Occupational stress: risk assessment and fitness for work.

The multidimensional and multifaceted aspects of the problem render the role and activity of the Occupational Health Physician (OHP) extremely complex and delicate, as both appraisal and implications cover a number of different domains (psychology, physiology, sociology, economy, work organisation and law), both in terms of risk assessment and stress evaluation, at collective and individual level. In this context, it is not only important to quantify the "external" work load, but mainly the individual "response", which in most cases is the crucial factor of the imbalance. that is, risk assessment has to be made more in "relative" terms rather than according to "absolute" criteria, and not only from the perspective of medical surveillance, but above all from that of risk prevention. When a health disability potentially connected to stress has to be assessed, there are three steps: a) stress exposure must be clearly assessed, both directly and indirectly; b) disease must be clearly identified; c) the biological plausibility of the relationship between stress and disease must be carefully checked, taking into account that stress disorders are typically psychosomatic and multi-causal. Consequently, cooperation with a psychologist and an accurate psycho-diagnostic approach are necessary, as well as consultation with other specialists and pertinent laboratory and instrumental tests.