Job Stress:
Experts Discuss Consequences, Causes, and Solutions
Job Stress May Lead to Illness
For a long time, the question has loomed, "can stress make people sick?" Although research has led to more definitive conclusions, the answer still is both "no" and "yes." Stress experienced over the short term may not make people sick. Experiencing stress over the long term, however, can lead to greater health risks and may result in illness or chronic health conditions.
Dr. Esther Sternberg, National Institute of Mental Health, spoke about job stress at the March "Sister to Sister: Everyone Has A Heart" event for women’s heart disease awareness in Washington, DC. Dr. Gwendolyn Keita of the American Psychological Association presented along with her at the same event.
Dr. Sternberg explained how scientific tools can now measure the physiological and neurological activities involved in the stress response. These activities depict the specific mechanisms involved in creating an illness.
The mechanisms involved with stress show that if the stress is of short duration, the body is usually able to recover. If stress is experienced over the long term, however, in general, it is likely to eventually have a negative effect on health. The impact on health depends to an extent on features such as the dose, pattern, and duration of stress.
When stress is experienced, Dr. Sternberg explained, the nervous system becomes activated, and hormones released from the brain’s "stress center" activate the adrenal glands to release specifically, adrenaline and cortisol.
"Over time," she said, "the chronic release of these stress hormones suppresses immune functions and predisposes the individual to conditions such as prolonged wound healing and increased susceptibility to infection." Countless studies show health risks associated with job stress. High stress on the job has been shown to generate a greater risk of coronary heart disease and other risks, such as immune disorders, back pain, and mental and emotional strain.
A famous study, the Whitehall II study, showed risks of coronary heart disease for civil servants who exerted a high level of effort on their jobs with little recognition or opportunity for advancement. The study also showed that when employees have little job control and little latitude in decision making, they had a 50% higher rate of coronary heart disease than individuals who felt more control on the job.
- High demand/high control = manageable stress
- High demand/low control = stress
- High demand/low control/low social support = greater stress
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Conditions that Create Stress on the Job
Almost 30 years of research on job stress reveals the following
precipitating factors:
- High demand/high control = manageable stress
- High demand/low control = stress
- High demand/low control/low social support = greater stress
FOCUS interviewed Dr. Robert Karasek, a trailblazer in demonstrating how work stress results in compromised health. Dr. Karasek outlined the "demand-control" theory for stress in his doctoral thesis at the Massachusetts Institute of Technology in 1976 and is widely published on the subject. He and Dr. Jeff Johnson later identified a third dimension and that was lack of social support.
"Although the classic job stressors are high demands and low control and lack of social support, other factors exist, such as role ambiguity and conflict, unclear expectations, repetitive and monotonous tasks, and stressful environmental conditions — that is, noise, poor access to resources, poor lighting or temperature control," said Dr. Karasek."
A poor manager may unwittingly present the employee with job stress factors, such as high demand/low control, role ambiguity/conflict, and unclear expectations. The same sets of factors could be presented with poor task design," he said. "Low social support, at its worst, is expressed when conflictual interpersonal relationships exist, especially with a supervisor."
Individual Solutions for Stress Reduction
Dr. Sternberg recommends that people use biology to their advantage to cope with stress. Dr. Sternberg said, "We must realize that we are not unbreakable. Listen to the warning signs. Know your stress responses. The goal is not to get rid of stress, but to harnass it and let recovery occur."
First and foremost, she explained, it’s important to recognize the signs of stress. Once aware, the goal is to experience "recovery" in some form or the other and/or keep the stress from accelerating. This could include rest, relaxation, or addition of social support, she said.
"Under great demands, when external circumstances can not be changed, assessing the situation, breaking it down into its smallest controllable parts, and changing the pieces that can be changed could curtail the negative assault of stress hormones," said Dr. Sternberg.
Workplace Solutions for Stress Reduction
Although individual changes are easier to affect, interestingly, studies have found that job changes have more impact on stress levels than individual changes.
Dr. Keita said that ideally changes could be made at the workplace. She stated that there are two general intervention strategies for controlling occupational stress: intervening with employees to help them more effectively deal with the stress and eliminating the stressors or reducing exposure to them.
Employers might reduce employees’ stress by:
- aligning workloads with capabilities;
- defining work roles and responsibilities very clearly;
- increasing decision making;
- increasing communication;
- increasing access to resources needed to do the job;
- decreasing job uncertainties;
- encouraging networks of social support; and
- promoting meaningful jobs that allow workers to use their skills.
Women may have a special need for stress interventions at work. Dr. Keita noted that surveys show 26% - 40% of U.S. workers feel that workplaces are very stressful. Employed women report nearly twice the levels of stress-related illness and job burn-out as employed men. Women, she said, are particularly prone to job stress. They are more likely than men to face greater demands due to work/family conflicts, gender-based discrimination, sexual harassment, and certain types of workplace violence.
She gave examples of workplace changes that can be especially important to female employees:
- flexible schedules;
- readily available, high quality child care;
- elder care support;
- enforced sexual harassment policies; and
- intolerance for gender discrimination.
Commenting on workplace solutions to job stress, Dr. Karasek, who introduced the demand/control model, stressed open communication at the workplace as a way to keep job stress in check. Workers should have key input about work design, rather than having decisions made solely by leaders who are, in the hierarchy, three or four levels removed from the base level of production. The culture he said, should foster trust in their workers through behaviors that demonstrate open communication.
Getting a handle on job stress begins with awareness and is driven by knowledge. The good news is that the knowledge base is expanding. On a global level, Japan and six European countries are now using Dr. Karasek’s findings for the study of job stress, heart disease and absenteeism, with 40,000 subjects in each case
