An official American Thoracic Society systematic review: Influence of psychosocial characteristics on workplace disability among workers with respiratory impairment.

RATIONALE Psychosocial characteristics likely play an important role in the severity of workplace disability for workers with a respiratory impairment. OBJECTIVES We performed a systematic review of the available literature to examine the impact of psychosocial characteristics on workplace disability among workers with a respiratory impairment. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, we searched Medline and other published and unpublished sources using the PubMed and Cochrane Central Register of Controlled Clinical Trials (CENTRAL) search engines from January 1, 1990 through March 8, 2013 for quantitative studies that examined the association of psychosocial characteristics with workplace disability among workers with a respiratory impairment. We also searched related citations and the bibliographies of selected studies and relevant review articles. One investigator abstracted data about study design and quality, psychosocial characteristics, and outcome measures. MEASUREMENTS AND MAIN RESULTS Of 5,746 potentially relevant studies, 20 met eligibility criteria and were included. Studies reported heterogeneous outcomes among heterogeneous samples of workers that precluded a quantitative synthesis. In general, mental illness was associated with increased workplace disability among workers with respiratory impairments. Few studies adjusted for disease severity, so the independent association of psychosocial characteristics and workplace disability is unclear. Most studies were cross-sectional, so the direction of the association could not be determined. We found only one trial of targeted therapy for the psychosocial condition, which was not effective at reducing disability. CONCLUSIONS Psychosocial characteristics likely influence workplace disability in workers with respiratory impairments. The impact of targeted therapies is unclear and warrants further study.