Perceptions of the impact of depression and anxiety and the medication for these conditions on safety in the workplace

Background: The number of people taking prescribed medication for anxiety and depression has increased greatly, but little is known of how this medication impacts on safety at work. Aims: To examine the relation between anxiety and depression, prescribed medication, performance, and safety in the workplace. Methods: The research involved nine focus groups with sufferers of anxiety and depression to investigate experiences of mental health problems and the impact of psychotropic drugs. A further three focus groups were conducted with staff in human resources, personnel, occupational health, and health and safety departments, to explore organisational perspectives. The sample comprised 74 individuals drawn from a wide range of occupational sectors. Finally, the results were presented to a panel of experts from occupational medicine, general practice, psychology, health and safety, and psychiatry, to consider the implications for practice. Results: Workers reported that both the symptoms and the medication impaired work performance. Participants described accidents which they attributed to their condition or to the medication. Workers with responsibilities for others, such as teachers, healthcare workers, and managers appeared to present a particular safety risk. Healthcare workers believed that they placed themselves and their patients at risk when carrying out medical procedures. Conclusions: Respondents in this study felt that their symptoms of anxiety and depression and the medication they took to treat these conditions placed them at risk with respect to safety in the workplace. Drawing on the results, the authors outline areas for improvement in the management of mental health problems at work.     

Leaving it up to the workers: sociological perspective on the management of health and safety in small workplaces.

Small workplaces present particular challenges for the promotion of occupational health and safety. However, little is known about the social organization of work in such settings and how it relates to matters of health and safety. The research on which this article is based relates patterns of occupational health behavior to the nature of social relationships within the workplace. From a qualitative analysis of interviews with 53 small business owners, the author describes the most common approach to managing workplace health and safety: leaving it up to the workers. This posture is explained in terms of the owners' perception of risk, particularly their understanding of workplace hazards, and their assessment of the social costs of ignoring or addressing such issues. Owners tended to discount or normalize health hazards, and to believe that management intervention in employee health behavior was paternalistic and inconsistent with prevailing patterns of labor relations and norms respecting individual autonomy. Many owners understood health and safety not as a bureaucratic function of management but as a personal moral enterprise in which they did not have legitimate authority. The conceptualization of the owners' responses in terms of "social rationality" has implications for addressing problems of health and safety in small workplaces.     

Patients' experiences of medication for anxiety and depression: effects on working life

BACKGROUND: and objectives. The prevalence of depression and anxiety has increased in recent years, leading to extensive use of medication. This study used a qualitative, in-depth approach to investigate patients' experiences of taking medication prescribed for these conditions. Sampling from a range of occupational sectors, the research explored the impact of medication on working life. METHODS: The research involved nine focus groups with sufferers of anxiety and depression to investigate the personal experiences of mental ill-health and the impact of psychotropic drugs. A further three focus groups were conducted with staff in human resources, personnel, occupational health, and health and safety departments, to explore the organizational perspectives on psychotropic medication in the workplace. Focus groups were held at Loughborough University and at workplace settings throughout the UK. Results were presented to an expert panel (comprising practitioners and researchers in health care and occupational health) to consider implications for practice. RESULTS: Physical symptoms associated with anxiety and depression included: nausea, headaches, dizziness, trembling, insomnia and lack of energy. Psychological symptoms involved: poor concentration, emotional distress and lack of motivation. Non-compliance was widespread due to side effects, lack of improvement in symptoms or because medication made patients feel worse. Patients did not feel well informed about their medication. People took less than the prescribed amount or stopped taking the medication. Concerns about dependency caused patients to cease medication prematurely. CONCLUSION: Patients felt ill informed about their medication and would have welcomed more information. Drawing on the results, the authors outline areas for improvement in the care of patients with anxiety and depression.     

Illnesses and injuries reported by Latino poultry workers in western North Carolina

BACKGROUND: Poultry processing is the largest sector of the meat products industry. Many workers are immigrants; few data exist on their illness and injury rates and the impact of workplace safety environment. METHODS: Survey interviews were conducted with a representative sample of 200 Latino poultry workers employed by three different companies in western North Carolina; topics included symptoms, work-related illnesses and injuries, and plant safety climate. RESULTS: Most respondents were <35 years of age and had been in the US <10 years. Frequency of self-reported symptoms was high, particularly for musculoskeletal symptoms. Despite symptoms, workers reported not missing work or seeking medical care. Occupational injuries and illnesses and symptoms varied by company. Between-company differences in injury and illness rates were consistent with perceived safety and company provision of personal protective equipment. CONCLUSIONS: Symptoms reported exceeded rates reported by other community, clinical, and occupational samples. Findings suggest policy changes and research are needed to reduce the high rates of occupational illnesses and injuries in this vulnerable population.     

Workers' perceptions, knowledge and responses regarding occupational health and safety: a report on a Canadian study

This paper presents data from interviews with 492 rank and file workers. It examines aspects of workers' perceptions, knowledge and actions regarding workplace hazards and views these as indicators of the potential strength of labour in improving occupational health and safety. Respondents had a strong consciousness of ways in which their work might damage their health and they or their fellow workers had experienced half of the symptoms they mentioned. However, they lacked information on the results of environmental and medical monitoring, their core legal rights and the more effective strategies for reducing hazards. Few respondents sought information and few were persistent in dealing with their worries about hazards. Knowledge of their rights under the current occupational health and safety legislation was linked with taking such actions. It is suggested that workers' pursuit of their health and safety concerns might be facilitated if they had better access to information about their legal rights and mechanisms for dealing with hazards in the workplace.     

A stage of change approach to reducing occupational ill health

OBJECTIVE: Interventions targeted by stage of change have been shown to improve the efficacy of public health promotion initiatives in areas such as smoking cessation, alcohol reduction, and mammography screening. Targeted interventions are designed to tackle the key attitudes, beliefs, and intentions that underpin an individual's health-related behavior. Work-related ill health is an increasingly serious issue, the most common cause of which in both the UK and the US is musculoskeletal disorders. This study examined whether the stage approach could be applied to workplace interventions aimed at improving occupational health. METHOD: A total of 24 multi-component occupational interventions aimed at reducing musculoskeletal disorders were monitored over a period of 4-6 months. In half of these cases, approaches were targeted according to workers' stage of change. RESULTS: Targeted interventions were found to be significantly more effective in promoting risk awareness and desired behavior change among workers. Significant reductions were also found in self-reported musculoskeletal discomfort among workers having received targeted interventions. No significant differences were found in self-reported musculoskeletal discomfort among workers following standard interventions. CONCLUSION: Stage-matched approaches may offer scope for substantially improving the efficacy of occupational health and safety interventions by increasing the uptake, implementation, and maintenance of risk-reducing measures.     

The Union Health Center: A working model of clinical care linked to preventive occupational health services

As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having filed a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure in three patients and their preventative workplace follow-up, affecting approximately 150 workers at three worksites, are described. Work-related conditions diagnosed during the first 3 years of clinic operation included cumulative trauma disorders (141 cases), carpal tunnel syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project represents a new model for effective integration of clinical care and occupational disease prevention efforts within a primary care center. It could serve as a prototype for development of such services in other managed and primary care settings. Am. J. Ind. Med. 31:263–273, 1997. © 1997 Wiley-Liss, Inc.     

Occupational health and safety among commercial sex workers

The concept of occupational health and safety (OHS) for commercial sex workers has rarely been investigated, perhaps because of the often informal nature of the workplace, the associated stigma, and the frequently illegal nature of the activity. We reviewed the literature on health, occupational risks, and safety among commercial sex workers. Cultural and local variations and commonalities were identified. Dimensions of OHS that emerged included legal and policing risks, risks associated with particular business settings such as streets and brothels, violence from clients, mental health risks and protective factors, alcohol and drug use, repetitive strain injuries, sexually transmissible infections, risks associated with particular classes of clients, issues associated with male and transgender commercial sex workers, and issues of risk reduction that in many cases are associated with lack of agency or control, stigma, and legal barriers. We further discuss the impact and potential of OHS interventions for commercial sex workers. The OHS of commercial sex workers covers a range of domains, some potentially modifiable by OHS programs and workplace safety interventions targeted at this population. We argue that commercial sex work should be considered as an occupation overdue for interventions to reduce workplace risks and enhance worker safety.     

Occupational toxicology and the control of exposure to pharmaceutical agents at work

BACKGROUND: The pharmaceutical industry employs >350 000 people worldwide in operations including research and development (R&D), manufacturing, sales and marketing. Workers employed in R&D and manufacturing sectors are potentially exposed to drug substances in the workplace that are designed to modify physiology and also to chemical precursors that are potentially hazardous to health. Pharmaceutical workers are at risk from adverse health effects, including occupational asthma, pharmacological effects, adverse reproductive outcomes and dermatitis. AIM: This study aimed to describe the approaches taken by pharmaceutical companies for identifying and communicating potential adverse health effects that may result from workplace exposures and in setting 'in-house' exposure control limits and to highlight the challenges in controlling workplace exposures to increasingly potent compounds. METHOD: The literature was reviewed by searching the Medline and HSELine databases. RESULTS: The findings are presented in five sections, covering: test methods and approaches to occupational toxicology; hazard communication; approaches to setting health-based occupational exposure limits for pharmaceutically active agents; recent approaches to risk control; and occupational hygiene and exposure controls. CONCLUSION: Significant efforts have been directed at predicting and evaluating potential occupational health hazards in the pharmaceutical industry. The pharmaceutical industry has provided leadership in controlling exposure to hazardous substances. Much of this work has been driven by a real need to control occupational exposures to substances that can have profound adverse health effects in exposed employees and that are becoming increasingly more potent.     

Screening questionnaires for bakers' asthma--are they worth the effort?

The use of a respiratory screening questionnaire is recommendedannually to screen bakery workers in the UK. We compared questionnairescreening with other methods of detecting workers with asthmaticsymptoms and then assessed the significance of these symptomswith careful investigation and follow-up. Reasons for questionnairefailures were then explored. A questionnaire was issued to 362flour-exposed workers in a large bakery. All positive respondentsto respiratory symptom questions were interviewed by an occupationalnurse. Workers with occupationally related symptoms at thisinterview were referred to the chest clinic. In addition, workerswith negative questionnaires were screened using attendancerecords, sick notes and direct workplace observations. Workerswith frequent absence from work or sick notes with respiratorydiagnoses were interviewed in the same manner as those answeringthe questionnaire positively and then referred to clinic. Atclinic, a diagnosis was made for each worker on the basis ofclinical assessment, spirometry, serial peak expiratory flowrate (PEFR) analysis and radioallergosorbent testing (RAST)testing for specific IgE. Using the clinic diagnoses, the referralroutes were audited to assess the rates of case detection ofasthma and occupational asthma. The respiratory screening questionnaireidentified 68 workers with respiratory symptoms. Of these, 21proceeded to full assessment. A diagnosis of asthma was madein five cases, one of which was bakers' asthma. In addition,11 workers not reporting any symptoms by questionnaire werereferred to clinic and five were diagnosed as having asthma.Screening questionnaires may lead to an underestimate of theprevalence of asthmatic symptoms and as such should not be usedalone in workplace screening.     

Smoking, atopy, and laboratory animal allergy.

This study examined data from three cross sectional surveys of 296 laboratory workers exposed to small mammals. Four indices of laboratory animal allergy were studied: symptoms suggestive of occupational asthma, symptoms suggestive of any occupational allergy, skin weals to animal urine extracts, and serum binding in radioallergosorbent tests with urine extracts. Pooled data from the three surveys showed an association between smoking and all indices except radioallergosorbent tests; the association was significant for symptoms of occupational asthma. One of the three surveys consistently showed a stronger association of allergy indices with smoking than with atopy (defined on skin tests with non-animal aeroallergens). Associations with smoking persisted after stratifying by atopic status, suggesting that smoking may be a risk factor for laboratory animal allergy.     

Smoking, atopy, and laboratory animal allergy

This study examined data from three cross sectional surveys of 296 laboratory workers exposed to small mammals. Four indices of laboratory animal allergy were studied: symptoms suggestive of occupational asthma, symptoms suggestive of any occupational allergy, skin weals to animal urine extracts, and serum binding in radioallergosorbent tests with urine extracts. Pooled data from the three surveys showed an association between smoking and all indices except radioallergosorbent tests; the association was significant for symptoms of occupational asthma. One of the three surveys consistently showed a stronger association of allergy indices with smoking than with atopy (defined on skin tests with non-animal aeroallergens). Associations with smoking persisted after stratifying by atopic status, suggesting that smoking may be a risk factor for laboratory animal allergy.     

Health, employment, and financial outcomes in workers with occupational asthma.

OBJECTIVE--To study the health, employment, and financial outcome of occupational asthma. DESIGN--A follow study of workers with confirmed occupational asthma. SETTING--A specialist occupational lung disease clinic. SUBJECTS--All workers had a diagnosis of occupational asthma made at least one year earlier. Diagnosis was confirmed by serial peak expiratory flow measurement, specific bronchial provocation testing, or specific immunology. MAIN OUTCOME MEASURES--Respiratory symptoms, medication, pulmonary function, employment state, and financial position. RESULTS--112 of a total of 140 eligible workers were followed up. 32% of patients remained exposed to the causative agent. These workers had more symptoms at follow up than those removed and a greater number were taking inhaled steroids. Continued exposure was also associated with a fall in % predicted forced expiratory volume in one second (FEV1) of 3% compared with that at presentation. Their median loss of annual income due to occupational asthma was 35%. Those removed from exposure were worse off financially (median loss 54% of annual income), had fewer respiratory symptoms than the group who remained exposed, and their % predicted FEV1 had improved by 4.6%. Statutory compensation and that obtained by common law suits did not match the loss of earnings due to the development of occupational asthma. Of the workers removed from exposure, those who no longer complained of breathlessness had been diagnosed significantly earlier after the onset of their first symptom (48 v 66 months, p = 0.001) and had a significantly higher FEV1 at presentation (90% v 73% predicted, p = 0.008) compared with those who were still breathless. They had developed symptoms earlier after first exposure (48 v 66 months, p > 0.05) and had been removed from exposure sooner (eight v 12 months, p > 0.05). CONCLUSION--Removal from exposure after diagnosis of occupational asthma is beneficial in terms of symptoms and lung function, but is associated with a loss of income. Early diagnosis is important for symptomatic improvement after removal from exposure. Inadequate compensation may contribute to the workers' decision to remain exposed after diagnosis.     

Greek employee awareness of carcinogenic exposure

BACKGROUND: Occupational risk factors contribute significantly to the development of lung cancer; however, little is known about the extent to which employees are informed of occupational exposure to carcinogenic substances. METHODS: Through a case-control study, we estimated the level of awareness among Greek employees potentially exposed to known carcinogenic substances within various occupational settings. RESULTS: Only 6.6% of men (n = 482) employed in occupations with potential exposure to carcinogenic substances were aware of such occupational exposures. Age, education, and residence were significantly associated with awareness. Employees having at least a secondary level of education were 3.5 times more aware than those having at most 6 years of educational training. CONCLUSIONS: Assessing awareness among workers potentially exposed to occupational risk factors and promoting occupational health education are important steps for increasing health and safety at the workplace.     

Case-by-case assessment of adult-onset asthma attributable to occupational exposures among members of a health maintenance organization

OBJECTIVE: In a general population of employed persons with health insurance, what proportion of adult-onset asthma is caused by occupational exposures? METHOD: We conducted a 2-year prospective study to identify adult-onset asthma among health maintenance organization (HMO) members. Telephone interviews regarding occupational exposures, symptoms, medication use, and triggers were used to assess likelihood of work-related asthma for each case. Weighted estimating equations were used to adjust the proportion of asthma attributable to workplace exposures for factors associated with interview participation. RESULTS: Overall, 29% (95% confidence interval, 25-34%) of adult-onset asthma was attributable to workplace exposures; 26% (21-30%) and 22% (18-27%) of cases had asthma attributable to occupational irritant and sensitizer exposures, respectively. CONCLUSIONS: Occupational exposures, including irritants, are important causes of adult-onset asthma.     

Workplace violence in municipal occupations

Although workplace homicide rates are decreasing, violent events in the workplace remain a high risk in many occupations. The number of violent victimizations in the workplace has been estimated to be as high as 2 million per year among workers. Many municipal workers are at high risk because they provide services and enforce regulations, often in unsecured environments. Compared to other causes of workplace death, homicides and other violent events are relatively new areas of formal study for occupational safety and health specialists. However, there is a growing body of knowledge about the types of interventions that are effective in reducing workplace violence. This chapter examines trends in workplace violence, risk factors for municipal workers, and approaches to prevention.     

Workers with occupational contact dermatitis: workplace characteristics and prevention practices

Background There are many gaps in knowledge related to prevention practices in place for workers who subsequently develop occupational contact dermatitis (OCD). Aims To describe the workplace characteristics and the prevention practices in workplaces where workers developed hand dermatitis. Methods Consecutive cases of probable OCD were enrolled from a specialist occupational health clinic. At the time of the initial assessment, questionnaires were administered to collect information about clinical presentation, workplace characteristics and prevention practices at work. Results 100 workers with hand dermatitis were enrolled in the study and 78 were considered to have OCD. Two-thirds of these had had some occupational health and safety or Workplace Hazardous Materials Information System (WHMIS) training in their workplace, however, training related to glove use and skin care was less common. Unionized workers were more likely to have received training. Workers involved in wet work were less likely to report training. Conclusions These findings suggest that there are gaps in prevention programs for work-related skin disease. Research is needed on effective strategies that are sustainable in the workplace.     

Risk and incidence of asthma attributable to occupational exposure among HMO members

Occupational asthma may account for a significant proportion of adult-onset asthma, but incidence estimates from surveillance of physician reports and workers' compensation data (0.9 to 15/100,000) are lower than expected from community-based cross-sectional studies of asthma patients. We conducted a prospective cohort study of 79,204 health maintenance organization members between the ages of 15 and 55 at risk for asthma. Computerized files, medical records, and telephone interviews were used to identify and characterize asthma cases. Evidence for asthma attributable to occupational exposure was determined from work-related symptoms and workplace exposure. The annual incidence of clinically significant, new-onset asthma was 1.3/1,000, and increased to 3.7/1,000 when cases with reactivation of previously quiescent asthma were included. Criteria for onset of clinically significant asthma attributable to occupational exposure were met by 21% (95% CI 12–32%) of cases giving an incidence of 71/100,000 (95% CI 43–111). Physicians documented asking about work-related symptoms in 15% of charts, and recorded suggestive symptoms in three cases, but did not obtain occupational medicine consultation, diagnose occupational asthma, report to the state surveillance program, or bill workers' compensation for any of them. These data suggest that the incidence of asthma attributable to occupational exposures is significantly higher than previously reported, and accounts for a sizable proportion of adult-onset asthma. Am. J. Ind. Med. 33:1–10, 1998. © 1998 Wiley-Liss, Inc.     

On the line: worker democracy and the struggle over occupational health and safety

In this article we present a qualitative analysis of worker involvement in a participatory project to improve occupational health and safety at a Canadian manufacturing site. Based on interviews with workers in the plant, we consider the manner and degree to which workers experienced meaningful participation in the intervention process and some of the main barriers to worker participation. Findings emphasize the importance of the social and political context in conditioning the dynamics of joint management labor ventures specifically in relation to health initiatives. Interviews revealed few instances in which workers felt included in the participatory initiative; most often they felt marginalized. In the absence of structural change in the plant, workers described the health initiative as seriously limited in its ability to render meaningful worker participation. These results extend beyond this analysis of a participatory workplace health initiative, offering insights into the dynamics of institutional participatory process, and into participatory research practice generally.     

Latex allergy and occupational asthma in health care workers: adverse outcomes

The prevalence of natural rubber latex (NRL) allergy has been estimated to be 5-18% in health care workers, and latex exposure has been one of the leading causes of occupational asthma in the last several years. We present the cases of two nurses who developed sensitivity to NRL, both with dermatologic symptoms and respiratory symptoms that included asthma. They were referred to the University of Maryland for evaluation of their allergies, then for occupational and environmental consults. The patients' allergy to NRL was confirmed on the basis of clinical history, a positive skin test to latex, and the presence of latex-specific immunoglobulin E (IgE) serology by radioallergosorbent test (RAST). Both patients worked in the same community hospital for approximately 20 years; one was an endoscopy nurse and the other worked in the emergency department. Following the diagnosis of allergy to latex, both patients avoided direct skin contact with latex, but they continued to work in the same respective environments, where powdered latex gloves and other potentially sensitizing chemicals were used. Instead of improving, the clinical condition of the patients worsened and they remained symptomatic, even after they were removed from their workplace. Their airways reacted to low levels of a variety of sensitizers and irritants in the environment, and they became depressed. Both nurses were referred for vocational rehabilitation.