2014-15 HWC Healthy Workplace Manage StressCampaign Partnership Meeting

Brussels, April 8 2014

Impact of stress and psychosocial risks on health and performance-

Evidence at the organizational level

Johannes Siegrist

Senior Professor of Workstress ResearchUniversity of Duesseldorf, Germany

Main Questions

• Is stress at work a real challenge to working populations across Europe?

• What is the scientific evidence linking stress at work with adverse health?

• What can be done at organizational level to manage stress and improve health at work?

Work …

provides a source of regular income and related opportunities

provides a source of personal growth and training of capabilities/competencies

provides social identity, social status and related rewards

enables access to social networks beyond primary groups

Impacts on personal health and well being by exposure to material and psychosocial stressors

Importance of work for health

Increase of work pressure, pace of work,and competition, including ‘high power work organization’ (impact of economic globalization)

High demand for flexibility, mobility, and adaption of workers to new taks/technologies

Fragmentation of occupational careers, de-standardized or atypical work, and growing job instability/insecurity

Increase of service and IT professions/occupations with high psychomental/emotional workload

Segmentation of labour market; social inequalities in quality of work and employment

Significant changes in the nature of work and labour market

Increased pressure of rationalisation(mainly due to wage competition)

Downsizing, Merging, Outsourcing

Work Job Low wage / intensification insecurity salary

Effects of economic globalisation: Labour market consequences in developed countries

Increase in work intensity 2004-2010: European Social Survey, 19 EU countries

Source: Gallie D (Ed.) (2013) ESS Topline Results Series 3, European Social Survey

Job insecurity 2004-2010European Social Survey, 19 EU countries

Source: Gallie D (Ed.) (2013) ESS Topline Results Series 3, European Social Survey

2. Question: What is the scientific evidence linking stress at work with adverse health?

Stress occurs if a person is exposed to a threatening demand(stressor) that taxes or exceeds her/his capacity of successful response risk of loss of control

Dimensions of stress reactions: • Cognitive appraisal (evaluation of threat)• Affective response (anxiety, anger)• Activation of stress axes in organism (SAM, HPA)• Behavioural reaction (fight or flight) (restricted option!)

Critical for health:• Chronic stressors requiring active coping allostatic load; risk of stress-related disorders (depression, CHD)

negative emotions

stress responses allostatic load

stress-related disorders

Working conditions as chronic stressors:How to identify ‘toxic’ components within complex

environments?

Demand-control model (R. Karasek, 1979; R. Karasek & T. Theorell, 1990)

Effort-reward imbalance model(J. Siegrist, 1996; J. Siegrist et al., 2004)

Organizational injustice model(J. Greenberg, 1990; M. Elovainio et al., 2002)

Focus on job task profile: high demand/low control

Focus on work contract: high effort/low reward

Focus on unfair procedures and interactions

Chronic psychosocial stress at work: Complementary stress-theoretical models

active

passive

lowdistress

highdistress

Quantitative demands

Scop

e of

dec

isio

n/co

ntro

l low high

low

high

The demand-control model(R. Karasek 1979; R. Karasek & T. Theorell 1990)

Psychometric scale of demand-control model: www.jcqcenter.org

effort

reward

demands / obligations

- labour income- career mobility / job security- esteem, respect

motivation(‘overcommitment‘)

motivation(‘overcommitment‘)

Extrinsic components

Intrinsic component

The model of effort-reward imbalance (J. Siegrist 1996)

Psychometric scale of effort-reward model: www.uniklinik-duesseldorf.de/med-soziologie

Mean level of work stress in 17 European countries(SHARE, ELSA, n = 14 254, aged 50-64)

Source: T. Lunau et al. (2013): Unpublished results

.75 1 1.25Mean ERI

Hungary

Portugal

Czechia

Poland

Italy

Estonia

Slovenia

England

Spain

France

Germany

Austria

Belgium

Denmark

Netherlands

Sweden

Switzerland

3.5 4 4.5 5Mean Low Control

Poland

Hungary

Italy

Czechia

Spain

Austria

Estonia

England

France

Germany

Belgium

Slovenia

Portugal

Switzerland

Netherlands

Sweden

Denmark

Psychosocial Working Conditions

Social gradient of work stress

0

5

10

15

20

25

30

35

40

Effort-Reward Imbalance Low control

Perc

ent h

igh

stre

ssed

Very low LowMediumHighVery high

Source: Wahrendorf M et al. (2013) European Sociological Review 29: 792-802

The social gradient of work stress in the European workforce (age 50-64): SHARE-study

Diagramm1

Effort-Reward ImbalanceEffort-Reward ImbalanceEffort-Reward ImbalanceEffort-Reward ImbalanceEffort-Reward Imbalance

Low controlLow controlLow controlLow controlLow control

Very low

Low

Medium

High

Very high

Percent high stressed

Social gradient of work stress

37.5

35.4

31.2

26

18.3

31.7

25.1

14.9

13.8

8.6

Tabelle1

Effort-Reward ImbalanceLow control

Occupational statusVery low37.531.7

Low35.425.1

Medium31.214.9

High2613.8

Very high18.38.6

Figure 2: Quality of life in wave II (mean scores of CASP-12 (range 12-48) and standard errors) according to voluntary work (3 categories) in wave I

Tabelle1

Very low

Low

Medium

High

Very high

Percent with poor Quality of Work

Occupational status and Quality of Work

Tabelle5

country_groupnoyes

EURO-DERInorthern0.11266620.1549296

western0.16007090.2367758

southern0.11293630.2071429

low controlnorthern0.11441210.1583794

western0.17389230.2270916

southern0.12453180.1951219

Figure 1: Prevalence of depressive symptoms in wave II (EURO-D) according to low quality of work in wave I (yes= highest tertile effort-reward ratio or low control; no= lower tertiles)

Tabelle5

yes

no

Effort-Reward imbalance Low control

Prevalence of depressive symptoms in %

• Depression:• ~ 30 studies (Europe, USA, Canada, Japan):

People exposed to stress at work: mean increase of relative risk: 80% = OR 1.8 (95% CI 1.1-3.1)

• Coronary heart disease:• ~ 20 studies (Europe, USA):

People exposed to stress at work: mean increase of relative . risk: 40% = OR: 1.4 (95% CI 1.2-1.6)• Additional evidence of elevated health risks:

Metabolic syndrome / type II diabetesAlcohol dependenceMusculoskeletal disorders

Scientific evidence from prospective cohort studies: Demand-control and effort-reward-imbalance models

Source: Steptoe A, Kivimäki M 2012. Nat Rev Cardiol.9 ; Stansfeld SA ,Candy B 2006 Scand J WEH 32: 443

0,5

1

1,5

2

2,5

1 2 3 1 2 3

High demand / low control

Source: Based on Kivimäki, M, et al. (2002), BMJ, 325: 857, doi:/10.1136/bmj.325.7369.857.

High effort / low reward

Tertile (work stress):1 = no 2 = low3 = high

#adj. for age, sex, SEP, smoking, phys. act., SBP, cholest., and BMI

**

Haz

ard

ratio

#Work stress and cardiovascular mortality: Finnish Cohort Study, n = 812 employees

Psychosocial stress at work and depressive symptoms: 13.128 employed men and women 50-64 yrs. from 17 countries in three

continents (SHARE, ELSA, HRS, JSTAR)

0

0,5

1

1,5

2

2,5

USA (N=1560) Europa (N=10342) Japan (N=1226)

ERILow control

Source: J. Siegrist et al (2012) Globalization and Health 8:27.

* *

** *

Diagramm1

USA (N=1560)USA (N=1560)

Europa (N=10342)Europa (N=10342)

Japan (N=1226)Japan (N=1226)

ERI

Low control

2.28

2.26

1.97

1.66

1.64

1.59

Tabelle1

ERILow control

USA (N=1560)2.282.26

Europa (N=10342)1.971.66

Japan (N=1226)1.641.59

Ziehen Sie zum Ändern der Größe des Diagrammdatenbereichs die untere rechte Ecke des Bereichs.

3. Question: What can be done at organizationallevel to manage stress and improve healthy work?

• Provide evidence of a business case• Provide shared commitment from management

and employees• Provide available expertise (e.g. occupational

safety & health) and equipment • Monitor working conditions and employees‘ health• Develop and implement programmes, invest in

improvements, consult models of best practice• Ensure continuity, evaluate outcomes, build

networks

Personal level: Stress prevention programs Interpersonal level: Leadership training;

communication skills; Structural level: Organizational/personnel

development (based on work stress models) Job enrichment/ enlargement (autonomy, control, responsibility) Skill utilization / active learning Participation / team work and social support Culture of recognition Fair wages/ gain-sharing Continued qualification/ promotion prospects

Develop and implement Healthy Workplace Programs

Personal level: Effects of worksite stress prevention programs: Meta-analysis

Source: D Montano et al. (2014) Scand J Work Environ Health, doi: 10.5271/sjweh.3412 .

Source: T. Theorell et al. (2001), Psychosom Med, 63: 724-733.

Intervention group Control group

Baseline

390.4

6.2

After 1 year

345.2

6.1

Mean Cortisol (nmol/l)

Mean decision latitude(range 2-8)

Interaction group X time: *p = .05, **p = .02

Baseline

387.2

6.0

After 1 year

391.3

5.7

**

*

Interpersonal level: Leadership training of managers and stress hormone excretion in subordinates

Variable

DemandControlSocial supportRewardEffort-reward imbal.Work-rel. burnout

Means at t2 adj. for t0

experimental - control hospital p

11.970.023.731.21.0

43.2

12.668.723.030.21.1

48.3

.008

.051

.011

.003

.001

.003

Source: R. Bourbonnais et al. (2011), Occup Environ Med, 68: 479-486.

Structural – level: Organizational intervention in a Canadian hospital vs. control hospital*

*36 month-follow-up, two Canadian hospitals, N=248 (intervention) vs. 240 (control hospital) (ANCOVA, adj. for baseline values)

1. Employment security2. Selective hiring of new personnel3. Self-managed teams; decentralization of decision

making4. Comparatively high compensation contingent

on performance5. Extensive training6. Reduced status distinctions and barriers7. Extensive sharing of financial and performance

information

Seven practices of successful organizations: Reconciling health promotion with economy!

Productivity and quality of outcomes

Health and wellbeing of employees

Client satisfaction

Workplace/-environment

Investments intogood quality

of work

The Sirdal Model of Improved Work

Thank you!

Slide Number 1Slide Number 2Main QuestionsImportance of work for healthSignificant changes in the nature of work and labour marketEffects of economic globalisation: Labour market consequences in developed countriesIncrease in work intensity 2004-2010: �European Social Survey, 19 EU countriesJob insecurity 2004-2010�European Social Survey, 19 EU countries2. Question: What is the scientific evidence linking stress at work with adverse health? Working conditions as chronic stressors:� How to identify ‘toxic’ components within complex environments?Chronic psychosocial stress at work: �Complementary stress-theoretical models The demand-control model�(R. Karasek 1979; R. Karasek & T. Theorell 1990)The model of effort-reward imbalance �(J. Siegrist 1996)Mean level of work stress in 17 European countries�(SHARE, ELSA, n = 14 254, aged 50-64)The social gradient of work stress in the European workforce (age 50-64): SHARE-studyScientific evidence from prospective cohort studies: Demand-control and effort-reward-imbalance modelsWork stress and cardiovascular mortality: �Finnish Cohort Study, n = 812 employeesPsychosocial stress at work and depressive symptoms: 13.128 employed men and women 50-64 yrs. from 17 countries in three continents (SHARE, ELSA, HRS, JSTAR)3. Question: What can be done at organizational level to manage stress and improve healthy work?�Develop and implement �Healthy Workplace ProgramsPersonal level: Effects of worksite stress prevention programs: Meta-analysisInterpersonal level: Leadership training of managers and stress hormone excretion in subordinatesStructural – level: Organizational intervention in a Canadian hospital vs. control hospital*Seven practices of successful organizations: Reconciling health promotion with economy!The Sirdal Model of Improved WorkSlide Number 26