Link between work pressures and psychological disorders
A recent study by the University of Gothenburg analyses the scientific foundation for application of the Work Injury Insurance Act in relation to psychological disorders. The act provides for financial compensation for workers who have suffered physical or psychological ill-health due to a poor work environment or accidents at work. The study reveals some evidence that high psychological requirements, lack of social support and strains at work can cause depression and anxiety.
In Sweden, according to the Work Injury Insurance Act (Lag om arbetsskadefA¶rsA¤kring, SFS 1976:380 (in Swedish)), workers who suffer from work-related injuries are entitled to compensation. The term aeuro~work-related injuryaeuroTM, in this case, refers to physical and psychological injuries and disorders caused by a poor work environment.
On the one hand, physical injuries can relatively easily be related to work accidents, just as physical disorders can be medically related to repetitive tasks or heavy lifting at work. On the other hand, it is more difficult to prove the relationship between psychological disorders and the work environment or work-related accidents. For instance:
- psychological disorders occur among the general public, without any connection with working conditions;
- disorders are difficult to define with scientific objectivity since doctors commonly make a diagnosis on the basis of their patientaeuroTMs own explanations of personal experiences;
- the causal background of psychological disorders is only partly identified and what is known is multi-faceted, including for example references to work relations, family relations, social ambient environment and the individualaeuroTMs mental state.
Due to these problems, receiving compensation for psychological work-related injuries can be difficult. Against this background, the recent study on aeuro~Mental disorders caused by strains at workaeuroTM aims to investigate the scientific foundation for an accurate appliance of the Work Injury Insurance Act in relation to psychological disorders.
About the study
The study is based on a review of research articles on causal links between a work-related psychological load and clinically significant depression diagnosed through established psychiatric methods. The methodology in question refers to the International Statistical Classification of Diseases and Related Health Problems (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM).
In selecting which research material to include in the study, the authors followed a thorough methodological framework. The screening for suitable material was limited to articles in scientific journals with a peer-review system. From a systematic search in two major literature databases aeuro" the Medical Literature Analysis and Retrieval System Online (MEDLINE) and PsycINFO aeuro" about 100 references were selected due to their abstractsaeuroTM relevance regarding poor psychological health caused by work-related conditions.
The selected articles were then analysed by the authors and judged according to relevance. In total, 28 articles were selected for inclusion in the study and were evaluated on the basis of their respective scientific quality. A number of criteria were used in this second screening process and the articles were graded on a scale of 1 to 3, where 3 was the highest score. For example, articles in which the outcome was a psychiatric diagnosis arrived at by interviewing the patient corresponded to 3 points, while grading of poor health by the patients themselves rendered 0 points. Furthermore, studies that included other employeesaeuroTM views on working conditions, those that controlled for earlier psychological disorders and studies of significant size were awarded high scores.
The articles were ranked according to scientific rate of evidence, thus determining how strong the scientific support of the outcome of the study was rendered. None of the selected articles reached the first rate of evidence (strong scientific support). However, according to the studyaeuroTMs conclusions, moderate scientific support (evidence rate 2) exists that:
- high psychological requirements at work can cause depression and states of anxiety;
- a lack of social support at work can cause depression and states of anxiety;
- job strain aeuro" such as the combination of a lack of possibilities for decision making and high psychological requirements aeuro" can cause depression and states of anxiety.
Limited scientific support (evidence rate 3) exists that:
- a lack of possibilities for decision making at work can cause depression and states of anxiety;
- a lack of stimulation at work can cause depression and states of anxiety;
- a low level of control at work aeuro" such as the combination of a lack of possibilities for decision-making and lack of stimulation aeuro" can cause depression and states of anxiety;
- negative, life-affecting incidents at work can cause (primary) depression.
Although the results of the study reveal a link between poor psychological health and certain working conditions, the causal chains are not particularly strong. Moreover, the authors conclude that it is continuously difficult to judge whether a state of depression, for instance, is caused by poor working conditions. Problems arise in every single case because of individual variation in, for instance, genetically or socially acquired powers of resistance to deal with strains or stressful situations in life.
More research on the subject has thus yet to be carried out. However, it is important to remember that perfectly controlled and randomised studies are unlikely to be conducted in this area even in the future, due to serious difficulties regarding practical and ethical matters.
Thomas Brunk and Lisa Olsson, Oxford Research