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Measuring Stress Correctly

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Title: Measuring Stress Correctly


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 conceptLoose
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 gt48 hours per
week Fallen due to EWTD Still gt 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 c
hanges 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 Personali
ty type Experience Learned behaviours
Stress Distress
Somatics
6
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
7
Incorrect Stress Definitions
A. Stress occurs when demands exist which are
outside a persons 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 !
8
  • Responses to Hazards
  • Physiological changes
  • Heart rate
  • Blood pressure
  • Biochemical
  • gt adrenaline gt cortisol
  • gt serotonin gt free histamine

Psychological changes Anxiety Depression Tension
Tired Worry Apathy Apprehension Alienation Res
entment Confidence Aggression Withdrawal Restless
ness Indecision Sleeping problems Concentration

9
Acute Stress and Chronic Stress
Common After-effects Leave behind Life
threatening One-off Ever-present By proxy
10
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
11
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
12
  • 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

13
Acute Hazards Work characteristics 1.
Potential for violence Accident
Emergency Services 2. Peril or Danger Ex
pected Dangerous Conditions 3. Potential for
aggression Hazardous conditions 1. Verbal
abuse Ordinary / Mundane Conditions 2.
Physical abuse Unpredictable Behaviour /
Incident 3. PTSD inducement
14
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
15
Chronic Hazards (cont) Work role Ambiguity Confli
ct Advancement structure Insecurity Promotion un
der and over Low status Poor pay Environment Haza
rds physical / chemical Home work
interface Conflicting demands Support Domestic
problems Commuting
Interpersonal Conflict Colleagues Superiors S
ubordinates Personal Issues Isolation Lack of
support Harassment Bullying Violence
Organisational Justice Fairness Promptness Equalit
y
16
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
17
  • 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)

18
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
19
Commuting People develop a constant internal
anger on crowded trains that they cannot easily
displacean individual's immune system could also
be suppressed by stress, making passengers more
susceptible to illnesses
45 minutes cut-off
20
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
21
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 meaningfuln
ess of any quantification individual
modification
22
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
23
Potential effects
cardiovascular
mental health
immune system
Stress
gastrointestinal
musculoskeletal
social effects
performance impairment
Fatigue
safety problems
Exposure
over-exposure
24
  • Potential Health Risks
  • How Widespread is it Really ?
  • Mental health problems (some)
  • Somatic symptoms
  • Consumption consequences
  • CHD
  • Cancers
  • Infection
  • Immuno-suppression
  • Over investigated ?

25
  • 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

26
Performance Indicators Objective Physical
health Quality control Performance Accidents
Errors Near misses - recording
problems Mental health problems Erratic / out
of character behaviour subjective Disputes S
hort term absence Staff turnover Trivial
complaints Poor timekeeping Subjective
27
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
28
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
29
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
30
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!
31
Common Coping Styles Adaptive coping Seek
those with similar experiences Confront
issue Stick to a plan of action LONG Sup
port 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 SOLUT
ION Drink, eat, smoke to relieve
tension Denial
32
Methods of Assessing Stress Questionnaire
Assessment Symptoms Behaviours Performance
Typical vs Maximum Checklist approach Normal
and Abnormal behaviours Systematic scoring
principles Qualitative classification cases s
tressed dysfunctional stress-prone healthy
33
Psychological Tests Occupational clinical odd
mix Testing standards blasé attitudes over
familiar Administration types open controlled
supervised managed Provides consequences perc
eptions perceived sources of stress
34
Usefulness of Stress Model
am i happy?
potential for change?
no
yes
yes
no
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
35
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? C
larity of procedure administration
method? competence of administrator? locations
suitable? Inquiries and complaints handled
by? competence of handler? what actions will
result? fair treatment?
36
Rights of test takers 2 Test information scorin
g interpretation evidence of competence communi
cation 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 awarene
ss of personal limitations
37
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 1995310771-775. 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
38
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
200461643-648. Work Stress The Making of a
Modern Epidemic. Michael Fitzpatrick. Open
University Press, 2002.
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