Occupational stressors, biological stress and workers' health

The evidence that occupational physical stressors can cause disease--in the sense that exposure, avoidance or manipulation of them increases, decreases, or removes the risk of becoming ill, or reverses ill health when it occurs--is established for a large number of stressors and diseases. The role of occupational psychosocial stressors is not so clear. Such stressors originate in work-related social structures and processes. They affect the human organism through psychological processes. They influence workers' health and well-being through four types of closely interrelated mechanisms--emotional, cognitive, behavioral, and physiologic. The outcome is modified by situational factors (e. g., social support) and individual ones (e. g., personality characteristics and coping repertoire). The work environment-stress-health system is a dynamic one with many feedback loops. The author reviews complementary epidemiological and experimental evidence of patho- and salutogenic interactions within this system, emphasizing the importance of neuroendocrine mechanisms as well as work stress and health related behaviors. There is little direct evidence of a causal relationship between work-related social structures and processes and their change (or lack of change), and the incidence and prevalence of stress-related occupational morbidity and mortality. But, a substantial body of indirect evidence strongly suggests that such associations exist and emphasizes the need to better understand their role. Accordingly, the research approach should aim at being: systems-oriented; interdisciplinary; problem-solving oriented; health-(and not only disease-) oriented; and participative. Among those interventions for which preliminary evidence suggests the value of research are: Increasing a worker's control of the work arrangements; Providing mechanisms for worker participation in decision making on the organization of work; Avoiding monotonous, machine-paced, and short but frequent work actions; Optimizing automation; Helping workers see their specific task in relation to the total product; Avoiding quantitative work over- and underload; and Facilitating communication and support systems among work mates and others.