Stress Is modern life really rubbish or are we just complaining too much? Dr. Craig A. Jackson Occupational Psychologis

1. Stress Is modern life really rubbish or are we just complaining too much? Dr. Craig A. Jackson Occupational Psychologist Research DirectorHealth Research Consultants ResearchConsultants.co.uk

2. Misperceptions of workplaces UK Climate of: over-perception of danger stress being unavoidable wanting too much in return Attention Deficit Trait

3. Common Popular Headlines

4. Workplace Hazards – current status Shiftworking: 1 in 5 employed likely to increase with growth Long hours: >48 hours per week Fallen due to EWTD Still > most of Europe Psychosocial: 5 mill employees perceive effects 13 mill working days lost Mundane occupations suffer Chronic stress more problematic Physical: Noise technical Dust changes Chemical monitoring Vibration OELs Fatigue Somatic symptoms Sleep MSDs Depression Cardiovascular Accidents Depression QoL

5. Dominance of the biopsychosocial model Mainstream in last 15 years Hazard Illness (well-being) Psychosocial Factors Attitudes Behaviour Quality of Life Rise of the worker as a “psychological entity”

6. The Biopsychosocial Model – works on all levels

7. “Everything is bad for us these days…”

8. Top 5 Occupational Health Problems 1. Hearing loss NIHL, TTS, Exposure 2. Respiratory problems Asbestosis, Carbon Black, Recycling 3. Skin problems Hairdressers, Health care, Engineering 4. Mental health Stress, Anxiety, Uncertainty 5. Musculoskeletal disorders Desk workers, Cleaners, Drivers

9. “High Effort Low Reward” “High Demand Low Control” Potential Health Risks 3x Cardiovascular problems 2x Substance abuse 3x Back pain STRESS! 2-3x Injuries 5x Certain cancers 2-3x Conflicts 2-3x Infections 2-3x Mental health problems Shain & Kramer 2004

10. Futility of Some Stress Research “One evening we had an almost inaudible talk from…..the BBC staff doctor who told us how to recognise stress in our staff: the body sits slumped, with the head shrunk between the shoulders. At least I think that is what he said. He was difficult to hear as we were all sitting slumped with our heads shrunk between our shoulders” Frank Muir in A Kentish Lad

11. Responses to Stress • Physiological changes • Heart rate • Blood pressure • Biochemical • > adrenaline > cortisol > serotonin > free histamine Psychological changes Anxiety Depression Tension Tired Worry Apathy Apprehension Alienation Resentment Confidence Aggression Withdrawal Restlessness Indecision Sleeping problems Concentration

12. Legal Aspects “Personal Injury” Any impairment or any disease of a person’s physical or mental condition 1974 Health and Safety at Work Act “Assessments of risks of activities associated with potential hazards” 1992 Management of Health & Safety at Work Regulations Big stress cases 1. Johnstone vs Bloomsbury H.A Doctor 2. Walker vs Northumberland C.C. Social Worker 3. Jones vs Birmingham C.C Teacher 4. Hurley vs Gwent Constabulary Police officer 5. Fearon vs Martin Burglar 6. Armstrong vs Home Office Prison warder

13. What workers expect Financial Reasonable expectations? Achievable ? Affordable ? Advancement Status Respect Perks Education / Training Autonomy Flexibility Dissatisfied workforce? Aggrieved employees? Unmotivated staff ? Pensions Support Security

14. Commuting “Cattle Truck Syndrome” Chronic health problems exacerbated by train travel? Cumulative impact theory Increased B.P, Anxiety, Chronic Heart Conditions Over-crowded trains / buses Straining public transport system Lack of control “People develop a constant internal anger on crowded trains that they cannot easily displace…an individual's immune system could also be suppressed by stress, making passengers more susceptible to illnesses”

15. Long Working Hours “Workaholism” Japan, South Korea, Indonesia, UK (Karojisatsu) uninterrupted heavy workload • irregular sleep habits • decreases in rest • decrease social time • alcohol abuse • increased smoking • unhealthy diet • neglecting medical checks • breakdown in family life heavy physical work excessive demands from irregular overtime and shift work excessive workloads from emotional stress, such as responsibility, transfers, and conflicts

16. Office Work “Veal – Fattening Crate” * “Small, cramped office workstations built of fabric covered disassemblable wall partitions and inhabited by junior staff members. Named after the small pre-slaughter cubicles used by the cattle industry” Douglas Coupland in Life After God (being ironic) *Do farm animals get better conditions than some workers?

17. Stress “Golden Age of Stress” Everyone is Stressed BBCi - “Stress” = 16,000 finds More people experiencing more stress Greater demands from employers People working longer hours 24 / 7 / 365 society

18. 21st Century Satanic Mills

19. 21st Century Satanic Mills

20. Psychosocial factors at the core of ill-health Individual vulnerability Personality type Experience Learned behaviours Stress Distress Somatics Will workers take responsibilityfor their ill-health? Recall ADT?

21. Stress Definitions #1 A.Stress occurs when demands exist which are outside a person’s capacity for meeting those demands B.Stress is a response to the presence of psychosocial hazards in the workplace C.Stress is the reaction people have when they feel they cannot cope with the pressures or demands placed upon them Over-simplistic definitions !

22. required STRESS! actual required actual required BORED actual Stress Definitions #2 Stress is the disparity between what needs to be done (required) and what can be done (actual) Problems demands are not static abilities are not static how to quantify disparity meaningfulness of any quantification individual modification

23. So who has the bad jobs? EXTREMELY STRESSFUL Police Fire Ambulance Prison VERY STRESSFUL Civil pilots Media Performers Teaching Nursing Health care (non-emergency) Social work Mining Construction ABOVE AVERAGE STRESS Marketing Publishing Printing Retail Catering Transport HOW MUCH FAITH CAN BE PUT INTO BROAD CATEGORIES? Cooper 1988

24. Don’t Mention the “S”-Word ! ! ! Stress Looks like a flaming deamon Sounds like an eagle squaking Tastes like a burnt sausage Smells like sour milk Feels like stroking a hedgchog Stress is when mum says NO!!!!! by Andrew (aged 10) Year 5 Potley Hill Primary School The curse of the Corpus Linguistic Common Parlance “Stress-Bunny” “Stress-Junkie”

25. Stress is Nothing New World Wars I and II Where was stress? Dud shell manufacture

26. performance stress Some Stress is good Keeps one alert Keeps one alive Evolutionary perspective: Too little stress = extinction Too much stress = extinction Balance stress = evolution Pressure is good - - Stress is bad

27. Stress Statistics 1995: Labour Force Survey 515,000 reported work-related stress 250,000 attributions of physical symptoms 30% increase in reports since 1990 1996: Institute of Management 270,000 daily absences for stress £10.2 Billion cumulative annual cost (sick pay, lost production, treatment) 2002: UK Health and Safety Executive 265,000 new “cases” in 2001 2000: Evans et al.Scottish heart attack deaths higher on Mondays 2004: UK Health and Safety Executive 13,000,000 working days lost / year £12 Billion cost

28. Admissions and World Cup 1998 • Examine hospital admissions for rangeof diagnoses on days surrounding England's 1998 World Cup footballmatches • Hospital admissions obtained fromEnglish hospital episodestatistics • Pop. Aged 15 – 64 years • Admissions for • Acute MI On match day • Stroke and 5 days after • Deliberate self harm match day • Road traffic injuries • Compared with admissions at the same time in 1997 and 1998 Carroll, D et al. 2002

29. Admissions and World Cup 1998 England's matches in the 1998 World Cup 15 June (England 2, Tunisia 0) win 22 June (Romania 2, England 1) lost 26 June(Colombia 0, England 2) win 30 June (Argentina 2, England 2) lost: penalties 4-2 Extracted hospital admissions data for acute myocardial infarction, stroke, deliberateself harm, and road traffic injuries among men and womenaged 15 to 64 Games all took place in late evening Examined the same associations using only the two days afterthe match omitting the day of the match as the exposedcondition

30. Admissions and World Cup 1998 Results: During the period of England's World Cup matches (15 June to 1 July) 81,433 emergency admissions occurred: 1348  (2%) formyocardial infarction 662  (1%) for stroke 856  (1%) for roadtraffic injury 3308  (4%) for deliberate self harm observed / expected actual – expected ARR admissions admissions Day of match 91 / 72 19 1.25 (0.99 to 1.57) 1 day after 88 / 72 16 1.21 (0.96 to 1.57) 2 days after 91 / 71 20 1.27 (1.01 to 1.61) 3 days after 76 / 74 2 0.99 (0.77 to 1.27) 4 days after 71 / 74 3 0.92 (0.71 to 1.19) 5 days after 83 / 72 11 1.13 (0.89 to 1.43)

31. Admissions and World Cup 1998 • Admission Within 2 days Within 2 days Within 2 days of P value • diagnosis of win of 1-2 loss loss on penalty • M.I 0.99 0.91 1.25 0.007 • 0.89 - 1.11 0.78 - 1.07 1.08 - 1.44 • Stroke 0.87 0.97 1.00 0.42 • 0.74 - 1.03 0.79 - 1.19 0.82 - 1.23 • RTA 0.99 0.96 0.85 0.51 • 0.85 - 1.14 0.79 - 1.17 0.69 - 1.05 • DSH 1.08 1.01 1.05 0.26 • 1.00 - 1.16 0.91 - 1.12 0.95 - 1.16 • Periodsafter a win (Tunisia, Columbia) and 1st first loss (Romania) were not associated with increasedadmissions • On match day, and two days after match against Argentinawith a penalty shoot-out, admissions for acute MIincreased by 25%. • No increases in admission were seen for anyof the other diagnoses.

32. Admissions and World Cup 1998 Major environmental events, whether physical catastrophes or cultural disappointments,are capable of triggering myocardial infarction. If the triggeringhypothesis is true, preventive efforts should consider strategiesfor dealing with the effects of acute physical and psychosocialupheavals. “Perhaps the national lottery or even the penalty shoot-out should be abandoned on publichealthgrounds.” Limitations: Harvesting effect? Reporting tendency? Sudden deaths?

33. “Oh Give Over!” This has all gone too far The Anti-Stress Backlash “Meddling Psychologists”

34. Iatrogenesis • Induced inadvertently by the medical treatment or procedures or activity, examination, manner or discussion of a physician. • The term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, (e.g. acquired infections) • A disease produced as a • consequence of medical • or surgical treatment.

35. Being cynical . . .

36. Common Coping Styles Adaptive coping Seek those with similar experiences Confront issue Stick to a plan of action LONG Support seeking TERM Day to day basis SOLUTION Change situation Seek information Maladaptive coping Withdraw from people in general Avoidance SHORT Deny what has happened Consumption TERM SOLUTION Drink, eat, smoke to relieve tension Denial

37. Individual Variability / Vulnerability Differing Attitudes & Differing perceptions Natural differences Complex reasons Experience Personality Learned behaviours Stress is associated directly with workplaces BUT is also mediated by individual differences No universal profile of what will certainly constitute stressful situations

38. Vulnerable People Important to be aware of vulnerable individuals and groups Associated with socio-economic, cultural or demographic status Females Immigrant workers Disabled Any group by definition which is un-empowered Excluded groups Ethnic minorities Personality – although some of this is spurious! “Type A” (uptight, goal oriented)  likelihood of stress-illness and CHD (?) “Type C” (high anxiety)  likelihood of Cancer (?) “Type D”(negative affectivity, emotional inhibition)  likelihood of CHD (?) “External” locus of control  poorer at handling stress “Hardiness”  greater resistance and operability

39. Personality Is this a good sign or a bad sign? Personality Optimism vs Pessimism Negative Affectivity Hardiness Hi Claire. Are you around and do you fancy a brew? Hey. On way home. Left lecture early cos feel like crap. Next time!

40. William Beaumont 1832 Historical Errors of Distress-Related-Ill Health Historically, distress was “blamed” for many ills Now we know better… CHD Cholera Pellagra Beri Beri All believed to be Asthma caused by stress Down’s syndrome at one time or another Scurvy Yellow fever Typhoid Peptic ulcer Puts “blame” for illness on the person

41. Acute Stress and Chronic Stress Common After-effects Leave behind Life threatening One-off Ever-present By proxy

42. Psychosocial Hazards • Commonplace consideration in last 5 years • Not straightforward • All workplaces have potential to expose workers to psychosocial hazards • All social relationships have potential for stress • Little relation between stress incidents and occupational status • Stress-Boom in last 3 years – VERY BIG INDUSTRY • Intolerance of work in environments deemed psychologically stressful • “suffering from” & “recognising stress” • rapidly increasing issues

43. Acute Hazards Work characteristics 1. Potential for violence Accident & Emergency Services 2. Peril or Danger Expected Dangerous Conditions 3. Potential for aggression Hazardous conditions 1. Verbal abuse Ordinary Conditions 2. Physical abuse Unpredictable Behaviour / Incident 3. PTSD inducement

44. Chronic Hazards Job content Work overload / underload Hazardous conditions Under utilisation of skills Time pressures Lack of control Work organisation Shift work Working hours unsociable long unpredictable Work Culture Communication too little (home-working) / too much (email) Change / technology Poor resources No feedback No decision process

45. Chronic Hazards (cont) Work role Ambiguity Conflict Advancement structure Insecurity Promotion under and over Low status Poor pay Environment Hazards physical / chemical Home – work interface Conflicting demands Support Domestic problems Commuting Interpersonal Conflict Colleagues Superiors Subordinates Personal Issues Isolation Lack of support Harassment Bullying Violence

46. Chronic Hazards - People

47. Sick Building Syndrome – A once popular theory Air qualityNoise Chemical pollutants Equipment Air con Telephones Ventilation Others Dust Tobacco Lighting Artificial SpaceGlare Crowding Control Isolation Job content Equipmentvdu’s Printers Monotony PC’s Overload Organisation Control, communication, feedback Is STRESS the common link with SBS?

48. Karasek’s demand-control model of stress development Productive, Motivated low strain active job control low high passive high strain Risk of psychological strain and increased illness low high job demands Karasek 1979

49. job demands low high low strain active job control low high passive high strain Karasek 1979

50. Karasek’s revised demand-control-support model Productive, Motivated Social Support Peer Support Heroes & Villains low strain active job control low high passive high strain low high job demands Risk of psychological strain and increased illness Karasek 1979