Measuring Stress Correctly Recovering a Stressed-out Workforce Professor Craig Jackson

1. Measuring Stress Correctly Recovering a Stressed-out Workforce Professor Craig Jackson Prof. Occupational Health Psychology Head of Psychology Birmingham City University

2. Stress – The Basics Definition problems Not just at workplace (home, commuting) Individual response Work-life Balance issues Control vs Demand Personality types Cause of many secondary health problems Not even a medical diagnosis Stress is not a useful concept:Loose criteria Too many triggers Too many responses Too many effect modifiers Used too casually Fashionable Positive perceptions Not reliably measured

3. Workplace Hazards – current status Shiftworking: 1 in 5 employed likely to increase with growth Long hours: >48 hours per week Fallen due to EWTD Still > most of Europe Psychosocial: 5 mill employees perceive effects 13 mill working days lost Mundane occupations suffer Chronic stress more problematic Physical: Noise technical Dust changes Chemical monitoring Vibration OELs Fatigue Somatic symptoms Sleep MSDs Depression Cardiovascular Accidents Depression QoL

4. 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

5. Psychosocial factors at the core of ill-health Individual vulnerability Personality type Experience Learned behaviours Stress Distress Somatics

6. 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 !

7. Responses to Hazards • Physiological changes • Heart rate • Blood pressure • Biochemical • > adrenaline > cortisol • > serotonin > free histamine Psychological changes Anxiety Depression Tension Tired Worry Apathy Apprehension Alienation Resentment Confidence Aggression Withdrawal Restlessness Indecision Sleeping problems Concentration

8. Acute Stress and Chronic Stress Common After-effects Leave behind Life threatening One-off Ever-present By proxy

9. Demand-Control model of stress development Productive, Motivated low strain active job control low high passive high strain Risk of psychological strain and increased illness low high job demands Karasek 1979

10. Demand-Control-Support model of stress Productive, Motivated Social Support Peer Support Heroes & Villains Organisational Justice low strain active job control low high passive high strain low high job demands Risk of psychological strain and increased illness Karasek 1979

11. 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

12. 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 / Mundane Conditions 2. Physical abuse Unpredictable Behaviour / Incident 3. PTSD inducement

13. Chronic Hazards Job content Work overload / underload Hazardous conditions Under utilisation of skills Time pressures Lack of control Work organisation Shift work Working hours unsociable long unpredictable Work Culture Communication too little (home-working) / too much (email) Change / technology Poor resources No feedback No decision process

14. 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 Organisational Justice Fairness Promptness Equality

15. Avoidable psychosocial hazards Eliminate exposure Reduce exposure Control exposure Change physical environment Change work organisation Provide extra resources Management / employee training Career development systems Increase participation Increase control Policies to identify and address future problem issues

16. Intrinsic & External Psychosocial Hazards • INTRINSIC HAZARDS • Safe systems of working • Training and education – Does this Work though? ? ? • PTSD counselling / debriefing – Does this Work though? ? ? • EXTERNAL HAZARDS • Provide protection and rehabilitation where necessary • Counselling services • Stress management training • Health promotion activities • Information relating to specific problems (gambling, alcohol, substance abuse, domestic)

17. 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

18. 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” 45 minutes cut-off

19. Long Working Hours “Workaholism” Japan, South Korea, Indonesia, UK (Karojisatsu) uninterrupted heavy workload • irregular sleep habits • decreases in rest • decrease social time • alcohol abuse • increased smoking • unhealthy diet • neglecting medical checks • breakdown in family life heavy physical work excessive demands from irregular overtime and shift work excessive workloads from emotional stress, such as responsibility, transfers, and conflicts

20. required STRESS! actual required actual required BORED actual Stress 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

21. Potential Health Risks “High Effort Low Reward” “High Demand Low Control” 3x Cardiovascular problems 2x Substance abuse 3x Back pain STRESS! 2-3x Injuries 5x Certain cancers 2-3x Conflicts 2-3x Infections 2-3x Mental health problems Shain & Kramer 2004

22. Potential effects cardiovascular mental health immune system Stress gastrointestinal musculoskeletal social effects performance impairment Fatigue safety problems Exposure over-exposure

23. Potential 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 staff • Spanish fishermen • Indian shoemakers Lebanese bank tellers

24. Performance 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

25. Performance Indicators Objective Physical 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 complaints Poor timekeeping Subjective

26. What workers expect Financial Reasonable expectations? Achievable ? Affordable ? Advancement Status Respect Perks Education / Training Autonomy Flexibility Dissatisfied workforce? Aggrieved employees? Unmotivated staff ? Pensions Support Security

27. Individual Variability / Vulnerability Best predictor of future stress responses are past stress responses 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 provide stressful responses

28. Vulnerable People Associated with socio-economic, cultural or demographic status Females Immigrant workers Disabled Any group by definition which is un-empowered Excluded groups Ethnic minorities 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

29. Personality A good sign or a bad sign? Personality type Optimism vs Pessimism Negative Affectivity Hardiness Hi. I need to see you first thing tomorrow in my office!

30. Common Coping Styles Adaptive coping Seek those with similar experiences Confront issue Stick to a plan of action LONG Support seeking TERM Day to day basis SOLUTION Change situation Seek information Maladaptive coping Withdraw from people in general Avoidance SHORT Deny what has happened Consumption TERM SOLUTION Drink, eat, smoke to relieve tension Denial

31. Methods of Assessing Stress Questionnaire Assessment Symptoms Behaviours Performance: Typical vs Maximum Checklist approach “Normal” and “Abnormal” behaviours Systematic scoring principles Qualitative classification cases stressed dysfunctional stress-prone healthy

32. agree not sure disagree 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 Psychological Tests Occupational & clinical odd mix Testing standards blasé attitudes over familiar Administration types open controlled supervised managed Provides… consequences perceptions perceived sources of stress

33. “Usefulness of Stress” Model am i happy? potential for change? no yes no yes make changes alternative plan: is my work… should i worry about this? safe? yes should it make me ill? yes fun? could it make me ill? pleasant? no valued? no does it make me ill? infinite options yes Stress! infinite options someone must act on this

34. Rights of test takers #1 ITC Guidelines BPS is only recourse at present www.bps.org.uk State purpose outcomes? specific tests used? evidence of relevance & appropriateness? Clarity of procedure administration method? competence of administrator? locations suitable? Inquiries and complaints handled by? competence of handler? what actions will result? fair treatment?

35. Rights of test takers #2 Test information scoring interpretation evidence of competence communication of scores accurate and meaningful communication of scores confidentiality of scores who can access scores and why? storage of scores / data Competence certificates of competence in testing monitor competence awareness of personal limitations

36. 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: 1527-1530. 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

37. 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: 538-541. 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.