management research journal articles

• Browse All Articles
• Newsletter Sign-Up

Management →

• 12 Mar 2024
• Research & Ideas

Publish or Perish: What the Research Says About Productivity in Academia

Universities tend to evaluate professors based on their research output, but does that measure reflect the realities of higher ed? A study of 4,300 professors by Kyle Myers, Karim Lakhani, and colleagues probes the time demands, risk appetite, and compensation of faculty.

• 29 Feb 2024

Beyond Goals: David Beckham's Playbook for Mobilizing Star Talent

Reach soccer's pinnacle. Become a global brand. Buy a team. Sign Lionel Messi. David Beckham makes success look as easy as his epic free kicks. But leveraging world-class talent takes discipline and deft decision-making, as case studies by Anita Elberse reveal. What could other businesses learn from his ascent?

• 16 Feb 2024

Is Your Workplace Biased Against Introverts?

Extroverts are more likely to express their passion outwardly, giving them a leg up when it comes to raises and promotions, according to research by Jon Jachimowicz. Introverts are just as motivated and excited about their work, but show it differently. How can managers challenge their assumptions?

• 05 Feb 2024

The Middle Manager of the Future: More Coaching, Less Commanding

Skilled middle managers foster collaboration, inspire employees, and link important functions at companies. An analysis of more than 35 million job postings by Letian Zhang paints a counterintuitive picture of today's midlevel manager. Could these roles provide an innovation edge?

• 24 Jan 2024

Why Boeing’s Problems with the 737 MAX Began More Than 25 Years Ago

Aggressive cost cutting and rocky leadership changes have eroded the culture at Boeing, a company once admired for its engineering rigor, says Bill George. What will it take to repair the reputational damage wrought by years of crises involving its 737 MAX?

• 16 Jan 2024
• Cold Call Podcast

How SolarWinds Responded to the 2020 SUNBURST Cyberattack

In December of 2020, SolarWinds learned that they had fallen victim to hackers. Unknown actors had inserted malware called SUNBURST into a software update, potentially granting hackers access to thousands of its customers’ data, including government agencies across the globe and the US military. General Counsel Jason Bliss needed to orchestrate the company’s response without knowing how many of its 300,000 customers had been affected, or how severely. What’s more, the existing CEO was scheduled to step down and incoming CEO Sudhakar Ramakrishna had yet to come on board. Bliss needed to immediately communicate the company’s action plan with customers and the media. In this episode of Cold Call, Professor Frank Nagle discusses SolarWinds’ response to this supply chain attack in the case, “SolarWinds Confronts SUNBURST.”

• 02 Jan 2024
• What Do You Think?

Do Boomerang CEOs Get a Bad Rap?

Several companies have brought back formerly successful CEOs in hopes of breathing new life into their organizations—with mixed results. But are we even measuring the boomerang CEOs' performance properly? asks James Heskett. Open for comment; 0 Comments.

• 12 Dec 2023

COVID Tested Global Supply Chains. Here’s How They’ve Adapted

A global supply chain reshuffling is underway as companies seek to diversify their distribution networks in response to pandemic-related shocks, says research by Laura Alfaro. What do these shifts mean for American businesses and buyers?

• 05 Dec 2023

What Founders Get Wrong about Sales and Marketing

Which sales candidate is a startup’s ideal first hire? What marketing channels are best to invest in? How aggressively should an executive team align sales with customer success? Senior Lecturer Mark Roberge discusses how early-stage founders, sales leaders, and marketing executives can address these challenges as they grow their ventures in the case, “Entrepreneurial Sales and Marketing Vignettes.”

• 31 Oct 2023

Checking Your Ethics: Would You Speak Up in These 3 Sticky Situations?

Would you complain about a client who verbally abuses their staff? Would you admit to cutting corners on your work? The answers aren't always clear, says David Fubini, who tackles tricky scenarios in a series of case studies and offers his advice from the field.

• 12 Sep 2023

Can Remote Surgeries Digitally Transform Operating Rooms?

Launched in 2016, Proximie was a platform that enabled clinicians, proctors, and medical device company personnel to be virtually present in operating rooms, where they would use mixed reality and digital audio and visual tools to communicate with, mentor, assist, and observe those performing medical procedures. The goal was to improve patient outcomes. The company had grown quickly, and its technology had been used in tens of thousands of procedures in more than 50 countries and 500 hospitals. It had raised close to $50 million in equity financing and was now entering strategic partnerships to broaden its reach. Nadine Hachach-Haram, founder and CEO of Proximie, aspired for Proximie to become a platform that powered every operating room in the world, but she had to carefully consider the company’s partnership and data strategies in order to scale. What approach would position the company best for the next stage of growth? Harvard Business School associate professor Ariel Stern discusses creating value in health care through a digital transformation of operating rooms in her case, “Proximie: Using XR Technology to Create Borderless Operating Rooms.”

• 28 Aug 2023

The Clock Is Ticking: 3 Ways to Manage Your Time Better

Life is short. Are you using your time wisely? Leslie Perlow, Arthur Brooks, and DJ DiDonna offer time management advice to help you work smarter and live happier.

• 15 Aug 2023

Ryan Serhant: How to Manage Your Time for Happiness

Real estate entrepreneur, television star, husband, and father Ryan Serhant is incredibly busy and successful. He starts his days at 4:00 am and often doesn’t end them until 11:00 pm. But, it wasn’t always like that. In 2020, just a few months after the US began to shut down in order to prevent the spread of the Covid-19 virus, Serhant had time to reflect on his career as a real estate broker in New York City, wondering if the period of selling real estate at record highs was over. He considered whether he should stay at his current real estate brokerage or launch his own brokerage during a pandemic? Each option had very different implications for his time and flexibility. Professor Ashley Whillans and her co-author Hawken Lord (MBA 2023) discuss Serhant’s time management techniques and consider the lessons we can all learn about making time our most valuable commodity in the case, “Ryan Serhant: Time Management for Repeatable Success.”

• 08 Aug 2023

The Rise of Employee Analytics: Productivity Dream or Micromanagement Nightmare?

"People analytics"—using employee data to make management decisions—could soon transform the workplace and hiring, but implementation will be critical, says Jeffrey Polzer. After all, do managers really need to know about employees' every keystroke?

• 01 Aug 2023

Can Business Transform Primary Health Care Across Africa?

mPharma, headquartered in Ghana, is trying to create the largest pan-African health care company. Their mission is to provide primary care and a reliable and fairly priced supply of drugs in the nine African countries where they operate. Co-founder and CEO Gregory Rockson needs to decide which component of strategy to prioritize in the next three years. His options include launching a telemedicine program, expanding his pharmacies across the continent, and creating a new payment program to cover the cost of common medications. Rockson cares deeply about health equity, but his venture capital-financed company also must be profitable. Which option should he focus on expanding? Harvard Business School Professor Regina Herzlinger and case protagonist Gregory Rockson discuss the important role business plays in improving health care in the case, “mPharma: Scaling Access to Affordable Primary Care in Africa.”

• 05 Jul 2023

How Unilever Is Preparing for the Future of Work

Launched in 2016, Unilever’s Future of Work initiative aimed to accelerate the speed of change throughout the organization and prepare its workforce for a digitalized and highly automated era. But despite its success over the last three years, the program still faces significant challenges in its implementation. How should Unilever, one of the world's largest consumer goods companies, best prepare and upscale its workforce for the future? How should Unilever adapt and accelerate the speed of change throughout the organization? Is it even possible to lead a systematic, agile workforce transformation across several geographies while accounting for local context? Harvard Business School professor and faculty co-chair of the Managing the Future of Work Project William Kerr and Patrick Hull, Unilever’s vice president of global learning and future of work, discuss how rapid advances in artificial intelligence, machine learning, and automation are changing the nature of work in the case, “Unilever's Response to the Future of Work.”

How Are Middle Managers Falling Down Most Often on Employee Inclusion?

Companies are struggling to retain employees from underrepresented groups, many of whom don't feel heard in the workplace. What do managers need to do to build truly inclusive teams? asks James Heskett. Open for comment; 0 Comments.

• 20 Jun 2023

Elon Musk’s Twitter Takeover: Lessons in Strategic Change

In late October 2022, Elon Musk officially took Twitter private and became the company’s majority shareholder, finally ending a months-long acquisition saga. He appointed himself CEO and brought in his own team to clean house. Musk needed to take decisive steps to succeed against the major opposition to his leadership from both inside and outside the company. Twitter employees circulated an open letter protesting expected layoffs, advertising agencies advised their clients to pause spending on Twitter, and EU officials considered a broader Twitter ban. What short-term actions should Musk take to stabilize the situation, and how should he approach long-term strategy to turn around Twitter? Harvard Business School assistant professor Andy Wu and co-author Goran Calic, associate professor at McMaster University’s DeGroote School of Business, discuss Twitter as a microcosm for the future of media and information in their case, “Twitter Turnaround and Elon Musk.”

• 05 Jun 2023

Is the Anxious Achiever a Post-Pandemic Relic?

Achievement has been a salve for self-doubt for many generations. But many of the oldest members of Gen Z, who came of age amid COVID-19, think differently about the value of work. Will they forge a new leadership style? wonders James Heskett. Open for comment; 0 Comments.

• 25 Apr 2023

Using Design Thinking to Invent a Low-Cost Prosthesis for Land Mine Victims

Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS) is an Indian nonprofit famous for creating low-cost prosthetics, like the Jaipur Foot and the Stanford-Jaipur Knee. Known for its patient-centric culture and its focus on innovation, BMVSS has assisted more than one million people, including many land mine survivors. How can founder D.R. Mehta devise a strategy that will ensure the financial sustainability of BMVSS while sustaining its human impact well into the future? Harvard Business School Dean Srikant Datar discusses the importance of design thinking in ensuring a culture of innovation in his case, “BMVSS: Changing Lives, One Jaipur Limb at a Time.”

Management Research

Issue(s) available: 69 – From Volume: 1 Issue: 1 , to Volume: 21 Issue: 4

• Issue 4 2023
• Issue 3 2023
• Issue 2 2023
• Issue 1 2023
• Issue 4 2022
• Issue 3 2022
• Issue 2 2022
• Issue 1 2022
• Issue 3/4 2021
• Issue 2 2021
• Issue 1 2021
• Issue 4 2020 Management Research and COVID-19: a quick response for action in Iberoamerica
• Issue 3 2020
• Issue 2 2020
• Issue 1 2020
• Issue 4 2019 Change and persistence in Latin American firm’s innovation
• Issue 3 2019
• Issue 2 2019 Healthy Organizations: Insights from Latin American Research
• Issue 1 2019
• Issue 4 2018
• Issue 3 2018
• Issue 2 2018
• Issue 1 2018
• Issue 4 2017
• Issue 3 2017 Location and dispersion of multinationals in Iberoamerica
• Issue 2 2017
• Issue 1 2017 Case Study Research in Mergers and Acquisitions
• Issue 3 2016
• Issue 2 2016
• Issue 1 2016
• Issue 3 2015 World in Transition: business, multiculturalism and society
• Issue 2 2015
• Issue 1 2015
• Issue 3 2014 Ethics, social responsibility and sustainability
• Issue 2 2014
• Issue 1 2014
• Issue 3 2013
• Issue 2 2013
• Issue 1 2013 Family firms in Iberoamerican countries
• Issue 3 2012
• Issue 2 2012
• Issue 1 2012
• Issue 3 2011
• Issue 2 2011
• Issue 1 2011
• Issue 3 2010
• Issue 2 2010
• Issue 1 2010
• Issue 3 2009
• Issue 2 2009
• Issue 1 2009
• Issue 3 2008
• Issue 2 2008
• Issue 1 2008
• Issue 3 2007
• Issue 2 2007
• Issue 1 2007
• Issue 3 2006
• Issue 2 2006
• Issue 1 2006
• Issue 3 2005
• Issue 2 2005
• Issue 1 2005
• Issue 3 2004
• Issue 2 2004
• Issue 1 2004
• Issue 3 2003
• Issue 2 2003
• Issue 1 2003

Social entrepreneurship in young students promoted by Latin American universitiesEmprendimiento social en jóvenes estudiantes impulsado por las universidades de América LatinaEmpreendedorismo social em jovens estudantes promovido por universidades latino-americanas

The purpose of this study is to analyze the strategies that allow sowing social entrepreneurship initiatives among young university students in Latin America. This study will also…

The formalization of microenterprises in middle-income countries: informal institutions as a mechanism to address institutional incongruenceLa formalización de las microempresas en los países de ingresos medios: las instituciones informales como mecanismo para abordar la incongruencia institucionalA formalização de microempresas em países de renda média: instituições informais como mecanismo de enfrentamento da incongruência institucional

The purpose of this study is to investigate the role of sales, as a proxy for size, in moderating the impact of institutional incongruence between formal and informal institutions…

Characteristics of the leaders of social and environmental enterprises in Latin America and the relationship with the success of their businessesCaracterísticas de los líderes de emprendimientos sociales y ambientales en América Latina y la relación con el éxito de sus negociosCaracterísticas dos líderes de empreendedorismos sociais e ambientais em América Latina e a relação com o sucesso de seus negócios

This study aims to understand the leadership characteristics of founders of social and environmental enterprises in Latin America who have achieved business success with a focus…

When connecting ventures to international markets falls short: examining the root mechanisms of perceived inefficacy in market-driven poverty alleviation effortsCuando la conexión de emprendimientos a mercados internacionales se queda corta: examinando los mecanismos fundamentales de la ineficacia percibida en los esfuerzos de alivio de la pobreza impulsados por el mercadoQuando a conexão de empreendimentos aos mercados internacionais fica aquém: examinando os mecanismos fundamentais da ineficácia percebida nos esforços de alívio da pobreza impulsionados pelo mercado

The purpose of this paper is to study triadic market relations between an international aid agency (IAA), local ventures and the poor communities where they are embedded in order…

Senior entrepreneurship in Latin America: evaluation and support from entrepreneurship ecosystems approach Emprendimiento senior en América Latina: evaluación y apoyo desde el enfoque de ecosistemas de emprendimiento Empreendedorismo sênior na América Latina: avaliação e apoio a partir da abordagem de ecossistemas de empreendedorismo

The purpose of this study is to make an exploratory analysis of the impact of the entrepreneurial ecosystem (EE) as defined by Acs et al. (2014) on opportunity-driven senior…

The effect of women’s entrepreneurship on corporate social responsibilityEl efecto del emprendimiento de mujeres en la responsabilidad social empresarialO efeito do empreendedorismo feminino na responsabilidade social corporativa

The purpose of this paper is to identify the causal (not correlational) effect of women’s entrepreneurship on corporate social responsibility (CSR) practices in Latin America.

Linking toxic leadership to exit, voice, silence and neglect: the mediating role of loyaltyA ligação entre a liderança tóxica e a saída, a voz, o silêncio e a negligência: O papel mediador da lealdadeEl vínculo entre liderazgo tóxico y salida, voz, silencio y abandono: el papel mediador de la lealtad

This study aims to analyze the relationship between toxic leadership and exit, prosocial voice, neglect and defensive silence. Second, this study investigates the mediating role…

What factors impact debt levels in the health sector? Evidence for a bank system-oriented country¿Qué factores impactan los niveles de deuda en el sector salud? Evidencia de un país orientado al sistema bancarioQue fatores afetam os níveis de dívida no setor da saúde? Evidência num país orientado à banca

The purpose of this study is to examine the determinants of the level of indebtedness in the health sector in Portugal, taking into account the effects of the COVID-19 pandemic…

The effect of resource slack on organizational decline of large Brazilian companies: the moderating effect of the industry’s dynamicEl Efecto del Sclack de Recursos sobre el Declive Organizacional de Grandes Empresas Brasileñas: El efecto moderador de la dinámica de la indústriaO Efeito do Excedente de Recursos sobre o Declínio Organizacional de Grandes Empresas Brasileiras: O efeito moderador da dinâmica da indústria

This study aims to investigate the influence of resource slack on the decline of Brazilian companies, with a particular focus on the moderating role of environmental dynamism. The…

Is work from home here to stay? Look from Mexico¿El trabajo desde casa llegó Para quedarse? Mirada desde méxico\O trabalho em casa veio Para ficar? Olha do méxico

This paper aims to answer the question of the future of work-from-home (WFH) from the position of productivity and employee well-being. In this research, the authors studied the…

“Respect my authority”: Spiritual self-managed teams and holacracy

This paper aims to introduce two draft concepts, spiritual self-managed teams and holacracy, as solutions for reducing the friction within neo-enterprises and the issues of…

Informality as a choice to do legitimate business: evidence from Peruvian women in times of COVID-19

In developing countries, women microentrepreneurs are characterized as being informal, creating a challenge for the sustainability of their businesses. The purpose of this study…

Sustainability and women entrepreneurship through new business models: the case of microfranchises in post-peace agreement Colombia

This study aims to analyze the establishment of sustainable microfranchises by women victims of the conflict (WVC) entrepreneurs who suffered the consequences and impacts of the…

Fall seven times, stand up eight: the neuropsychological and managerial configurations of resilience

Resiliency is essential for achieving the necessary level of performance and ensuring the survival of a new business during difficult times. However, neither this characteristic…

Family social capital as a mediator between socioemotional wealth and entrepreneurial orientation: evidence from Mexican SMEs

The type of social capital among families involved in business, or family social capital, has both positive and negative effects on family firms. This paper aims to investigate…

Online date, start – end:

Copyright holder:, open access:.

• José Ernesto Amorós

Further Information

• About the journal (opens new window)
• Purchase information (opens new window)
• Editorial team (opens new window)
• Write for this journal (opens new window)

We’re listening — tell us what you think

Something didn’t work….

Report bugs here

All feedback is valuable

Please share your general feedback

Join us on our journey

Platform update page.

Visit emeraldpublishing.com/platformupdate to discover the latest news and updates

Questions & More Information

Answers to the most commonly asked questions here

• Academy of Management Annals
• Academy of Management Collections
• Academy of Management Discoveries
• Academy of Management Journal
• Academy of Management Learning & Education
• Academy of Management Perspectives
• Academy of Management Review
• About AOM Insights
• Proceedings
• Global Proceedings
• Dynamic Editions
• Past Editorial Teams
• Most Read and Cited 2023
• Most Read and Cited 2022
• Permissions
• Subscriptions and Library Information
• Terms and Conditions of Use
• AOM Artificial Intelligence Policy
• Submitting to Annals
• Submitting to Collections
• Submitting to AMD
• Submitting to AMJ
• Submitting to AMLE
• Submitting to AMP

Submitting to AMR

• Submissions
• Ethics of Research and Publishing Video Series
• From the Editors: Publishing in AOM Journals
• Style Guide for Authors
• Accepted Author Toolkit
• Editor Resources
• Reviewer Resources
• Open Access
• AOM-CARMA Program
• 2023 Annual Meeting Program Awards
• 2022 Annual Meeting Program Awards
• 2021 Annual Meeting Program Awards
• 2020 Annual Meeting Program Awards
• 2019 Annual Meeting Program Awards
• 2018 Annual Meeting Program Awards
• 2017 Annual Meeting Program Awards
• 2022 Career Achievement Awards
• 2021 Career Achievement Awards
• 2020 Career Achievement Awards
• 2019 Career Achievement Awards
• 2018 Career Achievement Awards
• 2017 Career Achievement Awards
• 2016 Career Achievement Awards
• 2022 Division and Interest Group Awards
• 2021 Division and Interest Group Awards
• 2020 Division and Interest Group Awards
• 2019 Division and Interest Group Awards
• 2018 Division and Interest Group Awards
• 2017 Division and Interest Group Awards
• 2016 Division and Interest Group Awards
• 2023 George R. Terry Book Award
• 2022 George R. Terry Book Award
• 2021 George R. Terry Book Award
• 2020 George R. Terry Book Award
• 2019 George R. Terry Book Award
• 2018 George R. Terry Book Award
• 2017 George R. Terry Book Award
• 2016 George R. Terry Book Award
• 2015 George R. Terry Book Award
• 2014 George R. Terry Book Award
• 2013 George R. Terry Book Award
• 2023 Publication Awards
• 2022 Publication Awards
• 2021 Publication Awards
• 2020 Publication Awards
• 2019 Publication Awards
• 2018 Publication Awards
• 2017 Publication Awards
• Connect@AOM
• Directories
• DIG Elections
• DIG Nominations
• Social Media
• Volunteering
• Fellows Group
• PhD Project
• Exhibit Hall Info
• Exhibitor Information
• 2024: Innovating for the Future - Policy, Purpose, and Organizations
• 2023: Putting the Worker Front and Center
• 2022: Creating a Better World Together
• 2021: Bringing the Manager Back in Management
• 2020: Broadening our Sight
• 2019: Understanding the Inclusive Organization
• 2018: Improving Lives
• 2017: At The Interface
• 2016: Making Organizations Meaningful
• 2015: Opening Governance
• Annual Meeting Theme
• Professional Development Workshops
• Symposia and Paper Sessions
• Annual Meeting Proceedings
• Event Volunteers and Contacts
• Chicago Travel
• First Time Attendees
• Hotel Accommodations
• On-site Registration and Check In
• Visa Information
• Sustainability
• Why Attend?
• Reviewer Guidelines
• Submission Process
• Submission Guidelines
• Submission Policies and Ethics
• Caucus Call for Submissions
• TLC Call for Submissions
• Paper Development Workshops
• Israel: Start-Up to Scale-Up Conference
• England: Big Data Conference
• Africa Conference
• Mexico: Advancing Management Research in Latin America
• Slovenia: Responsible Leadership Conference
• Career Services Video Library
• Annual Meeting Career Fair
• Editorial Guidelines
• Design Guidelines
• Historical Timeline
• Terms of Use
• Academy News
• Division and Interest Group Newsletters
• Insights Newsletter
• Press Resources
• AOM Scholars On...
• Member Spotlights
• Code of Ethics
• Policies and Procedures for Handling Ethical Complaints
• Statement of Standards Regarding Sexual Harassment
• Board of Governors Elections
• Committees and Task Forces
• Presidential Gallery
• President's Corner
• Board of Governors Elections Results
• 2022 Annual Report President's Address
• 2022 Annual Report Goal One
• 2022 Annual Report Goal Two
• 2022 Annual Report Goal Three
• 2022 Annual Report Goal Four
• 2022 Annual Report Leadership
• 2022 Annual Report Recognition
• 2022 Annual Report Finances
• Articles of Incorporation
• Strategic Plan
• AOM Governance Policies
• Introductory Guide to AOM and the Annual Meeting

AMR Calls, Events, and Updates

Published quarterly in January, April, July, and October

The mission of Academy of Management Review (AMR) is to publish theoretical insights that advance our understanding of management and organizations. Submissions to AMR must extend theory in ways that develop testable knowledge-based claims. To do this, researchers can develop new management and organization theory, significantly challenge or clarify existing theory, synthesize recent advances and ideas into fresh, if not entirely new theory, or initiate a search for new theory by identifying and delineating a novel theoretical problem. The contributions of AMR articles often are grounded in "normal science disciplines" of economics, psychology, sociology, or social psychology as well as nontraditional perspectives, such as the humanities.

Journal Quick Links

• In-Press Articles
• Current Issue

Ask an AMR Associate Editor Session Series

• AMR Bridge Review Program
• Author Resources

Editorial Team

Previous Editorial Team

Journal Award Winners

Ask an AMR AE is a series of informal sessions with the Academy of Management Review ’s (AMR) Associate Editors (AEs). Each session begins with a short presentation by one or more associate editors on a specific topic related to publishing in AMR. After the presentation, the featured AE(s) will answer participants’ questions. These sessions will help authors who are considering submitting their work to AMR and who seek guidance on navigating the publication process. AMR Associate Editors, Dana Minbaeva and Chak Fu Lam, are coordinating this series.

Please visit the AMR Calls, Events, and Updates section below for a listing of upcoming events.

Bridge Reviewer Program

The Academy of Management Review’s Bridge Reviewer Program is an innovative program with a goal of expanding our pool of potential reviewers. Participants of this program complete self-guided learning modules on topics such as writing highly developmental reviews, observing the ethics of reviewing, and avoiding bias while reviewing. Learn more

Teaching Resources

Read through our  Teaching Resources  page for an Essay on Teaching Theory, information about developing a doctoral course, or pursuing your own professional development.

AOM Journals

_____________________________, aom publications.

• Academy of Management Insights

Publishing with AOM

Ranked 3 out of 227  journals in the category of Management Ranked 4 out of 155  journals in the category of Business

16.4  Impact Factor 17.0 Five-Year Impact Factor 8.94 Article Influence Score

Web of Science Journal Citation Reports dataset, 28 June 2023

Ask An AMR Associate Editor: The Review Process at AMR

Ask an amr associate editor: phenomenon-based theorizing at amr.

AMR Idea Development Workshop, Portugal

Ask an amr associate editor: special topic forum on artificial intelligence, ask an amr associate editor: learning from the review process at amr.

AMR Special Topic Forum - Artificial Intelligence in Management

• Call for Submissions

AMR Research in the News

Forbes: Misjudged jokes are no laughing matter. So when should CEOs use humor?

• Communicating
• Performance

Psychology Today: Vigilantes at work

Phys.org: new research promotes a business paradigm shift that emphasizes people, not just profit.

• Human Resources

Forbes: What the $500 million fix for local news says about trust and impact

Medium: what makes companies choose dark money.

Phys.org: Lessons from blockbusters to help teams adapt

Sustainable HRM and well-being: systematic review and future research agenda

• Published: 14 July 2023

Cite this article

• Faisal Qamar   ORCID: orcid.org/0000-0003-4916-8229 1 ,
• Gul Afshan   ORCID: orcid.org/0000-0003-0016-5721 1 &
• Salman Anwar Rana 1  

819 Accesses

3 Citations

Explore all metrics

This paper attempts to undertake a systematic literature review to identify ways and means by which sustainable human resource management (HRM) and well-being are linked for better individual and organizational outcomes. Its primary focus is to study whether sustainable HRM predicts well-being at work? If yes, how and when this prediction takes place? Systematic computerized search and review were conducted for articles published until December 2022. A total of 134 research articles were finally selected. It was found that sustainable HRM predicts well-being at work. However, our findings suggest that the area is largely underexplored and empirical work is too rare. Although few moderators and mediators are examined, research is required to propose and test more comprehensive models with more robust research designs and sophisticated theoretical links.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Data availability

Information/data of all the research papers analysed during this study are included in the body of this manuscript and its appendix. Any further information related to earlier research papers considered for this review are available from the corresponding author on reasonable request.

Aboramadan M, Kundi YM, Becker A (2021) Green human resource management in nonprofit organizations: effects on employee green behavior and the role of perceived green organizational support. Pers Rev Ahead-of-Print. https://doi.org/10.1108/PR-02-2021-0078

Article   Google Scholar  

Adjei-Bamfo P, Bempong B, Osei J, Kusi-Sarpong S (2020) Green candidate selection for organizational environmental management. Int J Manpow 41:1081–1096. https://doi.org/10.1108/IJM-10-2019-0480

Agarwal V, Mathiyazhagan K, Malhotra S, Saikouk T (2021) Analysis of challenges in sustainable human resource management due to disruptions by Industry 4.0: an emerging economy perspective. Int J Manpow. https://doi.org/10.1108/IJM-03-2021-0192

Ahmad I, Umrani WA (2019) The impact of ethical leadership style on job satisfaction. Leadersh Organ Dev J 40:534–547. https://doi.org/10.1108/LODJ-12-2018-0461

Al Kerdawy MMA (2019) The role of corporate support for employee volunteering in strengthening the impact of green human resource management practices on corporate social responsibility in the Egyptian Firms. Eur Manag Rev 16:1079–1095. https://doi.org/10.1111/emre.12310

Al Marzouqi AH, Khan M, Hussain M (2020) Employee social sustainability: prioritizing dimensions in the UAE’s airlines industry. Soc Responsib J 16:349–367. https://doi.org/10.1108/SRJ-07-2018-0166

Alberton A, Kieling AP, Lyra FR, Hoffmann EM, Lopez MPV, Stefano SR (2020) Competencies for sustainability in hotels: insights from Brazil. Empl Relat Int J. https://doi.org/10.1108/ER-01-2019-0093

Alcaraz JM, Susaeta L, Suarez E, Colon C, Gutiérrez-Martínez I, Cunha R, Leguizamón F, Idrovo S, Weisz N, Correia MF (2019) The human resources management contribution to social responsibility and environmental sustainability: explorations from Ibero-America. Int J Hum Resour Manag 30:3166–3189

Almarzooqi AH, Khan M, Khalid K (2019) The role of sustainable HRM in sustaining positive organizational outcomes. Int J Product Perform Manag 68:1272–1292. https://doi.org/10.1108/IJPPM-04-2018-0165

Al-Minhas U, Ndubisi NO, Barrane FZ (2020) Corporate environmental management. Manag Environ Qual Int J 31:431–450. https://doi.org/10.1108/MEQ-07-2019-0161

Alvarez-Risco A, Estrada-Merino A, Perez-Luyo R (2020) Sustainable development goals in hospitality management. In: Ruël H, Lombarts A (eds) Sustainable hospitality management. Emerald Publishing Limited, pp 159–178

Chapter   Google Scholar  

Amrutha V, Geetha S (2020) A systematic review on green human resource management: Implications for social sustainability. J Clean Prod 247:119131

Anlesinya A, Amponsah-Tawiah K (2020) Towards a responsible talent management model. Eur J Train Dev 44:279–303. https://doi.org/10.1108/EJTD-07-2019-0114

Anlesinya A, Susomrith P (2020) Sustainable human resource management: a systematic review of a developing field. J Glob Responsib

App S, Büttgen M (2016) Lasting footprints of the employer brand: can sustainable HRM lead to brand commitment? Empl Relat 38:703–723. https://doi.org/10.1108/ER-06-2015-0122

Ardichvili A (2012) Sustainability or limitless expansion: paradigm shift in HRD practice and teaching. Eur J Train Dev 36:873–887. https://doi.org/10.1108/03090591211280946

Arnold KA (2017) Transformational leadership and employee psychological well-being: a review and directions for future research. J Occup Health Psychol 22:381

Au WC, Ahmed PK (2014) Sustainable people management through work-life balance: a study of the Malaysian Chinese context. Asia-Pac J Bus Adm 6:262–280. https://doi.org/10.1108/APJBA-02-2014-0024

Aust I, Matthews B, Muller-Camen M (2020a) Common Good HRM: A paradigm shift in Sustainable HRM? Hum Resour Manag Rev 30:100705. https://doi.org/10.1016/j.hrmr.2019.100705

Aust I, Matthews B, Muller-Camen M (2020b) Common Good HRM: A paradigm shift in Sustainable HRM? Sustain Hum Resour Manag Triple Bottom Line Multi-Stakehold Strateg Concepts Engagem 30:100705. https://doi.org/10.1016/j.hrmr.2019.100705

Barrena-Martínez J, López-Fernández M, Romero-Fernández PM (2019) Towards a configuration of socially responsible human resource management policies and practices: Findings from an academic consensus. Int J Hum Resour Manag 30:2544–2580

Baum T, Hai NTT (2019) Applying sustainable employment principles in the tourism industry: righting human rights wrongs? Tour Recreat Res 44:371–381

Google Scholar  

Beer M, Boselie P, Brewster C (2015) Back to the future: implications for the field of HRM of the multistakeholder perspective proposed 30 years ago. Hum Resour Manage 54:427–438. https://doi.org/10.1002/hrm.21726

Bondarouk T, Brewster C (2016) Conceptualising the future of HRM and technology research. Int J Hum Resour Manag 27:2652–2671

Brannon DW, Burbach R (2021) Sustaining hospitality talent pools through a common pool resource lens. In: Jooss S, Burbach R, Ruël H (eds) Talent management innovations in the international hospitality industry. Emerald Publishing Limited, pp 53–78

Brunetto Y, Farr-Wharton B, Wankhade P, Saccon C, Xerri M (2022) Managing emotional labour: the importance of organisational support for managing police officers in England and Italy. Int J Hum Resour Manag 1–23

Bush JT (2020) Win-Win-Lose? Sustainable HRM and the promotion of unsustainable employee outcomes. Hum Resour Manag Rev 30:100676. https://doi.org/10.1016/j.hrmr.2018.11.004

Cabral C, Dhar RL (2021) Green competencies: insights and recommendations from a systematic literature review. Benchmark Int J 28:66–105. https://doi.org/10.1108/BIJ-11-2019-0489

Caldana ACF, Eustachio JHPP, Lespinasse Sampaio B, Gianotto ML, Talarico AC, da Batalhão SAC (2021) A hybrid approach to sustainable development competencies: the role of formal, informal and non-formal learning experiences. Int J Sustain High Educ. https://doi.org/10.1108/IJSHE-10-2020-0420

Chams N, García-Blandón J (2019) On the importance of sustainable human resource management for the adoption of sustainable development goals. Resour Conserv Recycl 141:109–122

Chaudhary R (2019) Green human resource management and job pursuit intention: examining the underlying processes. Corp Soc Responsib Environ Manag 26:929–937. https://doi.org/10.1002/csr.1732

Chaudhary R (2020) Corporate social responsibility and employee performance: a study among indian business executives. Int J Hum Resour Manag 31:2761–2784

Chillakuri B (2020) Understanding generation Z expectations for effective onboarding. J Organ Change Manag 33:1277–1296. https://doi.org/10.1108/JOCM-02-2020-0058

Chillakuri B, Vanka S (2020) Understanding the effects of perceived organizational support and high-performance work systems on health harm through sustainable HRM lens: a moderated mediated examination. Empl Relat Int J Ahead-of-Print. https://doi.org/10.1108/ER-01-2019-0046

Chillakuri B, Vanka S (2021) Examining the effects of workplace well-being and high-performance work systems on health harm: a sustainable HRM perspective. Soc Bus Rev 16:71–93. https://doi.org/10.1108/SBR-03-2020-0033

Christina S, Dainty A, Daniels K, Tregaskis O, Waterson P (2017) Shut the fridge door! HRM alignment, job redesign and energy performance. Hum Resour Manag J 27:382–402. https://doi.org/10.1111/1748-8583.12144

Clarke M (2011) Readings in HRM and Sustainability. Melb Tilde 117–132

Cook DJ, Mulrow CD, Haynes RB (1997) Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med 126:376–380

Cooke FL, Dickmann M, Parry E (2020) IJHRM after 30 years: taking stock in times of COVID-19 and looking towards the future of HR research. Int J Hum Resour Manag 32:1–23

Cooke FL, Xiao M, Chen Y (2021) Still in search of strategic human resource management? A review and suggestions for future research with China as an example. Hum Resour Manage 60:89–118

Cooper B, Wang J, Bartram T, Cooke FL (2019) Well-being-oriented human resource management practices and employee performance in the Chinese banking sector: The role of social climate and resilience. Hum Resour Manage 58:85–97

Csath M (2022) Organizational learning as the best business practice for adaptation in times of great changes: a viewpoint. Dev Learn Organ Int J

Dao V, Langella I, Carbo J (2011) From green to sustainability: information technology and an integrated sustainability framework. Green IT 20:63–79. https://doi.org/10.1016/j.jsis.2011.01.002

de Freitas SWR, Caldeira-Oliveira JH, Teixeira AA, Stefanelli NO, Teixeira TB (2020) Green human resource management and corporate social responsibility. Benchmark Int J 27:1551–1569. https://doi.org/10.1108/BIJ-12-2019-0543

de Freitas SWR, Caldeira Oliveira JH, Teixeira AA, Stefanelli NO (2021) Green human resource management, corporate social responsibility and customer relationship management: relationship analysis in the Brazilian context. Int J Product Perform Manag 70:1705–1727. https://doi.org/10.1108/IJPPM-12-2019-0597

De Prins P, Van Beirendonck L, De Vos A, Segers J (2014) Sustainable HRM: bridging theory and practice through the ’respect openness continuity (ROC)’-model. Manag Rev 25:263–284

De Prins P, Stuer D, Gielens T (2020) Revitalizing social dialogue in the workplace: the impact of a cooperative industrial relations climate and sustainable HR practices on reducing employee harm. Int J Hum Resour Manag 31:1684–1704

De Witte H, Pienaar J, De Cuyper N (2016) Review of 30 years of longitudinal studies on the association between job insecurity and health and well-being: Is there causal evidence? Aust Psychol 51:18–31

De-la-Calle-Durán M-C, Rodríguez-Sánchez J-L (2021) Employee engagement and wellbeing in times of COVID-19: a proposal of the 5Cs model. Int J Environ Res Public Health 18:5470

del-Castillo-Feito C, Blanco-González A, Hernández-Perlines F (2022) The impacts of socially responsible human resources management on organizational legitimacy. Technol Forecast Soc Change 174:121274. https://doi.org/10.1016/j.techfore.2021.121274

Denyer D, Tranfield D (2009) Producing a systematic review

Deshwal P (2015) Green HRM: an organizational strategy of greening people. Int J Appl Res 1:176–181

Di Vaio A, Palladino R, Hassan R, Escobar O (2020) Artificial intelligence and business models in the sustainable development goals perspective: a systematic literature review. J Bus Res 121:283–314. https://doi.org/10.1016/j.jbusres.2020.08.019

Diaz-Carrion R, López-Fernández M, Romero-Fernandez PM (2018) Developing a sustainable HRM system from a contextual perspective. Corp Soc Responsib Environ Manag 25:1143–1153. https://doi.org/10.1002/csr.1528

Diaz-Carrion R, López-Fernández M, Romero-Fernandez PM (2020) Sustainable human resource management and employee engagement: a holistic assessment instrument. Corp Soc Responsib Environ Manag 27:1749–1760. https://doi.org/10.1002/csr.1921

Diaz-Carrion R, López-Fernández M, Romero-Fernandez PM (2021) Constructing an index for comparing human resources management sustainability in Europe. Hum Resour Manag J 31:120–142. https://doi.org/10.1111/1748-8583.12286

Díez-Martín F, Blanco-González A, Díez-de-Castro E (2021) Measuring a scientifically multifaceted concept. The jungle of organizational legitimacy. Eur Res Manag Bus Econ 27:100131

Dixon-Fowler H, O’Leary-Kelly A, Johnson J, Waite M (2020) Sustainability and ideology-infused psychological contracts: An organizational- and employee-level perspective. Hum Resour Manag Rev 30:100690. https://doi.org/10.1016/j.hrmr.2019.100690

Donald WE, Baruch Y, Ashleigh MJ (2020) Striving for sustainable graduate careers. Career Dev Int 25:90–110. https://doi.org/10.1108/CDI-03-2019-0079

DuBois CLZ, Dubois DA (2012) Strategic HRM as social design for environmental sustainability in organization. Hum Resour Manage 51:799–826. https://doi.org/10.1002/hrm.21504

Ehnert I, Harry W, Zink KJ (2014) Sustainability and HRM. In: Sustainability and human resource management. Springer, pp 3–32

ElAlfy A, Palaschuk N, El-Bassiouny D, Wilson J, Weber O (2020) Scoping the evolution of corporate social responsibility (CSR) research in the sustainable development goals (SDGs) era. Sustainability 12:5544

Elkington J (1999) Triple bottom-line reporting: looking for balance. Aust CPA 69:18–21

Gardas BB, Mangla SK, Raut RD, Narkhede B, Luthra S (2019) Green talent management to unlock sustainability in the oil and gas sector. J Clean Prod 229:850–862

Ghouri AM, Mani V, Khan MR, Khan NR, Srivastava AP (2020) Enhancing business performance through green human resource management practices: an empirical evidence from Malaysian manufacturing industry. Int J Product Perform Manag 69:1585–1607. https://doi.org/10.1108/IJPPM-11-2019-0520

Gollan PJ (2000) Human resources, capabilities and sustainability

Gould-Williams J (2003) The importance of HR practices and workplace trust in achieving superior performance: a study of public-sector organizations. Int J Hum Resour Manag 14:28–54

Greenwood M, Anderson E (2009) ‘I used to be an employee but now I am a stakeholder’: implications of labelling employees as stakeholders. Asia Pac J Hum Resour 47:186–200

Greve HR (2021) The resource-based view and learning theory: overlaps, differences, and a shared future. J Manag 47:1720–1733

Guerci M, Shani ABR, Solari L (2014) A stakeholder perspective for sustainable HRM. Sustain Hum Resour Manag 205–223

Gutiérrez Crocco F, Martin A (2019) Towards a sustainable HRM in Latin America? Union-management relationship in Chile. Empl Relat Int J. https://doi.org/10.1108/ER-01-2019-0036

Hameed Z, Naeem RM, Hassan M, Naeem M, Nazim M, Maqbool A (2021) How GHRM is related to green creativity? A moderated mediation model of green transformational leadership and green perceived organizational support. Int J Manpow. https://doi.org/10.1108/IJM-05-2020-0244

Hooi LW, Liu M-S, Lin JJJ (2021) Green human resource management and green organizational citizenship behavior: do green culture and green values matter? Int J Manpow Ahead-of-Print. https://doi.org/10.1108/IJM-05-2020-0247

Hu X, Jiang Z (2018) Employee-oriented HRM and voice behavior: a moderated mediation model of moral identity and trust in management. Int J Hum Resour Manag 29:746–771

Jackson SE, Seo J (2010) The greening of strategic HRM scholarship. Organ Manag J 7:278–290

Jang S, Ardichvili A (2020) The role of HRD in CSR and sustainability: a content analysis of corporate responsibility reports. Eur J Train Dev 44:549–573. https://doi.org/10.1108/EJTD-01-2020-0006

Jerónimo HM, de Lacerda TC, Henriques PL (2020) From sustainable HRM to employee performance: a complex and intertwined road. Eur Manag Rev 17:871–884. https://doi.org/10.1111/emre.12402

Jithendran K, Baum T (2000) Human resources development and sustainability—the case of Indian tourism. Int J Tour Res 2:403–421

Kainzbauer A, Rungruang P, Hallinger P (2021) How does research on sustainable human resource management contribute to corporate sustainability: a document co-citation analysis, 1982–2021. Sustainability 13:11745

Kane C (2022) The future workplace: reimagining the office for the twenty-first century. in: european cities after COVID-19. Springer, pp 179–195

Kashyap V, Arora R (2020) Decent work and work–family enrichment: role of meaning at work and work engagement. Int J Product Perform Manag Ahead-of-Print. https://doi.org/10.1108/IJPPM-03-2020-0133

Kassen M (2022) Open data governance as a theoretical concept: a stakeholder and institutional analysis. In: Open data governance and its actors. Springer, pp 1–28

Kelloway EK, Barling J (1991) Job characteristics, role stress and mental health. J Occup Psychol 64:291–304

Kelman I (2021) Words without meaning? Examining sustainable development terminology through small states and territories. Small States Territories 4:231–244

Khan KS, Kunz R, Kleijnen J, Antes G (2003) Five steps to conducting a systematic review. J R Soc Med 96:118–121

Kitchenham B (2004) Procedures for performing systematic reviews. Keele UK Keele Univ 33:1–26

Kowalski TH, Loretto W (2017) Well-being and HRM in the changing workplace. Int J Hum Resour Manag 28:2229–2255

Kramar R (2014) Beyond strategic human resource management: is sustainable human resource management the next approach? Int J Hum Resour Manag 25:1069–1089

Kramar R (2021) Workplace performance: a sustainable approach. Asia Pac J Hum Resour 59:567–581. https://doi.org/10.1111/1744-7941.12289

Kumar Pradhan R, Prasad Panigrahy N, Kesari Jena L (2021) Self-efficacy and workplace well-being: understanding the role of resilience in manufacturing organizations. Bus Perspect Res 9:62–76

Kundu SC, Gahlawat N (2015) Socially responsible HR practices and employees’ intention to quit: The mediating role of job satisfaction. Hum Resour Dev Int 18:387–406

Lange T (2016) Sustainable HRM and employee well-being: an empirical agenda. Int J Manpow 37:918–923

Lansbury RD (2021) Introduction to the symposium ‘transforming our future: a new social contract at work’? Asia Pac J Hum Resour

Lăzăroiu G, Ionescu L, Andronie M, Dijmărescu I (2020) Sustainability management and performance in the urban corporate economy: a systematic literature review. Sustainability 12:7705

Lechuga Sancho MP, Martínez-Martínez D, Larran Jorge M, Herrera Madueño J (2018) Understanding the link between socially responsible human resource management and competitive performance in SMEs. Pers Rev 47:1211–1243. https://doi.org/10.1108/PR-05-2017-0165

Lee H-W (2017) Sustainable leadership: An empirical investigation of its effect on organizational effectiveness. Int J Organ Theory Behav 20:419–453. https://doi.org/10.1108/IJOTB-20-04-2017-B001

Lee H-W (2019) How does sustainability-oriented human resource management work?: examining mediators on organizational performance. Int J Public Adm 42:974–984

Lisovskaia A (2022) Implementing well-being practices through russian context: HRD perspective. J East-West Bus 1–16

Lombardi R, Manfredi S, Cuozzo B, Palmaccio M (2020) The profitable relationship among corporate social responsibility and human resource management: a new sustainable key factor. Corp Soc Responsib Environ Manag 27:2657–2667. https://doi.org/10.1002/csr.1990

Longoni A, Cagliano R (2016) Human resource and customer benefits through sustainable operations. Int J Oper Prod Manag 36:1719–1740. https://doi.org/10.1108/IJOPM-11-2014-0564

Lopez-Cabrales A, Valle-Cabrera R (2020) Sustainable HRM strategies and employment relationships as drivers of the triple bottom line. Hum Resour Manag Rev 30:100689. https://doi.org/10.1016/j.hrmr.2019.100689

Luu TT (2021a) Socially responsible human resource practices and hospitality employee outcomes. Int J Contemp Hosp Manag 33:757–789. https://doi.org/10.1108/IJCHM-02-2020-0164

Luu TT (2021b) A tale of two countries: How do employees with disabilities respond to disability inclusive HR practices in tourism and hospitality industry? J Sustain Tour. https://doi.org/10.1080/09669582.2021.1876073

Macini N, Fernandes Rodrigues Alves M, Oranges Cezarino L, Bartocci Liboni L, Cristina Ferreira Caldana A (2020) Beyond money and reputation: sustainable HRM in Brazilian banks. Empl Relat Int J Ahead-of-Print. https://doi.org/10.1108/ER-12-2018-0331

Macke J, Genari D (2019) Systematic literature review on sustainable human resource management. J Clean Prod 208:806–815

Maheshwari M, Samal A, Bhamoriya V (2020) Role of employee relations and HRM in driving commitment to sustainability in MSME firms. Int J Product Perform Manag 69:1743–1764. https://doi.org/10.1108/IJPPM-12-2019-0599

Mak A, Cheung L, Mak A, Leung L (2014) Confucian thinking and the implications for sustainability in HRM. Asia-Pac J Bus Adm 6:173–189. https://doi.org/10.1108/APJBA-02-2014-0029

Malik SY, Hayat Mughal Y, Azam T, Cao Y, Wan Z, Zhu H, Thurasamy R (2021) Corporate social responsibility, green human resources management, and sustainable performance: Is organizational citizenship behavior towards environment the missing link? Sustainability 13:1044

Mariappanadar S (2003) Sustainable human resource strategy. Int J Soc Econ 30:906–923. https://doi.org/10.1108/03068290310483779

Mariappanadar S (2012a) The harm indicators of negative externality of efficiency focused organizational practices. Int J Soc Econ 39:209–220. https://doi.org/10.1108/03068291211199378

Mariappanadar S (2012b) Harm of efficiency oriented HRM practices on stakeholders: an ethical issue for sustainability. Soc Bus Rev 7:168–184. https://doi.org/10.1108/17465681211237628

Mariappanadar S (2013) A conceptual framework for cost measures of harm of HRM practices. Asia-Pac J Bus Adm 5:103–114. https://doi.org/10.1108/17574321311321595

Mariappanadar S (2014) Stakeholder harm index: A framework to review work intensification from the critical HRM perspective. Hum Resour Manag Rev 24:313–329. https://doi.org/10.1016/j.hrmr.2014.03.009

Mariappanadar S (2016) Health harm of work from the sustainable HRM perspective: scale development and validation. Int J Manpow 37:924–944. https://doi.org/10.1108/IJM-12-2015-0204

Mariappanadar S (2020) Do HRM systems impose restrictions on employee quality of life? Evidence from a sustainable HRM perspective. J Bus Res 118:38–48. https://doi.org/10.1016/j.jbusres.2020.06.039

Mariappanadar S, Aust I (2017) The dark side of overwork: an empirical evidence of social harm of work from a sustainable HRM perspective. Int Stud Manag Organ 47:372–387

Mariappanadar S, Kramar R (2014) Sustainable HRM: The synthesis effect of high performance work systems on organisational performance and employee harm. Asia-Pac J Bus Adm. https://doi.org/10.1108/APJBA-03-2014-0039

Mariappanadar S, Maurer I, Kramar R, Muller-Camen M (2021) Is it a sententious claim? An examination of the quality of occupational health, safety and well-being disclosures in global reporting initiative reports across industries and countries. Int Bus Rev. https://doi.org/10.1016/j.ibusrev.2021.101922

Mashhady A, Khalili H, Sameti A (2021) Development and application of a service design-based process for improvement of human resource management service quality. Bus Process Manag J 27:459–485. https://doi.org/10.1108/BPMJ-04-2020-0164

Mowbray PK, Wilkinson A, Tse HHM (2021) High-performance work systems and employee voice behaviour: an integrated model and research agenda. Pers Rev 50:1530–1543. https://doi.org/10.1108/PR-12-2019-0692

Muisyo PK, Qin S, Julius MM, Ho TH, Ho TH (2021) Green HRM and employer branding: the role of collective affective commitment to environmental management change and environmental reputation. J Sustain Tour 1–18

Mujtaba M, Mubarik MS (2021) Talent management and organizational sustainability: role of sustainable behaviour. Int J Organ Anal Ahead-of-Print. https://doi.org/10.1108/IJOA-06-2020-2253

Müller-Christ G, Remer A (1999) Environmental economics or business ecology? Preliminary thoughts on a theory of resource management. Oper Environ Manag 21st Century Asp Tasks Perspect 69–87

Nuis JW, Peters P, Blomme R, Kievit H (2021) Dialogues in sustainable HRM: examining and positioning intended and continuous dialogue in sustainable HRM using a complexity thinking approach. Sustainability 13:10853

O’Donohue W, Torugsa N (2016) The moderating effect of ‘Green’HRM on the association between proactive environmental management and financial performance in small firms. Int J Hum Resour Manag 27:239–261

Okoli C, Schabram K (2010) A guide to conducting a systematic literature review of information systems research

Omidi A, Dal Zotto C (2022) Socially responsible human resource management: a systematic literature review and research agenda. Sustainability 14:2116

Onkila T, Sarna B (2021) A systematic literature review on employee relations with CSR: state of art and future research agenda. Corp Soc Responsib Environ Manag n/a. https://doi.org/10.1002/csr.2210

Parng Y-J, Kurrahman T, Chen C-C, Tseng ML, Minh Hà H, Lin C-W (2021) Visualizing the hierarchical sustainable human resource management under qualitative information and complex interrelationships. Manag Environ Qual Int J 32:1422–1447. https://doi.org/10.1108/MEQ-04-2021-0086

Paulet R, Holland P, Morgan D (2021) A meta-review of 10 years of green human resource management: is Green HRM headed towards a roadblock or a revitalisation? Asia Pac J Hum Resour 59:159–183. https://doi.org/10.1111/1744-7941.12285

Pellegrini C, Rizzi F, Frey M (2018) The role of sustainable human resource practices in influencing employee behavior for corporate sustainability. Bus Strategy Environ 27:1221–1232

Peng L, Liu H, Nie Y, Xie Y, Tang X, Luo P (2020) The transnational happiness study with big data technology. ACM Trans Asian Low-Resour Lang Inf Process TALLIP 20:1–12

Pham DDT, Paillé P (2020) Green recruitment and selection: an insight into green patterns. Int J Manpow 41:258–272. https://doi.org/10.1108/IJM-05-2018-0155

Piwowar-Sulej K (2021a) Human resources development as an element of sustainable HRM: with the focus on production engineers. J Clean Prod 278:124008. https://doi.org/10.1016/j.jclepro.2020.124008

Piwowar-Sulej K (2021b) Core functions of Sustainable Human Resource Management. A hybrid literature review with the use of H-Classics methodology. Sustain Dev

Pizzi S, Caputo A, Corvino A, Venturelli A (2020) Management research and the UN sustainable development goals (SDGs): a bibliometric investigation and systematic review. J Clean Prod 276:124033

Pluta A, Rudawska A (2016) Holistic approach to human resources and organizational acceleration. J Organ Change Manag 29:293–309. https://doi.org/10.1108/JOCM-11-2014-0210

Podgorodnichenko N, Akmal A, Edgar F, Everett AM (2020a) Sustainable HRM: toward addressing diverse employee roles. Empl Relat Int J Ahead-of-Print. https://doi.org/10.1108/ER-01-2019-0016

Podgorodnichenko N, Edgar F, McAndrew I (2020b) The role of HRM in developing sustainable organizations: Contemporary challenges and contradictions. Hum Resour Manag Rev 30:100685. https://doi.org/10.1016/j.hrmr.2019.04.001

Podgorodnichenko N, Edgar F, Akmal A (2021) An integrative literature review of the CSR-HRM nexus: Learning from research-practice gaps. Hum Resour Manag Rev. https://doi.org/10.1016/j.hrmr.2021.100839

Poon TS-C, Law KK (2020) Sustainable HRM: An extension of the paradox perspective. Hum Resour Manag Rev. https://doi.org/10.1016/j.hrmr.2020.100818

Pradhan RK, Jena LK, Panigrahy NP (2020) Do sustainability practices buffer the impact of self-efficacy on organisational citizenship behaviour? J Indian Bus Res 12:509–528. https://doi.org/10.1108/JIBR-05-2019-0170

Randev KK, Jha JK (2019) Sustainable human resource management: a literature-based introduction. NHRD Netw J 12:241–252

Ranjbari M, Esfandabadi ZS, Zanetti MC, Scagnelli SD, Siebers P-O, Aghbashlo M, Peng W, Quatraro F, Tabatabaei M (2021) Three pillars of sustainability in the wake of COVID-19: A systematic review and future research agenda for sustainable development. J Clean Prod 297:126660

Raub SP, Martin-Rios C (2019) “Think sustainable, act local”—a stakeholder-filter-model for translating SDGs into sustainability initiatives with local impact. Int J Contemp Hosp Manag 31:2428–2447. https://doi.org/10.1108/IJCHM-06-2018-0453

Ren S, Jackson SE (2020) HRM institutional entrepreneurship for sustainable business organizations. Hum Resour Manag Rev 30:100691. https://doi.org/10.1016/j.hrmr.2019.100691

Ribeiro RP, Gavronski I (2021) Sustainable management of human resources and stakeholder theory: a review. Rev Gest Soc E Ambient 15:e02729–e02729

Richards J (2020) Putting employees at the centre of sustainable HRM: a review, map and research agenda. Empl Relat Int J Ahead-of-Print. https://doi.org/10.1108/ER-01-2019-0037

Rincon-Roldan F, Lopez-Cabrales A (2021a) Linking organisational values and sustainability: the role of AMO practices. Pers Rev Ahead-of-Print. https://doi.org/10.1108/PR-06-2020-0414

Rincon-Roldan F, Lopez-Cabrales A (2021b) The impact of employment relationships on firm sustainability. Empl Relat Int J Ahead-of-Print. https://doi.org/10.1108/ER-12-2020-0522

Robinson RN, Martins A, Solnet D, Baum T (2019) Sustaining precarity: critically examining tourism and employment. J Sustain Tour 27:1008–1025

Roca-Puig V (2019) The circular path of social sustainability: an empirical analysis. J Clean Prod 212:916–924

Rubel MRB, Kee DMH, Rimi NN (2021) The influence of green HRM practices on green service behaviors: the mediating effect of green knowledge sharing. Empl Relat Int J 43:996–1015. https://doi.org/10.1108/ER-04-2020-0163

Samimi E, Sydow J (2021) Human resource management in project-based organizations: revisiting the permanency assumption. Int J Hum Resour Manag 32:49–83

Santana M, Lopez-Cabrales A (2019) Sustainable development and human resource management: a science mapping approach. Corp Soc Responsib Environ Manag 26:1171–1183. https://doi.org/10.1002/csr.1765

Sarvaiya H, Arrowsmith J (2021) Exploring the context and interface of corporate social responsibility and HRM. Asia Pac J Hum Resour n/a. https://doi.org/10.1111/1744-7941.12316

Sathasivam K, Che Hashim R, Abu Bakar R (2021) Automobile industry managers’ views on their roles in environmental sustainability: a qualitative study. Manag Environ Qual Int J 32:844–862. https://doi.org/10.1108/MEQ-09-2020-0194

Schulte P, Vainio H (2010) Well-being at work–overview and perspective. Scand J Work Environ Health 422–429

Secundo G, Ndou V, Del Vecchio P, De Pascale G (2020) Sustainable development, intellectual capital and technology policies: a structured literature review and future research agenda. Technol Forecast Soc Change 153:119917

Shah SMA, Jiang Y, Wu H, Ahmed Z, Ullah I, Adebayo TS (2021) Linking green human resource practices and environmental economics performance: the role of green economic organizational culture and green psychological climate. Int J Environ Res Public Health 18:10953

Sharpley R (2020) Tourism, sustainable development and the theoretical divide: 20 years on. J Sustain Tour 28:1932–1946

Shoaib M, Abbas Z, Yousaf M, Zámečník R, Ahmed J, Saqib S (2021) The role of GHRM practices towards organizational commitment: a mediation analysis of green human capital. Cogent Bus Manag 8:1870798

Silva S, Nuzum A-K, Schaltegger S (2019) Stakeholder expectations on sustainability performance measurement and assessment. a systematic literature review. J Clean Prod 217:204–215

Singh S, Vanka S (2019) Voice matters: Why HR should listen to employee voice? Strateg HR Rev 18:268–271. https://doi.org/10.1108/SHR-04-2019-0026

Singh SK, Pradhan RK, Panigrahy NP, Jena LK (2019) Self-efficacy and workplace well-being: moderating role of sustainability practices. Benchmarking Int J 26:1692–1708. https://doi.org/10.1108/BIJ-07-2018-0219

Sobhani FA, Haque A, Rahman S (2021) Socially responsible HRM, employee attitude, and bank reputation: the rise of CSR in Bangladesh. Sustainability 13:2753

Sorribes J, Celma D, Martínez-Garcia E (2021) Sustainable human resources management in crisis contexts: Interaction of socially responsible labour practices for the wellbeing of employees. Corp Soc Responsib Environ Manag 28:936–952. https://doi.org/10.1002/csr.2111

Sotome R, Takahashi M (2014) Does the Japanese employment system harm productivity performance? Asia-Pac J Bus Adm 6:225–246. https://doi.org/10.1108/APJBA-02-2014-0031

Southey K (2016) To fight, sabotage or steal: are all forms of employee misbehaviour created equal? Int J Manpow 37:1067–1084. https://doi.org/10.1108/IJM-12-2015-0219

Stahl GK, Brewster CJ, Collings DG, Hajro A (2020) Enhancing the role of human resource management in corporate sustainability and social responsibility: A multi-stakeholder, multidimensional approach to HRM. Sustain Hum Resour Manag Triple Bottom Line Multi-Stakehold Strateg Concepts Engagem 30:100708. https://doi.org/10.1016/j.hrmr.2019.100708

Stankevičiūtė Ž, Savanevičienė A (2018) Designing sustainable HRM: the core characteristics of emerging field. Sustainability 10:4798

Stankevičiūtė Ž, Savanevičienė A (2019) Can sustainable HRM reduce work-related stress, work-family conflict, and burnout? Int Stud Manag Organ 49:79–98

Teeuwisse V, Brannon DW (2020) A qualititaive exploration of sustainble talent management of hospitality interns’ career intentions based on their pre-, post- and present practical placement experiences. In: Ruël H, Lombarts A (eds) Sustainable hospitality management. Emerald Publishing Limited, pp 63–82

Tworzydło D, Gawroński S, Opolska-Bielańska A, Lach M (2021) Changes in the demand for CSR activities and stakeholder engagement based on research conducted among public relations specialists in Poland, with consideration of the SARS-COV-2 pandemic. Corp Soc Responsib Environ Manag n/a. https://doi.org/10.1002/csr.2189

Úbeda-García M, Claver-Cortés E, Marco-Lajara B, Zaragoza-Sáez P (2021) Corporate social responsibility and firm performance in the hotel industry. the mediating role of green human resource management and environmental outcomes. J Bus Res 123:57–69. https://doi.org/10.1016/j.jbusres.2020.09.055

Van Buren III HJ (2020) The value of including employees: a pluralist perspective on sustainable HRM. Empl Relat Int J Ahead-of-Print. https://doi.org/10.1108/ER-01-2019-0041

Van Dam K, Van Vuuren T, Kemps S (2017) Sustainable employment: the importance of intrinsically valuable work and an age-supportive climate. Int J Hum Resour Manag 28:2449–2472

Vecchi A, Della Piana B, Feola R, Crudele C (2021) Talent management processes and outcomes in a virtual organization. Bus Process Manag J 27:1937–1965. https://doi.org/10.1108/BPMJ-06-2019-0227

Vyas L (2022) “New normal” at work in a post-COVID world: work–life balance and labor markets. Policy Soc 41:155–167

Wellton L, Lainpelto J (2021) The intertwinement of professional knowledge culture, leadership practices and sustainability in the restaurant industry. Scand J Hosp Tour 21:550–566

Westerman JW, Rao MB, Vanka S, Gupta M (2020) Sustainable human resource management and the triple bottom line: Multi-stakeholder strategies, concepts, and engagement. Hum Resour Manag Rev 30:100742

WHO (2021) Comprehensive Mental Health Action Plan 2013–2030

Wikhamn W (2019) Innovation, sustainable HRM and customer satisfaction. Int J Hosp Manag 76:102–110. https://doi.org/10.1016/j.ijhm.2018.04.009

Wright PM, Steinbach AL (2022) Pivoting after almost 50 years of SHRM research: toward a stakeholder view. Asia Pac J Hum Resour 60:22–40

Xiao Y, Watson M (2019) Guidance on conducting a systematic literature review. J Plan Educ Res 39:93–112

Yang W, Nawakitphaitoon K, Huang W, Harney B, Gollan PJ, Xu CY (2019) Towards better work in China: mapping the relationships between high-performance work systems, trade unions, and employee well-being. Asia Pac J Hum Resour 57:553–576. https://doi.org/10.1111/1744-7941.12205

Ybema JF, van Vuuren T, van Dam K (2020) HR practices for enhancing sustainable employability: implementation, use, and outcomes. Int J Hum Resour Manag 31:886–907

Yong JY, Yusliza M-Y, Jabbour CJC, Ahmad NH (2020) Exploratory cases on the interplay between green human resource management and advanced green manufacturing in light of the ability-motivation-opportunity theory. J Manag Dev 39:31–49. https://doi.org/10.1108/JMD-12-2018-0355

Yusliza M-Y, Norazmi NA, Jabbour CJC, Fernando Y, Fawehinmi O, Seles BMRP (2019) Top management commitment, corporate social responsibility and green human resource management. Benchmarking Int J 26:2051–2078. https://doi.org/10.1108/BIJ-09-2018-0283

Zaugg RJ, Blum A, Thom N (2001) Sustainability in human resource management. Eval Rep Surv Eur Co Inst Arbeitsbericht Inst Für Organ Pers Univ Bern Eidgenöss Pers

Zheng X, Zhu W, Zhao H, Zhang C (2015) Employee well-being in organizations: theoretical model, scale development, and cross-cultural validation. J Organ Behav 36:621–644. https://doi.org/10.1002/job.1990

Zink KJ (2011) The contribution of quality of work to organisational excellence. Total Qual Manag Bus Excell 22:567–585

Download references

Acknowledgements

There are no acknowledgements for this manuscript.

The authors declare that no funds, grants or other support were received during the preparation of this manuscript.

Author information

Authors and affiliations.

Department of Business Administration, Sukkur IBA University, Sukkur, Pakistan

Faisal Qamar, Gul Afshan & Salman Anwar Rana

You can also search for this author in PubMed   Google Scholar

Contributions

Dr. GA and Mr. FQ contributed to the study conception and design. Material preparation and analysis were performed by Mr. FQ and Mr. SR. The first draft of the manuscript was prepared by Mr. FQ. Dr. GA and Mr. SR then commented on previous versions of the manuscript. Mr. SR significantly contributed to prepare the final manuscript alongwith Mr. Faisal. Dr. GA supervised the overall work. Finally, all the authors read and approved the final manuscript.

Corresponding author

Correspondence to Faisal Qamar .

Ethics declarations

Conflict of interest.

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Qamar, F., Afshan, G. & Rana, S.A. Sustainable HRM and well-being: systematic review and future research agenda. Manag Rev Q (2023). https://doi.org/10.1007/s11301-023-00360-6

Download citation

Received : 16 November 2022

Accepted : 21 June 2023

Published : 14 July 2023

DOI : https://doi.org/10.1007/s11301-023-00360-6

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Psychological health
• Sustainable HRM
• Find a journal
• Publish with us
• Track your research

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• Advanced Search
• Journal List
• Wiley - PMC COVID-19 Collection

COVID‐19 and the Future of Management Studies. Insights from Leading Scholars

Daniel muzio.

1 University of York

Jonathan Doh

2 Villanova University

The COVID‐19 pandemic and its medical, social and economic impacts presented profound challenges to business, government, and society. It also presents management scholars with an opportunity to rethink some of our core assumptions and directions of our research. In response, in the Summer of 2020, in our capacity as co‐ General Editors of the Journal of Management Studies , one of the foremost academic journals of management and organization studies, we commissioned short commentaries from leading management scholars. In total, we published 36 of these commentaries and intend to publish several more in the coming months. Topics ranged from strategy and entrepreneurship to OB/OT, innovation and sustainability. Below, we provide our synthesis and integration of three related – overarching themes that emerged from this collection, as well as a final set of insights that we derived from this initiative.

A common theme which runs across many of our commentaries concerns the extent and direction of change in the aftermath of the pandemic. For many of our authors COVID‐19 is an unforeseen exogenous shock which is reinforcing and accelerating some ongoing trends (flexible work arrangements; e‐commerce; digitalization) while reversing others (traditional forms of globalization as reflected in physical movement of people may slow permanently) (Ancona et al., 2021 ; Foss, 2021 ). Whilst some firms have simply shut or scaled down their operations, the pandemic has also intensified the need for rapid response, agility and adaptation as organizations contract, pivot, re‐invent themselves, and redeploy resources sometimes in a radical, sudden and potentially disruptive fashion (Ahlstrom and Wang, 2021 ; Hitt et al., 2021 ). At the global industry level, we see this in the disruption of supply chains and executive mobility patterns, at the organization level, in the rapid conversion from face to face to online business models, and the constant introduction of new health & safety regulations policies (Kano and Oh, 2020 ; Verbeke and Yuan, 2021 ). Scholars should study these practices – that don’t fit neatly into established management theory – more closely and intensively.

Relatedly, the exogenous jolt provided by COVID‐19 has created winners and losers, undermining many traditional face to face businesses while rewarding ‘asset light’, ‘virtual’ or ‘networked’ business models (George et al., 2020 ). This has generally cemented the dominance of a handful of global players in technology, retail, finance and other industries but in some instances it has also facilitated disruptive processes by favouring ‘challengers’ over ‘incumbents’ in a number of fields. As one example, Airbnb enjoyed an advantage on traditional hotels and tour operators as it was better positioned to service the increasing demand of families and groups who wanted to meet in remote locations and relative isolation, by providing longer term rentals and residential style self‐catered accommodation. Another example are digital subscription services such as Netflix which are increasing their share of releases and viewers relative to traditional operators. Of course some of these trends were already in train but they were certainly further accelerated by the pandemic.

At the same time, COVID and its broader impacts may have removed some barriers to entry for new business start‐ups. Indeed, research by John Haltiwanger at the University of Maryland suggests that the third quarter of 2020 was the highest on record for new business registrations in the USA, with nearly 1.6 million new business applications (Sasso and Matthews, 2021 ). Further bankruptcies in the USA declined substantially in 2020 as compared to 2019, partly because of the income support payments provided by government. As such, both markets and governments were, in their own ways, able to mitigate or buffer some of the more sever effects of the COVID‐19‐induced recession.

Control and Coordination at Work

One further debate that emerges from our commentaries pertains to the control and coordination of work tasks and activities. Once scenario, which is inspired by work on organizational routines (Pentland and Reuter, 1994 ) and technological interdependencies (Thompson, 1967 ), suggests that, since existing procedures, routines and systems cannot be easily stretched to cover virtual and home based working this will become increasingly reliant on output based forms of control, whereby delivering on objectives will matter more than displaying the right forms of behaviour. This will be supported by asynchronous and de‐centralized coordination processes which allow for the modularization and distributed coordination of tasks through technologies and processes (Foss, 2021 ; George et al., 2020 ). These include the increasing use of open access platforms and file repositories such as those originally pioneered by Linux, which allow for the direct observability and independent contribution to work activities. This scenario might also be characterized by more fluid and diffuse forms of collaboration and more permeable boundaries between tasks and organizations. Of course none of this is entirely new as these tendencies existed pre‐Covid‐19 but the pandemic is again accelerating and amplifying these trends.

An alternative scenario highlighted by some of our commentators sees organizations retreating onto themselves, by internalizing activities and reducing interdependencies whilst some may also further centralize decision making in the hands of restricted core of key managers (Foss, 2021 ). In this context organizational cultures may also be expected to become more autarchic and perhaps authoritarian (Spicer, 2020 ). Finally, in a more dystopian scenario, the new technologies developed and established during the lockdown may further accelerate a ‘control revolution’ (Beniger, 1986 ) within workplaces which could finally result in a digital version of Jeremy Bentham’s panopticon, as long anticipated by many scholars working in a labour process or critical management studies tradition (Mckinlay and Starkey, 1998 ; Sewell and Wilkinson, 1992 ). Here, employees just like the inmates in Bentham’s prison, are aware of the fact that at any point they may be under managerial observation without them necessarily knowing so. An exemplar of this is the notion of the ‘digital exhaust’ (Leonardi, 2021 ), whereby new technologies will allow organization to routinely and effortlessly capture increasingly fine grained information on its work processes and workforce, by automatically using the meta‐data produced by various technologies to create logs of employee behaviour. This in turn allows companies to create digital footprints for a particular employee or team which can be used to evaluate their current behaviours and even predict their future ones whilst also allowing organizations to render professional and white collar work observable, measurable and increasingly amenable to scientific management style types of intervention.

It is well established that COVID‐19, the lockdowns and ensuing economic crisis has had uneven consequences, penalizing in particular women, ethnic minorities and low wage earners in general. This is of course not because COVID‐19 is racist or classist. Rather it reflects how the pandemic further exposed existing fault lines and inequalities within society. A lot of this, of course, depends on the effects of ‘inequality regimes’ which govern how jobs and occupations are accessed, designed and rewarded and on how organizations are managed (Acker, 2006 ; Tomaskovic‐Devey and Avent‐Holt, 2019 ). In particular, low wage workers, which are disproportionally female and from ethnic minorities, are less likely to work from home and more likely to live in more cramped conditions. They rely on public transport and are more dependent on increasingly crowded and underfunded public services. They are also more likely to work for employers with a ‘low skill/low wage’ business model which prioritize cost effectiveness over wellbeing. Similarly, the pandemic and ensuing school closures laid bare the persistent gender imbalance in childcare, even where women have become integrated in high status, high paying and formerly male‐dominated domains (Milliken et al., 2020 ). Yet, the pandemic by bringing the scars of existing inequalities into stark relief, may also help to pierce ‘the veil of ignorance’ (Munir, 2021 ) and bring about transformational change in this area, by questioning how and in whose interest are our organizations and societies run (Amis and Greenwood, 2021 ).

For instance, we may become increasingly sensitive to organizations which have prioritized retaining their bonuses or dividends over avoiding redundancies, as in the case of companies such as JC Penney and Hertz which awarded multi‐million dollar bonuses to their CEOs just days before filing for bankruptcy (Munir, 2021 ). We may become more sceptical of celebrity CEOs and their turnaround stories and more attuned to noticing the everyday work of the front line workers who have kept these firms going. We may become more aware of differences between organizations in terms of their healthcare benefits, wellbeing policies and willingness to give their employees a voice in decision making processes. This may also prompt a process of occupational re‐rating as we confer more value and regard to those key workers, such as doctors and nurses but also teachers and transport, care and delivery workers who have been in the front line in the fight against COVID‐19 (Ashforth, 2020 ; Zannoni, 2021 ). Finally, at a more societal level, the pandemic and its management might make us more aware of institutional differences between countries and how countries with stronger cooperative and collectivist orientations may have outperformed more individualist ones in reducing both its healthcare and economic costs (Avery, 2020 ; Eaton and Hecksher, 2021 ).

We want to conclude to offer some of our thoughts which build and go beyond the rich commentaries included in our series. First, COVID‐19 has underscored the realty of non‐ergodic change, or of what some might call ‘Knightian’ uncertainty, whereby periods of relative stability are punctuated with radical, transformational change or even periods of constant, unpredictable, and therefore, difficult‐to‐prepare for change (Ahlstrom and Wang, 2021 ; Hitt et al., 2021 ). This realty has manifested at the national level as countries have scrambled to respond to multiple waves of the outbreak and various secondary and tertiary effects; at the industry level as companies in travel, hospitality, commercial real estate and others have been upended; at the firm‐level as companies have been forced to operate in constant crisis mode; and at the individual level as individuals have had to learn new ways of working, adapt to changing work shifts and hazards, and redefine work and family boundaries. Relatedly, COVID‐19 is simultaneously generating both centripetal and centrifugal effects: by exposing and reinforcing interdependencies among countries, sectors (business, government, civil society), groups, and individuals while also exacerbating divisions and differences in the form of economic and medical nationalism at the global and national level, pressures to source regionally or locally, rising inequalities and other forms of separation. Scholars must recognize that these forces can co‐exist in a dynamic and interactive fashion.

Second, COVID‐19 intersects with the growing debate around the future of work by, as discussed above, accelerating existing trends whilst halting or perhaps even reversing others. Indeed, a lot of writing on COVID‐19 is inevitably future projected and concerned with the balance between change and continuity, with some predicting a return to normality whilst others emphasizing the dawn of a ‘new normal’. Specifically, COVID‐19 is increasing our reliance on technology as epitomized by the rapid growth of video‐conferencing and other digital technologies and platforms, and as such fuelling trends towards digitalization and virtualization which are a staple of the Fourth Industrial revolution (Schwab, 2017 ). COVID‐19 is also creating the space and opportunity to trial and develop new artificial intelligence and machine learning solutions such as the growing use of increasingly sophisticated Bots in call centres as a way to handle growing consumer demand in the context of disrupted routines and reduced workforces. Yet, this is also exposing the unfairness and ineffectiveness of some of these technologies, as indicated by the controversial and ultimately unsuccessful attempts by the British government to use algorithms to award school qualifications following the cancellation of traditional exams. As such COVID‐19 is also creating the critical space where the limits and dangers of AI are exposed and discussed. Relatedly, as well as digitalizing many activities COVID‐19 has also brought to the foreground the importance of those often poorly paid critical jobs (careers, counsellors, health workers) which rely on a human touch and cannot be easily automated. As such COVID‐19 is certainly acting as key event in shaping the future of work by accelerating some of its trends but at the same time also highlighting some of their limitations.

Finally, COVID‐19 has suddenly and dramatically halted what seemed to be the inexorable rise of the ‘market logic’ and almost overnight displaced this with the values, discourses, and practices connected with alternative logics such as those of the ‘state’ and the ‘community’ (Thornton et al., 2012 ). In particular, the State has reasserted its central role across all economic and societal sectors, by imposing unprecedented levels of regulations and shutting down whole sectors (hospitality) whilst seeking to rapidly expand others through state intervention, increased funding and deregulation (medical research, healthcare, online education) (King and Carberry, 2020 ; Lawton et al., 2020 ). Furthermore, through the various subsidy and furlough schemes, the ‘frontiers of the state’, to reverse Margaret Thatcher’s famous expression, have been rolled forward to the point, that even in market oriented countries such as the UK, half of the workforce now directly depends on state employment or subsidy (Telegraph, 2020 ). Whilst across the media and public discourse the priorities of economic growth, solidarity and freedom of enterprise are subordinated to those of safety, collective wellbeing and community cohesion.

In this regard, COVID‐19 has drawn further attention to – and has brought into clear focus – the need for management scholars to address bigger, bolder, and broader questions. Indeed, management scholars have been challenging the management research community to tackle what are increasingly termed ‘grand challenges’, those complex, multi‐level, multi‐actor issues such as climate change, inequality, implications of mass migrations, and health crises (Bansal et al., 2021 ; Buckley et al., 2017 ; Crane and Matten, 2021 ; Howard‐Grenville, 2021 ; Munir, 2021 ). Many of these challenges have been exacerbated and aggravated by COVID‐19; for example, according to the United Nations, and additional 207 million people globally could be pushed into extreme poverty due to the Pandemic (UN, 2020 ). These realties underscore the necessity that management scholars think beyond traditional conceptualizations and consider more integrative and holistic topics and approaches in order to ensure that management research is fully engaged with the pressing global issues that COVID‐19 has helped to illuminate. With our collection of COVID‐19 commentaries, the Journal of Management Studies sought to encourage this process. We hope that over the year to come we will publish many articles addressing the questions and issues raised by this collection.

• Acker, J. (2006). ‘ Inequality regimes gender, class, and race in organizations ’. Gender & Society , 20 , 441–64. [ Google Scholar ]
• Ahlstrom, D. and Wang, L. C. (2021). ‘ Temporal strategies and firms’ speedy responses to COVID‐19 ’. Journal of Management Studies . 10.1111/joms.12664 [ CrossRef ] [ Google Scholar ]
• Amis, J. M. and Greenwood, R. (2021). ‘ Organisational change in a (post‐) pandemic world: Rediscovering interests and values ’. Journal of Management Studies . 10.1111/joms.12663 [ CrossRef ] [ Google Scholar ]
• Ancona, D. , Bresman, H. and Mortensen, M. (2021). ‘ Shifting team research after COVID‐19: Evolutionary and Revolutionary Change ’. Journal of Management Studies . 10.1111/joms.12651 [ CrossRef ] [ Google Scholar ]
• Ashforth, B. E. (2020). ‘ Identity and identification during and after the pandemic: How might COVID‐19 change the research questions we ask? ’ Journal of Management Studies , 57 , 1763–66. [ Google Scholar ]
• Avery, D. R. (2020). ‘ Lessons from the Losing: Implications of the covid‐19 pandemic for organizational diversity scholarship and practice ’. Journal of Management Studies , 57 , 1746–49. [ Google Scholar ]
• Bansal, P. , Grewatsch, S. and Sharma, G. (2021). ‘ How COVID‐19 informs business sustainability research: It’s time for a systems perspective ’. Journal of Management Studies . 10.1111/joms.12669 [ CrossRef ] [ Google Scholar ]
• Beniger, J. R. (1986). The Control Revolution: Technological and Economic Origins of the Information Society . Cambridge, MA: Harvard University Press. [ Google Scholar ]
• Buckley, P. O. , Doh, J. P. and Benischke, M. (2017). ‘ Towards a renaissance in international business research? Big questions, grand challenges, and the future of IB Scholarship ’. Journal of International Business Studies , 48 , 1045–64. [ Google Scholar ]
• Crane, A. and Matten, D. (2021). ‘ COVID‐19 and the future of CSR research ’. Journal of Management Studies . 10.1111/joms.12642 [ CrossRef ] [ Google Scholar ]
• Eaton, A. and Heckscher, C. (2021). ‘ COVID's Impacts on the field of labour and employment relations ’. Journal of Management Studies . 10.1111/joms.12645 [ CrossRef ] [ Google Scholar ]
• Foss, N. J. (2021). ‘ The impact of the Covid‐19 pandemic on firms’ organizational designs ’. Journal of Management Studies . 10.1111/joms.12643 [ CrossRef ] [ Google Scholar ]
• George, G. , Lakhani, K. R. and Puranam, P. (2020). ‘ What has changed? The impact of Covid pandemic on the technology and innovation management research agenda ’. Journal of Management Studies . 57 , 1754–58 [ Google Scholar ]
• Hitt, M. A. , Arregle, J.‐L. and Holmes, R. M. Jr (2021). ‘ Strategic Management Theory in a Post‐Pandemic and Non‐Ergodic World ’. Journal of Management Studies. , 58 , 259–264. 10.1111/joms.12646. [ CrossRef ] [ Google Scholar ]
• Howard‐Grenville, J. (2021). ‘ Grand challenges, covid‐19 and the future of organizational scholarship ’. Journal of Management Studies ‐ forthcoming. [ Google Scholar ]
• Kano, L. and Oh, C. H. (2020). ‘ Global value chains in the post‐covid world: Governance for reliability ’. Journal of Management Studies , 57 , 1773–77 [ Google Scholar ]
• King, B. G. and Carberry, E. J. (2020). ‘ Movements, societal crisis, and organizational theory ’. Journal of Management Studies , 57 , 1741–45. [ Google Scholar ]
• Lawton, T. C. , Dorobantu, S. , Rajwani, T. S. and Sun, P. (2020). ‘ The implications of COVID‐19 for nonmarket strategy research ’. Journal of Management Studies , 57 , 1732–36. [ Google Scholar ]
• Leonardi, P. M. (2021). ‘ COVID‐19 and the new technologies of organizing: Digital exhaust, digital footprints, and artificial intelligence in the wake of remote work ’. Journal of Management Studies . 10.1111/joms.12648 [ CrossRef ] [ Google Scholar ]
• McKinlay, A. and Starkey, K. (1998). Foucault, Management and Organization Theory: From Panopticon to Technologies of Self . London: Sage. [ Google Scholar ]
• Milliken, F. J. , Kneeland, M. K. and Flynn, E. (2020). ‘ Implications of the COVID‐19 pandemic for gender equity issues at work ’. Journal of Management Studies , 57 , 1767–72. [ Google Scholar ]
• Munir, K. A. (2021). ‘ Inequality in the time of Corona Virus ’. Journal of Management Studies . 10.1111/joms.12674 [ CrossRef ] [ Google Scholar ]
• Pentland, B. T. and Reuter, H. H. (1994). ‘ Organizational routines as grammars of action ’. Administrative Science Quarterly , 39 , 484–510. [ Google Scholar ]
• Sasso, M. and Matthews, S. (2021). ‘ U.S. business starts enjoyed their best year ever amid Covid‐19 ’. Bloomberg . Available at https://www.bloomberg.com/news/articles/2021‐01‐13/u‐s‐business‐starts‐enjoyed‐their‐best‐year‐ever‐amid‐covid‐19 (accessed 18 January 2021).
• Schwab, K. (2017). The Fourth Industrial Revolution . New York: Crown Publishing Group. [ Google Scholar ]
• Sewell, G. and Wilkinson, B. (1992). ‘ Someone to watch over me surveillance, discipline and the just‐in‐time labour process ’. Sociology , 26 , 271–81. [ Google Scholar ]
• Spicer, A. (2020). ‘ Organizational culture and COVID‐19 ’. Journal of Management Studies , 57 , 1737–40. [ Google Scholar ]
• Telegraph (2020). More Than Half of All Adults Now Paid by the State . Available at https://www.telegraph.co.uk/business/2020/05/04/half‐adults‐now‐paid‐state/ (accessed 19 January 2020). [ Google Scholar ]
• Thompson, J. D. (1967). Organizations in Action: Social Science Bases of Administrative Theory . New Brunswick, NJ: Transaction Publishers. [ Google Scholar ]
• Thornton, P. H. , Ocasio, W. and Lounsbury, M. (2012). The Institutional Logics Perspective . Oxford: Oxford University Press. [ Google Scholar ]
• Tomaskovic‐Devey, D. and Avent‐Holt, D. (2019). Relational Inequalities: An Organizational Approach . Oxford: Oxford University Press. [ Google Scholar ]
• United Nations (2020). Revealed: The Cost of the Pandemic on World's Poorest Countries . Available at https://news.un.org/en/story/2020/12/1079162 (accessed 12 January 2021). [ Google Scholar ]
• Verbeke, A. and Yuan, W. (2021). ‘ A few implications of the covid‐19 pandemic for international business strategy research ’. Journal of Management Studies . 10.1111/joms.12665 [ CrossRef ] [ Google Scholar ]
• Zanoni, P. (2021). ‘ Whither critical management and organization studies? For a performative critique of capitalist flows in the wake of the COVID‐19 pandemic ’. Journal of Management Studies . 10.1111/joms.12655 [ CrossRef ] [ Google Scholar ]

Business and Management Research

Journal Metrics

Google-based Impact Factor (2021): 0.39

h-index (January 2022): 28

i10-index (January2022): 66

h5-index (January 2022): N/A

h5-median(January 2022): N/A

RePEc simple impact factor: 0.43 (0.42)

RePEc h-index (August 2022): 5 (5)

Editor-in-Chief

Marta Peris-Ortiz , Universitat Politècnica de València, Spain

Associate Editors

• Dr. Aashish Srivastava , Monash University, Australia
• Ph.D Daniel Roque Gomes , Escola Superior de Educação de Coimbra - IPC, Portugal
• Prof. Mattia Iotti , University of Parma, Italy
• Ph.D. Shih Yung Chou , The University of Texas of the Permian Basin, United States
• Dr. Valeria Stefanelli , Unicusano University of Rome, Italy

Popular Links

Publication Frequency

Index/List/Archive

• Editorial Board

Author Guide

Author Fee

• Other Journals
• For Readers
• For Authors
• For Librarians

Announcements

• Recruitment
• ETHICAL GUIDELINES
• GOOGLE SCHOLAR CITATIONS

Business and Management Research (BMR) is a double-blind peer-reviewed journal, published by Sciedu Press. The journal seeks to publish original research articles that are  hypothetical and theoretical in its nature and that provide exploratory insights in the fields of General Management, Business Law, Marketing Theory and Applications, Business Finance and Investment, General Business Research, Business and Economics Education, Production/Operations Management, Organizational Behavior and Theory, Social Issues and Public Policy, Management Organization, Statistics and Econometrics, Personnel and Industrial Relations, Technology and Innovation, Case Studies and Management Information Systems, Accounting, Analysis, Communication, Information Technologies, Project management and Strategy. The journal is published in both online and printed versions. The online version is free access and download. The goal of Business and Management Research (BMR) is to broaden the knowledge of business professionals and academicians by promoting free access and provide valuable insight to business-related information, research and ideas.

This journal accepts article submissions online or by e-mail ( [email protected] ).

ABSTRACTING AND INDEXING:

• CNKI Scholar
• Google Scholar
• JournalSeek
• JournalTOCs
• PKP Open Archives Harvester
• SHERPA/RoMEO
• The Standard Periodical Directory
• Technische Informationsbibliothek (TIB)
• ZBW-German National Library of Economics
• Zeitschriften daten bank (ZDB)  

2023: Articles Received: 32; Accepted: 19; Rejected: 11; Published: 17; Retracted: 0

2022: Articles Received: 23; Accepted: 10; Rejected: 8; Published: 5; Retracted: 1

2021: Articles Received: 25; Accepted: 18; Rejected: 7; Published: 12; Retracted: 1

2020: Articles Received: 27; Accepted: 22; Rejected: 4; Published: 22; Retracted: 0

2019: Articles Received: 52; Accepted: 28; Rejected: 22; Published: 16; Retracted: 0

2018: Articles Received: 104; Accepted: 62; Rejected: 46; Published: 21; Retracted: 0

2017: Articles Received: 106; Accepted: 65; Rejected: 38; Published: 29; Retracted: 0

2016: Articles Received: 111; Accepted: 65; Rejected: 41; Published: 27; Retracted: 1

2015: Articles Received: 107; Accepted: 72; Rejected: 35; Published: 21; Retracted: 0

2014: Articles Received: 120; Accepted: 77; Rejected: 50; Published: 41; Retracted: 0

2013: Articles Received: 109; Accepted: 66; Rejected: 38; Published: 56; Retracted: 0

---------------------------------------------------------

• e-Version First TM (Vol. 13, No. 1)

What is e-Version First TM

e-Version First is a feature offered through our journal platform. It allows PDF version of manuscripts that have been peer reviewed and accepted, to be hosted online prior to their inclusion in a final printed journal. Readers can freely access or cite the article. We aim to publish accepted manuscripts in e-Version First in two week's time after the final draft completed.

Paper Selection and Publishing Process

a) Submission Acknowledgement

When you submit a manuscript online, you will receive a submission acknowledgement letter sent by the online system automatically. For email submission, the editor or editorial assistant sends an e-mail confirmation to the submission’s author within one to three working days. If you fail to receive this confirmation, please check your bulk email box or contact the editorial assistant by email: [email protected]

b) Basic Review

The editor or editorial assistant determines whether the manuscript fits the journal’s focus and scope. Next a check for the similarity rate is done using CrossCheck, powered by iThenticate . Any manuscripts out of the journal’s scope or containing plagiarism, including self-plagiarism, are rejected.

c) Peer Review

We use a double-blind system for peer review; both reviewers’ and authors’ identities remain anonymous. The submitted manuscript will be reviewed by at least two experts: one editorial staff member as well as one to three external reviewers. The review process may take four to ten weeks.

d) Decision Is Made

The decision to accept or reject an article is based on the suggestions of reviewers. If differences of opinion occur between reviewers, the editor-in-chief will weigh all comments and arrive at a balanced decision based on all comments, or a second round of peer review may be initiated.

e) Notification of the Result of Review

The result of review will be sent to the corresponding author and forwarded to other authors.

f) Publication Fee Is Paid

If the submission is accepted, the authors revise paper and pay the Article Processing Charge (Formatting and Hosting) ( 300USD ).

g)  Publication Notice

The authors and readers will be notified and invited to visit our website for the newly published articles.

Vol 13, No 1 (2024)

Table of contents.

Business and Management Research ISSN 1927-6001 (Print)   ISSN 1927-601X (Online)

Copyright © Sciedu Press  To make sure that you can receive messages from us, please add the 'Sciedupress.com' domain to your e-mail 'safe list'. If you do not receive e-mail in your 'inbox', check your 'bulk mail' or 'junk mail' folders.

Journal of Management Research

• Other Journals
• For Readers
• For Authors
• For Librarians

Announcements

• Recruitment
• Online Submissions

Journal of Management Research (JMR)    is an online scholarly journal, peer-reviewed, published by Macrothink Institute. The journal publishes research paper covers these subjects: Business, Management, Marketing, Finance, organizational development, corporation administration, human resource management and relevant subjects.

The scopes of the journal include, but are not limited to, the following fields:

•Management

•organizational development

•corporation administration

•human resource management and relevant subjects

The journal is published online  semiannually in April and October.  We aim to post articles online within 3 weeks of acceptance. The journal accepts article submissions  online  or by  e-mail . For any questions, please contact:  [email protected]

The journal is included and abstracted in: 

• Directory of Research Journals Indexing
• DTU FindIt (DTU Library)
• Electronic Journals Library
• EZB (Elektronische Zeitschriftenbibliothek)
• Google Scholar
• HOLLIS (Harvard Library)
• ICI World of Journals
• Index Copernicus
• PKP Open Archives Harvester
• SHERPA/RoMEO
• The Standard Periodical Directory

Each paper published in JMR is assigned a  DOI® number , which appears beneath the author's affiliation in the published paper. Click  HERE  to know what is DOI (Digital Object Identifier)? Click  HERE  to retrieve Digital Object Identifiers (DOIs) for journal articles, books, and chapters.

Paper Selection and Publication Process

a). Upon receipt of paper submission, the Editor sends an E-mail of confirmation to the corresponding author within 1-3 working days. If you fail to receive this confirmation, your submission/e-mail may be missed. Please contact the Editor in time for that.

b). Peer review. The review process may take  4-10 weeks .

c). Notification of the result of review by E-mail.

d). The authors revise paper and pay an Article Processing Charge (200USD).

e). E-journal in PDF is available on the journal’s webpage, free of charge for download. We aim to post articles within 3 weeks of acceptance.

Vol 16, No 1 (2024)

Table of contents.

Journal of Management Research ISSN 1941-899X

Email: [email protected]

Copyright ©  Macrothink Institute

To make sure that you can receive messages from us, please add the 'macrothink.org' domain to your e-mail 'safe list'. If you do not receive e-mail in your 'inbox', check your 'bulk mail' or 'junk mail' folders.

• Review article
• Open access
• Published: 20 December 2021

Is there a causal relationship between stress and migraine? Current evidence and implications for management

• Anker Stubberud   ORCID: orcid.org/0000-0003-0934-9914 1 , 2 ,
• Dawn C. Buse 3 ,
• Espen Saxhaug Kristoffersen 4 , 5 ,
• Mattias Linde 1 , 2 &
• Erling Tronvik 1 , 2  

The Journal of Headache and Pain volume  22 , Article number:  155 ( 2021 ) Cite this article

11k Accesses

28 Citations

40 Altmetric

Metrics details

The purpose of this narrative review is to examine the literature investigating a causal relationship between stress and migraine and evaluate its implications for managing migraine.

PubMed, PsycINFO and CINAHL were searched from 1988 to August 2021, identifying 2223 records evaluating the relationship between stress and migraine. Records were systematically screened. All potentially relevant records were thematically categorized into six mechanistic groups. Within each group the most recent reports providing new insights were cited.

First, studies have demonstrated an association of uncertain causality between high stress loads from stressful life events, daily hassles or other sources, and the incidence of new-onset migraine. Second, major stressful life events seem to precede the transformation from episodic to chronic migraine. Third, there is some evidence for changes in levels of stress as a risk factor for migraine attacks. Research also suggests there may be a reversed causality or that stress-trigger patterns are too individually heterogeneous for any generalized causality. Fourth, migraine symptom burden seems to increase in a setting of stress, partially driven by psychiatric comorbidity. Fifth, stress may induce sensitization and altered cortical excitability, partially explaining attack triggering, development of chronic migraine, and increased symptom burden including interictal symptom burden such as allodynia, photophobia or anxiety. Finally, behavioral interventions and forecasting models including stress variables seem to be useful in managing migraine.

The exact causal relationships in which stress causes incidence, chronification, migraine attacks, or increased burden of migraine remains unclear. Several individuals benefit from stress-oriented therapies, and such therapies should be offered as an adjuvant to conventional treatment and to those with a preference. Further understanding the relationship between stress, migraine and effective therapeutic options is likely to be improved by characterizing individual patterns of stress and migraine, and may in turn improve therapeutics.

The definition of stress has varied through the ages and literature, but generally speaking, stress can be defined as an organism’s perception of and response to a perceived stressor. This includes how the body responds, both physiologically and psychosocially, to perceived threats, challenges, or physical or psychological barriers.

The physiological stress response involves the autonomic nervous system, especially the hypothalamic-pituitary-adrenal (HPA) axis, and several other structures which undergo neurobiological changes [ 1 , 2 ]. Any stressor, both mental and/or physical, can elicit the physiological response resulting in pronounced sympathetic outflow and release of stress hormones such as epinephrine, norepinephrine, and cortisol. Increased activity of these stress systems induces behavioral, cardiovascular, endocrine, and metabolic cascades that enable the individual to fight, flee or freeze, to cope with the stress. The physiological stress response may be quantified in various ways, for example measuring the effector hormones (e.g., cortisol), or measuring the effect they produce (e.g., an increase in heart rate or blood pressure).

In addition to the physiological stress response, stress perception has a subjective side, i.e., how an individual perceives, reacts to, and copes with stress. This is described in the transactional stress model by Lazarus [ 3 ] which explains perceived stress as resulting in part from the “imbalance between demands and resources”, or a response where “pressure exceeds one’s perceived ability to cope.” Within this transactional model, stress ocurrs when perceived demands exceed perceived resources [ 4 ]. Perceived stress may be quantified using various patient reported outcome measures. A primary focus of cognitive behavioral therapy for migraine and related behavioral therapies involves teaching participants to first recognize the physiological and cognitive stress response, then observe their immediate automatic thoughts and then reappraise or reframe, replacing dysfunctional thoughts with more realistic thoughts [ 5 ]. Biofeedback and relaxation therapies also teach participants to recognize physiological and psychological activation and then engage in activities intended to reduce sympathetic activation and engage in mental and physical states of calm and well being [ 6 ].

The neuronal and hormonal changes associated with stress and the perceived psychological stress response may have multiple relationship to migraine. Stress may provoke the new-onset of migraine (incidence), it may act as a risk factor for migraine attacks, it may amplify migraine disability and/or burden; and it may contribute to the development of chronic migraine; Moreover, migraine attacks themselves and the resulting disability and impact might be a stressor in itself resulting in a vicious feedback cycle [ 7 ]. These relationships are exemplified in a common patient belief that “stress causes migraine.” [ 8 ] But, does the conventional belief hold? The aim of this article is to review currently available evidence and hypotheses for a causal relationship between stress and migraine and discuss important implications for management.

To identify relevant literature for this narrative review, PubMed, PsycINFO and CINAHL databases were searched for available records from 1 January 1988—to include all relevant records after the inception of the International Classification of Headache Disorders 1st edition—and last updated on 10 August 2021. The following search term was used across all three databases: (“stress” AND “migraine”), identifying a total of 3124 records. 743 duplicates were identified automatically in the citation manager EndNote 20 (Clarivate, US). Another 158 duplicates were manually identified. The remaining 2223 records were screened based on title and abstract, identifying 208 records that were deemed relevant to appraise the casual relationship between stress and migraine or its implications for management. These 208 records were reviewed and thematically categorized [ 9 ]. Records not available online, not available in English, and commentaries were excluded. From the thematic categorization six mechanistic groups crystallized:

Is stress a predisposing factor for migraine disease onset (incidence)?

Is stress a predisposing factor for migraine chronification (new onset of chronic migraine)?

Is stress a risk factor for migraine attacks?

Is migraine-related disability and/or burden increased by stress?

What are the physiological correlates of stress and migraine?

What are the implications of stress for migraine management?

Figure 1 is a PRISMA flowchart depicting the record selection process, and reasons for exclusion. 146 of the 208 identified records were excluded based upon the exclusion criteria. A total of 62 records from the electronic literature search are cited in this paper. Within each of the six themes, we cite records that provide insights into the causal relationship between stress and migraine, and attempt to use the most recently dated records.

PRISMA flow diagram

Evidence for a causal relationship between stress and migraine

Stress as a factor in new-onset migraine (incidence).

Stress, in a variety of fashions, seems to be associated with the new-onset of migraine. In a longitudinal analysis of almost 20,000 female employees with no history of migraine at study entry, no association between job strain and migraine was found at follow-up [ 10 ]. However, high effort-reward imbalance was associated with a slightly increased risk of migraine at follow-up. The proportion of new migraine cases attributable to high effort-reward imbalance was 6.2%. The association of high effort-reward imbalance to new-onset migraine was again confirmed in a 2020 prospective occupational health study [ 11 ]. Similarly, a study from 2019 investigated the association between early-life stressors and new-onset adolescent headache [ 12 ]. There was an influence of early life family-level factors on the prospective risk of developing migraine moderated through symptoms of depression and anxiety. Moreover, adverse childhood experiences have been demonstrated to have a stable association with an adult diagnosis of migraine [ 13 , 14 , 15 ], and the association seems to be mediated through neuroticism [ 16 ]. Pain as a neonate, defined as prescribed analgesics during stays at the neonatal intensive care unit, has also shown an association with an earlier onset of migraine [ 17 ]. All of these studies suggest that unfavorable allostatic load, contextualized as stress, may contribute to the new onset of migraine. Nevertheless, the associations are moderate, and a direct causal link to stress remains unclear.

Stress as a factor in migraine chronification or the new onset of chronic migraine

In a comprehensive systematic review from 2019, risk factors for the new onset of chronic migraine were assessed [ 18 ]. The main risk factors for chronification were increased headache day frequency, depression, and certain categories of acute medication overuse. However, major stressful life events were also identified as a risk factor. One of the studies included in the review reported more major stressful life events in the year before or the same year as the onset of chronic daily headache [ 19 ]. Similar results were also found in a study by De Benedittis and colleagues, where chronic primary headache patients reported significantly more stressful life events with negative impact in the year before chronic headache onset compared to headache-free controls [ 20 ]. More recently, a study investigating the effects of exposure to the 2011 Utøya adolescent summer camp mass shootings found an increased risk of persistent weekly and daily migraine in the months following the terror [ 21 ]. Together, this indicates that major stressful events can be associated with the new onset of chronic migraine, although it is unclear if such events directly cause the progression.

Stress as a migraine attack risk factor

Stress is perhaps the most commonly self-reported migraine attack trigger or risk factor [ 22 , 23 ]. A prospective study of more than twelve hundred consecutive migraine patients found that 76% of patients reported perceived identifiable “triggers”, with stress being the most commonly reported (80%) [ 24 ]. Even though stress is reported as the most common self-identified trigger, the literature has produced conflicting findings as to whether stress (both static levels or change in stress) actually causes migraine attacks. One of the main problems is the difficulty of genuinely establishing the causal attack “triggers” [ 25 ]. Simply asking patients to recall their usual headache triggers/risk factors or premonitory features retrospectively is limited by recall bias and false attribution. Because different variations and combination of factors may raise the risk of a migraine attack, and these factors have different potencies as risks for a migraine attack both on an interindividual and intraindividual level, we will use the term risk factor rather than trigger to connotate the increased probably of a subsequent attack. Several prospective studies using daily paper or e-diaries report a temporal relationship between stress and migraine that is significant for headache days vs. non-headache days [ 26 , 27 , 28 , 29 , 30 ]. These studies indeed reduce the influence of recall bias and false attribution—yet, fully resolving the temporal association, and influence of static or changing stress levels, is complex.

Let us ponder an example put forth by Lipton and colleagues: [ 25 ] Consider a patient that eats chocolate preictally. If chocolate consumption is a precipitant to the attack, then chocolate may be a risk factor. However, if the patient eats chocolate because she or he experiences cravings, the chocolate consumption could be a manifestation of the premonitory migraine phase (Fig. 2 a). To distinguish these possibilities, a randomized trial with chocolate and placebo is required. In such a trial, one could administer chocolate or placebo to patients at a selected time and see if there is an increased probability of a migraine attack in the verum group (the group that received chocolate), which would support the notion of chocolate as a risk factor. Alternatively, patients could be randomized to chocolate or placebo when they crave it. If both the verum and the placebo groups have high but equal probabilities of headache, craving chocolate is a premonitory feature. If the verum group has a higher rate of migraine attacks, this suggests chocolate is a risk factor. Remarkably, variants of these studies have been conducted with various perceived triggers or risk factors including both chocolate and stress. In one study, a group of 27 patients with self-perceived triggers was exposed to their personal risk factors (flickering lights or strenuous exercise), and only 3 of 27 patients had a migraine attack after exposure, thus disfavoring the notion of causal risk factors [ 31 ]. Along the same lines, a 2021 study demonstrated that there was good agreement for reporting stress as an attack risk factor and experimental nitroglycerin-triggered premonitory mood change, favoring the notion of risk factors a manifestation of the premonitorium [ 32 ].

Directed acyclic graphs illustrating the causality between attack risk factors and migraine attacks. a) Recall the experiment evaluating if chocolate is a migraine trigger, or rather the case of reverse causality where the premonitory craving of an impending migraine attack elicits chocolate consumption. b) Similarly, the manifestation of stress preictally may be the case of a state of increased vulnerability to stressors

Turner and colleagues conducted a study to explore the conditions necessary to assign causal status to headache risk factors [ 33 ]. Based on the Neymar-Rubin causal effects model, the researchers identified three basic assumptions that need to be met to determine causality in headache risk factors: (1) constancy of the individual; (2) constancy of the risk factor effect; and (3) constancy of the risk factor presentation. Houle and Turner attempted to explore the assumption of constancy in risk factor presentation in a real-world natural experiment [ 34 ]. They concluded that it is challenging to find days with similar patterns of headache risk factors when relying on natural reliability. This means that the assumption of constancy in risk factors, and thereby causal inference, is likely violated in natural experiments. Thus, the validity of personal uncovering of risk factors is questioned.

A study from 2014 by Lipton and colleagues found that the decline of perceived stress was associated with the onset of migraine attacks. The study reported that static stress levels were not associated with subsequent migraine attacks, but decline in stress from one evening to the next was associated with increased migraine attack onset over the subsequent 6, 12, and 18 hours [ 26 ]. The authors offer several explanations as to why a reduction in stress was observed prior to migraine attacks. The findings may be explained by an unmeasured mediator, such as missed medication, skipped meals, or disturbed sleep, that arise as a consequence of stress, but may also be attributed to a reversed causality. During the premonitory phase, there may be a period of increased vulnerability to stress followed by a phase of decreased vulnerability to stress. This is akin to the example proposed earlier with chocolate, i.e., increased stress is a manifestation of an impending attack (Fig. 2 b). To date, data are mixed on the “let down pattern” of reductions in stress triggering migraine attacks. Studies both support [ 35 , 36 ] and disclaim the support of “weekend”, “honeymoon” and “let-down” migraines [ 28 , 37 ].

However, two recent prospective diary studies adds additional insights [ 27 , 38 ]. In the first study, a digital health platform was used to prospectively capture stress and headache data and evaluate if the patterns of perceived stress varied through the migraine cycle [ 38 ]. Perceived stress was rated once daily on a 0–10 scale. Days were categorized into pre-migraine days, migraine days, post-migraine days and interictal days. Using a cluster analysis, the researchers found three dominant patterns of perceived stress across the migraine cycle: “let down” pattern; “flat pattern”; and “stress as a trigger/symptom” pattern [ 38 ]. The majority of headache episodes were assigned to cluster 2 (flat). Approximately one-quarter were assigned to cluster 3 (trigger), and the rest was assigned to cluster 1 (let down). Interestingly, very few patients had more than 90% of their headache episodes in one cluster. No patients had > 90% of episodes in cluster 1 or 3, indicating that there were no exclusively “let-down” or “trigger” pattern patients. The second study suggests that changes in several key variables relative to an individual’s typical habits had the most power as risk factors [ 27 ]. Information was collected on daily levels of several commonly perceived attack risk factors including stress (Daily Stress Inventory), number of caffeinated and alcoholic beverages, and mood disturbances. The probability of observing variations in each trigger was used to estimate the “surprisal” of experiencing each trigger. When expressed as units of “surprisal”, the highest odds ratio for an attack was found for stress (1.30; 95% CI 1.14 to 1.46). Together, this illustrates a vast heterogeneity in the manifestation of stress as a migraine attack risk factor, not only between individuals, but also from attack to attack within individuals—hampering the establishment of any simple or generalized causal relationship between stress as a risk factor and migraine.

Migraine-related disability, burden, impact and frequency in relation to stress

Even though there is no definite evidence that stress incites the incidence or progression of migraine, or directly triggers migraine attacks, there is a general understanding of a worsening of migraine burden in the setting of stress. A large prospective study with more than 5000 participants found that stress intensity was associated with headaches for individuals with tension-type headache, migraine and, coexisting tension-type headache and migraine [ 39 ]. They found a 4.3% increase in headache days for each 10-point stress increase on a 0–100 visual analog scale. Correlation analyses were adjusted for sex, age, abortive drug consumption, drinking, smoking, body mass index, and education, meaning that higher levels of stress are associated with a higher migraine symptom burden. Similarly, several observational studies demonstrate an association between stress and migraine symptom burden. Higher migraine frequency is associated with higher levels of perceived stress [ 40 ]. High job strain, resulting in lack of time for personal care and leisure, is associated with an increased odds of migraine [ 41 , 42 ]. Twenty-four hour shifts among medical residents increases migraine-related disability [ 43 ]. Among women, high levels of stress contribute to and increase the negative effects obesity has on migraine [ 44 ]. Stress facilitates the negative consequences poor sleep has on migraine occurrence [ 45 , 46 ]. Stress is associated with poorer response to acute treatment in chronic migraine patients [ 47 ]. Interestingly, minor life events, or daily hassles, seems to be more associated with migraine-related disability than major life events [ 48 ].

On the other hand, a case-control study from 2017 with 227 patients found that episodic migraine patients had no more perceived stress than controls after adjusting for depression and anxiety [ 49 ]. This indicates that migraine itself does not necessarily result in perceived stress. Remarkably, the chronic migraine patients had significantly more stress after adjusting for depression and anxiety, suggesting that chronic migraine appears to be a specific factor for perceived stress. If the total migraine symptom burden affects levels of perceived stress, one should consider the option that the migraine—in itself—is an essential factor driving stress. In fact, several studies have shown that individuals with severe headaches appraise events more negatively, which may contribute to increased stress [ 50 ]. This plausible collateral causality between stress and migraine means that stress indeed is a part of a vicious reinforcing feedback cycle involving stress and migraine [ 51 ].

Finally, it is interesting to mention changes in migraine symptom burden during the SARS-CoV-2 lockdowns, viewed in light of the stress caused by the COVID-19 pandemic and isolation. Several recent studies have produced conflicting findings [ 52 ]. As an example, one survey from Italy found an overall reduction in headache frequency and intensity during the quarantine compared to pre-quarantine [ 53 ]. On the other hand, a study from Spain found worsening of the usual pain during lockdown [ 54 ]. It may be that the perception of the pandemic of the individual combined with individual circumstances, resources and demands may lead to profoundly different impacts for different individuals. Future reports summarizing these findings will likely provide a better understanding of how global pandemics, cautionary measures such as lockdowns and mask mandates and their repercussions affects the migraine population.

Physiological measures of stress and migraine

The studies mentioned above have chiefly assessed the relationship between perceived stress and migraine—but how does this correlate to physiological measures? Herein we will briefly review the physiological changes corresponding to stress and migraine.

Stress induces a series of neurophysiological changes that may aid in understanding the stress-related triggering of migraine attacks. In a laboratory study of knock-in S218L familial hemiplegic migraine mutation mice, relief after chronic stress led to a lower cortical spreading depression threshold [ 55 ]. This model may, in part, explain why some patients experience “let down” migraine. Another laboratory study found that patients who did not report stress as a risk factor displayed deficient habituation to visual evoked potentials, suggesting that stress-sensitive patients lack this altered cortical excitability threshold [ 56 ]. Moreover, recall the idea that migraine risk factors may be a case of reversed causality, e.g., identifying chocolate as a risk factor may be the manifestation of a premonitory craving. Neuroimaging studies demonstrate that stress may be a manifestation of premonitory activation of pain processing regions, including the hippocampus [ 57 , 58 ], indicating that perceived stress is a manifestation of the impending attack.

Next, stress leads to central sensitization and hyperalgesia, which may concomitantly contribute to the debilitating characteristics of the migraine attack. Animal models show that both acute and chronic stress may enhance nociceptive responses [ 59 ]. Both peripheral and central sensitization seem to be important pathophysiological factors, contributing to many of the clinical characteristics of migraine including throbbing pain, motion sensitivity, hyperalgesia and allodynia [ 60 ] which may be exaggerated by stress. A recent study by Avona and colleagues [ 61 ] demonstrated that stress induced in mice produced a migraine-like state of hyperalgesia with increased response to the artificial migraine trigger sodium nitroprusside and subsequent blocking by calcitonin gene related peptide monoclonal antibodies. Similarly, allodynia exerts some effect on migraine-related disability, independent of the pain itself, and the relationship is partially driven by stress [ 62 ]. Moreover, emerging research has elucidated the role of NMDA receptors and microRNA in stress-related conditions such as major depressive disorder. Accumulated research suggests that chronic stress leads to an upregulation of NMDA receptor activation [ 2 ]. Glutamatergic medications acting as NMDA antagonists have shown an antidepressant and stabilizing effect in several brain circuits in animal models. Likewise, at the molecular level, dysregulation of microRNA seems to play a role in both acute and chronic stress and neuropsychiatric and affective disorders associated with stress [ 63 ]. It is conceivable that similar mechanisms apply to migraine in which stress seems to play a role.

Finally, the autonomic nervous system and HPA axis is worth mentioning. A body of research has traditionally focused on cardiovascular alterations among individuals with migraine [ 64 ], but there is now a trend toward the interactions of migraine and stress on the autonomic nervous system and HPA axis function. Yet, there are conflicting findings. Both lower and higher baseline sympathetic tone have been demonstrated in migraine patients [ 65 , 66 , 67 ]. Migraine patients also display significantly higher pain responses and sympathetic activation to stress than controls [ 68 , 69 ]. In total, there seems to be a sympathetic impairment interictally with increased sympathetic responsiveness during the migraine attack [ 70 ]. One possible explanation of this phenomenon might be that the constant stress by repeated headaches results in a sympathetic downregulation with a paradoxical hyperactivation during subsequent headaches. Studies of HPA activation have also produced conflicting findings. A systematic review found conflicting findings on the levels of corticotropic hormones in migraine patients, and the authors concluded that corticotropic hormones, at least as a direct causal link, seem to be irrelevant in the pathophysiology of migraine [ 71 ].

Implications for management

Behavioral interventions.

Behavioral treatments with evidence for migraine prevention include stress management, relaxation therapy, cognitive behavioral therapy, biofeedback, mindfulness-based therapies and acceptance and commitment therapy [ 72 , 73 , 74 , 75 , 76 ]. The US headache consortium has given relaxation therapy, cognitive behavioral therapy, and biofeedback Grade A evidence for migraine prevention [ 77 ]. Most, if not all, of these behavioral treatments include improvements in stress management as well as adjusting expectations and perceptions as therapeutic targets. However, in many of the studies of behavioral interventions, it has been illustrated that the reduction in headache frequency is not a function of the intended beneficial target organ response [ 51 , 78 , 79 , 80 ]. For example, in biofeedback training, improvement of circulation through hand warming does not necessarily translate to improvements in migraine outcomes. Thus, improvement in migraine and headache outcomes may be a consequence of non-specific effects, self-efficacy and the learned ability to cope with stressors combined with benefits of relaxation training to the nervous system—rather than stress reduction alone [ 80 ]. Moreover, trials of behavioral interventions have methodological challenges when using traditional pharmacological clinical trial standards, such as managing blinding and creating ideal control groups, which further hamper establishing causal effects. Even though the exact causal mechanisms of how stress management leads to improved migraine symptomatology are unclear, stress is a negative prognostic factor for migraine management and quality of life, clinical trial data and real-world experience show that many individuals have preventive benefits from established therapies, and some individuals prefer behavioral interventions. Therefore attention to individual management of stress is warranted and important [ 72 , 77 , 81 ].

A long-standing tradition in migraine management has been to advise patients to avoid headache risk factors, including increased stress. This strategy is traditionally implemented alongside general lifestyle measures such as good sleep hygiene, routine meal schedules, and regular exercise. Even though specific programs for identifying risk factors have been developed [ 82 ], some researchers suggest that complete avoidance of risk factors may have detrimental effects, in part driven by trigger sensitization [ 83 , 84 ]. From this, the new behavioral management strategy termed “Learning to Cope with Triggers” emerged [ 85 ]. Therapist and patient would identify triggers and decide what strategy to use with them. Three main strategies were employed: exposure to find out if the trigger resulted in a migraine attack; exposure to achieve desensitization/habituation; and exposure to enable practicing coping skills. A randomized controlled trial with 127 participants found that “Learning to Cope with Triggers” was superior to both waiting-list and avoidance for the outcomes headache frequency and abortive drug consumption [ 85 ]. Of note, the study merged both migraine and tension-type headache.

One promising behavioral intervention that directly targets stress management and perception is mindfulness-based stress reduction (MBSR). A meta-analysis from 2018, including five small sample studies of migraine and tension-type headache, found no benefit for MBSR in treating chronic headache [ 86 ]. In more recent randomized controlled trials, MBSR has been found to be superior to simple stress management with regards to headache frequency reduction [ 87 ]; superior to headache education with regards to reduction in disability and improvements in quality of life [ 88 ]; and superior to progressive muscle relaxation with regards to adaptive coping strategies, self-efficacy and reduced pain perception [ 89 ]. Of note, the two latter studies failed the primary clinical outcome of improvement in migraine frequency. In addition to the MBSR studies mentioned above, mindfulness-based cognitive therapy for migraine has demonstrated efficacy to reduce headache-related disability and attack level disability, and is another promising emerging treatment option [ 74 ]. Overall, there is no unambiguous evidence that mindfulness-based therapies is better than traditional guideline recommended behavioral interventions for migraine prevention and management in terms of headache day reduction; however, it is a promising emerging treatment for addressing migraine-related disability as well as other important outcomes.

Pharmacological interventions

Although pharmacotherapy alone is improbable to be paramount in managing migraine in a context of stress, behavioral interventions can be combined with pharmacotherapy to enhance the effects. Combining drugs and behavioral treatment seems to be more effective than betablockers alone or behavioral treatment alone [ 90 ]. In a four-armed randomized controlled trial, 232 migraine patients were randomized to placebo, betablockers, behavioral treatment and placebo or behavioral treatment and betablocker [ 90 ]. The combination of betablockers and behavioral treatments improved treatment outcomes and outcomes of acute treatment. The same benefits of combining drugs and behavioral treatments has been observed in a trial children and adolescents, in which amitriptyline plus cognitive behavioral therapy was superior to amitriptyline alone [ 91 ]. The study did not evaluate cognitive behavioral therapy alone, or placebo alone, making it unclear if it’s the behavioral therapy or the medications that is most efficient in the pediatric population.

Predictive models

A promising and emerging topic of research is the use of risk factor and premonitory features, including stress, in predictive models and forecasting models [ 92 ]. One very promising study by Houle and colleagues [ 93 ] looked into predicting headaches based on self-reported perceived stress. To the best of our knowledge, this is the first study investigating if self-reported stress may be used to forecast headaches. In the study, a low-dimensional model using today’s level of stress combined with the presence or absence of headache could predict headache tomorrow with an out-of-sample area under the curve precision of 0.65. Such predictive models can likely further improve the management of migraine for several reasons. Reducing the unpredictability of attacks might, in turn, lead to breaking the vicious circle of stress-migraine-stress. Predicting attacks increases self-efficacy among patients and allows for tailored stress management and management of factors that indeed predict attacks. Forecasting enables so-called preemptive treatment (or mini-prophylaxis) in which medication is focused on days with an increased probability of attacks. However, preemptive drug treatment based on forecasting models should only be utilized if future predictive models are highly accurate due to the increased risk of medication overuse in patients with higher frequency migraine. Another recent study examined changes in several potential risk factors to forecast migraine attacks [ 94 ]. In the study, a decrease in caffeine consumption, higher self-predicted probability of headache, and a higher level of stress were observed within the two days preceding a migraine attack. However, the multivariable model predicted migraine risk only slightly better than chance with a within-person C-statistic of 0.56. Both studies emphasize that the use of an electronic diary to capture data is effective but results in missed data and measurement errors which may compromise the validity and precision of the forecasting models. Still, we are likely far from the plausible biological roof for forecasting migraine attacks. If there are underlying neurobiological differences that explain the vast heterogeneity of observed risk factors and premonitory factors, including stress, identifying these, and incorporating them into predictive models could result in high forecasting accuracy.

Undoubtedly, there is a relationship between stress and migraine. The exact causal relationships in which stress causes incidence, chronification, migraine attacks, or increased burden of migraine remains unclear. Likely, the underlying neurobiology and pathophysiology is too complex, and the phenotype is too finely granulated to enable a generalized causal framework of migraine pathophysiology and treatment based on unitary stress biomarkers. However, actively engaging in how stress patterns unfold in each migraine patient could help the clinician in understanding why some patients transform to chronic migraine, how stress contributes as an attack risk factor, how stress may increase migraine symptom burden, and how to choose optimal therapy. Several individuals seem to benefit from stress management-oriented behavioral therapies, and such therapies should be offered as a adjuvant to pharmacological treatment or to those with a preference. Future studies should characterize large migraine cohorts to identify and exploit individual differences in treatment responsiveness of stress management-oriented therapies; and utilize all available data including triggers/ risk factors, premonitory features, and detailed facets of the physiological and psychosocial stress response, to create high-validity forecasting models.

Availability of data and materials

The literature database is available upon reasonable request to the authors.

Abbreviations

Hypothalamic-pituitary-adrenal

Mindfulness-based stress reduction

Charmandari E, Tsigos C, Chrousos G (2005) Endocrinology of the stress response. Annu Rev Physiol 67(1):259–284. https://doi.org/10.1146/annurev.physiol.67.040403.120816

Article   CAS   PubMed   Google Scholar  

Serafini G, Pompili M, Innamorati M, Dwivedi Y, Brahmachari G, Girardi P (2013) Pharmacological properties of glutamatergic drugs targeting NMDA receptors and their application in major depression. Curr Pharm Des 19(10):1898–1922. https://doi.org/10.2174/13816128113199990293

Lazarus RS, Folkman S (1984) Stress, appraisal, and coping. New York: Springer publishing company

Steptoe A. Psychobiological processes in the etiology of disease. Oxford: Pergamon Press; 1991.

Beck AT (1979) Cognitive therapy of depression. New York: Guilford press

Pérez-Muñoz A, Buse DC, Andrasik F (2019) Behavioral interventions for migraine. Neurol Clin 37(4):789–813. https://doi.org/10.1016/j.ncl.2019.07.003

Article   PubMed   Google Scholar  

Sauro KM, Becker WJ (2009) The stress and migraine interaction. Headache 49(9):1378–1386. https://doi.org/10.1111/j.1526-4610.2009.01486.x

Wöber C, Holzhammer J, Zeitlhofer J, Wessely P, Wöber-Bingöl Ç (2006) Trigger factors of migraine and tension-type headache: experience and knowledge of the patients. J Headache Pain 7(4):188–195. https://doi.org/10.1007/s10194-006-0305-3

Article   PubMed   PubMed Central   Google Scholar  

Thomas J, Harden A (2008) Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 8(1):1–10. https://doi.org/10.1186/1471-2288-8-45

Article   Google Scholar  

Mäki K, Vahtera J, Virtanen M, Elovainio M, Keltikangas-Järvinen L, Kivimäki M (2008) Work stress and new-onset migraine in a female employee population. Cephalalgia 28(1):18–25. https://doi.org/10.1111/j.1468-2982.2007.01462.x

Leineweber C, Eib C, Bernhard-Oettel C, Nyberg A (2020) Trajectories of effort-reward imbalance in Swedish workers: differences in demographic and work-related factors and associations with health. Work Stress 34(3):238–258. https://doi.org/10.1080/02678373.2019.1666434

Hammond NG, Orr SL, Colman I (2019) Early life stress in adolescent migraine and the mediational influence of symptoms of depression and anxiety in a Canadian cohort. Headache 59(10):1687–1699. https://doi.org/10.1111/head.13644

Fuller-Thomson E, Baker TM, Brennenstuhl S (2010) Investigating the association between childhood physical abuse and migraine. Headache 50(5):749–760. https://doi.org/10.1111/j.1526-4610.2010.01626.x

Tietjen GE, Brandes JL, Peterlin BL, Eloff A, Dafer RM, Stein MR, Drexler E, Martin VT, Hutchinson S, Aurora SK, Recober A, Herial NA, Utley C, White L, Khuder SA (2010) Childhood maltreatment and migraine (part I). Prevalence and adult revictimization: a multicenter headache clinic survey. Headache 50(1):20–31. https://doi.org/10.1111/j.1526-4610.2009.01556.x

Tietjen GE, Brandes JL, Peterlin BL, Eloff A, Dafer RM, Stein MR, Drexler E, Martin VT, Hutchinson S, Aurora SK, Recober A, Herial NA, Utley C, White L, Khuder SA (2010) Childhood maltreatment and migraine (part II). Emotional abuse as a risk factor for headache chronification. Headache 50(1):32–41. https://doi.org/10.1111/j.1526-4610.2009.01557.x

Karmakar M, Elhai JD, Amialchuk AA, Tietjen GE (2018) Do personality traits mediate the relationship between childhood abuse and migraine? An exploration of the relationships in young adults using the add health dataset. Headache 58(2):243–259. https://doi.org/10.1111/head.13206

Maneyapanda SB, Venkatasubramanian A (2005) Relationship between significant perinatal events and migraine severity. Pediatrics 116(4):e555–e558. https://doi.org/10.1542/peds.2005-0454

Buse DC, Greisman JD, Baigi K, Lipton RB (2019) Migraine progression: a systematic review. Headache 59(3):306–338. https://doi.org/10.1111/head.13459

Scher A, Stewart W, Buse D, Krantz DS, Lipton RB (2008) Major life changes before and after the onset of chronic daily headache: a population-based study. Cephalalgia 28(8):868–876. https://doi.org/10.1111/j.1468-2982.2008.01634.x

De Benedittis G, Lorenzetti A, Fieri A (1990) The role of stressful life events in the onset of chronic primary headache. Pain 40(1):65–75. https://doi.org/10.1016/0304-3959(90)91052-K

Stensland S, Zwart JA, Wentzel-Larsen T et al (2018) The headache of terror: a matched cohort study of adolescents from the Utøya and the HUNT study. Neurology 90(2):e111–e118. https://doi.org/10.1212/wnl.0000000000004805

Marmura MJ (2018) Triggers, protectors, and predictors in episodic migraine. Curr Pain Headache Rep 22(12):81. https://doi.org/10.1007/s11916-018-0734-0

Pellegrino ABW, Davis-Martin RE, Houle TT, Turner DP, Smitherman TA (2018) Perceived triggers of primary headache disorders: a meta-analysis. Cephalalgia 38(6):1188–1198. https://doi.org/10.1177/0333102417727535

Kelman L (2007) The triggers or precipitants of the acute migraine attack. Cephalalgia 27(5):394–402. https://doi.org/10.1111/j.1468-2982.2007.01303.x

Lipton RB, Pavlovic JM, Haut SR, Grosberg BM, Buse DC (2014) Methodological issues in studying trigger factors and premonitory features of migraine. Headache: J Head Face Pain 54(10):1661–1669. https://doi.org/10.1111/head.12464

Lipton RB, Buse DC, Hall CB, Tennen H, DeFreitas TA, Borkowski TM, Grosberg BM, Haut SR (2014) Reduction in perceived stress as a migraine trigger: testing the “let-down headache” hypothesis. Neurology 82(16):1395–1401. https://doi.org/10.1212/wnl.0000000000000332

Turner DP, Lebowitz AD, Chtay I, Houle TT (2019) Headache triggers as surprise. Headache 59(4):495–508. https://doi.org/10.1111/head.13507

Wöber C, Brannath W, Schmidt K, Kapitan M, Rudel E, Wessely P, Wöber-Bingöl C, PAMINA Study Group (2007) Prospective analysis of factors related to migraine attacks: the PAMINA study. Cephalalgia 27(4):304–314. https://doi.org/10.1111/j.1468-2982.2007.01279.x

Hashizume M, Yamada U, Sato A, Hayashi K, Amano Y, Makino M, Yoshiuchi K, Tsuboi K (2008) Stress and psychological factors before a migraine attack: a time-based analysis. Biopsychosoc Med 2(1):14. https://doi.org/10.1186/1751-0759-2-14

Vives-Mestres M, Casanova A, Hershey AD, Orr SL (2021) Perceived stress and pain severity in individuals with chronic migraine: a longitudinal cohort study using daily prospective diary data. Headache 61(8):1245–1254. https://doi.org/10.1111/head.14199

Hougaard A, Amin F, Hauge AW, Ashina M, Olesen J (2013) Provocation of migraine with aura using natural trigger factors. Neurology 80(5):428–431. https://doi.org/10.1212/WNL.0b013e31827f0f10

Karsan N, Bose P, Newman J, Goadsby PJ (2021) Are some patient-perceived migraine triggers simply early manifestations of the attack. J Neurol 268(5):1885–1893. https://doi.org/10.1007/s00415-020-10344-1

Turner DP, Smitherman TA, Martin VT, Penzien DB, Houle TT (2013) Causality and headache triggers. Headache: J Head Face Pain 53(4):628–635. https://doi.org/10.1111/head.12076

Houle TT, Turner DP (2013) Natural experimentation is a challenging method for identifying headache triggers. Headache: J Head Face Pain 53(4):636–643. https://doi.org/10.1111/head.12075

Torelli P, Cologno D, Manzoni GC (1999) Weekend headache: a retrospective study in migraine without aura and episodic tension-type headache. Headache: J Head Face Pain 39(1):11–20. https://doi.org/10.1046/j.1526-4610.1999.3901011.x

Article   CAS   Google Scholar  

Vaitl D, Propson N, Stark R, Walter B, Schienle A (2001) Headache and sferics. Headache: J Head Face Pain 41(9):845–853. https://doi.org/10.1111/j.1526-4610.2001.01155.x

Morrison D (1990) Occupational stress in migraine is weekend headache a myth or reality. Cephalalgia 10(4):189–193. https://doi.org/10.1046/j.1468-2982.1990.1004189.x

Vives-Mestres M, Casanova A, Buse DC, Donoghue S, Houle TT, Lipton RB, Mian A, Shulman KJ, Orr SL (2020) Patterns of perceived stress throughout the migraine cycle: a longitudinal cohort study using daily prospective diary data. Headache 61(1):90–102. https://doi.org/10.1111/head.13943

Schramm SH, Moebus S, Lehmann N, Galli U, Obermann M, Bock E, Yoon MS, Diener HC, Katsarava Z (2015) The association between stress and headache: a longitudinal population-based study. Cephalalgia 35(10):853–863. https://doi.org/10.1177/0333102414563087

An YC, Liang CS, Lee JT, Lee MS, Chen SJ, Tsai CL, Lin GY, Lin YK, Yang FC (2019) Effect of sex and adaptation on migraine frequency and perceived stress: a cross-sectional case-control study. Front Neurol 10:598. https://doi.org/10.3389/fneur.2019.00598

Griep RH, Toivanen S, Santos IS, Rotenberg L, Juvanhol LL, Goulart AC, Aquino EM, Benseñor I (2016) Work-family conflict, lack of time for personal care and leisure, and job strain in migraine: results of the Brazilian longitudinal study of adult health (ELSA-Brasil). Am J Ind Med 59(11):987–1000. https://doi.org/10.1002/ajim.22620

Santos IS, Griep RH, Alves MG et al (2014) Job stress is associated with migraine in current workers: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Eur J Pain (London, England) 18:1290–1297. https://doi.org/10.1002/j.1532-2149.2014.489.x

Navarro-Pérez MP, Suller-Marti A, Bellosta-Diago E, Roche-Bueno JC, Santos-Lasaosa S (2020) Impact of 24-hour on-call shifts on headache in medical residents: a cohort study. Headache 60(7):1427–1431. https://doi.org/10.1111/head.13861

Andreeva VA, Fezeu LK, Hercberg S, Galan P (2018) Obesity and migraine: effect modification by gender and perceived stress. Neuroepidemiology 51(1-2):25–32. https://doi.org/10.1159/000489663

Vgontzas A, Li W, Mostofsky E, Mittleman MA, Bertisch SM (2021) Baseline sleep quality, stress, and depressive symptoms, and subsequent headache occurrence in a six-week prospective cohort study of patients with episodic migraine. Headache 61(5):727–733. https://doi.org/10.1111/head.14105

Dikmen PY, Yavuz BG, Aydinlar EI (2015) The relationships between migraine, depression, anxiety, stress, and sleep disturbances. Acta Neurol Belg 115:117–122. https://doi.org/10.1007/s13760-014-0312-0

Cha MJ, Kim BK, Moon HS, Ahn JY, Oh K, Kim JY, Kim BS, Sohn JH, Chung JM, Song TJ, Kim J, Seo JG, Chu MK, Cho SJ (2018) Stress is associated with poor outcome of acute treatment for chronic migraine: a multicenter study. Pain Med 19(9):1832–1838. https://doi.org/10.1093/pm/pnx269

De Benedittis G, Lorenzetti A (1992) The role of stressful life events in the persistence of primary headache: major events vs. daily hassles. Pain 51(1):35–42. https://doi.org/10.1016/0304-3959(92)90006-w

Moon H-J, Seo J-G, Park S-P (2017) Perceived stress in patients with migraine: a case-control study. J Headache Pain 18(1):73. https://doi.org/10.1186/s10194-017-0780-8

Vladetić M, Jančuljak D, Butković Soldo S, Kralik K, Buljan K (2017) Health-related quality of life and ways of coping with stress in patients with migraine. Neurol Sci: Off J Ital Neurol Soc Ital Soc Clin Neurophysiol 38(2):295–301. https://doi.org/10.1007/s10072-016-2759-7

Martin PR (2016) Stress and primary headache: review of the research and clinical management. Curr Pain Headache Rep 20(7):45. https://doi.org/10.1007/s11916-016-0576-6

Buse D, Gerstein M, Wirth R et al (2021) Impact of the COVID-19 pandemic on people living with migraine: results of the MICOAS qualitative study. Headache:65–66

Delussi M, Gentile E, Coppola G, Prudenzano AMP, Rainero I, Sances G, Abagnale C, Caponnetto V, de Cesaris F, Frattale I, Guaschino E, Marcinnò A, Ornello R, Pistoia F, Putortì A, Roca ME, Roveta F, Lupi C, Trojano M, Pierelli F, Geppetti P, Sacco S, de Tommaso M (2020) Investigating the effects of COVID-19 quarantine in migraine: An observational cross-sectional study from the Italian National Headache Registry (RICe). Front Neurol 11:597881. https://doi.org/10.3389/fneur.2020.597881

Gonzalez-Martinez A, Planchuelo-Gómez Á, Guerrero ÁL, García-Azorín D, Santos-Lasaosa S, Navarro-Pérez MP, Odriozola-González P, Irurtia MJ, Quintas S, de Luis-García R, Gago-Veiga AB (2021) Evaluation of the impact of the COVID-19 lockdown in the clinical course of migraine. Pain Med 22(9):2079–2091. https://doi.org/10.1093/pm/pnaa449

Balkaya M, Seidel JL, Sadeghian H, Qin T, Chung DY, Eikermann-Haerter K, van den Maagdenberg AMJM, Ferrari MD, Ayata C (2019) Relief following chronic stress augments spreading depolarization susceptibility in familial hemiplegic migraine mice. Neuroscience 415:1–9. https://doi.org/10.1016/j.neuroscience.2019.07.006

Lisicki M, Ruiz-Romagnoli E, Piedrabuena R, Giobellina R, Schoenen J, Magis D (2018) Migraine triggers and habituation of visual evoked potentials. Cephalalgia 38(5):988–992. https://doi.org/10.1177/0333102417720217

Schwedt TJ, Chong CD, Chiang C-C, Baxter L, Schlaggar BL, Dodick DW (2014) Enhanced pain-induced activity of pain-processing regions in a case-control study of episodic migraine. Cephalalgia 34(12):947–958. https://doi.org/10.1177/0333102414526069

Schulte LH, Peng KP (2019) Current understanding of premonitory networks in migraine: a window to attack generation. Cephalalgia 39(13):1720–1727. https://doi.org/10.1177/0333102419883375

Kaufmann D, Brennan KC (2018) The effects of chronic stress on migraine relevant phenotypes in male mice. Front Cell Neurosci 12:294. https://doi.org/10.3389/fncel.2018.00294

Article   CAS   PubMed   PubMed Central   Google Scholar  

Burstein R (2001) Deconstructing migraine headache into peripheral and central sensitization. Pain 89(2):107–110. https://doi.org/10.1016/S0304-3959(00)00478-4

Avona A, Mason BN, Lackovic J, Wajahat N, Motina M, Quigley L, Burgos-Vega C, Moldovan Loomis C, Garcia-Martinez LF, Akopian AN, Price TJ, Dussor G (2020) Repetitive stress in mice causes migraine-like behaviors and calcitonin gene-related peptide-dependent hyperalgesic priming to a migraine trigger. Pain 161(11):2539–2550. https://doi.org/10.1097/j.pain.0000000000001953

Polk AN, Protti TA, Smitherman TA (2020) Allodynia and disability in migraine: the mediating role of stress. Headache 60(10):2281–2290. https://doi.org/10.1111/head.14012

Serafini G, Pompili M, Innamorati M, Giordano G, Montebovi F, Sher L, Dwivedi Y, Girardi P (2012) The role of microRNAs in synaptic plasticity, major affective disorders and suicidal behavior. Neurosci Res 73(3):179–190. https://doi.org/10.1016/j.neures.2012.04.001

Domingues RB, Fonseca KB, Ziviane LF, Domingues SA, Vassalo D (2010) Altered cardiovascular reactivity to mental stress but not to cold pressure test in migraine. Headache 50(1):133–137. https://doi.org/10.1111/j.1526-4610.2009.01567.x

Leistad RB, Stovner LJ, White LR, Nilsen KB, Westgaard RH, Sand T (2007) Noradrenaline and cortisol changes in response to low-grade cognitive stress differ in migraine and tension-type headache. J Headache Pain 8(3):157–166. https://doi.org/10.1007/s10194-007-0384-9

Gass JJ, Glaros AG (2013) Autonomic dysregulation in headache patients. Appl Psychophysiol Biofeedback 38(4):257–263. https://doi.org/10.1007/s10484-013-9231-8

Mamontov OV, Babayan L, Amelin AV, Giniatullin R, Kamshilin AA (2016) Autonomous control of cardiovascular reactivity in patients with episodic and chronic forms of migraine. J Headache Pain 17(1):52. https://doi.org/10.1186/s10194-016-0645-6

Leistad R, Sand T, Westgaard R, Nilsen KB, Stovner LJ (2006) Stress-induced pain and muscle activity in patients with migraine and tension-type headache. Cephalalgia 26(1):64–73. https://doi.org/10.1111/j.1468-2982.2005.00997.x

Rauschel V, Straube A, Süß F, Ruscheweyh R (2015) Responsiveness of the autonomic nervous system during paced breathing and mental stress in migraine patients. J Headache Pain 16(1):82. https://doi.org/10.1186/s10194-015-0567-8

Miglis MG (2018) Migraine and autonomic dysfunction: which is the horse and which is the jockey. Curr Pain Headache Rep 22(3):19. https://doi.org/10.1007/s11916-018-0671-y

Lippi G, Mattiuzzi C (2017) Cortisol and migraine: a systematic literature review. Agri 29(3):95–99. https://doi.org/10.5505/agri.2017.25348

Penzien DB, Irby MB, Smitherman TA, Rains JC, Houle TT (2015) Well-established and empirically supported behavioral treatments for migraine. Curr Pain Headache Rep 19(7):34. https://doi.org/10.1007/s11916-015-0500-5

Ailani J, Burch RC, Robbins MS, the Board of Directors of the American Headache Society (2021) The American headache Society consensus statement: update on integrating new migraine treatments into clinical practice. Headache: J Head Face Pain 61(7):1021–1039. https://doi.org/10.1111/head.14153

Seng EK, Singer AB, Metts C, Grinberg AS, Patel ZS, Marzouk M, Rosenberg L, Day M, Minen MT, Lipton RB, Buse DC (2019) Does mindfulness-based cognitive therapy for migraine reduce migraine-related disability in people with episodic and chronic migraine? A phase 2b pilot randomized clinical trial. Headache: J Head Face Pain 59(9):1448–1467. https://doi.org/10.1111/head.13657

Grazzi L, Andrasik F, Rizzoli P et al (2021) Acceptance and commitment therapy for high frequency episodic migraine without aura: findings from a randomized pilot investigation. Headache: J Head Face Pain 61(6):895–905

Grazzi L, Rizzoli P, Andrasik F (2020) Effectiveness of mindfulness by smartphone, for patients with chronic migraine and medication overuse during the Covid-19 emergency. Neurol Sci 41(S2):461–462. https://doi.org/10.1007/s10072-020-04659-0

Society AH (2019) The American headache Society position statement on integrating new migraine treatments into clinical practice. Headache: J Head Face Pain 59:1–18

Google Scholar  

Hermann C, Blanchard EB (2002) Biofeedback in the treatment of headache and other childhood pain. Appl Psychophysiol Biofeedback 27(2):143–162. https://doi.org/10.1023/A:1016295727345

Morrill B, Blanchard EB (1989) Two studies of the potential mechanisms of action in the thermal biofeedback treatment of vascular headache. Headache: J Head Face Pain 29(3):169–176. https://doi.org/10.1111/j.1526-4610.1989.hed2903169.x

Holroyd KA, Penzien DB, Hursey KG, Tobin DL, Rogers L, Holm JE, Marcille PJ, Hall JR, Chila AG (1984) Change mechanisms in EMG biofeedback training: cognitive changes underlying improvements in tension headache. J Consult Clin Psychol 52(6):1039–1053. https://doi.org/10.1037/0022-006X.52.6.1039

Probyn K, Bowers H, Caldwell F, Mistry D, Underwood M, Matharu M, Pincus T, On behalf of the CHESS Team (2017) Prognostic factors for chronic headache: a systematic review. Neurology 89(3):291–301. https://doi.org/10.1212/wnl.0000000000004112

Caroli A, Klan T, Gaul C, Kubik SU, Martin PR, Witthöft M (2020) Types of triggers in migraine - factor structure of the headache triggers sensitivity and avoidance questionnaire and development of a new short form (HTSAQ-SF). Headache 60(9):1920–1929. https://doi.org/10.1111/head.13896

Varkey E, Linde M, Henoch I (2013) “It’sa balance between letting it influence life completely and not letting it influence life at all”–a qualitative study of migraine prevention from patients’ perspective. Disabil Rehabil 35(10):835–844. https://doi.org/10.3109/09638288.2012.709304

Martin PR (2010) Behavioral management of migraine headache triggers: learning to cope with triggers. Curr Pain Headache Rep 14(3):221–227. https://doi.org/10.1007/s11916-010-0112-z

Martin PR, Reece J, Callan M, MacLeod C, Kaur A, Gregg K, Goadsby PJ (2014) Behavioral management of the triggers of recurrent headache: a randomized controlled trial. Behav Res Ther 61:1–11. https://doi.org/10.1016/j.brat.2014.07.002

Anheyer D, Leach MJ, Klose P, Dobos G, Cramer H (2019) Mindfulness-based stress reduction for treating chronic headache: a systematic review and meta-analysis. Cephalalgia 39(4):544–555. https://doi.org/10.1177/0333102418781795

Seminowicz DA, Burrowes SAB, Kearson A, Zhang J, Krimmel SR, Samawi L, Furman AJ, Keaser ML, Gould NF, Magyari T, White L, Goloubeva O, Goyal M, Peterlin BL, Haythornthwaite JA (2020) Enhanced mindfulness-based stress reduction in episodic migraine: a randomized clinical trial with magnetic resonance imaging outcomes. Pain 161(8):1837–1846. https://doi.org/10.1097/j.pain.0000000000001860

Wells RE, O’Connell N, Pierce CR et al (2021) Effectiveness of mindfulness meditation vs headache education for adults with migraine: a randomized clinical trial. JAMA Intern Med 181(3):317–328. https://doi.org/10.1001/jamainternmed.2020.7090

Simshäuser K, Lüking M, Kaube H, Schultz C, Schmidt S (2020) Is mindfulness-based stress reduction a promising and feasible intervention for patients suffering from migraine? A randomized controlled pilot trial. Complement Med Res 27(1):19–30. https://doi.org/10.1159/000501425

Holroyd KA, Cottrell CK, O’Donnell FJ et al (2010) Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial. BMJ (Clinical research ed) 341:c4871

Powers SW, Kashikar-Zuck SM, Allen JR, LeCates SL, Slater SK, Zafar M, Kabbouche MA, O’Brien HL, Shenk CE, Rausch JR, Hershey AD (2013) Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. Jama 310(24):2622–2630. https://doi.org/10.1001/jama.2013.282533

Buse DC, McGinley JS, Lipton RB. Predicting the Future of Migraine Attack Prediction. Headache. 2020;60(10):2125–2128. https://doi.org/10.1111/head.14025 .

Houle TT, Turner DP, Golding AN, Porter JAH, Martin VT, Penzien DB, Tegeler CH (2017) Forecasting individual headache attacks using perceived stress: development of a multivariable prediction model for persons with episodic migraine. Headache: J Head Face Pain 57(7):1041–1050. https://doi.org/10.1111/head.13137

Holsteen KK, Hittle M, Barad M, Nelson LM (2020) Development and internal validation of a multivariable prediction model for individual episodic migraine attacks based on daily trigger exposures. Headache 60(10):2364–2379. https://doi.org/10.1111/head.13960

Download references

Acknowledgements

This paper is based on the trial lecture by Anker Stubberud at his PhD defense December 10th, 2020.

The authors received no specific funding.

Author information

Authors and affiliations.

Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway

Anker Stubberud, Mattias Linde & Erling Tronvik

National Advisory Unit on Headaches, Department of Neurology, St. Olavs Hospital, Trondheim, Norway

Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA

Dawn C. Buse

Department of Neurology, Akershus University Hospital, Lørenskog, Norway

Espen Saxhaug Kristoffersen

Department of General Practice, University of Oslo, Oslo, Norway

You can also search for this author in PubMed   Google Scholar

Contributions

AS designed the review, wrote the initial manuscript draft, revised it for important intellectual content, and read and approved the final manuscript. DCB conceived and contributed to the design of the review, revised the manuscript for important intellectual content, and read and approved the final manuscript. ESK conceived and contributed to the design of the review, revised the manuscript for important intellectual content, and read and approved the final manuscript. ML designed the review, revised the manuscript for important intellectual content, and read and approved the final manuscript. ET designed the review, revised the manuscript for important intellectual content, and read and approved the final manuscript.

Corresponding author

Correspondence to Anker Stubberud .

Ethics declarations

Ethics approval and consent to participate.

Not applicable.

Consent for publication

Competing interests.

AS is a part-time employee and shareholder of Nordic Brain Tech AS, a company developing a mHealth behavioral migraine intervention; and has a patent mHealth Biofeedback treatment concept for episodic migraine pending and may benefit financially from a license agreement between Nordic Brain Tech AS and NTNU Norwegian University of Science and Technology.

DCB has grants from Amgen, the National Headache Foundation and the FDA. She has been a consultant for Amgen/Novartis, Allergan/Abbvie, Lilly, Lundbeck, and Teva. She is on the editorial board of Current Pain and Headache Reports.

ESK reports no competing interest.

ML is a shareholder of Nordic Brain Tech AS, a company developing a mHealth behavioral migraine intervention; has a patent mHealth Biofeedback treatment concept for episodic migraine pending and may benefit financially from a license agreement between Nordic Brain Tech AS and NTNU Norwegian University of Science and Technology of the same concept.

ET is a shareholder of Nordic Brain Tech AS, a company developing a mHealth behavioral migraine intervention; has a patent mHealth Biofeedback treatment concept for episodic migraine pending and may benefit financially from a license agreement between Nordic Brain Tech AS and NTNU Norwegian University of Science and Technology of the same concept. ET has received personal fees for lectures and advisory boards from Lundbeck, Allergan/Abbvie, Roche, TEVA, Novartis, Amgen, Eli-Lilly. He is board member and shareholder of Palion Medical AS.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Stubberud, A., Buse, D.C., Kristoffersen, E.S. et al. Is there a causal relationship between stress and migraine? Current evidence and implications for management. J Headache Pain 22 , 155 (2021). https://doi.org/10.1186/s10194-021-01369-6

Download citation

Received : 16 October 2021

Accepted : 01 December 2021

Published : 20 December 2021

DOI : https://doi.org/10.1186/s10194-021-01369-6

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Daily hassles
• Behavioral treatment

The Journal of Headache and Pain

ISSN: 1129-2377

• Submission enquiries: [email protected]

Featured Clinical Reviews

• Screening for Atrial Fibrillation: US Preventive Services Task Force Recommendation Statement JAMA Recommendation Statement January 25, 2022
• Evaluating the Patient With a Pulmonary Nodule: A Review JAMA Review January 18, 2022
• Download PDF
• Share X Facebook Email LinkedIn
• Permissions

Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes

• 1 Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
• 2 Research Division, Joslin Diabetes Center, and Harvard Medical School, Boston, Massachusetts
• 3 Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
• 4 Kaiser Permanente Washington Health Research Institute, Seattle
• 5 Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
• 6 Department of Internal Medicine, Division of Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City
• 7 Division of General & GI Surgery, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
• 8 Metamor Institute, Pennington Biomedical Research Center, Baton Rouge, Louisiana
• 9 Weill Cornell Medicine-New York Presbyterian, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York, New York
• 10 Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
• 11 Department of Medicine, University of Washington and VA Puget Sound Health Care System, Seattle
• 12 Pennington Biomedical Research Center, Baton Rouge, Louisiana
• Editorial Bariatric Surgery Produces Long-term Benefits in Patients with Type 2 Diabetes Thomas A. Wadden, PhD; Robert F. Kushner, MD; Ariana M. Chao, PhD, CRNP JAMA
• Original Investigation Association Between Bariatric Surgery and 5-Year Macrovascular Outcomes in Patients With Type 2 Diabetes David P. Fisher, MD; Eric Johnson, MS; Sebastien Haneuse, PhD; David Arterburn, MD, MPH; Karen J. Coleman, PhD; Patrick J. O’Connor, MD, MA, MPH; Rebecca O’Brien, MD; Andy Bogart, MS; Mary Kay Theis, MA, MS; Jane Anau, BS; Emily B. Schroeder, MD, PhD; Stephen Sidney, MD, MPH JAMA
• Review Benefits and Risks of Bariatric Surgery in Adults: A Review David E. Arterburn, MD, MPH; Dana A. Telem, MD, MPH; Robert F. Kushner, MD; Anita P. Courcoulas, MD, MPH JAMA
• Original Investigation Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Anita P. Courcoulas, MD, MPH; Steven H. Belle, PhD, MScHyg; Rebecca H. Neiberg, MS; Sheila K. Pierson, BS, BA; Jessie K Eagleton, MPH; Melissa A. Kalarchian, PhD; James P. DeLany, PhD; Wei Lang, PhD; John M. Jakicic, PhD JAMA Surgery
• Original Investigation Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass Kathleen M. McTigue, MD; Robert Wellman, MS; Elizabeth Nauman, MPH, PhD; Jane Anau, BS; R. Yates Coley, PhD; Alberto Odor, MD; Julie Tice, MS; Karen J. Coleman, PhD; Anita Courcoulas, MD; Roy E. Pardee, JD; Sengwee Toh, ScD; Cheri D. Janning, MS; Neely Williams, MDiv; Andrea Cook, PhD; Jessica L. Sturtevant, MS; Casie Horgan, MPH; David Arterburn, MD; for the PCORnet Bariatric Study Collaborative JAMA Surgery

Question   What is the long-term durability of glycemic control and safety of bariatric surgery compared with medical/lifestyle management of type 2 diabetes?

Findings   Bariatric surgery led to superior glycemic control compared with medical/lifestyle intervention (between-group difference in hemoglobin A 1c of 1.4% at 7 years and 1.1% at 12 years), with less diabetes medication usage and higher rates of diabetes remission.

Meaning   These results combined with existing evidence support the use of bariatric surgery for treatment of type 2 diabetes in people with obesity.

Importance   Randomized clinical trials of bariatric surgery have been limited in size, type of surgical procedure, and follow-up duration.

Objective   To determine long-term glycemic control and safety of bariatric surgery compared with medical/lifestyle management of type 2 diabetes.

Design, Setting, and Participants   ARMMS-T2D (Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes) is a pooled analysis from 4 US single-center randomized trials conducted between May 2007 and August 2013, with observational follow-up through July 2022.

Intervention   Participants were originally randomized to undergo either medical/lifestyle management or 1 of the following 3 bariatric surgical procedures: Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding.

Main Outcome and Measures   The primary outcome was change in hemoglobin A 1c (HbA 1c ) from baseline to 7 years for all participants. Data are reported for up to 12 years.

Results   A total of 262 of 305 eligible participants (86%) enrolled in long-term follow-up for this pooled analysis. The mean (SD) age of participants was 49.9 (8.3) years, mean (SD) body mass index was 36.4 (3.5), 68.3% were women, 31% were Black, and 67.2% were White. During follow-up, 25% of participants randomized to undergo medical/lifestyle management underwent bariatric surgery. The median follow-up was 11 years. At 7 years, HbA 1c decreased by 0.2% (95% CI, −0.5% to 0.2%), from a baseline of 8.2%, in the medical/lifestyle group and by 1.6% (95% CI, −1.8% to −1.3%), from a baseline of 8.7%, in the bariatric surgery group. The between-group difference was −1.4% (95% CI, −1.8% to −1.0%; P  < .001) at 7 years and −1.1% (95% CI, −1.7% to −0.5%; P  = .002) at 12 years. Fewer antidiabetes medications were used in the bariatric surgery group. Diabetes remission was greater after bariatric surgery (6.2% in the medical/lifestyle group vs 18.2% in the bariatric surgery group; P  = .02) at 7 years and at 12 years (0.0% in the medical/lifestyle group vs 12.7% in the bariatric surgery group; P  < .001). There were 4 deaths (2.2%), 2 in each group, and no differences in major cardiovascular adverse events. Anemia, fractures, and gastrointestinal adverse events were more common after bariatric surgery.

Conclusion and Relevance   After 7 to 12 years of follow-up, individuals originally randomized to undergo bariatric surgery compared with medical/lifestyle intervention had superior glycemic control with less diabetes medication use and higher rates of diabetes remission.

Trial Registration   ClinicalTrials.gov Identifier: NCT02328599

• Editorial Bariatric Surgery Produces Long-term Benefits in Patients with Type 2 Diabetes JAMA

Read More About

Courcoulas AP , Patti ME , Hu B, et al. Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes. JAMA. 2024;331(8):654–664. doi:10.1001/jama.2024.0318

Manage citations:

© 2024

Artificial Intelligence Resource Center

Cardiology in JAMA : Read the Latest

Browse and subscribe to JAMA Network podcasts!

Others Also Liked

Select your interests.

Customize your JAMA Network experience by selecting one or more topics from the list below.

• Academic Medicine
• Acid Base, Electrolytes, Fluids
• Allergy and Clinical Immunology
• American Indian or Alaska Natives
• Anesthesiology
• Anticoagulation
• Art and Images in Psychiatry
• Artificial Intelligence
• Assisted Reproduction
• Bleeding and Transfusion
• Caring for the Critically Ill Patient
• Challenges in Clinical Electrocardiography
• Climate and Health
• Climate Change
• Clinical Challenge
• Clinical Decision Support
• Clinical Implications of Basic Neuroscience
• Clinical Pharmacy and Pharmacology
• Complementary and Alternative Medicine
• Consensus Statements
• Coronavirus (COVID-19)
• Critical Care Medicine
• Cultural Competency
• Dental Medicine
• Dermatology
• Diabetes and Endocrinology
• Diagnostic Test Interpretation
• Drug Development
• Electronic Health Records
• Emergency Medicine
• End of Life, Hospice, Palliative Care
• Environmental Health
• Equity, Diversity, and Inclusion
• Facial Plastic Surgery
• Gastroenterology and Hepatology
• Genetics and Genomics
• Genomics and Precision Health
• Global Health
• Guide to Statistics and Methods
• Hair Disorders
• Health Care Delivery Models
• Health Care Economics, Insurance, Payment
• Health Care Quality
• Health Care Reform
• Health Care Safety
• Health Care Workforce
• Health Disparities
• Health Inequities
• Health Policy
• Health Systems Science
• History of Medicine
• Hypertension
• Images in Neurology
• Implementation Science
• Infectious Diseases
• Innovations in Health Care Delivery
• JAMA Infographic
• Law and Medicine
• Leading Change
• Less is More
• LGBTQIA Medicine
• Lifestyle Behaviors
• Medical Coding
• Medical Devices and Equipment
• Medical Education
• Medical Education and Training
• Medical Journals and Publishing
• Mobile Health and Telemedicine
• Narrative Medicine
• Neuroscience and Psychiatry
• Notable Notes
• Nutrition, Obesity, Exercise
• Obstetrics and Gynecology
• Occupational Health
• Ophthalmology
• Orthopedics
• Otolaryngology
• Pain Medicine
• Palliative Care
• Pathology and Laboratory Medicine
• Patient Care
• Patient Information
• Performance Improvement
• Performance Measures
• Perioperative Care and Consultation
• Pharmacoeconomics
• Pharmacoepidemiology
• Pharmacogenetics
• Pharmacy and Clinical Pharmacology
• Physical Medicine and Rehabilitation
• Physical Therapy
• Physician Leadership
• Population Health
• Primary Care
• Professional Well-being
• Professionalism
• Psychiatry and Behavioral Health
• Public Health
• Pulmonary Medicine
• Regulatory Agencies
• Reproductive Health
• Research, Methods, Statistics
• Resuscitation
• Rheumatology
• Risk Management
• Scientific Discovery and the Future of Medicine
• Shared Decision Making and Communication
• Sleep Medicine
• Sports Medicine
• Stem Cell Transplantation
• Substance Use and Addiction Medicine
• Surgical Innovation
• Surgical Pearls
• Teachable Moment
• Technology and Finance
• The Art of JAMA
• The Arts and Medicine
• The Rational Clinical Examination
• Tobacco and e-Cigarettes
• Translational Medicine
• Trauma and Injury
• Treatment Adherence
• Ultrasonography
• Users' Guide to the Medical Literature
• Vaccination
• Venous Thromboembolism
• Veterans Health
• Women's Health
• Workflow and Process
• Wound Care, Infection, Healing
• Register for email alerts with links to free full-text articles
• Access PDFs of free articles
• Manage your interests
• Save searches and receive search alerts

This paper is in the following e-collection/theme issue:

Published on 11.3.2024 in Vol 8 (2024)

Architecture and Development Framework for a Web-Based Risk Assessment and Management Platform Developed on WordPress to Address Opioid Overdose

Authors of this article:

• Alireza Kazemi 1 , MD, PhD   ; 
• Marisha Boyd 1 , BSc   ; 
• Fiona Choi 1 , PhD   ; 
• Andy Man Yeung Tai 1 , MSc   ; 
• Vivian WL Tsang 1 , MPH, MD   ; 
• Tam To 1 , BA   ; 
• Jane Kim 1 , MSc   ; 
• Kerry Jang 1 , PhD   ; 
• Farhud Shams 1 , MSc   ; 
• Stefanie Schreiter 2 , MD   ; 
• Maurice Cabanis 3 , MA, MD   ; 
• Reinhard Michael Krausz 1 , MD, PhD  

1 Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

2 Department of Psychiatry and Neurosciences, Charité Campus Mitte, Institution: Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

3 Hospital for Addiction and Addictive Behavior, Center of Mental Health, Klinikum Stuttgart, Esttutgarth, Germany

Corresponding Author:

Alireza Kazemi, MD, PhD

Institute of Mental Health

Department of Psychiatry

University of British Columbia

4th Floor, Room 430, David Strangway Building

5950 University Blvd

Vancouver, BC, V6T 1Z3

Phone: 1 236 888 8330

Fax:1 604 822 7756

Email: [email protected]

The number of overdose-related fatalities continues to reach historic levels across Canada, despite ongoing efforts by authorities. To reduce mortality, a clinical trajectory ranging from preventative measures to crisis intervention, skill training to treatment, and risk assessment to risk management needs to be supported. The web-based Risk Assessment and Management Platform (RAMP) was developed to realize this concept and to empower people who use drugs through an integrated tool that allows them to better understand and manage their risk of overdose. This paper outlines the architecture and development of RAMP, which is built on the WordPress platform. WordPress components are mapped onto a 3-tier architecture that consists of presentation, application, and database layers. The architecture facilitates the development of a modular software that includes several features that are independent in functionality but interact with each other in an integrated platform. The relatively low coupling and high coherence of the features may reduce the cost of maintenance and increase flexibility of future developments. RAMP’s architecture comprises a user interface, conceptual framework, and backend layers. The RAMP front end effectively uses some of the WordPress’ features such as HTML5, CSS, and JavaScript to create a mobile, friendly, and scalable user interface. The RAMP backend uses several standard and custom WordPress plug-ins to support risk assessment and monitoring, with the goal of mitigating the impacts and eliminating risks together. A rule-based decision support system has been hard-coded to suggest relevant modules and goals to complement each user’s lifestyle and goals based on their risk assessment. Finally, the backend uses the MySQL database management system and communicates with the RAMP framework layer via the data access layer to facilitate a timely and secure handling of information. Overall, RAMP is a modular system developed to identify and manage the risk of opioid overdose in the population of people who use drugs. Its modular design uses the WordPress architecture to efficiently communicate between layers and provide a base for external plug-ins. There is potential for the current system to adopt and address other related fields such as suicide, anxiety, and trauma. Broader implementation will support this concept and lead to the next level of functionality.

Introduction

The clinical problem.

In 2016, the British Columbia government declared a state of emergency in response to the increasing number of drug-related overdose fatalities [ 1 ]. Despite this measure, more than 14,000 British Columbians have since died due to high potent opioids, and the province has seen a >2-fold increase in the number of overdose deaths, from 20.5 per 100,000 individuals in 2016 to 46 per 100,000 individuals in 2023 [ 2 ]. High-risk substance use and overdose risk is often a reflection of complex concurrent mental and physical conditions, which are critical for understanding the risk constellation as well as overdose risk management [ 3 , 4 ]. Integration of informed approaches to address severe and early traumatic experiences, suicidality, and mental illness is necessary for a solution aimed at increasing the chance of survival and recovery among people who use drugs [ 5 ]. Web-based interventions have demonstrated effectiveness in improving health outcomes and reducing barriers for people who use drugs who are seeking support [ 6 , 7 ].

A Modular Architecture

Modular architecture is a model of designing web-based psychotherapy platforms and interventions [ 8 , 9 ]. A modular design implies that the content presented can be divided into multiple smaller pieces that can be completed independently or as a set [ 9 ]. The strengths of modular systems include the ability for users to focus on 1 area at a time and ease in replicating modules following a common structure. Therefore, this approach allows for the inclusion of new clinical trajectories beyond substance use and overdose for a significantly lower price. It will also reduce the cost of maintenance. This architecture lends itself well to web-based interventions for substance use because sections, topics, and features can work both independently and together to provide care to a unique population with diverse needs. Chronic conditions such as substance use disorder need to be seen as a long-term trajectory—a dynamic and often changing process, which requires a range of tools to adapt to the needs of users.

An ideal web-based platform addressing substance use would create an environment that provides tools to assess risks, gain deeper knowledge of risks, prevent deterioration and crises, and manage specific behavioral factors and symptoms. The tasks for the development team would be to add content and functionalities to make the system engaging and interactive. Our vision is a platform that can become a long-term tool providing an engaging learning environment where user choices and outcomes influence the trajectory and functionality of the platform. Tools such as machine learning and embedded trials would allow for a systematic internal evaluation of user choices as well as better referrals and decision support tools. Users can adapt the content and functionalities to their needs, add content and their own experiences, and provide feedback to become active drivers of the system.

Risk Assessment and Management Platform

The Risk Assessment and Management Platform (RAMP) was developed by the Addictions and Concurrent Disorders Research Group at the University of British Columbia, supported by funding from Health Canada. The goal of this web-based platform is to provide a low-barrier tool that educates and empowers users to make informed decisions for their own recovery journey. The platform consists of self-assessments, educational and therapeutic modules, and tools to help users plan and monitor their risk of overdose, for example, “Goal setting” and “Lifechart.” Interactions among RAMP features to identify and manage the risk of overdose are shown in Figure 1 .

Users must create a free account in order to use the full functionalities of RAMP, including having their scores and data tracked over time. New users have the option to explore some selected features, such as modules and “Art with a Meaning” before they register. This allows users to better understand the system and feel comfortable with it enough to create an account. It also enables public access to modules, which, on its own, will have significant psychotherapeutic benefits for users.

Upon registration, the High-Risk Assessment (HRA) is proposed to the user. The HRA is a screening tool developed by the Addictions and Concurrent Disorders Research Group to identify the risk of overdose among people who use drugs through a rule-based algorithm. Development of the HRA will be explained in a separate publication.

Based on the results of each user’s HRA score, a clinical decision support system suggests the most relevant modules and goals to the user. The user may comply with the recommendations or choose to work on additional or substitute modules of their choice. The modules will help the user to gain knowledge about their risky behaviors and how to prevent or mitigate those risks. The Goals setting function will allow the user to make their risk mitigation plan and monitor their progress through the Lifechart feature. An email notification is sent to the user to inform them about their progress and to encourage them to continue interacting with the software by reminding them about their recent usage and how they can resume.

The core concepts and theoretical frameworks of RAMP will be presented in a series of publications. Topics will include the clinical concept underlying RAMP, development of the HRA, development of modules, and user interface evaluation. This paper is focused on the design and architecture of RAMP. The modular architecture of RAMP uses WordPress’ multilayer architecture, which lends itself well to the dynamic and customizable application design.

Design of RAMP

RAMP is a web application developed using the WordPress content management system (CMS). Therefore, description of the architecture of WordPress is essential to describe RAMP’s design and architecture.

WordPress is built on a PHP and MySQL architecture [ 10 ]. It uses a multilayer architecture to provide a flexible platform for building and customizing websites [ 11 ]. The purpose of a layered architecture is to organize the components of an application into horizontal logical layers and physical tiers. A layer is a logical unit that separates a specific role and responsibility within an application. Each layer manages its own software dependencies. A tier is a physical unit where the code runs, for example, a web server or a database. Scalability, maintainability, and resiliency are increased when tiers are physically separated; however, latency increases due to additional network communication.

Though WordPress does not strictly follow the traditional 3-tier architecture to separate the presentation, application, and database tiers, the WordPress components that are used to develop web applications can be mapped on a 3-tier design model [ 12 , 13 ].

Presentation Tier

The presentation tier is responsible for showing the content and functionality to the user, using HTML, CSS, and JavaScript. HTML provides a way to create and structure the elements of a web page, such as headings, paragraphs, images, links, etc. CSS is a powerful tool for customizing the appearance and layout of WordPress websites. JavaScript is a scripting language that is used to add interactivity, dynamic behaviors, and effects such as animations, interactive forms, and user interface elements such as sliders and pop-up menus to web pages.

WordPress Themes

Themes control the appearance of a WordPress website. They include templates, CSS files, and other components that determine how the site is displayed.

Application Tier

The application tier in WordPress refers to the core PHP code that provides the underlying functionality and controls the flow of data between the presentation and database tiers. The application tier includes the WordPress core, plug-ins, and custom code that interacts with the database to store and retrieve data.

Plug-ins are add-ons that extend the functionality of WordPress. They can provide additional features such as contact forms, e-commerce functionality, etc.

The application tier is responsible for implementing the business logic as well as accessing the data stored in the database through the data access layer.

Business Logic Layer

The business layer in WordPress architecture refers to the layer that handles the business logic and processes in a WordPress website. This layer is responsible for performing tasks such as data validation, calculations, and decision-making.

In the context of WordPress, the business layer can be implemented in a number of ways, including custom plug-ins, custom code within the theme, or through the use of third-party plug-ins that provide specific functionality.

The business layer acts as the intermediary between the presentation and database tiers. It takes input from the presentation layer, performs the necessary business logic, and then communicates with the database tier to retrieve or store data. This architecture allows for greater flexibility and maintainability of WordPress products, as well as the ability to easily modify and extend the functionality of the website without affecting other tiers.

Data Access Layer

The data access layer in WordPress architecture refers to the layer responsible for accessing and manipulating data stored in the database. This layer is responsible for retrieving data from the database, performing operations on the data, and storing the results back in the database.

In WordPress, the data access layer is typically implemented using the WordPress database application programing interface (API), which provides a set of functions and methods for interacting with the database. These functions and methods allow developers to perform common database operations, such as inserting, updating, and retrieving data, in a consistent and efficient manner.

Database Tier

The database tier in WordPress is where all the data are stored, including posts, pages, users, and metadata. WordPress uses a Relational Database Management System, MySQL, to store this information, and it is accessed by the application tier to retrieve and manipulate data.

The database layer in WordPress works by creating tables and storing data in those tables. Each table contains rows and columns that represent the different data types stored in the database. For example, WordPress has separate tables for posts, users, comments, etc.

When a user interacts with a WordPress site, the database layer retrieves data from the appropriate table and returns it to the application tier. The data can then be displayed on the user interface of the site or being used to perform various operations in the backend.

In conclusion, the database layer in WordPress applications is a critical component that provides a structured way to store and retrieve data and plays an important role in the overall architecture of a WordPress site.

Overall, the architecture of WordPress promotes modularity. This modular design approach allows for easier customization, scalability, and maintainability of software products built on the WordPress platform. Developers can create independent modules that can be combined or modified without significant impact on other components, facilitating the creation of flexible and extensible software systems.

RAMP software design architecture follows the WordPress multilayer architecture.

Ethical Considerations

The RAMP HRA pilot project has undergone research ethics review and received ethics approval from the University of British Columbia Behavioural Research Ethics Board (H19-02231). Collection of data on RAMP is limited to only those necessary for the research objectives. Participant identities are kept confidential, and the research protocol is aligned with the Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans (TCPS2). Informed consent forms include information about data storage, data security, data sharing, privacy protections, legal limits to confidentiality, and contact information of the University of British Columbia Behavioural Research Ethics Board. It clearly delineates how the data will be used and shared, and the process to report participant concerns.

Upon registration, the system stores their registered email IDs, names, last names, usernames, passwords (encrypted), login times, and IP addresses. Data are stored on secure cloud servers, and security features such as reCAPTCHA and temporary login blocks are used to minimize the risk of brute force attacks. Upon login, their interactions with the system are stored and tracked. This includes assessments results, symptoms check, completed modules, goals, journal diaries, and achievements. Data are not shared with third parties unless for maintenance, software improvements, or legal obligations. The overall data governance plan of the project is modeled after the highest local, federal, and international standards of privacy, data management, and data sharing.

System Description

RAMP is designed as an engaging, learning, and open access web application that empowers users to manage their risk of overdose and concurrent mental health disorders. RAMP is a modular software that includes several features and functionalities.

The architecture and design of RAMP features is mapped on a 3-tier architecture model that uses WordPress components. Figure 2 demonstrates the mapping.

The Data Tier uses relational databases on the MYSQL 5.7.30 database management system. RAMP stores and retrieves various types of data including text, video, audio, and images, which can become bulky over time. The data layer is managed by the WordPress database tier, which provides secure and efficient methods to store, retrieve, and organize data. It uses indexing, caching, lazy loading, query optimization, and other techniques to improve its efficiency.

The Backend

The backend uses the WordPress 5.4 development framework. The system is a web application software compatible with most of the standard browsers such as Chrome, Safari, and Edge, and is responsive to mobile apps. The system’s administrative panel allows the administrator to add new reports, reorganize some user interface elements, and define new assessments ( Figure 3 ). This panel also allows the administrator to monitor users’ activities and progresses and add new modules and other content. Certain key performance indicators can be found on the administrative panel.

The RAMP backend also uses some standard and custom plug-ins. Some examples of the plug-ins that RAMP is using are listed below:

• Disable XML-RPC-API: a lightweight plug-in to disable XML-RPC API, Pingbacks, and Trackbacks for faster and more secure browsing of a website.
• Duplicate Page: a plug-in to duplicate posts, pages, and custom posts with a single click.
• LoginWP: a plug-in to redirect users to different URLs based on their role, capability, and more.
• Quform: a plug-in to create powerful and engaging quizzes, tests, and examinations within minutes, and to build an unlimited number of quizzes and questions.
• WP File Manager: a plug-in that manages WP files.
• WP SMTP: a plug-in that helps developers to send emails via SMTP instead of the PHP mail function. This plug-in is particularly useful to send email reminders to the user, which would less likely end up in junk mail; support superior authentication and encryption methods; and is more compatible with other WordPress plug-ins.

There are custom-built plug-ins created for different RAMP features such as Achievements, Assessments, Symptom Diary Forms, Journal, and Lifechart to enhance user experience.

The inference engine of a rule-based decision support system is custom-coded in the business layer. User responses to the HRA are used to determine relevant modules and goals, and to suggest them via the user interface.

The data access layer in RAMP uses the wp-config file to configure the database through different parameters. These parameters allow consistent and secure access to all tables of the RAMP database.

Conceptual Framework

RAMP’s conceptual framework is part of the backend and is currently tailored to substance use but can be modified to manage the risk of other mental health conditions such as suicide and trauma. The principles are in line with the core concept of the risk management process, which includes identifying and assessing risks, making a plan, and monitoring the plan to be able to mitigate or eliminate the risk as needed ( Figure 4 ).

The Front End

RAMP front end uses WordPress presentation layer components such as themes, HTML5, CSS, and JavaScript to communicate with the user and provide a pleasant experience when showing content.

RAMP uses BuddyBoss as its core theme. However, a subtheme was derived and customized from BuddyBoss to enhance user experience and use consistent visual themes across RAMP’s branding.

Using HTML5 in RAMP has created more modern and effective web pages for the system with better accessibility, improved search engine optimization, higher performance, and mobile friendliness. Additionally, pages have been further fine-tuned by the developers for a better mobile experience. HTML5 has also allowed the developers to embed audio and video content directly into the web pages, eliminating the need to rely on third-party plug-ins such as Adobe Flash. RAMP is also using native lazy loading of images and script execution in parallel, which can improve the performance of web pages and reduce their load times.

RAMP uses CSS effectively to create websites that are visually appealing, flexible, responsive to mobile devices, and easy to use.

Interaction With External Systems

RAMP uses different WordPress plug-ins and features to interact with different external systems. YouTube videos in the modules are embedded into Elementor, a popular visual page builder plug-in for WordPress that allows users to create custom designs for their website and ensures the correct publication of the videos.

The mental health resource map is another example of an external system that is integrated into RAMP. The development team used Google My Maps to pin the location of mental health services, including clinics, youth services, and urgent care centers, onto a Google map. This software enables users to view services and facilities in their area, find their locations, hours of operation, contact information, and more on a Google map in a layered format. The system embeds this software using a simple script method by adding its link to RAMP.

The development team has also been working on a parallel project to create a machine learning model that would predict the risk of fatal overdose based on a comprehensive data set called the British Columbia Provincial Overdose Cohort curated by the British Columbia Centre for Disease Control. The model will subsequently be embedded into an API, which allows the predictive model to be used as a stand-alone tool. The aim is to use the developed predictive model in RAMP using a service-oriented architecture, where RAMP calls upon the predictive model’s API using WordPress REST API plug-in to send user-specific risk factors to the model. The model will then process the overall risk of fatal overdose based on user inputs, determine the likelihood of overdose, and send the results back to RAMP. The RAMP interface will display the results and provide tailored recommendations based on each individual’s risk factors.

The aim of RAMP is to empower people who use drugs to become more aware of their overdose risk and to provide a tool that promotes agency in helping them manage their risk factors. Although risk management is broad and may include several activities, the core concepts include key steps to identify, plan, and monitor risks, as well as tools to execute the plan to eliminate or mitigate the impact of these risks [ 14 ].

RAMP is a web application. In contrast to native apps, web applications have certain advantages that RAMP benefits from:

• Cross-platform compatibility and being installation-free: RAMP can run on any device with a web browser, which means that it is platform-independent and can be accessed from a wide range of devices, including desktops, laptops, tablets, and smartphones without the need to install the software on the device. In contrast, native apps are developed for a specific platform, such as iOS or Android, and need to be downloaded and installed on the user's device. This is helpful when considering the population of people who use drugs, who might not have consistent access to a smartphone but can access public or shared computers [ 15 ].
• Easier maintenance: RAMP maintenance and updating is easier and less costly than native apps, as changes can be made on the server side, and users are not required to download updates. This can save time and resources for developers and ensure that all users are using the most up-to-date version of RAMP.
• Lower development costs: developing a web application typically requires fewer resources than developing a native app, as there is no need to develop separate versions for different platforms such as iOS and Android. This can result in lower development costs and less time to deploy the application.

While web applications offer certain benefits, native apps offer advantages such as better performance, native features, push notifications, and access to device-specific capabilities. Web applications always need an active internet connection to the server, but native apps may not need constant access to the internet if there is no need to communicate with a centralized server on a continuous basis.

RAMP features effectively use the WordPress components and their multilayer architecture to support the user to make informed decisions. One example is the design of HRA, a 29-question screening tool that helps users identify several overdose risk factors across different domains.

The integration of a dynamic color-coded heat map on the user interface of the presentation tier, featuring a sliding score bar that slides as the questions are answered, assists the user in comprehending the relative significance of individual factors and whether they represent risks or protective factors. Upon responding to each question, the inference engine of a rule-based decision support system will use the responses that are stored in the RAMP database layer to determine and suggest the most relevant modules and goals that are critical to the management of the most pressing risks. The use of these features across layers empowers the user to accurately identify their risks, gain knowledge of such risks, establish relevant goals, and monitor progress—all through the use of RAMP.

RAMP’s modular design allows novice users to follow the decision support system recommendations and create relevant goals and educational plans, while providing more freedom to experienced users to focus on specific areas that are most related to their personal risk of overdose and lifestyle. This design is important for the risk planning phase. When the user executes the plan and performs the given tasks, the system provides rewards to further engage the user.

Strategies to Enhance User Engagement

Reward systems are one of the most common gamification strategies designed to encourage users. The system awards badges as the user makes progress. This provides reinforcement as an individual continues their recovery journey. There is broad interest in the use of digital badges to enhance learners' motivation [ 16 ]. These web-enabled tokens of learning and accomplishment have the potential to induce excitement and elicit powerful forms of engagement and learning. Badges are one of the most powerful gaming elements that are widely used in digital health products to motivate users to keep interacting with the system [ 17 ]. This strategy is particularly important for the population of substance users where retention and long-term interaction might be difficult [ 18 , 19 ].

RAMP does not support on-screen or push notifications. Instead, the system uses reliable SMTP email notifications regularly to inform users about their progress and motivate them to continue their interaction with the system. Notifications are an important gamification tool to promote engagement with the platform [ 20 ]. The frequency and content of RAMP notifications is different for active and inactive users. Active users receive more frequent notifications with suggestions regarding next steps they might benefit from based on their current patterns of use, while inactive users may receive positive reinforcement notifications and encouragements to start interacting with the system or continue where they have stopped. Previous studies have shown that tailoring notifications to each user is an effective way of boosting the use of web-based health tools [ 21 ].

Application of RAMP to Other Disorders and Diseases

RAMP content is currently developed to support those struggling with substance use and who are at risk of overdose. However, the tool can also be used to empower patients in other related domains such as navigating trauma, managing anxiety, and preventing self-harm and suicide by adding relevant assessments, modules, and goals. Through the development of proper content, the same logic can be applied to other mental health domains without a need to customize or redevelop the features, which maximizes the reusability of the developed system. Furthermore, RAMP features are fairly independent but interact with each other based on the business logic and through interfaces. This is in line with the principles of software engineering in which subsystems of a modular software should have high internal cohesion and low coupling [ 22 ].

Limitations

The knowledge of the authors about the application of WordPress plug-ins and add-ons is limited to RAMP. RAMP is a web application; therefore, general limitations of web applications such as requiring continuous internet connection, etc, are also applicable to the present software.

RAMP is developed on the WordPress CMS. Security and performance of the software are limited to the WordPress development framework. Although many successful and secure applications are developed on the same CMS platform, there is news about possible security exploitations of the websites developed on WordPress such as being infected by malwares, backdoors, or being hacked [ 23 , 24 ]. The RAMP development team has attempted to use security best practices such as using a secure host and server, security protocols, reCAPTCHA, reducing log-in attempts, disabling XML RPC, and many more features to create a safe and secure environment for the users.

RAMP is developed with a limited number of users willing to share their ideas. Wider use of RAMP may reveal other limitations.

RAMP neither substitutes or replaces medical advice by professionals nor provides emergency services during times of crisis. RAMP is designed for adults and is not yet adapted for adolescents and young adults.

Conclusions

Web-based platforms such as RAMP can be powerful assets to address significant gaps in the mental health and substance use care systems and can address a major public health crisis. It can integrate different settings of care from prevention to crisis management, all on one accessible platform. In terms of its architecture, RAMP uses a modular design that allows for maximal personalization and integration of user engagement strategies. WordPress components that are used to develop RAMP are mapped onto a 3-tier architecture, where the presentation, application, and database layers communicate to ensure proper functionality for users.

Although web applications seem to be an appropriate development technology for the current and future developments of RAMP, users may also benefit from having certain features such as “Assessments” and “Goals” on a mobile app. This would allow users to access these features even without a reliable internet connection and to receive on-screen notifications as appropriate.

RAMP is currently focused on substance use disorders and specifically reducing overdose, but the tool is flexible enough to include many more domains such as suicide, anxiety, self-harm, and trauma. Broader implementation will support this concept and lead to the next level of functionality. RAMP’s modular design makes it a promising tool for addressing a breadth of mental health conditions among vulnerable populations, increasing the capacity of clinical settings and reducing barriers to care. Further research will need to investigate whether this architecture style is appropriate for eHealth tools addressing different populations and appropriate implementation strategies for eHealth tools addressing people who use drugs.

Acknowledgments

The authors appreciate and recognize Health Canada for funding the RAMP project and its publications (1819-HQ-000122). We also appreciate TelusHealth for their cooperation on providing detailed information on the design and development technologies of RAMP.

Data Availability

Data sharing is not applicable to this article as no data sets were generated or analyzed during this study.

Conflicts of Interest

None declared.

• Provincial health officer declares public health emergency. BC Gov News. 2016. URL: https://news.gov.bc.ca/releases/2016HLTH0026-000568 [accessed 2024-02-15]
• Unregulated Drug Deaths-2023 Summary. British Columbia Coroners Service. Jan 17, 2024. URL: http://tinyurl.com/3scccse4 [accessed 2024-02-17]
• Loxley W, Toumbourou J, Stockwell T, Haines B, Scott K, Godfrey C, et al. In: Kirsner A, editor. The prevention of substance use, risk and harm in Australia: a review of the evidence. Perth, Western Australia. Curtin Research Publications; 2004.
• Westenberg J. A paradigm shift in the treatment of high-risk substance use and overdose among youth. The University of British Columbia. 2021. URL: https://open.library.ubc.ca/soa/cIRcle/collections/ubctheses/24/items/1.0401385 [accessed 2024-02-15]
• Silove D. From Trauma to Survival and Adaptation: Towards a framework for guiding mental health initiatives in post-conflict societies. In: Forced Migration and Mental Health. Boston, MA. Springer; 2005.
• Boumparis N, Karyotaki E, Schaub MP, Cuijpers P, Riper H. Internet interventions for adult illicit substance users: a meta-analysis. Addiction. Sep 25, 2017;112(9):1521-1532. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Samuels E, Clark S, Wunsch C, Jordison Keeler LA, Reddy N, Vanjani R, et al. Innovation during COVID-19: improving addiction treatment access. J Addict Med. 2020;14(4):e8-e9. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Chorpita B, Daleiden E. Structuring the Collaboration of Science and Service in Pursuit of a Shared Vision. In: Future Work in Clinical Child and Adolescent Psychology. London. Routledge; 2017.
• Chorpita BF, Daleiden EL, Weisz JR. Modularity in the design and application of therapeutic interventions. Applied and Preventive Psychology. Sep 2005;11(3):141-156. [ CrossRef ]
• WordPress. Wikipedia. URL: https://en.wikipedia.org/wiki/WordPress [accessed 2024-02-15]
• Sayagh M, Adams B. Multi-layer software configuration: Empirical study on wordpress. Presented at: 2015 IEEE 15th International Working Conference on Source Code Analysis and Manipulation (SCAM); September 27-28, 2015, 2015; Bremen, Germany. [ CrossRef ]
• Ratnayake R. Wordpress Web Application Development: Building robust web apps easily and efficiently, Third Edition. Birmingham, United Kingdom. Packt Publishing; 2017.
• Williams B, Tadlock J, Jacoby J. Professional WordPress® Plugin Development. Hoboken, NJ. John Wiley & Sons; 2020.
• McNeely J, Adam A, on behalf of Substance Use Guideline Committee of the New York State Department of Health AIDS Institute (NYSDOH AI). Substance Use Screening and Risk Assessment in Adults. Baltimore, MD. Johns Hopkins University; 2020.
• Tsang VWL, Papamihali K, Crabtree A, Buxton JA. Acceptability of technological solutions for overdose monitoring: perspectives of people who use drugs. Subst Abus. Jul 01, 2021;42(3):284-293. [ CrossRef ] [ Medline ]
• Tran C, Schenke K, Hickey D. Design Principles for Motivating Learning with Digital Badges: Consideration of Contextual Factors of Recognition and Assessment. In: Polman JL, Kyza EA, O'Neill DK, Tabak I, Penuel WR, Jurow AS, et al, editors. Learning and Becoming in Practice: The International Conference of the Learning Sciences (ICLS) 2014. Volume 2. Boulder, CO. International Society of the Learning Sciences; 2014;1027-1031.
• Nicolaidou I, Aristeidis L, Lambrinos L. A gamified app for supporting undergraduate students' mental health: a feasibility and usability study. Digit Health. Jun 21, 2022;8:20552076221109059. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kennedy AJ, Wessel CB, Levine R, Downer K, Raymond M, Osakue D, et al. Factors associated with long-term retention in buprenorphine-based addiction treatment programs: a systematic review. J Gen Intern Med. Feb 19, 2022;37(2):332-340. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Oesterle T, Kolla B, Risma C, Breitinger S, Rakocevic D, Loukianova L, et al. Substance use disorders and telehealth in the COVID-19 pandemic era: a new outlook. Mayo Clin Proc. Dec 2020;95(12):2709-2718. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Saleem M, Kühne L, De Santis KK, Christianson L, Brand T, Busse H. Understanding engagement strategies in digital interventions for mental health promotion: scoping review. JMIR Ment Health. Dec 20, 2021;8(12):e30000. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Graham AL, Papandonatos GD, Jacobs MA, Amato MS, Cha S, Cohn AM, et al. Correction: optimizing text messages to promote engagement with internet smoking cessation treatment: results from a factorial screening experiment. J Med Internet Res. Jul 28, 2020;22(7):e21027. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Bruegge B, Dutoit AH. Object-Oriented Software Engineering Using UML, Patterns, and Java, 3rd edition. London, United Kingdom. Pearson; 2010.
• Gupta D. A Critical Review of WordPress Security Scanning Tools and the Development of a Next-Generation Solution. 2023. URL: https://norma.ncirl.ie/6517/ [accessed 2024-02-15]
• Mesa O, Vieira R, Viana M, Durelli V, Cirilo E, Kalinowski M, et al. Understanding vulnerabilities in plugin-based web systems: an exploratory study of wordpress. Presented at: SPLC '18: 22nd International Systems and Software Product Line Conference; September 10-14, 2018, 2018; Gothenburg, Sweden. [ CrossRef ]

Abbreviations

Edited by A Mavragani; submitted 12.06.23; peer-reviewed by J Walsh, R Rabiei, R Rahimi; comments to author 01.11.23; revised version received 18.12.23; accepted 29.12.23; published 11.03.24.

©Alireza Kazemi, Marisha Boyd, Fiona Choi, Andy Man Yeung Tai, Vivian WL Tsang, Tam To, Jane Kim, Kerry Jang, Farhud Shams, Stefanie Schreiter, Maurice Cabanis, Reinhard Michael Krausz. Originally published in JMIR Formative Research (https://formative.jmir.org), 11.03.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.

This paper is in the following e-collection/theme issue:

Published on 11.3.2024 in Vol 26 (2024)

Online Health Information Seeking and Preventative Health Actions: Cross-Generational Online Survey Study

Authors of this article:

There are no citations yet available for this article according to Crossref .