Wong M G P, Poole C J M, Agius R
NATS OHS Mailbox 34, Sopwith Way, Swanwick Centre, Southampton SO31 7AY, UK,
Department of Occupational Health, Northern General Hospital, Sheffield S5 7AU and Health & Safety Laboratory, Buxton SK17 9JN, UK.
Occup Med (Lond). 2015 Jul;65(5):391-7. doi: 10.1093/occmed/kqv050. Epub 2015 May 15.
Clinicians may be asked whether mental ill-health has been caused by work but there is no guidance on how this judgement should be made.
To seek a consensus on the factors that should be considered and how they should be sought when attributing mental ill-health to work.
A three-round Delphi study involving expert academics, occupational physicians, psychiatrists and psychologists. We deemed consensus had been reached when 66% or more of the experts were in agreement.
Of 54 invited experts, 35 (65%) took part in the first round, 30 of these 35 (86%) in the second and 29 of these 30 (97%) in the final round. Consensus was reached for 11 workplace stressors: high job strain; effort-reward imbalance; major trauma; interpersonal conflict; inadequate support; role ambiguity; person-job mismatch; organizational injustice; organizational culture; work scheduling and threats to job security. Seven personal factors were identified as being important: previous mental illness; personality traits of neuroticism; adverse life events or social circumstances; resilience; a family history of mental illness and secondary gain. The worker, manager and co-workers were thought to be the most useful sources of workplace information. Consensus was reached for a definition of occupational mental illness but not for a threshold of work-relatedness.
The attribution of mental ill-health to work is complex and involves the consideration of both workplace stressors and personal factors of vulnerability. Clinical consultation with an occupational physician who is familiar with the workplace is central to the process.
临床医生可能会被问及精神健康问题是否由工作导致，但对于如何做出这一判断并无指导意见。
就将精神健康问题归因于工作时应考虑的因素以及如何获取这些因素达成共识。
开展三轮德尔菲研究，参与专家包括学术专家、职业医师、精神科医生和心理学家。当66%或更多专家达成一致时，我们认为已达成共识。
在54位受邀专家中，35位（65%）参与了第一轮，这35位中的30位（86%）参与了第二轮，这30位中的29位（97%）参与了最后一轮。就11种工作场所压力源达成了共识：高工作压力；努力-回报失衡；重大创伤；人际冲突；支持不足；角色模糊；人岗不匹配；组织不公；组织文化；工作安排以及工作安全感受到威胁。确定了7个重要的个人因素：既往精神疾病；神经质人格特质；不良生活事件或社会环境；恢复力；精神疾病家族史以及继发获益。员工、经理和同事被认为是工作场所信息的最有用来源。就职业性精神疾病的定义达成了共识，但未就与工作相关性的阈值达成共识。
将精神健康问题归因于工作是复杂的，涉及对工作场所压力源和个人易感性因素的考量。与熟悉工作场所的职业医师进行临床咨询是这一过程的核心。
