Work-related stress and mobbing: presentation of a new interdisciplinary diagnostic protocol and case record

Occupational stress has been steadily increasing over the past years and it can cause severe psychopathological consequences. The “psychological and psychosomatic disorders due to dysfunctional working environment” (namely Adjustment Disorder -AD- and Post-Traumatic Stress Disorder -PTSD-) are included in the list of disorders for which filing a complaint is mandatory by law. The Maugeri ICS Institute of Pavia (affiliated with the University of Pavia) has put into place, since the early 2000s, a multidisciplinary assessment process that helps patients improve their psychological well-being and their reintegration in the workplace. In 2017 the assessment process has been updated to what is now the MaSD-2 (Maugeri Stress Diagnosis, second version). The MaSD-2 interdisciplinary diagnostic protocol includes: an occupational medicine evaluation, a psychologic interview, a psychiatric evaluation and psychodiagnostic tests. The tests are: Short-Negative Acts Questionnaire (S-NAQ), Cognitive Behavioral Assessment 2.0 (CBA2.0), Structured Clinical Interview for DSM (SCID), Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and Maugeri Stress Index – Reduced Form (MASI-R). In the three-year period spanning 2017-2019, 198 patients, that claimed to have a work-related stress disturbance, were evaluated with the MaSD-2 (120 women and 78 men, average age ± SD: 4,9 ± 9,0 years). Nine patients (4,5%) had already been examined with the original version of the diagnostic protocol, they all received confirmation of the original diagnosis (2 patients were affected by paranoid personality disorders, 7 by work-related anxiety-depressive disorder). Among the remaining 189 patients, 3 (1,6%) had no psychiatric disturbances, 12 (6,3%) had a non-work-related psychiatric disorder (anxiety disorder, mood disorder, personality disorder), 160 (84,7%) were affected by a work-related anxiety and/or depressive disorder. In 12 cases (6,3%) the diagnosis of AD was made and 2 patients (1.1%) were diagnosed with AD in prior PTSD. These constituted a total of 14 medico-legal reports that were sent to the competent authorities. Compared to the past, the case record showed a much higher percentage of work-related stress disorders. This is probably be due to a higher sensitivity of the MaSD-2 and to a better selection of the patient that come to the Maugeri Institute. Women, healthcare workers and employees in the services working sector are, as in the past, those more at risk of developing a work-related stress disorder. The diagnoses of AD and PTSD remain rare: it is therefore of critical importance that all the cases undergo a rigorous, prudent interdisciplinary diagnostic protocol before starting medico-legal procedures. Finally, adequate preventive measures should be put into place in order to prevent work-related stress disorders.