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Work, Stress, and Health '99
In March of 1999, the American Psychological Association and the National Institute for Occupational Safety and Health presented their fourth conference dedicated to examining the causes, effects, and prevention of stress in the workplace. For the Closing Plenary, participants were given a difficult challenge: to summarize the information that was presented at the conference and place it in context, and to complete this task during the course of the conference! The participants rose to the challenge, and what follows will give the reader an impression of those fresh insights, as they were presented at the Closing Plenary Session.


Introduction

Steven Sauter, PhD

National Institute for Occupational Safety and Health
Cincinnati, Ohio

and

Gwendolyn Puryear Keita, PhD

American Psychological Association
Washington, D.C.

Gwen Keita
Since 1985 The National Institute for Occupation Safety and Health (NIOSH) and the American Psychological Association (APA) have been working together to promote research and training to help prevent stress in the workplace. As the 20th century draws to an end, the landscape of work has changed in ways unanticipated when NIOSH and APA first joined forces, and there is now a new urgency to our mission. Today, workers worldwide confront an array of new organizational structures and processes—downsizing, lean production, flat management structures, long working hours and contingent employment, to name but a few. How these conditions may contribute to stress, illness and injury at work is still more speculative than understood. What is known, however, is that coincident with these developments stress at work has become a serious health and economic burden. In the U.S., for example, data from multiple surveys converge to suggest that one-fourth to one-third of the workforce experiences high levels of stress at work. Econometric analyses show that health care expenditures increase nearly 50% for these workers, and nearly 200% for workers reporting both high levels of stress plus depression.

Steven Sauter The goal of this fourth APA-NIOSH conference on work, stress and health was to focus attention more directly on the rapidly changing organization of work, and the implications for the safety and health of workers. As the last major scientific conference on work, stress and health of the millennium, we felt it especially appropriate to conclude the conference by considering key research needs and directions for the future. In the closing plenary session of the conference, leading international authorities expressed their viewpoints on the status of scientific knowledge (including new information revealed at the present conference) and research challenges for the future in the area of work organization and health. Summaries of these presentations are provided in the narratives following below.

Several themes for research in work organization and health emerged in these presentations. For example, there can be little doubt that the psychological demands of work, and thus the risk of job stress, have grown in response to increasingly leaner and more flexible production and employment practices in industry. However, reseach in work organization and health has failed to keep pace with these changes in the conditions of work. Notable too is the near absence of research addressing stresses encountered by aging workers and the growing population of ethnic and racial minorities in the changing workplace. These and other themes apparent in the discussants’ comments call for a much broader research agenda in work organization and health—to include not only accelerated study of safety and health risks in the changing workplace, but increased attention to intervention strategies for the primary of job stress through work redesign. Funding and opportunities to pursue a broader agenda of this nature are unlikely to develop, however, without increased participation of industry and labor in the planning and coordination of research in work organization and health. It is worth noting in this regard that NIOSH and APA, together with industry and labor partners, have undertaken a strategic planning process to promote a much more aggressive national program of research in work organization and health that is responsive to the concerns of discussants expressed during the conference closing session. More information about this process (the National Occupational Research Agenda - Organization of Work) can be found on the NIOSH Web Site.


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The Changing Workplace

Irene L.D. Houtman, PhD

TNO Work and Employment
Hoofddorp, The Netherlands

with the assistance of Steven Dhondt, Anneke Goudswaard and Robert W.M. Gründemann

Irene Houtman The 'changing workplace', in a strict and narrow sense, refers to the employee with his or her coping capacity who is confronted with (good, bad, or changing) working conditions, which results in some sort of outcome, i.e. a response, a performance,....or (in time good, or worse) consequences for health. This process can, however, strongly be influenced by all kinds of institutions like the company, home, or the (occupational) health service, as well as by even more 'macro' contextual variables like legislation, the economical and technological situation, as well as e.g. demographical changes (Figure 1). Since Töres Theorell will pay attention to the health outcomes in this plenary discussion, I will stick to discussing changes in the working capacity and working conditions.


Figure 1


To start with the working conditions, first we can see that several international statistics indicate a steady increase in quantitative psychological demands (Figure 2). Several factors are hypothesized to be responsible for that. For example, recent legislation has resulted in a decrease in the maximal number of working hours in several countries. In most cases though, this has not resulted in a diminished amount of work to be performed by the employees. Work has intensified over recent years. Other organizational changes, like downsizing, have often resulted in increasing demands as well. New organizational forms of work like lean production, by reducing buffers and stressing efficiency and client orientedness, contribute to the increase in psychological demands as well.


Figure 2


Secondly there is the continuing process of informatization. Today our work can increasingly be characterized by information (our input). Information has, however, had a much broader impact by way of information technology (IT): most of our tools are both dependent on information in order to work, and induce us to work with even more information. Also the context we work in 'is' all information (e.g. this internet).

Job insecurity is also increasing. Organizational changes like downsizing are responsible for that, but new organizational ways of work like flexibility have resulted in an increase of job insecurity as well.

Last, but not least, we see some increase in the autonomy at work because of the deregulation of the work force. This increased autonomy does not, however, match the increase in psychological demands and stress is thus bound to increase. The increase in autonomy is, however, also somewhat ambiguous since the number of small and medium sized enterprises has increased, and there has been a shift towards more work in the service sector as well. These latter changes will in fact result in a more 'dependent' work force.

With respect to the developments in working capacity (Figure 3), the working force is aging due to demographic changes. Also, the female participation in work is increasing, resulting in a quest for better ways to combine work, care and other aspects of life. In the Netherlands, women are more at risk for disability for work than men, particularly as a result of psychological disorders. For older employees, our information is based mainly on men.


Figure 3


Particularly in Europe, but in some other places like Japan as well, the potential work force is also changing due to 'nations on the move'. Refugees, and inhabitants of other countries who are drawn to safe and economically stable countries constitute a 'new' and not necessarily low educated potential workforce.

To conclude this short synopsis on the 'changing workplace', the following directions can be identified for research and practice with respect to this topic.
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Work and Family

Chaya S. Piotrkowski, PhD

Fordham University
New York, New York

with the assistance of  Naomi Swanson, PhD


Chaya Piotrkowski Current Status

Over the past twenty years, there has been a virtual explosion of research on the relationship between paid work and family life. No longer do we behave as if workers have no families. Instead, there is an emerging consensus that conditions of work influence family relationships and family members, beyond the effects of wages and benefits. In the US, much of the impetus for this research has been the entry of mothers into the labor force. The assumption that jobs affect only women's families has given way to the recognition that men also have families, and that they, too, must balance obligations to their employers and their families.

Workers in the US are more likely to report that their jobs interfere with their family life than vice versa. Not surprisingly, then, most researchers have focused on the ways in which working conditions affect families. For example, researchers are trying to determine which workplace conditions influence employees' experiences of conflict between work and family roles; they are studying the effects of job stress on spouses and on marriage; and they are studying how parents' working conditions may affect their parenting and their children. Researchers also are studying how unemployment affects family members and marriage.

Despite a growing body of research, knowledge in this field is still rudimentary. Because research into the links between paid work and family life spans many disciplines (e.g., psychology, sociology, social work, business, nursing) and specializations within disciplines (e.g., clinical, industrial/organizational, developmental, and occupational health psychology), knowledge is fragmentary and terminology inconsistent. We lack systematic, truly interdisciplinary theories that integrate knowledge across these many disciplines and fields of specialization. Furthermore, research that incorporates complex understandings of both the family and the workplace is rare.

Our methodologies are limiting as well. It is difficult to determine the extent to which the problems of workers and their families are actually caused by workplace conditions. Moreover, too often, information is collected only from workers, not from other family members, leaving open the possibility that personality factors influence people's reports. Findings from research are limited in their generalizability because studies have tended to focus on white professionals and managers, whereas the relationships between paid work and family life among the working poor and people of color have been neglected.

Conference Themes

Several themes emerged at the conference. We learned that women's experience of work-family conflict knows no national boundaries; that the home also is a workplace, so that stressors from "family work" can combine with job stressors to affect worker health; that the links between workplace and family are complex, so we need to take into account sex role ideologies, values, and coping strategies; and that researchers need to be sensitive to ethnic and cultural variations in workers' experiences.

Future Directions

Researchers should address several core questions to systematically identify not only concrete interventions that can prevent adverse impacts on family well-being, but also those than can enhance family well-being. These core research questions are as follows:

(1) Which workplace conditions have an adverse impact on family well-being? In addition to the job stressors we usually study-- such as work schedules, lack of autonomy, excessive demands--researchers should include racial discrimination and prejudice and sexual harassment as important psychosocial stressors. Family "well-being" should include marital stability and the quality of marital relations, family members' ability to enact essential household roles, child rearing values and practices, and the mental and physical health and development of every family member.

(2) What can work organizations and communities reasonably do to change conditions to enhance family well-being? It is important that we consider the community as part of the problem and the solution because lack of affordable childcare or accessible transportation may exacerbate work-related problems for families.

(3) Which families are most vulnerable to adverse working conditions? Families differ in the resources they have, so some families may find it especially difficult to cope with problematic working conditions.

(4) Do particular occupations place families at special risk?

(5) What is the impact of occupational injuries and illnesses on family well-being? We need to add an appreciation of the "family costs" of workers' injuries and illnesses to our understanding of the economic costs.

To adequately address these core research questions, it is important that we:
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Diversity

Lily Kelly-Radford, PhD

Center for Creative Leadership
Greensboro, North Carolina

with the assistance of Gwendolyn Puryear Keita, PhD and Jennie Ward-Robinson, PhD

Lily Kelly-Radford
Current Status
New Information
Future Directions

The review of the literature surrounding the occupational health and safety domain is limited with regard to its focus on diversity. The term diversity can refer to ethnicity, gender, sexual orientation, age, and ability/disability status. Research on occupational health among ethnic minorities has erroneously assumed homogeneity between and among the different subgroups and has failed to take into account differences between and among groups. Moreover, gender by ethnic group by socioeconomic status analysis has largely been ignored. Given the differences between the groups included under the "diversity" umbrella, and consequently, the difficulty in adequately addressing all, our focus will be limited to ethnic minorities and women.

The data revealed in the bullets under diversity demonstrate the tendency for researchers to examine the variables that are known to be stressors already and their failure to probe more deeply into the psychological constructs that shift or widen the paradigm. Not only has research using traditional measures of work stress often excluded ethnic minorities and women, but research examining special issues of concern and/or coping mechanisms of particular relevance to these populations has also been limited. For example, research is beginning to show that discrimination is a strong predictor of health outcomes for ethnic minorities. The importance of this factor relative to traditional job stressors must be assessed. Relatedly, there has been a concern that scales used to assess occupational stress may not include many important stressors for people of color, for example the chronic stressors such as discrimination, poverty, and/or language difficulties (for those for whom English is not the primary language).

Regarding coping strategies, research is beginning on the "dual identity" hypothesis for diverse populations. This hypothesis assumes that members of a given minority group maintain two identities-one for work and the other for "real life." This allows them to maintain a positive self image and to construct a "cognitively safe place to go" when they believe they are not well treated or are "torn down" in the workplace.

With the globalization of work and changing picture of workers, research on occupational stress must do a better job of including all groups in an immensely diverse world population and of understanding and respecting the differences between these groups.

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Health and Safety Outcomes

Töres Theorell, MD, PhD

Karolinska Institute
Stockholm, Sweden

Töres Theorell Increasing fatigue

Repeated surveys of the Swedish working population 1975-1995 have shown that fatigue has been an increasing phenomenon in the working force during the 1990's both in men and women. This phenomenon was discussed extensively.

Survey of Living Conditions, Statistics Sweden 1975-1995

Underemployment

Underemployment - working parttime involuntarily or being underpaid below poverty level - is a previously neglected phenomenon that was discussed during the congress 1999. This is particularly relevant to younger generations of workers. David Dooley and others reported on the basis of a study of a nationally representative US youth cohort that underemployment seriously affects depression, self-esteem and alcohol use.

Prause JA. Dooley D. Effect of underemployment on school-leavers' self-esteem. [Journal Article] Journal of Adolescence. 20(3):243-60, 1997 Jun.

Secondary traumatic stress

Post-traumatic stress disorder (PTSD) is widely discussed in psychosomatic medicine. A new perspective of this was discussed in the congress. Robert King and others reported on the basis of 282 health care workers in Australia that ”secondary experience” of severe trauma in patients may be associated with Secondary Traumatic Stress which resembles PTSD. 18% of participants (who were employed in community mental health services across Australia) were estimated to suffer from this condition.

Parents´ stress

Parents´ work overload has not been examined extensively in relation to teen-age wellbeing previously. Matthew Bumpus and others showed in a study of 190 dual-earner families, each with a firstborn and a secondborn adolescent, that a high work pressure in the parent had an indirect effect on teen-age wellbeing through parent role overload and parent-adolescent conflict.

Hyperventilation and muscular tension

Hyperventilation in relation to development of somatic symptoms has been discussed extensively in psychosomatic and behavioral medicine. Lawrence Schleifer and others reported that anxiety inducing hyperventilation may induce muscular tension. This may have great relevance in the working situation.

International collaboration

It was concluded that there is a strong need for international collaboration in the field of assessment of job psychosocial factors that may be possible to favorably influence through job redesign. Such efforts are already ongoing but it was hoped that they will be intensified during the coming ten-year period.

Gender specific research

Many researchers still consider the use of gender as a confounder to be adequate in the analytical treatment of the influence of gender. However, since the patterns of associations are often different both with regard to psychosocial and biological factors in men and women, there is strong reason to treat men and women separately in the analysis of epidemiological job data.

Avoid new symptom constructs

The introduction of concepts such as burnout and chronic fatigue syndrome may have been helpful from many points of view. It is necessary in the future, however, to avoid introduction of new psychological syndromes that are based mainly on the summation of potentially unrelated symptoms. There is need for more intensive studies of the physiological substrates of the bodily and mental consequences of modern working conditions - that have both physical and psychosocial components.

Avoid applying models constructed on the basis of laboratory experiments

The studies of the relationship between psychosocial working conditions and physiological mechanisms have been plagued by mechanistic applications of knowledge about short term reactions to adverse conditions when in fact long lasting reactions to real life difficulties at work are biologically different from those in the laboratory. We need to establish new frames of interpretation for such relationships.

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Methods

Stanislav V. Kasl, PhD

Yale University
New Haven, Connecticut

with the assistance of Joseph J. Hurrell, Jr., PhD

Stanislav Kasl
Psychometrics

We need an accumulation of external data in relation to our measures so that we can begin to understand their construct validity and predictive usefulness.

There is a serious problem in the psychometric emphasis we often encounter in etiological stress research: the wrong psychometric model is being used over and over again. The emphasis on coefficient alpha is an emphasis on internal consistency or item homogeneity. This is fine for measuring traits but not for measuring environmental dimensions characterizing work. There is no reason why components of such domains as decision latitude or psychological demands should align themselves to be high, medium, or low on a job. A job can be high on some and low on others.

New Measures

Rather full-blown new instruments are being offered in the spirit of "Use mine and not theirs." There is a need to carefully review current measures, identify gaps in measurement, and build on existing materials by offering new measures that are incrementally useful.

Objective Measures

There are areas of occupational health psychology where the commitment to measuring aspects of the objective environment is substantial. I think we need to expand these areas so that serious efforts to measure the work environment becomes the norm.

Cross Sectional Studies

We often have a naive expectation that cross-sectional data can be easily rescued from causal ambiguities by adding another wave of data collection. However, if the cohort is in a steady state --- what I call the arbitrary slice-of-life approach --- the analysis of T2 variables net of T1 values may be mostly an analysis of measurement error.

Confounders

There is a need to be more proactive about potential confounders. Instead of relegating them to a discussion of limitation of the study, because we did not measure them, we should include them in the study design.

Job Strain Model

The Job Strain Model remains a marvelous achievement in occupational health psychology, but this does not make it immune to some needed overhaul. Specifically, evidence seems converging the psychological demand component needs a second look. At this stage it seems to be in the never never land of being a mix of a trait measure, a psychological reaction measure, and a self reported assessment of the work environment. The challenge is to beef up the last component of that measure.

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Interventions

Tom Cox, PhD

Nottingham University
Nottingham, England

Tom Cox
Current Status
New Information
Future Directions
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International Perspectives

Takashi Haratani, PhD

National Institute of Industrial Health
Japan

and

Norito Kawakami, MD

Gifu University
Japan

with the assistance of Steven Sauter, PhD

Takashi Haratani Current Status

There is a common concern on job stress among post-industrialized countries, including issues related to gender, work and family, underemployment, worker compensation and others. Reports from the U.S. say that 40% of workers reported their job was very or extremely stressful (Northwestern National Life Company, 1997); and 29% of workers felt quite a bit or extremely stressed at work (Yale University, 1997). Job stress is one of the most common work-related health problems in the EU countries; the Second European Survey on Working Conditions (1996) showed that 28% of workers felt that their work causes stress. In Japan, the proportion of workers who reported strong anxieties, worries or stress concerning their job or working life has increased from 53% in 1982 to 63% in 1997. There is also an increasing concern on job stress from developing countries. An increased risk of work-related disease and accidents has been observed in Southeast Asian countries which have experienced rapid industrialization. Karoshi (death from overwork) is now a social issue in Korea, as well. There is a strong need for research and prevention of job stress and its adverse effects on worker health in developing countries. There is an accelerated globalization of company activities, resulting in more workers employed in multinational companies. New management models developed in one country have been exported to another country. The globalization of communication brings new work styles such as telework abroad and a sleepless office during a 24 hour workday. As more workers collaborate with workers from other countries, more cross-cultural conflicts and problems may be expected. These might be new sources of job stress.

New Information

The number of international job stress studies is increasing, along with more awareness of the importance of cultural difference in job stress, among North America, Europe, Asia and other areas. Several similarities and cultural differences on job stress are identified. Several standardized instruments for assessment of job stress, such as the Job Content Questionnaire, the NIOSH Generic Job Stress Questionnaire, the Pressure Management Indicator, the SWS Survey and others, are now available, which have been translated into many languages and extensively used. These instruments could be used for comparing and monitoring of job stress internationally. Several international efforts have already been made to promote education and training relevant to job stress for professionals, employees and managers and to seek better job stress interventions. Good examples are the European collaborations on the development of occupational health psychology (OHP) and job stress interventions. The Tokyo Declaration on Work-Related Stress and Health in Three Postindustrial settings - the European Union, Japan, and the United States was adopted as a result of the Triangular Conference (Europe, Japan and the U.S.) held at the Tokyo Medical University on November 1, 1998. The Declaration emphasizes a need for future collaborative efforts among post-industrialized countries for research and prevention of job stress.

Future Directions

Considering the globalization of job stress problems, international initiatives are needed for establishing global guidelines for the prevention of job stress and the dissemination of information relevant to job stress. There is a strong need for global collaboration to enrich education and training on the topic of job stress, including OHP for occupational health care professionals and others. International exchange of experience and knowledge, including educational programs and instruments should be encouraged in the future. Low-cost and easy-to-implement programs could be effective, especially in developing countries. International research on culture and job stress should be encouraged as a way to understand cultural differences in job stress and the implications for the implementation of job stress prevention strategies. The culture-specific and non-culture-specific (common) components of job stress should be identified and then integrated into a "trans-cultural" approach to job stress.

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Acknowledgements

Gwendolyn Keita & Steven Sauter, Conference Chairs

We wish to recognize the APA-NIOSH Conference Planning Committee for their long hours of work in the design and conduct of the conference, including this closing plenary session.


APA-NIOSH Planning Committee

APA/NIOSH Planning Committee


David Chrislip Special thanks are due to David Chrislip of NIOSH for coordinating all technical aspects of the closing plenary, for the electronic integration of information from panelists and preparation of the closing session PowerPoint presentations under an extremely tight deadline, and especially for the design and execution of this web page.


Wesley Baker Special thanks also go to Wesley Baker, conference coordinator, who worked diligently throughout the planning period and the conference itself, to ensure that the conference ran smoothly and efficiently.


And of foremost importance, the conference closing and this summary would not have been possible without the dedication of the panelists themselves—Drs. Irene Houtman, Chaya Piotrkowski, Lily Kelly-Radford, Töres Theorell, Stanislav Kasl, Tom Cox, Takashi Haratani, and Norito Kawakami who worked late into the evening hours of the conference to prepare these commentaries.

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This page was last updated on September 27, 1999

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