levi_rev_040730.doc - 1 WORKING LIFE AND MENTAL HEALTH – A CHALLENGE TO PSYCHIATRY Lennart Levi1,2 1 WPA Section on Occupational Psychiatry 2

levi_rev_040730.doc - 1 WORKING LIFE AND MENTAL HEALTH –...

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WORKING LIFE AND MENTAL HEALTH – A CHALLENGE TO PSYCHIATRY? Lennart Levi 1,2 1 WPA Section on Occupational Psychiatry 2 Karolinska Institutet, Stockholm, Sweden 1
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According to Hippocrates, “A physician visiting common people should not immediately feel the patient’s pulse, disregarding his conditions of life. And he should not discuss what is to be done standing up …. but sit down for a while … and cheerfully ask the patient what is ailing him, how it came about, and how many days it has already been bothering him … Also if he has had evacuation and what he eats”. To this quote, Ramazzini (1) added: “He should also enquire which craft the patient pursues”. The latter, ground-breaking, statement was published more than three centuries ago. Since then, there is no doubt whatsoever that a wide variety of living and working conditions are powerful determinants of health, for better or for worse. The relationship works both ways. Working conditions affect health, but health more often than not also affects a person’s productivity and earning capacity, as well as his or her social and family relationships. Needless to say, this holds true for all aspects of health, both physical and mental. However, before issuing any “call for action”, by psychiatrists or others, we need to consider whether there is, indeed, a problem – whether work-related or other stress and depression are widespread, have serious consequences, are becoming more prevalent and severe – and are accessible to interventions (2). The available evidence indicates that the answer to all these questions is yes. According to the World Health Organization (WHO) (3), “mental health problems and stress-related disorders are the biggest overall cause of early death in Europe”. But they are not only a matter of premature mortality. According to the same report, mental ill health and disorders are among the major health concerns in Europe today. In particular, depression, suicide and other stress-related conditions, together with destructive life-styles and psychosomatic diseases, cause immense suffering to people and their families, as well as placing “a great economic cost on society”. How great is this “economic cost”? According to a report prepared during the Finnish European Union (EU) presidency and quoted by the International Labour Office (ILO) (4), the cost of mental health problems in the 15 member states of the European Union in the year 2000 was estimated to be on average 3-4% of gross domestic product (GDP). If we approximate the percentage to, say, 3.5% and use the EU15 GDP (19,301 billion euro in 2003) as a basis for our calculation, the cost would amount to 325 billion euro. The root causes Do we know the root causes of these outcomes, and, if so, are they accessible to change?
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