Occupational Health Psychology

Occupational Health Psychology

Occupational health psychology (OHP) emerged out of two distinct applied disciplines within psychology, health psychology and industrial/organizational psychology, and occupational health. OHP is concerned with the psychosocial characteristics of workplaces that contribute to the development of health-related problems in people who work. The field also speaks to ways to effect workplace changes that benefit worker health without adversely affecting productivity.

OHP researchers and practitioners are concerned with a variety of psychosocial work characteristics that may be related to physical and mental health problems. The physical health problems range from accidental injury to cardiovascular disease. The mental health problems include psychological distress, burnout, and depression. OHP researchers and practitioners are also concerned with the relation of psychosocial working conditions to health behaviors (e.g., smoking and alcohol consumption) and workplace morale (e.g., job satisfaction). Examples of psychosocial workplace characteristics that OHP researchers have linked to health outcomes include decision latitude and psychological workload, the balance between a worker's efforts and the rewards (e.g., pay, recognition, status, prospects for a promotion, etc.) received for his or her work, and the extent to which supervisors and co-workers are supportive. Another topic of great concern to occupational health psychology is the problem of carryover of deleterious workplace experiences to the worker's home life. Given its roots occupational health, OHP is also concerned with factors that affect workplace safety and accident risk. In addition, occupational health psychologists document the adverse impact of deteriorating economic conditions, and identify ways to mitigate that impact.

Professional organizations. Three professional organizations closely linked to OHP are the Society for Occupational Health Psychology (SOHP), the European Academy of Occupational Health Psychology (EA-OHP), and the International Commission on Occupational Health's committee on Work Organisation and Psychosocial Factors (ICOH-WOPS). Two important OHP journals are the Journal of Occupational Health Psychology (JOHP) and Work & Stress (W & S). The journals are associated with two or the three OHP organizations (JOHP with SOHP; W & S with EA-0HP).

Serials and the interdisciplinary character of OHP. In addition to JOHP and W & S, OHP researchers and practitioners consult a variety of other periodicals. These include, but are not limited to, Social Science & Medicine, the Journal of Applied Psychology, the Journal of Organizational Behavior, the Journal of Health and Social Behavior, the Scandinavian Journal of Work, Environment & Health, the Journal of Occupational and Organizational Psychology (originally published as the Journal of Occupational Psychology), the American Journal of Public Health, Organizational Research Methods, Occupational Medicine, the European Journal of Work and Organizational Psychology, Psychosomatic Medicine, the Journal of Occupational and Environmental Medicine (originally published as the Journal of Occupational Medicine), Occupational and Environmental Medicine, and Professional Psychology: Research and Practice. The diversity in journals consulted by OHP professionals underlines the interdisciplinary nature of OHP.

Historical overview

Early forerunners. A number of individuals contributed to the foundation of OHP. The Industrial Revolution in the nineteenth century prompted thinkers to concern themselves with the nature of work. For example, Marx's theory of alienation of the industrial worker has been influential. Taylor's (1911) Principles of Scientific Management and Mayo’s research in the late 1920s and early 1930s on workers at the Hawthorne Western Electric plant helped to inject work and its impact on workers into the subject matter psychology addresses. Jahoda, Lazarsfeld, and Ziesel's (1971/1932) pioneering research on the impact of unemployment on a small Austrian community also contributed to the development of OHP.

From the years after World War II to the 1970s. The creation in 1948 of the Institute for Social Research (ISR) at the University of Michigan was an important stimulus to research on work and health because of the institute's interdisciplinary character. Many psychological and sociological studies of work were initiated by researchers at the ISR. Research by Trist and Bamforth (1951) that showed that the reduction in autonomy that accompanied organizational changes in English mining operations affected worker morale was very influential in later OHP circles. A study by Gardell (1971) that examined the impact of work organization on mental health in Swedish pulp and paper mill workers and engineers was also influential. It was one of the few studies to operationalize the concept of worker alienation.

Groundbreaking research by Kasl and Cobb (1971), which documented the impact of unemployment on blood pressure, influenced the emergence of OHP in at least two respects. First, Kasl and Cobb's study showed that a work-related psychosocial stressor can affect a physical condition. Second, the study demonstrated that rigorous methods can be applied to research on the impact of psychosocial work factors on an aspect of health.

From the 1980s to the present. In 1986, the term occupational health psychology first appeared in print when George Everly, Jr. used the expression in a book chapter devoted to integrating the fields of occupational health and psychology (in his original paper, Everly advocated for psychologists' role in health promotion in the workplace; although OHP includes health promotion, the field is much broader). The field of OHP advanced when the journal Work & Stress was founded in 1987. In 1990, Raymond, Wood, and Patrick, in a watershed article published in the American Psychologist, articulated the idea that a goal for psychology should be to create healthy workplaces.[22] In order to help achieve that goal, Raymond et al. recommended that psychologists organize cross-disciplinary doctoral programs in OHP. OHP advanced further when in 1990 the American Psychological Association (APA) and the National Institute for Occupational Safety and Health (NIOSH) jointly organized an international conference in Washington, DC devoted to work, stress, and health. Ever since the initial conference, APA and NIOSH have organized work, stress, and health conferences that convened in two- to three-year cycles. Later in the 1990s, APA and NIOSH expanded their collaboration by providing seed money for the development of OHP graduate programs (a list of U.S. doctoral programs in OHP, many of which benefited from this seed money, can be found on the bottom of this page). In 1996 the Journal of Occupational Health Psychology (JOHP) was founded. It is published by APA. In the late 1990s, the coverage of the journal Work & Stress, in response to the development of the field of occupational health psychology, expanded beyond its original concentration to cover OHP more broadly.

In 1998, ICOH-WOPS organized its first international conference in Copenhagen. The second conference was held in Okayama, Japan in 2005, after which ICOH-WOPS adopted a two- to three-year cycle for its conference schedule.

In 1999, the European Academy of Occupational Health Psychology (EA-OHP) was established. The EA-OHP initiated its own series of international conferences on the psychological aspects of work and health. In 2005, the Society for Occupational Health Psychology (SOHP) was founded in the United States. Work & Stress became associated with the EA-OHP. The JOHP became associated with the SOHP although it is still published by APA. In 2008, SOHP became a full partner with APA and NIOSH in organizing the, by then, biennial Work, Stress, and Health conferences. Also in 2008, the EA-OHP and the SOHP began to coordinate activities (e.g., conference schedules).

For more details on the historical development of OHP, see Barling and Griffiths's (2010) fine overview of the history of the discipline.

Avenues of OHP research

The purpose of this section is not to provide an exhaustive survey of OHP research. A short entry in Wikipedia cannot do that. Rather, the section serves to show the breadth of OHP research and a number of important questions OHP research addresses. In the sections below, the reader can observe that OHP research examines the impact of work on both physical and mental well-being. Knowledge derived from this research helps researchers and practitioners devise means for improving the lives of people who work.

Research methods

Before examining some of the main avenues of OHP research, it should be noted that occupational health psychologists commonly employ a number of different research methods.

Standard research designs. Like researchers in many branches of psychology, OHP investigators employ cross-sectional designs. Cross-sectional studies are often the first to show that a workplace factor and a dimension of health covary; such studies, however, cannot establish the presence of a cause-effect relation. Although less common in OHP research, some OHP investigators employ case-control designs. OHP researchers underline the value of longitudinal designs (and a type of longitudinal design known as a prospective study), research designs that can be helpful in examining the temporal relation between a workplace stressor and health or well-being. OHP investigators have also become interested in a relatively new kind of longitudinal design, the diary study, with its comparatively short duration. In a diary study workers contribute data on work events every day over consecutive days or, as in some studies, multiple times in a day as the events occur over successive days. Experimental and quasi-experimental designs are found in OHP-related intervention research although quasi-experimental designs are more common.

Statistical methods. Statistical methods applied to the above research designs include correlation, multiple linear regression (MLR), and the analysis of variance. OHP researchers use logistic regression when the outcome variables they study are binary in nature (e.g., disease endpoints, the presence of severe musculoskeletal pain). Other methods that are commonly employed by OHP researchers include structural equation modeling and hierarchical linear modeling (HLM; also known as multilevel modeling). Compared to traditional statistical methods such as MLR and the analysis of variance, HLM is particularly helpful in research on the impact of psychosocial workplace factors on health outcomes because HLM can better accommodate similarities among employees found within the same economic units. In comparison to MLR and repeated measures analyses of variance, HLM is especially well suited to longitudinal research in which investigators, employing three or more waves of data collection, evaluate the lagged impact of work stressors on health outcomes; in this research context HLM can help minimize censoring (e.g., the loss of workers from analyses because they participated in some but not all of a study's data-collection periods). Given its applications in longitudinal research, HLM is an important analytic tool in OHP diary studies because such studies require multiple data collection points, albeit over a relatively short time span. Finally, OHP researchers will employ meta-analyses to aggregate data from well-designed studies in order to estimate the average size of effects of factors such as job insecurity on outcomes such as depression or distress in workers.

Qualitative research methods. Although rarer than the methods described above, OHP investigators have also employed qualitative research methods. These include interviews that allow the worker to describe one or more stressful work experiences, the ways the worker and his/her coworkers managed or coped with a job stressor, and the psychological aftermath of a stressful event at work; workers' unconstrained self-reported, written descriptions of stressful incidents at work; focus groups in which small groups of workers are interviewed about their work lives; first-hand observation of workers on the job without the investigator obtaining the job targeted for study; and participant observation, research in which an investigator obtains the job targeted for study, and describes the work "from the inside."

Job stress and cardiovascular disease

A number of well-known 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. Using 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.

Job strain and CVD. Job strain refers to the combination of low work-related decision latitude and high workload. Fredikson, Sundin, and Frankenhaeuser (1985) found that job strain was related to increased activity in the sympathoadrenomedullary and adrenocortical axes. Belkić et al. (2000)[50] found that many of the 30 studies mentioned above indicated 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 job strain 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.

Effort-reward imbalance and CVD. An alternative model of job stress is the effort-reward imbalance model. 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 cardiovascular health. At least five studies of men have linked effort-reward imbalance with CVD.

Job loss. OHP-related research has also shown that job loss adversely affects cardiovascular health as well as health in general.

Adverse working conditions and economic insecurity linked to psychological distress and reduced job satisfaction

What is meant by psychological distress. A number of well-designed longitudinal studies have adduced evidence for the view that adverse working conditions contribute to the development of psychological distress. Before turning to those studies, the reader should note that psychological distress refers to feelings of demoralization that are aversive to people, and often drive them to seek professional help, without the individuals necessarily meeting criteria for a psychiatric disorder. Psychological distress is often expressed in affective (depressive) symptoms, psychophysical or psychosomatic symptoms (e.g., headaches, stomachaches, etc.), and anxiety symptoms. The relation of adverse working conditions to psychological distress is thus an important avenue of research. Job satisfaction is included in this section because it is a key variable in a great deal of research on organizations and is related to a host of health outcomes.

Working conditions and psychological distress. Parkes (1982) conducted one of the methodologically soundest studies of 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 methodologically sound study, Frese (1985) showed 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 and psychological distress. There is increasing interest in the OHP community in (a) understanding the impact of the latest economic crisis 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. Mounting evidence indicates that persistent job insecurity, even in the absence of job loss, is related to higher levels of depressive symptoms, i.e., psychological distress, as well as worse overall health.

Work and mental disorder

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 support for the finding from data collected in the Epidemiologic Catchment Area (ECA) study.

Depression. Using data from the ECA study, Eaton, Anthony, Mandel, and Garrison (1990) found 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 are at increased risk for 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.

Alcohol use. Another study based on cross-sectional ECA data found high rates of alcohol abuse and dependence in the construction and transportation industries as well as among waiters and waitresses, controlling for sociodemographic factors. 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.

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 (there had previously been elevated suicide risk at the complex), 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.

NIOSH-related interventions. 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

OHP has played a role in interventions employed in very difficult work-related circumstances. 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 highly focused and modestly scaled, successful OHP interventions that helped workers abstain from smoking, exercise more frequently, and shed weight.[85] Other, even less expensive, yet successful 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.

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.[88] In research on more than 1000 U. S. civil service workers, Cortina, Magley, Williams, and Langhout (2001) found that more than 70% of the sample experienced workplace incivility in the past five years.[88] Compared to men, women were more exposed to incivility; incivility was associated with psychological distress and reduced job satisfaction. The reduction of workplace incivility is a fertile area for further OHP research.

Workplace violence

Homicide. OHP is also concerned with work-related violence. According to figures from the United States Bureau of Labor Statistics, in 1996 there were 927 work-associated homicides, 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. Although one work-related homicide is too many, work-related homicide is relatively rare.

Assault. Workplace assault is much more prevalent. 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 than men, and health and social service workers, transit workers, and members of the education sector were at high risk 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.

Curbing or preventing workplace violence. 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. OHP research suggests that there continue to be difficulties in successfully "screening out applicants who may be prone to engaging in aggressive behavior," suggesting that anti-aggression training of existing employees may be an alternative to screening. There have not, however, been enough rigorously evaluated studies of the effectiveness of training programs aimed at reducing workplace violence. The curtailing of job-related violence is an important area needing further OHP research.

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