**6. The advanced tertiary sector and related work stress**

If construction and manufacturing activities are still the most significant components of the accident phenomenon, the issue of occupational diseases, with their relative impact on the health system, increasingly concerns the tertiary sector as well. In this context, the phenomenon of work-related stress has grown in recent years, linked to increasingly widespread pathologies. Work-related stress occurs among workers when the demands made on them exceed the ability to cope with it, with harmful consequences for health and mental balance, which are also reflected in the relational life of those affected. Some examples of working conditions that involve psychosocial risks and which could therefore cause work-related stress are:


Intense and prolonged stress over time can cause psychosomatic, physical, mental, and behavioral disorders, even severe ones, in workers, with more or less stable effects. By analyzing the relationship between work-related stress and some pathologies, in fact, a directly proportional correlation was identified between the risk of psychological deficit and an increase in work stress. The conditions most often encountered range from mood disorders, to alterations in the sleep-wake rhythm, to interpersonal and family conflicts, up to burnout and depression. A pre-existing psychophysical disorder, such as that of adaptation or post-traumatic stress disorder, can also coexist with one related to work events, sometimes strengthening it. Alongside these psychosomatic and behavioral disorders, the consequences of prolonged work-related stress can also affect the cardiovascular and nervous, endocrine, gastrointestinal, and immune systems. There is also a link between work-related stress and musculoskeletal disorders [15].

In Italy, in the case of pathologies due to work-related stress, in order for Inail to deliver the relative economic services, the worker must demonstrate that the pathology is caused by an adverse working condition, reconstructing (through documentary and possibly testimonial evidence) work environment that contributed to the emergence of occupational stress disease.

Mental disorders can be considered of professional origin, and therefore eligible for compensation by Inail as an occupational disease, only if they are caused, even if only predominantly, by situations of organizational coercion, that is, if they involve clear and relevant consequences on the working position and on the possibilities of carrying out the work. Stress itself is not a disease, but its consequences may be. Continuous exposure to situations and sources of stress can in fact lead to physical and psychological somatization of the problem. In recent years, the evolution of pathologies and the data of occupational diseases in Italy reported by Inail makes evident the presence and growth of the phenomenon of work-related stress.

According to the European Agreement on work-related stress of 2004, stress is "a condition that can be accompanied by disorders or dysfunctions of a physical, psychological or social nature and is a consequence of the fact that some individuals do not feel able to meet the demands or to the expectations placed in them" [16]. Work-related stress can therefore potentially affect every workplace and every worker as it is caused by different aspects closely related to the organization and the work environment.

In Italy, the current regulatory framework, consisting of Legislative Decree 81/2008 and related laws, obliges employers to assess and manage the work-related stress risk on a par with all other risks, in acknowledgment of the contents of the European agreement. In this regard, the Permanent Advisory Commission for Occupational Health and Safety has developed the necessary information for assessing the risk of work-related stress, identifying a methodological path that represents the minimum level of implementation of the obligation. The Department of Medicine, Epidemiology, Occupational Hygiene, and the Environment has developed a Methodology for assessing and managing work-related stress risk and published a specific online platform that can be used by Italian companies to carry out risk assessment pursuant to Legislative Decree 81/2008.

The proposed method offers companies validated tools and specific resources, which can be used by companies following a sustainable and integrated approach, divided into phases, which involve the involvement of prevention figures and workers. The aspect of the risk from work-related stress, also in the assessment of the allowances recognized by Inail, which represent only the most evident and emerged aspect of a much broader phenomenon, show how the evolution of work and its organization, despite the perspective of Fourth Capitalism, it continues to produce conditions of risk to health and safety, whether physical, mental or psychological. In this dimension, the aspects connected to the digitization and its impact on working conditions must also be considered, which the spread of smart working during the months of the pandemic has made it particularly widespread everywhere, even in Italy.

*The Social and Health Impact of Accidents at Work: The Analysis of the Italian Case DOI: http://dx.doi.org/10.5772/intechopen.101501*
