Is pre-employment health screening by questionnaire effective?
BACKGROUND
Following a job offer, many employers require the chosen candidate to undergo health screening by questionnaire before the applicant commences work. Despite their widespread use, the effectiveness of such questionnaires remains uncertain.


OBJECTIVE
To systematically review the evidence for the effectiveness of pre-employment health questionnaires in predicting health and employment outcomes.


METHODS
We used a sensitive search strategy to search electronic databases from 1985 to September 2009. The search included dissertations for Membership of the UK Faculty of Occupational Medicine (MFOM). The authors independently selected abstracts and papers for critical appraisal and inclusion in the review using methods based on guidelines produced by the National Health Service Centre for Reviews and Dissemination, University of York.


RESULTS
Five hundred and three abstracts were identified; nine papers and two MFOM dissertations were critically appraised. Seven papers and two MFOM dissertations were included in the final review. Six studies explored pre-employment predictors of respiratory symptoms, one explored predictors of back pain in nurses, and two dissertations explored work outcomes including sickness absence and ill-health retirement. No papers addressing mental health outcomes met our inclusion criteria. Included studies either failed to identify pre-employment predictors of health and work outcomes or found very weak predictors.


CONCLUSIONS
Pre-employment health screening (PEHS) by questionnaire has a low predictive value in detecting future adverse health and occupational outcomes. Where PEHS takes place, the health standards required and criteria for rejection of applicants should be based on a full risk assessment of the prospective post.
Occupational Health Department, Guy's and St Thomas' NHS Foundation Trust, London, UK. ira.madan@kcl.ac.uk
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Madan
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Williams
D006801:Humans; D008403:Mass Screening; D016272:Occupational Health; D011237:Predictive Value of Tests; D018570:Risk Assessment; D011795:Surveys and Questionnaires