case study of workplace stress

Workplace stress: an occupational health case study

This case study on workplace stress shows how the evidence base for occupational health underpinned a successful intervention. Anne Donaldson and Anne Harriss explain.

Stress, anxiety or depression underpin much work-related ill health, accounting for 9.9 million days of sickness absence in 2014-15, with, on average, 23 days lost per person. It resulted in 35% of all days missed from work due to ill health. Industries reporting the highest prevalence of ill health from work-related stress included health and social care, teaching, public administration and defence (HSE, 2015).

The Mental Health Foundation claims 12 million adults consult their GP each year due to mental illness, much of it stress related; one in six of the population experiences anxiety (MHF, 2014).

The main causes of work-related stress reported to GPs (THOR – GP) were workload pressures, interpersonal relationships, including bullying, harassment and difficulty with superiors, and work changes, including responsibilities and reduction of resources (HSE, 2014). A YouGov survey (2012) found 48% of the British workforce said they were stressed most of the time and 47% cited performance issues as key reasons.

Impact of workplace stress on individuals and work colleagues

Stress wanes when stressors are reduced. Conversely, anxiety can persist without a clear cause to the individual.

Anxiety and stress are closely linked with similar signs and symptoms; anxiety may be associated with depression as the most common mood disorder seen in primary care (Kumar and Clark, 2012). People with low psychosocial resources are more likely to succumb to mood disturbance when stress levels increase despite experiencing few stressors (DeLongis et al, 1988).

Colleagues often undertake the work responsibilities of absent staff. This may lead to spiralling absences among co-workers, who are stressed because of the additional responsibility (HSE, 2014). This case study presents the assessment of an employee, Norman, in order to ensure his fitness to return to his role without impacting on his health (Palmer et al, 2013).

The objectives of the consultation were two-fold:

• evaluating whether work had adversely affected Norman’s health and whether it may continue to do so; and
• providing impartial advice to management regarding his sickness absence, suggesting modifications for their consideration in order to support a successful return to work.

Norman’s referral by management was precipitated by a four-week absence related to stress and anxiety. There had been four further single-day absences in the preceding six months attributed to gastrointestinal upsets.

The consultation

Norman, a 22-year-old part-time receptionist and administrative assistant, had been employed in this role for 10 months working 30 hours per week. He had been absent from work for a month on the day of the consultation and was preparing to return to work. On entering the department, his mobility difficulties and an obviously awkward gait and altered balance were noted. He disclosed treatment by his GP for stress, anxiety and depression.

He described previous short-term absences resulting from nausea and vomiting, relating these to his anxiety at attending work. In the previous five to six weeks, in addition to nausea he also referred to difficulty sleeping, restlessness, loss of appetite, palpitations and rumination on his low self-esteem. Rumination can be a negative effect of stress. Genet and Siemer (2012) claim that rumination moderates the relation between unpleasant daily effects and negative mood.

Although excessive rumination is maladaptive, McFarland et al (2007) agree that some limited self-focus can be beneficial. Norman felt anxious about returning to the same situation and was accessing counselling support to help anxiety management. Hunsley et al (2014) suggest that psychological treatments are of at least equal benefit to medication for common mental disorders.

He had been prescribed 75mg of Venlafaxine a day with good effect. Venlafaxine is a serotonin and noradrenaline re-uptake inhibitor used to treat depression or generalised anxiety disorder. His GP also prescribed 5mg of diazepam – a long-acting benzodiazepine anxiolytic – to be taken as required. Recently he had not taken this as he felt better.

Past health and social history

Norman had cerebral palsy and experienced difficulty walking during his early years. Achilles tendon surgery in childhood improved this, although surgery left him with residual lower leg discomfort if he walked too far or stood for sustained periods without resting. The orthopaedic team monitored him every 18 months.

Norman described excellent family support. A non-smoker and non-drinker of alcohol, he took no formal exercise but walked as much as he felt able. Increasing physical activity within his ability was advised as it is found to improve mental health (Crone & Guy, 2008; McArdle et al, 2012).

Work issues

Norman generally enjoyed his role, shared with an able-bodied colleague with whom he alternated his reception duties. He indicated the interface with the public could be challenging and stressful. His workload had increased in the previous four months following the resignation of a colleague who indicated that he too found this role stressful. Financial constraints resulted in this position remaining unfilled, increasing Norman’s responsibilities. Stress is recognised as contributing to high staff turnover and low morale (Wolever et al, 2012).

Although working primarily at the reception desk, Norman frequently got up from his chair to deal with customers and to undertake photocopying duties. On one occasion he spent an afternoon mostly standing, which resulted in leg discomfort. No workplace adjustments had been effected to support his disability.

On recruitment, his manager had enquired whether he required any adjustments. Norman declined this offer, not wanting to “make a fuss”. He had not disclosed his disability at pre-employment screening (PES) as he did not consider himself disabled.

Many of Norman’s perceived stressors are normal daily occurrences of reception duties, but his physical disability exacerbated this. As he had not requested adjustments, there was nothing in place to support him in relation to his mobility difficulties.

Although his disability had not been disclosed at PES, under s.2 of the Health and Safety at Work etc Act 1974, Norman’s employer has a duty of care to him. Withholding information at PES that later comes to light could lead to disciplinary action but Norman considered that declaring his disability may have precluded his employment.

Cerebral palsy describes a group of childhood syndromes, apparent from birth or early childhood, characterised by abnormalities in motor function and muscle tone caused by genetic, intrauterine or neonatal insults to brain development. Resulting disabilities, of varying degrees, may be physical and mental.

A full functional capability assessment should have been performed at the start of his employment, facilitating adjustments enabling him to function effectively (Palmer et al, 2013). This had not been undertaken.

Norman usually managed his leg discomforts but occasionally had been unable to rest them at work. A study of workers with rheumatoid arthritis suggested that the workers reported greater discomfort on the days when they experienced more undesirable work events or job “strain” (Fifield et al, 2004).

Although this study looked at rheumatoid arthritis, issues concerning chronic pain and discomfort are relevant in this case. Although ultimately a legal decision, Norman was likely to be covered under the Equality Act 2010 as he had a long-term disability.

Withholding information at PES was fundamental to the case of  Cheltenham Borough Council v Laird (2009) . The council accused Laird of lying on her PES questionnaire by not disclosing her mental health history. She had been taking long-term antidepressants that kept her depression under control, but after some work problems her health deteriorated and she retired on health grounds. The judge confirmed there was no general duty of disclosure of information that was not specifically requested.

Thus, if a PES form does not directly ask about cerebral palsy, disclosure was not required. Kloss (2010) mentions these types of dilemmas are often only answered through the courts, but unless the employer is given information regarding disability, he cannot reasonably put adjustments in place. In the case of  Hanlon v Kirklees Metropolitan Council and others , the employee declined to consent to the disclosure of medical records, arguing this would contravene his right to privacy, and subsequently lost his case of disability discrimination.

The Health and Safety Executive (HSE 2007) defines stress as: “The adverse reaction people have to excessive pressures or other types of demand placed on them at work.”

The stress response

Stressors initiate physiological responses, evolved to protect and preserve the individual in times of threat by ensuring a reaction (Alexander et al, 2006).

This response is triggered by the limbic system within the brain. This is a series of centres controlling emotions, reproductive and survival behaviours (Blows, 2011). When survival is threatened, the system is instantly triggered into action to protect the individual, regardless of the threat magnitude.

A chain reaction occurs: the hypothalamus mediates the autonomic nervous system (Alexander et al, 2006), resulting in a sequence of physiological changes. The initial reaction is very fast, and only when the information reaches the cerebrum can the urgency of the situation be determined and responses modified (Blows, 2011).

The initial flight-or-fight response acts on the sympathetic division of the autonomic nervous system. Noradrenaline from the adrenal medulla immediately prepares the body for physical activity, mobilising glucose and oxygen to the heart, brain and skeletal muscles, preparing for flight or fight.

Non-essential functions, including digestion, are inhibited. Reduced bloodflow to the skin and kidneys promote the release of rennin, triggering the angiotensin – aldosterone pathway leading to fluid retention and hypertension. The resistance reaction results from corticotropin-releasing factor from the hypothalamus, stimulating the release of adrenocorticotropic hormone from the pituitary. This effects a release of cortisol from the adrenal cortex.

Cortisol effects are far-reaching, including lipolysis, gluconeogenesis and reducing inflammation. (Tortora and Grabowski, 2003). The body compensates for the effects of stress as long as possible. Three phases of stress are described as the general adaptation syndrome: alarm phase, resistance and exhaustion (Blows, 2011). The resistance and exhaustion phases may lead to immunosuppression and consequent disease (Tortora and Grabowski, 2003).

There is a reciprocal feedback link between the thalamus and amygdala. When the amygdala becomes overactive, fear and anxiety result. While adrenaline keeps the stress response active, endorphins protect the brain from the effects of fear (Blows, 2011). With so many physiological responses, there are numerous symptoms of stress that vary with each individual.

Significantly, stress causes muscle tension (HSE, 2007), exacerbating Norman’s discomfort, influencing his quality of life. As Kumar and Clark (2012) note, this is associated with depression.

The HSE (2007) management standards for work stress cover six main areas of primary work design that can contribute to stress if not properly managed. These include:

• Demands – including work patterns, workloads and work environment.
• Control – the extent of the worker’s job control.
• Support – provided by the organisation, management and colleagues.
• Role – understanding of their role and avoiding role-conflict.
• Change – management and communication of organisational change.
• Conflict – avoiding conflict, unacceptable behaviour and promoting positive working.

Fitness to work

The fitness-for-work assessment was based on a phenomenological appraisal as the effects of stress vary with each individual and their resilience (Alexander et al, 2006). A bio-psychosocial model informed the assessment. Norman stated that his condition was improving and he was ready to return to work. He no longer experienced symptoms that had taken him to the GP, but he was concerned at ending up in the same situation as before.

A patient health questionnaire (PHQ-9), providing an indication of depression, could have been used to assess Norman. Arroll et al (2010) found that the PHQ-9 is unreliable for diagnosing depression, whereas Manea et al (2012) refutes this assertion. At the time it seemed to be of limited value as he was making good progress.

Norman was advised to discuss his work concerns with his manager. With Norman’s consent, his manager was contacted and advised to carry out a comprehensive stress risk assessment as per the HSE management standards. It was suggested to Norman that he contact the organisation’s employee assistance programme and Access to Work, which offers grants for practical support for individuals with disabilities/health conditions to assist them with starting and staying at work. A phased return to work was formulated assisting Norman back into work and supporting him to stay at work. The following work regime was recommended:

• Week 1: Four hours on two days.
• Week 2: Four hours on four days.
• Week 3: Six hours on four days.
• Week 4: Full working week with the option of a review should Norman struggle.

Norman was to meet with his manager at the end of each week to review his progress, with the option to delay the next stage if this programme proved ineffective. In general, Norman had indicated that he had let his concerns take over without making any attempt to talk with his managers. He realised he should have discussed his work issues with his managers at an earlier stage. As Waddell and Burton (2006) note, early interventions are more effective at reducing long-term sickness absence and keeping workers at work.

Norman’s case illustrates how lack of control and apparent excessive demands and change can influence stress at work to negatively affect health. It reached a successful conclusion, but Norman’s case may have been prevented from requiring OH intervention had he been able to discuss his concerns and feelings with his manager in the first instance and a proactive approach, including the use of HSE stress management standards, been used at an earlier stage.

Anne Donaldson is an occupational health adviser. Anne Harriss is associate professor and course director, London South Bank University.

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Crone D, and Guy H (2008). “I know it is only exercise, but to me it is something that keeps me going: a qualitative approach to understanding mental health service users’ experiences of sports therapy”. International Journal of Mental Health Nursing, vol.17(3), pp.197-207.

DeLongis A, Folkman S, and Lazarus Richard S (1988). “The impact of daily stress on health and mood: psychological and social resources as mediators”. Journal of Personality and Social Psychology, vol.54(3), pp.486-495. Available online. Accessed 19 April 2014.

Fifield J, McQuillan J, Armeli S, Tennen H, Reisne S, and Affleck G (2004). “Chronic strain, daily work stress and pain among workers with rheumatoid arthritis: does job stress make a bad day worse?” Work & Stress, vol.18(4), pp.275-291. Accessed 12 April 2014.

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Kumar P and Clark M (2012). Clinical Medicine, 8th edition, Edinburgh, Saunders Elsevier.

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McArdle S, McGale N, and Gaffney P (2012). “A qualitative exploration of men’s experiences of an integrated exercise/CBT mental health promotion programme”. International Journal Of Men’s Health, vol.11(3), pp.240-257. doi:10.3149/jmh.1103.240.

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Mental Health Foundation (2014). Mental Health Statistics Available online. Accessed 17 April 2016.

Palmer K, Brown I, and Hobson J (2013). Fitness for Work, 5th edition, Oxford University Press.

Tortora G and Grabowski S (2003). Principles of anatomy and physiology, 10th edition, Hoboken NJ, John Wiley & Sons.

Waddell G, Burton K, and Kendall N (2008). Vocational Rehabilitation, what works, for whom and when? London: TSO pdf. Available online. Accessed 19 April 2016.

Wolever RQ, Bobinet KJ, McCabe K, Mackenzie ER, Fekete E, Kusnick CA, and Baime M (2012). “Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial”. Journal of Occupational Health Psychology, vol.17(2), pp.246-258.

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Cheltenham Borough Council v Laird [2009] IRLR 621.

Hanlon v Kirklees Metropolitan Council and others [2004] EAT 0119/04 (IDS Brief 767).

• 1 No poverty
• 2 Zero hunger
• 3 Good health and well-being
• 4 Quality education
• 5 Gender equality
• 6 Clean water and sanitation
• 7 Affordable and clean energy
• 8 Decent work and economic growth
• 9 Industry, innovation and infrastructure
• 10 Reduced inequalities
• 11 Sustainable cities and communities
• 12 Responsible consumption and production
• 13 Climate action
• 14 Life below water
• 15 Life on land
• 16 Peace, justice and strong institutions
• 17 Partnership for the goals

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ORIGINAL RESEARCH article

Work stress, mental health, and employee performance.

• 1 School of Business, Zhengzhou University, Zhengzhou, China
• 2 Henan Research Platform Service Center, Zhengzhou, China

The COVID-19 pandemic outbreak—as a typical emergency event—significantly has impacted employees' psychological status and thus has negatively affected their performance. Hence, along with focusing on the mechanisms and solutions to alleviate the impact of work stress on employee performance, we also examine the relationship between work stress, mental health, and employee performance. Furthermore, we analyzed the moderating role of servant leadership in the relationship between work stress and mental health, but the result was not significant. The results contribute to providing practical guidance for enterprises to improve employee performance in the context of major emergencies.

Introduction

Small- and medium-sized enterprises (SMEs) are the key drivers of economic development as they contribute >50, 60, 70, 80, and 90% of tax revenue, GDP, technological innovation, labor employment, and the number of enterprises, respectively. However, owing to the disadvantages of small-scale and insufficient resources ( Cai et al., 2017 ; Flynn, 2017 ), these enterprises are more vulnerable to being influenced by emergency events. The COVID-19 pandemic outbreak—as a typical emergency event—has negatively affected survival and growth of SMEs ( Eggers, 2020 ). Some SMEs have faced a relatively higher risk of salary reduction, layoffs, or corporate bankruptcy ( Adam and Alarifi, 2021 ). Consequently, it has made employees in the SMEs face the following stressors during the COVID-19 pandemic: First, employees' income, promotion, and career development opportunities have declined ( Shimazu et al., 2020 ). Second, as most employees had to work from home, family conflicts have increased and family satisfaction has decreased ( Green et al., 2020 ; Xu et al., 2020 ). Finally, as work tasks and positions have changed, the new work environment has made employees less engaged and less fulfilled at work ( Olugbade and Karatepe, 2019 ; Chen and Fellenz, 2020 ).

For SMEs, employees are their core assets and are crucial to their survival and growth ( Shan et al., 2022 ). Employee work stress may precipitate burnout ( Choi et al., 2019 ; Barello et al., 2020 ), which manifests as fatigue and frustration ( Mansour and Tremblay, 2018 ), and is associated with various negative reactions, including job dissatisfaction, low organizational commitment, and a high propensity to resign ( Lu and Gursoy, 2016 ; Uchmanowicz et al., 2020 ). Ultimately, it negatively impacts employee performance ( Prasad and Vaidya, 2020 ). The problem of employee work stress has become an important topic for researchers and practitioners alike. In this regard, it is timely to explore the impact of work stress on SME problems of survival and growth during emergency events like the COVID-19 pandemic.

Although recent studies have demonstrated the relationship between work stress and employee performance, some insufficiencies persist, which must be resolved. Research on how work stress affects employee performance has remained fragmented and limited. First, the research into how work stress affects employee performance is still insufficient. Some researchers have explored the effects of work stress on employee performance during COVID-19 ( Saleem et al., 2021 ; Tu et al., 2021 ). However, they have not explained the intermediate path, which limits our understanding of effects of work stress. As work stress causes psychological pain to employees, in response, they exhibit lower performance levels ( Song et al., 2020 ; Yu et al., 2022 ). Thus, employees' mental health becomes an important path to explain the relationship mechanism between work stress and employee performance, which is revealed in this study using a stress–psychological state–performance framework. Second, resolving the mental health problems caused by work stress has become a key issue for SMEs during the COVID-19 pandemic. As the core of the enterprise ( Ahn et al., 2018 ), the behavior of leaders significantly influences employees. Especially for SMEs, intensive interactive communication transpires between the leader and employees ( Li et al., 2019 ; Tiedtke et al., 2020 ). Servant leadership, as a typical leader's behavior, is considered an important determinant of employee mental health ( Haslam et al., 2020 ). Hence, to improve employees' mental health, we introduce servant leadership as a moderating variable and explore its contingency effect on relieving work stress and mental health.

This study predominantly tries to answer the question of how work stress influences employee performance and explores the mediating impact of mental health and the moderating impact of servant leadership in this relationship. Mainly, this study contributes to the existing literature in the following three ways: First, this research analyzes the influence of work stress on employee performance in SMEs during the COVID-19 pandemic, which complements previous studies and theories related to work stress. Second, this study regards mental health as a psychological state and examines its mediating impact on the relationship between work stress and employee performance, which complements the research path on how work stress affects employee performance. Third, we explore the moderating impact of servant leadership, which has been ignored in previous research, thus extending the understanding of the relationship between the work stress and mental health of employees in SMEs.

To accomplish the aforementioned tasks, the remainder of this article is structured as follows: First, based on the literature review, we propose our hypotheses. Thereafter, we present our research method, including the processes of data collection, sample characteristics, measurement of variables, and sample validity. Subsequently, we provide the data analysis and report the results. Finally, we discuss the results and present the study limitations.

Theoretical background and hypotheses

Work stress and employee performance.

From a psychological perspective, work stress influences employees' psychological states, which, in turn, affects their effort levels at work ( Lu, 1997 ; Richardson and Rothstein, 2008 ; Lai et al., 2022 ). Employee performance is the result of the individual's efforts at work ( Robbins, 2005 ) and thus is significantly impacted by work stress. However, previous research has provided no consistent conclusion regarding the relationship between work stress and employee performance. One view is that a significant positive relationship exists between work stress and employee performance ( Ismail et al., 2015 ; Soomro et al., 2019 ), suggesting that stress is a motivational force that encourages employees to work hard and improve work efficiency. Another view is that work stress negatively impacts employee performance ( Yunus et al., 2018 ; Nawaz Kalyar et al., 2019 ; Purnomo et al., 2021 ), suggesting that employees need to spend time and energy to cope with stress, which increases their burden and decreases their work efficiency. A third view is that the impact of work stress on employee performance is non-linear and may exhibit an inverted U-shaped relationship ( McClenahan et al., 2007 ; Hamidi and Eivazi, 2010 ); reportedly, when work stress is relatively low or high, employee performance is low. Hence, if work stress reaches a moderate level, employee performance will peak. However, this conclusion is derived from theoretical analyses and is not supported by empirical data. Finally, another view suggests that no relationship exists between them ( Tănăsescu and Ramona-Diana, 2019 ). Indubitably, it presupposes that employees are rational beings ( Lebesby and Benders, 2020 ). Per this view, work stress cannot motivate employees or influence their psychology and thus cannot impact their performance.

To further explain the aforementioned diverse views, positive psychology proposes that work stress includes two main categories: challenge stress and hindrance stress ( Cavanaugh et al., 2000 ; LePine et al., 2005 ). Based on their views, challenge stress represents stress that positively affects employees' work attitudes and behaviors, which improves employee performance by increasing work responsibility; by contrast, hindrance stress negatively affects employees' work attitudes and behaviors, which reduces employee performance by increasing role ambiguity ( Hon and Chan, 2013 ; Deng et al., 2019 ).

During the COVID-19 pandemic, SMEs have faced a relatively higher risk of salary reductions, layoffs, or corporate bankruptcy ( Adam and Alarifi, 2021 ). Hence, the competition among enterprises has intensified; managers may transfer some stress to employees, who, in turn, need to bear this to maintain and seek current and future career prospects, respectively ( Lai et al., 2015 ). In this context, employee work stress stems from increased survival problems of SMEs, and such an external shock precipitates greater stress among employees than ever before ( Gao, 2021 ). Stress more frequently manifests as hindrance stress ( LePine et al., 2004 ), which negatively affects employees' wellbeing and quality of life ( Orfei et al., 2022 ). It imposes a burden on employees, who need to spend time and energy coping with the stress. From the perspective of stressors, SMEs have faced serious survival problems during the COVID-19 pandemic, and consequently, employees have faced greater hindrance stress, thereby decreasing their performance. Hence, we propose the following hypothesis:

H1 . Work stress negatively influences employee performance in SMEs during the COVID-19 pandemic.

Work stress and mental health

According to the demand–control–support (DCS) model ( Karasek and Theorell, 1990 ), high-stress work—such as high job demands, low job control, and low social support at work—may trigger health problems in employees over time (e.g., mental health problems; Chou et al., 2015 ; Park et al., 2016 ; Lu et al., 2020 ). The DCS model considers stress as an individual's response to perceiving high-intensity work ( Houtman et al., 2007 ), which precipitates a change in the employee's cognitive, physical, mental, and emotional status. Of these, mental health problems including irritability, nervousness, aggressive behavior, inattention, sleep, and memory disturbances are a typical response to work stress ( Mayerl et al., 2016 ; Neupane and Nygard, 2017 ). If the response persists for a considerable period, mental health problems such as anxiety or depression may occur ( Bhui et al., 2012 ; Eskilsson et al., 2017 ). As coping with work stress requires an employee to exert continuous effort and apply relevant skills, it may be closely related to certain psychological problems ( Poms et al., 2016 ; Harrison and Stephens, 2019 ).

The COVID-19 pandemic has disrupted the normal operating order of enterprises as well as employees' work rhythm. Consequently, employees might have faced greater challenges during this period ( Piccarozzi et al., 2021 ). In this context, work stress includes stress related to health and safety risk, impaired performance, work adjustment, and negative emotions, for instance, such work stress can lead to unhealthy mental problems. Hence, we propose the following hypothesis:

H2 . Work stress negatively influences mental health in SMEs during the COVID-19 pandemic.

Mediating role of mental health

Previous research has found that employees' mental health status significantly affects their performance ( Bubonya et al., 2017 ; Cohen et al., 2019 ; Soeker et al., 2019 ), the main reasons of which are as follows: First, mental health problems reduce employees' focus on their work, which is potentially detrimental to their performance ( Hennekam et al., 2020 ). Second, mental health problems may render employees unable to work ( Heffernan and Pilkington, 2011 ), which indirectly reduces work efficiency owing to increased sick leaves ( Levinson et al., 2010 ). Finally, in the stress context, employees need to exert additional effort to adapt to the environment, which, consequently, make them feel emotionally exhausted. Hence, as their demands remain unfulfilled, their work satisfaction and performance decrease ( Khamisa et al., 2016 ).

Hence, we propose that work stress negatively impacts mental health, which, in turn, positively affects employee performance. In other words, we argue that mental health mediates the relationship between work stress and employee performance. During the COVID-19 pandemic, work stress—owing to changes in the external environment—might have caused nervous and anxious psychological states in employees ( Tan et al., 2020 ). Consequently, it might have rendered employees unable to devote their full attention to their work, and hence, their work performance might have decreased. Meanwhile, due to the pandemic, employees have faced the challenges of unclear job prospects and reduced income. Therefore, mental health problems manifest as moods characterized by depression and worry ( Karatepe et al., 2020 ). Negative emotions negatively impact employee performance. Per the aforementioned arguments and hypothesis 2, we propose the following hypothesis:

H3 . Mental health mediates the relationship between work stress and employee performance in SMEs during the COVID-19 pandemic.

Moderating role of servant leadership

According to the upper echelons theory, leaders significantly influence organizational activities, and their leadership behavior influences the thinking and understanding of tasks among employees in enterprises ( Hambrick and Mason, 1984 ). Servant leadership is a typical leadership behavior that refers to leaders exhibiting humility, lending power to employees, raising the moral level of subordinates, and placing the interests of employees above their own ( Sendjaya, 2015 ; Eva et al., 2019 ). This leadership behavior provides emotional support to employees and increase their personal confidence and self-esteem and thus reduce negative effects of work stress. In our study, we propose that servant leadership reduces the negative effects of work stress on mental health in SMEs.

Servant leadership can reduce negative effects of work stress on mental health in the following ways: Servant leaders exhibit empathy and compassion ( Lu et al., 2019 ), which help alleviate employees' emotional pain caused by work stress. Song et al. (2020) highlighted that work stress can cause psychological pain among employees. However, servant leaders are willing to listen to their employees and become acquainted with them, which facilitates communication between the leader and the employee ( Spears, 2010 ). Hence, servant leadership may reduce employees' psychological pain through effective communication. Finally, servant leaders lend employees power, which makes the employees feel trusted. Employees—owing to their trust in the leaders—trust the enterprises as well, which reduces the insecurity caused by work stress ( Phong et al., 2018 ). In conclusion, servant leadership serves as a coping resource that reduces the impact of losing social support and thus curbs negative employee emotions ( Ahmed et al., 2021 ). Based on the aforementioned analysis, we find that servant leaders can reduce the mental health problems caused by work stress. Hence, we propose the following hypothesis:

H4 . Servant leadership reduces the negative relationship between work stress and mental health in SMEs during the COVID-19 pandemic.

Methodology

Data collection and samples.

To assess our theoretical hypotheses, we collected data by administering a questionnaire survey. The questionnaire was administered anonymously, and the respondents were informed regarding the purpose of the study. Owing to the impact of the pandemic, we distributed and collected the questionnaires by email. Specifically, we utilized the network relationships of our research group with the corporate campus and group members to distribute the questionnaires. In addition, to ensure the quality of the questionnaires, typically senior employees who had worked for at least 2 years at their enterprises were chosen as the respondents.

Before the formal survey, we conducted a pilot test. Thereafter, we revised the questionnaire based on the results of the trial investigation. Subsequently, we randomly administered the questionnaires to the target enterprises. Hence, 450 questionnaires were administered via email, and 196 valid questionnaires were returned—an effective rate of 43.6%. Table 1 presents the profiles of the samples.

Table 1 . Profiles of the samples.

Table 1 shows the descriptive statistics of the sample. Based on the firm size, respondents who worked in a company with 1–20 employees accounted for 9.2%, those in a company with 21–50 employees accounted for 40.8%, those in a company with 51–200 employees accounted for 38.8%, and those in a company with 201–500 employees accounted for 11.2%. Regarding industry, the majority of the respondents (63.8%) worked for non-high-technology industry and 36.2% of the respondents worked for high-technology industry. Regarding work age, the participants with a work experience of 3 years or less accounted for 32.1%, those with work experience of 3–10 years accounted for 32.7%, and those with a work experience of more than 10 years accounted for 35.2%.

Core variables in this study include English-version measures that have been well tested in prior studies; some modifications were implemented during the translation process. As the objective of our study is SMEs in China, we translated the English version to Chinese; this translation was carried out by two professionals to ensure accuracy. Thereafter, we administered the questionnaires to the respondents. Hence, as the measures of our variables were revised based on the trial investigation, we asked two professionals to translate the Chinese version of the responses to English to enable publishing this work in English. We evaluated all the items pertaining to the main variables using a seven-point Likert scale (7 = very high/strongly agree, 1 = very low/strongly disagree). The variable measures are presented subsequently.

Work stress (WS)

Following the studies of Parker and DeCotiis (1983) and Shah et al. (2021) , we used 12 items to measure work stress, such as “I get irritated or nervous because of work” and “Work takes a lot of my energy, but the reward is less than the effort.”

Mental health (MH)

The GHQ-12 is a widely used tool developed to assess the mental health status ( Liu et al., 2022 ). However, we revised the questionnaire by combining the research needs and results of the pilot test. We used seven items to measure mental health, such as “I feel that I am unable (or completely unable) to overcome difficulties in my work or life.” In the final calculation, the scoring questions for mental health were converted; higher scores indicated higher levels of mental health.

Servant leadership (SL)

Following the studies by Ehrhart (2004) and Sendjaya et al. (2019) , we used nine items to measure servant leadership, including “My leader makes time to build good relationships with employees” and “My leader is willing to listen to subordinates during decision-making.”

Employee performance (EP)

We draw on the measurement method provided by Chen et al. (2002) and Khorakian and Sharifirad (2019) ; we used four items to represent employee performance. An example item is as follows: “I can make a contribution to the overall performance of our enterprise.”

Control variables

We controlled several variables that may influence employee performance, including firm size, industry, and work age. Firm size was measured by the number of employees. For industry, we coded them into two dummy variables (high-technology industry = 1, non-high-technology industry = 0). We calculated work experience by the number of years the employee has worked for the enterprise.

Common method bias

Common method bias may exist because each questionnaire was completed independently by each respondent ( Cai et al., 2017 ). We conducted a Harman one-factor test to examine whether common method bias significantly affected our data ( Podsakoff and Organ, 1986 ); the results revealed that the largest factor in our data accounted for only 36.219% of the entire variance. Hence, common method bias did not significantly affect on our study findings.

Reliability and validity

We analyzed the reliability and validity of our data for further data processing, the results of which are presented in Table 2 . Based on these results, we found that Cronbach's alpha coefficient of each variable was >0.8, thus meeting the requirements for reliability of the variables. To assess the validity of each construct, we conducted four separate confirmatory factor analyses. All the factor loadings exceeded 0.5. Overall, the reliability and validity results met the requirements for further data processing.

Table 2 . Results of confirmatory factor analysis and Cronbach's alpha coefficients.

To verify our hypotheses, we used a hierarchical linear regression method. Before conducting the regression analysis, we performed a Pearson correlation analysis, the results of which are presented in Table 3 .

Table 3 . Descriptive statistics and correlation analysis.

In the regression analysis, we calculated the variance inflation factor (VIF) of each variable and found that the VIF value of each variable was <3. Hence, the effect of multiple co-linearity is not significant. The results of regression analysis are presented in Tables 4 , 5 .

Table 4 . Results of linear regression analysis (models 1–6).

Table 5 . Results of linear regression analysis (models 7–9).

Table 4 shows that model 1 is the basic model assessing the effects of control variables on employee performance. In model 2, we added an independent variable (work stress) to examine its effect on employee performance. The results revealed that work stress negatively affects employee performance (β = −0.193, p < 0.01). Therefore, hypothesis 1 is supported. Model 5 is the basic model that examines the effects of control variables on mental health. In model 6, we added an independent variable (work stress) to assess its effect on mental health. We found that work stress negatively affects mental health (β = −0.517, p < 0.001). Therefore, hypothesis 2 is supported.

To verify the mediating effect of mental health on the relationship between work stress and employee performance, we used the method introduced by Kenny et al. (1998) , which is described as follows: (1) The independent variable is significantly related to the dependent variable. (2) The independent variable is significantly related to the mediating variable. (3) The mediating variable is significantly related to the dependent variable after controlling for the independent variable. (4) If the effect of the independent variable on the dependent variable becomes smaller, it indicates a partial mediating effect. (5) If the effect of the independent variable on the dependent variable is no longer significant, it indicates a full mediating effect. Based on this method, in model 4, mental health is significantly positively related to employee performance (β = 0.343, p < 0.001), and no significant correlation exists between work stress and employee performance (β = −0.016, p > 0.05). Hence, mental health fully mediates the relationship between work stress and employee performance. Therefore, hypothesis 3 is supported.

To verify the moderating effect of servant leadership on the relationship between work stress and mental health, we gradually added independent variables, a moderator variable, and interaction between the independent variables and moderator variable to the analysis, the results of which are presented in Table 5 . In model 9, the moderating effect of servant leadership is not supported (β = 0.030, p > 0.05). Therefore, hypothesis 4 is not supported.

For SMEs, employees are core assets and crucial to their survival and growth ( Shan et al., 2022 ). Specifically, owing to the COVID-19 pandemic, employees' work stress may precipitate burnout ( Choi et al., 2019 ; Barello et al., 2020 ), which influences their performance. Researchers and practitioners have significantly focused on resolving the challenge of work stress ( Karatepe et al., 2020 ; Tan et al., 2020 ; Gao, 2021 ). However, previous research has not clearly elucidated the relationship among work stress, mental health, servant leadership, and employee performance. Through this study, we found the following results:

Employees in SMEs face work stress owing to the COVID-19 pandemic, which reduces their performance. Facing these external shocks, survival and growth of SMEs may become increasingly uncertain ( Adam and Alarifi, 2021 ). Employees' career prospects are negatively impacted. Meanwhile, the pandemic has precipitated a change in the way employees work, their workspace, and work timings. Moreover, their work is now intertwined with family life. Hence, employees experience greater stress at work than ever before ( Gao, 2021 ), which, in turn, affects their productivity and deteriorates their performance.

Furthermore, we found that mental health plays a mediating role in the relationship between work stress and employee performance; this suggests that employees' mental status is influenced by work stress, which, in turn, lowers job performance. Per our findings, due to the COVID-19 pandemic, employees experience nervous and anxious psychological states ( Tan et al., 2020 ), which renders them unable to devote their full attention to their work; hence, their work performance is likely to decrease.

Finally, we found that leaders are the core of any enterprise ( Ahn et al., 2018 ). Hence, their leadership behavior significantly influences employees. Per previous research, servant leadership is considered a typical leadership behavior characterized by exhibiting humility, delegating power to employees, raising the morale of subordinates, and placing the interests of employees above their own ( Sendjaya, 2015 ; Eva et al., 2019 ). Through theoretical analysis, we found that servant leadership mitigates the negative effect of work stress on mental health. However, the empirical results are not significant possibly because work stress of employees in SMEs is rooted in worries regarding the future of the macroeconomic environment, and the resulting mental health problems cannot be cured merely by a leader.

Hence, due to the COVID-19 pandemic, employees experience work stress, which precipitates mental health problems and poor employee performance. To solve the problem of work stress, SMEs should pay more attention to fostering servant leadership. Meanwhile, organizational culture is also important in alleviating employees' mental health problems and thus reducing negative effects of work stress on employee performance.

Implications

This study findings have several theoretical and managerial implications.

Theoretical implications

First, per previous research, no consistent conclusion exists regarding the relationship between work stress and employee performance, including positive relationships ( Ismail et al., 2015 ; Soomro et al., 2019 ), negative relationships ( Yunus et al., 2018 ; Nawaz Kalyar et al., 2019 ; Purnomo et al., 2021 ), inverted U-shaped relationships ( McClenahan et al., 2007 ; Hamidi and Eivazi, 2010 ), and no relationship ( Tănăsescu and Ramona-Diana, 2019 ). We report that work stress negatively affects employee performance in SMEs during the COVID-19 pandemic; thus, this study contributes to the understanding of the situational nature of work stress and provides enriching insights pertaining to positive psychology.

Second, we established the research path that work stress affects employee performance. Mental health is a psychological state that may influence an individual's work efficiency. In this study, we explored its mediating role, which opens the black box of the relationship between work stress and employee performance; thus, this study contributes to a greater understanding of the role of work stress during the COVID-19 pandemic.

Finally, this study sheds light on the moderating effect of servant leadership, which is useful for understanding why some SMEs exhibit greater difficulty in achieving success than others during the COVID-19 pandemic. Previous research has explained the negative effect of work stress ( Yunus et al., 2018 ; Nawaz Kalyar et al., 2019 ; Purnomo et al., 2021 ). However, few studies have focused on how to resolve the problem. We identify servant leadership as the moderating factor providing theoretical support for solving the problem of work stress. This study expands the explanatory scope of the upper echelons theory.

Practice implications

First, this study elucidates the sources and mechanisms of work stress in SMEs during the COVID-19 pandemic. Employees should continuously acquire new skills to improve themselves and thus reduce their replaceability. Meanwhile, they should enhance their time management and emotional regulation skills to prevent the emergence of adverse psychological problems.

Second, leaders in SMEs should pay more attention to employees' mental health to prevent the emergence of hindrance stress. Employees are primarily exposed to stress from health and safety risks, impaired performance, and negative emotions. Hence, leaders should communicate with employees in a timely manner to understand their true needs, which can help avoid mental health problems due to work stress among employees.

Third, policymakers should realize that a key cause of employee work stress in SMEs is attributable to concerns regarding the macroeconomic environment. Hence, they should formulate reasonable support policies to improve the confidence of the whole society in SMEs, which helps mitigate SME employees' work stress during emergency events like the COVID-19 pandemic.

Finally, as work stress causes mental health problems, SME owners should focus on their employees' physical as well as mental health. Society should establish a psychological construction platform for SME employees to help them address their psychological problems.

Limitations and future research

This study has limitations, which should be addressed by further research. First, differences exist in the impact of the pandemic on different industries. Future research should focus on the impact of work stress on employee performance in different industries. Second, this study only explored the moderating role of servant leadership. Other leadership behaviors of leaders may also affect work stress. Future research can use case study methods to explore the role of other leadership behaviors.

This study explored the relationship between work stress and employee performance in SMEs during the COVID-19 pandemic. Using a sample of 196 SMEs from China, we found that as a typical result of emergency events, work stress negatively affects employees' performance, particularly by affecting employees' mental health. Furthermore, we found that servant leadership provides a friendly internal environment to mitigate negative effects of work stress on employees working in SMEs.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.

Ethics statement

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent from the patients/participants or patients/participants legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.

Author contributions

BC: conceptualization, methodology, writing—original draft, and visualization. LW: formal analysis. BL: investigation, funding acquisition, and writing—review and editing. WL: resources, project administration, and supervision. All authors contributed to the article and approved the submitted version.

This research was supported by the major project of Henan Province Key R&D and Promotion Special Project (Soft Science) Current Situation, Realization Path and Guarantee Measures for Digital Transformation Development of SMEs in Henan Province under the New Development Pattern (Grant No. 222400410159).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: COVID-19, work stress, mental health, employee performance, social uncertainty

Citation: Chen B, Wang L, Li B and Liu W (2022) Work stress, mental health, and employee performance. Front. Psychol. 13:1006580. doi: 10.3389/fpsyg.2022.1006580

Received: 29 July 2022; Accepted: 10 October 2022; Published: 08 November 2022.

Reviewed by:

Copyright © 2022 Chen, Wang, Li and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Biao Li, lib0023@zzu.edu.cn

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

• Research article
• Open access
• Published: 13 May 2020

Decreasing employees’ work stress by a participatory, organizational level work stress prevention approach: a multiple-case study in primary education

• Maartje C. Bakhuys Roozeboom 1 ,
• Roosmarijn M. C. Schelvis 2 ,
• Irene L. D. Houtman 1 ,
• Noortje M. Wiezer 1 &
• Paulien M. Bongers 1 , 3  

BMC Public Health volume  20 , Article number:  676 ( 2020 ) Cite this article

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Work stress is an important problem among employees in education in the Netherlands. The present study aims to investigate the effects of a participatory organizational level work stress prevention approach to reduce (quantitative) job demands, increase resources (i.e. autonomy, supervisor and coworker support) and to reduce work stress and increase job satisfaction of employees in primary education.

This study makes use of a multiple case study research design. The stress prevention approach is implemented at 5 primary schools and questionnaires were filled out by 119 employees of the 5 schools at baseline and 1 year later, measuring job demands, resources, work stress, job satisfaction and implementation factors.

Multilevel analyses showed a significant decrease in job demands and a significant increase in job satisfaction between baseline and follow up. In addition, employees that were more satisfied with the communication about the intervention showed more improvements in autonomy and job satisfaction. However, employees reporting an increased dialogue in work stress between employees and management showed a smaller decrease in job demands.

The study shows a decrease in job demands and an increase in job satisfaction in the schools that implemented a stress prevention approach. Results of the study underline the importance of communication about the intervention as part of the implementation process, impacting the effectiveness of the intervention to improve autonomy and job satisfaction.

Trial registration

ISRCTN registry, study ID: ISRCTN14697835 , registration date: 11-10-2019 (retrospectively registered).

Peer Review reports

Among EU-workers, 25% consider their health to be at risk due to work stress [ 1 ], and this number is even higher for workers in education (42%) [ 2 ]. According to a survey that is representative for the Dutch workforce, one in five employees in education in the Netherlands actually suffers from work stress [ 3 ], i.e. they feel emotionally drained and exhausted especially at the end of the work day, and are tired when they get up again in the morning. In primary education, the target group of the present study, this would equal 32,165 of the 168,400 employed workers in 2017. In addition, at present there is a significant shortage of teachers in the Netherlands, especially in primary education and this problem is jeopardizing the quality of the Dutch educational system.

There is a lot of evidence that work stress causes major health problems, such as cardiovascular diseases [ 4 , 5 , 6 , 7 ], musculoskeletal disorders [ 8 ], and poor mental health [ 9 ]. Work stress is also found to increase sickness absence [ 10 ], decrease job satisfaction [ 11 ] and lower productivity [ 12 ]. Considering the severe consequences of work stress for employees and employers, it is important that organizations take measures to reduce these risks. The high prevalence of work stress in primary education, combined with the shortage of teachers in this sector, ask for effective interventions to reduce work stress and increase job satisfaction, to prevent teachers from leaving their profession.

In the last decades, a lot of research has focused on causes of work stress and several theoretical models have been developed (e.g. JDC(S)-model [ 13 ], the DISC-model [ 14 ] and JDR-model [ 15 ]). These models are all based on the balance principle: work stress as a result of excessive job demands combined with a shortage of available resources. Job demands are the physical, social or organizational aspects of the job that require effort [ 16 ]. Resources refer to aspects of the job that reduce job demands and the required efforts, help to achieve work goals and stimulate learning and development [ 17 ].

Job demands that have been found to correlate positively with teacher burnout are time pressure and work overload [ 18 , 19 , 20 , 21 ]. Resources that are found to be related to work stress in teachers are amongst others lack of autonomy [ 22 , 23 ] and lack of supervisor support [ 20 , 24 ].

According to the “hierarchy of controls” principle, interventions are presumed to be most (cost-) effective when work stress risks are managed at their source (i.e. primary prevention, aiming at job demands and resources) [ 25 ]. In addition, it is assumed that organizational interventions hold most potential for structural changes as opposed to individual interventions. These latter interventions may improve the well-being of individuals, but organizational interventions target the actual causes of stress, and may thus lead to substantial and sustainable improvements at both individual and organizational level. In practice, most interventions to prevent or reduce work stress in education focus on empowering individuals to deal with job demands. Different studies have shown only partial effects of these interventions on work stress [ 26 , 27 , 28 ]. Based on their review of organizational interventions aimed at reducing work stress in teachers, Naghieh et al. [ 29 ] conclude that organizational interventions lead to improvements in well-being of teachers, even though good quality effect evaluations of organizational interventions are scarce.

In the last decades, considerable efforts have been put into the consolidation of evidence concerning good practice interventions dealing with stress in the workplace. A large study on best practices of psychosocial risks (including work stress) management in Europe has resulted in a best practice framework for psychosocial risk management (PRIMA-EF) [ 30 ]. Based on interviews and focus group meetings, seven key features of work stress interventions have been identified. That is, interventions need to: 1) be theory and evidence-based; 2) follow a systematic, stepwise approach, including developing clear goals, tasks and intervention-planning; 3) apply a proper risk assessment, identify risk factors and vulnerable groups; 4) be tailored to the organizational context (e.g. sector, size, culture), and be adaptable and flexible; 5) be accessible and user friendly; 6) be targeted at the individual as well as the organization, and 7) develop (management and leadership) capacities and skills. Several interventions that include these features have been tested [ 31 , 32 , 33 , 34 ]. In most cases, the intervention consists of several steps that can be summarized as: a preparation phase, a risk assessment phase, an action planning phase, an implementation phase, and an evaluation phase. The first three steps of the intervention, the preparation phase, risk assessment phase and the action planning phase, result in a tailored action plan that targets organization specific stressors or hindrances. Implementation of this action plan is – in line with the Job Demands Resources model – hypothesized to reduce job demands and increase resources, which will in turn decrease levels of work stress and increase job satisfaction [ 16 , 17 , 35 ].

However, the implementation of these interventions is complex [ 36 ] and the success of such interventions depends on many factors [ 37 , 38 ]. Several implementation factors that appear to be important for the success of the intervention are employee participation, communication, and dialogue [ 39 ]. Implementation factors are not only considered to be crucial for successful implementation, but these factors in themselves can be considered as active ingredients of the intervention since they provide resources for employees. The process evaluation model of Nielsen & Randall [ 40 ] identifies participation of employees during the implementation process as an important driver of change. Employee participation is important because employees have expert knowledge of the workplace and work processes, and by involving them in managing psychosocial risks this knowledge is accessible [ 31 , 34 ]. In addition, participation of employees in the intervention, provides opportunities for employees to control their working conditions and “worker control” is an important determinant of employee wellbeing [ 13 ]. Furthermore, involving employees in identifying stressors and finding solutions will increase employees’ readiness for change and ensure commitment for the implementation of the measures. For these reasons, the participatory approach has been broadly advocated as an effective strategy in organizational interventions to improve occupational health [ 34 ]. Another important implementation factor mentioned in previous research is clear and transparent communication [ 39 , 41 , 42 , 43 ]. Communication about and throughout the process is very important to get and keep employees informed and involved. Communication about the intervention and the intervention process contributes to employees’ understanding of the intentions behind the interventions, increasing employee participation in and commitment to the intervention [ 44 ]. In their model of process evaluation, Nielsen & Randall [ 40 ] consider communication to be a crucial aspect of the implementation strategy. In addition, Nielsen & Randall [ 40 ] stress the importance of the perceptions and appraisals of individuals in the organization towards the intervention, since these so-called mental models determine how individuals behave and react to the intervention. Different individuals in the organization (e.g. employees, supervisors, management) can have different and conflicting agendas. Aust et al. [ 45 ] showed that differences in stakeholder views may hinder successful implementation, stressing the importance of shared mental models of individuals in the organization towards the intervention. The dialogue on stress among employees and between employees and management can contribute to shared mental models and facilitate the implementation. Other researchers also stress the importance of the dialogue between management and employees as a driver for organizational improvement regarding the work environment and employee health [ 39 , 41 , 43 , 46 ].

Not only is the implementation of an organizational level work stress intervention difficult, the evaluation of intervention effects is challenging as well. In applied research, the research design has been a topic of discussion for years. Traditional research designs in the psychology and health domain are experimental designs and randomized controlled trials (RCT), usually involving a pre- and posttest, an experimental (or intervention) and a control group and random assignment of respondents or research units to the experimental (or intervention) and control group. These research designs are by many considered as the golden standard. However, in applied organizational research, these research designs are often not feasible since (quasi-)experimental designs with a control and experimental group are often difficult to establish and the organizational context is often complex and therefore hard to control, making extrapolation of the results to other organizations and individuals difficult [ 47 , 48 , 49 , 50 ]. Randall, Griffith and Cox [ 48 ] propose an alternative research design to cope with these problems, that better fits the organizational context, by using the results of the process evaluation of the implementation (measuring e.g. participant’s participation and intervention exposure as a proxy of the level of implementation) in the effect evaluation. Huijs et al. [ 51 ] followed a similar approach by using data obtained in a process evaluation of participants’ experiences and exposure to the intervention and investigated whether changes in the outcome measure between baseline and follow-up were related to the level of intervention exposure. Following this approach provides the possibility to account for the complex and often uncontrollable organizational setting.

Work stress prevention approach

For the present study, a work stress prevention guideline for intervention facilitators (e.g. internal HR-advisor or external consultant) was developed, based on the above described existing knowledge. The guideline is designed as an interactive pdf document, in order to tailor information based on the facilitator’s prior knowledge of the topic. The guideline provides a detailed description of a participative, five-step approach to prevent work stress (the work stress prevention approach), including per step what to do, how to do it, when to do it and with whom. And since the implementation factors described earlier are considered very important for the success of the intervention, the guideline provides information and inspiration to enhance employee participation, to provide employees with clear communication during the intervention and to improve the dialogue on work stress within the organization. Following the work stress prevention approach results in a tailored action plan for each school, that addresses school specific risk factors (in terms of job demands and resources).

The work stress prevention approach consists of five successive steps aiming to facilitate the formulation, implementation and evaluation of specific work stress measures. These steps are: 1) preparation, 2) risk assessment, 3) action planning, 4) implementation, and 5) evaluation. In all the five schools that participated in this study, the implementation process of the approach is facilitated and coordinated by the same intervention facilitator. The intervention facilitator is experienced in change- and project management and received three two-hour training sessions on the work stress prevention approach by the researchers. In this training the approach is explained in detail, and special attention is paid to the important implementation factors: employee participation, communication and the dialogue on stress. The facilitator follows the protocol as described in the work stress prevention guideline.

Step 1 entails the preparation phase. In this phase a working group is formed in each school consisting of the director, 1–3 workers with an interest in the topic of work stress and the intervention facilitator. The working group is responsible for facilitating steps 1–5 to be followed in their own school, involving and informing employees and monitoring the implementation process. The working group decides upon a suitable communication strategy to keep employees informed during the intervention process (e.g. weekly newsletters, posters in the staff room, presentation at personnel meetings). A kick-off meeting is organized and the project is announced by the working group to all employees. Tasks of the working group are performed within working hours.

In step 2 - the risk assessment phase - causes of work stress are examined. For this purpose a questionnaire is administered by the researchers with amongst others questions on determinants (job demands and resources) and on outcomes (work stress and job satisfaction) (see paragraph on measures). Results of the baseline questionnaire are benchmarked against data representative for the entire Dutch primary education sector, based on the Netherlands Working Condition Survey [ 3 ] in order to prioritize the factors causing work stress. In addition, a participatory focus group session is organized with all personnel to present and discuss the results of the questionnaire, to check whether the priorities based on the numbers relate to their experience of the causes of stress and to identify additional causes of stress (if any) in their school.

In step 3, the action planning phase, work stress measures are jointly developed. In a brainstorm session with all personnel an extensive list with all possible solutions based on expert knowledge of the participants about their working environment was formed (divergent technique). Next, a selection of the 5–10 most appropriate and feasible work stress measures is made (convergent technique). Based on this selection a detailed action plan is developed by the working group under supervision of the facilitator.

Step 4 - the implementation phase - entails the implementation of the measures as described in the action plan resulting from step 3. The working group implements the measures according to the action plan and regularly discusses progress and communicates about the process to the employees.

In step 5 - the evaluation phase - the effects of the work stress prevention approach and the implementation process are investigated. A follow up questionnaire, the same as the baseline questionnaire, is administered, and 4 interviews are conducted per school by the researchers. Results from the questionnaire and interviews are discussed with the working group by the facilitator to evaluate the success of the measures and to decide upon next steps. Results of the questionnaire and interviews are also shared with all personnel.

The current study aims to explore the effect of the work stress prevention approach on (quantitative) job demands and resources (autonomy, supervisor and coworker support) and on work stress and job satisfaction. The current study follows a similar approach as Huijs et al. (2019) by investigating the effects of the intervention in relation to the implementation success, as measured by the level of employee participation, communication and dialogue on stress.

The study examines the effects of the work stress prevention approach as a whole, rather than the effects of specific measures as described in the school specific action plans (result of Step 3).

Each school developed or selected their own measures, and as a result of the variation in contexts and priorities there is also a variation of different kinds of measures, making it difficult to examine the effects of separate measures. The authors believe that the effects of the stress prevention approach is related to the approach as a whole. The fact that the measures as determined in the action planning phase are tailored to school specific problems is considered more important than the exact content of the measures.

Based on the above, the following hypotheses were formulated (see Fig.  1 ):

Hypothesis 1 (H1): The level of job demands will decrease and resources (autonomy, supervisor and coworkers support) will increase between baseline and follow-up (proximal outcomes)

Hypothesis 2 (H2): Work stress will decrease and job satisfaction will increase between baseline and follow-up (distal outcomes).

Hypothesis 3 (H3): The implementation factors (participation, communication and dialogue on stress) will positively affect the decrease in job demands and the increase in resources (proximal outcomes) between baseline and follow-up.

Hypothesis 4 (H4): The implementation factors (participation, communication and dialogue on stress) will positively affect the decrease in work stress and the increase in job satisfaction (distal outcomes) between baseline and follow-up.

Schematic overview of hypotheses

Study population

The study population consisted of teaching (i.e. teachers) and non-teaching staff (i.e. managers, support staff) from five schools in primary education ( N  = 119). Schools were recruited via the network of the primary education labour market platform (Arbeidsmarktplatform Primair Onderwijs) by placing an advertisement in a sector specific magazine. Five schools applied for participation. Reasons for participation were amongst others signals of work stress reported by employees. The schools were geographically spread throughout the Netherlands. The schools differed in size, and included small, medium and large schools (teaching and non-teaching staff at baseline: school A: N  = 15, school B: N  = 61, school C: N  = 45, school D: N  = 37 and school E: N  = 41). The study did not require ethical approval, since the study did not fall under the Medical Research Involving Human Subjects Act (WMO) [ 52 , 53 ].

Data collection

A digital questionnaire was sent out by email to all personnel of the five primary schools as part of step 2 ‘risk analysis’ (baseline) and step 5 ‘evaluation’ (follow-up) of the work stress prevention approach. The baseline questionnaire was sent out in March 2016. The follow up questionnaire was sent out 12 months after the baseline questionnaire. Data on proximal outcomes (job demands and resources) and distal outcomes (job satisfaction and work stress) were collected by means of the baseline and follow up questionnaires. Data on implementation factors were collected by means of the follow up questionnaire.

Job demands and resources (proximal outcomes)

Job demands and resources are measured using a proxy of subscales of the Dutch version of the Job Content Questionnaire (JCQ [ 54 ]): quantitative job demands (4 items; α = .84) and resources: autonomy (3 items, α = .67), supervisor support (4 items; α = .77) and co-worker support (4 items: α = .73). Response scales range from 1 =  strongly disagree to 4 =  strongly agree .

Outcome variables (distal outcomes)

Work stress was measured with a shortened version the Utrecht Burnout Scale (UBOS) [ 55 ], a slightly adjusted Dutch version of the Maslach Burnout Inventory-General Survey (MBI-GS) [ 56 ]. The questionnaire consists of 5-items including the key dimension of burnout: emotional exhaustion (feeling drained by one’s work). Response scales range from 0 =  never to 6 =  every day (α = .84). Studies have shown that the MBI-GS and its subscales are excellently reliable and valid [ 57 , 58 ].

Job satisfaction can be viewed as a general and one-dimensional construct, resulting from positive and negative work experiences [ 59 ]. It was measured with one item: “ I am satisfied with my present job ” . This item was rated on a 5-point Likert scale, response scales range from 1 = strongly disagree to 5 = strongly agree .

Implementation factors

The follow up questionnaire contained the following items on the implementation that are used in the analyses to indicate the implementation success: the level of employee participation, communication and dialogue on stress. Employee participation was assessed by a single item : "Could you rate your involvement with the intervention program on a scale from 1 (=poor) to 10 (=excellent)?" Communication was measured by a single exploratory item: " Could you rate your satisfaction with the communication about the intervention program on a scale from 1 (=poor) to 10 (=excellent)?" Dialogue on stress was measures by three separate items. Respondents were asked to indicate on a 5-point Likert scale (response scales range from 1 (strongly disagree) to 5 (strongly agree)) “to what extent did you notice any changes regarding the following areas?”: “ Work stress is discussed more often among employees ” (dialogue between employees); “ Work stress is discussed more often between employees and management ” (dialogue with management); “ There is more attention for the issue of work stress throughout the school ” (attention for work stress).

Data analyses

Analyses were performed on the data of the five primary schools combined. To adjust for clustering of persons in schools, multilevel analyses were performed using IBM Statistics SPSS version 25.0. Multilevel modelling can be used to analyze data that contain an inherent hierarchical structure. The data from the current study contain two levels: the first level of the data contains the individual scores of the participants on the proximal and distal outcomes at baseline and follow-up (within-subjects level) and the second level of the data contains the schools in which the individual participants are nested (between schools level). To start, the variables have been prepared for analyses. For all the variables a new ‘centered’ variable was calculated, by subtracting its mean from each individual score, to make the interpretation of the output of the analyses more straightforward. For each outcome a random intercept was added to the model to adjust for differences between the schools in the way the proximal and distal outcomes changed over time.

To test hypotheses 1 and 2, difference scores (between baseline and follow-up) were calculated for each outcome. Univariate analyses were carried out with the difference scores of each of the proximal (job demands, resources) and distal outcomes (work stress and job satisfaction) as dependent variable; the centered score of the outcome at baseline as the independent variable and the intercept to indicate the average change in the outcome between baseline and follow up. In the analysis covariates were added based on differences between schools regarding the baseline measurement of general characteristics. These analyses test the difference between baseline and follow up for each of the proximal and distal outcomes corrected for age and the outcome at baseline.

In addition, the analyses of the previous step were repeated including the centered implementation factors as covariates. These analyses test hypotheses 3 and 4, and show whether a difference between baseline and follow up in the proximal and distal outcomes (job demands, resources, work stress and job satisfaction) was moderated by the implementation factors (participation, communication and dialogue) controlling for covariates (differences between schools on the baseline measure of general characteristics) and the outcome at baseline. To obtain the amount of variance explained by the differences between the schools, the intraclass correlation coefficient (ICC) was calculated for each analysis. For all hypotheses a p -value of < 0.05 was indicated as statistically significant.

Qualitative analyses

In addition to the quantitative data that were collected to explore the effects of the intervention and test the hypotheses, also qualitative data were collected to explore the implementation process in more detail. Qualitative data on the implementation process were collected during Step 5 by four semi-structured interviews in each primary school on the experience of various employees with different roles during the implementation of the approach. These interviews were conducted by the researchers. In each school interviews were held with the director, a working group member, a randomly selected worker not taking part in the working group, and the intervention facilitator who accommodated all five schools. The interviews were conducted according to a semi-structured interview protocol, either by telephone ( n  = 15) or face to face ( n  = 5), and lasted between 30 and 60 min. Minutes were made during the interview by a research assistant. The interview transcripts were coded according to different topics that were determined beforehand: experiences with the five phases of the work stress prevention approach and the actions within each phase (questionnaire, focus group meeting, brainstorm session, conducting action plan, progress meetings, role of intervention facilitator, role of working group, participation of employees), drivers and barriers for implementation of the work stress prevention approach and strengths and weaknesses of the work stress prevention approach (the semi-structured interview protocol is added as supplementary file).

Figure  2 shows the participant flow and response rates of the baseline and follow up. At baseline, the response rate was 78% (of all eligible workers), and at follow up the response rate was 80% (of all eligible workers). In total 119 respondents completed both baseline and follow up and were included in the analyses since this is the group for which repeated measure analyses could be performed.

Flow-chart of response rates for the five primary schools

Table  1 shows general personal characteristics of the study population. There are some statistically significant differences between schools in relation to several of these characteristics, particularly regarding age. For this reason, age was added as a covariate in the analyses. There are no statistically significant differences on the baseline proximal and distal outcome measures between the schools.

Quantitative analyses

Table  2 shows the results of the analyses performed to test H1 and H2. Even though in the analyses we corrected for clustering effects of school by means of a multilevel approach, for job demands, co-worker support, work stress and job satisfaction no differences were found between the schools (Table  2 ). Results show a statistically significant decrease in job demands and increase in job satisfaction from baseline to follow up, partly confirming H1 and H2. All other proximal and distal outcomes appear to have changed between baseline and follow up in a favorable direction, although these results are not statistically significant (for work stress the effect is marginally significant, p  < .10).

Table  3 shows the results of the analyses performed to test H3 and H4 indicating an effect of the implementation factors on the change in proximal and distal outcomes between baseline and follow up. Results show that the implementation factor communication affects the differences between baseline and follow up on job satisfaction and autonomy. Respondents who were more satisfied with the communication about the work stress prevention approach, showed a larger increase in job satisfaction and autonomy between baseline and follow up, than respondents who were less satisfied with the communication.

Finally, results show that the ‘dialogue with employer’ affects the differences between baseline and follow up on job demands. The direction of this effect was in contrast to the hypothesis and indicates that respondents who did report an increased dialogue between employees and their employer regarding work stress, showed a smaller decrease in job demands between baseline and follow up, compared to respondents who reported no increased dialogue between employees and their employer regarding work stress.

To summarize, the results show a statistically significant decrease in job demands and an overall increase in job satisfaction between baseline and follow up, partly confirming H1 and H2. And satisfactory communication about the work stress prevention approach is related to an increase in job satisfaction and autonomy between baseline and follow up. In contrast to our expectations, results show that an increased dialogue between employees and the management is related to a smaller decrease in job demands between baseline and follow up. H3 and H4 are partly confirmed.

Preparation phase

At all schools, a working group was installed according to protocol, with the director, 1–3 workers, and the intervention facilitator.

Risk assessment phase

The response on the baseline questionnaire was quite high (response rates ranges 71–89%). In the interviews, respondents mentioned that they appreciated that the questionnaire provided ‘objective’ data on this sensitive topic of work stress, which provided a good starting point for discussion in the focus group sessions. In the focus group sessions, the participants valued the fact that they could provide input regarding the risk assessment, and that their view on work stress risks was taken into account. The risk factors for work stress at the schools were relatively similar, although there were some differences in relation to unwanted behavior from external persons (e.g. parents) which was particularly a problem for two of the five schools (Table  4 ).

Action planning phase

At all schools, almost all personnel participated in the brainstorm session. At two schools the brainstorm session was combined with the focus group session. Participants valued the possibility to give their input regarding the measures which were considered needed. According to the intervention facilitator, the commitment of participants of the focus group meetings and the brainstorm sessions was high. Based on the results of the brainstorm session, the working groups developed an action plan. The schools differed in relation to the measures identified as well as to the persons who were made responsible for the implementation of the measures (Table  4 ). At some schools the implementation of the action plan was delegated among several persons, at other schools only one or two persons were made responsible.

Implementation phase

The implementation phase was considered by the intervention facilitator as the most difficult phase. Different progress meetings were planned with the working groups to discuss progress, and to discuss drivers and barriers of the implementation. The most often mentioned barrier for the implementation of the action plan was lack of time and lack of priority. The progress meetings and regular talks between the working group and the intervention facilitator stimulated the working group to give priority to the implementation of the action plan. The working group members and the intervention facilitator mentioned that it was challenging to keep all personnel informed and involved. Several communication channels were used to inform personnel (e.g. newsletters, meetings, blogs, flip-overs in staff room).

Evaluation phase

Comparable to the baseline questionnaire the response of the follow-up questionnaire was high (response rate ranged from 72 to 92% per school). In the interviews, the participants were asked whether they had noticed effects from the work stress prevention approach. The results were somewhat inconclusive. Participants valued some of the concrete measures (e.g. more efficiency in administration, meetings and checking students results). But some argued that important determinants of work stress are out of the reach from the primary schools (e.g. some of the administrative tasks are obliged). Participants explicitly mentioned the value of the participative approach and they mentioned that the dialogue on stress within the school helped to raise awareness and making stress prevention a shared responsibility.

The aim of the present study was to explore the effect of the work stress prevention approach on job demands, resources, work stress and job satisfaction in five primary schools and to investigate whether and how implementation factors were related to these effects. The study investigated the effects of the approach as a whole, rather than the school specific measures as described in the action plans of the schools. Despite the fact that the schools conducted different action plans, the analyses showed that differences between schools in relation to the effects of the work stress prevention approach were small or absent.

Quantitative analyses were performed to test whether there was a positive change between baseline and follow-up in job demands and resources (H1) and whether there was a decrease in the level of work stress and an increase in the level of job satisfaction (H2) after the intervention. Results of the analyses showed no significant changes for resources (autonomy, supervisor and co-worker support) and work stress, but there was a statistically significant decrease in job demands and an increase of the level of job satisfaction, partly confirming H1 and H2. From the literature it is known that job satisfaction is an important predictor of company performance [ 60 ], and high job satisfaction decreases turnover intention [ 61 ]. This finding could form an argument for making a business case for stress management, encouraging employers to take action.

Although the study found a decrease in job demands, and in job satisfaction no significant changes in resources and work stress were found between baseline and follow up. A possible explanation is that the follow up questionnaire was conducted too early in time to be able to show any significant changes in these indicators since the implementation process may have been slow and actual changes might only have just started. In addition, the implementation of the interventions followed the same steps on each of the five schools, but the timing of the steps was not exactly the same. According to De Lange et al. [ 62 ] the time interval between baseline and follow up is ideally 1 year, and a similar time interval was applied in the present study. However, the cyclical character of the work stress prevention approach makes it difficult to determine a good timing for the follow up, since ideally the approach does not end, but will be adopted as part of the policy cycle within the organization. At the time of the follow up questionnaire all schools were still implementing measures from their action plans, but some of the schools had already implemented more measures than others. Furthermore, the effects of some of the measures could be assumed to manifest themselves earlier than the effects of other measures. For example, reducing unnecessary work tasks may have had an immediate effect on job demands, but increasing social support and autonomy may take more time.

Looking at the difference between the resources and outcomes at baseline and follow up, all changed in a favorable direction, however, the changes were not statistically significant with the exception of -as indicated before- job demands and job satisfaction (for work stress the effect was marginally significant, p  < 0.1). It is possible that, if there had been more time between baseline and follow up, more measures from the action plans could have been implemented, and possibly more effects of the measures on resources and work stress would have been found. On the other hand, it is also possible that by postponing the follow up, some of the effects may already have faded away.

To attribute changes between baseline and follow up to the intervention, the changes on the proximal and distal outcomes between baseline and follow up were related to the implementation factors: employee participation, communication and the dialogue on stress. The assumption was that, when employees participated in the intervention, were satisfied about the communication, and the dialogue on work stress had increased during the intervention, this would form a proxy of implementation success, and the intervention would be more likely to result in positive effects on job demands and resources (H3) and on work stress and job satisfaction (H4).

In line with these hypotheses, results of the quantitative analyses suggest that employees who are more satisfied with the communication about the intervention, appeared to have benefited more from the intervention. Results show that the level of satisfaction with the communication over the intervention did affect favorable changes between baseline and follow up in autonomy and job satisfaction.

The level of participation of employees in the intervention did not appear to affect changes on job demands, resources and outcomes. Regarding the dialogue on stress, the results were somewhat inconclusive. Although participants explicitly mentioned the dialogue on stress within the school as a key feature of the work stress prevention approach, the results of the analyses show that in fact the level in which the intervention increased the dialogue on work stress between employees and management, was related to less of an increase in job demands between baseline and follow up. Respondents who reported an increase regarding the dialogue between employees and management on work stress showed less of a decrease in job demands. A possible explanation is that the dialogue between the employees and management may have led to extra tasks, at least at short term. Discussing work stress and its causes, may result in actions that have to be carried out to improve the situation. This often requires a time investment before benefits can be experienced. An additional measurement, a second follow-up, could provide more insights into the development of job demands over time.

In sum, the results of the quantitative analyses suggest that the intervention was related to positive improvements in job demands and job satisfaction. In addition, results indicate that satisfaction with the communication about the intervention was related to improvements in autonomy and job satisfaction. Furthermore, results show that an increased dialogue between employees and management was related to less of a decrease in job demands.

The interviews provided more detailed information about the success of the implementation process. These results showed that working groups have put effort in the communication about the work stress prevention approach towards employees. However, the working group members and the intervention facilitator mentioned that it was challenging to keep employees involved and they believed that improvements could be made in relation to communication. Considering the results of the quantitative analyses, it is worthwhile to invest in good communication. For future interventions it is recommended to plan more meetings with all personnel to inform and involve them also during the implementation phase (Step 4), since the focus group (Step 2) and brainstorm sessions (Step 3) with all personnel were highly appreciated by employees.

Results from the interviews suggest that the intervention has increased the dialogue on stress between employees, as well as between employees and management and raised the attention for managing work stress. Participants explicitly mentioned the dialogue within the school on work stress as a key value of the work stress prevention approach. However, the effects of the increased dialogue between employees and management are somewhat inconclusive considering the fact that an increased dialogue between employees and management was related to less of a decrease in job demands.

Strengths and weaknesses

A strength of the present study is that it involved the evaluation of an intervention implemented at five different schools, each with its own organizational context, making it possible to draw more general conclusions about the work stress prevention approach as such. In addition, the mixed method design that was used, combining quantitative data based on questionnaires and qualitative data based on interviews, and the inclusion of implementation factors in the quantitative analyses, make it possible to get a more detailed insight into the implementation process and the results of the intervention as experienced by employees. Although the sample sizes of the different schools were too small to make a comparison between schools, the response rates at the schools were quite high (at pretest as well as posttest response rates were higher than 70%) and group analyses could be performed using multilevel techniques. It has to be noted that, like the schools that participated in this study, primary schools in the Netherlands are quite small in relation to other countries (e.g. US), which may have consequences for the generalizability of the results.

The absence of a control group makes it a bit more difficult to attribute changes between baseline and follow up to the intervention. Implementation factors were measured to get an indication of the success of the implementation and were added in the analyses to explain changes between baseline and follow up on the job demands, resources and outcomes. Although the results suggest that satisfaction with communication about the intervention, an important indicator for the implementation success, is related to intervention effects on autonomy and job satisfaction, additional research is needed to look further into the mechanisms of different implementation factors (e.g. participation, involvement, communication, dialog).

For future research it would be interesting to look again at effects of the intervention and at the influence of the implementation factors. Adding a third measurement might give more insight in the effects in time and the sustainability of the effects.

Despite the limitations that are discussed above, the study shows a decrease of job demands and an increase in job satisfaction in the schools that implemented the stress prevention approach. The study has provided valuable insights into the impact of the implementation of the work stress prevention approach linking the level of implementation of the intervention to improvements in autonomy and job satisfaction. Results of the study underline the importance of communication about the intervention as part of the implementation process, impacting the effectiveness of the intervention on autonomy and job satisfaction.

Availability of data and materials

Due to the privacy of the participants, the dataset generated and analysed during the study is not publicly available. On reasonable request data are available from the corresponding author.

Abbreviations

European framework for psychosocial risk management

Hypothesis 1–4

Medical Research Involving Human Subjects Act

Job content questionnaire

Utrecht work engagement scale

Intraclass correlation coefficient

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Acknowledgements

The authors would like to thank Arbeidsmarktplatform PO, all participants of the primary schools and the intervention facilitator for their participation.

The implementation of the stress prevention guideline and data collection was funded by Arbeidsmarktplatform PO. The writing of the article was funded by TNO and financially supported by the Ministry of Social Affairs and Employment in the Netherlands. Funding bodies had no role in the selection of the study design, the collection, analysis and interpretation of the data, or the writing of the manuscript.

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MBR conducted the study and was responsible for data collection and drafting the article. RS, NW, IH and PB provided intellectual input. All authors provided comments on the draft versions. All authors have read and approved the final version of the manuscript.

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All researchers are employed at TNO and perform their work in alignment with the corporate code for research integrity. In the Netherlands, a study needs ethical approval when it falls under the scope of the Medical Research Involving Human Subjects Act (WMO). Then it must undergo a review by an accredited MREC or the CCMO. In general, research with human subjects only falls under the WMO if there is an infringement of the physical and/or psychological integrity of the subject [ 53 ]. As stated in Paragraph 1, Article 1b of the WMO, in the Netherlands research is subject to the WMO if two criteria are met: 1) the study concerns medical scientific research, and 2) participants are subject to procedures or are required to follow rules of behaviour. As present investigation does not concern medical scientific research the first criterium is not met, and an official approval by a Medical Ethical Review Board is not obligatory [ 52 ]. For this reason, the study did not require ethical approval at that time. From 15 March 2018 onwards, all human-related research that is not subject to WMO is reviewed by the Netherlands Organization for Applied Scientific Research Institutional Review Board. This study was carried out before this date and therefore not reviewed ethically.

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Bakhuys Roozeboom, M.C., Schelvis, R.M.C., Houtman, I.L.D. et al. Decreasing employees’ work stress by a participatory, organizational level work stress prevention approach: a multiple-case study in primary education. BMC Public Health 20 , 676 (2020). https://doi.org/10.1186/s12889-020-08698-2

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Exercises • 7 min read

Under Pressure: a Stress Management Case Study

Helping team members reflect on the symptoms of stress and how to alleviate it.

By the Mind Tools Content Team

This plausible case study will enable participants to recognize the symptoms of stress in themselves or in colleagues and take action to remedy the situation.

Participants will be able to …

• develop a higher level of awareness of stress in the workplace
• highlight the symptoms of stress and recognize them in themselves and in colleagues
• learn methods of dealing with stress in the workplace

Facilitator’s Guide

This straightforward case study requires little in the way of facilitation but mingle with the groups and be on hand to answer any questions or prompt discussion.

It could be used as part of a stress management workshop or stress awareness campaign. It would work best with groups of up to six participants. Allow just over an hour for completion.

Suggested Resources

• copy of task sheet per delegate
• white board or flipchart

What to Do (35 Minutes)

• Introduce the case study explaining its objectives to the participants.
• If you are dealing with a larger group, split them into sub–groups of five or six people.
• Distribute the task sheets amongst participants and allow 30 minutes for completion.

Review Activity (10 Minutes)

Bring the group(s) back to discuss their results. Possible answers to the questions could include the following:

1. What behavioral and psychological changes in Jen suggest that she may be stressed? Jen has become short–tempered, forgetful, intolerant, feels constantly anxious, her concentration is impaired and she is under–eating.

2. Can you list two other behavioral changes suggestive of stress? This could include any two of the following:

• aggressive behavior
• pessimistic and negative
• increased alcohol/drug use or smoking
• carelessness
• over–eating
• withdrawal and listlessness

3. What physical symptoms is Jen showing that suggest she may be stressed? Jen has decreased appetite, sleep disturbance, weight loss and she is susceptible to minor illnesses.

4. List five other physical symptoms or signs of stress. This could include any of the following:

• tightness of the chest, neck, jaw, face, abdomen, shoulder and back muscles
• hunched posture and clenched fists
• breathing becomes shallow and rapid
• irritable bowel symptoms such as diarrhea or constipation
• shaking hands
• chronic (long–term) pain
• facial expression shows tension – frown, tightened eyebrows, clenched jaw, pursed lips

5. If you were Ahmed, what would you do to help Jen? There are a number of approaches Ahmed could take to help Jen. Depending on his seniority, he may be able to take action in one of the following ways:

• arrange a meeting with Jen. Give her some notice, and outline why you want to meet her. You’re concerned about her health and you want to establish if it is work related. If so, establish what can be done to resolve these issues and to support Jen
• allow half a day, in private, perhaps away from the workplace, to explore your observations and Jen’s response in detail
• review the project objectives, timescales, resources, processes. Establish realistic goals and think creatively around overcoming the constraints. But, the constraints must be addressed
• assign another project manager to co–manage the project with Jen
• look at the hours that Jen is working and, if they are excessive, try to reduce them
• change the hours of Jen’s work week so that she is not traveling in rush-hour traffic
• offer Jen the opportunity to work from home where appropriate

In addition to the above, he could also:

• encourage Jen to take up a sport or a hobby
• suggest that she takes up yoga
• suggest that she speaks to her GP who may refer her on to a counselor or suggest other forms of treatment
• encourage her to investigate other methods of relaxation including aromatherapy, relaxation exercises and breathing exercises

It could be that Jen would find some of these options intrusive, others less so. Make sure that the group is aware of the sensitivities surrounding this.

This list is by no means exhaustive. There are positives and negatives surrounding each of these suggestions. Make sure that you cover all of these with the group.

Apply Learning (15 Minutes)

Ask participants to work individually for five minutes and either select a colleague they are concerned about, or themselves and list up to three:

• behavioral or psychological changes
• physical symptoms

Encourage them to select a learning partner if they wish and discuss what they can do to manage their own stress or how they can help/support their colleague.

Under Pressure – Task Sheet

Jen Breeze is a project manager for Techtron, a multinational IT consultancy. She has always enjoyed her work, but has recently found herself under increasing pressure in the workplace. Although when in her early 20s and 30s Jen ‘thrived on stress’ she feels that now, at 45, her work is taking a toll on both her health and her personal life.

Jen was recently assigned to work on her biggest project to date. As an experienced manager, she recognizes that both the budget and the timescale for the project are highly unrealistic. She has discussed her concerns with senior management, but her words fell on deaf ears. She knows that she is accountable for the success of the project and feels constantly uneasy. She has even found herself lying thinking about it in the early hours of the morning. On top of this, Jen has to drive 30 miles, each way, every day to reach work through rush-hour traffic.

A senior colleague, Ahmed Nazir, meets with Jen in the staff canteen for lunch on a regular basis, and has seen a gradual change in her over the last few months. She never seems to listen to him anymore and he has difficulty holding a sensible conversation with her. She looks tired and rarely eats much. He finds her forgetful and is concerned that this will have a knock-on effect on the quality of work that she is producing. He is, however, more worried about Jen and wants to help.

Jen herself is also worried, not only about the forthcoming project launch meeting, but about herself. Although Jen has a reputation for being approachable, she has found herself regularly ‘snapping’ without good reason at team members. At home too, she feels that she is short–tempered and intolerant of her husband. She feels ‘wound up’ all the time and can’t seem to relax. She knows that she has inadvertently lost a significant amount of weight. Her friends complain that they have not seen her in weeks, but she cannot face the simple task of phoning them. To make matters worse she has had a recurring cold for over three months and has been unable to shake it off. The thought of going into work each day fills her with dread and she is unsure how much longer she can go on functioning like this.

Task Consider the following questions:

• What behavioral and psychological changes in Jen suggest that she may be stressed?
• Can you list two other behavioral changes suggestive of stress?
• What physical symptoms is Jen showing that suggest she may be stressed?
• List five other physical symptoms or signs of stress.
• If you were Ahmed, what would you do to help Jen?
• If you were Jen what steps would you take to help yourself, and the project?

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16 Causes of Workplace Stress & How to Prevent Its Effects

• Are you falling behind with your work commitments?
• Snappy with loved ones and having trouble sleeping?
• Are you working long hours yet not getting enough done?

If your job demands more than you can deliver, you could be experiencing workplace stress (Schwartz & McCarthy, 2014). According to the American Psychological Association (2018), “everyone who has had a job has, at some point, felt the pressure of work-related stress.”

While seemingly inevitable, we can do much to prevent stress and reduce its effects. This article explores many of the causes and introduces practical measures that help.

Before you continue, we thought you might like to download our three Stress & Burnout Prevention Exercises (PDF) for free . These science-based exercises will equip you and your clients with tools to better manage stress and find a healthier balance in your life.

This Article Contains:

The psychology of workplace stress, symptoms of workplace stress: 3 examples, 16 possible causes of stress at work, 5 negative effects of workplace stress, how to manage stress according to research, 9 tips to prevent workplace stress, our stress-relief resources & more, a take-home message.

“Stress is one of the major reasons employees cite for their absence from work, and stress-related absence is increasing.”

Neenan, 2018, p. 92

Unfortunately, chronic stress is all too common in the workplace. According to the American Psychological Association’s (2020) annual Stress in America survey , work is consistently cited as one of the top sources of stress in people’s lives.

What is stress?

It is important to begin by understanding what we mean by the term stress.

Definitions of stress typically fall into three categories (Gross, 2020, p. 199):

• “Stress as a stimulus. ”
• “Stress as a response. ”
• “Stress as an interaction between an organism and its environment.”

Each category is a good match for the three models of stress most often used in research (Gross, 2020):

• Engineering model Suggests that external stressors ( stimuli ) produce a stress reaction in the individual. Stress is what happens to the person, not within the person.
• Physiological model Focuses on what happens within the person in response to the stress.
• Transactional model A blend of the other two models concerned with the relationship between the person and the environment.

This article mainly focuses on the transactional model, looking at what causes workplace stress ,  its effects , and how we cope.

Workplace stress

According to former associate director of the Centre for Stress Management and Cognitive-Behavioral Therapist Michael Neenan (2018), stress is the result of pressures exceeding our ability to cope with them.

If we experience too much stress in the workplace, we become psychologically overwhelmed and unable to avoid the tensions found in our jobs (American Psychological Association, 2018).

Resilience and stress

Psychology literature broadly agrees that resilience offers a buffer against stress (Rutter, 1985, 2012).

While the popular view of resilience concerns bouncing back from adversity or stressful situations, Neenan (2018) suggests that building resilience requires us to face adversity, handle it, and ultimately return stronger.

Most importantly, resilience and the capacity to handle stress are for everyone , not just the extraordinary few (Neenan, 2018). Crucially, resilience can be learned and grown using lessons from Cognitive-Behavioral Therapy (CBT).

CBT’s strength in handling stress and difficult situations involves recognizing what can be changed and what cannot (yet), as follows (modified from Neenan, 2018):

• If you can change some, or all, of the situation, then take the required steps to do so.
• If you cannot change any aspect of the situation, then make every effort to change your emotional reaction to it.
• If you can change some or all of the situation, but your degree of emotional distress means you can’t see that as an option, then moderate that distress before taking practical problem-solving steps.

This CBT approach (along with other therapeutic treatments) has proven successful in managing difficult situations while handling and reducing stress.

After all, “you can’t always avoid the tensions that occur on the job. Yet you can take steps to manage work-related stress” (American Psychological Association, 2018).

With more people working remotely and able to work anytime and anywhere, there is even more spillover of workplace stress into our home lives (Stitch, 2020).

“A stressful work environment can contribute to problems such as headache, stomachache, sleep disturbances, short temper, and difficulty concentrating.”

American Psychological Association, 2018

Over time, the symptoms of workplace stress may become chronic, damaging physical and mental health.

Prolonged occupational stress resulting from extended, frequent, or intense stressors leads to distress, occurring in one or more of the following forms (Quick & Henderson, 2016).

Medical distress

The impact of long-term stress on the body is profound and well documented. Research has linked shift work, hazardous working conditions, and social hazards (all factors known to increase stress) with cardiovascular disease.

Other studies indicate that stress is an important factor in “the onset of cancers and having an indirect role in worsening the disease and limiting recovery” (Quick & Henderson, 2016, p. 3).

Surprisingly, an increased risk of physical injuries – the fourth leading cause of death – has also been linked to stress.

Psychological distress

Two of the leading and most severe psychological impacts of stress include the increased likelihood of anxiety and depression (Quick & Henderson, 2016).

Depression is ranked as one of the most significant factors in illness, disease, and loss of productivity in the workplace, affecting around 16% of adults (Quick & Henderson, 2016). Prolonged stress can also lead to anxiety disorders and burnout, with high costs to the individual and the organization.

Behavioral distress

Stress is also a significant factor in behavioral distress, increasing drug use, including reliance on tobacco, alcohol, and prescription and illicit drugs.

Download 3 Free Stress & Burnout Prevention Exercises (PDF)

These detailed, science-based exercises will equip you or your clients with tools to manage stress better and find a healthier balance in their life.

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Stress at work has many causes, often specific to the individual and the workplace. Common workplace stressors include (American Psychological Association, 2018; Neenan, 2018):

• Longer working hours impacting work–life balance
• Job insecurity
• Excessive and tiring commutes
• Increasing work demands
• Unrealistic deadlines
• Limited opportunities for growth, development, or advancement
• Challenging or difficult colleagues
• Too many meetings
• Email overload
• Incompetent or uncaring managers and supervisors
• Meaningless targets
• Constantly changing technology
• Lack of social support
• Insufficient control over job-related decisions
• Conflicting job demands and unclear performance expectations

In most cases, multiple stressors combine to produce our work-related stress, differing in severity through the day and even our career.

While the highest performers can often survive and thrive in stressful environments, stress remains overwhelming and damaging for the rest of us (Kovacs, 2007).

The adverse effects of workplace stress can take many forms, including the following (Contrada & Baum, 2011):

Unhealthy eating

Research shows that stress impacts not only our physiology, but also our behavior. High levels of stress can be associated with both increased (e.g., saturated fat consumption) and decreased (e.g., overall calories) food intake (Contrada & Baum, 2011).

Studies in adolescents and adults have also shown they consume more snacks when stressed (Contrada & Baum, 2011).

Recreational drug use

Stress is associated with a marked increase in recreational drug use – legal (e.g., alcohol, nicotine, and caffeine) and illegal (e.g., heroin and cocaine). While the exact reasons for the association may vary, they may include the belief that drug use can reduce stress. Further complicating matters, physical and psychological reactions to abstaining from previously self-administered drugs can increase stress as a symptom of withdrawal (Contrada & Baum, 2011).

Burnout & workplace stress

Prolonged stress in the workplace often leads to burnout and is particularly likely in suppliers of critical services to the public. During natural disasters or health crises, healthcare and emergency service workers often work long hours over many days and weeks, reporting severe psychological distress (Moss, 2021).

Can workplace stress cause depression?

Workplace stress has a significant impact on the incidence and duration of depression. However, research has found that improving workers’ ability to cope and manage stressful situations through stress management programs (including cognitive-behavioral approaches) reduces absence rates due to sickness and staff turnover, and eases depressive symptoms (Mino, Babazono, Tsuda, & Yasuda, 2006).

Negative effects at the company level

While stress can be harmful to the employee, it also has the potential to damage the company due to increased staff absence due to sickness, poor productivity, high turnover, low morale, poor motivation, and increased employee complaints (Attridge, 2017).

The American Institute of Stress estimates the cost of stress to U.S. industry to be over $300 billion annually.

The cost of workplace stress – and how to reduce it – Rob Cooke

The American Psychological Association (2018) offers several research-based techniques for managing stress, at work and beyond:

• Track your stressors. Keep a journal and track situations that create the most stress over several weeks and how you handle them. What are you thinking? How does it feel? In what environments do the stressors (people, circumstances, physical) appear? You are looking for patterns in what is causing stress and how you react.
• Develop healthy, helpful, and positive responses. We often rely on unhealthy choices to cope with stress: fast food, alcohol, or a cigarette. Look for healthy ways to de-stress, such as exercising (even a fast walk will help), getting into nature, meeting with friends, meditation, or yoga. Good sleeping habits are also essential.
• Establish boundaries. In our always available online world, it is increasingly important to set clear work–life boundaries. Don’t check emails after your evening meal or over the weekend. Agree to only talk (or vent) about work for 30 minutes when at home .
• Recharge and switch off. We need time to reach our pre-stress balance. Walking after work (whether working remotely or in the office) or using the commute to listen to music or an audiobook can encourage the transition between work and home life. Such practices can help by bookending the workday, disconnecting, and focusing on non-work activities.
• Learn how to relax. While it sounds easy, learning to relax may take practice until it becomes a habit. Find ways to experience the present moment, perhaps using breathing exercises, mindfulness techniques, savoring a meal , or listening to music.
• Talk to your supervisor. It is in your boss’s interest for you to be happy, healthy, and in a positive and productive working environment. Talk to your manager to develop a realistic plan for managing or removing stressors. Being given more meaningful tasks may help.
• Seek support. Support is often all around us when we look. Friends, family, and employee support programs can help you manage stress and adopt more healthy coping mechanisms.

Stress doesn’t always need to be bad. By encountering stress and learning how to cope, we can grow and develop greater resilience to make future situations less difficult. Remember, “resilience is about managing emotions, not suppressing them” (Neenan, 2018, p. 9).

The following tips help reduce the likelihood of feeling overloaded and overwhelmed (modified from Halvorson, 2014):

• Practice self-compassion , permitting yourself to make mistakes. Rather than dwell on the past, learn from it and improve your performance.
• Picture the overall goal or purpose and reflect on the why behind your behavior. You will be more likely to stop and plan rather than burn too much energy on being busy.
• Use routines whenever possible. Each new task and choice takes time and creates mental tension, so find ways to reduce the number of decisions.
• Interesting activities replenish energy. Being curious and finding something that captivates you will help you recharge.
• Add when and where to every item on your task to avoid the week slipping away without getting everything done on time.
• Consider situations and events that trigger stress. Come up with a set of if–then plans (e.g., “ If X happens, I will do Y .”). Planning for the worst will leave you prepared and less stressed if it happens.
• Striving for perfection can lead to procrastination and even burnout. Focus on being good and on improving, rather than setting standards you can’t meet.
• Reflect on past successes and the progress you have already made. You have come a long way; give yourself the credit you deserve.
• Recognize what motivates you. Life is full of opportunities; find what excites you and apply yourself to the challenge.

17 Exercises To Reduce Stress & Burnout

Help your clients prevent burnout, handle stressors, and achieve a healthy, sustainable work-life balance with these 17 Stress & Burnout Prevention Exercises [PDF].

Created by Experts. 100% Science-based.

Before looking at a sample of the many worksheets and exercises we have available, you might like to download our three Stress & Burnout Prevention Exercises (PDF) for free .

These science-based exercises were sourced from our Positive Psychology Toolkit© , an online collection of over 400 mindfulness-based exercises, interventions, and tests. They will equip you and your clients with tools to better manage stress and find a healthier balance in life.

For some additional free stress-relief tools to help you or your client better manage stress, check out the following:

• Squeeze and Release This group activity helps participants discover the energizing potential of positive stress, known as  eustress , which can help improve motivation, performance, and emotional wellbeing.
• Coping With Stress This two-part exercise invites clients to list experienced physiological and emotional symptoms of stress and brainstorm strategies to reduce, cope with, or eliminate these sources of stress.
• Coping: Stressors and Resources This worksheet helps clients identify past, present, and future stressors and link them with coping resources they can use to overcome them.
• Identifying Your Stress Resources This worksheet helps clients identify external resources they can connect with and draw strength from during stressful times.
• One Hour Stress Plan This worksheet provides a 60-minute action plan for dealing with intense demands, helping clients work systematically through a list of tasks that require their most urgent attention.

17 Stress & Burnout Prevention Exercises If you’re looking for more science-based ways to help others manage stress without spending hours on research and session prep, check out this collection of 17 validated stress management tools for practitioners . Use them to help others identify signs of burnout and create more balance in their lives.

Stress affects us all. While a certain amount of pressure in the workplace can be invigorating and even exciting, too much for too long can damage our physical and mental wellbeing.

Increased stress potentially leads to cardiovascular disease, cancer, poor sleep, difficulty concentrating, damage to relationships, and more (American Psychological Association, 2018; Quick & Henderson, 2016).

Psychological distress is also a significant factor in burnout and can lead to depression and other mental health issues.

For employers, having a stressed staff results in lost productivity, absenteeism, and the risk of accidents and legal proceedings.

It doesn’t have to be this way. Stress can be managed and even become positive by addressing, reducing, or removing some of the causes; establishing boundaries between work and life outside; and allowing staff to recharge.

Review the theoretical background to stress, understand its causes (for you or your client), and adopt tools and techniques that reduce feelings of being overloaded and overwhelmed. Over time, it is possible to form helpful habits, discard old negative ones, and change our relationship to stress.

We hope you enjoyed reading this article. Don’t forget to download our three Stress & Burnout Prevention Exercises (PDF) for free .

• American Psychological Association. (2018). Coping with stress at work . http://www.apa.org/topics/healthy-workplaces/work-stress
• American Psychological Association. (2020). Stress in America: A national mental health crisis.  Retrieved August 26, 2021, from https://www.apa.org/news/press/releases/stress/2020/sia-mental-health-crisis.pdf
• Attridge, D. (2017). Effects of work-related stress . University of Cambridge Human Resources. Retrieved August 26, 2021, from https://www.hr.admin.cam.ac.uk/policies-procedures/managing-stress-and-promoting-wellbeing-work-policy/policy-statement/effects
• Contrada, R. J., & Baum, A. (2011). The handbook of stress science: Biology, psychology, and health . Springer.
• Gross, R. D. (2020). Psychology: The science of mind and behaviour . Hodder and Stoughton.
• Halvorson, H. (2014). Nine ways successful people defeat stress. In HBR guide to managing stress at work (pp. 1–11). Harvard Business Review Press.
• Kovacs, M. (2007). Stress and coping in the workplace . The British Psychological Society. Retrieved August 25, 2021, from https://thepsychologist.bps.org.uk/volume-20/edition-9/stress-and-coping-workplace
• Mino, Y., Babazono, A., Tsuda, T., & Yasuda, N. (2006). Can stress management at the workplace prevent depression? A randomized controlled trial. Psychotherapy and Psychosomatics , 75 (3), 177–182.
• Moss, J. (2021). Rethinking burnout. In HBR guide to beating burnout (pp. 1–13). Harvard Business Review Press.
• Neenan, M. (2018). Developing resilience: A cognitive-behavioural approach . Routledge.
• Quick, J., & Henderson, D. (2016). Occupational stress: Preventing suffering, enhancing wellbeing. International Journal of Environmental Research and Public Health , 13 (5), 459.
• Rutter, M. (1985). Resilience in the face of adversity: Protective factors and resistance in psychiatric disorder. British Journal of Psychiatry , 147 (1), 598–611.
• Rutter, M. (2012). Resilience as a dynamic concept. Development and Psychopathology , 24 (2), 335–344.
• Schwartz, T., & McCarthy, C. (2014). Manage your energy not your time. In HBR guide to managing stress at work (pp. 53–80). Harvard Business Review Press.
• Stitch, J. (2020). A review of workplace stress in the virtual office. Intelligent Buildings International , 12 (3), 208–220.

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Work and mental health

On this page, mentally healthy work and why it matters, what influences mental health at work, building a mentally healthy workplace, your mental health at work, supporting someone at work, rights and obligations.

• Protect against risks to mental health. Mentally healthy work prevents harm to your mental health. Among other things, this means fair workloads. Fair work practices. And a safe environment.
• Promote wellbeing and the positive aspects of work . Mentally healthy work means things such as fairness, inclusion, and employee development. Good culture thrives from good work.
• Support people with poor mental health. In a mentally healthy workplace, your mental health is prioritised. Awareness, capability, commitment, and meaningful support exist. To help workers feel better, earlier.

Key facts - mental health at work

• Nearly 1 in 5 people experience poor mental health each year. Nearly half of us will experience poor mental health during our lives.
• Many people spend a third of their lives at work.
• Poor mental health costs the Australian economy from $12.2 to 22.5 billion each year (according to the Australian Government Productivity Commission).
• Work is a key setting to improve and support mental health.
• improves productivity
• improves commercial outcomes
• helps attract and retain staff.

Research has shown that investment in mental health has a positive return on investment. This can range from an average of $2.30 upwards for each dollar invested. Learn more about this research on the Mentally Healthy Workpla  ces website

• clarity on what you’re doing
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• having the training, skills and tools to perform your work
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• exposure to traumatic events or information.

Good work design

Practical tools to improve mental health at work, the key to change.

• commitment from leadership
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Practical tools to stay well at work

Check your mental health.

In Australia, there are protections and responsibilities relating to mental health in discrimination, privacy, and work health and safety laws.

Work health and safety

Workplace health and safety (WHS) laws require work to be reasonably safe for all. This includes measuring and managing risks to mental health. Learn more about WHS and mental health on the SafeWork Australia website . You can find links to your local Work Health and Safety Regulator at the bottom of this page.

Discrimination

Disability discrimination laws make it unlawful to discriminate against people with disabilities, including mental health conditions. Discrimination includes both direct and indirect actions. So not making reasonable adjustments to support your needs can be a type of discrimination. Find information about the Disability Discrimination Act on the Australian Human Right Commission website . Learn about reasonable adjustments. The Fair Work Act prohibits an employer from taking action against a worker for discriminatory reasons. Learn more about protection from discrimination at work on the Fair Work Ombudsman website . ​

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Opinion The case for a 32-hour workweek with no loss in pay

Bernie Sanders, an independent, represents Vermont in the U.S. Senate. Shawn Fain is president of the United Auto Workers.

Although it is rarely discussed in the media, the Senate overwhelmingly passed legislation to establish a 30-hour workweek in 1933. While that legislation ultimately failed because of intense opposition from corporate America, a few years later President Franklin D. Roosevelt signed the Fair Labor Standards Act into law and a 40-hour workweek was established in 1940.

Unbelievably, 84 years later, despite massive growth in technology and worker productivity, nothing has changed.

Today, American workers are more than 400 percent more productive than they were in the 1940s. And yet, despite this fact, millions of our people are working longer hours for lower wages. In fact, 28.5 million Americans now work over 60 hours a week, and more than half of full-time employees work more than 40 hours a week.

The sad reality is, Americans work more hours than the people of most other wealthy nations. In 2022, U.S. workers logged 204 more hours a year than employees in Japan, 279 more hours than those in the United Kingdom and 470 more hours than those in Germany.

Despite these long hours, the average worker in America makes almost $50 a week less than he or she did 50 years ago, after adjusting for inflation.

Let that sink in for a moment. In a 1974 office, there were no computers, email, cellphones, conference calling or Zoom. In factories and warehouses, there were no robots or sophisticated machinery, no cloud computing. In grocery stores and shops of all kinds, there were no checkout counters using bar codes.

Think about all the incredible advancements in technology — computers, robotics, artificial intelligence — and the huge increase in worker productivity that has been achieved. What have been the results of these changes for working people? Almost all the economic gains have gone straight to the top, while wages for workers are stagnant or worse.

While CEOs are making nearly 400 times as much as their average employees, many workers are seeing their family lives fall apart, missing their children’s birthday parties and Little League Baseball games, as they are forced to spend more time at work. What stresses them out even further is that many still do not have enough money to pay rent, put food on the table and send their kids to college without going deeply into debt.

This should not be happening in the United States of America in 2024. It’s time for a 32-hour workweek with no loss in pay.

Let’s be clear. This is not a radical idea: Belgium has already adopted a four-day workweek. Other developed countries are moving toward this model, such as France (35-hour workweek and considering reducing to 32) and Norway and Denmark (roughly 37-hour workweeks). In 2019, Microsoft tested a four-day workweek in Japan and reported a 40 percent increase in productivity.

Last year, the United Kingdom conducted a four-day workweek pilot program of 3,000 workers at more than 60 companies, and it was a huge success for both workers and employers. Over 73 percent of workers who participated in this program reported greater satisfaction with their work. Businesses that participated in this program saw a 35 percent average increase in revenue, and 91 percent of businesses opted to continue a four-day workweek after the study concluded.

Studies have shown that workers are either equally or more productive during a four-day workweek — one study found that worker productivity rose , with 55 percent saying their ability at work increased after companies adopted this new schedule. In addition, 57 percent of workers in companies that have moved to a four-day workweek have indicated that they are less likely to quit their jobs.

Moreover, at a time when so many of our people are struggling with their mental health, 71 percent of workers in companies that have moved to a four-day workweek report feeling less burnout, 39 percent reported feeling less stress and 46 percent reported feeling less fatigued .

Even Bill Gates, the founder of Microsoft, and Jamie Dimon, CEO of JPMorgan Chase, predicted last year that advancements in technology could lead to a three- or 3½-day workweek.

The question is: Who will benefit from this transformation? Will it be the billionaire class or workers? In our view, the choice is obvious. At a time of massive income and wealth inequality and huge increases in productivity, the financial gains from new technology must go to workers, not just to the people on top.

As part of their historic contract negotiations with the Big Three automakers — General Motors, Ford Motor Co. and Stellantis (formerly Chrysler) — the United Auto Workers called for the introduction of a four-day, 32-hour workweek at the same rate of pay and overtime pay for anything beyond that.

Despite significant gains for workers in their new contract, they were not successful in winning that demand. The struggle continues.

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Perceptions of work stress causes and effective interventions in employees working in public, private and non-governmental organisations: a qualitative study

Kamaldeep bhui.

1 Barts and The London School of Medicine and Dentistry

Sokratis Dinos

2 BPP University, London

Magdalena Galant-Miecznikowska

Bertine de jongh, stephen stansfeld.

Aims and method

To identify causes of stress at work as well as individual, organisational and personal interventions used by employees to manage stress in public, private and non-governmental organizations (NGOs). Qualitative interviews were conducted with 51 employees from a range of organisations.

Participants reported adverse working conditions and management practices as common causes of work stress. Stress-inducing management practices included unrealistic demands, lack of support, unfair treatment, low decision latitude, lack of appreciation, effort–reward imbalance, conflicting roles, lack of transparency and poor communication. Organisational interventions were perceived as effective if they improved management styles, and included physical exercise, taking breaks and ensuring adequate time for planning work tasks. Personal interventions used outside of work were important to prevent and remedy stress.

Clinical implications

Interventions should improve management practices as well as promoting personal interventions outside of the work setting.

The conceptualisation of work stress is of crucial importance when developing interventions for the workplace. Work-related stress is defined as ‘a harmful reaction that people have to undue pressures and demands placed on them at work’. 1 As many as 440 000 people in the UK complain of work-related stress, depression or anxiety that makes them ill; nearly 9.9 million work days were lost as a consequence in 2014/2015. 1 The most recent Health and Safety Executive (HSE) report (2015) gives a prevalence of 1380 and an incidence of 740 per 100 000 workers, and also concludes that work stress is more common in public service institutions. 1 The estimated economic costs to the British economy as a result of stress at work are considerable, with £14.3 billion lost in 2013/2014, 2 and the higher costs in public service amount to £1.2 billion per year. 3

Work stress can lead to physical illness, as well as psychological distress and mental illness. 4 , 5 , 6 The recent increase in work stress has been linked with the global and national recession, 7 - 9 job insecurity and work intensity, all leading to greater workloads and more interpersonal conflicts, 3 and can have an impact on children's mental health through disrupted parenting. 10 Essentially, stress in the workplace may be the result of exposure to a range of work stressors and appears to arise when people attempt to manage their responsibilities, tasks or other forms of pressure related to their jobs, and encounter difficulty, strain, anxiety or worry in this attempt. 11 Work stressors can take different forms depending on the characteristics of the workplace, and may be unique to an organisation or an industry. 12 Theoretical models of stress consider it to be either related to adverse life events and stressful environments or the individual's physiological and psychological responses to stressors, or a ‘transactional’ interaction between the individual and environment. 13 , 14 – 17 Although theoretical models conceptualise stress as a result of an imbalance between perceptions of external demands and internal resources, the consensus between theoretical academic models and lay representations of definitions of stress is far from clear. Definitions of stress in the research literature as well as those reported by lay people vary considerably. For example, Kinman & Jones 18 found that there was a lack of consensus on conceptualisations of stress, and a number of different personal, social, environmental and work-related factors were used to define and interpret the meaning of stress. 11 Brooker & Eakin 19 suggest that concepts such as power or control in relation to gender and class are related to stress, yet models of stress do not explicitly take them into account. For example, Page et al 20 found that participants perceived stress as a feminine trait associated with weakness, thus few people admit to it.

Cahil, 16 Cooper et al 13 and Marine et al 21 describe categories of stress management interventions that target individuals or organisations; these can be further segmented as preventive interventions at primary, secondary or tertiary levels. 22 Primary interventions aim to prevent the causal factors of stress, secondary interventions aim to reduce the severity or duration of symptoms, and tertiary or reactive interventions aim to provide rehabilitation and maximise functioning among those with chronic health conditions. 23 Individual interventions may include stress awareness training and cognitive–behavioural therapy (CBT) for psychological and emotional stress. Organisational interventions affect groups of people at work and may include workplace adjustments or conflict management approaches in a specific organisation. Some interventions target both the individual and the organisation, for example policies to secure a better work–life balance and peer-support groups. Bhui et al 's systematic review 24 found that interventions that target individuals show larger effects compared with organisational interventions on individual outcomes such as levels of depression and anxiety. However, individual interventions did not improve organisational outcomes such as absenteeism, which is the most important indicator of loss of organisational productivity. The evidence gaps identified in this review included studies that compared different types of organisation (e.g. public, private and non-governmental organisation (NGO)), and studies that examine whether they employ and benefit from similar interventions, given that different sectors deploy very different business processes, levels and consistency of resources and profit focus, and public service or charitable objectives. Furthermore, studies tended to be based in work settings, rather than considering all interventions applied outside of work that people found helpful. 25

These evidence gaps continue to exist despite the growing body of research into work stress. Our systematic synthesis of the research evidence on managing work stress showed a wide variety of organisational settings, research methods and outcome measures, such that too many questions were being asked but few answered definitively. 24 We concluded that more empirical research was required, but that surveys were premature until there was a better understanding of:

• What work stress issues do employees and managers face on a day-to-day basis?
• What are organisations and employees already doing about work stress in the workplace and outside of work?
• What are the interventions that employees perceive to be the most effective when managing work-related stress?
• Should the approaches taken by public and private organisations and NGOs be distinct given the very different levels and consistency of resources, focus on profit, and public service or charitable objectives?

The present study used qualitative interviews to address these questions and to identify individual, organisational and personal interventions and their perceived effectiveness in managing work-related stress. Contrasts between different types of organisation were also investigated.

Participants

The sample used in this study was purposive (e.g. type and size of organisation, vocational role) and explored participants' experiences of work stress in the course of their working day. A total of 12 organisations took part in the study, of which 6 were public organisations, 4 were private organisations and 2 were NGOs. Three organisations were based outside London, whereas the remaining 9 were based in London. Organisations were from a variety of sectors, including education, health services, insurance, graphic design and betting agencies. The purposive sampling methods aimed to ensure as broad as possible a representation of organisations, levels of the organisation and types of work within the organisation.

For the organisations that met the inclusion criteria, the senior manager was contacted by telephone and informed about the nature of the study, and agreement was reached for participation in the study. The researchers selected a number of employees in different positions along the hierarchy so there is representation from different roles: 28 of the participants were in managerial roles, and the remaining were in non-management positions. We interviewed approximately 5 participants per organisation. A total sample of 51 employees (17 men and 34 women) took part in the study; 26 participants were aged 30 years or under, 17 were between 31 and 50 years and 8 were over 51 years old.

Procedure and topic guide

The topic guide was piloted on six employees who had experienced work stress. The content of these pilot interviews was used to refine the topic guide and to gain feedback from participants on clarity and appropriateness of the questions. Organisations were approached and invited to participate by e-mails containing information on the nature of the study and the data collection processes. Participation was voluntary; the interviews were conducted face to face and, whenever possible, at the interviewee's place of work. The interviews were semi-structured and lasted up to 45 minutes. The topic guide focused on factors that may cause stress and/or absence, personal experiences of and/or recommendations on managing stress at work and experiences of effective individual and organisational interventions to manage work-related stress (see the appendix for topic guide).

The interviews were transcribed verbatim, excluding any potentially identifying information. The data collected were subject to thematic analysis in order to identify and describe recurring themes. 26 Themes and subthemes were organised using the framework approach that is commonly used in policy-relevant qualitative research. 27 Charts were generated from the themes, the range and nature of the experiences were mapped, and patterns between and within themes were revealed. Typologies were iteratively generated to accommodate the data if existing themes were inadequate or were better grouped within a higher theme. Content analysis was also performed by counting the frequency of themes in order to identify their relative prominence in the data, and also to reveal types of interventions and contexts, and views about effectiveness. These frequencies are presented only to support the strength of the findings in these data rather than to estimate prevalence more generally. With this purpose in mind, the analysis proceeded until saturation was reached, and only themes on which saturation was reached are presented.

Data were organised by three higher themes that captured the aims of the study:

• perceived causes of stress at work
• individual and organisational stress management interventions and their perceived effectiveness
• personal interventions to manage stress at work.

Causes of stress at work

The narrative data on participants' understanding of factors that may cause stress at work suggested working conditions, management practices, nature of job, life events and financial factors ( Table 1 ). The majority of participants ( n = 42/51) referred to working conditions as a main source of stress. Working conditions were mainly related to factors such as workload, the physical environment (e.g. noisy offices, lack of windows, small rooms, and offices in which the temperature was either too low or too high for comfort), long working hours, heavy workloads and understaffing.

NGO, non-governmental organisation.

‘We are short [staffed] so two people cannot go on holiday at the same time, so it's such an inconvenience and … we are trying to cover the days, nights and it's like wrrrr … really stressful place to be … ’ (female, 24, NGO).

Working conditions were the main cause of stress regardless of the sector people worked in; people working in the NGO or the public sector more often referred to the physical environment and workloads as relevant factors. Private sector employees more often referred to long working hours and a lack of structure to the working day.

A similar number of participants ( n = 40) suggested that the nature of the job itself contributed to stress, with participants from private organisations and NGOs more often reporting this as a cause of stress. Participants attributed stress more specifically to a job with high unpredictability in what may be required from day to day, or a job that demands unsociable hours.

‘Shift work … I find that quite stressful because it affects my personal life because I have to work during the weekends and that's when most of my family and friends are off … ’ (female, 26, NGO).

Management practice was proposed as a cause of stress by more than half of the interviewees ( n = 32), but was least often implicated in the public sector organisations. Participants in high managerial positions (e.g. head of unit) tended to refer to management practice as a cause of stress less often than employees in non-managerial positions. However, for all other participants (e.g. middle management positions and employees) no differences were observed. Management practice as a cause of stress related to personal style of leadership, implicating lack of warmth and support with a feeling that staff were unimportant and not respected as people; insufficient praise or confidence-building were also important omissions that caused stress. Limited opportunities for decision-making (often referred to as low decision latitude) and lack of transparency as well as unrealistic demands, poor communication and effort–reward imbalance were all implicated.

‘That's what makes you angry, because there's nobody taking my case. As soon as this phone goes to my boss and they complain about me, nobody asks me what happened. And even if I'm right, they still apologise. Why? I've done nothing wrong. It's them. They've done the wrong thing’ (male, 45, public). ‘ … the message the organisation gives to you is that you don't really matter’ (female, 40, NGO).

Life events were identified as another contributor to the level of stress experienced by employees regardless of the type of organisation they worked for ( n = 21). Life events referred to problems with family or relationships, death and sickness, as well as trying to maintain a balance between work demands and responsibilities in the social and personal or family lives of respondents.

A small number of respondents ( n = 6) reported financial factors as a cause of work stress; financial strain causing work stress was related to working for organisations that lacked a benefits package, or in which the salary did not reflect the amount of effort invested in work. Job insecurity as a cause of work stress reflected fears about losing income and facing further financial strain.

Individual and organisational stress management interventions

Participants were asked about any interventions at their workplace for managing stress. Overall, participants referred less frequently to individual interventions; such interventions were also either secondary or tertiary. In particular, they were either psychological interventions such as face-to-face telephone or internet counselling, or educational interventions or training courses that taught practical skills such as organisational management and assertiveness ( Table 2 ).

NGO, non-governmental organisation; TOIL, time off in lieu.

Some patterns emerged in the use of individual interventions by type of organisation: NGOs were least likely to deliver individual interventions to employees, perhaps owing to cost. In terms of effectiveness, those participants who received one-to-one counselling interventions thought these were effective, mainly because they could be accessed promptly when needed.

‘So [I] went to my [general practitioner] GP and they set it up through my local authority for face-to-face counselling, so I was seeing the occupational therapist, [had] face-to-face counselling and that happened on my day off. So [I] could do some work at home, because I was very tired I didn't have the stress of having to get into work, so just took a bit off. So [it was] kind of a package of things that just assisted me for a while’ (female, 49, public).

Organisational interventions were more often mentioned by workers in public sector employment and in contrast to individual interventions, they were mainly primary or secondary ( Table 2 ). Most of these organisational interventions were related to management practices ( n = 35/51). In particular, participants mentioned efforts to develop a management style that was supportive and improved communication, as well as frequent team meetings and supervision and two-way feedback.

‘[The manager is] one of those people that make you feel appreciated, even if it's a little thing she will praise you for it. A lot goes for being praised, that in itself can take away stress. If someone turns around and says what you are doing is a fantastic job you feel good’ (female, 52, public).

A supportive organisational and team culture, a collective spirit including dialogue in groups and space for discussion, and educational and training courses to improve management skills were frequently reported as effective interventions to manage stress at work ( n = 27/51).

‘ … it's good that we all sit down together and discuss anything that may be causing a problem or tension, or anything we feel needs to be adjusted’ (female, 27, public).

Flexibility in working hours, well-planned shifts and environmental or structural interventions such as a staff room for relaxation were mentioned by almost a third of the participants as effective ways of managing work stress. Participants working in private sector organisations rarely report the existence of any interventions related to work structure (e.g. flexibility in work times), whereas in the public sector there was evidence of trying to introduce more flexibility.

‘ … time off in lieu […] seems to work quite well 'cos it's about that work–life balance’ (female, 54, public).

Almost half of participants ( n = 22) said training and career development opportunities in the workplace were effective for managing work-related stress, as they made them feel adequately informed and valued. Appropriate training and adequate equipment and resources allowed employees to perform their roles effectively. A small number of interviewees ( n = 3) suggested training in stress management was a useful intervention.

‘[My manager] is very good at sending people on training courses. I've just been on one which is positive interactions, which was telling you the right way of dealing with situations’ (female, 52, public).

Finally, a small number of participants ( n = 9/51) reported that there were a number of health promotion interventions (e.g. courses, exercise) at their workplace to help them prevent work stress. Participants thought that being subsidised for gym membership or being encouraged by their organisation to exercise during their working day were very effective interventions. None of the participants working for NGOs mentioned health promotion.

‘ … we're quite actively encouraged to do lots of exercise in this trust, we get lots of emails about walking to work, or running … I think linking exercise and well-being and being healthy at work […] I think that's always good, it would be good to have that in every institution’ (female, 28, public).

Personal interventions to manage work stress

Participants were asked general questions about their personal strategies to manage work stress. We were interested in personal interventions not provided by their employers but ones that were used and considered effective.

Table 3 shows the types of personal interventions used at work. Some interventions helped employees process stressful thoughts and think through difficult situations, akin to what CBT therapists might suggest as cognitive restructuring and tackling cognitive distortions – for example, focusing on positive rather than stressful situations, and using self-reflection to gain a better perspective.

Effective personal interventions to manage stress at work (total number of respondents: 51)

‘Yeah, yeah or if something happens I try and think, erm, so there's another technique I learnt in the last place I worked at was five questions so I ask, the why questions five times, why this? why is it causing stress? … because of this, why is that? Why is that? And I usually get to the root cause and that usually chills me out a bit if I deal with the root cause rather than the thing causing me the stress’ (male, 30, public).

Support from colleagues and friends was the most frequently reported personal intervention for managing stress at work.

‘I actually had to say to a colleague, “I can't see the wood for the trees here, can you help me?” and the colleague was absolutely brilliant and helped me so we got through it. I got some excellent help from a colleague yeah and that was someone I worked with in the team who does the same job as me. My manager was very supportive and helpful as well’ (male, 41, private).

Keeping oneself organised and maintaining a structured schedule at work were thought to be very effective personal interventions. These included planning, reducing overtime, prioritising tasks and keeping a better balance between work and personal life.

‘One of the signals for me is if my desk starts getting a bit messy, it means I'm chasing between too many projects and that's often the time when I personally just take stock, think, right, what do I need to do, look at a priority list, clear the decks again and sort of take a bit of a step back and review. So that's how I manage it and I find that to be helpful for me’ (male, 47, public).

Almost half of the participants ( n = 24) pointed out the importance of a healthy lifestyle when trying to manage stress at work. In particular, exercise was the most frequently reported personal intervention. Participants also acknowledge the importance of healthy eating as a means of maintaining a healthy weight and better health in general, both of which helped people to better manage stress at work.

‘Exercise is the most important thing for me for stress. So yeah, if I'm stressed, as long as I can, I'll often leave work at a decent time and go for a run and come back to work or go take my computer home and go for a swim and then do some more work. As long as I can make sure I can get some exercise in then I'm fine. It kinda works quite good 'cause I can generally take a longer lunch break and go to the gym at lunch and then, you know, work later or whatever it is. That's probably the most important flexibility for me at work is being able to have that’ (female, 32, private).

Finally, having out-of-work interests and leisure activities was reported by more than half of the participants ( n = 31). For example, participants mentioned relaxation during lunch breaks and going on holidays as an effective personal intervention.

‘We do get inspired by going to talks and design galleries and illustration events and all that sort of thing, they're hobbies as much as they are a career but, at the same time, I think that, in a way, [this] helps to alleviate the stress levels at work because what you're doing at work is part of your hobby as well’ (male, 30, private).

A mixture of personal, organisational and individual interventions were reported in our study, but these are not often captured together, with emphasis often being given to workplace changes or separate public health approaches to lifestyle and physical activity. 28 – 30 The majority of individual and organisational interventions reported were secondary and tertiary preventive interventions, with less emphasis on primary prevention.

High-demand and low-control situations and effort–reward imbalance related to working conditions, management style and the type of job were causing distress at work. 12 , 31 , 32 It is also important to address management practices as one of the most significant and consistent work-related stressors. Management practice as a stressor was also more prominent in private and NGO sectors than in the public sector and in middle and low management positions than in higher management ones. Participants identified poor communication with management, unfair treatment and, above all, the feeling of not being appreciated as the biggest sources of stress for them. Furthermore, many participants highlighted working conditions, such as physical environment, unsociable working hours and under-staffing, as causes of their work stress, the harmful effects of which have been identified in previous research. 18 , 33 Financial factors, mainly a lack of financial recognition by the organisation, were also reported as a cause of stress. According to Stranks, 11 when workers experience insufficient rewards in the form of salary or amount of praise received, or are missing recognition, the feeling of devaluation might appear and can contribute to an experience of work stress.

Interventions used by employees to manage stress at work: perceived effectiveness

Participants in the present study tended to report mainly the presence of primary and secondary organisational interventions (as opposed to individual interventions) at their workplace. With regard to individual approaches, these were mainly psychological interventions. Although there is much research that has documented the effectiveness of psychological interventions, these are usually provided at the secondary or tertiary level rather than for primary prevention. 34 – 36

Organisational interventions were discussed by the participants more frequently and were also more often perceived as effective in managing stress at work than individual interventions. One of the main reasons that organisational interventions were identified as an effective way of managing stress was because they were primary interventions with the aim to modify or eliminate environmental stressors. Participants in the present study identified the organisational interventions to manage stress at work as: job redesign, change of organisational culture, encouragement of participative management, introduction of work–life balance policies, flexible working and reconstruction of the organisation as well as improvement of organisational communications. 11 The literature on organisational interventions does not identify management practices as an intervention. The main reason may stem from the fact that management is seen as part of organisational structures rather than as potentially subject to modification to manage stress. Our findings highlighted management practices as an important workplace intervention, especially management characteristics such as open communication, supportiveness, approachability and being appreciative; these ranked the highest in terms of perceived effectiveness. Improving management practices as an intervention and introducing flexibility in working structures were much more apparent in the public sector as opposed to the private sector and the NGOs. Content analysis suggested that there may be a relationship between reported causes of stress and individual and organisational interventions. For example, stress was less often reported in the public sector because there were more management interventions than in other sectors, and these were perceived to be effective by the participants.

Most personal interventions identified by participants were related to health behaviours such as exercise, meditation and healthy eating, as well as leisure activities and social support from family and colleagues. Although personal interventions outside the workplace were not considered by the organisations, it is important to emphasise the power of such interventions and that they should be included in future intervention packages. For example, physical activity programmes have been among the few organisational interventions that show convincing effects on absenteeism in accord with our previous reviews, but physical activity could be encouraged more generally. 24 , 30 By adapting organisational interventions to capitalise on and encourage personal individual interventions outside the workplace, stress management in the workplace may be less necessary or more effective where it is needed.

Strengths and limitations

The results suggest that employees in private organisations and NGOs report more perceived causes of stress and have fewer interventions in place to help employees manage stress compared with public sector organisations, notably National Health Service (NHS) employers. We have listed potential organisational, individual and personal interventions that were used and found to be helpful. These might be tested as correlates of better workforce health and well-being and less work stress.

A limitation of the study was related to the sample characteristics. Although there were variations, especially with regard to type, size and location of the organisations involved, the sample consisted of only 12 organisations in total. A larger number of organisations would have provided us with more variety of occupations and organisation size and location, which would have given a more complete picture concerning the causes of stress and interventions between sectors. Our study is exploratory, and although these are perceived causes, the findings should not be understood in terms of epidemiological causal relationships, but rather as important ways in which workers think about and manage work stress, providing clues as to how interventions might be developed, tested and located in these work settings.

Qualitative studies offer new insights and provide the in-depth and experience-near perspectives of participants, rather than an overtheorised and superficial analysis. The findings will contribute to future in-depth work including more varied samples, as well as survey research to test for interventions that correlate with organisational measures of health and well-being. Future work should also consider how to improve management practices, as these seemed to have the most important influence on reducing work stress. More research is needed to further explore the differences between private, public and NGO sectors and different job types such as education and healthcare to examine whether they respond to the same or different intervention techniques. Finally, research needs to take into account compositional effects including the demographic characteristics of samples, and the cost effectiveness of interventions.

Topic guide

General questions to start the interview

• How do you find your job with regard to demands, pressure, working hours, etc.?
• Are there any elements in your job that you find stressful?
• What are the common organisational factors that can cause stress at work?
• What are the common individual factors that can cause stress at work?

Managing stress at work (both managing yourself and other people)

• If you manage other people, how do you manage stress?
• How do you manage other people's stress at work?
• How do you deal with this?
• What were/are the challenges?
• Can you give any examples?

Managing return to work (managing both yourself and other people)

• How do you manage your return to work after sickness?
• How do/did you manage their return to work after sickness?
• If no experience, how would you manage their return to work?

Policies: managing stress at work and return to work

• How has this policy been put together?
• How effective is it in practice?
• What are the strong and weak points of this policy, if any? Or
• How (in what ways) would you change this policy?
• 12. What would you say are the best (individual and organisational) policies for managing employee stress?
• 13. What would you say are the best (individual and organisational) policies for managing employee return to work after sickness absence?

Declaration of interest None.

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Over 70 Percent of Employees Blame Work Stress on Breakups and Divorces, Study Finds

Anyone who has ever held a particularly stressful position likely knows all too well the toll that it can take on your mental health. However, a new study found that, quite overwhelmingly, employees are finding work stress is spilling over into their personal lives and even impacting relationships.

The findings were part of the sixth annual workplace mental health trends report published by the meditation and mindfulness app Headspace. The company partnered with Dimensional Research to survey over 2,000 employees in the United States and U.K., as well as over 200 CEOs and 245 Human Resources leaders, to ask about their experiences with mental health and employee benefits.

Of those surveyed, nearly half of employees (47 percent) and two-thirds of CEOs (66 percent) said that the majority of the stress they experience comes from work, not their personal lives.

However, this stress is leading to an abnormally high rate of breakups and divorces, with 71 percent of respondents reporting that work stress caused a personal relationship to end. Another 39 percent say their ability to care for their family or children’s mental health had been negatively impacted; while 37 percent say that the stress contributed to serious mental health issues, such as substance abuse or suicidal thoughts.

More than three-quarters of respondents likewise say that work stress has had a negatively impact their physical health. And 75 percent have attributed weight gain to the stress they've experience.

But the findings weren't all doom and gloom. Work was also found to have a positive effect on employee wellbeing, with 53 percent saying their job helps them find a community of people with similar lived experiences and 48 percent reporting that work improves their confidence or all-around sense of self. "These positive impacts can drive deeper engagement at work and foster healthier workplace environments," the study writes.

If you or someone you know is in emotional distress or considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

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