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Home > Public Resources > Trauma Blog > 2022 - August > Protecting those with the tough job that someone has to do

Protecting those with the tough job that someone has to do

Michelle O'Sullivan, Laurence Carnall, Bob Patton, & Oliver Mason

August 19, 2022

Social support, working conditions and exposure to traumatic events, can all impact mental health. Exposure to traumatic events is common for many professionals, including police officers, firefighters, and ambulance crews (Skogstad et al., 2013).  Rail industry workers can be exposed to a range of stressful and threatening situations.  The U.K. Health and Safety Executive (HSE) termed these “psychosocial hazards,” reflecting any aspect of work that could detrimentally affect an employee’s well-being (HSE, 2001). Along with general psychosocial hazards (e.g., how work is organised, workplace social factors, work environment), rail industry workers can be exposed to verbal abuse, threatening behavior, violence or assault, witnessing death, and hearing the details of death relayed by another person (Rail Safety and Standards Board, 2019). In many countries, there is legislation in place that requires employers to assess and take measures to control risk from work activities. In addition to the legal and moral obligations to manage psychosocial hazards, many employees who are exposed to traumatic events fulfil a crucial public service, often requiring a high level of skill and attention to detail, making mental health difficulties a potential concern with regard to both safety (Jeon et al., 2014) and employee well-being. 
 
Through a cross-sectional survey of 3912 UK rail workers, this study examined rates of posttraumatic stress disorder (PTSD), complex PTSD (CPTSD), depression, and anxiety, as well as their relationship with key psychosocial hazards relevant to rail-industry workers, working conditions, individual factors, demographic characteristics, and the impact of the COVID-19 pandemic. 
 
Experiences of mental ill-health was common amongst this population, with 38.6% and 29.2% of all participants scoring in the moderate-to-severe range for depression and anxiety, respectively. Amongst those who reported trauma exposure, 24.3% met the criteria for PTSD or CPTSD. Some of the key factors associated with mental ill-health included bullying/harassment, hearing about and witnessing a fatality, work intensity, poor workplace ergonomics, and greater physical health problems. In contrast, higher job satisfaction was associated with lower rates of PTSD, CPTSD, anxiety and depression.  
 
Although causality cannot be implied with a cross-sectional survey, these results signpost to modifiable factors that employers can target to protect employees and add to the growing body of work that shows that good work is good for your mental health, and poor-quality work is bad for your mental health (Business in the Community, 2021). Many good health and safety practices which manage risks associated with human error; e.g. job clarity, are also likely to support good mental health. Features that are typically associated with a good working culture, such as having supportive managers and colleagues, and reinforcing the value of people’s work, may also help. Focussing on trauma, the UK Psychological Trauma Society have published guidance for organisations who staff work in high risk environments (2018).
 
Worryingly, despite the prevalence of poor mental health, only half of participants had sought help (Rail Safety and Standards Board, 2021). Generic counselling and medication were the most common sources of formal help received. Access to evidence-based therapy for those who met criteria for a PTSD was low. Only 2% had Eye Movement Desensitization and Reprocessing (EMDR) and 5% had trauma-focused cognitive behavioural therapy (TFCBT). Organisations should consider providing targeted supported to individuals who may be vulnerable.

Target Article

Carnall LA, Mason O, O'Sullivan M, Patton R. Psychosocial hazards, posttraumatic stress disorder, complex posttraumatic stress disorder, depression, and anxiety in the U.K. rail industry: A cross-sectional study. J Trauma Stress. 2022 Jun 22. doi: 10.1002/jts.22846. Epub ahead of print. PMID: 35733296.
 

Discussion questions 

  • How can employers reduce the risk of psychological injury to employees, associated with work activities?
  • How can clinical mental health professionals influence mental health in the workplace?

About the Authors 

Michelle O’Sullivan, Psych.D, is a Consultant Clinical Psychologist at Westminster Drugs Project in London. Her clinical and research interests include workplace mental health, addictive behaviours, and PTSD.
 
Laurence Carnall, Psych.D, is a Clinical Psychologist currently working in a complex depression, anxiety and trauma service based in Oxleas NHS Foundation Trust, Southeast London. His clinical interests include developmental and chronic interpersonal trauma in both the general population and secondary care mental health service users.
 
Bob Patton is a lecturer in Clinical Psychology at the University of Surrey. He is a Chartered Psychologist (Health, Research), Associate Fellow of the British Psychological Society, Fellow of the Software Sustainability Institute, Fellow of the Higher Education Academy and a Chartered Scientist. During the 1990s he worked for the Home Office Drugs Prevention Initiative as a consultant, and then as a research associate in health promotion for the University of Northumbria, before moving to London where he has worked for Kings College London (medical education), Royal Holloway (violence prevention), London School of Hygiene & Tropical Medicine (cancer communication), Imperial College London (alcohol) and for King's Health Partners where he was the Health Services Research Coordinator for Addictions between 2004 – 2011.
 
Oliver Mason is an Associate Professor at the University of Surrey. As a clinical research psychologist he is interested in predictors of mental health both in community and clinical populations, and has published over a hundred articles and books. Details at https://www.surrey.ac.uk/people/oliver-mason.

References Cited

Business in the Community. (2021). What if your job was good for you? https://www.bitc.org.uk/report/what-if-your-job-was-good-for-you/
Institute for Employment Studies for the Health & Safety Executive. (2001). A critical review of psychosocial hazard measures (Contract Research Report 356/2001). http://www.hse.gov.uk/research/crr_pdf/2001/crr01356.pdf
 
Jeon, H. J., Kim, J.-H., Kim, B. -N., Park, S. J., Fava, M., Mischoulon, D., Kang, E. -H., Roh, S., & Lee, D. (2014). Sleep quality, posttraumatic stress, depression, and human errors in train drivers: A population-based nationwide study in South Korea. Sleep, 37(12), 1969–1975. https://doi.org/10.5665/sleep.4252
 
Rail Safety and Standards Board. (2019). Guidance for responding to potentially traumatic incidents in rail.https://www.rssb.co.uk/-/media/Project/RSSB/RssbWebsite/Documents/Registered/Registered-content/Insight-and-News/Health-and-Wellbeing/guidance-for-responding-to-potentially-traumatic-incidents-in-rail.pdf
 
Rail Safety and Standards Board. (2021). The Rail Industry Mental Wellbeing Survey. https://www.rssb.co.uk/what-we-do/key-industry-topics/health-and-wellbeing/mental-wellbeing/how-is-the-mental-health-of-rail-employees
 
Skogstad, M., Skorstad, M., Lie, A., Conradi, H. S., Heir, T., & Weisæth, L. (2013). Work-related post-traumatic stress disorder. Occupational Medicine, 63(3), 175–182. https://doi.org/10.1093/occmed/kqt003
 
UK Psychological Trauma Society. (2018). Traumatic Stress Management Guidance. https://ukpts.org/wp-content/uploads/2018/03/UKPTS-Guidance-on-Traumatic-Stress-Management.pdf