Stress in the workplace

Stress in the workplace

Keeping stress in check could create a healthier – and safer – workforce

March 1, 2011


  • A number of factors such as work hours, management style, and interpersonal relationships can affect an individual's stress levels at work.
  • Dangerous levels of stress often display physical warning signs, such as tension headaches, heartburn, fatigue and changes in body weight.
  • To combat stress in the workplace, employers should assess their employees to find out what the common stressors are are and work toward mitigating stressful elements of the workplace. 

Recently released research from the New York-based Families and Work Institute found 41 percent of workers who responded to a survey on workplace stress reported experiencing stress “often” or “very often” on the job.

Although small doses of stress are not harmful, situations in which stress is very high or constant can create serious problems, according to NIOSH.

Far from being a mere annoyance, stress can play a larger role in more serious, chronic illnesses when it persists for long periods of time, studies suggest. Research indicates stress can increase an employee’s risk of developing cardiovascular disease and musculoskeletal disorders, particularly in the back and upper extremities. There also is growing concern that high levels of workplace stress can increase on-the-job injuries by interfering with safe work practices.

Dismissing concerns of stress in the workplace may be detrimental to the health and well-being of the workforce.
Stress and your health

The link between high levels of workplace stress and the development of cardiovascular disease seems to have garnered the most attention from researchers.

One of the factors linking the two may be the propensity for stressed individuals to make unhealthy life choices. Lyle H. Miller has been studying stress for 30 years. Currently, he directs the Bio Behavioral Institute, a nonprofit research organization focused on stress and behavioral health, and is chairman and CEO of Boston-based Stress Directions Inc., which provides consulting services to employers.

In his work with police officers, Miller found certain measures workers take to control their stress can exacerbate the issue. “They drink too much coffee on the job,” he said. “And one of the things that coffee does is it liberates adrenaline from the adrenal gland, which is part of the stress response. So they raise their level artificially.”

Because stress does not magically disappear when an officer is off duty, he or she may look for ways to manage it at home. “Often, one of the solutions for the officer is, ‘Well, just a little drink will calm me down. And if one works, well, maybe two would work even better,’” Miller said.

A 2007 University of Melbourne study examining the relationship between smoking habits and job stress found men who experience “moderate” or “extreme” job stress were twice as likely to smoke as other workers.

Yet the negative health effects of stress are not limited to poor lifestyle choices.

A 2008 study of British civil servants found that people with the most severe levels of job stress had a 68 percent higher risk of developing heart disease. Although this was linked, in part, to the stressed workers’ propensity for unhealthy foods and forgoing exercise, biological factors were identified as well.

The stressed workers were found to have lower heart rate variability and increased levels of cortisol, which can damage heart and blood vessels. Adjusting for lifestyle factors did not impact the relationship between stress levels and cardiovascular health.

NIOSH warns that the effects of job stress on chronic diseases can be difficult to determine because these diseases can take a long time to develop and are influenced by factors other than stress. Past research links stress not only to cardiovascular disease, but also to musculoskeletal disorders, psychological disorders, suicide, cancer, ulcers and impaired immune function.

Steps workers can take to manage stress

In addition to workplace modifications, NIOSH recommends workers try to better manage their job stress levels by taking the following actions:

  • Develop a strong social support system in the workplace. A co-worker or other ally who is available to talk through problems can help put things in perspective and minimize stress.
  • Take a break to avoid “burnout.” Even something as brief as a walk around the block can help clear your head and distance you from stressors, enabling you to return to the job with a fresh outlook.
  • Set realistic expectations for the amount of work you can complete in the time you have available. Do not attempt to take on more than you can reasonably handle.
  • Recognize you are not perfect and every minor detail in your work will not be perfect either.
  • Try to remain organized and keep your work area free of clutter, which can add to stress.
  • Avoid negativity and negative people, and try to maintain a positive attitude about your work and your co-workers.

– LC

Common workplace stressors

Rather than pointing to individual personality traits that make a person more prone to stress, NIOSH contends that working conditions play a primary role in causing job stress.

Paul J. Rosch, M.D., is president of the American Institute of Stress, a Yonkers, NY-based nonprofit organization. Rosch agrees with NIOSH’s assessment and points to the following as common causes of workplace stress:

  • Task design: Heavy workload, long work hours, infrequent breaks, routine tasks, not enough time to complete a job
  • Management style: Little participation in making decisions, little control over the finished product, poor communication, lack of family-friendly policies, little recognition for good job performance
  • Interpersonal relationships: Poor social environment and lack of support from co-workers or supervisors; prejudice or discrimination because of race, religion, gender or age
  • Work roles: Conflicting or uncertain job expectations, too much responsibility, too many bosses or “hats to wear”
  • Career concerns: Job insecurity; lack of opportunity for growth, advancement or promotion
  • Enviromental concerns: Unpleasant or dangerous physical conditions such as crowding, noise, air pollution, ergonomic issues and fear of exposure to toxic chemicals

“Also, many times, the issues of stress at work are really not issues with work per se,” Miller said. Not only can a worker’s personal life impact one’s levels of workplace stress, but “it has to do with other things that impact on work like, for instance, traffic. By the time the person gets there, their level of stress has gone up considerably, so it just takes a few more things on the job to really trigger some unfortunate kinds of reactions.”

Although certain high-risk, fast-paced industries may be more prone to stress, Steven Sauter, coordinator of NIOSH’s Work Organization Stress-Related Disorders Program and co-author of NIOSH’s document “Stress … at work,” said the institute believes stress results from the job itself, rather than from the worker. “We don’t think so much about the personality of the individual worker,” he said. “We look at the job context and what it is the job requires of them and the types of stressful working conditions that employees encounter in the workplace.”

Miller says personality plays a large role in the level of stress a worker may experience. “For example,” he said, “if you don’t particularly like people, then stay out of retail sales.”

Some indicators point to stress becoming more prevalent as the economy worsens and more workers fear unemployment. “Numerous surveys confirm that the recent progressive downturn in the economy has resulted in a corresponding sharp increase in job stress due to job loss, and job insecurity as a result of layoffs and downsizing,” Rosch said.

Warning signs of stress

“The first warning signs of stress are primarily emotional, and anger is one of the first ones,” Miller said. When workers find themselves feeling these emotions more quickly or more intensely than they normally would, it is an indicator of high stress levels.

“Muscle contraction headaches, or tension headaches, are one of the really early physical signs,” he said, as are intestinal issues such as heartburn or gastroesophageal reflux disease. Additionally, according to the American Institute of Stress, workers suffering from stress may experience shortness of breath, hair loss, changes in appetite, fatigue or panic attacks. 

Miller draws a distinction between acute stress and the more dangerous chronic stress. “When you’re under acute stress, you know you’re stressed,” he said. “But when it’s chronic stress, it becomes so much a part of the landscape of your life that you don’t even realize it’s there and it just grinds on and on and on. It just wears people out, wears their immune system out so that they develop all kinds of diseases.”

The impact on safety

Although the link between stress and  worker health is becoming stronger through a wide range of studies, the impact stress has on the safety of workers is not as well-known.

“The data are weaker for injuries [being related to stress] than they are for illnesses,” Sauter said. “But I would say the weight of the evidence points to a linkage between both stress and illness and workplace injury.”

NIOSH calls for more research, yet cites “growing concern” that stress can lead to incidents by interfering with safe work practices. In a recent survey of nurses conducted by the American Nurses Association in Silver Spring, MD, 80 percent said on-the-job stress levels impact workplace safety, and 59 percent of nurses said when they feel pressured they are more inclined to work faster and take shortcuts.

“Accident levels go up dramatically when stress climbs,” Miller said, pointing out stress also can increase the incidence of workplace bullying and violence.

Employer response

So how can employers act to mitigate stress in the workplace? The first step is to find out what is causing the stress. “You have to measure what goes on,” Miller said. “Once you measure it, you can manage it, but you can’t manage what you can’t measure.”

“Although there are some common denominators, there is no ‘one-size-fits-all’ solution” to managing stress in the workplace, Rosch said. He recommended employers perform a stress audit, where workers can anonymously list the various things that cause them stress. From there, he said, employers can “analyze the results to determine what are the most common stressors and whether any of these are the employer’s responsibility or require some remedial action.”

NIOSH’s stress document noted that some employers believe stress is a natural part of the workplace and applying pressure to workers will make them productive. However, the paper also noted “studies show that stressful working conditions are actually associated with increased absenteeism, tardiness, and intentions by workers to quit their jobs – all of which have a negative effect on the bottom line.”

The institute identified some common characteristics among organizations that have a healthy, low-stress, highly productive workforce. Rather than being high pressure, these organizations were likely to recognize employees for good work performance and provide a structure that values workers and allows them room for advancement.

Managing stress in the workplace may not only be beneficial for employees’ health – it also can have a positive impact on the organization’s bottom line. Stress costs employers money in many ways. Although health care costs may have the largest impact on the company’s bottom line, the American Institute of Stress determined workplace stress costs American businesses an estimated $300 billion annually in the form of workplace incidents, turnover, presenteeism, insurance premiums, disability and workers’ compensation.

To have a truly positive impact on the health of the workforce, Miller believes employers need to legitimately invest in combating stress. “You have to develop a culture of wellness in the workplace to really deal with it effectively,” he said. “Stress is a huge chunk of that wellness culture.”

Are the dangers of stress sufficiently recognized?

“There’s a lot of controversy” about recognizing stress as a legitimate medical concern, said Steven Sauter, coordinator of NIOSH’s Work Organization Stress-Related Disorders Program and co-author of NIOSH’s document “Stress … at work.” Both employers and those in the medical industry still feel some uncertainty about the health effects of stress, “although the weight of the evidence certainly points toward associations between stress and a variety of health outcomes,” Sauter said.

Paul J. Rosch, president of the American Institute of Stress in Yonkers, NY, pointed out that the National Institutes of Health, the Institute of Medicine and many cardiologists acknowledge the link between stress and hypertension and cardiovascular disease – although some in the field believe the medical community’s response to stress has not been strong enough. 

“It’s not as accepted as I would like it to be,” said Lyle H. Miller, chairman and CEO of Boston-based Stress Directions Inc., “but it’s much more accepted than it was 20 years ago or 30 years ago.” 

He laid part of that blame on the structure of the medical system in the United States and its dependence on specialization. “If you go to a cardiologist, he has no idea about your tension headaches; he has no idea about your stomach and bowel problems,” which can be indicators of stress, Miller said. “It used to be you would go to the doctor and would run through your symptoms and they would really treat you as a whole person,” he said. “But now they want to treat the individual symptoms of a specific system. And we don’t function that way – we function as a whole.”

Miller also believes doctors are too inclined to medicate when they do not have the full picture of what is causing cardiovascular or other stress-related health problems in patients. “If your only tool is a hammer, then the whole world is a giant nail,” he said.  

But this medication can lead to additional health problems for workers, as they now are subject to the myriad of side effects of various medications – some of which could impair their workplace performance, he said.

– LC