The trouble with stress

The stress epidemic hitting today’s workforce has become a headline favourite in recent years. Masses of column inches are taken up highlighting how we are all under too much pressure at work. From financial reports to health and lifestyle magazines, ‘stress’ has become the catch-all word to attribute blame for poor performance, whether it be physical, psychological or in business.

Reports such as the annual Employee Absence Survey from the Chartered Institute of Personnel and Development (CIPD) only highlight the bottom line effects of stress-related illness. In its 2004 survey, it revealed that sickness absence cost businesses 588 per employee each year. It also reported that more than half of employers surveyed had seen an increase in workplace stress during the last year.

According to the Health & Safety Executive (HSE), up to five million people in the UK feel ‘very’ or ‘extremely’ stressed by their work and about half a million people believe work-related stress is making them ill. But how many people actually understand what the term ‘stress’ means? The fact that it is not a recognised medical term goes some way to show how even doctors find it a confusing label. The HSE’s definition is hardly clear-cut, describing stress on its website as: ‘The adverse reaction people have to excessive pressures or other types of demand placed on them’.

With uncertainty over which symptoms count as stress, is there really evidence that levels are rising?

If we look at the Department for Work and Pension’s (DWP) statistics on the prime causes for people claiming incapacity benefits, it seems, at first glance, that stress is on the rise.

In the past few years, mental and behavioural disorders – which predominantly cover conditions included under the stress label, such as anxiety and depression – have become the number one claims area, overtaking the traditional front runner, musculoskeletal disorders.

In 1997, mental and behavioural illness accounted for 28% of claims. The latest figures show that in 2003 this had risen to 37%. The DWP predicts that 2004’s figures will show another increase.

Symptom shift

But despite this, Andrew Pemberton, director of rehabilitation consultancy Human Focus, does not believe there are more people suffering from stress. He says the increase in new incapacity benefit claims for mental illness and the decrease in claims for back pain have to be linked.

“It indicates that there are not necessarily more cases of stress, but that there has been a ‘symptom shift’ towards anxiety and depression from musculoskeletal conditions,” he says.

This symptom shift implies that there is no actual change in the type of conditions being suffered by claimants, just in the type of illnesses that are being diagnosed by doctors.

This could be because patients now feel there is less of a stigma attached to mental illness so are more likely to seek medical help than they would have been a few years ago. It may also be because there has been a change in the way doctors are labelling certain conditions.

Is the sudden surge of reported stress cases really down to a change of attitude? Kathy Barlow, spokeswoman for the DWP, believes it is.
“Not only patients, but also doctors have shifted their attitudes,” she says. “The medical profession is now more able to pinpoint symptoms of stress, so there is a bigger acceptance of diagnosing mental illness.”

Dr Michael O’Donnell, consultant occupational physician and chief medical officer for disability insurer Unum-Provident, says more GPs need to address the way they diagnose stress-related illness. Instead of issuing sicknotes, he believes the medical profession should be encouraging patients to become more proactive about their recovery.

“A high proportion of mental illness is loosely described as work-related stress. Stress is a poor term that misses the point. Instead of giving out a sicknote, GPs should say, ‘what are you going to do about it?’.”

There is evidence that a high percentage of stress-related illness is subjective and down to ‘everyday conditions’ such as tiredness or worry.
But no matter how common certain complaints are, it does not mean that they are any less serious. Speaking at a recent seminar on sickness absence about the rise of stress-related illness, Mansel Aylward, medical director and chief scientist to the DWP, pointed out that, for around 70% of people attending GP surgeries, there is no pathological reason for the extent of their symptoms.

“We all feel tired, worried and depressed at times. So why is it that while we all suffer these conditions, a few of us don’t recover from them? There has not been an epidemic of mental health problems in a definable way. We are seeing something we are not able to explain medically,” says Aylward.

However, the lack of concrete medical evidence, does not mean that we are a nation of fakers. “If people were skiving from work, it wouldn’t be a difficult problem to solve,” says Aylward. “But the majority are not fraudulent. They are ill with symptoms they don’t understand.”

This ambiguity has arguably contributed to the over-use of the label ‘workplace stress’. One danger of this label is that it may be being used to hide a far more serious problem.

Increasing pressures

Jane Cranwell-Ward, a psychologist and associate faculty member at Henley Management College, argues that there is evidence that the workplace is a more pressured environment than it was just a few years ago and that high stress levels are on the rise.

She says the rise of technology has made it more difficult for people to switch off after work, as e-mails and mobile phones mean many workers are on call after hours. And the vision of the future workplace that was held in the 1980s has not come to fruition.

“We use to talk about the ‘leisured world’. But the reality is that those who have the time for leisure don’t have the money to enjoy it and those who have the money don’t have the time,” she says.

Cranwell-Ward also believes the terrorist attacks on New York’s World Trade Centre in the US in 2001 have been a catalyst for heavier workloads.

“Some of the trends in working conditions post 9/11 have pointed to a downward spiral. Many companies have downsized, meaning more people are now doing the job of more than one person,” she says. “In addition, worsening transport problems, especially in the South East, mean many commuters are stressed out even before they get to work.”

Outside forces

However, Pemberton says work pressures cannot entirely be to blame for reported cases of stress. Personal problems, such as relationship or money troubles, can also mean people find it difficult to cope.

“If you really want to reduce stress in the workplace, it is about employee communication, appreciation and giving staff control over their working environment. Stress and anxiety are often caused by home life as much as work life, but it can still manifest itself as time off work,” says Pemberton.

Whether stress levels are on the increase is debatable. But this does not mean that stress, in its many guises, is not a continuing problem in today’s workforce. With absence costing UK companies billions each year, it is vital that stress-related conditions are not ignored.

The HSE has made steps to help employers get to the root of stress, with the publication of its stress management standards last year. The standards set out six key areas – demands, control, support, relationships, role and change – which, if properly managed, can help reduce work-related stress.

Don Iszatt, research director at consultancy Team Works, says the HSE’s standards have brought much needed clarity to measuring workplace stress.

“Everyone now has a clear idea based on solid work by the HSE about how to go forward,” he says.

So while there may be a lack of solid medical evidence to prove that stress levels are rising, one certainty is that stress is not going to go away.
If employers want to ensure their workforces do not contribute to next year’s CIPD employee absence figures, it is essential that HR professionals are able to recognise whether stress is becoming a problem in their organisation, and learn how to manage it more effectively.

Related articles

Have we got it wrong with stress?
go to www.personneltoday.com/27993.article

Stress outbreak grips the nation
go to www.personneltoday.com/27740.article

Will stress standards make any difference?
go to www.personneltoday.com/26610.article


Exploding the five myths of workplace stress

According to The Work Foundation, there are five popular misconceptions
about workplace stress:

Misconception: Stress is a recognised medical condition
Reality: It is an unhelpful umbrella term for a series of mild to moderate mental disorders

Misconception: Some jobs are more stressful than others
Reality: It is subjective, depending on an individual’s capacity to cope

Misconception: GPs are the right people to diagnose stress
Reality: Occupational health professionals are often better placed to identify underlying causes

Misconception: Stress increases with seniority
Reality: There is no evidence it is more prevalent than for juniors

Misconception: Stress management is the answer
Reality: It is more effective to manage its causes

Stress in numbers

The proportion of people on incapacity benefits with mental and behavioural disorders:

1997 28%

1998 30%

1999 31%

2000 33%

2001 34%

2002 36%

2003 37%

Source: Department for Work & Pensions

– About half a million people in the UK experience work-related stress at a level they believe is making them ill

– Up to five million people in the UK feel ‘very’ or ‘extremely’ stressed by their work

Source: Health & Safety Executive



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