Stress as the modern day back pain

Abstract

It has been estimated by MIND, the mental health charity, that in excess of five million people in the United Kingdom are suffering such an extreme level of work related stress as to put them at risk of a complete breakdown (cited in Laurence 2005). The pressures on individuals suffering from stress frequently results in them being absent from work although, whilst they remain in work there are effects on the level of accidents and the productivity rates. With the significant financial loss that this gives business, it would be expected that managers are highly proactive in reducing the causes and effects of stress.

This report sets out to determine if this is true and to measure people’s knowledge of stress, their awareness of its prevalence and the ways in which it is being controlled.

The research suggests that managers have very little knowledge of any of these areas. Despite the increasing level of publicity in both the public and professional press, the problem of stress remains unmonitored and its effects inaccurately measured by the majority of the companies questioned.

The guidelines produced by the Health and Safety Executive and the legal requirements under the Health and Safety at Work Act have seemingly had no impact on organisations. Failure to recognise and address the issue of work-related stress will, therefore, lead to it becoming a blight on British industry, being misunderstood, unchecked and poorly measured, as the problem of non-specific back pain was for much of the second half of the last century.

The costs of work-related stress are well reported. The European Agency for Safety and Health at Work reports that over 40 million days a year are lost to British industry because of stress-related problems (Health and Safety Executive 2004). A recent report by the mental health charity, MIND, states that more than five million people in the United Kingdom are suffering such as extreme level of work related stress as to put them at risk of a complete breakdown (cited in Laurence 2005).Their report goes on to say that for every £10 generated in the economy, £1 is lost due to stress related issues and that “less than 10% of companies have a policy to deal with it” (cited in Laurence 2005pg. 16).

ACAS report the Health and Safety Executives findings of 1995 that the cost to society of work related stress was £3.7 billion. Lord Layard reported to a Government seminar more recently that he estimates the current costs to be £25 billion (cited in Laurence 2005). It is noted that they do not define what is included in these costs. The most recent statistics show that disability claims due to mental and behavioural disorders has risen from 28% of the total claims submitted in 1997, to 37% in 2003 and is expected to continue to rise (Personnel Today magazine 2005).

The subject of stress is appearing more often in both the popular press and professional publications. O’Driscoll et al refer to the work offset and Schuler who suggest that there are four main reason for this: “concern for individual employee health…the financial impact on organisations…organisational effectiveness and legal obligations on employers to provide safe and healthy work environments” (O’Driscollet al 2002 pg 188).

The question remains as to how organisations are monitoring, reducing and managing the stress experienced by their employees and how they can improve in these areas.

Literature Review

Stress is not a new phenomenon. It was first identified in 1910 by Sir William Osler who identified that some patients appeared to be under strain during medical treatment. In was not until 1936 that a specific definition of stress as a reaction to a demand on a person was reported by Selly (O’Driscoll et al 2002). A major period of research was in the1950s, when Lazarus et al examined the effects of stress on work performance. McGrath noted that stress is due to “environmental demands exceeding a person’s resources and capacity, when the outcomes are important for the person” (cited in O’Driscoll et al 2002 pg 190) and French et al formalised the role of the environment in stress by saying that “strain can result from the mismatch between the person and the environment on dimensions important to the well-being of the individual” (cited in O’Driscoll et al 2002 pg 190).

Lazarus continued his work to examine the three phases of cognitive appraisal of stress. He identified that these are primary – the initial reaction to a risk, secondary – the assessment of how to overcome the source and reappraisal – judging whether or not the reaction to the source of stress was successful (cited in O’Driscoll et al 2002). This work was important as it initiated more investigations into coping mechanisms. Behr and Franz’s work differentiated between the concept of stressors as “the environmental stimulus or event” and strains “the person’s response to the stimulus or event” (cited in O’Driscoll et al 2002 pg192) and this differentiation became and has remained important when looking at how to reduce stress in the workplace (Fontana 1989).

It is recognised that stress is a natural aspect of life, but also that work-related stress is becoming global in nature and affects both manual and professional staff in industrialised and developing countries. The University of Manchester Institute of Science and Technology have measured certain jobs as being prone to more than 6 one stress scale rating of 1 to 10. These include miner, police officer and prison officer (Health and Safety Executive 2004).

The National Institute for Occupational Safety and Health (NIOSH) is the American equivalent of the UK’s Health and Safety Executive. NIOSH is a Federal agency responsible for “conducting research and making recommendations for the prevention of work-related illness and injury”(Saunter et al 1999). Their report, publication number 99-101, cites three statistics to illustrate the problem of work-related stress in the USA. Northwester National Life found that work is the main stressor for a quarter of people, Princeton Survey Research Associates report that three quarters of workers think there is more stress at work than the previous generation experienced and St Paul Fire and Marine Insurance found that health complaints are much more likely to be duet factors associated with work than with family or financial problems(Saunter et al 1999).

This leads us to determine the exact nature of stress.

Fontana makes the point that it is not so much “the events that determine whether we’re stressed or not, as our reaction to them”(Fontana 1989 pp. 3). He goes on to call individual’s reaction to potentially stressful situations as a result of their cognitive appraisal of the situation i.e. what one person sees as being stressful, someone else will not. He cites the philosopher, Epictetus, who said “men are not disquieted by things themselves, but by their idea if things” (Fontana 1989 pg. 63).

The Health and Safety Executive echo this view in defining stress as “the adverse reaction people have to excessive pressure or other types of demand placed on them” (Sauté ret al 1999). Similarly, the European Commission’s definition is: “the emotional, cognitive, behavioural and psychological reaction to aversive and noxious aspects of work, work environments and work organisations. It is a state characterised by high levels of arousal and stress and often by feelings of not coping” (Health and Safety Executive 2004). Selly noted that stress is not always a detrimental emotion. He defined the difference between “eustress”, which is seen as positive, motivating and challenging circumstances, which give people an opportunity to stretch themselves and achieve self-satisfaction, and “distress”, which is where people cannot cope (cited in Foot et al1999).

Within the human resources professional publications, it is frequently cited that there is no actual definition of stress or its symptoms as it is not a recognised medical term (Personnel Today magazine 2005).However, several writers have described the body’s reaction to stress and the effects it has.

Fontana defines stress as the demand on the adaptive capacity of the body and mind and highlights that too little of this demand leads to boredom and under stimulation, whereas too much results in being overstretched and overwhelmed. When faced with a challenge, the natural reaction of the body is that of fight or flight – either standing the ground and confronting the source of the challenge or by strategically withdrawing. This fight or flight reaction is meant to be a short term, immediate reaction to perceived danger as a method of survival. If its allowed to continue, it can have an adverse effect. As Fontana points out, “our modern society doesn’t usually allow us physically to fight or run away when we face stressors so that we are allowed to relax. We remain in a state of preparedness for action which we aren’t permitted to take” (Fontana 1989 pp. 6).

The body’s responses to stress can be divided into four categories. Firstly, several chemicals are released into the bloodstream including adrenalin, no radelin, thyroid hormones and cholesterol. These stimulate the body through increasing the reflex rate and increasing the blood supply and blood sugar levels to increase the metabolism. However, if this increase in metabolism is not dissipated through physical activity, it can increase the likelihood of heart disease, strokes and kidney disease and aggravate diabetes (Fontana 1989). A racing metabolism can lead to tiredness and exhaustion.

The second response is the redirection of blood from those organs which can cope with this forth short term, such as the skin and the stomach, to the air passages in the lungs to increase the aeration of the blood to feed the muscles. Again, if this continues over an extended period of time it can resulting digestive problems, bouts of unconsciousness and malfunctions of the body’s natural temperature control mechanism. The third reaction is an increase in concentration abilities. This is caused by the release of endorphins and cortisone which lowers the body’s natural immunity system and decreases the body’s sensitivity to pain. Again, over the long term, this can result in increased susceptibility to infection, ulcers and extreme allergies. Finally, because the blood thickens to accelerate the clotting process in the case of injury, it also becomes more difficult to move round the body, putting pressure on the heart and possibly leading to heart disease and strokes (Fontana 1989).

The phenomenon of “burn out” is described by Malachi as the state where “emotional exhaustion, depersonalisation of others in the work context, and feelings of low personal accomplishment on the job” lead to an inability to function in the work environment (cited in O’Driscoll teal 2002 pg. 202) and is seen as the end result of unchecked stress.

The causes of stress may come from several sources. Work is seen by many as being a primary source. General organisational problems include insufficient or poorly communicated process and procedures, unclear roles and responsibilities and a lack of basic tools and facilities. A lack of support functions which are often viewed as non-essential, not only increases the workload of individuals who have to do more in their day-to-day activities, but can also lead to feelings of worthlessness.

The increased tendency to long or unsociable hours can not only affect the body’s natural circadian rhythm, but can make it difficult to establish and maintain those things which people find help to diffuse their stress e.g. relationships and hobbies. Lack of prospects in apposition can be stressful, although, as will be discussed later, thesis not the case for everyone. A lack of job security is seen as an initiator of stress and becomes particularly significant during a time of change when other stressor may be encountered such as having to alter established work routines and methods. Apart from these general organisational problems, there are a whole host of specific conditions which lead to high levels of stress (Fontana 1989).

NIOSH summarise these as: “the design of tasks, management style, interpersonal relationships, work roles, career concerns and environmental conditions” (cited in Saunter et al 1999). NIOSH relate a list of eighteen work-related areas that can produce stress (cited in Saunter teal 1999). These are referred to in more depth later in the report. What also needs to be taken into account are the sources of stress outside the workplace which lead to the symptoms being displayed whilst artwork. These include domestic problems and also more deeply seated psychological issues such as obsessionality, sensation seeking and over-identification (Fontana 1989).

It has been suggested that certain personality types are more susceptible to stress. Commonly used is the distinction between Type And Type B people, as initially defined by Cooper and Bram well (cited in O’Driscoll et al 2002). Fontana describes this distinction impersonality types as being generally accepted by psychologists and medical doctors. A Type A person displays the characteristics of competitiveness, impatience and inflexibility. They work better when given tough deadlines and will tend to take a leadership role. They set themselves high standards to achieve and our highly self-critical if they don’t achieve them.

Although Fontana does not provide details, he claims that Type A people are more likely to develop heart disease and high blood pressure. He goes on to suggest that Type A people are more likely to be susceptible to stress as they are highly competitive and “mobilised almost permanently for action” (Fontana 1989 pg. 72). Other writers, Gangster and Schaubroeck 1991, Haskins, Baglioni and Cooper1990 and Froggatt and Cotton, all cited in O’Driscoll et al 2002,debate whether Type A people are subject to increased stress because they put themselves in more situations that can be deemed as being stressful because of their competitive nature, or that they are more likely to experience stress in any given situation NIOSH report that whilst some employers believe that remain competitive in the economy, organisations need to exert pressure on their employees to maximise productivity and reduce costs, research shows that organisational performance is adversely impacted by the increase absenteeism, error rates and poor motivation. Similarly, they have found that those organisations that incorporate policies that encourage good health in employees showed a corresponding healthiness in their competitiveness in the economy (cited in Saunter et al 1999).

This differentiation as to the relative importance of environmental factors over personality traits has remained an important factor in stress research and, consequently, the approaches to managing stress in the workplace. Ivancevich et al suggest three approaches to managing organisational stress. These are: “reduce the number or intensity of stressors experienced by employees, help employees modify their appraisal of the stressfulness of the situation or help employees in coping more effectively with stressors and their consequences” (cited in O’Driscoll et al 2002 pg 213).

Kahn and Bossier, 1992, identified that the majority of action taken in relation to stress occurred at the second level i.e. involved in changing the way people viewed stressful situations through training and employee assistance programmes (EAPs),rather than trying to remove the actual source of the strain (cited in O’Driscoll et al 2002 pg 213). O’Driscoll (2002) argues that the evidence for the effectiveness of these programmes is limited and that there are questionable benefits to training employees to be able to cope with poor working conditions or practices.

Despite this, NIOSH report that nearly half of large companies in the United Sates offer stress management training to their employees, usually involving such topics as time management and relaxation techniques. They point out that these types of interventions have only a short-term effect on the symptoms of stress as well as emphasising the need to alleviate the root causes of the stress (cited in Saunter et al 1999).

Elkin and Rosh have put forward a number of actions that could be taken to resolve the stress at source. These include task redesign, allowing flexible work patterns, empowerment of employees and reviewing reward systems to ensure they are equitable. Evaluations of these interventions are reported by O’Driscoll as being positive, but he goes on to emphasise that their use has been limited (O’Driscoll et al2002). Burke noted that the “removal or reduction of stressors is the most direct way to reduce stress since it deals with the source” (Burke1993 pg. 85). Whilst he does concede that “these approaches may entail immediate costs for the organisation”, he also notes that “these will be offset by long-term benefits not only for individual employees but also the organisation as a whole” (Burke 1993 pg. 85).

NIOSH recommends combined approach, as even if the causes of stress for the majority of employees were removed, because of individual appraisal of stressors, it would be impossible to remove them all. They also emphasise the need for the size and nature of the organisation to be taken into consideration, as what is possible and desirable for a large multinational may not be appropriate or practical for a small enterprise (cited in Saunter et al 1999).

NIOSH identify that the three main factors required for an individual to be able to “reduce the effects of stressful work conditions” are: “balance between work and family or personal life, a support network of friends and co-workers and a relaxed and positive outlook” (cited insurer et al 1999). They also advocate a basic programme to initiate actress prevention programme. This involves awareness building for all employees, securing the support and commitment of the senior management team, seeking an utilising employee input to all areas of the programme and ensuring the technical skills of stress management are incorporated through training specific employees of using the resources of consultants. They see employee involvement as being particularly useful when looking at the job design causes of stress and the employee have first-hand knowledge of the tasks (cited in Saunter et al 1999).

The Health and Safety at Work Act 1974 and the Management of Health and Safety at Work Regulations of 1999 made employers legally bound to undertake risk assessments in the workplace to identify the potential hazards and to take measures to reduce them. Within the definition of potential hazards was stress. As there remained some confusion as tithe nature and causes of stress, the HSE developed a series of standards to be used by employers to identify and manage the key causes of stress at work. These are: “the demands made on employees, the level of control employees have over their work, the support employees receive from managers and colleagues, the organisational policies in place, the clarity of the employees role within the organisation, the nature of relationships at work and the way that change is managed”(ACAS 2004).

In the second half of the last century, a common problem for businesses was the amount of absence from work due to no specific back pain. As it’s difficult to prove that someone is not suffering from back pain, concerns existed as to how it could be controlled. It is suggested that, not only may work-related stress take this position as the main cause of absence from work, but also that the two conditions are related. Occupational Health magazine has reported the findings of research which indicates that musculo skeletal disorders (MSDs) are one of the most common symptoms of stress (Occupational Health 2004).

It is suggested that the rise in incapacity benefit claims related to mental or behavioural problems is directly linked to the decrease in claims for back problems and this is due to doctors being more likely to diagnose mental problems as they have less of a stigma than previously for patients. It is therefore possible, that there has been no actual increase in the amount of stress related illness, rather that it is now called that whereas previously people reported one of the symptom of stress which was back pain (Personnel Today magazine 2005).

The difficulties in determining whether a reported illness is merely symptom of the deeper underlying problem of stress leads to questions being raised as to amount of stress experienced by today’s workers. Charlesworth (1984) suggests that “as many as 75% of all medical complaints are stress related” in the United States.

Methodolgy

The questionnaire was divided into two parts. The first section was asked only of those in senior management positions such as general managers and personnel managers. This was done to determine organisational policies, procedures and measurement of stress. The second set of questions was asked of everybody and included the senior managers so that the effects of stress on them could also be measured.

The questionnaire was sent out to variety of business types including catering, production and financial services. The objective was to gain an overall view of the effects of stress on businesses, not to concentrate on those industries which have been classed as particularly stressful as this would have given a distorted view. A limitation of this approach is noted however, as being that some of the respondents indicated low levels of stress or no stress at all and may have therefore been unable to answer all the questions from personal experience.

The main objective of the questionnaire was to collect information on the effects of stress in the workplace, the cost of stress and the benefits of a stress free environment. The questionnaire included admixture of quantitative questions to determine factual information and qualitative questions to collect opinions. As the research did not want to suggest answers to the respondents, all the questions were asked aspen questions. Providing multiple-choice answers may have had detrimental effects on the replies received, as it would provide options the respondent may not have considered.

However, it is accepted that there may have been an effect in that people did not realise that point was relevant. For example, in the question regarding the symptoms of stress, the respondents might not consider backache unless it was suggested to them. Two exceptions to this were question nine in the manager’s questionnaire and question eight in the general questionnaire which examined the respondents views on the sources of work-related stress given by NIOSH (cited in Salter et al 1999).

The replies given to all the other questions were then categorised byte writer. When collating the replies on managing stress, the guidelines set out by the Health and Safety Executive were used and the writer determined which category the answer came under (demands, support, control, policies, role and change). It is accepted that this was a potential weakness in this part of the questionnaire as it was based on the writer’s opinion.

The questionnaire was distributed in a postal format to non-senior managers following personal visits to the organisations to conduct separate survey with the senior managers and to gain their consent. Whilst this method has benefits in that respondents would be more likely to be honest as the replies were anonymous (except for those in specific management positions), there are also drawbacks in that a low response rate was expected. To overcome this, the number of questionnaires sent out allowed a population sample of one hundred tube expected with a return rate of 20%.

The actual number returned was seventy-five. The questionnaire was conducted on a face-to-face basis for the management roles, as it was important that their questionnaires were returned to provide important information as to policies and procedures. This resulted in a 100% return rate of management surveys. The responses from the general questionnaire were subdivided into those from management and non-management with the supervisors being defined as managers.

This allowed better analysis of the results. Where appropriate, it is indicated whether the respondents were manual workers, office based and/or customer facing as this is seen as being relevant to the research. As stated earlier, as the purpose of the research was not to determine which job sectors are more stressful, the results do not differentiate between organisations.

Questionaire – Managers

1. What do you understand by the word “stress”?

Answer Number of respondents Percentage of respondents
An inability to cope with something that causes panic 4 31
Anxiety 5 38
Fear of failure or not being able to continue 7 54
Depression 2 15
When you have too much to do and not enough time or resources to do it 8 62
When you cannot remain rationale about a situation 2 15
Losing control 1 8
Don’t know 0 0

2. What causes stress?

Answer Number of respondents % of respondents
Too much to do and not enough time to do it 6 46
Different things for different people 4 31
Don’t know 2 15
Other 1 8

3. What would indicate to you that an employee is suffering from work related stress?

Answer Number of respondents Percentage of respondents
Through being absent and giving stress as the cause 10 77
They would submit a grievance 1 8
They would tell their manager 1 8
Other 0 0
Don’t know 1 8

4. Do you or your organisation, actively measure stress levels amongst your employees, and if yes, how?

Answer Number of respondents Percept of respondents
Absenteeism reported as due to stress 10 77
Performance measures 1 8
Combination of these 1 8
Do not actively measure 1 8

5. How do you evaluate the success of any interventions to reduce stress?

Answer Number of respondents Percentage of respondents
Look for a reduction in absenteeism with stress given as the reason 12 92
Don’t measure 0 0
Staff surveys 1 8
Don’t know 0 0

6. Where is the emphasis of your efforts to manage stress

Answer Number of respondents Percentage of respondents
Reducing or eliminating the causes of stress 1 8
Helping employees to modify their appraisal of the stressfulness of situations 0 0
Helping employees in coping more effectively with stressors and their consequences 2 15
Managing attendance issues 8 60
None of these 0 0
No effort 0 0
Don’t know 2 15

7. How do you balance people’s needs for challenge and achievement under pressure with ensuring they are able to cope?

Answer Number of respondents Percentage of respondents
By setting realistic targets 9 69
By allowing people to work at a rate they feel comfortable with 0 0
By asking them 0 0
By identifying when stress occurs and reducing it 2 15
Bu setting consistent expectations 2 15
Other 0 0
Don’t know 0 0

8. What do you feel are the main causes of stress in life in general?

Answer Number of respondents Percentage of respondents
Financial problems 10 77
Relationship problems 6 46
Peer pressure 2 15
Work 3 25
Traffic 7 54
Concerns over the environment 3 25
Concerns over politics 4 30
Concerns over war or terrorist attacks 4 30
Concerns over family members 9 75
Don’t know 0 0

9. Which of the following factors do you believe cause stress to your employees in your workplace?

Answer Number of respondents Percentage of respondents
Workload – too much or not enough 2 15
Pace/variety/meaningfulness of work 6 46
Autonomy 2 15
Shift work/hours of work 3 23
Physical environment (noise/air quality etc.) 2 15
Isolation at the workplace (e.g. working alone) 0 0
Role conflict 0 0
Role ambiguity 0 0
Level of responsibility 0 0
Under/over promotion 0 0
Job security 0 0
Supervisors 0 0
Co-workers 0 0
Subordinates 0 0
Threat of violence 0 0
Participation in decision making 0 0
Management style 0 0
Communication patterns 0 0
None of these 0 0

10. What are your legal obligations in terms of identifying and managing work-related stress?

Answer Number of respondents Percentage of respondents
There aren’t any 7 54
Comes under HASAW Act 2 15
Have to complete risk assessments which includes assessing possible sources of risk 1 8
Other 0 0
Don’t know 3 23

11. What are the HSE standards that organisations should use to identify and manage stress?

Answer Number of respondents Percentage of respondents
Don’t know 13 100
Could name all six 0 0
Could name five 0 0
Could name four 0 0
Could name three 0 0
Could name two 0 0
Could name one 0 0

12. What actions do you take under each of the HSE standards:

Answer Number of respondents Percentage of respondents
Demands 7 54
Support 6 46
Control 4 31
Policies 7 54
Role 0 0
Change 5 38
Other 0 0
Don’t know 0 0

a. demands – ensuring employees do not become overloaded and unable to cope with the amount of work they are asked to do (job design, flexible hours and training)
b. support – management style and degree of intervention
c. control – allowing employees to have input into how they complete their tasks
d. relationships – personnel policies on grievance, poor performance etc.
e. role – induction, objectives
f. change – managing change

13. How would one of your employees alert management if they were experiencing work-related stress?

Answer Number of respondents Percentage of respondents
Through grievance procedure 8 62
During appraisal 7 54
Through formal representatives e.g. union of employee consultative committee 4 31
Would just say 0 0
Don’t know 0 0
Other 0 0

14. What are the symptoms of stress?

Answer Number of respondents Percentage of respondents
Being absent from work 4 31
Panicking 4 31
Nervousness 2 15
Heart problems 1 8
Crying 7 54
Alcohol and drug use 6 46
Accidents in the workplace 1 8
Don’t know 0 0
Other

15. What is the absence rate in your organisation?

Answer Number of respondents Percentage of respondents
0 – 2% 7 69
2 – 4% 5 8
4 – 6% 0 8
6 – 8% 1 15
Don’t know 0 0

16. What percentage of this absence level is due to stress related illnesses?
Answer Number of respondents Percentage of respondents
Less than 10% 9 69
More than 10% but less than 30% 1 8
More than 30% but less than 50% 1 8
More than 50% but less than 75% 2 15
More than 75% 0 0
Don’t know 8 62

17. What is the financial impact of stress in your workplace?

Answer Number of respondents Percentage of respondents
Calculated the same as any absence from work 13 100
Don’t measure 0 0
Don’t know 0 0

18. What do you include when you measure the financial impact of stress which you do not include when measuring the cost of other reasons for absenteeism:

Answer Number of respondents Percentage of respondents
Reduced productivity 0 0
Employee turnover 0 0
Absenteeism 0 0
Medical costs 0 0
Recruitment 0 0
Use of temporary staff 0 0
Retraining costs 0 0
Loss of production 0 0
Poor customer service 0 0
None 13 100
19. Which level of employee do you feel is more susceptible to stress in your organisation?

Answer Number of respondents Percentage of respondents
Senior managers only 0 0
Blue collar workers only 3 23
Middle managers only 0 0
All management levels 8 62
Everyone is equally susceptible 2 15
Don’t know 0 0

20. What type of