in harm’s way: job stress in the usaf -- implications ......
TRANSCRIPT
In Harm’s Way: Job Stress and Mental Health
in the Military Steven Pflanz, Col, USAF, MC, FS
American Psychiatric Association
2016 Annual Meeting
Disclosures
• The material presented in this briefing and contained in these slides represent the views of the presenter and not the USAF or DoD
• Steven Pflanz has no financial interests to disclose
• Commercial Support was not received for this activity.
Learning Objectives
At the conclusion of this activity, the participant will be able to:
1. Describe the prevalence and causes of work stress in the military
2. Discuss the impact of work stress on mental health & work performance
3. Examine strategies for managing and reducing the adverse impact of job stress
Anecdotal Observations
• Military mental health patients frequently c/o job stress when presenting for treatment at military mental health clinics
• Military mental health patients often complain about difficulties with supervisors
• These patients often attribute their mental health issues to problems in the workplace
Work Stress in America
• Roughly one third of US workers report exposure to severe job stress
• Work stress costs industry over $300 billion per year in lost productivity, absenteeism, increased health care utilization, and disability claims
Cost Per Year of Lost Productive Time Due to Depressive Disorders
Presenteeism, $35.7 billion, 81%
Absenteeism, $8.3 billion, 19%
Average Lost Productive Hours Per Week From Mental Health Problems
8.4
3.3
5.3
5.6
1.5
0 2 4 6 8 10
None
All Depression
Partial Remission
Dysthymia
Major Depression
Treatment Works
• Stress & mental health problems often unrecognized and untreated
• Multiple studies have shown that treatment:
–Returns workers to the job more rapidly
–Decreases work impairment
–Reduces medical care utilization and costs
Sources of Job Stress
• Conflict with boss
• Conflict with co-workers
• Work overload
• Lack of challenge
• Exposure to harassment
• Fear of job loss
• Being bypassed for promotion
• Low wages
• Role ambiguity
• Role conflict
• Long job hours
• Poor work-life balance
Sources of Job Stress
• Inadequate training
• Inadequate resources
– Staff
– Materials
• Unsafe job environment
• Workplace violence
• Traumatic events
• Poor work conditions:
– Excessive noise
– Excessive heat or cold
– Overcrowding
– Isolation
– Poor ergonomic design
– Inadequate lighting
Combat
• Wartime activities clearly cause distress and are associated with psychiatric disorders
– Exposure to combat
– Exposure to heavy casualties
– Witnessing or experiencing injuries
– Deployment of units to a war zone
– Unexpected mobilizations of reserve units
Iraq & Afghanistan
0
2
4
6
8
10
12
14
16
18
% Psychiatric Illness % PTSD
Marines Iraq
Army Iraq
Army Afghanistan
Army Before
Military Job Stress
• In 1981, work was identified as the #1 contributor to their emotional problems by 371 active duty outpatients at three US military mental health clinics in Europe
• In 1993, amongst 3,370 active duty outpatients at a US military mental health clinic in Texas, 23% were given the diagnosis of Occupational Problem
DoD Survey HRB 2002 & 2005
• One third of respondents c/o high job stress
• High job stress much more common than high family stress (18%)
• High job stress associated with MH problems, MH treatment, & impaired job performance
• Never deployed personnel reported similar rates of high job stress as personnel with deployment history (30.3% vs. 35.4%)
DoD Survey HRB 2011 Military Related Job Stressors
42%
31% 33%
26% 24%
27%
42%
36%
25%
42%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Military Work Stress: 1,701 subjects
60%
26% 27% 20%
0%
10%
20%
30%
40%
50%
60%
70%
ADAF MentalHealth Patients, TX,
1998 (n=85)
ADAF, WY, 1999(n=472)
ADAF, WY, 2001(n=809)
ADAF, Afghanistan,2013 (n=335)
Significant Work Stress
Generic Stressors Most Common (e.g., ADAF Afghanistan)
Stressor: Percentage (Number)
Long Work Hours 43% (n=144)
Work Overload 23% (n=77)
Inadequate Staffing 18% (n=61)
Conflict with Supervisors 18% (n=59)
Indirect Fire (IDF) 8% (n=26)
Combat Exposure 5% (n=17)
Military Disciplinary Action 4% (n=15)
Frequent Indirect Fire (IDF) 2% (n=6)
Frequent Combat Exposure 2% (n=6)
Other 19% (n=63)
Costs of Work Stress in Military
• Decreased productivity
• Increased mistakes, accidents & missed deadlines
• Decreased individual & unit morale
• Increased conflict with supervisors & co-workers
• Poorer physical & emotional health
• Increased medical & MH care utilization
Specific populations that report greater levels of work stress
• Jobs with low autonomy
• Jobs that require working long hours
• Health care professionals
• Middle-aged workers
• Military personnel
• Employees with abusive supervisors
Why might the military have high levels of work stress?
• Little autonomy or control:
– Emphasis on discipline, respect for rank hierarchy & obedience
– Work long hours to complete mission
– Can’t quit
– Can’t choose job or location
– Conflicts often resolved in favor of supervisor
– “Do more with less” government mentality
Management
To be effective, psychiatrist needs to:
• Perform competent evaluations
• Advocate effectively for patient
• Work effectively with leadership
• Offer realistic treatment recommendations – Set reasonable date for return to work
– Identify appropriate work restrictions
– Secure support for treatment plan from all parties
– Be sensitive to both cost and time duration of recommended treatment
• Goal is to match worker’s resources to job’s demands
Resources
• NIOSH Stress at Work
– http://www.cdc.gov/niosh/topics/stress/
• National Partnership for Workplace Mental Health
– www.workplacementalhealth.org
• Academy of Organizational and Occupational Psychiatry
– www.aoop.org
