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April 2015: Psychosocial Risk Factors
By all accounts, Rachel is a healthy and beautiful 26 year old administrative assistant. Her work injury diagnosis is relatively benign with no significant or objective medical findings to explain the severe neck, upper back and arm pain she’s had for the last year. She has no apparent loss of function either. However, when asked about her pain, she rates her discomfort level as an 8 to 9 on a 10 point scale (0= none and 10=excruciating). Despite physical therapy, intermittent leave, task restrictions and providing her with good ergonomic equipment including a sit to stand workstation, why isn’t Rachel getting better?
In this story, conservative medical management and good ergonomics are not enough to get Rachel well. So what’s causing the pain and the ongoing workers’ compensation claim? Once physical ergonomics, including demonstrable safe work practices is ruled out, employers should explore the psychosocial risk factors at work.
If your employees are unhappy, in pain and/or dissatisfied with their life or job, it will affect their health and wellbeing at work. Job stress, job demands, job support and job control at work may be to blame if workers’ compensation claims continue unresolved. The psychosocial work environment variables of high, demand, low control and low social support are consistently associated with workers’ experiencing high strain and low wellbeing.
According to Karasek’s model (1979) (Figure 1.), job demands are the psychological stressors:
1. Involved in accomplishing the work load.
2. Related to unexpected task assignments.
3. Associated with job-related personal conflicts.
4. Of job control and decision latitude in day to day work tasks.
The combination of high job demand and low job control produce job strain, which can be associated with high pain levels, often disproportionate to a diagnosed medical condition, such as an ongoing musculoskeletal disorder like Rachel’s case. In such instances, the doctor is not likely to recognize this as contributing to the claim or document it either in the medical record. Psychosomatic pain is real, but often not acknowledged, especially in workers’ compensation claims. So employers should be willing to explore solutions focusing on the interactions between employee and supervisor as they may be hampering healing and wellness.
Based on the literature and in my experiences dealing with similar cases, management should:
1. Engage and interact with injured workers sincerely regarding the performance of essential functions.
2. Understand the importance of social support by providing employees with advice, assistance and feedback on balancing work demands within their abilities and limitations.
3. Provide helpful social interaction with co-workers including them in committee or team work.
4. Provide emotional support, empathy, and active listening to employee’s problems.
5. Allow co-workers to assist with task completion when needed to reduce stress and work demands.
The impact of psychological job demands, job control and social support are consistently found to be predictors of employee strain and wellbeing. Providing support, empathy and being more engaged in discussing work demands, work flow and productivity with injured workers is critical if progress is not evident with typical ergonomic changes and medical management. Such actions will shift the balance of demands and control allowing for reduced stress, pain and ultimately, return to normalcy, work/life balance and wellbeing.
So what’s next for Rachel? More time off or restructuring her work demands giving her more control over her essential functions? Which option is likely to reduce her pain level and help resolve her workers’ compensation claim? For support in dealing with complex workers’ compensation claims with psychosocial overtones,
See in the site under: Our Services/workersComp
Ref: Review of the Job Demand-Control and Job Demand-Control-Support models: Elusive moderating predictor effects and cultural implications, Southeast Asia Psychological Journal, Vol 1 (2012)10-21.
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