Causes and Symptoms (Magill’s Medical Guide, Sixth Edition)
Stress is a psychophysiological response, within an individual animal, to a perceived danger. Stress involves a complex interplay of nervous and hormonal reactions to internal and external stimuli. All living organisms respond to stimuli, usually by means of gene-regulating chemical messengers called hormones.
Chemistry of stress. Hormones are produced in certain cells within the individual and then target tissues elsewhere in the body; these hormones control by controlling the gene regulation within their target cells. Hormones will activate certain genes within target tissue cells while inactivating other genes. If a hormone activates the control region of a gene so that the gene is “on,” then it can be “read” by an enzyme (RNA polymerase), thereby leading to RNA and protein production. The produced protein may affect cellular chemical processes or may affect the expression (the on/off status) of other genes. In the latter case, the protein would be a type of intracellular hormone called an alarmone.
If a hormone inactivates the control region of a gene so that the gene is “off,” then RNA polymerase will be unable to read the DNA nucleotide sequence of the gene. Therefore, no RNA and no protein will be produced. In this fashion, a hormone may activate certain genes while inactivating others. Consequently, a hormone controls what happens within the cell.
Such control is critical within...
(The entire section is 1638 words.)
Treatment and Therapy (Magill’s Medical Guide, Sixth Edition)
Psychologists, psychiatrists, physicians, and other medical professionals are becoming more aware of the physiological effects of stress. Through this awareness, professionals have sought to examine whether there are any characteristic styles of stress response. In response, psychologists have identified two principal behavioral types when it comes to stress among humans: type A behavior pattern and type B behavior pattern. Type A individuals are highly anxious, task-oriented, time-conscious, constantly in a rush to accomplish their jobs and other objectives, and somewhat prone to hostility. Research indicates that type A individuals may have a higher incidence of heart disease. Increasingly, the hostility component of type A behavior is seen as a very important contributing factor. On the other hand, type B individuals are more relaxed and experience less stress. Nevertheless, it should be emphasized that behavior is a continuum: Different people may exhibit varying degrees of type A and B behavior patterns. Given this discovery, it is not uncommon for professionals to recommend to their stressed clients to monitor their participation in type A behavior and to try behaving more in kind with type B behavior patterns.
Another important focus for health care has become the prevention, management, and treatment of stress itself. Health education programs emphasize the importance of physical fitness and stress reduction in...
(The entire section is 359 words.)
Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
Because stress is a major contributor to illness and disease in American and Western societies, a major objective of health care professionals in these countries is the identification of stress initiators and the reduction of stress in the general population. Stress cannot be eliminated entirely in any individual. Humans always will experience stress as a result of their continuous interactions with one another and with the environment. Stress is an important survival adaptation for animal life on earth. Nevertheless, stressful events in an individual’s life serve as negative environmental stimuli that hyperactivate the human nervous and endocrine systems to create a fight-or-flight response. When this fight-or-flight response is maintained for abnormally long periods of times, prolonged elevations in nervous and hormonal activity modify body tissues and the developmental gene expression within cells to produce abnormal growths (such as cancers) and abnormal system functioning (such as diabetes mellitus). Breakdown of the human immune system under stress makes the body less capable of fighting spontaneous tumors, cancers, and infectious disease. The net result from physiological stress is illness, disease, rapid aging, and death.
Stress reduction should be a prime focus of medical research and education. The simplicity of educating the public with respect to stress can yield incredible savings in terms of lives...
(The entire section is 282 words.)
For Further Information: (Magill’s Medical Guide, Sixth Edition)
Bremner, Douglas J. Does Stress Damage the Brain? Understanding Trauma-Related Disorders from a Neurological Perspective. New York: W. W. Norton, 2002. Questions whether what one sees, hears, feels, and in other ways experiences, especially during times of stress, can result in permanent changes to the brain and argues that extreme stress may result in lasting damage to the brain, especially a part of the brain involved in memory.
Day, Stacey B., ed. Cancer, Stress, and Death. 2d ed. New York: Plenum Press, 1986. This informative work is a collection of scientific survey papers that demonstrate the relationship between stress and disease. The papers are clearly written for both scientific and general audiences.
Goodman, H. Maurice. Basic Medical Endocrinology. 4th ed. Boston: Academic Press/Elsevier, 2009. Focuses on research advances in the understanding of hormones involved in regulating most aspects of bodily functions. Includes in-depth coverage of individual glands and regulatory principles.
Henry, Helen L., and Anthony W. Norman, eds. Encyclopedia of Hormones. 3 vols. San Diego, Calif.: Academic Press, 2003. A comprehensive overview of the role of hormones, the major physiological systems in which they operate, and the biological consequences of an excess or deficiency of a particular hormone.
Kronenberg, Henry M., et al., eds. Williams Textbook of...
(The entire section is 386 words.)
Stress (Encyclopedia of Medicine)
Stress is defined as an organism's total response to environmental demands or pressures. When stress was first studied in the 1950s, the term was used to denote both the causes and the experienced effects of these pressures. More recently, however, the word stressor has been used for the stimulus that provokes a stress response. One recurrent disagreement among researchers concerns the definition of stress in humans. Is it primarily an external response that can be measured by changes in glandular secretions, skin reactions, and other physical functions, or is it an internal interpretation of, or reaction to, a stressor; or is it both?
Stress in humans results from interactions between persons and their environment that are perceived as straining or exceeding their adaptive capacities and threatening their well-being. The element of perception indicates that human stress responses reflect differences in personality, as well as differences in physical strength or general health.
Risk factors for stress-related illnesses are a mix of personal, interpersonal, and social variables. These factors include lack or loss of control over one's physical environment, and lack or loss of social support networks. People who are dependent on others (e.g., children or the elderly) or who are socially...
(The entire section is 1385 words.)
Stress (Encyclopedia of Mental Disorders)
Stress is a term that refers to the sum of the physical, mental, and emotional strains or tensions on a person. Feelings of stress in humans result from interactions between persons and their environment that are perceived as straining or exceeding their adaptive capacities and threatening their well-being. The element of perception indicates that human stress responses reflect differences in personality as well as differences in physical strength or health.
A stressor is defined as a stimulus or event that provokes a stress response in an organism. Stressors can be categorized as acute or chronic, and as external or internal to the organism. The Diagnostic and Statistical Manual of Mental Disorders(DSM-IV-TR) defines a psychosocial stressor as "any life event or life change that may be associated temporally (and perhaps causally) with the onset, occurrence, or exacerbation [worsening] of a mental disorder."
Stress affects the lives of most adults in developed countries in many ways. It is a major factor in rising health care costs; one public health expert maintains that 90% of all diseases and disorders in the United States are stress-related. Stress plays a part in many social problems such as child and elder abuse, workplace violence, juvenile crime,...
(The entire section is 4183 words.)
Stress (Encyclopedia of Science)
Stress is mental or physical tension brought about by internal or external pressures. The feeling of stress may be mild or severe and it can last a short time or over a longer period. Many events may cause stress. They range from everyday occurrences such as taking a test or driving through rush-hour traffic to more traumatic experiences such as the death of a loved one or a serious illness.
Stress may be a factor in causing disease. Researchers believe that stress disrupts the body's homeostasis or balanced state, which leads to a weakening of the body's immune system. Chronic (frequently occurring) stress can thus bring about serious illnesses.
People who experience severe traumas, such as soldiers during combat, may develop a condition called post-traumatic stress disorder (PTSD). This condition was called shell shock during World War I (19148) and battle fatigue during World War II (19395). Sufferers of PTSD experience depression, nightmares, feelings of guilt for having survived, and flashbacks to the traumatic events. They may be excessively sensitive to noise and may even become violent.
Until the twenty-first century, scientists believed humans and animals reacted to stress in a common manner, by preparing to do battle or to flee. This syndrome is known as "fight or flight." In 2000, however, a group of researchers issued a report asserting...
(The entire section is 640 words.)
Stress (Encyclopedia of Psychology)
The physiological and psychological responses to situations or events that disturb the equilibrium of an organism.
While there is little consensus among psychologists about the exact definition of stress, it is agreed that stress results when demands placed on an organism cause unusual physical, psychological, or emotional responses. In humans, stress originates from a multitude of sources and causes a wide variety of responses, both positive and negative. Despite its negative connotation, many experts believe some level of stress is essential for well-being and mental health.
Stressorsvents or situations that cause stresscan range from everyday hassles such as traffic jams to chronic sources such as the threat of nuclear war or over-population. Much research has studied how people respond to the stresses of major life changes. The Life Events Scale lists these events as the top ten stressors: death of spouse, divorce, marital separation, jail term, death of close family member, personal injury or illness, marriage, loss of job through firing, marital reconciliation, and retirement. It is obvious from this list that even good thingsarriage, retirement, and marital reconciliationan cause substantial stress.
When presented with a stressful event or situation, the process of cognitive...
(The entire section is 858 words.)
Stress (Encyclopedia of Alternative Medicine)
Stress is an individual's physical and mental reaction to environmental demands or pressures.
When stress was first studied, the term was used to denote both the causes and the experienced effects of these pressures. More recently, however, the word stressor has been used for the stimulus that provokes a stress response. One recurrent disagreement among researchers concerns the definition of stress in humans. Is it primarily an external response that can be measured by changes in glandular secretions, skin reactions, and other physical functions, or is it an internal interpretation of, or reaction to, a stressor; or is it both?
Stress was first studied in 1896 by Walter B. Cannon (1871945). Cannon used an x-ray instrument called a fluoroscope to study the digestive system of dogs. He noticed that the digestive process stopped when the dogs were under stress. Stress triggers adrenal hormones in the body and the hormones become unbalanced. Based on these findings, Cannon continued his experimentation and came up with the term homeostasis, a state of equilibrium in the body.
Hans Selye, a Canadian scientist (1907982), noticed that people who suffered from chronic illness or disease showed some of the same symptoms. Selye related this to stress and he began to test his...
(The entire section is 2360 words.)
Stress (Encyclopedia of Nursing & Allied Health)
Stress is defined as an organism's total response to environmental demands or pressures. When stress was first studied in the 1950s, the term was used to denote both the causes and the experienced effects of these pressures. Since the 1990s, however, the word stressor has been used for a stimulus that provokes a stress response. One recurrent disagreement among researchers concerns the definition of stress in humans. The issue is whether it is primarily an external response that can be measured by changes in glandular secretions, skin reactions, and other physical functionsr if it is an internal interpretation of, or reaction to, a stressor, or both.
Stress in humans results from interactions between persons and their environment that are perceived as straining or exceeding their adaptive capacities and threatening their well-being. The element of perception indicates that human stress responses reflect differences in personality, as well as differences in physical strength or general health. Researchers have found that stressors can be:
- acute, such as a disaster or death of a loved one
- sequential, such as events leading up to a job promotion or a move
- intermittent, such as college exams
- chronic, such as living with a life-threatening illness, being in an unhappy marriage, or living in poverty
Risk factors for stress-related illnesses are a mix of personal, interpersonal, and social variables. These factors include lack or loss of control over one's physical environment, and lack or loss of social support networks. People who are dependent on others (e.g., children or the elderly) or who are socially disadvantaged (i.e., because of race, gender, education level, or similar factors) are at greater risk of developing stress-related illnesses. Other risk factors include feelings of helplessness, hopelessness, extreme fear or anger, and cynicism or distrust of others.
Causes and symptoms
The causes of stress can include any event or occurrence that a person considers a threat to his or her coping strategies or resources. Researchers generally agree that a certain degree of stress is a normal part of a living organism's response to the inevitable changes in its physical or social environment, and that positive, as well as negative, events can generate stress as well as negative occurrences. Stress-related disease, however, results from excessive and prolonged demands on an organism's coping resources.
The symptoms of stress can be either physical and psychological. Stress-related physical illnesses, such as irritable bowel syndrome, heart attack, and chronic headache, result from long-term overstimulation of a part of the nervous system that regulates the heart rate, blood pressure, and digestive system. Stress-related emotional illness results from inadequate or inappropriate responses to major changes in one's life situation, such as marriage, completing one's education, becoming a parent, losing a job, or retiring. Psychiatrists sometimes use the term adjustment disorder to describe this type of illness. In the workplace, stress-related illness often takes
the form of burnout loss of interest in, or ability to perform, one's jobue to long-term high stress levels.
According to the American Institute of Stress:
- Forty-three percent of all adults suffer adverse health effects due to stress.
- Seventy-five to 90% of all visits to primary care physicans (PCPs) are for stress-related complaints or disorders.
- An estimated 1 million workers are absent on an average workday due to stress-related complaints. Stress is believed to be responsible for more than half of the 550 million workdays lost annually because of absenteeism.
- Stress has been linked to all the leading causes of death, including heart disease, cancer, lung ailments, cirrhosis, and suicide.
- Nearly half of all American workers suffer from symptoms of burnout, a disabling reaction to stress on the job.
- Workplace violence is rampant. There are almost 2 million reported instances of homicide, aggravated assault, rape, or sexual assault. Homicide is the second leading cause of fatal occupational injury and the leading cause of death for working women.
When the doctor suspects that a patient's illness is connected to stress, he or she will take a careful history that includes stressors in the patient's life (i.e., family or employment problems; other illnesses). Many physicians will also evaluate the patient's personality, to assess his or her coping resources and emotional response patterns. There are a number of personality inventories and psychological tests that can be used to help evaluate the amount of stress the patient experiences and the coping mechanisms that he or she uses to deal with it. Stress-related illness can be diagnosed by PCPs or psychiatrists. The physician will need to distinguish between adjustment disorders and anxiety or mood disorders, and between psychiatric disorders and physical illnesses (e.g., thyroid deficiency or surplus) that have psychological side effects. A test that is used for measuring life stress is "Life Events Scale." It is used to determine whether the patient is at risk for stress-related illnesses, and can be administered while taking a social history at no extra cost. The test comprises stressors that are ranked in from most stressful (e.g., death of a spouse) to least stressful (e.g., minor violations of the law). Each item is assigned a value and is based on thousands of interviews and medical histories identifying the kinds of events that people found stressful.
Recent advances in the understanding of the many complex connections between the human mind and body have produced a variety of treatments for stress-related illness. Present treatment regimens may include one or more of the following:
- Medications. These may include drugs to control blood pressure or other physical manifestations of stress, as well as drugs (e.g., tranquilizers and antidepressants) that affect a patient's mood.
- Homeopathy and herbal remedies. Some may relieve symptoms of stress.
- Stress management programs. These may be either individual or group treatments, and usually involve analysis of the stressors in the patient's life. They often focus on job-or workplace-related stress.
- Behavioral approaches. These strategies include relaxation techniques, breathing exercises, and physical exercise programs, such as walking.
- Massage. Therapeutic massage relieves stress by relaxing the large groups of muscles in the back, neck, arms, and legs.
- Cognitive therapy. This approach teaches patients to reframe or mentally re-interpret the stressors in their lives, so that they can modify the body's physical reactions.
- Meditation and associated spiritual or religious practices. Recent studies have found positive correlations between such activity and ability to manage stress.
- Drawing, dance, music, sculpting, and other art forms. These forms of therapy are used to help the patient get in touch with his or her sources of stress, and release them through creative expression.
- Biofeedback. Through this form of therapy, a patient learns to control his or her internal reactions to stressors, and discovers how to control them.
- Yoga, t'ai chi, aikido. A combination of physical and mental exercise are used to promote relaxation.
- Aromatherapy. Scented oils that are designed to generate relaxation.
- Nutrition-based treatments (e.g., dietary control; nutritional supplements). These help teach patients undergoing stress to focus on eating healthy foods.
- Acupuncture. This treatment corrects the imbalance of body energy that produces stress
The prognosis for recovery from a stress-related illness is related to a wide variety of factors in a person's life, many of which are genetically determined (i.e., race, sex, illnesses that run in families) or beyond the individual's control (e.g., economic trends, cultural stereotypes and prejudices). It is possible, however, for humans to learn new responses to stress. A person's ability to remain healthy in stressful situations is sometimes referred to as "stress hardiness." Stress-hardy people have a cluster of personality traits that strengthen their abilities to cope with stress. These traits include believing in the importance of what they are doing; believing that they have some power to influence their situation; and viewing life's changes as positive opportunities, rather than threats.
Complete prevention of stress is neither possible nor desirable, because stress is an important stimulus of human growth and creativity, and an inevitable part of life. In addition, specific strategies for stress prevention vary widely from person to person, depending on the nature and number of the stressors in an individual's life, and the amount of control he or she has over these factors. In general, however, a combination of attitude and behavioral changes works well for most patients.
Adjustment disorder psychiatric disorder marked by inappropriate or inadequate responses to a change in life circumstances. Depression following retirement from work is an example of adjustment disorder.
Burnoutn emotional condition, marked by tiredness, loss of interest, or frustration, that interferes with job performance. Burnout is usually regarded as the result of prolonged stress.
Stress hardiness personality characteristic that enables persons to stay healthy in stressful circumstances. It includes belief in one's ability to influence the situation; being committed to or fully engaged in one's activities; and having a positive view of change.
Stress management category of popularized programs and techniques intended to help people deal more effectively with stress.
Stressor stimulus, or event, that provokes a stress response in an organism. Stressors can be categorized as acute or chronic, and as external or internal to the organism.
Clark, R. Barkley. "Psychosocial Aspects of Pediatrics andPsychiatric Disorders." In Current Pediatric Diagnosis & Treatment, edited by William W. Hay, Jr., et al. Stamford, CT: Appleton & Lange, 1997.
Eisendrath, Stuart J. "Psychiatric Disorders." In Current Medical Diagnosis &Treatment 1998, edited by Lawrence M. Tierney, Jr., Stephen J. McPhee, and Maxine A. Papadakis. Stamford, CT: Appleton & Lange, 1997.
Barbara M. Chandler
Stress (Encyclopedia of Public Health)
Over the course of evolution, the human mind and body have developed means of handling stressful situations. Over the short term, such stress response pathways are highly adaptive, allowing a person to manage his or her resources in order to navigate the crisis; in some cases, however, these processes go awry and result in pathology. Chronic stress is becoming increasingly problematic in the United States as workers work longer and harder hours. Approximately one-third of all workers report that they are in high-stress jobs, and that not only is stress implicated in 15 percent of all disability claims, the number of stress-related absences is increasing. Such prolonged exposure to stress can also result in consequences in the form of physical illness. Alternatively, a severe acute stressor may result in a stress-response syndrome such as an acute stress disorder or a post-traumatic stress disorder.
In acute stress, the mind and body respond with a fight or flight response that involves activation of the sympathetic nervous system and release of stress hormones such as cortisol. Psychologically, this increases the organism's alertness and response time. Physiologically, these changes provide the organism with the energy needed to meet the emergency. Such intense activation helps the organism in the short term, but prolonged activation of this system creates problems in that it may increase the risk of certain disease states, and, once set into motion, chronic stress responses may be difficult to extinguish. This has led some researchers to investigate potential mediating factors such as personality. For example, a correlation has been established between a personality characterized by hostile competitiveness (type A) and increased risk of myocardial infarction (heart attack).
An acute stressor or psychological trauma, such as a life-threatening circumstance, presents a person with new information that may be difficult to assimilate. In an attempt to adapt, the person will typically alternate between contemplation of the stressor and avoidance of reminders of the event. Such a cycle allows for dose-by-dose psychological processing of the event. Difficulties in adaptation may present as an acute stress disorder that manifests itself as an extreme version of this cycle. People with such a disorder may have intrusive remembrances, nightmares, or even flashbacks of the stress event. These can alternate with emotional numbing, interpersonal alienation, and extreme avoidance of traumatic reminders. A diagnosis of postraumatic stress disorder (PTSD) is made if these symptoms persist longer than one month. Studies suggest that approximately 0.5 percent of men and 1.3 percent of women meet criteria for PTSD over their lifetime. A larger percentage (approximately 15%) of subjects were found to have some symptoms but did not meet criteria for the full disorder.
At present, psychotherapy is the mainstay of treatment for stress response syndromes. A variety of approaches exist, but they share a common goal of assisting the patient with conscious contemplation of the event in such a way that it may be assimilated and anxiety responses extinguished. Care must be taken to create an environment of safety and to avoid retraumatization, which may occur with overly rapid exposure to traumatic memories. Patients experience decreased feelings of guilt and shame as they learn that they responded to the trauma as adequately as possible. Contemplation of the event in therapy may lead to further benefits, including an enhanced understanding of the meaning of the event in the larger context of the individual's life.
Psychopharmacologic treatment may be a useful adjunct for specific symptom clusters such as associated anxiety, depression, and insomnia. The prognosis for treatment is good and is improved if the patient was without preexisting psychiatric comorbidity and if the treatment occurs in close proximity to the event. Brief treatment is frequently helpful in restoring a patient to a baseline level of functioning, but longer-term treatment may be necessary if exposure to the stressor was chronic or occurred in childhood.
Stress response systems have developed in humans as an adaptive mechanism to assist individuals in times of crisis. These systems, however, may also result in physical or psychological pathology. Chronic overactivation of the stress response may predispose an individual to greater risk for physical illnesses such as heart disease. Overly intense exposure to an acute stressor may result in a stress response syndrome with potentially disabling consequences. Treatment is, however, available and may return individuals to their previous level of functioning. A subset of patients even report a sense of enhanced insight into their lives as a result of the trauma.
STUART J. EISENDRATH
(SEE ALSO: Mental Health)
Eisendrath, S. J., and Feder, A. (1995). "The Mind and Somatic Illness: Psychological Factors Affecting Physical Illness." In Review of General Psychiatry. ed. H. H. Goldman. Norwalk CT: Appleton & Lang.
Horowitz, M. J. (1997). Stress Response Syndromes: PTSD, Grief and Adjustment Disorders, 3rd edition. Northvale, NJ: Aranson.
Van der Kolk, B. A.; McFarlane, A. C.; and Weisaeth, L. (1996). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society. New York: Guilford Press.
Stress (Encyclopedia of Management)
STRESS IN ORGANIZATIONS
As the pace at which our society operates increases, the pressures for every member of society to keep up with this pace also increase. Many of these pressures affect people through their jobs. Stress has become the "buzzword" that many people use to describe the impact that these pressures cause. In the short-term, stress can enable individuals to meet high levels of demand or pending deadlines. Prolonged stress, however, has been shown to cause illness and other conditions that can have detrimental effects on an employer's workforce. As Leon Warshaw noted in 1979 in his book on dealing with stress in the workplace: "Stress affects personality, modifying our perceptions, feelings, attitudes and behavior. And it reaches beyond its immediate victims to affect the political, social and work organizations whose activities they direct and carry out." In other words, the increasing rate of stress at work has wide-ranging effectsbsenteeism, impaired teamwork, workplace violence, decreased efficiency, increased rates of physical and mental illness, employee burnout, risk of discrimination and growth in early retirement.
In his 2004 article "Workplace Stress Sucks $300 Billion Annually from Corporate Profits," Ron Ball cites a recent study by Ravi Tangi that establishes a formula for measuring the "hard costs" of stress on business as whole. This formula quantified stress as causing the following:
- 19 percent of absenteeism
- 40 percent of turnover
- 55 percent of employee assistance programs
- 30 percent of short- and long-term disability
- 10 percent of drug plan costs
- 60 percent of total workplace accidents
- 100 percent of workers compensation and litigation complaints
There are many factors that contribute to making a workplace stressful. Research clearly indicates that certain jobs are more stressful than others. For example, people who work as police officers, fire fighters, air traffic controllers, and elected officials are exposed to higher levels of stress that people who work as janitors, florists, medical records technicians, forklift operators, librarians and musical instrument repairers. The factors that contribute to making some jobs more stressful include: level of decision-making required; level of monitoring workers must endure; unpleasant or dangerous physical or emotional conditions; repeated exchange of information with others; and whether job tasks are generally structured or unstructured.
Understanding the factors that contribute to creating stress in the workplace can help employers begin to manage stress among the workforce. The rest of this section will describe some of the detrimental effects of stress on the workplace and offer potential solutions for employers to minimize the potential harm to employees and to the work environment as a whole.
In increasing numbers, employees are calling in "sick" when they are really suffering from stress. A 2005 survey reported in the Silicon Valley/San Jose Business Journal found that only 38 percent of the employees who called in sick were actually suffering from a physical illness. The other 62 percent of these workers who failed to show up were dealing with stress, family issues, morale issues, motivational issues, etc. These results indicate a need for employers to implement some type of absence control measures.
Research from a wide range of organizations from around the world indicates that about 5 percent of the workforce accounts for about one-third of the absences, or lost days of work. This same research indicates that younger workers often have more absence patterns than older workers. Also, workers with the best attendance records are not always the healthiest or most fit employees. In many instances, the workers with poor attendance records demonstrate poor irregular attendance problems at previous jobs, and within the first six months of any new job. Therefore, employers must take note of attendance patterns of prospective workers (when available) and pay close attention to attendance issues during probationary periods for new hires. Second, employers must set clear rules for attendance at work and identify disciplinary rules that will be enforced if workers fail to comply with the attendance rules. Supervisors must be adequately trained to set for these rules and enforce them for the employer. Further, the employer could examine monthly or quarterly budget reports that review the absenteeism statistics for each department of the company. If there is one department that seems to be experiencing higher-than-normal rates of absenteeism, it could be indicative of stress or morale problems that the employer may need to address.
Traditional research has taught us that teamwork in the workplace is generally desirable and tends to produce positive results. It is important to note, however, that many workplace teams fail to produce positive results because people often prefer to worth with other people who are similar to them. These teams are often comprised of workers who come from diverse backgrounds, and they bring their own biases and cultural perceptions to the team dynamic. On some teams, this diversity can add richness and depth, and on other depths, this diversity facilitates the creation of barriers between team members. Employers can avoid breakdowns in teams by assigning manageable tasks to teams and setting reasonable deadlines for completion of these tasks. Also, employers should clearly define the charge and expectations for the team project and how it should undertake its mission. The less time teams have to get mired down in harmful infighting, the greater the chance of success.
The following scenario is becoming increasingly typical: In December 2000, Michael McDermott, a software engineer at Edgewater Technology, selects and shoots co-workers in his Wakefield, Mass., office. Seven people die. Employers at the Internet solution provider had recently told McDermott that wages would be garnished from his paycheck to pay the IRS for back taxes.
Because of their increasing frequency, violent acts are now considered a major workplace safety and health threat. A 1999 study by Yale University's School of Management, which surveyed workers throughout the country asked, "How often are you angry at work?" and more than 20 percent of respondents answered, "All the time." That seed of dissatisfaction often grows as time passes. The Occupational Safety and Health Administration estimates that two million workers are victims of violent workplace acts each year. By 2003, workplace violencencluding assaults and suicidesccounted for 16 percent of all work-related fatal occupational injuries. Homicides are annually among the top three causes of workplace fatalities for all workers.
Organizational interventions aimed at preventing workplace violence satisfy employers' moral and ethical obligations to provide their employees with safe work environments. Moreover, such interventions also help companies reduce their costs and comply with the law. Workplace violence can cost employers large sums of money. Employers must pay for victims' medical and psychiatric care, repairs and clean-up, insurance rate hikes, and increased security measures. Additional costs are incurred as the result of absenteeism, as the average victim misses 3.5 days of work following an incident.
Employers must also be concerned about workplace violence for legal reasons. The General Duty Clause of the Occupational Safety and Health Act states that employers can be cited for a violation if there is a recognized danger of workplace violence in their establishment, and they do nothing to prevent it. In addition to being fined by OSHA, employers can also be sued by victims of violence. The legal test for determining employer liability for violent acts committed by non-employees is as follows. The employer is liable if:
- it knew or should have known that a criminal act was probable (e.g., it was warned about threats made to an employee); and
- it could have reasonably protected the employee from criminal assault, but failed to do so; and
- its failure to protect the employee caused the subsequent injuries to occur (in other words, had the employer done its part, the injury would not have happened).
A similar legal test is used to determine employer liability for violent acts committed by employees. An employer is liable for negligent hiring if it knew or should have known of the applicant's violent tendencies, yet decided to hire that person anyway. In a similar vein, successful negligent retention suits can be filed when an employer retains a current employee despite knowledge of violent tendencies. Employers are liable in these situations if they had (or should have had) information signaling the danger of future violent acts, yet ignored this danger.
So what can a company do to minimize the occurrences of violent acts? In 2002, OSHA issued a set of guidelines listing some of the security measures that can be implemented to reduce the threat of violence. These measures include:
- provide improved lighting and employee escort services to and from parking lots
- ensure reception areas can be locked when no one is on duty
- create a policy stipulating that there are always at least two people on duty
- provide security systems, such as electronic access control systems, silent alarms, metal detectors, and video cameras
- establish policies regarding visitor access (sign-in, identification badges)
- equip field staff with cellular phones
- install curved mirrors at hallway intersections or concealed areas as well as bullet-proof glass
- provide safety education for employees so they know what conduct is unacceptable, and what to do if they witness or are subjected to workplace violence
- provide drop safes to limit the amount of cash on hand
- instruct employees not to enter any location where they feel unsafe.
An employer should consider these measures in light of the level of risk at a particular worksite. For example, metal detectors and bullet-proof glass would be appropriate for inner-city emergency departments, abortion clinics, and psychiatric facilities where violence is highest. In addition to implementing OSHA recommendations, an employer can further minimize violent acts through the use of pre-employment screening, strict anti-violence and anti-drug/alcohol policies, and training. All workers should be taught how to recognize early signs of a troubled or potentially violent person and how to respond to such persons. Managers should be further trained on how to properly handle terminations since such acts often trigger violence.
DECREASED EFFICIENCY AND INCREASED RATES OF PHYSICAL AND MENTAL ILLNESS
Excessive amounts of stress can have debilitating health effects, such as ulcers, colitis, hypertension, headaches, lower back pain, carpel tunnel syndrome and cardiac conditions. Stressed workers may perform poorly, quit their jobs, suffer low morale, generate conflicts among coworkers, miss work, or exhibit indifference toward coworkers and customers. These stress-induced outcomes now cost U.S. businesses somewhere between $200 and $500 billion per year.
Stress can sometimes cause workers to turn to drugs and alcohol. The use of drugs and alcohol is pervasive in the United States. For instance, nearly 10 percent of all full-time employees use illicit drugs (primarily marijuana and cocaine), and another 10 percent are alcoholics. An increasing number of U.S. workers are taking some type of stimulanteyond caffeine. A 1999 Drug Enforcement Agency survey estimated that at least 15 percent of United States adults methamphetamine. Substance had tried abuse costs U.S. employers an estimated $75 billion a year in terms of lost productivity, accidents, workers' compensation, health insurance claims, and theft of company property.
While most organizations are taking steps to keep their workplaces drug-free voluntarily, government contractors are required to take such steps. The 1988 Drug-Free Workplace Act states that government contractors must ensure a drug-free workplace by notifying employees about:
- the dangers of drug abuse in the workplace;
- its policy of maintaining a drug-free workplace;
- any available drug counseling, rehabilitation, and employee assistance programs; and
- the penalties that may be imposed upon employees for drug abuse violations occurring in the workplace.
Employers can combat substance abuse at the workplace by screening out applicants and discharging employees who have been identified as substance abusers. Substance abuse is most commonly detected through urine and blood tests. About two-thirds of all corporations presently require drug testing of current or future employees. Supervisors can also detect substance abuse by observing their employees' behavior. Some of the symptoms to look for are mood swings, slurred speech, flushed cheeks, frequent absences on Mondays and Fridays, missing deadlines, and overreacting to criticism.
Detecting substance abuse early can be quite useful to a company, as illustrated by the findings of a U.S. Postal Service study. The Postal Service tested 5,465 applicants for drugs, but did not use these results in hiring decisions. About 4,000 of these applicants were eventually hired. In a three-year follow-up, employees who tested positive had a 66 percent higher absenteeism rate and a 77 percent greater termination rate than those testing negative. The Postal Service now estimates that had it not hired the drug-positive group, it could have saved $150 million in absenteeism, rehiring, retraining, and injury compensation costs.
When dealing with current employees with drug problems, some employers take a rehabilitative approach: they help abusers overcome their problem through remedial counseling. Employee assistance programs (EAPs) employ mental health professionals (usually on a contract basis) to provide services to workers who are experiencing substance abuse or other personal problems. For example, the EAP at the Chase Manhattan Bank helps employees resolve problems of drug or alcohol abuse, child care, elder care, marital or family relationship concerns, emotional distress, anxiety, depression, or financial difficulties. Employees may seek help on a voluntary, confidential basis, or may be referred by a supervisor who suspects that the employee's declining job performance is being caused by personal problems.
Many companies currently use EAPs. The potential payoff of an EAP is evidenced by a study that found that every dollar spent on an EAP returned an estimated $3 to $5 in lower absenteeism and greater productivity.
Employers must develop written substance abuse policies that specify their approach to handling these problems. The policy should specify the prohibited behaviors and note the consequences employees will face if they break the rules. Such policies serve two purposes: (1) to act as a deterrent and (2) to establish a sound legal basis for taking punitive action (e.g., suspension or discharge).
Employee wellness is a relatively new human resource management focus that seeks to eliminate certain debilitating health problems (e.g., cancer, heart disease, respiratory problems, hypertension) that can be caused by a person's poor lifestyle choices (e.g., smoking, poor nutrition, lack of exercise, obesity). Such health problems have become quite prevalent: Cancer, heart, and respiratory illnesses alone account for 61 percent of all hospital claims. These ailments can cause workplace problems such as absenteeism, turnover, lost productivity, and increased medical costs. For instance, people who have high blood pressure are 70 percent more likely than others to have medical claims of more than $5,750 per year, and the cost of medical claims for smokers is 22 percent higher than it is for nonsmokers.
Many organizations attempt to help employees improve or maintain their overall health by offering them employee wellness programs. Such programs provide employees with physical fitness facilities, on-site health screening, and programs to help them quit smoking, manage stress, and improve nutritional habits. Employee wellness programs can be quite effective. Research indicates that participation in a wellness program reduces both absenteeism and turnover, and increases productivity. A study conducted at Mesa Petroleum, for example, found that the productivity difference between participants and non-participants amounted to $700,000 in the first year, and $1.3 million in the second year.
If they are to work, wellness programs must successfully enlist "high-risk" individualshose in greatest need of the program. Unfortunately, most employees who participate in wellness programs are those who fall into a low-risk category. Because at-risk individuals do not seek help, many employee wellness programs fail to meet their objectives. Employers must, then, find some way to motivate high-risk individuals to participate. Some companies offer positive inducements (e.g., cash bonuses) to individuals who participate; other companies focus their efforts on non-participants by imposing certain penalties. For example, they may increase insurance premium contributions of non-participants or raise their deductible levels.
Companies can help eliminate, or at least minimize, job stress. A firm can eliminate many sources of employee stress by implementing effective HRM practices. For instance, the implementation of effective selection and training procedures can help ensure that workers are properly suited to the demands of their jobs. Providing clearly written job descriptions can reduce worker uncertainty regarding job responsibilities. The use of effective performance appraisal systems can relieve stress by clarifying performance expectations. And the implementation of effective pay-for-performance programs can relieve stress by reducing worker uncertainty regarding rewards.
Unfortunately, companies cannot always eliminate all sources of job stress; some stress may be inherent in the job. For instance, some jobs are dangerous (e.g., logging, police work, firefighting), and some place the worker in demanding interpersonal situations (e.g., customer relations specialists). When job stresses cannot be relieved, the worker must learn to cope with them. A firm can help by offering employees stress counseling or by providing them the opportunity to "work off" their stress through physical exercise. Some of the organizational interventions described earlier, such as the use of EAPs and wellness programs, can be helpful in this regard.
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Stress (Encyclopedia of Drugs, Alcohol, and Addictive Behavior)
Stress is best thought of as a negative emotional state psychophysiological experience that is both a product of the appraisal of situational and psychological factors as well as an impetus for coping (Baum, 1990). Stressorsvents posing threat or challenge or otherwise demanding effort and attention for adaptationre judged in terms of the situational variables and one's personal attributes and assets. Negative affect may ensue; and stress responses, which appear directed at the mobilization of bodily systems as a means of coping, strengthen specific problem solving aimed at eliminating the sources of threat or demand and at reducing emotional distress (Baum, Cohen, & Hall 1993).
(SEE ALSO: Vulnerability As Cause of Substance Abuse)
BAUM, A. (1990). Stress, intrusive imagery, and chronic stress. Health Psychology, 1, 217-236.
BAUM, A., COHEN, L., & HALL, M. (1993). Control and intrusive memories as determinants of chronic stress. Psychosomatic Medicine, 55, 274-286.