The longer he waited, the more David worried. For weeks he had been plagued

by aching muscles, loss of appetite, restless sleep, and a complete sense of

exhaustion. At first he tried to ignore these problems, but eventually he became

so short-tempered and irritable that his wife insisted he get a checkup. Now,

sitting in the doctor’s office and wondering what the verdict would be, he didn’t

even notice when Theresa took the seat beside him. They had been good friends

when she worked in the front office at the plant, but he hadn’t seen her since she

left three years ago to take a job as a customer service representative. Her gentle

poke in the ribs brought him around, and within minutes they were talking and

gossiping as if she had never left.

Scope of Stress in the American Workplace

David’s and Theresa’s stories are unfortunate but not unusual. Job stress has

become a common and costly problem in the American workplace, leaving few

workers untouched. For example, studies report the following:

  • One-fourth of employees view their jobs as the number

one stressor in their lives.

Northwestern National Life

  • Three-fourths of employees believe the worker has more

on-the-job stress than a generation ago.

Princeton Survey Research Associates

  • Problems at work are more strongly associated with health

complaints than are any other life stressor—more so than

even financial problems or family problems.

St. Paul Fire and Marine Insurance Co.

Fortunately, research on job stress has greatly expanded in recent years. But in

spite of this attention, confusion remains about the causes, effects, and prevention

of job stress. This booklet summarizes what is known about job stress and what

can be done about it.


What is Job Stress?

Job stress can be defined as the harmful physical and emotional responses that

occur when the requirements of the job do not match the capabilities, resources,

or needs of the worker. Job stress can lead to poor health and even injury.

The concept of job stress is often confused with challenge, but these concepts are

not the same. Challenge energizes us psychologically and physically, and it

motivates us to learn new skills and master our jobs. When a challenge is met, we

feel relaxed and satisfied. Thus, challenge is an important ingredient for healthy

and productive work. The importance of challenge in our work lives is probably

what people are referring to when they say “a little bit of stress is good for you.”

But for David and Theresa, the situation is different—the challenge has turned

into job demands that cannot be met, relaxation has turned to exhaustion, and a

sense of satisfaction has turned into feelings of stress. In short, the stage is set for

illness, injury, and job failure.


What are the Causes of Job Stress?

Nearly everyone agrees that job stress results from the interaction of the worker

and the conditions of work. Views differ, however, on the importance of worker

characteristics versus working conditions as the primary cause of job stress.

These differing viewpoints are important because they suggest different ways to

prevent stress at work.

According to one school of thought, differences in individual characteristics such

as personality and coping style are most important in predicting whether certain

job conditions will result in stress—in other words, what is stressful for one

person may not be a problem for someone else. This viewpoint leads to

prevention strategies that focus on workers and ways to help them cope with

demanding job conditions.

Although the importance of individual differences cannot be ignored, scientific

evidence suggests that certain working conditions are stressful to most people.

The excessive workload demands and conflicting expectations described in

David’s and Theresa’s stories are good examples. Such evidence argues for a

greater emphasis on working conditions as the key source of job stress, and for

job redesign as a primary prevention strategy.

NIOSH Approach to Job Stress

On the basis of experience and research, NIOSH favors the view that working

conditions play a primary role in causing job stress. However, the role of

individual factors is not ignored. According to the NIOSH view, exposure to

stressful working conditions (called job stressors) can have a direct influence on

worker safety and health. But as shown below, individual and other situational

factors can intervene to strengthen or weaken this influence. Theresa’s need to

care for her ill mother is an increasingly common example of an individual or

situational factor that may intensify the effects of stressful working conditions.

Examples of individual and situational factors that can help to reduce the effects

of stressful working conditions include the following:

  • Balance between work and family or personal life
  • A support network of friends and coworkers
  • A relaxed and positive outlook


Job Conditions That May Lead to Stress

The Design of Tasks. Heavy workload, infrequent rest breaks,

long work hours and shiftwork; hectic and routine tasks that have little

inherent meaning, do not utilize workers’ skills, and provide little sense

of control.

Example: David works to the point of exhaustion. Theresa is tied

to the computer, allowing little room for flexibility, self-initiative,

or rest.

Management Style. Lack of participation by workers in decisionmaking,

poor communication in the organization, lack of familyfriendly


Example: Theresa needs to get the boss’s approval for everything,

and the company is insensitive to her family needs.

Interpersonal Relationships. Poor social environment and lack

of support or help from coworkers and supervisors.

Example: Theresa’s physical isolation reduces her opportunities to

interact with other workers or receive help from them.

Work Roles. Conflicting or uncertain job expectations, too much

responsibility, too many “hats to wear.”

Example: Theresa is often caught in a difficult situation trying to

satisfy both the customer’s needs and the company’s expectations.

Career Concerns. Job insecurity and lack of opportunity for

growth, advancement, or promotion; rapid changes for which workers

are unprepared.

Example: Since the reorganization at David’s plant, everyone is

worried about their future with the company and what will happen


Environmental Conditions. Unpleasant or dangerous physical

conditions such as crowding, noise, air pollution, or ergonomic




Job Stress and Health

Stress sets off an alarm in the brain, which responds by preparing the body

for defensive action. The nervous system is aroused and hormones are

released to sharpen the senses, quicken the pulse, deepen respiration, and

tense the muscles. This response (sometimes called the fight or flight

response) is important because it helps us defend against threatening

situations. The response is preprogrammed biologically. Everyone responds

in much the same way, regardless of whether the stressful situation is at

work or home.

Short-lived or infrequent episodes of stress pose little risk. But when

stressful situations go unresolved, the body is kept in a constant state of

activation, which increases the rate of wear and tear to biological systems.

Ultimately, fatigue or damage results, and the ability of the body to repair

and defend itself can become seriously compromised. As a result, the risk

of injury or disease escalates.

In the past 20 years, many studies have looked at the relationship between

job stress and a variety of ailments. Mood and sleep disturbances, upset

stomach and headache, and disturbed relationships with family and friends

are examples of stress-related problems that are quick to develop and are

commonly seen in these studies. These early signs of job stress are usually

easy to recognize. But the effects of job stress on chronic diseases are more

difficult to see because chronic diseases take a long time to develop and can

be influenced by many factors other than stress. Nonetheless, evidence is

rapidly accumulating to suggest that stress plays an important role in

several types of chronic health problems—especially cardiovascular

disease, musculoskeletal disorders, and psychological disorders.

Early Warning Signs of Job Stress


Sleep disturbances

Difficulty in concentrating

Short temper

Upset stomach

Job dissatisfaction

Low morale


Job Stress and Health:

What the Research Tells Us

Cardiovascular Disease

Many studies suggest that psychologically demanding jobs that allow employees

little control over the work process increase the risk of cardiovascular disease.

Musculoskeletal Disorders

On the basis of research by NIOSH and many other organizations, it is widely

believed that job stress increases the risk for development of back and upperextremity

musculoskeletal disorders.

Psychological Disorders

Several studies suggest that differences in rates of mental health problems (such as

depression and burnout) for various occupations are due partly to differences in job

stress levels. (Economic and lifestyle differences between occupations may also

contribute to some of these problems.)

Workplace Injury

Although more study is needed, there is a growing concern that stressful working

conditions interfere with safe work practices and set the stage for injuries at work.

Suicide, Cancer, Ulcers, and Impaired Immune Function

Some studies suggest a relationship between stressful working conditions and these

health problems. However, more research is needed before firm conclusions can be


Encyclopaedia of Occupational Safety and Health


Stress, Health, and Productivity

Some employers assume that stressful working conditions are a necessary evil—

that companies must turn up the pressure on workers and set aside health

concerns to remain productive and profitable in today’s economy. But research

findings challenge this belief. Studies show that stressful working conditions are

actually associated with increased absenteeism, tardiness, and intentions by

workers to quit their jobs—all of which have a negative effect on the bottom line.

Recent studies of so-called healthy organizations suggest that policies benefiting

worker health also benefit the bottom line. A healthy organization is defined as

one that has low rates of illness, injury, and disability in its workforce and is also

competitive in the marketplace. NIOSH research has identified organizational

characteristics associated with both healthy, low-stress work and high levels of

productivity. Examples of these characteristics include the following:

  • Recognition of employees for good work performance
  • Opportunities for career development
  • An organizational culture that values the individual worker
  • Management actions that are consistent with organizational values


What Can Be Done About Job Stress?

The examples of Theresa and David illustrate two different approaches for

dealing with stress at work.

Stress Management. Theresa’s company is providing stress management

training and an employee assistance program (EAP) to improve the ability of

workers to cope with difficult work situations. Nearly one-half of large companies

in the United States provide some type of stress management training for their

workforces. Stress management programs teach workers about the nature and

sources of stress, the effects of stress on health, and personal skills to reduce

stress—for example, time management or relaxation exercises. (EAPs provide

individual counseling for employees with both work and personal problems.)

Stress management training may rapidly reduce stress symptoms such as anxiety

and sleep disturbances; it also has the advantage of being inexpensive and easy to

implement. However, stress management programs have two major


  • The beneficial effects on stress symptoms are often short-lived.
  • They often ignore important root causes of stress because they focus on the

worker and not the environment.

Organizational Change. In contrast to stress management training and

EAP programs, David’s company is trying to reduce job stress by bringing in a

consultant to recommend ways to improve working conditions. This approach is

the most direct way to reduce stress at work. It involves the identification of

stressful aspects of work (e.g., excessive workload, conflicting expectations) and

the design of strategies to reduce or eliminate the identified stressors. The

advantage of this approach is that it deals directly with the root causes of stress at

work. However, managers are sometimes uncomfortable with this approach

because it can involve changes in work routines or production schedules, or

changes in the organizational structure.

As a general rule, actions to reduce job stress should give top priority to

organizational change to improve working conditions. But even the most

conscientious efforts to improve working conditions are unlikely to eliminate

stress completely for all workers. For this reason, a combination of

organizational change and stress management is often the most useful

approach for preventing stress at work.


Preventing Job Stress – Getting Started

No standardized approaches or simple “how to”

manuals exist for developing a stress prevention

program. Program design and appropriate

solutions will be influenced by several factors—

the size and complexity of the organization,

available resources, and especially the unique

types of stress problems faced by the

organization. In David’s company, for example,

the main problem is work overload. Theresa, on

the other hand, is bothered by difficult

interactions with the public and an inflexible work schedule.

Although it is not possible to give a universal prescription for preventing stress

at work, it is possible to offer guidelines on the process of stress prevention in

organizations. In all situations, the process for stress prevention programs

involves three distinct steps: problem identification, intervention, and

evaluation. These steps are outlined beginning on page 17. For this process to

succeed, organizations need to be adequately prepared. At a minimum,

preparation for a stress prevention program should include the following:

  • Building general awareness about job stress (causes, costs, and control)
  • Securing top management commitment and support for the program
  • Incorporating employee input and involvement in all phases of the


  • Establishing the technical capacity to conduct the program (e.g.,

specialized training for in-house staff or use of job stress consultants)

Bringing workers or workers and managers together in a committee or

problem-solving group may be an especially useful approach for developing a

stress prevention program. Research has shown these participatory efforts to

be effective in dealing with ergonomic problems in the workplace, partly

because they capitalize on workers’ firsthand knowledge of hazards

encountered in their jobs. However, when forming such working groups, care

must be taken to be sure that they are in compliance with current labor laws.*


Steps Toward Prevention

Low morale, health and job complaints, and employee turnover often provide the

first signs of job stress. But sometimes there are no clues, especially if employees

are fearful of losing their jobs. Lack of obvious or widespread signs is not a good

reason to dismiss concerns about job stress or minimize the importance of a

prevention program.

Step 1 – Identify the Problem. The best method to explore the scope and

source of a suspected stress problem in an organization depends partly on the size

of the organization and the available resources. Group discussions among managers,

labor representatives, and employees can provide rich sources of information.

Such discussions may be all that is needed to track down and remedy stress

problems in a small company. In a larger organization, such discussions can be

used to help design formal surveys for gathering input about stressful job conditions

from large numbers of employees.

Regardless of the method used to collect data, information should be obtained

about employee perceptions of their job conditions and perceived levels of stress,

health, and satisfaction. The list of job conditions that may lead to stress (page 9)

and the warning signs and effects of stress (page 11) provide good starting points

for deciding what information to collect.

Objective measures such as absenteeism,

illness and turnover rates, or

performance problems can also be

examined to gauge the presence and

scope of job stress. However, these

measures are only rough indicators of

job stress—at best.

Data from discussions, surveys, and

other sources should be summarized

and analyzed to answer questions about

the location of a stress problem and job

conditions that may be responsible—

for example, are problems present

throughout the organization or confined

to single departments or specific jobs?




Step 2 – Design and Implement Interventions. Once the sources of

stress at work have been identified and the scope of the problem is understood,

the stage is set for design and implementation of an intervention strategy.

In small organizations, the informal discussions that helped identify stress

problems may also produce fruitful ideas for prevention. In large organizations, a

more formal process may be needed. Frequently, a team is asked to develop

recommendations based on analysis of data from Step 1 and consultation with

outside experts.

Certain problems, such as a hostile work environment, may be pervasive in the

organization and require company-wide interventions. Other problems such as

excessive workload may exist only in some departments and thus require more

narrow solutions such as redesign of the way a job is performed. Still other

problems may be specific to certain employees and resistant to any kind of

organizational change, calling instead for stress management or employee

assistance interventions. Some interventions might be implemented rapidly (e.g.,

improved communication, stress management training), but others may require

additional time to put into place (e.g., redesign of a manufacturing process).

Before any intervention occurs,

employees should be informed about

actions that will be taken and when they

will occur. A kick-off event, such as an

all-hands meeting, is often useful for

this purpose.

Step 3 – Evaluate the Interventions. Evaluation is an essential step in

the intervention process. Evaluation is necessary to determine whether the intervention

is producing desired effects and whether changes in direction are needed.

Time frames for evaluating interventions should be established. Interventions

involving organizational change should receive both short- and long-term

scrutiny. Short-term evaluations might be done quarterly to provide an early

indication of program effectiveness or possible need for redirection. Many

interventions produce initial effects that do not persist. Long-term evaluations are

often conducted annually and are necessary to determine whether interventions

produce lasting effects.

Evaluations should focus on the same

types of information collected during

the problem identification phase of the

intervention, including information

from employees about working

conditions, levels of perceived stress,

health problems, and satisfaction.

Employee perceptions are usually the

most sensitive measure of stressful

working conditions and often provide

the first indication of intervention

effectiveness. Adding objective

measures such as absenteeism and

health care costs may also be useful.

However, the effects of job stress

interventions on such measures tend to

be less clear-cut and can take a long

time to appear.

The job stress prevention process does not end with evaluation.

Rather, job stress prevention should be seen as a continuous process

that uses evaluation data to refine or redirect the intervention strategy.