Organisational downsizing and musculoskeletal problems in employees: a prospective study

Objectives - To study the association between organisational downsizing and subsequent musculoskeletal problems in employees and to determine the asso ciation with changes in psychosocial and behavioural risk factors. Methods - Participants were 764 municipal employees working in Raisio, Finl and before and after an organisational downsizing carried out between 1991 and 1993. The outcome measures were self reports of severity and sites of m usculoskeletal pain at the end of 1993 and medically certified musculoskele tal sickness absence for 1993-5. The contribution of changes in psychosocia l work characteristics and health related behaviour between the 1990 and 19 93 surveys was assessed by adjustment. Results - After adjustment for age, sex, and income, the odds ratio (OR) fo r severe musculoskeletal pain between major and minor downsizing and the co rresponding rate ratios for musculoskeletal sickness absence were 2.59 (95% confidence interval (95% CI) 1.5 to 4.5) and 5.50 (3.6 to 7.6), respective ly. Differences between the mean number of sites of pain after major and mi nor downsizing was 0.99 (0.4 to 1.6). The largest contribution from changes in work characteristics and health related behaviour to the association be tween downsizing and musculoskeletal problems was from increases in physica l demands, particularly in women and low income employees. Additional contr ibutory factors were reduction of skill discretion (relative to musculoskel etal pain) and job insecurity. The results were little different when analy ses were confined to initially healthy participants. Conclusions - Downsizing is a risk factor for musculoskeletal problems amon g those who remain in employment. Much of this risk is attributable to incr eased physical demands, but adverse changes in other psychosocial factors m ay also play a part.