responsibility for others, and lack of job security. The study showed that work stress contributed to heart disease, chronic ulcers, and mental health problems.

A strong link was found between work stress and health status in a subgroup whose jobs were perceived as highly stressful, both by the workers themselves and by experts (i.e. in jobs evaluated as stressful both subjectively and objectively). In a group of employees who perceived their work stress as low, though it was rated high by experts, the incidence of psychosomatic complaints and mental health disorders was less frequent than in a comparative group, where work stress was rated low by both the employees and experts. The design of this study made it difficult to establish a causal relationship between stress and the incidence of mental health complaints. It is hoped that a follow-up study will make it possible to draw inferences about causal relationships.

In 1995, the Institute began research into the psychological consequences of traumatic events in the workplace.¹² These may manifest themselves as post-traumatic stress disorder (PTSD). PTSD can occur as an acute disorder soon after a trauma or have a delayed onset in which symptoms occur more than 6 months after the trauma. It can occur at any age and can follow a natural or man made disaster. The subjects of the study are firemen, policemen, and ambulance service workers. The incidence of traumatic events in these occupational groups is high. Between 70% and 80% of the subjects reported experiencing such events in their work. In about 4% of cases PTSD developed. One of the major risk factors for PTSD turned out to be a lack of opportunity to talk with colleagues about the traumatic event. This finding indicates a need for preventive interventions, in the form of debriefing teams for emergency and rescue service workers.

The Institute of Occupational Medicine has launched an experimental programme of stress management in the police force. A pilot study using two approaches to stress management, is under way at four police stations. In the first approach, psychologists focus on the individual, training the person to become more competent at coping with stress. The second focuses on identifying stressors within the organisation and on finding ways to either eliminate them or diminish their severity. The individual and organisational approaches will each be applied exclusively to one of the four police stations. A combination of the two will be applied to the third station. The fourth station will serve as a control group. Effectiveness will be evaluated during a 24-month follow-up.

Until 1996 Poland maintained a nation-wide database on absenteeism. It recorded number of days lost from work due to disease or accidents, estimated from a random sample of workers employed in state institutions and factories. A preliminary analysis of the data for the years 1990-1994 (i.e. the period of dramatic socio-economic change) indicates that absenteeism resulting from mental health problems increased more than twofold in men, and by over 10% in women. Unfortunately, the analysis treated mental health disorders as a uniform group without identifying specific problems, i.e. depression, anxiety etc. However, the database makes it possible to analyse absenteeism due to mental health problems by gender, age, and economic sector. ¹³

No statistical data is available on costs resulting from the absenteeism of people with depression or on the benefits they receive from insurance companies. There have been no studies on accidents caused by employees with depression/mental illness.