Musculoskeletal Disorders and Mental Health

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Chris: It's the end of your shift and you realize you didn't get your to-do list done. So, you work harder and faster and all the while feeling overwhelmed, exhausted, and maybe even a bit unsupported. In this scenario, not only does your level of stress increase, but your risk of a musculoskeletal disorder or mental health injury does too.

Joining us today is Dr. Heather O'Reilly, Assistant Professor in the School of Interdisciplinary Science at McMaster University, to talk to us about the relationships between psychosocial  factors, musculoskeletal disorders, also known as MSDs, and mental health, and the role that psychosocial factors can play in improving prevention for both.

Welcome, Dr. O'Reilly and thank you for speaking with us.

Dr. O’Reilly: Thanks for having me. It's great to be here today. I'm passionate about this topic and I think it's really great to see that so many people are interested in injury prevention at more holistic level in their workplaces and, I'd say probably, their lives more broadly.

Chris: To begin our conversation, let's talk about the scenario I just mentioned: an employee who's working quickly, maybe without taking breaks, and feeling the stress that comes with it. It how does this type of activity put workers at risk of a musculoskeletal or a mental health injury?

Dr. O’Reilly: Yeah, for starters, I’d like to look kind of at the overlap in body systems. Sometimes we, you know, enthusiasts may use the term Mind Body Connection and what I'm leaning towards is more so that the fact that our psychology is intertwined with our physical components; like we can't kind of disentangle the parts of our body.

So, if we start from kind of that objective view of just watching a person work, like in the scenario you described, we usually see these traditional risk factors for MSD like force, repetition, or posture. Especially, many of us can relate to that, as we think about how we sit at our computer. Each of these, kind of directly, influences the way we move, the muscles we engage with, and how we complete our task, but what's less likely to be kind of scene are the factors that you just mentioned, this like working fast or feeling pressure, tired, lack of rest, or just general stress. And we might kind of lump these in as psychosocial factors associated with the worker, we can start to look at this pathway of psychological considerations: So, the time demands, pressure, stress, how that then might influence physiological changes in the body. Something like increased heart rate, increased muscle tension, and then that outputs kind of as an altered biomechanical demand to be able to complete that task. So, a change in posture, for example.

Another great example, and I often give this to the students when I'm working with them, is a common occurrence in public speaking and we feel stressed or nervous about getting up and talking in front of a crowd and so that's kind of a psychological, maybe cognitive, demand that we're talking about and then we look down the hands start shaking or sweating a little bit. therein lies kind of the psychology, the physiology, the biomechanics, kind of all combining together.

The other piece that kind of comes to mind is that this relationship kind of goes both ways and I'll give the example of someone who's previously experienced an injury. And in this example talk about shoulder injuries. So, something like a rotator cuff tear. They might have had a lot of overhead work in their job and so we can approach this from a physical lens, and I'd say you know, there was high force, there was repetition and an awkward posture, that person might then undergo some sort of treatment be that surgery or physical therapy. They're sent back to work, and they might have been cleared physically, but many of the studies that look at return to work, you'll start to see these psychosocial or psychological components starting to influence that road too kind of successful reintegration into work. And in some of the research that I've done, it was kind of easy to see that people who had had a shoulder injury, but then we're totally cleared, you know, it had been over two, three, four years ago, who were like fully physically rehabilitated, still experienced some sort of fear of re-injury or fear of activity whether that be in sport or work.

Chris: That's interesting! Based on your studies and experience, can you elaborate on what these psychosocial factors look like and how they're related to common workplace injuries?

Dr. O’Reilly: Yeah, psychosocial factors aren't really a new topic for workplace injury prevention. There's lots of historical research dating back to the 60s 70s, historical models on psychosocial factors. And there's lots of pioneers who can speak to the operating definitions and they might look a little bit different depending on who you're talking to and one example I'll give is from the International Labour Organization, so the ILO, and they described psychosocial factors as the interactions between and among the work environment, job content, organizational conditions, and workers’ capacity, needs, culture, personal and extra job considerations, that might influence perceptions, experience, and influence their health, work, performance, and job satisfaction.
It's kind of a lengthy description there, but what we're trying to get at is all of these relationships, these psychosocial, socio cultural, environmental relationships, outside of just looking at the physical components of the job.

Chris: What are some current resources our listeners can refer to?

Dr. O’Reilly: In Canada, we can turn now to the psychological health and safety standards. So, we have a CSA standard for that, and they highlight different factors job resources, job demands. Guarding Minds at Work is another resource kind of created in mind with the psychological health and safety standard.
Broadly, when I look at this and when I look at different definitions what I see are different categories or kind of lenses that we can look at psychosocial factors through in the workplace. For example, we can look at an individual level or an organizational level. So, if we take the example of something like social support, in theory, this could be maybe an individual factor, if a person doesn't perceive that they have a great team or maybe support at home. But then when we look at it at kind of an organizational factor, we might be looking at the reporting structure of the organization, the management, the leadership.

The other thing to consider in kind of grouping or categorizing psychosocial factors is those that are modifiable or non-modifiable. So, from an occupational health and safety lens, what is it that we can actually intervene with and modify? If a worker has something that's going on at home and, kind of, this that might relate to these work-life conflicts or work-life balance conflicts. That's not to say we ignore this, but we have to think about that we might not as an ergonomist, or an occupational health and safety professional have much that we can actually change with respect to that, but we can start looking at the organizational modifiable factors.

Chris: Right. We’re looking at what we can do in the workplace.

The last piece I'll kind of say on this when it comes into categorizing these. there's been some work coming out of the UK that summarizes survey data related to individual level interventions related to job demands and then versus kind of organizational level demands. And so, what they found is that some of these individual level interventions weren't really providing the appropriate resources in the workplace context. So, the summary or the findings in this would be moving towards kind of an organizational change versus focusing on each individual specifically.

Chris: So, factors like job satisfaction and the balance of effort and reward can actually increase or decrease the risk of physical injuries, like musculoskeletal disorders?

Dr: O’Reilly: Mmm. That's a great question!

Many of these factors can increase or decrease risk. We can look at, I think, a lot of risk factors and workplaces is kind of sitting on a paradigm or a continuum. We often tend to think about prevention from kind of the negative lens and then kind of forget about kind of the promotion or the health promotion side of things.
An example I’ll give is social support. So, if we have a manager who exhibits poor leadership skills, micromanages, maybe gives unclear tasks, we're setting the stage for higher risk of injury and that could be physical or psychological based on some of the descriptors I mentioned earlier. If we flip the narrative and then bring in a supervisor who goes above and beyond for their staff, takes time to listen, advocates for their staff and upper management. We're moving towards that psychosocial factor of social support is really a positive and a good thing.

The same notion is applied for something like job satisfaction. I recall is a kid my parents telling me if you find a job you like you won't work a day in your life and perhaps, they were onto something maybe pioneers of psychosocial factors. But job satisfaction had a lot of research back in the 80s and 90s and it was highly correlated to the risk of musculoskeletal disorders and return to work post recovery from a musculoskeletal disorder.

So what's really interesting to me when we look at the interconnectivity of all of these psychosocial factors, is we tend to talk about these research them and intervene kind of independently, for example, I'm going to implement a strategy that focuses just on job satisfaction, but we might forget that these strategies kind of influence these other psychosocial factors and kind of from my statistical mindset we're talking about something called collinearity or a situation where two or more variables are really closely related to one another and so in my mind these examples like social support and job satisfaction demonstrate exactly this: if you have a supportive supervisor you might feel a bit better at your job that might in turn kind of give you that higher job satisfaction.

Chris: Thanks for shedding light on that, let's talk about prevention. What are some practical ways for workplaces to assess their workers, the environment, and psychosocial factors, to prevent musculoskeletal injuries?

Dr. O’Reilly: So, from an assessment lens, we have lots of well-established physical assessments these range from observational through to measuring forces, loads, and modeling, and simulation. On the psychosocial side of things, we rely a little bit more heavily on worker reports and surveys. And so, some known tools in the research evidence that I'm aware of. We have the Copenhagen Psychosocial Questionnaire that can have over sixty questions that you could ask a worker to kind of gain insight into psychosocial factors. There's also the Stress Assess in Canada, kind of building on that COPSOC questionnaire. Guarding Minds.

[There are] different toolkits coming out now, the Job Content Questionnaire is a long-used questionnaire. Practitioners, compensation boards, H-S-As, they all tend to have their own tools as well. And that's kind of one of the support systems that we are fortunate to have in this context, especially with in Ontario. And in chatting with some of the ergonomist in both in Ontario and kind of Canada more broadly, through some of my research, some of the major challenges when it comes to this assessment and using these different assessment tools was the ability to capture multifactorial problems or multitask problems. And so, just focusing in on physical factors, you might use one tool, but then if you want to capture psychosocial factors, you might kind of bring in another tool and how do you combine those two make a kind of more holistic assessment.

Chris: Okay. It sounds like it takes more than one tool to make a complete assessment. And they’re readily available. That’s good to know.

Dr. O'Reilly: The other piece that they expressed was challenged in kind of addressing the underlying factors. So, in some sectors we might just say that psychosocial and cognitive risk factors are kind of just part of the job. I say that kind of with in quotations. I'll give the example if we use surveys that I previously mentioned in something like an understaffed hospital and we identify that there's high emotional demands, high work pace, long hours of work, low job control, we might be met with a response from workers or management that says well that's just kind of part of the job, we already knew that.

And so, I think that's kind of one of the tricky places from the assessment side of things is going towards kind of a bit more of a participatory approach and asking workers what strategies might support them.

So, moving from that kind of assessment to more of a strategy lens I’ll kind of back out by saying I don't have all the specifics answers as the needs of the workplace will differ kind of based on the context. And the other piece that I'll say is kind of from the research perspective. Sometimes it's really difficult to gather information on what practices are working. And one of the reasons for that is research likes things really controlled. We like a nice, controlled setting and we know that the workplace is not a controlled setting it's very dynamic and so their strategies sometimes that are made on the fly and implemented. The ergonomist or OHS teams within an organization may take that under their, kind of, wing and create something.

Going back to kind of that concept of modifiable organizational factors. I think kind of the cross between risk assessment and prevention and health promotion is maybe a good way to conceptualize it and again integrating that participatory approach where you have both worker and management buy in. And when I talk to other colleagues and ergonomists who work within this space a question tends to pop up is, do we even know if workplaces are ready to address these factors or to kind of take a proactive approach? And most of us are kind of guessing the answer is probably no and so I guess therein lies kind of our starting point.

Chris: Yes. How and where to start?

Dr. O’Reilly: When we think about strategically thinking of the occupational health and safety system or something more broadly, identifying what strategies are already in place and what might be missing is an avenue to take.

The other piece I recommend based on some of my experience is getting different parts of the organization to talk to one another. Well, this example might only apply to kind of larger workplaces. I'll give a situation that I have or where I was consulting on an ergonomics program. I identified that there were some gaps can kind of addressing the psychosocial factors and I was actually kind of met with the response of that's the wellness team’s role. It's not ours. So, I had to laugh a little at that point. We call it health and safety for a reason and that example right their kind of brings me back to the point. I mentioned at the start of our conversation treating physical and psychological health separately, in my opinion, doesn't really make sense because a) they're connected and b) a little bit of a waste of resources, two departments trying to address the same problem kind of seems a bit redundant.

Chris: Those are useful recommendations. Moving on to workers. Do you have any tips that they can put into place to reduce their risk of physical or mental injury?

Dr. O’Reilly: Yeah. I think one of the things that comes to mind is general awareness of rights and responsibilities.
It's a great place to start.

I think about a friend who worked in a waste management role. He would lift the heavy items that he thought maybe some of his older colleagues shouldn't or couldn't be able to lift and he didn't really know that there were weight limits to what someone should be lifting at work. And that resulted in a chronic shoulder injury that removed him from the job and that was many years in the process of working through a workers compensation claim.

And so that's kind of a starting point. He didn't know that there were rules responsibilities of a workplace to prevent those types of injuries. And so therein lies an example. The same thing goes for the psychosocial factors; giving workers knowledge to know that let's say a boss is expecting them to respond to an email or call it 10 p.m. at night, and that's actually considered after work hours is a risk factor. That's not something that's supposed to be happening. We have new kind of legislations coming into place for that.

The other piece of highlighting things like social support or you know, what your colleagues or how they're treating you. If your colleagues are making small little derogatory comments continuously at work that that is a form of micro aggression and harassment and so you don't have to tolerate that and there are, or should be, systems in place to be able to communicate that to your workplace.

Chris: That makes sense.

Dr. O'Reilly: With that in mind again I say general awareness of rights and responsibilities is important. We need to just kind of be mindful of when we're adding that and that might sound like something like, oh well add in like another training module and I think workers complete a lot of training as it is and maybe sometimes don't always remember all of the training that they get and so that's something I mean, I'm thinking about even more readily right now as I work kind of in the education sector I would argue that sometimes we need to start this as early as high school like that might be when a kids getting their first job and therein lies an opportunity to teach them kind of these rights and responsibilities as a worker.

The other piece that kind of maps over directly for workers [is providing] just the space for communication and making sure that they have the voice and strength to communicate where they see risk, be those physical, psychosocial, cognitive, in nature and then also identify different solutions and maybe accommodations that would be helpful for them.

Chris: That’s great advice. Would you like to share some final words with workplaces who are just starting to make the connection between workplace musculoskeletal injuries and psychosocial factors?

Dr. O’Reilly: I’ve got one small thing and I'm drawing to social media here. I saw an interesting post on LinkedIn. It's not really research evidence, but it resonated with me, and it was a billboard that had some words on it, and it said, “your manager has greater impact on your health than your doctor act accordingly.”  And I think on the note of this topic that chatting about here today that resonated with me. We spend most of our waking hours at work, and so it's a joint responsibility that we make sure we can take care of our health and safety.

Chris: Thanks for sharing your insights, Dr. O'Reilly and thank you listeners for joining us to learn more about the role of Psychosocial factors in preventing musculoskeletal injuries at work.

For more information about workplace health and Safety, please visit C-C-O-H-S dot c-a.

Bye for now.