Measuring Stress Measuring Stress CorrectlyCorrectly
Recovering a Recovering a Stressed-out WorkforceStressed-out Workforce
Professor Craig JacksonProfessor Craig JacksonProf. Occupational Health PsychologyProf. Occupational Health Psychology
Head of Psychology Head of Psychology Birmingham City UniversityBirmingham City University
Stress – The BasicsStress – The Basics
Definition problemsDefinition problems
Not just at workplace (home, commuting)Not just at workplace (home, commuting)
Individual responseIndividual response
Work-life Balance issuesWork-life Balance issues
Control vs DemandControl vs Demand
Personality typesPersonality types
Cause of many secondary health problemsCause of many secondary health problems
Not even a medical diagnosisNot even a medical diagnosis
Stress is not a useful concept:Stress is not a useful concept:
Loose criteriaLoose criteria
Too many triggersToo many triggers
Too many responsesToo many responses
Too many effect modifiersToo many effect modifiers
Used too casuallyUsed too casually
FashionableFashionable
Positive perceptionsPositive perceptions
Not reliably measuredNot reliably measured
Workplace Hazards – current statusWorkplace Hazards – current status
Shiftworking:Shiftworking: 1 in 5 employed1 in 5 employedlikely to increase with growthlikely to increase with growth
Long hours:Long hours: >48 hours per week>48 hours per weekFallen due to EWTD Fallen due to EWTD Still > most of EuropeStill > most of Europe
Psychosocial:Psychosocial: 5 mill employees perceive effects5 mill employees perceive effects13 mill working days lost13 mill working days lostMundane occupations sufferMundane occupations sufferChronic stress more problematicChronic stress more problematic
Physical:Physical: NoiseNoise technicaltechnicalDustDust changeschangesChemicalChemical monitoringmonitoringVibrationVibration OELsOELs
FatigueFatigue
Somatic symptomsSomatic symptoms
SleepSleep
MSDsMSDs
DepressionDepression
CardiovascularCardiovascular
AccidentsAccidents
DepressionDepression
QoLQoL
Stress StatisticsStress Statistics
1995: Labour Force Survey1995: Labour Force Survey515,000 reported work-related stress515,000 reported work-related stress
250,000 attributions of physical symptoms250,000 attributions of physical symptoms30% increase in reports since 199030% increase in reports since 1990
1996: Institute of Management1996: Institute of Management270,000 daily absences for stress270,000 daily absences for stress
£10.2 Billion cumulative annual cost£10.2 Billion cumulative annual cost(sick pay, lost production, treatment)(sick pay, lost production, treatment)
2002: UK Health and Safety Executive2002: UK Health and Safety Executive 265,000 new “cases” in 2001265,000 new “cases” in 2001
2000: Evans e2000: Evans et al.t al. Scottish heart attack deaths higher Scottish heart attack deaths higher on Mondayson Mondays
2004: UK Health and Safety Executive2004: UK Health and Safety Executive 13,000,000 working days lost / year13,000,000 working days lost / year£12 Billion cost£12 Billion cost
Psychosocial factors at the core of ill-healthPsychosocial factors at the core of ill-health
Individual vulnerabilityIndividual vulnerability
Personality typePersonality type
ExperienceExperience
Learned behavioursLearned behaviours
MSDsMSDs
Mental HealthMental HealthSomaticsSomaticsSomaticsSomatics
StressStressDistressDistress
Incorrect Stress Definitions Incorrect Stress Definitions
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 !
Responses to HazardsResponses to Hazards
Physiological changesPhysiological changes
• Heart rateHeart rate• Blood pressureBlood pressure• Biochemical Biochemical
> adrenaline> adrenaline > cortisol> cortisol> serotonin> serotonin > free histamine> free histamine
Psychological changesPsychological changes
AnxietyAnxiety DepressionDepression TensionTension TiredTired WorryWorry
Apathy Apathy ApprehensionApprehension AlienationAlienation ResentmentResentment
Confidence Confidence AggressionAggression WithdrawalWithdrawal RestlessnessRestlessness
IndecisionIndecision Sleeping problemsSleeping problems Concentration Concentration
Acute Stress and Chronic Stress Acute Stress and Chronic Stress
Common
After-effects
Leave behind
Life threatening
One-off
Ever-present
By proxy
Demand-Control model of stress developmentDemand-Control model of stress development
lowlow high highjob demandsjob demands
job
co
ntr
ol
job
co
ntr
ol
low
low
hig
h h
igh
low strainlow strain
passivepassive
activeactive
high strainhigh strain
Risk of Risk of psychological psychological strain and strain and increased illnessincreased illness
Productive, Motivated
Karasek 1979
lowlow high highjob demandsjob demands
job
co
ntr
ol
job
co
ntr
ol
low
low
hig
h h
igh
low strainlow strain
passivepassive
activeactive
high strainhigh strain
Risk of Risk of psychological psychological strain and strain and increased illnessincreased illness
Productive, Motivated
SocialSocialSupportSupport
Peer Peer SupportSupport
Heroes Heroes & &
VillainsVillains
Organisational Organisational JusticeJustice
Karasek 1979
Demand-Control-Support model of stress Demand-Control-Support model of stress
Psychosocial Hazards Psychosocial Hazards
• Commonplace consideration in last 10 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 15 years – VERY BIG INDUSTRY
• Intolerance of work in environments deemed psychologically stressful
“suffering from” & “recognising stress”rapidly increasing issues
Acute Hazards Acute Hazards
Work characteristics
1. Potential for violence Accident & Emergency Services
2. Peril or DangerExpected Dangerous Conditions
3. Potential for aggression
Hazardous conditions
1. Verbal abuseOrdinary / Mundane Conditions
2. Physical abuseUnpredictable Behaviour / Incident
3. PTSD inducement
Chronic HazardsChronic Hazards
Job contentWork overload / underloadHazardous conditionsUnder utilisation of skillsTime pressuresLack of control
Work organisationShift workWorking hours unsociable long unpredictable
Work CultureCommunication too little (home-working) / too much (email)Change / technologyPoor resourcesNo feedbackNo decision process
Chronic Hazards (cont)Chronic Hazards (cont)
Work roleAmbiguityAmbiguityConflictConflict
Advancement structureInsecurityInsecurityPromotionPromotion under and overunder and overLow statusLow statusPoor payPoor pay
EnvironmentHazardsHazards physical / chemicalphysical / chemical
Home – work interfaceConflicting demandsConflicting demandsSupportSupportDomestic problemsDomestic problemsCommutingCommuting
Interpersonal ConflictInterpersonal ConflictColleagues
SuperiorsSubordinates
Personal IssuesPersonal IssuesIsolation
Lack of supportHarassment
BullyingViolence
Organisational JusticeOrganisational JusticeFairness
PromptnessEquality
Avoidable psychosocial hazardsAvoidable psychosocial hazards
EliminateEliminate exposure exposure
ReduceReduce exposure exposure
ControControll exposure exposure
Change physical environmentChange physical environment
Change work organisationChange work organisation
Provide extra resourcesProvide extra resources
Management / employee trainingManagement / employee training
Career development systemsCareer development systems
Increase participationIncrease participation
Increase controlIncrease control
Policies to identify and address future problem issuesPolicies to identify and address future problem issues
Intrinsic & External Psychosocial HazardsIntrinsic & External Psychosocial Hazards
INTRINSIC HAZARDSINTRINSIC HAZARDS
• Safe systems of working
• Training and education – Does this Work though? ? ?
• PTSD counselling / debriefing – Does this Work though? ? ?
EXTERNAL HAZARDSEXTERNAL HAZARDS
• Provide protection and rehabilitation where necessaryProvide protection and rehabilitation where necessary
• Counselling servicesCounselling services
• Stress management trainingStress management training
• Health promotion activitiesHealth promotion activities
• Information relating to specific problemsInformation relating to specific problems
(gambling, alcohol, substance abuse, domestic) (gambling, alcohol, substance abuse, domestic)
CommutingCommuting
““Cattle Truck Syndrome”Cattle Truck Syndrome”
Chronic health problems exacerbated Chronic health problems exacerbated by train travel?by train travel?
Cumulative impact theoryCumulative impact theory
Increased B.P, Anxiety, Increased B.P, Anxiety, Chronic Heart ConditionsChronic Heart Conditions
Over-crowded trains / busesOver-crowded trains / busesStraining public transport systemStraining public transport systemLack of controlLack of control
CommutingCommuting
““People develop a constant internal People develop a constant internal anger on crowded trains that they anger on crowded trains that they cannot easily displace…ancannot easily displace…anindividual's immune system couldindividual's immune system couldalso be suppressed by stress,also be suppressed by stress,making passengers more susceptible making passengers more susceptible to illnesses”to illnesses”
45 minutes cut-off45 minutes cut-off
Long Working HoursLong Working Hours
““Workaholism”Workaholism”
Japan, South Korea, Indonesia, UKJapan, South Korea, Indonesia, UK(Karojisatsu)(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
Stress MeasurementStress Measurement
Stress is the disparity between what needs to be done (required) and what can be done (actual)
Problems
demands are not static
abilities are not static
how to quantify disparity
meaningfulness of any quantification
individual modification
required
actualSTRESS!
required
actualBORED
required
actual
“High EffortLow Reward”
“High DemandLow Control”
2x Substance abuse
2-3x Injuries
2-3x Infections
3x Back pain
5x Certain cancers
2-3x Conflicts
2-3xMental health problems
3xCardiovascular problems
Potential Health RisksPotential Health Risks
Shain & Kramer 2004Shain & Kramer 2004
Potential effectsPotential effects
StressStress
FatigueFatigue
ExposureExposure
cardiovascularcardiovascular
mental healthmental health
immune systemimmune system
gastrointestinalgastrointestinal
musculoskeletalmusculoskeletal
social effectssocial effects
performance impairmentperformance impairment
safety problemssafety problems
over-exposureover-exposure
Potential Health RisksPotential Health Risks
How Widespread is it Really ?
• Mental health problems (some)
• Somatic symptoms
• Consumption consequences
• CHD
• Cancers
• Infection
• Immuno-suppression
Over investigated ?
Dutch truck drivers Taiwanese Casino staffSpanish fishermen
Indian shoemakers Lebanese bank tellers
Performance effectsPerformance effects
Accuracy
• Accuracy drops• Errors increase• Near-misses increase• Accidents increase• Inefficiency increases• Speed increase (some tasks)
Attitudes
• Risk taking increases• Reduced attention to Health & Safety of colleagues• Reduced compliance with rules
Performance Indicators
ObjectivePhysical health
Quality control
Performance
Accidents
Errors
Near misses - recording problems
Mental health problems
Erratic / out of character behaviour – subjective
Disputes
Short term absence
Staff turnover
Trivial complaintsPoor timekeeping
Subjective
What workers expectWhat workers expect
FlexibilityFlexibility
AutonomyAutonomy
PensionsPensions
Education / Training Education / Training
SupportSupport
AdvancementAdvancement
SecuritySecurity
PerksPerks
Respect Respect
FinancialFinancial
StatusStatus
Reasonable expectations?Reasonable expectations?
Achievable ?Achievable ?
Affordable ?Affordable ?
Dissatisfied workforce?Dissatisfied workforce?
Aggrieved employees?Aggrieved employees?
Unmotivated staff ?Unmotivated staff ?
Individual Variability / VulnerabilityIndividual Variability / Vulnerability
Best predictor of future stress responses are past stress responsesBest predictor of future stress responses are past stress responses
Differing AttitudesDiffering AttitudesDiffering perceptionsDiffering perceptionsNatural differencesNatural differencesComplex reasonsComplex reasons
ExperienceExperience PersonalityPersonality
Learned behavioursLearned behaviours
Stress is associated directly with workplaces BUT is also mediated by Stress is associated directly with workplaces BUT is also mediated by individual differencesindividual differences
No universal profile of what will certainly provide stressful responsesNo universal profile of what will certainly provide stressful responses
Vulnerable PeopleVulnerable People
Associated with Associated with socio-economicsocio-economic, , culturalcultural or or demographic statusdemographic status
FemalesFemalesImmigrant workersImmigrant workersDisabledDisabled Any group by definition which is un-empoweredAny group by definition which is un-empoweredExcluded groupsExcluded groupsEthnic minoritiesEthnic minorities
Personality – although some of this is spurious!Personality – although some of this is spurious!““Type A”Type A” (uptight, goal oriented) (uptight, goal oriented) likelihood of stress-illness and CHD (?) likelihood of stress-illness and CHD (?)““Type C”Type C” (high anxiety) (high anxiety) likelihood of Cancer (?) likelihood of Cancer (?)““Type D”Type D” (negative affectivity, emotional inhibition) (negative affectivity, emotional inhibition) likelihood of CHD (?) likelihood of CHD (?)
““External” locus of controlExternal” locus of control poorer at handling stress poorer at handling stress““Hardiness”Hardiness” greater resistance and operability greater resistance and operability
PersonalityPersonality
A good sign or a bad sign?A good sign or a bad sign?
Personality typePersonality type
Optimism vs PessimismOptimism vs Pessimism
Negative AffectivityNegative Affectivity
HardinessHardiness
Hi. I need to see you first thing tomorrow in my office!
Common Coping Styles Common Coping Styles
Adaptive copingAdaptive coping
Seek those with similar experiencesSeek those with similar experiencesConfront issueConfront issue
Stick to a plan of actionStick to a plan of action LONGLONGSupport seekingSupport seeking TERMTERM
Day to day basisDay to day basis SOLUTIONSOLUTIONChange situationChange situation
Seek informationSeek information
Maladaptive copingMaladaptive coping
Withdraw from people in generalWithdraw from people in general AvoidanceAvoidanceSHORTSHORT
Deny what has happenedDeny what has happened ConsumptionConsumption TERMTERMSOLUTIONSOLUTION
Drink, eat, smoke to relieve tensionDrink, eat, smoke to relieve tension DenialDenial
Methods of Assessing Stress
Questionnaire Assessment
Symptoms
Behaviours
Performance: Typical vs Maximum
Checklist approach
“Normal” and “Abnormal” behaviours
Systematic scoring principles
Qualitative classificationcases stressed dysfunctionalstress-prone healthy
Psychological TestsPsychological Tests
Occupational & clinicalOccupational & clinicalodd mixodd mix
Testing standardsTesting standardsblasé attitudesblasé attitudesover familiarover familiar
Administration typesAdministration typesopenopencontrolledcontrolledsupervisedsupervisedmanagedmanaged
Provides…Provides…consequencesconsequencesperceptionsperceptionsperceived sources of stressperceived sources of stress
agree not sure disagreeThere is too much pressure to geteverything done on time
If I have a personal problem, I talkto people about it
I often feel drained and tired
I get headaches at the end of the dayI feel much better at weekends
My partner asks me how my day hasbeen
am i happy?
yes
potential for change?
alternative plan: is my work…
safe?
infinite options
no make changes
no yes
fun?
pleasant?
valued?
yes
no does it make me ill?
could it make me ill?
should i worry about this?
no
yes
should it make me ill?
infinite options
Stress!
yes
someone must act on this
““Usefulness of Stress” ModelUsefulness of Stress” Model
Rights of test takers #1
ITC GuidelinesBPS is only recourse at present www.bps.org.uk
State purposeoutcomes?specific tests used?evidence of relevance & appropriateness?
Clarity of procedureadministration method?competence of administrator?locations suitable?
Inquiries and complaintshandled by?competence of handler?what actions will result?fair treatment?
Rights of test takers #2
Test informationscoringinterpretationevidence of competencecommunication of scoresaccurate and meaningful communication of scoresconfidentiality of scoreswho can access scores and why?storage of scores / data
Competence
certificates of competence in testing
monitor competence
awareness of personal limitations
Recommended ReadingRecommended Reading
Carroll D, Davey Smith G, Sheffield D, Shipley MJ, and Marmot MGCarroll D, Davey Smith G, Sheffield D, Shipley MJ, and Marmot MG. Pressor . Pressor reactions to psychological stress and prediction of future blood pressure: data from reactions to psychological stress and prediction of future blood pressure: data from the Whitehall II study. the Whitehall II study. BMJ 1995;310:771-775.BMJ 1995;310:771-775.
Chen C, David AS, Nunnerley H, Michell M, Dawson JL, Berry H, Dobbs J, and Fahy Chen C, David AS, Nunnerley H, Michell M, Dawson JL, Berry H, Dobbs J, and Fahy T. T. Adverse life events and breast cancer: case-control studyAdverse life events and breast cancer: case-control study. BMJ 1995; 311: 1527-. BMJ 1995; 311: 1527-1530.1530.
Jackson CA and Cox T. Jackson CA and Cox T. Health and well-being of working age people.Health and well-being of working age people. ESRC Seminar ESRC Seminar Series. ESRC. London. 2006Series. ESRC. London. 2006
Jackson CA. Psychosocial Aspects of the Workplace. In Aw, T.C Jackson CA. Psychosocial Aspects of the Workplace. In Aw, T.C et al.et al. (eds) (eds) Occupational Health Pocket Consultant (fifth edition). Occupational Health Pocket Consultant (fifth edition). Oxford: Blackwell Scientific Oxford: Blackwell Scientific Publishing; 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 ReadingRecommended Reading
Kivimäki M, Leino-Arjas P, Luukkonen R, Riihimäki H, Vahtera J, and Kirjonen J. 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 Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employeesindustrial employees. BMJ 2002; 325: 857.. BMJ 2002; 325: 857.
Levenstein S. Levenstein S. Stress and peptic ulcer: life beyond helicobacter. Stress and peptic ulcer: life beyond helicobacter. BMJ 1998; 316: 538-BMJ 1998; 316: 538-541.541.
Shain M and Kramer DM. Health Promotion in the Workplace: Framing the Concept; Shain M and Kramer DM. Health Promotion in the Workplace: Framing the Concept; Reviewing the Evidence. Reviewing the Evidence. Occupational and Environmental MedicineOccupational and Environmental Medicine 2004;61:643-648. 2004;61:643-648.
Work Stress: The Making of a Modern Epidemic. Michael Fitzpatrick. Open University Work Stress: The Making of a Modern Epidemic. Michael Fitzpatrick. Open University Press, 2002.Press, 2002.
