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Stress and Work

Introduction to Occupational Stress

Stress has been defined in a number of ways and the range of stress management techniques is even wider still. Essentially what most people understand by 'stress' is a physiological or psychological response to external stressors that goes beyond what is accepted as normal. Perhaps 'strain' would have been a better word and an analogy with a rubber band appropriate. Limited external stresses produce a response, a 'strain', which beyond a certain point becomes disproportionate and beyond the capability of the elastic properties of the subject. 

As regards the prevention of occupational stress there are two poles of attitude. One which often prevails is to focus on individual behaviour by support and advice, to help coping with the stress. The other is to identify situations which include potential stressors, assess the risks of stress, and then take steps to reduce the stressors so as to reduce the stress. Occupational health professionals should concentrate, and focus employers' and employees' attention on this latter approach. However this is not necessrily easy, especially since stress is usually multifactorial.

Case History:
A 53 year-old computing officer came to consult the occupational health service after her manager had informally suggested that some form of counselling or stress management advice might help her. The employee was tense, anxious and distressed because she had found progressive difficulty in keeping up with increased work demands. The unit was due to merge with another and she was uncertain of the consequences that this might have on her employment. She had some slight difficulties with vision because of severe short-sightedness and a retinal detachment which had been treated, but this in itself was not a major problem, provided she could work at her own pace. Her manager who was involved in a later meeting said that she had become increasingly withdrawn into simple repetitive tasks while allowing a backlog of important requests to accumulate. The occupational health professional's advice was that an adequate and sustained improvement in her well being would best be achieved by a change in her work plan and responsibilities. This was difficult to arrange but she was eventually given responsibility for the induction training in keyboard skills and basic computer training for new members of staff. This was a fairly circumscribed job with a steady and relatively predictable load and which was well within her skills and resulted in continuing useful employment and well being. A few years later her duties were changed again because of a reorganisation and she developed an anxiety neurosis. This together with some worsening of her vision prompted a premature retirement on ill-health grounds.
The above cases illustrate some of the common occupational stressors which may affect even the most senior employees in an organisation. Sometimes individual employees are reluctant for their particular issues to be taken up in a way in which they might be identified and possibly be labelled as 'not coping'. However occupational health professionals can progressively build up a picture of the health of the organisation after seeing a number of workers with common problems. A responsible and open manager should be willing to explore the organisational determinants of stress and try hard to remedy them. Such an approach is more likely to result in lasting benefit to the workers and the organisation than the hiring of a stress consultant to lecture on individual coping strategies.

Different people vary in their responses to outside factors, be they psychological or otherwise, and therefore exhibit different degrees of vulnerability. Thus with agents such as noise and respirable dust, it is generally the case that the more there is, the worse it is for everybody, while on the other hand, psychological stressors may affect different people in opposite directions. For example tasks such as in information technology, which require a specific but limited degree of skill and knowledge, might be stressful to an employee who is set in ways and habits and is finding difficulty with coping. It could also become stressful to a keener, motivated employee who easily masters the skills, but for an opposite reason, in that the latter may become frustrated at not being able to progress and use his or her initiative and control over the programmes being dealt with. 

Unemployment is a very important direct cause of stress, while indirectly the fear of losing one's job is a similarly serious stressor. Moreover physical ill health, family and other social problems, especially lack of support can add to occupational factors in provoking or exacerbating stress reactions.

Incidence, and relationship with sickness absence:

Data on medically reported incidence of work-related illhealth in the UK suggests that overall stress and mental illness is, or has been until recently the second commonest reported category (after musculoskeletal ill health). However the gap between the reported incidence of the two categories is narrowing. Thus in some occupational categories, stress and mental illness attributed to work has a higher reported  incidence than work related musculoskeletal ill health. 

In  the UK data on medically reported incidence is collected from occupational physicians (OPRA), GPs (THOR-GP) and psychiatrists (SOSMI) participating in the THOR network.

Data from THOR-GP  in the UK, is studying the relationship between GP certified sickness absence for work related stress and mental illness on the one hand, and GP certified sickness absence for musculoskeletal ill health.

Stressors in the workplace

Common adverse factors in the workplace leading to psychological breakdown include:
  • Recent promotion beyond capacity
  • Conflicts due to multiple responsibilities
  • Too many demands on time
  • A tiring shift pattern, excess overtime
  • Too little or boring work
  • New technology
  • A new or unreasonable boss
  • Increased productivity targets
  • Threat of redundancy
  • Sexual harassment or bullying
  • High sickness absence in colleagues
Acknowledgements Reproduction: Part of this page has been adapted, with permission, from Practical Occupational Medicine (Copyright) - Arnold publishers. 

A guide as to the audit of process of consultations in occupational health practice relating to mental health is presented in a separate page

An abstract of some of the author's research on occupational stress now follows:

The following is an adaptation, reproduced with permission from the publishers of an abstract of a paper published in Occupational and Environmental Medicine 1996;53:217-224


RM Agius, H Blenkin, IJ Deary, HE Zealley, RA Wood.



The objectives of this study were to determine the work demands of health service consultants (medical doctors who have completed their higher specialist training) in relation to their role as potential stressors, and to describe the development of tools for measuring stress experiences of consultants. 


A stratified random sample of 500 Health Service consultants in Scotland was targeted by a postal questionnaire, and 375 (75%) returned a valid response. They completed questionnaires, including information on demographic factors, work demands, occupational stressors and burnout.


Principal components analysis showed that professional work demands of consultants fell into three categories: clinical, academic and administrative. Their perceived stressors separated into four main factors: 
  • Clinical Responsibility, 
  • Demands on Time, 
  • Organisational Constraints, and 
  • Personal Confidence. 
These were assessed by 25 questions in the Specialist Doctors' Stress Inventory (SDSI), described in full in the paper. Specific questions about perceived stressors which resulted in a high positive response included questions about demands on time, and organisational change in the National Health Service. There was a significant correlation between health service sessions worked and burnout. Clinical work demands correlated positively with personal accomplishment. Academic work demands correlated inversely (favourably) with depersonalisation and emotional exhaustion.


These self reported data characterise and quantify the consultants' work demands and their role as potential stressors. These measurements could form the baseline for strategies to reduce occupational stress in these workers. 

While 'Clinical Responsibility' is an intrinsic dimension of the work of consultant doctors, 'Demands on Time' and 'Organisational Constraints' are two dimensions which should be amenable to appropriate organisational interventions, thus reducing the risk to the mental health of senior doctors. The smallest dimension 'Personal Confidence' should be amenable to appropriate training and individual support.

Acknowledgement: This work was supported by a grant from the Royal College of Physicians of Edinburgh.


Other publications on the same subject include:

Blenkin H, Deary I, Sadler A, Agius R. Stress in NHS Consultants. BMJ 310, p534, 1995. (letter) 

Deary IJ, Agius RM, Endler NS, Zealley H, Wood R. Models of job-related stress and personal achievement among consultant doctors. Br J Psychol 87, pp 3-29 1996. 

Deary IJ, Agius RM, Sadler A. Personality and Stress in Consultant Psychiatrists. International Journal of Social Psychiatry. 42, p112-123, 1996.