Gallozzi Alessia, Scafa Fabrizio, Mongiovì Maria Carmela, Negri Claudia, Crisafulli Giulia, Malgara Giovanni, Bellini Daniela R, Candura Stefano Massimo
Unità Operativa di Medicina del Lavoro, Istituti Clinici Scientifici Maugeri IRCCS, Pavia.
Consulente Psichiatra, Istituti Clinici Scientifici Maugeri IRCCS, Pavia.
G Ital Med Lav Ergon. 2022 Mar;44(1):22-31.
Occupational stress can exceed the workers' individual capacity to adapt, and cause psychopathological conditions, including adjustment disorder (AD) and post-traumatic stress disorder (PTSD), for which medico-legal reporting is mandatory by law. Since the early 2000s, an interdisciplinary diagnostic protocol has been in use at our Institute to address patients towards an appropriate therapeutic path, in order to promote their psychological well-being and work reintegration. In 2017, the protocol was updated and expanded. The current version (MaSD-2) includes: occupational medicine examination, psychological counselling, psychiatric interview, and psychodiagnostic testing: Short-Negative Acts Questionnaire (S-NAQ), Cognitive Behavioral Assessment 2.0 (CBA-2.0), SCID (Structured Clinical Interview for DSM: Diagnostic and Statistical Manual of Mental Disorders), Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), Maugeri Stress Index - Reduced form (MASI-R). Between 2017 and 2019, we used the MaSD-2 to assess, for suspected psychopathological work-related problems, 198 patients (120 women and 78 men; mean age SD: 47.9 9.0 years). Nine (4.5%), already examined with the original version of the protocol, received diagnostic confirmation (2 cases of paranoid personality disorder, 7 of work-related anxiety-depressive disorder). Of the other 189 subjects, three (1.6%) were not affected by psychiatric disease, 12 (6.3%) had a psychiatric disorder (e.g., anxiety disorder, mood disorder, personality disorder) independent of work, 160 (84.7%) a work-related anxiety and/or depressive disorder. DA was identified in 12 cases (6.3%), and two patients (1.1%) were diagnosed with DA in pre-existent DPTS, for a total of 14 medico-legal reports of occupational disease. Compared to the past, the case record presents a much higher percentage of psychiatric disorders related to occupational stress. This may be due to a greater sensitivity of the new diagnostic protocol, and to a better selection of the patients referred to us. Women and tertiary workers continue to be at greater risk, with significant involvement of health professionals. Diagnoses of DA and DPTS remain rare, confirming the need for a rigorous and cautious interdisciplinary approach, aimed at selecting the cases for which to start medico-legal procedures. Finally, the study calls for adequate preventive measures.
职业压力可能超出工人的个人适应能力，导致精神病理状况，包括适应障碍（AD）和创伤后应激障碍（PTSD），对此法律强制要求进行法医学报告。自21世纪初以来，我们研究所一直在使用一种跨学科诊断方案，引导患者走上适当的治疗路径，以促进他们的心理健康和重返工作岗位。2017年，该方案进行了更新和扩展。当前版本（MaSD - 2）包括：职业医学检查、心理咨询、精神科访谈和心理诊断测试：简短负面行为问卷（S - NAQ）、认知行为评估2.0（CBA - 2.0）、SCID（精神疾病诊断与统计手册结构化临床访谈）、明尼苏达多相人格调查表 - 2修订版（MMPI - 2 - RF）、毛杰里压力指数简化版（MASI - R）。在2017年至2019年期间，我们使用MaSD - 2对198例疑似与工作相关的精神病理问题患者（120名女性和78名男性；平均年龄±标准差：47.9±9.0岁）进行了评估。其中9例（4.5%）已用该方案的原始版本进行过检查，得到了诊断确认（2例偏执型人格障碍，7例与工作相关的焦虑抑郁障碍）。在其他189名受试者中，3例（1.6%）未患精神疾病，12例（6.3%）患有与工作无关的精神障碍（如焦虑症、情绪障碍、人格障碍），160例（84.7%）患有与工作相关的焦虑和/或抑郁障碍。12例（6.3%）被确诊为适应障碍，2例（1.1%）在已有的创伤后应激障碍中被诊断为适应障碍，共有14份职业病法医学报告。与过去相比，病例记录显示与职业压力相关的精神障碍比例要高得多。这可能是由于新诊断方案的敏感性更高，以及转介给我们的患者选择得更好。女性和第三产业工人仍然面临更大风险，卫生专业人员也有大量涉及。适应障碍和创伤后应激障碍的诊断仍然很少见，这证实了需要一种严谨且谨慎的跨学科方法，旨在筛选出启动法医学程序的病例。最后，该研究呼吁采取适当的预防措施。
