Introduction Employers around the globe are being encouraged, recommended or legally mandated to consider the health of their employees beyond the scope of physical health. This broader scope of psychological health and safety in the workplace encompasses issues like depression, inadequate sleep, excessive job demands, low job satisfaction, extending their consideration into areas of direct and indirect business impact.

Methods Responses of 4 20 000 employees in 123 countries to an online health risk appraisal that included measures of psychological and organisational factors were used to compare and correlate the impact of these factors, stratified by level of severity, on health and work. Psychosocial factors included work-related sources of personal stress, depression, sleep and organisational stress, the imbalance of job satisfaction and job stress. Impact on work was measured based on self-reported limitations on performance of work functions and absence from work.

Results As the severity of psychosocial risk factors increases, so does the unfavourable impact on job performance limitations and absenteeism, directly and indirectly, through the interaction with worsening physical health risk. For example, for individuals screened for depression (PHQ-9), comparing those with no depression symptoms to those with severe depression, we see globally 3.6 times the prevalence of individuals with 4 or more lifestyle-related risk factors, 13.0 times prevalence of 4 or more chronic conditions, 7.2 times prevalence of severe sleep problems and 11.5 times prevalence individuals reporting more stress than satisfaction from their work. Globally, prevalence of psychosocial risks varies by region, country and site. (e.g. prevalence of mild to severe depression ranges from 16% for North America to 37% for Asia and 39% for Africa and Middle East.

Discussion When evaluating health risk, it is important to include psychosocial factors. More studies are required to investigate the impact of psychosocial factors on work and interaction between psychosocial factors and health.