title: Attribution of mental illness to work: a Delphi study.
abstract: BACKGROUND
  Clinicians may be asked whether mental ill-health has been caused by work but there is no guidance on how this judgement should be made.
  
  
  OBJECTIVE
  To seek a consensus on the factors that should be considered and how they should be sought when attributing mental ill-health to work.
  
  
  METHODS
  A three-round Delphi study involving expert academics, occupational physicians, psychiatrists and psychologists. We deemed consensus had been reached when 66% or more of the experts were in agreement.
  
  
  RESULTS
  Of 54 invited experts, 35 (65%) took part in the first round, 30 of these 35 (86%) in the second and 29 of these 30 (97%) in the final round. Consensus was reached for 11 workplace stressors: high job strain; effort-reward imbalance; major trauma; interpersonal conflict; inadequate support; role ambiguity; person-job mismatch; organizational injustice; organizational culture; work scheduling and threats to job security. Seven personal factors were identified as being important: previous mental illness; personality traits of neuroticism; adverse life events or social circumstances; resilience; a family history of mental illness and secondary gain. The worker, manager and co-workers were thought to be the most useful sources of workplace information. Consensus was reached for a definition of occupational mental illness but not for a threshold of work-relatedness.
  
  
  CONCLUSIONS
  The attribution of mental ill-health to work is complex and involves the consideration of both workplace stressors and personal factors of vulnerability. Clinical consultation with an occupational physician who is familiar with the workplace is central to the process.
authors.affiliation: NATS OHS Mailbox 34, Sopwith Way, Swanwick Centre, Southampton SO31 7AY, UK, marcus.wong@nats.co.uk.
authors.forename: M G P
authors.initials: MG
authors.lastname: Wong
authors.affiliation: Department of Occupational Health, Northern General Hospital, Sheffield S5 7AU and Health & Safety Laboratory, Buxton SK17 9JN, UK.
authors.forename: C J M
authors.initials: CJ
authors.lastname: Poole
authors.affiliation: Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, the University of Manchester, Manchester M13 9PL, UK.
authors.forename: R
authors.initials: R
authors.lastname: Agius
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D032921:Consensus; D003697:Delphi Technique; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D009784:Occupational Diseases / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects*; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D017132:Workplace
keywords: Attribution; mental ill-health; work.