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Article contents

Work, stress, coping, and stress management.

• Sharon Glazer Sharon Glazer University of Baltimore
•  and  Cong Liu Cong Liu Hofstra University
• https://doi.org/10.1093/acrefore/9780190236557.013.30
• Published online: 26 April 2017

Work stress refers to the process of job stressors, or stimuli in the workplace, leading to strains, or negative responses or reactions. Organizational development refers to a process in which problems or opportunities in the work environment are identified, plans are made to remediate or capitalize on the stimuli, action is taken, and subsequently the results of the plans and actions are evaluated. When organizational development strategies are used to assess work stress in the workplace, the actions employed are various stress management interventions. Two key factors tying work stress and organizational development are the role of the person and the role of the environment. In order to cope with work-related stressors and manage strains, organizations must be able to identify and differentiate between factors in the environment that are potential sources of stressors and how individuals perceive those factors. Primary stress management interventions focus on preventing stressors from even presenting, such as by clearly articulating workers’ roles and providing necessary resources for employees to perform their job. Secondary stress management interventions focus on a person’s appraisal of job stressors as a threat or challenge, and the person’s ability to cope with the stressors (presuming sufficient internal resources, such as a sense of meaningfulness in life, or external resources, such as social support from a supervisor). When coping is not successful, strains may develop. Tertiary stress management interventions attempt to remediate strains, by addressing the consequence itself (e.g., diabetes management) and/or the source of the strain (e.g., reducing workload). The person and/or the organization may be the targets of the intervention. The ultimate goal of stress management interventions is to minimize problems in the work environment, intensify aspects of the work environment that create a sense of a quality work context, enable people to cope with stressors that might arise, and provide tools for employees and organizations to manage strains that might develop despite all best efforts to create a healthy workplace.

• stress management
• organization development
• organizational interventions
• stress theories and frameworks

Introduction

Work stress is a generic term that refers to work-related stimuli (aka job stressors) that may lead to physical, behavioral, or psychological consequences (i.e., strains) that affect both the health and well-being of the employee and the organization. Not all stressors lead to strains, but all strains are a result of stressors, actual or perceived. Common terms often used interchangeably with work stress are occupational stress, job stress, and work-related stress. Terms used interchangeably with job stressors include work stressors, and as the specificity of the type of stressor might include psychosocial stressor (referring to the psychological experience of work demands that have a social component, e.g., conflict between two people; Hauke, Flintrop, Brun, & Rugulies, 2011 ), hindrance stressor (i.e., a stressor that prevents goal attainment; Cavanaugh, Boswell, Roehling, & Boudreau, 2000 ), and challenge stressor (i.e., a stressor that is difficult, but attainable and possibly rewarding to attain; Cavanaugh et al., 2000 ).

Stress in the workplace continues to be a highly pervasive problem, having both direct negative effects on individuals experiencing it and companies paying for it, and indirect costs vis à vis lost productivity (Dopkeen & DuBois, 2014 ). For example, U.K. public civil servants’ work-related stress rose from 10.8% in 2006 to 22.4% in 2013 and about one-third of the workforce has taken more than 20 days of leave due to stress-related ill-health, while well over 50% are present at work when ill (French, 2015 ). These findings are consistent with a report by the International Labor Organization (ILO, 2012 ), whereby 50% to 60% of all workdays are lost due to absence attributed to factors associated with work stress.

The prevalence of work-related stress is not diminishing despite improvements in technology and employment rates. The sources of stress, such as workload, seem to exacerbate with improvements in technology (Coovert & Thompson, 2003 ). Moreover, accessibility through mobile technology and virtual computer terminals is linking people to their work more than ever before (ILO, 2012 ; Tarafdar, Tu, Ragu-Nathan, & Ragu-Nathan, 2007 ). Evidence of this kind of mobility and flexibility is further reinforced in a June 2007 survey of 4,025 email users (over 13 years of age); AOL reported that four in ten survey respondents reported planning their vacations around email accessibility and 83% checked their emails at least once a day while away (McMahon, 2007 ). Ironically, despite these mounting work-related stressors and clear financial and performance outcomes, some individuals are reporting they are less “stressed,” but only because “stress has become the new normal” (Jayson, 2012 , para. 4).

This new normal is likely the source of psychological and physiological illness. Siegrist ( 2010 ) contends that conditions in the workplace, particularly psychosocial stressors that are perceived as unfavorable relationships with others and self, and an increasingly sedentary lifestyle (reinforced with desk jobs) are increasingly contributing to cardiovascular disease. These factors together justify a need to continue on the path of helping individuals recognize and cope with deleterious stressors in the work environment and, equally important, to find ways to help organizations prevent harmful stressors over which they have control, as well as implement policies or mechanisms to help employees deal with these stressors and subsequent strains. Along with a greater focus on mitigating environmental constraints are interventions that can be used to prevent anxiety, poor attitudes toward the workplace conditions and arrangements, and subsequent cardiovascular illness, absenteeism, and poor job performance (Siegrist, 2010 ).

Even the ILO has presented guidance on how the workplace can help prevent harmful job stressors (aka hindrance stressors) or at least help workers cope with them. Consistent with the view that well-being is not the absence of stressors or strains and with the view that positive psychology offers a lens for proactively preventing stressors, the ILO promotes increasing preventative risk assessments, interventions to prevent and control stressors, transparent organizational communication, worker involvement in decision-making, networks and mechanisms for workplace social support, awareness of how working and living conditions interact, safety, health, and well-being in the organization (ILO, n.d. ). The field of industrial and organizational (IO) psychology supports the ILO’s recommendations.

IO psychology views work stress as the process of a person’s interaction with multiple aspects of the work environment, job design, and work conditions in the organization. Interventions to manage work stress, therefore, focus on the psychosocial factors of the person and his or her relationships with others and the socio-technical factors related to the work environment and work processes. Viewing work stress from the lens of the person and the environment stems from Kurt Lewin’s ( 1936 ) work that stipulates a person’s state of mental health and behaviors are a function of the person within a specific environment or situation. Aspects of the work environment that affect individuals’ mental states and behaviors include organizational hierarchy, organizational climate (including processes, policies, practices, and reward structures), resources to support a person’s ability to fulfill job duties, and management structure (including leadership). Job design refers to each contributor’s tasks and responsibilities for fulfilling goals associated with the work role. Finally, working conditions refers not only to the physical environment, but also the interpersonal relationships with other contributors.

Each of the conditions that are identified in the work environment may be perceived as potentially harmful or a threat to the person or as an opportunity. When a stressor is perceived as a threat to attaining desired goals or outcomes, the stressor may be labeled as a hindrance stressor (e.g., LePine, Podsakoff, & Lepine, 2005 ). When the stressor is perceived as an opportunity to attain a desired goal or end state, it may be labeled as a challenge stressor. According to LePine and colleagues’ ( 2005 ), both challenge (e.g., time urgency, workload) and hindrance (e.g., hassles, role ambiguity, role conflict) stressors could lead to strains (as measured by “anxiety, depersonalization, depression, emotional exhaustion, frustration, health complaints, hostility, illness, physical symptoms, and tension” [p. 767]). However, challenge stressors positively relate with motivation and performance, whereas hindrance stressors negatively relate with motivation and performance. Moreover, motivation and strains partially mediate the relationship between hindrance and challenge stressors with performance.

Figure 1. Organizational development frameworks to guide identification of work stress and interventions.

In order to (1) minimize any potential negative effects from stressors, (2) increase coping skills to deal with stressors, or (3) manage strains, organizational practitioners or consultants will devise organizational interventions geared toward prevention, coping, and/or stress management. Ultimately, toxic factors in the work environment can have deleterious effects on a person’s physical and psychological well-being, as well as on an organization’s total health. It behooves management to take stock of the organization’s health, which includes the health and well-being of its employees, if the organization wishes to thrive and be profitable. According to Page and Vella-Brodrick’s ( 2009 ) model of employee well-being, employee well-being results from subjective well-being (i.e., life satisfaction and general positive or negative affect), workplace well-being (composed of job satisfaction and work-specific positive or negative affect), and psychological well-being (e.g., self-acceptance, positive social relations, mastery, purpose in life). Job stressors that become unbearable are likely to negatively affect workplace well-being and thus overall employee well-being. Because work stress is a major organizational pain point and organizations often employ organizational consultants to help identify and remediate pain points, the focus here is on organizational development (OD) frameworks; several work stress frameworks are presented that together signal areas where organizations might focus efforts for change in employee behaviors, attitudes, and performance, as well as the organization’s performance and climate. Work stress, interventions, and several OD and stress frameworks are depicted in Figure 1 .

The goals are: (1) to conceptually define and clarify terms associated with stress and stress management, particularly focusing on organizational factors that contribute to stress and stress management, and (2) to present research that informs current knowledge and practices on workplace stress management strategies. Stressors and strains will be defined, leading OD and work stress frameworks that are used to organize and help organizations make sense of the work environment and the organization’s responsibility in stress management will be explored, and stress management will be explained as an overarching thematic label; an area of study and practice that focuses on prevention (primary) interventions, coping (secondary) interventions, and managing strains (tertiary) interventions; as well as the label typically used to denote tertiary interventions. Suggestions for future research and implications toward becoming a healthy organization are presented.

Defining Stressors and Strains

Work-related stressors or job stressors can lead to different kinds of strains individuals and organizations might experience. Various types of stress management interventions, guided by OD and work stress frameworks, may be employed to prevent or cope with job stressors and manage strains that develop(ed).

A job stressor is a stimulus external to an employee and a result of an employee’s work conditions. Example job stressors include organizational constraints, workplace mistreatments (such as abusive supervision, workplace ostracism, incivility, bullying), role stressors, workload, work-family conflicts, errors or mistakes, examinations and evaluations, and lack of structure (Jex & Beehr, 1991 ; Liu, Spector, & Shi, 2007 ; Narayanan, Menon, & Spector, 1999 ). Although stressors may be categorized as hindrances and challenges, there is not yet sufficient information to be able to propose which stress management interventions would better serve to reduce those hindrance stressors or to reduce strain-producing challenge stressors while reinforcing engagement-producing challenge stressors.

Organizational Constraints

Organizational constraints may be hindrance stressors as they prevent employees from translating their motivation and ability into high-level job performance (Peters & O’Connor, 1980 ). Peters and O’Connor ( 1988 ) defined 11 categories of organizational constraints: (1) job-related information, (2) budgetary support, (3) required support, (4) materials and supplies, (5) required services and help from others, (6) task preparation, (7) time availability, (8) the work environment, (9) scheduling of activities, (10) transportation, and (11) job-relevant authority. The inhibiting effect of organizational constraints may be due to the lack of, inadequacy of, or poor quality of these categories.

Workplace Mistreatment

Workplace mistreatment presents a cluster of interpersonal variables, such as interpersonal conflict, bullying, incivility, and workplace ostracism (Hershcovis, 2011 ; Tepper & Henle, 2011 ). Typical workplace mistreatment behaviors include gossiping, rude comments, showing favoritism, yelling, lying, and ignoring other people at work (Tepper & Henle, 2011 ). These variables relate to employees’ psychological well-being, physical well-being, work attitudes (e.g., job satisfaction and organizational commitment), and turnover intention (e.g., Hershcovis, 2011 ; Spector & Jex, 1998 ). Some researchers differentiated the source of mistreatment, such as mistreatment from one’s supervisor versus mistreatment from one’s coworker (e.g., Bruk-Lee & Spector, 2006 ; Frone, 2000 ; Liu, Liu, Spector, & Shi, 2011 ).

Role Stressors

Role stressors are demands, constraints, or opportunities a person perceives to be associated, and thus expected, with his or her work role(s) across various situations. Three commonly studied role stressors are role ambiguity, role conflict, and role overload (Glazer & Beehr, 2005 ; Kahn, Wolfe, Quinn, Snoek, & Rosenthal, 1964 ). Role ambiguity in the workplace occurs when an employee lacks clarity regarding what performance-related behaviors are expected of him or her. Role conflict refers to situations wherein an employee receives incompatible role requests from the same or different supervisors or the employee is asked to engage in work that impedes his or her performance in other work or nonwork roles or clashes with his or her values. Role overload refers to excessive demands and insufficient time (quantitative) or knowledge (qualitative) to complete the work. The construct is often used interchangeably with workload, though role overload focuses more on perceived expectations from others about one’s workload. These role stressors significantly relate to low job satisfaction, low organizational commitment, low job performance, high tension or anxiety, and high turnover intention (Abramis, 1994 ; Glazer & Beehr, 2005 ; Jackson & Schuler, 1985 ).

Excessive workload is one of the most salient stressors at work (e.g., Liu et al., 2007 ). There are two types of workload: quantitative and qualitative workload (LaRocco, Tetrick, & Meder, 1989 ; Parasuraman & Purohit, 2000 ). Quantitative workload refers to the excessive amount of work one has. In a summary of a Chartered Institute of Personnel & Development Report from 2006 , Dewe and Kompier ( 2008 ) noted that quantitative workload was one of the top three stressors workers experienced at work. Qualitative workload refers to the difficulty of work. Workload also differs by the type of the load. There are mental workload and physical workload (Dwyer & Ganster, 1991 ). Excessive physical workload may result in physical discomfort or illness. Excessive mental workload will cause psychological distress such as anxiety or frustration (Bowling & Kirkendall, 2012 ). Another factor affecting quantitative workload is interruptions (during the workday). Lin, Kain, and Fritz ( 2013 ) found that interruptions delay completion of job tasks, thus adding to the perception of workload.

Work-Family Conflict

Work-family conflict is a form of inter-role conflict in which demands from one’s work domain and one’s family domain are incompatible to some extent (Greenhaus & Beutell, 1985 ). Work can interfere with family (WIF) and/or family can interfere with work (FIW) due to time-related commitments to participating in one domain or another, incompatible behavioral expectations, or when strains in one domain carry over to the other (Greenhaus & Beutell, 1985 ). Work-family conflict significantly relates to work-related outcomes (e.g., job satisfaction, organizational commitment, turnover intention, burnout, absenteeism, job performance, job strains, career satisfaction, and organizational citizenship behaviors), family-related outcomes (e.g., marital satisfaction, family satisfaction, family-related performance, family-related strains), and domain-unspecific outcomes (e.g., life satisfaction, psychological strain, somatic or physical symptoms, depression, substance use or abuse, and anxiety; Amstad, Meier, Fasel, Elfering, & Semmer, 2011 ).

Individuals and organizations can experience work-related strains. Sometimes organizations will experience strains through the employee’s negative attitudes or strains, such as that a worker’s absence might yield lower production rates, which would roll up into an organizational metric of organizational performance. In the industrial and organizational (IO) psychology literature, organizational strains are mostly observed as macro-level indicators, such as health insurance costs, accident-free days, and pervasive problems with company morale. In contrast, individual strains, usually referred to as job strains, are internal to an employee. They are responses to work conditions and relate to health and well-being of employees. In other words, “job strains are adverse reactions employees have to job stressors” (Spector, Chen, & O’Connell, 2000 , p. 211). Job strains tend to fall into three categories: behavioral, physical, and psychological (Jex & Beehr, 1991 ).

Behavioral strains consist of actions that employees take in response to job stressors. Examples of behavioral strains include employees drinking alcohol in the workplace or intentionally calling in sick when they are not ill (Spector et al., 2000 ). Physical strains consist of health symptoms that are physiological in nature that employees contract in response to job stressors. Headaches and ulcers are examples of physical strains. Lastly, psychological strains are emotional reactions and attitudes that employees have in response to job stressors. Examples of psychological strains are job dissatisfaction, anxiety, and frustration (Spector et al., 2000 ). Interestingly, research studies that utilize self-report measures find that most job strains experienced by employees tend to be psychological strains (Spector et al., 2000 ).

Leading Frameworks

Organizations that are keen on identifying organizational pain points and remedying them through organizational campaigns or initiatives often discover the pain points are rooted in work-related stressors and strains and the initiatives have to focus on reducing workers’ stress and increasing a company’s profitability. Through organizational climate surveys, for example, companies discover that aspects of the organization’s environment, including its policies, practices, reward structures, procedures, and processes, as well as employees at all levels of the company, are contributing to the individual and organizational stress. Recent studies have even begun to examine team climates for eustress and distress assessed in terms of team members’ homogenous psychological experience of vigor, efficacy, dedication, and cynicism (e.g., Kożusznik, Rodriguez, & Peiro, 2015 ).

Each of the frameworks presented advances different aspects that need to be identified in order to understand the source and potential remedy for stressors and strains. In some models, the focus is on resources, in others on the interaction of the person and environment, and in still others on the role of the person in the workplace. Few frameworks directly examine the role of the organization, but the organization could use these frameworks to plan interventions that would minimize stressors, cope with existing stressors, and prevent and/or manage strains. One of the leading frameworks in work stress research that is used to guide organizational interventions is the person and environment (P-E) fit (French & Caplan, 1972 ). Its precursor is the University of Michigan Institute for Social Research’s (ISR) role stress model (Kahn, Wolfe, Quinn, Snoek, & Rosenthal, 1964 ) and Lewin’s Field Theory. Several other theories have since evolved from the P-E fit framework, including Karasek and Theorell’s ( 1990 ), Karasek ( 1979 ) Job Demands-Control Model (JD-C), the transactional framework (Lazarus & Folkman, 1984 ), Conservation of Resources (COR) theory (Hobfoll, 1989 ), and Siegrist’s ( 1996 ) Effort-Reward Imbalance (ERI) Model.

Field Theory

The premise of Kahn et al.’s ( 1964 ) role stress theory is Lewin’s ( 1997 ) Field Theory. Lewin purported that behavior and mental events are a dynamic function of the whole person, including a person’s beliefs, values, abilities, needs, thoughts, and feelings, within a given situation (field or environment), as well as the way a person represents his or her understanding of the field and behaves in that space. Lewin explains that work-related strains are a result of individuals’ subjective perceptions of objective factors, such as work roles, relationships with others in the workplace, as well as personality indicators, and can be used to predict people’s reactions, including illness. Thus, to make changes to an organizational system, it is necessary to understand a field and try to move that field from the current state to the desired state. Making this move necessitates identifying mechanisms influencing individuals.

Role Stress Theory

Role stress theory mostly isolates the perspective a person has about his or her work-related responsibilities and expectations to determine how those perceptions relate with a person’s work-related strains. However, those relationships have been met with somewhat varied results, which Glazer and Beehr ( 2005 ) concluded might be a function of differences in culture, an environmental factor often neglected in research. Kahn et al.’s ( 1964 ) role stress theory, coupled with Lewin’s ( 1936 ) Field Theory, serves as the foundation for the P-E fit theory. Lewin ( 1936 ) wrote, “Every psychological event depends upon the state of the person and at the same time on the environment” (p. 12). Researchers of IO psychology have narrowed the environment to the organization or work team. This narrowed view of the organizational environment is evident in French and Caplan’s ( 1972 ) P-E fit framework.

Person-Environment Fit Theory

The P-E fit framework focuses on the extent to which there is congruence between the person and a given environment, such as the organization (Caplan, 1987 ; Edwards, 2008 ). For example, does the person have the necessary skills and abilities to fulfill an organization’s demands, or does the environment support a person’s desire for autonomy (i.e., do the values align?) or fulfill a person’s needs (i.e., a person’s needs are rewarded). Theoretically and empirically, the greater the person-organization fit, the greater a person’s job satisfaction and organizational commitment, the less a person’s turnover intention and work-related stress (see meta-analyses by Assouline & Meir, 1987 ; Kristof-Brown, Zimmerman, & Johnson, 2005 ; Verquer, Beehr, & Wagner, 2003 ).

Job Demands-Control/Support (JD-C/S) and Job Demands-Resources (JD-R) Model

Focusing more closely on concrete aspects of work demands and the extent to which a person perceives he or she has control or decision latitude over those demands, Karasek ( 1979 ) developed the JD-C model. Karasek and Theorell ( 1990 ) posited that high job demands under conditions of little decision latitude or control yield high strains, which have varied implications on the health of an organization (e.g., in terms of high turnover, employee ill-health, poor organizational performance). This theory was modified slightly to address not only control, but also other resources that could protect a person from unruly job demands, including support (aka JD-C/S, Johnson & Hall, 1988 ; and JD-R, Bakker, van Veldhoven, & Xanthopoulou, 2010 ). Whether focusing on control or resources, both they and job demands are said to reflect workplace characteristics, while control and resources also represent coping strategies or tools (Siegrist, 2010 ).

Despite the glut of research testing the JD-C and JD-R, results are somewhat mixed. Testing the interaction between job demands and control, Beehr, Glaser, Canali, and Wallwey ( 2001 ) did not find empirical support for the JD-C theory. However, Dawson, O’Brien, and Beehr ( 2016 ) found that high control and high support buffered against the independent deleterious effects of interpersonal conflict, role conflict, and organizational politics (demands that were categorized as hindrance stressors) on anxiety, as well as the effects of interpersonal conflict and organizational politics on physiological symptoms, but control and support did not moderate the effects between challenge stressors and strains. Coupled with Bakker, Demerouti, and Sanz-Vergel’s ( 2014 ) note that excessive job demands are a source of strain, but increased job resources are a source of engagement, Dawson et al.’s results suggest that when an organization identifies that demands are hindrances, it can create strategies for primary (preventative) stress management interventions and attempt to remove or reduce such work demands. If the demands are challenging, though manageable, but latitude to control the challenging stressors and support are insufficient, the organization could modify practices and train employees on adopting better strategies for meeting or coping (secondary stress management intervention) with the demands. Finally, if the organization can neither afford to modify the demands or the level of control and support, it will be necessary for the organization to develop stress management (tertiary) interventions to deal with the inevitable strains.

Conservation of Resources Theory

The idea that job resources reinforce engagement in work has been propagated in Hobfoll’s ( 1989 ) Conservation of Resources (COR) theory. COR theory also draws on the foundational premise that people’s mental health is a function of the person and the environment, forwarding that how people interpret their environment (including the societal context) affects their stress levels. Hobfoll focuses on resources such as objects, personal characteristics, conditions, or energies as particularly instrumental to minimizing strains. He asserts that people do whatever they can to protect their valued resources. Thus, strains develop when resources are threatened to be taken away, actually taken away, or when additional resources are not attainable after investing in the possibility of gaining more resources (Hobfoll, 2001 ). By extension, organizations can invest in activities that would minimize resource loss and create opportunities for resource gains and thus have direct implications for devising primary and secondary stress management interventions.

Transactional Framework

Lazarus and Folkman ( 1984 ) developed the widely studied transactional framework of stress. This framework holds as a key component the cognitive appraisal process. When individuals perceive factors in the work environment as a threat (i.e., primary appraisal), they will scan the available resources (external or internal to himself or herself) to cope with the stressors (i.e., secondary appraisal). If the coping resources provide minimal relief, strains develop. Until recently, little attention has been given to the cognitive appraisal associated with different work stressors (Dewe & Kompier, 2008 ; Liu & Li, 2017 ). In a study of Polish and Spanish social care service providers, stressors appraised as a threat related positively to burnout and less engagement, but stressors perceived as challenges yielded greater engagement and less burnout (Kożusznik, Rodriguez, & Peiro, 2012 ). Similarly, Dawson et al. ( 2016 ) found that even with support and control resources, hindrance demands were more strain-producing than challenge demands, suggesting that appraisal of the stressor is important. In fact, “many people respond well to challenging work” (Beehr et al., 2001 , p. 126). Kożusznik et al. ( 2012 ) recommend training employees to change the way they view work demands in order to increase engagement, considering that part of the problem may be about how the person appraises his or her environment and, thus, copes with the stressors.

Effort-Reward Imbalance

Siegrist’s ( 1996 ) Model of Effort-Reward Imbalance (ERI) focuses on the notion of social reciprocity, such that a person fulfills required work tasks in exchange for desired rewards (Siegrist, 2010 ). ERI sheds light on how an imbalance in a person’s expectations of an organization’s rewards (e.g., pay, bonus, sense of advancement and development, job security) in exchange for a person’s efforts, that is a break in one’s work contract, leads to negative responses, including long-term ill-health (Siegrist, 2010 ; Siegrist et al., 2014 ). In fact, prolonged perception of a work contract imbalance leads to adverse health, including immunological problems and inflammation, which contribute to cardiovascular disease (Siegrist, 2010 ). The model resembles the relational and interactional psychological contract theory in that it describes an employee’s perception of the terms of the relationship between the person and the workplace, including expectations of performance, job security, training and development opportunities, career progression, salary, and bonuses (Thomas, Au, & Ravlin, 2003 ). The psychological contract, like the ERI model, focuses on social exchange. Furthermore, the psychological contract, like stress theories, are influenced by cultural factors that shape how people interpret their environments (Glazer, 2008 ; Thomas et al., 2003 ). Violations of the psychological contract will negatively affect a person’s attitudes toward the workplace and subsequent health and well-being (Siegrist, 2010 ). To remediate strain, Siegrist ( 2010 ) focuses on both the person and the environment, recognizing that the organization is particularly responsible for changing unfavorable work conditions and the person is responsible for modifying his or her reactions to such conditions.

Stress Management Interventions: Primary, Secondary, and Tertiary

Remediation of work stress and organizational development interventions are about realigning the employee’s experiences in the workplace with factors in the environment, as well as closing the gap between the current environment and the desired environment. Work stress develops when an employee perceives the work demands to exceed the person’s resources to cope and thus threatens employee well-being (Dewe & Kompier, 2008 ). Likewise, an organization’s need to change arises when forces in the environment are creating a need to change in order to survive (see Figure 1 ). Lewin’s ( 1951 ) Force Field Analysis, the foundations of which are in Field Theory, is one of the first organizational development intervention tools presented in the social science literature. The concept behind Force Field Analysis is that in order to survive, organizations must adapt to environmental forces driving a need for organizational change and remove restraining forces that create obstacles to organizational change. In order to do this, management needs to delineate the current field in which the organization is functioning, understand the driving forces for change, identify and dampen or eliminate the restraining forces against change. Several models for analyses may be applied, but most approaches are variations of organizational climate surveys.

Through organizational surveys, workers provide management with a snapshot view of how they perceive aspects of their work environment. Thus, the view of the health of an organization is a function of several factors, chief among them employees’ views (i.e., the climate) about the workplace (Lewin, 1951 ). Indeed, French and Kahn ( 1962 ) posited that well-being depends on the extent to which properties of the person and properties of the environment align in terms of what a person requires and the resources available in a given environment. Therefore, only when properties of the person and properties of the environment are sufficiently understood can plans for change be developed and implemented targeting the environment (e.g., change reporting structures to relieve, and thus prevent future, communication stressors) and/or the person (e.g., providing more autonomy, vacation days, training on new technology). In short, climate survey findings can guide consultants about the emphasis for organizational interventions: before a problem arises aka stress prevention, e.g., carefully crafting job roles), when a problem is present, but steps are taken to mitigate their consequences (aka coping, e.g., providing social support groups), and/or once strains develop (aka. stress management, e.g., healthcare management policies).

For each of the primary (prevention), secondary (coping), and tertiary (stress management) techniques the target for intervention can be the entire workforce, a subset of the workforce, or a specific person. Interventions that target the entire workforce may be considered organizational interventions, as they have direct implications on the health of all individuals and consequently the health of the organization. Several interventions categorized as primary and secondary interventions may also be implemented after strains have developed and after it has been discerned that a person or the organization did not do enough to mitigate stressors or strains (see Figure 1 ). The designation of many of the interventions as belonging to one category or another may be viewed as merely a suggestion.

Primary Interventions (Preventative Stress Management)

Before individuals begin to perceive work-related stressors, organizations engage in stress prevention strategies, such as providing people with resources (e.g., computers, printers, desk space, information about the job role, organizational reporting structures) to do their jobs. However, sometimes the institutional structures and resources are insufficient or ambiguous. Scholars and practitioners have identified several preventative stress management strategies that may be implemented.

Planning and Time Management

When employees feel quantitatively overloaded, sometimes the remedy is improving the employees’ abilities to plan and manage their time (Quick, Quick, Nelson, & Hurrell, 2003 ). Planning is a future-oriented activity that focuses on conceptual and comprehensive work goals. Time management is a behavior that focuses on organizing, prioritizing, and scheduling work activities to achieve short-term goals. Given the purpose of time management, it is considered a primary intervention, as engaging in time management helps to prevent work tasks from mounting and becoming unmanageable, which would subsequently lead to adverse outcomes. Time management comprises three fundamental components: (1) establishing goals, (2) identifying and prioritizing tasks to fulfill the goals, and (3) scheduling and monitoring progress toward goal achievement (Peeters & Rutte, 2005 ). Workers who employ time management have less role ambiguity (Macan, Shahani, Dipboye, & Philips, 1990 ), psychological stress or strain (Adams & Jex, 1999 ; Jex & Elaqua, 1999 ; Macan et al., 1990 ), and greater job satisfaction (Macan, 1994 ). However, Macan ( 1994 ) did not find a relationship between time management and performance. Still, Claessens, van Eerde, Rutte, and Roe ( 2004 ) found that perceived control of time partially mediated the relationships between planning behavior (an indicator of time management), job autonomy, and workload on one hand, and job strains, job satisfaction, and job performance on the other hand. Moreover, Peeters and Rutte ( 2005 ) observed that teachers with high work demands and low autonomy experienced more burnout when they had poor time management skills.

Person-Organization Fit

Just as it is important for organizations to find the right person for the job and organization, so is it the responsibility of a person to choose to work at the right organization—an organization that fulfills the person’s needs and upholds the values important to the individual, as much as the person fulfills the organization’s needs and adapts to its values. When people fit their employing organizations they are setting themselves up for experiencing less strain-producing stressors (Kristof-Brown et al., 2005 ). In a meta-analysis of 62 person-job fit studies and 110 person-organization fit studies, Kristof-Brown et al. ( 2005 ) found that person-job fit had a negative correlation with indicators of job strain. In fact, a primary intervention of career counseling can help to reduce stress levels (Firth-Cozens, 2003 ).

Job Redesign

The Job Demands-Control/Support (JD-C/S), Job Demands-Resources (JD-R), and transactional models all suggest that factors in the work context require modifications in order to reduce potential ill-health and poor organizational performance. Drawing on Hackman and Oldham’s ( 1980 ) Job Characteristics Model, it is possible to assess with the Job Diagnostics Survey (JDS) the current state of work characteristics related to skill variety, task identity, task significance, autonomy, and feedback. Modifying those aspects would help create a sense of meaningfulness, sense of responsibility, and feeling of knowing how one is performing, which subsequently affects a person’s well-being as identified in assessments of motivation, satisfaction, improved performance, and reduced withdrawal intentions and behaviors. Extending this argument to the stress models, it can be deduced that reducing uncertainty or perceived unfairness that may be associated with a person’s perception of these work characteristics, as well as making changes to physical characteristics of the environment (e.g., lighting, seating, desk, air quality), nature of work (e.g., job responsibilities, roles, decision-making latitude), and organizational arrangements (e.g., reporting structure and feedback mechanisms), can help mitigate against numerous ill-health consequences and reduced organizational performance. In fact, Fried et al. ( 2013 ) showed that healthy patients of a medical clinic whose jobs were excessively low (i.e., monotonous) or excessively high (i.e., overstimulating) on job enrichment (as measured by the JDS) had greater abdominal obesity than those whose jobs were optimally enriched. By taking stock of employees’ perceptions of the current work situation, managers might think about ways to enhance employees’ coping toolkit, such as training on how to deal with difficult clients or creating stimulating opportunities when jobs have low levels of enrichment.

Participatory Action Research Interventions

Participatory action research (PAR) is an intervention wherein, through group discussions, employees help to identify and define problems in organizational structure, processes, policies, practices, and reward structures, as well as help to design, implement, and evaluate success of solutions. PAR is in itself an intervention, but its goal is to design interventions to eliminate or reduce work-related factors that are impeding performance and causing people to be unwell. An example of a successful primary intervention, utilizing principles of PAR and driven by the JD-C and JD-C/S stress frameworks is Health Circles (HCs; Aust & Ducki, 2004 ).

HCs, developed in Germany in the 1980s, were popular practices in industries, such as metal, steel, and chemical, and service. Similar to other problem-solving practices, such as quality circles, HCs were based on the assumptions that employees are the experts of their jobs. For this reason, to promote employee well-being, management and administrators solicited suggestions and ideas from the employees to improve occupational health, thereby increasing employees’ job control. HCs also promoted communication between managers and employees, which had a potential to increase social support. With more control and support, employees would experience less strains and better occupational well-being.

Employing the three-steps of (1) problem analysis (i.e., diagnosis or discovery through data generated from organizational records of absenteeism length, frequency, rate, and reason and employee survey), (2) HC meetings (6 to 10 meetings held over several months to brainstorm ideas to improve occupational safety and health concerns identified in the discovery phase), and (3) HC evaluation (to determine if desired changes were accomplished and if employees’ reports of stressors and strains changed after the course of 15 months), improvements were to be expected (Aust & Ducki, 2004 ). Aust and Ducki ( 2004 ) reviewed 11 studies presenting 81 health circles in 30 different organizations. Overall study participants had high satisfaction with the HCs practices. Most companies acted upon employees’ suggestions (e.g., improving driver’s seat and cab, reducing ticket sale during drive, team restructuring and job rotation to facilitate communication, hiring more employees during summer time, and supervisor training program to improve leadership and communication skills) to improve work conditions. Thus, HCs represent a successful theory-grounded intervention to routinely improve employees’ occupational health.

Physical Setting

The physical environment or physical workspace has an enormous impact on individuals’ well-being, attitudes, and interactions with others, as well as on the implications on innovation and well-being (Oksanen & Ståhle, 2013 ; Vischer, 2007 ). In a study of 74 new product development teams (total of 437 study respondents) in Western Europe, Chong, van Eerde, Rutte, and Chai ( 2012 ) found that when teams were faced with challenge time pressures, meaning the teams had a strong interest and desire in tackling complex, but engaging tasks, when they were working proximally close with one another, team communication improved. Chong et al. assert that their finding aligns with prior studies that have shown that physical proximity promotes increased awareness of other team members, greater tendency to initiate conversations, and greater team identification. However, they also found that when faced with hindrance time pressures, physical proximity related to low levels of team communication, but when hindrance time pressure was low, team proximity had an increasingly greater positive relationship with team communication.

In addition to considering the type of work demand teams must address, other physical workspace considerations include whether people need to work collaboratively and synchronously or independently and remotely (or a combination thereof). Consideration needs to be given to how company contributors would satisfy client needs through various modes of communication, such as email vs. telephone, and whether individuals who work by a window might need shading to block bright sunlight from glaring on their computer screens. Finally, people who have to use the telephone for extensive periods of time would benefit from earphones to prevent neck strains. Most physical stressors are rather simple to rectify. However, companies are often not aware of a problem until after a problem arises, such as when a person’s back is strained from trying to move heavy equipment. Companies then implement strategies to remediate the environmental stressor. With the help of human factors, and organizational and office design consultants, many of the physical barriers to optimal performance can be prevented (Rousseau & Aubé, 2010 ). In a study of 215 French-speaking Canadian healthcare employees, Rousseau and Aubé ( 2010 ) found that although supervisor instrumental support positively related with affective commitment to the organization, the relationship was even stronger for those who reported satisfaction with the ambient environment (i.e., temperature, lighting, sound, ventilation, and cleanliness).

Secondary Interventions (Coping)

Secondary interventions, also referred to as coping, focus on resources people can use to mitigate the risk of work-related illness or workplace injury. Resources may include properties related to social resources, behaviors, and cognitive structures. Each of these resource domains may be employed to cope with stressors. Monat and Lazarus ( 1991 ) summarize the definition of coping as “an individual’s efforts to master demands (or conditions of harm, threat, or challenge) that are appraised (or perceived) as exceeding or taxing his or her resources” (p. 5). To master demands requires use of the aforementioned resources. Secondary interventions help employees become aware of the psychological, physical, and behavioral responses that may occur from the stressors presented in their working environment. Secondary interventions help a person detect and attend to stressors and identify resources for and ways of mitigating job strains. Often, coping strategies are learned skills that have a cognitive foundation and serve important functions in improving people’s management of stressors (Lazarus & Folkman, 1991 ). Coping is effortful, but with practice it becomes easier to employ. This idea is the foundation for understanding the role of resilience in coping with stressors. However, “not all adaptive processes are coping. Coping is a subset of adaptational activities that involves effort and does not include everything that we do in relating to the environment” (Lazarus & Folkman, 1991 , p. 198). Furthermore, sometimes to cope with a stressor, a person may call upon social support sources to help with tangible materials or emotional comfort. People call upon support resources because they help to restructure how a person approaches or thinks about the stressor.

Most secondary interventions are aimed at helping the individual, though companies, as a policy, might require all employees to partake in training aimed at increasing employees’ awareness of and skills aimed at handling difficult situations vis à vis company channels (e.g., reporting on sexual harassment or discrimination). Furthermore, organizations might institute mentoring programs or work groups to address various work-related matters. These programs employ awareness-raising activities, stress-education, or skills training (cf., Bhagat, Segovis, & Nelson, 2012 ), which include development of skills in problem-solving, understanding emotion-focused coping, identifying and using social support, and enhancing capacity for resilience. The aim of these programs, therefore, is to help employees proactively review their perceptions of psychological, physical, and behavioral job-related strains, thereby extending their resilience, enabling them to form a personal plan to control stressors and practice coping skills (Cooper, Dewe, & O’Driscoll, 2011 ).

Often these stress management programs are instituted after an organization has observed excessive absenteeism and work-related performance problems and, therefore, are sometimes categorized as a tertiary stress management intervention or even a primary (prevention) intervention. However, the skills developed for coping with stressors also place the programs in secondary stress management interventions. Example programs that are categorized as tertiary or primary stress management interventions may also be secondary stress management interventions (see Figure 1 ), and these include lifestyle advice and planning, stress inoculation training, simple relaxation techniques, meditation, basic trainings in time management, anger management, problem-solving skills, and cognitive-behavioral therapy. Corporate wellness programs also fall under this category. In other words, some programs could be categorized as primary, secondary, or tertiary interventions depending upon when the employee (or organization) identifies the need to implement the program. For example, time management practices could be implemented as a means of preventing some stressors, as a way to cope with mounting stressors, or as a strategy to mitigate symptoms of excessive of stressors. Furthermore, these programs can be administered at the individual level or group level. As related to secondary interventions, these programs provide participants with opportunities to develop and practice skills to cognitively reappraise the stressor(s); to modify their perspectives about stressors; to take time out to breathe, stretch, meditate, relax, and/or exercise in an attempt to support better decision-making; to articulate concerns and call upon support resources; and to know how to say “no” to onslaughts of requests to complete tasks. Participants also learn how to proactively identify coping resources and solve problems.

According to Cooper, Dewe, and O’Driscoll ( 2001 ), secondary interventions are successful in helping employees modify or strengthen their ability to cope with the experience of stressors with the goal of mitigating the potential harm the job stressors may create. Secondary interventions focus on individuals’ transactions with the work environment and emphasize the fit between a person and his or her environment. However, researchers have pointed out that the underlying assumption of secondary interventions is that the responsibility for coping with the stressors of the environment lies within individuals (Quillian-Wolever & Wolever, 2003 ). If companies cannot prevent the stressors in the first place, then they are, in part, responsible for helping individuals develop coping strategies and informing employees about programs that would help them better cope with job stressors so that they are able to fulfill work assignments.

Stress management interventions that help people learn to cope with stressors focus mainly on the goals of enabling problem-resolution or expressing one’s emotions in a healthy manner. These goals are referred to as problem-focused coping and emotion-focused coping (Folkman & Lazarus, 1980 ; Pearlin & Schooler, 1978 ), and the person experiencing the stressors as potential threat is the agent for change and the recipient of the benefits of successful coping (Hobfoll, 1998 ). In addition to problem-focused and emotion-focused coping approaches, social support and resilience may be coping resources. There are many other sources for coping than there is room to present here (see e.g., Cartwright & Cooper, 2005 ); however, the current literature has primarily focused on these resources.

Problem-Focused Coping

Problem-focused or direct coping helps employees remove or reduce stressors in order to reduce their strain experiences (Bhagat et al., 2012 ). In problem-focused coping employees are responsible for working out a strategic plan in order to remove job stressors, such as setting up a set of goals and engaging in behaviors to meet these goals. Problem-focused coping is viewed as an adaptive response, though it can also be maladaptive if it creates more problems down the road, such as procrastinating getting work done or feigning illness to take time off from work. Adaptive problem-focused coping negatively relates to long-term job strains (Higgins & Endler, 1995 ). Discussion on problem-solving coping is framed from an adaptive perspective.

Problem-focused coping is featured as an extension of control, because engaging in problem-focused coping strategies requires a series of acts to keep job stressors under control (Bhagat et al., 2012 ). In the stress literature, there are generally two ways to categorize control: internal versus external locus of control, and primary versus secondary control. Locus of control refers to the extent to which people believe they have control over their own life (Rotter, 1966 ). People high in internal locus of control believe that they can control their own fate whereas people high in external locus of control believe that outside factors determine their life experience (Rotter, 1966 ). Generally, those with an external locus of control are less inclined to engage in problem-focused coping (Strentz & Auerbach, 1988 ). Primary control is the belief that people can directly influence their environment (Alloy & Abramson, 1979 ), and thus they are more likely to engage in problem-focused coping. However, when it is not feasible to exercise primary control, people search for secondary control, with which people try to adapt themselves into the objective environment (Rothbaum, Weisz, & Snyder, 1982 ).

Emotion-Focused Coping

Emotion-focused coping, sometimes referred to as palliative coping, helps employees reduce strains without the removal of job stressors. It involves cognitive or emotional efforts, such as talking about the stressor or distracting oneself from the stressor, in order to lessen emotional distress resulting from job stressors (Bhagat et al., 2012 ). Emotion-focused coping aims to reappraise and modify the perceptions of a situation or seek emotional support from friends or family. These methods do not include efforts to change the work situation or to remove the job stressors (Lazarus & Folkman, 1991 ). People tend to adopt emotion-focused coping strategies when they believe that little or nothing can be done to remove the threatening, harmful, and challenging stressors (Bhagat et al., 2012 ), such as when they are the only individuals to have the skills to get a project done or they are given increased responsibilities because of the unexpected departure of a colleague. Emotion-focused coping strategies include (1) reappraisal of the stressful situation, (2) talking to friends and receiving reassurance from them, (3) focusing on one’s strength rather than weakness, (4) optimistic comparison—comparing one’s situation to others’ or one’s past situation, (5) selective ignoring—paying less attention to the unpleasant aspects of one’s job and being more focused on the positive aspects of the job, (6) restrictive expectations—restricting one’s expectations on job satisfaction but paying more attention to monetary rewards, (7) avoidance coping—not thinking about the problem, leaving the situation, distracting oneself, or using alcohol or drugs (e.g., Billings & Moos, 1981 ).

Some emotion-focused coping strategies are maladaptive. For example, avoidance coping may lead to increased level of job strains in the long run (e.g., Parasuraman & Cleek, 1984 ). Furthermore, a person’s ability to cope with the imbalance of performing work to meet organizational expectations can take a toll on the person’s health, leading to physiological consequences such as cardiovascular disease, sleep disorders, gastrointestinal disorders, and diabetes (Fried et al., 2013 ; Siegrist, 2010 ; Toker, Shirom, Melamed, & Armon, 2012 ; Willert, Thulstrup, Hertz, & Bonde, 2010 ).

Comparing Coping Strategies across Cultures

Most coping research is conducted in individualistic, Western cultures wherein emotional control is emphasized and both problem-solving focused coping and primary control are preferred (Bhagat et al., 2010 ). However, in collectivistic cultures, emotion-focused coping and use of secondary control may be preferred and may not necessarily carry a negative evaluation (Bhagat et al., 2010 ). For example, African Americans are more likely to use emotion-focused coping than non–African Americans (Knight, Silverstein, McCallum, & Fox, 2000 ), and among women who experienced sexual harassment, Anglo American women were less likely to employ emotion focused coping (i.e., avoidance coping) than Turkish women and Hispanic American women, while Hispanic women used more denial than the other two groups (Wasti & Cortina, 2002 ).

Thus, whereas problem-focused coping is venerated in Western societies, emotion-focused coping may be more effective in reducing strains in collectivistic cultures, such as China, Japan, and India (Bhagat et al., 2010 ; Narayanan, Menon, & Spector, 1999 ; Selmer, 2002 ). Indeed, Swedish participants reported more problem-focused coping than did Chinese participants (Xiao, Ottosson, & Carlsson, 2013 ), American college students engaged in more problem-focused coping behaviors than did their Japanese counterparts (Ogawa, 2009 ), and Indian (vs. Canadian) students reported more emotion-focused coping, such as seeking social support and positive reappraisal (Sinha, Willson, & Watson, 2000 ). Moreover, Glazer, Stetz, and Izso ( 2004 ) found that internal locus of control was more predominant in individualistic cultures (United Kingdom and United States), whereas external locus of control was more predominant in communal cultures (Italy and Hungary). Also, internal locus of control was associated with less job stress, but more so for nurses in the United Kingdom and United States than Italy and Hungary. Taken together, adoption of coping strategies and their effectiveness differ significantly across cultures. The extent to which a coping strategy is perceived favorably and thus selected or not selected is not only a function of culture, but also a person’s sociocultural beliefs toward the coping strategy (Morimoto, Shimada, & Ozaki, 2013 ).

Social Support

Social support refers to the aid an entity gives to a person. The source of the support can be a single person, such as a supervisor, coworker, subordinate, family member, friend, or stranger, or an organization as represented by upper-level management representing organizational practices. The type of support can be instrumental or emotional. Instrumental support, including informational support, refers to that which is tangible, such as data to help someone make a decision or colleagues’ sick days so one does not lose vital pay while recovering from illness. Emotional support, including esteem support, refers to the psychological boost given to a person who needs to express emotions and feel empathy from others or to have his or her perspective validated. Beehr and Glazer ( 2001 ) present an overview of the role of social support on the stressor-strain relationship and arguments regarding the role of culture in shaping the utility of different sources and types of support.

Meaningfulness and Resilience

Meaningfulness reflects the extent to which people believe their lives are significant, purposeful, goal-directed, and fulfilling (Glazer, Kożusznik, Meyers, & Ganai, 2014 ). When faced with stressors, people who have a strong sense of meaning in life will also try to make sense of the stressors. Maintaining a positive outlook on life stressors helps to manage emotions, which is helpful in reducing strains, particularly when some stressors cannot be problem-solved (Lazarus & Folkman, 1991 ). Lazarus and Folkman ( 1991 ) emphasize that being able to reframe threatening situations can be just as important in an adaptation as efforts to control the stressors. Having a sense of meaningfulness motivates people to behave in ways that help them overcome stressors. Thus, meaningfulness is often used in the same breath as resilience, because people who are resilient are often protecting that which is meaningful.

Resilience is a personality state that can be fortified and enhanced through varied experiences. People who perceive their lives are meaningful are more likely to find ways to face adversity and are therefore more prone to intensifying their resiliency. When people demonstrate resilience to cope with noxious stressors, their ability to be resilient against other stressors strengthens because through the experience, they develop more competencies (Glazer et al., 2014 ). Thus, fitting with Hobfoll’s ( 1989 , 2001 ) COR theory, meaningfulness and resilience are psychological resources people attempt to conserve and protect, and employ when necessary for making sense of or coping with stressors.

Tertiary Interventions (Stress Management)

Stress management refers to interventions employed to treat and repair harmful repercussions of stressors that were not coped with sufficiently. As Lazarus and Folkman ( 1991 ) noted, not all stressors “are amenable to mastery” (p. 205). Stressors that are unmanageable and lead to strains require interventions to reverse or slow down those effects. Workplace interventions might focus on the person, the organization, or both. Unfortunately, instead of looking at the whole system to include the person and the workplace, most companies focus on the person. Such a focus should not be a surprise given the results of van der Klink, Blonk, Schene, and van Dijk’s ( 2001 ) meta-analysis of 48 experimental studies conducted between 1977 and 1996 . They found that of four types of tertiary interventions, the effect size for cognitive-behavioral interventions and multimodal programs (e.g., the combination of assertive training and time management) was moderate and the effect size for relaxation techniques was small in reducing psychological complaints, but not turnover intention related to work stress. However, the effects of (the five studies that used) organization-focused interventions were not significant. Similarly, Richardson and Rothstein’s ( 2008 ) meta-analytic study, including 36 experimental studies with 55 interventions, showed a larger effect size for cognitive-behavioral interventions than relaxation, organizational, multimodal, or alternative. However, like with van der Klink et al. ( 2001 ), Richardson and Rothstein ( 2008 ) cautioned that there were few organizational intervention studies included and the impact of interventions were determined on the basis of psychological outcomes and not physiological or organizational outcomes. Van der Klink et al. ( 2001 ) further expressed concern that organizational interventions target the workplace and that changes in the individual may take longer to observe than individual interventions aimed directly at the individual.

The long-term benefits of individual focused interventions are not yet clear either. Per Giga, Cooper, and Faragher ( 2003 ), the benefits of person-directed stress management programs will be short-lived if organizational factors to reduce stressors are not addressed too. Indeed, LaMontagne, Keegel, Louie, Ostry, and Landsbergis ( 2007 ), in their meta-analysis of 90 studies on stress management interventions published between 1990 and 2005 , revealed that in relation to interventions targeting organizations only, and interventions targeting individuals only, interventions targeting both organizations and individuals (i.e. the systems approach) had the most favorable positive effects on both the organizations and the individuals. Furthermore, the organization-level interventions were effective at both the individual and organization levels, but the individual-level interventions were effective only at the individual level.

Individual-Focused Stress Management

Individual-focused interventions concentrate on improving conditions for the individual, though counseling programs emphasize that the worker is in charge of reducing “stress,” whereas role-focused interventions emphasize activities that organizations can guide to actually reduce unnecessary noxious environmental factors.

Individual-Focused Stress Management: Employee Assistance Programs

When stress become sufficiently problematic (which is individually gauged or attended to by supportive others) in a worker’s life, employees may utilize the short-term counseling services or referral services Employee Assistance Programs (EAPs) provide. People who utilize the counseling services may engage in cognitive behavioral therapy aimed at changing the way people think about the stressors (e.g., as challenge opportunity over threat) and manage strains. Example topics that may be covered in these therapy sessions include time management and goal setting (prioritization), career planning and development, cognitive restructuring and mindfulness, relaxation, and anger management. In a study of healthcare workers and teachers who participated in a 2-day to 2.5-day comprehensive stress management training program (including 26 topics on identifying, coping with, and managing stressors and strains), Siu, Cooper, and Phillips ( 2013 ) found psychological and physical improvements were self-reported among the healthcare workers (for which there was no control group). However, comparing an intervention group of teachers to a control group of teachers, the extent of change was not as visible, though teachers in the intervention group engaged in more mastery recovery experiences (i.e., they purposefully chose to engage in challenging activities after work).

Individual-Focused Stress Management: Mindfulness

A popular therapy today is to train people to be more mindful, which involves helping people live in the present, reduce negative judgement of current and past experiences, and practicing patience (Birnie, Speca, & Carlson, 2010 ). Mindfulness programs usually include training on relaxation exercises, gentle yoga, and awareness of the body’s senses. In one study offered through the continuing education program at a Canadian university, 104 study participants took part in an 8-week, 90 minute per group (15–20 participants per) session mindfulness program (Birnie et al., 2010 ). In addition to body scanning, they also listened to lectures on incorporating mindfulness into one’s daily life and received a take-home booklet and compact discs that guided participants through the exercises studied in person. Two weeks after completing the program, participants’ mindfulness attendance and general positive moods increased, while physical, psychological, and behavioral strains decreased. In another study on a sample of U.K. government employees, study participants receiving three sessions of 2.5 to 3 hours each training on mindfulness, with the first two sessions occurring in consecutive weeks and the third occurring about three months later, Flaxman and Bond ( 2010 ) found that compared to the control group, the intervention group showed a decrease in distress levels from Time 1 (baseline) to Time 2 (three months after first two training sessions) and Time 1 to Time 3 (after final training session). Moreover, of the mindfulness intervention study participants who were clinically distressed, 69% experienced clinical improvement in their psychological health.

Individual-Focused Stress Management: Biofeedback/Imagery/Meditation/Deep Breathing

Biofeedback uses electronic equipment to inform users about how their body is responding to tension. With guidance from a therapist, individuals then learn to change their physiological responses so that their pulse normalizes and muscles relax (Norris, Fahrion, & Oikawa, 2007 ). The therapist’s guidance might include reminders for imagery, meditation, body scan relaxation, and deep breathing. Saunders, Driskell, Johnston, and Salas’s ( 1996 ) meta-analysis of 37 studies found that imagery helped reduce state and performance anxiety. Once people have been trained to relax, reminder triggers may be sent through smartphone push notifications (Villani et al., 2013 ).

Smartphone technology can also be used to support weight loss programs, smoking cessation programs, and medication or disease (e.g., diabetes) management compliance (Heron & Smyth, 2010 ; Kannampallil, Waicekauskas, Morrow, Kopren, & Fu, 2013 ). For example, smartphones could remind a person to take medications or test blood sugar levels or send messages about healthy behaviors and positive affirmations.

Individual-Focused Stress Management: Sleep/Rest/Respite

Workers today sleep less per night than adults did nearly 30 years ago (Luckhaupt, Tak, & Calvert, 2010 ; National Sleep Foundation, 2005 , 2013 ). In order to combat problems, such as increased anxiety and cardiovascular artery disease, associated with sleep deprivation and insufficient rest, it is imperative that people disconnect from their work at least one day per week or preferably for several weeks so that they are able to restore psychological health (Etzion, Eden, & Lapidot, 1998 ; Ragsdale, Beehr, Grebner, & Han, 2011 ). When college students engaged in relaxation-type activities, such as reading or watching television, over the weekend, they experienced less emotional exhaustion and greater general well-being than students who engaged in resources-consuming activities, such as house cleaning (Ragsdale et al., 2011 ). Additional research and future directions for research are reviewed and identified in the work of Sonnentag ( 2012 ). For example, she asks whether lack of ability to detach from work is problematic for people who find their work meaningful. In other words, are negative health consequences only among those who do not take pleasure in their work? Sonnetag also asks how teleworkers detach from their work when engaging in work from the home. Ironically, one of the ways that companies are trying to help with the challenges of high workload or increased need to be available to colleagues, clients, or vendors around the globe is by offering flexible work arrangements, whereby employees who can work from home are given the opportunity to do so. Companies that require global interactions 24-hours per day often employ this strategy, but is the solution also a source of strain (Glazer, Kożusznik, & Shargo, 2012 )?

Individual-Focused Stress Management: Role Analysis

Role analysis or role clarification aims to redefine, expressly identify, and align employees’ roles and responsibilities with their work goals. Through role negotiation, involved parties begin to develop a new formal or informal contract about expectations and define resources needed to fulfill those expectations. Glazer has used this approach in organizational consulting and, with one memorable client engagement, found that not only were the individuals whose roles required deeper re-evaluation happier at work (six months later), but so were their subordinates. Subordinates who once characterized the two partners as hostile and akin to a couple going through a bad divorce, later referred to them as a blissful pair. Schaubroeck, Ganster, Sime, and Ditman ( 1993 ) also found in a three-wave study over a two-year period that university employees’ reports of role clarity and greater satisfaction with their supervisor increased after a role clarification exercise of top managers’ roles and subordinates’ roles. However, the intervention did not have any impact on reported physical symptoms, absenteeism, or psychological well-being. Role analysis is categorized under individual-focused stress management intervention because it is usually implemented after individuals or teams begin to demonstrate poor performance and because the intervention typically focuses on a few individuals rather than an entire organization or group. In other words, the intervention treats the person’s symptoms by redefining the role so as to eliminate the stimulant causing the problem.

Organization-Focused Stress Management

At the organizational level, companies that face major declines in productivity and profitability or increased costs related to healthcare and disability might be motivated to reassess organizational factors that might be impinging on employees’ health and well-being. After all, without healthy workers, it is not possible to have a healthy organization. Companies may choose to implement practices and policies that are expected to help not only the employees, but also the organization with reduced costs associated with employee ill-health, such as medical insurance, disability payments, and unused office space. Example practices and policies that may be implemented include flexible work arrangements to ensure that employees are not on the streets in the middle of the night for work that can be done from anywhere (such as the home), diversity programs to reduce stress-induced animosity and prejudice toward others, providing only healthy food choices in cafeterias, mandating that all employees have physicals in order to receive reduced prices for insurance, company-wide closures or mandatory paid time off, and changes in organizational visioning.

Organization-Focused Stress Management: Organizational-Level Occupational Health Interventions

As with job design interventions that are implemented to remediate work characteristics that were a source of unnecessary or excessive stressors, so are organizational-level occupational health (OLOH) interventions. As with many of the interventions, its placement as a primary or tertiary stress management intervention may seem arbitrary, but when considering the goal and target of change, it is clear that the intervention is implemented in response to some ailing organizational issues that need to be reversed or stopped, and because it brings in the entire organization’s workforce to address the problems, it has been placed in this category. There are several more case studies than empirical studies on the topic of whole system organizational change efforts (see example case studies presented by the United Kingdom’s Health and Safety Executive). It is possible that lack of published empirical work is not so much due to lack of attempting to gather and evaluate the data for publication, but rather because the OLOH interventions themselves never made it to the intervention stage, the interventions failed (Biron, Gatrell, & Cooper, 2010 ), or the level of evaluation was not rigorous enough to get into empirical peer-review journals. Fortunately, case studies provide some indication of the opportunities and problems associated with OLOH interventions.

One case study regarding Cardiff and Value University Health Board revealed that through focus group meetings with members of a steering group (including high-level managers and supported by top management) and facilitated by a neutral, non-judgemental organizational health consultant, ideas for change were posted on newsprint, discussed, and areas in the organization needing change were identified. The intervention for giving voice to people who initially had little already had a positive effect on the organization, as absence decreased by 2.09% and 6.9% merely 12 and 18 months, respectively, after the intervention. Translated in financial terms, the 6.9% change was equivalent to a quarterly savings of £80,000 (Health & Safety Executive, n.d. ). Thus, focusing on the context of change and how people will be involved in the change process probably helped the organization realize improvements (Biron et al., 2010 ). In a recent and rare empirical study, employing both qualitative and quantitative data collection methods, Sørensen and Holman ( 2014 ) utilized PAR in order to plan and implement an OLOH intervention over the course of 14 months. Their study aimed to examine the effectiveness of the PAR process in reducing workers’ work-related and social or interpersonal-related stressors that derive from the workplace and improving psychological, behavioral, and physiological well-being across six Danish organizations. Based on group dialogue, 30 proposals for change were proposed, all of which could be categorized as either interventions to focus on relational factors (e.g., management feedback improvement, engagement) or work processes (e.g., reduced interruptions, workload, reinforcing creativity). Of the interventions that were implemented, results showed improvements on manager relationship quality and reduced burnout, but no changes with respect to work processes (i.e., workload and work pace) perhaps because the employees already had sufficient task control and variety. These findings support Dewe and Kompier’s ( 2008 ) position that occupational health can be reinforced through organizational policies that reinforce quality jobs and work experiences.

Organization-Focused Stress Management: Flexible Work Arrangements

Dewe and Kompier ( 2008 ), citing the work of Isles ( 2005 ), noted that concern over losing one’s job is a reason for why 40% of survey respondents indicated they work more hours than formally required. In an attempt to create balance and perceived fairness in one’s compensation for putting in extra work hours, employees will sometimes be legitimately or illegitimately absent. As companies become increasingly global, many people with desk jobs are finding themselves communicating with colleagues who are halfway around the globe and at all hours of the day or night (Glazer et al., 2012 ). To help minimize the strains associated with these stressors, companies might devise flexible work arrangements (FWA), though the type of FWA needs to be tailored to the cultural environment (Masuda et al., 2012 ). FWAs give employees some leverage to decide what would be the optimal work arrangement for them (e.g., part-time, flexible work hours, compressed work week, telecommuting). In other words, FWA provides employees with the choice of when to work, where to work (on-site or off-site), and how many hours to work in a day, week, or pay period (Kossek, Thompson, & Lautsch, 2015 ). However, not all employees of an organization have equal access to or equitable use of FWAs; workers in low-wage, hourly jobs are often beholden to being physically present during specific hours (Swanberg McKechnie, Ojha, & James, 2011 ). In a study of over 1,300 full-time hourly retail employees in the United States, Swanberg et al. ( 2011 ) showed that employees who have control over their work schedules and over their work hours were satisfied with their work schedules, perceived support from the supervisor, and work engagement.

Unfortunately, not all FWAs yield successful results for the individual or the organization. Being able to work from home or part-time can have problems too, as a person finds himself or herself working more hours from home than required. Sometimes telecommuting creates work-family conflict too as a person struggles to balance work and family obligations while working from home. Other drawbacks include reduced face-to-face contact between work colleagues and stakeholders, challenges shaping one’s career growth due to limited contact, perceived inequity if some have more flexibility than others, and ambiguity about work role processes for interacting with employees utilizing the FWA (Kossek et al., 2015 ). Organizations that institute FWAs must carefully weigh the benefits and drawbacks the flexibility may have on the employees using it or the employees affected by others using it, as well as the implications on the organization, including the vendors who are serving and clients served by the organization.

Organization-Focused Stress Management: Diversity Programs

Employees in the workplace might experience strain due to feelings of discrimination or prejudice. Organizational climates that do not promote diversity (in terms of age, religion, physical abilities, ethnicity, nationality, sex, and other characteristics) are breeding grounds for undesirable attitudes toward the workplace, lower performance, and greater turnover intention (Bergman, Palmieri, Drasgow, & Ormerod, 2012 ; Velez, Moradi, & Brewster, 2013 ). Management is thus advised to implement programs that reinforce the value and importance of diversity, as well as manage diversity to reduce conflict and feelings of prejudice. In fact, managers who attended a leadership training program reported higher multicultural competence in dealing with stressful situations (Chrobot-Mason & Leslie, 2012 ), and managers who persevered through challenges were more dedicated to coping with difficult diversity issues (Cilliers, 2011 ). Thus, diversity programs can help to reduce strains by directly reducing stressors associated with conflict linked to diversity in the workplace and by building managers’ resilience.

Organization-Focused Stress Management: Healthcare Management Policies

Over the past few years, organizations have adopted insurance plans that implement wellness programs for the sake of managing the increasing cost of healthcare that is believed to be a result of individuals’ not managing their own health, with regular check-ups and treatment. The wellness programs require all insured employees to visit a primary care provider, complete a health risk assessment, and engage in disease management activities as specified by a physician (e.g., see frequently asked questions regarding the State of Maryland’s Wellness Program). Companies believe that requiring compliance will reduce health problems, although there is no proof that such programs save money or that people would comply. One study that does, however, boast success, was a 12-week workplace health promotion program aimed at reducing Houston airport workers’ weight (Ebunlomo, Hare-Everline, Weber, & Rich, 2015 ). The program, which included 235 volunteer participants, was deemed a success, as there was a total weight loss of 345 pounds (or 1.5 lbs per person). Given such results in Houston, it is clear why some people are also skeptical over the likely success of wellness programs, particularly as there is no clear method for evaluating their efficacy (Sinnott & Vatz, 2015 ).

Moreover, for some, such a program is too paternalistic and intrusive, as well as punishes anyone who chooses not to actively participate in disease management programs (Sinnott & Vatz, 2015 ). The programs put the onus of change on the person, though it is a response to the high costs of ill-health. The programs neglect to consider the role of the organization in reducing the barriers to healthy lifestyle, such as cloaking exempt employment as simply needing to get the work done, when it usually means working significantly more hours than a standard workweek. In fact, workplace health promotion programs did not reduce presenteeism (i.e., people going to work while unwell thereby reducing their job performance) among those who suffered from physical pain (Cancelliere, Cassidy, Ammendolia, & Côte, 2011 ). However, supervisor education, worksite exercise, lifestyle intervention through email, midday respite from repetitive work, a global stress management program, changes in lighting, and telephone interventions helped to reduce presenteeism. Thus, emphasis needs to be placed on psychosocial aspects of the organization’s structure, including managers and overall organizational climate for on-site presence, that reinforces such behavior (Cancelliere et al., 2011 ). Moreover, wellness programs are only as good as the interventions to reduce work-related stressors and improve organizational resources to enable workers to improve their overall psychological and physical health.

Concluding Remarks

Future research.

One of the areas requiring more theoretical and practical attention is that of the utility of stress frameworks to guide organizational development change interventions. Although it has been proposed that the foundation for work stress management interventions is in organizational development, and even though scholars and practitioners of organization development were also founders of research programs that focused on employee health and well-being or work stress, there are few studies or other theoretical works that link the two bodies of literature.

A second area that requires additional attention is the efficacy of stress management interventions across cultures. In examining secondary stress management interventions (i.e., coping), some cross-cultural differences in findings were described; however, there is still a dearth of literature from different countries on the utility of different prevention, coping, and stress management strategies.

A third area that has been blossoming since the start of the 21st century is the topic of hindrance and challenge stressors and the implications of both on workers’ well-being and performance. More research is needed on this topic in several areas. First, there is little consistency by which researchers label a stressor as a hindrance or a challenge. Researchers sometimes take liberties with labels, but it is not the researchers who should label a stressor but the study participants themselves who should indicate if a stressor is a source of strain. Rodríguez, Kozusznik, and Peiró ( 2013 ) developed a measure in which respondents indicate whether a stressor is a challenge or a hindrance. Just as some people may perceive demands to be challenges that they savor and that result in a psychological state of eustress (Nelson & Simmons, 2003 ), others find them to be constraints that impede goal fulfillment and thus might experience distress. Likewise, some people might perceive ambiguity as a challenge that can be overcome and others as a constraint over which he or she has little control and few or no resources with which to cope. More research on validating the measurement of challenge vs. hindrance stressors, as well as eustress vs. distress, and savoring vs. coping, is warranted. Second, at what point are challenge stressors harmful? Just because people experiencing challenge stressors continue to perform well, it does not necessarily mean that they are healthy people. A great deal of stressors are intellectually stimulating, but excessive stimulation can also take a toll on one’s physiological well-being, as evident by the droves of professionals experiencing different kinds of diseases not experienced as much a few decades ago, such as obesity (Fried et al., 2013 ). Third, which stress management interventions would better serve to reduce hindrance stressors or to reduce strain that may result from challenge stressors while reinforcing engagement-producing challenge stressors?

A fourth area that requires additional attention is that of the flexible work arrangements (FWAs). One of the reasons companies have been willing to permit employees to work from home is not so much out of concern for the employee, but out of the company’s need for the focal person to be able to communicate with a colleague working from a geographic region when it is night or early morning for the focal person. Glazer, Kożusznik, and Shargo ( 2012 ) presented several areas for future research on this topic, noting that by participating on global virtual teams, workers face additional stressors, even while given flexibility of workplace and work time. As noted earlier, more research needs to be done on the extent to which people who take advantage of FWAs are advantaged in terms of detachment from work. Can people working from home detach? Are those who find their work invigorating also likely to experience ill-health by not detaching from work?

A fifth area worthy of further research attention is workplace wellness programing. According to Page and Vella-Brodrick ( 2009 ), “subjective and psychological well-being [are] key criteria for employee mental health” (p. 442), whereby mental health focuses on wellness, rather than the absence of illness. They assert that by fostering employee mental health, organizations are supporting performance and retention. Employee well-being can be supported by ensuring that jobs are interesting and meaningful, goals are achievable, employees have control over their work, and skills are used to support organizational and individual goals (Dewe & Kompier, 2008 ). However, just as mental health is not the absence of illness, work stress is not indicative of an absence of psychological well-being. Given the perspective that employee well-being is a state of mind (Page & Vella-Brodrick, 2009 ), we suggest that employee well-being can be negatively affected by noxious job stressors that cannot be remediated, but when job stressors are preventable, employee well-being can serve to protect an employee who faces job stressors. Thus, wellness programs ought to focus on providing positive experiences by enhancing and promoting health, as well as building individual resources. These programs are termed “green cape” interventions (Pawelski, 2016 ). For example, with the growing interests in positive psychology, researchers and practitioners have suggested employing several positive psychology interventions, such as expressing gratitude, savoring experiences, and identifying one’s strengths (Tetrick & Winslow, 2015 ). Another stream of positive psychology is psychological capital, which includes four malleable functions of self-efficacy, optimism, hope, and resilience (Luthans, Youssef, & Avolio, 2007 ). Workplace interventions should include both “red cape” interventions (i.e., interventions to reduce negative experiences) and “green cape” interventions (i.e., workplace wellness programs; Polly, 2014 ).

A Healthy Organization’s Pledge

A healthy workplace requires healthy workers. Period. Among all organizations’ missions should be the focus on a healthy workforce. To maintain a healthy workforce, the company must routinely examine its own contributions in terms of how it structures itself; reinforces communications among employees, vendors, and clients; how it rewards and cares for its people (e.g., ensuring they get sufficient rest and can detach from work); and the extent to which people at the upper levels are truly connected with the people at the lower levels. As a matter of practice, management must recognize when employees are overworked, unwell, and poorly engaged. Management must also take stock of when it is doing well and right by its contributors’ and maintain and reinforce the good practices, norms, and procedures. People in the workplace make the rules; people in the workplace can change the rules. How management sees its employees and values their contribution will have a huge role in how a company takes stock of its own pain points. Providing employees with tools to manage their own reactions to work-related stressors and consequent strains is fine, but wouldn’t it be grand if organizations took better notice about what they could do to mitigate the strain-producing stressors in the first place and take ownership over how employees are treated?

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A Qualitative Study of Workplace Factors Causing Stress Among University Teachers and Coping Strategies A Qualitative Study of Workplace Factors

• Human Arenas
• Published: 10 August 2022

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• Iqbal Ahmad 1 ,
• Rani Gul   ORCID: orcid.org/0000-0003-1951-3351 1 &
• Muhammad Kashif 1  

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Workplace stress is a common phenomenon worldwide. University teachers perform many types of duties apart from teaching load and are always under stress. The purpose of the study was to explore workplace factors causing stress among university teachers. A qualitative case study design was adopted to investigate the problem. Data were collected through semi-structured interviews with 20 university teachers based on purposive sampling. The collected data was analyzed using thematic analysis technique. The main finding of this study is that extra workload, working space, job security, delay in promotions, and work atmosphere were important workplace factors causing stress among university teachers. It is concluded that workplace stress among university teachers can be reduced by providing a conducive working environment and giving opportunities for continuous professional development.

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Ahmad, I., Gul, R. & Kashif, M. A Qualitative Study of Workplace Factors Causing Stress Among University Teachers and Coping Strategies A Qualitative Study of Workplace Factors. Hu Arenas (2022). https://doi.org/10.1007/s42087-022-00302-w

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WORK STRESS AND EMPLOYEE PERFORMANCE: AN ASSESSMENT OF IMPACT OF WORK STRESS

Stress may be a universal element and individuals in every walk of life should face it. The staff working in several organizations should cater to stress. Especially, bankers are under a good deal of stress because of many antecedents of stress. These stresses result in decreased organizational performance, decreased employees’ overall performance, and decreased quality of labor, high staff turnover, and absenteeism. It also causes health problems like anxiety, depression, headache and backache. Eight components of

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Nowadays, it is being reported that bank employees are facing highest levels of stress which is leading to the thought of ending their lives while at work. This entails the need of the present study. The basic idea of the present study is to find out how is stress caused in banking employees. The survey details that due to prolonged working hours and less payments, there is frustration among the employees. The present study intends to bring such factors which should be focused by employers so as to better utilize the capacities of the employees in banks.

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How Did Work-Related Depression, Anxiety, and Stress Hamper Healthcare Employee Performance during COVID-19? The Mediating Role of Job Burnout and Mental Health

Jianmin sun.

1 School of Management, Nanjing University of Posts and Telecommunications, Nanjing 210006, China

Muddassar Sarfraz

2 School of Management, Zhejiang Shuren University, Hangzhou 310015, China

Larisa Ivascu

3 Faculty of Management in Production and Transportation, Politehnica University of Timisoara, 300191 Timisoara, Romania

Kashif Iqbal

4 School of Business, Shanghai Dianji University, Nanhui Xincheng Town, Shanghai 201306, China

Athar Mansoor

5 Division of Public Policy, Hong Kong University of Science and Technology, Hong Kong

Associated Data

The current study data can be obtained from the corresponding author.

The study objective was to examine the psychological impact of the COVID-19 pandemic on the performance of healthcare employees. The study was informed by a theoretical framework that incorporates different psychological issues (i.e., stress, depression, and anxiety) that influence healthcare workers’ performance through the mediating roles of job burnout and mental health. The study data was gathered through structured questionnaires from 669 participants working in the healthcare sector in Pakistan. A structured equation modeling (SEM) technique was used for data analysis and hypothesis development. It was found that stress, depression, and anxiety positively affected healthcare employees’ job performance during COVID-19. Psychological factors had a positive and significant impact on job burnout and mental health. Job burnout and mental health mediated the relationship between stress, anxiety, depression, and employee performance. The ongoing repercussions of COVID-19 include their impact on employee performance in the healthcare sector. Healthcare worker performance is critical to fostering industrial economic growth. Elevated levels of stress, depression, and anxiety have profoundly exacerbated employee mental health issues. COVID-19 has created challenging working conditions in organizations requiring that they address the growing psychological issues which impact negatively on worker performance.

1. Introduction

In recent years, the emergence of the COVID-19 pandemic has demonstrated how a new virus can significantly alter human life. The profound changes caused by COVID-19 have presented major social challenges across the world with significant effects across a variety of domains [ 1 ]. The prolonged nature of the crisis, and its widespread impact, has led to its declaration as a global health emergency. The sudden onset of the COVID-19 pandemic caused psychological distress across industries throughout the world [ 2 ]. Notably, the very significant mental health impacts arising have exacted an extreme toll on the healthcare industry, with a particularly severe impact on healthcare performance.

For these reasons, COVID-19 has become a global threat to healthcare performance [ 3 ]. The prevalent psychological problems occurring in the healthcare sector can be partly attributed to the disease’s ability to cause previously healthy employees to become vulnerable caretakers. COVID-19 has also exacerbated existing mental health problems among healthcare employees due to the psychological trauma and distress they face in their work. Research has shown that front-line workers in the healthcare sector (e.g., nurses, doctors, medical staff, and health professionals) are presently facing unprecedented psychological challenges [ 4 ].

In dealing with these exacerbated health vulnerabilities, Pakistan’s economy has experienced a setback with front-line workers exposed to significant risks to their health. A recent study from Pakistan found that the COVID-19 crisis meant that healthcare workers had experienced increasing psychological pressure, leaving them ill-equipped to tackle the increasing challenges they faced [ 5 ]. The virus has caused healthcare workers to experience significant psychological repercussions, which have detrimentally affected their job performance. The crisis has created an enhanced sense of helplessness in health professionals, that can further deteriorate employee performance [ 6 ]. The literature demonstrates, however, that, despite growing evidence of mental health problems, the healthcare workforce is not seeking the mental healthcare necessary to ensure their well-being and performance [ 7 , 8 ]. Therefore, to limit the impact of COVID-19, it has become imperative for global healthcare institutions to recognize their responsibility toward their workers’ well-being, specifically regarding the increase in the COVID-19-related psychological burden. Previous studies have emphasized the need for multidisciplinary research in the healthcare sector concerning the growing psychological issues that influence employee mental health and job performance.

This global threat of COVID-19 has impacted the psychological health of individuals, with outbreaks representing stressful events for front-line workers. The COVID-19 crisis provoked nations globally to take action to combat the devastating spread of the pandemic. The authors of one study observed that the significant repercussions of COVID-19 have damaged employees’ psychological well-being, thereby negatively impacting their normal intellectual functioning [ 9 ]. Overall, the pandemic has overwhelmed the healthcare sector by reducing employees’ work performance [ 10 , 11 ].

The COVID-19 pandemic has gravely impacted the psychological health of individuals, causing them to experience significant mental health issues. The ongoing crisis has negatively impacted employees, making them psychologically ill-prepared to perform their normal tasks. Further, the situation has exacerbated existing psychological problems (e.g., stress and anxiety) [ 12 ], substantially impeding individuals’ job performance. Aguiar-Quintana et al. [ 13 ] found that high levels of COVID-19 exposure led to stress, anxiety, and depression symptoms, thus influencing workers’ performance. Overall, the pandemic has imposed significant strain on an already traumatized workforce, with increased anxiety and tension further exacerbating its impact on healthcare performance [ 14 ].

Employee mental health during the pandemic has also increased the burnout rate in the healthcare industry. Accelerating absenteeism and turnover intentions among healthcare employees caused by COVID-19, with high burnout rates reported, have had very damaging consequences,. Unsurprisingly, job burnout detrimentally impacts individuals’ mental health [ 15 ], thereby hampering their performance. Factors contributing to increasing burnout increase workplace mental pressure, affecting healthcare workers’ ability to perform their work tasks [ 16 ].

Therefore, to address the negative consequence of the pandemic, this study sought to investigate the effect of COVID-19 on healthcare workers in Pakistan. This paper presents evidence of the adverse effects of COVID-19 in the light of previous literature. The paper highlights the harsh realities of fighting the virus, and the need to safeguard healthcare employees against the psychological impacts of the pandemic and to prepare them physically and psychologically. Previous studies have investigated the clinical characteristics of the pandemic, its negative features, and the health measures implemented. In this regard, this study represents a valuable addition, providing information to help address the uncertainties of an unprecedented pandemic situation. Adding to previous studies that have considered the psychological and mental health impacts of COVID-19, this study provides a unique perspective by considering the role of both mental health and job burnout. The study provides essential information by highlighting these vital factors to increase awareness regarding the impact of COVID-19 on health workers’ mental health and performance.

The study calls for urgent action to mitigate the devastating effects of COVID-19 on employee performance and psychological health. The study findings provide vital tools to combat the increasing impact of stress, anxiety, and depression influencing healthcare performance. It provides a concrete basis for adapting and executing appropriate mental health policies to address the psychological vulnerabilities generated by COVID-19. It encourages government bodies, health professionals, and policymakers to protect the psychological well-being of healthcare workers in different parts of the world, specifically in Pakistan.

2. Theoretical Background

2.1. stress and employee performance.

In recent years, globalization and technological advancement have enhanced individuals’ working standards. However, the sudden outbreak of the COVID-19 pandemic has altered the working environment and job demands. In recent years, this profound crisis has made working conditions difficult, significantly raising organizations’ concerns regarding employee management. Yunita and Saputra [ 17 ] found that stress is the foremost factor that has influenced employee functioning during the pandemic. Stress has adversely affected individuals’ morale, performance, and motivation. In particular, the negative changes caused by COVID-19 have altered healthcare workers’ lives by significantly impeding their work performance. Prasada et al. [ 18 ] demonstrate that the growing pandemic stress has created a sense of chaos, leading organizations to report poor worker performance.

Various studies have reported that stress is the prime determinant influencing employee performance [ 19 ]. The pandemic has caused healthcare employees to experience workplace stress to an unprecedented extent. The increasing COVID-19 stress has exerted intense pressure on healthcare workers by creating additional job demands. The literature suggests that employees who experience stress tend not to meet job expectations. In the healthcare industry, the crisis situation has increased stress symptoms in frontline workers, with detrimental impacts on employee output. Tu et al. [ 20 ] observed that COVID-19-induced stress has influenced individuals’ ability to perform well, leading to substantial decreases in employees’ quality of work.

The occupational stress experienced during the pandemic outbreak has significantly influenced the economic functioning of nations, necessitating a focus on workers’ job performance. Evidence provided in the literature indicates that stress occurring as a result of the COVID-19 pandemic is prevalent as an issue affecting healthcare employee performance [ 21 ]. An employee experiencing a high degree of stress has lower motivation to perform the task. The COVID-19 crisis has caused individuals’ to focus less well on work-related tasks, substantially reducing their overall work performance. The pandemic has affected the flow of work, potentially increasing individuals’ workload. The perceived work burden has elevated stress in individuals, resulting in a decrease in individuals’ work performance [ 22 ].

In sum, the uncontrollable nature of COVID-19 has negatively affected healthcare workers, provoking anxiety and stress. COVID-19 has caused increasing uncertainty, with healthcare staff reporting psychological symptoms, emotional exhaustion, and workload stress. As the pandemic worsened, these symptoms accelerated, causing healthcare workers to face increased traumatic stress [ 23 ]. The issue of social stigmatization and shortages of healthcare equipment have made it difficult for employees to deal with the impacts of COVID-19 [ 24 ]. As this industry has faced a particularly marked increase in stress and depression during the pandemic, it is important to focus on the health of Pakistan’s healthcare workers to ensure enhanced work output.

2.2. Depression and Employee Performance

In recent years, the growing strain of the pandemic has encircled the globe, negatively impacting countries across the world. The COVID-19 outbreak has impacted healthcare services internationally, including in the Pakistan healthcare sector. The aggregate effect of the pandemic has meant healthcare employees have experienced an increasing intensity of demands due to the crisis, giving rise to the need for immediate investment in healthcare recovery. Healthcare workers are at risk of being affected psychologically by the pandemic situation. Depression has emerged as a harmful outcome that hinders employee functioning [ 25 ]. In healthcare, depression has become a major obstacle to employee performance. Healthcare employees are vulnerable to depression during the pandemic because of their exposure to various psychological stressors. Examination of mental responses related to COVID-19 has confirmed that depression drastically impedes healthcare performance. One study demonstrated how intense workloads occurring during the pandemic have increased depression among individuals, in turn negatively affecting work quality [ 26 , 27 ].

The pandemic has resulted in significant changes in the work environment of healthcare workers. The pandemic has led to worsened working conditions, causing employees to be more vulnerable to depression and distress. The elevated psychological pressure has raised management concerns, leading to demands for a reduction in employee workloads. Studies on the causes of poor healthcare performance suggest that the alarming COVID-19 situation has meant that employees are at risk of depression, impeding their performance [ 28 , 29 ]. Depression considerably affects the work status of healthcare workers, overwhelming them and negatively impacting their work performance. Research findings indicate that depression results in poorer work outcomes, negatively affecting healthcare performance [ 30 ]. Research into the impacts of the pandemic suggests that measures must be taken so that healthcare employees can deal with the increasing depression that can influence their productivity.

2.3. Anxiety and Employee Performance

COVID-19 has altered the typical working patterns of healthcare workers and significantly affected the psychological well-being of medical staff. Combating this new virus, initially without proven prevention measures or treatments, imposed a significant burden on the medical workforce. This situation has required that organizations globally take care of their workers and protect them against the psychological effects of their vulnerability to COVID-19 exposure. Despite awareness of this need, healthcare workers have been significantly affected across the globe. One empirical study found that around 53.8% of healthcare employees have been diagnosed with psychological issues [ 21 ]. Additionally, 21.3% of healthcare workers have experienced anxiety [ 31 ]. Results of studies from the Asian region indicate that, currently, healthcare employees are experiencing a high level of stress, anxiety, and depression symptoms [ 32 ].

Depression and anxiety significantly influence individuals’ professional lives, and coping with anxiety has become a widespread challenge in today’s world. In the era of COVID-19, increasing work anxiety has led to significant impacts on the healthcare industry. The pandemic has increased anxiety in individuals, necessitating the study of its effect on individuals’ job performance. Work anxiety experienced as a result of the COVID-19 situation can potentially influence healthcare performance. For example, Fu et al. [ 33 ] found that prevalent COVID-19 anxiety heightened job-related concerns, substantially diminishing employees’ healthcare performance.

Several factors affect employee performance, but among them, anxiety is a critical factor that demands the attention of researchers. Due to the uncertainty brought about by the pandemic, employee anxiety has had a devastating impact as a result of changed working environments, contributing to reduced work performance. Clercq et al. [ 34 ] suggested that anxiety associated with the pandemic has elevated job-related worries in healthcare workers, causing them to exhibit poor performance. The negative influence of COVID-19 has caused employees to experience excessive tension and anxiety, particularly in the healthcare sector. Anxiety has been demonstrated to have a toxic effect on employee performance, with Kumar et al. [ 35 ] stating that the high prevalence of anxiety and depression during the pandemic has undermined the performance of the healthcare workforce. Consistent with this discussion, Nadeem et al. [ 36 ] observed that the healthcare workforce had encountered severe anxiety, making it difficult for individuals to cope with work complexities brought about by COVID-19.

2.4. The Mediating Role of Job Burnout

Burnout is a global phenomenon and has been exacerbated as the world’s healthcare industry has faced the growing consequences of the pandemic. In 2020 and 2021, the progressive impact of COVID-19 has generated burnout. Inevitably, the pandemic has negatively influenced the lives of healthcare workers. Since the beginning of 2020, the Pakistan health workforce has had to cope with a wide range of crises, leading to job burnout. A recent study from Pakistan indicated that around 46.6% of healthcare workers have left their job due to the pandemic [ 37 ]. Healthcare burnout is an accelerating phenomenon that has raised awareness of the need to find solutions to combat COVID-19 work stress and job burnout [ 38 ]. Bradley and Chahar [ 39 ] found that burnout has drastically increased during the pandemic years, emphasizing the need to provide immediate support.

The emergence of a fourth wave of COVID-19 saw anxiety and stress rapidly increase in Pakistan. The wide circulation of the virus has placed a psychological burden on healthcare workers, causing them to experience an increased level of burnout [ 40 ]. The uncertainty surrounding the outbreak has increased concerns about healthcare workers and their rate of burnout [ 41 ]. Despite the ongoing nature of the crisis, Pakistan still lacks the medical equipment needed to function effectively in this difficult situation. In this regard, medical support for healthcare workers is urgently required to maintain superior quality services [ 42 ], and to ensure employees’ intention to stay in the sector. During the pandemic, the accelerating incidence of burnout has exacerbated the negative effect of healthcare workers’ psychological conditions. In the current period of the pandemic, the public health emergency has caused the healthcare workforce to experience numerous physical and psychological issues, leading to excessive employee burnout. Employee burnout has been the most prevalent negative health outcome observed in the healthcare industry in the past few years. As a result, today, the increasing impact of burnout has caused health professionals to be less focused on their work performance [ 43 , 44 ].

The outbreak of COVID-19 has significantly affected the working lives of healthcare workers. In recent years, these issues have strongly increased the turnover rate. The high prevalence of stress, anxiety, and depression have clearly caused burnout in healthcare employees [ 45 ]. The psychological adversity experienced has influenced healthcare employees‘ job performance, leading some to give up their profession [ 46 ]. Saleem et al. [ 47 ] found that, faced with the excessive burden of the pandemic, pandemic stress and depression have caused healthcare employees to leave healthcare organizations, substantially impeding the ability of these organizations to perform their role.

Healthcare employees have experienced reduced work productivity due to the pandemic, thus leading to a higher turnover rate. One study found that, in the healthcare sector, reduced work performance had elevated the feeling of negativity (e.g., stress, anxiety) in individuals, increasing the overall turnover rate [ 48 ]. Further, in a previous systematic review, it was found that, in the COVID-19 era, health professionals frequently experience burnout with consequent reduced job performance [ 49 ]. Long-term stress and anxiety have become critical factors leading to the increase in the burnout rate among healthcare workers [ 50 ].

2.5. The Mediating Role of Mental Health

In the current pandemic scenario, employees’ organizational performance has been impacted by COVID-19′s effect on individuals’ mental health [ 51 ]. Organizations strive to sustain themselves in this competitive world by empowering employees to perform well. To achieve this goal, organizations emphasize maintaining positive mental health for superior work performance. Satici et al. [ 52 ] state that the negative consequences of the COVID-19 pandemic have created a high level of anxiety, stress, and depression in individuals, thus hindering their healthcare performance.

Arguably, various factors affect the psychological well-being of workers. Among them, stress, depression, and anxiety hold a prominent position in impeding employee work performance. As the pandemic unfolds, numerous mental health problems have been highlighted, demanding researchers’ attention [ 47 ]. An employee’s mental health considerably influences their work performance. During COVID-19, workplace changes have made healthcare employees exhibit poorer work performance. Stress, depression, and anxiety are the most prominent psychological issues that have emerged as the dominant threats to employee well-being and performance [ 53 ]. Mental health issues, such as stress, depression, and anxiety affect the performance of front-line workers, as shown by Lei et al. [ 54 ].

COVID-19-related psychological problems (e.g., distress and depression) threaten healthcare employees’ mental health, and result in poor work performance [ 17 ]. In particular, Lai et al. [ 55 ] showed that, in the nursing profession, the excessive pandemic workload posed a threat to work efficiency and productivity. Therefore, the literature has highlighted the need to analyze the psychological factors that influence mental health and performance in the workplace.

Figure 1 represents the direct and indirect relationships among the study variables (stress, depression, anxiety, job burnout, mental health problems and employee performance).

Conceptual Framework.

3.1. Study Procedure

A quantitative research design using a self-reported questionnaire was used to collect data from healthcare employees of 30 hospitals in Pakistan. A purposive sampling technique was used to gather data from healthcare employees from January to March 2022. The healthcare workers sampled were treating COVID-19 patients. In this study, we considered government COVID-19 treatment facilities located in three major cities of Pakistan (Lahore, Islamabad, and Karachi). To design the online questionnaire, a public platform recommended by Google INC: Google Docs was used, and the survey link was sent to healthcare employees. It was confirmed through a confidential statement that the personal information of participants would be protected and that the responses provided would only be used for research purposes. In accordance with the Declaration of Helsinki, an information letter was provided and an informed consent form obtained from the study participants.

3.2. Common Method Bias

This study addressed common method bias using Harman’s single-factor methodology. The variance extracted using one factor was 20.900% which was less than 50%. This indicated that there was no common method bias [ 56 ].

3.3. Measures

Depression, anxiety, and stress were assessed using seven-item scales adopted from Vignola and Tucci [ 57 ]. Sample items included, “I felt like I was being a little too emotional/sensitive”, “I was intolerant of the things that kept me from continuing to do what I had been doing”, and “I knew my heartbeat had changed even though I hadn’t done anything physically rigorous (for example: increased heart rate, irregular heartbeat)”. In this study, the depression, anxiety, and stress scales had Cronbach’s alphas of 0.896, 0.902, and 0.897, respectively.

Job burnout was assessed using a three-item scale adopted from Ninaus [ 58 ]. Sample items included, “I feel used up at the end of a workday”, and “I feel burned out from my work”. The job burnout scale had a Cronbach’s alpha value of 0.773 in this study.

Mental health problems were assessed on a 15-item scale adopted from Sharma and Devkota [ 59 ]. Sample items included in the questionnaire were, “Have you been less confident than before?”, “Do you use alcohol or other substances that are causing problems in your daily life? and “Have you been anxious, restless, or having multiple worries and doubts in mind more than usual?”. The mental health problems scale had a Cronbach’s alpha value of 0.945.

Employee performance was assessed using a 16-item scale adopted from Ferozi and Chang [ 60 ]. The Cronbach’s alpha value for the employee performance scale was 0.945; the sample items included, “I give advanced notice when unable to come to work”, “I take action to protect the organization from potential problems”, and “I perform tasks that are expected of me”.

3.4. Statistical Analysis

The data was analyzed using the Statistical Package for the Social Sciences (SPSS) and the Analysis of Moment Structures (AMOS) software. In this study, structural equation modeling (SEM) was used to analyze multivariate causal associations. Confirmatory factor analysis (CFA) was carried out to assess the internal validity of the model.

Table 1 shows the demographic details of the study participants. Of 669 collected questionnaires, 311 useful responses were received from the male participants (46.5%) and 358 from the female participants (53.5%). Therefore, the study sample comprised an approximately equal proportion of male and female respondents. In terms of age, 92 (13.8%) respondents were 19–30 years old, 182 (27.2%) were 31–40, 158 (23.6%) were 41–50, 141 (21.1%) were 51–60, and 96 (14.3%) of the respondents were more than 60 years old. Regarding educational level, 130 (19.4%) had an intermediate degree, 216 (32.3%) had a bachelor’s degree, 240 (35.9%) had a master’s degree, and 83 (12.4%) had MPhil/other qualifications. With respect to marital status, 118 (17.6%) of the respondents were single, while 551 (82.4%) were married.

Study participant’s demographic information.

Assessment of Model Fit and Measurement Model

As shown in Table 2 , the results of the model fit indicated that the overall measurement model provided an adequate fit of the data with all 55 items, with Chi-square = 1454.113 and df = 1415. The value of GFI was 0.929; greater than the recommended value of 0.9 as recommended by Hoyle (1995). Based on the CFI, TLI and IFI indices having values greater than the cut-off value of 0.9 (0.998; 0.998; and 0.932, respectively), the model was inferred to represent a good fit of the data [ 60 , 61 ]. The root mean square error of approximation (RMSEA) was 0.006, which was below the threshold of 0.08 recommended by Steiger [ 62 ]. Further, the standardized root mean squared residual (SRMR) was 0.025, which was below the threshold of 0.08 recommended by Hu and Bentler [ 63 ]. Additionally, the relative CMIN/df was 1.028, which, at less than five, indicated a good fit of the model [ 61 ].

Model fit and reliability and validity analysis.

*** p < 0.001.

As presented in Table 2 , the results of an assessment of the standardized factor loadings of the model’s items indicated that the initial standardized factor loadings of all 55 items were above 0.6, as recommended by Hair [ 69 ], ranging from 0.692 (for EP_14) to 0.771 (STR_6).

Each of the constructs was evaluated for reliability after the uni-dimensionality of the constructs was determined. The average extracted variance (AVE), construct reliability (CR), and Cronbach’s alpha were used to evaluate reliability. The AVE results are presented in Table 2 ; all the values were higher than 0.5, as recommended by Nunnally and Bernstein [ 70 ], ranging between 0.52 (for employee performance) to 0.567 (for anxiety).

The CR value, which indicates the degree to which the construct indicators reflect the latent construct, exceeded the recommended value of 0.7 for all constructs, as recommended by Bagozzi and Yi [ 71 ], ranging between 0.773 (for job burnout) and 0.945 (for mental health problems). The Cronbach’s alpha value, which describes the degree to which a measure is error-free, ranged between 0.773 (for job burnout) and 0.945 (for mental health problems), which were above the threshold of 0.7 recommended by Nunnally and Bernstein [ 70 ].

The correlation between the mental health problems scale scores and the employee performance scale scores was -0.601. The correlation between the job burnout and the mental health problems scale scores was 0.681. The data presented in Table 3 highlight that both were less than the threshold of 0.85 [ 72 ]. The results also revealed, as shown in Table 3 , that the value of the off-diagonal items was lower than the value of the square root of AVE on the diagonal. This supported the view that each latent construct measurement was discriminating relative to the others, according to the Fornell–Larcker interpretation [ 73 , 74 ].

Discriminant validity analysis (Fornell–Larcker and HTMT).

Note: Values on the diagonal (italicized) represent the square root of the average variance extracted, while the off diagonals are correlations.

The descriptive statistics of the constructs are also provided in Table 3 . These statistics include the mean and standard deviation. Evaluating the data presented in this table, it is evident that the highest mean value was 3.65, recorded for employee performance, and the lowest mean value was 3.59, recorded for depression. The highest standard deviation value was 0.886, for measurement of burnout, and the lowest standard deviation value was 0.785, for measurement of mental health problems.

In predicting employee performance, stress had a significance value below 0.001, as highlighted in Table 4 . For this relationship, a t -value of −5.541 and a p -value were obtained.

Hypotheses testing—direct effect.

Indicates significant paths: * p < 0.05, ** p < 0.01, *** p < 0.001.

Stress has a negative and significant impact on employee performance.

As shown in Table 4 , H1 was supported because the regression weight for stress in the prediction of employee performance was significantly different from zero at the 0.001 level (two-tailed). A negative relationship was highlighted because the standardized path coefficient was −0.205. So, employee performance decreased by 0.205 standard deviations when stress increased by 1 standard deviation.

Depression has a negative and significant impact on employee performance.

There is a less than 1% chance of obtaining a t-value that is as large as the observed −3 in absolute value. With a standardized path coefficient of −0.123, the effect of depression on employee performance was, thus, negative and significant at the 0.01 level. Following these arguments, H2 was supported.

Anxiety has a negative and significant impact on employee performance.

There is a less than 5% chance of obtaining a t-value as large as the observed −2.897 in absolute value. With a standardized path coefficient of −0.113, the effect of anxiety on employee performance was, thus, negative and significant at the 0.05 level. As a result, H3 was confirmed.

Stress has a positive and significant impact on job burnout.

There is a less than 0.1% chance of obtaining a t-value as large as the observed 9.938 in absolute value. In other words, with a standardized path coefficient of 0.318, the impact of stress on job burnout was positive and significant at the 0.001 level. As a result, H4 was confirmed.

Depression has a positive and significant impact on job burnout.

There is a less than 0.1% chance of obtaining a t-value as high as the observed 11.871 in absolute value. In other words, with a standardized path coefficient of 0.368, the relationship between depression and job burnout was positive and significant at the 0.001 level. As a result, H5 was confirmed.

Anxiety has a positive and significant impact on job burnout.

There is a less than 0.1% chance of obtaining a t-value as high as the observed 8.968 in absolute value. In other words, with a standardized path coefficient of 0.278, the relationship between anxiety and job burnout was positive and significant at the 0.001 level. As a result, H6 was confirmed.

Stress has a positive and significant impact on mental health problems.

There is a less than 0.1% chance of obtaining a t-value as large as the observed 6.950 in absolute value. In other words, with a standardized path coefficient of 0.278, the impact of stress on mental health problems was positive and significant at the 0.001 level. As a result, H7 was confirmed.

Depression has a positive and significant impact on mental health problems.

There is a less than 0.1% chance of obtaining a t-value as high as the observed 7.541 in absolute value. In other words, with a normalized path coefficient of 0.279, the relationship between depression and mental health problems was positive and significant at the 0.001 level. As a result, H8 was confirmed.

Anxiety has a positive and significant impact on mental health problems.

Anxiety had a substantial positive impact on mental health problems at the 0.001 level with a standardized path coefficient of 0.341. Therefore, H9 was supported.

Job burnout has a negative and significant impact on employee performance.

Employee performance was adversely affected by job burnout at the 0.001 level with a standardized path coefficient of −0.195. Therefore, H10 was supported

Mental health problems have a negative and significant impact on employee performance.

The results indicated that the effect of mental health problems on employee performance was negative and significant at the 0.001 level with a standardized path coefficient of −0.183. Therefore, H11 is supported.

The results indicated that the most important determinants of job burnout, mental health problems, and employee performance were stress (β = −0.205), depression (β = 0.368), and anxiety (β = 0.341).

Table 5 shows that the p -values obtained were less than the standard level of 0.05. All hypothesized mediation effect paths were determined to be statistically significant, as shown in Table 5 . Hence, hypotheses H10a, H10b, H10c, H11a, H11b, and H11c, were all supported. The next subsections explain the path analysis findings in relation to the mediation effect hypotheses.

Hypothesis results—indirect effects.

Indicates significant paths: ** p < 0.01, *** p < 0.001.

Job burnout mediates the relationship between stress and employee performance.

The bootstrapping results revealed that the indirect effect of stress on employee performance through job burnout was negative and significant at the 0.001 level (β = −0.062, p < 0.001), the 95% confidence interval (CI) using a 5000 bootstrap sample did not include 0, and the CIs were −0.058 and −0.019. The results indicate that job burnout partially mediated the association between stress and employee performance. Thus, H10a was supported.

Job burnout mediates the relationship between depression and employee performance.

The bootstrapping results revealed that the indirect effect of depression on employee performance through job burnout was negative and significant at the 0.01 level (β = −0.072, p < 0.01, CI = 95%, CI-LL = −0.077, CI-UL = −0.031). The results indicate that job burnout partially mediated the association between depression and employee performance. Thus, H10b was supported.

Job burnout mediates the relationship between anxiety and employee performance.

The bootstrapping results revealed that the indirect effect of anxiety on employee performance through job burnout was negative and statistically significant at the 0.001 level (β = −0.054, p < 0.001, CI = 95%, CI-LL = −0.059, CI-UL = −0.020). The results indicate that job burnout partially mediated the association between depression and employee performance. Thus, H10c was supported.

Mental health problems mediate the relationship between stress and employee performance.

The bootstrapping results showed the indirect effect of stress on employee performance through mental health problems was negative and significant at the 0.01 level (β = −0.051, p < 0.01, CI = 95%, CI-LL = −0.068, CI-UL = −0.027). Mental health problems partially mediated the association between stress and employee performance. Hence, H11a was supported.

Mental health problems mediate the relationship between depression and employee performance.

Table 5 shows the bootstrapping results, which indicate that the indirect effect of depression on employee performance through mental health problems was negative and significant at the 0.01 level; β = −0.051, p < 0.01, CI = 95%, CI-LL = −0.058, and CI-UL = −0.022. Mental health problems partially mediated the relationship between depression and employee performance. Thus, H11b was supported.

Mental health problems mediate the relationship between anxiety and employee performance.

Table 5 and Figure 2 shows the bootstrapping results, which indicate that the indirect effect of anxiety on employee performance through mental health problems was negative and statistically significant at the 0.01 level; β = −0.054, p < 0.01, CI = 95%, CI-LL = −0.071, and CI-UL = −0.021. These results, along with the significant effect of anxiety on employee performance (from Table 4 ), suggest that mental health problems partially mediated the relationship between anxiety and employee performance. As a result, H11c was accepted and supported.

Structural Model.

The value of R 2 represents the proportion of variance in the dependent variable explained by its predictors (see Table 6 ). For mental health problems, job burnout, and employee performance, the three dependent variables in the research model, the R 2 values were 0.619, 0.715, and 0.508, respectively. This shows that the five predictors (i.e., stress, depression, anxiety, job burnout, and mental health problems) accounted for 50.8% of the variance in employee performance. Overall, the R 2 values were found to meet the cut-off value of 0.30 recommended by Sarfraz [ 11 ].

R 2 Values.

5. Discussion

The COVID-19 emergency has heavily affected the psychological condition of healthcare workers. Pakistan’s healthcare industry is at high risk of experiencing COVID-19 vulnerabilities [ 41 ]. COVID-19 has altered employees’ lives by causing them to experience unprecedented health consequences arising from their work. Healthcare employees are an organization’s most critical asset, able to enhance workplace productivity by delivering superior performance. To explain the effect of psychological problems on employee job performance, this discussion offers insights into the current study findings in light of previous literature. As such, the study seeks to provide an understanding of the effect of the COVID-19 emergency on front-line workers in Pakistan.

During the COVID-19 pandemic, organizations have reported negative consequences for healthcare performance. Kumar et al. [ 35 ] showed that COVID-19 induced stress in healthcare workers, inevitably undermining their job performance. Our study findings support previous studies that have demonstrated how COVID-19 stress significantly impacted healthcare performance [ 75 ]. These findings lead us to accept H1. Similarly, during the initial declaration of the COVID-19 pandemic, healthcare employees also reporting feeling depressive symptoms. Hennekam et al. [ 76 ] showed that increasing depression arising from the experience of COVID-19 caused healthcare workers to exhibit poor work performance. Previous research also indicated that COVID-19 intensified anxiety with negative effects on healthcare performance [ 77 ]. These studies support our findings, leading us to accept H2 and H3.

Several studies have illuminated the symptomatology of stress, anxiety, and depression during the pandemic. These psychological issues have deteriorated employees’ mental health and performance. Greenberg et al. [ 10 ] state that COVID-19-related psychological problems (e.g., stress, depression, and anxiety) have exerted unbearable pressure on workers’ mental health, influencing their work performance. A further consequence of the pandemic, and healthcare workers’ increased vulnerability to its effects, has been the growing incidence of burnout affecting healthcare performance. Poor health negatively affects employee performance. In this regard, Dyrbye et al. [ 78 ] found that many healthcare employees decided to quit their jobs due to increasing psychological problems during the pandemic. In the healthcare industry, these psychological problems (i.e., depression, stress, and anxiety) have drastically impeded workers’ performance, and increased the rate of job burnout [ 79 ]. Our study analysis, while supporting previous literature, has highlighted the mediating role of mental health and job burnout on employee performance. Overall, the study findings support the acceptance of all the proposed hypotheses and their assumptions.

This study was limited to healthcare employees working in three major cities of Pakistan, and future research could involve a comparative analysis of female and male healthcare workers’ job performance in public and private healthcare centers. The study employed cross-sectional data, but future research could consider longitudinal data. This study is based on a quantitative approach; in future research, mixed or qualitative approaches could be adopted.

6. Conclusions

In recent years, the negative impact of COVID-19 has altered the professional lives of healthcare workers. The clinical features of COVID-19, including its infectivity, have placed a significant burden on employees’ mental health and performance. It has made front-line workers vulnerable, resulting in an increased level of psychological problems.

The current study explored the extreme toll COVID-19 has taken on the healthcare industry of Pakistan. Significantly, the study results confirm the prevalence of stress, depression, and anxiety in front-line workers. The findings show that increasing COVID-19 stress and depression have caused employees to lose interest in their work tasks, thus decreasing their performance. Similarly, the results showed that COVID-19 anxiety significantly influenced employee performance. In addition, this review of the impact of the COVID-19 pandemic demonstrates that psychological issues (e.g., stress, depression, and anxiety) have influenced employees’ mental health and performance. Furthermore, the study has confirmed a significant mediating role of job burnout in influencing employee performance.

Undoubtedly, the pandemic has made today’s employees vulnerable, and negatively impacted their workplace functioning. The literature shows that the impact of the pandemic drew the attention of researchers to individuals’ mental well-being. The results of the current study suggest that managers should respond to the adversity caused by the pandemic by ensuring superior job performance through improved mental health support. In conclusion, health professionals, practitioners, and policymakers should take steps to improve employees’ mental well-being and job performance.

Funding Statement

We acknowledge the financial support from the National Natural Science Foundation of China (Grant No: 71974102) and from the Philosophy; Social Science Fund of Tianjin City, China (Grant No: TJYJ20-012).

Author Contributions

Conceptualization, M.S. and L.I.; methodology, J.S.; software, M.S.; validation, A.M. and K.I.; formal analysis, M.S.; investigation, J.S.; resources, L.I. and K.I.; data curation, K.I.; writing—original draft preparation, M.S.; writing—review and editing, L.I. and M.S.; supervision, M.S.; project administration, L.I. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Ethical review and approval were not required for the study on human participants in accordance with the local legislation and institutional requirements.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Advancing social justice, promoting decent work ILO is a specialized agency of the United Nations

Heat is a silent killer that threatens the health and lives of a growing number of workers around the world, ILO report finds.

25 July 2024

GENEVA (ILO News) – A new report from the International Labour Organization (ILO),  Heat at work: Implications for safety and health , warns that more workers are being exposed to heat stress worldwide. The new data reveals that regions previously unaccustomed to extreme heat will face increased risks, while workers in already hot climates will confront ever more dangerous conditions. 

Heat stress is an invisible and silent killer that can quickly cause illness, heatstroke or even death. Over time it can also lead to serious heart, lung and kidney problems for workers, the study underlines.

Overall, the report indicates that workers in Africa, the Arab states and Asia and the Pacific are most often exposed to excessive heat. In these regions, 92.9 per cent, 83.6 per cent and 74.7 per cent of the workforce are affected, respectively. The figures are above the global average of 71 per cent, according to the most recent figures available (2020). 

The fastest changing working conditions are seen in Europe and Central Asia, says the report. From 2000 to 2020 the region recorded the largest increase in excessive heat exposure, with the proportion of workers affected rising by 17.3 per cent, almost double the global average increase.

Meanwhile, the Americas and Europe and Central Asia are witnessing the largest rise in workplace injuries from heat stress since the year 2000, with increases of 33.3 per cent and 16.4 per cent respectively. This is possibly due to hotter temperatures in regions where workers are unaccustomed to heat, the report notes.

The report estimates that 4,200 workers globally lost their lives to heatwaves in 2020. In total, 231 million workers were exposed to heatwaves in 2020, marking a 66 per increase from 2000. Nonetheless, the report stresses that nine out of ten workers globally were exposed to excessive heat outside of a heatwave and eight in ten occupational injuries from extreme heat happened outside of heatwaves. 

Excessive heat is creating unprecedented challenges for workers worldwide year-round, and not only during periods of intense heatwaves.

"As the world continues to grapple with rising temperatures, we must protect workers from heat stress year-round. Excessive heat is creating unprecedented challenges for workers worldwide year-round, and not only during periods of intense heatwaves, said ILO Director-General Gilbert F. Houngbo. 

Improved safety and health measures to prevent injuries from excessive heat in the workplace could save up to US$361 billion globally – in lost income and medical treatment expenses – as the heat stress crisis accelerates, affecting global regions differently, emphasizes the study. 

The ILO estimates show that low- and middle-income economies, in particular, are the most affected, as the costs of injuries from excessive heat in the workplace can reach around 1.5 per cent of national GDP.

“This is a human rights issues, a workers’ rights issue, and an economic issue, and middle-income economies are bearing the biggest brunt. We need year-round heat action plans and legislation to protect workers, and stronger global collaboration among experts to harmonize heat stress assessments and interventions at work,” added Houngbo.

The impact of heat on workers worldwide is fast becoming a global issue, and one that requires action.

“If there is one thing that unites our divided world, it’s that we’re all increasingly feeling the heat. Earth is becoming hotter and more dangerous for everyone, everywhere. We must rise to the challenge of rising temperatures – and step up protections for workers, grounded in human rights,” explained the UN Secretary General, Antonio Guterres.

The ILO report looks at legislative measures in 21 countries worldwide to find common features that can guide the creation of effective workplace heat safety plans. It also describes the key concepts of a safety and health management system to protect workers from heat-related illnesses and injuries.

The findings build on a previous report, published in April this year , which indicated that climate change was creating a “cocktail” of serious health hazards for an estimated 2.4 billion workers who are exposed to excessive heat. The April report indicated that excessive heat alone causes 22.85 million occupational injuries and the loss of 18,970 lives each year.

Report findings per region:

• Workplace exposures to excessive heat in Africa were above the global average, affecting 92.9 per cent of the workforce.
• The Africa region has the greatest proportion of occupational injuries attributable to excessive heat, accounting for 7.2 per cent of all occupational injuries.
• The Americas region has seen the most rapidly increasing proportion of heat-related occupational injuries since the year 2000, with an increase of 33.3 per cent.
• The Americas also have a significant proportion of occupational injuries due to excessive heat, at 6.7 per cent.

Arab States

• Workplace exposures to excessive heat in the Arab States were above the global average, affecting 83.6 per cent of the workforce.

Asia and the Pacific

• Workplace exposures to excessive heat in Asia and the Pacific were above the global average, affecting 74.7 per cent of the workforce.

Europe and Central Asia

• Europe and Central Asia had the greatest increase in excessive heat exposure, with a 17.3 per cent increase between 2000 and 2020. This is almost double the global average increase of 8.8 per cent.
• The region has seen a rapid increase in the proportion of heat-related occupational injuries since 2000, with a 16.4 per cent increase.

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• Download multimedia assets:  Video News Offer with interviews with an ILO OSH Expert and with a greenhouse agricultural worker from Mexico, B-roll and  photos .
• Watch the UN Secretary-General's Call to Action on Extreme Heat

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• Copy URL https://www.pbs.org/newshour/economy/video-game-performers-are-going-on-strike-over-ai-concerns-heres-what-to-know

Video game performers are going on strike over AI concerns. Here’s what to know

LOS ANGELES (AP) — Hollywood’s video game performers voted to go on strike Thursday after negotiations with game industry giants that began nearly two years ago came to a halt over artificial intelligence protections.

Leaders of the Screen Actors Guild-American Federation of Television and Radio Artists have billed the issues behind the labor dispute — and AI in particular — as an existential crisis for performers. Game voice actors and motion capture artists’ likenesses, they say, could be replicated by AI and used without their consent and without fair compensation.

WATCH: Why artificial intelligence is a central dispute in the Hollywood strikes

The union says the unregulated use of AI poses “an equal or even greater threat” to performers in the video game industry than it does in film and television because the capacity to cheaply and easily create convincing digital replicas of performers’ voices is widely available.

“We’re not going to consent to a contract that allows companies to abuse AI to the detriment of our members. Enough is enough. When these companies get serious about offering an agreement our members can live — and work — with, we will be here, ready to negotiate,” SAG-AFTRA President Fran Drescher said in a statement Wednesday.

Here are five things to know about the strike, which starts at 12:01 a.m. Friday:

Who is covered under the contract?

The agreement covers more than 2,500 “off-camera voiceover performers, on-camera (motion capture, stunt) performers, stunt coordinators, singers, dancers, puppeteers, and background performers,” according to SAG-AFTRA.

Which game companies are involved?

The union had been negotiating with an industry bargaining group consisting of signatory video game companies, including divisions of Activision and Electronic Arts. Those companies are Activision Productions; Blindlight; Disney Character Voices; Electronic Arts; Productions Inc.; Formosa Interactive; Insomniac Games; Take 2 Productions; VoiceWorks Productions; ad WB Games.

The game companies have said that they were negotiating in good faith and had reached tentative agreements “on the vast majority of proposals.”

Not the first time video game actors have gone on strike

Wednesday’s labor action marks the second time SAG-AFTRA’s video game performers have gone on strike. Their first work stoppage, in October 2016, began after more than one year of negotiations failed. The union and video game companies reached a tentative deal 11 months later, in September 2017. At the time, the strike — which helped secure a bonus compensation structure for voice actors and performance capture artists — was the longest in the union’s history, following the merger of Hollywood’s two largest actors unions in 2012.

What are performers asking for?

SAG-AFTRA has said that some of the key issues include securing wages that keep up with inflation, protections around “exploitative uses” of artificial intelligence and safety precautions that account for the strain of physical performances as well as vocal stress. Union negotiators told The Associated Press that they had made gains in bargaining over wages and job safety, but that the game studios refused to “provide an equal level of protection from the dangers of AI for all our members.”

The signatory companies refused to extend AI protections to on-camera performers, the union said.

“They’re saying we’ll protect voiceover performers, but we won’t protect anybody else,” Duncan Crabtree-Ireland, SAG-AFTRA’s executive director, said in an interview last month. “The bottom line is if you have performers working for you, helping create the content that’s in your game, whether it’s voice content, whether it’s stunt work, whether it’s motion work…all of those performers deserve to have their right to have informed consent and fair compensation for the use of their image, their likeness or voice, their performance. It’s that simple.”

AI is the sticking point

Although the unchecked use of artificial intelligence has been a sticking point in talks, voice actors and members of the union negotiating committee have said they are not anti-AI. The performers are worried, however, that unchecked use of AI could provide game makers with a means to displace them — by training an AI to replicate an actor’s voice, or to create a digital replica of their likeness without consent.

READ MORE: Why artists are pushing for U.S. copyright reforms amid proliferation of AI models

Some also argue that AI could also strip less experienced actors of the chance to land smaller background roles, such as non-player characters, where they typically cut their teeth before landing larger roles. The unchecked use of AI, performers say, could also lead to ethical issues if their voices or likenesses are used create content that they do not morally agree with.

SAG-AFTRA created a separate contract in February that covered indie and lower-budget video game projects. The tiered-budget independent interactive media agreement contains some of the protections on AI that video game industry bargaining group rejected.

The union also announced a side deal with AI voice company Replica Studios in January that enables major studios to work with unionized actors to create and license a digital replica of their voice. It also sets terms that allow performers to opt out of having their voices used in perpetuity.

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When Tech Fails, It Is Usually With a Whimper Instead of a Bang

While in some corners of Silicon Valley people worry about the risks of A.I., a simple failed software update caused a worldwide outage.

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By David Streitfeld and Kate Conger

Reporting from San Francisco and New York

For a couple of years now, the artificial intelligence community has been warning that there is a chance their work will go south and humanity will end in a conflagration worthy of a superhero movie.

Friday brought a pointed reminder that disaster is at least as likely to creep in quietly, perhaps from a piece of technology so mundane that hardly anyone knows it exists.

Our lives are built on systems piled on systems. As we board airplanes, cross bridges, pay bills, download updates, track our children at camp and generally try to make it through the day, we take them for granted.

Until they fail.

This week’s global software outage, immediately proclaimed as the biggest in history, was not caused by terrorists or A.I. or rogue hackers demanding billions in ransom. It wasn’t even done as a lark by some off-the-charts smart teenager. Those are the Hollywood versions. Instead, it was a routine upgrade that somehow went off the rails.

CrowdStrike, a Texas company, specializes in protecting corporate clients from cyberthreats. It has been very successful at this. This time, though, the threat came from CrowdStrike itself, a problem for which it seemed unprepared.

The trouble began with a small Windows software update CrowdStrike sent to its customers on Thursday night. For some reason, this crashed every computer it touched. “Your PC ran into a problem,” users were cheerily informed. “It looks like Windows didn’t load correctly,” messages announced. The backdrop was the color of a perfect sky, also known as the Blue Screen of Death.

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