Family and Environmental Factors. Rationale of the Study

Emotionally over- involved family, anxious as well as over –protective families may predispose a person to development of somatization symptoms. It is worth noting that in families that have certain health problems within it, the children born out of these families may develop unexplained medical conditions that mirrors the family`s illness. In addition, existence of physical problems as well as somatization symptoms within the family exposes the upcoming lineage. Chronically stressful situations in most cases predispose the children of such a family to the re-occurrence of the symptoms. Parent’s distress over the un-healing children conditions exposes them to more illness that exposes them to somatization. In a nutshell the distress created out of the development of unexplained medical conditions among the children exposes the parents to chronic distress that leads to somatization. The parents are put into a position that they can`t offer the best care to their children as they also fail to work efficiently. The anxiousness created exposes them to more risks of somatization.      Any illness in the family affects each and every person. For instance if a child is sick, the parents are forced to have decreased leisure time as most of their time is spent while taking care of the kid. On the other hand if a parent is sick, he or she will not attend the duties allocated to him or her effectively. In the long run, the entire society suffers as it tries to offer medical intervention to the sick victim.

Environmental Factors

Academic pressure, peer problems, work-related pressure as well as relationships with work-colleagues as well as teachers may expose both the children as well as the parents in a certain family to somatization. The aspect is due to the fact that back at school the children may not be in a position to absorb all the pressure put in from both her fellow students as well as from his or her teachers. The aspect may expose the child to somatization that may end up affecting the parents. The parents on the other hand may fail to meet all the assigned duties due to the pressure created in their work- places as well as within their family members. In the long run, the entire society is exposed to somatization that may end having negative implications to the economy. The aspect is worsened by the fact that more days are lost as the victims seek medical attention from time to time. The other aspect that makes the debut of this condition to be worse is the fact that most of these symptoms have no relationship with any physiological process such that they are medically unexplained. The parents as well as the victims affected end up sufferings from to time to time and in the long run the whole society suffers. Organizations therefore need to re-organize its duties allocation such that incase of such a situation, their standards are maintained and the working lot aren’t affected by increased work-load. Premises should also ensure that the working schedules are well arranged to minimize any related distress to her workers.

Rationale of the Study

Within the NHS there is a variation in sickness absence rates amongst staff groups [n’s sickness rates]. In England in 2016, NHS Digital reported on sickness absence data compiled from the electronic staff record (ESR) over a six month period. Whilst it has been shown that there is variation in the quality and accuracy of this data, it illustrates overall trends that healthcare assistants (HCA) and ambulance staff had the highest sickness absence rate at 6.25% compared to nursing, midwifery and health visitor students at 1.13% [n’s sickness rates]. Whilst the factors that affect HCAs and ambulance staff leading to this apparent difference have not been studied, it is feasible that the SA demonstrated is influenced by the psychosocial aspects of work. Occupations which impose a risk of poor psychological outcomes have features in common such as job strain; high job demands coupled with low decision latitude, imbalances between effort and reward, support and satisfaction [Sergio]. Imbalance of work and socially defined rewards, such as salary, promotion and recognition, is recognized stress trigger [Sergio]. Healthcare workers who enter the profession to help others may have intrinsic tendencies to over commit to their work, and this group of people, are particularly affected by this type of work related stress. Health risks therefore depend on personal characteristics in addition to the type and place of employment.

Sickness absence is an established surrogate marker for the health of the working population, with strong associations between sickness absence rates and various measures of health [Ferried]. As illustrated earlier, within the NHS the highest cause of SA remains MSDs and attempts to prevent SA have mainly focused on addressing the physical demands of the job. Occupational physicians have tried to prevent MSDs by altering working practices, as they have assumed that ergonomically badly designed workplaces are the primary cause of MSDs. The traditional school of thought is to follow a hierarchy of controls to protect the worker. Tasks have been ergonomically modified to reduce the physical demands on the human body with the aim to minimize tissue injury such as those thought to cause back pain [coggon turning point]. In addition, modern technology has replaced tasks traditionally undertaken by manual labourers and reduced the overall size of the workforce in the manufacturing sector [coggon turning point]. In the NHS, manual handling techniques are taught and the use of hoist employed rather than lifting bed bound patients. Despite this reduction in exposure, the rate of sickness absence attributed to back pain has not decreased as would be expected but increased by a factor of 8 over 40 years [turning point].

The biophysical paradigm (the traditional disease model) does not fully explain the presentation and symptoms of physical disorders of individuals with MSD such as back pain. There is often no pathological cause or the tissue injury does not correlate well to the level of pain and disability. Coggon makes a key distinction between disease and illness that is important when considering causation of sickness absence. Disease is a pathological process that is amenable to objective, external verification. Illness, however, is a subjective state – an indication of how the person feels and their experiences. It may be thought of as the human response and hence may be due to an organic disease or a psychological process. Illness and disease may coexist although they do not always do so [turning point]. A person may have a disease but is asymptomatic and hence do not consider themselves to be ill. Comparably, a person may have no identifiable disease but feels unwell and demonstrates illness behaviour. Simultaneously, research has shown that poor mental health can adversely affect pain and recovery []. Pain is always subjective and defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage []. Pain can persist in the absence of noxious stimuli implying that the subjective and emotional components take a more central role in the causation when poor mental health coexists. This has led researchers to propose the biopsychosocial model, to explain illness behavior. Pain and coping behaviors are influenced by culturally determined health beliefs [Sergio]. Stigma and cultural beliefs amongst healthcare professionals regards mental health conditions often leads to fear of accessing appropriate medical assistance, which is believed could be detrimental to career progression. A culture exists to devalue psychological suffering as compared to physical pain. Illness and sickness behavior secondary to physical diseases is therefore more acceptable. Humans can express emotions through a physical response, some of which are voluntary whilst others are not. Sadness produces tears, embarrassment a red flush of the skin. Stress, anxiety or worry can induce a headache, fatigue and pain. Most people would accept that these physical symptoms are normal and transient manifestations of their emotional state. Others however, find that their behavior around these symptoms changes, causing them to disproportionately worry and focus on these symptoms.  It follows that illnesses that lead to sickness absence where pain is a prominent feature, may not necessarily secondary to a pathological process amenable to conventional treatment, but may be a psychological response to a stress.

The CUPID study showed that there is a strong association between non-specific musculoskeletal complaints and a general tendency to report somatic symptoms [cupid]. Somatising tendency (ST) is defined as a predisposition to be unusually aware of, and to worry about, common somatic symptoms [des epic coggon]. Cultural influences and personal characteristics make certain individual more susceptible to have a Somatising tendency.  Somatization refers to the tendency of a person to have physical symptoms in response to stress or emotions [o’sullivan].It has been demonstrated to be a stable trait and contributes to differences in sickness behavior and sickness absence rates amongst different occupational groups and cultures [des epic, cupid]. Understanding the characteristics of NHS workers with ST and identifying its descriptive epidemiology could be helpful in tackling sickness absence rates. SD sickness absence rates have not declined over the years despite several interventions. Perhaps it is time our approach is changed by understanding the psychological risk factors predisposing to these illnesses and addressing them accordingly.

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