Prevention of work-related psychological disorders: A national strategy proposed by the National Institute for Occupational Safety and Health (NIOSH).

The National Institute for Occupational Safety and Health (NIOSH) recognizes psychological disorders as a leading occupational health problem.This" document, developed by a NIOSH working group led by the present authors, represents a first attempt to fashion a comprehensive national strategy to protect andpromote the psychological health of workers'.Roles" are identified for industry, labor, government, and academia.Key initiatives include (a) steps to improve working conditions and employee mental health services and (b) increased research and surveillance to advance understanding of the problem.Because work-related psychological disorders appear to be a rapidly developing problem lacking complete definition in terms of scope and etiology, this strategy is not to be considered a final statement Of NIOSH policy.With regard to the physical health and safety of workers, the work environment is generally viewed as a threat or risk factor.Similarly, work can have adverse consequences for mental health, but it can also have an important positive impact.In Western society at least, work experience plays an integral role in psychological development and well-being.This perspective is aptly expressed by Albert Camus ( 1955): "Without work, all life goes rotten, but when work is soulless, life stifles and dies."Smith and Smith (1973) claimed that occupations can provide a framework for the organization of behavior.Gardell (1971) suggested that "due to influences exerted by the Protestant ethic and other culturally conditioned factors.., it is probable that most people perceive work to be one of the most important life areas for the individual's general satisfaction" (p.149).Psychoanalytic theorists view work as a primary source of self-identity.Lazarus ( 1981) recounted Erikson's (1963) depiction of Biff, a character in Arthur Miller's Death of a Salesman, as suffering "ego-diffusion" for lack of ability to develop a sense of usefulness or productivity (p.57).Herzberg (1966), McGregor (1960), and Argyris (1964) wrote of motivation, esteem, and self-actualization through work.Lazarus saw another psychologically healthful function of work: a form of coping and refuge and a haven against problems, loneliness, and depression.Several studies on termination from work tend to bear out such tenets.Linn, Sandifer, and Stein (1985) found increased levels of somatization, depression, and anxiety in the unemployed, as well as increased visits to the doctor, medication use, and days in bed.These considerations add significance to the prevention of work-related psychological disorders and distinguish such efforts from efforts toward the prevention of other occupational injuries and diseases; that is, the promise is not only reduced morbidity, but the potential to actually enhance psychological growth and well-being. Focus of the Strategy Disorders of Current InterestAn initial hurdle in developing a national strategy to prevent psychological disorders is a semantic one.The very expression psychological disorders connotes a category of problems encompassing a wide array of social, behavioral, and biomedical conditions with diverse and often unknown etiologies.The focus of this strategy is on psychological disorders of general concern in the occupational health arena--those that are commonly investigated under the general rubric of "job stress ''1 and are believed to be amenable to workplace interventions.These are not necessarily conditions that are always identifiable under recognized systems of medical classification, such as the International Classification of Diseases (U.S.