Project Leader: Author(s): Science Group

1 Harpur Hill, Buxton Derbyshire, SK17 9JN T: +44 (0)1298 218000 F: +44 (0)1298 218590 W: Applying the Biopsychosocial Approach to Managing Risks of Contemporary Occupational Health Conditions: Scoping Review HSL/2007/24 Project Leader: Jennifer Lunt Author(s): Jennifer Lunt, David Fox, Jo Bowen, Gret Higgins, Sarah Crozier and Louise Carter Science Group :Human Factors and Health Improvement Crown copyright (2007) ii ACKNOWLEDGEMENTS The authors would like to thank the following individuals for their valuable contribution to the Project : Prof Kim Burton, Prof David Coggon, Dr Jo Harris-Roberts, Prof Colin Mackay, Mr Steve Pointer, Dr Roger Rawbone, Mrs Liz Standen, Ms Pauline Stenhouse, Mr Kerry Trow, Dr David Sheffield and Dr Keith Wiley.

2 Thanks are also due to HSE library information services for their help in undertaking the literature searches. iii CONTENTS 1 1 Background .. 1 3 2 ORIENTATION PHASE: METHOD .. 7 Evidence Weighting: .. 7 3 ORIENTATION PHASE: RESULTS AND DISCUSSION .. 8 Non- Standard Approaches to Well-being and Work .. 8 Coping and Representations of Illness .. 22 Predicting and Changing Health Behaviours .. 29 4 RISK MANAGEMENT PHASE: 36 36 Background.

3 36 Search strategy .. 36 Sources .. 39 5 RISK MANAGEMENT PHASE: RESULTS .. 41 Application of risk management by employers .. 41 Comparisons with the HSG 65 Risk Management Model and with Sensible Risk Management Principles .. 45 Reasons for any variations from HSE s recommended approach .. 45 General 45 Risk Management: Discussion .. 46 6 BPS MECHANISMS PHASE: METHOD .. 48 48 Search Strategy .. 48 Selection 48 Data Extraction .. 50 50 7 BPS MECHANISMS PHASE: RESULTS .. 51 What are the biopsychosocial mechanisms underpinning common health problems?.. 51 The Mechanisms.

4 56 Precipitating 59 Progression Mechanisms .. 66 SECTION D: WELL-BEING INFLUENCES .. 70 8 WELL-BEING INFUENCES PHASE: METHOD .. 71 71 Search Strategy .. 71 Selection 71 iv Data Extraction .. 72 Evidence 74 9 WELL-BEING INFLUENCES PHASE: RESULTS .. 75 What determines well-being at work? .. 75 10 DISCUSSION .. 89 What are the main findings? .. 89 Caveats .. 91 What does a holistic view of well-being offer that stress does not?

5 91 What are the implications for promoting attendance?.. 93 What are the implications for rehabilitation? .. 97 What are the potential research options? .. 98 Ways Forward .. 100 11 GLOSSARY .. 102 12 REFERENCES .. 104 13 APPENDICES .. 120 Appendix 1: Articles Summary - Biopsychosocial Mechanisms .. 120 Appendix 2: Articles Summary - Well-Being Antecedents .. 148 v EXECUTIVE SUMMARY Objectives As part of a wider review exploring the utility of the risk management process for contemporary occupational health conditions, this literature review was commissioned by the Health and Safety Executive s Policy Group to identify: 1.

6 Employer s current practices in applying risk management, as advocated by HSE, to common health problems1 that are without a clear dose-response relationship between exposure and harm. Stress, anxiety, depression and musculoskeletal disorders are examples of such conditions 2. The biopsychosocial mechanisms by which such health problems arise. This refers to the interactions between biological, psychological and social or contextual variables implicated in the development and maintenance of contemporary occupational health conditions. 3. Important individual, work environment and socio-demographic influences upon well-being in the workplace, and interactions between these influences.

7 This literature review is occurring against a backdrop in which: A national health, work and well-being strategy is endeavouring to harness the potential benefits of work for well-being. Common health problems and management of associated sickness absence remain a stubborn challenge. HSE is emphasising the merits of sensible risk management to employers. Sensible risk management is about practical steps that manage the risks that cause real harm and suffering, not bureaucratic back covering. The Department of Work and Pensions, as part of its welfare reform programme, is providing additional support to help people off incapacity benefit and to return to work.

8 Ageing population predictions highlight the growing need for employers to accommodate people at work who have less than perfect health. Approach A systematic methodology for identifying relevant literature, and synthesising findings from a disparate evidence base was used. The review was broken down into four stage. An initial orientation stage (Section A) was followed by stages focussing on risk management (Section B), biopsychosocial mechanisms (Section C), and well-being influences (Section D) respectively. Search strategies varied between sections to balance need for comprehensiveness where a paucity of evidence was anticipated (risk management practices) with more stringent strategies prioritising recent good quality reviews and investigations for areas more extensively searched (biopsychosocial mechanisms and well-being influences).

9 Evidence statements were produced 1 Common health problems refer to health conditions that have high prevalence rates within the adult population, but do not appear to have a readily definable physical basis. vi to capture the main findings of each section, and weighted according to the quality of underpinning evidence. Broad weighting criteria were developed to accommodate the disparate evidence base.

10 Inter-rater2 reliability checks were incorporated into article selection, data-extraction and evidence statement stages. This flexible approach allowed the review s aims to be tackled within the pragmatic constraints surrounding the review. Main Findings 1. Application of risk management to common health problems (from Section B): In spite of utilising a broad-brush search strategy, employer s actual practices in applying risk management to common health problems were found to be poorly documented. Where undertaken, risk management has mainly been applied to the physical rather than psychosocial aspects of common health problems.