Academic journal article Scandinavian Journal of Work, Environment & Health

Comprehensive Profiles of Psychological and Social Work Factors as Predictors of Sitespecific and Multi-Site Pain

Academic journal article Scandinavian Journal of Work, Environment & Health

Comprehensive Profiles of Psychological and Social Work Factors as Predictors of Sitespecific and Multi-Site Pain

Article excerpt

Some of the most influential theories of occupational health psychology have highlighted multifactoriality. Both the job strain (1) and effort-reward imbalance (ERI) models highlight how combinations of factors influence health. However, only a limited number of factors - and factor combinations - are well studied. Building on the notion that the work environment comprises an ensemble of factors that may, as a whole, influence health, the current study examined typically experienced combinations of a comprehensive range of work factors. Furthermore, we wanted to determine whether employees reporting different exposure combinations also differed with respect to somatic pain complaints of six different anatomical sites.

Psychological work factors are thoroughly documented predictors of musculoskeletal pain [see eg, (2-4)]. This evidence pertains largely to factors of the job strain model predicting neck and back pain. The ERI model may be the second most influential model in the field, but a 2015 systematic review of prospective studies relating it to musculoskeletal complaints asserted that limited available evidence did not allow any reliable conclusion (5). Nevertheless, although a limited number of factors have been studied thoroughly, authors often discuss in rather general terms how pain relates to "the psychosocial work environment". However, the "underlying nature" of work is probably multifaceted and continuously changing (6, 7). To harness this complexity and determine its health impact, contemporary approaches to "the psychosocial work environment" may need to explore broader arrays of factors within each study. Recently, calls have been made specifically for more inductive explorative approaches to supplement the hypothetico-deductive approaches that have dominated occupational health psychology (8) in order to map out aspects of work that are not adequately captured by prevailing models.

Recent studies have reflected a growing interest in exposure combinations. For instance, one study investigated combined job strain and ERI with medically certified sickness absence due to mental health problems (9). Another study examined effects of combined low support, job strain, ERI, and high over-commitment on long-term sickness absence due to mental illness (10). Yet another study examined the impact of combined ERI and organizational injustice on self-rated health and psychiatric morbidity (11). All of these studies found that the risk associated with combined exposure was higher than the risk associated with each exposure separately. This implies that the studied models indeed represent different aspects of work that may converge and result in particularly aversive work situations.

All work factors co-occur with other work factors. Some of the complexity of work may be captured by considering how different aspects of it unfold together, capturing the "composition of the work situation". The net impact of such constellations of co-occurring work factors may not be readily deducible from separate effects of those factors, as there may be interactions involved. Thus, studying typical configurations of important work factors may provide more complete descriptions of working conditions and their consequences. The typical, real-life impact of co-occurring work factors may be obscured when they are studied separately or mutually adjusted. If a factor is typically a part of a factor complex with a substantial net impact on pain, studying that factor separately may conceal its contribution. And when the mutually adjusted unique explained variance is studied, results may not be directly applicable to most real world scenarios. Studying pre-specified combinations of exposure is possible to examine worst case scenarios ("bad jobs") or other combinations derived from specific theoretical models. However, relevant factor combinations may exist that are not known a priori, and the number of possible combinations may be vast with many exposure factors, especially if measured on a continuous scale. …

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