New tools to monitor occupational health hazards
Since 1998, the occupational health department of the French Institute for Health Surveillance has been developing a comprehensive programme of problem-oriented monitoring in relation to health hazards in the workplace. Among a range of sub-programmes, the institute examines the situation with regard to mental health at work. Up to now, little monitoring has taken place in this area.
The French Institute for Health Surveillance (Institut de veille sanitaire, InVS) is a governmental organisation reporting to the Ministry of Health, Youth and Sport (Ministère de la santé, de la Jeunesse et des Sports). Over the past 10 years, InVS has developed a comprehensive programme of problem-oriented monitoring in relation to health hazards in the workplace. The range of sub-programmes include: a mortality analysis by economic sector (Cosmop); occupational risk exposure monitoring in the general working population (Matgéné); post-retirement health surveillance, examining carcinogen exposure among retired persons (Spirale and Espri); and a monitoring system for mental health at work (Samotrace).
This article will outline the work of the Samotrace programme only; for more information on the other programmes, please refer to the Bulletin Epidémiologique Hebdomadaire (in French, abstracts also in English). Most of the programmes have been launched recently and the information thus far focuses on methodology more than on results.
Deficit in monitoring mental health at work
Psychological factors represent the second most common cause of sick leave in France – after musculoskeketal disorders (MSD) (see occupational illness statistics 1993–2001). According to recent surveys at national and European level, 30% of the French population have suffered mental health problems including anxiety disorders, depression, somatoform disorders such as pain, nausea or dizziness, and substance-dependent illnesses. Data show that the prevalence of these problems differs according to socio-occupational variables, and international studies have demonstrated the impact of working conditions on mental health.
In France, no general monitoring of the relation between mental health and occupational factors existed until January 2006, apart from the SUMER (Surveillance Médicale des Risques [Medical monitoring of risks]) survey, including a self-administered questionnaire initiated in 2003, and some cohort studies on specific population groups. Therefore, InVS established the Samotrace programme to assess the frequency of mental health disorders according to job and occupational risk exposure.
The Samotrace programme relies on three separate projects developed in two pilot geographic areas: the Centre region and surrounding area since January 2006, and the Rhône-Alpes region in 2007.
Monitoring risk exposure in companies
In the Centre region and surrounding area, occupational doctors – participating in a voluntary capacity – gather data during the regular medical examination, which is scheduled every two years, on a random sample of workers. The aim is to provide mental health indicators according to occupation and sector of activity, and evaluations of exposure to risk factors. The workers themselves complete a questionnaire in respect of socio-demographic information such as sex, age, level of education and income, as well as personal information such as significant events in recent life or in childhood. Moreover, the workers are invited to describe psychosocial factors at work using a scale based on Robert Karasek’s Job Content Questionnaire and Johannes Siegrist’s Effort-Reward Imbalance Model. In addition, they outline an assessment of their mental health using the General Health Questionnaire.
The doctor then collects the occupational data – including occupation, sector, type of contract, type of employer and work organisation – and information on the medical history, use of psychiatric medicine and sick leave. In the Rhône-Alpes region, this information is gathered during a Mini International Psychiatric Interview (MINI).
In the Centre region and surrounding area, 200 doctors volunteered to participate in the programme and more than 10,000 questionnaires should be collected within two years. After a two-year pilot phase, methodologies will be designed to implement a permanent national monitoring system on mental health at work.
As part of the second instrument in compiling a knowledge base, a network of occupational doctors with experience in mental health and in the writing of monographs on this subject has compiled a detailed qualitative analysis of mental health suffering and psychopathological disorders of workers. The purpose of this programme is to better understand dynamics of pleasure and suffering, and their development over the career path and in work situations. The project also aims to clarify sources of difficulty at work, and to identify actual events and their effects on health-work dynamics.
Medical and administrative data
In this project, the data usually recorded when the health insurance system awards mental health disability compensation to workers are complemented with information on the patient’s professional life, that is, the most recent occupation and that held for the longest period of time. The purpose is to assess the distribution of psychiatric problems by occupation and sector, and to use the data systematically recorded during compensation claims to monitor occupational health risks.
Anne-Marie Nicot, ANACT