Faculty of Medical and Human Sciences, Centre for Occupational and Environmental Health, Institute of Population Health, The University of Manchester, Manchester, UK.
Occup Environ Med. 2013 May;70(5):317-24. doi: 10.1136/oemed-2012-100904. Epub 2013 Jan 23.
To determine UK trends (from 1996 to 2009) in incidence of work-related mental ill-health and musculoskeletal disorders, for all industry as well as for health and social care employees. Second, to investigate whether there may have been a recent shift from a physical to psychological perspective in how patients present their illness by comparing reporting trends for back pain and 'other work stress'.
Multilevel models were used to investigate changes in incidence of work-related illness, as diagnosed by specialist physicians. The dependent variable comprised case reports to The Health and Occupation Research network. Comparisons were made between medical specialties, industry (health and social care vs all other employees), gender and diagnosis.
Trends for Occupational Physicians' (OP) reporting mental ill-health (average annual increase +3.7% (95% CI +2.2% to +5.2%)) differed significantly (p<0.001) from psychiatrists' reporting over the same time period (-5.9% (95% CI -7.6% to -4.2%)). For OPs' reporting, the rate of increase was greater for females and for health and social care employees. A fall in incidence of musculoskeletal disorders for OPs of -5.8% (95% CI -7.3% to -4.3%) and rheumatologists' reporting -6.6% (95% CI -8.3% to -4.8%) was found, with little variation by gender or industry. Within health and social care, an increase in incidence of 'other work stress' was accompanied by a similar decrease in 'spine/back pain'.
The evidence presented is consistent with a shift in the presentation of ill-health from a physical to psychological perspective, although changes in hazards, prevention measures and physician awareness should also be considered as explanations.
确定英国(1996 年至 2009 年)与工作相关的心理健康和肌肉骨骼疾病的发病率趋势,包括所有行业以及医疗保健和社会护理行业员工的发病率趋势。其次,通过比较背痛和“其他工作压力”的报告趋势,研究患者呈现疾病的方式是否可能从身体方面向心理方面转变。
使用多层次模型调查专家医生诊断的与工作相关疾病的发病率变化。因变量包括向健康和职业研究网络报告的病例。对不同医学专业、行业(医疗保健和社会护理与其他所有员工)、性别和诊断进行了比较。
职业医生(OP)报告的心理健康问题(年均增长率为+3.7%(95%CI:+2.2%至+5.2%))的趋势与同期精神病医生的报告(-5.9%(95%CI:-7.6%至-4.2%))差异显著(p<0.001)。对于 OP 的报告,女性和医疗保健和社会护理员工的增长率更高。OP 报告的肌肉骨骼疾病发病率下降了-5.8%(95%CI:-7.3%至-4.3%),风湿病医生的报告下降了-6.6%(95%CI:-8.3%至-4.8%),性别或行业差异不大。在医疗保健和社会护理行业中,“其他工作压力”的发病率增加,而“脊柱/背部疼痛”的发病率则相应下降。
虽然危害、预防措施和医生意识的变化也应被视为解释因素,但所提供的证据与从身体方面向心理方面呈现健康问题的转变是一致的。