Occupational health psychology (OHP) is an interdisciplinary area of psychology that is concerned with the health and safety of workers. OHP addresses a number of major topic areas including the impact of occupational stressors on physical and mental health, the impact of involuntary unemployment on physical and mental health, work-family balance, workplace violence and other forms of mistreatment, accidents and safety, and interventions designed to improve/protect worker health. OHP emerged from two distinct disciplines within applied psychology, namely, health psychology and industrial and organizational psychology, as well as occupational medicine. OHP has also been informed by other disciplines including industrial sociology, industrial engineering, and economics. as well as preventive medicine and public health. OHP is concerned with the relationship of psychosocial workplace factors to the development, maintenance, and promotion of workers' health and that of their families. Thus the field's focus is on work-related factors that can lead to injury, disease, and distress.
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Historical overview
Origins
The Industrial Revolution prompted thinkers, such as Karl Marx with his theory of alienation, to concern themselves with the nature of work and its impact on workers. Taylor's (1911) Principles of Scientific Management as well as Mayo's research in the late 1920s and early 1930s on workers at the Hawthorne Western Electric plant helped to inject the impact of work on workers into the subject matter psychology addresses. The creation in 1948 of the Institute for Social Research (ISR) at the University of Michigan was important because of its research on occupational stress and employee health.
Research in the U.K. by Trist and Bamforth (1951) suggested the reduction in autonomy that accompanied organizational changes in English coal mining operations adversely affected worker morale. Arthur Kornhauser's work in the early 1960s on the mental health of automobile workers in Michigan also contributed to the development of the field. A 1971 study by Gardell examined the impact of work organization on mental health in Swedish pulp and paper mill workers and engineers. Research on the impact of unemployment on mental health was conducted at the University of Sheffield's Institute of Work Psychology. In 1970 Kasl and Cobb documented the impact of unemployment on blood pressure in U.S. factory workers.
Recognition as a field of study
The term "occupational health psychology" first appeared in print in 1986 when Everly advocated for psychologists' role in workplace health promotion. In 1988, in response to a dramatic increase in the number of stress-related worker's compensation claims in the U.S. the National Institute for Occupational Safety and Health (NIOSH) adding psychological factors as a "leading occupational health risk" (p. 201). When this was coupled with an increased recognition of the impact of stress on a range of problems in the workplace, NIOSH found that their stress-related programs were significantly increasing in prominence. In 1990, Raymond et al. argued that the time has come for doctoral-level psychologists to get interdisciplinary OHP training, integrating health psychology with public health, because creating healthy workplaces should be a goal for the field.
Emergence as a discipline
Established in 1987, Work & Stress, according to Cox and Tisserand, is the first and "longest established journal in the fast developing discipline that is occupational health psychology" (p. 1). Three years later, the American Psychological Association (APA) and NIOSH jointly organized the first international Work, Stress, and Health conference in Washington, DC. The conference has since become a biannual OHP meeting. In 1996, the Journal of Occupational Health Psychology was published by APA. That same year, the International Commission on Occupational Health created the Work Organisation and Psychosocial Factors (ICOH-WOPS) scientific committee,International Commission on Occupational Health's Scientific Committee on Work Organisation and Psychosocial Factors (ICOH-WOPS). which focused primarily on OHP (p. 31). In 1999, the European Academy of Occupational Health Psychology (EA-OHP) was established.
In 2000 an informal International Coordinating Group for Occupational Health Psychology (ICGOHP) was formed as to facilitate the development of research, education, conferences, and practice of OHP through meetings at major conference events. In 2005, the Society for Occupational Health Psychology (SOHP) was founded in the United States. In 2000 Work & Stress became associated with the EA-OHP. In 2008, SOHP joined with APA and NIOSH in co-sponsoring the Work, Stress, and Health conferences. In 2017, SOHP began to publish an OHP-related journal entitled Occupational Health Science.
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Research methods
The main purpose of OHP research is to understand how working conditions affect worker health, use that knowledge to design interventions to protect and improve worker health, and evaluate the effectiveness of such interventions. The research methods used in OHP 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. Cross-sectional designs are commonly used, case-control designs less often. Longitudinal designs including prospective cohort studies and experience sampling studies can examine relationships over time. Quasi-experimental designs and, less commonly, experimental approaches have been used.
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 and hierarchical linear modeling (HLM; also known as multilevel modeling). HLM can better adjust for similarities between employees 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. Meta-analyses have been used to aggregate data (modern approaches to meta-analyses rely on HLM), and draw conclusions across multiple studies.
Qualitative research methods
Qualitative research methods include interviews, focus groups, and self-reported, written descriptions of stressful incidents at work. First-hand observation of workers on the job has also been used, as has participant observation.
Research topics
Important models in OHP research
Demand-control model
A model that has been very influential in OHP research has been the demand-control model. According to the model, the combination of low work-related decision latitude (i.e., autonomy and control over the job) and high workloads (high levels of work demands) can be particularly harmful to workers (they can lead to "job strain," a term representing the combination of low decision latitude and high workload leading to poorer mental or physical health). The model suggests not only that these two job factors are related to poorer health but that high levels of decision latitude on the job will buffer or reduce the adverse health impact of high levels of demands. Research has clearly supported the idea that decision latitude and demands relate to strains, but research findings about buffering have been mixed with only some studies finding support. The demand-control model asserts that job control can come in two broad forms: 'skill discretion' and 'decision authority'. Skill discretion refers to the level of skill and creativity required on the job and the flexibility an employee is permitted in deciding what skills to use (e.g. opportunity to use skills, similar to job variety). Decision authority refers to employees being able to make decisions about their work (e.g., having autonomy). These two forms of job control are traditionally assessed together in a composite measure of decision latitude; there is, however, some evidence that the two types of job control may be not be similarly related to health outcomes.
Effort-reward imbalance model
The, perhaps, second most influential model in OHP research is the effort-reward imbalance (ERI) model. It links job demands to the rewards employees receive for the job. 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 mental and physical health.
Occupational stress and cardiovascular disease
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. 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 and women, most have found an association between workplace stressors and CVD.
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, particularly ambulatory blood pressure. A meta-analysis and systematic review involving 29 samples linked job strain to elevated ambulatory blood pressure. Belki? et al. (2000) 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. A review of 17 longitudinal studies having reasonably high internal validity found that 8 showed a significant relation between the combination of low latitude and high workload (the job strain condition) and CVD and 3 more showed a nonsignificant relation. The findings, however, were clearer for men than for women, on whom data were more sparse.
There is evidence that, consistent with the ERI model, high work-related effort coupled with low control over job-related rewards adversely affects cardiovascular health. At least five studies of men have linked effort-reward imbalance with CVD.
Job loss
Research has suggested that job loss adversely affects cardiovascular health as well as health in general.
Burnout
There is evidence from a prospective study that job-related burnout, controlling for traditional risk factors, such as smoking and hypertension, 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.
Musculoskeletal disorders
Musculoskeletal disorders (MSDs) involve injury and pain to the joints and muscles of the body. Approximately 2.5 million workers in the US suffer from MSDs, which is the third most common cause of disability and early retirement for American workers. In Europe MSDs are the most often reported workplace health problem. The development of musculoskelelatal problems cannot be solely explained in the basis of biomechanical factors (e.g., repetitive motion) although such factors contribute. There has been evidence that psychosocial workplace factors (e.g., job strain) also contribute to the development of these problems.
Workplace mistreatment
There are many forms of workplace mistreatment ranging from relatively minor incivility to serious cases of bullying.
Abusive supervision
Abusive supervision is the extent to which a supervisor engages in a pattern of behavior that harms subordinates.
Workplace bullying
Although definitions of workplace bullying vary, it involves a repeated pattern of harmful behaviors directed towards an individual.
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). 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. 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.
Sexual harassment
Sexual harassment is behavior that denigrates or mistreats an individual due to his or her gender, creates an offensive workplace, and interferes with an individual being able to do the job.
Workplace violence
Workplace violence is a significant health hazard for employees.
Homicide
In 1996 there were 927 work-associated homicides in the United States, in a labor force that numbered approximately 132,616,000. The rate works out to be about 7 homicides per million workers for the one year. Men are more likely to be victims of workplace homicide than women.
Nonfatal assault
Most workplace assaults are nonfatal, with an annual physical assault rate of 6% in the U.S. 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. A Minnesota workers' compensation study found that women workers had a twofold higher risk of being injured in an assault than men, and health and social service workers, transit workers, and members of the education sector were at high risk for injury compared to workers in other economic sectors. 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. Another workers' compensation study found that excessively high rates of assault-related injury in schools, healthcare, and, to a lesser extent, banking. 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.
Mental disorder
Alcohol abuse
Workplace factors can contribute to alcohol abuse and dependence of employees. Rates of abuse can vary by occupation, with high rates in the construction and transportation industries as well as among waiters and waitresses. 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. 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) concluded 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. 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 (high-strain jobs as per the demand-control model) are at increased risk of experiencing an episode of major depression. 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.
Personality disorders
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.
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.). 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 supporting evidence from the Epidemiologic Catchment Area (ECA) study.
Psychological distress
Longitudinal studies have suggested 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. Psychological distress is often expressed in affective (depressive), psychophysical or psychosomatic (e.g., headaches, stomach aches, 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.
Working conditions
Parkes (1982) 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) concluded 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.
Economic insecurity
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. Economic insecurity contributes, at least partly, to psychological distress and work-family conflict. Ongoing job insecurity, even in the absence of job loss, is related to higher levels of depressive symptoms, psychological distress, and worse overall health.
Work and family
Employees must balance their working lives with their home lives. Work-family conflict is a situation in which the demands of work conflict with the demands of family, making it difficult to adequately do both.
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. 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. 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.
OHP research at the National Institute for Occupational Safety and Health
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, improve the health and safety of workers who are assigned to shift work or who work long hours, and reduce the incidence of falls among iron workers.
Military and first responders
The Mental Health Advisory Teams of the United States Army employ OHP-related interventions with combat troops. OHP also has a role to play in interventions aimed at helping first responders.
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. 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. The interventions tended reduce organization health-care costs.
Health promotion
Organizations can play a role in the health behavior of employees by providing resources to encourage healthy behavior in areas of exercise, nutrition, and smoking cessation.
Prevention
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. Research suggests that there continue to be difficulties in successfully "screening out applicants [for jobs] who may be prone to engaging in aggressive behavior," 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.
Accidents and safety
Psychological factors are an important factor in occupational accidents that can lead to injury and death of employees. An important influence on the incidence of accidents is the organization's safety climate that is employees' shared beliefs about how supervisors reward and support safety behavior.
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