Psychosocial Exposures Research Articles

Biomechanical and psychosocial occupational exposures: joint predictors of post-retirement functional health in the French GAZEL cohort.

Biomechanical and psychosocial occupational exposures are seldom considered simultaneously and over extended follow-up in occupational epidemiologic studies, although there is some evidence that combined exposures have interactive effects on workers' health during working life. Given high prevalence of functional disability among retirees, research on earlier-life determinants of subsequent functional outcomes can help shape workplace policies and practices. This study investigates whether health effects of combined occupational exposures during working life are observed after individuals retire and are no longer exposed. Analyses were conducted among retirees in the French GAZEL occupational cohort (n=9168). Cumulative exposure during working life to eight biomechanical strains and to one or more reports of psychosocial job strain (high-demand, low-control work) were assessed as predictors of three outcomes: difficulty with physical functioning, role limitations due to physical difficulties, and bodily pain. Individuals were classified by joint exposure to both biomechanical and psychosocial constraints. We modeled risk ratios (RR) between exposure to biomechanical and psychosocial factors at work (separately and in combination) and disability after retirement, and we calculated the relative excess risk due to interaction (RERI) to test whether combined effects departed from additivity. Both psychosocial and biomechanical exposures during working life were independent predictors of the three functional health outcomes. Compared with individuals who had neither biomechanical nor psychosocial exposures, in fully adjusted log-binomial models of the combined effects of biomechanical and psychosocial exposure, among those with low biomechanical exposures, the RR for physical functioning difficulties associated with psychosocial exposures was 1.18 (95% CI 1.01, 1.37). Among those with the highest levels of biomechanical exposures, RR was 1.42 (95% CI 1.21, 1.65) among those with low psychosocial exposures and 1.91 (95% CI 1.61, 2.26) among those with high psychosocial exposures. The two exposure types were modestly super-additive, with an RERI of 0.32 (95% CI 0.00, 0.62) between those with the highest and lowest levels of biomechanical exposures; if the effects were strictly additive, we would have expected an RERI of 0. For the other two outcomes results were similar, although there was no significant departure from additivity. Some effects varied in magnitude by gender. Across the sample, combined biomechanical and psychosocial occupational exposures during working life appear to have additive or perhaps interactive effects on functional health in retirement. However, the relationship is less straightforward among women. Improving overall working conditions may lessen future disability among retirees.

Role of Ethnicity and Environment as Risk Factors on Asthma in Two Ethnic Groups in Michigan State, United States of America

Background: Asthma is an increasing worldwide health problem. The prevalence of asthma is higher in some ethnic minorities and lower in other ethnic groups. Environmental exposures, and psychosocial factors, have been suggested to be main mediators for asthma. Ethnicity related to racial background can influence the differences in asthma through the disease susceptible alleles.
 Objective: To evaluates environmental and cultural risk factors for asthma among different ethnic groups.
 Methods: Random sample of 337 Iraqi selected from 5,490 Iraqi residents’ in the Greater Detroit area. Validated questionnaire was used. Chi-square, t-test and logistic regression were used.
 Results: Results showed a significant difference in the prevalence of asthma among Chaldeans (0.7%) and Arabs (8.7%). However environmental and psychosocial exposures and socioeconomic status were not significantly associated with asthma in Arabs, nor Chaldeans.
 Conclusion: Even though Arabs and Chaldeans are from the same geographical region, and therefore share similar environmental background history, the asthma prevalence was about 9 times higher in Arabs as compared to Chaldeans. Ethnic background was the only significant risk factor associated with asthma. Genetic differences could explain the high susceptibility to asthma in Arab compared to Chaldean. .

HPA axis changes during the initial phase of psychosocial stressor exposure in male mice

Chronic subordinate colony (CSC) housing for 19 days results in unaffected basal morning corticosterone (CORT) levels despite a pronounced increase in adrenal mass, likely mediated by an attenuation of adrenal corticotropin (ACTH) responsiveness. Given that the pronounced increase in basal morning plasma CORT levels returns to baseline as early as 48 h after the start of CSC, it is likely that the attenuated ACTH responsiveness develops already during this initial phase. This was tested in the present study. In line with previous findings, basal morning plasma CORT levels were elevated following 10 h, but not 48 h, of CSC exposure. Basal morning plasma ACTH concentrations and relative in vivo adrenal CORT content were increased following 10 h and to a lesser extent following 48 h of CSC exposure, positively correlating. Relative in vitro adrenal CORT secretion in response to ACTH (100 nM) and kidney protein expression of 11β-hydroxysteroid dehydrogenase type 2 (HSD11B2) were unaffected following both time points. Adrenal mRNA expression of key steroidogenic enzymes was unaffected/decreased following 10 h and unaffected/increased following 48 h of CSC exposure. Together, our findings suggest that basal plasma hypercorticism during the initial CSC phase is mainly prevented by an attenuation of pituitary ACTH release. An increased absolute adrenal weight following 10 h, but not 48 h, of CSC exposure indicates that restoration of normal adrenal mass also adds to a lesser extent to prevent basal hypercorticism. A contributing role of alterations in enzymatic CORT degradation and steroidogenic enzyme availability is likely, but has to be further addressed in future studies.

Work-related psychosocial and mechanical risk factors for neck/shoulder pain: a 3-year follow-up study of the general working population in Norway

This study examines the impact of work-related psychosocial and mechanical exposure on the development of neck/shoulder pain in the general working population. A randomly drawn cohort from the general population in Norway aged 18-66 was followed up for 3 years (n = 12,550, response rate = 67 %). Eligible respondents were in paid work during the reference week in 2006 and 2009, or temporarily absent from such work (n = 6,745). Four work-related psychosocial factors and six mechanical exposures were measured. Outcomes of interest were moderate or severe neck/shoulder pain at follow-up adjusted for baseline neck/shoulder pain. In total, 16.9 % (1,138 individuals) reported neck/shoulder pain during the last month at follow-up. Work related psychosocial predictors of neck/shoulder pain were high job demands (highest OR 1.41, 95 % CI 1.11-1.78) and low levels of supportive leadership (highest OR 1.66, 95 % CI 1.08-2.54). Mechanical factors were neck flexion (highest OR 1.77, 95 % CI 1.31-2.39) and lifting in awkward postures (highest OR 1.81, 95 % CI 1.21-2.71). The estimated population risk attributable to these factors was about 23 %. The relative risk for neck/shoulder pain associated with psychosocial exposure was slightly influenced by adjustment for physical risk factors, and vice versa. There was no substantial confounding related to age, gender, education, occupation or psychological distress. Highly demanding jobs, neck flexion and awkward lifting appear as the most important predictors of neck/shoulder pain.

Current employment status, occupational category, occupational hazard exposure and job stress in relation to telomere length: the Multiethnic Study of Atherosclerosis (MESA)

ObjectiveTelomere length has been proposed as a biomarker of cell senescence, which is associated with a wide array of adverse health outcomes. While work is a major determinant of health,...

Work environment and disability pension – an 18-year follow-up study in a Norwegian working population

To investigate the associations between work environment indicators and health- related work disability. A health survey of 5,749 working 40-42-year-old Norwegians from Nordland County were linked to a national register for disability pension during a follow-up of over 18 years. The risk for disability pension following various self-reported physical and psychosocial work environmental exposures (individual and cumulative) were estimated using Cox regression analysis. Both cumulative physical and psychosocial work environmental exposures were associated with an increased risk for disability pension, although this association was attenuated for most variables after adjusting for health and education. An increase in five poor psychosocial work environmental exposures was associated with a 22% increased risk for disability (adjusted hazard ratio, aHR, 1.22, 95% CI 1.04-1.44), whereas a similar increase in five poor physical work environmental exposures was associated with a 29% increased risk (aHR, 1.29, 95% CI 1.16-1.44). There were no indications of statistical interaction between either sex or education and work exposures. People who report a poor work environment are at a higher risk for subsequent work disability. This finding suggests that improving working conditions may be an area of intervention in order to reduce the number of people who leave the labour market with a disability pension.

Social stress and the polymorphic region of the serotonin reuptake transporter gene modify oestradiol-induced changes on central monoamine concentrations in female rhesus monkeys.

Psychosocial stress exposure is linked to the disruption of emotional regulation that can manifest as anxiety and depression. Women are more likely to suffer from such psychopathologies than men, indicating that sex-based differences in gonadal steroids may be a key factor in the aetiology of stress-induced adverse health outcomes. Oestradiol (E2 ) positively influences mood and cognition in females, an effect likely related to the ability of E2 to modulate the serotonin and dopamine neurotransmitter systems. Furthermore, genetic variation as a result of the polymorphism in the promoter region of the gene (SLC6A4) encoding the serotonin transporter (5HTTLPR) also can influence the ability of E2 to modulate behaviour and physiology. However, it remains uncertain whether exposure to social stress interacts with the 5HTTLPR to influence E2 -induced changes in behaviour and physiology. The present study used ovariectomised adult female rhesus monkeys to investigate acute and chronic effects of E2 on central monoamine metabolite concentrations using cerobrospinal fluid sampling. We further assessed how E2 -induced changes in monoamine metabolite levels are modified by the unpredictable stress of social subordination and the 5HTTLPR polymorphism. Levels of the serotonin metabolite 5-hydroxyindoleacetic acid decreased significantly during chronic E2 treatment only in dominant females with the long promoter length of SLC6A4. Chronic administration of E2 decreased levels of the dopamine metabolite dihydrophenylacetic acid in a manner independent of the social status, 5HTTLPR genotype, or their interactions. Overall levels of dopamine and serotonin metabolites were increased in subordinate females, although this effect of social stress was not influenced by 5HTTLPR genotype. Together, these data emphasise how E2 can modulate central neurotransmitter systems and indicate that social subordination in female monkeys is a valid model for examining how chronic psychosocial stress alters sensitivity to E2 . Future studies are necessary to elaborate how changes in central neurotransmitter metabolism affect behaviour and physiology as a result of E2 and prolonged exposure to stress.

Neighborhood disorder and telomeres: Connecting children's exposure to community level stress and cellular response

Our objective was to explore the utility of salivary telomere length (sTL) as an early indicator of neighborhood-level social environmental risk during child development. We therefore tested the hypothesis that sTL would be associated with markers of social stress exposure in children. Children age 4–14 from 87 neighborhoods were recruited through five urban schools in New Orleans, Louisiana, U.S. Data were collected at the level of the child, family/household, and neighborhood. DNA was obtained from saliva using commercially available kits and sTL was determined for 104 children using quantitative PCR. Analysis was performed on 99 children who had complete data including sTL, social environmental stress, and additional covariates. The mean sTL value was 7.4 T/S (telomere signal/single-copy signal) ratio units (±2.4, range = 2.5–18.0), and 4.7% of the variance in sTL was attributed to differences across neighborhoods. Children living in neighborhoods characterized by high disorder had an sTL value 3.2 units lower than children not living in high disordered environments (p < 0.05) and their odds of having low relative sTL (defined as <1 standard deviation below standardized Z-score mean) values was 3.43 times that of children not living in high disorder environments (adjusted OR = 3.43, 95% CI = 1.22, 9.62). Our findings are consistent with previous studies in adults demonstrating a strong link between psychosocial stress and sTL obtained from peripheral blood, consistent with previous studies in youth demonstrating an association between early life stress and sTL obtained from buccal cell DNA and offer increased support for the hypothesis that sTL represents a non-invasive biological indicator of psychosocial stress exposure (i.e., neighborhood disorder) able to reflect differences in stress exposure levels even in young children.

Changes in the systemic immune status following chronic psycho-social stress exposure in male mice

Animal models of chronic social stress are known to contribute to a great extent to the research of stress-related disorders in humans. Our previous data revealed a generalized activation of T cells and an altered reaction of T cell subtypes not showing a shift towards Th2 responses after 19 days of chronic subordinate colony housing (CSC), a chronic psycho-social stress model in male mice. In this study, we evaluated the time-dependent effects of CSC on the T cell activation status. Our results demonstrated changes in T cell composition concerning CD3, CD8, CD4 as well as Treg, Th1, and Th17 cells. In addition, the activation status of T cells differed during the time of CSC. In conclusion, CSC stress induced distinct changes in the T cell compartment depending on the duration of stress exposure.

Increased anxiety, voluntary alcohol consumption and ethanol-induced place preference in mice following chronic psychosocial stress

Stress exposure is known to be a risk factor for alcohol use and anxiety disorders. Comorbid chronic stress and alcohol dependence may lead to a complicated and potentially severe treatment profile. To gain an understanding of the interaction between chronic psychosocial stress and drug exposure, we studied the effects of concomitant chronic stress exposure on alcohol reward using two-bottle choice and ethanol-conditioned place preference (CPP). The study consisted of exposure of the chronic subordinate colony (CSC) mice “intruders” to an aggressive “resident” mouse for 19 consecutive days. Control mice were single housed (SHC). Ethanol consumption using two-bottle choice paradigm and ethanol CPP acquisition was assessed at the end of this time period. As expected, CSC exposure increased anxiety-like behavior and reduced weight gain as compared to SHC controls. Importantly, in the two-bottle choice procedure, CSC mice showed higher alcohol intake than SHC. When testing their response to ethanol-induced CPP, CSC mice achieved higher preference for the ethanol-paired chamber. In fact, CSC exposure increased ethanol-CPP acquisition. Taken together, these data demonstrate the long-term consequences of chronic psychosocial stress on alcohol intake in male mice, suggesting chronic stress as a risk factor for developing alcohol consumption and/or anxiety disorders.

Work-related psychosocial and mechanical risk factors for low back pain: a 3-year follow-up study of the general working population in Norway

AimsThis study examines the impact of work-related psychosocial and mechanical exposure on the development of low back pain (LBP) in the general working population.MethodsA randomly drawn cohort from the general...

Work-related complaints and diseases of physical therapists – protocol for the establishment of a “Physical Therapist Cohort” (PTC) in Germany

BackgroundOnly few studies deal with the workload of physical therapists and the health consequences, although this occupational group is quite important for the health care system in many industrialized countries (e.g. ca. 136 000 people are currently employed as physical therapists in Germany). Therefore, the current state of knowledge of work-related diseases and disorders of physical therapists is insufficient. The aim of the "Physical Therapist Cohort" (PTC) study is to analyze the association between work-related exposures and diseases among physical therapists in Germany. This article describes the protocol of the baseline assessment of the PTC study.Methods/DesignA cross-sectional study will be conducted as baseline assessment and will include a representative random sample of approximately 300 physical therapists employed in Germany (exposure group), and a population-based comparison group (n = 300). The comparison group will comprise a sample of working aged (18–65 years) inhabitants of a German city. Variables of interest will be assessed using a questionnaire manual including questions regarding musculoskeletal, dermal, and infectious diseases and disorders as well as psychosocial exposures, diseases and disorders. In addition to subjective measures, a clinical examination will be used to objectify the questionnaire-based results (n = 50).DiscussionThe study, which includes extensive data collection, provides a unique opportunity to study the prospective association of work-related exposures and associated complaints of physical therapists. Baseline results will give first clues with regard to whether and how prevalent main exposures of physiotherapeutic work and typical work areas of physical therapists are associated with the development of work-related diseases. Thereby, this baseline assessment provides the basis for further investigations to examine causal relationships in accordance with a longitudinal design.

Epigenetic regulation of the oxytocin receptor gene: implications for behavioral neuroscience.

Genetic approaches have improved our understanding of the neurobiological basis of social behavior and cognition. For instance, common polymorphisms of genes involved in oxytocin signaling have been associated with sociobehavioral phenotypes in healthy samples as well as in subjects with mental disorders. More recently, attention has been drawn to epigenetic mechanisms, which regulate genetic function and expression without changes to the underlying DNA sequence. We provide an overview of the functional importance of oxytocin receptor gene (OXTR) promoter methylation and summarize studies that have investigated the role of OXTR methylation in behavioral phenotypes. There is first evidence that OXTR methylation is associated with autism, high callous-unemotional traits, and differential activation of brain regions involved in social perception. Furthermore, psychosocial stress exposure might dynamically regulate OXTR. Given evidence that epigenetic states of genes can be modified by experiences, especially those occurring in sensitive periods early in development, we conclude with a discussion on the effects of traumatic experience on the developing oxytocin system. Epigenetic modification of genes involved in oxytocin signaling might be involved in the mechanisms mediating the long-term influence of early adverse experiences on socio-behavioral outcomes.

Prevalence, comorbidity and predictors of anxiety disorders in children and adolescents in rural north-eastern Uganda.

BackgroundChild and adolescent anxiety disorders are the most prevalent form of childhood psychopathology. Research on child and adolescent anxiety disorders has predominantly been done in westernized societies. There is a paucity of data on the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in non-western societies including those in sub-Saharan Africa. This paper investigates the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in north-eastern Uganda.ObjectiveTo determine the prevalence of DSM-IV anxiety disorders, as well as comorbidity patterns and predictors in children and adolescents aged 3 to 19 years in north-eastern Uganda.MethodsFour districts (Lira, Tororo, Kaberamaido and Gulu) in rural north-eastern Uganda participated in this study. Using a multi-stage sampling procedure, a sample of 420 households with children aged 3–19 years from each district was enrolled into the study. The MINI International Neuropsychiatric Interview for children and adolescents (MINI KID) was used to assess for psychiatric disorders in 1587 of 1680 respondents.ResultsThe prevalence of anxiety disorders was 26.6%, with rates higher in females (29.7%) than in males (23.1%). The most common disorders in both males and females were specific phobia (15.8%), posttraumatic stress disorder (PTSD) (6.6%) and separation anxiety disorder (5.8%). Children below 5 years of age were significantly more likely to have separation anxiety disorder and specific phobias, while those aged between 14–19 were significantly more likely to have PTSD. Anxiety disorders were more prevalent among respondents with other psychiatric disorders; in respondents with two or more co-morbid psychiatric disorders the prevalence of anxiety disorders was 62.1%. Predictors of anxiety disorders were experience of war trauma (OR = 1.93, p < 0.001) and a higher score on the emotional symptom scale of the SDQ (OR = 2.58, p < 0.001). Significant socio-demograghic associations of anxiety disorders were found for female gender, guardian unemployment, living in permanent housing, living without parents, and having parents without education.ConclusionThe prevalence of anxiety disorders in children and adolescents in rural north-eastern Uganda is high, but consistent in terms of gender ratio and progression over time with a range of prior work in other contexts. Patterns of comorbidity and predictors of anxiety disorders in this setting are also broadly consistent with previous findings from western community studies. Both psychosocial stressors and exposure to war trauma are significant predictors of anxiety disorders.Prevention and treatment strategies need to be put in place to address the high prevalence rates of anxiety disorders in children and adolescents in Uganda.

Maternal psychosocial stress during pregnancy is associated with newborn leukocyte telomere length

In adults, one of the major determinants of leukocyte telomere length (LTL), a predictor of age-related diseases and mortality, is cumulative psychosocial stress exposure. More recently we reported that exposure to maternal psychosocial stress during intrauterine life is associated with LTL in young adulthood. The objective of the present study was to determine how early in life this effect of stress on LTL is apparent by quantifying the association of maternal psychosocial stress during pregnancy with newborn telomere length. In a prospective study of N = 27 mother-newborn dyads maternal pregnancy-specific stress was assessed in early gestation and cord blood peripheral blood mononuclear cells were subsequently collected and analyzed for LTL measurement. After accounting for the effects of potential determinants of newborn LTL (gestational age at birth, weight, sex, and exposure to antepartum obstetric complications), there was a significant, independent, linear effect of pregnancy-specific stress on newborn LTL that accounted for 25% of the variance in adjusted LTL (β = -0.099; P = .04). Our finding provides the first preliminary evidence in human beings that maternal psychological stress during pregnancy may exert a "programming" effect on the developing telomere biology system that is already apparent at birth, as reflected by the setting of newborn LTL.

Exposure–response relationships in work-related musculoskeletal disorders in elbows and hands – A synthesis of group-level data on exposure and response obtained using uniform methods of data collection

There is a serious lack of quantitative data regarding exposure–response relationships between occupational risk factors and musculoskeletal elbow and hand disorders. This paper explores such relationships in group-level data from our earlier cross-sectional studies.Prevalence of complaints (Nordic Questionnaire) and diagnoses (physical examination) were recorded in 19 groups of female workers (1891 individuals), and 8 groups of male workers (761 individuals), with highly similar work tasks within each group. Linear regression was performed on the group means of wrist postures and angular velocity (obtained by electrogoniometers), as well as muscular load (obtained using electromyography), recorded in representative sub-samples, and psychosocial exposure (Job Content Questionnaire). To tackle within-group variations in physical exposure, sensitivity analyses were performed by bootstrapping simulations, rendering confidence intervals.The sex-adjusted slope of the regression line (β) for wrist angular velocity vs. complaints during the past 7 days was 0.6%/(°/s), (95% CI 0.3–0.9), and for carpal tunnel syndrome (CTS) 0.2%/(°/s), (0.1–0.3). For palmar flexion, p50, β over the past 7 days was 0.8%/° (0.4–1.2); for CTS 0.3%/° (0.1–0.5); β for muscular activity p90: 0.9%/%MVE (0.3–1.6), and 0.3%/%MVE (−0.03–0.6) respectively and finally β for muscular rest: −1.2%/%time (−2.4–0.03) and −0.5%/%time (−0.9 to −0.01). Relationships were also demonstrated for low job control, job strain and isostrain. Women exhibited a higher prevalence of complaints than men.In conclusion, we have established quantitative exposure–response relationships between physical work load and elbow/hand disorders. Wrist angular velocity was the most consistent risk factor.

Genetic Susceptibility to Sickness Absence is Similar Among Women and Men: Findings From a Swedish Twin Cohort

Previous studies of risk factors for sickness absence (SA) focus primarily on psychosocial and work environmental exposures. The aim of this study was to investigate the relative contribution of genetic influences on SA among women and men. The population-based study sample of Swedish twins (34,547) included 13,743 twin pairs of known zygosity, 3,495 monozygotic, 5,073 same-sexed dizygotic, and 5,175 opposite sexed. The point prevalence of long-term SA (≥15 days) in each zygosity and sex group was calculated. The risk of SA was estimated as an odds ratio (OR) with 95% confidence intervals (CI) where the odds for twins on SA to have a co-twin on SA was compared to the OR for SA in twins whose co-twin were not sickness absent. Intrapair correlations and probandwise concordance rates were calculated and standard biometrical genetic model-fitting methods were used to estimate the heritability of SA. The prevalence of SA was 8.8% (women 10.7%; men 6.5%). Intrapair similarity was higher among monozygotic than dizygotic twin pairs. The best-fitting model showed no sex differences in genetic effects or variance components contributing to SA. The heritability estimate was 36% (95% CI: 35-40%). Results suggest genetic contribution to the variation of SA and that environmental factors have an important role, for women and men. As SA seem to be influenced by genetic factors, future studies of associations between risk factors and SA should consider this potentially confounding effect.

Multi‐site pain and working conditions as predictors of work ability in a 4‐year follow‐up among food industry employees

We investigated the separate and joint effects of multi-site musculoskeletal pain and physical and psychosocial exposures at work on future work ability. A survey was conducted among employees of a Finnish food industry company in 2005 (n = 1201) and a follow-up survey in 2009 (n = 734). Information on self-assessed work ability (current work ability on a scale from 0 to 10; 7 = poor work ability), multi-site musculoskeletal pain (pain in at least two anatomical areas of four), leisure-time physical activity, body mass index and physical and psychosocial exposures was obtained by questionnaire. The separate and joint effects of multi-site pain and work exposures on work ability at follow-up, among subjects with good work ability at baseline, were assessed by logistic regression, and p-values for the interaction derived. Compared with subjects with neither multi-site pain nor adverse work exposure, multi-site pain at baseline increased the risk of poor work ability at follow-up, allowing for age, gender, occupational class, body mass index and leisure-time physical activity. The separate effects of the work exposures on work ability were somewhat smaller than those of multi-site pain. Multi-site pain had an interactive effect with work environment and awkward postures, such that no association of multi-site pain with poor work ability was seen when work environment was poor or awkward postures present. The decline in work ability connected with multi-site pain was not increased by exposure to adverse physical or psychosocial factors at work.

Toward an Integrated Theoretical Model of Risk Factors for Post-Deployment PTSD and its Implications for Justice-Involved Veterans

At present, very little knowledge exists about individual differences in susceptibility to posttraumatic stress disorder (PTSD) after combat trauma. Two differing perspectives have emerged. Some researchers maintain that a distinct linear dose-response relationship exists between the severity of combat trauma and the later development of PTSD. Conversely, others have questioned whether differential exposure to combat alone is sufficient to explain differences in the prevalence of post-deployment PTSD. This debate has implications for military veteran offenders who suffer from PTSD. In this paper, I propose a cumulative stress model that posits that it is the particular combination of psychosocial factors and combat exposure that interact to predict the likelihood of developing and maintaining PTSD after deployment. Therefore, PTSD influences post-deployment offending and antisocial behavior through this mechanism. Finally, this paper will discuss implications for criminal justice policy and practice.

Do physical or psychosocial factors at work predict multi-site musculoskeletal pain? A 4-year follow-up study in an industrial population

Musculoskeletal pain at multiple sites is common among working-age people and greatly increases work disability risk. Little is known of the work-related physical and psychosocial factors contributing to multi-site pain. Survey responses from 734 employees (518 blue- and 216 white-collar; 65% female) of a food processing company were collected twice, in 2005 and 2009. Information on musculoskeletal pain during the preceding week, and on environmental, biomechanical and psychosocial work exposures were obtained through a structured questionnaire. The association of multi-site pain with work exposures was estimated with logistic regression by gender and age group. At baseline, 54% of informants reported pain in more than one area, and 50% at 4-year follow-up. Forty percent of all employees had multi-site pain both at baseline and at follow-up. Among those with multi-site pain at baseline, 69% had multi-site pain at follow-up. Both repetitive work and awkward work postures at baseline were associated with multi-site pain at follow-up. Psychosocial factors (low job satisfaction, low team spirit, and little opportunity to exert influence at work) also strongly predicted multi-site pain at follow-up, especially among younger workers and men. This prospective study provides new evidence of the high occurrence and persistence of musculoskeletal pain at multiple body sites in an industrial population with a strong association between biomechanical and psychosocial exposures at work and multi-site pain. Prevention of multi-site pain with many-sided modification of work exposures is likely to reduce work disability.