Workplace Challenges - A Collective Challenges

ACOLLECTIVECHALLENGE
WORLD DAY FOR SAFETY AND HEALTH AT WORK
28 APRIL 2016
WORKPLACE
STRESS

WORKPLACE STRESS:
A collective challenge
WORLD DAY FOR SAFETY AND HEALTH AT WORK
28 APRIL 2016

Copyright © International Labour Organization 2016
First published 2016
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Workplace stress: A collective challenge
ISBN: 978-92-2-130641-2 (print)
978-92-2-130642-9 (web pdf)
Also available in French: Stress au travail: un défi collectif, 978-92-2-230641-1 (print), 978-92-2-230642-8 (web pdf),
Geneva, 2016; and in Spanish: Estrés en el trabajo: un reto colectivo, 978-92-2-330641-0 (print), 978-92-2-330642-7
(web pdf), Geneva, 2016.
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1
TABLE OF CONTENTS
INTRODUCTION ........................................................................................................................................................... 2
1. WHAT IS WORK-RELATED STRESS? ..................................................................................................................... 2
THE CAUSES 2
THE PROTECTION OF MENTAL HEALTH AT WORK 4
2. WHAT IS THE IMPACT OF STRESS IN THE WORKING POPULATION? ................................................................. 5
THE MAGNITUDE OF THE PROBLEM 5
IMPACT ON WORKERS HEALTH, SAFETY AND WELLBEING 6
PREVALENCE 7
THE GENDER DIMENSION 9
IMPACT ON PRODUCTIVITY AND ECONOMIC COSTS OF WORK-RELATED STRESS
AND ASSOCIATED MENTAL HEALTH DISORDERS 9
3. WHAT IS THE EXISTING LEGAL FRAMEWORK ON WORK-RELATED STRESS
AND MENTAL HEALTH AT WORK? ....................................................................................................................... 11
INTERNATIONAL LABOUR STANDARDS 11
REGIONAL STANDARDS 11
NATIONAL LEGISLATION 12
INCLUSION OF WORK-RELATED STRESS AND MENTAL DISORDERS IN NATIONAL LISTS OF OCCUPATIONAL DISEASES 14
NON-BINDING TECHNICAL STANDARDS ON PSYCHOSOCIAL RISKS PREVENTION AND MANAGEMENT 14
SOCIAL PARTNERS’ AGREEMENTS 15
LABOUR INSPECTION 15
4. STRATEGIES FOR THE PREVENTION AND MANAGEMENT OF PSYCHOSOCIAL HAZARDS AND RISKS .......... 17
INTERNATIONAL ORGANIZATIONS 17
REGIONAL ORGANIZATIONS AND INSTITUTIONS 18
NATIONAL STRATEGIES AND INITIATIVES 19
SOCIAL PARTNERS’ ENGAGEMENT 23
PROFESSIONAL ASSOCIATIONS’ AND NETWORKS’ CONTRIBUTION 25
5. GLOBAL TRENDS AND FORESIGHT OF FUTURE SCENARIOS ............................................................................ 26
EXPERT OPINION SURVEY 26
FORESIGHT OF FUTURE SCENARIOS 28
FINDINGS AND GLOBAL TRENDS 29
6. WHY IS IT NECESSARY TO HAVE A COLLECTIVE APPROACH TO PREVENTING
AND CONTROLLING THE CAUSES OF WORK-RELATED STRESS? ..................................................................... 30
CONCLUDING REMARKS ............................................................................................................................................32
REFERENCES ..............................................................................................................................................................33
ANNEX 1. ASSESSMENT AND INTERVENTION TOOLS ............................................................................................. 36
ANNEX 2. GLOBAL TRENDS AND FORESIGHT OF FUTURE SCENARIOS ................................................................. 42
BIBLIOGRAPHY .......................................................................................................................................................... 49

WORKPLACE STRESS: A COLLECTIVE CHALLENGE2
INTRODUCTION
This report aims at presenting trends on work-related stress in
both developed and developing countries with a view to raising
awareness of the magnitude of the problem in the new context of
the world of work. To this end it provides an interregional overview
of the prevalence and impact of work-related stress, and examines
legislation, policies and interventions for its management at
international, regional, national and workplace levels. Through a
Delphi survey it further identifies and assesses future scenarios and
contributing factors in this field. The results of this study will also
be used in supporting ILO constituents to take action in this field at
national and enterprise levels.
Focusing on the study of stress in the world of work has
increased since the 1990s, particularly on the impact of work-
related stress on workers’ health and its management. There has
been growing attention on the effects of psychosocial hazards
and risks and work-related stress among researchers and
policymakers. Occupational safety and health (OSH) practice has
expanded beyond its traditional scope to incorporate behavioural
medicine, occupational health psychology and social wellbeing,
thereby acknowledging people’s need to conduct a socially and
economically productive life.
Today workers all over the world are facing significant changes
in work organization and labour relations; they are under greater
pressure to meet the demands of modern working life. With the
pace of work dictated by instant communications and high levels
of global competition, the lines separating work from life are
becoming more and more difficult to identify.
Psychosocial hazards such as increased competition, higher
expectations as regards performance and longer working hours
are all contributing to an ever more stressful working environment.
In addition, owing to the current economic recession that is
augmenting the pace of organizational change and restructuring,
workers are increasingly experiencing precarious work, reduced
work opportunities, fear of losing their jobs, massive layoffs,
unemployment, and decreased financial stability, with serious
consequences for their mental health and wellbeing. Work-related
stress is now generally acknowledged as a global issue affecting
all professions and all workers in both developed and developing
countries. In this complex context, the workplace is at the same
time an important source of psychosocial risks and the ideal venue
for addressing them with a view to protecting the health and
wellbeing of workers through collective measures.
It is a universal principle that people have the right to the highest
attainable standards of health. Without health at work a person
cannot contribute to society and achieve wellbeing. If health at
work is threatened, there is no basis for productive employment
and socio-economic development. The burden of mental ill-
health is highly relevant to the world of work. It has an important
impact on people’s wellbeing, reducing employment prospects
and wages, with a deleterious effect on families’ income and
enterprises’ productivity, and causing high direct and indirect costs
to the economy.
1. WHAT IS
WORK-RELATED
STRESS?
The term “stress” is used in numerous ways today, describing
everything from feeling ill in the morning to anxiety leading to
depression. Among certain scientific groups, it has both negative
and positive connotations. Within the context of this report, stress
will only be considered as having a negative impact and will be
dealt with in the framework of the workplace. Stress is not a health
impairment, but is the first sign of a harmful physical and emotional
response.
The definition of stress and the terminology to refer to psychosocial
hazards and risks has changed over the years. The term “stress”
was first used by Hans Selye in 1936 to define stress in biological
terms as “a non-specific response of the body to any demand of
change”.1 His research led to the study of stress in brain functions.
He also defined “stressors” as events that trigger a physiological
and psychological response from the organism, in order to
distinguish stimulus from response.2 In this context a stressor can
be a biological agent, an environmental condition, an external
stimulus, or an event. Stress can define a negative condition or a
positive condition that responds to a stressor and that can have
an impact on a person’s mental or physical health and wellbeing.I
Today health is acknowledged as a combination of biological,
psychological (thoughts, emotions, and behaviour), and social
(socio-economical, socio-environmental, and cultural) factors.3
For the ILO stress is the harmful physical and emotional response
caused by an imbalance between the perceived demands and the
perceived resources and abilities of individuals to cope with those
demands. Work-related stress is determined by work organization,
work design and labour relations and occurs when the demands
of the job do not match or exceed the capabilities, resources,
or needs of the worker, or when the knowledge or abilities of
an individual worker or group to cope are not matched with the
expectations of the organizational culture of an enterprise.4
THE CAUSES
The workplace factors that can cause stress are called
psychosocial hazards. The ILO defined psychosocial factors
(hazards) in 1984, in terms of “interactions between and among
work environment, job content, organizational conditions
and workers’ capacities, needs, culture, personal extra-job
considerations that may, through perceptions and experience,
influence health, work performance and job satisfaction”. This
definition emphasised the dynamic interaction between the
work environment and human factors. A negative interaction
between occupational conditions and human factors may lead
to emotional disturbances, behavioural problems, biochemical
and neuro-hormonal changes, presenting added risks of mental
or physical illness. On the contrary, when working conditions and
human factors are in balance, work creates a feeling of mastery
and self-confidence; increases motivation, working capacity and
satisfaction; and improves health.5
I Levi (1971, 1976) was the first to distinguish between positive and negative
stress and to link it to the working environment. Selye defined “positive stress” as
eustress as opposed to distress. Eustress refers to a positive response one has
to a stressor, which can depend on one’s current feelings of control, desirability,
location, and timing of the stressor (Seyle,1974).

1. WHAT IS WORK-RELATED STRESS? 3
The term has evolved over the years, from stressors, stress factors
to psychosocial factors, psychosocial hazards or psychosocial
risks.II The terms “psychosocial hazards” and “psychosocial risks”
are sometimes used interchangeably in the scientific literature.III
A number of experts agree in defining psychosocial hazards
as those aspects of the design and management of work and
its social and organizational contexts which have the potential
for causing psychological or physical harm. Today there is a
reasonable consensus in the scientific community regarding the
nature of psychosocial hazards; however it should be noted that
new forms of work and the changing working environment give
rise to new hazards; and therefore the definition of psychosocial
hazards can still evolve.6 Cox identified ten types of stressful work
characteristics (psychosocial hazards), which are divided into two
groups: “content of work” and “context of work”.7 See Table 1.
CONTENT OF WORK
The first group, “content of work”, refers to psychosocial hazards
related to working conditions and work organization. The impact of
workload on workers’ health was one of the first aspects of work
to be studied. Both quantitative workload (the amount of work
to be done) and qualitative workload (the difficulty of work) have
been associated with stress. Workload has to be considered in
relation to workpace, meaning the speed at which work has to be
completed and the nature and control of the pacing requirements
(self-systems or machine-paced). Job content (or task design)
includes several aspects which are hazardous, such as low value
of work, low use of skills, lack of task variety and repetitiveness
in work, uncertainty, lack of opportunity to learn, high attention
demands, conflicting demands and insufficient resources.
Uncertainty may be expressed in different ways, including lack
of performance feedback, uncertainty about desirable behaviour
II Stress has also been wrongly defined as a psychosocial hazard instead of as one
of their consequences.
III As in the OSH discipline, a hazard is the intrinsic property or potential capacity
of an agent, process or situation (including the working environment, work
organization and working practices with adverse organizational outcomes) to
cause harm or adverse health effects at work. Risk is the combination of the
likelihood of a hazardous event and the severity of health damage to a worker
caused by this event. The relationship between hazard and risk is exposure
whether immediate or long term. In this context, it includes both physical and
psychological outcomes. For the purpose of this report, risk is the likelihood or
probability that a person will be harmed or experience adverse health effects if
exposed to a psychosocial hazard.
(role ambiguity), and uncertainty about the future (job insecurity).8
Much of the literature on work schedules focuses on shift and
night work and long working hours. These factors are associated
with upsetting biological circadian rhythms, reduced length
and poor quality of daytime sleep, and conflicting work-home
demands which contribute to increasing the level of stress and
fatigue. Finally, a number of studies have investigated the effects
of physical hazards on stress. Overall, evidence suggests that
poor physical working conditions and environment, including the
workplace layout and exposure to hazardous agents, can affect
both workers’ experience of stress and their psychological and
physical health.9
CONTEXT OF WORK
The second group, “context of work”, concerns psychosocial
hazards in the organization of work and labour relations, such
as organizational culture and function, role in the enterprise,
career development, decision latitude and control, home-work
interface, and interpersonal relationships at work. Aspects of
organizational culture and function are particularly significant: the
organization as a task performance environment, as a problem-
solving environment, and as a development environment. Available
evidence suggests that if the organization is perceived to be poor
in respect of these environments, then this is likely to be associated
with increased levels of stress.10 Several hazardous aspects of
organizational roles have been identified, including role ambiguity
and role conflict, role overload, role insufficiency and responsibility
for other people.11 Role insufficiency (when individual’s abilities
and training are not fully used) is also associated with low job
satisfaction and organizational commitment.12 Four sources
of hazardous situations have been identified relating to career
development, namely: mergers and acquisitions; retrenchment
and budget cutbacks; ambiguity and insecurity regarding one’s
job future; and occupational locking-in.13 Participation in decision-
making and control are important positive aspects of job design
and work organization.
According to the theoretical model developed by Karasek
and colleagues,IV participation in decision-making moderates
the stressor effects of job demands and leads to reduced
IV Robert Karasek designed the Job Demand-Control-Support Model (JDCS), a
management model of job strain. This model predicts that mental strain results
from the interaction of job demands and job decision latitude.
TABLE 1 · STRESSFUL CHARACTERISTICS OF WORK (PSYCHOSOCIAL HAZARDS)
CATEGORY CONDITIONS DEFINING HAZARD
CONTENT OF WORK
Work environment and work
equipment
Problems regarding the reliability, availability, suitability and maintenance or repair of both equipment and
facilities.
Task design Lack of variety or short work cycles, fragmented or meaningless work, underuse of skills, high uncertainty
Workload / workpace Work overload or underload, lack of control over pacing, high levels of time pressure.
Work schedule Shift working, inflexible work schedules, unpredictable hours, long or unsocial hours.
CONTEXT OF WORK
Organisational culture and function Poor communication, low levels of support for problem-solving and personal development, lack of
definition of organisational objectives.
Role in organisation Role ambiguity and role conflict, responsibility for people.
Career development Career stagnation and uncertainty, under-promotion or over-promotion, poor pay, job insecurity, low
social value of work.
Decision latitude / Control Low participation in decision-making, lack of control over work (control, particularly in the form of
participation, is also a contextual and wider organisational issue)
Interpersonal relationships at work Social or physical isolation, poor relationships with superiors, interpersonal conflict, lack of social support.
Home-work interface Conflicting demands of work and home, low support at home, dual career problems.
Source: Cox et al, 2000

WORKPLACE STRESS: A COLLECTIVE CHALLENGE4
psychological strain.14 Overall, research indicates that greater
opportunities for participating in decision-making are associated
with greater satisfaction and a higher feeling of self-esteem.15 In
the long term, even small amounts of autonomy in the execution
of tasks are beneficial for the mental health and productivity of
workers.16 The link between work and home is increasingly being
recognised as a potential source of stress, particularly for dual
career couples and those experiencing financial difficulties or life
crises.17 An appropriate balance between work and private life can
be difficult to achieve, in particular when workers are experiencing
fast-paced and intensive work, shift work, irregular working hours,
unsympathetic treatment by management and co-workers, and a
lack of control over the content and organization of work.18 Social
relationships both inside and outside the workplace are most
commonly viewed as playing a moderating role, while adverse
effects of exposure to other psychosocial hazards are more likely
or more pronounced when relationships provide little support.19
Another important issue is workplace violence, which can generate
elevated stress levels.V Episodes of violence can affect not only the
V The ILO defines workplace violence as “any action, incident or behaviour that departs
from reasonable conduct in which a person is assaulted, threatened, harmed or
injured in the course of, or as a direct result of his or her work.” Physical violence
refers to the use of physical force against another person or group that results in
physical, sexual or psychological harm. It includes beating, kicking, slapping, stabbing,
shooting, pushing, biting, and pinching among others. Psychological violence
(emotional abuse) is the intentional use of power, including the threat of physical
force, against another person or group that can result in harm to a person’s physical,
mental, spiritual, moral or social state or development. It includes verbal abuse,
bullying/mobbing, harassment, and threats. Bullying and mobbing are repeated and
offensive behaviours in the form of vindictive, cruel, or malicious attempts to humiliate
or undermine an individual or a group of workers (the difference is that bullying is done
by one person, whereas mobbing is done by a group of people ganging up on one
person). Much has been written concerning the different forms of violence at work, in
particular psychological harassment. This report does not intends to reflect the wealth
of research carried out on the subject over the years, but to make reference to those
aspects closely related to the purpose of this report.
victims but also the witnesses, particularly in jobs involving a great
deal of teamwork and customer orientation.20 Violence can also be
a consequence of psychosocial hazards and work-related stress.
For example, several organizational factors have been identified
as contributing to the occurrence of bullying, such as stressful
jobs, monotonous jobs, low level of control, role conflict ambiguity,
excessive workload, poor conflict management, and organizational
changes.21
Examples of collective workplace actions to manage stress are
presented in Table 2.
THE PROTECTION OF MENTAL
HEALTH AT WORK
Since the 1960s it has become evident that organizational and
managerial practices influence the mental health of workers and
that their impact varies between organizations.22 But only recently
concern for the wellbeing of workers, and not merely for their
capacity to be productive in organizations, has been bringing
about changes in management practices and occupational safety
and health.
Traditional approaches to occupational health, behavioural
medicine and organizational psychology have been challenged by
the new social and economic contexts influencing the search for
new perspectives of positive organizational behaviour in support of
the potential for meaningful work and wellbeing. The first studies
on health and wellbeing reoriented the approach away from how
pre-existent mental illnesses affected organizational efficiency
towards an understanding of the effects of work on mental health,
TABLE 2 · WORKPLACE COLLECTIVE MEASURES TO PREVENT WORK-RELATED STRESS
Control ensuring adequate staffing levels
allowing workers a say in how their work is to be carried out
Workload regularly assess time requirements and assign reasonable deadlines
ensure that working hours are predictable and reasonable
Social support allow for social contact between workers
maintain a workplace that is free of physical and psychological violence
ensure that there are supportive relationships between supervisors and workers
provide an infrastructure in which supervisory staff take responsibility for other workers and there is an appropriate level of contact
encourage workers to discuss any conflicting demands between work and home
reinforce motivation by emphasizing the positive and useful aspects of the work
Matching the job and
the worker
match jobs to the physical and psychological skills and abilities of the workers
assign tasks according to experience and competence
ensure proper utilization of skills
Training and education provide adequate training to ensure that worker skills and jobs are matched
provide information on psychosocial risks and work-related stress and how to prevent them
Transparency and
fairness
ensuring tasks are clearly defined;
assigning clear roles, avoiding role conflict and ambiguity;
providing job security to the extent possible;
providing adequate pay for work performed;
ensuring transparency and fairness in procedures for dealing with complaints
Physical working
environment
providing appropriate lighting, equipment, air quality, noise levels
avoiding exposure to hazardous agents
taking into account ergonomic aspects to limit workers’ stress.
Source: ILO (2012b)