Occupational health psychology

Occupational health psychology (OHP) is concerned with the psychosocial characteristics of workplaces that contribute to the development of health-related problems in people who work. OHP is concerned about equally with problems of physical and mental health. The field emerged out of two distinct applied disciplines within psychology, health psychology and industrial/organizational psychology, and occupational health.

Two professional organizations closely linked to OHP are the Society for Occupational Health Psychology and the European Academy of Occupational Health Psychology. Two important OHP journals are the Journal of Occupational Health Psychology and Work & Stress. The journals are associated with the two OHP organizations.

OHP researchers and practitioners also consult a variety of other periodicals including, but not limited to, Social Science and Medicine, the Journal of Applied Psychology, the Journal of Organizational Behavior, the Journal of Health and Social Behavior, the Scandinavian Journal of Work, Environment, and Health, 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)., and Professional Psychology: Research and Practice. The diversity in journals consulted by OHP professionals underlines the interdisciplinary character of OHP.

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 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 as well as the extent to which supervisors and co-workers are supportive.

Historical overview
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, Karl Marx's theory of alienation of the industrial worker has been influential. Frederick Winslow Taylor's Principles of Scientific Management and Elton Mayo’s research on workers at the Hawthorne Western Electric plant helped to inject work and its impact 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 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 reseachers at the ISR. Other pioneering work 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, their study showed that a work-related psychosocial stressor can affect a physical condition. Second, the study demonstrated that rigorous methods can be applied to the study of the impact of psychosocial work factors on an aspect of health.

In addition to the above mentioned research, which was conducted in the United States, research conducted in Europe also played an important role in laying the foundation for OHP. Trist and Bamforth's (1951) research, which showed that the reduction in autonomy that accompanied organizational changes in English mining operations affected worker morale, was very influential in later OHP circles. Gardell's study, which 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.

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. The field of OHP advanced when the journal Work & Stress was founded in 1987. 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, the APA and NIOSH have organized work, stress, and health conferences that convened in two- to three-year cycles. In the 1990s, the APA and NIOSH began to provide seed money for the development of OHP graduate programs. By 1996 the Journal of Occupational Health Psychology (JOHP) was founded. It is published by the APA. In 1999, the European Academy of Occupational Health Psychology (EA-OHP) was established. In 2005, the Society for Occupational Health Psychology (SOHP) was founded. Work & Stress became associated with the EA-OHP and the JOHP, with the SOHP. In 2008, the EA-OHP and the SOHP began to coordinate activities.

For more details on the historical development of OHP, see Barling and Griffiths's (2002) 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 the 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.

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. Among 30 studies involving men and women, most have found an association between workplace stressors and CVD. In regard to the concept of job strain, which reflects the combination of low work-related decision latitude and high workload. Fredikson, Sundin, and Frankenhaeuser (1985) found evidence that job strain increased activity in the sympathoadrenomedullary and adrenocortical axes. Belkić et al. (2000) 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.

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.

Adverse working conditions linked to psychological distress and job satisfaction
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.

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.

Work and mental disorder
Using data from the Epidemiologic Catchment Area (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 cities, 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, however, indicates that individuals in the highest quartile of occupational stress are at increased risk for an episode of major depression. Another study based on the ECA 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. The 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.

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 the ECA data.

Workplace interventions
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.

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.

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. 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.

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.

Workplace incivility and violence
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, Cortina, Magley, Williams, and Langhout (2001) found that 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.

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. 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 1000,000 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 violence without being directly victimized are at increased risk for experiencing adverse effects, as found in a study of Los Angeles teachers. 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 [for jobs] 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 reduction of workplace incivility and the curtailing of job-related violence are fertile areas for further OHP research.

Doctoral programs in OHP
Universities in the U. S. 
 * Bowling Green State University
 * Clemson University
 * Colorado State University; also see pages 5-6 of volume 4 of the Newsletter of the SOHP
 * Kansas State University
 * Portland State University
 * University of California, Los Angeles
 * University of Connecticut
 * University of Houston
 * University of Minnesota
 * University of South Florida; also see page 5 of volume 3 of the Newsletter of the SOHP
 * University of Texas at Austin

Universities in Europe
 * University of Nottingham

Bibliography/further reading

 * Cohen, A., & Margolis, B. (1973). Initial psychological research related to the Occupational Safety and Health Act of 1970. American Psychologist, 28, 600-606.
 * Frese, M. (1985). Stress at work and psychosomatic complaints: A causal interpretation. Journal of Applied Psychology, 70, 314-328.
 * Karasek, R. A. (1979). Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly, 24, 285-307.
 * Kasl, S. V. (1978). Epidemiological contributions to the study of work stress. In C. L. Cooper & R. L. Payne (Eds.), Stress at work (pp. 3-38). Chichester, UK: Wiley.
 * Kasl, S. V., & Cobb, S. (1970). Blood pressure changes in men undergoing job loss: A preliminary report. Psychosomatic Medicine, 32, 19-38.
 * Kelloway, E.K., Barling, J., & Hurrell, J.J., Jr. (Eds.) (2006). Handbook of workplace violence. Thousand Oaks, CA: Sage Publications.
 * Parkes, K. R. (1982). Occupational stress among student nurses: A natural experiment. Journal of Applied Psychology, 67, 784-796.
 * Quick, J.C., Murphy,L.R., & Hurrell, J.J., Jr. (Eds.) (1992). Work and well-being: Assessments and instruments for occupational mental health. Washington, DC: American Psychological Association.
 * Quick, J. C., & Tetrick, L. E. (Eds.). (2003). Handbook of occupational health psychology. Washington, DC: American Psychological Association.
 * Sauter, S.L., & Murphy, L.R. (Eds.) (1995). Organizational risk factors for job stress. Washington, DC: American Psychological Association.
 * Zapf, D., Dormann, C., & Frese, M. (1996). Longitudinal studies in organizational stress research: A review of the literature with reference to methodological issues. Journal of Occupational Health Psychology, 1, 145-169.