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    • 1. Psychosocial Risks Experience and Methodology Sergio Iavicoli MD PhD INAIL - Department of Occupational Health (formerly ISPESL) ICOH - Secretary General IV International Forum on Preventive Culture Tenerife 2 March 2011 Gran Canaria 3 March 2011
    • 2. IS MENTAL HEALTH AT WORK AN EMERGING ISSUE…? 1934
    • 3. 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”
    • 4. ? Is work related stress an emerging Risk or a manageable and preventable one?
    • 5. Scientific Evidence Risks Management Tools Stakeholders Perception Policy Framework MOVING FROM RESEARCH TO PRACTICE
    • 6. Risks Management Tools Stakeholders Perception Policy Framework MOVING FROM RESEARCH TO PRACTICE Scientific Evidence
    • 7. SCIENTIFIC OUTPUT
    • 8. ADJUSTED HAZARD RATIOS FOR CARDIOVASCULAR MORTALITY BY LEVELS OF WORK STRESS # N max=812 (73 deaths); mean follow-up 25,6 years High demand / Low control Tertiles 1 = 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-Reward Imbalance * * * p < .0 5
    • 9. DOWNSIZING AND MORTALITY AMONG FINNISH MEN AND WOMEN (hazard ratio, n=22.430; observation period: 7,5 jahre) Source: J. Vahtera et al. (2004), BMJ, 328: 555. Overall mortality CHD mortality no Downsizing low high Downsizing no low high
    • 10. MORTALITY AMONG LONG-TERM UNEMPLOYED (>1 YR.) COMPARED WITH PERMANENTLY EMPLOYED (10 YRS. FOLLOW UP 1990-2000) Quelle: M. Kivimäki et al. (2003), Am J Epidemiol, 158:663-668. Hazard Ratio
    • 11. 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)
    • 12. 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
    • 13. Scientific Evidence Risks Management Tools Policy Framework MOVING FROM RESEARCH TO PRACTICE Stakeholders Perception
    • 14. 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
    • 15. Work related stress & Mental 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 240 BILLION EURO PER YEAR
    • 16. 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
    • 17. PUBLIC HEALTH RELEVANCE OF STRESS-RELATED DISORDERS
      • &quot; By the year 2020 depression and coronary heart disease will be the leading causes of premature death and of life years defined by disability (DALY ' s) worldwide &quot;
      • (Murray and Lopez 1996)
      Focus on coronary heart disease and depression Source: Siegrist 2010
    • 18. EUROPEAN SURVEY ON PERCEPTION OF WORK RELATED STRESS ISSUES WHITHIN EUROPEAN STAKEHOLDERS 13,4% (3) 15,0% (2) 7,5% (7) 10,7% (4) 15,1% (2) 13,2% (4) Migrant workers 13,4% (3) 15,0% (2) 17,0% (1) 16,5% (2) 13,3% (4) 14,6% (3) Economic effects 17,3% (2) 13,0% (4) 15,1% (3) 14,0% (3) 16,3% (1) 15,3% (2) Work-life balance 18,1% (1) 17,0% (1) 11,3% (5) 19,0% (1) 13,9% (3) 16,0% (1) Job insecurity Government Trade Union Employers' New EU 27 Countries EU 15 STAKEHOLDERS COUNTRIES TOTAL  
    • 19. Scientific Evidence Stakeholders Perception Policy Framework MOVING FROM RESEARCH TO PRACTICE Risks Management Tools
    • 20. WHY DO WE NEED THEORETICAL MODELS?
      • A theoretical model...
      • provides an explanation of associations between work and health
      • selects relevant components from the complex reality
      • allows for generalisation beyond single observations
      • serves as a guide for health-promoting interventions at work
      Source Siegrist 2010
    • 21. THE D EMAND- C ONTROL M ODEL ( R. KARASEK 1979; R. KARASEK & T. THEORELL 1990) Source Siegrist 2010 active passive low distress high distress Quantitative demands Scope of decision/control low high low high
    • 22. THE MODEL OF EFFORT-REWARD IMBALANCE ( J. Siegrist 1996) Effort Reward Demands / Obligations
      • Labour income
      • Career mobility / job security
      • Esteem , respect
      Motivation (‘overcommitment‘) Motivation (‘overcommitment‘) Extrinsic components Intrinsic component Source Siegrist 2010
    • 23. OBJECTIVE ASSESSMENT
      • Task Diagnosis Survey (Hacker 2002)
        • Rating of task characteristics on predefined scales by trained experts
        • Assessment by written job profile information, observation, supplemented interviews
      • Problems
        • Time-consuming, costly procedure
        • Availability of trained experts
        • Restricted time window
        • Bypassing employees‘ own experience
      Source Siegrist 2010
    • 24. PSYCHOSOCIAL RISK MANAGEMENT – EUROPEAN FRAMEWORK (PRIMA -EF) http://prima-ef.ispesl.it/
    • 25. 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 P rogramme Subprogramme Leonardo da Vinci
    • 26. Scientific Evidence Risks Management Tools Stakeholders Perception Policy Framework MOVING FROM RESEARCH TO PRACTICE
    • 27. 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. FRAMEWORK AGREEMENT ON WORK-RELATED STRESS (2004) 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
    • 28. 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
    • 29. 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
      • 19 EU countries now have legislation or binding collective agreements that address stress or other psychological risks at work (European Commission, 2011)
      Translation of the European framework agreement National agreements with social parties Implementation through national legislation
    • 30. NATIONAL APPROACHES TO PSYCHOSOCIAL RISK MANAGEMENT
    • 31. 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)
      H S E
      • 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
      S O B A N E
      • 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
      S T A R T
    • 32. WORK-RELATED STRESS AND RISK ASSESSMENT IN ITALY 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, …
    • 33. PUBLIC RESEARCH BODIES DEBATE Lgs. Degree 81/08 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 OSQ JSS OCS M_DQ10 JCQ PSS JSQ OSI BODIES/ISTITUTIONS &quot;AD HOC&quot; METHODS
    • 34. INTEGRATED APPROACH TO DEVELOP A NATIONAL PLATFORM FOR WORK RELATED STRESS MANAGEMENT Networking and policy advice Research International analysis and cooperation Transfer knowledge
    • 35. NETWORKING AND POLICY ADVICE 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 “P sychosocial Risk Factors”) Technical support in the “ad hoc” temporary sub committee of the Permanent Consultative Commission on Occupational Health and Safety
    • 36. HSE FRAMEWORK FOR ASSESS AND MANAGE WORK- RELATED STRESS IN THE ITALIAN CONTEXT Dissemination Translation, validation and adaptation of HSE global framework Testing of the framework Multidisciplinary Working group International Advisory Group Translation and back-translation Pre-testing Focus group at field level Administration of Italian version through Key National Contact Representatives Validation of Indicator Tool and set up of management standards
    • 37. WORK RELATED STRESS: ASSESSMENT AND MANAGEMENT
    • 38. 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 Investing in prevention culture
    • 39. It is time to act!

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