, avoidance coping also predicted increased symptoms. Avoidance coping also served to partially mediate the relationship between work stressors and symptoms in the cross-sectional model, but not in the longitudinal model. Active coping was related to fewer psychological symptoms in both models, thereby reducing the negative effect of work stressors on symptoms. Likewise, work-related social support served an indirect protective function by contributing to lower levels of reported work stressors and greater use of active coping. Work stressors but not active coping mediated the relationship between social support and symptoms. Implications for future research and workplace interventions are discussed.     

Psychosocial safety climate,psychosocial and physical factors in the aetiology of musculoskeletal disorder symptoms and workplace injury compensation claims

Causal agents for workers' compensation claims and physical injury have largely been identified as physical demands. We proposed an integrated theory of physical injury (i.e. musculoskeletal disorder symptoms [MSDs]) and workers' compensation claims, which combined psychosocial and physical mechanisms. A random, population-based sample of 1095 Australian workers completed a telephone interview on two occasions 12 months apart. As expected, the physical mechanism was confirmed; physical demands were related to MSDs, which in turn predicted workers' compensation claims. Further, a novel psychosocial mechanism was confirmed. Psychosocial safety climate (PSC; perceptions about the organisation's climate for psychological health) was a precursor to psychosocial risks (e.g. harassment, violence, bullying and work pressure). In turn, these psychosocial risks were related to emotional exhaustion, MSDs and then workers' compensation claims. Evidence was therefore provided for psychosocial-physical processes in explaining MSDs and workers' compensation for claims for physical injury. Occupational health and safety legislators and policy makers should be aware that, beyond physical demands, factors usually associated with risk for mental stress claims (e.g. harassment, bullying, and violence) may additionally manifest in physical health problems and workers' compensation injury claims. Focusing on modifying the PSC in an organisation, “the cause of the causes”, may be an effective injury prevention and intervention strategy.     

Changing work environments: Innovative coping responses to occupational stress

To what degree do individuals adapt their work environments in response to occupational stress? The research reported below addresses this question through a qualitative questionnaire survey that assesses the extent to which innovation is used as a stress coping strategy amongst health care professionals (community and hospital nurses, administration workers and paramedics; N = 333). Overall, 32% of these workers reported a coping response subsequently coded as innovative, and significant between-occupational group differences in the frequency of usage were found. Overwork, procedural difficulties and dealing with others were the stressors eliciting the greatest number of innovative coping responses. The study indicated that such responses were perceived as an effective and important way of dealing with occupational stress. It is concluded that stress management programmes that encourage individuals to change workplace factors through innovation, would be a worthwhile addition to interventions that emphasize individual adaptation to stressful work environments.     

Risk factors for neck and back pain in a working population in Sweden

The relationship between lifestyle, ergonomie and psychosocial workplace factors and musculo-skeletal pain was examined in this cross-sectional study. A total of 22180 employees undergoing screening examinations at their occupational health-care service filled in a series of questionnaires concerning their health, lifestyle and working situation. Of these 31% reported having had neck pain and 18% had seen a health professional for such pain during the previous year. Similarly, 39% reported having had back pain and 16% had seen a professional during the year. Odds ratios were calculated to estimate the relative risk of the various exposure factors. Although not eating regularly and smoking increased the risk for both neck and back pain somewhat, not exercising and consuming alcohol did not increase the risk for these musculoskeletal pains. Lifting, monotonous work tasks, vibration and uncomfortable work postures were the most important ergonomie factors (odds ratios from 1.01 to 2.95). Sitting, however, did not increase the risk for either neck or back pain. A 'poor' psychosocial work environment, as compared to a 'good' one, increased the risk for both neck and back pain (odds ratios from 1.62 to 3.01). Work content and social support were of particular relevance. Finally, a combination of a 'poor' psychosocial work environment and exposure to one of the ergonomic variables produced the highest risk factors (odds ratios from 2.42 to 3.61). Although the conclusions that may be drawn are limited by the cross-sectional nature of this study, the results seem to underscore the complex aetiology of musculoskeletal pain and especially the importance of psychosocial variables. Prevention programmes should therefore be broad-based and include psychosocial as well as ergonomic measures.     

Work and other factors influencing coronary health and sickness absence

Two major problems encountered in studies of the impact of work on health are the determination of which diseases and health states may be affected, and the separation of work from other factors affecting health. The greatest burden of ill-health may be due to the psychosocial work environment, rather than exposure to traditionally studied environmental agents. A common concern is with coronary heart disease (CHD). The author and his colleagues have been studying CHD, mental health and sickness absence, this last as a measure which combines social, psychological and physical functioning. Two longitudinal studies were conducted on civil servants, with the major aim of investigating the effect on health of occupational and other socioeconomic influences on white-collar workers. It was found that the lowest risk of CHD was in administrators, and the highest risk in the lower socioeconomic groups. Type A behaviour was higher in higher grades of worker. Lower-grade workers had less healthy lifestyle habits. It may not be possible to separate the effect of work from other influences on an individual, and it could be that the point of intervention should be not the individual but the environment.     

Occupational overuse syndrome and the effects of psychosocial stressors on keyboard users in the newspaper industry

There is continuing concern about the incidence of occupational overuse syndrome (OOS) among workers using keyboards. Following results from research showing positive correlations between psychosocial factors in the workplace and the incidence of OOS symptoms, it was hypothesizcd that differences in rates of pain reporting by keyboard workers are related to job stress caused by different levels in thc quality of the psychosocial work environment. An interaction between autonomy and the impact of work pressure on pain reporting was also predicted. Data were used from a sample of 550 keyboard users in several different types of job, working in eight different newspaper offices of the same newspaper company. The results confirmed the hypotheses. Post hoc analysis showed that there were important differences between the types of stressors that predicted the reporting of pain between offices, and those that predicted pain reporting between types of job. These results confirm the importance of considering psychosocial factors in work and workplace design in connection with the prevention of OOS. Conclusions are also drawn about the situation specificity of such empirical research, and the need for more theoretical work in the search for the aetiology of OOS.     

The impact of VDU use and psychosocial factors at work on musculoskeletal shoulder symptoms among white-collar workers

This investigation of white-collar workers ( n = 201) in Swedish industrial environments focused on an empirical examination of the relationships between work with visual display units (VDUs), psychosocial factors (skill discretion, appraised work load, job satisfaction), physical work load and musculoskeletal shoulder symptoms. This cross-sectional study was based upon questionnaire surveys carried out at industrial companies. The prevalence of shoulder symptoms during the previous year was 39%. Nearly one-half of the participants reported that they used a VDU for at least 4 h/day ('high VDU use'). High VDU use was related to increased Prevalence Odds Ratio (POR) for shoulder symptoms. After adjustment for physical work load, significant PORs were found in groups with high VDU use in combination with low job satisfaction (POR = 4.8) or high appraised work load (POR = 3.5), compared to groups with low VDU use in combination with high job satisfaction or low work load (reference groups).     

Work-related psychosocial,physical and individual factors associated with musculoskeletal symptoms in computer users

The aim of this study was to study associations between psychosocial, physical and individual factors, and musculoskeletal symptoms in the neck, shoulder and hand/wrist regions of computer users. Questionnaires were distributed to 5033 employees in 11 Danish companies; these employees all used computers for at least some of their work time. The response rate was 69% ( n = 3475). The analyses were based on employees working 32-41 h/week ( n = 2579). Symptomatic respondents reported symptoms for at least 8 days within the previous year. Multiple logistic regression analyses were used. Gender (female), age and duration of employment in the same job were associated with an increased prevalence of symptoms. High quantitative job demands and low possibilities for development at work were predictors of neck and hand/wrist symptoms. A high degree of repetitiveness and disturbing reflections on the computer screen were associated with symptoms in all three body regions. Repetitive movements were defined as the same finger, hand or arm movements performed many times per minute for at least 75% of their work time. Repetitiveness was the only factor that could partly explain associations between symptoms and duration of computer use, i.e. respondents who used the computer almost all the time at work reported more repetitive movements than those who used it less. Thus, long hours of computer use may be associated with musculoskeletal symptoms, due to physical factors such as repetitive movements, whereas psychosocial factors appeared to be associated with the symptoms independently of the duration of computer use.     

Work-related psychosocial, physical and individual factors associated with musculoskeletal symptoms in computer users

The aim of this study was to study associations between psychosocial, physical and individual factors, and musculoskeletal symptoms in the neck, shoulder and hand/wrist regions of computer users. Questionnaires were distributed to 5033 employees in 11 Danish companies; these employees all used computers for at least some of their work time. The response rate was 69% ( n = 3475). The analyses were based on employees working 32-41 h/week ( n = 2579). Symptomatic respondents reported symptoms for at least 8 days within the previous year. Multiple logistic regression analyses were used. Gender (female), age and duration of employment in the same job were associated with an increased prevalence of symptoms. High quantitative job demands and low possibilities for development at work were predictors of neck and hand/wrist symptoms. A high degree of repetitiveness and disturbing reflections on the computer screen were associated with symptoms in all three body regions. Repetitive movements were defined as the same finger, hand or arm movements performed many times per minute for at least 75% of their work time. Repetitiveness was the only factor that could partly explain associations between symptoms and duration of computer use, i.e. respondents who used the computer almost all the time at work reported more repetitive movements than those who used it less. Thus, long hours of computer use may be associated with musculoskeletal symptoms, due to physical factors such as repetitive movements, whereas psychosocial factors appeared to be associated with the symptoms independently of the duration of computer use.     

Psychosocial predictors of health status

This prospective study examined, in a sample of male and female adults, the relationship between specific psychosocial factors and health status. Measures of stress, health habits, social support, Type A behaviour, and coping style were collected for 203 professional employees in a large aerospace organization in 1988. One year later a follow-up questionnaire assessing self-reported physical illness and job burn-out was administered resulting in a final sample of 95 employees. When adjustments for age, sex, education, and initial psychological well-being were made, perceived stress, physical exercise, and an avoidant coping style significantly contributed to predictions of physical illness in multiple regression analyses. Employees who possessed less hardy appraisals of work/life and expressed greater Type A behaviour reported significantly more fatigue and exhaustion one year later. Type A individuals also reported being significantly less sensitive and caring towards others. Finally, individuals who perceived less stress and expressed more cognitive hardiness reported significantly greater work/life satisfaction. Overall, the data supported the view that psychosocial factors may be differentially associated with diverse physical and psychological health outcomes.     

Psychosocial work environment and psychosomatic health of nurses in Hungary

The main goal of this preliminary study was to detect the relative effects of sociodemographics, socio-economic factors and some variables of psychosocial work environment on an overall index of psychosomatic symptoms as an indicator of psychosomatic health in a sample of female Hungarian nurses. The participants were registered nurses and student nurses chosen at random from public hospitals ( n =420). Self-administered questionnaires contained various items on psychosomatic symptoms, sociodemographics, socio-economic variables, work schedule, the frequency of stressful situations and emotionally provoking problems at work, and social support from peers. Multiple regression models revealed that the frequency of stressful situations and emotionally provoking problems, and the lack of social support from peers, i.e. measures of psychosocial work environment, proved to be the only significant contributors to psychosomatic health complaints, after controlling for other variables in both registered and student nurses.     

Interventions for musculoskeletal disorders in computer-intense office work: a framework for evaluation

Workplace interventions for work-related musculoskeletal disorders (WMSDs) are usually multifaceted. These interventions tend to deal with multiple work organizational and physical risk factors and have components occurring at different organizational levels. The organizations are often changing, with shifting initiatives and priorities. Evaluation of such interventions poses challenges in documentation of implementation, reduction in exposures, and assessment of improved health outcomes. We describe a means-outcomes framework for evaluating field interventions that includes strategies, activities, objectives and metrics for outcomes using quantitative and qualitative methods. We demonstrate application of the framework to our work with a large newspaper, which builds on existing laboratory, aetiological and best practice evidence to improve musculoskeletal health. The newspaper had adopted several organizational strategies aimed at improving financial performance, including restructuring into teams, a major set of moves/renovations and introduction of new software. Concomitant WMSD-related organizational strategies include an ergonomics policy, human resources activities, promotion of team work, changes in environment and equipment specifications and development of information systems. We have found the framework useful for focusing the purpose of data collection and ensuring coverage of important components. At the same time, it provides sufficient flexibility to respond to the changing process of implementation.     

Social support at work and its relationship to absenteeism

In this study, the impact of psychosocial work characteristics on illness and work absenteeism has been examined. The study group consisted of 133 civil servants (33 men and 100 women) with a mean age of 43 years (range 21-65 years). Psychosocial work characteristics, social support, quality of life, work absenteeism, psychosomatic and gastrointestinal symptoms were assessed by means of questionnaires. Five different work support or functions were identified by factor analysis: appraisal support, belonging support, instrumental support, emotional support and supportive atmosphere. The analysis showed that work absenteeism was associated with lower belonging support and a less supportive atmosphere. Furthermore, psychosomatic symptoms were associated with lack of support at work, measured as belonging support, instrumental support and supportive atmosphere. Gastrointestinal symptoms were associated with lack of belonging support and lack of social integration outside work. A bad general health status was associated with lack of insrumental support. The association between work absenteeism and social support at work was confirmed in multivariate analysis with control for confounding factors. In this analysis, high work strain and low social support were associated with a lower quality of life, which in turn was associated with increased absenteeism. Although there are well-known difficulties in drawing causal conclusions from cross-sectional studies, it seems reasonable to conclude that social support at work is an important factor to take into consideration when analysing illness and absenteeism from work.     

Interventions for musculoskeletal disorders in computer-intense office work: A framework for evaluation

Workplace interventions for work-related musculoskeletal disorders (WMSDs) are usually multifaceted. These interventions tend to deal with multiple work organizational and physical risk factors and have components occurring at different organizational levels. The organizations are often changing, with shifting initiatives and priorities. Evaluation of such interventions poses challenges in documentation of implementation, reduction in exposures, and assessment of improved health outcomes. We describe a means-outcomes framework for evaluating field interventions that includes strategies, activities, objectives and metrics for outcomes using quantitative and qualitative methods. We demonstrate application of the framework to our work with a large newspaper, which builds on existing laboratory, aetiological and best practice evidence to improve musculoskeletal health. The newspaper had adopted several organizational strategies aimed at improving financial performance, including restructuring into teams, a major set of moves/renovations and introduction of new software. Concomitant WMSD-related organizational strategies include an ergonomics policy, human resources activities, promotion of team work, changes in environment and equipment specifications and development of information systems. We have found the framework useful for focusing the purpose of data collection and ensuring coverage of important components. At the same time, it provides sufficient flexibility to respond to the changing process of implementation.     

Psychosocial work environment and psychosomatic health of nurses in Hungary

The main goal of this preliminary study was to detect the relative effects of sociodemographics, socio-economic factors and some variables of psychosocial work environment on an overall index of psychosomatic symptoms as an indicator of psychosomatic health in a sample of female Hungarian nurses. The participants were registered nurses and student nurses chosen at random from public hospitals ( n =420). Self-administered questionnaires contained various items on psychosomatic symptoms, sociodemographics, socio-economic variables, work schedule, the frequency of stressful situations and emotionally provoking problems at work, and social support from peers. Multiple regression models revealed that the frequency of stressful situations and emotionally provoking problems, and the lack of social support from peers, i.e. measures of psychosocial work environment, proved to be the only significant contributors to psychosomatic health complaints, after controlling for other variables in both registered and student nurses.     

Social support at work and its relationship to absenteeism

Abstract

In this study, the impact of psychosocial work characteristics on illness and work absenteeism has been examined. The study group consisted of 133 civil servants (33 men and 100 women) with a mean age of 43 years (range 21-65 years). Psychosocial work characteristics, social support, quality of life, work absenteeism, psychosomatic and gastrointestinal symptoms were assessed by means of questionnaires. Five different work support or functions were identified by factor analysis: appraisal support, belonging support, instrumental support, emotional support and supportive atmosphere. The analysis showed that work absenteeism was associated with lower belonging support and a less supportive atmosphere. Furthermore, psychosomatic symptoms were associated with lack of support at work, measured as belonging support, instrumental support and supportive atmosphere. Gastrointestinal symptoms were associated with lack of belonging support and lack of social integration outside work. A bad general health status was associated with lack of insrumental support. The association between work absenteeism and social support at work was confirmed in multivariate analysis with control for confounding factors. In this analysis, high work strain and low social support were associated with a lower quality of life, which in turn was associated with increased absenteeism. Although there are well-known difficulties in drawing causal conclusions from cross-sectional studies, it seems reasonable to conclude that social support at work is an important factor to take into consideration when analysing illness and absenteeism from work.     

Psychosocial stressors at work, psychological stress and musculoskeletal symptoms in the care for the elderly

This study was conducted in order to determine how occupational stressors (psychosocial stressors and physical load) are related to psychological stress (symptoms) and musculoskeletal symptoms among staff of Finnish residential homes, nursing homes and home help services (n = 204). Data obtained from questionnaires was used to test two hypotheses: that psychosocial stressors (time pressure, troublesome patients with dementia) are associated with psychological stress, and that musculoskeletal disorders are associated with physical load. The authors also tested whether psychological stress has a mediating effect between psychosocial stressors and musculoskeletal symptoms. The findings supported the hypothesis regarding the mediating effect of psychological stress.     

Adverse psychosocial working conditions and subjective health in freelance media workers

In recent years there has been a steady growth of non-standard work contracts in advanced societies. These contracts are characterized by increased flexibility of work arrangements and increased job instability, which holds particularly true for the media industry. This pilot study analyses associations of work stress with subjective health in a group of German freelancers (N = 290) working in the media industry. The measurement of work stress is based on the effort-reward imbalance model. Results of logistic regression analyses indicate significant effects of high effort in combination with low reward (money, esteem, promotion prospects, job security) on subjective health in men and women, with the effects being higher in men. Moreover, among men a critical pattern of coping with work stress enhanced the reported effect. In conclusion, the preliminary evidence from this study indicates an elevated risk of poor subjective health among freelance workers who are exposed to adverse psychosocial work conditions.     

Relationships between bullying, psychosocial work environment and individual stress reactions

It is frequently assumed that a poor psychosocial working environment will create conditions that encourage bullying. However, few studies have examined this assumption while comparing work environment ratings of bullied and non-bullied employees who work in the same organization and/or department. The objectives of this study were therefore, first, to investigate relationships between bullying and other psychosocial work environment factors within a particular organizational setting and, second, to investigate if bullied employees reported higher levels of stress than non-bullied employees. A total of 186 blue-collar employees from a Danish manufacturing company participated in the study (response rate of 93%). Results showed significant differences in bullied and non-bullied employees' ratings of psychosocial factors such as job control, management style, role clarity, social climate, social contact and work centrality. In order to investigate assumptions that a poor psychosocial work environment creates conditions that encourage bullying, a number of analyses compared the company's manufacturing departments with either high, medium or low levels of bullying. Results showed significant departmental differences. Yet, when bullied employees were removed from the statistical analyses, with regard to the perceived psychosocial environment these same departments could be differentiated only on the basis of rated job demands and management style. The results therefore bring into question the assumption that a generally poor work environment contributes to bullying. None the less, they do suggest that management style may directly or indirectly have contributed to a higher level of bullying. Also, bullied employees reported significantly more symptoms of psychological stress and mental fatigue than non-bullied employees.