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Introduction
While globalization and technological advances have certainly opened up many opportunities for economic growth and development, they have also brought about considerable challenges in terms of managing new forms of work organization and employee relations (Perry-Jenkins & Wadsworth, 2017). In this light, jobs have become increasingly more complex and cognitively more demanding. Employees are thus required to not only devote high levels of energy to perform their work roles (Maslach & Leiter, 2016) but also invest significant resources in their own professional development by going through lengthy and expensive educational programs to be able to increase (or even maintain) their employability and career prospects in a considerably more competitive labor market (Cappelli & Keller, 2017). Moreover, as employee-employer relations have become more transactional in nature (see Rousseau, 2008), there has been a surge of part-time contracts and short-term employment agreements, which have resulted in greater uncertainty and job insecurity for individuals (Gallie et al., 2017).
Technological advances also play a role in this changing workplace context. Thus, even when the emergence of smart phones, video calls, and many other technological advances has increased job flexibility (in terms of both time and location) and has definitely opened a wider spectrum of job opportunities that transcend local and regional boundaries for highly skilled individuals, it has undoubtedly contributed to the blur of boundaries between work and personal life (Leung & Zhang, 2017). Indeed, organizations often expect (or even require) their employees to 'be available' and respond quickly to job-related issues outside working hours, which may increase the likelihood of conflicts (or interferences) between the demands of work and those of other spheres of life (International Labor Organization, 2016). All of these considerations become of heightened importance when considering the fact that for the past year and a half the COVID-19 pandemic has considerably increased the psychosocial risks to which employees are exposed, imposing unprecedented job demands on their work life (see Franklin & Gkiouleka, 2021).
The scenario described above and its multiple implications for employees' well-being and organizational effectiveness has led to a significant increase in scholarly and managerial attention devoted to the study of the factors and underlying dynamics that expose individuals to higher psychosocial risks at work, especially in disciplines like organizational psychology, human resource management, and public policy (Neffa, 2015). In this context, the term 'psychosocial risks' is an umbrella concept that reflects an aggregate of work-related factors (or psychosocial factors) that either by excess, absence, or combination pose a risk to the physical and/or psychological health of individuals (Meliá et al., 2006). It should be noted that psychosocial risks arise not only when job demands (or job stressors; e.g., emotional demands) are high but also when the resources provided by organizations are insufficient to cope with those demands (e.g., inadequate leadership style) (Pujol-Cols & Lazzaro-Salazar, 2018).
Some studies have shown that a high, sustained, and chronic exposure to psychosocial risks (such as the ones discussed above) is likely to lead to the experience of occupational distress, which, in turn, has been found to be associated with several symptoms indicating poor health status, including, for instance, psychiatric symptoms and cardiovascular diseases (e.g., Arial et al., 2010; Kivimäki & Kawachi, 2015). Moreover, past research has also demonstrated that psychosocial risks have many implications for organizational performance, as they may increase, for instance, absenteeism, medical costs, occupational disability, work-related accidents, and turnover (e.g., Bjerkan, 2010; Borritz et al., 2010; Fukui et al., 2019; Hinkka et al., 2013; Kuusio et al., 2013). Individuals experiencing occupational distress may also be more prone to engaging in counterproductive behaviors, service sabotage, and interpersonal conflicts with colleagues, subordinates, or supervisors, and become less innovative and creative, which altogether may affect organizational performance (e.g., Albort-Morant et al., 2020; Bowling & Eschleman, 2010; Chi et al., 2013; Meier & Spector, 2013; Rich, 2016).
In spite of the far-reaching effects of psychosocial risks on individuals' health and on organizational performance, most research on the relationship among these three aspects of organizational life has been conducted in Anglo-Saxon contexts, particularly in Europe and the United States (see García et al., 2016; Pujol-Cols & Lazzaro-Salazar, 2018). In this regard, contributions of studies examining this relationship in Latin-American contexts remain modest and scattered (consider Monroy-Castillo & Juárez-García, 2019), which raises the need to do a systematic and critical review of the research available to date in order to identify their contributions and limitations for the Latin American region. In this regard, it is worth noting that most systematic reviews of this relationship (e.g., Franklin & Gkiouleka, 2021; Lang et al., 2012) have considered only papers in English, indexed in international databases, such as the Web of Science, thus ignoring to a considerable extent studies conducted in Latin America. Furthermore, most systematic reviews of this relationship that do include Latin-American studies have focused on only one profession or occupation and one kind of psychosocial risk (see Monroy-Castillo & Juárez-García, 2019; Tabares-Díaz et al., 2020), which also contributes to producing scattered empirical evidence of this relationship. In this sense, because psychosocial risks affect all positions and professions and, therefore, may be considered a global issue, a comprehensive systematic review of the studies involving all kinds of occupations and professions that examine the effects of a wide variety of psychosocial risks on individuals' health and organizational performance remains vital to, on the one hand, provide evidence of the cultural validity of the results of Anglo-Saxon research, and, on the other hand, design preventive strategies that consider the particularities of the Latin-American context (see considerations in Kortum & Leka, 2014; Kortum et al., 2010).
This paper then reports the results of a comprehensive and critical systematic review of studies that examined the relationships between work-related psychosocial risks, health, and performance in Latin America over the last ten years. The paper contributes to the literature on psychosocial risks, health and performance by (a) critically reviewing and integrating the most recent studies on this topic in Latin America, (b) identifying their main limitations at multiple levels of analysis, and (c) proposing future lines of research that update the debate on this relationship and move this field of study forward.
Theoretical Framework
Psychosocial Risks and Health Outcomes
Before delving into the methodology and analysis of this review, it is relevant to revise some of the theoretical constructs that underpin the field's core theories, models, and assumptions in the study of the relationship between psychosocial risks, health outcomes, and organizational performance. In this light, it is first important to reflect on the fact that individuals' work involves numerous psychosocial factors that reflect both the characteristics of the tasks or responsibilities associated with a particular position in an organization (that is, the intrinsic psychosocial factors of a job) and of the physical, organizational, and social context in which those tasks are performed (that is, the extrinsic psychosocial factors of a job). The way these aspects are planned, organized and structured by organizations may affect the chances that employees experience strain (that is, a physiological reaction to the feeling that their personal resources 'crumble') in response to work-related factors (Oldham & Fried, 2016; Parker et al., 2017). In this sense, these psychosocial factors may expose individuals to a varying degree of 'psychosocial risks' (also called 'psychosocial hazards'), which reflect an aggregate of work-related factors (or psychosocial factors) that either by excess, absence, or combination pose a risk to the physical and/or psychological health of individuals (Meliá et al., 2006). The term 'risk' is used here to indicate that a particular combination of psychosocial factors does not necessarily damage employees' health but, instead, may either increase or decrease the likelihood that they experience strain in the workplace and, therefore, exhibit a poor health status.
From a demand-resource theory perspective (Demerouti et al., 2001; also see Bakker & Demerouti, 2017), every job or profession requires individuals to invest different physical and/or psychological resources while performing their work roles, which are commonly known as job demands (or job stressors). Job demands are expected to negatively affect individuals' wellbeing through health impairment processes, as these tend to drain their personal resources over time and lead to, for instance, anxiety, exhaustion, burnout, psychiatric symptoms, cardiovascular diseases, and musculoskeletal disorders (e.g., Arial et al., 2010; Bailey et al., 2015; Cañadas-De la Fuente et al., 2015; Kivimäki & Kawachi, 2015; Murcia et al., 2013). To mitigate the psychological and physiological costs of job demands as much as possible, organizations often provide their employees with various job resources, such as a clean working space, a fair compensation, access to relevant information, a supportive leadership style, and a healthy social environment, among others. Job resources not only help individuals to reach their goals but also lead to positive states, as they are likely to increase their motivation and personal fulfillment over time (Tadi et al., 2015; Xanthopoulou et al., 2007). With these considerations in mind, it follows that psychosocial risks may arise not only when job demands, such as emotional demands, are high but also when the resources provided by organizations, such as an inadequate leadership style, are insufficient to cope with those demands (Pujol-Cols & Lazzaro-Salazar, 2018; Schaufeli, 2017).
Regarding the operationalization of the psychosocial risks construct, it should be noted that numerous models and taxonomies have been proposed so far in the literature. First, Karasek's (1979; also see Karasek & Theorell, 1990) demand-control-social support model argues that occupational distress occurs when jobs pose high psychological demands on individuals but provide them with low levels of work control (that is, the extent to which an employee is able to participate or exert a meaningful influence on those decisions that affect their job and is offered enough chances to develop new capabilities or skills) and social support (that is, the extent to which an employee feels they can count on their supervisors or colleagues both instrumentally and emotionally when needed). In a similar vein, Siegrist's (1996) effort-reward imbalance model proposes that individuals experience distress when the rewards they receive (such as monetary compensations, opportunities for career advancement, job stability, and recognition) are insufficient when compared to the contributions (or efforts) they make. Finally, Moorman's (1991) organizational justice model argues that the deterioration in employees' health can be explained by their beliefs concerning what is fair or unfair in the organization regarding, for instance, their relationships with their supervisors or colleagues, the procedures followed in decision making, the extent to which relevant and reliable information is shared, and how resources are distributed and allocated. From this last perspective, occupational distress emerges as a consequence of a perceived violation of a set of shared, socially-construed norms of organizational justice (see the concept of relational, informational, procedural, and distributional justice in Moorman, 1991).
The three models explained above have played a significant role in the literature on psychosocial risks, and their principles have been used as the rationale for many studies around the world (see Neffa, 2015). In the Ibero-American literature in particular, increasing attention has been given to the so-called ISTAS model (Moncada et al., 2014), which was developed by the Spanish Trade Union Institute of Work, Environment, and Health (in Spanish, Instituto Sindical de Trabajo, Ambiente y Salud de España) based on the early contributions of Karasek (1979), Siegrist (1996), and Moorman (1991). This model claims that individuals experience occupational distress when there is an imbalance between their personal resources and a set of psychosocial factors representing both job demands and job resources. More specifically, the ISTAS model identifies six work-related factors that expose individuals to higher psychosocial risks. “Psychological demands” reflect those aspects of the job that require a sustained cognitive or emotional effort, including, for instance, the volume and intensity of workload. “Double presence” (also known as 'work-family conflict') refers to the extent to which the individual struggles to balance the demands of work and those of their family, such as being unable to attend a school event as a consequence of having to work overtime. “Job insecurity” increases when the employee experiences a high level of uncertainty regarding the continuity of their current working conditions (e.g., the possibility of being fired or demoted). “Work control” (also called 'autonomy') reflects the degree to which the individual is provided with sufficient opportunities to participate in the decisions that affect their work and apply different skills and knowledge. “Social support” refers to the extent to which the employee feels they can count on their supervisors or colleagues when needed. Finally, “esteem” increases when the individual feels that the compensations they receive are adequate and fair when compared with the efforts they make, including, for instance, monetary compensations, or symbolic rewards.
Most papers reviewed in this study draw on these four models and the different constructs revised here as they explore the relationship between psychosocial risks and health outcomes, which is why they will be made relevant at different stages of our exploration of the papers selected for this review.
Psychosocial Factors and Organizational Performance
In addition to the effects of psychosocial risks on individuals' health, past research has shown that they may also affect organizational performance in several ways. At the individual level, those employees who are exposed to an excessive and sustained level of psychosocial risks may suffer from a severe resource loss over time (i.e., they are likely to feel that their resources 'crumble' in their efforts to face and respond effectively to psychosocial risks) and experience high levels of strain and exhaustion, which may subsequently affect their productivity, creativity, and innovative potential (e.g., Albort-Morant et al., 2020; Liu et al., 2013; Rich, 2016). Moreover, individuals who feel organizations exert too much pressure on them or who believe their organizations do not do enough to help them cope with psychosocial risks may also be more likely to engage in counterproductive behaviors and service sabotage, all of which may impact on organizational performance (e.g., Bowling & Eschleman, 2010; Chi et al., 2013; Meier & Spector, 2013). At the group level, individuals experiencing occupational distress may be more irritable, impatient, negative, and 'on edge', which could make them more prone to engaging in interpersonal conflicts with colleagues, subordinates, or supervisors (Cox, 2003; Pross & Schweitzer, 2010). Altogether, at the organizational level, psychosocial risks may result in, for instance, absenteeism, high medical costs, occupational disability, work-related accidents, and turnover (e.g., Bjerkan, 2010; Borritz et al., 2010; Fukui et al., 2019; Hinkka et al., 2013; Kuusio et al., 2013). Thus, critically examining the Latin-American literature that investigates the relationship among a wide variety of psychosocial risks, individuals' health and organizational performance will allow us to propose new research avenues that help design preventive strategies that promote healthy organizational environments and employees' wellbeing considering the particularities of the Latin-American context.
Method
To maximize the chances of identifying all relevant research on psychosocial risks, health, and performance in Latin-American countries, we performed separate searches in five electronic databases, including the Web of Science (WoS), Scopus, ProQuest, LILACS (Latin American and Caribbean Health Sciences Literature), and SciELO (Scientific Electronic Library Online) following guidelines in Moher et al. (2009). We introduced different combinations of keywords in both English and Spanish in advanced searches limited to the title, abstract, and descriptors. This set of keywords was selected to reflect the different ways in which the constructs 'psychosocial risks', 'health', and 'performance' have appeared most commonly in the literature, such as 'stressors', 'well-being', and 'effectivity', respectively (see Table 1). It is worth mentioning that these keywords did not intend to reflect any theoretical model in particular, but rather were sufficiently wide in scope to enable the identification of a large number of studies on the topic. Moreover, to select the most recent developments in the field, we prioritized research conducted in the last ten years (2010-2021).
Following Lipsey and Wilson (2001), to minimize publication bias, we did not limit our searches exclusively to journal articles but also included book chapters, dissertations, technical reports, and conference proceedings. Eligible studies had to (a) be published in either English or Spanish1, (b) be conducted in a Latin-American country, (c) be published in the 2010-2021 period, (d) provide empirical evidence (for this reason other types of articles, such as editorial letters, were excluded), and (e) involve human participants who were active workers or were in some kind of an employment relationship (other types of human subjects, such as students, were excluded from the systematic review). This procedure resulted in the identification of 254 articles (234 after the elimination of duplicates; see Figure 1). Further, we proceeded to eliminate those articles that either (a) did not focus on a topic related to psychosocial risks, (b) were not conducted by following a quantitative approach, or (c) did not empirically examine a relationship or association between a measure of psychosocial risks and a measure of health or between a measure of psychosocial risks and a measure of performance. The aforementioned combination of strategies resulted in the identification of 85 papers for analysis. A reference list of studies included in the present analysis can be found in the References section.
We then conducted a critical analysis of the papers that were included in the systematic review in order to evaluate the most recent advances in the literature on psychosocial risks, health, and performance in Latin America to identify the main limitations of the field and to propose relevant and attractive avenues for future research. Each article was analyzed separately and then described in terms of how the constructs of interest were operationalized, the statistical techniques used to examine the proposed relationships, the characteristics and size of the sample (or samples) collected to test the models, and their main findings and limitations (see Tables 2 and 3).
Results
Overview
The combination of strategies described in the previous section resulted in the identification of 85 papers. Table 4 provides an overall characterization of these studies in terms of the countries where they were conducted, their research design, the context and sample in which the data were collected, the kind of instruments that were used to measure the variables of interest, and the statistical techniques that were applied to test their hypotheses. These aspects are further discussed in the following sections.
Theoretical background and operationalization. As shown in Tables 2 and 3, most of the studies have drawn on Karasek and Theorell's (1990) model and, to a comparatively lesser extent, Siegrist's (1996) model. Some of this research has taken a more comprehensive and holistic approach to the study of the relationship among psychosocial risks, health, and organizational performance, as scholars such as Griep et al. (2011) have demonstrated that the predictive power may increase when both theoretical perspectives are simultaneously considered in the measurement models. A minor proportion of studies have drawn on less validated models, such as the ISTAS model (e.g., Rojas et al., 2019), or did not provide a clear theoretical rationale for their study (e.g., Silva Henao et al., 2014).
As a consequence, variables such as job demands (or more specific constructs such as 'psychological demands', 'physical demands' or 'emotional demands'), autonomy (also labeled as 'job control', 'work control', 'decision latitude' or 'decision authority'), social support (or some more specific constructs such as 'supervisory support', 'coworker support' or 'social support from colleagues and leaders'), effort-reward imbalance, and overcommitment represent the most widely used taxonomies to measure psychosocial risks. A significantly lower percentage of studies have considered more specific categories of work-related characteristics that may represent psychosocial risks, including, for instance, work-family conflict (e.g., de Oliveira & Carlotto, 2020), verbal violence (e.g., Alcantara et al., 2019) or exposure to night work (e.g., Silva-Costa et al., 2018). An even smaller proportion of studies have included more context-specific measures, such as the characteristics of the nurse-physician relationship, when studying psychosocial risks in healthcare institutions (e.g., dos Santos Alves et al., 2017).
Regarding the health construct, most studies have focused on the physical domain of health and examined, for instance, the implications of psychosocial risks in the experience of musculoskeletal disorders, that is, the different conditions that affect muscles, bones, and joints and include, for example, neck, shoulder, or back pain (e.g., da Silva et al., 2017). Some other studies have followed a more psychological approach and investigated various illnesses or disorders mostly associated with the mind such as depersonalization (e.g., Pujol-Cols et al., 2021), burnout (e.g., Nogueira et al., 2018), common mental disorders (e.g., Mattos et al., 2017), psychiatric disorders (e.g., Pinhatti et al., 2018), and depressive symptoms (e.g., Palma-Contreras & Ansoleaga, 2020). At this point, it should be noted that even when this research stream has mostly studied negative phenomena, a few other studies have taken a more positive stance and examined the effects of work-related factors on positive health-related states such as health-related quality of life (e.g., Ordóñez-Hernández et al., 2017).
Finally, as shown in Table 3, the relationships between psychosocial risk factors and performance have been rather scarcely explored in the literature. Indeed, only a small amount of studies have shed light on the effects of work-related factors on variables associated with performance including, for instance, work ability (that is, a worker's capacity to perform their work as a result of the influence of work demands and their mental and physical health status; e.g., de Alcantara et al., 2019), productivity (e.g., Umann et al., 2014), individual performance (e.g., Perugini et al., 2018), turnover intentions (e.g., de Oliveira & Rocha, 2017), absenteeism (e.g., Guerrero et al., 2020), and work accidents (e.g., Useche et al., 2018). Very interestingly, this research focuses exclusively on the individual aspects of performance and none of the selected studies examined these effects at the group (such as group effectiveness) or at organizational level (such as profitability).
Context of study and sample. As shown in Table 4, research in this field in the Latin-American context seems to be mainly led by Brazil, as the majority of selected studies (62.35%) were conducted in this country. A significantly lower proportion of studies included participants from other countries, like Argentina (e.g., Pujol-Cols & Lazzaro-Salazar, 2020), Chile (e.g., Ansoleaga et al., 2019), Mexico (e.g., García-Rojas et al., 2015), or Colombia (e.g., Astorquiza Bustos et al., 2018). Moreover, and though some of these studies (27.06%) have included numerous participants from diverse occupational backgrounds (e.g., Gómez Ortiz et al., 2020), most studies involved smaller and more homogeneous samples of employees from a single context of study or organizational setting. In fact, our review shows that the highest proportion of studies have drawn on evidence collected in the healthcare sector (e.g., Martínez & Fischer, 2019a) or in educational institutions (e.g., Pujol-Cols et al., 2021).
Data collection and analytical techniques.Table 4 shows that the majority of the selected studies (97.65%) have used cross-sectional designs, a significantly smaller number of studies (2.35%) have relied on longitudinal designs (e.g., Martínez & Fischer, 2019b) and, surprisingly, none of the selected papers collected data through diary studies. Regarding data collection techniques, most research has relied on self-report scales whose reliability and validity is well established in the literature. Examples of these instruments are the Job Content Questionnaire (JCQ), the Effort-Reward Imbalance (ERI) questionnaire, and the SUSESO-ISTAS questionnaire to measure psychosocial risks; the Nordic Musculoskeletal Questionnaire to examine musculoskeletal disorders; the Maslach Burnout Inventory (MBI) to measure emotional exhaustion, depersonalization, and professional inefficacy; and the Work Ability Index (WAI) to measure self-performance. Nonetheless, it is worth highlighting the fact that a significant amount of articles analyzed here reported using ad-hoc scales, that is, an instrument specifically designed for the purposes of the study, and only a small proportion of them conducted a proper assessment of their psychometric properties.
Although, as discussed above, most studies on the relationships among psychosocial risks and health, particularly among psychosocial risks and performance, have relied on cross-sectional and self-reported data (97.65% and 90.59% of the selected papers, respectively), some of them have gone one step further in terms of methodological sophistication and considered more objective measures of the constructs of interest. To provide an example, Cendales-Ayala et al. (2017) examined the effects of job demands and decision latitude (or work control) on the performance and well-being of a sample of bus drivers by adopting an experimental approach and manipulating the level of exposure to psychosocial risk factors. In addition, Lopes Juvanhol et al. (2017) measured participants' casual blood pressure by using a validated oscillometric device to produce a more objective health status of the employees in their study. Similarly, Tavares et al. (2017) examined individuals' salivary cortisol by collecting, centrifuging, freezing, and analyzing samples of saliva in their study of the role of effort impairment in the health status of military police officers in Brazil. More recently, Silva-Costa et al. (2018) examined carotid intima-media thickness through image analysis and also included other objective indices and measures that are relevant in examining cardiovascular health, such as body mass, waist circumference, hypertension, cholesterol level, and blood glucose.
Regarding the analytical strategies and techniques used in the studies reviewed here, Table 4 shows that only a relatively small percentage of papers (25.88%) performed only bivariate analysis to test their hypotheses, such as the estimation of chi-square statistics, t-test statistics, or correlation coefficients (e.g., Nogueira et al., 2018). The majority of the selected studies (74.12%) conducted multivariate analysis, such as logistic regressions (e.g., Palma-Contreras et al., 2020), hierarchical regressions (e.g., Pujol-Cols & Lazzaro-Salazar, 2020), multinomial regressions (e.g., Martinez & Fischer, 2019b), Poisson regressions (e.g., Rocco et al., 2017), and structural equation modeling (e.g., Pujol-Cols et al., 2021). This approach allowed researchers to test the relative influence of several predictors simultaneously and to control their results for the effects of numerous covariates or control variables.
Bibliometric impact.Table 5 provides an assessment of the bibliometric impact of the 52 journals in which the 85 selected papers of the review were published. Most of these journals are from Latin-American countries (63.46%), and the remaining ones from European countries (19.2%), the USA (9.6%), and Asian countries (5.7%). Of the Latin-American journals, Brazil concentrates 63.6% of the scholarly productivity in the field, followed by Colombia with 18.1%. Moreover, while a few journals are only indexed in either Scielo (25%) or Scopus (30.8%), most journals are indexed in both Scopus and WoS (44.2%). Sixty-one point five percent of those papers found in journals indexed in WoS and/or Scopus were published in the highest two quartiles according to the 2019 H-Index of the Scimago Ranking, and 38.5% were published in Q3 and Q4 journals. Finally, only 28 papers were published in Q2 Latin-American journals, while none of the Q1 journals belong to Latin-American countries (USA = 3, UK = 3, and South Korea = 1).
Exploration of the Effects of Psychosocial Risks on Health and Performance
Psychosocial risks and health. Overall, research has shown that an increasing exposure to psychosocial risks is associated with a poorer health status (e.g., Gómez-García et al., 2020; Gómez Ortiz et al., 2020). In this regard, previous studies have reported significant correlations between, for instance, high strain (a situation in which the individual faces high job demands and is provided with insufficient job control) or effort-reward imbalance, and common mental disorders (e.g., Araújo et al., 2016; Mattos et al., 2017). In this context, common mental disorders consist of various symptoms associated with mental health problems that affect an important part of the population by causing them suffering and functional impairment. These include, for instance, anxiety, decreased vitality, depressive thoughts, fatigue, and insomnia (see de Oliveira & Carlotto, 2020). More specifically, Valente et al. (2016) found that high strain, effort-reward imbalance, and overcommitment were related to depressive symptoms (also see Ansoleaga & Toro, 2010; Ansoleaga et al., 2014). Similarly, Ansoleaga (2015) demonstrated that isostrain (a situation in which the employee is exposed to high job demands but receives insufficient social support from their coworkers or leaders) was associated with depression in a sample of 782 workers from a healthcare center in Chile.
In addition to the implications of work-related factors on mental health, previous studies have also reported significant associations between psychosocial risks and physical health symptoms (Pujol-Cols & Lazzaro-Salazar, 2020). For instance, Rocco et al. (2017) found that individuals with low skill discretion, decision authority, and social support tended to report lower cardiovascular health in a large sample of 11,351 workers in Brazil. Some other studies, however, have obtained inconclusive results regarding the relationship between psychosocial risks and cardiovascular health. For instance, García-Rojas et al. (2015) and, more recently, Muniz et al. (2019) reported mixed findings regarding the impact of psychosocial risk factors and cardiovascular risks, which suggests that these effects may not be so straightforward and may be, in fact, affected by other third variables. In this sense, personal lifestyle might assume a relevant mediating role in these relationships, since workers who are exposed to more stressful working conditions (such as high strain) tend to have a worse diet, reduced physical activity, and smoking profiles (e.g., Muniz et al., 2019; Rocco et al., 2017), which may increase their body mass index and chances of suffering from, for instance, diabetes (see Silva-Costa et al., 2018). In a similar vein, Ansoleaga et al. (2015) and, more recently, Palma-Contreras et al. (2020) found that job strain due to an excessive exposure to psychosocial risks was associated with substance abuse, which may subsequently affect individuals' health status in the long term.
Musculoskeletal disorders represent, perhaps, the most widely studied phenomena in the literature on psychosocial risks and health. Overall, research has shown that the presence of high physical and psychosocial demands is related to neck, shoulder, leg, and back musculoskeletal disorders (e.g., Fernandes et al., 2010; García et al., 2010; Magnago et al., 2010). More specifically, Márquez Gómez and Márquez Robledo (2016) reported that shoulder and neck disorders were more strongly associated with bad posture, work repetitiveness, and psychological demands, whereas back disorders were more strongly associated with poor posture and physical demands. Regarding the influence of job resources (or, in this case, insufficient job resources) in particular, Melzer and Iguti (2010) provided evidence that lack of work control and poor relationships with supervisors were associated with musculoskeletal pain.
Psychosocial risks and performance. As mentioned in previous sections of this article, the relationship between psychosocial risks and performance remains largely understudied, especially when compared to the effects of work-related factors on individuals' health and wellbeing. In this light, this systematic review resulted in the identification of only 19 papers that examined the relationship between psychosocial risks and performance-related phenomena. As shown in Table 3, the most widely studied construct in this research stream is work ability, that is, a worker's capacity to perform their work as a result of the influence of work demands and their mental and physical health status. In this regard, studies have shown that an increasing exposure to high strain conditions, effort-reward imbalance, and workplace violence is significantly related to lower work ability (e.g., Fischer & Martinez, 2013; Martinez et al., 2015; Prochnow et al., 2013).
The findings and implications discussed above are in line with studies that examined the effects of psychosocial risks on other performance-related variables at the individual level. To provide an example, Umann et al. (2014) found that job stressors, such as interpersonal relations, role stressors, and intrinsic work factors, were positively related to lost productivity. More recently, de Souza-Talarico et al. (2020) demonstrated that high strain jobs were associated with lower cognitive performance scores.
Most of the studies included in this systematic review have focused on the direct effects of psychosocial risks on performance, but the mechanisms and dynamics through which an increasing exposure to psychosocial risk factors is related to lower performance levels remain unclear in the Latin-American literature. In this regard, Alcantara et al. (2019) shed some light on this matter by showing that work characteristics (e.g., high demands, social support, noise at work, verbal violence) exhibited not only a direct effect on work ability but also an indirect, mediating effect via health status, revealing that a poorer health status was associated with lower work ability (also see Ferreira & Carvalho, 2016). In addition to the effects of individuals' health on individual performance, it should be noted that some studies have demonstrated that employees' health status and strain levels due to their exposure to psychosocial risks may affect performance at the organizational level by increasing sickness leaves and medical costs (e.g., Guerrero et al., 2020).
Furthermore, research has shown that psychosocial risks may have a negative impact on employees' job attitudes, particularly on their organizational commitment, and intentions to leave a particular profession or job (e.g., de Oliveira et al., 2017; de Oliveira & Rocha, 2017). Although these individual-level variables may not exert a direct effect on organizational performance, they may affect it indirectly by increasing the costs associated with absenteeism, turnover, and dismissal rates (e.g., Guerrero et al., 2020; Martinez & Fischer, 2019b; Vidal Gamboa et al., 2017). Similarly, Shimabuku and Mendonça (2018) found that an excessive exposure to job demands is negatively related to presenteeism, although these negative effects seem to be moderated (or mitigated) by work control levels.
A final set of studies have highlighted the fact that psychosocial risks may damage individual and organizational performance by affecting employees' personal styles and behavior. Indeed, there is evidence to suggest that excessive exposure to highly stressful working conditions may lead to substance abuse. This increases consumption levels of alcohol, medication, or drugs (e.g., Palma-Contreras et al., 2018), which may not only reduce individuals' cognitive performance in the short term but also make them more prone to work accidents and injuries (e.g., Useche et al., 2018).
Discussion
As jobs have become increasingly more complex and demanding, and organizations strive to remain competitive, innovative, and sustainable in an often hostile and fast-changing market, a great deal of attention has been given to the effects and implications of work-related psychosocial risks on individuals' health and organizational performance (Maslach & Leiter, 2016). A vast number of studies around the world have shown that this is true not only in regions like Europe or the United States, where the study of psychosocial risks certainly has a long-standing tradition, but also in the Latin American context, where a growing amount of studies have been conducted in the last ten years. Despite these valuable efforts, most systematic reviews have either ignored research produced in Latin America completely or focused only on one occupation and a few categories of psychosocial risks (e.g. Monroy-Castillo & Juárez-García, 2019; Tabares-Díaz et al., 2020), all of which has contributed to produce biased and scattered evidence of this relationship. Thus, the present article contributed to the field of organizational psychology by critically examining the Latin-American literature that investigates the relationship among a wide variety of psychosocial risks, individuals' health, and organizational performance. In what follows, we provide an overview of the findings of this systematic review and propose new research avenues that, ultimately, will help design preventive strategies that promote healthy organizational environments and employees' wellbeing considering the particularities of the Latin-American context.
Regarding the specific contexts in which this research has been conducted, the systematic review showed that most empirical contributions came from Brazil and, to a comparatively lesser extent, from other countries like Chile, Colombia, Mexico, and Argentina. Moreover, the majority of studies have been done in the healthcare contexts, educational institutions, and manufacturing industries. Only very few of them have examined the constructs of interest and their relationships in more novel occupational contexts, such as the managerial profession (e.g., Pujol-Cols & Lazzaro-Salazar, 2020), or have collected their data in diverse samples of workers with different backgrounds and occupations (e.g., Gómez-Ortiz et al., 2020). We believe that future research should not only involve other regions of Latin America but also include individuals who are expected to be exposed to the highest levels of work-related psychosocial risks, such as police officers, firefighters, social workers, surgeons in ER or trauma units, crisis counselors, hospice caregivers, and emergency dispatchers, among many others.
In regards to the research designs, most studies have relied on cross-sectional and self-report data, which may be susceptible to common method bias (see Podsakoff et al., 2003) and social desirability bias (see Piedmont et al., 2000). Though we believe future research should adopt more complex, longitudinal designs that involve the collection of systematic and/or diary data, studies could also minimize the limitations and optimize the advantages of cross-sectional designs by using a number of strategies (see considerations in Spector, 2019). On the one hand, they could measure the constructs of interest at different points of time or, in other words, collect data at different stages. On the other hand, they could combine both self-reports and other independent measures that examine the variables of interest more objectively, for instance, by conducting a thorough and detailed analysis of job descriptions to measure psychosocial risks, using information from clinical records to assess physical and mental health symptoms, or evaluating various indicators or ratios to examine performance levels. In addition to overcoming some of the limitations involved in cross-sectional research, such mixed and transdisciplinary approach may offer a valuable opportunity for advancing our understanding of the dynamics involved in the relationships among psychosocial risks, health, and performance in a more holistic and, thus, comprehensive way (see Pujol-Cols & Lazzaro-Salazar, 2020).
Furthermore, this systematic review showed that constructs like psychological demands, job control, social support, and effort-reward imbalance have been studied rather exhaustively in the literature on psychosocial risks in Latin America by using large and diverse samples of employees and internationally validated instruments. However, a still large number of the selected studies measured similar (or the same) constructs using different variable labels, or drew on data collected through ad-hoc scales that offered little or no evidence of psychometric validity. This hinders the possibility of integrating and analyzing an important amount of the empirical evidence coming from Latin-American research in meta-analyses of these relationships. Thus, it is fundamental that future research is more consistent in labeling phenomena and rely on the use of instruments whose reliability and validity has been properly and systematically demonstrated across studies.
From a conceptual standpoint, the present systematic review revealed that the majority of studies have focused on the direct effects of various psychosocial risk factors on different variables related to individuals' health and organizational performance, but the mechanisms and processes underlying these relationships remain largely understudied in this literature. Future research in Latin America should address the potential moderating or mediating effects of third variables in these dynamics. In this sense, since this systematic review indicated that personal factors have been particularly neglected in the proposed models, future studies could examine the role of, for instance, individuals' personality traits in the processes through which they cope with psychosocial risks in order to experience positive states, maintain their health status, and improve their performance levels. Future research could also examine the positive and negative spillover of these processes on other spheres of individuals' life (outside the organizational context), such as their social and/or family relationships. It would also be interesting to understand how the level of other resources not related to the job (e.g., family support) may (or not) help employees cope with the most stressful aspects of their job. Furthermore, since this review showed that this body of research has concentrated almost exclusively on the effects of psychosocial risks on performance at the individual level (e.g., productivity), future studies should examine performance at the organizational level by including measures of, for instance, market share, profitability, medical costs, or turnover rates.
Moreover, this paper revealed that psychosocial risks, such as psychological demands, job control, social support, effort-reward imbalance, workplace violence, and work-family conflict, among others, were indeed found to be significant predictors of individuals' health status and organizational performance across a large body of studies. This, naturally, has strong implications for professional practice, and, thus, we recommend that future research involves an impact evaluation of different strategies, policies, and programs that becomes vital for providing organizations with valuable information that can be used to design preventive strategies that promote healthy organizational environments and employees' wellbeing in Latin America (see guidelines in Khandker et al., 2009).
Last but not least, it is important to discuss the limitations of this systematic review. Firstly, since it only included papers published in either English or Spanish, some relevant contributions written in other languages (e.g. Portuguese) may have been excluded from this review. Nonetheless, we believe this study is still comprehensive enough as it was able to include a significant amount of studies (over 60%) that were conducted in Latin American countries where neither English nor Spanish is their first language. Secondly, this article provided a qualitative assessment of the relationships among psychosocial risks, health, and performance and, therefore, its conclusions should be interpreted with caution. However, and though the present review did not result in the estimation of a quantitative effect or relationship among the variables of study, it allowed us to critically analyze each of the 85 selected papers, identify their main contributions and limitations, and propose avenues for future research. Finally, since our searches included terms that intended to be sufficiently wide in scope to enable the identification of a large number of studies on the topic, they did not consider other specific categories of psychosocial risks, such as 'telework'. Although this procedure may have resulted in the exclusion of some pertinent studies, it is worth highlighting the fact that the combination of search strategies used in this paper was still effective and comprehensive enough to identify a significant number of recent and relevant contributions in the field.
