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Stress Is modern life really rubbish or are we just complaining too much? Dr. Craig A. Jackson Occupational Psychologist Research Director Health Research Consultants Research Consultants .co.uk. Misperceptions of workplaces UK Climate of: over-perception of danger

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slide1

Stress

Is modern life really rubbish or

are we just complaining too much?

Dr. Craig A. Jackson

Occupational Psychologist

Research DirectorHealth Research Consultants

ResearchConsultants.co.uk

slide2

Misperceptions of workplaces

UK Climate of:

over-perception of danger

stress being unavoidable

wanting too much in return

Attention Deficit Trait

slide4

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

slide5

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”

slide8

Top 5 Occupational 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

slide9

“High Effort

Low Reward”

“High Demand

Low Control”

Potential Health Risks

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

slide10

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

slide11

Responses to Stress

  • 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

slide12

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 Bloomsbury H.A Doctor

2. Walker vs Northumberland C.C. Social Worker

3. Jones vs Birmingham C.C Teacher

4. Hurley vs Gwent Constabulary Police officer

5. Fearon vs Martin Burglar

6. Armstrong vs Home Office Prison warder

slide13

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

slide14

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

“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”

slide15

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

slide16

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?

slide17

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

slide20

Psychosocial factors at the core of ill-health

Individual vulnerability

Personality type

Experience

Learned behaviours

Stress

Distress

Somatics

Will workers take responsibilityfor their ill-health?

Recall ADT?

slide21

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 !

slide22

required

STRESS!

actual

required

actual

required

BORED

actual

Stress Definitions #2

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

slide23

So who has the bad jobs?

EXTREMELY STRESSFUL

Police Fire Ambulance Prison

VERY STRESSFUL

Civil pilots Media Performers Teaching Nursing

Health care (non-emergency) Social work Mining Construction

ABOVE AVERAGE STRESS

Marketing Publishing Printing

Retail Catering Transport

HOW MUCH FAITH CAN BE PUT INTO BROAD CATEGORIES?

Cooper 1988

slide24

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

The curse of the Corpus Linguistic

Common Parlance

“Stress-Bunny”

“Stress-Junkie”

slide25

Stress is Nothing New

World Wars I and II

Where was stress?

Dud shell manufacture

slide26

performance

stress

Some Stress is good

Keeps one alert

Keeps one alive

Evolutionary perspective:

Too little stress = extinction

Too much stress = extinction

Balance stress = evolution

Pressure is good - - Stress is bad

slide27

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

slide28

Admissions and World Cup 1998

  • Examine hospital admissions for rangeof diagnoses on days surrounding England's 1998 World Cup footballmatches
  • Hospital admissions obtained fromEnglish hospital episodestatistics
  • Pop. Aged 15 – 64 years
  • Admissions for
  • Acute MI On match day
  • Stroke and 5 days after
  • Deliberate self harm match day
  • Road traffic injuries
  • Compared with admissions at the same time in 1997 and 1998

Carroll, D et al. 2002

slide29

Admissions and World Cup 1998

England's matches in the 1998 World Cup

15 June (England 2, Tunisia 0) win

22 June (Romania 2, England 1) lost

26 June(Colombia 0, England 2) win

30 June (Argentina 2, England 2) lost: penalties 4-2

Extracted hospital admissions data for acute myocardial infarction, stroke, deliberateself harm, and road traffic injuries among men and womenaged 15 to 64

Games all took place in late evening

Examined the same associations using only the two days afterthe match omitting the day of the match as the exposedcondition

slide30

Admissions and World Cup 1998

Results:

During the period of England's World Cup matches (15 June to 1 July)

81,433 emergency admissions occurred:

1348  (2%) formyocardial infarction

662  (1%) for stroke

856  (1%) for roadtraffic injury

3308  (4%) for deliberate self harm

observed / expected actual – expected ARR

admissions admissions

Day of match 91 / 72 19 1.25 (0.99 to 1.57)

1 day after 88 / 72 16 1.21 (0.96 to 1.57)

2 days after 91 / 71 20 1.27 (1.01 to 1.61)

3 days after 76 / 74 2 0.99 (0.77 to 1.27)

4 days after 71 / 74 3 0.92 (0.71 to 1.19)

5 days after 83 / 72 11 1.13 (0.89 to 1.43)

slide31

Admissions and World Cup 1998

  • Admission Within 2 days Within 2 days Within 2 days of P value
  • diagnosis of win of 1-2 loss loss on penalty
  • M.I 0.99 0.91 1.25 0.007
  • 0.89 - 1.11 0.78 - 1.07 1.08 - 1.44
  • Stroke 0.87 0.97 1.00 0.42
  • 0.74 - 1.03 0.79 - 1.19 0.82 - 1.23
  • RTA 0.99 0.96 0.85 0.51
  • 0.85 - 1.14 0.79 - 1.17 0.69 - 1.05
  • DSH 1.08 1.01 1.05 0.26
  • 1.00 - 1.16 0.91 - 1.12 0.95 - 1.16
  • Periodsafter a win (Tunisia, Columbia) and 1st first loss (Romania) were not associated with increasedadmissions
  • On match day, and two days after match against Argentinawith a penalty shoot-out, admissions for acute MIincreased by 25%.
  • No increases in admission were seen for anyof the other diagnoses.
slide32

Admissions and World Cup 1998

Major environmental events, whether physical catastrophes or cultural disappointments,are capable of triggering myocardial infarction.

If the triggeringhypothesis is true, preventive efforts should consider strategiesfor dealing with the effects of acute physical and psychosocialupheavals.

“Perhaps the national lottery or even the penalty shoot-out should be abandoned on publichealthgrounds.”

Limitations:

Harvesting effect? Reporting tendency? Sudden deaths?

slide33

“Oh Give Over!”

This has all gone too far

The Anti-Stress Backlash

“Meddling Psychologists”

slide34

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.
slide36

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

slide37

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

slide38

Vulnerable People

Important to be aware of vulnerable individuals and groups

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

slide39

Personality

Is this a good sign or a bad sign?

Personality

Optimism vs Pessimism

Negative Affectivity

Hardiness

Hi Claire. Are you around and do you fancy a brew?

Hey. On way home. Left lecture early cos feel like crap. Next time!

slide40

William Beaumont 1832

Historical Errors of Distress-Related-Ill Health

Historically, distress was “blamed” for many ills

Now we know better…

CHD

Cholera

Pellagra

Beri Beri All believed to be

Asthma caused by stress

Down’s syndrome at one time or another

Scurvy

Yellow fever

Typhoid

Peptic ulcer

Puts “blame” for illness on the person

slide41

Acute Stress and Chronic Stress

Common

After-effects

Leave behind

Life threatening

One-off

Ever-present

By proxy

slide42

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
slide43

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

slide44

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

slide45

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

slide47

Sick Building Syndrome – A once popular theory

Air qualityNoise

Chemical pollutants Equipment

Air con Telephones

Ventilation Others

Dust

Tobacco Lighting

Artificial

SpaceGlare

Crowding Control

Isolation

Job content

Equipmentvdu’s

Printers Monotony

PC’s Overload

Organisation

Control, communication, feedback

Is STRESS the common link with SBS?

slide48

Karasek’s 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

slide49

job demands

low high

low strain

active

job control

low high

passive

high strain

Karasek 1979

slide50

Karasek’s revised demand-control-support model

Productive, Motivated

Social

Support

Peer

Support

Heroes

&

Villains

low strain

active

job control

low high

passive

high strain

low high

job demands

Risk of psychological strain and increased illness

Karasek 1979

slide51

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

slide52

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”

slide53

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?

slide54

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. 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 and Cox T. Health and well-being of working age people. ESRC Seminar Series. ESRC. London. 2006

Jackson CA. Psychosocial Hazards. In Smedley, J et al. (eds) Oxford Handbook of Occupational Health. Oxford. Oxford University Press 2006 (in press). 

slide55

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.