Mental ill health and fitness for work

Nick Glozier

doi:10.1136/oem.59.10.714

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Mental ill health and fitness for work

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Mental ill health in workers: observations from a few Indian populations
Nilamadhab Kar
Published on: 26 September 2017

Published on: 26 September 2017
Mental ill health in workers: observations from a few Indian populations
- Nilamadhab Kar, Associate Professor of Psychiatry
Dear Editor
The article titled mental ill health and fitness for work [1] by Glozier has focused on work related mental ill health issues and has discussed various topics like screening, safety and legal issues. However as the work environments differ considering bio-psycho-social factors and different levels of exposure, which are known to increase the vulnerability for the psychiatric disorder in the workers [2] it w...
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Dear Editor
The article titled mental ill health and fitness for work [1] by Glozier has focused on work related mental ill health issues and has discussed various topics like screening, safety and legal issues. However as the work environments differ considering bio-psycho-social factors and different levels of exposure, which are known to increase the vulnerability for the psychiatric disorder in the workers [2] it would be better to specify the work environments while considering the prevalence of mental ill health.
The informations in the article are mostly from the developed countries. It may be relevant here to give similar perspective from developing countries like India. It would also be interesting to note similar morbidity in specific population of industrial employees, as they are known to be more vulnerable for mental ill health.[2]
The available information of prevalence of psychiatric morbidity in industrial workers show that it is considerably higher than that in general population.[3] The reported prevalence of psychiatric morbidity in working population in Western countries 20-35% as reported in the article[1] is comparable with that from Indian industrial sites (14 - 37%).[4] However, comparison would be meaningful if the working environments are similar.
The types of the mental illness reported to be common in the Western countries are similar to what is observed in various industrial set-ups in India.[4] They are basically anxiety disorders, adjustment disorders, mood disorders especially depression, somatoform disorders, alcohol and tobacco harmful use and dependence. As reported[1] comorbidies are also commonly noted in the Indian studies. The most common comorbidities are with substance use disorders.
There has been an important observation that screening for common mental disorders is probably pointless because of rapid change in illness status, numbers of persons having problem may overwhelm the occupational health service and the predictive value is low.[1] In addition different assessing instruments will give different figures. It was observed in an epidemiological survey that even if around 36.2% of employees had psychiatric problem only 9.7% of them came for the psychiatric services (Kar et al, unpublished data). It suggests that various factors influence psychiatric service utilization, like unawareness and stigma to name a few. Though the clinic population reflect realistically the magnitude of the felt need of the workers for the mental health services, periodic screening with standardized and reliable instruments may suggest the mental health need of the population, based on which optimum care programmes can be planned.
References
(1) Glozier N. Mental ill health and fitness for work. Occup Environ Med 2002;59:714-720.
(2) WHO. Epidemiology of Occupational Health, Assessment of Occupational Health. 1986 Geneva: WHO.
(3) Kar N, Dutta S, Shaktibala P, Jagadisha, Nair S. Mental health in an Indian Industrial Population: screening for psychiatric symptoms. Indian Journal of Occupational and Environmental Medicine 2002;6(2): 86-88.
(4) Kar N, Dutta S, Patnaik S, Mishra BN, Singh P. A comparative study of psychiatric morbidity among managers and workers of a fertilizer factory. Industrial Psychiatry Journal 2001;10(2):7-18.
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Conflict of Interest:
None declared.
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