Comorbidity in the Workplace: Why Biopsychosocial Perspective Matters
By Eilidh Stewart-Barritt
The Biopsychosocial Model at Work
The Biopsychosocial (BPS) model, originally proposed by George Engel M.D 1977, formulated that health and functioning arise from the interaction of biological, psychological, and social factors. Still referred to today and applied in a variety of modalities, Ergonomists and Human Factor specialists use this model in occupational contexts to examine, interpret and provide solutions in how people interact with systems, environments, tools and organisational cultures.
Applied to work, a biopsychosocial approach recognises that physical symptoms are influenced by cognitive load, stress, trauma, and environmental and sociological demands. Psychological distress is shaped by physical discomfort, fatigue, sensory overload, pain, and systemic barriers. Social factors such as job design, management practices, stigma, dogma, gender norms, power dynamics and organisational politics modulate both physical and mental health outcomes.
Comorbidity sits at the intersection of these domains. Treating human needs and conditions in isolation risks misunderstanding root causes, misattributing performance issues, inadvertently increasing harm and damaging overall workplace effectiveness. Why would any organisation want that?
Why this matters now
Globally, three impactful dynamics are converging to make comorbidity-aware workplace support a strategic priority, not a wellbeing “nice-to-have.”
First, post-COVID does not mean “post health impact.” The World Health Organization has framed COVID-19 as an established and ongoing health issue even after ending the Public Health Emergency of International Concern in 2023, and many workplaces continue to see fluctuating capacity, fatigue, and episodic health presentations that rarely map to a single diagnosis.
Second, the talent and retention context remains tight and values driven. UK Labour market analysis continues to report persistent vacancies alongside concerns about job quality and the lived impacts of the cost-of-living environment — conditions that increase the organisational value of sustainable work design, trust, and psychologically safe conversations about support.
Third, DEI maturity is being tested under economic and geopolitical strain. Global risk assessments describe an increasingly fractured landscape shaped by geopolitical, societal, and economic pressures, while labour market oversight warns that deteriorating economic conditions and trade uncertainty are weakening employment growth. In this context, organisations that can reduce avoidable friction, prevent ill health, and keep experienced people well are building resilience. Comorbidity aware practice that is grounded in biopsychosocial thinking and human factors is one of the most practical and data led ways to do that.
Hypermobility as a case study in comorbidity
Hypermobility provides a clear illustration of why holistic thinking is essential. Generalised joint hypermobility and hypermobility spectrum disorders are associated with a wide range of comorbid conditions affecting multiple body systems.
Common Comorbidities
Research consistently identifies higher prevalence of:
- Chronic musculoskeletal pain and recurrent soft‑tissue injuries
- Fatigue and autonomic dysfunction
- Gastrointestinal disorders
- Anxiety, depression, and trauma‑related symptoms
- Neurodivergent profiles, particularly autism and ADHD
- Proprioceptive and interoceptive differences
From an ergonomics and physiotherapy perspective, pain and instability may be exacerbated by:
- Prolonged static postures
- Poorly designed workstations
- High repetition tasks.
From a psychological perspective, the lived experience of hypermobility is known to include:
- Fear of unpredictable pain
- Injury history
- Repeated invalidation contributing to hypervigilance, anxiety, and burnout.
From a neurodiversity lens, sensory processing differences and executive function demands may further compound strain.
Workplace Implications
If hypermobility is addressed only as a musculoskeletal issue, organisations may miss:
- Cognitive fatigue linked to pain processing and autonomic load
- Sensory sensitivities interacting with open‑plan environments
- The cumulative impact of masking, over‑compensation, and presenteeism
Effective support therefore extends beyond chairs and desks. It includes a joined-up approach from across an organisation’s strategic and operational departments. Support factors an organisation should consider or seek to include:
- Workload pacing- work life balance vs deliverables
- Flexibility- locations in the office, remote working, start and finish times
- Autonomy- reduction of micromanagement signaling lack of trust
- Task design- considering the individual in task expectations
- Education for managers- workshops, webinars, co-coaching
- Validation of fluctuating capacity- using contingencies to balance individual’s vs organisational needs
Musculosketal disorders, stress and mental health as a case study
Musculoskeletal (MSK) conditions remain one of the leading causes of work‑related disability worldwide. However, decades of occupational health and pain science research demonstrate that MSK pain is rarely purely bio-mechanical.
Psychosocial Comorbidity
Commonly associated factors with reported MSK conditions include:
- Chronic stress and high job demands
- Low job control and poor role clarity
- Anxiety and depressive disorders
- Sleep disruption and fatigue
- Fear‑avoidance beliefs and pain catastrophising
Human factors research shows that environments characterised by time pressure, low predictability, and poor support increase both injury risk and pain persistence. Psychology and psychiatry literature further demonstrate bidirectional relationships between pain and mood disorders: pain increases depression risk, while depression predicts poorer recovery outcomes.
Risks of Narrow Interventions
When MSK issues are treated solely with equipment changes or short‑term medical interventions such as physiotherapy, without addressing workload, management behaviour, or psychological safety, organisations risk:
- Recurring absence and escalating symptoms
- Increased compensation and healthcare costs
- Loss of trust in occupational health processes
A biopsychosocial ergonomics approach integrates physical design with stress reduction, supportive management, and realistic performance expectations and contributes to more accurate strategic decision making.
Reproductive Health and Systemic Comorbidity case study
Reproductive health conditions highlight the intersection of biological, psychological, and social factors, and the gendered assumptions that often shape workplace approaches to performance, resilience and support.
Gender‑Specific and Gender‑Neutral Considerations
Conditions such as endometriosis, adenomyosis, polycystic ovary syndrome, menopause‑related symptoms, and fertility‑related hormonal treatments are frequently comorbid with:
- Chronic pain and fatigue
- Gastrointestinal symptoms
- Migraines and neurological symptoms
- MSK pain
- Anxiety, depression, and trauma responses
These conditions are often invisible, episodic, and poorly understood, leading to delayed diagnosis and workplace stigma. Importantly, hormonal and reproductive health impacts are not limited to one gender identity; inclusive approaches recognise trans, non‑binary, and intersex experiences, as well as the effects of reproductive health treatments across all gender populations.
Organisational Blind Spots
Failure to acknowledge comorbidity in reproductive health can result in:
- Misinterpretation of fluctuating performance as disengagement
- Inadequate adjustments focused on attendance rather than capacity
- Increased attrition of experienced employees
Biopsychosocial support design would include:
- Flexibility in start times and work locations, including remote work and quiet office locations
- Autonomy- supporting people to meet their own needs by removing barriers
- Pain‑aware workload design using contingency planning and inclusive resourcing
- Psychologically safe disclosure pathways, where mutual trust contributes to organisational resilience
Neurodivergence, sensory differences and physical health perspective
Neurodivergent employees frequently experience co‑occurring physical and sensory conditions. These may include hypermobility, gastrointestinal disorders, migraines, sleep disorders, hearing impairments, dermatology conditions and chronic pain.
From a human factors perspective, sensory environments designed for a hypothetical normative worker often amplify cognitive load and fatigue. From a functional health perspective, sustained sensory stress can exacerbate physical symptoms and autonomic dysregulation.
When neurodivergence is addressed only through communication strategies or cognitive accommodations, organisations may overlook:
- The physical and emotional toll of sensory overload
- The interaction between posture, movement, and attention
- The cumulative effect of masking on mental and physical health
The Risks of Not Thinking Holistically
Organisations that fail to account for comorbidity face tangible risks:
- Ineffective or counterproductive adjustments- costing time and money.
- Increased sickness absence and turnover- costing time and money.
- Higher risk of discrimination claims- costing time and money.
- Reduced engagement and innovation- costing time and money,
- Erosion of trust between employees and leadership- costing time and money.
- Higher risk of non-compliance with UK Health and Safety legislation and the Equality Act 2010- costing time and a lot of money!
Perhaps most critically, employees learn whether it is safe to be honest about their lived experience and their corresponding loyalty to the organisation. When support feels transactional or dismissive, disclosure decreases and problems escalate underground.
The benefits of open-minded, whole-person support
By contrast, organisations that adopt a biopsychosocial, comorbidity‑aware approach benefit from:
- Earlier intervention and better health outcomes
- More precise and sustainable adjustments
- Improved retention of skilled employees
- Stronger psychological safety and trust
- A reputation for ethical, inclusive, trustworthy leadership
- Ergonomics, when integrated with psychology, physiotherapy, and occupational health, becomes a strategic tool rather than a reactive fix.
Building Trust Through Understanding Lived Experience
Trust is built when employees feel seen as whole people rather than as diagnoses and loyalty is built when people feel valued and invested in rather than solely as a resource. This does not require intrusive questioning or medicalisation. It requires curiosity, humility, and a willingness to accept complexity.
Leaders who acknowledge uncertainty, invite dialogue, and avoid assumptions send a powerful message: performance and wellbeing are not competing priorities. They are mutually reinforcing and intrinsically linked.
Final thoughts
Comorbidity challenges simplistic models of workplace health and performance. A biopsychosocial perspective, grounded in ergonomics and human factors, offers a more accurate, humane, and effective framework for supporting people at work.
By recognising the interconnected nature of physical, psychological, and social factors, and by designing work accordingly, organisations can move beyond compliance and toward genuinely healthy, high‑trust, high performing workplaces.
References and Further Reading
- World Health Organization. (2023). Statement on the fifteenth meeting of the IHR (2005) Emergency Committee regarding the COVID-19 pandemic (5 May 2023).
- Health and Safety Executive (HSE). (2024/25). Work-related stress, depression or anxiety in Great Britain (latest statistical release).
- CIPD. (2024). Good Work Index 2024: Summary report.
- CIPD. (2024). Labour Market Outlook: Spring 2024.
- World Economic Forum. (2025). The Global Risks Report 2025.
- International Labour Organization (ILO). (2025). World Employment and Social Outlook: May 2025 Update.
- Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136.
- Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain. Psychological Bulletin, 133(4), 581–624.
- Waddell, G., & Burton, A. K. (2006). Is work good for your health and wellbeing? The Stationery Office.
- Nicholas, M. K., et al. (2011). Implementation of the biopsychosocial model in pain management. Pain, 152(8), 1723–1730.
- Baeza-Velasco, C., et al. (2018). Joint hypermobility syndrome and psychological distress: A systematic review. Rheumatology International, 38, 1005–1018.
- Eccles, J. A., & Owens, A. P. (2021). Joint hypermobility and autonomic dysfunction. American Journal of Medical Genetics Part C.
- Bulbena, A., et al. (2017). Anxiety disorders in joint hypermobility. Psychiatry Research, 258, 400–406.
- Cederlöf, M., et al. (2016). Nationwide population-based cohort study of psychiatric disorders in individuals with Ehlers–Danlos syndrome or hypermobility syndrome. BJPsych Open, 2(6), 407–413.
- McWilliams, L. A., Cox, B. J., & Enns, M. W. (2003). Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample. Pain, 106(1–2), 127–133.
- Linton, S. J., & Shaw, W. S. (2011). Impact of psychological factors in the experience of pain. Physical Therapy, 91(5), 700–711.
- Vandenbroucke, L., et al. (2020). Psychosocial factors and musculoskeletal disorders at work. Occupational and Environmental Medicine, 77(5), 324–331.
- Zondervan, K. T., et al. (2020). Endometriosis. The Lancet, 396(10257), 730–742.
- Armour, M., et al. (2019). The cost of illness and productivity loss associated with endometriosis. Human Reproduction, 34(7), 1363–1371.
- Nappi, R. E., & Davis, S. R. (2012). The use of hormone therapy for the management of menopause. Journal of Steroid Biochemistry and Molecular Biology, 142, 21–26.
- Kroll, M. E., et al. (2016). Hormonal factors and musculoskeletal pain. Rheumatology, 55(4), 676–685.
- Bishop-Fitzpatrick, L., & Kind, A. J. H. (2017). A scoping review of health disparities in autistic adults. Autism, 21(5), 1–15.
- Mason, D., et al. (2018). Health conditions in autistic adults. Autism Research, 11(6), 805–815.
- Hocking, C. (2017). Occupational justice and occupational therapy: What does this mean for practice? Canadian Journal of Occupational Therapy, 84(2), 1–8.
- Edmondson, A. (2018). The Fearless Organization: Creating psychological safety in the workplace for learning, innovation, and growth. Wiley.
- World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF).
