We have presented a multi-facetted view of the Occupational Stress Index (OSI). Its roots come from basic principles of cognitive ergonomics and insights from brain research, while also incorporating the perspectives and experience of the leading occupational psychosocial models. The OSI offers a complementary approach to these more sociological models, and actually helps to confirm the validity of the Job Strain construct, by operationalizing the less apparent features of mental load upon the central nervous system, as well as the often interrelated constraining and limiting conditions that can create "strain". Of critical importance in this process has been the development of occupation-specific OSI instruments that are germane to a given line of work, and yet mutually compatible, as part of a unified theoretical framework. The OSI views the work environment as a whole, and includes "mental", physical, ergonomic and organizational factors, as these all impact upon the central nervous system, so that the additive burden effect can be assessed. The often unrecognized, yet vital dimension of threat-avoidant vigilant activity is also included in the OSI.

The practical utility of the OSI is demonstrated in the clinical arena, where it provides the basis for preparing a comprehensive occupational history that could be incorporated into the general medical records. We have shown how insights gained from the OSI can inform diagnostic and management strategies, including the identification of key modifiable work stressors. This clearly illustrates why the workplace needs to become an integral consideration in those clinical domains, most notably cardiology and...