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Behavioral medicine is “the interdisciplinary field concerned with the development and integration of psychosocial, behavioral and biomedical knowledge relevant to health and illness and the application of this knowledge to prevention, etiology, diagnosis, treatment and rehabilitation.” (the Charter of ISBM). More simply, it is an interdisciplinary field between medicine/public health, psychology and social science. The International Society of Behavioral Medicine (ISBM) is a union of member societies related to behavioral medicine in each country. Among others, behavioral medicine could contribute to occupational health. One of the areas is psychosocial factors at work, which has been a major occupational health problem in both developed and developing countries. This keynote will address the current understanding of stress at work, strategies for improving psychosocial factors at work and future challenges in this field.
Basic mechanisms underlying job stress and health
Chronic job stressors, defined with the job demands-control and effort-reward imbalance model, have been linked with a wide range of adverse health effects in many previous epidemiological studies. Psychology and sociology theories have suggested that chronic demands cause sustained arousal, hyperactivity in brain and cognitive bias, interacting with environmental and personal resources, such as control, support, reward, and expectation, coping, resilience. A recent research in an interdisciplinary field of brain science and psychology has demonstrated that the forebrain function is lowered among the workers exposed to a chronic job stressor, and it is associated with hypersensitivity of the limbic system to an acute psychological stimulus, followed by peripheral autonomic and hormonal reactions. The hypersensitivity of the limbic system caused by by a deteriorated forebrain function may be a central mechanism of job stress. There are some studies on genetic contributions to individual’s sensitivity to job stress, but it is still unclear.
Three ways of improving psychosocial factors at work
A research collaborated with occupational health and psychology has provided evidence that several approaches are effective in reducing stress and improving mental and physical health. These include work-environmental improvement, individual-oriented stress management and supervisor education/training. Randomized control trials and well-designed controlled trials have indicated that work-environmental improvement programs, particularly with worker participation, are effective in improving psychological distress and work performance. Many previous studies applied cognitive-behavioral techniques to a stress management education program for workers and have found that they are effective in improving psychological distress, particularly in the case that they are combined with a group discussion. Not a single session but multiple sessions with a follow-up session may be needed to improve health outcomes, such as depression and anxiety. In recent years, a more effort has been taken to apply a web-based training on stress management, which is costless and easy for people in remote areas to handle. To date, six studies have showed that supervisor education/training on how to manage worker stress at their workplace is effective in improving psychological distress among their subordinate workers, when their findings are combined in a meta-analysis. The researches suggest that every supervisor should receive such education/training once a year. An evidence-based guideline has been developed to effectively implement these approaches at a workplace, with appropriate easy-to-apply tools. Some cost-effective analyses were also recently conducted.
Higher-level organizational characteristics and worker health
In recent years, it has been recognized that health of workers is affected not only by task-level or interpersonal-level psychosocial factors at work, such as job demands, but also by a broad range of organizational characteristics at a higher level. Those include a company policy on business management, human resource development, diversity, and work-family balance, and managers’ management styles, and organizational culture. For instance, a research in an interdisciplinary field has suggested that organizational justice and social capital at work are important resources at work to promote health and well-being of workers. While these higher-level organizational factors have not been a major target of improvement of psychosocial factors at work, it is an increasing need to tackle with these aspects of a company/organization to protect and promote workers’ health.
Social determinants outside the workplace and worker health
Social and economic environment outside the workplace also affects health among workers. For instance, a disparity in health by occupations became greater during a recession period. Experience of unemployment in early stage of working life results in the later deterioration of health among workers. A community-level unemployment rate affects poorer health among people in the community including workers. Psychosocial factors at work, such as increased perception of job insecurity, may play a role in linking these factors outside workplace with worker health. In addition, from a broader view, the unemployed and the employed in precarious jobs are also within a broad spectrum of the working population, since they come in and leave a workplace. They are exposed to poor psychosocial factors. Economy and labor policies of the society should be considered as a target in improving psychosocial factors at work among those currently employed.
Conclusions
Recent advancement in research on psychosocial factors at work has indicated that “stress at work” is an occupational health problem in which a hazardous agent, i.e., chronic exposure to job stressor, affects a target organ, i.e., the forebrain. It has suggested three effective approaches to improve psychosocial factors at work and promote health of workers. These approaches could be disseminated to developed and developing countries as a part of the basic occupational health service (BOHS). However, new challenges exit in the act that worker health is affected not only by factors in the health sector, but also by those in the non-health sector (such as a company policy or management style). Also a societal level policy could be a target for improving psychosocial factors at work. In summary, an issue related to psychosocial factors at work should be considered with a picture including the brain, workplace and society.
While behavioral medicine research has been already active within the field of occupational health, it could have a more contribution to occupational health, and thus to health and well-being among workers in the world. Particularly, developing countries could obtain a merit of low-cost behavioral interventions.
Author's details
Norito Kawakami
Professor
Department of Mental Health, School of Public Health, The University of Tokyo
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
TEL +81-3-5841-3521
FAX +81-3-5841-3392
E-mail: norito@m.u-tokyo.ac.jp