A perceived lack of control over work responsibilities can escalate employee stress levels, but can be mitigated by watchful HR practitioners.

It’s widely recognised that stress is not good for our physical health. The worldwide Interheart study found that moderate or severe general stress increases the risk of a heart attack by 60 per cent. This is consistent across national regions, ethnic groups and gender.

One of the main psychosocial stressors relates specifically to work environments.

While many of us recognise that there is a link between stress and both physical and mental health, there is also a fascinating body of literature that specifically deals with job stress and how it impacts on individuals.

Medical facts

The seminal research came from the Whitehall studies, which commenced in the 1970s looking at British civil servants and the link between social class and health outcomes.

The term ‘job strain’ was coined in 1979 to account for the relationship between job demands, job control and negative health and psychological outcomes. What is critical in this term is the interplay between work overload and an individual’s personal sense of control over demands made when doing the work.

A 2012 meta-analysis pooled together multiple studies looking at the association between job strain and coronary heart disease, and collectively included data from almost 200,000 people.

The researchers found that people who experience job strain are 23 per cent more likely to experience a heart attack, compared to people without such work stress.

Job strain results from doing highly demanding work with little freedom to control decisions about that work.

This finding remained true even when lifestyle, age, gender and socio-economic status were consistent and taken into account, indicating that job strain is an independent risk factor for a heart attack.

This fits in with existing research linking stress to the laying down of fatty build-up within arteries.

The association with job strain also applies to stroke and other arterial blockages, as well as further being linked to depression, alcohol abuse, cigarette smoking, increased use of medical services, decreased job performance, lower productivity and increased absenteeism.

Females more at risk

Job strain is a problem for both genders. Its metabolic effects, particularly through excess cortical release, are linked to obesity and its sequelae, the metabolic syndrome.

This syndrome refers to obesity plus a combination of high blood pressure, high lipids and insulin resistance. There is a gender difference here. While the risk of developing metabolic syndrome with job stress is three times greater for men who are experiencing job strain, it’s even higher for women, at five times the greater risk.

Chronic work stress is particularly associated with heart attacks and strokes in people under the age of 50. Some studies have reported that low job predictability at work (where predictability is a central component of job control) increases the long-term risk of heart attacks among middle-aged employees.

What to be watchful for

Environmental factors associated with work stress include the amount of work needed to be done in the time allocated, the amount of decision-making authority an individual has, and the extent to which an individual can choose to employ his or her skills.

To overcome this lack of control, employers need to communicate the decision-making latitude given to their employees, indicating where they are free to make decisions, be creative in their work, and exercise their skills and aptitudes.

Employees who are under high psychological demand, in which large quantities of time is constrained, or who are doing intellectually taxing jobs without any decision latitude, are exposed to at least three times the risk of suffering psychological distress.

Role ambiguity and role conflict may also contribute to this psychological malaise.

Mitigating risks

Identification and intervention is the key, along with recognising a culture in the workplace that may result in employees undergoing job strain, high psychological demand and low decision latitude or job control.

Occupations with low autonomy and poor promotion prospects are classic examples.

Employers can also keep an eye out for individual employees who may be overwhelmed. The profile of high-risk employees could be those who are overweight, working long hours and are not looking after themselves.

Individually they may be demonstrating either over-commitment or hostility, as well as exhibiting symptoms and signs of psychological distress, which could include decreased productivity and increased absenteeism.

One study showed the effectiveness of an intervention incorporating education around stress management and self-efficacy, with periodic telephone calls from a health educator given over a six-month time period.

Respondents from the Bank of America who participated in this intervention showed the greatest improvement in the ratings of mental health status and exercised their own initiative to reduce occupational stress. The intervention was relatively inexpensive with a potential for considerable return on investment.