The recognition of psychosocial disorders as occupational diseases

Introduction: Psychosocial disorders are commonplace among workers and can, under certain conditions, be recognized under occupational disease legislation. This involves the use of a specific medical-administrative system. Research aim: Psychosocial disorders “constitute the second largest group of occupationally-induced conditions affecting the French working population.” The path to getting these conditions recognized with a medical certificate is poorly understood by patients. We outline the medical-administrative system in place to recognize occupationally-induced psychological disorders, highlighting, in particular, medical confidentiality between the various parties involved. Results: The psychosocial risks identified are as follows: stress, internal violence committed by workers, external violence against employees, and professional burnout syndrome. The main factors of these risks are as follows: work demands, emotional demands, lack of autonomy and room for maneuver, poor social and work relationships, value conflicts, and job insecurity. The consequences are as follows: depressive episodes, anxiety disorders, post-traumatic stress disorders, and suicidal tendencies. “Burn-out” or professional exhaustion syndrome may be considered and studied as part of an occupational illness claim if it is accompanied by an adjustment disorder, an anxiety disorder, a depressive disorder, or a post-traumatic stress disorder. The system for recognizing an occupational illness includes a declaration of occupational illness and an initial medical certificate mentioning the mental disorder. Additional information required includes a degree of seriousness, as assessed by a French National Health Insurance (CNAM) medical advisor, a description of the employee’s working conditions by an official French Primary Health Insurance Fund (CPAM) investigating officer, a confirmation of the direct and fundamental link between the psychological disorder and the employee’s usual professional activity by the Regional Committee for the Recognition of Occupational Diseases (CRRMP), and notification of the CPAM’s decision concerning the employee. Conclusions: The drafting of medical certificates for occupational accidents and illnesses constitutes a legal exception to medical confidentiality. With regard to French tables of occupational diseases, the doctor must draw up a certificate indicating the nature of the illness, its manifestations, as well as its probable consequences. The doctor must declare all symptoms and illnesses not included within the list of French tables of occupational disease, if they are of an occupational nature. Mental pathologies can, under certain conditions, fall under the complementary system of occupational disease outside of the table system, provided they qualify for the initial medical certificate and that they reach a certain degree of seriousness.