iavicoli canarie 2-3_marzo_2011_def2

Psychosocial Risks Experience and Psychosocial Risks Experience and MethodologyMethodology

Sergio Iavicoli MD PhDSergio Iavicoli MD PhD

INAIL - Department of Occupational Health (formerly ISPESL) INAIL - Department of Occupational Health (formerly ISPESL) ICOH - Secretary GeneralICOH - Secretary General

IV International Forum on Preventive CultureIV International Forum on Preventive Culture

Tenerife 2 March 2011Tenerife 2 March 2011

Gran Canaria 3 March 2011Gran Canaria 3 March 2011

1934

IS MENTAL HEALTH AT WORK AN EMERGING ISSUE…?

The term, ‘mental health problem’ covers a wide range of problems which affect someone’s ability to get on with their daily life. Mental health problems can affect anyone, of any age and background, as well as having an impact on the people around them such as their family, friends and carers.

Common mental health problems usually consist of experiences such as depression and anxiety. With support, most people recover from their mental health problems, so it is important to overcome the stigma associated with mental health problems in the workplace.

“MENTAL HEALTH”

?Is work related stress Is work related stress an emerging Risk or a an emerging Risk or a manageable and manageable and preventable one?preventable one?

Scientific EvidenceScientific Evidence

Risks Management Tools


Stakeholders Perception


MOVING FROM RESEARCH TO PRACTICE

SCIENTIFIC OUTPUT

0

50

100

150

200

250

1976 - 1980 1981 - 1985 1986 - 1990 1991 - 1995 1996 - 2000 2001 - 2005 2006 - 2010

"work-related stress" or "occupational stress"perception of work-related stressmanagment and assessment of work-related stresspsychosocial risk factors

ADJUSTED HAZARD RATIOS FOR CARDIOVASCULAR ADJUSTED HAZARD RATIOS FOR CARDIOVASCULAR MORTALITY BY LEVELS OF WORK MORTALITY BY LEVELS OF WORK STRESSSTRESS##

N max=812 (73 deaths); mean follow-up 25,6 yearsN max=812 (73 deaths); mean follow-up 25,6 years

0,5

1

1,5

2

2,5

1 2 3 1 2 3High demand /

Low control

Tertiles1 = low; 2 = intermediate;3 = high

#adj. for age, sex, occupational group, smoking, physical activity, SBP, total chol., BMI

Source: M. Kivimäki et al. (2002), BMJ, 325: 857

Effort-RewardImbalance

**

* p < .05

Source: J. Vahtera et al. (2004), BMJ, 328: 555.

DOWNSIZING AND MORTALITY DOWNSIZING AND MORTALITY AMONG FINNISH MEN AND WOMEN AMONG FINNISH MEN AND WOMEN

(hazard ratio, n=22.430; observation period: 7,5 jahre)(hazard ratio, n=22.430; observation period: 7,5 jahre)

0,8

1

1,2

1,4

1,6

1,8

2

2,2

Overall mortality CHD mortality

no

Downsizing low high

Downsizing no low high

MORTALITY AMONG LONG-TERM UNEMPLOYED (>1 YR.) MORTALITY AMONG LONG-TERM UNEMPLOYED (>1 YR.) COMPARED WITH PERMANENTLY EMPLOYED COMPARED WITH PERMANENTLY EMPLOYED

(10 YRS. FOLLOW UP 1990-2000)(10 YRS. FOLLOW UP 1990-2000)

Quelle: M. Kivimäki et al. (2003), Am J Epidemiol, 158:663-668.

2,66

2,36

2,81

5,35

4,23

2,91

0

1

2

3

4

5

6

total cardiovascular external

men (n=15653/3858)

women (n=35770/3395)

Haz

ard

Rat

io

Source: Siegrist & Wahrendorf (2009) Quality of work, health, and retirement. The Lancet 374: 1872-1873

EFFORT-REWARD IMBALANCE AND INTENTION TO LEAVE THE JOB PREMATURELY

(share-study employed people 50+ in 15 countries)

EARLY RETIREMENT

Main Causes

• Psychological factors

• Physical difficulties

• Shift work

• Lack of social acknowledgement

• Possibility of taking early retirement

• Low wages

Source: Nurses‘ Early Exit Study – NEXT

SOCIO-ECONOMIC IMPACT OF WORK-RELATED STRESS IN EU

Over the last ten years, work-related stress has increased in nine EU countries and has only fallen in Sweden;

Studies suggest that between 50% and 60% of all lost working days are related to stress;

In France for example, the cost of stress has been reported to reach at least €2 to €3 billion each year;

In the UK it's estimated that 10 million working days are lost due to anxiety, stress and depression linked to work;

The direct costs related to stress at work are now estimated to be as high as 4% of EU GDP.

Source: European Commission – Employment, Social Affairs and Inclusion, 2011

Work related stress Work related stress &&

Mental health problemsMental health problems

Absenteism

Unemploiment

Long term disability

THE COST OF MENTAL HALTH IN EUROPE

Lost productivity including sick leave absenteeism

Medical treatment

Source: ENWHP- A guide to the business case for mental health, 2009

WHAT ARE THE EFFECTS AND COST OF THE COMPANY DOING NOTHING?

Weakening of the collective workforce:

• excess work for the team• withdraw of spirit of cooperation• training and orientation of replacement employee

Decrease in collective performance:

• production, qualitiy, image• atmosphere and industrial • relations affected: interpersonal conflicts and tension

Absenteism problem

Presenteism problem

Source: ENWHP- A guide to the business case for mental health, 2009

An emploee who is

suffering

PUBLIC HEALTH RELEVANCE OF STRESS-RELATED DISORDERSPUBLIC HEALTH RELEVANCE OF STRESS-RELATED DISORDERS

""By the year 2020 depression By the year 2020 depression and coronary heart disease will be the and coronary heart disease will be the

leading causes of premature death and of leading causes of premature death and of life years defined by disability (DALYlife years defined by disability (DALY''s) s)

worldwideworldwide""

(Murray and Lopez 1996)(Murray and Lopez 1996)

Focus on coronary heart disease and depression

Source: Siegrist 2010

EUROPEAN SURVEY ON PERCEPTION OF WORK RELATED EUROPEAN SURVEY ON PERCEPTION OF WORK RELATED STRESS ISSUES WHITHIN EUROPEAN STAKEHOLDERSSTRESS ISSUES WHITHIN EUROPEAN STAKEHOLDERS

TOTAL

COUNTRIES STAKEHOLDERS

EU 15New EU 27 Countries

Employers'

Trade Union

Government

Job insecurity 16,0% (1) 13,9% (3) 19,0% (1) 11,3% (5) 17,0% (1) 18,1% (1)

Work-life balance 15,3% (2) 16,3% (1) 14,0% (3) 15,1% (3) 13,0% (4) 17,3% (2)

Economic effects 14,6% (3) 13,3% (4) 16,5% (2) 17,0% (1) 15,0% (2) 13,4% (3)

Migrant workers 13,2% (4) 15,1% (2) 10,7% (4) 7,5% (7) 15,0% (2) 13,4% (3)

Scientific EvidenceScientific EvidenceStakeholders Perception





WHY DO WE NEED THEORETICAL MODELS?WHY DO WE NEED THEORETICAL MODELS?

A theoretical model...

provides an explanationexplanation of associations between work and health

selectsselects relevant componentscomponents from the complex reality

allows for generalisationgeneralisation beyond single observations

serves as a guide for health-promoting interventionsinterventions at work

Source Siegrist 2010

active

passive

lowdistress

highdistress

Quantitative demandsS

cop

e of

d

ecis

ion

/con

trol

low highlo

wh

igh

THE THE DDEMAND-EMAND-CCONTROL ONTROL MMODELODEL((R. KARASEK 1979; R. R. KARASEK 1979; R. KARASEK & KARASEK & T. T. THEORELL 1990)THEORELL 1990)


Effort

Reward

Demands / Obligations

Labour income Career mobility / job security Esteem, respect

Motivation

(‘overcommitment‘)Motivation

(‘overcommitment‘)

THE MODEL OF EFFORT-REWARD IMBALANCE THE MODEL OF EFFORT-REWARD IMBALANCE ((J. J. Siegrist 1996)Siegrist 1996)

Extrinsic componentsExtrinsic components

Intrinsic componentIntrinsic componentSource Siegrist 2010

OBJECTIVE ASSESSMENT

Task Diagnosis SurveyTask Diagnosis Survey (Hacker 2002)Rating of task characteristics on predefined scales

by trained expertsAssessment by written job profile information,

observation, supplemented interviews

ProblemsProblemsTime-consuming, costly procedureAvailability of trained expertsRestricted time windowBypassing employees‘ own experience


PSYCHOSOCIAL RISK MANAGEMENT – EUROPEAN FRAMEWORK (PRIMA -EF)

http://prima-ef.ispesl.it/

PRIMA-EF THE WAY FORWARD

It aims to provide the quality of training systems through the

development of innovative contents for psychosocial risk management delivered by means of a virtual

learning environment.

PRIMA-eT

Psychosocial Risk Management – Vocational Education and Training

Lifelong Programme

Subprogramme Leonardo da Vinci

http://images.google.it/imgres?imgurl=http://www.faipresa.com/obiettivo.jpg&imgrefurl=http://www.faipresa.com/corso.html&usg=__1MPvZD5YC9bWEtMrUdU88Rhnu_4=&h=300&w=500&sz=15&hl=it&start=4&sig2=ckoDpt1-ZEAmVyx8P3Qu6A&um=1&itbs=1&tbnid=sQDMy6FYgDldqM:&tbnh=78&tbnw=130&prev=/images%3Fq%3Dobiettivo.%26um%3D1%26hl%3Dit%26sa%3DN%26tbs%3Disch:1&ei=QFCjS9GFD471_AbAqK3zCQ

European Commission –Communication

Adapting to change in work and society: a new Community strategy on health and safety at work 2002–

2006

The various elements of the social dialogue structure might usefully

address certain of the new risks, more especially stress, whose multifarious nature.. fully justifies an approach of

this kind, involving the social partners.

8 October 2004 Approval of Executive Body – ETUC/UNICE-UEAPME/CEEP

According to the Art. 139, section 1 of the Treaty

European framework agreement on work-related stress

2002- The Commission will, in 2002, open consultations with the social partners on work-related stress, pursuant to the procedure laid down in Art. 138 of the Treaty

22 February 2003: Bruxelles, Joint planning

seminar

18 September 2003: start of negotiations

27 May 2004: end of negotiations

FRAMEWORK AGREEMENT ON WORK-RELATED STRESS (2004)

CHALLENGES AND NEEDS FOR MANAGING PSYCHOSOCIAL RISKS AT WORK

Company-sustainable approach to managing and assessing psychosocial risks

Central role of Occupational Health and Safety representatives/managers/professionals

Use of validated platforms

Global support for risk assessment and management

Applicability to different productive sectors

Source: ETUC, BUSINESSEUROPE, UEAPME, CEEP. Implementation of the European autonomous framework agreement on work related stress. Report by the European Social Partners adopted at the Social Dialogue Committee on 18 June 2008.

IMPLEMENTATION OF THE FRAMEWORK CONVENTION ON WORK-RELATED STRESS

Translation of the European framework agreement

National agreements with social parties

Implementation through national legislation

19 EU countries now have legislation or binding collective agreements that address stress or other psychological risks at work

(European Commission, 2011)

NATIONAL APPROACHES TO PSYCHOSOCIAL RISK MANAGEMENT

ADVANTAGES AND DISADVANTAGES OF THREE APPROACHES

Advantages Disadvantages

• It ensures a joint evaluation • It may be used cyclically and is funded on a global approach• It may be combined with other instruments• It provides an analysis software• It is a validated tool and approach• Standard benchmarks are provided • In-house management is ensured in coordination with OSH representatives/ managers/ professionals

• Limited availability of practical corrective interventions

• Poorly adapting to small enterprises (with less than 10 employees)

HSE

• It ensures a joint evaluation• It may be used cyclically and is founded on a global approach• It may be combined with other tools• It focuses on prevention• Internal and external counseling services are provided• No standard benchmark is provided

SOBANE

• Interventions are not detailed• Lack of a specific tool• High risk to give-up during screening phase

• It ensures a joint evaluation• It may be used cyclically and is founded on a global approach• It focuses on prevention• External counseling service is provided• It is an adaptable tool• It provides comparisons between objective and subjective indicators

• No standard benchmark is provided

• Interventions are not detailed• Lack of a standardized tool• Limited participation of internal OSH representatives/ managers/professionals

START

Lgs. Decree 81/2008 Art. 28

The assessment as set out in Article 17, section. 1, letter a),…, must take account of all risks to the health and safety of workers, including risks affecting groups of workers exposed to particular

risks, including risks which are associated with

work-related stress, pursuant to the contents of the European

agreement of 8th October 2004, …

WORK-RELATED STRESS AND RISK ASSESSMENT IN ITALY

PUBLIC RESEARCH

BODIES

DEBATE

Lgs. Degree81/08 and

modification

DEBATE/RESEARCH/METHODOLOGICAL

PROPOSALS

TRAINING COURSES

PRIVATE TRAINING

COMPANIES

SCIENTIFIC/PROFESSIONAL ASSOCIATIONS

REGIONS

CONSULTING COMPANIES

ASSOCIATIONS/ PROFESSIONAL

BOARDS

TOOL/SOFTWARE/QUESTIONNAIRES

GUIDELINES

GUIDELINES (INITIATIVES, DECREE)

ORGANIZATION FOR

STANDARDIZATION

METHODOLOGIES/TOOLS

REGIONAL TECHNICAL

COORDINATION COMMITTEE

FOCUS GROUPS/GUIDELINES

INTEGRATED APPROACH TO DEVELOP A NATIONAL PLATFORM FOR WORK RELATED STRESS MANAGEMENT

Networking and policy advice

Research

International analysis and cooperation Transfer knowledge

National Network for the Prevention of Psychosocial Distress in the Workplace

Network on psychosocial risk, active participation and prevention in finance and banking sector

PRIMA Network

PEROSH (pillar “Psychosocial Risk Factors”)

Technical support in the “ad hoc” temporary sub committee of the Permanent Consultative Commission on Occupational Health and Safety

NETWORKING AND POLICY ADVICE

HSE FRAMEWORK FOR ASSESS AND MANAGE WORK- RELATED STRESS IN THE ITALIAN CONTEXT

Translation, validation and adaptation of HSE

global framework

Testing of theframework

Multidisciplinary

Working groupInternational

Advisory Group

Translation and back-translation

Pre-testingFocus group at field level

Administration of Italian version

through Key National Contact Representatives

Dissemination

Validation of Indicator Tool and set up of

management standards

WORK RELATED STRESS: ASSESSMENT AND MANAGEMENT

STRATEGY FOR WORK-RELATED STRESS MANAGEMENT

Development of OSH prevention system and

compatible infrastructures

Development of management models and

good practices in line with the organizational risk

management system

Multidisciplinarity and competences in OSH

representatives/managers/professionals

It is time to act!

iavicoli canarie 2-3_marzo_2011_def2

Documents