Studying the effect of the psychosocial work environment on risk of ill-health: towards a more comprehensive assessment of working conditions

Abstract

The Nordic countries have a long tradition of research studying the impact of the psychosocial work environment on health (1, 2). Fittingly, the Scandinavian Journal of Work, Environment and Health has been a key place for the presentation and discussion of studies examining the complex relations between working conditions, psychological processes, and health and illness. Chances are high that this will continue in the foreseeable future as an increasing proportion of the workforce, particularly - but not exclusively - in high-income countries, is facing potentially health-affecting psychosocial working conditions, such as working with people in need, team work, demands for high flexibility, job insecurity, international competition, or working with tight deadlines -to name just a few examples (3). Additionally, mental ill-health, which is known to be caused to a substantial extent by adverse psychosocial circumstances in life (4), is on the rise to become the leading cause of disability-adjusted life years lost in high-income countries (5). Examining whether and how psychosocial working conditions contribute to mental ill-health, and ultimately how this knowledge can be used for preventive efforts, is an important task for occupational health research (6, 7).Over the last decade, major improvements have been made in the designs of psychosocial work environment studies. Earlier research has often been hampered by an over reliance on cross-sectional data, with the immanent limitations in establishing temporality of exposure and outcome and drawing causal inference (8). Today, however, data from several large-scale cohort studies are available, not least in the Nordic countries. The number of cohort studies has grown to such an extent that a European Research Consortium recently launched a project on an Individual-participant-data meta-analysis of working populations (IPD-Work), aiming to synthesize the data from the numerous European psychosocial work environment cohort studies (9).Despite this progress, there are still important methodological challenges that need to be tackled. A major concern is how the psychosocial work environment can be assessed in the most precise and unbiased way.Self-administered questionnaires. By far, the most widely-used method for assessing the psychosocial work environment is the self-administered questionnaire. Several instruments with good psychometric properties have been developed, both for testing specific theoretical models (10, 1 1 ) and assessing the psychosocial work environment in all its broadness (12-14). Using self-reported data has many advantages. First, it is a convenient and cost-effective way to collect a lot of information from a large number of people, the latter being necessary when the aim is to investigate incident of disease. Second, workers are the obvious experts of their own workplaces; they are likely those who know most about their work environment. Third, questionnaires enable researchers to enquire about typical or average working conditions and are not restricted to the work environment of a specific day.These important advantages must be balanced against one major disadvantage. The response in selfadministered questionnaires is in all likelihood not only driven by characteristics of the work environment (ie, the entity that is intended to be measured) but also by other factors, such as personal dispositions, mood, expectations, previous experiences, or health. This might cause both non-differential and differential misclassification, resulting in under- and overestimations of effects. For researchers mainly focused on how individual differences shape the perception and appraisal process of the person (15), the precise measurement of psychosocial working conditions might be of lesser concern. However, for researchers interested in the characteristics of the work environment that harm, protect or promote workers' health, the most accurate and valid assessment of psychosocial working conditions is a major concern. …