Work-related stress and organizational level interventions - addressing the problem at source

Intermediate Diploma Thesis, 2007

81 Pages, Grade: 1,3


Table of Contents

Executive Summary

List of Abbreviations

Index of Figures

Index of Tables

Index of Appendices

1. Introduction
1.1 Adressing the Problem
1.2 Research Objective
1.3 Research Method and Proceeding

2. New Risks: Stress Caused by Organizational Factors
2.1 Definition of Stress
2.2 Work-related Stress
2.2.1 Impact of Work-related Stress
2.2.2 Levels to Approach Work-related Stress
2.3 Responsibilites of Organizations and Ethical Reasoning

3. Stress Prevention: An Organizational Approach
3.1 First Step: Risk Assessment
3.1.1 Identifying the Risk
3.1.2 The Indicator Tool
3.2 Second Step: Stress Prevention
3.2.1 Theoretical Basis of the Management Standards
3.2.2 The Management Standards
3.3 Third Step: Evaluation

4. Stress Prevention in Practice: Evidence of Case Studies
4.1 Workload Reduction: Study by Parkes et al. (1986)
4.1.1 Results
4.2 Workload Reduction: Study by Meijman et al. (1992)
4.2.1 Results
4.3 Flexible Work Schedules: Study by Kim and Campagna (1981)
4.3.1 Results
4.4 Communication during Times of Organizational Change: Study by Schweiger and DeNisi (1991)
4.4.1 Results
4.5 Discussion of Interventions

5. Excursus: What Policymakers Can Do

6. Summary and Recommendations for Future Research



Executive Summary

Business has become dramatically dynamic and competitive during the past decades. Globally, organizations turn up the pressures on workers and set aside health concerns to remain profitable, commonly resulting in significant employee stress. Surveys in business publications regularly report alarming statistics about the health consequences of work-related stress, which is causally related to a vast and varied range of negative impacts on employees, organizations and society. Numerous studies show that job stress has escalated progressively over the past decades. Therefore, stress prevention at the organizational level is necessary in our fast moving business world, since it addresses the problem of work-related stress at source rather than curing its symptoms.

I introduce the Management Standards approach by the British Health and Safety Executive (HSE), as it recommends a practical three-phase approach to stress prevention, consisting of risk assessments, appropriate interventions and subsequent evaluations. The six Management Standards (MS) offer guidelines for organizations in the domains Demands, Control, Support, Relationships, Role and Change to comply with their legal duties under the law, namely to ensure the health of workers. The suggestions on what can be done to tackle organizational stress are generally instructive and intended specifically for employers of today`s globalized organizations.

By analyzing case studies in the MS` domains Demands, Control and Change that describe socio-technical and psychosocial interventions in workplaces, I find evidence in support of the hypothesis that reducing the workload of employees, introducing flexible work schedules and engaging in intense communication during times of change are effective in reducing work-related stress in employees. Besides other beneficial effects, these interventions have the potential to increase job satisfaction, reduce adrenalin levels and increase performance efficiency of workers.

I suggest that introducing regular risk assessments, rewarding good practice, providing specific assistance for small and medium sized enterprises and increasing the level of research activity in the area of occupational stress are strategies by which policymakers can encourage organizations to implement stress interventions.

List of Abbreviations

illustration not visible in this excerpt

Index of Figures

Figure 1: The Indicator Tool .

Figure 2: The HSE Process of a Risk Assessment for Stress

Index of Tables

Table 1: Demands Summary Table .

Table 2: Control and Change Summary Table

Index of Appendices

Appendix I: Occupations with High Stress Levels on a Stress Rating Scale of 0 to 10

Appendix II: Potential Stress Factors

Appendix III: Stress and the Perception of Health

Appendix IV: The Development Process of the Management Standards

1. Introduction

In today´s times of globalization, the world grows together more closely. Economic transactions, political negotiations and cultural traditions are no longer narrowed to definite habitats, but embrace the whole globe.[1] Doing business crosses territorially defined borders with the consequence that global competition has hugely intensified, especially during the past decades. The cutback of trade barriers like tariffs, the decline of market entry barriers and the demonopolization of markets like telecommunications have contributed to this intensified competition. On a global level, nations and organizations compete against each other.[2]

The demands of an increasingly global market have led to a change in the shape and structure of many organizations. Since the 1980´s, many European organizations have been involved in domestic and cross border mergers, acquisitions, strategic alliances and major organizational restructuring as a result of privatization or in response to increased market competition. Traditional organizational structures have become flatter and leaner, which has the effect of increased demands and workload on the individuals.[3]

“The business of business is not only business.”[4]

1.1 Adressing the Problem

In today´s competitive business environment, employees are used to their full capacity by the organizations in order to increase productivity growth.[5] Employees, who are referred to as internal stakeholders[6], seem to be just a factor of production to the firms, which make use of this ressource to the maximum extent, as at most firms market efficiency strongly determines the role of corporate behavior.[7] The stress of global competition and the need for efficiency are passed over to the employees of today´s organizations that treat workers like items, which they can make use of either way they want. Moreover, they feel authorized to behave in that manner, since they pay a salary. Maximum job performance and ever more working hours are required. The work environment and high demands, which are put upon the employees, result in significant work-related stress levels and reduced welfare in the workforce.[8]

As the International Labour Organization, ILO (2005), states, occupational stress is becoming increasingly globalized and affects all countries, all professions and also all categories of workers: blue and white-collar workers, families and society in general. Most frequently, stress at work is considered in the context of the industrialized countries, however, workers in developing countries are also affected. Evidence also indicates that a broad range of occupations is susceptible to organizational stress.[9]

As Crane and Matten (2004) note:

“(...) the increasing threat of unemployment for some has been matched with almost exactly the opposite problems for others, namely the increasing incursion of working hours into social life. (...) there has been a growing pressure for longer hours in (and travelling to) the workplace. This is most notable amongst professionals, such as doctors or accountants, but it has been evident in other jobs too.”[10]

Several studies confirm the detrimental effects of stress on our health. The American Institute of Stress (AIS), for example, found out that “(...) up to 90% of all health problems are related to stress.”[11] A survey by the U.S. National Institute of Occupational Safety and Health (NIOSH) reveals that stress-related conditions are one of the most important health issues of the 1990s and that psychological disorders are one of the ten leading occupational health problems.[12] According to Cooper et al. (1996), “stress can make people ill, impairs their day-to-day functioning and relationships with others and reduces their effectiveness in the workplace.”[13] According to Palmer (1989), stress-related illnesses account for at least half of all premature deaths in the United Kingdom (UK).[14] Moreover, various specialists suggest that the official professional illnesses registered each year make up only the tip of the iceberg.[15]

Taken together, these facts indicate that work can make people ill. However, work should be a means for maintaining and promoting health. Therefore, it is urgently necessary to reduce stress in employees` working lives and to deal with this modern epidemic [16], especially since stress is suspected to have increased even further during the past ten years.

In this paper, the ethical question of whether stress control is the responsibility or even the domain of employers is answered with a clear “yes”. Organizations should make commitments to facilitate the employees´ mental and physical well-being.[17] It is necessary to take action in order to minimize health risks of employees wherever possible. In short, we have to deal with the “alienation” of the individual worker in the era of globalization and industrialized mass production in that, from an ethical perspective, workers should not be treated as a means only.[18]

1.2 Research Objective

The objective of this paper is to examine stress in the work environment, to provide recommendations as to how this problem could be coped with and to evaluate the effectiveness of organizational level stress interventions.

I recommend, as a result of my exploration of the need to reduce work-related stress, six Management Standards (MS) and their corresponding three-step approach aimed at preventing stress in organizations manifested at different firm levels. The MS represent - to my knowledge - the actual state of research in the field of preventing work-related stress.

By analyzing case studies that applied socio-technical and psychosocial interventions in workplaces to tackle the problem of work-related stress, I hypothesize that reducing the workload of employees, introducing flexible work schedules and realizing intense communication during times of change have the potential to reduce stress in employees. As outcome measures I have chosen job satisfaction, adrenalin levels, sickness absence/sick leave and performance efficiency. I will examine as to how these outcome measures are influenced by interventions and whether the organizational level interventions discussed in this paper are effective in reducing stress.

The advice that will be given is intended for organizations and in particular for their owners and leaders. The given suggestions are not intended to apply to a particular firm, but are generally instructive. Although it is not possible to give a universal prescription for preventing stress at work, it is possible for this paper to offer guidelines and recommendations based on research pertaining to the process of stress prevention in organizations.

This paper does not aim at assessing ratios of costs and benefits of the proposed interventions[19], as organizational health extends beyond a simple analysis of the profit and loss account. Rather, it is also an ethical issue.

In short, the aims of this paper are to:

- clarify and examine the phenomenon of work-related stress,
- introduce the MS and their three-step approach to effectively managing organizational stress,
- analyze case study material in order to find evidence in support of the hypothesis that organizational interventions are effective in preventing organizational stress from occurring,
- suggest ways in which policymakers can encourage stress prevention activities
- propose a number of resources alongside my analysis for those wishing to deepen their knowledge of the subject and provide recommendations for future research in the area of occupational stress.

1.3 Research Method and Proceeding

The basis of this paper is formed of an analysis of secondary literature on the topic of organizational stress and of case studies that were conducted in different workplace settings. Some of the analyzed articles, the data on costs of stress and the resources concerning the MS were retrieved from the internet. Thus, an analysis of documents, articles and reports is applied, in which the internet inquiry plays an important role.

To clarify the issue of work-related stress and to fulfill the objective of this investigation, namely to provide and examine suggestions on what can be done to approach organizational stress, the paper is divided into the following chapters:

The chapter New Risks: Stress Caused by Organizational Factors intends to clarify the problem of job stress by taking a look at definitions of stress in general and in the workplace in specific. The impact of stress on individuals, organizations and society is analyzed. It is pointed out which dimension work-related stress has reached so far. Subsequently, the levels on which stress control can be applied are introduced. The section Responsibilities of Organizations and Ethical Reasoning concludes this chapter.

The chapter Stress Prevention: An Organizational Approach is designed to introduce the three-phase stress prevention program by the Health and Safety Executive (HSE)[20] of the UK. This program is made up of a risk assessment by means of the Indicator Tool, stress prevention by applying appropriate interventions on basis of the Management Standards and following evaluations of the applied interventions . Each of the six MS, which represent standards of good management practice for a range of stressors, is elaborated in detail.[21]

In the chapter Stress Prevention in Practice: Evidence of Case Studies discussion then concentrates upon some pivotal case studies in the MS` domains Demands, Control and Change. Interventions in these three areas are examined. A Discussion of Interventions concludes this chapter.

The chapter Excursus: What Policymakers Can Do addresses the question of how policymakers can encourage organizations to instigate and maintain stress intervention stra-tegies.

In the final chapter Summary and Recommendations for Future Research the key findings of this paper are summarized. Moreover, recommendations on what should be considered for future research are given.

2. New Risks: Stress Caused by Organizational Factors

In the world of work, the technological evolution and the transformations accompanying it, have had many positive effects on work conditions, such as automation, flexibi-lity and access to IT. However, these transformations also have negative side-effects on the content of the tasks carried out as well as on the social relations within companies.[22] Both factors can influence the physical and mental health of employees; a problem that is defined by the generic term new risks. As Domenighetti et al. (2004) note:

“The damage to health, which is a result of these [new risks], eludes statistics to a large extent, as it does not appear as professional sickness in the classic sense, while the costs caused by the new risks in general and by stress in particular are externalized towards health and disability insurances or social security.”[23]

Further, the authors state that the new risks emanate from the present model of economic development, which is based on globalization. They note that the optimization of income from invested capital and on taking work flexibility to the limit has deeply transformed the conditions in which work used to be carried out and that it is the employees who are affected by the changed and aggravated conditions in that they suffer from being stressed.[24]

2.1 Definition of Stress

There are many biological, engineering and physiological definitions of stress. Originally, the term stress has a technical meaning, stemming from the field of material testing. It describes the shaping and deformation of an object being under pressure.[25] The Hungarian-Canadian health professional Hans Selye brought the term stress into our habitual language use in 1936.[26] He is regarded as the pioneer of stress research and was the first to use the term in medical science.[27] According to Selye, stress is defined as “the nonspecific response of the body to any demand placed upon it.”[28] In medical terms, stress is defined as “a physical or psychological stimulus that can produce mental tension or physiological reactions that may lead to illness.”[29]

Stress is an ambivalent phenomenon, referred to as eustress or distress. Being under pressure often improves performance. In this case, one talks about eustress (positive stress), which is essential to life and peoples´ health. Positive stress acts as a stimulant. Corresponding tasks are perceived as challenges, activating both physical and mental ability.[30] If one gets carried away with something or is excited about a positive event in life, he or she feels contented and time flies.[31] The happiness researcher Mihaly Csikszentmihalyi calls this optimal psychological state a flow.[32]

Pressure to perform and external activation of eustress act on an individual. If performance enhancement is not possible anymore and demands and pressures become excessive, they lead to distress (negative stress), roughly meaning overload and causing physical illness and psychological disorders.[33] It often results in inadequate adaption to situations and people and failure to perform at an optimal level. If the term stress is used alone, typically it is referring to distress. Since the last decades, it is this term used to describe complex reaction combinations as a consequence of the pressures to perform and the time pressures in modern industrial societies.[34]

2.2 Work-related Stress

For most people, work is a significant feature of life. It can provide individuals with purpose, satisfaction, structure, self-esteem and spending power. However, the workplace can also be a setting of stress and worry.[35] Everybody is at least sometimes under some pressure in the workplace. As described above, under a limited amount of added pressure some people actually thrive. However, excessive and reoccuring stress can produce a range of physical and emotional health problems, which have come to get grouped as work-related stress.[36]

Work-related stress is defined as:

“(...) the emotional, cognitive, behavioral and physiological reaction to aversive and noxious aspects of work content, work environments and work organizations. It is a state characterized by high levels of arousal and distress and often by feelings of not coping.”[37]

There is no single cause of work-related stress. It can be provoked by unexpected and sudden pressures, but most often it is the result of a combination of stressful factors that accrue over time.[38] Aspects of work content, work environment and work organization, as mentioned in the citation, can be subsumed under organizational factors . These organizational factors contain a huge spectrum of potential stressors[39], which encourage the onset of stress responses.[40]

2.2.1 Impact of Work-related Stress

Not only executives, even housewives, students, sportsmen, workers and actually pensioners are stressed. Cooper et al. (1996) state that occupational stress is ultimately a wider societal problem shared by all members of the EU.[41] The effects of stress are manifold, they can be psychological, behavioral or physiological. They are an important public health concern, being expensive for everyone: the suffering workers, their families, providers of health care, insurance companies, those paying legal fees and employers.[42]

When dealing with the impact of occupational stress one can distinguish between the impact on affected individuals, organizations and society. In the following, the consequences and costs of stress for these three parties will be presented to document the extent of the adversity and to highlight the necessity to alleviate work-related stress. Impact of Stress on Individuals

Many employees and employers are unaware of the health hazards that stress can impose on a persons physical and emotional state of well-being. As surveyd by the State Secretariat for Economic Affairs (SECO) in Switzerland, 46,6% of employees who are often or very often stressed suffer from bad health.[43] The symptoms of bad health and human reactions to stress can be grouped into the following categories:

- Psychological symptoms: fear, frustration, depression, anger, intensive emotions, losing appetite, short temperedness at work and at home, etc.
- Behavioral symptoms: huffiness, working hastily, lack of rests, inability to plan, concentrate and control work, etc.
- Physiological symptoms: high blood pressure and puls, high levels of adrenalin and breathing rate, headaches, tiredness, difficulty sleeping, inceased susceptibility to colds and other infections, heart attacks, strokes, organ malfunctions, etc.[44]

It is clear from the recognized symptoms that stress leads to ill-health and a lower quality of life. In addition to the dramatic impact of serious health damages referred to above, stress can lead to a loss of capacity to cope with working and social situations. This in turn can lead to less success at work, including loss of career options and even unemployment. Moreover, it can give rise to higher strain in familiy relationships, with friends and co-workers. As the ILO (2005) states, “it may even ultimately result in depression, death or suicide.”[45]

Moreover, as many examples of stressed out managers show, permanent stress will result in a burn-out syndrome.[46] Managers suffering from a burnout are literally burned out, have no more energy left and perceive their work as senseless. Similarly, another typical stress phenomenon is a blackout, which may occur during an examination.[47] A further indicator of being stressed is violence and dependency on alcohol, tablets, cigarettes etc.[48] Also, stressed individuals suffer from an intensified biological aging process and irreparable damages of their DNA.[49] As the ILO (2005) notes, all described disorders taken together “are responsible for the great majority of diseases, deaths, disabilities and medical care uses in most industrialized countries.”[50] Impact of Stress on Organizations

For organizations the costs of stress take on numerous forms. As the ILO (2005) states, many studies have related organizational stress to high absenteeism, poor employment relations, low quality of work, low productivity and efficiency, staff with low morale, high accident and illness rates, high numbers of customer complaints, higher medical costs and staff turnover, with the associated costs of recruiting and training new workers.[51] Aditionally, employers may leave themselves open to compensation claims from workers who have suffered diseases from work-related stress.[52]

Therefore, good health of employees is an economic factor for organizations. However, stress reduction should not just be instrumentally oriented in order to save costs and improve profitability. Instead, organizations should endeavor to make work an enjoyable feature of their employees´ lives, since employees possess the same moral claim on an organization as shareholders do. Impact of Stress on Society

Since work-related stress affects individuals and organizations, it also brings along consequences for society as a whole. The macroeconomic costs caused by stress are not a matter of small amounts, but of billions. They are made up of the entirely demanded medical benefits, self-medication as well as the costs provoked by times absent and loss of production.[53] In the following, some country-specific numbers are presented.

In the United States, up to 70% of all visits to primary care physicians are a consequence of stress-related symptoms. According to Stöppler (2005), research has shown that individuals who are stressed utilize health care services more often than their less-stressed-out counterparts.[54]

Workplace stress costs the nation more than $300 billion each year in health care, missed work and stress reduction efforts.[55] According to Rapaport (2006), every year since 2000, health care premiums rose at least twice as fast overall as inflation and worker earnings.[56]

In Switzerland, the costs of stress for the working population were estimated at 4.2 billion Swiss Francs in 2000, which was equal to 1.2% of the Gross Domestic Product (GDP). These costs, assessed by the State Secretariat for Economic Affairs (SECO), were composed of 1.4 billion medical costs, 348 million for self-medication and 2.4 billion in conjunction with absence from work and production downtimes.[57] Not contained in this sum were the costs of invalidity and death as well as the nonmonetary costs of human suffering. Therefore, the total economic costs could have been decidedly higher.

In Germany, 491 million days of disability were detected in 2002, with associated economic costs of 35.55 billion Euro.[58]

In the United Kingdom, job stress accounts for over a third of all new incidences of ill- health. According to the HSE (2006), each case of stress-related ill-health leads to an average of 30.9 working days lost. In 2004/05, a total of 12.8 million workings days was lost to stress, depression and anxiety.[59]

In the light of all this evidence there is no doubt that the conditions on which work is carried out represent a central theme of public health, which, according to Domenigehtti et al. (2004), “(...) is hardly recognized neither at a social nor political level.”[60] How-ever, in response to these data, it should be widespread agreed upon that action is necessary.

2.2.2 Levels to Approach Work-related Stress

Having examined the impact of work-related stress, the question arises of how it can be decreased or entirely avoided. Experts and institutions in the field of stress management and prevention are convinced that stress control can only be truly successful if it is tackled at three different levels, namely the primary, secondary and tertiary level. These levels comprise both organizations and individuals.[61]

At the primary level, stress at work is to be prevented by identifying and addressing stressors at the level of the organization. The focus of organizational interventions is in adapting the environment to “fit” the individual.[62] The approach is to create a healthy place of work and control stressors so that to the extent possible, the work is interesting, rewarding and within the individuals` capabilities. As will become obvious, especially important when dealing with organizational stress factors is the work context (how the workplace is organized) and the work content (what the job involves).[63] Typical triggers of work-related stress which have to be overcome include: excessive time pressures, excessive or inflexible working hours, too much or too little work or responsibility, lack of control over work, inadequate training, lack of support and lack of contact with colleagues, difficult relationships at work, confusion about duties and responsibilities, job change, restructuring, uncertainty over job prospects, etc.[64] If extreme levels of these factors are present, the work may need to be re-organized. Where this occurs, it involves balancing operational issues, achievability and costs against ethical motivations.

At the secondary respectively individual level, prevention is essentially concerned with the management of stress by increasing awareness and improving the stress management skills of employees through education and training.[65]

Stress management involves helping employees to deal with job stressors more effectively, for example, by enhancing coping skills (e.g. time management) and by alleviating symptoms of job stress (e.g. relaxation training, exercise).[66]

At the tertiary level, stress management is concerned with the treatment, rehabilitation and recovery process of stressed employees who are suffering from serious ill-health. Those individuals are provided with assistance to help them cure the symptoms of stress.[67]

While examples of all three types of interventions exist within Europe, clearly the most popular form of stress intervention is directed at changing the individuals and improving their stress management skills and lifestyles.[68] On the other hand, organizational level interventions are comparatively rare.[69] As Cooper et al. (1996) assume, a reason for the lack of organizational interventions is that “(...) it is considered easier and less disruptive to business to change the individual than to embark on any extensive (...) organizational development programme.” Furthermore, the authors assume that secondary and tertiary level interventions “(...) present a high profile means by which organizations can «be seen to be doing something about stress» (...).”[70]

According to Parkes and Sparkes (1998), individually-oriented interventions can sometimes be beneficial, however, “they do not meet the more general point that employees should not be required to adapt to work environments that impose unnecessary, excessive or inappropriate demands.”[71] Rather, the authors postulate that the work environment itself should be the initial focus of concern. Handy (1988) considers the use of individual level interventions to be “conceptually naive”[72] and Ganster et al. (1982) consider them to be “ethically questionable”[73] as a response to chronic work stress.


[1] See Ohmae (1990), p. 8, according to Münch (1998), p. 12.

[2] See Scherer (2003), pp. 109-111.

[3] See Cooper et al. (1996), p. 7.

[4] Kofi Annan, UN Secretary General (2001).

[5] See Liikanen (2004), pp. 8-9.

[6] The term stakeholder was first introduced by Edward Freeman in his 1984 book Strategic Management: A Stakeholder Approach. Freeman´s definition of the term is as follows: “A stakeholder in an organization is any group or individual who can affect or is affected by the achievement of the activities of an organization”, p. 46. Specifically, internal stakeholders are those who are “members” of the business organization, for example owners, managers and employees. External stakeholders are not part of the firm.

[7] See OECD (2004), p. 14.

[8] See ILO (2005).

[9] See ILO (2005). Refer to Appendix I for a table that lists Occupations with High Stress Levels on a Stress Rating Scale from 0 to 10.

[10] Crane/Matten (2004), p. 260.

[11] AIS (2003), according to HeartMath LLC (2004).

[12] See NIOSH (2006), pp. 1-5.

[13] Cooper et al. (1996), p. 2.

[14] See Palmer (1989), p. 16, according to Cooper et al. (1996), p. 2.

[15] See Domenighetti et al. (2004), p. 2.

[16] See Theorell (2004), p. 218.

[17] Well-being is defined as a “(…) multidimensional construct reflecting a general state of acceptance and satisfaction in various facets of one`s life.” Subjective well-being is directly influenced by positive and negative stressors, problem and emotion-focused coping and emotional and instrumental social support. See Scheck et al. (1997), p. 97.

[18] See Crane/Matten (2004), p. 227 and p. 258.

[19] If you are interested in the topic of cost-benefit analyses of stress interventions, you should refer to the book Stress Prevention in the Workplace: Assessing the Costs and Benefits to Organizations by Cooper et al. (1996). As well, the study Ökonimischer Nutzen Betrieblicher Gesundheitsförderung by Helmenstein et al. (2004) is worth reading. Further meta studies of cost-benefit analyses of health management are the ones by Aldana (2001), Heaney/Goetzel (1997), Pelletier (2001) and Chapman (2005).

[20] The HSE is the body responsible for Occupational Safety and Health in the UK.

[21] See Briner et al. (2003), p. 3 and Mackay et al. (2004), p. 92.

[22] See Marmot et al. (1997), p. 236 and Davey Smith/Harding (1997), p. 1369, according to Domenighetti et al. (2004), p. 2.

[23] Domenighetti et al. (2004), p. 2.

[24] See Domenighetti et al. (2004), p. 2.

[25] See Wikipedia (2006).

[26] See Selye (1936).

[27] See Brockhaus (1996), p. 258.

[28] Selye (1956), p. 63.

[29] American Heritage Stedman`s Medical Dictionary (2002).

[30] See Brockhaus (1996), p. 258.

[31] See Jackson/Marsh (1996), p. 17.

[32] See Csikszentmihalyi (1975, 1990, 1993).

[33] Note that what causes distress for one person may cause eustress for another, depending upon each individual`s perception of life.

[34] See Brockhaus (1996), p. 258.

[35] See Hyndburn and Ribble Valley Primary Care Trust (2006), p. 7.

[36] See Cooper et al. (1996), pp. 5-6.

[37] European Commission (2002), p. 7.

[38] See BUPA´s Health Information Team (2004).

[39] A stressor is a physical or physiological stimulus that encourages the onset of stress responses. Stressors that are antecedent prerequisites to experiencing strain, are classified as irrelevant events, benign-positive events or stressful events. See Lazarus (1966), according to Scheck et al. (1997), pp. 100-101. Individuals are affected by diverse stressors stemming from many different situations in the various environments that people are part of each day. The following factors contain stressors: organizational, individual, social, performance, physical and corporal factors. One could additionally consider environmental and political stressors. See Portunê et al. (2003), p. 5, according to Hamann (2004), pp. 4-7. For a detailed description of Potential Stress Factors refer to Appendix II.

[40] It stands to reason that it depends on each unique person how susceptible he or she is to certain stress factors. Some groups of people are more susceptible to symptoms of stress. For example, those who are not able to cope, lack social support, work in disadvantaged socio-economical conditions or are disabled. Also, especially younger employees fall prey to stress in comparison to older employees, aged between 45 and 65. See SECO (2000), pp. 5-6. If you are interested in Sex Differences in Work Stress, refer to the paper by Jick and Mitz (1985).

[41] See Cooper et al. (1996), p. VIII.

[42] See Hotopf/Wessely (1997), p. 1.

[43] Refer to the figure Stress and the Perception of Health in Appendix III.

[44] See Portunê et al. (2003), p. 5, according to Hamann (2004), p. 7 and Psychology Online (2006).

[45] ILO (2005).

[46] The burnout syndrome is defined as “(…) a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.” Maslach/Jackson (1984), p. 134.

[47] See Infoquelle (2002).

[48] See ILO (2005). For information on the links between work-related stress, violence at work, drug and alcohol abuse and tobacco consumption consult the review of literature Bibliography on the Links between Stress, Violence, Drug Abuse, Alcohol and Tobacco in the Workplace by Daniele Armand Ugon (2000).

[49] See (2004).

[50] See ILO (2005).

[51] See ILO (2005).

[52] See HSE (2001), p. 1.

[53] See SECO (2000), p. 1.

[54] See Stöppler (2005).

[55] See (2004), according to AIS (2003).

[56] See Rapaport (2006).

[57] See SECO (2000), p. 3.

[58] See WIdO (2004).

[59] See HSE (2006).

[60] Domenighetti et al. (2004), p. 3.

[61] See ILO (2000a).

[62] See Cooper et al. (1996), p. 85.

[63] See Mackay et al. (2004), p. 95.

[64] See BUPA`s Health Information Team (2004).

[65] See Cooper et al. (1996), p. 87. Many benefit packages offer an Employee Assistance Program (EAP) to improve the ability of workers to cope with difficult work situations. An EAP can provide various services, such as stress management training, professional counselling, financial advice or legal assistance.

[66] See Parkes/Sparkes (2004), p. 1. Individual stress management training has been the subject of many literature reviews. See, for example, Ivancevich et al. (1990), Groth-Marnat and Schumaker (1995) and Van der Hek and Plomp (1997).

[67] See Cooper et al. (1996), p. 88. Also, nowadays, many organizations have introduced sabbatical schemes. They allow people in highly demanding jobs to take a period of time off in order to enable them to restore balance. See Crane/Matten (2004), p. 260.

[68] See Cooper et al. (1996), p. 8.

[69] See Cooper et al. (1996), p. 89.

[70] Cooper et al. (1996), p. 90.

[71] Parkes/Sparkes (1998), p. 1.

[72] Handy (1988), according to Parkes/Sparkes, p. 1.

[73] Ganster et al. (1982), according to Parkes/Sparkes, p. 1.

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Work-related stress and organizational level interventions - addressing the problem at source
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