Occupational stress

Occupational stress is stress related to one's job. Occupational stress often stems from unexpected responsibilities and pressures that do not align with a person's knowledge, skills, or expectations, inhibiting one's ability to cope. Occupational stress can increase when workers do not feel supported by supervisors or colleagues, or feel as if they have little control over work processes.[1]

Models

Because stress results from the complex interactions between a large system of interrelated variables, there are several psychological theories and models that address occupational stress.[2][3][4]

Person Environment Fit Model: This model "suggests that the match between a person and their work environment is key in influencing their health. For healthy conditions, it is necessary that employees’ attitudes, skills, abilities and resources match the demands of their job, and that work environments should meet workers’ needs, knowledge, and skills potential. Lack of fit in either of these domains can cause problems, and the greater the gap or misfit (either subjective or objective) between the person and their environment, the greater the strain as demands exceed abilities, and need exceeds supply. These strains can relate to health related issues, lower productivity, and other work problems. Defense mechanisms, such as denial, reappraisal of needs, and coping, also operate in the model, to try and reduce subjective misfit" [4]

Job Characteristics Model: This model "focuses on important aspects of job characteristics, such as skill variety, task identity, task significance, autonomy, and feedback. These characteristics are proposed to lead to ‘critical psychological states’ of experienced meaningfulness, and experienced responsibility and knowledge of outcomes. It is proposed that positive or negative work characteristics give rise to mental states which lead to corresponding cognitive and behavioral outcomes, e.g. motivation, satisfaction, absenteeism, etc. In conjunction with the model, Hackman and Oldham (1980) developed the Job Diagnostic Survey, a questionnaire for job analysis, which implies key types of job-redesign including combining tasks, creating feedback methods, job enrichment, etc." [4]

Diathesis-Stress Model: This model looks at behaviors as a susceptibility burden together with stress from life experiences.[5][6] It is useful to distinguish stressful job conditions or stressors from an individual's reactions or strains.[7] Strains can be mental, physical or emotional. Occupational stress can occur when there is a discrepancy between the demands of the environment/workplace and an individual’s ability to carry out and complete these demands.[8][9] Often a stressor can lead the body to have a physiological reaction that can strain a person physically as well as mentally. A variety of factors contribute to workplace stress such as excessive workload, isolation, extensive hours worked, toxic work environments, lack of autonomy, difficult relationships among coworkers and management, management bullying, harassment and lack of opportunities or motivation to advancement in one’s skill level.[10]

Jobs-Demand Resources Model: This model posits that strain are a response to imbalance between demands of one's job and the resources he or she has to deal with those demands.

Effort-Reward Imbalance Model: This model focuses on the reciprocal relationship between efforts and rewards at work. "More specifically, the ERI Model claims that work characterized by both high efforts and low rewards represents a reciprocity deficit between high ‘costs’ and low ‘gains’, which could elicit negative emotions in exposed employees. The accompanying feelings may cause sustained strain reactions. So, working hard without receiving adequate appreciation or being treated fairly are examples of a stressful imbalance. Another assumption of the ERI Model concerns individual differences in the experience of effort-reward imbalance. It is assumed that employees characterized by a motivational pattern of excessive job-related commitment and a high need for approval (i.e., overcommitment) will respond with more strain reactions to an effort-reward imbalance, in comparison with less overcommitted people." [12]

Origins

Sources of occupational stress come from:[10]

These individual sources demonstrate that stress can occur specifically when a conflict arises from the job demands of the employee and the employee itself. If not handled properly, the stress can become distress.[13]

  1. Coping: the ability of the employee coping with the specific hours worked, the level of productive rate expected, the physical environment, as well as the expectancy of the work desired by management. For instance, research shows that night shifts in particular has a high possibility of negative impact towards the health of the employee. In relation to this, approximately 20 percent of night shift workers have experienced psycho-physiological dysfunctions, including heart diseases. Extreme factors can affect the competence levels of employees.
  2. Role in the organization: associated with the hierarchical ranking of that particular employee within the organization. Upper management is entitled to oversee the overall functioning of the organization. This causes potential distress as the employee must be able to perform simultaneous tasks.
  3. Career development: Security of their occupation, promotion levels, etc. are all sources of stress, as this business market in terms of technology of economic dominance is ever-changing.
  4. Interpersonal relationships within the workplace: The workplace is a communication and interaction based industry. These relationships (either developed or developing) can be problematic or positive. Common stressors include harassment, discrimination, biased opinions, hearsay, and other derogatory remarks.
  5. Organizational climate or structure: The overall communication, management style, and participation among groups of employees are variables to be considered. In essence, the resultant influence of the high participation rate, collaborative planning, and equally dispersed responsibilities provides a positive effect on stress reduction, improved work performance, job satisfaction, and decreased psychosomatic disorders.

Prevalence

Distress is a prevalent and costly problem in today's workplace. About one-third of workers report high levels of stress.[8] 20-30% of workers in different sectors of the European Union reported in 2007 that they believed work-related stress was potentially affecting their health.[14] Three-quarters of employees believe the worker has more on-the-job stress than a generation ago.[15] In Great Britain, a sixth of the workforce experiences occupational stress every year.[14] Evidence also suggests that distress is the major cause of turnover in organizations.[8] With continued distress at the workplace, workers will develop psychological and physiological dysfunctions and decreased motivation in excelling in their position.[10] Increased levels of job stress are determined by the awareness of having little control but lots of demands in the work area.[16] Occupational stress and its sequelae represent the majority of work-related illnesses causing missed work days.[14] Those in the protective services, transportation and materials moving, building grounds cleaning and maintenance, and healthcare are more susceptible to both work injuries and illnesses, as well as work-related stress.[17]

Negative health effects

Stress-related disorders encompass a broad array of conditions, including psychological disorders (e.g., depression, anxiety, post-traumatic stress disorder) and other types of emotional strain (e.g., dissatisfaction, fatigue, tension, etc.), maladaptive behaviors (e.g., aggression, substance abuse), and cognitive impairment (e.g., concentration and memory problems). In turn, these conditions may lead to poor work performance, higher absenteeism, less work productivity or even injury.[10][14] "If untreated, consistently high stress can become a chronic condition, which can exacerbate existing mental health conditions and chronic physical conditions (diabetes, hypertension, weak immune system). These conditions not only diminish the well-being of workers and increase the employer's health benefits expenses, they contribute to increased injury incidence. Consistently high levels of stress increase the risk of occupational injury. A study of light/short haul truckers, a group that experiences high rates of injury and mental health issues, found that frequent stress increased the odds of occupational injury by 350%." [17]

Job stress is also associated with various biological reactions that may lead ultimately to compromised health, such as cardiovascular disease,[14][18] or in extreme cases death. Due to the high pressure and demands in the work place the demands have been shown to be correlated with increased rates of heart attack, hypertension and other disorders. In New York, Los Angeles, and London, among other municipalities, the relationship between job stress and heart attacks is acknowledged.[19]

Problems at work are more strongly associated with health complaints than are any other life stressor-more so than even financial problems or family problems.[20] Occupational stress accounts for more than 10% of work-related health claims.[21] Many studies suggest that psychologically demanding jobs that allow employees little control over the work process increase the risk of cardiovascular disease. Research indicates that job stress increases the risk for development of back and upper-extremity musculoskeletal disorders.[22] Other disorders that can be caused or exacerbated by occupational stress include sleep disorders, headache, mood disorders, upset stomach, hypertension, high cholesterol, autoimmune disease, cardiovascular disease, depression, and anxiety. Stress at work can also increase the risk of acquiring an infection and the risk of accidents at work.[23]

High levels of stress are associated with substantial increases in health service utilization.[8] Workers who report experiencing stress at work also show excessive health care utilization. In a 1998 study of 46,000 workers, health care costs were nearly 50% greater for workers reporting high levels of stress in comparison to “low risk” workers. The increment rose to nearly 150%, an increase of more than $1,700 per person annually, for workers reporting high levels of both stress and depression.[24] Health care costs increase by 200% in those with depression and high occupational stress.[23] Additionally, periods of disability due to job stress tend to be much longer than disability periods for other occupational injuries and illnesses.[25]

Physiological reactions to stress can have consequences for health over time. Researchers have been studying how stress affects the cardiovascular system, as well as how work stress can lead to hypertension and coronary artery disease. These diseases, along with other stress-induced illnesses tend to be quite common in American work-places.[26] There are four main physiological reactions to stress:[27]

Gender

Frustrated man at a desk

Men and women are exposed to many of the same stressors.[28] Although men and women might not differ in overall strains, women are more likely to experience psychological distress, whereas men experience more physical strain. Desmarais and Alksnis suggest two explanations for the greater psychological distress of women. First, the genders may differ in their awareness of negative feelings, leading women to express and report strains, whereas men deny and inhibit such feelings. Second, the demands to balance work and family result in more overall stressors for women that leads to increased strain.[28]

The Kenexa Research Institute released a global survey of almost 30,000 workers which showed that females suffered more workplace distress than their male counterparts. According to the survey, women's stress level were 10% higher for those in supervisory positions, 8% higher stress in service and production jobs than men, and 6% higher in middle and upper management than men in the same position.[29]

Causes

Job stress results from various interactions of the worker and the environment of the work they perform their duties. Location, gender, environment, and many other factors contribute to the buildup of stress. Job stress results from the interaction of the worker and the conditions of work. Views differ on the importance of worker characteristics versus working conditions as the primary cause of job stress. The differing viewpoints suggest different ways to prevent stress at work. Differences in individual characteristics such as personality and coping skills can be very important in predicting whether certain job conditions will result in stress. In other words, what is stressful for one person may not be a problem for someone else. This viewpoint underlies prevention strategies that focus on workers and ways to help them cope with demanding job conditions.[8] In general, occupational stress is caused by a mismatch between perceived effort and perceived reward, and/or a sense of low control in a job with high demands. Low social support at work and job insecurity can also increase occupational stress.[14] Psychosocial stressors are a major cause of occupational stress.[23]

Working conditions

Although the importance of individual differences cannot be ignored, scientific evidence suggests that certain working conditions are stressful to most people. Such evidence argues for a greater emphasis on working conditions as the key source of job stress, and for job redesign as a primary prevention strategy.[8] Large surveys of working conditions, including conditions recognized as risk factors for job stress, were conducted in member states of the European Union in 1990, 1995, and 2000. Results showed a time trend suggesting an increase in work intensity. In 1990, the percentage of workers reporting that they worked at high speeds at least one-quarter of their working time was 48%, increasing to 54% in 1995 and to 56% in 2000. Similarly, 50% of workers reported they work against tight deadlines at least one-fourth of their working time in 1990, increasing to 56% in 1995 and 60% in 2000. However, no change was noted in the period 1995–2000 (data not collected in 1990) in the percentage of workers reporting sufficient time to complete tasks.[30]

Workload

In an occupational setting, dealing with workload can be stressful and serve as a stressor for employees. There are three aspects of workload that can be stressful.

  • Quantitative workload or overload: Having more work to do than can be accomplished comfortably.
  • Qualitative workload: Having work that is too difficult.
  • Underload: Having work that fails to use a worker's skills and abilities.[31]

Workload as a work demand is a major component of the demand-control model of stress.[32] This model suggests that jobs with high demands can be stressful, especially when the individual has low control over the job. In other words, control serves as a buffer or protective factor when demands or workload is high. This model was expanded into the demand-control-support model that suggests that the combination of high control and high social support at work buffers the effects of high demands.[33]

As a work demand, workload is also relevant to the job demands-resources model of stress that suggests that jobs are stressful when demands (e.g., workload) exceed the individual's resources to deal with them.[34]

Long hours

A substantial percentage of Americans work very long hours. By one estimate, more than 26% of men and more than 11% of women worked 50 hours per week or more in 2000. These figures represent a considerable increase over the previous three decades, especially for women. According to the Department of Labor, there have been a rise in increasing amount of hours in the work place by employed women, an increase in extended work weeks (>40 hours) by men, and a considerable increase in combined working hours among working couples, particularly couples with young children.[35][36]

Evidence of occupational stress due to an individual's status in the workplace

Status

A person's status in the workplace can also affect levels of stress. While workplace stress has the potential to affect employees of all categories; those who have very little influence to those who make major decisions for the company. However, less powerful employees (that is, those who have less control over their jobs) are more likely to suffer stress than powerful workers. Managers as well as other kinds of workers are vulnerable to work overload.[37]

Economic factors

Economic factors that employees are facing in the 21st century have been linked to increased stress levels. Researchers and social commentators have pointed out that the computer and communications revolutions have made companies more efficient and productive than ever before. This boon in productivity however, has caused higher expectations and greater competition, putting more stress on the employee.[26]

The following economic factors may lead to workplace stress:

Bullying

Bullying in the workplace can also contribute to stress. This can be broken down into five different categories:[10]

This in effect can create a hostile work environment for the employees that, which in turn, can affect their work ethic and contribution to the organization.[38]

Narcissism and psychopathy

Thomas suggests that there tends to be a higher level of stress with people who work or interact with a narcissist, which in turn increases absenteeism and staff turnover.[39] Boddy finds the same dynamic where there is corporate psychopath in the organisation.[40]

Workplace conflict

Interpersonal conflict among people at work has been shown to be one of the most frequently noted stressors for employees.[41][42] Conflict has been noted to be an indicator of the broader concept of workplace harassment.[43] It relates to other stressors that might co-occur, such as role conflict, role ambiguity, and workload. It also relates to strains such as anxiety, depression, physical symptoms, and low levels of job satisfaction.[43]

Sexual harassment

Women are more likely than men to experience sexual harassment, especially for those working in traditionally masculine occupations. In addition, a study indicated that sexual harassment negatively affects workers' psychological well-being.[19][44] Another study found that level of harassment at workplaces lead to differences in performance of work related tasks. High levels of harassment were related to the worst outcomes, and no harassment was related to least negative outcomes. In other words, women who had experienced a higher level of harassment were more likely to perform poorly at workplaces.[44]

Occupational group

Lower occupational groups are at higher risk of work-related ill health than higher occupational groups. This is in part due to adverse work and employment conditions. Furthermore, such conditions have greater effects on ill-health to those in lower socio-economic positions.[45]

Effects

Stressful working conditions can lead to three types of strains: Behavioral (e.g., absenteeism or poor performance), physical (e.g., headaches or coronary heart disease), and psychological (e.g., anxiety or depressed mood).[46][47] Physical symptoms that may occur because of occupational stress include fatigue, headache, upset stomach, muscular aches and pains, weight gain or loss, chronic mild illness, and sleep disturbances. Psychological and behavioral problems that may develop include anxiety, irritability, alcohol and drug use, feeling powerless and low morale.[48][47] The spectrum of effects caused by occupational stress includes absenteeism, poor decision making, lack of creativity, accidents, organizational breakdown or even sabotage.[49] If exposure to stressors in the workplace is prolonged, then chronic health problems can occur including stroke. An examination was of physical and psychological effects of workplace stress was conducted with a sample of 552 female blue collar employees of a microelectronics facility. It was found that job-related conflicts were associated with depressive symptoms, severe headaches, fatigue, rashes, and other multiple symptoms.[50] Studies among the Japanese population specifically showed a more than 2-fold increase in the risk of total stroke among men with job strain (combination of high job demand and low job control).[51] Those in blue-collar or maual labor jobs are more likely to develop heart disease compared to those in white-collar jobs.[52] Along with the risk of stroke, stress can raise the risk of high blood pressure, immune system dysfunction, coronary artery disease.[14][53] Prolonged occupational stress can lead to occupational burnout.[14] Occupational stress can also disrupt relationships.[23]

The effects of job stress on chronic diseases are more difficult to ascertain because chronic diseases develop over relatively long periods of time and are influenced by many factors other than stress. Nonetheless, there is some evidence that stress plays a role in the development of several types of chronic health problems—including cardiovascular disease, musculoskeletal disorders, and psychological disorders.[8][14] Job stress and strain has been associated with poor mental health and wellbeing over a 12-year period.[47]

Occupational stress has negative effects for organizations and employers. Occupational stress is the cause of approximately 40% of turnover and 50% of workplace absences. The annual cost of occupational stress and its effects in the US is estimated to be over $60 billion to employers and $250–300 billion to the economy.[23]

Prevention

A combination of organizational change and stress management is often the most useful approach for preventing stress at work.[8][14] Both organizations and employees can employ strategies at organizational and individual levels.[14] Generally, organizational level strategies include job procedure modification and employee assistance programs (EAP). Individual level strategies include taking vacation. Getting a realistic job preview to understand the normal workload and schedules of the job will also help people to identify whether or not the job fit them.

How an Organization Can Prevent Job Stress[54]

An insurance company conducted several studies on the effects of stress prevention programs in hospital settings. Program activities included (1) employee and management education on job stress, (2) changes in hospital policies and procedures to reduce organizational sources of stress, and (3) the establishment of employee assistance programs. In one study, the frequency of medication errors declined by 50% after prevention activities were implemented in a 700-bed hospital. In a second study, there was a 70% reduction in malpractice claims in 22 hospitals that implemented stress prevention activities. In contrast, there was no reduction in claims in a matched group of 22 hospitals that did not implement stress prevention activities.[57]

Telecommuting is another way organizations can help reduce stress for their workers. Employees defined telecommuting as "an alternative work arrangement in which employees perform tasks elsewhere that are normally done in a primary or central workplace, for at least some portion of their work schedule, using electronic media to interact with others inside and outside the organization." One reason that telecommuting gets such high marks is that it allows employees more control over how they do their work. Telecommuters reported more job satisfaction and less desire to find a new job. Employees that worked from home also had less stress, improved work/life balance and higher performance rating by their managers.[58]

A systematic review of stress-reduction techniques among healthcare workers found that cognitive behavioral training lowered emotional exhaustion and feelings of lack of personal accomplishment.[59]

Signs and symptoms of excessive job and workplace stress

Signs and symptoms of excessive job and workplace stress include:[60]

  • Feeling anxious, irritable, or depressed
  • Apathy, loss of interest in work
  • Problems sleeping
  • Fatigue
  • Trouble concentrating
  • Muscle tension or headaches
  • Stomach problems
  • Social withdrawal
  • Loss of sex drive
  • Using alcohol or drugs to cope

Both yoga and mindful-based stress reduction have been shown to reduce work-related stress.[61][62] Nursings participating in cognitive behavioral interventions less perceived stress, a greater sense of coherence, and increased mood.

Expanding Research on Stress: Contemporary opinions hold that jobs designed to support skill variety, task identity, significance, autonomy, and feedback, while providing for existence and growth needs, will sustain a healthier, greater satisfied workforce.


 For team-oriented work environments, Patrick Lencioni’s[63] The Five Dysfunctions of a Team profiles the behavior of cohesive teams:

1. They trust one another

2. They engage in unfiltered conflict around ideas

3. They commit to decisions and plans of action

4. They hold one another accountable for delivering against those plans

5. They focus on the achievement of collective results.

For immediate individual stress management, rudimentary mental coping strategies may be adopted in the work environment.

See also

References

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