Invited commentary: Structure and context matters--the need to emphasize "social" in "psychosocial epidemiology"

A high level of influence on core aspects of life in general and at the workplace in particular is believed to reduce the risk of ill health. In this issue of the Journal, Joensuu et al. (Am J Epidemiol. 2012;175(7):609-619) shake this belief by presenting prospective associations between high decision authority at work and increased all-cause, cardiovascular, and alcohol-related mortality among Finnish forest company employees followed through 2005. In this invited commentary, the author welcomes these findings as a much needed inspiration for reflections on the current state of psychosocial epidemiology and how it can be advanced in the future. Although it is important to investigate possible harmful effects of too high decision authority, the author argues that it is even more important to be aware that psychosocial factors originate from societal structures and social contexts. Understanding these structures and contexts, their changes over time, and their relation to psychosocial factors is key for understanding the effect of psychosocial factors on health and illness. Joensuu et al. have presented thought-provoking findings. It is the hope of the author that this will push the research community to emphasize the "social" in "psychosocial epidemiology."