Work-related Psychosocial Risk Factors Research Articles

Physical and psychosocial work-related exposures and the occurrence of disorders of the shoulder: A systematic review update

This review is an update of a previous systematic review and assesses the evidence for the association of work-related physical and psychosocial risk factors and specific disorders of the shoulders. Medline, Embase, Web of Science Core Collection, Cochrane Central and PsycINFO were searched and study eligibility and risk of bias assessment was performed by two independent reviewers. A total of 14 new articles were added with the majority focusing on rotator cuff syndrome (RCS) with seven studies. Nine articles reported psychosocial exposures in addition to physical exposures. The strongest evidence was found for the association between elevation, repetition, force and vibration and the occurrence of SIS and tendinosis/tendonitis. Evidence also suggests that psychosocial exposures are associated with the occurrence of RCS and tendinosis/tendonitis. Other findings were inconsistent which prevents drawing strong conclusions.

Work-related psychosocial risk factors: a contemporary analysis

Resumo Introdução: nos debates sobre a proteção e a promoção da saúde nos contextos laborais, o tema dos fatores psicossociais relacionados ao trabalho (FPRT) tem se destacado. Objetivo: demonstrar que a ausência da tematização do antagonismo e do conflito estrutural entre capital e trabalho, bem como a captura da temática pela lógica gerencialista neoliberal, produz o empobrecimento do debate e o enfraquecimento de iniciativas voltadas para a transformação do contexto laboral. Método: a reflexão é realizada a partir de revisão da literatura, tendo como referencial o materialismo histórico. Resultados: as formulações de políticas, instrumentos e medidas destinadas à proteção da saúde dos trabalhadores, gestadas nos marcos ideológicos do regime de acumulação capitalista e da governamentalidade neoliberal, convertem-se em compreensões e intervenções que, longe de transformarem as situações concretas de trabalho, mascaram o papel exercido pelo trabalho em relação à saúde dos trabalhadores, consagram as ações voltadas aos indivíduos, arrefecem as lutas sociais e ampliam as pressões sobre os trabalhadores. Conclusão: o enfrentamento dos riscos psicossociais não deve se limitar à mitigação desses riscos, mas sim encontrar seus propósitos e seus fundamentos em um horizonte teórico-prático que descortine a necessidade de superação da própria economia capitalista.

Precision and Recall of Search Strategies for Identifying Studies on Work-Related Psychosocial Risk Factors in PubMed.

This study aims to report on the effectiveness of various search strategies and keywords to find studies on work-related psychosocial risk factors (PRF) in the PubMed bibliographic database. We first selected by hand-searching 191articles published on PRF and indexed in PubMed. We extracted 30 relevant MeSH terms and 38 additional textwords. We then searched PubMed combining these 68 keywords and 27 general keywords on work-related factors. Among the 2953 articles published in January 2020, we identified 446 articles concerning exposure to PRF, which were gathered in a Gold Standard database. We then computed the Recall, Precision, and Number Needed to Read of each keyword or combination of keywords. Overall, 189 search-words alone or in combination were tested. The highest Recall with a single MeSH term or textword was 43% and 35%, respectively. Subsequently, we developed two different search strings, one optimizing Recall while keeping Precision acceptable (Recall 98.2%, Precision 5.9%, NNR 16.9) and one optimizing Precision while keeping Recall acceptable (Recall 73.1%, Precision 25.5%, NNR 9.7). No single MeSH term is available to identify relevant studies on PRF in PubMed. Locating these types of studies requires the use of various MeSH and non-MeSH terms in combination to obtain a satisfactory Recall. Nevertheless, enhancing the Recall of search strategies may lead to lower Precision, and higher NNR, although with a non-linear trend. This factor must be taken into consideration when searching PubMed.

Synthetic indicators to analyze work-related physical and psychosocial risk factors: evidence from the European Working Conditions Survey

In modern workplaces, alongside physical, chemical, and biological hazards, other risks are linked to the organisation of work and to the nature of the work itself. This paper investigates the association between workers’ well-being and both psychosocial and physical risk factors at work proposing a synthetic measure suitable to generate insights on well-being at work and on individual risk factors. Exploiting data from the European Working Conditions Survey, we select as response variable the “self-assessed health”. As this proxy of well-being is measured on a Likert scale, Ordered Probit analyses are run, and respondents’ profiles are illustrated. Then, a Principal Component Analysis is carried out to build two synthetic measures summarising the selected risk determinants. The resulting first principal components are subsequently used as synthetic indicators in further, simplified, Ordered Probit models to explain the impact of different sets of risks on perceived health. Such a methodology allows for a straightforward interpretation of the results since many different risk drivers are replaced by two continuous synthetic indicators. Our findings, in line with existing research, confirm that both types of risk factors do exert a substantial impact on workers’ health, although the psychosocial determinants seem to be more prominent.

Exploring life satisfaction difference between domestic and international medical graduates: Evidence from a national longitudinal study

ABSTRACT Background Studies of doctors’ life satisfaction (subjective well-being) have largely overlooked the specific experiences of international or overseas trained doctors. This study explores any difference in life satisfaction and its determinants between international and domestic medical graduates (i.e. IMGs vs. DMGs), in Australia (a major destination country). Methods We pooled eight waves of data from the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of Australian doctors (2009–2016). Life satisfaction was measured on a standard 10-point scale. We applied Oaxaca and Ransom's linear decomposition method to evaluate factors associated with any observed difference in satisfaction between the two groups of doctors. Results IMGs were more likely to report lower life satisfaction than DMGs (mean 7.37 vs 7.48, p-value < 0.001). The well-being gap (of 0.11) was largely attributable to the groups’ differences in observable characteristics such as psychosocial and demographic factors. Most notably, the IMG group was worse off with respect to self-reported financial security, exposure to work-related psychosocial risk factors, and community integration. Conclusion Our study highlights the importance of the workplace and community context in understanding the life satisfaction difference between IMGs and DMGs. The study results may have important implications for policies and programs that seek to promote the integration and retention of IMGs.

Work-related physical and psychosocial risk factors cluster with obesity, smoking and physical inactivity

ObjectiveThis study investigated associations between the co-existence of multiple types of work-related psychosocial and physical risk factors, and (1) obesity; (2) smoking; and (3) leisure-time physical inactivity. It also aimed to identify sociodemographic characteristics related to clustering of work-related risk factors and lifestyle factors.MethodsCross-sectional data on work-related risk factors (e.g., decision authority and repetitive movements) and lifestyle was measured using a standardized questionnaire among 52,563 Dutch workers in health care, services, manufacturing and public sector. Multiple-adjusted logistic regression models assessed associations between the co-existence of multiple types of psychosocial and physical risk factors and lifestyle factors. Additionally, logistic regression models related age, gender and educational level to clustering of risk factors and lifestyle factors.ResultsThe co-existence of multiple types of work-related psychosocial risk factors was associated with higher odds of smoking and being physically inactive. For example, workers exposed to three psychosocial risk factors had a 1.55 times higher odds of being physically inactive (95%CI: 1.42–1.70) compared to unexposed workers. A higher number of physical risk factors was also significantly associated with higher odds of smoking and obesity. The co-existence of multiple types of physical risk factors was not associated with higher odds of physical inactivity. Clustering of work-related risk factors and at least one unhealthy lifestyle factor occurred in particular among workers with low educational level.ConclusionsResults imply that interventions are needed that focus on workers with a low educational level and address work-related physical and psychosocial risk factors as well as lifestyle.

Impacto dos fatores psicossociais de risco na qualidade de vida da população no processo de reforma

O objetivo principal deste estudo é compreender e caracterizar a relação entre os fatores de risco psicossocial relacionados ao trabalho e as dimensões de qualidade de vida (QV) em adultos profissionalmente ativos e reformados em Portugal. Os dados foram recolhidos ao nível nacional. Participaram 1.330 indivíduos, sendo 62,2% do género feminino, com idades entre 55 e 75 anos. Foram analisadas as diferenças de género, idade e situação profissional (profissional ativo e reformado) em relação aos fatores psicossocial de risco e QV. Para analisar esta relação foram testados cinco modelos de regressão. Os resultados mostraram que a gestão do stress/burnout e a sobrecarga de trabalho são os fatores de risco psicossocial que apresentaram um impacto mais forte na qualidade de vida. O estudo permitiu concluir que a QV no processo de reforma é influenciada pelos riscos psicossociais relacionados com o trabalho, principalmente a gestão do stress e a sobrecarga de trabalho.

Work-related psychosocial risk factors for stress-related mental disorders: an updated systematic review and meta-analysis

ObjectiveThe objective was to conduct an update of a previously published review and meta-analysis on the association between work-related psychosocial risk factors and stress-related mental disorders (SRD).DesignSystematic review and meta-analysis.Data...

The effects of integrating work-related factors and improving cooperation in musculoskeletal physical therapy practice: protocol for the \u2018WORK TO BE DONE\u2019 cluster randomised controlled trial

BackgroundMusculoskeletal disorders (MSDs) are the primary cause of disability worldwide and a major societal burden. Recent qualitative research found that although a patient’s work is considered important, physical therapists take work participation insufficiently into account as a determining factor in the treatment of patients with MSDs. Therefore, the aim of this study is to improve the effectiveness of physical therapy (in primary healthcare) with respect to the work participation of employees with MSDs by increasing the knowledge and skills of generalist physical therapists and by improving the collaboration between generalist physical therapists and physical therapists specialised in occupational health.Methods/designThis trial is a two-arm non-blinded cluster randomised controlled trial. Working patients with MSDs visiting a physical therapy practice are the target group. The control group will receive normal physical therapy treatment. The intervention group will receive treatment from a physical therapist with more knowledge about work-related factors and skills in terms of integrating work participation into the patients’ care. Data are gathered at baseline (T0), at four months (T1) and eight months (T2) follow-up. Most outcomes will be assessed with validated patient-reported questionnaires. Primary outcomes are the limitations in specific work-related activities and pain during work. Secondary outcomes include limitations in general work-related activities, general pain, quality of life, presenteeism, sick leave (absenteeism), estimated risk for future work disability, work-related psychosocial risk factors, job performance, and work ability. Based on a sample size calculation we need to include 221 patients in each arm (442 in total). During data analysis, each outcome variable will be analysed independently at T1 and at T2 as a dependent variable using the study group as an independent variable. In addition to the quantitative evaluation, a process evaluation will be performed by interviewing physical therapists as well as patients.DiscussionThe trial is expected to result in a more effective physical therapy process for working patients with MSDs. This will lead to a substantial reduction of costs: lower costs thanks to a more effective physical therapy process and lower costs due to less or shorter sick leave and decreased presenteeism.Trial registrationNetherlands Trial Register, registration number: NL8518, date of registration 9 April 2020, URL registration: https://www.trialregister.nl/trial/8518

Work-related psychosocial risk factors and psychiatric disorders: A cross-sectional study in the French working population.

The study estimates the prevalence of probable psychiatric disorder in the working population, determines the proportion of people presenting a probable psychiatric disorder among people exposed to work-related psychosocial risk factors (PSRFs), and identifies which PSRF has the strongest association with having a probable psychiatric disorder. A cross-sectional study conducted in March 2018 involved a representative sample of the French working population. The General Health Questionnaire 28 (GHQ-28) was used to estimate the prevalence of probable psychiatric disorder and 44 items were gathered from theoretical models of PSRFs. We used multiple logistic regression to estimate the association of each PSRF with having a probable psychiatric disorder, adjusted on individual, health, and job confounders. This study involved 3200 French participants. The proportion of probable psychiatric disorder was 22.2% [20.6; 24.0]. Ten PSRFs were significantly associated with it. The strongest association was for having problems handling professional and personal responsibilities (reported by 15% of the study population) (OR = 1.97 [1.52; 2.54]), with 45% pathological GHQ-28 scores (potential psychiatric cases) for people exposed to this PSRF versus 18% non-exposed. The next strongest association was lack of support of colleagues (reported by 28%) (OR = 1.63 [1.29; 2.06]). The third strongest association was feeling sometimes afraid when doing the job (reported by 63%) (OR = 1.53, [1.21; 1.93]). Our study identified 10 PSRFs associated with psychiatric disorder, with substantial exposure rate among the population. The results of our research could help develop recommendations to improve work environment.

Comparison of burnout, anxiety and depressive syndromes in hospital psychiatrists and other physicians: Results from the ESTEM study

AimsTo compare prevalence and risk factors for burnout, anxiety and depression among hospital psychiatrists and non-psychiatrists. MethodRegional online survey of psychiatric and non-psychiatric hospital physicians was performed including: a job-stress scale, the Hospital Anxiety and Depression Scale (HADS), the Copenhagen Burnout Inventory (CBI), a stressful work relationships list and a six items scale about work-related psychosocial risk factors (PRFs). The client-related burnout scale of the CBI has been changed to an interpersonal burnout scale. Cases were defined by a score of 8+ for the HADS-A/HADS-D and 50+ for the three CBI subscales. Results285 psychiatrists and 326 non-psychiatrists participated. The prevalence of depression, personal burnout and work-related burnout did not differ between physicians. Anxiety was lower in psychiatrists and interpersonal burnout was higher in senior psychiatrists.Multivariate analysis showed two main PRFs, common to both groups of physicians: “work intensity and time” was associated with four of the five syndromes and “emotional demands” with the three burnout syndromes. Interpersonal burnout was associated with stressful relationships with leaders, but not with patients. ConclusionReducing the workload, improving the management of emotions and increasing managerial skills are important approaches for prevention.

PMS34 IMPACT OF OCCUPATIONAL PSYCHOSOCIAL RISK FACTORS ON FREQUENT, SEVERE LOW BACK PAIN IN THE US WORKING POPULATION

Low back pain can pose a significant functional limitation for the working population. Current study assessed the association between emerging occupational psychosocial risk factors and frequent, severe low back pain (LBP) among US workers aged 18 - 64 years using a national database. A cross-sectional study was conducted using 2015 National Health Interview Survey data and its Occupational Health Survey Supplement. Operationalization of LBP was based on the frequency and severity of LBP in past 3 months. Bivariate analyses were conducted using Rao-Scott Chi-Square tests to test between-group differences. A multivariable logistic regression was done to measure the association between work-related psychosocial risk factors and LBP. Additionally, the role of perceived supervisor support, work strain, type of sick leave (paid vs. unpaid) was also assessed. Adjusted odds ratios (ORs) and their 95% confidence intervals (CI) were reported. Complex survey design of NHIS was accounted for in all analyses. The prevalence of LBP was found to be 7.97%. All psychosocial risk factors included in this study – hostile work environment (OR: 1.364, CI: 1.018 - 1.828), high job insecurity (OR: 1.322, CI: 1.024 - 1.706) and, work-family conflict (OR: 1.241, CI: 1.012 - 1.523) were found to have significant positive association with LBP. However, perceived positive supervisor support was found to lower the odds (OR: 0.767, CI: 0.592 - 0.993) of LBP. Functional limitation (OR: 7.085, CI: 5.745 – 8.738), work strain (OR: 1.321, CI: 1.039 – 1.680), and unpaid sick leave (OR: 1.234, CI: 1.004 – 1.517) were found to increase the odds of LBP significantly. Current study adds to literature supporting the relationship between occupational stressors and their impact on LBP. It is important to consider the role occupational psychosocial risk factors in the design and implementation of occupational health strategies, programs, and LBP management and prevention guidelines among US workers.

Low back pain among primary school teachers in Rural Kenya: Prevalence and contributing factors.

BackgroundLow back pain (LBP) has been recognised as a common occupational problem with a high prevalence among work-related musculoskeletal disorders. Although there appears to be a high prevalence of LBP among school teachers, there is inadequate information on the prevalence and predisposing factors of LBP among primary school teachers in rural Western Kenya.AimTo determine the prevalence, factors associated with LBP and physical disability caused by LBP.SettingThe setting was public schools in rural Western Kenya selected by simple random sampling method.MethodsA cross-sectional study was conducted among primary teachers from public schools using a self-administered questionnaire. The questionnaire included information on LBP, demographic data, occupational and psychosocial factors and disability score. The 12-month prevalence, associated factors and LBP disability were analysed.ResultsThe 12-month self-reported prevalence of LBP among primary teachers was 64.98%, with close to 70% of them reporting minimal disability. The logistic regression analysis showed that female gender (odds ratio [OR]: 1.692, p < 0.02) was associated with LBP and high supervisor support (OR: 0.46, p < 0.003) was negatively associated with LBP.ConclusionThe prevalence of LBP among primary school teachers in rural Western Kenya is 64.98%, with the majority of them reporting minimal disability. The identified risk factors were female gender and low supervisor support. The presence of work-related psychosocial risk factors in this study suggests a comprehensive approach in evaluation and management of LBP. Preventive measures should be in place to prevent and reduce the progression of LBP disability.Keywordslow back pain; rural; Kenya; teachers, primary school; public schools; risk factors; disability.

Work-related psychosocial risk factors and risk of disability pension among employees in health and personal care: A prospective cohort study

BackgroundResearchers have suggested that psychological factors at work contribute to early retirement due to disability pension in the general working population. Disability pension is a problem that shortens working careers among nursing professionals and personal care or related workers, but few researchers have focused on these occupational groups. Also, a need for studies based on measurements of specific work exposure instead of combined measures has been identified. ObjectivesThe aim was to study the potential influence of work-related psychosocial risk factors on the future risk of disability pension among nursing professionals and care assistants in Sweden. Those occupational groups are compared to all other occupations in Sweden. A specific aim was to describe differences in associations to cause-specific disability, and how the results were modified by occupation categories. ParticipantsA representative sample of 79,004 women and men in Sweden comprising 2,576 nursing professionals, 10,175 care assistants and 66,253 workers in other occupations. MethodsFactors of the psychosocial work environment were obtained from questionnaire data of the Swedish Work Environment Surveys (SWES) 1993–2013. Information on cause-specific disability pension during follow-up was added from the Social Insurance Agency’s database (1994–2014). We calculated Cox’s proportional hazards with 95% confidence intervals. ResultsDuring a mean follow-up time of 11.1 years, 6.6% of nursing professionals and 9.4% of care assistants, as compared to 6.1% among all other occupations, received disability pension. Among nursing professionals and care assistants, high quantitative job demands and low social support, but not job control, were associated with future disability pension also after controlling for age, year of interview, socio demographic conditions, and physical work factors. An increase in risk was also noticeable among nursing professionals and care assistants who reported an active job in combination with low social support. An increased risk for disability pension due to mental diagnosis was found among care assistants who reported high job demands. In all other occupations, low social support was associated with an increased risk for disability pension under any condition of job strain (high strain, low strain, active, and passive jobs). ConclusionBased on the results we conclude that high quantitative job demands and poor social support are predictors of future disability pension.

Work-Related Psychosocial Risk Factors and Care Workers Mental Health (In Estonian Nursing Homes)

Abstract The humankind is ageing rapidly, and as a result, there is an increasing need for old people’s homes. The nursing homes face different problems in financing and recruiting the labour force and management. Lack of resources causes the situation, when managers have to find possibilities to accomplish services and to provide quality care with the limited funds. This situation has an additional impact on the nursing professionals, who have to deal with many psychosocial risk factors in their work. The aim of the paper is to explore the work-related psychosocial risk factors and their relationships with mental health problems (MHPs) amongst care workers. A cross-sectional survey was undertaken amongst the care workers in nine Estonian nursing homes. Psychosocial work factors and MHPs (stress, somatic symptoms, depressive symptoms, burnout, cognitive symptoms, and sleep disorders) were analysed using the second version of the Copenhagen Psychosocial Questionnaire (COPSOQ II). Descriptive statistics and Pearson’s r correlation were used to analyse the data. The analysis was based on 340 care worker surveys. The highest mean scores for the studied work-related psychosocial factors were recorded for the quantitative demands, influence, rewards, role conflicts, trust, insecurity and work-family balance. Low mean scores were recorded for the meaning of work, role clarity, social relationships at work. The lowest score was followed by burnout and the highest - by cognitive symptoms.

The relationship between work-related psychosocial factors and burnout among Iranian nurses: Job Demand-Control-Support model.

Background:Nursing work environment consists of a number of work-related psychosocial risk factors such as excessive workloads, lack of social support, emotional demands, job insecurity and confronting with challenging situations all of which may induce burnout. The aim of the current study was to investigate the relationship between work-related psychosocial factors and burnout among Iranian nurses.Methods:A cross-sectional study was carried out among 522 nurses. The data related to work-related psychosocial factors and burnout was gathered using Job Content Questionnaire (JCQ) and Maslach Burnout Inventory (MBI), respectively. Pearson’s correlation coefficients were used to examine the relationship between work-related psychosocial factors and burnout.Results:Mean scores of the dimensions of burnout for emotional exhaustion, depersonalization, and reduced personal accomplishment were 13.6 (SD=8.6), 18.42 (SD=7.1), and 28.45 (SD= 9.15), respectively. Psychological and physical job demands were positively correlated with different dimensions of burnout while social support and job control showed negative correlation with them.Conclusion:Appropriate interventions on reducing job demands both psychologically and physically and increasing social support and job control are suggested in prevention of burnout among the studied nurses.

Risk factors associated with self-reported musculoskeletal pain among short and long distance industrial gas delivery truck drivers

AimThis study investigated and compared the associations between self-reported exposures to individual as well as work-related physical and psychosocial risk factors for musculoskeletal (MS) disorders and the prevalence of MS symptoms in different body areas among short- (P&D) and long-distance (Bulk delivery) truck drivers working for the same large gas delivery company in Canada. Methods123 truck drivers nationwide participated in this questionnaire-based cross-sectional study. Univariate and multivariate logistic regression analyses were performed. Results43.1% of drivers reported MS pain in at least one body area over the past 12 months and 26.8% over the past 7 days. Bulk drivers had a significantly higher prevalence of MS pain than P&D drivers for both periods. When P&D and Bulk drivers were pooled together, belonging to the Bulk subgroup emerged as the strongest factor for low back pain (OR = 8.45, p = 0.002), for shoulder pain (OR = 3.70, p = 0.027) and for MS pain in any body area (OR = 4.05, p = 0.006). In Bulk drivers "High effort-reward imbalance" was strongly associated with MS pain in any body area (OR = 6.47, p = 0.01), with shoulder pain (OR = 4.95, p = 0.016), and with low back pain (OR = 4.51, p = 0.02). In P&D drivers MS pain in any body area was strongly associated with "Working with hands above shoulders" (OR = 6.58, p = 0.009) and "Whole-body vibration" (OR = 5.48, p = 0.018), while shoulder pain was strongly associated with "Hand-arm vibration" (OR = 7.27, p = 0.041). ConclusionsPrevalence of MS pain was higher among industrial gas delivery truck drivers than in the general Quebec male worker population, and higher for Bulk drivers compared to P&D drivers. MS pain in Bulk drivers was mainly associated with psychosocial risk factors and lifestyle; MS pain in P&D drivers was mainly associated with physical risk factors.

Measuring work-related psychosocial and physical risk factors using workplace observations: a validation study of the “Healthy Workplace Screening”

Occupational health research has demonstrated that work-related risk factors affect employees’ physical and mental health, performance and ability to work. In order to design healthy workplaces, a valid and comprehensive assessment of potential work-related risk factors is needed. Currently, observation-based methods are scarce, even though they would provide a meaningful complement to self-report instruments. The present study aimed at validating an observational interview, the “Healthy Workplace Screening” (Screening Gesundes Arbeiten, SGA), which measures work-related psychosocial and physical risk factors. We collected a sample of 641SGA profiles representing various jobs and occupational settings to test construct and criterion validity. Results regarding construct validity showed medium-sized correlations with the stressor subscales of an established self-report job analysis instrument (SQUAW). Providing support for the criterion validity, jobs with varying risk profiles in SGA dimensions significantly differed with regard to mental health and musculoskeletal complaints. In sum, the SGA can be recommended asa valid and efficient observation-based instrument to identify critical work-related risk factors. Together with its suggestions for work design, it can serve as an easy to apply tool for workplace health promotion.

The forgotten realm of the new and emerging psychosocial risk factors.

In Europe, employers of all private and public enterprises have a legal obligation to protect their employers by all the different types of workplace hazards to the safety and health of workers. The most important methods developed for the work-related stress risk assessment are based on the Cox's research commissioned by European Agency for Safety and Health at Work (EU-OSHA) and are the Management Standard HSE for work-related stress in United Kingdom, the START method in Germany, the Screening, Observation, Analysis, Expertise (SOBANE) in Belgium, and the National Institute for Prevention and Safety at Work (INAIL-ISPESL) model in Italy, the latter based on the British Management Standard. Unfortunately, the definition of "work-related stress" elaborated by EU-OSHA was criticized, because it is not completely equal to the broader "psychosocial risk," which includes new and emerging psychosocial risk factors, such as the combined exposure to physical and psychosocial risks, job insecurity, work intensification and high demands at work, high emotional load related to burnout, work-life balance problems, and violence and harassment at work. All these new emerging psychosocial hazards could require different and additional methodologies to save workers' health and safety. For this reason, the concept that stakeholders and policy makers should keep in mind in order to develop better national regulations and strategies is that work-related stress risk and psychosocial risk factors are not the same.

\u201cBlue flags\u201d, development of a short clinical questionnaire on work-related psychosocial risk factors - a validation study in primary care

BackgroundWorking conditions substantially influence health, work ability and sick leave. Useful instruments to help clinicians pay attention to working conditions are lacking in primary care (PC). The aim of this study was to test the validity of a short “Blue flags” questionnaire, which focuses on work-related psychosocial risk factors and any potential need for contacts and/or actions at the workplace.MethodsFrom the original“The General Nordic Questionnaire” (QPSNordic) the research group identified five content areas with a total of 51 items which were considered to be most relevant focusing on work-related psychosocial risk factors. Fourteen items were selected from the identified QPSNordic content areas and organised in a short questionnaire “Blue flags”. These 14 items were validated towards the 51 QPSNordic items. Content validity was reviewed by a professional panel and a patient panel. Structural and concurrent validity were also tested within a randomised clinical trial.ResultsThe two panels (n = 111) considered the 14 psychosocial items to be relevant. A four-factor model was extracted with an explained variance of 25.2%, 14.9%, 10.9% and 8.3% respectively. All 14 items showed satisfactory loadings on all factors. Concerning concurrent validity the overall correlation was very strong rs = 0.87 (p < 0.001).). Correlations were moderately strong for factor one, rs = 0.62 (p < 0.001) and factor two, rs = 0.74 (p < 0.001). Factor three and factor four were weaker, bur still fair and significant at rs = 0.53 (p < 0.001) and rs = 0.41 (p < 0.001) respectively. The internal consistency of the whole “Blue flags” was good with Cronbach’s alpha of 0.76.ConclusionsThe content, structural and concurrent validity were satisfactory in this first step of development of the “Blue flags” questionnaire. In summary, the overall validity is considered acceptable. Testing in clinical contexts and in other patient populations is recommended to ensure predictive validity and usefulness.