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Workplace Stress
Is modern life really rubbish?
Are we just moaning too much?
Professor Craig Jackson
Prof. Occupational Health Psychology
Head of Psychology
BCU
craig.jackson@bcu.ac.uk
Stress – The Basics
Stress is not a useful concept because:
Definition problems
Not just at workplace
Individual response
Work-life Balance
Control Demand
Personality
Cause of many secondary health problems
Loose diagnostic criteria
Too many triggers
Too many responses
Too many effect modifiers
Used too casually
Fashionable
Positive perceptions
Not reliably measured
Workplace Hazards – current status
Shiftworking:
1 in 5 employed
likely to increase with growth
Fatigue
Somatic symptoms
Long hours:
Psychosocial:
Physical:
>48 hours per week
Fallen due to EWTD
Still > most of Europe
Sleep
MSDs
5 mill employees perceive effects
13 mill working days lost
Mundane occupations suffer
Chronic stress more problematic
Depression
Noise
Dust
Chemical
Vibration
Depression
technical
changes
monitoring
OELs
Cardiovascular
Accidents
QoL
France Telecom Case
Privatised in 1998
40,000 jobs gone since 1998
186,000 employees
45% of those outside France
Used to be public sector employer
new working conditions
modernisation
cultural & organisational changes needed
internal job transfers
4.3% fall in profits in 1Q of 2009
182 million customers in 5 continents
France Telecom Case
France Telecom Case
Between Feb 2008 – Sep 2009
23 staff committed suicide
• 9th Sept: 49 yr old male employee stabbed himself in meeting – told he
would be undergoing internal job transfer
• 11th Sep: 32 yr old female employee leapt to death from office window
• 14th Sep 53 yr old senior manager overdosed
• 1st Oct: 51yr old male employee jumped from road bridge – note blamed
work “atmosphere”
French suicide rate:
26.4 per 100,000 male deaths
9.2 per 100,000 female deaths
17.8 per 100,000 all deaths
France Telecom’s Defence
France Telecom’s two-point defence:
1) “There were 28 suicides in the company in 2000, so 23 suicides over
17 months is actually an improvement and not evidence of an
epidemic”
2) “Most suicides caused by personal problems not professional ones”
France Telecom Case
Oct 2009
Deputy CEO Louis-Pierre Wenes (second in command) resigns
CEO Didier Lombard – vowed to end the “Spiral of death”
Phone helpline
Counselling
Suspending job transfers
French Labour Minister, Xavier Darcos wants:
2,500 biggest companies to plan “anti-stress” strategies
Plan it with Unions
Govt has 27% stake in FT
Health & Happiness now on “National Agenda” in France
Foxconn and the iPad
Manufacturing giant in China
Renowned for efficiency – 300,000 employees
Laptops, mobiles - Nokia, Apple, Dell HP
13 suicide attempts since Jan 2010 – 10 deaths
Foxconn and the iPad
Compensation for families in poverty
Working conditions – long shifts, rigid,
Oppressive, poor pay
Company asked workers to sign a letter promising not to kill themselves
(now withdrawn)
Building giant safety net to prevent jumpers from Dorms and Workshops
Hiring counsellors and Buddhist monks
Work has not really changed . . .
. . . Attitudes have changed
When did this happen?
NOTICE
OUR STAFF HAVE
THE RIGHT TO
WORK IN AN
ENVIRONMENT FREE
FROM VIOLENCE
We will prosecute
anyone found abusing
or threatening
employees
*
* This will not affect your treatment
Misperceptions of workplaces
UK Climate of:
over-perception of danger
stress being unavoidable
wanting too much in return
Common Popular Headlines
High Profile Stress Cases
Isaac Blake VS Ragdoll Productions
2008
“Cold-blooded murder of English Justice”
Johnstone
vs
Bloomsbury H.A
Doctor
Walker
vs
Northumberland C.C.
Social Worker
Jones
vs
Birmingham C.C
Teacher
Hurley
vs
Gwent Constabulary
Police officer
Fearon
vs
Martin
Burglar
Armstrong
vs
Home Office
Prison officer
High Profile Case 1
Andrew Hurley vs Gwent Constabulary
Armed Response Unit
First on scene of armed robbery –
Three armed offenders at bank
Hurley shot 1. all 3 in custody
Won a commendation for the job
Resultant stress & depression
Left job 5 months later
Wanted £250,000 for loss of earnings and pension rights
Claimed offered no post-intervention counselling
Kept isolated for an hour after event – blood on hands
Tribunal heard evidence from Gwent Co. that counselling was offered 2
months after the shooting
Gwent Co. Claimed Hurley turned down initial offers of counselling
Court of Appeal Guidelines (16 points)
Individuals who do not notify their employer of any
problems are less likely to to succeed in claiming
compensation
Employers entitled to assume employee can withstand normal job-pressure
unless any vulnerability or problem is known
No occupations should be regarded as intrinsically dangerous to mental
health
Employers offering counselling and access to treatment unlikely to be found
in breach of duty
Employers not in breach of duty if only option is to demote or fire employee,
if a willing worker continues in same job
Necessary to identify all steps employers (could) have taken before finding
them in breach
Traditional model of Disease Development
Pathogen
Modifiers
Lifestyle
Individual susceptibility
Disease (pathology)
Dominance of the biopsychosocial model
Mainstream in last 15 years
Hazard
Illness (well-being)
Psychosocial Factors
Attitudes
Behaviour
Quality of Life
Rise of the worker as
a “psychological
entity”
The Biopsychosocial Model – works on all levels
“Everything is bad for us these days…”
Top 5 Workplace Health Problems
1. Hearing loss
NIHL, TTS, Exposure
2. Respiratory problems
Asbestosis, Carbon Black, Recycling
3. Skin problems
Hairdressers, Health care, Engineering
4. Mental health
Stress, Anxiety, Uncertainty
5. Musculoskeletal disorders
Desk workers, Cleaners, Drivers
Potential Health Risks
3x
Cardiovascular problems
“High Demand
Low Control”
3x Back pain
2x Substance abuse
2-3x Injuries
5x Certain cancers
2-3x Conflicts
2-3x Infections
2-3x
Mental health problems
Shain & Kramer 2004
“High Effort
Low Reward”
Futility of Some Stress Research
“One evening we had an almost inaudible talk from…..the
BBC staff doctor who told us how to recognise stress in our
staff: the body sits slumped, with the head shrunk between
the shoulders. At least I think that is what he said. He was
difficult to hear as we were all sitting slumped with our heads
shrunk between our shoulders”
Frank Muir in A Kentish Lad
Responses to Stress
Physiological changes
• Heart rate
• Blood pressure
• Biochemical
> adrenaline
> cortisol
> serotonin
> free histamine
Psychological changes
Anxiety
Depression
Tension
Tired
Apathy
Apprehension
Alienation
Resentment
Confidence
Aggression
Withdrawal
Restlessness
Indecision
Sleeping problems
Concentration
Worry
Legal Aspects
“Personal Injury”
Any impairment or any disease of a person’s physical or mental condition
1974 Health and Safety at Work Act
“Assessments of risks of activities associated with potential hazards”
1992 Management of Health & Safety at Work Regulations
Big stress cases
1. Johnstone vs
2. Walker
vs
3. Jones
vs
4. Hurley
vs
5. Fearon
vs
6. Armstrong vs
Bloomsbury H.A
Northumberland C.C.
Birmingham C.C
Gwent Constabulary
Martin
Home Office
Doctor
Social Worker
Teacher
Police officer
Burglar
Prison warder
High Profile Case 2
Isaac Blake VS Ragdoll Productions
2008
“Cold-blooded murder of English Justice”
Tombliboo
Homophobia , Bullying, Harassment
Faulty animatronics - Painful work – hip joints
Lost 4 / 5 claims
Awarded £2000 for being called a “faggot” twice
High Profile Case 3
Armstrong vs Home Office 1996
PO while west on remand
Close escort duties
31 day trial
Volunteered for escort
Claims was forced to covertly gather evidence
SA - stress and depression
High Profile Case 4
Psychological interventions can work
Cromwell Street Murders
John Bennett SIO
Team of 40 detectives
Sought “Stress Counselling”
Proactive
Some accepted – others did not
Upon retirement . . .
What workers expect
Reasonable expectations?
Financial
Achievable ?
Advancement
Affordable ?
Status
Respect
Perks
Education / Training
Autonomy
Dissatisfied workforce?
Aggrieved employees?
Unmotivated staff ?
Flexibility
Pensions
Support
Security
Commuting
“Cattle Truck Syndrome”
Chronic health problems exacerbated
by train travel?
Cumulative impact theory
Increased B.P, Anxiety,
Chronic Heart Conditions
Over-crowded trains / buses
Straining public transport system
Lack of control
Commuting
“People develop a constant
internal anger on crowded
trains that they cannot easily
displace…an individual's
immune system could also
be suppressed by stress,
making passengers more
susceptible to illnesses”
Long Working Hours
“Workaholism”
Japan, South Korea, Indonesia, UK
(Karojisatsu)
uninterrupted heavy workload
heavy physical work
excessive demands from irregular
overtime and shift work
excessive workloads from emotional
stress, such as responsibility,
transfers, and conflicts
• irregular sleep habits
• decreases in rest
• decrease social time
• alcohol abuse
• increased smoking
• unhealthy diet
• neglecting medical checks
• breakdown in family life
Office Work
“Veal – Fattening Crate” *
“Small, cramped office workstations built of fabric covered disassemblable
wall partitions and inhabited by junior staff members. Named after the small
pre-slaughter cubicles used by the cattle industry”
Douglas Coupland in Life After God
(being ironic)
*Do farm animals get better conditions than some workers?
Stress
“Golden Age of Stress”
Everyone is Stressed
BBCi - “Stress” = 16,000 finds
More people experiencing more stress
Greater demands from employers
People working longer hours
24 / 7 / 365 society
21st Century Satanic Mills
21st Century Satanic Mills
Psychosocial factors at the core of ill-health
Individual vulnerability
MSDs
Personality type
Experience
Stress
Distress
Somatics
Learned behaviours
Mental Health
Will workers take responsibility
for their ill-health?
Recall ADT?
Stress Definitions #1
A.
Stress occurs when demands exist which are outside a person’s capacity for
meeting those demands
B.
Stress is a response to the presence of psychosocial hazards in the
workplace
C.
Stress is the reaction people have when they feel they cannot cope with the
pressures or demands placed upon them
Over-simplistic definitions !
Stress Definitions #2
Stress is the disparity between what needs to be done (required) and what
can be done (actual)
required
Problems
actual
demands are not static
required
actual
required
actual
abilities are not static
how to quantify disparity
meaningfulness of any quantification
individual modification
So who has the “bad” jobs?
EXTREMELY STRESSFUL
Police
Fire
Ambulance
Prison
VERY STRESSFUL
Civil pilots
Media
Health care (non-emergency)
Performers
Social work
ABOVE AVERAGE STRESS
Marketing
Publishing
Retail
Catering
Printing
Transport
Teaching
Mining
Nursing
Construction
HOW MUCH FAITH CAN BE PUT INTO BROAD CATEGORIES?
Cooper 1988
Don’t Mention the “S”-Word ! ! !
Stress
Looks like a flaming deamon
Sounds like an eagle squaking
Tastes like a burnt sausage
Smells like sour milk
Feels like stroking a hedgchog
Stress is when mum says NO!!!!!
by Andrew (aged 10)
Year 5
Potley Hill Primary School
“Stress-Bunny”
The curse of the
Corpus Linguistic
Common Parlance
“Stress-Junkie”
Stress is Nothing New
World Wars I and II
Where was stress?
Dud shell manufacture
Some Stress is good
Keeps one alive
performance
Keeps one alert
Evolutionary perspective:
Too little stress = extinction
Too much stress = extinction
Balance stress = evolution
Pressure is good - - Stress is bad
stress
Stress Statistics
1995: Labour Force Survey
515,000 reported work-related stress
250,000 attributions of physical symptoms
30% increase in reports since 1990
1996: Institute of Management
270,000 daily absences for stress
£10.2 Billion cumulative annual cost
(sick pay, lost production, treatment)
2002: UK Health and Safety Executive
265,000 new “cases” in 2001
2000: Evans et al.
Scottish heart attack deaths higher
on Mondays
2004: UK Health and Safety Executive
13,000,000 working days lost / year
£12 Billion cost
Admissions and World Cup 1998
Examine hospital admissions for range of diagnoses on days surrounding
England's 1998 World Cup football matches
Hospital admissions obtained from English hospital episode statistics
Pop. Aged 15 – 64 years
Admissions for
• Acute MI
• Stroke
• Deliberate self harm
• Road traffic injuries
On match day
and 5 days after
match day
Compared with admissions at the same time in 1997 and 1998
Carroll, D et al. 2002
Admissions and World Cup 1998
England's matches in the 1998 World Cup
15 June
22 June
26 June
30 June
(England 2, Tunisia 0)
(Romania 2, England 1)
(Colombia 0, England 2)
(Argentina 2, England 2)
win
lost
win
lost: penalties 4-2
Extracted hospital admissions data for acute myocardial infarction, stroke,
deliberate self harm, and road traffic injuries among men and women aged
15 to 64
Games all took place in late evening
Examined the same associations using only the two days after the match
omitting the day of the match as the exposed condition
Admissions and World Cup 1998
During the period of England's World Cup matches (15 June to 1 July)
81,433 emergency admissions occurred:
1348
662
856
3308
Day of match
1 day after
2 days after
3 days after
4 days after
5 days after
(2%) for myocardial infarction
(1%) for stroke
(1%) for road traffic injury
(4%) for deliberate self harm
observed / expected
admissions
91 / 72
88 / 72
91 / 71
76 / 74
71 / 74
83 / 72
actual – expected
admissions
19
16
20
2
3
11
ARR
1.25 (0.99 to 1.57)
1.21 (0.96 to 1.57)
1.27 (1.01 to 1.61)
0.99 (0.77 to 1.27)
0.92 (0.71 to 1.19)
1.13 (0.89 to 1.43)
Admissions and World Cup 1998
Admission
diagnosis
Within 2 days
of win
Within 2 days
of 1-2 loss
Within 2 days of
loss on penalty
P value
M.I
0.99
0.89 - 1.11
0.91
0.78 - 1.07
1.25
1.08 - 1.44
0.007
Stroke
0.87
0.74 - 1.03
0.97
0.79 - 1.19
1.00
0.82 - 1.23
0.42
RTA
0.99
0.85 - 1.14
0.96
0.79 - 1.17
0.85
0.69 - 1.05
0.51
DSH
1.08
1.00 - 1.16
1.01
0.91 - 1.12
1.05
0.95 - 1.16
0.26
•Periods after a win (Tunisia, Columbia) and 1st first loss (Romania) were not
associated with increased admissions
• On match day, and two days after match against Argentina with a penalty
shoot-out, admissions for acute MI increased by 25%.
• No increases in admission were seen for any of the other diagnoses.
Admissions and World Cup 1998
Major environmental events, whether physical catastrophes or cultural
disappointments, are capable of triggering myocardial infarction.
If the triggering hypothesis is true, preventive efforts should consider
strategies for dealing with the effects of acute physical and psychosocial
upheavals.
“Perhaps the national lottery or even the
penalty shoot-out should be abandoned on
public health grounds.”
Limitations:
Harvesting effect?
Reporting tendency?
Sudden deaths?
“Oh Give Over!”
This has all gone too far
The Anti-Stress Backlash
“Meddling Psychologists”
Iatrogenesis
•
Induced inadvertently by the medical treatment or procedures or
activity, examination, manner or discussion of a physician.
•
The term is now applied to any adverse condition in a patient
occurring as the result of treatment by a physician or surgeon,
(e.g. acquired infections)
•
A disease produced as a
consequence of medical
or surgical treatment.
Being cynical . . .
Common Coping Styles
Adaptive coping
Seek those with similar experiences
Stick to a plan of action
Day to day basis
Seek information
Confront issue
Support seeking
Change situation
LONG
TERM
SOLUTION
Maladaptive coping
Withdraw from people in general
Avoidance
Deny what has happened
Consumption
Drink, eat, smoke to relieve tension
Denial
SHORT
TERM
SOLUTION
The Self-Loathing and Self-Improvement Culture
The age of the medical / health professional life-coach-guru-reality-tv-show
We’re all defective and we need to change ourselves
“I like
money”
“I like
money too”
“Not as much
as I do”
Individual Variability / Vulnerability
Differing Attitudes
&
Differing perceptions
Natural differences
Complex reasons
Experience
Personality
Learned behaviours
Stress is associated directly with workplaces
BUT
is also mediated by individual differences
No universal profile of what will certainly constitute stressful
situations
Vulnerable People
Important to be aware of vulnerable individuals and groups
Associated with socio-economic, cultural or demographic status
Females
Immigrant workers
Disabled
Excluded groups
Ethnic minorities
Any group by definition which is un-empowered
Personality – although some of this is spurious!
“Type A” (uptight, goal oriented)  likelihood of stress-illness and CHD (?)
“Type C” (high anxiety)  likelihood of Cancer (?)
“Type D” (negative affectivity, emotional inhibition)  likelihood of CHD (?)
“External” locus of control  poorer at handling stress
“Hardiness”  greater resistance and operability
Personality
Hey.
On way
Hi
Claire.
Are
home. Left
you
around
lecture
earlyand
do
cosyou
feelfancy
like a
crap. Next time!
brew?
A good sign or a bad sign?
Personality type
Optimism vs Pessimism
Negative Affectivity
Hardiness
Historical Errors of Distress-Related-Ill Health
Historically, distress was “blamed” for many ills
Now we know better…
CHD
Cholera
Pellagra
Beri Beri
Asthma
Down’s syndrome
Scurvy
Yellow fever
Typhoid
Peptic ulcer
Sir William Beaumont 1832
All believed to be
caused by “stress”
or “distress” at one
time or another
Puts
“blame”
for
illness
on the
person
Acute Stress and Chronic Stress
Common
After-effects
Leave behind
Life threatening
One-off
Ever-present
By proxy
Post Traumatic Stress Disorder (PTSD)
Response to specific traumatic / extreme event
DSM IV Diagnostic condition
&
ICD-10 Diagnostic condition
1. Experience intense fear
2. Persistent re-experience
3. Avoidance of associations
4. Persistent increased arousal since event
5. Flashbacks
Associated most with Disasters and Warfare
Not new - 6th Century BC
Every conflict since American Civil War in 1863
A COMPLETELY POLITICALLY MOTIVATED DIAGNOSIS
“Shell-Shock” “Battle fatigue” “Combat Syndrome”
NOT GULF WAR SYNDROME
Psychosocial Hazards
• Commonplace consideration in last 5 years
• Not straightforward
• All workplaces have potential to expose workers to psychosocial hazards
• All social relationships have potential for stress
• Little relation between stress incidents and occupational status
• Stress-Boom in last 3 years – VERY BIG INDUSTRY
• Intolerance of work in environments deemed psychologically stressful
“suffering from” & “recognising stress”
rapidly increasing issues
Acute Hazards
Work characteristics
1. Potential for violence
Accident & Emergency Services
2. Peril or Danger
Expected Dangerous Conditions
3. Potential for aggression
Hazardous conditions
1. Verbal abuse
Ordinary Conditions
2. Physical abuse
Unpredictable Behaviour / Incident
3. PTSD inducement
Chronic Hazards
Job content
Work overload / underload
Hazardous conditions
Under utilisation of skills
Time pressures
Lack of control
Work organisation
Shift work
Working hours
Work Culture
Communication
Change / technology
Poor resources
No feedback
No decision process
unsociable
long
unpredictable
too little (home-working) / too much (email)
Chronic Hazards (cont)
Work role
Ambiguity
Conflict
Advancement structure
Insecurity
Promotion
under and over
Low status
Poor pay
Environment
Hazards physical / chemical
Home – work interface
Conflicting demands
Support
Domestic problems
Commuting
Interpersonal Conflict
Colleagues
Superiors
Subordinates
Personal Issues
Isolation
Lack of support
Harassment
Bullying
Violence
Chronic Hazards - People
Sick Building Syndrome – A once popular theory
Air quality
Chemical pollutants
Air con
Ventilation
Dust
Tobacco
Space
Crowding
Isolation
Equipment
Printers
PC’s
Noise
Equipment
Telephones
Others
Lighting
Artificial
Glare
Control
Job content
vdu’s
Monotony
Overload
Organisation
Control, communication, feedback
Is STRESS the common link with SBS?
Karasek’s demand-control model of stress development
high
Productive,
Motivated
active
job control
low strain
high strain
low
passive
low
high
job demands
Karasek 1979
Risk of
psychological
strain and
increased illness
job demands
low
high
active
passive
high strain
low
job control
high
low strain
Karasek 1979
Karasek’s revised demand-control-support model
high
Productive,
Motivated
active
job control
low strain
Peer
Support
high strain
low
passive
low
high
job demands
Karasek 1979
Social
Support
Heroes
&
Villains
Risk of
psychological
strain and
increased illness
Psychological Tests
Occupational & clinical
odd mix
Testing standards
blasé attitudes
over familiar
Administration types
open
controlled
supervised
managed
agree
There is too much pressure to get
everything done on time
If I have a personal problem, I talk
to people about it
I often feel drained and tired
I get headaches at the end of the day
I feel much better at weekends
My partner asks me how my day has
been
Provides…
consequences
perceptions
perceived sources of stress
not sure
disagree
Summary of Occupational Stress
Any workplace / person / social interaction
Stress is a natural / healthy response
Some responses to stress are pathological
Worker intolerance
Impossible to predict stress reliably – easier to predict intolerance
Individual modifiers – personality, behaviour, coping style, perceptual processes
Legal obligation clearer than ever
Psychosocial hazards unavoidable & intrinsic in some cases
Most psychometric stress testing unethical
HUMAN CONDITION, NOT A “VARIABLE”
Questions
Why become stress intolerant?
Post-Industrial society?
Who benefits from this?
Too much personal freedom?
Celebrity culture - nobody wants the bad jobs?
What happens to stress-prone workers?
Who is to blame for being stressed?
Who is to blame for being ill?
Recommended Reading
Carroll D, Davey Smith G, Sheffield D, Shipley MJ, and Marmot MG. Pressor reactions
to psychological stress and prediction of future blood pressure: data from the
Whitehall II study. BMJ 1995;310:771-775.
Chen C, David AS, Nunnerley H, Michell M, Dawson JL, Berry H, Dobbs J, and Fahy
T. Adverse life events and breast cancer: case-control study. BMJ 1995; 311: 15271530.
Jackson CA and Cox T. Health and well-being of working age people. ESRC Seminar
Series. ESRC. London. 2006
Jackson CA. Psychosocial Aspects of the Workplace. In Aw, T.C et al. (eds)
Occupational Health Pocket Consultant (fifth edition). Oxford: Blackwell Scientific
Publishing; 2006. 191-201
Jackson CA. Psychosocial Hazards. In Smedley, J et al. (eds) Oxford Handbook of
Occupational Health. Oxford. Oxford University Press; 2007. 167-179
Recommended Reading
Kivimäki M, Leino-Arjas P, Luukkonen R, Riihimäki H, Vahtera J, and Kirjonen J. Work
stress and risk of cardiovascular mortality: prospective cohort study of industrial
employees. BMJ 2002; 325: 857.
Levenstein S. Stress and peptic ulcer: life beyond helicobacter. BMJ 1998; 316: 538541.
Shain M and Kramer DM. Health Promotion in the Workplace: Framing the Concept;
Reviewing the Evidence. Occupational and Environmental Medicine 2004;61:643-648.
Work Stress: The Making of a Modern Epidemic. Michael Fitzpatrick. Open University
Press, 2002.