Mobbing at the workplace: clinical experience with the MaSD-2 interdisciplinary diagnostic protocol.

The concept of work-related stress encompasses a series of phenomena inflicting physical and mental strain to the individual that can result in severe psychological distress up to the development of well defined psychiatric disorders. Mobbing can be considered as a form of work-related stress in which constant and repeated harassment is voluntarily perpetrated towards a victim by one or more of the victim’s colleagues, superiors or, more rarely, subordinates. Since the early 2000s the Maugeri Operative Unit of Occupational Medicine has been working on the development of an interdisciplinary diagnostic protocol for the evaluation of individual’s exposure to work-related stress and mobbing. The second revision of this protocol, adopted in 2017 and in use until the end of 2019, is the MaSD-2. The meaning of the acronym comes from the Italian “Maugeri Stress e Diagnosi”, and delineates a diagnostic tool employed to assess the presence of risk factors for work-related stress, recognize and analyze the stressors, assess the symptomatology the patient is presenting with and reach a diagnosis. Applicants are individually evaluated by a multidisciplinary staff including occupational medicine specialists, psychologists and a psychiatrist, and submitted a series of questionnaires comprising Short Negative Act Questionnaire [SNAQ], Cognitive Behavioural Assessment 2.0 [CBA 2.0], Structured Clinical Interview for DSM [SCID-II], Minnesota Multiphasic Personality Inventory-2-Restructured Form [MMPI-2-RF] and Maugeri stress index – reduced form [MASI-R]. Clinical records analyzed in this research have been collected by our ward from the beginning of 2017, year of the introduction of the MaSD-2 protocol in clinical practice, until the end of 2019. The records account for a total of 198 cases, 120 women and 78 men, evaluated for the development of suspected psychopathologies allegedly deriving from work-related stress and mobbing. Out of this 198 patients sample, 9 subjects had been also evaluated in the past [before 2017] through the previous version of the Maugeri’s protocol. Re-evaluation of said subjects with the MaSD-2 protocol has confirmed the previously established diagnoses as well as underlined a worsening of the clinical picture in the patients. For 2 of these 9 patients a diagnosis of Paranoid personality disorder [DSM V Axis II cluster A, ICD 10 F60.0] was formulated while the other 7 exhibited a history and symptomatology consistent with a diagnosis of work-induced Mixed anxiety-depressive disorder [ICD 10 F41.2] As for the remaining 189 patients, after evaluation trough MaSD-2 protocol, emerged that 3 subjects didn’t meet the criteria for a psychiatric diagnosis, henceforth were found not to be suffering from a psychiatric pathology. 12 subjects met the criteria for a psychiatric diagnosis but the causal relationship between work-related stress and the disorders diagnosed was disproven and therefore the onset of said pathologies could not be attributable to the occupational environment. A total of 174 patients, 63 males and 111 females, were instead found to be suffering from a psychiatric disorder attributable to the occupational environment: 160 (92%) suffered from an anxiety and/or depressive disorder while 14 (8%) were diagnosed with either AD [12 cases] (6,9%) or AD superimposed to PTSD [2 cases] (1,1%). The Unit’s precedent experience encountered a considerably smaller number of diagnoses of occupational stress induced psychopathologies, but a clear parallelism between this study and our past experiences is found in the nature of diseases diagnosed [predominantly anxiety and/or depressive disorders] and in the presence of a female predominance. At last, this study indicates the necessity to assess, monitor, minimize and, where possible, remove psychological risk factors found in the workplace, in order to decrease the occurrence of pathologies directly linked to occupational stress.