Stress at Work Research Paper

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1. The Changing Nature Of Work And The Role Of Stress

The nature of work has changed considerably over the past several decades in economically advanced societies. Industrial mass production no longer dominates the labor market. This is due, in part, to technological progress, in part to a growing number of jobs available in the service sector. Many jobs are confined to information processing, controlling, and coordination. Sedentary rather than physically strenuous work is becoming more and more dominant. New management techniques, including quality management, are introduced, and economic constraints produce work pressure, rationalization, and cut-down in personnel. These changes go along with changes in the structure of the labor market. More employees are likely to work on temporary contracts, on fixed term, or in flexible job arrangements. The workforce is getting older, and an increasing proportion of women enters the labor market, with an increase of double exposure among women with children or, more generally, in dual career families. Most importantly, overemployment in some segments of the workforce is paralleled by underemployment, job instability, or structural unemployment in other segments. This latter trend currently hits the economically most advanced societies as well as economies that lag behind. Overall, a substantial part of the economically active population is confined to insecure jobs, to premature retirement, or job loss.

Why is work so important for human well-being, and how does work contribute to the burden of stress and its adverse effects on health? In all advanced societies work and occupation in adult life are accorded primacy for the following reasons. First, having a job is a principal prerequisite for continuous income and, thus, for independence from traditional support systems (family, community welfare, etc.). Increasingly, level of income determines a wide range of life chances. Second, training for a job and achievement of occupational status are the most important goals of socialization. It is through education, job training, and status acquisition that personal growth and development are realized, that a core social identity outside the family is acquired, and that goal-directed activity in human life is shaped. Third, occupation defines an important criterion of social stratification. Amount of esteem in interpersonal life largely depends on type of job and level of occupational achievement. Furthermore, type and quality of occupation, and especially the degree of self-direction at work, strongly influence personal attitudes and behavioral patterns in areas that are not directly related to work, such as leisure or family life (Kohn and Schooler 1983). Finally, occupational settings produce the most pervasive continuous demands during one’s lifetime, and they absorb the largest amount of active time in adult life, thus providing a source of recurrent negative or positive emotions. It is for these reasons that stress research in organizations where paid work takes place is of particular relevance.

It is important to recognize that traditional occupational hazards, such as exposure to toxic substances, heat, cold, or noise, are no longer the dominant challenges of health at work. Rather, distinct psychological and emotional demands and threats are becoming highly prevalent in modern working life. There has been a recognition that the importance of work goes beyond traditional occupational diseases and, indeed, it is likely that work makes a greater contribution to diseases not thought of as ‘occupational’ in conventional terms. At a descriptive level, recent reports find that, for instance, almost half of the workforce are exposed to monotonous tasks or lack of task rotation; 50 percent work at a very high speed or to tight deadlines. Thus, overand underload at work are highly prevalent. Every third employee has no influence on work rhythm, and every fifth is exposed to shiftwork (Paoli 1997). There is now growing awareness among all parties of the labor market that psychosocial stress at work produces considerable costs, most importantly a high level of absenteeism, reduced productivity, compensation claims, health insurance, and direct medical expenses. Permanent disability and loss of productive life years due to premature death add to this burden. In the European Union, the costs of stress to organizations and countries are estimated to be between 5 and 10 percent of GNP per annum (Cooper 1998). At the same time scientific evidence on associations between psychosocial stress at work and health is growing rapidly.

2. Concepts Of Work-Related Stress And Selected Findings

Research on psychosocial work-related stress differs from traditional biomedical occupational health research by the fact that stressors cannot be identified by direct physical or chemical measurements. Rather, theoretical models are needed to analyze the particular nature of the psychosocial work environment. A theoretical model is best understood as a heuristic device that selectively reduces complex reality to meaningful components. Components are meaningful to the extent that they provide the material from which the researcher can deduce explanations and, thus, produce new knowledge. Ideally, a theoretical model of psychosocial stress at work with relevance to health should encompass a wide variety of different occupations and should not be restricted to a specific time or space.

Before describing some prominent theoretical models of occupational stress, the basic terminology needs to be clarified. Much critique has been raised against the ambiguity of the term ‘stress.’ To avoid this, the following terms were suggested: ‘stressor’ is defined as an environmental demand or threat that taxes or exceeds a person’s ability to meet the challenge; ‘strain’ is defined as the person’s response to such a situation in psychological and physiological terms. Psychological responses include specific cognitions and negative emotions (e.g., anger, frustration, anxiety, helplessness), whereas physiological responses concern the activation of the autonomic nervous system and related neuro-hormonal and immune reactions. Stressors, in particular novel or dangerous ones, are appraised and evaluated by the person, and as long as there is some perception of agency on the part of the exposed person efforts are mobilized to reverse the threat or to meet the demands. Such efforts are termed ‘coping,’ and they occur at the behavioral (even interpersonal), cognitive, affective, and motivational level. Clearly, when judging strain, the quality and intensity of a stressor as well as the duration of exposure have to be taken into account, as well as individual differences in coping and in vulnerability to strain reactions. Recent research indicates that only part of human strain reactions are subject to conscious information processing, whereas a large amount bypasses awareness. The term ‘stressful experience’ is introduced to delineate that part of affective processing that reaches consciousness. Stressful experiences at work are often attributed to adverse working conditions by exposed people themselves. While they usually refer to some common sense notions of stress, it is crucial to note that these attributions differ from the explanatory constructs of stressful experience at work that have been identified by science.

2.1 Person–Environment Fit

The first significant contribution to modern occupational stress research dates back to studies conducted more than 30 years ago at the Institute for Social Research at the University of Michigan. They were guided by a theoretical concept termed ‘person–environment fit’ (Caplan et al. 1980). Stressful experience at work, in this model, is conceptualized in two ways: first, as an experience where the work environment does not provide adequate supplies to meet the person’s needs; second, as an experience where the abilities of the person fall short of demands that are prerequisite to receiving supplies. In both conditions stressful experience results from a misfit between needs or abilities of the working person and demands or opportunities of the work environment. Further job opportunities may fail to fulfill the person’s needs as a consequence of unmet demands. As an example, a worker with limited skills is excluded from any promotion prospects, although, to meet his level of living, he badly needs better pay.

This approach represents a type of theorizing that is termed process theory. As such, it is applicable to a wide range of work but does not specify the particular content dimensions on which person and environment should be examined (Edwards et al. 1998). As its basic terms are rather broad, it may be difficult to reach a consensus on how to measure core constructs. Nevertheless, person–environment fit offers an elaborate set of propositions of how critical constellations of work-related environmental and personal characteristics contribute to the development of stressful experience. At the empirical level, most up-to-date studies have tested adverse effects on subjective health. Therefore, it is not quite evident to what extent these types of misfit are capable of eliciting sustained physiological strain and thus contribute to the development of bodily disease.

2.2 Demand, Support, And Control

The argument of how strain reactions affect physiological regulation has received special attention in a second influential contribution to current occupational stress research that focuses on the theoretical construct of control. Animal stress research and psycho-physiological experiments in humans confirmed the critical impact on physiological and psychological strain reactions produced by lack of control in a challenging situation (Frankenhaeuser 1979, Henry and Stephens 1977). Control is defined as the ability of a person to choose their own actions to cope with a challenge. In the workplace it ranges from task autonomy to participation in decision making, and strain evolves from challenging situations at work that leave the person with limited choice on how to react. This idea was elaborated in terms of the demand–control model of occupational stress by Karasek (Karasek and Theorell 1990, see Occupational Health). This model posits that strain is contingent on the combined effects of high demand and low control; though both high demands and low control may also have independent additive effects on strain and health.

Stress research based on the concept of control resulted in several important discoveries. First, it was shown that physiological strain reactions are not uniform, but may vary according to the degree of perceived control. For instance, stressful experience in terms of striving without success was found to elicit strain reactions that exert particularly harmful effects on the cardiovascular system (Kaplan et al. 1983). Second, epidemiologic studies on work-related control and health, most importantly in the framework of the demand–control model, help explaining the social distribution of some major chronic diseases, especially coronary heart disease (CHD). An inverse social gradient of CHD has been documented. Exposure to low control jobs is more frequent among lower status groups as is the prevalence of CHD. In fact, recent studies found evidence that a considerable part of the social variation in CHD is attributed to adverse psychosocial work conditions (Marmot et al. 1999). Finally, research on control at work has put special emphasis on coping resources, in particular the buffering effects produced by social support. Strain reducing effects of social support are due to positive experience resulting from social relationships at the instrumental, emotional, and cognitive level (House 1981). This evidence has implications both for a broader conceptualization of occupational stress (e.g., the revised demand–support–control model (Karasek and Theorell 1990)) and for the design of workplace intervention measures.

2.3 Effort And Reward

In physiological terms, theories of control at work deal with the experience of power and influence which, at the psychological level, is paralleled by feelings of autonomy and self-efficacy. An alternative model of stressful experience at work, the model of effort– reward imbalance, is concerned with distributive justice, that is, with deviations from a basic ‘grammar’ of social exchange rooted in the notions of reciprocity and fairness (Siegrist 1996). This model assumes that effort at work is spent as part of a socially organized exchange process to which society at large contributes in terms of rewards. Rewards are distributed by three transmitter systems: money, esteem, and career opportunities including job security. The model of effort–reward imbalance claims that lack of reciprocity between costs and gains (i.e., high ‘cost’ low ‘gain’ conditions) elicits sustained strain reactions. For instance, having a demanding, but unstable job, achieving at a high level without being offered any promotion prospects, are examples of high cost low gain conditions at work. In terms of current developments of the labor market in a global economy, the emphasis on occupational rewards including job security reflects the growing importance of fragmented job careers, of job instability, underemployment, redundancy, and forced occupational mobility including their financial consequences.

According to this model, strain reactions are most intense and long-lasting under the following conditions: (a) lack of alternative choice in the labor market may prevent people from giving up even unfavorable jobs, as the anticipated costs of disengagement (e.g., the risk of being laid-off) outweigh the costs of accepting inadequate benefits; (b) unfair job arrangements may be accepted for a certain period of one’s occupational trajectory for strategic reasons; by doing so employees tend to improve their chances for career promotion at a later stage; (c) a specific personal pattern of coping with demands and of eliciting rewards characterized by overcommitment may prevent people from accurately assessing cost–gain relations. ‘Overcommitment’ defines a set of attitudes, behaviors, and emotions reflecting excessive striving in combination with a strong desire for being approved and esteemed (Siegrist 1996). At the psychological level, experience of effort–reward imbalance is often paralleled by feelings of impaired self-worth or self-esteem.

2.4 Empirical Evidence

Evidence of impaired health due to exposure to stressors that are defined by the concepts described is growing rapidly. In particular, a number of well-designed prospective social-epidemiological studies found moderately elevated relative risks (two-to threefold) of incident CHD in economically active middle-aged men and women who were suffering from high demand/low control or effort–reward imbalance. Other health effects observed in prospective and cross-sectional studies concern distinct cardiovascular risk factors, gastrointestinal symptoms, mild psychiatric disorders, poor subjective health, and musculo-skeletal disorders. In addition, rates of absenteeism are elevated (Marmot et al. 1999). There is also evidence of changes in physiological patterns, release of stress hormones, and altered immune competence following stressful experience at work. Taken together, the burden of illness that can be attributed, at least in part, to exposure to an adverse psychosocial work environment turns out to be impressive. While further research is needed to address important issues, practical implications of this new evidence deserve special attention.

3. Practical Implications And Future Directions

Overall, worksite health promotion activities are realized with little concern about scientific advances obtained in the field of occupational stress research. Eventually, this may change in the future as all three models described in the last paragraph (as well as additional models not mentioned in detail, for summary see Cooper 1998) provide a rationale for evidence-based preventive activity. Person–environment fit theory concludes that work demands need to be tailored according to the worker’s abilities. This involves both specific measures of organizational development and person development. Moreover, organizational interventions must suit the needs of affected individuals that are closely linked to the work role (e.g., motivation, learning, satisfaction; Edwards et al. 1998). In the demand–support–control model, special emphasis is put on autonomy, skill discretion, and personal growth. Measures of work reorganization include job enlargement, job enrichment, skill training, enhanced participation, and teamwork (Karasek and Theorell 1990). Practical implications of the effort–reward imbalance model concern the development of compensatory wage systems, the provision of models of gain sharing, and the strengthening of nonmonetary gratifications. Moreover, ways of improving promotional opportunities and job security need to be explored. Supplementary measures are interpersonal training and skill development, in particular leadership behavior.

Clearly, the power of economic life and the constraints of globalization limit the options and range of worksite health promotion measures. Moreover, such measures are difficult to apply to medium-sized and small enterprises where the majority of the workforce in advanced societies is employed. Finally, it must be stated that many instrumental activities that qualify as work are no longer confined to the conventional type of workplace located within an enterprise or organization, particularly with the advent of advanced communications technology (Cooper 1998).

3.1 Future Challenges For Research

There are at least three obvious future directions for occupational stress research. First, the theoretical concepts of stressful experience at work discussed need to be examined in a comparative perspective, with emphasis on their potential overlap or cumulative effects. For instance, recent studies found independent statistical prediction of the demand–control and the effort–reward imbalance model when tested simultaneously (Marmot et al. 1999). Moreover, the estimation of health risk was considerably improved when based on combined information derived from both models.

A second direction of research addresses the link or interface between work and nonwork settings, in particular work and family. In advanced societies work and family have been identified as the two most central domains, especially so in midlife. Therefore, stress-enhancing and stress-buffering experiences in these two domains significantly contribute to personal health and well-being. This interface is conceptualized in terms of spillover, compensation, or cumulation. Spillover refers to the transfer of experience and behavior from one domain to the other. For instance, work overload or shiftwork schedules may have negative effects on family life. Alternatively, experience of competence and success at work can have beneficial effects on marital life and relationships between parents and children (Kohn and Schooler 1983). Compensation represents efforts to reduce stressful experience in one domain by improving satisfaction in another domain. For instance, leisure and family activities are enhanced to the extent that decreasing involvement in a stressful work environment is feasible. Compensation often occurs in terms of resource management in a stressful situation. In conceptual terms, there is some overlap between the buffering model of social support and compensation processes (House 1981). Cumulation refers to the fact that the critical components of stressful psychosocial experience, such as lack of control or effort–reward imbalance, generalize across core life domains. For instance, disease vulnerability may be highest among people with insecure, badly paid, effortful jobs who also live in a family arrangement that offers little emotional and material satisfaction. It is desirable to extend the theoretical models discussed, both conceptually and operationally, to life domains other than work.

A third direction of research concerns intervention studies. The implementation and evaluation of theorybased intervention is a promising area for creating new knowledge although it is admitted that established methodological principles of scientific trials cannot be fully met. Recent theory-based intervention studies have documented favorable health effects (Cooper 1998, Karasek and Theorell 1990, Siegrist 1996, see Occupational Health). In view of the importance of work for health, it is well justified to advance the field of occupational stress both at the science and policy level.

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