Organizational Stress Around the

World

Stress is defined as a feeling experienced when a person perceives that demands

exceed the personal and social resources the individual is able to mobilize. It can
occur due to environmental issues, such as a looming work deadline, or
psychological, for example, persistent worry about familial problems. While the
acute response to life-threatening circumstances can be life-saving, research
reveals that the body’s stress response is largely similar when it reacts to less
threatening but chronically present stressors such as work overload, deadline
pressures, and family conflicts. It is proffered that chronic activation of stress
response in the body can lead to several pathological changes such as elevated
blood pressure, clogging of blood vessels, anxiety, depression, and addiction.
Organizational Stress Around the World: Research and Practice aims to
present a sound theoretical and empirical basis for understanding the evolving
and changing nature of stress in contemporary organizations. It presents research
that expands theory and practice by addressing real-world issues across cultures
and by providing multiple perspectives on organizational stress and research
relevant to different occupational settings and cultures. Personal, occupational,
organizational, and societal issues relevant to stress identification along with
management techniques/approaches to confronting stress and its associated
problems at the individual and organizational levels are also explored.
It will be of value to researchers, academics, practitioners, and students
interested in stress management research.

Kajal A. Sharma is the Associate Head of the Organizational Studies and

Human Resource Management Department in the Portsmouth Business
School at the University of Portsmouth, United Kingdom.

Cary L. Cooper is a 50th anniversary Professor of Organizational

Psychology and Health in Manchester Business School at the University of
Manchester, United Kingdom.

D.M. Pestonjee is a GSPL Chair Professor in the School of Petroleum

Management at Pandit Deendayal Petroleum University, Gandhinagar,
India.
Routledge Studies in Management, Organizations,
and Society

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Alexander Styhre
Organizational Culture and Paradoxes in Management
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The Democratic Organisation
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Thomas Diefenbach
Management and the Sustainability Paradox
David M. Wasieleski, Paul Shrivastava, and Sandra Waddock
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Organizational Stress Around the World
Research and Practice
Edited by Kajal A. Sharma, Cary L. Cooper, and D.M. Pestonjee
Public Administration and Epistemology
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Organizational Stress
Around the World
Research and Practice

Edited by Kajal A. Sharma,

Cary L. Cooper,
and D.M. Pestonjee
First published 2021
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to be identified as the authors of the editorial material, and of the
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Names: Sharma, Kajal Anurag, 1982- editor. | Cooper, Cary Lynn,
1940- editor. | Pestonjee, Dinyar Minocher, 1939- editor.
Title: Organizational stress around the world : research and practice /
edited by Kajal A. Sharma, Cary L. Cooper and D.M. Pestonjee.
Description: 1 Edition. | New York : Routledge, 2021. | Series:
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Includes bibliographical references and index.
Identifiers: LCCN 2020034948 (print) | LCCN 2020034949 (ebook)
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Subjects: LCSH: Job stress.
Classification: LCC HF5548.85 .O747 2021 (print) | LCC HF5548.85
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Contents

Tables viii
Figures x
Contributors xi
Foreword xxi
Acknowledgments xxv

1 Introduction 1
Kajal A. Sharma, Carry L. Cooper, and
D.M. Pestonjee

2 “She’ll Be Right, Mate!”: Occupational Stress

Research in Australia 7
Paula Brough, Mitchell Raper, and
Jason Spedding

3 Work Stress Research in Brazil 23

Maria Cristina Ferreira, Helenides Mendonça,
Ronald Fischer, and Leonardo Fernandes Martins

4 Job Stressors in Greater China: An Explorative

Study Using the Qualitative and Quantitative
Approaches 43
Chang-qin Lu, Oi-ling Siu, Hai-Jiang Wang,
and Luo Lu

5 The Causes and Consequences of Organizational

Stress: The Case of Greece 62
Ritsa Fotinatos-Ventouratos
vi Contents
6 Work Stress: A Systematic Review of Evidence
from India 80
Kajal A. Sharma

7 Organizational Stress in Contemporary Japan 128

Tsuyoshi Ohira, Tetsushi Fujimoto, and
Tomoki Sekiguchi

8 Organizational Stress: A Critical Review

from Nigeria 145
Chianu H. Dibia, Emeka S. Oruh, Omotayo
A. Osibanjo, and Ojebola Oluwatunmise

9 Increasing Work-Related Stress in the

Netherlands and Belgium: How Do These
Countries Cope? 167
Irene L.D. Houtman, Christophe Vanroelen,
and Karolus O. Kraan

10 Occupational Stress, Coping Strategies, and the

Impact of Culture in the Middle East: A Systematic
Review of Evidence from Oman 194
Kaneez Fatima Sadriwala and Mustafa Malik

11 Occupational Stress, Health, and Well-Being

Research in Portugal: A Qualitative Systematic
Literature Review 221
Maria José Chambel, Vânia Sofia Carvalho, and
Mariana Neto

12 Organizational Stress in Russia 268

Natalia Ermasova, Natalia Rekhter, and
Sergey Ermasov

13 Occupational Stress in South Africa: From the

Past to the Fourth Industrial Revolution 284
Claude-Hélène Mayer and Rudolf M. Oosthuizen

14 Organizational Stress in the United States of

America Research and Practice 303
James C. Quick
 Contents vii
15 Key Issues and Future Research 318
Kajal A. Sharma, Carry L. Cooper, and
D.M. Pestonjee

Index 330
Tables

3.1 Characterization of workers composing the samples 28

3.2 Stressors adopted in the studies 29
3.3 Work stress reactions adopted in the studies 30
4.1 Results of open-ended interviews in Study 1
(N = 91, total incidents = 88) 47
4.2 Results of descriptive statistics in Study 2
(N = 379) 49
4.3 Intercorrelations of Chinese stressors in
Study 2 (N = 379) 50
4.4 Summary of fit statistics for measurements of
Chinese job stressors in Study 2 (N = 379) 50
4.5 Intercorrelations of main variables in Study 3
(N = 1,032) 53
4.6 Results of regression analyses in Study 3
(N = 1,032) 54
6.1 Stressor identifies in studies 87
6.2 Consequences of stress 92
7.1 The average annual number of hours worked by
individual workers and the proportion of workers working
49 hours or more weekly in developed counties 131
8.1 Summary of stressors/strains and coping
mechanisms identified within reviewed studies
on organizational stress in Nigeria 162
9.1 Trends in different demands and control
indicators (percentages for high risk) for
Belgium and the Netherlands 170
9.2 Evolution in the prevalence of “acute problematic”
risk factors and workability outcomes
among Flemish employees (2004–2016) 180
9.3 Psychosocial risk factors present in enterprises
(% establishments) 180
9.4 Measures implemented to prevent psychosocial
risks during the last three years (% establishments) 181
10.1 Reliability statistics 202
 Tables ix
10.2 KMO and Bartlett’s Test 203
10.3 Stress level 203
10.4 Gender 203
10.5 Education 204
10.6 Nationality 205
10.7 Occupation 205
10.8 Do you feel that your life is interesting? 205
10.9 Do you think that you have achieved the
standard of living and the social status that
you had expected? 206
10.10 Do you feel you can manage situations even
when they do not turn out as expected? 206
10.11 Do you feel easily upset if things don’t turn
out as expected? 206
10.12 Do you feel disturbed by the feeling of anxiety
and tension? 207
10.13 Do you consider your family as a source of help
to you in finding solutions to most of the
problems you have? 207
10.14 Do you sometimes worry about your health? 207
10.15 Are you troubled by disturbed sleep? 208
11.1 Summary of reviewed studies 224
11.2 Two-step cluster analysis 250
Figures

3.1 Flowchart of survey strategy and inclusion of studies 25

3.2 Temporal distribution of the articles reviewed 27
3.3 Distribution of articles by knowledge area 27
3.4 Research methodology adopted in the studies 28
6.1 Yearly distribution of articles reviewed 83
6.2 Type of organizations studied 84
6.3 Work sectors studied 85
6.4 Research methods used in studies 85
6.5 Research methodologies applied in studies 86
9.1 Mean levels of burnout in Europe (scale 1–5) 169
9.2 Psychosocial risks in the Netherlands and Belgium as
compared to the rest of Europe 176
9.3 Trends in burnout complaints among a representative
sample of Dutch employees 177
9.4 Relative evolution of disabled workers in Belgium
1999–2018 179
10.1 Low, moderate, and high-stress score 204
10.2 Behavioral changes 208
10.3 Coping strategies 209
11.1 Flow diagram of the systematic selection of studies 223
Contributors

Paula Brough is a Professor of Organizational Psychology in the School

of Applied Psychology at Griffith University in Brisbane, Australia.
Paula’s primary research and teaching areas are occupational stress
and coping, employee mental health and well-being, work
engagement, work-life balance, workplace conflict (e.g., bullying,
harassment, and toxic leadership), and the psychosocial work
environment. Paula assesses how work environments can be improved
via job redesign, supportive leadership practices, and enhanced equity
to improve employee health, work commitment, and productivity.
Paula has authored over 60 industry reports and over 100 journal
articles and book chapters and has produced 9 scholarly books based
on her research.
Jason Spedding is an organizational researcher currently completing his
PhD at Griffith University. His key research areas are in shared and
formal leadership processes, occupational stress, organizational
climate, and team dynamics in complex workplaces. He also has an
interest in advancing quantitative methodologies in occupational
health research through the application of multilevel modeling, the
Bayesian analysis, and the Monte Carlo simulation.
Mitchell Raper is a PhD candidate in organizational psychology at
Griffith University, Australia. His research focuses on occupational
stress and coping and how employee proactivity can reduce workplace
stress. In particular, he is interested in the categorization of workplace
stressors and how cognitive appraisals and future-oriented coping
impact daily well-being at work.
Maria Cristina Ferreira is a Professor and the Psychology Graduate
Program Coordinator at Universidade Salgado de Oliveira (Universo –
Niterói), Brazil, where she has been teaching and advising master and
doctoral students. Her work focuses on culture and positive
organizational behavior, with a special interest in Brazilian cultural
characteristics, well-being, engagement, and passion at work. She is a
xii Contributors
member of the Brazilian Society of Organizational and Work
Psychology.
Helenides Mendonça is a Professor at Pontifícia Universidade Católica
de Goiás (PUC Goiás), Brazil. She has been teaching and advising
undergraduate, master, and doctoral students at PUC Goiás. She was
a board member of the Brazilian Society of Organizational and Work
Psychology and held the following positions at PUC Goiás: Director
of Psychology Faculty and Dean of Institutional Development. Her
research focuses on the field of culture and positive psychology.
Particularly, she is interested in creativity, innovation in
organizations, and psychological well-being at work.
Ronald Fischer is a Professor in Psychology at Victoria University of
Wellington, New Zealand and is a Researcher at Instituto D’Or de
Pesquisa e Ensino, Brazil. His work focuses on cultural and evolutionary
dynamics, with a special interest in cultural similarities and differences
in values, norms, prosociality, and well-being. His work on culture has
been highly influential and he has been named as one of the top 10 most
highly cited researchers in culture and psychology. His latest book
entitled, “Personality, Values, Culture: An Evolutionary
Perspective,” appeared with Cambridge University Press.
Leonardo Fernandes Martins is a Professor at Universidade Salgado de
Oliveira (Universo – Niterói), Brazil. He has been lecturing and
advising undergraduate and master students at Universo – Niterói.
His work focuses on training health professionals to reduce social
stigma related to people who use alcohol and other drugs. He is a
member of the Latin American Network about Drugs and Stigma and
a member of the Association for Contextual Behavioral Science.
Chang-Qin Lu is a Research Professor at the School of Psychological and
Cognitive Sciences, Peking University, China. He received his PhD in
Industrial and Organizational Psychology from the Institute of
Psychology, Chinese Academy of Sciences. His research focuses
broadly on job insecurity, work stress, self-efficacy, spillover, and
crossover effects of work-family conflict/balance. His work has been
published in the Journal of Applied Psychology, the Journal of
Organizational Behavior, the Journal of Vocational Behavior,
Human Relations, and the Journal of Occupational and
Organizational Psychology, among others. Prof. Lu is currently the
Associate Editor of Applied Psychology: An International Review.
Professor Oi-ling Siu is Chair Professor of Applied Psychology and Dean
of Faculty of Social Sciences, Lingnan University. Her research
interests include occupational stress, work-life balance, and psychology
of safety. Prof. Siu was the Editor of the International Journal of Stress
 Contributors xiii
Management from 2015 to 2020 and Associate Editor of the Journal of
Occupational Health Psychology since 2015. She has published 80
journal articles and 23 book chapters.
Hai-Jiang Wang is an Associate Professor in the School of Management
at the Huazhong University of Science and Technology, Wuhan,
China. He received his PhD in Industrial and Organizational
Psychology from the Eindhoven University of Technology,
Netherlands. His research areas include job insecurity, job crafting,
leadership, and employee work engagement.
Professor Luo Lu received her PhD in Psychology from the University of
Oxford, United Kingdom, and she is currently the Distinguished
Professor in the Department of Business Administration, College of
Management, National Taiwan University, Taiwan. Her major
research interests are stress and adjustment, work stress and
occupational health, subjective well-being, and culture and self. She
has published more than 190 referred journal papers and authored
over 30 books and book chapters. She is currently the Editor of the
International Journal of Stress Management (SSCI, APA journals), the
Senior Associate Editor of the Journal of Organizational Effectiveness:
People and Performance (ESCI, Scopus), and the Editor-in-chief of
Research in Applied Psychology(Taiwan).
Professor Ritsa Fotinatos-Ventouratos obtained her Doctorate Degree in
Organizational Psychology from the University of Manchester
Institute of Science & Technology (UMIST), United Kingdom. Her
areas of research lie in the field of psychological well-being at work,
occupational stress, gender differences, as well as investigating the
social impact of the changing and diverse nature of the world of work.
As a Professor employed at the Deree College, The American College
of Greece, she lectures in the areas of Industrial-Organizational
Psychology and Social Psychology. In addition to presenting her
research at international congresses and publishing in the domains of
work psychology, she serves as a member of the British Psychological
Society, International Relations Committee, for the Division of
Occupational Psychology.
Dr. Kajal A. Sharma is the Associate Head of Organisation Studies and
Human Resource Management Group at the University of
Portsmouth, United Kingdom. Prior to joining the University in
2010, she had seven years of work experience in India. Her research
areas are evaluating and enhancing HR systems in healthcare, work
stress, cross-culture management, and organizational culture. Her
work in these areas has been published on various platforms. She has
been a consultant to many private hospitals, delivering management
xiv Contributors
development programs for medics and non-medics on stress
management and has also steered Stress Audits Indian hospitals.
Professor Cary L. Cooper, CBE, is a 50th Anniversary Professor of
Organizational Psychology and Health at the Manchester Business
School, University of Manchester, United Kingdom. He is the
Founding President of the British Academy of Management,
President of the Chartered Institute of Personnel and Development
(CIPD), former President of RELATE, and the President of the
Institute of Welfare. He was the Founding Editor of the Journal of
Organizational Behavior, the former Editor of the scholarly journal
Stress and Health, and is the Editor-in-Chief of the Wiley-Blackwell
Encyclopaedia of Management, now in its’ 3rd Edition. He has been
an advisor to the World Health Organization, ILO, and EU in the field
of occupational health and well-being, and was Chair of the Global
Agenda Council on Chronic Disease of the World Economic Forum
(2009–2010) – then served for five years on the Global Agenda
Council for mental health of the WEF – and was Chair of the
Academy of Social Sciences 2009–2015. Professor Cooper is the Chair
of the National Forum for Health and Well-Being at Work which is
comprised of 40 global companies (e.g., BP, Microsoft, NHS
Executive, UK government, Rolls Royce, John Lewis Partnership,
etc.). Professor Cooper is the author/editor of over 250 books in the
field of occupational health psychology, workplace well-being,
women at work, and occupational stress. He was awarded the CBE
by the Queen for his contributions to occupational health, and in
2014, he was awarded Knighthood for his contribution to the social
sciences.
Professor D.M. Pestonjee, PhD, is currently associated with the School of
Petroleum Management, Pandit Deendayal Petroleum University,
Gandhinagar, as GSPL Chair Professor since July 2009. He is also
associated with CEPT University, Ahmedabad, as Dean of the Faculty
of Applied Management. He has served at eminent institutions like
IIM, Ahmedabad, and Banaras Hindu University. He is a psychologist
who has a PhD in Industrial Psychology from the Aligarh Muslim
University, and he was conferred the DLitt (Honoris Causa) by the
Banaras Hindu University in April 2003. In November 2000, he was
conferred the title of Honorary Professor of the Albert Schweitzer
International University, Geneva, Switzerland. He was awarded the
Albert Schweitzer Medal for Science and Peace in April 2004. He has
over four decades of teaching and research experience. Among his
better-known works are: Organization Structure and Job Attitudes
(1973), Behavioral Processes in Organization (1981), Second
Handbook of Psychological and Social Instruments (1988), Third
Handbook of Psychological and Social Instruments (1997), Studies in
 Contributors xv
Organizational Roles and Stress and Coping (1997), Studies in Stress
and Its Management (1999), and the celebrated Stress and Coping:
The Indian Experience (1992, 2002).
Tetsushi Fujimoto is a Professor of Sociology at the Graduate School of
Policy and Management, Doshisha University, Kyoto, Japan. His
research interests include the intersection of gender, work, and family.
He is currently investigating the non-linear patterns of career
development for Japanese women holding advanced degrees in
science and engineering. His article, co-authored by Sayaka
Shinohara and Tsuyoshi Oohira, entitled Work-Family Conflict and
Depression for Employed Husbands and Wives in Japan: Moderating
Roles of Self and Spousal Role Involvement received the 2015
Outstanding Author Contribution award in Contemporary
Perspectives in Family Research from the Emerald Group Publishing.
Tsuyoshi Ohira is a Postdoctoral Fellow of Organizational Behavior at
the Organization for Research Initiatives and Development and the
Department of Policy Studies, Doshisha University, Kyoto, Japan. His
research focuses on the effects of aging, technology, and social
interaction on organizational effectiveness including efficiency,
service quality, and employee retention.
Tomoki Sekiguchi is a Professor at the Graduate School of Management,
Kyoto University, Japan. His research interests include employee
behaviors, person-environment fit, cross-cultural organizational
behavior, and international human resource management. His work
has been published in such journals as Personnel Psychology,
Organizational Behavior, and Human Decision Processes, the
Journal of World Business, Management International Review, and
the International Journal of Human Resource Management. He
currently serves as the Co-Editor-in-Chief of Applied Psychology:
An International Review, the Vice President (Asia) of the Euro-Asia
Management Studies Association (EAMSA), and the Vice President of
the Association of Japanese Business Studies (AJBS), among many
other positions.
Chianu Harmony Dibia (BSc, MSc, PhD) teaches Organizational Studies
and Human Resource Management at the University of Portsmouth,
United Kingdom. His research focuses on human resource
management, lean manufacturing, and employee working conditions
in organizations operating in Nigeria.
Emeka Smart Oruh is a Lecturer in Organizational Studies and Human
Resource Management at the University of Portsmouth Faculty of
Business and Law, United Kingdom. He obtained his PhD in
Employment Relations (ER) and Human Resource Management
xvi Contributors
(HRM) at Brunel University London, United Kingdom. His key
research examines ER, OB, and HRM issues within international
business, particularly in emerging markets. Dr. Smart has authored
several publications – some of which have appeared in reputable
international journals such as the International Journal of Human
Resource Management and Employee Relations.
Omotayo Adewale Osibanjo is an Associate Professor in the Department
of Business Management at Covenant University, Nigeria. He
obtained a Doctorate degree of Philosophy in Management at Babes
Bolyai University, Cluj-Napoca, Romania under the scholarship of the
Romanian Government in the year 2008. His research focuses on
human resource management, industrial relations, communication,
and management.
Ojebola Oluwatunmise is a doctoral student in the Department of
Business Management at Covenant University, Nigeria. He obtained
his first degree in Business Administration at Ambrose Alli University,
Nigeria, and his second degree in Project Management at Virginia
International University, United States. His research focuses on
human resource management, organization behavior, industrial
relations, and management.
Irene Houtman has been working at TNO since 1990. After her PhD on
Stress and Coping in Lecturing at the Free University in Amsterdam in
1990, she was involved in many large-scale projects at TNO on
occupational risks at work, often with particular emphasis on
psychosocial risks, mental health, and prevention of occupational
risks as well as stimulating return to work. These projects are financed
by national and international funds. From 1995 onwards, she has
been working at TNO as a senior researcher.
Christophe Vanroelen is an Associate Professor and the Director of
Interface Demography – a research center connected to the
Department of Sociology of the Vrije Universiteit Brussel. He holds
a PhD in Social Health Sciences and Master’s Degrees in Sociology
and Applied Social Science Statistics. He collaborated in several
scientific research projects regarding socioeconomic health
inequalities, work-related health, and job quality. His current
research focuses predominantly on the quality of work and
employment as determinants of health and well-being among
workers.
Karolus Kraan has been working at TNO since 1998 as a Research
Scientist. During these years, he has conducted a large number of
studies on working conditions, work organization, and technology, in
relation to health and well-being outcomes. He is well familiar with
 Contributors xvii
many large-scale surveys among employees and employers – both
national and international. He has also conducted a lot of cross-
country studies – for instance, on behalf of the Dutch Ministry of
Employment and Social Affairs, the European Commission, and
European agencies.
Kaneez Fatima Sadriwala is an Associate Professor in Accounting, Acting
Head of the Department of Accounting. Dr. Kaneez Fatima works in
the field of accounting, business statistics, marketing, and management.
Her research span is multidisciplinary, ranging from financial analysis,
accounting for SMEs, e-Learning, entrepreneurship, stress
management, work-life balance, students' learning process, and
measurement of learning outcome to accounting ontology, etc. She,
along with her student team, won TRC FURAP awards twice for Best
Research Project, one in the year 2015, and followed by another in the
year 2018. She has published two books, Marketing Management and
Mall Management from Himalaya Publishers, with several research
papers on national and international platforms. She is a renowned
orator and has represented the university on various international
platforms. Dr. Kaneez Fatima received her Master’s Degree in
Commerce (Accounting and Business Statistics) in 1991 and her PhD
degree in Commerce (Business Administration) from Mohanlal
Sukhadia University, Udaipur, India in 2004, and FDP from Indian
Institute of Management (IIMA), India in 2009 and served as Professor
cum Director at Aravali Institute of Management, Udaipur, India prior
to joining the University of Nizwa in February 2010.
Mustafa Malik has been teaching in the areas of tourism and sustainable
development, tourist consumer behavior, and marketing of tourism
services. He has been teaching Tourism Management courses for the
past seven years. Dr. Mustafa received his PhD degree in Commerce
(Tourism Management) from Aligarh Muslim University, India in
2004 and his Master’s degree in Tourism Administration (MTA) from
Aligarh Muslim University, India in 2001. He has also qualified at the
UGC-NET examination in Tourism Management in 2004. He is a
two-time recipient of the University Medal from Aligarh Muslim
University (AMU) for securing 1st position in B.Sc (Hon’s) 1999 and
in MTA 2001.
Maria José Chambel is an Associate Professor at the Faculty of
Psychology, the University of Lisbon in Lisbon, Portugal. She has a
PhD in Social Psychology and teaches work and organizational
psychology and occupational health psychology. She is a member of
the Research Center of Psychology Science of the University of Lisbon
(CicPsi), where she coordinates the group of Adaptation Process in
Context (Applied Psychology) and has participated in several research
xviii Contributors
projects. Her main research interests include subjects such as
employment relations and stress and well-being at work.
Vânia Sofia Carvalho is an Assistant Professor at the Faculty of
Psychology, University of Lisbon, Portugal. She has a PhD in
Human Resources, Work and Organizational Psychology and teaches
in the field of work and organizational psychology. She is a member of
the Research Centre of Psychology Science of the University of Lisbon
(CicPsi) and the Institute of Cognitive Psychology (IPCDHS/FPCE,
University of Coimbra). Her research focuses on work-life
intersectionality with boundary management, job design, and
organizational supportive cultures to advance employees’ well-being.
Mariana Neto is a Public Health Doctor and an Occupational Medicine
Specialist working at the National Institute of Health Doutor Ricardo
Jorge, Portugal, where she is the Coordinator of the Health
Observation and Epidemiological Surveillance Unit of the Epidemiology
Department. She has Master of Science degrees in Public Health and
Organizational Behavior. She has also a PhD in Environmental Health.
She is directly responsible for the National Health Interview Survey at
the Ministry of Health and for the health household panel survey
(ECOS) among others. Her research interests are mainly related to the
fields of mental health, social determinants of health, occupational
health, and the effects of environmental risks on health.
Natalia Ermasova is an Associate Professor at Governors State University,
Illinois, United States. She received a PhD for Public Affairs at the Indiana
University, United States and a PhD for Economics at the Saratov State
Technical University, Russia. Her primary research interests are strategic
management, business ethics, public finance, risk management, innovation
management, and the state capital budgeting. Before starting her work in
the United States, she worked as a Professor of Finance in the Volga
Region Academy for Civil Services in Russia for 12 years and as a
Professor of Saratov State University for 2 years. She was a Visiting
Professor in the Ludwigsburg Academy for Civil Services, Germany, a
Fulbright Visiting Professor at the SPEA, Indiana University in Indiana and
the Corvinus University in Hungary. She has published more than 30
articles in the United States and more than 45 books and articles in Russia.
Her articles were published in the Journal of Management Development,
State and Local Government Review, Public Organization Review, World
Review of Business Research, Post-Communist Economies, and the SAM
Advanced Management Journal.
Natalia Rekhter obtained her Master's Degree in Health Services
Administration from the University of Michigan, Ann Arbor and
her PhD in Higher Education from Indiana University, Bloomington.
Currently, she is an Assistant Professor and a Director of the
 Contributors xix
Undergraduate Health Administration program at the Governors
State University. Natalia's research interests include the use of social
media for education and health maintenance. She is a recipient of ten
grants, two Fulbright Specialist awards, and an author of several
research articles. She also has over a decade's worth of healthcare
industry experience.
Sergey Ermasov has a PhD in Economics, Russia. He is a teacher at the
Russian School of Indiana. He has worked as a Professor of the
Finance Department at Saratov State University, Russia since 2007.
He worked as an Associate Professor of Finance at the Saratov
Economic University from 1992 to 2007. His primary research
interests are innovation management, risk management, project
management, and insurance. Dr. Ermasov is the author of several
books on insurance, innovation management, and financial management.
He has published more than 50 articles in Russia.
Claude-Hélène Mayer (Dr. Habil., PhD) is a Professor in Industrial and
Organizational Psychology at the Department of Industrial Psychology
and People Management at the University of Johannesburg, an Adjunct
Professor at the European University Viadrina in Frankfurt (Oder),
Germany, and a Senior Research Associate at Rhodes University,
Grahamstown, South Africa. She holds Master’s degrees in MA
Cultural Anthropology (MA) and Crime Sciences (MSc), PhD’s in
Psychology and Management, a Doctorate in Political Sciences and a
Habilitation in Psychology with focus on work, organizational, and
cultural psychology. She has published work on transcultural mental
health and well-being, a sense of coherence, shame, transcultural
conflict management and mediation, women in leadership, the Fourth
Industrial Revolution, and psychobiography.
Rudolf M Oosthuizen received a BA degree (cum laude) from the
University of Pretoria, South Africa in 1992 and obtained a B.A.
Honors in Psychology at the same university in 1993. In 1999, he
received an MA degree in Industrial and Personnel Psychology from
the Potchefstroom University for Christian Higher Education. In
1999, he registered as an Industrial Psychologist with the Health
Professions Council of South Africa. In 2005, he completed a DLitt et
Phil in Industrial and Organizational Psychology at the University of
South Africa (Unisa). Currently, Rudolf is an Associate Professor in
the Department of Industrial and Organizational Psychology at the
University of South Africa. Rudolf’s fields of interest are career
psychology, positive psychology, employment relations, and the
Fourth Industrial Revolution.
James Campbell Quick is a Distinguished University Professor and
Professor Emeritus at the University of Texas at Arlington and a
xx Contributors
Professor at the Alliance Manchester Business School, The University
of Manchester, United Kingdom. Dr. Quick and his brother Jonathan’s
signature work is the Theory of Preventive Stress Management (TPSM).
His awards include the 2016 Regents Outstanding Teaching Award
(The University of Texas System) and the Maroon Citation (Colgate
University). Dr. Quick is a Fellow of the American Psychological
Association. Colonel Quick retired from the United States Air Force.
His highest military award is the Legion of Merit. Dr. Quick is married
to the former Sheri Grimes Schember.
Foreword

“Organizational stress” is commonly defined as an emotional, cognitive,

behavioral, and physiological response to noxious aspects of work, work
environment, and organizational climate. As amply documented in this
highly important and timely volume, there is no doubt that occupational
stressors have been – and still remain – major determinants of human
morbidity and mortality worldwide. The World Economic Forum (2020)
publishes annual reports on “Global Risks” facing mankind and our
planet, however, without including working-life related risks – except
“unemployment” – in its graph. One of the many complex, powerful and
interacting risks included (see Figure 1) is “Infectious diseases,” such as
the Covid-19 pandemic. This pandemic’s direct and indirect impacts on
productive employment, unemployment, and occupational and public
health are likely to become both severe and long-lasting.
To counteract such global risks – as well as the present mounting
disaffection and disruption across the world partly due to short-term and
silo thinking by many elites – all 193 member states of the United
Nations have agreed on Agenda 2030, comprising 17 very ambitious
Sustainable Development Goals (SDGs) and 169 targets (United
Nations, 2015).
The SDGs are concerned with a wide multitude of stressors, and
accordingly intend to reach an entire “package” of interacting goals: end
poverty, end hunger, encourage good health and well-being, provide
quality education, promote gender equality, provide clean water and
sanitation, promote affordable and clean energy, provide decent work
and economic growth, address industry, innovation, and infrastructure,
reduce inequalities, develop sustainable cities and communities,
encourage responsible consumption and production, take action on
climate change, promote life below water, promote life on land, work
towards peace, justice, and strong institutions, and create partnerships to
achieve these goals (United Nations, 2015).
xxii Foreword

Figure 1 Global risks.

However, recent political changes put this hope at risk. To increase the
likelihood of success for these 17 SDGs, higher education institutions
worldwide must teach and train today’s students – tomorrow’s decision-
makers – to think both critically and ethically, to learn to cope with
ethical dilemmas, and to apply systems-thinking approaches to serious
and complex societal problems (Levi & Rothstein, 2018; Levi, 2020).
Needless to say, the resulting stress and/or otherwise pathogenic
effects of noxious exposures also depend on our resilience and coping
 Foreword xxiii
ability. Such aspects remain important targets for disease prevention and
health promotion.
However, they can never replace the situational factors focused on in
this Foreword.
Students need to be made aware of the local, regional, and global
contexts in which they live and make decisions. Many of today’s students
do not grasp their role in, and their responsibility to, the world – and a
large number do not seem to care.
A single course at college can only be the beginning. Families, media,
religious bodies, primary and secondary schools, and workplaces as well
as higher education institutions must be educated and recruited to play
their part.
The 2030 Agenda for Sustainable Development aims to promote the
entire cluster of 17 SDGs and 169 targets. The critical-ethical analytic
skills and systems-based approach mentioned above are indispensable
prerequisites to achieving this.
By “critical” we may refer to “the application of careful, exact
evaluation and judgment” (cf. Paul & Elder, 2013). By “ethical” we
may refer to “a set of principles about the right way to behave” (cf.
United Nations, 1948). By “systems” we may refer to “a group of
interacting, interrelated, or interdependent elements forming a complex
whole” (OECD, 2017). Accordingly, systems-thinking is based on the
recognition of interconnectedness and systems processes.
The International Association of Universities (IAU) – with more than
640 member universities world-wide – has designated 16 lead
universities, each taking on one of the SDGs and each in collaboration
with a cluster of allies for its specific purpose – combing economic, social,
and environmental sustainability. Integrating all of this (SDG # 17)
remains a task for IAU.
Similarly, the European Branch of the World Health Organization
(WHO), has requested its Regional Director to “take the leading exploring
ways to bring together policymakers from other sectors responsible for the
determinants of health, including education, housing, employment, the
environment, and poverty reduction, in order to develop a systematic
approach to taking action.”
But as a Chinese proverb formulates it, “words do not cook rice.”
There exists a very considerable gap between what we know and what
we implement (Levi, 2017).
Recognizing the university sector´s potential and responsibility to help
shape the moral contours of society for the better and given the societal
benefits from increased social capital, they should endorse a cross-faculty
approach to broaden the curricula to include components of critical-
ethical analysis and systems thinking to implement Agenda 2030, with,
for example, Hedenus et al. (2019) as required reading.
xxiv Foreword
But do we have a mandate? The answer is yes, from the United
Nations and from all 193 Member States (Target # 4.7): “Ensure that all
participants acquire by 2030 the knowledge and skills needed to
promote sustainable development and lifestyles, including education in
human rights, gender equality, peace, nonviolence, global citizenship,
appreciation of diversity, and respect for the role of culture.”
As wisely put by Harari (2015), “starvation, war, and disease have
been transformed from incomprehensible forces of nature – to problems
that can actually be solved.” So, dear Reader, please, just start doing it!
Lennart Levi; MD, PhD
Emeritus Professor of Psychosocial Medicine (Karolinska Institutet)

References
World Economic Forum. (2020). The Global Risks. Insight Report. 15th Edition.
Levi, L., & Rothstein, B. (2018). To cope with present and future catastrophic
risks – Higher education must train future decision makers to think critically,
ethically and in systems. World Academy of Art and Sciences Rome conference
proceedings 13–15. http://worldacademy.org/files/rome2017/papers/RCP-
compiled-papers.pd.
Levi, L. (2019/2020). Stressors at work and elsewhere – A global survival ap­
proach. The American Institute of Stress: Contentment Magazine, Winter,
pp. 46–51.
United Nations. (1948). Universal Declaration of Human Rights. General
Assembly Resolution 217 A.
OECD. (2017). Systems approach to public sector challenges: Working with
change. Paris: OECD Publishing. https://doi.org/10.1787/9789264279865-en.
Levi, L. (2017). Bridging the science-policy and policy-implementation gaps.
In Cooper, C. L. & Campbell Quick, J. (Eds.). The handbook of stress and
health – A guide to research and practice. Wiley.
Paul, R. & Elder, L. (2013). Critical thinking. FT Press.
European Commission. (2020). The EU Budget Powering the Recovery Plan for
Europe. COM, 442 Final.
WHO. (2019). Regional Office for Europe: Resolution EUR/RC69/R5.
Acknowledgments

The current health and well-being scenario in our globalized world calls
for a collective and thoughtful approach by multiple stakeholders to
prevent and manage negative health outcomes for the world population.
Although there is voluminous literature on work stress and its significant
impact on the workforce, there are glaring national differences in stress
research and practice. In developed countries, we see a close collaboration
between policymakers and other stakeholders at all levels – working on
defining health priorities, identifying action plans, recognizing drivers and
barriers to change, and implementing strategic interventions at national,
regional, organizational, and individual levels. However, in most of the
developing countries, policymakers have only recently come to recognize
the full-scale of the impact of work stress on society. Hence we are seeing
increasing discussions on issues related to the rights of workers, improving
working conditions, introducing new legislation, the challenges of formal
and informal workforce, the need for public-private partnership, discourse
with other social partners, international research collaborations, raising
stress awareness in workers, responsible and responsive organizations,
and the implementation of effective stress management initiatives. Such
dissimilarities in identification, prevention, management, and treatment of
stress in societies mean that there is a considerable research gap.
We hope that, by providing an overview of organizational stress
research and stress management initiatives from different countries, this
volume will prove useful to academics, students, and practitioners alike.
With this book, we aim to facilitate the development of stress management
research and education, while also developing practitioner knowledge on
the importance of stress and stress management in a global environment.
We extend our thankfulness to all our international contributors for
sharing their latest thinking with us and making this effort successful.
We would like to say a special thank you to Professor Lennart Levi for
graciously writing the foreword for our book. We are also grateful to
publishing team who helped in preparing the final versions of the
manuscript.
xxvi Acknowledgments
Cary would also like to thank all his international students who
contributed to his research over the years.
Dinyar would also like to thank all his colleagues, students, and family
for their support.
Finally, I would like to thank my Dad, who gave me the best things in
life – his time, his care, and his love and to my husband, Anurag, for his
unconditional love and motivation.
Kajal A. Sharma
Cary L. Cooper
D.M. Pestonjee
1 Introduction
Kajal A. Sharma, Cary L. Cooper,
and D.M. Pestonjee

Stress has been accepted as a reality of modern work life. It is not a new
problem but has aggravated in recent years and reached epidemic pro-
portions. Today it is recognized as a massive health and safety challenge,
and all countries are attempting to establish various strategies to over-
come it. In a survey conducted by the International Labour Organization
(2016), over 90% of participants acknowledged that work stress was a
concern in their country, and nearly 70% of respondents reported that it
was a source of higher concern in specific sectors like healthcare, edu-
cation, services, finance, retail trade, transport, construction, and the
public sector in general. The World Health Organisation’s report
(2017a, 2017b) states that work-related health problems result in an
economic loss of 4–6% of GDP for most countries. Hence, work stress is
now recognized as an issue with global impact.
The modern, dynamic, complex, and stressful world of work has its
roots in many old and new developments around the world. The de-
veloped economies, like the United States, United Kingdom, and other
European countries, are currently facing economic uncertainty and
minimal growth whereas emerging economies, like China, India, Russia,
and Brazil, are expanding but have regional concerns resulting in chal-
lenges. Moreover, factors like rapid globalization, technological ad-
vancement, the rise of consumerist society, and climate change, to name
a few, are also influencing the world of work. Such changes test the
sustainability of organizations and drive their strategic choices like
mergers, acquisitions, downsizing, restructuring, offshoring, out-
sourcing, the use of a temporary workforce, and many others. These
circumstances have a profound impact on employees who face financial
concerns, fewer choices, less control, job insecurity, unrealistic and
multiple job demands, constant competition, and the continually chan-
ging nature of work and the work environment. All this translates into
pressure at work for employees. Additionally, such employees receive
little support from their managers and colleagues, and their fundamental
needs, like recognition and respect at work, are not met due to work
intensification (Semmer, 2007). Many work stressors like workload,
DOI: 10.4324/9780429292538-1
2 Kajal A. Sharma et al.
family-work conflict, increasing work intensity, leadership styles,
workplace conflict, organizational downsizing, restructuring, and orga-
nizational mergers have been identified across cultures and outcomes
have typically considered job satisfaction, commitment, psychological
health, work-family balance, and withdrawal behaviors (Burke, 2010).
Results reveal that as increased work demands exceed employees’ ca-
pacity and ability to cope, it often leads to distress.
Painful experiences at work lead to various emotional, cognitive, be-
havioral, and physiological fallouts (Kompier & Marcelissen, 1990)
in employees. The effects of stress on employees are well documented in
literature. Ailments like frequent headaches, hypertension, obesity, in-
creased heart rate, blood pressure, and cardiac arrest are linked to stress.
Moreover, many health problems like anxiety, emotional disorders,
musculoskeletal disorders, depression, burnout, and work-life imbalance
in employees are also caused due to stress experienced at work. Belief in
optimal levels of stress has been exploited, on various occasions by the
organizations to justify poor management practices, but stress also has
far-reaching consequences on the organization in terms of low motiva-
tion and productivity, an increase in health cost, and employee turnover
(Sharma & Cooper, 2016). A report by the Health and Safety Executive
(2019) suggested that in 2018/2019 stress, depression, or anxiety ac-
counted for 44% of all work-related ill health cases, and 54% of all
working days are lost due to employee ill health in the United Kingdom.
Research in Malaysia concluded that the cost of absenteeism and pre-
senteeism equated to 4.5% of the GDP in 2015 (Wee et al., 2019), and
according to the Japanese Ministry of Health, Labor, and Welfare, work-
related suicide (known as Karo-Jisatsu – suicide due to overwork and
stressful working conditions) has become a social concern. Depression,
sickness absence and presenteeism problems cost Australian employers
approximately AU$8 billion per year, and of that figure, AU$693 million
is due to job strain and bullying (Dollard et al., 2012). A Canadian study
(Anderssen, 2011) estimated that mental health problems cost employers
about CA$20 billion annually. These results reflect that work stress leads
to human distress and diminished economic performance globally.
Organizations have realized that they cannot eliminate stress from
employees’ work life, but, at the same time, they cannot afford to be
passive - as a decline in employee mental and physical health invariably
leads to a decline in the organization’s productivity and competitiveness.
According to the WHO (2019), negative working environment in or-
ganizations may lead to physical and mental health problems, use of
harmful substances or alcohol, absenteeism, and lost productivity in
employees; whereas, workplaces that promote employee mental health
are more likely to reduce absenteeism, increase productivity, and benefit
from associated economic gains. Hence, organizations have now con-
centrated energies toward creating a healthier work environment where
 Introduction 3
there is a balance of job demands, resources, control, and support for
employees to thrive. Emphasis is on handling stress by limiting the
harmful conditions at work and endorsing health-promoting initiatives
by managing issues like work-life balance, developing social support
structures, mental health issues, diversity, and gender management.
Research by Spreitzer and Porath (2012) suggests that thriving em-
ployees are highly energized as they know how to avoid burnout.
Organizations can integrate the key components of a thriving
environment-vitality and learning as suggested by Spreitzer and Porath
(2012) in their culture to create healthy and creative work organizations.
Additionally, organizations can address this problem with a three-tier
approach of primary, secondary, and tertiary prevention strategies as
suggested by Cartwright and Cooper (2011). In the primary prevention
stage, organizations identify and minimize or eliminate the source of
employee stress. The secondary prevention stage consists of learning and
training related to stress management for employees. Lastly, the tertiary
prevention stage is comprised of rehabilitation of employees affected by
stress through various support mechanisms in the role and organization.
Organizations can select any intervention strategy; however, their key
initiatives should embrace elements like changing poor business prac-
tices, building healthy culture, acknowledging stress, and providing ap-
propriate support to employees experiencing stress caused by factors
both inside and outside the workplace. Organizational culture and
practices should focus on the physical and psychological safety of em-
ployees considering a whole-person approach. It is also important for
contemporary organizations to build a trusting and healthy work culture
wherein all employee groups – including women, BAME, and LGBT –
achieve physical and psychological safety. It is important to emphasize
that all employees should be trained on how to deal with stress at work,
but it is equally important to train managers so that they can be sensi-
tized to stress and mental health issues and illness at work, develop
critical skills like empathy to break down the employee stigma and build
trust, and effectively support employee well-being and welfare through
engagement, performance, resilience, and general happiness. The right
support received at the right time from the organization can help em-
ployees overcome stress, succeed, and thrive at work. Therefore, it
should be the organization’s prime responsibility to devise proactive
systems and strategies to support employees.
The current globally unfolding emergency caused by Covid-19 has
once again highlighted the social relevance of work stress and employee
health issues and has put the organization’s role in supporting employee
health at the forefront. As businesses struggle to survive during the
current pandemic, employers are also starting to realize the impact it has
had on the mental and physical health of employees. According to CIPD
(2020), early research on Covid-19 effects on employee health indicates
4 Kajal A. Sharma et al.
an increase in fatigue, musculoskeletal conditions, poor work-life bal-
ance, reduced exercise, increased alcohol consumption, reduced moti-
vation, loss of purpose and motivation, anxiety, and isolation. Such
health implications have the potential to significantly impact the ability
of many organizations to survive and cope during and post Covid-19
work and economic scenarios. However, timely and effective organiza-
tional policies and interventions to support employees achieve better
health and work-life balance can make a real difference under the current
circumstances. Recognizing workplace stress as a priority issue, this
volume presents chapters representing the work of authors from several
countries that offer an understanding of the evolving and changing
nature of work stress in contemporary organizations across different
countries. All contributors have reviewed country-specific organizational
stress literature and drawn comparisons with international literature
trends. We believe that issues raised concerning the nature of stress and
its management in the following chapters are thought-provoking and can
help organizations mitigate the barriers to creating healthy organizations
around the world that offer safe, empowering, enterprising, and sa-
tisfying work environments for employees.
The second chapter in this volume offers insights on common inter-
national trends and unique stress topics like the impact of geographic
distance, extreme heat, and threat from wildlife related to occupational
stress research in Australia. It also provides an understanding of the
primary flavors of contemporary occupational stress research conducted
in Australia. The third chapter is on Brazil, which presents a literature
review based on 118 studies published in the last decade. The discussion
uncovers stress issues exclusive to the social, cultural, and economic
contexts in Brazil. It climaxes with the discussion on future research
which highlights the need to consider more explicitly the specific work
conditions in the country, evolving more powerful methodological pro-
cedures, as well as more sophisticated analysis strategies, to provide a
more holistic understanding of work stress in Brazil. Chapter Four in-
vestigates main job stressors and its consequences in Greater China
(covering Beijing, Hong Kong, and Taipei) using a two-tier mixed-
method study. A Six-factor model of job stressors was developed, tested,
and found suitable in the contemporary Chinese work environment. The
discussion also covers the investigation of local and international trends
in literature. The fifth chapter on Greece scientifically exhibits how the
occupational stressors and strains in Greece are unique, ever-changing,
severe, and chronic as a result of economic and political instability as-
sociated with turbulent recessionary times. The sixth chapter is India-
centric. It offers a systematic review of Indian stress studies published in
the last decade encompassing descriptive and thematic analysis.
Distinctive theoretical and methodological challenges and concerns are
 Introduction 5
examined while comparing Indian research trends with international
literature.
Chapter Seven offers a review of organizational stress research in
Japan. Devastating stress problems unique to Japanese work culture –
like long work hours, nonregular employment, workplace harassment,
Karoshi (death from overwork), and Karo-Jisatsu (suicide caused by
work stress) – are assessed in detail. Government policies and organi-
zational responses to manage stress are also scrutinized. Chapter Eight
investigates the status of organizational stress in different work sectors in
Nigeria. Unique stressors and strains experienced by the Nigerian
worker and their coping approaches are reviewed. The conclusion ex-
plores the mediating roles of state and culture on organizational stress in
Nigeria. The Ninth chapter studies the increasing trend associated with
psychosocial risks and work-related mental health risks in the
Netherlands and Belgium. Consequences of these risks, challenges as-
sociated with their management, and effective strategies to prevent such
risks are deliberated in the chapter. Chapter Ten offers a literature re-
view on occupational stress research in Oman. The analysis explains
culture-specific stressors and demonstrates that Oman is undergoing a
rapid demographic, educational, and economic transition, but religion
and culture have an immense influence on society. The Eleventh chapter
summarizes the literature on occupational stress, health, and well-being
research in Portugal. A qualitative systematic review and the two-step
cluster analysis was undertaken based on 75 published papers. Critical
observations on trends in Portuguese literature are presented in the
conclusions.
Organizational stress in the Russian context is investigated in the
Twelfth chapter. Stressors unique to Russian society are discussed at
length; simultaneously, prevalent unhealthy coping approaches have
been highlighted. The Thirteenth chapter is based on the South African
occupational stress context. It offers an overview of South African stress
studies and highlights specific work and living contexts from historical
and contemporary perspectives of the Fourth Industrial Revolution.
Contemporary stressors, its consequences, and stress management stra-
tegies at individual, organizational, and societal levels have been re-
searched in depth. The Fourteenth chapter provides coverage of salient
concepts and measures relevant to organizational stress in the United
States. The chapter explores the influence of the cultural context on
organizational stress and concludes with a discussion of contemporary
practices in physical fitness, positive stress, organizational clinical psy-
chology, and healthy work organization. Lastly, in the Fifteenth chapter,
editors have identified and discussed the common themes emerging from
all the contributions in this volume. Directions for future research are
explored in light of these popular themes.
6 Kajal A. Sharma et al.
References
Anderssen, E. (2011, June 17). Ottawa to fund mental-health strategy: First-ever
Canadian-wide standards to tackle problem estimated to cost $20-billion a
year in workplace losses alone. The Globe and Mail, A3.
Burke, R. J. (2010). Workplace stress and well‐being across cultures: Research
and practice. Cross Cultural Management: An International Journal,
17(1), 5–9.
Cartwright, S., & Cooper, C. (2011). Innovations in stress and health.
Basingstoke, UK: Palgrave Macmillan.
CIPD (20 May, 2020). Coronavirus (Covid-19): Mental health and returning to
the workplace. https://www.cipd.co.uk/knowledge/culture/well-being/
supporting-mental-health-workplace-return.
Dollard, M. F., Bailey, T., McLinton, S., Richards, P., McTernan, W., Taylor, A.,
& Bond, S. (2012). The Australian Workplace Barometer: Report on psy-
chosocial safety climate and worker health in Australia. Centre for Applied
Psychological Research, University of South Australia.
International Labour Organization. (2016). Workplace stress: A collective
challenge. https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---
safework/documents/publication/wcms_466547.pdf.
Kompier, M. A. J., & Marcelissen, F. H. G. (1990). Handboek werkstress
[Handbook of work stress] (Vol. 6, pp. 681–703). Amsterdam, The
Netherlands: NIA.
Sharma, R. R., & Cooper, C. L. (2016). Executive burnout: Eastern and western
concepts, models and approaches for mitigation. Emerald Group Publishing.
Spreitzer, G., & Porath, C. (2012). Creating sustainable performance. Harvard
Business Review, 90(1), 92–99.
Semmer, K. N. (2007). Recognition and respect (or lack thereof) as predictors of
occupational health and well-being. Conference Presentation. WHO, Geneva:
Universität Bern, 14, February.
Wee, L. H., Yeap, L. L. L., Chan, C. M. H., Wong, J. E., Jamil, N. A., Nantha, Y.
S., & Siau, C. S. (2019). Anteceding factors predicting absenteeism and pre-
senteeism in urban area in Malaysia. BMC Public Health, 19(4), 540.
World Health Organisation. (2017a). Occupational health: Stress at the work-
place. https://www.who.int/occupational_health/topics/stressatwp/en.
World Health Organisation. (2017b). Protecting workers health (Fact sheet).
https://www.who.int/news-room/fact-sheets/detail/protecting-workers’-health.
World Health Organisation. (2019, May). Mental health in the workplace.
https://www.who.int/mental_health/in_the_workplace/en/.
Health and Safety Executive. (2019). Annual Statistics. Work-related stress,
anxiety or depression statistics in Great Britain. https://www.hse.gov.uk/
statistics/causdis/stress.pdf.
2 “She’ll Be Right, Mate!”
Occupational Stress Research
in Australia
Paula Brough, Mitchell Raper,
and Jason Spedding

Introduction
In this chapter, we discuss key occupational stress empirical research
conducted within Australia. First some context: Australia is the planet’s
sixth-largest country after Russia, Canada, China, the United States of
America, and Brazil – accounting for 5% of the world’s land area.
Australia has a continental landmass of 7.692 million square kilometers
and is the smallest continental landmass but the world’s largest island.
Australia is about 32 times larger than the United Kingdom, 21 times
larger than Japan, 14 times larger than France, and 2.5 times larger than
India. Australia has a relatively small total population of approximately
26 million people and is ranked at 55th place in national population
totals. Approximately half of the Australian population (13 million
people) is of working age. The Gross Domestic Product (GDP) in
Australia was approximately US$1,432 billion in 2018, representing
approximately 2.3% of the world economy.
Similar to many developed countries, occupational stress is a major public
health problem in Australia, costing the economy up to AU$15 billion per
annum (Safe Work Australia, 2013). The physical and mental health of
Australian employees is protected by the 2011 Work Health and Safety Act.
Each of the eight Australian states and territories implements this Act with
compensation legislation to support all workers’ who experience any work-
related physical or psychological injury or illness. Approximately 7,800
Australians are compensated for work-related mental health conditions each
year, and the vast majority (90%) of these mental disorder claims are at-
tributed to mental stress (Safe Work Australia, 2015). These claims total
approximately AU$543 million and equate to approximately 6% of the
annual number of workers’ compensation claims submitted. Thus, the
number of submitted work-related mental health claims is relatively small,
but their combined costs are substantial. Lost productivity specifically at-
tributable to employee absenteeism, caused by the physical and mental
health impacts of occupational stress, costs Australian organizations a total
of approximately $5 billion per annum (Price Waterhouse Coopers, 2014).

DOI: 10.4324/9780429292538-2
8 Paula Brough et al.
The primary causes of occupational stress within Australia are un-
ambiguous and are common to antecedents reported internationally,
namely: excessive work demands, inadequate work resources, and ex-
posure to psychologically unhealthy work environments predominately
marked by interpersonal conflicts including “toxic leadership” (Brough,
Drummond, & Biggs, 2018; Brough, O’Driscoll, Kalliath, Cooper, &
Poelmans, 2009; Webster, Brough, & Daly, 2016). The occupations in
Australia which report the highest levels of occupational stress, also
reflect those in international reports, namely: public service occupations
characterized by hierarchical, bureaucratic structures, involving high
levels of interactions with the public, and which may also include ex-
perience with a high frequency of physical dangers. These occupations
consist of military and emergency services workers, school teachers, and
health and social welfare workers (Brough, Brown, & Biggs, 2016).
Later in this chapter, we discuss the occupational stress antecedents
which are unique to Australian workers – including indigenous culture,
geographic distance, climate, and threats from wildlife. Next, we discuss
the primary “flavors” of occupational stress research currently being
conducted in Australia and represented in the scholarly international
literature.

Key Areas of Australian Occupational Stress Research

Similar to research being conducted internationally, in Australia, there
are several researchers and their teams spread throughout the country
focusing on specific areas of occupational stress research. Here, we
provide an overview of four of these occupational stress research topics.

Occupational Stress Interventions

How best to manage, reduce, and recover from occupational stress ex-
periences underpins occupational stress intervention research. Professor
Paula Brough and her team at Griffith University in Brisbane have
worked with numerous “high-risk of stress” occupations to develop
evidence-based stress management interventions (SMIs). For example,
Biggs, Brough, and Barbour (2014a) described the implementation of a
quasi-experimental SMI with police managers, focusing on improving
their confidence in their personal people management skills. This SMI
program was based on the theoretical framework of the job demands-
resources model (Demerouti, Bakker, Nachreiner, & Schaufeli, 2001),
contained multiple components including both group and individual
coaching sessions, and linked the police leaders’ skills to the well-being
and performance of their direct reports (subordinates). Importantly,
Biggs, Brough, and Barbour (2014a) noted how improving leadership
abilities “produces significant improvements in some aspects of the
 “She’ll Be Right, Mate!” 9
psychosocial work environment for the leader’s direct subordinates”
(p. 60). Thus, how an employee’s experience of stress can be reduced by
enhancing their leader’s behaviors. This research also demonstrated that
high-quality SMI research could be conducted within a quasi-
experimental research design, including both control and experimental
groups and multiple pre- and post-assessments individually tracked over
time (see also: Biggs, Brough, & Barbour, 2014c, 2014d; Brough &
Biggs, 2015b). An extension of this work was also described by Webster
et al. (2016) who demonstrated how the chronic experiences of a “toxic”
manager can have serious health and performance consequences for their
subordinates.
Professor Angela Martin and her team in Tasmania have also con-
ducted pertinent SMI research focused on reducing levels of occupational
stress experienced by small to medium-sized enterprise (SMEs) owners.
Martin, Sanderson, Scott, and Brough (2009) also conducted their SMI
via a quasi-experimental research design – comparing the impact of a
self-administered versus telephone-coaching intervention, with a control
group of SMEs managers. Martin and colleagues demonstrated the
success of the telephone-coaching SMI component in reducing levels of
psychological distress experiences reported by the SME managers (see
also: Martin et al., 2015).

Job Demands, Job Resources, and Stressor Appraisals

A second key area of occupational stress research in Australia focuses on the
assessment of stress caused by different types of job demands. Australian
occupational stress research has been instrumental in expanding our un-
derstanding of job demands, the categorization of these demands, and the
employees’ interpretation (i.e., appraisal) of these demands. Research led by
both Peter Hart in Melbourne and Paula Brough in Brisbane has demon-
strated the importance of assessing both generic (global) job demands and
occupational-specific job demands in order to provide accurate estimates of
stress. Hart and his colleagues, for example, developed and validated
measures of negative stressors (work hassles) and positive experiences
(work uplifts) experienced by police officers (Hart, Wearing, & Headey,
1995). Hart and colleagues’ (Hart et al., 1995) research is important for
two reasons. First, this work demonstrated that both positive and negative
“minor” work experiences independently contribute to an officer’s per-
ceived quality of life. Second, Hart et al. (1995) demonstrated that orga-
nizational work demands, rather than operational experiences were more
important in estimates of police officers’ well-being. Thus, organizational
work demands such as managing bureaucratic red tape and correctly
completing paperwork were rated as more onerous for the police officers’
long-term well-being, as compared to operational demands such as going
on a raid or making an arrest.
10 Paula Brough et al.
Hart’s work was also validated by Brough (Brough, 2004; Brough &
Biggs, 2015a) who demonstrated that organizational work demands
were stronger predictors of a police officer’s mental ill-health levels over
time, as compared to either generic job demands or traumatic work
experiences. Brough (Brough & Biggs, 2010; Brough & Williams, 2007)
also extended this work by developing a measure of occupational-
specific job demands experienced by correctional (prison) officers.
Brough and Williams (2007) recommended that assessing common work
experiences of correctional officers, such as violence from offenders and
offenders’ deaths or escapes, in combination with generic measures of
job demands were necessary to produce accurate estimates of correc-
tional officers’ mental health. In similar more recent work, Brough and
Boase (2019), found that relaxing and cognitive restructuring were the
two common stress management techniques employed by lawyers, re-
flecting international findings and relating to these two methods of stress
management. Of particular interest, was how the use of cognitive re-
structuring had a similar impact upon levels of job satisfaction and work
engagement, compared to the generic job demands experienced by this
sample of lawyers. As seen above, Brough and Boase recommended the
inclusion of lawyer-specific measures of occupational stress in addition
to generic job demands, to better explore this reported use of cognitive
restructuring within the stress process.
Research conducted by Brough and colleagues also considered the
distinction between generic and specific job resources. One investigation
assessed whether specific organizational resources (i.e., strategic align-
ment) assisted in promoting work engagement and reducing stress ex-
periences for police officers, in comparison with generic job resources
(i.e., social support and job control). Strategic alignment refers to an
employee’s perception and awareness of their organization’s strategic
priorities and how their daily tasks contribute to these priorities. Biggs et
al. (2014d) not only found strategic alignment increased work engage-
ment across multiple time lags, but these associations were stronger
compared to the equivalent associations with both job control and social
support. Raper, Brough, and Biggs (2019) extended this research and
investigated the impact of strategic alignment with both work engage-
ment and psychological strain over time. The results also indicated
strategic alignment reduced psychological strain compared to generic job
resources and highlighted the importance of assessing both specific and
broad work resources
Similar research was conducted by Michelle Tuckey and colleagues in
Adelaide. Tuckey and Hayward (2011) argued that occupational-specific
emotional resources (i.e., camaraderie) may be more effective in reducing
the negative outcomes of emotional demands experienced by firefighters,
as compared to generic emotional resources. They demonstrated that
camaraderie did indeed significantly reduce – moderated – levels of
 “She’ll Be Right, Mate!” 11
burnout and psychological distress when emotional demands were high.
This impact of camaraderie was stronger than the impact of generic
emotional resources. These findings are also consistent with other
Australian stress research calling for inclusions of organizational level
resources in promoting positive workplace environments (e.g., Albrecht,
2012; Albrecht, Breidahl, & Marty, 2018).
Research conducted by Tuckey and colleagues has also focused on a
different typology of job demands. Tuckey, Searle, Boyd, Winefield,
and Winefield (2015) argued the challenge-hindrance framework
(Cavanaugh, Boswell, Roehling, & Boudreau, 2000) does not ade-
quately account for threat demands or cognitive appraisals. Instead,
Tuckey et al. (2015) proposed the typology of a challenge-hindrance-
threat framework and argued that employees’ exposure to these dif-
ferent demands impacts specific emotional outcomes including posi-
tive affect, anger, anxiety, and dedication. Furthermore, Searle and
Auton (2015) noted the presence of inconsistent results reported in
the challenge-hindrance framework literature and argued the same job
demands can be appraised as a challenge or a hindrance, or indeed as
both, by employees. Their findings also indicated that challenge and
hindrance cognitive appraisals accounted for significant proportions
of unique variance in positive affect, anger, and venting (see also:
Espedido & Searle, 2018; Espedido, Searle, & Griffin, 2019; Searle &
Tuckey, 2017).

Psychosocial Safety Climate

Recent research in occupational health has advanced knowledge re-
garding the organizational climates in which the stress-strain processes
are nested. Maureen Dollard in Adelaide has advanced one such climate
construct, the Psychosocial Safety Climate (PSC). PSC refers to the
shared perceptions of policies, practices, and procedures endorsed by
senior leaders within an organization designed to protect the psycholo-
gical health of employees (Dollard & Bakker, 2010). Heightened levels
of PSC have been directly linked to a range of organizational and in-
dividual benefits such as reduced bullying and exhaustion (Bond,
Tuckey, & Dollard, 2010; Law, Dollard, Tuckey, & Dormann, 2011)
and enhanced employee engagement (Dollard & Bakker, 2010). In ad-
dition, the direct benefits of maintaining positive PSC offer pertinent
implications for extending existing theory, namely as a distal antecedent
(an “upstream resource”) within the job demands-resources model
(Demerouti et al., 2001).
In many organizations it is the remit of senior leaders to design and
enact macro-level policies that balance both employee productivity
and well-being, this balance is largely captured via the measurement
of PSC. The PSC-12 (Hall, Dollard, & Coward, 2010) collates four
12 Paula Brough et al.
subscales of PSC into an aggregate climate construct. As organiza-
tional climates are inherently multilevel phenomena, this process of
conceptualization and measurement is rife with difficulties (cf.
Schneider, González-Morales, Ostroff, & West, 2017); however,
contemporary research has begun to explore the benefits of main-
taining supportive PSCs within organizations. One large scale popu-
lation study explored the potential psychological risk factors facing
Australian workplaces (Dollard et al., 2012). Data collected from over
5,000 participants demonstrated the positive relationship between
PSC and perceptions of organizational resources, productivity, and
health outcomes, and negatively predicted job demands. PSC ex-
plained 13% of the variance in employee work engagement and up to
9% of the variance in employee self-reported health outcomes. The
impacts of rural versus urban workplace demands were also assessed.
Urban employees reported heightened job demands compared to their
rural counterparts, albeit with less physical demands, less work-
family conflict, and reported less mental and physical health issues.
In another investigation of the impact of PSC, Afsharian, Zadow,
Dollard, Dormann, and Ziaian (2018) operationalized the standard de-
viation of PSC, to quantify the strength of climate exhibited within or-
ganizational work units. This technique of dispersion modeling (Chan,
1998), investigated the effects of aligned perceptions of climate.
Afsharian et al. (2018) reported the direct effects of PSC were moderated
by the perceived strength of the climate, such that employees in high PSC
work units were more engaged in their work roles. Research exploring
how climate strength may impact other group-level workplace dynamics
remains a pertinent avenue for future scholars.

Bullying and Workplace Incivility

While workplace bullying and incivility are global workplace issues,
Australian research has assisted researchers and practitioners to better
understand these complex issues and has developed interventions to re-
duce these incidents. Approximately 10% of Australian employees ex-
perience these forms of workplace mistreatment (Safe Work Australia,
2016), corresponding with international estimations of between 10%
and 15% (Zapf, Escartin, Einarsen, Hoel, & Vartia, 2011). Brough,
Brown, and Biggs (2016) provided an overview of negative workplace
behaviors commonly experienced within the criminal justice systems.
They noted criminal justice (military, police, corrections, and law) or-
ganizations that contain strong hierarchical structures are more likely to
adopt toxic work environments, as compared to organizations with
lateral or flatter structures. Webster et al. (2016) also highlighted the
issues of toxic management styles in creating unsafe workplaces by
providing key recommendations for organizations and employees to be
 “She’ll Be Right, Mate!” 13
more proactive in reporting and reducing these negative workplace be-
haviors.
Australian research has also focused on the job characteristics and
personal resources which may precipitate bullying and harassment in the
workplace. Tuckey, Chrisopoulos, and Dollard (2012) found hindrance
job demands (organizational constraints, role conflict, ambiguity, and
overload) resulted in aggressive behaviors when the demands out-
weighed the buffering effects of job resources. These findings were va-
lidated by Li, Chen, Tuckey, McLinton, and Dollard (2019), who argued
that job design is one of the key prevention mechanisms to reduce
workplace bullying. Job characteristics – including irregular work
schedules and conflictual contact – increase job demands which, in turn,
increase workplace bullying. Re-designing occupations to reduce
stressful job characteristics and to enhance beneficial job characteristics
is recommended to prevent the propagation of bullying work environ-
ments (Tuckey & Neall, 2014).
Australian research has also highlighted the influence of PSC on the
occurrence of workplace bullying. Law et al. (2011), for example, de-
monstrated that the associations between bullying, employee psycholo-
gical distress, and work engagement were reduced – moderated – by high
levels of PSC. Similarly, Bond et al. (2010) demonstrated that high levels
of PSC in police stations reduces the positive association between bul-
lying and post-traumatic stress experienced by the police officers
over time.

Australian-Specific Occupational Stress Research

Australia’s isolation, size, climate, and proliferation of dangerous wild-
life have also generated more nuanced fields of occupational stress re-
search. In this section, we highlight three areas of stress research that are
more specific to the Australian context.

Distance
Australia has a very centralized population with approximately 68% of
its population living within or close to a capital city, particularly along
the eastern coast of Australia (Australian Bureau of Statistics, 2019). For
those who live and work in rural inland areas of Australia, the vast
distances involved can be a significant stressor. These remote commu-
nities also commonly contain fewer healthcare professionals per capita,
resulting in poorer health outcomes as compared to Australia’s urban
populations (Opie et al., 2010). Consequently, the remote area nurses
(RANs) working in these rural communities report high levels of occu-
pational stress – characterized by high workloads, high turnover, less
access to medical resources, and high levels of workplace violence (Opie
14 Paula Brough et al.
et al., 2010). Lenthall et al. (2009) also found that the isolation reduced
the social resources accessible to these RANs, resulting in reduced pro-
fessional and personal boundaries (see also Opie, Dollard, Lenthall, &
Knight, 2013).
A specific pattern of work referred to as fly-in fly-out (FIFO) em-
ployment, involves mining and construction workers commuting long
distances to rural inland work sites by airplane, living and working on-
site for several weeks and then taking another one or two weeks of leave
when they commute back to their homes and families. These elongated
work-rest cycles represent new challenges to occupational health re-
search and theory, with recent work building our understanding of how
these processes impact both employee well-being and their family out-
comes. Considine et al. (2017), for example, conducted a multisite study
of FIFO coal workers and found these employees experienced additional
stressors. Considine and colleagues reported that 39% of the FIFO
workers in their sample reported moderate to very high levels of psy-
chological distress, which is significantly higher than the 26% prevalence
within a comparable community sample. They also reported that 46% of
male FIFO workers had hazardous levels of alcohol use, which is almost
twice as high as comparable community samples (Tynan et al., 2017).
Job-specific stressors for these FIFO workers included high levels of job
insecurity and pursuing mining work purely for extrinsic financial rea-
sons (Considine et al., 2017).
Other research with FIFO workers has identified how misalignment
between employee’s needs and the organizational culture can attenuate
workers’ negative mental health outcomes (Morrow & Brough, 2019).
Finally, utilizing ecological momentary assessment, Gardner, Alfrey,
Vandelanotte, and Rebar (2018) found that during work trips, both the
FIFO workers and their spouses/partners who remained at home re-
ported reduced sleep quality, reduced exercise, and consumed more ci-
garettes, compared to when FIFO workers remained at home. Reducing
the occupational stress experienced by these workers employed in remote
communities is also a focus of other Australian research (e.g., Rickard
et al., 2012; Robinson, Peetz, Murray, Griffin, & Muurlink, 2017;
Vojnovic, Michelson, Jackson, & Bahn, 2014).

Heat
Australia is renowned for its extreme heat. Indeed, heat is the most
dangerous environmental hazard in Australia, accounting for 55% of
natural hazard-related deaths each year (Coates, Haynes, O’Brien,
McAneney, & De Oliveira, 2014). Australia’s hot and humid climates
cause considerable risk and additional stress for employees who work
outside – particularly in construction, mining, farming, and emergency
services. The impact of climate change has caused the Australian climate
 “She’ll Be Right, Mate!” 15
to recently become even warmer, with more frequent occurrences of
extreme heat events across the country (Hanna, Kjellstrom, Bennett, &
Dear, 2011). Rising numbers of very hot days (i.e., above 35 °C) places
increasing strain on outdoor workers (Hanna et al., 2011; Xiang, Bi,
Pisaniello, Hansen, & Sullivan, 2013). Estimated costs to the Australian
economy due to workers’ experiences of heat-related stress are ap-
proximately AU$9 billion per annum, and this cost is increasing annually
(Zander, Botzen, Oppermann, Kjellstrom, & Garnett, 2015). These costs
have negative consequences for economic output. For example, during
the 2002–2003 drought, GDP in Australia dropped by 1.0 percentage
point (Australian Bureau of Statistics, 2006). As such, increasing re-
search is focused on how to best relieve heat stress among the work-
forces, especially for workers who must work outside (Maté &
Oosthuizen, 2012; Zander, Mathew, & Garnett, 2018).
Employers are very much aware of the occurrence of heat stress and
commonly provide a variety of heat prevention measures to protect
employees – including the provisions of cool drinking water on work-
sites, heat stress training, shaded rest areas, protective hats, and cooling
fans. However, Xiang, Hansen, Pisaniello, and Bi (2015) reported
common barriers to the prevention of heat stress-related injuries, namely
a lack of adequate training and awareness for employees, lack of man-
agement commitment, and low compliance rates (see also Jia,
Rowlinson, & Ciccarelli, 2016; Singh, Hanna, & Kjellstrom, 2015). The
negative impact of heat on the productivity and well-being of office
employees has also been identified (Lamb & Kwok, 2016). Finally,
Australia’s increasing prevalence of heatwaves and other extreme
weather conditions (e.g., cyclones, floods, and bushfires) emphasize the
importance of the appropriate provisions of work resources for both
emergency and volunteer workers during their management of these
natural disasters (Biggs et al., 2014d).

Dangerous Wildlife
A discussion of Australian-specific stressors would not be complete
without some mention of rather dangerous wildlife residents in this
country. While visitors of the Australia commonly anticipate en-
countering snakes, spiders, crocodiles, and sharks at every turn, most
Australians actually experience relatively few encounters with these an-
imals, and, indeed, typically experience more frequent encounters with
the “cuddlier” part of Australian wildlife: koalas, kangaroos, wallabies,
etc. Nevertheless, unique and considerable stress can be experienced by
workers who do interact with dangerous Australian wildlife, although
published research on this topic is scarce.
Whether the Australian animal encountered is cuddly or dangerous,
risks arise from its capture and handling. Clearly, physical risks (e.g.,
16 Paula Brough et al.
being bitten) are the most prevalent and for animal professionals, these
risks can be considered as a specific job demand. Thompson and
Thompson (2007), for example, described the necessity of using ap-
propriate types of traps for capturing snakes, spiders, and small mam-
mals in Western Australia – for the physical safety of both the animal
and the human worker. Mirtschin (2006) provided more details of the
dangers for herpetologists with the enviable task of extracting venom
from Australia’s deadly snakes. Snake venom is required for the pro-
duction of antivenoms. Mirtschin (2006) reported that most herpetolo-
gists’ deaths are caused by the highly venomous tiger snake and that,
bizarrely, many herpetologists died after willingly being bitten – in order
to demonstrate the effectiveness (or lack thereof) of the antivenom that
they had produced.
Stevenson, Gowardman, Tozer, and Woods (2015) reported on the
physical dangers for Australian park rangers from wildlife encounters –
specifically via the transmission of Q-fever from both live and dead
animals – including the disposal of deceased “road-kill” kangaroos and
wallabies. Similarly, seal handlers may also be exposed to an arthritis
infection called “spaek finger” arising from seal bites or the handling of
seal skins (Dendle & Looke, 2008). While Australia is free of rabies,
people working with bats may be exposed to a similar unpleasant and
potentially fatal disease – the Australian bat lyssavirus – caused by bat
bites (Dendle & Looke, 2008). Finally, Baynes‐Rock (2019) provided an
interesting account of the social connections occurring between croco-
diles and their handlers at a Queensland crocodile farm. The physical
safety of these farmworkers is a paramount concern; however, the strong
attachments formed between the workers and their reptilian charges
were surprising, and care is taken to ensure these attachments do not
override the physical risks to these workers.

Final Thoughts
Australian researchers collaborate with numerous international collea-
gues based in Europe and the United States. However, increasing colla-
boration is also occurring with researchers based in the Asia-Pacific
region and this more “local” collaboration is likely to intensify in the
future. The establishment of the multidisciplinary Asia Pacific Academy
for Psychosocial Factors at Work in 2012 (www.apapfaw.org), is a
significant boost to formalizing research collaborations between
Australian researchers and equivalent scholars in Japan, China,
Malaysia, South Korea, Indonesia, Hong Kong, Taiwan, and neigh-
boring countries. Similar to its European and United States counterparts,
this academy hosts annual conferences and workshops to encourage
research discussions and collaborations and has produced output high-
lighting research collaborations occurring in this region (Brough,
 “She’ll Be Right, Mate!” 17
Dollard, & Tuckey, 2014; Dollard, Shimazu, Bin Nordin, Brough, &
Tuckey, 2014). Both the membership of this Academy and the colla-
boration it fosters continue to grow.
Occupational stress research in Australia remains a productive and
pertinent growth area of organizational psychology and is unlikely to
diminish in the near future. Indeed, with continual technological ad-
vances, it is likely that increased interest will be placed on web-based and
smartphone application-based stress management developments. Such
developments will be of significant value to workers particularly based in
rural areas, where vast distances isolate them from readily accessing
other forms of assistance (e.g., Brew, Inder, Allen, Thomas, & Kelly,
2016). The concentration of the majority of the Australian population in
coastal cities and towns is also predicted to increase, with Australian
projected population estimates of up to 42.5 million people by 2056 and
62.2 million people by 2101 (Treasury, 2010). This population growth
will require more public services and thus, more public servants. Unless
working conditions for these workers are significantly changed, we can
anticipate a steady increase in occupational stress experiences reported
by these workers.
To conclude, in this chapter, we have discussed the key foci of
occupational stress research being conducted in Australia and iden-
tified the common stressors experienced by Australian workers, in-
cluding stressors that are somewhat unique to Australia – such as
dangerous wildlife encounters, the heat, and the vast distances. We
have highlighted the growth of research collaborations with our Asia-
Pacific neighbors, and how the projected population growth will en-
sure a continuing need for innovative and impactful Australian oc-
cupational stress research.

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3 Work Stress Research in Brazil
Maria Cristina Ferreira, Helenides
Mendonça, Ronald Fischer, and
Leonardo Fernandes Martins

Introduction
This chapter presents a systematic review of Brazilian literature on work
stress over the last decade. Similar to international trends, the labor
market situation has deteriorated significantly. This further exacerbated
an already precarious working context characterized by high un­
employment, low labor rights, and endemic levels of corruption. The
combination of poor pre-existing labor conditions with increasing
market pressures helped to shape a profound economic, financial, and
political crisis that continues to affect the country.
Brazilian corporate organizations have sought to restructure their
production and work processes, as well as their management models to
increase competitiveness, leading to the adoption of technical and or­
ganizational innovations designed to reduce costs, making companies
more efficient and competitive nationally and internationally. The out­
come has been a dramatic reduction in staffing in some sectors of the
economy, large-scale privatizations, and outsourcing of a number of
support services.
In the wake of this process, employment instability has further risen,
there has been a progressive expansion of temporary labor contracts and
self-employment, as well as an increase in outsourcing services to ex­
ternal consultancies and service providers. These processes have led to an
increase in the number of workers entering the informal labor market.
These trends have had negative repercussions throughout the working
population and increased work stress.
Statistics on workers’ psychological health problems are alarming. In
Brazil, 70% of the active population report being stressed (Silva &
Salles, 2016) with an unknown but potentially harmful impact on
workers, organizations, and society. As indicated by international lit­
erature, stress at work can trigger depressive conditions, hypertension,
and heart problems, as well as medical insurance costs, loss of staff
productivity, and absenteeism, among other problems. How has the
Brazilian academic community responded to these conditions? Our

DOI: 10.4324/9780429292538-3
24 Maria Cristina Ferreira et al.
review aims to describe the Brazilian literature on the topic of work
stress, which has been conducted and reported over the last 10 years.

Method
This systematic review followed the Transparent Reporting of Systematic
Reviews and Meta-Analysis (PRISMA, http://www.prisma-statement.
org/). Our review covers Brazilian literature on work stress for the
period of 2009 to 2018.

Survey Strategy and Inclusion of Studies

The database search was performed in June 2019, covering research
published from January 2009 to December 2018. We focused on the last
10 years to capture the most recent literature on work stress in Brazil and
to describe the most current work conditions. The search was done using
Scielo Brasil, a Brazilian database that gathers the full articles published
in the most peer-reviewed journals in Brazil. The following keywords
were used: “stress at work,” “occupational stress,” “professional
stress,” “work stress,” “psychosocial stress in the workplace,” “psy­
chosocial stress at work,” “job stressors,” “occupational stressors,”
“professional stressors,” “labor stressors,” “psychosocial job stressors,”
and “psychosocial stressors in the workplace.”
This initial search yielded 235 publications. No additional records
were identified through other sources. We first examined titles and ab­
stracts and used the following criteria for inclusion in our database: (a)
published in a peer-reviewed Brazilian journal, (b) having “stress at
work” as the core theme of the publication, which led to the exclusion of
articles that focused on workers’ health, mental illness at work or psy­
chological illness,1 (c) including empirical data, both qualitative or
quantitative data collection, and (d) involving samples composed of
Brazilian workers. From the original list, 87 publications were excluded
for the following reasons: theoretical or conceptual papers (4), literature
reviews on work stress (22), student samples (2), samples of non-
Brazilian workers (9), and articles that did not focus on job stress (50).
This list of 148 articles was read in detail. Another 30 articles were
excluded due to any of the above reasons. The final literature review was
based on a total of 118 publications (see Figure 3.1).

Coding Scheme
The articles were analyzed and coded in a spreadsheet by the first author.
The following information were coded: year of publication, author/s,
journal area, theoretical models adopted, type of empirical research,
sample size, workers surveyed, job stressors considered, stressor
 Work Stress Research in Brazil 25

Identification

Records identified through Additional records identified

database searching through other sources
(n =283) (n = 0)

Records after duplicates removed

(n =235)
Screening

Records screened Records excluded

(n = 235) (n = 87)
Eligibility

Full-text articles excluded,

Full-text articles assessed
with reasons
for eligibility
(n = 30)
(n = 148)
-theoretical/conceptual
-literature reviews
-student samples
-non-Brazilian workers
-not focused on job stress
Included

Studies included in
qualitative synthesis
(n =118)

Figure 3.1 Flowchart of survey strategy and inclusion of studies.

measurement instruments, stress reactions considered, stress reaction

measurement instruments, and the main results obtained. Afterward, the
second author independently coded 33% of the studies, and 28 studies
randomly selected, to ensure consistency and accuracy of the adopted
classification. Cohen’s Kappa Coefficients of rater agreement were all
above 0.75, indicating sufficient levels of agreement.

Results
We present the results in four main sections. First, we present a review of
the theoretical and conceptual foundations of the investigations. In the
second section, we review temporal trends, research areas, and metho­
dological characteristics of the studies. Third, we describe the different
work stressors and stress reactions included in the studies. The final
section discusses the main findings observed in the studies that were
reviewed separately based on their methodological features.
26 Maria Cristina Ferreira et al.
Theoretical Grounds of the Studies Reviewed
The most commonly cited theoretical model (n = 81; 67%) was the
Demand-Control-Social Support Model (JDCS; Karasek & Theörell,
1990). It describes the interplay between job demands that a worker
faces, the degree of control that a worker has to make decisions and
influence results, and social support that a worker receives.
Psychological demand and control are characterized as independent
dimensions, both ranging from low to high levels, generating four pos­
sibilities for psychosocial work experiences. A high-demand or high-
stress job combines high demand with low control; active work is
characterized by high demand and high control; passive work features
low demand and low control; and finally, low-demand or low-stress
work is encountered in situations of low demand and high control
(Karasek & Theörell, 1990).
The second most common theoretical model (n = 11; 14%) was the
Effort-Reward Imbalance model (ERI; Siegrist, 1996), although it was
considerably less prevalent compared to the JDCS. Effort concerns the
demands and obligations arising from the labor organization, while re­
wards relate to financial gains and occupational status. The imbalance
between a lot of effort and little recognition can lead to stressful situa­
tions. A third and novel dimension of the model refers to over­
commitment to garner approval and esteem, which can interact with the
effort-reward imbalance and increase the risks of work stress. The re­
maining studies adopted different theoretical approaches or did not ex­
plicitly report their theoretical basis.

Temporal, Geographical, and Methodological Characteristics

From 2009 to 2018, the number of published empirical articles ranged
from 7 to 19 per year, with the lowest number of publications (7) in
2012 and the largest number (19) in 2015. The average number in other
years was relatively stable, ranging between 9 to 12 articles. Thus, the
publications within the ten-year time frame have been relatively stable
(see Figure 3.2).
The articles were published in journals across different fields, with the
highest concentration occurring in nursing journals (n = 52; 44%), fol­
lowed by journals in other health areas, such as public health, or med­
icine (n = 35; 30%), and by psychology journals (n = 16; 14%)
(see Figure 3.3). This distribution reflects the multidisciplinarity work
stress research in Brazil.
Regarding the research methodology adopted in the studies, more
studies used quantitative (n = 104; 88%) compared to qualitative
methods (n = 14, 11%). Among the quantitative studies, cross-sectional
 Work Stress Research in Brazil 27

20 19

18

16
14
14
12 12 12 12
12 11
10
10 9

8 7

0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Figure 3.2 Temporal distribution of the articles reviewed.

2%

4%
6%
NURSING

14% HEALTH
44%
PSYCHOLOGY
EPIDEMIOLOGY
BUSINESS
OTHERS
30%

Figure 3.3 Distribution of articles by knowledge area.

investigations prevailed (n = 76; 73%), while other types of research

showed much lower percentages (see Figure 3.4).
In the qualitative studies, sample sizes ranged from 1 to 62 partici­
pants (M = 20.14). In contrast, quantitative studies reported data from
samples ranging from 18 to 3,253 participants (M = 380.91), with the
highest concentration observed in the range of up to 100 participants
28 Maria Cristina Ferreira et al.

3% 2%

7%

Cross-sectional
15% Descriptive
Intervention
Instrument development
Longitudinal
73%

Figure 3.4 Research methodology adopted in the studies.

(n = 28; 30%), followed by the range of up to 200 participants (n = 16;

17%). Finally, among the intervention studies, samples ranged from 20
to 105 participants (M = 43.42).
The majority of the studies were conducted with workers of a specific
sector (health institutions, educational institutions, etc.), although some
of them involved heterogeneous samples of individuals from different
labor sectors. Most studies (n = 64; 54%) were carried out with health
professionals – especially nursing professionals, followed by education
professionals (n = 23; 19%) – especially teachers (Table 3.1). These data
are in line with previous reviews carried out in Brazil (Rodrigues &
Faiad, 2019) and abroad (Havermans et al., 2016).

Stressors and Reactions to Work Stress

Out of the 118 articles reviewed, only 81 (67%) explicitly measured
some stressors. The remaining articles typically focused on socio­
demographic relationships and work organization with different

Table 3.1 Characterization of workers composing the samples

Work Sectors Frequency Percentage

Health 64 54
Education 23 19
Safety 8 7
Industry 8 7
Service renderers 8 7
Workers in general 7 6
Total 118 100
 Work Stress Research in Brazil 29
reactions to work stress. Considering that the JDCS model is the main
theoretical reference adopted in Brazilian work stress research, the most
frequently investigated job stressors were demands at work and the de­
gree of work control (n = 47; 58%). The job stressors advocated by the
ERI model – such as effort, reward, and overcommitment – are less
frequently reported in the literature (n = 11; 14%). Six studies combined
the two theoretical models mentioned, thus using the six job stressors
together. Interpersonal relationships, overload and conflict, and role
ambiguity have been measured in a smaller number of studies
(Table 3.2).
For measuring the job stressors included in the JDCS, the most fre­
quently adopted instruments (n = 6) were the Job-Content Questionnaire
(JCQ; Karasek, 1985) and its reduced version (Job Stress Scale-JSS;
Theörell et al., 1988; n = 41). For measuring the ERI, the only scale used
was the Effort-Reward Imbalance Questionnaire (ERIQ; n = 11) – both
in its complete and reduced versions (Siegrist et al., 2004). A few studies
(n = 10) included scales originally developed in Brazil, among which the
Work Stress Scale (EET; Paschoal & Tamayo, 2004; n = 3) and the
Nurses’ Stress Inventory (IEE; Stacciarini & Tróccoli, 2000; n = 4)
stand out.
The specific work stress reactions were explicitly mentioned in 96
(81%) of the reviewed articles. Table 3.3 summarizes the different ca­
tegories of work stress reactions used in those studies. The most frequent
reaction was burnout (n = 22; 23%), followed by self-perceived stress
(n = 14; 15%), work ability (n = 10; 11%), and psychophysiological in­
dicators such as hypertension, salivary cortisol, and low back pain
(n = 10; 11%).
The main scale adopted to measure burnout was the Maslach Burnout
Inventory (Maslach, Jackson, & Leiter, 1996; n = 15). As for the other
reactions to work stress, the main measurement instruments used were
the Self Reporting Questionnaire (Harding et al., 1980; n = 6) – already
validated in Brazil (Mari & Williams, 1985) – and the Lipp’s Inventory
of Symptoms of Stress for Adults (ISSL; Lipp, 2000; n = 5) – originally
developed in Brazil.

Table 3.2 Stressors adopted in the studies

Stressors Frequency Percentage

Demands, control, social support 47 58

Effort, reward, overcommitment 11 14
Interpersonal relationships 9 10
Overload 7 9
Conflict and role ambiguity 7 9
Total 81 100
30 Maria Cristina Ferreira et al.
Table 3.3 Work stress reactions adopted in the studies

Work Stress Reactions Frequency Percentage

Burnout 22 23
Self-perceived stress 14 15
Ability to work 10 11
Psychophysiological indicators 10 11
Coping 9 9
Self-perceived health 6 6
Depression 5 5
Vocal condition 5 5
Minor psychic disorders 4 4
Work satisfaction 3 3
Common mental disorders 3 3
Patient care 2 2
Alcohol consumption 1 1
Anxiety 1 1
Negative affects at work 1 1
Total 96 100

Main Results Observed in the Reviewed Studies

There were six qualitative studies that were generally conducted through
interviews and subsequently subjected to content analysis. The outcome of
these analyses indicated that the identified main categories of job stressors
mentioned by workers were similar to those reported in non-Brazilian
contexts: work overload, pressure at work, repetition of tasks, lack of
autonomy at work, difficulties in interpersonal relationships, and the lack
of resources for work (Cardoso, Padovani, & Tucci, 2014). Similarly,
among the qualitatively reported: stress symptoms, changes in sleep pat­
terns, psychosomatic complaints, and the reduced ability to concentrate
were generally mentioned in the studies (Mininel, Baptista, & Felli, 2011).
Quantitative descriptive studies focused mainly on the percentages of
different stressors. Focusing on job stressors, high percentages of de­
mand, control, effort-reward imbalance and overcommitment, as well as
low percentages of social support, were reported (Silva-Junior & Fischer,
2015). Other studies reported a high percentage of work overload, ne­
gative aspects related to work organization – such as night work, and the
lack of resources to perform the job (Martins, Enumo, & Paula, 2016). It
is noteworthy that these patterns do not concord with the general per­
ception of Brazilian workplaces that were outlined in the introduction.
Regarding the incidence of stress indicators, stress percentages on the
average (Maffia & Pereira, 2014), and low burnout percentages (Padilha
et al., 2017) were found in general in the samples considered.
The studies testing the JDCS model mainly analyzed associations via
correlation coefficients and regression analyzes. The general pattern we
 Work Stress Research in Brazil 31
found is in line with international findings: the higher the demands and
the lower the degree of control over work, the higher the rates of de­
pression (Lima, Assunção, & Barreto, 2015), of job dissatisfaction
(Costa & Ferreira, 2014), of back pain occurrence (Fernandes, Carvalho,
Assunção, & Silvany Neto, 2009), the more negative assessments on
working conditions (Pelegrini, Cardoso, Claumann, Pinto, & Felden,
2018), the lower quality of life (Fogaça, Carvalho, Nogueira, & Martins,
2009), of lower self-perceived health (Griep, Rotenberg, Landsbergis, &
Vasconcellos-Silva, 2011), of lower ability to work (Martinez, Latorre,
& Fischer, 2017), and the lower job satisfaction. Regarding social
support, in line with international patterns, it was found that lower
social support is associated with worse self-rated health (Theme Filha,
Costa, & Guilam, 2013), more precarious working conditions (Pelegrini
et al., 2018), lower quality of life (Fogaça et al., 2009), less ability to
work (Martinez et al., 2017), job dissatisfaction (Costa & Ferreira,
2014), depression (Costa & Ferreira, 2014), psychosomatic complaints
(Costa & Ferreira, 2014), and burnout (Vidotti, Ribeiro, Galdino, &
Martins, 2018). In other words, the higher the social support, the lower
the stress at work (Lopes & Silva, 2018). However, it is also noteworthy
that, in contrast to previous international studies, some studies have
not found significant correlations between the typically reported job
stressors and either burnout (Mota, Dosea, & Nunes, 2014) or work
ability (Negeliskii & Lautert, 2011).
Focusing on the categories of work conditions proposed by the JDCS
model, Brazilian studies have shown similar patterns to international
studies. These studies demonstrated that high-demand work (high de­
mand and low control) is associated with more illness (Pinhatti et al.,
2018), higher prevalence of common mental disorders (Araújo, Mattos,
Almeida, & Santos, 2016), higher occurrence of minor psychological
disorders (Urbanetto et al., 2013), higher rates of psychosomatic
complaints (Pereira, Kothe, Bleyer, & Teixeira, 2014), greater voice
disorders (Giannini, Latorre, & Ferreira, 2012), higher blood pressure
rates (Pimenta & Assunção, 2016), worse health self-assessment
(Theme Filha et al., 2013), worse self-reported mouth health (Scalco,
Abegg, Celeste, Hökerberg, & Faerstein, 2013), lower work capacity
(Sampaio, Coelho, Barbosa, Mancini, & Parreira, 2009), and worse
quality of life (Azevedo, Nery, & Cardoso, 2017). In contrast, active
work (high demand and high control) was correlated with a lower in­
cidence of burnout (Silva et al., 2015), but also with a higher occur­
rence of minor psychological disorders (Urbanetto et al., 2013) and
psychosomatic complaints (Pereira et al., 2014). This is somewhat
contrary to international trends. Passive work (low demand and low
control) conditions were correlated with a lower incidence of burnout
(Silva et al., 2015). Some studies did not observe significant associa­
tions between the different categories of work stress (high demand,
32 Maria Cristina Ferreira et al.
passive work, and active work) and hypertension (Alves, Chor,
Faerstein, Werneck, & Lopes, 2009).
Studies testing the Effort-Reward Imbalance Model generally showed
similar patterns as international literature. The greater imbalance be­
tween efforts and rewards, which indicates higher degrees of stress, was
associated with a greater prevalence of common mental disorders
(Marcelino Filho & Araújo, 2015), minor psychological disorders
(Marconato et al., 2017), lower mental health (Silva, Souza, Borges, &
Fischer, 2010), more illness indicators (Pinhatti et al., 2018), lower self-
reported health indexes (Griep et al., 2011), quality of life at work
(Fogaça et al., 2009), and work ability (Martinez et al., 2017).
Other studies also reported significant associations of job stress with
work overload (Meneghini, Paz, & Lautert, 2011), conflicts between
personal and organizational values (Meneghini et al., 2011), lack of
adequate resources for proper work performance (Andolhe, Barbosa,
Oliveira, Costa, & Padilha, 2015), task conflicts (Costa &
Martins, 2011), and teacher-student relationship issues (Rodrigues,
Paula, Silveira, & Silveira, 2017). Focusing on possible factors for pro­
tection, the organizational values of autonomy, well-being, ethics, and
community concern (Canova & Porto, 2010), the possibilities of pro­
fessional development and advancement (Meneghini et al., 2011), and
receiving rewards (Meneghini et al., 2011) have been considered
protective factors for work stress.
Correlations and consequences of work stress were increased levels of
depression (Pozzebon, Piccin, Silva, & Corrêa, 2016), anxiety (Pozzebon
et al., 2016), self-perceived deterioration of health (Guido, Linch,
Pitthan, & Umann, 2011), decreased productivity (Umann, Guido, &
Silva, 2014), self-reported voice disorders (Valente, Botelho, & Silva,
2015), work ability index (Martinez & Latorre, 2009), alcohol con­
sumption (Maffia & Pereira, 2014), and lower job satisfaction (Andolhe
et al., 2015). These patterns are, again, generally in line with interna­
tional trends.
Investigating burnout as a chronic consequence of stress, some studies
found that younger workers (Trindade, Lautert, Beck, Amestoy, & Pires,
2010) with less work experience (Guedes & Gaspar, 2016), who ex­
perience greater relationship problems with their students
(Dalagasperina & Monteiro, 2014), and who have a greater workload
(Guedes & Gaspar, 2016) are those who are most likely to be affected by
burnout. Burnout was also associated with lower job satisfaction
(Ferreira & Lucca, 2015).
There were seven intervention studies – four of which used quasi-
experimental pre- and posttest designs with a single group. The inter­
ventions adopted in these studies consisted of: a set of stress-related
lectures (Dalcin & Carlotto, 2018), workplace exercises sessions
(Freitas-Swerts & Robazzi, 2014), a physical activity program (Freitas,
 Work Stress Research in Brazil 33
Carneseca, Paiva, & Paiva, 2014), and a wellness program (Jacques
et al., 2018). Only the study by Dalcin and Carlotto (2018) found a
significant reduction in stress indices between the post- and pretest.
Among the three studies with control groups, Damásio, Habigzang,
Freitas, and Koller (2014) showed reduced burnout among participants
in an intervention group using cognitive behavioral therapy compared to
a nonrandomized control group. Freitas, Calais, and Cardoso (2018)
reported reduced stress symptoms in a progressive relaxation interven­
tion compared with two nonrandomized control groups. Montibeler
et al. (2018) conducted a completely randomized experiment testing the
effectiveness of aromatherapy massage. The results showed a reduction
in blood pressure and heart rate indicators between the posttest and
the pretest of the experimental group, but there were no significant
differences between the self-reported stress symptoms pre and post.
Finally, only three studies reported new development or refinement of
instruments. One of them concerns the construction of a Brazilian scale
for the evaluation of psychosocial stressors in the workplace, but with a
specific focus on measuring the theoretical model of Cooper, Dewe, and
O’Driscoll (2001). The instrument is composed of seven factors – role
conflict and ambiguity, role overload, interpersonal difficulties, career
insecurity, lack of autonomy, work/family conflict, and pressure on the
degree of responsibility – and the final scale showed good psychometric
characteristics (Ferreira et al., 2015). Tamayo and Tróccoli (2009) de­
veloped a Brazilian Burnout Inventory which is based on the burnout
syndrome model proposed by Maslach et al. (1996). Similar to the
United States scale, it is composed of three factors – emotional exhaus­
tion, dehumanization, and job disappointment – and has shown ade­
quate psychometric characteristics. Aguiar, Fonseca, and Valente (2010)
conducted a test-retest reliability analysis of the Job Stress Scale
(Theörell et al., 1988). The results of that investigation suggested high
stability of the three dimensions of the scale – psychological demands,
work control, and social support.

Discussion
Our review found that there has been a steady rate of publication of
stress-related work in Brazilian journals. The work conducted in Brazil is
largely influenced by international models, instruments, and trends. We
discuss some suggestions for future development.
The first observation is the prevalence of Western theories, models,
and instruments in the context of Brazilian research. As outlined in our
introduction, the economic context in Brazil is characterized by more
precarious labor market conditions compared to many other Western
countries. Furthermore, the social and cultural environment in Brazil is
more complex with a large number of different ethnic and racial groups
34 Maria Cristina Ferreira et al.
that are socially and economically stratified. Overall, the Brazilian con­
text is characterized by a greater emphasis on traditional in-groups –
most notably extended family networks and correspondingly much
lower levels of individualism and self-orientation – as well as higher
hierarchies and power distance, but with greater informality in social
interactions than would be indicated by those marked by hierarchy
differences and higher levels of uncertainty avoidance, which is highly
relevant for understanding stress processes (Hofstede, 2001). Recent
research suggested that there are a number of cultural problem-solving
strategies such as Jeitinho Brasileiro (Ferreira, Fischer, Porto, Pilati, &
Milfont, 2012) that emerged in a highly bureaucratic and unequal so­
cietal context, which in turn is likely to affect social health and well-
being. We would encourage more specific consideration of the social,
cultural, and economic conditions in Brazil when studying work stress.
It is also noteworthy that there was little to no consideration of the
specific macroeconomic conditions that Brazilian workers and compa­
nies are facing and how these processes may diverge from international
trends, typically reported in the United States or European contexts. It is
also worrisome that the large majority of studies used instruments de­
veloped elsewhere with little consideration of cultural, economic, or
social conditions that may render results open to alternative interpreta­
tions. Simply reporting reliability or factor analyses is not sufficient for
an adequate adaption of instruments, since it may miss important locally
relevant indicators and information and may not adequately cover the
domain of interest.
In line with these trends, the most frequently adopted theoretical
models have been the Demand-Control-Social Support Model and the
Effort-Reward Imbalance Model. These models have been developed in
the United States and Western Europe, and it would be useful to more
critically question their relevance and appropriateness for Brazilian
contexts.
Another important avenue for future studies would be the develop­
ment of novel theoretical models that jointly consider stress and well-
being processes in the workplace – such as, the Job Demands and
Resources Theory (JD-R) (Bakker & Demerouti, 2017). Such models
allow the joint analysis of the illness processes that are thought to cause
job stress and of motivational processes that are assumed to lead to well-
being at work. When adopting these models, it would be important to
conduct investigations that broaden the scope of the job stressors usually
adopted in research by considering the role played by broader contextual
factors – such as leadership style and organizational culture – since both
types of variables are organizational characteristics capable of causing
work stress (Cooper et al., 2001).
The majority of studies tested relatively simple designs, with not a
single study in our review testing mediators and moderators in the stress
 Work Stress Research in Brazil 35
process. Such models have made a significant contribution to our un­
derstanding of the stress process in the international arena. We would
encourage more sophisticated models and more longitudinal research
that can adequately test the presence of possible mediators between
stressors and stress reactions, as well as their impact on work perfor­
mance outcomes. In addition, individual-difference variables – such as
personality characteristics (e.g., proactive personality, extroversion, etc.)
and organizational context dimensions (e.g., leadership styles, organi­
zational culture, etc.) should be investigated and included as potential
causes and/or moderators of the work stress process.
Our review also showed a preoccupation with stress in health pro­
fessionals – especially nurses – followed by studies conducted with
education professionals. On one hand, we would encourage more re­
search in diverse occupations and work environments to get a better
perspective on occupations and sectors that were underrepresented and
to provide a more holistic understanding of work stress in Brazil. In this
regard, the category of security professionals deserves special mention, as
it is considered a high-risk category in the current Brazilian reality
(Calazans, 2010). At the same time, we would also encourage more
focused research on those occupations where work stress is likely to have
significant negative consequences. For example, medical doctors are
likely to show high levels of burnout (Rosa, Falavigna, & Silva, 2019),
which is likely to impact their ability to perform medical procedures and
jeopardizes the health and physical well-being of both doctors and pa­
tients. These effects of stress on the larger society – beyond the im­
mediate respondent of a survey – need to be documented. Similarly, more
high-quality intervention studies that can be used to address these stress-
related effects are needed.
Methodologically, cross-sectional correlational studies were most
prevalent. We found a single study that adopted a more state-of-the-art
structural equation modeling. Structural equation modeling is a more
robust statistical technique for testing complex multivariate relationships
between job stressors and reactions to work stress. Similarly, only two
longitudinal studies were found in this review, which also contrasts with
the international literature on work stress – in which longitudinal studies
are more prevalent. We strongly encourage longitudinal studies as they
allow a more detailed understanding of the pattern and evolution of
stress conditions over time. Also, no preregistered studies were found
and the null-hypothesis significance testing framework was dominant.
This is a concern, given the current replication crisis within the social and
medical sciences, and concerns the null-hypothesis testing framework.
We had already mentioned that experimental and quasi-experimental
studies designed to test the effectiveness of different interventions in
reducing stress at work were scarce. This contrasts with international
literature, in which publications focusing on interventions have steadily
36 Maria Cristina Ferreira et al.
increased and systematic reviews on the subject have become available
(Havermans et al., 2016). Moreover, Brazilian studies lack methodolo­
gical rigor. Among the seven intervention articles included in our review,
four reported quasi-experimental interventions involving a single pre-
and posttest group and three used an experimental group and a control
group, but without randomization. Thus, only one study actually met the
criteria needed to establish causal relationships between the type of stress
reduction intervention adopted and the stress reactions measured. We
strongly recommend more randomized control trials with control
groups, preferably with active control groups to show the effectiveness of
the assumed theoretical process in the experimental group. This is ne­
cessary to more reliably test the effectiveness of different intervention
strategies in reducing work stress.
In summary, it is important for future research on work stress in Brazil
to more explicitly consider the economic, social, and cultural conditions
of workplaces in the country and to evolve toward more powerful
methodological procedures, such as longitudinal and experimental stu­
dies, as well as more sophisticated analysis strategies, such as structural
equation modeling and multilevel analysis. Such studies can undoubtedly
contribute to a better understanding of this phenomenon within the
Brazilian reality.

Note
1 Job stress might have been measured or included in these articles.

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4 Job Stressors in Greater China
An Explorative Study Using the
Qualitative and Quantitative
Approaches
Chang-qin Lu, Oi-ling Siu,
Hai-Jiang Wang, and Luo Lu
Introduction
Job stress is becoming one of the most prevalent health issues nowadays,
especially for the Greater China regions. These regions are undergoing
fundamental transformations of industrial structures, as well as rapid
social modernization in both work and lifestyles (e.g., Siu, Spector,
Cooper, Lu, & Yu, 2002; Wang, Lu, & Siu, 2015; Xie, Schaubroeck, &
Lam, 2008). Moreover, with the globalization of the world economy and
Mainland China joining the World Trade Organization (WTO), many
multinational companies are attracted to put more investments in these
regions. In the spirit of free competition, employees in Mainland China,
Hong Kong, and Taiwan are becoming more exposed to stressful
Western and industrialized work situations. Recently, scholars and
practitioners (e.g., Bliese, Edwards, & Sonnentag, 2017; Houtman,
Jettinghoff, & Cediollo, 2007) call for more job stress research in de-
veloping countries. Therefore, Greater China offers one of the most
important contexts for job stress research.
The majority of job stress models have been developed in Western
societies, which demonstrated that stressors at the workplace lead to job
strains – such as low level of job satisfaction, poor physical and psy-
chological well-being, and poor performance (e.g., Bliese et al., 2017;
Chang & Baard, 2011; Ganster & Rosen, 2013). The sources of job stress
have been well-documented since the late 1970s (Cooper, Sloan, &
Williams, 1988). Although researchers developed or adopted different
schemes of categorization, there are also considerable commonalities. For
instance, Burke (1988) provided a summary of findings for six categories
of stressors – physical environment, role stressors, organizational struc-
ture and job characteristics, relationships with others, career develop-
ment, and work-family conflict. Cooper, Sloan, and Williams (1988)
identified six sources of job stress at the workplace – job-intrinsic sources
of stress, management roles, relationships with others, career and
achievement, organizational structure and climate, and work-to-home
interface. These scales were also adapted in a variety of languages for use

DOI: 10.4324/9780429292538-4
44 Chang-qin LU et al.
in non-English-speaking countries. Moreover, the British-originated
Occupational Stress Indicator (OSI) (Cooper et al., 1988) was devel-
oped into the Chinese version and used for job stress-related studies (e.g.,
Lu, Cooper, Chen, Hsu, Li, Wu, & Shih, 1995; Lu, Kao, Cooper, &
Spector, 2000; Lu, Siu, Au, & Leung, 2009; Lu, Siu, & Cooper, 2005;
Siu, Donald, & Cooper, 1997; Yu, Sparks, & Cooper, 1998), which has
broadened our understandings of job stress in Chinese society.
However, it has been argued that almost all of the job stress models
and stress theories were developed and empirically tested in Western,
industrialized countries, which are based on the experiences of the
employees there (Chang & Baard, 2011; Xie, 1996). Moreover, the
environments among these countries seem more stable compared with
Chinese society. One of the major limitations in using these models is
their global approach, assuming that the people experience the same
stressor under the different social and cultural contexts. Although the
negative impacts and damages of job stress on individuals and organi-
zations in different cultural societies may be the same, the types of
stressors may not be so. Stress is influenced by cultural and social vari-
ables such as values, attitudes, and appraisals (Chang & Baard, 2011;
Liu, Spector, & Shi, 2007; Xie et al., 2008). From the transactional
approach, Lazarus (1991) reiterated that “stress is not a property of the
person, or of the environment, but arises when there is a conjunction
between a particular kind of environment and a particular kind of person
that leads to a threat appraisal” (p.3). Moreover, culture is one of the
fundamental aspects of society that influences both the environment and
the person. Culture can set the tone for the characteristics of the en-
vironmental system, and for the dominant aspects of the social system,
which both largely determine the pressures on a person – stressors – and
the available resources to cope with these stressors. Culture offers in-
dividuals very different views about their nature and the way in which
they themselves are related to the environments (Kitayama & Park,
2007). Therefore, stress implies a process rather than a static arrange-
ment, mostly resulting from the interactions of the person with his/her
environment.
Cross-cultural differences are also reported in several studies on job
stressors. For instance, in an open-ended study comparing stressors
in India – one of the collectivistic societies – and the United States,
Narayanan, Menon, and Spector (1999) found that lack of structure
was a major stressor in India but not in the United States. Spector,
Sanchez, Siu, Salgado, and Ma (2004) found differences in perceived
job stressors between the employees in the United States and Greater
China. Role ambiguity was significantly higher in those from Hong
Kong than in those from the United States, but it was significantly
higher in the United States than in Mainland China. For interpersonal
conflict, Hong Kong employees reported the highest level, Mainland
 Job Stressors in Greater China 45
China employees scored in the middle, and the United States employees
were the lowest. Recently, Hirst et al.’s (2008) cross-cultural study
also found that climates for autonomy (or lack of autonomy) benefited
and enhanced employees’ well-being in the United Kingdom, but did
harm to Chinese employees’ well-being. Probst and Lawler (2006)
found that Chinese employees suffered from the threat of job insecurity
more than United States employees.
In addition, most studies about work stress – including those conducted
in Greater China – have relied on the traditional approach, where the
structured scales with close-ended measurements were adopted to in-
vestigate an individual’s job stress over an unspecified time period. This
was helpful to job stress researchers because they could use similar scales
to tap the same set of job stressors – such as role overload and inter-
personal conflict. However, it may be insufficient to identify the promi-
nent stressors resulting from social and environmental changes. Moreover,
cross-cultural researchers have questioned the extent to which such a way
can be used to explore the prominent culture-specific stressors (Chang &
Baard, 2011; Xie, 1996). A few researchers (e.g., Glowinkowski &
Cooper, 1985; Liu et al., 2007; Liu, Spector, & Shi, 2008) have expressed
concern about exclusive reliance on such traditional quantitative methods.
Moreover, with the significant changing of work, the perceived stressors
in the workplace seem to be changing. It is necessary and reasonable
to explore the stressors associated with these changes, especially in a
transitional society such as Greater China. Thus, some researchers
(e.g., Cox, 1985; Mazzola, Schonfeld, & Spector, 2011; Schonfeld &
Mazzola, 2015) have suggested using alternative approaches, such as
qualitative methods, to examine stress at work. One qualitative approach
is the open-ended method developed by Newton and Keenan (1985).
Targeting professional engineers, they examined stress in an occupation-
specific context, which was different from conventional approaches. We
believe that open-ended methodology works better in capturing culture-
specific stressors which may be obscured by using structured quantitative
scales. Later on, Liu Spector and Shi (2007) used both quantitative and
qualitative ways to explore cross-national (China versus the United States)
job stress and found some interesting results. However, their study had
two limitations. One is the representation of the samples. Their samples
were from employees in universities which are in the public sector, and
their job characteristics are very different from other professions. Another
limitation is the research procedure. They did quantitative and qualitative
studies all at once, and used quantitative scales in advance, which might
have prevented them from exploring certain sensitive and contextual job
stressors under the Chinese context. Therefore, the generalizability of their
findings might be doubtful.
The above limitations provide the impetus for our study. The present
study extended Liu and colleagues’ study (2007) by using diverse group
46 Chang-qin LU et al.
samples from three regions of Greater China, which were representatives
of the Chinese working population. Moreover, we used a qualitative
method to explore those serious job stressors inherent in the changing
Chinese society and then combined the quantitative survey method to
validate the measurement of the job stressors. To provide strong evi-
dence, we also included job performance rated by supervisors as one of
the outcomes. The whole study consisted of three studies. In Study 1, an
open-ended method was used to collect qualitative data on employees’
job stressors experienced at the workplace to be able to derive the most
common job stressors. In Study 2, scales were adapted or modified to
measure the stressors identified in Study 1. In Study 3, a quantitative
survey study was conducted to investigate the relationships between job
stressors and outcomes and to provide valid evidence for these measures
as well. Using both qualitative and quantitative methods allowed us to
explore and to identity those job stressors in contemporary Chinese
society that are associated with employees’ well-being, work attitudes,
and performance during the transition process.

Study 1

Method
An open-ended qualitative methodology was used, asking respondents
to describe a stressful critical incident at work using a modified version
of the Stress Incident Record designed by Newton and Keenan (1985).
A protocol was developed where a structured list of questions was
constructed to explore the stressors reported by employees in Greater
China. Specific questions were: “Think of a stressful event that oc-
curred in the past month and describe it in detail, including what led
up to it and what happened” and “How did it make you feel at that
time.” It aimed to obtain qualitative data on respondents’ concerns
with the job stressors they experienced at their current workplace. The
qualitative data were analyzed by content to develop an exhaustive set
of job stressors categories. Relative frequencies corresponding to each
category were reported.

Sample and Procedure

A total of 91 employees from the public and private sectors in equal
proportions of gender and rank – from line employees to top managers –
in Hong Kong (N = 36), Beijing (N = 25), and Taipei (N = 30) were
invited to participate in the study. Participants in Hong Kong were
interviewed and tape-recorded, whereas those in Beijing and Taipei
were asked to complete the same open-ended questionnaires. Each in-
terview lasted for 30 to 45 minutes. The average age ranged from 31 to
 Job Stressors in Greater China 47
36 years, and the average tenure ranged from three to six years across
the three samples.
The responses generated from both the interviews and questionnaires
were analyzed by content analysis, and coded by two independent raters –
the first author (Dr. Chang-qin Lu) and a graduate student – to derive the
most frequent stressors faced by Chinese employees. The first rater listened
to tapes and read the open-ended materials, and the incidents were placed
into as many categories as they fit in. The second rater then independently
created categories. Both raters specifically sought to sort incidents into
only a single category area. There was a 94.5% agreement rate between
the two independent raters in the placement of incidents into categories.
The remaining 2% were discussed to reach consensus, and 3% were
thrown away. A total of 88 incidents were collected.

Results and Discussion

Table 4.1 shows the six most reported stressors categories generated
from content analysis. They included “Interpersonal conflict” (22.7%),
“Quantitative workload” (19.4%), “Organizational constraints”
(15.9%), “Organizational politics” (12.5%), “Job insecurity” (10.2%),
and “Work-family conflict” (8.0%). Some examples of incidents are
presented in Table 4.1.
The result of the open-ended interviews corroborates Liu et al.’s study
(2007), in which quantitative workload, interpersonal conflict, and or-
ganizational constraints were found to be the most common job stressors
faced by Chinese employees. These stressors were also experienced by
Western employees (Spector & Jex, 1998). Like previous studies in
collectivistic societies (e.g., Liu et al., 2007; Narayanan et al., 1999;

Table 4.1 Results of open-ended interviews in Study 1 (N = 91, total

incidents = 88)

Stressors Frequency Percentages Example

Interpersonal 20 22.7% “I don’t find harmony with

conflict superiors.”
Quantitative 17 19.4% “Heavy workload or meeting
workload deadlines.”
Organizational 14 15.9% “Due to poor work supplies or
constraints training, it is hard to fulfill
my task.”
Organizational 11 12.5% “Some persons in my department
politics implicitly favor in-group, which
makes me hard to deal with.”
Job insecurity 9 10.2% “I am afraid I will lose my job.”
Work-family 7 8.0% “It’s difficult for me to balance
conflict work and home life.”
48 Chang-qin LU et al.
Xie, 1996), the lack of job control, which is a common job stressor in
Western society, was not found to be a stressor in the current study of
Chinese society. Moreover, job insecurity (e.g., Feng, Lu, & Siu, 2008;
Wang, Lu, & Lu, 2014; Wang et al., 2015) and work-family conflict (e.g.,
Lu, Wang, Siu, Lu, & Du, 2015; Spector et al., 2004; Yang, Chen, &
Zou, 2000) were discovered to be the major job stressors in the present
Chinese workplace.

Study 2

Method
Study 21 aimed to develop a set of measures for these common job
stressors explored in Study 1 and to test their reliabilities and validities.

Sample and Procedure

A purposive sampling method was adopted to select various types of en-
terprises in the public and private service sectors in Hong Kong, Beijing,
and Taipei. A total of 610 questionnaires were distributed, with a valid
number of 379 returned, making an average response rate of 62.1%. The
sample from Hong Kong consisted of 105 – 54 males, 50 females, and 1
unidentified – with an average age of 35.64 years (SD = 6.68), and an
average tenure of 7.11 years (SD = 6.43), respectively. The sample from
Beijing consisted of 128 – 46 males, 82 females – with an average age
of 35.78 years (SD = 6.82), and an average tenure of 7.55 years (SD = 7.44),
respectively. The sample from Taiwan consisted of 146 – 102 males, 43
females, and 1 unidentified – with an average age of 35.78 years (SD = 6.82
years), and an average tenure of 7.55 years (SD = 7.54), respectively.
In order to identify each of the six job stressors, the existing scales or
items which measure these job stressors were collected. The scales which
have Chinese version were primarily important. If unavailable, the authors
tried to select the items from the developed Western scales. Moreover, two
items from the composite stress index (Motowidlo, Packard, & Manning,
1986) were included to measure total perceived stress, which was used to
examine where the stressor item was retained or not.
All of these were administered in Chinese. The scales that were ori-
ginally developed in English were not previously used in Chinese were
translated into Chinese by a back-translation method to assure the
accuracy (Brislin, 1986) (the same procedure in Study 3).

Results and Discussion

Among those items, 29 items that were correlated, and more than .30
items with the total perceived stress were retained. The two-item
 Job Stressors in Greater China 49
measure of total perceived stress (Motowidlo et al., 1986) was reliable
(α = .86). There are examples of incidents such as “I feel a great deal of
stress because of my job” and “my job is extremely stressful.” Each item
was assessed using a six-point scale that ranged from strongly disagree
(1) to strongly agree (6). High scores indicate a high level of total
perceive stress.
These 29 items were intended to measure the six job stressors. They
are interpersonal conflict (4 items) (Spector & Jex, 1998) (e.g., “How
often are people rude to you at work?”), quantitative overload (5 items)
(Spector & Jex, 1998) (e.g., “How often is there a great deal to be
done?”), organizational constraints (11 items) (Spector & Jex, 1998)
(e.g., “poor equipment or supplies”), job insecurity (3 items) (ASSET,
Cartwright & Cooper, 2002) (e.,g. “Your job is likely to change in the
future”), organizational politics (3 items) (one item from Cooper et al.,
1988; two items from Kacmar & Carlson, 1997; e.g., “There has always
been an influential group in your department that no one ever crosses”),
and work-family conflict (3 items) (one item from ASSET, Cartwright, &
Cooper, 2002; two items from OSI, Cooper et al., 1988) (e.g., “You are
pursuing a career at the expense of home life”). Each item was rated by
frequency ranged Less than once per month or never (1) to Several times
per day (6). For the first four subscales, reliability and validity were
provided by the study conducted in China (Siu, Spector, Cooper, &
Lu, 2005).
Tables 4.2 and 4.3 showed the descriptive statistics of six job stressors
and their intercorrelations. All of the six job stressors scales were reli-
able, with Cronbach’s alphas ranging from .73 to .93. In order to test
whether the six scales were adequately distinct from each other, the
Confirmatory Factor Analysis (CFA) was conducted. The results of the
CFA demonstrated that the six-factor model fitted better (χ2/df = 4.99,
GFI = 0.89, NFI = 0.90, IFI = 0.92, CFI = 0.92, RMSEA = 0.06) than the
one-factor model (see Table 4.4). Thus, the valid structures of Chinese
job stressor scales were verified. This also implied that our measurements

Table 4.2 Results of Descriptive Statistics in Study 2 (N = 379)

Subscales Number M SD Range Coefficient a

of Items

Interpersonal conflict 4 7.27 3.37 4–24 .81

Quantitative workload 5 13.66 6.25 5–30 .93
Organizational 11 27.73 11.37 4–24 .93
constraints
Organizational politics 3 7.23 3.49 3–18 .76
Job insecurity 3 5.87 3.17 3–18 .73
Work-family conflict 3 7.25 3.29 3–18 .80
50 Chang-qin LU et al.
Table 4.3 Intercorrelations of Chinese Stressors in Study 2 (N = 379)

Variables 1 2 3 4 5 6

1. Interpersonal conflict 1.00

2. Organizational constraints .52*** 1.00
3. Quantitative workload .52*** .57*** 1.00
4. Organizational politics .58*** .43*** .61*** 1.00
5. Job insecurity .44*** .34*** .44*** .43*** 1.00
6. Work-Family Conflict .54*** .60*** .54*** .57*** .40*** 1.00

Note
* ** ***
p < .05, p < .01, p < .001

Table 4.4 Summary of Fit Statistics for Measurements of Chinese Job Stressors
in Study 2 (N = 379)

Models χ2/df GFI AGFI RMSEA NFI CFI IFI

1. One-factor 49.34/9 .963 .914 .109 .946 .955 .955

model
2. Six-factor 360.86/174 .918 .891 .053 .929 .961 .962
model

Note
One-factor model – combining six job stressors; Six-factors model – hypothesized mode,
including Interpersonal Conflict, Quantitative Workload, Organizational Constraints,
Organizational Politics, Job Insecurity, Work-Family Conflict.

are not seriously affected by common method bias (Podsakoff,

MacKenzie, Lee, & Podsakoff, 2003).
Based on the results above, it is reasonable for us to conclude that there
were six major job stressors in the contemporary Chinese workplace.

Study 3

Method
Study 3 aimed to verify the results obtained in Study 2 by collecting
samples from the three regions again. The Confirmatory Factor Analysis
was conducted to provide pieces of evidence for the reliability and va-
lidity of Chinese job stressors scales. Furthermore, Study 32 was done to
investigate the impact that these stressors have on employees’ well-being,
work attitude, and job performance.

Sample and Procedure

A multistage cluster random sampling method was used to recruit em-
ployees in Hong Kong, and a purposive sampling method was adopted to
 Job Stressors in Greater China 51
select employees in Beijing and Taipei. A total of 1,384 questionnaires
were distributed with a valid number of 1,032 returned, making an
average response rate of 74.6%. The Hong Kong sample consisted of
132 males and 192 females, with an average age of 32.07 years
(SD = 9.40 years) and an average tenure of 6.27 years (SD = 6.12), re-
spectively. The Beijing sample consists of 209 males and 182 females,
and 11 unidentified participants, with an average age of 31.85 years
(SD = 7.41 years) and an average tenure of 4.34 years (SD = 5.15), re-
spectively. The Taipei sample consists of 134 males and 172 females,
with an average age of 32.85 years (SD = 6.65 years) and an average
tenure of 6.31 years (SD = 6.31), respectively.
A survey packet consisting of an employee and a supervisor ques-
tionnaire, each marked with the same code, was distributed to the em-
ployees and the supervisors. An addressed self-adhesive envelope was
included for employees and supervisors to return completed ques-
tionnaires independently.

Measures

Job Stressors
For five stressor scales – quantitative overload, interpersonal conflict,
organizational constraints, organizational politics, and work-family
conflict – all items were retained except for three. The three items
were somewhat modified because of the loading of two factors si-
multaneously. For the job insecurity scale, two new items measuring
affective job insecurity (e.g., “The thought of getting fired really scares
you”) were added (Feng et al., 2008).

Job Satisfaction
Job satisfaction was assessed with the three-item Cammann, Fichman,
Jenkins, and Klesh (1979) job satisfaction subscale from the Michigan
Organizational Assessment Questionnaire, in which a higher score in-
dicates a higher level of job satisfaction. The Chinese version had a
coefficient alpha of .82 (Siu et al., 2005).

Strains
The psychological well-being scale of An Organizational Stress Screening
Tool (ASSET) (Cartwright & Cooper, 2002) was used to measure phy-
sical and psychological strains (20 items). The items are symptoms of
stress-induced strains such as panic attacks and constant tiredness, with
a respective high score denoting more strains. The scales were developed
52 Chang-qin LU et al.
into the Chinese version and had a coefficient alpha of .82 and .92,
respectively (Siu et al., 2005).

Job Performance
Items of the scale were chosen from Visewsevaran, Ones, and Schmidt
(1996) supervisory job performance rating, which includes the quantity
of work, quality of work, and others. A summation of ratings of these
items constitutes the total performance score. The Chinese version had a
coefficient alpha of .78 (Siu, Lu, & Spector, 2013).

Results
Confirmatory Factor Analysis was used to verify the structure of Chinese
job stressor scales. The results demonstrated that the six-factor model
fitted well (χ2/df = 4.99, GFI = 0.89, NFI = 0.90, IFI = 0.92, CFI = 0.92,
RMSEA = 0.06). The Cronbach’s alpha for each subscale (ranging from
.77 to .94) also provided support for the reliabilities of the job stressors
measures.
Table 4.5 shows the intercorrelations among the main variables and
the reliabilities. The results of a series of regression analyses demon-
strated that the job stressors were positively related to strains and ne-
gatively related to job satisfaction and job performance rating by
supervisors, and the coefficients were significant except for two (see
Table 4.6).
These results provided support for the criterion validity of the Chinese
job stressor measures.
One interesting and rather surprising result is that quantitative
workload was positively associated with job performance rated by su-
pervisors. It implied that employees with too much work might maintain
good job performance. Recently, the challenge-hindrance stress
framework suggests that the stressors could be categorized into challenge
stressors and hindrance-stressors and that challenge-stressor related
positively to performance, while hindrance-stressors associated nega-
tively with job performance, despite the harm caused by both stressors
to employees’ well-being (LePine, Podsakoff, & LePine, 2005).
Quantitative workload is usually perceived as one of the challenging
stressors (LePine et al., 2005; Lu, Du, & Xu, 2016).

Discussion
The purpose of the present study is to investigate the common important
job stressors in Chinese societies, and how to measure these job stressors.
A three-phase study design was conducted using both qualitative and
quantitative approaches. From the perspective of the interaction between
Table 4.5 Intercorrelations of Main Variables in Study 3 (N = 1032)

Variables Mean SD 1 2 3 4 5 6 7 8 9

1. Conflict 7.90 4.31 .91

2. Constraints 13.20 6.22 .64*** .94
3. Workload 26.12 12.12 .68*** .70*** .86
4. Politics 6.39 3.50 .65*** .55*** .69*** .78
5. Job insecurity 5.90 3.19 .57*** .45*** .56*** .60*** .86
6. WFC 6.92 3.37 .56*** .63*** .62*** .62*** .57*** .80
7. Strains 57.16 18.20 .49*** .47*** .50*** .45*** .42*** .51*** .94
8. Job satisfaction 12.46 2.89 −.29*** −.24*** −.38*** −.38*** −.28*** −.24*** −.31*** .74
9. Job performance 23.84 3.11 −.16*** −.02 −.06* −.08* −.10*** −.05 −.13*** .07* .76

Notes
Conflict = Interpersonal Conflict; Workload = Quantitative Workload; Constraints = Organizational Constraints; Politics = Organizational Politics;
WFC = Work-Family Conflict; Strains = Physical Strain + Psychological Strain; Job Performance = Job Performance Rated by Supervisor. Cronbach’s
reliabilities are in parentheses on the diagonal.
* ** ***
p < .05, p < .01, p < .001.
Job Stressors in Greater China
53
 54

Table 4.6 Results of Regression Analyses in Study 3 (N = 1032)

Independent Variables Dependent Variables

Strains Job Satisfaction Job Performance

Step 1 Gender .01 .03 −.04

Age −.12** .12** .05
Tenure .09* −.08* −.02
Job level .17*** .01 .03
Chang-qin LU et al.

Type of organizations −.02 .03 .01

Adjusted R2 .033 Adjusted R2 .007 Adjusted R2 .001
ΔR2 = .037 ΔR2 = .012 ΔR2 = .005
F change = 7.96*** F change = 2.44* F change = 1.13
Step 3 Conflict .10* −.02 −.20***
Workload .10* .06 .10*
Constraints .13** −.28*** .05
Politics .01 −.25*** −.01
Job insecurity .15*** .02 −.09*
WFC .20*** .05 .01
Adjusted R2 .316 Adjusted R2 .165 Adjusted R2 .031
ΔR2 = .286 ΔR2 = .162 ΔR2 = .036
F change = 71.95*** F change = 33.40*** F change = 6.45***

Notes
Conflict = Interpersonal Conflict; Workload = Quantitative Workload; Constraints = Organizational Constraints; Politics = Organizational Politics;
WFC = Work-Family Conflict; Strains = Physical Strain + Psychological Strain. Job Performance = Job Performance Rated by Supervisor.
** ***
p < .05, p < .01, p < .001.
 Job Stressors in Greater China 55
the person and the environment (Lazarus, 1991), the concept of stress is
highly culture-specific. The present study intends to investigate job stres-
sors in contemporary Chinese society. Previous studies (e.g., Liu et al.,
2007; Narayanan et al., 1999; Spector et al., 2004) reported cultural
differences in the perception of job stressors. We have updated the
knowledge by providing support for a more comprehensive approach in
studying job stressors under the context of Greater China, because only a
few related studies have been conducted across the three regions of
Greater China. The necessity of such research is even more prominent
because of huge differences between the Chinese and Western societies in
terms of cultural beliefs, society, politics, and economic systems.
In terms of methodology, the three-phase study approach is compre-
hensive and structurally systematic. Qualitative studies are advantageous
in identifying employees’ subjective and specifically experienced stres-
sors, while quantitative studies are advantageous in efficient adminis-
tration, high objectivity, and amenability to highly-developed
psychometric techniques (Mazzola et al., 2011; Schonfeld & Mazzola,
2015). We combined both approaches to determine both advantages in
developing culture-specific as well as valid job stressors measures.
The present study has found similar results as Liu et al.’s study (2007)
in terms of the top three stressors – quantitative workload, interpersonal
conflict, and organizational constraints – which were found to be
common among both Chinese and Western employees. However, three
other stressors were found distinctive in contemporary Chinese society –
namely organizational politics, job insecurity, and work-family conflict.
As one of the specific social stressors in the workplace, organizational
politics has recently attracted attention in many Western societies (Ferris,
Frink, Galang, Zhou, Kacmar, & Howard 1996; Siu, Lu, & Spector,
2013). Organizational politics can be defined as “self-serving behavior
not formally sanctioned by organizations that creates conflict or dis-
harmony in the workplace” (Ferris et al., 1996). It is a distinctive stressor
from “interpersonal conflict” since the former is frequently used as an
upward influence strategy to promote the self-interests, such as salary
raise or promotion, while the latter mainly refers to conflicts among
colleagues. Chinese employees might be more vulnerable to organiza-
tional politics stressors. Due to cultural emphasis on hierarchy, Chinese
organizations are structured with higher “power distance” and “pa-
ternalistic leadership” (Cheng, Chou, Wu, Huang, & Farh, 2004). Such
organizational structures provide ground for two important predictors
for organizational politics perceptions: a high degree of centralization
and a low degree of formalization (Ferris et al., 1996). The former means
the concentration of power and control at top levels while the latter
means a lack of formal written rules and procedures. Low control and
power as well as high uncertainty and ambiguity could increase the
employees’ perception of organizational politics. Meanwhile, Chinese
56 Chang-qin LU et al.
people are culturally known for being relationship-oriented. The strong
emphasis on “Guanxi” extends to the workplace. Good relationships
between supervisors and subordinates are maintained by mutually ben-
eficial transactions (Ling & Powell, 2001). Therefore, employees might
inevitably be divided into in-group versus out-group. Supervisors usually
treat the employees impersonally or play favorites based on the degree of
their relationships, which makes these employees feel that they are
second-class citizens in the organization (Deluga, 1994). As a result, the
employee feels more stressed to deal with such issues. Moreover, with a
strong preference for uncertainty avoidance (Hofstede, 1980), Chinese
employees would find undercover political activities in the workplace
particularly intolerable and stressful.
Another distinctive stressor is job insecurity, which refers to “the
anticipation of a stressful event in such a way that the nature and con-
tinued existence of one’s job are perceived to be at risk” (Sverke &
Hellgren, 2002, p.27). Decades of economic restructuring have given
rise to major shifts in employment policies and practices which can be
attributed to recent economic transformations and fierce competition in
the job market. In Mainland China, government policies of downsizing
state-owned enterprises and supporting a competitive labor market in-
dicated the end of the “iron rice bowl” era. Workers are no longer
guaranteed an “iron bowl” (i.e., permanent jobs) and face the threat of
job loss. Moreover, with globalization and further economic growth in
Mainland China, employees have to face the serious threat of job loss or
job insecurity (Price & Fang 2002; Wang et al., 2015). Meanwhile,
employees in the Taiwan area have also suffered from job security and
the overall prevalence of job insecurity is nearly 50% (Cheng, Chen,
Chen, & Chiang, 2005). A survey in Hong Kong showed that employees
perceived a relatively high level of job insecurity (Ngo, Loi, & Foley,
2013). Job insecurity implies a great deal of uncertainty, which con-
stitutes as a great source of stress for individuals (Lazarus, 1991). Thus,
the salience of perceived job insecurity is probably attributed to Chinese
culture with relatively more conservative or traditional values in which
security and stability are more affected (Probst & Lawler, 2006; Wang
et al., 2014).
Work-family conflict is another common job stressor that has received
increasing research attention. With reference to previous studies (Ling &
Powell, 2001; Spector et al., 2004; Yang et al., 2000), we believe that
employees in Greater China are vulnerable to this form of job stressor,
which represents the inter-role conflict when incompatible role pressures
are exerted from both work and family domains (Greenhaus & Powell,
2003). In Greater China, dual-earner families are common and people
play simultaneous roles as employees and husbands/wives, or even fathers/
mothers (Lu, Lu, Du, & Brough, 2016). In terms of the work context,
with increasing competition in the workplace, employees face great job
 Job Stressors in Greater China 57
demands from long working hours and maintaining interpersonal re-
lationships in the workplace. Workplace stress is further intensified by
high job insecurity and high-performance pressure. In terms of family
context, people face great demands from fulfilling roles and maintaining
relationships. Thus, employees are vulnerable to open conflicts over issues
of mutual fulfillment of duties and division of housework. With great
demands from both work and family contexts, employees in Greater
China are distinctively vulnerable to the job stressor of work-family
conflict (Lu et al., 2015; Siu et al., 2005). Recently, Lu, Gilmour, Kao, and
Huang (2006) also found that employees in the Taiwan area reported
more work-family conflict than those in Britain.
The main contribution of the present study is to explore common
serious job stressors and to further modify and develop the Chinese ver-
sion of job stressors measures. Thus, our study steps toward the calling of
more job stress research in the developing country (Bliese et al., 2017;
Houtman et al., 2007). Moreover, we used both qualitative and quanti-
tative approaches to explore the major job stressors in the changing
Chinese society, since different cultures and social-economical environ-
ments should shape an individual’s experience of job stress at the work-
place. It would enrich job stress research literature by using such mixed
methods – including both qualitative and quantitative approaches –
to study the design (Liu et al., 2008; Mazzola et al., 2011; Schonfeld &
Mazzola, 2015). In terms of practical implications, our study could pro-
vide reliable and valid measures of job stressors for conducting job stress
research in Greater China and good tools for practitioners to implement
certain job stress prevention or management programs.
It should be acknowledged that the current study has some limitations,
although the merit of both qualitative and quantitative approaches ex-
ists. One limitation is that the data came from self-reported measures
except for job performance. Future research could use objective mea-
sures of strains or health, such as levels of cortisol or recorded sick days
to provide stronger evidence to support the validation of our job stres-
sors measures. In addition, it should be noted that there are subcultural
differences in social institutions, political systems, as well as regional
development histories in these three regions of Greater China, which
may exert different impacts on these six job stressors and the con-
sequences of these stressors.

Notes
1 The data were part of a larger data set for job stress project (Lu, Kao, Siu, &
Lu, 2010).
2 The data were part of a larger data set for job stress project (Siu, Lu, &
Spector, 2013).
58 Chang-qin LU et al.
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5 The Causes and Consequences
of Organizational Stress
The Case of Greece
Ritsa Fotinatos-Ventouratos

Introduction
Greece, officially known as the Hellenic Republic and also known as
Hellas, is a relatively small country located in Southern Europe. As of
2018, it had a total population of approximately 10.8 million people,
of which 3.4 million people live in the capital of Athens (Wikipedia). In
1981, Greece became a member of the European Union, and in 2001,
it became a member of the Eurozone, forming a common European
Monetary Currency. Confirming evidence (Fotinatos-Ventouratos &
Cooper, 2015) suggests that this latter move did not prove to be a
smooth transition, rather, it resulted in major upheavals for the country,
and, therefore, for most citizens and organizations. This decision set the
ball in motion for many unique organizational and societal stressors.
For a country that often relies on a few isolated and specialized in-
dustries (e.g., shipping and tourism) to generate income, Greece became
a vulnerable target that was often unable to compete with stronger
European Union Countries – such as Germany and France. These ac-
cumulating factors, followed by the Global Economic Crisis that un-
folded in 2008, placed Greece as a forerunner and on the front stage of
European economic misfortune (Fotinatos-Ventouratos & Cooper,
2015). This resulted in total destabilization of its economy, which sent
major ripple effects across the nation-state, thus making Greece a
country of high vulnerability and causing major disruption of labor
market fragility. It was coupled with uncertainty and sensitivity for years
to come. Consequently, the intensity and severity of organizational
stress, with its multiple manifestations of strain, became evident
throughout Greece. Simultaneously, one may suggest that Greece is no
longer considered a collectivist culture, but rather a country in “transit”
towards a highly individualistic culture. This factor of cultural
re-adjustment, as well as the eruption of the economic crisis, provided a
potent mixture of both societal and organizational problems in its
extreme, and thus warrants assessment and evaluation by organizational
psychologists and scientists at large.

DOI: 10.4324/9780429292538-5
 The Causes and Consequences 63
However, before proceeding to assess the causes and consequences of
occupational stress in relation to this specific country, it is deemed ne-
cessary to provide a suitable definition of the term “stress” for readers to
encapsulate in a uniform manner. For most organizational psychologists
and on an international scale, it is recognized that this term has a long
history within our scientific field, and one may suggest that it is a de-
batable one too. Indeed, the term stress can be referred to in a host of
ways, ranging from assessing it either as a dependent variable or an in-
dependent variable or by viewing the term from an interactionist per-
spective (Fotinatos, 1996). Beyond the scope of this chapter is to assess
and to scrutinize the specific terminology, although for continuity rea-
sons and to be in alignment with a European perspective, the following
definitions and terminology are deemed appropriate and often utilized
on a European platform. To that end, The European Foundation for the
Improvement of Living and Working Conditions (2010), have utilized
the 2004 EU social partners’ agreement, which describes stress as:

Stress is a state, which is accompanied by physical, psychological, or

social complaints or dysfunctions and which results from individuals
feeling unable to bridge a gap with the requirements or expectations
placed on them.

And, more specifically, under the guidance of Work-Related Stress,

prepared by the European Commission (see European Foundation for
the Improvement of Living and Working Conditions, 2010), work stress
is defined as:

The emotional, cognitive, behavioural, and psychological reaction to

aversive and noxious aspects of work, work environments and work
organisations. It is a state characterized by high levels of arousal and
distress and often by feelings of not coping.

Evaluation of Work-Related Stress: Placing Greece in the

European Context
As mentioned above, work-related stress is often difficult to define and
evaluate. Moreover, and as acknowledged by a plethora of literature in
our specific field, there is an abundance of intervening factors, as well as
various methodologies used in research. Furthermore, one may propose
that in some countries, stress is widely recognized as a work-related
issue, yet elsewhere, well-being in the workplace is promoted, while in
other countries it may not have such a high profile. Thus, contextual
factors play a pivotal role in the assessment and overall evaluation of
work-related stress factors. Nonetheless and according to the European
Foundation for the Improvement of Living and Working Conditions
64 Ritsa Fotinatos-Ventouratos
(2010), some studies have shown that there are different stress levels
among different countries, as well as by demographics, such as age. It is
interesting to note, for example, that in Cyprus, a survey conducted by
the Department of Labour Inspection in 2006 showed that those who
have worked for 25 years report the greatest proportion of stress-related
problems. This is backed up by data from the Czech Republic which
showed that levels of stress at work tend to increase with age. In
Germany, however, surveys showed that people aged between 30–39
were most affected by stress, listing work-related stress as the main
source. Interestingly and on a relevant note for Greece, information re-
leased shows that stress levels fall away sharply after the age of 54; 8%
of people up to age 54 said that they suffered from work-related stress,
compared to 1.8% of those aged 55 over. Taken together, therefore, one
may clearly speculate that a multitude of intervening factors plays a
substantial role, as does the “perception of stress,” in relation to cultural
and contextual factors.
Taking such information into consideration, it is vitally important to
state that when positioning Greece on the map for work-related stress,
the European Foundation of Living and Working Conditions in 2010 has
recently reported that “Work-related stress is a growing concern for
employees and employers in the European Union. Accordingly, in 2005,
22% of European workers reported suffering from stress, lower back-
ache, muscular pain, and fatigue. About a quarter of those employed in
Europe is exposed to job strain – between 13% in Sweden and 43%
in Greece.”
Similarly, in 2009, EU-OSHA reported that there are significant dif-
ferences in stress prevalence across Europe, and indeed, the highest levels
of stress were reported in Greece (55%), in Slovenia (38%), Sweden
(38%), and Latvia (37%). Given such an insight, therefore, and in
summary, it does seem that work-related stress in this particular country
is a worrying state of affairs, and it is a phenomenon that is operating
at high strength and intensity in comparison to other European noted
countries.

The Causes and Consequences of Organizational Stress:

The Case of Greece

A Review of the Economic Crisis

Focusing foremost on this unique and severe stressor and placing it in the
context of this specific culture, Greece received its first financial aid
package in May 2010 when Greece’s economic output fell by a quarter.
Living standards collapsed when more than a million people lost their
jobs in a very short period of time, pushing unemployment to a high
28% (OECD, cited CIPD The People’s Program in 2018). This overall
 The Causes and Consequences 65
distressed the debt market and weak economic demand explains in part –
the huge upheaval and severe problems – that subsequently encroached
in the working domain, and therefore touched on the lives of all em-
ployees both in the public and private sector. To that end, one can
suggest that the severity of this problem, in relation to other specific
European and International countries, is considered to be relatively
high (Fotinatos-Ventouratos & Cooper, 2015). Indeed, and over the
accumulating years, changes in market forces resulted in two factors:
First, great turmoil was felt in the economic and financial world, and
second, such changes resulted in extreme turbulence at the individual,
organizational, and societal levels – which subsequently manifested ne-
gatively in terms of the psychosocial well-being of most Greek citizens.
Frankly, the organizational setting was subjected to massive changes in
both content and context, reflecting highly constrained and competitive
activities (Fotinatos-Ventouratos & Cooper, 2015). Moreover and as
a spillover effect, it should be noted that in recent years, for example,
youth unemployment in Greece reached an unprecedented level; whereby
in 2013, Greece hit the highest-ever recorded figures of approximately
30% (see Fotinatos-Ventouratos & Cooper, 2015).
Today at almost a decade later, Greece is still on the tail end of
the worst economic crisis experienced since the Great Depression of the
1930s (Burke, 2015). However, taking all of the above into considera-
tion, it should be noted that reports by Eurostat did emerge in October
2013, suggesting that unemployment in economically starved Greece was
anticipated to remain at a tremendous high of approximately 34% until
the year 2016, and that is approximately how the economic and financial
mappings unfolded. Indeed, and according to OECD Economic Surveys
for Greece in April 2018, it was reported that “the economy is re-
covering, and fiscal credibility has improved.” For instance, in 2017, the
GDP expanded by 1.3% – the fastest pace since the onset of the crisis.
Thus, according to such figures, one may suggest that the economic crisis
in Greece has begun to fade; however – and to be further analyzed –
the true assessment of the organizational and corresponding socio-
psychological consequences of this world crisis still remains vague and
under-assessed, although one may suggest that it is severely tarnished.
In the same footprints, the OECD report of 2018 is quick to note that:

“Despite significant reforms, cumbersome regulation, and lack of

finance hinder private investment.” More worrying for organiza-
tional psychologists is the fact that

“Labour market reforms have boosted employment, but wages and

productivity remain depressed…. Workers’ skills often do not match
workplace’s needs, trapping workers in low-skill and low-wage
jobs.” Hence, and as stated by OECD (2018), is the fact that:
66 Ritsa Fotinatos-Ventouratos
“The long crisis in Greece, combined with an ineffective social
protection system caused a surge in poverty, especially among young
families with children, the young and the unemployed .… and …
work poverty is also high.”

What may be implied and partially acknowledged is that the economic

crisis for Greece was immense and, in many aspects, is still ongoing.
While human beings are resilient and able to change, how quickly and
how successfully Greece and the Greek people are able to adapt to
these global markets is still not known. It can be speculated that it
may take decades for their physiological and psychological char-
acteristics to adapt to the ever-changing and demanding organizational
environment.

Restructuring of Organizations and Its Effects on the

Well-Being of the Worker
In order to make any economic recovery feasible and for Greece to stay
afloat, huge changes and restructuring at the macro and micro levels of
the economy and subsequent organizational levels were necessary. In
relation to the world of work, this meant an immense restructuring of the
workforce, encapsulating both the public and private sector as well as
including blue-collar and white-collar occupational groups: However, it
should be acknowledged that Greece was not the only country to re-
structure and have such adjustments taken place with a relatively strong
force at the whole European level. Indeed and as stated by Storrie (2006),
“Restructuring is often an organization’s response to the changing eco-
nomic environment .… In other words, restructuring of organizations is
driven by the need to maintain or enhance profitability, and, therefore, to
ensure the survival of the company and jobs over the long term.” In the
case of Greece, the “Kallikratis Reform” or the “New Architecture of
Local Government and Decentralization” (Law 3852/2010) immediately
came into effect and was aimed at cutting down public spending through
limitation in the number of Local Government Organisations (OTA). At
the beginning of 2011, over 4,000 legal entities were abolished, resulting
in some 20,000 to 25,000 employees made redundant. Such drastic
measures sent huge ripple effects throughout Greece. At the organiza-
tional level, these negative manifestations spilled over and into the pri-
vate lives of many Greek people and engulfed their families. To that end
and in a very recent study by Koukoulaki et al. (2017), which evaluated
the restructuring of the actual Kallikratis program throughout Greece, it
was confirmed that higher levels of work intensification and stress arose.
More analytically, increased work-related stress was found to be related
to increased emotional and quantitative job demands, as well as with job
insecurity. As the authors specifically note “higher levels of emotional
 The Causes and Consequences 67
exhaustion were found to be related to increased job demands, job
insecurity, and unfair treatment during change.”

Lack of Transparency and Perceived Level of Justice in

the Organization
It is exactly in this last paragraph that one needs to shine the torch on.
Significant factors that may regulate the stress-strain relationship at
work are the perceived level of justice, trustworthiness, and fairness in-
volved in any major or minor alteration of work. During the midst of the
economic recession, Antoniou and Cooper (2013) were quick to note
that the story of the recession is not only economic. Macroeconomic
factors – including regional, national, or international economic situa-
tions – put pressure directly on the unemployed as well as employed
people in terms of the individual’s reactions to the economic situation
and indirectly through organizational restructuring. More specifically
“As the workplace has changed and the economic recession increased,
researchers indicate high job insecurity, low job satisfaction, reduced
involvement, as well as a decline in the ratings of the organizations as
trustworthy” (Antoniou & Cooper, 2013).
In regard to the specific country of Greece, lack of transparency in
the operation of an organization and unfair treatment appears to
sometimes prevail. Novel research has confirmed that new reforms and
unplanned organizational changes – as a result of the economic crisis –
have had an effect on certain occupational groups, such as school
teachers, and their stress levels. More specifically and in a study by
Mouza and Souchamvali (2016), it was revealed that the foremost
factors that increased perceived stress under unplanned organizational
change are related to exogenous factors that teachers cannot control,
which include: reduction of wages, job insecurity, and the assessments
used for distribution methods. Hence, and it is important to note, the
results showed that teachers’ increased stress levels in Greece were not
related to demographic variables such as sex or age, or even qualifi-
cations such as work experience and educational level, that one may
consider. Rather, these are associated with external factors that orga-
nizational changes and reforms bring about.
Such manifestations should not come as a surprise; however, as lit-
erature is scattered with studies that demonstrate the overall downsizing
of activities – including staff reduction – negatively affect employee well-
being (see e.g., Bohle, Quinlan, & Mayhew, 2001). Indeed in a well-
known study by Vahtera et al., 2004, poorer health was reported among
employees who were made redundant, in addition to those who remain
in the organization after the changes took place.
In a similar vein with key elements in Greece, it has been noted that
nonstandard and atypical employment arrangements have taken place, in
68 Ritsa Fotinatos-Ventouratos
tandem with the poor economic crisis. For example and according to data
of Labor Inspectorate Authorities (SEPE) which is cited in Koukiadaki and
Kretsos, 2012, undeclared work increased, and a more bleak picture re-
vealed that one in four companies in the private sector had not paid its
employees for three months or more (see Koukiadaki & Kretsos, 2012).
One may suggest, however, that even if several years have passed since
such information was brought to the forefront, one may still suspect that
the consequences in terms of felt occupational stress are far from gone or
forgotten by many Greek employees today. From the evidence noted, it
seems that restructuring and any form of organizational change, which
has been a fundamental and ongoing business practice in Greece, has
manifested in a host of negativities and uncertainty. Along with this un-
certainty are possible breached and/or shadowed operations that lack full
transparency. It may be suggested, therefore, that in times of organiza-
tional changes and economic swings, all forms of justice should become
critically important and placed as a top priority for the overall well-being
of workers. The paradox appears, however, that some organizations are
subdued in maintaining fairness and adhering to procedures of justice, and
especially so during this exceptionally stressful time of change and reforms
in Greece.

Physical and Psychological Well-Being of the Greek People

From the review of literature as stated above, one can solidly confirm
that since the onset of the economic crisis, the stressors and strains in
Greece have been unique and ever-changing. Consequently and due to
the rugged economic, political, and organizational landscape that sub-
sequently unfolded, the well-being of Greek citizens has been scarred. To
that end, and noted by Fotinatos-Ventouratos and Cooper (2015), sui-
cide rates began to rise in tandem with the economic crisis, and more
analytically according to the APA, suicide rates increased by 45% during
the first four years of Greece’s financial crisis.
With more recent information and according to Stylianidis and
Souliotis (2019), the long-lasting crisis with unemployment, financial
hardship, and income loss has resulted in substantial consequences on
the physical health and mental health of the population. To that end, the
researchers confirm that converging evidence corroborates a deteriora-
tion of self-rated health, an alarming rise in suicide rates, and a gradual
increase in the prevalence of major depression. Taking this issue one step
further Stylianidis and Souliotis claim that:

Concomitantly, the healthcare system is incapable of addressing

the emerging needs, and, therefore, a multifaceted and concerted
effort is urgently needed to mitigate the mental health effects of
the recession.
 The Causes and Consequences 69
The above statement does not come unwarranted, given the fact that
previous studies (Karanikolos et al., 2013) have also documented
that the impact on health systems in Europe revealed a decrease in the
extent of medical coverage. Specifically for Greece, an estimated 40% of
cutbacks in hospital budgets have been evident – which reflect in un-
derstaffing in hospitals, medical supply shortages, as well as excessive
patients’ queues (Kentikeleris & Papanicolas, 2011). On the same note
and again very recently, this matter has led several scholars to further
investigate the adjustment levels in times of crisis in Greece from a
psychosocial perspective. More analytically, Lahad, Cohen, Fanaras, and
Apostolopoulou (2018) advocate from their study that the participants
generally rated their psychological health lower than their physical
health. Moreover, their findings showed significantly higher perceptions
of financial uncertainty and difficulties in coping with economic com-
mitments. Again and recently, Theofanidis (2017) is quick to note from
his study entitled, “Greek Nursing Under Austerity,” that the ongoing
implications of austerity measures imposed on the Greek health care
system have had a particular emphasis on its effects on nursing and
care delivery. Furthermore, the prolonged poor working environment
has resulted in emotional strain – leading to possible burnout and
detachment in the nursing staff.
Taken together, one may say in the affirmative that the economic and
organizational misfortune has had serious physical and psychological
connotations for the Greek people, and current assessments and eva-
luations are showing poor overall welfare at a national level and across
wide occupational spectrums.

Specific Organizational Stressors in Greece:

Opening Pandora’s Box
The harsh implications that the economic crisis brought with it, in ad-
dition to other unique stressors that Greece has been confronted with
(e.g., the sudden influx of immigrants) (Fotinatos-Ventouratos, 2016), as
well as political change and often with turmoil has led to the manifes-
tations of unique and specific organizational stressors emerging in this
country. However, and as previously mentioned, one of the most recent
economic surveys of this country (OECD, April 2018) does indicate that
Greece is on the road to recovery, and the economy is bearing fruit again.
For instance, one notices that exports have led to expansion – from 24%
of GDP in 2008 to 34% in 2017, although this is still below the
European Union average of 46%. Certain labor market reforms have
been installed, improved economic competitiveness has begun, and
overall employment figures are rising, albeit slowly. As stated by the
OECD in 2018, “rebuilding employment is essential for the recovery in
activity for reducing poverty.” More analytical and updated information
70 Ritsa Fotinatos-Ventouratos
states that the seasonally adjusted unemployment rate in Greece fell to
17.8% in April of 2019 from an upwardly revised 18.2% in the previous
month and as compared with 19.8% in April 2018. It was the lowest
unemployment rate since June of 2011, as the number of unemployed
people dropped by 3.1% from the prior month while the number of
employed went up by 0.7%. The unemployment rate in Greece averaged
at 16.26% in July 2013 and hit a record low of 7.30% in May of 2008
(Trading Economics, July 2019). However, and as one can generically
attest, there is still much to be done at the organizational level – to
sustain well-being, productivity, job satisfaction, and stability. For in-
stance and beginning with demographic data, one can concur that
challenges exist – for example, improving female labor participation is
still among the lowest across all the OECD countries (OECD Economic
Surveys: Greece, 2018), which is a bleak fact to report on, especially
since gender struggles at the European level still exist. For example,
much has been assessed and documented on the embedded gender
wage gap and the psychological and social implications that this brings
(Fotinatos-Ventouratos, 2019).
Moreover in Greece, such problems are also hindered by the fact that
reported skill mismatch is also high, irrespective of the fact that overall
participation in education compares very well with other OECD countries.
Indeed, completion rates for high school and tertiary education among
younger cohorts are above most of the other European Union members,
and Greece’s top students “go one to perform well on a global stage”
(OECD, April 2018). Despite the fact that Greek people appear to be well-
equipped with appropriate education, sadly, an unusually large share of
Greek workers report being over-skilled for their job – reflecting low de-
mand for skills from workplaces and high skill mismatch. This may lead
one to suggest that adults in Greece may also have fewer opportunities to
reskill via job training and to participate in professional courses, which is
a worrying state of affairs for organizational psychologists to contend with.
Our science acknowledges, with a plethora of literature, that correct
training, talent retention, and professional development act as a shield to
enhance worker satisfaction, motivation, and overall well-being at work
(Robbins & Judge, 2009; Greenberg, 2008).
Also, encapsulating the right skills for the right job and utilizing valid
and reliable selection and training methods allow a worker to feel in
control of their job and clearly lead to increased overall autonomy. As
early as 1998, Fotinatos-Ventouratos and Cooper clearly demonstrated
that there is a fundamental need for all workers – whether white-collar
or blue-collar workers and male or female – to feel in control of their
job and possess autonomy at work, and this is a necessary requirement
for both job satisfaction and overall well-being to materialize. One
may suggest, therefore, that it is vitally important that Greece swiftly
addresses issues of any business inequality, and it is necessary more
 The Causes and Consequences 71
than ever before to effectively address these problems of labor market
discrepancies.
Another important and associated issue in regard to the varying
organizational stressors in Greece and the consequences in terms of
manifested strain refers to the recent attitudes toward women mangers
and female authority in a particular county. One recognizes that during
the past decades, women’s active participation in the labor market has
increased tremendously at a global level (Drosos & Antoniou, 2019;
Fotinatos-Ventouratos, 2019). Nevertheless, the level of gender equality
is uneven across different countries and regions – including within the
European Union. For example, in Greece, the employment rate for
women was 46.8%, while for men the rate was 65.8% (see Drosos &
Antoniou, 2019). Although the gender employment gap in 2016 was
11.9%, it was 19% in Greece. Furthermore, and despite the growing
numbers of women in the workforce, their representation in specific
managerial and leadership positions in the corporate sector is scarce. In
2016, only 23.3% of the board members of the largest publicly listed
companies in the European Union were women, while in Greece the
figure was just 9.4% (European Commission, 2016, cited in Drosos &
Antoniou, 2019). However, working women tend to have a higher level
of education than men, and according to Eurostat (2017), in 2016,
38.5% of women in employment had tertiary level education compared
to 31.2% of men. As noted well by researchers, it is clear that the skills
of highly qualified women are underutilized and, in economic terms,
there is a lack of return on investment and a loss of economic growth
potential – as marvelously commented on “It is remarkable that in times
when the labor market faces shortages of skilled personnel, a large
percentage of human capital is wasted.”
In addition to the above comments and findings, one may also sug-
gest that such an unbalanced seesaw in regard to gender differences in
the Greek workplace may result in tremendous stressors and strain for
working women of all socioeconomic classes, and such findings should
not go undetected or under-assessed by our profession. Furthermore
and shining the torch on this specific study conducted by Drosos and
Antoniou (2019), a bold attempt was made to investigate Greek female
managers’ attitudes toward women managers and female authority and
their correlation with various personal characteristics – such as age,
family status, educational level, work experience, and managerial
success – on a sample of over 360 female managers who are employed
in Greek private companies. The sample consisted of 26.9% high-level
managers and 73.1% middle level managers. It is noteworthy that the
average age was 34.42 years old, while the average years of working
experience were 12.61. The shocking findings showed that female
managers reported having several disturbing beliefs regarding the role
of gender in career advancement. That is, the vast majority (63.1%)
72 Ritsa Fotinatos-Ventouratos
stated that gender plays a very important role in career advancement,
while 92% felt that women’s family status is taken into account in
recruitment and hiring procedures! Moreover, almost one-third of the
participants responded with the view that discrimination again women
exists within their company, and there are no women-friendly policies
regarding promotion.
Given such bleak findings reported in this study, one may suggest that
it would be highly beneficial if future research investigates the exact
underpinnings of women’s career paths in Greece and further explores
the stress-strain relationship that may exist in the working environment
for female professional occupational groups, in comparison to men.
Given what has already been established, it may indeed be found that
there are unprecedented consequences in terms of occupational stress
among female managerial occupational groups, and the price tag in
terms of psycho-social well-being may indeed be significant.

Intervention Strategies and Coping Mechanisms for Greece and

Its Workforce
It is suggested that – in order to assess any possible intervention stra-
tegies to combat organizational stress and to promote well-being at
work – firstly, a full assessment of this particular country with its
corresponding culture, organizational structures, and economic per-
formance needs to be taken into account. Therefore and essentially, one
should recognize that the Greek economy is not only trying to recover
from a huge recessionary period as discussed above but, it is often
overcast by an economy that is made up of many small, traditional,
and often family-run businesses. In fact, this issue has been well-
documented in literature (see e.g., Zambarloukos & Constantelou,
2002). Given such a spectrum, it should be further noted that Greece is
often overrepresented by small and medium-sized enterprises (SMEs) –
classified with less than 250 employees (Makrydakis, Papagiannakis, &
Caloghirou, 1996). If this is the case, it may not be surprising to find
out that any attempt to install nationwide interventions and policies
may be stalled by virtue of the organizational setup, and financial li-
quidity is available. Furthermore, it may indeed be the case that small
companies have limited resources, often do not hire adequately trained
personnel, and do not – or cannot – invest in innovative training
methods for their employees. In Greece, thus, it may also be anticipated
that firms which are often family-run, may lack professional manage-
ment that would even enable them to undertake organizational changes
and use new technologies (Zambarloukos & Constantelou, 2002).
Such underlying factors surely impede organizational success and
certainly play a crucial role in the manifestation of stress, with their
corresponding risk factors. Thus the causes and consequences of
 The Causes and Consequences 73
occupational stress in Greece are far from a simple cause-effect re-
lationship, but these appear to be a multitude of important variables all
interwoven together.
A further obstacle for organizational psychologists to contend with
is that evidence of current organizational stress prevention measures in
Greece is somewhat limited, not often visible, and is rather scattered
in literature. However, some evidence does appear to be picking up the
pace. For instance, it does seem to be that large organizations have in
part attempted to install work-related stress management interventions,
with Piraeus Bank Group being an example (see European Foundation
for the Improvement of Living and Working Conditions, 2010). Here for
example, and in collaboration with Hellas Employee Assistance
Programs (Hellas EAP), the large bank provides a program to support
and to actively manage workers’ health and well-being. The program
provides information and support on preventative measures and trau-
matic events management – with an emphasis on prevention as well as
support in cases such as bank robberies to critical family and work-
related stress issues. It also offers guidance and support for workers on
issues of career advancement and is aimed at realizing the full potential
of workers’ skills. Therefore, the attempt is being made, and one is
positive that further strong and conscientious developments will abide
in the not too distant future.
Concerning any structural reforms, one could also state, that a con-
sequence of the financial crisis also resulted in the installation of severe
and drastic austerity policies that were imposed in this country, and
encapsulated many organizational effects too. On a political and eco-
nomic front, this may be considered an advantage for some, while for
others not so. While any political connotation is beyond the scope of this
chapter, it is noteworthy to point out that this severe debt crisis did
allow insight to take place in regard to employment protection in Greece;
and for many governing bodies, employment protection came to be re-
garded as a major obstacle to structural change and the liberalization
of domestic markets. Indeed, and as stated by La Spina and Sciortino
(see Koukiadaki & Kretsos, 2012):

Greece suffered from the “Mediterranean Syndrome,” a low admin-

istrative capacity for policy implementation – linking noncompliance
with particular institutional and cultural deficiencies.

If this is the case, then ripple effects in terms of employment regulations

and best work practices may become more apparent, as one may sug-
gest that any interventions must always address possible inequalities
arising from weak welfare state policies and impediments. As one re-
cognizes, in the absence of any correct social dialogue, correct proce-
dures at the organizational level may be difficult to implement. Hence,
74 Ritsa Fotinatos-Ventouratos
it is suggested that individual labor laws must be scrutinized to assist
the worker and enhance well-being at all times: For instance and ac-
cording to Koukiadaki and Kretsos (2012), until recently, the termi-
nation of employment under Greek Labor Law has been permitted
without the employer having to justify the action or invoke a poten-
tially fair reason. For us, as organizational psychologists, we recognize
and understand that such obstacles inherent in the “Greek system”
must surely result in ripple effects with Greek employees feeling highly
insecure in already insecure and turbulent economic times. For ex-
ample, and in recent research by Anagnostopoulos and Siebert (2015)
conducted in Central Greece (Thessaly, Greece), they, unfortunately,
found that high temporary work contracts are evident especially among
workplaces that pay low wages. In particular, it was noted that man-
agers prefer temporary contracts because they are less protected by any
form of employment rights and regulations. Additionally, the recent
Troika (2012) (cited in Kathimerini, 2012) allowed freezing of wage
increments, reduction of the minimum wage (especially among un-
skilled workers), as well as the abolition of the 13th and 14th salaries
(i.e., payment of an extra month or two’s salary). While such issues
are currently being readdressed, it did, for a very long period of time,
put immense psychological pressure on all Greek workers – who
were abruptly faced with challenging conditions to work in and with
apparently no safety net installed.

Forward Initiatives
It may be more proactive, therefore, if one encourages the individual
worker to attempt to install interventions and best practices from an
individual’s perspective to enhance well-being and sustain prosperity
as best as possible. For instance, practices to increase resilience and
enhance personal adjustment may be more viable and are avenues that
one should encourage and explore. Recently and as assessed by Petrou,
Demerouti, and Xanthopoulou (2017), the role of employee job
crafting may be advantageous. In their study, it was revealed that in
times of Organizational Change Contexts, job crafting can relate to
employee work-related well-being. More specifically, they confirmed
that in times of threatening cutback-related change (i.e., due to the
financial recession in Greece), seeking resources when job autonomy is
low is associated with better well-being and greater engagement. Thus
job crafting is proactive employee behavior that is targeted at seeking
job resources and challenges and at limiting job demands. As Griffin,
Neal, and Parker, 2007 propose (cited in Petrou et al., 2017), job
crafting strategies enable new work roles to emerge to help employees
in dealing with changing situations. Thus for the case of Greece and the
Greek worker, one may propose that this is a “hand in glove” proposal
 The Causes and Consequences 75
for the imminent Greek worker. Thus, more attention should be given
to what employees can do themselves to deal effectively with stressful
times and when turbulence sets in. Hence, an assessment in terms of
promoting all types of interventions – ranging from primary interven-
tions (i.e., aiming to prevent exposure to known risk factors and to
increase resilience) to secondary interventions (i.e., aimed at reversing
a progression, to finally assessing tertiary interventions, and to
reduce severity may be advantageous) (WHO, 2008, cited in Leka &
Jain, 2017).
More analytically and at all times, Greece with its corresponding or-
ganizations should bear in mind that organizational approaches to well-
being at work involve a combination of organizational interventions
which should provide a portfolio of employee-friendly options that si-
multaneously benefit the organization (Weinberg & Cooper, 2012;
Robertson & Cooper, 2011). Specifically, therefore, the three-pronged
approach to organizational health in this specific country may be war-
ranted. As previously mentioned, it combines prevention, management,
and treatment options to tackle the immediate concerns of the day as
well as to lay the foundations for a longer-term strategy for employee
well-being – which appears to be needed in this particular country, which
is on the road to recovery from recessionary times. Specifically shown
below, is this triangular approach (as cited in Fotinatos-Ventouratos &
Cooper, 2015):

• Primary interventions are focused on the prevention of problems

from arising in the first place. Examples are considerate and
compassionate management with clear communication strategies
which are essential during organizational change (which is apparent
in Greece), participative job redesign, promoting organizational
citizenship, and management coaching.
• Secondary interventions aim to manage the symptoms of strain and
associated factors by targeting the individual in the workplace.
Examples are stress management programs – such as relaxation
techniques, stress management techniques, assertiveness training,
interview skills, job-seeking workshops, and coaching initiatives.
• Tertiary interventions are designed to help the individual who may
need more specialized input to deal with strain. An example is an
employee assistance program offering counseling.

Therefore, and given the range of identified risk factors in Greece, rea-
sonable intervention strategies can be proposed to modify such nega-
tivities as well as increase individual well-being at work. Furthermore
and as previously discussed, most attempts to date appear to have been
made by large organizations; understandably, they are most likely to
76 Ritsa Fotinatos-Ventouratos
have the available resources and financial leverage to carry out inter-
vention strategies. Nonetheless, an attempt should be made in Greece
to encourage ALL organizations to participate in stress intervention
programs, thereby making good individual health benefits, as well as
good organizational benefits – leading to possible increased profits.
Furthermore, to promote intervention strategies in the workplace, it is
necessary that management in Greece understands that there are multi-
methods as well as multi-models. Utilizing more than one technique
simultaneously will enhance effectiveness and maximize results, thereby
producing a greater understanding of the multitude of demands currently
being placed on the Greek worker. This way, both the organization and
its corresponding workforce will understand that there are solutions
and remedies available to assist the Greek people, and, especially so,
after the tarnished and toxic environment that emerged as a consequence
of the recession.

Conclusion
What is certain is that there are many causes of occupational stress
in Greece, and the consequences are varied and complex; however, the
principal stressors and strains in the occupational world in Greece
are unique and ever-changing, primarily as a consequence of the eco-
nomic and political instability found in global recessionary times
(Fotinatos-Ventouratos & Cooper, 2015). It is evident that most orga-
nizations in both the public and private sector have been directly tarn-
ished by turbulent times, making these occupational stressors both severe
and chronic, while simultaneously touching on the lives of most em-
ployees in this particular country. Furthermore, and as observed in this
chapter, accelerating the stress-strain relationship is a specific cultural
issue that often hinders the Greek situation, making possible scientifi-
cally proven intervention strategies difficult to install and maintain.
However, one does feel confident that if implemented correctly and
conscientiously, then positive results will abide. Additionally, it may be
beneficial if the Greek people have an eye on the past to provide a vision
for the future, as indeed it was the Ancient Greeks that taught us many,
many, years ago, that a “fool is a fool if they make the same mistake
twice.” It is important that all of us in Greece learn from the man-made
mistakes that have engulfed this country and its people. Although and
at the same time, the Greeks have been told from ancient times
that “misfortunes and misdeeds will make a man stronger,” and with
this, one may suggest that despite the turmoil and challenges set upon
the Greek people, that we will move forward ever more positively
and strongly, taking us from sustainability to overall well-being and
prosperity in the years to come.
 The Causes and Consequences 77
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6 Work Stress
A Systematic Review of Evidence
from India
Kajal A. Sharma

Introduction
India is one of the most powerful and fastest emerging economies and is
the country with the world’s second-largest population. By International
Monetary Fund (IMF) estimates, India already accounts for 15% of
global growth (World Economic Forum, 2018). It has experienced
a rapid social, cultural, and economic transition in recent years. The
Indian economy has been predominantly rural, but, over the years, there
has a steady decline in the rural population and workforce. This can
be attributed to the push-pull forces of migration and the steady urba­
nization stemming from influences like an increase in education, social
awareness, the mass proliferation of white-collar jobs, and the explosion
of social media platforms, among others. Although contemporary Indian
society has changed, family institutions and community ties continue
to play a central role in the lives of people.
The Indian economy has some unique strengths and parallel chal­
lenges which makes it fascinating and complex at the same time. The
Indian workforce has three distinct characteristics: (a) it is the biggest
young workforce in the world; (b) the skills base of this workforce
remains underdeveloped; and (c) most jobs are being created in the
informal economy (Saran & Sharan, 2018). The biggest policy
implications of these characteristics are the urgent response to
value-adding job creation and the inclusion and welfare of the new
workforce. To meet these policy implications, the state must regulate
diversified sets of economic activities taking place in the formal (or­
ganized) and informal (unorganized) sectors. The unorganized sector
employs 83% of the workforce and contributes to 50% of the GDP
(National Statistical Office, 2019). Hence, the interest and rights of the
majority of the Indian workforce in the unorganized sector are com­
promised as they work without a written contract, paid leave, health
benefits, social security, and welfare protection. Secondly, the state
needs to enhance its ability to form appropriate workforce welfare
legislation and oversee its stricter statutory compliance. Such laws

DOI: 10.4324/9780429292538-6
 Work Stress 81
should principally consider providing the availability of income se­
curity (minimum wages), critical needs (health, retirement, and life
insurance cover), and safe and congenial working conditions to its
workforce (OECD, 2017). Although legislative action in recent years
has been quite promising, more needs to be done.
This backdrop has given rise to a challenging and multifaceted work
environment and culture in India. Factors like globalization, population,
competition, migration to urban areas, scarcity of resources, limited
opportunities, societal changes, technological advancements, family de­
mands, multiple roles, and personal aspirations further complicate work
dynamics. Employees face multiple, unrealistic, and uncertain demands
at work. Due to these pressures, employees find themselves being pushed
to limits by profit-focused organizations. The latest reports show that
one in seven Indians were affected by mental disorders of varying se­
verity in 2017, and the proportional contribution of mental disorders
to the total disease burden in India has almost doubled since 1990 (Sagar
et al., 2020). This signals that stress has become a constant feature of
modern life. It is felt by most, irrespective of their status, occupation,
position, gender, competence, education, and experience. Its causes, le­
vels, assessment, consequences, and coping might vary on an individual
basis. Some amount of stress is considered good for an individual to feel
driven toward their goals, but the rigid rules and regulations and ever-
changing and continuous work demands of modern work life make
job commitments complex and unmanageable. It has become very dif­
ficult to switch off from work, and so work-life balance is difficult to
achieve for an average Indian employee.
Stress has also become a significant challenge for Indian employers in
recent years. It is a double-edged sword as it impacts employee well-being
and also the organization’s effectiveness and profitability. Research has
shown that stress relates to an organization’s problems – such as man­
agerial ineffectiveness, poor job performance, turnover, absenteeism, acci­
dents, and errors. It also leads to various psychological, physiological, and
behavioral problems in employees. Therefore, employers are increasingly
becoming sensitive and engaged in finding effective interventions through
expert counseling assistance, career guidance, stress management sessions,
or health awareness programs to help employees manage stress better.
However, there are certain challenges in this process. A key issue around
resource constraints is a test for small and medium-sized organizations.
Another reason is that the Indian workforce is multigenerational. This
makes the office space a ripe platform for intra-organizational disputes
resulting from the lack of group conformity and group cohesion on one end
of the spectrum and groupthink on the other, especially in orthodox Indian
cultures wherein merely questioning elders or raising doubts is still con­
sidered akin to insulting them. Nevertheless, there has been a gradual shift
82 Kajal A. Sharma
from organizational performance orientation to focus on employee well-
being.
Indian stress research has addressed different stress-related issues and
has followed international trends. However, the literature highlights that
a more proactive approach is needed by organizations for designing
sustainable stress-inhibiting systems and cultures, in addition to stress
management initiatives, to nurture employee happiness, health, and well-
being to help them achieve work-life balance. This chapter presents a
review of stress studies from the period of 2009–2018, highlighting
unique trends in Indian stress literature and also identifying its com­
monalities with international literature. The areas for future research in
the Indian context are also identified.

Methodology
This review adopted the systematic review methodology proposed by
Tranfield, Denyer, and Smart (2003). There were three reasons for
adopting this methodology. Firstly, compared to the traditionally used
narrative method, this methodology has proved to be a more trans­
parent, scientific, and reproducible procedure for literature search and
analysis (Suarez-Barraza, Smith, & Dahlgaard-Park, 2012; Fisch &
Block, 2018). Secondly, it provides extensive and clear guidance on how
to conduct a literature review and present the findings. Lastly, this ap­
proach is widely adopted in different fields of management research
(Rashman, Withers, & Hartley, 2009).
The systematic review consists of three stages: planning, con­
ducting and dissemination. The author has adopted these stages while
working on this chapter. In the first phase, a pool of all relevant journal
and research articles was created through searching various search
platforms like EBSCO, Emerald, JSTOR, Science Direct, Scopus, Taylor
and Francis, Elsevier, and Google Scholar and by using keywords such as
“work stress,” “occupational stress,” and “job stress.” Papers generated
from the search were then examined for their compatibility with this
research by reviewing their titles, abstracts, and keywords. The sources –
such as reports published by government and non-government organi­
zations, eBooks, working papers, conference proceedings, and disserta­
tions – were excluded from the search process.
All papers from 2009 to 2018 were searched and screened. Papers
based on literature reviews add, cross-culture research and not written in
the English language were excluded from the review. After reviewing all
the papers, 158 relevant papers were screened out. The studies were then
classified based on various characteristics – like the year of publication,
author details, research methodology, industry/sector, gender, sampling
process, sample characteristics, and results. An Excel spreadsheet was
created to record all of the characteristics of these selected studies.
 Work Stress 83
Tranfield et al. (2003) recommends that the reporting and dis­
semination stage should cover two parts: “descriptive analysis” and
“thematic analysis.” Following this, the data captured on the Excel
spreadsheet was analyzed and used to identify and study the trends. The
resulting descriptive analysis is presented in the next section through
various graphs and pie charts. In the final phase, a detailed analysis of
these papers was conducted to identify main literature themes, gaps in
the literature, key findings, conclusions, and scope of future research.
The analysis of the main thematic trends is presented in the Discussion
section.

Descriptive Analysis
A total of 158 studies were examined for this review. These empirical
studies covered a period of ten years, starting from 2009 to 2018 (see
appendix for details). Figure 6.1 represents the number of empirical
studies published each year from 2009 to 2018. The range of yearly
publications has been between a minimum of ten studies in 2010 to a
maximum of 27 studies in 2015. In other years, the number of published
empirical studies has been between 12 and 19. The studies reviewed were
published in several journals across multiple fields reflecting the multi­
disciplinary approach undertaken to understand the work stress phe­
nomenon in the Indian context. The majority of the research studies were
published in four types of journals – nursing-focused journals (38%),
followed by medical and nonmedical healthcare journals (21%), psy­
chology stream journals (20%), and business journals (17%).
As shown in Figure 6.2, the studies covered employees working
in different types of organizations. There were 57 studies covering
public sector employees, 54 studies focusing on the private sector, and
34 studies covering both private and public organizations, which offered

30 27

25

19
20 18
No of Studies

16 16
15
14
15 12
11
10
10

0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Year

Figure 6.1 Yearly Distribution of Articles Reviewed.

84 Kajal A. Sharma

60 57
54

50

40
No of Studies

34

30

20
12
10
1
0
Type of Organisation

Public Private Public & Private Non-profitable/Voluntary Multiple

Figure 6.2 Type of Organizations Studied.

comparative insights about factors and consequences of stress. Public

organizations included banks, insurance companies, universities,
schools, healthcare institutions, the military, law enforcement, and
railways. Private sector organizations included airlines, academic in­
stitutions, chemical/steel/mining/manufacturing industries, information
and technology (IT), private healthcare providers, and automotive firms.
Figure 6.3 presents the percentage breakdown of studies undertaken
in various work sectors. Out of the 158 studies, the maximum number of
studies was undertaken in the health sector (35 or 22%) where samples
consisted of various healthcare professionals like doctors, nurses, mid­
wives, dentists, anesthetists, and pharmacists. The academic sector was
the second most researched sector with 28 studies (18%) and included
samples from various employee groups like school teachers, college
teachers, university lecturers, non-academic staff, and research staff.
There was an equal number of studies (n = 21, 13%) covering IT/BPO
and law enforcement sectors. Overall 8% of studies (n = 13) had a het­
erogeneous sample. There were 12 studies (8%) that examined only male
samples, 22 studies (14%) that collected only female samples, and the
remaining 124 studies (78%) covered both genders in different work
settings.
Figure 6.4 highlights that most studies examined (n = 133, 84%) fol­
lowed a quantitative research approach. Questionnaires were extensively
used in these studies. The quantitative analysis ranged from descriptive
statistics on the data to more sophisticated analysis techniques like t-test,
chi-square test, correlation, regression modeling, and factor analysis
through the use of various statistical software. The Organizational Role
Stress Scale (Pareek, 1983), Occupational, Stress Index (Srivastava &
Singh, 1981), Perceived Stress Scale (Cohen, Kamarck, & Mermelstein,
 Work Stress 85

Percentage (%)

Multiple 8
Construction 2
Hospitality 1
Transport
Work Sectors

3
Banking/ Insurance 8
Aviation 1
IT/BPO 13
Academic 18
Agriculture 2
Law Enforcement 13
Manufacturing 9
Health 22
0 5 10 15 20 25
No of Studies

Figure 6.3 Work Sectors Studied.

Mixed Methods
11%

Qualitative
5%

Quantitative
84%

Quantitative Qualitative Mixed Methods

Figure 6.4 Research Methods Used in Studies.

1983), Coping Strategies Scale (Srivastava & Singh, 1988), General

Health Questionnaire (Goldberg & Williams, 2000), and Burnout
Inventory (Maslach & Jackson, 1981) have been widely used as tools to
gather data in many studies. There were eight studies (5%) that adopted
a qualitative approach and used methods like observation, interviews,
case studies, and focus groups. Understandably, smaller samples were
covered by such studies. There were 17 studies (11%) that applied mixed
methods.
Stress research has been dominated by cross-sectional studies
(Figure 6.5) which reveals a dearth of good longitudinal studies. Out of
86 Kajal A. Sharma

2%
11%
1%

Cross sectional
9% Longitudinal
Instrument Development
Intervention Based
Descriptive
77%

Figure 6.5 Research Methodologies Applied in Studies.

the 158 studies examined, there were only 14 (9%) longitudinal studies
compared to 122 (77%) cross-sectional studies. The sample sizes varied
in the studies. A maximum number of studies (n = 58, 37%) covered the
sample size up to 100. Studies with sample sizes ranging from 101 to 200
were 24% (n = 38), 201 to 300 were 13% (n = 21), 301 to 400 were 6%
(n = 10), 401 to 500 were 8% (n = 12), 501 to 1,000 were 9% (n = 14),
and 1,001 and above were 3% (n = 5). The range of sample size in
qualitative studies was from 9 to 150 employees/workers, whereas the
range of sample size for quantitative studies was found to be from 50 to
4,500 employees/workers. Intervention studies were very few.

Thematic Analysis

Causes of Stress in Studies

Most studies covered in the review have not specifically tested any of the
popular stress models from international literature. Only one study –
Frank, Lambert, and Qureshi (2017) – has explicitly examined the Job
Demands-Resources model (Karasek, 1979) in the policing context.
Most studies have covered a few job demands, job resources, context,
and support-related issues for various occupational groups in different
sectors. However, there is much support in Indian literature that job
demands are positively related, whereas resources are negatively related
to work stress. Job demands are a major stress factor in the Indian
context and are associated with higher levels of stress in employees from
various occupational groups. Compared to this, job resources and sup­
port factors generate lower stress levels. Factors related to the Effort-
 Work Stress 87
Reward Imbalance model (Siegrist,1996) – such as effort, rewards, and
organizational justice – are less frequently reported in literature. Most
studies in the review have focused on identifying the causes of stress in
different occupational groups. The main stressors identified in the re­
viewed studies are presented in Table 6.1.
Reviewed studies examined different occupational groups like nurses
(e.g., Oommen, Wright, & Maijala, 2010; Fernandes & Nirmala, 2015),
the police (e.g., Joseph & Nagrajamurthy, 2014), and IT professionals
(e.g., Dhar & Dhar, 2010; Kumari, Joshi, & Pandey, 2014; Babu,
Sathyanarayana, Ketharam, Kar, & Detels, 2015). Most of these studies
found high stress in employees due to various factors; the most common
stressors that cut across all of the sectors were heavy workload, in­
adequate staff, role ambiguity, job control/autonomy, income, work
culture, and interpersonal relationships. These studies also highlighted
the behavioral, emotional, physical, and psychosomatic symptoms of
stress on employees. Problem avoidance, mental disengagement, problem
solving/planning, and social support were identified as the main coping
strategies in such employees. The results were consistent with interna­
tional literature.
Studies in healthcare have documented stressors like work overload
(Sharma, Davey, Davey, Shukla, Shrivastava, & Bansal 2014; Gandhi,
Sahni, Padhy, & Mathew, 2018; Dasgupta & Kumar, 2009), inter-role
distance and resource inadequacy (Baba, 2012), low pay (Rajan, 2014),
staff shortage (Fernandes & Nirmala, 2015), conflict with patient

Table 6.1 Stressor Identified in Studies

Main Stressors No. of Studies Percentage (%)

Factors associated with the role (overload, 46 33

working hours, unrealistic role
expectations, role ambiguity, role
conflict, poor work conditions)
Relevance of the role in the organization 19 15
(high responsibility/less autonomy,
scarce resources)
Career and monetary aspects (lack of 23 19
advancement and training opportunities,
less or unequal pay, benefits, job
insecurity)
Work relationships (role isolation, poor 14 11
working relations, lack of social support)
Organizational factors (conflict, culture, 11 9
unfair policies, poor communication,
lack of transparency)
Personal issues (conflicting family 16 13
commitments, work-life balance)
Total 124 100
88 Kajal A. Sharma
relatives (Kane, 2009), staff attitude (Davey, Sharma, Davey, Shukla,
Srivastava, & Vyas, 2016), conflict with supervisors and inadequate
emotional preparation (Jathanna, Latha, & Prabhu, 2012), time pressure
and personal issues (Bhatia, Kishore, Anand, & Jiloha, 2010), criticism,
underappreciation and lack of personal time (Sharma et al., 2018), night
shifts (Haldar & Sahu, 2015), and an inadequate amount of resources,
facilities, and financial support (Purohit & Vasava, 2017) impacted the
employees the most.
Studies undertaken on law enforcement personnel identified main stress
factors like role ambiguity, role conflict, and role (Frank et al., 2017;
Almale, Vankudre, Bansode-Gokhe, & Pawar, 2014), lack of basic ame­
nities, long working hours, and privacy issues (Bora, Chatterjee, Rani, &
Chakrabarti, 2016), tough working conditions, physical separation from
the family, tight controls, and rigidly stratified hierarchies (Chhabra &
Chhabra, 2013), staff shortage, limited time with family, overtime demand,
fatigue, and health issues (Parsekar, Singh, & Bhumika, 2015; Kumar &
Mohan, 2009), operational and organizational factors (Ragesh, Tharayil,
Raj, Philip, & Hamza, 2017), and political pressure, negative public image,
and low salary (Joseph & Nagrajamurthy, 2014) are associated with high
levels of stress. Female personnel scored higher stress scores than their male
counterparts in many of these studies (Suresh, Anantharaman, Angusamy,
& Ganesan, 2013; Hunnur, Bagali, & Sudarshan, 2014).
Banking studies observed stress reasons like long working hours,
conflict and political pressure (Kishori & Vinothini, 2016), highly in­
tricate nature of the job, the lack of time for family and personal care,
insufficient training, career uncertainties, performance constraints/pres­
sures, surveillance required, unwanted criticism, traveling, transfers, and
family obligations (Kang & Sandhu, 2012; Yadav & Dabhade, 2013;
Neelamegam & Asrafi, 2010; Shukla &Garg, 2013). On the other hand,
work stress was also a major concern for highly stressed Indian
IT/BPO employees. Role stagnation, inter-role distance, and role erosion
(Bhatt & Pathak, 2013), organizational climate, unequal pay, and no
work-life balance (Gladies & Kennedy, 2011), relationships with others
(Rao & Chandraiah, 2012), and long working hours, work pressure, and
erratic working style (Mohan, Balaji, & Kumar, 2016) were some of the
reasons of employee stress.
Academic sector studies also found medium to high stress levels
in employees. Teachers showed stress due to reasons like high work­
load, noncooperation from colleagues, insufficient facilities, and un­
clear expectations from higher authorities (Singh, 2009; Nema, Nagar,
& Mandhanya, 2010), unpleasant work conditions, poor quality stu­
dents, lack of control (Kang & Sidhu, 2015; Aftab & Khatoon, 2015),
poor work relationships (Banerjee & Mehta, 2016), location, admin­
istrative work and position (Dawn, Talukdar, Bhattacharje, & Singh,
 Work Stress 89
2017), type of school (Hashmi, Hasan, & Khan, 2017), and the lack of
organizational justice (Sehgal & Verma, 2017).
Heat stress was identified as an important occupational health
risk/stressor in both formal and informal sector organizations.
Various studies undertaken in different sectors (Ayyappan, Sankar,
Rajkumar, & Balakrishnan, 2009; Lundgren, Kuklane, & Venugopal,
2014, Venugopal, Chinnadurai, Lucas, & Kjellstrom, 2016;
Lundgren, Kuklane, & Venugopal 2014; Raval et al., 2018) echo the
effect of heat exposure on employees/workers.

Different Variables Explored in Studies

Stress and burnout relationship has been explored in the reviewed studies
but was restricted to the health and academic sectors. A clear and po­
sitive relationship was established between occupational stress and
professional burnout in groups like university teachers (Reddy &
Poornima, 2012), cardiologists (Roz, Mondal, Podder, & Raval, 2016),
nurses and support staff (Sihag & Bidlan, 2014), and anesthetists and
surgeons (Gandhi et al., 2018). These studies found high levels of stress
and burnout in these professional groups which are identical to the
trends in international literature. Results have also indicated that gender
and occupation types have a significant role in determining stress and
burnout levels (Bidlan & Sihag, 2014a). There was also an indication
that emotional intelligence has a facilitative role in the relationship
between stress and burnout (Bidlan & Sihag, 2014b).
Nine studies scrutinized work stress-related coping methods and styles
adopted by employees. Most of the studies were in the IT and health
sectors. Studies like Jathanna, Latha, and Prabhu (2012), Dhar and Dhar
(2010), and Sihag and Bidlan (2014) concluded that employees resorted
to healthier modes of coping – like resorting to humor, seeking social
support, positive appraisal, and abstaining from using substances/drugs.
However, other researchers like Ranta (2009), Bhatt and Pathak (2013),
Chandramouleeswaran, Edwin, and Braganza (2014), and Fernandes
and Nirmala (2015) established that employees also resorted to un­
healthy coping mechanisms like adopting denial or avoidance tactics,
mental disengagement, and the use of alcohol. Results also showed si­
milar coping styles were adopted by the same professional groups in
different types of organizations (Rao & Chandraiah, 2012), but there
were significant differences in the coping styles adopted by different
professional groups working in the same organizations (Sihag & Bidlan,
2014). More than one type of coping styles existed within professional
groups, like doctors, which embraced avoidance coping, followed by
approach coping (Rashid & Talib, 2015), whereas problem avoidance,
mental disengagement, and religious coping were followed more by
nurses (Fernandes & Nirmala, 2015).
90 Kajal A. Sharma
Some studies have explored the relationship between stress and emo­
tional intelligence. The results are mixed because few studies concluded
that people with higher emotional intelligence (EI) will have lower oc­
cupational stress, and EI competencies can be used to improve
physical and psychological health and overall efficiency of employees
(Chhabra & Chhabra, 2013; Satija & Khan, 2013; Singh & Sharma,
2012); however, the level of EI and work stress varied significantly across
different management ranks (Chhabra & Mohanty, 2013). On the
contrary, Krishnakumar and Lalitha (2014) established the presence of
high stress in employees with high EI in their study, and Mahmood
and Yadav (2017) showed an insignificant relationship between the two
variables.
Studies have also found that occupational stress affects the perfor­
mance of employees in terms of efficiency and productivity. Prasad,
Vaidya, and Anil Kumar (2018) suggested that there was a statistically
significant association between occupational stress factors – like working
hours, job insecurity, and social support – affecting performance.
Findings by Singh and Prasad (2018) and Frank et al. (2017) showed
that stress significantly affected job performance in relation to job de­
mand and expectation, which had a deleterious effect on the physical and
physiological health of professionals. Outcomes in the study by Banerjee
and Mehta (2016) showed that overall workload, long working hours,
negative behavior of the management, and the lack of communication
with colleagues lead to work avoidance and job dissatisfaction, which
affects performance. Finally, studies by Prasad, Vaidya, and Anil Kumar
(2015) and Goswami (2015) found job-related factors like the nature of
work, time pressure, insufficient information, lack of career prospects,
and job security influenced performance. These results are similar to
those found in international literature.
Job satisfaction was also linked to work stress. Davey et al. (2016)
found job satisfaction linked to stress in government, semi-government,
and private school teachers, and Goswami (2015) explained that stress
largely increases the level of fear, anger, anxiety, and nervousness
among employees and simultaneously reduces the level of job satisfaction –
which causes behavioral and physiological consequences. Gandhi,
Sangeetha, Ahmed, and Chaturvedi (2014) reported that, in nurses, so­
matic symptoms are positively correlated with stress perception and are
negatively correlated with perceived job satisfaction. They also found that
public hospital nurses had higher job satisfaction, which was probably due
to higher financial benefits. This finding was surprising and contradicts
other Indian studies on nursing. Other studies, like Rajan (2014), estab­
lished that stress due to inconsistent practices of management leads
to job dissatisfaction in employees were a powerful source of stress
influencing job satisfaction. Lastly, studies like Madhura, Subramanya,
and Balaram (2014), Jacob (2012) and Koshy, Ramesh, Khan, and
 Work Stress 91
Sivaramakrishnan (2011) have observed that high levels of job satisfaction
are negatively associated with stress but positively associated with job
challenge, work commitment, and empowerment.
A smaller number of studies linked stress with workplace spirituality
but the results were contradictory. Papers like Kumar and Kumar (2014)
found that health was negatively correlated with stress and positively
correlated with workplace spirituality; whereas, Chand and Koul (2012)
reported a reduction in stress due to workplace spirituality practices
among employees of public and private companies. Doraiswamy and
Deshmukh (2015) concluded that workplace spirituality was negatively
correlated to stress in nurses, and data analysis in Garg, Garg, and
Prakash (2018) revealed that workplace spirituality emerged as the
strongest mechanism to cope with job stress in insurance sector em­
ployees.
The review included three intervention-based studies that used the pre
and post test design and carried out statistical analysis using repeated-
measures analysis of variance. Ranta (2009) used multidimensional
psychological interventions – like relaxation training, self-management,
and mood management techniques – on police personnel to reduce their
stress using a control group technique. Findings suggested that the in­
terventions were significant in reducing job stress and enhanced the
coping behavior of subjects. A different study on nurses (Sailaxmi &
Lalitha, 2015) scrutinized the effect of the stress management program.
The data was collected immediately after intervention and four weeks
later, revealed that the stress management strategies positively impacted
the nurses’ stress levels. Lastly, Chitra and Karunanidhi (2018) examined
the efficacy of a resilience training program in female police officers.
Training included self-awareness, positive attitudes, emotional manage­
ment, and interpersonal skills. Results revealed that resilience training
was effective in enhancing resilience, job satisfaction, and the psycho­
logical well-being of female police officers and in reducing occupational
stress. There was only one study (Lal & Singh, 2015) that worked
on proposing a new stress model known as “a general model of work­
place stress.” This model proposed six stages of stress – job stressors,
job reactions, mental reactions, the need for counseling and help, body
reactions, and extreme helplessness.

Main Consequences of Stress in Studies

Several types of stress consequences were reported as presented in
Table 6.2. Stress was found to be linked to emotional consequences like
depression (Vimala & Madhavi, 2009), burnout (Reddy & Poornima,
2012; Amin, Vankar, Nimbalkar, & Phatak, 2015), and hypertension
(Babu, Mahapatra, & Detels, 2013). Behavioral outcomes like smoking/
drinking habits and substance abuse (Ragesh et al., 2017), negative
92 Kajal A. Sharma
attitude toward superiors and work in general (Neelamegam & Asrafi,
2010), diurnal bruxism (Rao, Bhat, & David, 2011), deprivation of
general well-being, high absenteeism, and high attrition (Bhatt and
Pathak, 2013), reduced levels of satisfaction (Bora et al., 2016; Mishra
et al., 2011), loss of productivity (Lundgren et al., 2014), social dys­
function (Davey et al., 2016), and negative effects on personal life (Nema
et al., 2010) were observed by various researchers. Physical concerns like
work-related musculoskeletal disorder (Sharan & Ajeesh, 2012; Sethi,
Sandhu, & Imbanathan, 2011) and other occupational disorders like
pain in the neck, shoulder, wrist, and lower back and also eye problems
like irritation and burning sensations and bad work postures (Ghosh,
Das, & Gangopadhyay, 2010), oral problems (Acharya & Pentapati,
2012), knee pain (Anap, Iyer, & Rao, 2013), high systolic and diastolic
blood pressure and heart rate (Das, Ghosh, & Gangopadhyay, 2013),
perceived exertion, alertness, and uneven sleep patterns (Haldar & Sahu,
2015) were detected in various employee groups.

Discussion
The review reveals that there has been more concentration of studies in
the health and academic sectors. The workforce in other sectors has not
been researched as much, so there is less understanding of employees’
encounters with stress in these work environments. Some of the less-
studied sectors, like the service and manufacturing are key contributors
to the Indian economy. Hence, future research should focus on such
sector organizations. Researching the unexplored work sectors will
generate further insights on stressors, their consequences and coping
mechanisms adopted by employees. This will enable organizations to
develop specific interventions to manage stress and promote beneficial
coping styles in their specific work settings.
This review highlights that most stress research has been concentrated
on examining the types of stressors faced by different occupational
groups. There has been less focus on exploring the full impact of stress
on the mental, physical, emotional, and behavioral state of an individual.
It is strongly suggested that future research should focus more attention

Table 6.2 Consequences of Stress

Consequences of Stress No. of Studies Percentage (%)

Physical 18 16
Mental 44 37
Emotional 24 21
Behavioral 30 26
Total 116 100
 Work Stress 93
on examining the impact of stressors on the health of employees, as
extensively captured in Western literature (Cooper & Quick, 2017). This
is not only important for managing and treating stress, but also for
preventing stress at the workplace. Another related observation is that
there is less research undertaken on the subject of involving the phy­
siological measurement of stress. This review found only 18 (16%)
studies that discussed the physiological consequences of stress on
workers/employees. Hence, future research should focus on these areas.
International literature has explored issues related to gender differ­
ences in experiencing stress, its consequences and coping mechanisms in
much depth. However, this review highlights the need for generating
more data related to gender differences on stress-related parameters in
the Indian context, which is similar to conclusions found in studies like
Doble and Supriya (2010), Gaur and Jain (2013), Jain and Osmany
(2019), and Tripathy, Tripathy, Gupta and Kar (2020). Further studies
should explore issues like the involvement of women in different sectors
and professions in the Indian workforce and a comparison of stressors,
their consequences, and coping styles in males and females. Based on
such data, more informed and beneficial interventions can be designed by
organizations.
It has been observed that most of the studies in the Indian context have
used quantitative methods over qualitative methods. There has been a
debate on the usefulness of both types of methods in conducting stress
research. Some researchers have highlighted the importance of qualita­
tive studies in generating insights on the undercurrents related to the
concept of stress (Mazzola, Schonfeld, & Spector, 2011; Hasan, Dollard,
& Winefield, 2010). However, in recent years, there has been a growing
focus on applying a mixed methods strategy (qualitative-quantitative)
which is considered as a balanced approach to carry out stress research
in international literature. Researchers like Cooper, DeweDewe, and
O’Driscoll (2001), Liu, Spector, and Shi (2007, 2008), Skakon, Nielsen,
Borg, and Guzman (2010), Barley, Meyerson, and Grodal (2011), and
many others have endorsed that both designs can complement each
other. We can see the use of the mixed methods strategy as a slow but
growing trend in Indian studies. More studies based on mixed methods
should be undertaken to eliminate the limitations of qualitative and
quantitative methods and produce a more holistic understanding of the
stress phenomenon.
This review, as many others carried out in international literature –
for example, Lambert and Lambert (2001), Burke (2010), Skakon
et al. (2010), Mäkikangas, Kinnunen, Feldt, and Schaufeli (2016), and
Burman and Goswami (2018) – observes that stress research has been
dominated by cross-sectional studies which reveals a dearth of good
longitudinal studies in overall literature. Longitudinal studies require
more commitment of time, resources, and effort, which may not be
94 Kajal A. Sharma
realistic for most individual researchers due to the lack of institutional
and financial support. Accordingly, future research can focus on de­
veloping a larger assortment of longitudinal stress studies as its po­
tential remains underrealized in literature.
This investigation has shown that Western tools of measurement have
been extensively used in Indian studies. There was only one study on tool
development in the review. It has also been noted that researchers have
not actively attempted to revalidate or revise any of the popular scales in
the Indian context. It needs to be stressed that these tools were developed
years ago and since then, the landscape of work and work environment
has changed drastically due to several global trends. Considering con­
temporary dynamics, most of such tools used for generating data may
have become less effective. Thus, there is a critical need for the revision
of current scales and the development of new culture-specific, purpose-
specific, and well-designed scales that can help capture relevant data and
enhance our understanding of the stress phenomenon in the Indian
culture and context. This issue has been highlighted in
both Indian and international literature (Cooper et al., 2001; Pandey,
Gaur, & Pestonjee, 2013; Burman & Goswami, 2018).
Culture has a significant influence on stress research. Aldwin (2004)
suggested that culture can affect stress and coping processes in different
ways. Several researchers have been able to establish a significant influ­
ence of culture on stress-coping (Laungani, 2007; Bhagat et al., 2010;
Behera & Hasan, 2018). Most of the stress models, theories, and mea­
sures utilized by Indian researchers to study and understand stress have
been developed in Western cultures. Such research may not give an ac­
curate and complete understanding of stress-related issues in the Indian
context, as the cultural characteristics differ between countries. Though
few of these measuring tools have been translated in regional Indian
languages and sufficient standardization methods were applied before
using them, deriving culture-specific interpretations from the data is
challenging for researchers – as highlighted by various studies in litera­
ture (Bhagat et al., 2010; Behera & Hasan, 2018). There might be
commonalities in work settings due to the globalized nature of the world,
but the cultural dimensions within societies can affect the dynamics of
the stress-coping process significantly. Future studies should try to work
on the development of culture-specific stress models and tools to develop
understanding of important cultural characteristics that influence in­
dividual and organizational stress process.
In conclusion, work stress was and remains to be an important
concern for employees and organizations alike. Research highlights
the acknowledgment and awareness of various individual and orga­
nizational stressors, which have changed over the years. This
knowledge has changed the outlook of organizations toward con­
tinuous and effective management of stress to some extent but more
 Work Stress 95
needs to be done. Future research in the areas emphasized in the
discussion will expand understanding of stress and its implications on
different groups of the population, especially in the Indian context.
Given the dynamic and complex nature of stress and the ever-
changing external environment, it will also enable organizations to
become proactive in stress identification, diagnosis, and treatment.

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APPENDIX Table: Summary of studies reviewed

Year Authors Methodology Design Sample Sample Sector Type of Male/
Size Organisation Female

2009 Dasgupta, H. and Quantitative Cross- sectional Doctors and 150 Health Public Both
Kumar, S. nurses
2009 Kane, P.P. Quantitative Cross- sectional Nurses 106 Health Public Both
2009 Ayyappan, R., Quantitative Longitudinal Automotive, 3300 Manufacturing Private Both
Sankar, S., glass, and
Rajkumar, P. & textile
Balakrishnan, workers
K.
2009 Kumar, G.R., & Quantitative Cross-sectional Traffic 100 Law Public Both
Mohan, S.R. police Enforcement
officers
2009 Ramesh, A. S., & Quantitative Cross-sectional Farmers 200 Agriculture Public Both
Madhavi, C.
2009 Suri, S., & Quantitative Cross-sectional Managers 80 Multiple Multiple Both
Arora, N.
2009 Benedict, J. N., Quantitative Cross-sectional Employees 52 Multiple Private Both
Gayatridevi, S.,
&
Velayudhan, A.
2009 Gupta, B., & Quantitative Cross-sectional Managers 221 Multiple Private Both
Tyagi, A.
2009 Scott, J., Evans, Quantitative Cross-sectional Police 1300 Law Public Both
D., & personnel Enforcement
Verma, A.
2009 Singh, M. Quantitative Cross-sectional School 100 Academic Multiple Both
teachers
(Continued)
Work Stress 109
 110

Year Authors Methodology Design Sample Sample Sector Type of Male/

Size Organisation Female

2009 Ranta, R. S. Quantitative Cross-sectional Police 280 Law Public Male

personnel Enforcement
2009 Vimala, B., & Quantitative Cross-sectional IT 500 IT/BPO Private Female
Madhavi, C. employees
2010 Bhatt, S., & Quantitative Cross-sectional IT 241 IT/BPO Private Both
Kajal A. Sharma

Pathak, P. employees
2010 Chandra, A., & Quantitative Cross-sectional Managers 53 Manufacturing Public Both
Sharma, B. R.
2010 Sayeed, O. B., & Quantitative Cross-sectional Air traffic 52 Aviation Public Both
Kumar, S. C con­
trollers
2010 Nema, G., Nagar, Quantitative Cross-sectional College 50 Academic Private Both
D., & teachers
Mandhanya, Y.
2010 Dhar, R. L., & Qualitative Cross-sectional IT 26 IT/BPO Private Both
Dhar, M. employees
2010 Bhatia N, Kishore Quantitative Cross-sectional Nurses 87 Health Public Both
J, Anand T,
Jiloha RC.
2010 Neelamegam, R.; Quantitative Cross-sectional Cooperative 74 Banking/ Non- Both
Asrafi, S. bank Insurance profitable/
employees Voluntary
2010 Oommen, H., Qualitative Longitudinal Nurses 9 Health Public Female
Wright, M., &
Maijala, H.
(Continued)
Year Authors Methodology Design Sample Sample Sector Type of Male/
Size Organisation Female

2010 Balakrishnan, K., Mixed Cross-sectional Manufactur­ 242 Manufacturing Public & Both
Ramalingam, Methods ing Private
A., Dasu, V., employees
Chinnadurai
Stephen, J., Raj
Sivaperumal,
M.,
Kumarasamy,
D.,… &
Sambandam, S.
2010 Ghosh, T; Das, B; Quantitative Cross-sectional Goldsmiths 120 Manufacturing Private Male
Gangopadhyay,
S.
2011 Rajan, P., & Quantitative Cross-sectional Doctors 71 Health Private Female
Bellare, B.
2011 Rao, S.K., Bhat, Mixed Cross-sectional IT 147 IT/BPO Private Both
M., and Methods employees
David, J.
2011 Sethi, J., Sandhu, Quantitative Cross-sectional BPO 100 IT/BPO Private Both
J. S., & employees
Imbanathan, V.
2011 Selokar, D., Quantitative Cross-sectional Police 102 Law Public Both
Nimbarte, S., personnel Enforcement
Ahana, S.,
Gaidhane, A.,
Wagh, V.
Work Stress 111

(Continued)
 112

Year Authors Methodology Design Sample Sample Sector Type of Male/

Size Organisation Female

2011 Mishra, B., Quantitative Cross-sectional University 406 Academic Public Both
Mehta, S.C., employees
Sinha, N.,
Shukla, S. K.,
& Ahmed, N.
Kajal A. Sharma

2011 Bano, B., & Quantitative Cross-sectional Government 35 Multiple Multiple Both
Talib, P. Employee­
s
2011 Sharan, D., Quantitative Longitudinal IT 4500 IT/BPO Private Both
Parijat, P., employees
Sasidharan, A.
P.,
Ranganathan,
R., Mohandoss,
M., & Jose, J.
2011 Koshy, R. C., Quantitative Cross-sectional Anaesthesio­ 115 Health Public & Both
Ramesh, B., logists Private
Khan, S., &
Sivaramakrish­
nan, A.
2011 Gladies, J. J., Quantitative Cross-sectional IT 450 IT/BPO Private Female
Kennedy, V. employees
2011 Kumar, D., Singh, Quantitative Cross-sectional Railway 185 Transport Public Both
J. V., & employees
Kharwar, P. S.
(Continued)
Year Authors Methodology Design Sample Sample Sector Type of Male/
Size Organisation Female

2011 Kumari, G., & Quantitative Cross-sectional Steelworkers 100 Manufacturing Public & Both
Pandey, K. M. Private
2012 Kumar, K, S. & Quantitative Cross-sectional Workers 860 Manufacturing Public & Both
Madhu, G. Private
2012 Reddy, G, L. and Quantitative Longitudinal University 955 Academic Public & Both
Poornima, R. teachers Private
2012 Sett, M and Mixed Cross-sectional Jute mill 219 Manufacturing Public Male
Sahu, S. Methods workers
2012 Vijayadurai, J and Quantitative Cross-sectional College 50 Academic Private Female
Venkatesh, S teachers
2012 Abhyankar, S., & Mixed Cross-sectional Employees 210 Manufacturing Private Both
Pujari, U. Methods
2012 Kumar, K, S. & Quantitative Cross-sectional Chemical 860 Manufacturing Public Both
Madhu, G. industry
workers
2012 Acharya, S. Quantitative Cross-sectional IT 134 IT/BPO Public & Both
&Pentapati employees Private
KC,
2012 Rao, J.V. & Quantitative Cross-sectional IT 200 IT/BPO Public & Both
Chandraiah, K. employees Private
2012 Sharan,D. & Quantitative Cross-sectional IT 200 IT/BPO Private Both
Ajeesh, A.P. employees
2012 Jacob, D. K. Quantitative Cross-sectional Banking 100 Banking/ Public & Both
employees Insurance Private
(Continued)
Work Stress 113
 114

Year Authors Methodology Design Sample Sample Sector Type of Male/

Size Organisation Female

2012 Lakshmi, K.S., Quantitative Cross-sectional Nurses 200 Health Public & Female
Ramachandra­ Private
n, T. &
Boohene, D.
2012 Tabassum, S. Quantitative Cross-sectional Insurance 100 Banking/ Public & Both
Kajal A. Sharma

employees Insurance Private

2012 Kang, L. S., & Quantitative Cross-sectional Bank 316 Banking/ Public & Both
Sandhu, R. S. managers Insurance Private
2012 Jathanna, P. N. Quantitative Cross-sectional Nurses 329 Health Private Both
R., Latha, K. S.,
& Prabhu, S.
2012 Baba, I. Quantitative Cross-sectional Doctors 73 Health Public Both
2012 Rao, J. V., & Quantitative Cross-sectional IT 180 IT/BPO Private Male
Chandraiah, K. employees
2013 Das, B., Ghosh, Mixed Cross-sectional Farmers 170 Agriculture Public Male
T., & Methods
Gangopadhyay,
S.
2013 Sharma, M., & Quantitative Cross-sectional Lecturers 120 Academic Public & Female
Kaur, G. Private
2013 Babu, G. R., Mixed Cross-sectional IT 1071 IT/BPO Private Both
Mahapatra, T., Methods employees
& Detels, R.
(Continued)
Year Authors Methodology Design Sample Sample Sector Type of Male/
Size Organisation Female

2013 Joy P, J. I. N. S., Quantitative Cross-sectional Tile industry 200 Manufacturing Private Male
& worker
Radhakrishna­
N, R.
2013 Bhatt, S., & Quantitative Cross-sectional BPO 234 IT/BPO Private Both
Pathak, P. employees
2013 Borkakoty, A., Quantitative Cross-sectional Employees 100 Multiple Multiple Both
Baruah, M., &
Nath, A. S.
2013 Jose, T. T., & Quantitative Cross-sectional Nurses 200 Health Public & Both
Bhat, S. M. Private
2013 Chhabra, B & Quantitative Cross-sectional Managers 103 Multiple Private Both
Mohanty, R,P.
2013 Rashid, I., & Quantitative Longitudinal Doctors 176 Health Public Both
Talib, P
2013 Tabassum, S. Quantitative Cross-sectional Insurance 100 Banking/ Public & Both
employees Insurance Private
2013 Nidhikakkar, A Quantitative Cross-sectional Lecturers 100 Academic Public & Female
and Jyothi, A. Private
2013 Shukla, H. and Quantitative Cross-sectional Bank 50 Banking/ Public Both
Garg, R. employees Insurance
2013 Anap,D.,Iyer,C. Quantitative Cross-sectional Nurses 228 Health Public & Female
and Rao, K. Private
2013 Satija, S., & Quantitative Cross-sectional Working 150 Multiple Multiple Both
Khan, W. Professio­
nal
Work Stress 115

(Continued)
 116

Year Authors Methodology Design Sample Sample Sector Type of Male/

Size Organisation Female

2013 Kumar, V. K., Quantitative Longitudinal Dentists 646 Health Public & Both
Kumar, S. P., & Private
Baliga, M. R.
2013 Ahmed, A. Quantitative Cross-sectional Textile 450 Manufacturing Public Both
workers
Kajal A. Sharma

2013 Chhabra, M., & Quantitative Cross-sectional BSF 161 Law Public Male
Chhabra, B. personnel Enforcement
2013 Rathi, N., Quantitative Cross-sectional Hotel 204 Hospitality Private Both
Bhatnagar, D., employees
& Mishra, S. K.
2013 Yadav, R. K., & Quantitative Cross-sectional Bank 100 Banking/ Public Female
Dabhade, N. employees Insurance
2014 Kumar, V., & Quantitative Cross-sectional Bank 150 Banking/ Public & Both
Kumar, S. employees Insurance Private
2014 Chandramoulees­ Quantitative Cross-sectional Doctors 93 Health Public Both
waran, S.,
Natasha C
Edwin, N,C.,
and
Braganza, D.
2014 Jolly, L. Quantitative Cross-sectional College 30 Academic Private Both
teachers
2014 Rajan, D. Mixed Cross-sectional Nurses 120 Health Private Female
Methods
(Continued)
Year Authors Methodology Design Sample Sample Sector Type of Male/
Size Organisation Female

2014 Joseph, J.K. and Qualitative Cross-sectional Police 118 Law Public Both
Nagarajamurt­ officers Enforcement
hy, B.
2014 Modekurti- Quantitative Longitudinal Employees 411 Multiple Public & Both
Mahato, M., Private
Kumar, P., &
Raju, P. G.
2014 Rajan, D. Quantitative Cross-sectional Pharmacists 60 Health Private Both
2014 Manjula, C. Quantitative Cross-sectional School 70 Academic Private Both
teachers
2014 Gandhi, S., Quantitative Cross-sectional Nurses 150 Health Multiple Both
Sangeetha, G.,
Ahmed, N., &
Chaturvedi,
S. K.
2014 Almale, B. D., Quantitative Cross-sectional Police 276 Law Public Male
Vankudre, A. personnel Enforcement
J., Bansode-
Gokhe, S. S., &
Pawar, V. K.
2014 Sihag, A., & Quantitative Cross-sectional Health 600 Health Public & Both
Bidlan, J. S. workers Private
2014 Sharma, P., Quantitative Cross-sectional Nurses 100 Health Private Both
Davey, A.,
Davey, S.,
Shukla, A.,
Work Stress 117

(Continued)
 118

Year Authors Methodology Design Sample Sample Sector Type of Male/

Size Organisation Female

Shrivastava, K.,
& Bansal, R.
2014 Kashyap, S. P., Quantitative Cross-sectional Manufactur­ 315 Manufacturing Private Both
Kumar, S., & ing
Krishna, A. employees
Kajal A. Sharma

2014 Madhura, S., Quantitative Cross-sectional IT 141 IT/BPO Private Both

Subramanya, employees
P., &
Balaram, P.
2014 Das, B. Quantitative Cross-sectional Brickfield 350 Construction Private Both
workers
2014 Kumari, G., Joshi, Mixed Cross-sectional IT 100 IT/BPO Private Both
G., & Pandey, Methods employees
K. M.
2014 Lundgren, K., Quantitative Cross-sectional Workers 77 Multiple Multiple Both
Kuklane, K., &
Venugopal, V.
2014 Sharma, R., & Quantitative Cross-sectional BPO 250 IT/BPO Private Both
Sharma, K. employees
2015 Amte, R., Munta, Quantitative Cross-sectional Doctors 242 Health Private Both
K., & Gopal,
P. B.
2015 Shirotriya, A. K., Quantitative Cross-sectional Teachers 369 Academic Public Both
& Quraishi,
M. I.
(Continued)
Year Authors Methodology Design Sample Sample Sector Type of Male/
Size Organisation Female

2015 Babu, G. R., TN, Qualitative Longitudinal IT 32 IT/BPO Private Both

S., Ketharam, employees
A., Kar, S. B.,
& Detels, R.
2015 Kang, L. S., & Quantitative Cross-sectional University 570 Academic Public Both
Sidhu, H. teachers
2015 Rao, S., & Quantitative Cross-sectional Industrial 90 Manufacturing Public Male
Ramesh, N. workers
2015 Karunanidhi, S., Quantitative Cross-sectional Police 72 Law Public Female
& Chitra, T. personnel Enforcement
2015 Amin, A. A., Quantitative Longitudinal Nurses 129 Health Public both
Vankar, J. R.,
Nimbalkar, S.
M., & Phatak,
A. G.
2015 Sailaxmi, G., et al Quantitative Longitudinal Nurses 53 Health Public Both
2015 Rashid, I. and Quantitative Cross-sectional Doctors 334 Health Public Both
Talib, P.
2015 Singh, S. and Mixed Cross-sectional Police 300 Law Public Both
Kar, S.K. Methods Personnel Enforcement
2015 Aftab, M., & Quantitative Cross-sectional School 608 Academic Multiple Both
Khatoon, T. teachers
2015 Padma V, Anand Quantitative Cross-sectional IT 1000 IT/BPO Private Both
NN, Gurukul employees
SS, Javid SS,
Prasad A,
Arun S.
Work Stress 119

(Continued)
 120

Year Authors Methodology Design Sample Sample Sector Type of Male/

Size Organisation Female

2015 Prasad, K.D,V., quantitative Cross-sectional Research 232 Academic Public Both
Vaidya, R., and employees
Kumar, V.A.
2015 Anuradha N., Quantitative Cross-sectional School 100 Academic Public & Both
Swarna Latha, teachers Private
Kajal A. Sharma

P., and
Naidu, G.T.
2015 Pal, A., De, S., Mixed Cross-sectional Cultivators 155 Agriculture Private Female
Sengupta, P., Methods
Maity, P., and
Dhara, P. C.
2015 Singh, P. and Quantitative Cross-sectional College 120 Academic Private Female
Rani, S. teachers
2015 Malamardi, S. N., Quantitative Cross-sectional Bank 562 Banking/ Public Both
Kamath, R., employees Insurance
Tiwari, R.,
Nair, B. V. S.,
Chandrasekar­
an, V., &
Phadnis, S.
2015 Ravi, R., Quantitative Cross-sectional Audiologists 100 Health Private Both
Gunjawate, D.,
& Ayas, M.
2015 Mohanraj, C., & Mixed Cross-sectional Police 240 Law Public Female
Natesan, M. Methods constables Enforcement
(Continued)
Year Authors Methodology Design Sample Sample Sector Type of Male/
Size Organisation Female

2015 Jain, P., & Quantitative Cross-sectional Employees 62 Multiple Private Both
Batra, A.
2015 Parsekar, S. S., Quantitative Cross-sectional Police 76 Law Public Both
Singh, M. M., Personnel Enforcement
& Bhumika,
T. V.
2015 Moom, R. K., Quantitative Cross-sectional Employees 50 Banking/ Private Both
Sing, L. P., & Insurance
Moom, N.
2015 Haldar, P., & Quantitative Cross-sectional Nurses 122 Health Public Female
Sahu, S.
2015 Sharma, S. Quantitative Cross-sectional Army 415 Law Public Male
personnel Enforcement
2015 Dolai, D. Quantitative Cross-sectional Employees 224 Banking/ Public & Both
Insurance Private
2015 Sharma, E. Quantitative Cross-sectional Employees 750 Manufacturing Private Both
2015 Fernandes, W. N., Mixed Cross-sectional Nurses 51 Health Public & Both
& Nirmala, R. Methods Private
2016 Singh, A. Quantitative Cross-sectional College 250 Academic Public & Both
teachers Private
2016 Kishori, B. and Quantitative Cross-sectional Banking 100 Banking/ Public Both
Vinothini, B. employees Insurance
2016 Shivendra, D., & Quantitative Cross-sectional School 75 Academic Multiple Both
Kumar, M. M. teachers
2016 Banerjee, S., & Quantitative Cross-sectional University 110 Academic Multiple Both
Mehta, P. employees
Work Stress 121

(Continued)
 122

Year Authors Methodology Design Sample Sample Sector Type of Male/

Size Organisation Female

2016 Asma Zaheer, Quantitative Cross-sectional University 90 Academic Public & Female
Jamid Ul Islam, employees Private
Nahid
Darakhshan
2016 Davey, A., Quantitative Cross-sectional Nurses 100 Health Private Both
Kajal A. Sharma

Sharma, P.,
Davey, S.,
Shukla, A.,
Srivastava, K.,
& Vyas, S.
2016 Priyanka, R., Quantitative Cross-sectional Law 304 Law Public Both
Rao, A., enforce­ Enforcement
Rajesh, G., ment
Shenoy, R., & personnel
Pai, B. M.
2016 Lambert, E.G., Quantitative Cross-sectional Police 827 Law Public Both
Qureshi, H. officers Enforcement
and Frank, J.
2016 Batham, C., & Quantitative Cross-sectional Dentists 93 Health Public & Both
Yasobant, S. Private
2016 Mohan, D. A. C., Quantitative Cross-sectional IT 300 IT/BPO Private Both
Balaji, K. D., & Professio­
Kumar, T. K. nals
2016 Qazi, S., & Quantitative Cross-sectional University 155 Academic Public & Both
Nazneen, A. employees Private
(Continued)
Year Authors Methodology Design Sample Sample Sector Type of Male/
Size Organisation Female

2016 Kashyap, S. P., Quantitative Cross-sectional Manufactur­ 315 Manufacturing Private Both
Kumar, S., & ing
Byadwal, V. employees
2016 Roz, H. K. B., Quantitative Cross-sectional Cardiologis­ 180 Health Private Both
Mondal, S., ts
Podder, P., &
Raval, D. T.
2016 Venugopal, V., Mixed Longitudinal Workers 442 Multiple Public & Both
Chinnadurai, J. Methods Private
S., Lucas, R. A.,
&
Kjellstrom, T.
2016 Shiji, P., Sequera, Quantitative Cross-sectional Nurses 40 Health Public & Female
S., & Private
Mathew, S.
2017 Dawn, S., Quantitative Cross-sectional School 338 Academic Private Both
Talukdar, P., teachers
Bhattacharje,
S., & Singh,
O. P.
2017 Frank, J., Quantitative Cross-sectional Police 827 Law Public Both
Lambert, E.G. personnel Enforcement
and
Qureshi, H.
2017 Bakshi, S.G., Quantitative Cross-sectional Anesthesiol­ 1178 Health Public & Both
Divetia, J.V., ogists Private
Work Stress 123

(Continued)
 124

Year Authors Methodology Design Sample Sample Sector Type of Male/

Size Organisation Female

Kannan, S. and
Myatra, S.N.
2017 Ragesh, G., Quantitative Cross-sectional Police 406 Law Public Both
Tharayil, H. personnel Enforcement
M., Raj, M. T.,
Kajal A. Sharma

Philip, M., &

Hamza, A.
2017 Singh, S., & Quantitative Cross-sectional IT 102 IT/BPO Private Both
Sharma, T. employees
2017 Mahmood, A., & Quantitative Cross-sectional Employees 470 Multiple Multiple Both
Yadav, L. K.
2017 Singh, A. Quantitative Cross-sectional Police 240 Law Public Both
personnel Enforcement
2017 Mohanty, S. P.. Quantitative Cross-sectional School 100 Academic Public & Both
teachers Private
2017 Dey, S.C.; Dey, Quantitative Longitudinal Mineworke­ 35 Transport Public Male
N.C.; rs
Sharma, G.D.
2017 Sehgal, M., & Quantitative Cross-sectional School 60 Academic Private Female
Verma, J. teachers
2017 Parashar, M., Quantitative Longitudinal Working 345 Multiple Multiple Female
Singh, M., women
Kishore, J.,
Pathak, R., &
Panda, M.
(Continued)
Year Authors Methodology Design Sample Sample Sector Type of Male/
Size Organisation Female

2017 Kumar, V., & Quantitative Cross-sectional Police 491 Law Public Both
Kamalanabhan, personnel Enforcement
T. J.
2017 Jayakumar, D. Quantitative Cross-sectional Loco pilots 230 Transport Public Both
2017 Hashmi, K., Quantitative Cross-sectional School 120 Academic Public Both
Hasan, B., & teachers
Khan, K. A.
2017 Ahmad, A. Quantitative Cross-sectional Mineworke­ 421 Construction Public Both
rs
2017 Purohit, B., & Quantitative Cross-sectional Nurses 84 Health Public Both
Vasava, P.
2018 Garg, N., Garg, Quantitative Cross-sectional Insurance 197 Banking/ Public & Both
N. and employees Insurance Private
Prakash, C.
2018 Dey, S.C., Dey, Quantitative Cross-sectional Mineworke­ 20 Transport Public Male
N.C. & rs
Sharma, G.D.
2018 Bharathi, S.; Quantitative Cross-sectional IT 100 IT/BPO Private Both
Rajan, V. T. employees
2018 Gandhi, K., Quantitative Cross-sectional Doctors 200 Health Private Both
Sahni, N.,
Padhy, S. K., &
Mathew, P. J.
2018 Prasad, K.D,V., Quantitative Cross-sectional Research 756 Academic Public Both
Vaidya, R. and employees
Kumar, V.A.
Work Stress 125

(Continued)
 126

Year Authors Methodology Design Sample Sample Sector Type of Male/

Size Organisation Female

2018 Chitra, T., & Mixed Longitudinal Police 63 Law Public Both
Karunanidhi, S. Methods personnel Enforcement
2018 Agarwal, S., Quantitative Cross-sectional University 204 Academic Public & Both
Sayal, A., & employees Private
Mishra, A.
Kajal A. Sharma

2018 Sharma, N., Quantitative Cross-sectional Nurses 81 Health Public Female

Takkar, P.,
Purkayastha,
A., Jaiswal, P.,
Taneja, S.,
Lohia, N., &
Augustine,
A. R.
2018 Mitra, S., Sarkar, Quantitative Cross-sectional Doctors 63 Health Private Both
A. P., Haldar,
D., Saren, A.
B., Lo, S., &
Sarkar, G. N.
Private Both
2018 Onkari, D., & Mixed Cross-sectional Police 60 Law Public Female
Itagi, S. Methods personnel Enforcement
2018 Raval, A., Dutta, Quantitative Cross-sectional Traffic 16 Law Public Both
P., Tiwari, A., police Enforcement
Ganguly, P. S., officers
Sathish, L. M.,
(Continued)
Year Authors Methodology Design Sample Sample Sector Type of Male/
Size Organisation Female

Mavalankar,
D., & Hess, J.
2018 Singh, N., & Mixed Cross-sectional University 440 Academic Private Both
Srivastava, Methods employees
D. R.
2018 Singh, V. & Quantitative Cross-sectional University 550 Academic Public & Both
Prasad, H. N. librarians Private
Work Stress 127
7 Organizational Stress in
Contemporary Japan
Tsuyoshi Ohira, Tetsushi Fujimoto,
and Tomoki Sekiguchi

Introduction
Organizational stress is a contemporary social problem that undermines
workers’ physical and mental health in Japan. The stress that Japanese
workers experience is tightly connected to the ways in which employ-
ment is structured in society. Traditionally, Japanese employment has
been characterized by things such as seniority wages, lifetime employ-
ment, and enterprise labor union (Hamaaki, Hori, Maeda, & Murata,
2012). Although this employment system was a powerful engine to
prompt economic growth in postwar Japan (Hamaaki et al., 2012), it
started changing after 1973 when an oil shock hit the economy, dete-
riorating the conditions of work and affecting the lives of employed men
and women. The problem of organizational stress emerged and became
increasingly serious as an inevitable consequence of this change.
In this chapter, we conduct a systematic review of existing studies of
organizational stress in Japan, with particular focus on the following
issues: (1) Karoshi (death from overwork) and Karo-Jisatsu (suicide
caused by work stress), (2) long hours of work, (3) non-regular em-
ployment, and (4) workplace harassment. Since a number of earlier re-
search in Japan examined the relationship between organizational
stressors and physical and mental health for Japanese workers (Nagata,
2005), we investigate this relationship by exploring peer-reviewed arti-
cles written in both Japanese and English and were published after the
year 2000. We searched two databases – CiNii Articles and Google
Scholar – for articles by using keywords such as “Karoshi,” “Karo-
Jisatsu,” “Cho-Jikan Rodo” (long hours of work), “Zangyo” (overtime
work), “Hiseiki Koyo” (non-regular employment), and “Harasumento”
(harassment). In addition to these keywords, we also used the word
“Japan” when searching for articles written in English and the word
“Sutoresu” (stress) to search for articles written in Japanese. After the
search, we selected 38 articles – these included two articles on Karoshi
and Karo-Jisatsu, 17 articles on long hours of work, 11 articles on non-
regular employment, and 8 articles on workplace harassment. Each

DOI: 10.4324/9780429292538-7
 Organizational Stress in Contemporary Japan 129
section consists of an outline of issues including definitions, statistics,
and a summary of findings. We also conducted an overview of govern-
ment policies in Japan and the ways that Japanese employers respond to
the problem of organizational stress. We conclude this chapter by noting
some limitations in this review and by offering directions for future re-
search.

Karoshi and Organizational Stress

Karoshi
Karoshi, or death from overwork, is perhaps the worst worker outcome
of organizational stress in Japan. Japan’s Act of Promoting Measures to
Prevent Death and Injury from Overwork defines Karoshi as “death due
to cerebrovascular or heart disease brought on by an overload of work,
or death by suicide related to mental disorder from the intense psycho-
logical burden at work” (Ministry of Health, Labour, and Welfare,
2019d). Karo-jisatsu is suicide caused by a work-related mental disorder,
and it is usually separated from Karoshi (Iwata, 2009; Komorida, 2016).
According to the 2018 Status Report of Industrial Accident
Compensation for Karoshi (Ministry of Health, Labour and Welfare,
2019e), the number of Karoshi incidents, legally admitted as compen-
sable by insurance, amounted to 82 in 2018 as compared to 160 in-
cidents in 2002, while the number of Karo-Jisatsu, including attempted
suicide, rose from 43 in 2002 to 76 incidents in 2018.

Similarities and Differences between Karoshi and Karo-Jisatsu

There are similarities and differences between Karoshi and Karo-Jisatsu.
According to the Ministry of Health, Labour, and Welfare (2019e), one
of the similarities is that most workers who died from Karoshi or Karo-
Jisatsu are men in regular employment. As for differences, a vast ma-
jority of Karoshi victims are in their 40s and 50s; whereas, Karo-Jisatsu
tends to occur in all age groups.　Employees who died from Karoshi are
concentrated in the mailing and transportation industry; whereas, those
who died from Karo-Jisatsu are distributed across a wide variety of in-
dustries – such as manufacturing, retail, lodging, and wholesale. In ad-
dition, many of the workers who died from Karoshi put in more than 60
hours of work per week, although Karo-Jisatsu occurred even among
those who worked only a few hours of overtime in a day.

Causes of Karoshi and Karo-Jisatsu

Previous studies suggest that working long hours is a significant cause of
Karoshi (Kanai, 2008). Long hours generally reduce sleep time, while
130 Tsuyoshi Ohira et al.
increasing the risk of cerebrovascular and heart disease (Iwasaki, 2008).
In addition to long hours, the presence of an extremely heavy workload
is required for death to be certified as Karoshi by the Industrial Accident
Compensation Insurance (Ministry of Health, Labour, and Welfare,
2019d). On the other hand, a prerequisite for suicide to be insured as
Karo-Jisatsu is an individual experience of strong psychological pressure
from work (Ministry of Health, Labour, and Welfare, 2019d). For ex-
ample, Karo-Jisatsu is associated with unreasonable changes in job as-
signments, overtime work exceeding 80 hours per week, workplace
harassment, and interpersonal problems with supervisors (Ministry of
Health, Labour, and Welfare, 2019e).

Karoshi, Karo-Jisatsu, and Organizational Stress in Japan

Although a variety of work stressors is relevant to Karoshi and Karo-
Jisatsu, a limited number of studies have explored how they may be
related to organizational stress. Iwata (2009) found that workers who
died from Karoshi had experienced a sudden increase in workload, and
their work conditions were more likely to be severe compared to those
who committed Karo-Jisatsu. In contrast, unexpected job assignments
and interpersonal problems with their supervisors were more likely to be
observed in the cases of Karo-Jisatsu. Komorida (2016) showed that
those who committed Karo-Jisatsu, compared to those who died from
Karoshi, tend to have been assigned an unreasonable amount of work
and have experienced harassment in their workplace.

Long Work Hours and Organizational Stress

Long Work Hours

A general consensus seems to be that Japanese workers work long hours
(Ogura, 2008). According to the Monthly Labor Survey conducted by
the Japanese Ministry of Health, Labor, and Welfare (Ministry of
Health, Labour, and Welfare, 2019a), the average annual hours rendered
by an individual worker in 2018 is 1,706. Due to the increase in non-
regular employment, the overall hours of work for the Japanese have
gradually decreased in recent years. However, the hours for regular
workers have not noticeably changed (2,010 hours in 2018), and they
still work nearly twice as long as non-regular workers (1,025 hours in
2018). Moreover, men in their 30s and 40s and those who work in the
mailing, transportation, building, manufacturing, and information and
communication industries are more likely to put long hours at work.
Table 7.1 shows the average number of hours worked by individual
workers annually, as well as the proportion of workers working 49
hours or more per week in developed countries. As shown in the table,
 Organizational Stress in Contemporary Japan 131
Table 7.1 The Average Annual Number of Hours Worked by Individual
Workers and the Proportion of Workers Working 49 Hours or More
Weekly in Developed Countries

The Average Annual Number The Proportion of Workers

of Hours Worked by Working 49 Hours or More
Individual Workers in 2017 Weekly in 2017

Japan 1,709 20.6%

USA 1,780 19.3%
Canada 1,695 12.3%
UK 1,543 11.7%
Germany 1,360 8.5%
France 1,522 10.1%
South Korea 2,018 29.0%

Sources: OECD (2020); International Labour Organization (2020).

Japan (1,713 hours in 2016) is among the countries with the longest
hours of work in 2016. Other countries include South Korea (2,069
hours) and the United States (1,783 hours). While Japan’s work hours
are decreasing, the average annual overtime hours have slowly increased
after 2009 – reaching 129 hours in 2018. Note that the number of
employees working for more than 60 hours per week, excluding those
who work in agricultural industries, has decreased in recent years, yet
4.32 million workers (7.7% of all workers) are still at risk of Karoshi. As
Table 7.1 shows, the proportion of Japanese workers working 49 hours
or more per week was 20.8% in 2015, and this proportion is the second
largest next to Korea (32.0%).

Long Hours of Work and Organizational Stress in Japan

A number of studies conducted in Japan attempted to examine the
relationship between long work hours and workers’ health, but the
results remain unclear. Approximately half of the research reported
that long hours made workers’ physical and mental health deteriorate.
For example, an increase in work hours and overtime was negatively
related to mental health for women workers with children and
workers in community services (Koizumi, Sugawara, Maekawa, &
Kitamura, 2003; Suzumura et al., 2013; Yamaguchi, 2010). Long
hours and overtime also exerted harmful influence on workers’ phy-
sical health – such as back and neck pain, fatigue, sleep deprivation,
and tinnitus (Koda et al., 2000; Kubo, Sasaki, & Matsumoto, 2010;
Nakata et al., 2001). Furthermore, Umehara, Ohya, Kawakami,
Tsutsumi, and Fujimura (2007) showed that psychosomatic symptoms
were more likely to result when workers work long hours and over-
time. Fukui, Haratani, Fukazawa, Nakata, Takahashi, and Fujioka
132 Tsuyoshi Ohira et al.
(2003) found a significantly higher level of psychological and physical
strain among IT engineers who work long hours beyond 10 P.M. The
remaining half of the research failed to confirm the presence of a
significant relationship between long hours and individual health
(Fukuyama & Inoue, 2017; Haoka et al., 2010; Kataoka, Kazuhiro,
Masahito, Tetsuya, & Beth, 2014; Nakada et al., 2016; Nishikitani,
Nakao, Karita, Nomura, & Yano, 2005; Nishitani & Sakakibara,
2010; Nozaki et al., 2012; Tarumi & Hagihara, 2002; Tominaga &
Asakura, 2006). Rather than long hours and overtime, some research
showed that having heavy workload was negatively associated with
physical and mental health (Fukuyama & Inoue, 2017; Haoka et al.,
2010; Nakada et al., 2016; Tominaga & Asakura, 2006).

Non-Regular Employment and Organizational Stress

Non-Regular Employment
Expansion of non-regular employment is one of the most significant
changes that took place in Japanese labor markets during the past 20
years. While there is no solid agreement on the definition of non-
regular employment (Kitagawa, Ohta, & Teruyama, 2018), a recent
labor force survey conducted by the Japanese government has cate-
gorized non-regular employment based on the terms used in em-
ployment contracts and divided non-regular employment into six
types (Fu, 2013). Part-time workers share a large proportion of non-
regular employees, and they can be classified further into paato (part-
time workers) and arubaito (fringe workers). On one hand, the vast
majority of paato workers are married mothers with children, and
they are likely to have fixed work schedules. On the other hand, many
arubaito workers tend to consist of young people, including students,
who often have flexible and short work schedules. Contract workers
work in a fixed-term employment contract. Haken workers (dispatch
workers) are hired by and sent from a staffing agency. Entrusted
workers tend to consist of older workers who are reaching retirement.
Others include seasonal, emergency, or daily workers who are em-
ployed for a designated period of time.

Increasing Non-Regular Employment

According to the 2018 Labor Force Survey conducted by the Ministry of
Internal Affairs and Communications (Ministry of Internal Affairs and
Communications, 2019), the number of non-regular workers has gra-
dually increased over the years and has reached 21.2 million in 2018.
This includes 10.35 million paato, 4.55 million arubaito, 2.94 million
contract workers, 1.36 million haken, 1.2 million of entrusted workers,
 Organizational Stress in Contemporary Japan 133
and 0.8 million others. Non-regular workers consist of approximately
38% of all employees in 2018. Why have non-regular workers increased
in Japan? Asano, Ito, and Kawaguchi (2013) argue that a part of the
reason why non-regular employment boomed in Japan is that a large
number of young men and women had to reluctantly choose non-regular
work due to employer reluctance of long-term hiring of employees. In
addition, Japanese Ministry of Health, Labour, and Welfare (2019c)
suggests that the increase in foreign-born part-time workers, including
international students, may have contributed to the increase of non-
regular workers.

Non-Regular Employment and Organizational Stress in Japan

Along with an increase in non-regular workers, researchers have come to
focus on two topics relevant to non-regular employment. The first topic
is the antecedents of non-regular workers’ stress. Earlier studies showed
that organizational stressors – such as a wide range of job assignments
(Ozono, 2010), employment insecurity (Takahashi, Morita, & Ishidu,
2014), and heavy workload (Takahashi et al., 2014) – have a detrimental
effect on non-regular workers’ mental health. Furthermore, women in
non-regular employment (Ozono, 2010) and economically challenged
non-regular workers (Takahashi et al., 2014) experience higher levels of
stress in their jobs. Previous research also found several antecedents that
exert positive effects. For example, job autonomy (Ozono, 2010;
Uehara, Kanbara, Shido, Nishi, & Miyake, 2014), supervisors’ active
listening, and the number of supportive co-workers are likely to ame-
liorate non-regular workers’ mental health. Moreover, age (Morita,
2018), family satisfaction (Nakahara, 2007; Uehara et al., 2014), health
satisfaction (Uehara et al., 2014), internal locus of control (Uehara et al.,
2014), job satisfaction (Nakahara, 2007; Takahashi et al., 2014), per-
ceived work-life balance (Uehara et al., 2014), and a sense of con-
tributing to their work (Morita, 2018) are also positively related to non-
regular workers’ mental health.
The second relevant topic is the difference in mental health between
regular workers and non-regular workers. Compared to regular em-
ployment, M. Inoue (2012) argued that non-regular work may nega-
tively affect an individual’s mental health due to employment insecurity,
severe work conditions, and limited opportunities for job training and
career development. Although previous research conducted in the United
States and European Union countries showed that non-regular workers’
mental health is worse than those in regular employment (Virtanen et al.,
2005), many earlier Japanese studies failed to confirm the difference in
mental health between regular and non-regular workers (Imai, 2018;
Matsuyama, 2010; Mori, Iwata, & Tanaka, 2014; Morita, 2018;
Nakahara, 2007; Takahashi et al., 2014; Uehara et al., 2014). Only A.
134 Tsuyoshi Ohira et al.
Inoue, Kawakami, Tsuchiya, Sakurai, and Hashimoto (2010) found that
men in part-time work experience a higher level of psychological distress
than men regular workers. Inoue et al. (2010) also showed that women
in temporary/contract work are more likely to experience psychological
distress than women regular workers. Some prior research, however,
found better mental health among non-regular workers than among
regular workers (Kamiya, Sugiyama, Toda, & Murayama, 2011;
Komura & Ishitake, 2012). Thus, results are mixed when it comes to the
difference in mental health between regular and non-regular workers in
Japan.

Workplace Harassment and Organizational Stress

Workplace Harassment
In Japan, workplace harassment is a serious emergent social problem at
work. Although workplace harassment includes various types of har-
assment and bullying, this section deals with two major types of har-
assment in Japan: power harassment and sexual harassment. Power
harassment is the most common type of harassment at work (Ministry
of Health, Labour, and Welfare, 2017), and it is defined as “the acts of
a worker that cause his/her co-workers (usually subordinates) mental
or physical pains, or cause their work environment to deteriorate, using
his/her managerial or relational superiority in the workplace” (The
Japan Institute for Labour Policy and Training, 2013). Sexual harass-
ment is the second most common type of harassment at work (Ministry
of Health, Labour, and Welfare, 2017). The Japanese government de-
fines sexual harassment as “an incident when a worker suffers dis-
advantages such as dismissal, demotion, and a decrease in wages as a
result of his/her responses to harassment, and such incident seriously
causes the work environment to deteriorate, thus exerting serious and
adverse effects on the worker’s performance” (Ministry of Health,
Labour, and Welfare, 2012).

Characteristics of Power Harassment and Sexual Harassment

The Workplace Power Harassment Survey conducted in 2016 by
Japanese Ministry of Health, Labour, and Welfare (Ministry of Health,
Labour, and Welfare, 2017) reported that approximately one-third of
Japanese workers had experienced power harassment at work in the
past. According to the survey results, power harassment mainly consists
of psychological abuse (73.5%) and physical attack (14.6%) (Ministry
of Health, Labour, and Welfare, 2017). In most cases, supervisors are the
perpetrators who harass their subordinates, and some junior and non-
regular workers are also among the victims. In addition, the lack of
 Organizational Stress in Contemporary Japan 135
communication between supervisors and subordinates in the workplace
tended to cause power harassment.
According to the Annual Health, Labor, and Welfare Report 2018
(Ministry of Health, Labour, and Welfare, 2019b), sexual harassment
is a type of job discrimination that Japanese women experience most
frequently. A survey conducted in 2015 reported that 34.7% of reg-
ular workers experienced sexual harassment in the past, while only
17.8% of non-regular workers experienced it (The Japan Institute for
Labour Policy and Training, 2016). The survey also found that 53.9%
of the victims experienced unwanted remarks about their age and
physical appearance, and 40% were asked sexual questions and ex-
perienced nonconsensual bodily touch. In a large proportion of cases,
men, – particularly men in supervisory positions – harassed women,
and the vast majority of victims could do nothing but tolerate such
harassment.

Workplace Harassment and Organizational Stress in Japan

Although no prior research has focused on the relationship between
power harassment and organizational stress, some studies looked at
how workplace harassment may be related to Japanese workers’
health. First, sexual harassment exerts a negative influence on
workers’ physical and mental health. For example, sexual harassment
induces anxiety and stress-related physical symptoms for women in
care work (Taniguchi et al., 2012; Taniguchi, Takaki, Hirokawa,
Fujii, & Harano, 2016). Although Kakuyama, Matsui, and Tsuzuki
(2003) showed that sexual harassment is not associated with psy-
chological and physical stress responses, they found a moderating
effect of the victim’s vulnerability in the relationship between sexual
harassment and physical stress responses for women. Furthermore,
sexual harassment has a positive influence on burnout of research
workers (Takeuchi et al., 2018). Second, workplace bullying is ne-
gatively associated with workers’ physical and mental health. Person-
targeted bullying at work (e.g., malicious gossip and rumors) has a
negative effect on vigor for women in care work (Taniguchi et al.,
2012) and has a positive effect on their psychological and physical
stress responses (Taniguchi et al., 2016). Work-related bullying (e.g.,
intentionally withholding necessary information to affect co-worker’s
or subordinate’s work) is negatively related to men care workers’
vigor and positively associated with women’s depression (Taniguchi
et al., 2012), but it has no significant influence on psychological and
physical stress responses for care workers (Taniguchi et al., 2016).
Moreover, workplace bullying not only increases depression, but also
intensifies the relationship between job strain and depression (Takaki
et al., 2010).
136 Tsuyoshi Ohira et al.
Government Policies and Employer Responses to
Organizational Stress in Japan
As reviewed above, there are various issues relevant to organizational
stress in Japan. Now then, how do the Japanese government and em-
ployers attempt to tackle the problems? In this section, we briefly sum-
marize Japanese government policies and employer responses to
organizational stress.

Acts for Promoting Work Style Reform

The Japanese government set goals in 2018 to reduce the proportion of
workers who were rendering more than 60 hours of work per week to no
more than 5% while increasing the usage rate of paid vacation days by
up to 70% in 2020 (Ministry of Health, Labour, and Welfare, 2019d).
To promote the Japanese government’s Work Style Reform wherein the
Japanese government attempted to decrease long hours of work, reg-
ulations on overtime work were tightened by amending the Labor
Standards Law (Ministry of Health, Labour, and Welfare, 2018). The
new regulation caps overtime at 45 hours per month and 360 hours per
year, and employers must agree that the number of overtime hours is
within the limits of the law and their employees. Moreover, the gov-
ernment encourages employers to adopt a work time scheduling system
for reducing hours of work. The system sets intervals between each day’s
work so that employees have enough time to recover from fatigue.

Fair Treatment of Non-Regular Employment

The government has implemented policies to improve the work condi-
tions of non-regular workers. Although employers have increasingly
hired non-regular employees to reduce labor costs and to adjust em-
ployment (Hirano, 2010), they will be required to provide fair treatment
for regular and non-regular workers from 2020 – if non-regular workers
have the same job assignments as regular workers (Ministry of Health,
Labour, and Welfare, 2018). In addition, the government has raised the
minimum wage, and this has increased the number of social insurance
holders among non-regular workers (Ministry of Health, Labour, and
Welfare, 2019b).

Preventing Harassment at Work

The Japanese government stipulates that employers should take active
measures against workplace harassment. For example, an act that will
become effective in 2020 requires that employers launch consultation
services and training programs to tackle power harassment while
 Organizational Stress in Contemporary Japan 137
penalizing perpetrators of power harassment in accordance with their
employment rules (The Japan Institute for Labour Policy and Training,
2019). As revealed in the 2016 Workplace Power Harassment Survey
(Ministry of Health, Labour, and Welfare, 2017), a large number of
employers had already implemented preventive measures against power
harassment. Although employers are likely to opt for verbal reprimands
and job transfers as punitive measures for perpetrators of power har-
assment, they are much less likely to fire or cut salaries of perpetrators
(Ministry of Health, Labour, and Welfare, 2017). The government also
obliges employers to respond firmly to sexual harassment, while pro-
viding appropriate consultations and educational programs (Cabinet
Office, 2019). Employers commonly investigate sexual harassment
claims and give warnings to those who are accused, yet some employers
force victims of harassment into resigning or ignore their claims without
taking any action (The Japan Institute for Labour Policy and
Training, 2016).

Stress Check Program

The Japanese government initiated the Stress Check Program in 2015
in order to screen workers experiencing high levels of psychosocial
stress in the workplace (Kawakami & Tsutsumi, 2016; Tsutsumi,
Shimazu, Eguchi, Inoue, & Kawakami, 2018). The program requires
employers to do the following steps (Tsutsumi et al., 2018): First,
employers are required to examine workers’ stress every year by ad-
ministering the Brief Job Stress Questionnaire (BJSQ), a survey de-
veloped in Japan in reference to the Job Content Questionnaire (JCQ)
(Karasek, 1979) and the NIOSH Generic Job Stress Questionnaire
(Enoki, Maeda, Iwata, & Murata, 2017; Inoue et al., 2014). Second,
they must inform workers of their stress levels based on the ques-
tionnaire results. Third, it is stipulated that employers must arrange
physician interviews for workers experiencing high levels of work
stress. Fourth, employers are expected to improve their workers’ job
environment in accordance with the physician’s advice. Although the
BJSQ predicts future risks of employees’ long-term sick leaves
(Tsutsumi et al., 2018), there is little evidence as to why and how the
physician interviews may be effective (Kawakami & Tsutsumi, 2016;
Tsutsumi et al., 2018). Moreover, it is indicated that employers are
less likely to arrange interviews for highly stressed workers (Tsutsumi
et al., 2018). The program also urges employers to take advantage of
the survey data for improving their workplace, and it is expected that
data analyses are conducted by more than 60% of employers
(Ministry of Health, Labour, and Welfare, 2019d).
138 Tsuyoshi Ohira et al.
Facilitating Health and Productivity Management
Health and productivity management is viewed as an effective measure
to enhance organizational performance by improving workers’ health
(Morinaga, 2019). The government launched the Certified Health and
Productivity Management Organization Recognition Program to re-
cognize outstanding organizations engaging in health and productivity
management (Ministry of Economy, Trade, and Industry, 2018).
Although no more than 0.1% of all profit and non-profit organizations
in Japan obtained this certification in 2019, there are many unique ex-
amples. For instance, an information systems company provided a lump
sum of money based on the extent of workers’ engagement in health
practices and the results of medical examinations. Another power and
telecommunications company installed monkey bars at work, so that
employees may exercise at the office (Morinaga, 2019).

Limitations and Future Directions

In this chapter, we reviewed existing research on organizational stress in
Japan, focusing on Karoshi and Karo-Jisatsu, long work hours, non-
regular employment, and workplace harassment. We conclude this
chapter by underscoring some limitations in our review and by showing
directions for future research.

Limitations
First, we admit that some stressors (e.g., workload) and outcomes (e.g.,
job satisfaction and absenteeism) were not included in this chapter.
Although we are fully aware of their importance in organizational stress
research, we decided to limit the content of this chapter to keep it fo-
cused. Second, although articles published without peer reviews in in-
house journals of Japanese universities report interesting findings, we
only included the results from peer-reviewed articles in this chapter, so
that we could keep our systematic review academically acceptable.
Third, we used a limited number of keywords when searching databases,
so we may have omitted possible searchable studies with other keywords
– such as “medical research.”

Directions for Future Research

First, researchers examining the relationship between long work hours
and workers’ health must look at the influence of workload. Some of
the previous studies showed that the impact of long hours on physical
and mental health disappears when workload is taken into con-
sideration (Fukuyama & Inoue, 2017; Haoka et al., 2010; Nakada
 Organizational Stress in Contemporary Japan 139
et al., 2016; Tominaga & Asakura, 2006). The information on
workload might tell us something about the root cause of the negative
influence that long hours exert on workers. Second, researchers
studying Karoshi and Karo-Jisatsu should look more carefully at the
specific characteristics of workplaces and organizations. There are
many studies investigating the cause of Karoshi and Karo-Jisatsu
(e.g., Ministry of Health, Labour, and Welfare(2019d)), but few
have focused on how those causes might be related to characteristics of
workplaces and organizations in which Karoshi and Karo-Jisatsu take
place. We believe it is valuable to integrate the contexts of workplaces
and organizations in analyses of Karoshi and Karo-Jisatsu. Third, re-
searchers comparing regular and non-regular employment would
benefit by using all types of non-regular employment in their analyses.
It may be possible that the unsubstantiated difference in mental health
between regular and non-regular workers reflects a variety of back-
grounds and work conditions associated with each type of non-regular
employment. Fourth, researchers should pay more attention to power
harassment. Despite the growing awareness about the devastating
consequences of workplace harassment (Tsuno, 2016), there has been
little research that focuses on power harassment (e.g., Nii, Tsuda, Tou,
Yamahiro, and Irie (2018)). In particular, research examining the re-
lationship between power harassment and mental health is important
because Karo-Jisatsu is related to interpersonal problems with their
supervisors (Iwata, 2009; Komorida, 2016). Fifth, it would be worth
conducting intervention studies in order to confirm the effectiveness of
certain policies and management strategies. Since the vast majority of
reports highlight unique examples of workplace practices, it is im-
portant for policymakers and employers to expand their scope by
engaging in a new endeavor, like intervention study, so that Karoshi
and Karo-Jisatsu – as well as deterioration of workers’ health – may
better be prevented.

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8 Organizational Stress
A Critical Review from Nigeria
Chianu H. Dibia, Emeka S. Oruh,
Omotayo A. Osibanjo, and
Ojebola Oluwatunmise

Introduction
Stress has become a global phenomenon that occurs in all facets of life –
including the workplace. Stress is a contemporary and fundamental
problem that reflects a sense of anxiety, tension, and depression that
spans through human endeavor; it has become an unavoidable con-
sequence of modern living (Okeke, Echo, & Oboreh, 2016). Stress is
generally believed to be a state of the mind as well as the body and
is created by specific biochemical reactions in the human body as well
as psychological responses to situations caused by demands from the
environmental or internal forces that cannot be met by the resources
available to the individual (Suresh, 2008). Basically, it can be con-
ceptualized as an unpleasant emotional reaction that a person has when
he or she perceives an event either internally or from their environment
to be threatening, and, when an individual faces such threatening events,
he or she is vulnerable to anxiety, depression, anger, hostility, in-
adequacy, and low frustration tolerance (Halgin & Whitbourne, 2007).
However, Akinyele, Epetimehin, Ogbari, Adesola, and Akinyele
(2014) suggest that a reasonable amount of stress is essential to foster
enthusiasm and creativity for optimal productivity but observed that
intense, or simply put, “too much” stress in the work environment could
lead to considerable risk to workers’ safety, health, and emotional sta-
bility. This is further corroborated by Okeke et al. (2016) who have
argued that stress can either be positive (eustress) or negative (distress).
Eustress results in stimulating an employee, thus enhancing work per-
formance and positively encouraging workers to make efforts, while
distress results in adverse effects on workers’ health and performance.
Greenberg and Baron (2008) however, added that, in respect of how
stress is viewed, it is essential to note that stress on the job will have a
negative outcome on the job and the worker at most times.
Work has become an essential part of our existence as human beings,
and the quality of the workforce and the workplace significantly con-
tribute to an organization’s ability to deliver its goals and existence.

DOI: 10.4324/9780429292538-8
146 Chianu H. Dibia et al.
However, stress is prevalent in the Nigerian work environment, as a
review of extant literature highlights that the stress phenomenon remains
a fundamental problem plaguing organizations across several sectors –
including healthcare and education (Okebukola & Jegede, 1989;
Ofoegbu & Nwadiani, 2006; Dibia, 2017; Ezenwaji et al., 2019).
Organizational stress is of serious concern to organizations as a whole
and to managers in particular, because, when employees feel helpless,
desperate, and disappointed, they experience distress, which fosters a
sense of loss of feelings of security and adequacy. In turn, this affects the
effectiveness and productivity of organizations as well as the morale and
health of the workers (Bewell, Yakubu, Owotunse, & Ojih, 2014).
Workplace stress which is experienced by individuals working in Nigeria
can be attributed to the desperate quest by organizations to reduce labor
costs and the drive to maximize production within a difficult economic
terrain (David, 2016; Dibia, 2017). In such instances, workers are en-
gaged in a multiplicity of tasks and thereby face undue pressure. That
said, when people experience work-related stress in other climes, espe-
cially in industrialized countries, they are encouraged to understand how
they feel and to take advantage of the stress management measures put in
place to help them cope. Unfortunately, this is not often the case in
Nigeria (Bewell et al., 2014). In a more recent study by Nwokeoma et al.
(2019), it was observed that, and despite significant exposure to stressors
at work – such as high workloads and traumatic events on the job –
workers in Nigeria are still deprived of basic stress management me-
chanisms (e.g., counseling) by their employers and ultimately the
Nigerian state, thereby compounding the levels of stress experienced.
It is against this backdrop that a substantial review of systematically
selected studies on organizational stress and the coping mechanisms
employed by workers in Nigeria, as well as the role of culture and weak
institutional framework as mediating factors for this phenomenon
within the Nigerian context, is subsequently undertaken.

Organizational Stress in Nigeria versus Other Parts

of the World
Stress in organizations is a widespread phenomenon globally, with
varying consequences. Reviewed literature revealed that stress exists
virtually everywhere. For instance, in 2018, 64% of Americans con-
sidered in a survey perceived “work” to be one of the significant causes
of stress (American Psychological Association, 2018). Some of the
leading causes of workplace stress in the United States are a lack of
employee-decision freedom especially in high work demands with low
control, uncertainty about workplace aspects such as job insecurity, and
poorly managed conflicts at work (Quick & Henderson, 2016). In the
United Kingdom (UK), a survey conducted in the Health and Safety
 Organizational Stress 147
Executive (HSE) found that work-related stress accounts for 57% and
ill-health for 44% of working days lost between 2017 and 2018 (HSE,
2018). This work-related stress in the UK was attributed to factors such
as lack of managerial support, high workload, role uncertainty, and
violence at work; these are somewhat similar to the identified workers’
stressors in the United States.
In the context of emerging economies – which perhaps share a higher
similarity with Nigeria – in India, inadequate workplaces were attributed
to being a leading cause of organizational stress (Venugopal et al., 2016).
In Brazil, Macedo, Junior, and Sant`Anna (2017) emphasize that the lack
of organizational structure, work overload and monotonous job tasks,
absence of recognition, lack of career development, unsupportive leader-
ship style, and the lack of inter and intradepartmental communication all
constitute as work stressors.

Unique Stressors and Strains in Nigeria

Nigeria is commonly referred to as the giant of Africa, and, in 2014 –
following a change in the approach used in measuring her Gross
Domestic Product (GDP), Nigeria was acclaimed to have the biggest
economy in Africa (Nigerian Bureau of Statistic, 2014). Evidence of the
Nigerian economy, when considered superficially, suggests a prosperous
nation. However, a consideration of studies on workplace stress in the
Nigerian context shows that the growth of the Nigerian economy could
perhaps be at the expense of the welfare of the workforce, as there has
been a significant rise in the stressful conditions which individuals
working in Nigeria are exposed to (Nweke, 2015; Amazue & Onyishi,
2016). Specifically, in the Nigerian setting, causes of workplace stress are
not only numerous, but also complex. In most instances, organizations
cite the need to reduce costs (due to rising costs of production), which
often results in increased fear, uncertainty, and higher levels of stress on
the part of the workers (Nweke, 2015).
Other research in Nigeria, such as Ibem, Anosike, Azuh, and Mosaku
(2011), also identify high workload, lack of feedback, bureaucracy, and
inadequate on-the-job training as stressors facing workers in the
Nigerian work environment. In addition, authoritarian leadership style,
ineffective communication channels, excessive workload, pressure from
families, conflicting demands of the three elements in the organization
(i.e., the employer, the employee, and the customer) are all stressors that
Nigerian workers are exposed to (Okeke et al., 2016).
More broadly, Nicholas, Obasi, and Anene (2017) contextualized
stressors which Nigerian workers are exposed to into work content and
work context. Work content that triggers stress experienced by workers
in Nigeria includes tedious work repetition and meaningless tasks,
workload and work pace (either too much or too little to do and
148 Chianu H. Dibia et al.
working under time pressure), working hours (inflexible, long and un-
social, unpredictable, and ill-designed shift systems), participation and
control (lack of participation in decision-making, lack of control over
work processes, pace, hours, methods, and the work environment).
Work context, however, includes lack of career development, job in-
security, lack of promotion opportunities, work of low social value,
unclear or unfair performance evaluation systems, being over or un-
derskilled for a job, poor interpersonal relationships with supervisors
and colleagues, and work-life imbalance like conflicting demands of
work and home (Nicholas et al., 2017). Other all so common stressors to
workers in Nigeria are socioeconomic variables like family issues, high
cost of living, and poor purchasing power (Olusegun, Oluwasayo, &
Olawoyimn, 2014; Amazue & Onyishi, 2016).
The reasons for Nigeria’s enormous numbers of strains and stressors
are not farfetched. Nigeria as a society is regarded as a fecund ground in
which stressors emanate due to factors such as unreliable electricity and
water supply, inflation, bad roads, and armed banditry (Onoyase, 2015;
Amazue & Onyishi, 2016). Also, it is obvious that the Nigerian economic
environment is accompanied by occupational stress as a result of re-
structuring, downsizing, and re-engineering owing to the intense compe-
tition which organizations are contending with (David, 2016; Dibia,
2017). Workers in Nigeria are exposed to excessive and unpredictable
work schedules and the absence of job security, as is evident in the frequent
mass retrenchment of thousands of workers both in the public and private
sectors due to the constant shifts in the Nigerian economy.
Furthermore, the present state of the Nigerian work environment has
led authors such as Olusegun, Oluwasayo, and Olawoyim (2014) to state
that more than half of all Nigerian workers feel the pressure of job-related
stress – an assertion which is possibly not improbable when industry-
specific studies are reviewed. The industry-specific studies included in this
chapter follow from a systematic search of open access sources for studies
about organizational stress in Nigeria (see Table 8.1 in the Appendix, for
the summary of studies reviewed, their authors, context considered,
stressors/strains identified, and coping mechanisms)1. 24 studies were
found, and they have been evaluated in completing this chapter. 22 studies
are included in Appendix 1, as they represent contemporary views on
organizational stress in Nigeria; while the other two studies – Cooper
(1984) and Okebukola and Jegede (1989) – found as part of the search,
were excluded from the table and subsequent discussion, as they were
published in 1984 and 1989. However, the sectors which they considered
as part of their early studies in the Nigerian context are perhaps covered
by more recent studies included in the subsequent section. The industries
covered by most of the studies were education (7), healthcare (7), banking
(3), and manufacturing (3). Other sectors considered by fewer studies are
construction (1) and policing (1).
 Organizational Stress 149
Stress in the Nigerian Education Sector
The education sector is one of the prominent sectors given considerable
coverage by workplace stress studies in the Nigerian context (e.g., Salami,
2010; Onyishi & Ugwu, 2012; Ejue, 2013; Osibanjo, Salau, Falola, &
Oyewunmi, 2016; Ogbuanya et al., 2017; Ugwoke et al., 2018). Sadly,
evidence of significant levels of workplace stress can be found in all levels
of the education sector in Nigeria – from primary to tertiary education.
The effects of workplace stress on workers and on the educational in-
stitutions where they work are damning. Onyishi and Ugwu (2012)
mention in their study involving administrative staff that, in one of the
prominent public universities in Nigeria, workplace stress as a result of
high workload, role conflict, and ambiguity led to a reduction in worker
engagement and the excessive use of alcohol by workers, not just outside
of work but notably during working hours.
In their study on the issue of workplace stress and organizational
performance in another Nigerian public university, Osibanjo et al.
(2016) report that, following the current high rates of student enrolment
and massive expansion drives by higher education institutions in Nigeria,
workplace stress is on the increase. Some of the stressors identified are
role conflict or incongruence (inadequate match between the demands of
work and worker’s characteristics), inequity and unfair treatment of
workers (topics regarding pay, recognition, and promotion), and the
distance traveled by workers from their homes to work and back. Role
conflict was also one of the causes of stress stated in the preceding study
in this section by Onyishi and Ugwu (2012). Ejue (2013) supports these
findings and points out that there are high levels of stress due to work
experienced by university workers in Nigeria, and it is irrespective of
whether individuals work for federal or state-owned universities.
There is also evidence that highlights that workers in privately owned
universities in Nigeria are also plagued by stress at work. Akinyele et al.
(2014), in their account of workplace stress experienced by academic
staff in a private university located in Southwest Nigeria, identify similar
stressors as those found by studies in public universities. Stressors –
which include work overload and resource inadequacy and workload or
work intensification – were linked to having an adverse impact on the
quality of graduates produced by the university. According to Akinyele
et al. (2014), contributory factors to the increase in workload include
lack of time for adequate preparation of teaching materials, meetings,
and research, large class sizes and students’ diverse needs, and the im-
plementation of new study programs that are not adequately resourced.
Resource inadequacy was considered to harm the quality of research
published by academics as well as academic excellence.
In a more recent study (Ugwoke et al., 2018) which centered on special
education teachers in southeast Nigeria, it was shown that these teachers
150 Chianu H. Dibia et al.
are highly vulnerable to workplace stress, which might result in in-
dividuals experiencing insomnia, fatigue, and engagement in substance
abuse. This is besides a reduction of the quality of teaching delivered by
these teachers, a decline in the tolerance of students’ misbehavior, and
the adoption of cruel disciplinary measures to students’ misdeeds.
Interestingly, the causes of stress which Ugwoke et al. (2018) focus on
are work-related irrational beliefs rather than typical stressors such as
workload, role conflict, and role ambiguity as mentioned by other stu-
dies in the sector. That said, the authors do not give examples as to what
these work-related irrational beliefs could be. The study by Ugwoke et al.
(2018) mirrors the study and findings of Ogbuanya et al. (2017) on
workplace stress, albeit involving a different group of workers (i.e.,
electronics workshop instructors working in technical colleges in
Southeast Nigeria). Ogbuanya et al. (2017) describe work-related irra-
tional beliefs as “beliefs that result in stress due to unhelpful ways of
thinking adopted by highly stressed teachers about themselves”. These
thoughts or beliefs are about the high demands of the work they ex-
perience and are associated with high stress which might considerably
exacerbate stress.
In secondary schools, Salami (2010) points out that workplace stress
could result in counterproductive work behaviors (CWB) by teachers in
Southwest Nigeria. Negative affectivity, i.e., the extent that individuals
experience distressing emotions – for example, fear, hostility, and an-
xiety (Salami, 2010), is considered to be a mediating factor. The CWBs
include harming or an intent to harm the organization and its stake-
holders, physical and verbal aggression, acts of theft and sabotage, and
bullying. Besides this, it was discovered that, in the Nigerian context,
workers with high negative affectivity are more prone to engage in CWBs
when faced with high levels of work stress. However, job stress did not
increase the tendency of workers with low negative affectivity to
adopt CWBs.

Stress in the Nigerian Healthcare Sector

Organizational stress has been studied in the Nigerian healthcare sector
by numerous scholars (e.g., Mojoyinola, 2008; Gandi, Wai, Karick, &
Dagona, 2011; Abaraogu, Ezema, & Nwosu, 2016; Olusegun et al.,
2014; Lawal & Idemudia, 2017; Ezenwaji et al., 2019). A significant
number of these studies focus on nurses (e.g., Mojoyinola, 2008; Gandi
et al., 2011; Lawal & Idemudia, 2017; Ezenwaji et al., 2019). Overall,
the studies highlight the current high levels of stress experienced by
workers within this sector.
In the study by Gandi et al. (2011) about the role of stress and the level
of burnout as a result of work among 2,245 nurses working in Nigeria, it
was found that the job demands on nurses were high. However, high
 Organizational Stress 151
levels of resources were provided to nurses to perform their jobs, and these
serve as a buffer for the negative effects of job demands. That said, the
authors go on to state that, in most instances, the resources provided to
balance job demands are not sufficient to prevent the organizational stress
faced by nurses. This is due to each nurse having many patients with
different needs to attend to – such as the patients’ need for empathy and
connections. In addition, the authors state that nurses in Nigeria experi-
ence high levels of exhaustion that may reflect accumulated tiredness as a
result of broader political and economic worries which nurses bear, and
this spills over into work and results in work-related exhaustion.
In a parallel and more recent study about work-related stress, burnout,
and associated sociodemographic factors – such as gender, age, and
work experience and environment – that are affecting nurses in
Southeast Nigeria by Ezenwaji et al. (2019), it was discovered that so-
ciodemographic factors explained, to a minute extent, the variability in
work stress and burnout experienced by nurses. Gender was identified to
be the only sociodemographic factor with a significant correlation with
work-related stress – with female nurses being more stressed than their
male counterparts. However, this significant correlation does not extend
to burnout. The findings on gender and susceptibility to work-related
stress perhaps highlight the entrenchment of gender roles and reactions
in the Nigerian context.
Other research, such as Olusegun et al. (2014), looks at a wider se-
lection of workers in the Nigerian healthcare sector. They identify
workload, career development, and work-family conflict as major causes
of organizational stress experienced by healthcare workers. Other
sources of job-related stress mentioned in the study are repetitive
work, the lack of communication between superiors, subordinates,
and co-workers, underloading (having little or no work to do), un-
comfortable working conditions, and exposure to dangerous conditions
on the job (unsuitable physical work environment). Following these
stressors, 57% of healthcare workers who took part in the study by
Olusegun et al. (2014) said that they have or have had one form of illness
or another as a result of the stressful conditions of work. These illnesses
include headaches, body pains, fevers, and malaria. In another study
about healthcare workers in a hospital in the Oyo State, Southwest
Nigeria by Owolabi, Owolabi, OlaOlorun, and Olofin (2012), con-
tinuous exposure to highly stressful conditions at work was linked to
the development of hypertension in healthcare workers.

Stress in the Nigerian Banking Sector

The Nigerian banking sector, which is driven by a free market economy,
places higher demands on workers because of today’s competitive en-
vironment as well as global bank reforms. For instance, the introduction
152 Chianu H. Dibia et al.
of the e-payment system into the banking industry demands that em-
ployees must get trained to acquire the needed skills associated with the
new reform. However, Nigerian banks always want to achieve more
with less input because profitability is always their focus, at the detri-
ment of the workforce (Ogungbamila, Balogun, Ogungbamila, &
Oladele, 2014; Okeke et al., 2016). The authors go on to state that
workers in the Nigerian banking system always live in persistent fear as
a result of work overload, risk of fraud, unrealistic targets, job in-
security, risk of kidnapping and armed robbery attacks on banks, as well
as organizational restructurings like mergers and acquisition.
In another study (Olatona, Ezeobika, Okafor, & Owoeye, 2014) con-
ducted in the Lagos State – a state with the largest population and industry
in Nigeria – the level of knowledge, the prevalent associated factors of
stress amongst bank staff (on permanent contracts), and their coping
strategies (see coping mechanism section of this chapter for coping stra-
tegies) were investigated. In the study, it was found that the majority of
bank workers who took part in the study had poor to fair knowledge of
the causes of stress, despite the workers classifying themselves as experi-
encing significantly moderate to high levels of stress (91.5%). Indeed, it
was acknowledged that there is an inverse association between poor levels
of knowledge of stress by workers and the experience of stress. The causes
of stress to Nigerian bankers identified by Olatona et al. (2014) included
some of the stressors found by Okeke et al. (2016), such as high workload
and job insecurity. However, other stressors such as long working hours
(e.g., some workers in the Nigerian banking sector start work as early as
7:30 a.m. and might not leave work until 9:00 p.m. and, in most cases,
with a commute of no less than an hour to-and-fro home to work), lack of
time to relax, and impatient customers were also mentioned as significant
causes of stress. These stressors caused workers to develop anxiety and
hypertension and had an adverse impact on their overall health. Workers
also reported a rise in job dissatisfaction, poor working relationships with
colleagues and other stakeholders, and low productivity.

Stress in the Nigerian Manufacturing Sector

Workplace stress is also prevalent in the Nigerian manufacturing sector.
Following a study of manufacturers in Nigeria, Babajide and Akintayo
(2011) attribute organizational stress experienced by workers to a poor
relationship with superiors, task structure, workload, and working
environment and technology. The experience of high-level stress in the
workplace affected workers’ psychological well-being negatively –
causing mental disorders, depression, and fatigue – and this was reflected
in their behavior at work (e.g., difficulties in complying with rules and
regulations at work and instruction given by superiors, as well as a re-
fusal to identify with the organization). For demographic factors, it was
 Organizational Stress 153
pointed out that the effects of increased exposure to high levels of
workplace stress were more pronounced in older workers, and they
considered this to be more deleterious to work behavior when compared
to younger workers in the manufacturing sector. However, there was no
significant difference between genders.
It is important to state that both domestic and foreign-owned man-
ufacturers operating in Nigeria are all culprits in subjecting workers to
high levels of workplace stress – a conclusion reached by David (2016),
following a study on work-related stress among workers of foreign-
owned manufacturers operating in Nigeria. David (2016) identifies one
of the stressors pointed out by Babajide and Akintayo (2011), i.e.,
unfavorable physical working conditions – excessive noise and heat,
and insufficient space and crowding, in addition to other stressors such
as poor career development, job insecurity, and long working hours.
These stressors were found to harm workers’ health and well-being as
they cause restlessness, nervousness, indigestion, anxiety, neck pain,
headache, and an inability to concentrate.
Beyond a mixture of discrete and process, product manufacturers
considered by the previous authors (whose works have been reviewed in
this section), it is essential to discuss the work of Umege (2014) who studies
organizational stress in the Nigerian oil and gas industry – a critical sector
in the Nigerian economy. The study compares the incidence of occupa-
tional stress-induced hypertension between onshore and offshore en-
gineering workers in the Nigerian oil and gas manufacturing sector. It was
found that there is an association between the prevalence of occupational
stress-induced hypertension and job location, with onshore workers/
professionals being more prone to this type of hypertension as compared to
their offshore peers. Also, age and gender were found to be relevant
factors. Male workers were found to be more susceptible to occupational
stress-induced hypertension as compared to their female colleagues.
Likewise, workers between the ages of 30–49 had an increased tendency of
suffering from occupational stress-induced hypertension as compared to
other age groups.

Other Sectors
Aside from the sectors already discussed in this chapter on workplace
stress, other sectors in which studies about workplace stress have been
conducted in Nigeria include construction (Ojo, Adeyeye, Opawole, &
Kajimo-Shakantu, 2019) and policing (Nwokeoma et al., 2019).
However, compared to the education, healthcare, banking, and manu-
facturing sectors, these sectors have been relatively underexplored.
Despite the minimal levels of exploration into the occurrences and ex-
periences of workplace stress in these sectors, the studies in construction
154 Chianu H. Dibia et al.
and in policing paint almost similar pictures of the happenings in
other sectors.
Ojo et al. (2019), in their study of quantity surveyors working for both
public and private establishments in Southwest Nigeria, highlight that
the significant stressors experienced by these quantity surveyors include:
inadequate staffing, insufficient training on the job, poor planning, poor
communication, lack of feedback, interpersonal conflicts, bullying and
harassment, inadequate pay and poor work status, discrimination, and a
lack of career progression. It is mentioned that discriminatory barriers
between the genders over career and financial advancement is common
in the construction industry – quantity surveying included – and this
causes higher levels of stress experienced by women in the profession.
These stressors lead to increased irritability, invasion of family life, loss
of self-esteem, anger, and feelings of helplessness among quantity sur-
veyors. It also affects the quantity surveying organizations adversely, as
it was stated that workplace stress experienced by individuals might lead
to delays in project completion (Ojo et al., 2019).
In the Nigerian Police Force, Nwokeoma et al. (2019) observe the
incidence of high levels of workplace stress among police officers. It is
stated that officers in the Nigerian Police Force are stressed not only as
a result of low wages and high workloads, but also because of frequent
exposure to traumatic situations. The situations are comprised of
community clashes, killings as a result of oil licks, bombs, and flooding,
which result in severe psychological trauma. Also, there have been
significant cases of police officers being killed while discharging their
duties, not to mention they are also faced with inadequate support from
the Nigerian authorities if ever harmed during the discharge from their
duties. Nwokeoma et al. (2019) further assert that cultural demands for
professional excellence in policing make the experience of stress worse.
There have also been instances when Nigerian police officers have
attempted suicide while out on patrol, as a result of the stress-inducing
traumatic events that they are exposed to as part of their jobs.

Coping Mechanisms
Following a discussion of the unique stressors or strains in the Nigerian
organizational context, this section will consider the coping mechanisms
used in managing workplace stress. Stress management refers to the
strategies of coping, recovering, reinterpreting, refraining, and cognitive
restructuring adopted by an individual which may be with the help of
their organization to make changes that can reduce stress or to take
actions that can alter the impacts of stress (Agwu & Tiemo, 2012). From
the review of studies on stress in the Nigerian context, evidence suggests
that there are limited organizational provisions of stress-coping strate-
gies used to mitigate this contemporary issue (Salami, 2010; Olatona
 Organizational Stress 155
et al., 2014; Amazue & Onyishi, 2016; Ojo et al., 2019; Nwokeoma
et al., 2019). In addition, workers are charged with the responsibility of
developing their own mechanisms to cope with stress, which are often
unhealthy or a mixture of both helpful and unhelpful practices – prob-
ably due to inadequate knowledge of stress-related issues and how to
cope with them (Onyishi & Ugwu, 2012; Olatona et al., 2014; Amazue
& Onyishi, 2016).
Olatona et al. (2014), in their study about workplace stress in
Nigerian banks, identify some of the diverse coping mechanisms adopted
by workers – such as listening to music, exercising, meditating, relaxing,
drinking alcohol, smoking, crying, overeating, and doing nothing. They
also highlight that most of the workers adopted healthy coping me-
chanisms (92.4%), although most (69.5%) combined the healthy prac-
tices with unhealthy ones – making a case for banks to implement stress
management programs to help their workers in developing better coping
mechanisms or in supplying them with the knowledge of healthy and
unhealthy coping mechanisms. Amazue and Onyishi (2016) also allude
to the latter point, following their study of organizational stress ex-
perienced by bank workers in Nigeria. They state that banks have a
responsibility to develop programs involving professionals as part of
their human resource policies to interact with their workers and to
provide them with training on more effective approaches to managing
organizational stress.
Beyond banks, the studies reviewed other sectors of work in the
Nigerian context (e.g., Onyishi & Ugwu, 2012 – education and
Nwokeoma et al., 2019 – policing) and provided similar accounts on
coping with stress. However, other identified approaches to coping with
stress include a flexible work schedule, break periods at work, exercise,
and seeking clarification from colleagues and superiors. The use of ra-
tional emotive behavior coaching or intervention (REBC), was also put
forward by several studies on workplace stress in Nigeria as a means for
workers to develop effective ways of coping (Ogbuanya et al., 2017;
Ugwoke et al., 2018; Nwokeoma et al., 2019). The approach promotes
coaching workers to develop stress-coping skills such as goal setting,
Socratic questioning, and relaxation training (see Table 8.1 in the ap-
pendix for extended list). That said, although the studies confirm the
effectiveness of this approach in helping workers cope during the period
of the studies/interventions, and following the completion of these stu-
dies, there has been no further evidence to suggest the long-term sus-
tainability of the benefits or practices from this approach. At this point, it
is safe to say that high levels of workplace stress are prevalent in
Nigeria’s contemporary organizations, and workers are predominately
charged with the responsibility of coping with stress with little or no
organizational support.
156 Chianu H. Dibia et al.
Culture and the Nigerian State as Culprits to the
Organizational Stress Experience of Workers in Nigeria
It would be difficult, if not impossible, to consider the topic of con-
temporary organizational stress in Nigeria without accounting for the
roles of institutions (i.e., the Nigerian government) and the national cul-
ture in contributing to the increasingly stressful nature of work and the
difficulties faced by the Nigerian worker in coping with organizational
stress.
The failure of the Nigerian government and its contribution to the
current state of organizational stress in Nigeria is exemplified by in-
adequate infrastructural provisions and weak enforcement of labor leg-
islation that pervades the Nigerian terrain, making it difficult for
workers to go about their daily lives and to demand better conditions of
employment from their employers. For instance, in the Lagos State,
which is the commercial nerve center of the country, one of the studies
reviewed (Amazue & Onyishi, 2016) has highlighted that workers have
to commute on roads that are in a deplorable state. Also, workers face
chaotic traffic on roads, which leaves workers held up on the road for
several hours every day. Workers also have to put up with chronic water
shortage and erratic power supply – a situation not just limited to the
Lagos State but also the entire nation (Gandi et al., 2011; Osibanjo et al.,
2016). The situation is in addition to the weak enforcement of labor
legislation that pervades the Nigerian employment context and the in-
adequate provisions for the rights of a Nigerian worker (Atilola, 2012;
Umege, 2014). For instance, although the Employee’s Compensation
Act of 2010 makes provisions for employees to be able to make claims
against their employers and to be compensated when work leads to
“mental stress” (Atilola, 2012, p. 33), the Act has been criticized for
failing to explicitly define a framework in determining mental stress
(Atilola, 2012). It has even been suggested that the inclusion of mental
stress as a part of this Act may have well been an afterthought
(Atilola, 2012).
Thus, given the deplorable state of affairs, which contributes to high
levels of organizational stress experienced by workers in Nigeria, one
might question why the Nigerian workers are not outrightly demanding
for a better deal. While this might be a difficult and complex question
to fully answer within this chapter, one of the probable explanations
that could be put forward as the answer is the national culture – the
collective programming of the mind of individuals within a nation-state
(Hofstede, 2001).
The role of culture as a contributory factor to the current levels
of organizational stress in Nigeria can be illuminated using one of
Hofstede’s cultural dimensions – “power distance”. Nigeria is categor-
ized as a high power distance culture (Hofstede Insights, 2019), and in a
 Organizational Stress 157
high power distance culture, it is common for individuals not to question
the unequal distribution of power or the ill-treatment received from the
executive. This provides a plausible explanation for the current condi-
tions that propagate and entrench the present state of organizational
stress that permeates the Nigerian context – where workers struggle to
cope with stressful conditions of work yet fail to heighten their demands
for better conditions of work.

Conclusions and Summary

This chapter has explored organizational stress in Nigeria, examining
the stressors and strains experienced by workers, stress-coping me-
chanisms, and the roles of the Nigerian state and culture in contributing
to the current experience of workplace stress. Within the chapter, it is
observed that organizational stress is a topical phenomenon that exists
globally. However, there is a variation in the response to this issue
among different jurisdictions.
In the Nigerian context, significant levels of organizational stress are
observed. Workers are exposed to a wide range of stressors and strains
at work against which they are struggling to cope. Besides this, it is
observed that workers in Nigeria are also faced with exogenous stressors
like threats emanating from social vices – such as kidnapping, armed
robbery, and inadequate public infrastructure – which compound their
experience of stress. Not to mention, the role of a high power distance
culture prevents workers from challenging the status quo, as both the
Nigerian Government and the owners of organizations are complacent
to the plights of workers.
Furthermore, from the account provided in this chapter, it can be
observed that most of the stress-coping mechanisms employed by
workers are developed by the individual worker with little or no orga-
nizational or state support. That said, it is crucial to assert that most
of the studies reviewed on organizational stress focus on identifying the
stressors and strains at work, and less on how workers cope with stress.
In view of the current evidence, it is therefore recommended that perti-
nent organizations and the Nigerian Government do more in helping
workers within Nigeria to cope more effectively with stress and, where
possible, reduce the significant factors leading to distress. Also, a more
detailed study of the stress coping mechanisms of workers in Nigeria
would be desirable.

Note
1 The databases interrogated include Business Source Complete, Scopus, and
Google Scholar - using search terms such as “stress”, “work* stress”, “organi-
zation stress”, “job* stress”, “occupational stress” AND “Nigeria*”.
158 Chianu H. Dibia et al.
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Appendix
Table 8.1 Summary of Stressors/Strains and Coping Mechanisms identified within reviewed studies on organizational stress in Nigeria
162

Author and Year Context Stressors/Strains Coping Mechanisms

Salami (2010) Education Workload, time pressure, Counterproductive work behaviors such
interpersonal problems working as: harming or an intention to harm
conditions, inadequate facilities, the organization and its stakeholders,
personal problems, and leadership physical and verbal aggression, acts of
problems. theft and sabotage, and bullying
Onyishi and Ugwu (2012) Education High workload, role conflict and Excessive alcohol use
ambiguity, and boredom
Ejue (2013) Education Workload, job role, university None stated
Chianu H. Dibia et al.

structure and climate, and career

development
Akinyele et al. (2014) Education Workload, and resource inadequacy, Counseling
for example, teaching staff, quality
books, computers, and internet
services.
Osibanjo et al. (2016) Education Role conflict or incongruence, inequity None stated
and unfair treatment of workers,
noise, the distance between workers’
home and work, poor ergonomics
and inadequate office spaces, and
lack of recognition and engagement.
Ogbuanya et al. (2017) Education Work-related irrational beliefs Rational emotive behavior coaching
(REBC) with practices such as sensory
awareness training, Socratic
questioning, future self-technique,
REBC dating technique, wheel of life
(Continued)
Table 8.1 (Continued)

Author and Year Context Stressors/Strains Coping Mechanisms

technique, and relaxation training and

rational emotive imagery
Ugwoke et al. (2018) Education Work-related irrational beliefs Rational emotive stress-management
intervention program with practices
such as goal setting, relaxation,
disputing, role play, direct teaching,
use of rational self-talk, Socratic
questioning, motivational interviewing
techniques, imagery techniques,
homework assignments,
desensitization techniques, and
cognitive rehearsals
Olatona et al. (2014) Banking Work overload, long working hours, Exercise, meditation/yoga, refocusing/
impatient customers, lack of time to reflection on the positive, muscle
relax, and job insecurity relaxation, breathing relaxation,
listening to music, sleeping,
withdrawal/detachment, drinking
alcohol, smoking, crying, over-eating,
and doing nothing
Amazue and Onyishi (2016) Banking Poor work-life balance, long working Positive thinking, feigning sickness
hours
Ogungbamila et al. (2014) Banking and Long working hours, low pay, work Emotional intelligence (e.g., by adopting
healthcare pressure, excessive workload, high mood repair strategies like
job target, and pressure from remembering the pleasures of life when
customers upset)
(Continued)
Organizational Stress 163
Table 8.1 (Continued)
164

Author and Year Context Stressors/Strains Coping Mechanisms

Gandi et al. (2011) Healthcare Workload, the demands of nurse Social support, distancing self from
empathy for and connection with patients
patients, economic and political
worries
Abaraogu et al. (2016) Healthcare High physical job demands Job control, a high sense of job security,
and social support
Ezenwaji et al. (2019) Healthcare Limited resources, workload, under- None stated
training, inadequate supervision,
Chianu H. Dibia et al.

and feeling undervalued

Lawal and Idemudia (2017) Healthcare Workload, the risk posed by contact Emotional intelligence (understating of
with patients (e.g., unpleasant sights one’s emotions and that of others and
and sounds), standing for long the constructive use of this
periods, time pressures, and failure understanding in managing work
of colleagues to complete their stress), and organizational support
duties
Mojoyinola (2008) Healthcare Excessive workload, poor working Job control, and work-related social
condition, inadequate pay, lack of support, withdrawal, bullying,
promotion, inadequate staffing, and absenteeism, and resignation from jobs
poor working relationships
Olusegun et al. (2014) Healthcare Workload, career development, work/ Flexible work schedule, break periods at
family conflict, repetitive work, work, exercise, absence from work,
workers being under-loaded (having leave from work, watching movies,
little or no work to do), and smoking, excessive drinking, and
unsuitable physical work sleeping.
environment
(Continued)
Table 8.1 (Continued)

Author and Year Context Stressors/Strains Coping Mechanisms

Owolabi et al. (2012) Healthcare High job demands, conflicting None stated
demands, time pressure, low control
overwork, and limited job variety
and possibilities to learn new skills.
Babajide and Manufacturing Relationship with superiors, task None stated
Akintayo (2011) structure, workload, and working
environment and technology
David (2016) Manufacturing Unfavorable working conditions, poor None stated
career development, job insecurity,
and long working hours
Umege (2014) Manufacturing None stated None stated
Ojo et al. (2019) Construction Inadequate staffing, insufficient Seeking clarification with colleagues and
training on the job, poor planning, superiors, belonging to professional
poor communication, lack of associations, opportunity to discuss
feedback, interpersonal conflicts, with manager/supervisor, prioritizing
bullying and harassment, poor pay future workloads, clubbing or
and work status, discrimination, socializing, offloading/delegating
and lack of career progression. work, self-control, continuous
professional development, coffee
break, smoking, time management,
seeking social instrumental support,
seeking emotional support, time off
work, avoidance/escapism of stressful
event and leaving the organization for
another
(Continued)
Organizational Stress 165
Table 8.1 (Continued)
166

Author and Year Context Stressors/Strains Coping Mechanisms

Nwokeoma et al. (2019) Policing High workloads and poor salary, Rational emotive occupational health
dysfunctional feelings and irrational coaching through techniques such as:
thoughts, organizational stressors relaxation training, self-regulation
due to: change of policy and routine skills training, time management, and
at work, supervision. Operational setting realistic goals.
stressors such as: arresting
criminals, witnessing brutality due
to community clashes and killings,
Chianu H. Dibia et al.

repeated killings of police officers.

9 Increasing Work-Related Stress
in the Netherlands and Belgium
How Do These Countries Cope?
Irene L.D. Houtman, Christophe
Vanroelen, and Karolus O. Kraan

Introduction
The majority of people living with a common mental disorder are em­
ployed, but many are at greater risk of job loss and permanent labor market
exclusion than colleagues without these problems (OECD – Organization
for Economic Co-operation and Development, 2012). In addition, the costs
of mental ill-health for society are large, reaching 3–4.5% of GDP across a
range of selected OECD countries in 2010 (OECD – Organization for
Economic Co-operation and Development, 2012). It is shown that in par­
ticular, mental illness is responsible for a significant loss of potential labor
supply, high rates of unemployment, a high incidence of sickness absence,
reduced productivity at work, and a large burden of disease (Eaton et al.,
2008; Goetzel et al., 2004; OECD – Organization for Economic Co-
operation and Development, 2012; Wittchen, Jacobi, & Rehm, 2011).
Matrix Insight (2013) estimated that the total costs of work-related de­
pression in the European Union are nearly €620 billion per year. The major
impact is suffered by employers (44%), followed by the economy in terms
of lost output (39%), the health care systems due to treatment costs (10%),
and the social welfare systems due to disability benefit payments (€40 bil­
lion). Given the high costs for individuals, employers, and society at large,
investing in mental health awareness, psychosocial risk management,
mental ill-health prevention, and stimulating return to work after having
left work because of mental health problems are urgently needed.
In this chapter, we focus on the management of mental health in the
Netherlands and Belgium – two neighboring countries that were both
founding members of the European Union. Both countries adhere to
European directives, including the European Working Conditions Act,1
which puts acting on risks to tackle work-related health problems at
their source as a priority. Taking this into account, we will notice that in
this chapter, both countries deal with the challenges of tackling work-
related mental health problems at their source differently.
In the first paragraph, we will first focus on national trends in mental
health and work-related mental health in particular. Subsequently, trends in

DOI: 10.4324/9780429292538-9
168 Irene L.D. Houtman et al.
their related occupational risk factors – often denoted as psychosocial risks –
are discussed in reference to the traditional Job Demands-Control model
(JDC-model: Karasek, 1979; Karasek & Theorell, 1990) and the more recent
and related Job Demands-Resources Model (JDR-model; Bakker &
Demerouti, 2007). These trends will mainly be described based on European
Union data – more specifically, data from the European Working Conditions
Survey (EWCS) collected by Eurofound (Eurofound, 2017). The EWCS data
enable international comparative analyses. Subsequently, we will focus on
psychosocial risk management in enterprises using the European Survey of
Enterprises on New and Emerging Risks (ESENER-2). Next, we will discuss
how prevention infrastructure in both countries deals with psychosocial and
other work-related mental health risks in terms of policy. In the final chapter,
we will derive conclusions from these analyses and interpretations in two
national contexts and complete them with the lessons learned.

The Prevalence and Development of Work-Related

Mental Health in the Netherlands and Belgium
At present, there is not much evidence on the comparative indicators of
work-related mental health in the Netherlands and Belgium, let alone in
Europe, apart from the EWCS which included one item of the burnout
exhaustion scale in its sixth wave (Eurofound, 2017: this item is phrased
as “I feel exhausted at the end of the working day”). Although this item
only refers to one of three commonly recognized burnout dimensions,
Schaufeli 2018 shows that this item behaves well as an approximation of
burnout within Europe and in combination with other relevant concepts.
Therefore, we consider it interesting to present the prevalence of ex­
haustion at the country-level derived from the EWCS-2015 here below
(Figure 9.1 and some methodological information on the EWCS and this
burnout item are presented in Appendix A). The most often used defi­
nition of burnout comes from Maslach, Jackson, and Leiter, (1996;
p. 20) who describe it as “… a state of exhaustion in which one is cynical
about the value of one’s occupation and doubtful of one’s capacity to
perform”. More specifically, the core dimension of burnout—exhaus­
exhaustion—refers to serious and persistent fatigue, and to feeling
emotionally drained and worn out. The second dimension—cyni­
cynicism—also includes loss of interest and enthusiasm and doubting the
significance and meaning of one’s job. The final dimension of burnou­
t—lack of professional efficacy—refers to feelings of incompetence and
ineffectiveness and reduced personal accomplishment at work. In other
words, burnout is a multidimensional construct that includes a stress
reaction (exhaustion), a mental distancing response (cynicism), and a
negative belief (lack of professional efficacy). For an overview of
burnout, its measurement, antecedents, consequences, and explanations,
see Maslach, Schaufeli, and Leiter (2001) and Schaufeli, Leiter, and
 Increasing Work-Related Stress 169

4
3.5
3
2.5
2
1.5
1
0.5
0
The Netherlands
Norway
Denmark
Finland
Sweden
Latvia
Czech Republic
Germany
Ireland
Associated countries
Lithuania
Portugal
Austria
Belgium
Greece
Slovakia
Romania
United Kingdom
Cyprus
Estonia
Total EU
Bulgaria
Italy
Hungary
Malta
Switzerland
Spain
Poland
Croatia
France
Slovenia
Luxembourg
Albania
Montenegro
Serbia
Candidate countries
FYROM (Macedonia)
Turkey
Figure 9.1 Mean Levels of Burnout in Europe (scale 1–5)5.
Source: 6th EWCS – 2015 (Eurofound).

Maslach (2009). Figure 9.1 shows the variation within Europe on this
EWCS item on emotional exhaustion.
Figure 9.1 shows that the workforce in the Netherlands (2.68) reports the
lowest of all mean exhaustion levels; whereas, the workforce of Belgium
(3.06) rates only just below the European Union mean of 3.10. Both coun­
tries are “on the safe side” European-wise, but still quite irregular within the
European spectrum. Traditionally, the work and health situation in the
Netherlands is considered a bit comparable to the Scandinavian situation
regarding welfare and social security systems (Esping-Andersen, 2013).
It is interesting to further consider what the trend has been – both in this
outcome indicator as well as in its causes – to better place the national
settings and the way in which these problems are dealt with in these
settings.

The Work-Related Drivers - Psychosocial Risks At Work:

The Netherlands versus Belgium, and the Rest of Europe
As determinants of work-related mental health risks, we consider dif­
ferent psychosocial demands as well as opportunities for control as our
core indicators. First, we will consider the comparison of demands and
opportunities for control among workers in the Netherlands and
Belgium based on the EWCS. Both the prevalence – expressed as the
percentage of high scores – and the trends in prevalence are compared
in Table 9.1.
In the period considered, many of the trends in job demands, as well as
opportunities for control, have been developing differently in Belgium
and the Netherlands. As for quantitative demands, workers in Belgium
Table 9.1 Trends in Different Demands and Control Indicators (Percentages for High Risk) for Belgium and the Netherlands
170

Belgium The Netherlands Interaction of

Time by Country
Job Demands 1995 2000 2005 2010 2015 1995 2000 2005 2010 2015 ΔB (Δβ) p

High quantitative 29.7%▼ 33.1%▼ 39.8% 42.0%▲ 45.5%▲ 44.0% 50.0%▲ 39.3% 42.0% 39.3% −5,8% (−0,083)▼.
job demands Belgium shows a
(working at very significant
high speed/very increase; whereas
tight deadlines) the Netherlands
[% half of the does not and even
time or more] tends to decrease.
Does your job – – – – 29.2% – – – – 21.3% –
Irene L.D. Houtman et al.

involve being in
situations that
are emotionally
disturbing for
you? [% around
1/4 of the time
or more]
Does your job 30.3%▼ 39.6%▲ 23.6%▼ 44.9%▲ 35.5% 39.6% 43.5% 45.2%▲ 37.7% 31.7%▼ −3,7% (−0,055)▼.
involve complex Complex tasks
tasks? [% yes] are rising until
2015 in Belgium;
in the
Netherlands,
complex tasks
have declined
significantly in
(Continued)
Table 9.1 (Continued)

Belgium The Netherlands Interaction of

Time by Country
Job Demands 1995 2000 2005 2010 2015 1995 2000 2005 2010 2015 ΔB (Δβ) p

2015, but the

decline seems to
have started
already in 2010 –
although not
significantly.
Negative social – – – 18.8% 17.6% – – – 14.6%▼ 27.0%▲ +14% (+0.086)▲.
interactions (last Negative social
month at work, interactions
subjected to appear to be
verbal abuse stable in Belgium;
and/or whereas, these are
unwanted sexual increasing in the
attention and/or Netherlands
past 12 months -resulting in
physical violence higher
and/or sexual percentages
harassment and/ in 2015.
or bullying/
harassment?
[% yes]
Opportunities for
control
43.1% 52.0%▲ 43.3% 46.9% 44.1% 36.2%▼ 35.3%▼ 44.6% 45.4%▲ 43.8%
Increasing Work-Related Stress 171

(Continued)
Table 9.1 (Continued)
172

Belgium The Netherlands Interaction of

Time by Country
Job Demands 1995 2000 2005 2010 2015 1995 2000 2005 2010 2015 ΔB (Δβ) p

Job autonomy +2.9% (+0.041)Δ.

(choose order/ Low job control
methods/ speed) tends to be
[% low] significantly more
frequent in
Belgium; whereas,
there is no
difference with
Irene L.D. Houtman et al.

the Netherlands
anymore in 2010
and 2015.
Skill discretion 55.4% 59.5%▲ 55.2% 52.0% 51.0% 39.9%▼ 43.5% 49.2% 45.9% 53.4%▲ +4.6% (+0.065)▲.
(meeting precise Low skill
quality standards/ discretion is
assessing quality significantly more
own work/solving frequent in
unforeseen Belgium; whereas,
problems/learning it is not different
new things) from the
[% low] Netherlands
anymore in 2015.
In the
Netherlands, skill
discretion has
(Continued)
Table 9.1 (Continued)

Belgium The Netherlands Interaction of

Time by Country
Job Demands 1995 2000 2005 2010 2015 1995 2000 2005 2010 2015 ΔB (Δβ) p

been developing
quite unfavorably
over the last 20
years.
Colleague help and – – – 30.0%▲ 22.9%▼ – – – 23.9% 23.6% +6.7% (+0.039)Δ.
support [% Low co-worker
Sometimes/ support in
rarely/ never] Belgium tends to
be decreasing
towards the level
of the
Netherlands in
the last five years.
Manager help and – – – 43.9%▲ 35.2%▼ – – – 38.1% 41.0% +12% (+0.060)▲.
support [% Low management
sometimes/ support in
rarely/ never] Belgium is
decreasing;
whereas, this
tends to be
increasing in the
Netherlands.
(Continued)
Increasing Work-Related Stress 173
Table 9.1 (Continued)
174

Belgium The Netherlands Interaction of

Time by Country
Job Demands 1995 2000 2005 2010 2015 1995 2000 2005 2010 2015 ΔB (Δβ) p

Participation – – – 54.1%▲ 46.1%▼ – – – 35.6% 35.4% +7.9% (+0.040)Δ.

(consulted Low participation
before objectives is more frequent
set / involved in in Belgium as
improving work compared to the
organization/ Netherlands. Low
processes / say in participation is
choice of decreasing in
Irene L.D. Houtman et al.

colleagues / Belgium.
apply own ideas
in work / can
influence
important
decisions)
[% low]

Source: EWCS 1995–2015, Eurofound.

Note
Percentages indicate one side of the dichotomy (e.g., low versus high) and are tested with the Pearson χ²-test (horizontal comparisons: low versus high).
Means are tested with the t-test. The contrast is a subgroup versus “rest” (weighted deviation contrast). ▲ and ▼: p < 0.05, significant-high (low)
percentages, and Cohen’s d is at least 0.10. Open arrows Δ and ∇: also significant, but Cohen’s d is smaller than 0.10. Trend-analysis: B = unstandardized
linear regression coefficient = average increase/decrease per interval (β = standardized linear regression coefficient) p = significance. Interaction: Test on
linear interaction between “year of the survey” and “Belgium versus the Netherlands” on each (category of each) row variable ( = test whether B1=B2).
 Increasing Work-Related Stress 175
used to rate these demands as much less taxing in 1995 as compared to
2015. Quantitative demands have continuously risen over this period of
20 years. In the Netherlands, quantitative job demands appeared to have
been rising until the year 2000 and have stabilized since, resulting in a
quite comparable level of quantitative job demands to be reported by
Belgian and Dutch workers. The fact that quantitative job demands rose
until the end of the last century and have leveled off since is corroborated
by the national monitor data in the Netherlands (e.g., Houtman, 1997;
Houtman & van den Bossche, 2010). Workers in Belgium also report
that their jobs increasingly involve complex tasks. Workers in the
Netherlands did so too until the year 2005, but this was also reduced in
the following decade. Demands imposed upon workers with violence
and harassment have been measured quite differently over the years.
However, In the fifth and sixth EWCS, it was measured as “negative
social interactions.” This indicator of violence and harassment appeared
to be stable at the level of about 18% for workers in Belgium, whereas it
rose according to Dutch workers, resulting in 27% confirming that they
had experienced negative social interactions in 2015.
Opportunities for control – like job autonomy, skill discretion, as well
as social support by colleagues and managers – used to be better or more
favorable, as reported by Dutch workers and as compared to Belgian
workers. However, more recent surveys showed a deterioration of par­
ticularly job autonomy and skill discretion as reported by Dutch
workers, resulting in an almost comparable position on job autonomy
and skill discretion in Belgian and Dutch workers. Although the in­
formation on social support does not have a long history, in 2015, the
differences are not significantly high for social support of colleagues in
both the Netherlands and Belgium but have become better for social
support by the managers. This latter positive development in the last five
years is not reported by Dutch workers. Finally, the level of participation
of employees in decision-making organizational processes is better in the
Netherlands, as reported by Dutch workers, although it is improving, as
reported by Belgian workers.
Summarizing the trends in demands and control as reported by
workers in Belgium and the Netherlands, the workers in Belgium report
increasing quantitative and qualitative demands, except for negative
social interactions. For the Dutch workers, this is the other way around.
They reported high and increasing quantitative demands around
20 years ago, which actually leveled off after the turn of the century.
Since the rest of the European Union workers still rose on quantitative
demands after the turn of the century, the Dutch worker has turned to be
more average on quantitative demands as compared to other European
Union workers. However, negative social demands are on the rise in the
Netherlands and are also more prominent in 2015 as compared to
Belgian workers. This is paralleled by a decrease in job autonomy and
176 Irene L.D. Houtman et al.
skill discretion of Dutch workers over the last 20 years, resulting in a
comparable situation as reported by Dutch and Belgian workers in 2015.
Particularly, social support by colleagues and participation in decision-
making processes appear to be stable and more favorable, as reported by
Dutch workers and as compared to Belgian workers.
In Figure 9.2 we have compared the position of workers in the
Netherlands and Belgium to that of the average of the rest of the
European Union (EU-26), where the European Union average is taken as
the middle line, and the differences (after calculating z-scores from the
scale or item ratings) are positioned as differing in either a positive or
negative way. Figure 9.2 shows that, on average, workers in both the
Netherlands and Belgium report to have lower demands (e.g., quanti­
tative, emotional, and complexity demands) and higher levels of re­
sources at work (e.g., job control/autonomy, participation, and social

<-favorable EU26 unfavorable ->

-0.5 -0.4 -0.3 -0.2 -0.1 0.0 0.1 0.2 0.3 0.4
Quantitative job demands

Emotionally disturbing situations in job

Job complexity

Job control

Skill discretion
Belgium

Netherlands
Participation

Social support colleagues

Social support immediate boss

Discrimination at work

Negative social interactions at work

Figure 9.2 Psychosocial Risks in the Netherlands and Belgium as Compared

to the Rest of Europe.
Source: EWCS 2015 (Eurofound).
 Increasing Work-Related Stress 177
support) than the European Union average. Only the social interactions
at work, as well as discrimination at work, are reported to be more
negative as compared to the workers in the rest of the European Union.
On almost all scales, except for skill discretion, the ratings by the Dutch
workers are more extreme as compared to the Belgium workers.

Political Urgency Is Often Based on the National Level

and has Recently Increased Both in the Netherlands and
Belgium for Slightly Different Reasons
Trend information on the emotional exhaustion scale as the core of the
burnout scale is only available based on national data. For the
Netherlands, these data are based on the Netherlands Working
Conditions Survey (NWCS; the Dutch acronym is NEA; Hooftman
et al., 2019) by TNO together with Statistics Netherlands. For emo­
tional exhaustion, the same five-item scale has also been monitored for
some years by Statistics Netherlands in their Living Situation Survey.
These data show a split trend for the emotional exhaustion scale – a
new way of sampling the data. Recently, a consistent increase in this
exhaustion indicator is seen since 2013 – at least a net increase of 1%
per year since 2013 (see Figure 9.3). This recent increase sets off several
national alarm bells and recently made the State Secretary of the
Netherlands promise the Parliament that the Ministry would start a
project to better understand this trend and its causes and to identify the
most important risk groups.2 Unfortunately, information on the pro­
mised research is not available yet. However, it shows that these trend
data do have an impact on the national policy level and may make
room for new policy action. In the Netherlands, the trend is to act on
primary prevention first.

% burnout complaints
20

18

16

14

12

10

0
1997 1998 1999 2000 2001 2002 2003 2004 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Figure 9.3 Trends in Burnout Complaints Among a Representative Sample of

Dutch Employees.
Source: POLS3 1995–2004 (CBS); NEA 2007–2018 (TNO/CBS 2007–2018).
178 Irene L.D. Houtman et al.
Despite the fact that burnout per definition is a work-related mental
health outcome, there is no clear increase in psychosocial risk factors at
work which could explain this increase in burnout complaints (see the
EWCS trends presented in the previous paragraph, which also parallels
the trends in the NWCS; Houtman, de Vroome, van der Ploeg, &
Ramaekers, 2019; Houtman, Bakhuys Roozeboom, Kraan, & van den
Bossche, 2017). The psychosocial risks that have been changing in the
Netherlands are job autonomy and negative social interactions. Job
autonomy has been decreasing since the start of the economic crisis in
the Netherlands and has been leveling off since economic recovery.
However, the reduction in autonomy has been quite specific in certain
groups of workers with nonpermanent jobs and particularly in younger
employees (Houtman & de Vroome, 2015; Houtman et al., 2019).
These are not specifically the groups with high ratings of burnout or
emotional exhaustion. An increase in negative social interactions, as
shown in Dutch workers, can be strongly related to burnout com­
plaints. However, this trend is not found in the way violence and
harassment have been operationalized in the NWCS (Houtman et al.,
2019; Houtman et al., 2017).
For Belgium, no reliable trend data on self-reported burnout or one
of its components are available, as it is still impossible to create trend
analyses with the EWCS data. However, a similar “state of alarm” was
created by the official figures on disability and, more specifically, dis­
ability related to psychiatric problems. As is shown in Figure 9.4, the
number of disabled workers had a steep increase between 1999 and
2018 – with 124% for all possible causes and 177% specifically for
psychiatric causes. This represented an absolute number of about
400,000 and 150,000 workers respectively in a total working popu­
lation of about 4.8 million. Recent measures to control and reverse this
increase seem to have a limited impact. Apart from causes related to
the nature of the OSH system and recent reforms in different social
security schemes, the assumed increasing work demands and job
complexity have been cited as causes of the increase in psychiatric
disability. The results shown above are, to a degree, confirmed by the
results from a regional workability survey conducted periodically in
the region of Flanders (Bourdeaud’hui et al., 2017). In this survey, an
item set on “psychological fatigue” is also included. This is probably
the best available proxy for burnout. The figures show an increase in
“problematic fatigue” of about 3% between 2013 and 2016
(Bourdeaud’hui et al., 2017) – see Table 9.2.

Do Organizations Acknowledge and Manage these Risks?

The European Survey of Enterprises on New and Emerging Risks
(ESENER) was held for the second time in 20144 and inventories
 Increasing Work-Related Stress 179

Relative‟ evolution‟ of‟ disabled‟ workers‟ (1999=100)

300
N= 400,745
Relative‟ increase,‟ compared‟ to‟ 1999

250
N= 145,180

200

150

100

50

0
99
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Disabled‟ for‟ psychiatric‟ causes All‟ disabled

Figure 9.4 Relative Evolution of Disabled Workers in Belgium (1999–2018).

Source: Riziv, 2019 https://www.inami.fgov.be/fr/statistiques/indemnites/Pages/default.
aspx#.XYst3S2B1TY).

the acknowledgment of risks at work – including psychosocial risks at

work, as well as procedures and measures directed at the management of
these risks within the organizations (EU-OSHA, 2016). The ESENER
survey can be seen as the “employer’s” story of risk management, as
opposed to the EWCS, which is the employee’s story. In ESENER-2, “the
one who knows best about OSH” in the enterprise is interviewed. In
SMEs this is often the owner or director of the enterprise, but in larger
organizations, this may be a representative from human resources or an
OSH-representative.
Regarding the acknowledgment of psychosocial risks, the “one who
knows best about OSH” in enterprises in Belgium, in the Netherlands,
and in the rest of the European Union (EU-26) states whether these
risks are present (see Table 9.3). The questions that have been asked in
ESENER-2 partly tap into different concepts as compared to the
EWCS. As for issues common in both surveys, we see that organizations
rate time pressure as more present in enterprises in the Netherlands
and Belgium as compared to the EU-28 average. This contrasts with the
findings from employees reported in Figure 9.2, showing that em­
ployees in the Netherlands and Belgium rate their “quantitative job
demands as more favorable as compared to the rest of the European
Union“. The percentage of ESENER respondents, which indicate the
number of employees in the organization who deal with difficult cus­
tomers, patients, pupils, etc., is higher for Belgium but equal for the
Netherlands, as compared to the EU-28. On the other hand, these
180 Irene L.D. Houtman et al.
Table 9.2 Evolution in the Prevalence of “Acute Problematic” Risk Factors and
Workability Outcomes Among Flemish Employees (2004–2016)

2004 2007 2010 2013 2016

Workability risks factors

Work pressure (quantitative demands) 12,8 12,5 12,3 11,1 16,3
Emotional demands 4,0 4,3 4,1 4,0 5,0
Autonomy 7,3 7,5 6,5 6,4 6,2
Skill discretion 11,5 10,5 10,5 10,3 10,5
Superior support 6,1 6,2 5,4 5,3 5,0
Workability outcomes
Psychological fatigue 10,4 9,7 9,4 9,6 12,3

Source: Bourdeaud’hui et al. (2017). Vlaamse Werkbaarheidsmonitor 2016 – werknemers.

Brussels.
Note: Due to different survey instruments and different methodologies, these results cannot
be directly confirmed with the EWCS data.

Table 9.3 Psychosocial Risk Factors Present in Enterprises (% Establishments)

Psychosocial Risk Netherlands Belgium EU-28

Time pressure 62 53 43
Having to deal with difficult customers, 58 65 58
patients, pupils, etc.
Poor communication or cooperation 22 26 17
within the organization
Employee’s lack of influence on their 18 13 13
work pace or work processes
Discrimination (for example – due to 5 4 2
gender, age, or ethnicity)

Source: EU-OSHA, 2016.

respondents report that both in Belgium and in the Netherlands, the

psychosocial risks related to poor communication and cooperation
within the organization are more prevalent as compared to the EU-28.
The data on workers for both the Netherlands and Belgium show that,
in both countries, but particularly in the Netherlands, negative social
interactions are much more prevalent than in the rest of the European
Union. However, the latter may concern both contacts with customers,
patients, clients, etc., as well as with colleagues or managers within the
organization.
A somewhat contradictory finding between enterprise and worker
opinion about psychosocial risk is the influence workers have on the
pace of work or work processes. The respondents in the enterprises in­
dicate that this is more of a problem in Dutch enterprises as compared to
 Increasing Work-Related Stress 181
the EU-28, whereas it is equally experienced as a problem in Belgian
enterprises. The EWCS showed a more favorable rating of control or
autonomy and skill discretion for workers both in the Netherlands and
Belgium, as compared to the rest of the EU.
In Table 9.4 we represent measures taken in enterprises in the
Netherlands, Belgium, and in the EU-28 during the last three years. The
overall picture is that all of the measures taken – reorganization in order
to reduce job demands and work pressure, as well as confidential
counseling and set-up of a conflict resolution procedure – were more
often taken by enterprises in Belgium as compared to EU-28, and were
less often taken by enterprises in the Netherlands as compared to EU-28.
The ESENER-2 also shows that about 37% of the enterprises in
Belgium and 28% in the Netherlands as opposed to 17% in the EU-28
indicate using a psychologist or an in-house or externally contracted
specialist. In addition, the “one who knows best about OSH” in the
Netherlands and Belgium indicates quite often that there are plans and
procedures to prevent bullying and harassment (70% and 83% respec­
tively) and violence (72% and 65% respectively) more frequently, as
compared to the EU-28 (47% on bullying and harassment, and 55% on
violence). As for having an action plan and procedures, the “one who
knows best about OSH” indicates that this is the case for about 27% of
Dutch enterprises, about 36% of Belgian enterprises, and about 33% of
EU-28 enterprises (EU-OSHA, 2016).

What is in Place to Tackle Psychosocial Risks at Work

in Belgium and in the Netherlands? What are the Do’s
and Don’t’s?
In the above text, some discrepancy is shown between the development
in work-related stress disorders and the trends in their work-related
causes. This suggests that either non-work-related causes or societal
processes may have influenced the perception of work-related mental
health. Other factors like the history of prevention and previous pre­
ventive activities (not as recent as the measures taken in the last three

Table 9.4 Measures Implemented to Prevent Psychosocial Risks During the Last
Three years (% Establishments)

Psychosocial Risk Netherlands Belgium EU-28

Reorganization of work in order to reduce 28 40 38

job demands and work pressure
Confidential counseling for employees 33 46 36
Set-up of a conflict resolution procedure 25 40 29

Source: EU-OSHA, 2016.

182 Irene L.D. Houtman et al.
years) may also have had an impact on the “outcome” measure of
burnout or other mental health outcomes.
The Netherlands was one of the first countries to pay attention to
psychosocial risks in their occupational safety and health legislation, as
this legislation was first introduced in 1990. This legislation explicitly
paid specific attention to well-being at work. From 1990 onward, a lot of
initiatives were undertaken by the government together with employer
and employee representatives. These activities included raising awareness
among employers and employees and supporting the risk assessment and
evaluation – including psychosocial risks at work. This was done by
having books published – like the “Handbook on work-related stress”
(Handboek werkstress; Kompier & Marcelissen, 1990) and union bro­
chures deduced from the stepwise approach as presented in this hand­
book – and by initiating related conferences. Best practices were
initiated, subsidized by, and published with the help of the Ministry of
Social Affairs (e.g., “Aan de slag” [i.e., “Get going”], Kompier,
Gründemann, Vink, & Smulders, 1996; Preventing Stress, Improving
Productivity; Kompier & Cooper, 1999). In addition, an expert ap­
proach was developed for improving well-being at work and job level,
and courses were developed for professionals – “train the trainer”
courses as well as courses and material for the Labor Inspectorate (e.g.,
Vaas, Dhondt, & Peeters, 1995). Sectoral activity directed at risk man­
agement appeared to be strongly associated with more active risk man­
agement at the organizational level (Houtman et al., 1995; Houtman
et al., 1998). Already at the end of the previous century (1998), the
Work and Health covenants marked the beginning. A covenant can be
described as a gentleman’s agreement between the employer and em­
ployee representatives of a sector, who – in the presence of and with
the advice of the Ministry – agree on the risks to tackle, the approaches
or measures to take, and the specific goals to be formulated at the
sectoral level. In fact, these were large-scale OSH interventions, and
since psychosocial factors at work were considered a major risk in the
Netherlands, psychosocial risk management often was a core topic
in these covenants (see also Taris, Van der Wal, & Kompier, 2010). In
those days, the Dutch Ministry of Social Affairs and Employment ac­
tively encouraged and subsidized this sectoral approach to risk man­
agement. The overall aim was to achieve a reduction in exposure to
sector-specific psychosocial and physical risks of about 10% over a
period of approximately three years. The government funded part of the
initiatives. The covenant program ended in 2007, and at the end of the
Work and Health Covenant period, two large evaluations initiated by
the Ministry of Social Affairs and Employment took place. One was
mainly directed at absence and cost reduction, whereas the other was
more directed at risk reduction at the national level, comparing risk
change in sectors that did and did not participate in the covenants. The
 Increasing Work-Related Stress 183
evaluation that considered absence and cost reduction resulted in quite
a positive message – absence and related costs were reduced (Veerman
et al., 2007). However, the study considering risk exposure was not so
positive – no differences were found (Blatter, Van den Bossche, Van
Hooff, De Vroome, & Smulders, 2008). These latter findings may have
been an underestimation of the effects of exposure since, even in sectors
where covenants had been agreed upon, not all organizations im­
plemented interventions, and not all employees participated. Already,
Semmer (2003) indicated that, comparing whole populations where in­
terventions were or were not implemented, the impact of the interven­
tions should be very high in order to show a significant effect, since parts
of the population where interventions were implemented would not do
anything about it. The latter might well have been the case in the sectors
where the Work and Health Covenants had been agreed upon. Another
explanation may be that only a post covenant comparison of sectors with
and without such a covenant was possible. No national measurement, so
no comparison, could be performed on risk exposure before the cove­
nants were agreed upon. The fact that only a comparison on risk ex­
posure could take place after the covenants were implemented and the
fact that high-risk sectors were selected and approached to enter into
these covenants may have caused bias on the comparison on exposure
(Blatter et al., 2008).
Taris et al. (2010) performed more in-depth (qualitative and quanti­
tative) analyses in nine, mainly public sector-level work-related stress
programs. They concluded that the quality of the sector-level programs
varied strongly across sectors. However, organizations in sectors with
high-quality work-related stress programs at the sector-level were not
necessarily more active than organizations in sectors with lower quality
programs, but their programs were more effective. It was hypothesized
that the sectors with high-level quality programs already had more ex­
perience and knowledge in the sector and that this may have increased
the program's effectiveness. In sectors with less experience and knowl­
edge on a different approach, involving the establishment of this
knowledge and experience by having pilot projects, conducting research
into the antecedents of work-related stress, and providing good practices
may be more effective in motivating organizations to reduce job stress.
In this way, the sector may begin to build a body of knowledge about
the effects of job stress interventions. Within the scope of the differences
between countries in psychosocial risk management activities, these
conclusions on sector differences and their already installed infra­
structural benefits may well apply to the results of EWCS and ESENER
by country as well.
Since 2007 there are no Work and Health Covenants anymore. In
2007 and 2017, the Working Conditions Act was updated, and in
2007, well-being, as well as other specific risks, were skipped from the
184 Irene L.D. Houtman et al.
law text. One important aspect of the Dutch Working Conditions
Act – in both the old as well as the more recent and updated act – is
that employers are obliged to make a risk inventory and evaluation
(RI&E). Under the Working Conditions Act, all employers must re­
cord the risks faced by their employees, as well as when and how they
intend to reduce these risks in their working conditions policy.
Psychosocial risks like violence and harassment are also included in the
risks that may be prevalent in a company. In a consultation period
with the employees, a plan of risk management measures has to be
developed in which the management indicates how and when they plan
to deal with the risks.
In the Netherlands, collective agreements are voluntary. We call
them the “three-quarter law,” because once accepted by the social
partners, the agreement can be made obligatory for all companies in
the sector by means of a general acceptance procedure by the Dutch
Ministry of Social Affairs and Employment. Working conditions are
mostly not included in collective agreements, but appointments can be
made to establish a separate Education and Development Fund that
deals with the main questions on working and employment conditions
in the sector. These funds are often financed by fees from employers
and employees. It is well known that several of these funds co-finance
activities that are still supporting research, pilots, and best practices
on psychosocial factors. One example is the large project financed by
a specific project group of the Ministry of Home Affairs on violence
and harassment as a risk factor for employees in the public sector
(“veilige publieke taak”: http://www.rijksoverheid.nl/onderwerpen/
agressie-en-geweld/geweld-tegen-overheidspersoneel5). The current
OSH-catalogue policy of the Dutch government can be part of a
sectoral collective agreement. The aim of the government is to cover
all sectors and employees by an OSH-catalogue (https://www.
arboportaal.nl/externe-bronnen/arbocatalogi). In a number of these
OSH catalogs, attention has been paid to psychosocial risks and their
management.
In addition, the main activity specific for psychosocial risks and risk
management undertaken at the national level by the Ministry of Social
Affairs and Employment of the Netherlands has been a yearly campaign
since 2014. It is called “the week of work-related stress” and is aimed
to shed light on these risks and their corresponding risk management.
There has not been an attempt to evaluate the effectiveness of the
campaign.
Belgium is a complex country in terms of institutional structure – in­
volving many policy competences scattered over the federal and regional
(Flanders, Wallonia, and Brussels) policy levels. OSH competences,
however, are mainly concentrated at the federal level, leading to relatively
uniform legislation and policy practices over the entire territory.
 Increasing Work-Related Stress 185
Notwithstanding, sectors and regions also have certain discretion when it
comes to psychosocial risks at work.
While actions regarding psychosocial risk factors have been included
in OSH legislation as early as 1996 and gradually developed more in the
subsequent years, this domain has strongly been expanded with the “Act
of 28 February 2014” on the prevention of psychosocial risks at work –
including violence, harassment and sexual harassment at work”6 and a
series of related legislative initiatives. The Belgian OSH system puts a
strong emphasis on prevention and uses a broad definition of OSH as
“well-being at work,”7 incorporating seven domains: “work safety,”
“protection of workers health at work,” “psychosocial aspects of work,”
“ergonomic matters,” “work hygiene,” “embellishing of the work­
place,” and “all measures regarding the natural environment with an
impact on the former points.”8 Prevention and control of psychosocial
risks are therefore incorporated into the main OSH legislation and in­
frastructure. In the 2014 legislation, the concept of a psychosocial risk is
defined as “the probability of one or more workers being at risk of or
exposed to some aspect of the environment or behavior that creates an
objective danger over which the employer has some control” (e.g.,
“stress,” “violence,” “bullying,” and “sexual harassment”).9 Employers
are deemed to control these psychosocial factors at five sub-domains of
the work environment: work organization (e.g., distribution of tasks,
relations of authority, management style), employment conditions (e.g.,
contract, work patterns), work content (e.g., the nature of work, com­
plexity), relationships at work (e.g., relationships with co-workers and
members of management), and occupational health and safety (e.g.,
physical efforts, harmful exposures) (FPS Employment, Labour, & Social
Dialogue, 201310). The Belgian OSH system gives a prominent position
to the social partners in shaping and supervising OSH practices. At the
company level, workers and trade union representatives have the legal
right to be actively involved in the process of identifying and addressing
psychosocial risks. Social partners also play a key role in setting policy
initiatives at the national and sectoral levels.
At the federal policy level, the National Labour Council11 is the first
institution that plays an important role in shaping social and well-being
policies. As an example, in 2018 and 2019, subventions to companies for
pilot projects on the primary prevention of burnout have been launched
by the National Labour Council12. Another important agent is the
Higher Council for Prevention and Protection at Work. While composed
of representatives from employees and employers’ organizations and
experts, this council acts as a national policy advisory body on OSH-
related topics. The Federal Department Employment, Labor, and Social
Dialogue plays the most important role in terms of policy execution –
including research funding, application and enforcing of legislation, and
dissemination of expertise.13 For the latter purpose, the Belgian Safe
186 Irene L.D. Houtman et al.
Work Information Center14 serves as an interface for the field of prac­
tice. Moreover, for two periods in recent history (2008–2012 and
2016–2020), national strategies for the improvement of health and
safety at work have been put in place in Belgium. The 2008 to 2012
strategy has been evaluated in a comprehensive study (Wlodarski, 2013)
and concluded that the first plan contained insufficient accurate specifi­
cations of responsibilities of actors involved, objectives, and perfor­
mance indicators to reach tangible results. The current National Strategy
for Well-Being at Work 2016–202015 sets a total number of 13 opera­
tional objectives aimed at continuously improving well-being at work by
strategically focusing on optimizing prevention, installing a prevention
culture, optimizing the functioning of the main OSH actors, and
strengthening inclusive labor market participation.
Some initiatives are located at the sectoral and regional levels. At the
sector level, OSH initiatives have only started to emerge rather recently.
These initiatives are in fact an enlargement of the competences of the so-
called “sectoral funds,” which already exist since 195816 and can be
considered partially managed foundations funded through employer
contributions and are aimed at enhancing social protection, training, and
well-being of workers in a given sector. Recently, some sectors started to
allocate part of their resources to specific workability foundations. A
good example is the “DemografieFondsDémographie” founded in 2016
in the chemical sector.17 The Belgian regions can take action based on
their competences in the domains of labor market policy and preventive
health. Only the Flemish region, however, has taken some initiatives
complementary to the federal policies. Most important here are the ac­
tivities that the Flemish social partners gathered in the Socio-Economic
Council for Flanders (SERV). Since 2003, they have conducted a
workability survey every three years, and connected to this is a policy
program to promote workability – including a publicly accessible
toolbox of good practices, training programs, and modest subventions
to promote workability at the workplace.18 From the perspective of
health prevention, the Flemish Institute for Healthy Living (VIGO) is
deploying primary prevention initiatives in the realm of healthy work
and, more specifically, mental well-being at work.
Of course and also in Belgium, the main entry point to psychosocial risk
prevention is employing organizations. Here, the principle of primary
prevention by means of collective and participatory risk assessment pro­
cedures is the key. The collective and participatory approach toward the
identification of risks involves management, workers’ representatives, in­
dividual workers, HR, and OSH specialists (e.g. Mensura19). Based on the
risk analysis, an action plan must be developed, implemented, and eval­
uated (FPS Employment, Labor, and Social Dialogue20). In this whole
process, important actors are the so-called External Services for
Prevention and Protection at Work. These are nonprofit organizations
 Increasing Work-Related Stress 187
that are accredited by the federal authorities and are equipped to assume
the multidisciplinary OSH support that is required by law. The federal
government has financed action research aimed at establishing good ex­
amples of sustainable prevention strategies in practice (Lamberts &
Terlinden, 2016).
At the level of secondary prevention, the 2014 law has specified a
number of new measures in the case of individual problems of psy­
chosocial nature. These innovations were partly informed by an eva­
luation of the performance of earlier legislation on psychosocial risk
factors (Eertmans & Mertens, 2011). Currently, a trained “person of
confidence” is charged with duties of information provision and first-
line aid. An employee facing psychosocial well-being problems can
appeal to this person of confidence and initiate an “informal inter­
vention” in order to alleviate the problem. Employees may also appeal
to a “formal psychosocial intervention.” Such intervention implies a
formal claim to the employer to take the necessary measures required to
alleviate an individual of a problem or a collective problem of psy­
chosocial nature. During a formal intervention, the applicant is pro­
tected against reprisals from the part of the employer or other members
of management. An important characteristic of both the informal and
formal procedures is the intent to provoke structural change to a
stressful situation by taking collective and participatory actions. Finally
and recently, efforts have been increased to reintegrate disabled
workers in the labor market. New legislation came into effect from
January 1, 2017.21 This legislation is particularly significant for stress-
related causes, as the cases of psychiatric disability almost tripled in
number in 20 years' time (see supra). It is important to note that rising
disability claims are putting the financial sustainability of the social
security system under stress. The new legislation aims to make re­
integration swifter than before by involving the development of a
mandatory reintegration plan. The new legislation has been heavily
criticized by trade unions, who accused the new law of facilitating
dismissal for medical reasons. At present, no evaluation of the new
legislation is available, although a first evaluation study is on its way.22
To conclude, for employers who are still not convinced that psycho­
social risks are a problem for worker health as well as general organi­
zational health, some figures on the impact of psychosocial risks at the
employee level, as well as organizational level, may help.
Building infrastructure on OSH, or more specifically on psychosocial
risk management, takes time, and time, as well as good practice, will
help convince more employers and enterprises that psychosocial risks
are a problem in need of risk management. Allowing employees to
participate in decisions on how these risks should or could be managed
is important.
188 Irene L.D. Houtman et al.
Active engagement of employees in the active risk management pro­
cess is a sine qua non for effective risk management.

Notes
1 The European Union legislation that covers psychosocial risks has existed
since 1989 (Directive 89/391/EEC, the European Framework Directive on
Safety and Health of Workers at Work). 20 additional daughter directives
include provisions in relation to psychosocial risks and mental health in the
workplace. Several pieces of guidance have been produced by the European
Commission since 1999. More recently, a review of policies and practices on
mental health in the workplace, which included occupational health and
safety legislation as well as other types of policies and initiatives, was pub­
lished by the European Commission in 2014 (European Commission, 2014).
This also included the publication of “Promoting mental health in the
workplace: Guidance to implementing a comprehensive approach” as well as
an interpretative document of the European Union legislation in relation to
mental health in the workplace. See: https://osha.europa.eu/en/legislation/
guidelines/interpretative-document-implementation-council-directive-
89391eec-relation.
2 https://www.rijksoverheid.nl/documenten/kamerstukken/2018/06/14/
kamerbrief-stand-van-zaken-psychosociale-arbeidsbelasting.
3 POLS = Permanent Onderzoek LeefSituatie/Permanent Living Conditions
Survey.
4 The data of ESENER-3 will probably be published at the end of 2019.
5 Because of a renewal of the website toward one portal for all Dutch
Ministries, the texts on this website are only in Dutch thus far.
6 http://www.ejustice.just.fgov.be/cgi_loi/change_lg.pl?language=nl&la=N&
table_name=wet&cn=2014022821.
7 https://oshwiki.eu/wiki/OSH_system_at_national_level_-_Belgium.
8 http://www.employment.belgium.be/WorkArea/linkit.aspx?LinkIdentifier=
id&ItemID=1896.
9 https://www.eurofound.europa.eu/publications/article/2014/belgium-
preventing-psychosocial-risks-at-work.
10 http://www.emploi.belgique.be/publicationDefault.aspx?id=44860.
11 http://www.werk.belgie.be/defaultNews.aspx?id=48275.
12 http://www.werk.belgie.be/defaultNews.aspx?id=48275.
13 https://www.beswic.be/nl/themas/psychosociale-risicos-psr.
14 https://www.beswic.be/nl/over-beswic.
15 http://www.employment.belgium.be/WorkArea/DownloadAsset.aspx?id=
45387.
16 http://www.werk.belgie.be/defaultTab.aspx?id=519.
17 https://www.demografiefondsdemographie.be/travail-faisable/travail/.
18 https://www.werkbaarwerk.be/werkbaarwerk.
19 https://www.mensura.be/en/client-portal/case-studies/2014-legislation-for-
better-management-of-psychosocial-risks.
20 http://www.emploi.belgique.be/publicationDefault.aspx?id=44860.
21 http://www.werk.belgie.be/moduleTab.aspx?id=45586&idM=102.
22 http://www.werk.belgie.be/moduleDefault.aspx?id=47772.
23 http://www.eurofound.europa.eu/surveys/european-working-conditions-surveys.
24 www.esener.eu.
25 We used all NACE sectors, except for private households (NACE T) and
 Increasing Work-Related Stress 189
extraterritorial organisations (NACE U). NACE is the European industrial
activity classification as is approved by the European Commission. The term
NACE is derived from the French Nomenclature statistique des activités
économiques dans la Communauté européenne.
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Appendix A
The European Working Conditions Survey (EWCS) 2015(23)

In 2015, the sixth EWCS was carried out. The objectives of the EWCS are
to provide an overview of working conditions in order to:

• assess and quantify the working conditions of both employees and the
self-employed across Europe on a harmonized basis;
• analyze relationships between different aspects of working conditions;
• identify groups at risk and issues of concern, as well as identify progress;
• monitor trends by providing homogeneous indicators on these issues; and
• contribute to European policy development, in particular, on quality of
work and employment issues.

The scope of the survey questionnaire has widened substantially since the first
192 Irene L.D. Houtman et al.
edition, aiming to provide a comprehensive picture of everyday working life in
Europe. Topics covered include employment status, working time duration and

EU-Countries N Mean Standard

Deviation

Austria 1,027 3.06 1.06

Belgium 2,561 3.06 1.10
Bulgaria 1,061 3.19 1.05
Croatia 1,001 3.31 0.95
Cyprus 1,001 3.18 0.91
Czech Republic 1,001 2.99 1.00
Denmark 1,000 2.89 0.97
Estonia 1,009 3.18 0.92
Finland 1,000 2.93 0.87
France 1,526 3.33 1.05
Germany 2,088 3.00 0.92
Greece 1,001 3.15 0.94
Hungary 1,012 3.21 1.00
Ireland 1,055 3.02 1.00
Italy 1,399 3.20 0.99
Latvia 978 2.94 1.03
Lithuania 1,002 3.04 0.99
Luxembourg 1,003 3.36 1.08
Malta 1,003 3.21 1.15
The Netherlands 1,025 2.68 1.09
Poland 1,191 3.28 1.03
Portugal 1,027 3.04 1.03
Romania 1,062 3.17 0.95
Slovakia 995 3.15 0.96
Slovenia 1,601 3.33 1.14
Spain 3,354 3.22 1.18
Sweden 1,001 2.93 0.99
United Kingdom 1,622 3.17 1.09
Candidate countries 6,036 3.51 1.05
Albania 1,002 3.36 0.99
North Macedonia 1,009 3.61 1.20
Montenegro 999 3.39 1.02
Serbia 1,028 3.47 1.08
Turkey 2,000 3.62 1.08
Associated countries 2,033 3.02 1.00
Switzerland 1,005 3.21 1.04
Norway 1,028 2.83 0.94
Total sample 43,675 3.18 1.06
 Increasing Work-Related Stress 193
organization, learning and training, safety and health, physical and psychosocial
factors, and work and health.
Sample sizes, means, and standard deviations of burnout per country - 6th
EWCS-2015
The second European Survey of Enterprises on New and Emerging
Risks (ESENER-2) (24)

EU-OSHA’s ESENER-2 survey asked “those who know best about safety and
health in the establishment” about the way safety and health risks are
managed in the workplace, with a particular focus on PSRs (i.e. work-related
stress, violence, and harassment). In 2014, a total of 49,320 establishments
across all sectors (25) and with at least five employees, were surveyed in 36
countries covering the 28 European Union Member States (EU-28), as well as
Albania, Iceland, Montenegro, the former Yugoslav Republic of Macedonia,
Serbia, Turkey, Norway, and Switzerland. On average, the dataset included
about 1,400 establishments per country. For ESENER-2, data were collected
at the enterprise level by means of telephone interviews with the person ‘who
knows best about OSH issues’. In micro and small enterprises (MSEs), this
was mostly the owner/director, but in larger enterprises, it was an OSH
specialist, such as a health and safety officer, or a safety manager. The
questionnaire was structured around similar topics to ESENER-1, including:

• day-to-day management of OSH risks;

• special focus on PSRs and risks of MSDs (emerging risks);
• drivers and barriers to OSH management; and
• worker involvement.
10 Occupational Stress, Coping
Strategies, and the Impact of
Culture in the Middle East
A Systematic Review of Evidence
from Oman
Kaneez Fatima Sadriwala
and Mustafa Malik
Introduction
Occupational stress is one of the recurring factors in modern society. The
culture of a particular place plays a huge role in the perception and
expression of stress and distress. Stress is a phenomenon that jeopardizes
a person’s mental and physical health. It affects their work-life balance
and job performance. A detailed study through the scientific method is
very much required in this field. The available literature in form of sci­
entific studies is scant in the context of Oman; however, there have been
regular discussions in various forums. Dr. Amira al Raaidan, a director
for health education and awareness programs and the head of the Mental
Health Department in the Ministry of Health in Oman, said that “Just
like every other country, people in Oman undergo problems arising from
workplace stress, and among these, some of the main problems are de­
pression and anxiety. Both are very dangerous and need to be treated
adequately and immediately to avoid complications that may arise from
these two conditions”. A young marketing executive Fatma al Lawati
(name changed to protect identity), who works with one of Oman’s
leading banks believes that ageism, gender bias, bullying, and ever-
increasing workloads are driving employees mad. Another article pub­
lished in Times Oman quoted, “By 2020, depression will become the
biggest form of mental health illness. That is a sign that things need to be
done, and we need to take care of the well-being of these people who are
suffering”. On the other hand, an article published in Y Magazine (April
2017) by one of the leading newspapers in Oman reported that Omanis
are happy at work. Oman is undergoing a demographic shift and a
transition from traditional behavior to the modern lifestyle. In the wake
of such situations, certainly, there would be effects on stress levels. In
light of the above real-life situations, Oman is no exception to the vul­
nerability caused by stress. The purpose of learning about stress and the
impact of culture on stress management is not to eliminate stress,

DOI: 10.4324/9780429292538-10
 Impact of Culture in the Middle East 195
because stress is inevitable, but to know the proper means and ways to
recognize the stressors and to manage them to help the society to de­
velop. Not all kinds of stress are bad. There is positive stress called
Eustress, and negative stress called Distress (Tummers and Rocco, 2014),
in their book ‘Stress Management’. According to Al-Sinawi and Al-
Adawi (2006),

The Omani population is undergoing a “demographic transition”,

with declining death rates complemented by high birth rates. This is
likely to be accompanied by an increase in the number of people
with psychiatric disorders. There is also an indication that the
country is bracing itself for the social and economic consequences of
a more youthful population, with far more job-seekers than the
labor market can absorb. The traditional passage to adulthood is
also changing, as youngsters are expected to marry late and to have
children when they are well into their 20 s. However, the “adoles­
cent turmoil” seen in Western societies is not evident in Omani
society, which emphasizes family obedience.

Oman and its Culture: An Overview

Located at the southeastern corner of the Arabian Peninsula, the Sultanate
of Oman occupies a strategic position on the trade route between Europe
and Asia. To the east of Oman lie the Gulf of Oman and the Arabian Sea,
to the west are the United Arab Emirates and the Kingdom of Saudi
Arabia, to the north is the Islamic Republic of Iran, and to the south is the
Republic of Yemen. Oman’s total population at the end of 2018 stood at
4.6 million (2.58 million nationals and 2.02 million expatriates). It
occupies a land area of approximately 309,500 square kilometers with a
coastline extending to almost 1,700 kilometers overlooking the Arabian
Gulf, Gulf of Oman, and the Arabian Sea. With Muscat as the capital of
the Sultanate of Oman, the Sultanate is divided into eleven governorates.
Culturally, Oman is steeped in the religion of Islam. While the ma­
jority of its population is Arabs, a sizable minority consists of Balochs
and Swahilis. In addition, nearly half of the population consists of for­
eign workers. The culture of Oman is deeply rooted in Islam. Omanis in
general are highly tolerant, adaptive, and accommodative by nature. The
men and women follow a specific cultural dress code outside of their
homes. The men wear a dishdasha (a simple collarless, long-sleeved,
ankle-length gown that is usually of white color), a special type of
headdress called mussar (embroidered woolen cloth woven over the
tradition skull cap), and a special form of dagger called the khanjar
which is affixed on waistbands or belts and is usually worn on formal
and special occasions. Some men carry an ornamental stick called the
assa, and most Omani men wear sandals on their feet. On the other
196 Kaneez Fatima Sadriwala et al.
hand, the Omani women wear a long robe called abbaya that covers
them from the neck to the feet and this is mostly black in color. Women
cover their heads with scarves all the time. Omani women also wear
elaborate gold and silver jewelry around the head, neck, wrists, ankles,
fingers, and toes. Most Omani women wear sandals or Western-type
fashion shoes. Omani cuisine has a great variety and includes unique
dishes from other Arab countries. Kahwa (which appears similar to
coffee) is served with dates. Rice, meat, fish, and bread are the main
ingredients of most Omani dishes – like maqbous and aursia. Shuva
(whole lamb steamed with a variety of dried whole spices) is a popular
festive meal in Oman. Lately, Oman has modernized itself with sound
infrastructure including roads, communication systems, hospitals, and
places of tourist attraction.

Literature Review

Occupational Stress in General

Occupational stress refers to stress or distress experienced at work. It arises
due to the conflict between job demands and the amount of control over
the situation (Rao & Chandraiah, 2012). Various studies have identified
and established reasons for occupational stress and burnout, such as job
demands (Bakker & Demerouti, 2014; Perrewe & Ganster, 1989), lack of
control (Johnson et al., 2005; Mineka and Kelly, 1989), lower managerial
support (Johnson et al., 2005; Van der Colff & Rothmann, 2009), role
ambiguity (Grant & Langan-Fox, 2006; Beehr, Bowling, & Bennett,
2010), high workload (McVicar, 2003; Ilies, Dimotakis, & De Pater,
2010), bullying and harassment (Vickers, 2006; Hodgins, MacCurtain, &
Mannix-McNamara, 2014), blame culture (Conti, Angelis, Cooper,
Faragher, & Gill, 2006), poor working conditions (Dellve et al., 2015), and
poor work-life balance (Byrne, 2005).
Work-related stress has been identified as a significant contri-
buting factor to organizational inefficiency and lower performance
(Mohammadi, 2011, Ongori & Agolla, 2008; Arnetz, 2006), high staff
turnover (Rajamohan, Porock, & Chang, 2019; Kim & Barak, 2015;
Avey, Luthans, & Jensen, 2009), absenteeism (Staufenbiel & König, 2010;
Darr & Johns, 2008), decreased job satisfaction (Hoboubi, Choobineh,
Ghanavati, Keshavarzi, & Hosseini, al., 2017; Bemana, Moradi, Ghasemi,
Taghavi, & Ghayoor, et al., 2013; AbuAlRub, 2004; Flanagan &
Flanagan, 2002), and employee well-being (Jamal, 1999; Avey, Luthans,
Smith, & Palmer, 2010). While stress is unavoidable in a modern orga­
nizational context, it needs to be reduced.
Employees respond to stress differently and use different stress-coping
strategies. According to Lazarus and Folkman (1984), stress is experi­
enced only when situations are appraised as exceeding one’s resources.
 Impact of Culture in the Middle East 197
Thus, a person may interpret additional work responsibilities as a
threat, whereas another may regard extra responsibilities as a challenge.
Lazarus and Folkman (1984) define coping as “constantly changing
cognitive and behavioral efforts made to master, tolerate, or reduce
external and internal demands and conflicts among them”.
Various coping strategies that are used by employees to reduce stress
include the use of resources, peer support, teamwork, balancing priorities,
fostering social relations, family support, etc. Outside work factors, such
as family support, social and cultural norms, and religion and spirituality,
play an important mediating role coping with occupational stress.

Some Conceptual Definitions

Occupational Stress
Hans Selye, the Founder of Stress Theory and the Father of Stress, de­
fined stress as “the non-specific response of the body to any demand for
change” in 1936. Seyle (1976) further expanded the definition of stress
to explain that, since there are too many alternatives, the perception of
imposed demand creates stress. While Lazarus and Folkman (1984)
explained in their research that when internal or environmental demands
exceed the available resources, a judgment must be made – which is the
actual reason for stress. Skinner (1985) defined stress as “a reaction of a
particular individual to a stimulus event”. Later, Eliot (1988) concluded
that “stress may be viewed as the body’s response to any real or ima­
gined event perceived as requiring some adaptive response and/or pro­
ducing strain”.
Various researchers studying stress at work and how to manage it also
defined stress in various ways. For example, Steinberg and Ritzmann
(1990) defined stress as “an underload or overload of matter, energy or
information input to, or output from, a living system”. Likewise,
Humphrey (1992) argued that “stress can be considered as any factor,
acting internally or externally, that makes it difficult to adapt and that
induces increased effort on the part of the person to maintain a state of
equilibrium both internally and with the external environment”.
McEwen and Mendelson (1993) explained that “stress is a term for
certain types of experiences, as well as the body’s responses to such
experiences, and this term generally refers to the ‘challenges’ – real or
implied, to the homeostatic regulatory process of the organism”.
Furthermore, Levi and Lunde-Jensen (1996) concluded that “stress is
caused by a multitude of demands (stressors), such as an inadequate fit
between what we need and what we are capable of, what our environ­
ment offers, and what it demands of us”. Roger and Najarian (1998)
described stress as a “preoccupation with the negative emotion following
the event”.
198 Kaneez Fatima Sadriwala et al.
Coping
Coping used to be seen as an individually possessed habitual style for
dealing with stressful situations. Lazarus and Folkman (1984) defined
it as “the cognitive and behavioral efforts that people use to manage
specific external and/or internal demands of a situation appraised as
stressful”. They argued that, while appraising the events, people first
evaluate whether or not what is happening is relevant to their values,
goal commitments, beliefs about the self and the world, and situational
intentions. Next, they think about what they can do to deal with the
situation – if it is perceived as stressful and threatening. If an event
has been appraised as stressful, then individuals begin to engage in the
coping process and try to return to their previous emotional state.
Coping strategies can be broadly categorized as a) problem-focused
and b) emotion-focused (Lazarus & Folkman, 1984; Lazarus, 1993).
While problem-focused coping acts directly on the environment or the
individual to allow the person to readjust to the changed environment,
emotion-focused coping reduces emotional distress by helping the in­
dividual to avoid things that cause the stress or by changing the meaning
of what is occurring (Lazarus, 1993; Lazarus & Folkman, 1984).
Skinner, Edge, Altman, and Sherwood (2003) argued that when
coping is regulated flexibly, “behavior is active and intentional, emotion
is channeled, and orientation is goal-directed”. On the other hand,
Compas, Connor-Smith, Saltzman, Thomsen, and Wadsworth (2001)
defined coping as “conscious volitional efforts to regulate emotion,
cognition, behavior, physiology, and the environment in response to
stressful events or circumstances”. These two definitions show that
stress responses can be placed along two dimensions – voluntary versus
involuntary – and engagement (fight) versus disengagement (flight).

Culture and Coping

Culture plays an important role in coping with stress. According to
Markus and Kitayama (1991), people from different cultures have re­
markably different construals of the self and of others. For example,
many Western cultures emphasize independence and uniqueness, while
many Asian cultures assert that the relationships of a person to others is
central. Thus, an individual’s response to stress may vary upon whether
he/she has an independent or interdependent self. The people with in­
terdependent selves (i.e. people from Asian cultures) are more likely to
express other-focused emotions such as sympathy and shame (Markus
and Kitayama, 1991), avoid anger to promote harmony (Wang, 2001),
and use more evading and compromising styles to deal with conflict
(Triandis, 1995). Since interdependent selves value social constructs of
belongingness and harmony, they use self-control and self-restraint to
 Impact of Culture in the Middle East 199
adjust with social contingencies, unlike independent selves who are
more likely to motivated by self motives and autonomous desires and
individual needs.
Many studies comparing coping and its effectiveness among different
cultural backgrounds have confirmed the importance of cultural differ­
ences in coping with stress. For example, Sinha, Willson, and Watson
(2000) found that social support was more widely used among Asians
than among Americans. In a similar study, Liang and Bogat (1994)
found that perceived social support played a buffering role in coping
with stress among the Chinese.

Oman-Specific Studies on Occupational Stress and

Burnout
While occupational stress has been a widely researched area across the
world, only scant and scattered work has been done in the context
of Oman. Preliminary research of the literature was done on the Oman
database, Masader EBSCOhost, with the Boolean phrases: “occupational
stress”, “work-related stress”, “job stress”, “burnout”, “coping”, and
“Oman”. The initial result was run for 20 years, from 2000 to 2019, but
there were no studies found before 2010. All of the studies included in this
paper are from 2011 until 2019. The results were from ten academic
journals, out of which only five were related to the subject matter. The
thesaurus terms were burnout (psychology) (3), job stress (3), job sa­
tisfaction (2), quality of work life (2), career development (1), civil service
(1), but unrelated papers were excluded from our study. The publications
were from the Arab Journal of Psychiatry (4), the Oman Medical Journal
(2), the Asian Academy of Management Journal (1), Global Business and
Management Research (1), the Journal of Management and Public Policy
(1), and The South Asian Journal of Management (1), among others. The
geographic area covered was Oman (6), Muscat (1), and Saudi Arabia (1).
The databases were Business Source Ultimate (4), Academic Search
Ultimate (3), and the Arab World Research Source (3). A further search
was done on Google Scholar and ResearchGate, where some more studies
were found.
Most of the studies are focused on only a few sectors/industries such as
the health sector (Lawati, Short, Abdulhadi, Panchatcharam, & Dennis,
2019; Al-Hashemi et al., 2019; Al-Nabhani, Sinawi, & Toubi, 2016; and
Emam & Al-Lawati, 2014) and the education sector (Al-Alawi et al.
2019; Abu-Hilal, Al-Bahrani, & Al-Zedjali, 2017; Jahan et al., 2016;
Aldhafri, 2016; Hans et al., 2015 and Kumar, 2015). There have also
been a few articles in newspapers, magazines, and conference presenta­
tions specific to occupational stress. One such article was found in the oil
sector by Al-Rubaee and Al-Maniri (2011). Nevertheless, one of the
studies conducted by Al Busaidy and Borthwick (2012) studied the role
200 Kaneez Fatima Sadriwala et al.
of Islamic cultural values in mitigating occupational stress and high­
lighted its therapeutic importance.
Al-Rubaee (2011), while studying stress among employees working in
the oil fields of a particular oil company, highlighted that the possibility
of physical injury during work has been one of the major stressors for
workers working in the oil sector. While in most of the instances the
employees who encountered physical injuries were of a younger age (i.e.
25–34 years), these have been attributed generally to lack of informa­
tion, lack of training, lack of supervision, lack of experience, and the
lack of knowledge and skills.
Najat and Alan (2012), argue that much of occupational therapy
theory in practice, even in non-Western countries such as those in the
Middle East, is based on Western cultural values. Their study empha­
sized the importance of local cultural beliefs and values to the practice of
occupational therapy. Through semi-structured interviews with actively
practicing occupational therapists in Oman, the study established that
occupational therapy based on Western principles may not always fit in
a culturally different context – such as Oman. While “individualism” is
emphasized in Western occupational therapy literature, the study by
Najat and Alan (2012) in the context of Oman emphasized religion, the
family structure, culture, and gender as important aspects.
Al-Hashemi et al. (2019), through a cross-sectional study among 190
primary care physicians, found that occupational burnout among
healthcare professionals (i.e. physicians) was high on all three burnout
symptoms of emotional exhaustion, depersonalization, and personal ac­
complishments. While Inadequate staff, frequent conflicts, stress in per­
sonal life, and lack of social support have been cited as the common
reasons for burnout, the study established that longer working hours have
been the most critical factor in burnout among primary health physicians
in Oman. A similar study by Al-Nabhani et al. (2016) investigating
burnout perceived stress and coping strategies among 276 practicing
nurses and concluded that younger nurses (aged below 35 years) were
more prone to experiencing stress rather than their older counterparts.
Also, unmarried nurses perceived more stress than their married collea­
gues. Longer working hours have been seen as a critical stress factor, along
with demanding patient care and fewer work breaks.
A cross-sectional study by Jahan et al. (2016) exploring the reception
of occupational stress and coping strategies among medical students
concluded that – while a higher level of stress among students is asso­
ciated with poor academic performance, large content of study materials,
and time constraints – the major coping strategies used by the students
were better time management, seeking emotional support, talking to
family and friends, and having adequate sleep time. A similar study by
Al-Alawi et al. (2019) explores determinants of burnout and depression
among medical students in Oman and showed that about 24.5% of
 Impact of Culture in the Middle East 201
medical students were found with depressive symptoms while 7.4% of
cohorts endorsed the presence of burnout syndrome. Another cross-
sectional study on 237 medical students by Elsheshtawy, Taha,
Almazroui, Joshi, and Almazroui (2018), found that individual person­
ality traits are helpful in reducing hospital anxiety and depression. They
found that Individuals who had high neuroticism were more prone to
have high perceived stress – which resulted in a higher development of
depression and anxiety. Abu-Hilal et al. (2017), through an empirical
study on 344 college students in Oman, concluded that religiousness
(in this case, belief in Islam) is an important predictor of the sense of
meaning in life for college students in Oman. Hence, religion can be
employed in counseling and rehabilitation programs to reduce stress
among students.
Hans et al. (2015) studied work-life quality and occupational stress
among teachers of Business Management in private higher educational
institutions and found that there was relatively low stress among the
aforementioned teachers. In a similar study by Kumar (2015) on private
higher education institutes, where he examined the relationship between
burnout and job satisfaction, he found that emotional exhaustion and
reduced personal accomplishment reduces job satisfaction and results in
burnout, but spirituality worked as a coping strategy and had moder­
ately affected the relationship between burnout and job satisfaction.
A study by Emam & Al-Lawati (2014) conducted among 142 female
support staff from community disability centers in Oman argued that
personal commitment and spirituality were modest predictors of support
staff stress. The study concluded that spiritual belief, participating
in religious communities, having faith, and using prayer were some
important coping strategies used by respondents.

Culture and Work-Related Stress

Work-related stress is a pattern of physiological, emotional, cognitive,
and behavioral reactions to some extremely taxing aspects of work
content, work organization, and work environment. When people ex­
perience work-related stress, they often feel tense, distressed, and unable
to cope. Due to globalization and changes in the nature of work, people
in developing countries have to deal with increasing work-related stress.
In industrialized countries, people are becoming more familiar with
work-related stress and have developed mechanisms to manage it.
However, in developing countries, this may not be the case yet. They are
stressed due to the country’s economic development and political en­
vironment also, other than their own personal traits and characteristics
and family size and structure. Social obligations, cultural norms, and
behavior impact their work environment which, in turn, results in stress
(Hernandez & Blazer, 2006).
202 Kaneez Fatima Sadriwala et al.
Empirical Studies on Perceived Stress in Oman

Methodology
The main objectives of conducting this research are to determine the prevailing
occupational stress level among people in Oman, to list down the effects on
their well-being, and to examine strategies on how do they cope with stress.
A questionnaire was prepared and had four sections. The first section
was based on a precise measure of personal stress called the Perceived
Stress Scale. The Perceived Stress Scale (PSS) is a classic stress assessment
instrument. The tool, while originally developed in 1983 by Cohen, S.
and is available for academic use in the public domain, remains a pop­
ular choice for helping us understand how different situations affect our
feelings and our perceived stress. The questionnaire has been adapted
from Mind Garden, Inc., info@mindgarden.com www.mindgarden.com.
The PSS is reprinted with the permission of the American Sociological
Association, from Cohen, Kamarck, and Mermelstein (1983).
The second section is based on the “ill effects on the job”, “behavioral
changes’”, followed by “coping mechanisms”.
Primary data was collected by administering the questionnaire on
Google Forms. Proper care was taken so that the questionnaire was filled
up by the target population – representing men and women, the gov­
ernment and private sectors, and nationals and expatriates in Oman. The
questionnaire was converted into the local Arabic language, and it was
distributed by the snowball technique through e-mails and WhatsApp.
The response rate was very poor, which is again very peculiar about
Oman and depicts their behavior towards research and education.
Another important reason for the poor response is avoiding self-
disclosure. The questionnaire was sent to more than 600 people, but
overall, only (66) 10.1% of responses were received. The authors then
conducted focus group discussions and one-on-one interviews. The full
chapter theory is based on such group discussions and interviews.

Analysis of Data
The reliability of the first section of the questionnaire – ten questions
were adopted from Cohen et al. (1983) – was checked and established by
Cronbach’s Alpha, which is 0.795 (Table 10.1), and Kaiser-Meyer-Olkin

Table 10.1 Reliability Statistics

Cronbach’s Cronbach’s Alpha Based N of Items

Alpha on Standardized Items

.796 .795 10
 Impact of Culture in the Middle East 203
(KMO), which measured the sampling adequacy for each variable in the
model at 0.813, as given below in Table 10.2. (Reliability Statistics).

Table 10.2 KMO and Bartlett’s Test

Kaiser-Meyer-Olkin Measure of Sampling Adequacy. .813

Bartlett’s Test of Sphericity Approx. Chi-Square 265.420
df 45
Sig. .000

Questions number 4, 5, 7, and 8 (“In the last month, how many times
have you felt confident about your ability to handle your personal pro­
blems?”, “How often you felt that things were going your way?”, “How
often have you been able to control irritations in your life?”, and “How
often have you felt that you were on top of things?”) were reversed, and
the total score was summed up. Having a total score of 13 and below
was perceived to be low stress, 14 to 26 was moderately stressed, and
above 27 was highly stressed. The analysis of the data (Table 10.3 and
Figure 10.1) revealed that 15.4% of respondents were from the low-
stress level, 10.8% were from the high-stress level, and 72.3% were
ranging between 14 to 26 – which demonstrates moderate stress level.
Moderate stress can be indicated as positive stress to foster individual
performance and organizational climate (Hans et al., 2015).

Table 10.3 Stress Level

Grand Total N 65 Score Percentage Stress level

Less than 13 15.4% Low

From 14 to 26 72.3% Moderate
More than 27 10.8% High

Demographic Data of the Respondents

Table 10.4 shows the gender of respondents, Table 10.5 shows the
education level of respondents. The highest responses were having
higher diploma or bachelors degree. Oman is a country having various
nationalities, in this research, maximum respondents (86.4%) were
from Oman as shown in Table 10.6. Table 10.7 gives the detail about
occupation of the respondents. 31.8% respondents were government
employees, where is 34.8% are employed in large organizations. In
response to the question, “Do you feel that your life is interesting?” (see
Table 10.8), 40.9% responded said that, they found life very much
interesting, 34.8% said, to some extent they found life interesting and
204 Kaneez Fatima Sadriwala et al.

Stress level (Low, Moderate, High)

50.0

37.5
Stress Score

25.0

12.5

0.0
2 3 4

Figure 10.1 Low, Moderate, and High Stress Scores.

Table 10.4 Gender

Frequency Percent Valid Percent Cumulative Percent

1 1.5 1.5 1.5

Female 28 42.4 42.4 43.9
Male 37 56.1 56.1 100.0
Total 66 100.0 100.0

Table 10.5 Education

Frequency Percent Valid Cumulative

Percent Percent

1 1.5 1.5 1.5

Diploma 3 4.5 4.5 6.1
Higher Diploma/Bachelors 33 50.0 50.0 56.1
Masters 25 37.9 37.9 93.9
PhD/MPhil or above 3 4.5 4.5 98.5
Professional Certification 1 1.5 1.5 100.0
Total 66 100.0 100.0

22.7% were of the opinion that life is not so much interesting. In re­
sponse to the question, “Do you think that you have achieved the
standard of living and social status that you have expected?”
 Impact of Culture in the Middle East 205
Table 10.6 Nationality

Frequency Percent Valid Cumulative

Percent Percent

1 1.5 1.5 1.5

Indian 7 10.6 10.6 12.1
Jordan 1 1.5 1.5 13.6
Oman 57 86.4 86.4 100.0
Total 66 100.0 100.0

Table 10.7 Occupation

Frequency Percent Valid Cumulative

Percent Percent

1 1.5 1.5 1.5

Government Employment 21 31.8 31.8 33.3
Large Organization (more 23 34.8 34.8 68.2
than 50 employees)
Not Employed 10 15.2 15.2 83.3
Private Medium Organization 2 3.0 3.0 86.4
(10 to 50)
Private Small Organization 2 3.0 3.0 89.4
(Less than 10)
Self-Employed 1 1.5 1.5 90.9
Student 6 9.1 9.1 100.0
Total 66 100.0 100.0

Table 10.8 Do you feel that your life is interesting?

Frequency Percent Valid Cumulative

Percent Percent

Very much 27 40.9 41.5 41.5

To some extent 23 34.8 35.4 76.9
Not so much 15 22.7 23.1 100.0
Total 65 98.5 100.0
System 1 1.5
Total 66 100.0

Table 10.9 shows the data that 42.4% respondents achieved, “To some
extent,” 28.8% “Very much” and 27.3% opined “Not so much,”
standard of living and social status has been achieved as expected. The
data in Table 10.10 show the response for the question, “Do you feel
that you can manage situations when they do not turn out as ex­
pected?” 95.4% respondents said that they were either very much or to
some extent confident in managing situation if they did not turn out as
expected. In response to the question, “Do you feel easily upset if things
206 Kaneez Fatima Sadriwala et al.
Table 10.9 Do you think that you have achieved the standard of living and the
social status that you have expected?

Frequency Percent Valid Cumulative

Percent Percent

Valid Very much 19 28.8 29.2 29.2

To some extent 28 42.4 43.1 72.3
Not so much 18 27.3 27.7 100.0
Total 65 98.5 100.0
Missing System 1 1.5
Total 66 100.0

Table 10.10 Do you feel that you can manage situations even when they do not
turn out as expected?

Frequency Percent Valid Cumulative

Percent Percent

Valid Very much 16 24.2 24.6 24.6

To some extent 46 69.7 70.8 95.4
Not so much 3 4.5 4.6 100.0
Total 65 98.5 100.0
Missing System 1 1.5
Total 66 100.0

Table 10.11 Do you feel easily upset if things don’t turn out as expected?
Frequency Percent Valid Cumulative
Percent Percent

Valid Very much 17 25.8 26.2 26.2

To some extent 33 50.0 50.8 76.9
Not so much 15 22.7 23.1 100.0
Total 65 98.5 100.0
Missing System 1 1.5
Total 66 100.0

don’t don’t turn out as expected?,” 23.1% said they were “Not so
much” upset, but 50.8% said they were “To some extent” upset if
things don’t turn out as expected and 26.2% were “Very much” easily
upset. In response to the question, “Do you feel disturbed by the feeling
of anxiety and tension?,” 12.3% were not so much disturbed but
87.7% for disturbed either to some extent or very much disturbed
(Table 10.12). 76.9% respondent considered family as a source of help
in finding solutions to most of the problems they have, where is 23.1%
do not consider family as a source of help (Table 10.13). 83.1% re­
sponded and said they worried about their health to some extent or
 Impact of Culture in the Middle East 207
very much, only 16.9% said they were not so much worried about their
health (Table 10.14). In response to the questionare you troubled by
disturbed sleep?,” 26.2% of find they were very much troubled, 41.5%
were trouble to some extent and 32.3% were not so much troubled by
disturbed sleep (Table 10.15).
The behavioral changes (Figure 10.2) experienced by Omanis
are 42.2% related to poor performance in their jobs. 32.8% are
inclined to shouting at family members and 36% tend to seek
help from others in performing their jobs. 23.4% sought frequent
hospitalization.
People in Oman are highly religious, and the data, as in Figure 10.3,

Table 10.12 Do you feel disturbed by the feeling of anxiety and tension?
Frequency Percent Valid Cumulative
Percent Percent

Valid Very much 15 22.7 23.1 23.1

To some extent 42 63.6 64.6 87.7
Not so much 8 12.1 12.3 100.0
Total 65 98.5 100.0
Missing System 1 1.5
Total 66 100.0

Table 10.13 Do you consider your family as a source of help to you in finding
solutions to most of the problems you have?
Frequency Percent Valid Cumulative
Percent Percent

Valid Very much 24 36.4 36.9 36.9

To some extent 26 39.4 40.0 76.9
Not so much 15 22.7 23.1 100.0
Total 65 98.5 100.0
Missing System 1 1.5
Total 66 100.0

Table 10.14 Do you sometimes worry about your health?

Frequency Percent Valid Cumulative
Percent Percent

Valid Very much 19 28.8 29.2 29.2

To some extent 35 53.0 53.8 83.1
Not so much 11 16.7 16.9 100.0
Total 65 98.5 100.0
Missing System 1 1.5
Total 66 100.0
208 Kaneez Fatima Sadriwala et al.
Table 10.15 Are you troubled by disturbed sleep?
Freque­ Percent Valid Cumulative
ncy Percent Percent

Very much 17 25.8 26.2 26.2

To some extent 27 40.9 41.5 67.7
Valid
Not so much 21 31.8 32.3 100.0
Total 65 98.5 100.0
Missing System 1 1.5
Total 66 100.0

What are the behavoural cahnges that you experience due to

physical and mental health problems?

Taking rest from job and walking… 1.5%

1.5%
Stay alone and keep silent 1.5%
1.5%
More isolation 1.5%
1.5%
Talking too much with self 1.5%
1.5%
Seeking help from others 35.8%
43.3%
Shouting at family members 34.3%
10.4%
Scuicidal thoughts 3.0%
6.0%
Withdrawal from relationships 28.4%
25.4%
General pronesess to accidents 11.9%
6.0%
Increased smoking 16.4%
23.9%

Figure 10.2 Behavioral Changes.

proves that they resort to prayers and meditation as part of their coping
mechanisms. Self-positive thinking also forms a major part of their
coping strategies. Yoga, travel, and playing with pets are less popular
among the respondents.

Oman-Specific Cultural Behavior: How are Stress and

Distress Experienced in Oman?
According to Hofstede, there are four key dimensions to any country’s
cultural behavior. Cultural behavior also tends to add Eustress or
Distress to an individual’s behavior.

1 Individualism vs. Collectivism: Hofstede states that “Individualism

means to play alone or to the extent wherein people believe that, in
achieving personal success, they must work alone – which brings in
more sophistication and professionalism. On the other hand, people
 Impact of Culture in the Middle East 209

Coping Strategies

In the last month, how often have you felt that difficulties were piling 4
13
22
up so high that you could not overcome them? 17
12
In the last month, how often have you been angered because of the 4
17
22
things that were out of your control? 17
8
In the last month, how often have you felt that you were on the top of 5
16
23
the things? 16
8
In the last month, how often have you been able to control irritations in 5
18
23
your life? 20
2
In the last month, how often have you felt that you could not cope with 2
16
19
all things that you had to do? 23
8
In the last month, how often have you felt that things were going your 4
21
25
way? 14
4
In the last month, how often have you felt confident about your ability 11
23
16
to handle personal problems? 13
4
8
In the last month, how often have you felt nervous and stressed? 20
27
10
3
In the last month, how often have you felt that you were unable to 5
21
17
control important things in your life? 14
11
In the last month, how often have you been upset because of something 8
18
21
that happened unexpectedly? 13
8
0 8 15 23 30
4 3 2 1 0

Figure 10.3 Coping Strategies.

who believe in Collectivism must work together for the mutual

benefit of all in the group. This uplifts the weaker ones who are also
in the group.”

Collectivism and Occupational Stress

Oman falls purely in the dimension of collectivism. Omanis have tightly
knit families and social groups, wherein they take great care of family
members and friends. In addition to this, they will help anyone in need
whether personally known or otherwise, with unquestioning loyalty.
The degree of collectivism may vary from organization to organization,
but in workplaces where collectivism is high, employees are friends
with one another, absenteeism is low, the turnover rate is low, and even
if financial benefits are less, people will still continue their jobs due to
the healthy work environment. Omanis do not care much about money.
Rather, they care more about their companies, companions, workplace,
and, above all, their bosses or supervisors. If they are in good relations
with their seniors, they continue the job. Otherwise, they quit even
without having another job in hand. Students also like to work in a
team. If they have something to discuss with their instructor, they come
in a group. They are not confident to speak and assert their case on
their own.
As noted by Al-Sinawi and Al-Adawi (2006)
210 Kaneez Fatima Sadriwala et al.
The principle of unity begins with the belief in the unity of Allah:
there is only one God, followed by unity of purpose of the cosmos,
that is Ibadah or worship, and unity of the human community in this
purpose. Worship includes any Amal-Salih or constructive work or
good deed (Khan, 1986). Ashy (1999) states the major goal of Islam
is unity of all aspects of personality and of society. For example,
when one’s neighbour does not have food or is sick, it is within this
goal of unity that one is expected to help the neighbour. With
modernization, the social status of Omani individuals have under­
gone some notable changes. These have been brought about by
unprecedented prosperity, expansion of educational opportunities,
and, most importantly and from the point of view of psychiatry, an
increased preference for an individualistic rather than the traditional
collectivistic mindset and social behavior.

2 Hofstede talks about Power Distance: “This dimension expresses

the degree to which the less powerful members of a society accept
and expect that power is distributed unequally. The fundamental
issue here is how a society handles inequalities among people.” In
the case of societies with low power distance, all of the members of
society are treated equally and are given equal opportunity to
express their views. In Omani society, there is a high degree of
power distance – the young respect the old and do not counter
reply to the older members of the family. They keep their voices
low and avoid eye contact with the elders. On the contrary, major
decisions in the family are done through the consultation and
direction of females only. Mothers are usually the decision-makers
of the family.

Power Distance in Oman

In occupations, this dimension clearly marks its presence. The junior
employee seldom speaks in front of the senior. Very few women occupy
higher positions in offices, and male dominance is seen in almost all
facets of life in Oman. Highly educated females tend to have more stress
in comparison to their male counterparts. Expatriates experience more
stress than Omani workers on the same hierarchy level. Power distance is
observed more in family circles than in the workplace.

3 Masculinity versus Femininity: This dimension focuses on the

extent to which a society stresses achievement or nurturing.
Masculinity is seen to be the trait that emphasizes ambition,
acquisition of wealth, and differentiated gender roles. Femininity
is seen to be the trait that stresses caring and nurturing behaviors,
sexuality equality, environmental awareness, and more fluid
 Impact of Culture in the Middle East 211
gender roles.
From Hofstede (2001), Culture’s Consequences, 2nd ed. p 297.
“Masculinity stands for a society in which social gender roles are
clearly distinct: Men are supposed to be assertive, tough, and focused
on material success; women are supposed to be more modest, tender,
and concerned with the quality of life.” “Femininity stands for a
society in which social gender roles overlap: Both men and women are
supposed to be modest, tender, and concerned with the quality of
life.” Usually, the Gulf countries are masculinity-based.
In Oman, the social norms are highly ego-oriented. Money and
material things have value in society and act as a stressor, but social
norms are shifting towards the quality of life and focus on people.
Oman’s economic growth is of high priority, but one of the major
reasons for distress is the oil crisis in the last few years. The country’s
revenue was affected as a result of the dip in crude oil prices, which, in
turn, resulted in an increase in domestic petrol and gasoline prices.
Commuting has become more expensive now more than ever before,
which is one of the biggest stressors for Oman. The government
relaxed the population by increasing the minimum wage rate of the
Omanis, but the pay remained the same for the expatriates – adding
more vulnerability to their lives. Recent developments show the
Oman Government’s great concern for environmental protection, as
they provide licenses for small and medium-sized organizations after
these organizations obtain environment-protection certificates from
competent authorities. Oman is highly evolving into a modern society.
Thus, Oman does not fall purely into the cultural dimension of being
masculinity-based.
The people of Oman are humble and kind. They are very polite.
Conflicts are solved through negotiation, but religion is still the most
important part of life, and only men can be priests. As far as work is
considered there is a smaller or no gender wage gap, as fewer women
are in management. Omanis also have a preference for higher pay for
fewer working hours. They have a traditional family structure, and
this clearly forms behavior and expectations from boys and girls, but
failure is not considered to be a disaster. The male head is the
dominant member of the family. Females usually occupy the least
heard or most suppressed voice in the family. They keep their voices
low and hide away from the presence of males. Omani women are
expected to portray the ideal image of Muslim women – a carer of the
house, of children, and of their husbands. However, women are also
expected to hold a full-time job in addition to their household job.
Women technically have the same rights as men but are often at a
disadvantage when it comes to disputes over adultery, divorce, and
child custody. In addition, many women don’t report spousal and
domestic abuse. Women in Oman make up the majority of the
212 Kaneez Fatima Sadriwala et al.
population going to universities or other places of higher learning, but
also hold the highest rates of illiteracy (i.e. mainly women living in
rural areas). Men and women technically have the same rights under
the law; however, men often have privileges in the Sharia law. In the
gender debate: “Are women equal to men in Oman?” 07 Mar 2018,
posted by, Y Magazine, new laws, broad mindsets, and rev–amped
social milieus have brought in a fresh wave of optimism in society
about women’s rights. Hasan al Lawati explored the gender myths
and reported that women in Oman are more empowered – they have
the right to vote, the right to contest elections, the right to education,
the right to own property, the right to employment, the right to earn
fair and equal pay, and the right to equal opportunities, but having
these rights does not mean that there is no discrimination at all against
women in Oman. Women lag behind. In Oman, women make 41.5%
of government employees and enjoy equal pay, according to the
National Statistics and Information Center as of October 2017, but
women make only 24% of private-sector employees and comprise
63% of total job seekers.
A recent study by Sumaya Al Weheibi, a specialist on women and
gender inequality, shows that the level of education is “significantly
related to happiness” of Omani women. The higher the level of
education, the higher the rate of happiness was – according to the
study that targeted 1,926 Omani females from 11 governorates. Al-
Wahaibi’s study revealed that occupation-wise, Omani women who
run their own businesses are the happiest, compared to students and
employees. However, the recent study said that majority of the one-
on-one interviews sample indicated that “the society is anti-women
empowerment and social equality”. Eight of 12 (67%) of the
participants said employment status contributes to their happiness.
“They expressed that obtaining a tertiary education enhanced their
everyday life from different perspectives”. Thus, getting a higher
degree gave women the opportunity to be engaged in the workforce,
and this leads them to be financially independent, and that increases
their confidence and well-being positively,” the researcher said. All
participants indicated that the households’ roles in the Omani society
are highly gendered in favor of men, according to the paper. All
participants indicated that the roles of the household in Omani society
are highly gender-based, according to the study. The new generation,
new mindset, and young Omani ladies who are empowered by the
state’s laws are now conquering many male-dominated fields.
4 Uncertainty Avoidance: Uncertainty Avoidance states tolerance
towards risk. Countries with low uncertainty avoidance have more
tolerance of risk (e.g., Japan has low uncertainty avoidance).
Uncertainty avoidance deals with a society’s tolerance for
uncertainty and ambiguity; it ultimately refers to “man’s search for
 Impact of Culture in the Middle East 213
Truth”.
It indicates to what extent a culture programs its members to feel
either uncomfortable or comfortable in unstructured situations.
Unstructured situations are “novel, unknown, surprising, and
different from the usual”. Uncertainty avoiding cultures try to
minimize the possibility of such situations by strict laws and rules,
safety and security measures, and, on the philosophical and religious
level, by a belief in absolute Truth – “there can only be one Truth and
we have it”. Uncertainty Avoidance is basically how cultures adapt to
changes and cope with uncertainties or the unknown future and the
level of how a culture feels threatened or is anxious about ambiguity.
It is not risk avoidance but rather, how one deals with uncertainty.

Oman Perspective
Oman experiences a high score on Uncertainty Avoidance. People prefer
to avoid uncertainty; they avoid taking risks. For all official work, forms
are available, be it opening a bank account, getting a driver’s license,
payment of supplies – name anything. The country follows strict rules
and regulations. Safety and security measures are very high. Roads are
monitored with radar, and speeding limits are regulated. This sometimes
brings in frustration among commuters as they have to travel long dis­
tances to either drop off or pick up their children or reach workplaces.
Road rage is also observed. However, adaption to new technologies is far
higher in comparison to other countries. E-governance is of high priority
in Oman. Most of the work has now been converted to electronic media.
Culturally, they are a fearless and brave, ocean-exploring tribe. Oman is
known for its ‘Dhow’ culture, but agriculture and fishing are still the
traditional economic activities in Oman. The seafaring culture – tradi­
tionally followed – brings in collectivism and a transfer of knowledge
from old to young. The dhow-building in Oman is one of the finest in the
world. Omani sailors are known for their maritime expertise and sur­
vival in adverse conditions, but knowledge transfer is from generation to
generation. Uncertainty, in general, is avoided.

Culturally-Oriented Unique Distress in Omani Society

Some of the unique stressors and strains in Oman’s cultural setting and
some reflections on related social, cultural, and anthropological-related
issues are as follows.

1 The avoidance of self-disclosure: The traditional value system in

Oman is that of collectivism and in the event of social impropriety,
like corruption, stealing, dishonesty, failure (e.g., students caught
cheating during exams, name-calling in public) an individual feels
214 Kaneez Fatima Sadriwala et al.
“ashamed”. They like to hide their identity. Females prefer to hide
their faces and turn down requests to have their pictures clicked.
This behavior indicates that they are very conscious and that their
feelings are controlled by how others look at them – people’s
perception. Their image in society is very important.
2 Wasta, magic, the evil eye, and hasad: The Omani people still
greatly believe in spirit, jinn, and that all ill-happenings are
attributed to this belief, but much attribution of this distress on
external forces depends upon the level of education. In the deep
desert and isolated villages, such beliefs are very high, and mental
distress is treated by the traditional healers rather than doctors.
Distress is communicated in a psychosomatic manner rather than
psychological ways (Al-Adawi et al., 2002). If a child is hyperactive,
then the family discourages the child, attributing his/her behavior to
the evil eye or hasad. Similarly, falling ill, failure in any kind of job,
or even non-performance in schools is linked to the evil eye, which
means somebody thinks negatively about the individual and thus this
was the result. Distress in Oman is not perceived in psychiatric
parlance but rather as intra-psychic conflict.
3 Effort-reward imbalance: Effort-reward imbalance is possible
predisposing factors leading to distress in occupational settings.
Many Omani feel that their efforts are not appropriately rewarded.
There are mixed feelings in both workforces in the public and private
sectors. On June 24, the Times News Service revealed that around
51.8% of Omanis who are working in the private sector get a
monthly salary ranging from OMR325 ($845) to OMR500 ($1,300),
whereas the median household income worldwide is $9,733 (as
per the World population review) http://worldpopulationreview.
com/countries/median-income-by-country/The National Center for
Statistics and Information (NCSI) in Oman also revealed that
13,670 (5%) of the total number of workers earn salaries of more
than OMR2,000. The NCSI reported that the unemployment rate
for Omanis between the ages of 25 and 29 dropped to 13.6% over
the last month, but the same is not applicable to the case of expatriate
workers. There is no minimum wage limit for them. Thus, this acts
as a stressor for many expatriate workers. A closed focus group
discussion also revealed that Omanis working in both the public and
private sectors were equally stressed. For the ones working in the
public sector, the lack of appreciation for good work and the lack
of growth opportunities were causes of stress; whereas, for the
ones working in the private sector, the employee-boss relationships
and organizational politics coupled with wasta (i.e. informal ways and
means to turn things in one’s favor) were the causes of concern
and stress.
4 The perceived threat of Omanization: Over the years, the Omani
 Impact of Culture in the Middle East 215
society has depended on public sector jobs. Private sector employment
is still seen as only a second choice. While the Omanization policy of
the country has led to an increased focus on creating employment in
the private sector, the population perceives private sector employment
as more stressful and with less attractive compensation and benefits
packages (Al-Lamki, 2011).
5 Difficult topography and scattered inhabitation: Oman is sparsely
populated with a population density of 39 people per square mile.
Stretched over a landmass of 309,501 square kilometers and
comprised of sparsely populated valleys, deserts, and mountains,
the people have to either travel hundreds of kilometers to reach their
workplaces or live away from their families. This is one of the
reasons why Omanis feel stressed.
6 Dependence on expatriates: As brought out earlier, about half of the
population in Oman is comprised of foreigners. The country
depends very much on the foreign workforce not only to support
the organized public and private sectors, but also to uphold
disorganized domestic and small family business activities. The
overdependence of the Omani population on foreign workers
becomes a cause of stress especially when these workers have no
legal work permits. According to a report published in Times Oman
on April 16, 2019, about 750 expatriate workers were deported, and
another 859 were arrested in violation of Omani labor law.
7 Strict social order, limited socializing, and less recreation: Omani
society follows an adaptive but restricted social order. Men and
women follow a strict dress code while out of their homes.
Socializing is restricted especially for women. Entertainment
facilities are limited and whatever is available is not equally
available to men and women. The restricted lifestyle, though not
forced, becomes the cause of stress, especially for women.

Conclusion
The study of literature and primary data analysis, along with the in-depth
interviews, focus group studies and observations reveal the deeply embedded
cultural behavior of the Omani population. The dominant behavior reveals
that Oman does have many cultural-specific stressors, but they are success­
fully able to cope with stressors. The traditional society pattern is slowly
changing and education is spreading its paws all over the country. The
country is gradually adapting to modernization. The Islamic religious society
is in its transition phase. Modern, as well as traditional patterns, are still
prevailing, but some of the areas like mental health need to addressed ser­
iously, and awareness in this area needs to be created. The detailed literature
review also revealed that there is a dearth of systematic literature on occu­
pational stress, job-related stress, and related fields. The major studies that
216 Kaneez Fatima Sadriwala et al.
have been conducted are also from the last five years – from 2015 to 2019 –
and those too are concentrated in two major areas: medicine and education,
while all of the other industries have been left out. This depicts a major gap in
the literature, and future studies should focus on these areas. The Oman
government and related research communities should address this area of
research. There is a high impact of culture on the stress level of people in
Oman, and further studies should address that Omanis and expatriates are
two different groups. However, the overall stress level among people in
Oman is relatively moderate, as also identified by some of the studies. At
some level, ignorance is also bliss, but some of the unique stressors in Oman
should be taken due care of, and proper education and training can play an
important role in mitigating superstitions and beliefs.

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11 Occupational Stress, Health,
and Well-Being Research in
Portugal
A Qualitative Systematic
Literature Review
Maria José Chambel, Vânia Sofia
Carvalho, and Mariana Neto
Introduction
It is long-standing knowledge that a professional activity and the char­
acteristics and conditions of the context in which it is developed influence
the health and well-being of workers. In fact, it was during the nineteenth
century, after the Industrial Revolution, that various aspects of the work
context were seen to potentially influence the physical and mental health
of workers. The dehumanization experienced in the factories during this
period was not only the object of debate for sociologists and political sci­
entists, but also for several literary writers (Chambel, 2016). However, over
recent years, we have witnessed profound changes in the world of labor and
enterprises which have brought consequences for the health and well-being
of workers. New forms of work organization, increased pressure on pro­
fessionals to work longer hours, uncertainties regarding employment se­
curity, and restructuring threats are some of the reasons that contribute not
only to the persistence of the more traditional risks, but also to the emer­
gence of new risks (Neto & André, 2016). European surveys on work
conditions have referred to this adverse effect of work on the health and
well-being of workers. The 2014 report indicated that over 25% of parti­
cipants referred to stress as the cause of loss of well-being (Eurofound &
EU-OSHA, 2014). By the same token, the 2018 report stated that 25% of
participants had claimed to experience stress in the workplace during most
of or throughout their working schedule, regarding this situation as having
a negative impact on their health (Eurofound & EU-OSHA, 2018). In the
specific case of Portugal, in the second Survey of Enterprises on New and
Emerging Risks – Psychosocial Risks, it was discovered to be the country
where respondents manifested most concern with stress (70% of surveyed
establishments). However, no systematic review has been conducted on
occupational stress, health, and well-being in Portuguese professionals.
Integration of the research on this topic will contribute to further data-
based knowledge and will facilitate future research by shedding light upon
current gaps in the literature.
DOI: 10.4324/9780429292538-11
222 Maria José Chambel et al.
Methodology
To provide an indication of the potential size and nature of the
available literature examining the occupational stress, health, and
well-being of Portuguese workers, a qualitative systematic review was
conducted (Paré, Trudel, Jaana, & Kitsiou, 2015). We followed the
recommendations of Daudt Van Mossel, and Scott (2013) and the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA; Moher, Liberati, Tetzlaff, & Altman, 2009). The first step
of the systematic review consisted of using three databases, namely ISI
Web of Science, PubMed, and Scopus. Titles and abstracts were
identified using three search terms. The first used the combination
[“occupational stress” AND “Portugal”]. The second used the com­
bination [“occupational health” AND “Portugal”]. Lastly, the third
search term used the combination [“occupational well-being” AND
“Portugal”]. A total of 401 papers were found. An initial screening
was then conducted in order to remove duplicates and non-English
language papers, and a total of 91 papers remained for the next step of
the systematic review.
In order to eliminate papers that did not address the scope of the
present review, inclusion and exclusion criteria were established
(Daudt et al., 2013). The inclusion criteria were the following: (1)
studies conducted with Portuguese workers, (2) studies that are em­
pirical qualitative and quantitative, (3) studies evaluating occupa­
tional stress, health, and/or well-being, and (4) studies published in a
scientific journal. As exclusion criteria, the following were not in­
cluded: (1) literature reviews and meta-analyses including an indirect
analysis of occupational stress, health, and/or well-being, (2) studies
with a mixed sample composed not only of Portuguese workers, but
also workers from other countries, and (3) studies published in con­
gress proceedings.
Based on the inclusion and exclusion criteria, two reviewers cri­
tically and independently appraised the quality of 91 papers by as­
sessing each paper’s title and corresponding abstract. As a result of
the titles and abstracts’ appraisal, a total of 82 papers were con­
sidered to meet the inclusion criteria. A third reviewer then checked
the remaining papers and analyzed all the 82 full-text articles.
Following the full-text articles’ analysis, five papers were excluded
due to the fact that they did not evaluate occupational stress, health,
and/or well-being, and two papers had been published in congress
proceedings. Hence, 75 papers met the inclusion criteria and were
used to perform the qualitative systematic review and two-step
cluster analysis. In Figure 11.1, it is possible to observe the flow
diagram of the systematic selection of studies undertaken in the
present study.
 Occupational Stress, Health 223

Identification
Records identified through database
searches on ISI Web of Science,
PubMed and Scopus (n = 401)

Records after removing duplicates and

non-English language papers
(n = 91)
Screening

Records screened on the basis of the Records excluded

Titles and Abstracts’ assessment (n = 8)
(n = 82)

Full-text articles eligible Full-text articles

Eligibility

for qualitative excluded, with reasons

systematic review (n = 7)
(n = 75)

Figure 11.1 Flow Diagram of the Systematic Selection of Studies.

Adapted from: Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G.,
The PRISMA Group (2009). Preferred Reporting Items for
Systematic Reviews and Meta-Analyses: The PRISMA Statement.
PLoS Med, 6(7): e1000097. https://doi.org/10.1371/journal.pmed1
000097

Analysis
Table 11.1 summarizes the reviewed studies, providing information
on: (a) authors and data, (b) periodical and area of publication (i.e.,
Psychology/ Social Sciences, Medicine/Health/ Mental Health, Nursing
and/or other), (c) study design and data analysis (i.e., quantitative or
qualitative, cross-sectional, longitudinal or intervention, descriptive, re­
gression, structural equation model or latent profile analysis), (d) parti­
cipants (i.e., sample size and occupation), (e) indicator studied and
measure used (i.e., stress, health, and/or well-being), and (f) aim of
the study.
In order to find similar groups of studies, a two-step cluster analysis
(TSC) using a log-likelihood distance measure was performed, using
SPSS Version 25 (IBM, Armonk, NY, USA). The two-step cluster ana­
lysis was used to classify groups of studies that were similar to one an­
other in terms of sample size, work population, qualitative/quantitative
Table 11.1 Summary of Reviewed Studies
224

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Afonso, Fonseca, Occupational Quantitative, 429 higher Anxiety and Depression – To evaluate differences in
and Pires (2017) Medicine Cross-sectional, students Hospital Anxiety and sleep quality and anxiety
(Medicine) Descriptive Depression Scale and depression symptoms
(HADS); Sleep – between the longer
Pittsburgh Sleep working hours group
Quality Index (LWHG) and regular
working hours group
(RWHG) and to examine
factors influencing weekly
working hours, sleep
Maria José Chambel et al.

quality, and anxiety and

depressive symptoms.
Ângelo and European Journal Quantitative, 1,487 rescue Burnout- Maslach To encourage the expansion
Chambel (2014) of Work and Cross-sectional, mission Burnout Inventory- of the Job
Organizational Structural firefighters General Version; Demands–Resources (JD-
Psychology Equation Model Engagement – Utrecht R) model with the
(Psychology) Work Engagement introduction of proactive
Scale–General Version coping, in both health
impairment and
motivational processes.
Ângelo and Stress & Health Quantitative, 651 firefighters Burnout – Maslach To analyze the dynamic
Chambel (2015) (Psychology, Longitudinal Burnout Inventory- nature with normal and
Medicine) (two waves), General Version; reversed causation effects
Structural Engagement – Utrecht between work
Equation Model Work Engagement characteristics and
Scale – General psychological well-being.
Version
(Continued)
Table 11.1 (Continued)

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Barbosa, Nolan, American Journal Quantitative, 53 care workers Stress – Perceived Stress To assess the effects of a
Sousa, Marques, of Alzheimer’s Intervention Scale (PSS); Burnout – psychoeducational
and Disease & Other (pretest-posttest Maslach Burnout intervention, designed to
Figueiredo, (2016) Dementias control group Inventory – Human improve direct care
(Medicine, design) Services Survey workers’ stress, burnout
Psychology) and job satisfaction, and
person-centered
communicative behavior
in people with dementia.
Barbosa, Silva, Ata Médica Quantitative, 102 medical Burnout – Maslach To measure self-regulated
Ferreira, and Portuguesa Longitudinal, students Burnout Inventory – learning skills and self-
Severo. (2016) (Medicine) (two waves), Student Version study across secondary-
Regression higher education
transition and to explore
its effect on academic
burnout in the first year
of medical school.
Barbosa Nolan American Journal Quantitative, 56 direct care Stress – Perceived Stress To assess the effects of a
Sousa, and of Alzheimer’s Intervention workers Scale (PSS); Burnout- person-centered care-
Figueiredo (2014) Disease & Other (pretest-posttest Maslach Burnout based psychoeducational
Dementias control group Inventory – Human intervention on direct
(Medicine, design) Services Survey care workers’ stress,
Psychology) burnout, and job
satisfaction.
(Continued)
Occupational Stress, Health 225
Table 11.1 (Continued)
226

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Baylina, Barros, Journal of Medical Quantitative, 361 healthcare Emotional, social, Explore the relation of
Fonte, Alves, and Systems Cross-sectional, workers psychological well- work-related risk factors
Rocha, (2018) (Medicine) Regression being – Mental Health and well-being among
Continuum- Short healthcare workers.
Form (MHC-SF)
Cabeças and Advances in Quantitative, 906 financial Well-being- Negative To identify relevant
Mota (2014) Intelligence Cross-sectional, services Well-Being Matrix occupational hazards in
Systems and Descriptive employes the financial sector
Computing workplace level and
Maria José Chambel et al.

negative mental or
physical well-being
complaints.
Carvalho and Social Indicators Quantitative, 1,390 bank Health – Health To examine the relationship
Chambel (2014) Research Cross-sectional, employees Perceptions; between job demands,
(Psychology) Structural Satisfaction with Life control and support, and
Equation Model work-family enrichment
and, more interestingly,
the work-family
enrichment as a
mechanism for explaining
the relationship between
job characteristics and
employees’ well-being
and to, furthermore,
analyze the relationship
(Continued)
Table 11.1 (Continued)

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

of employees’ perceptions
of High-Performance
Work System (HPWS)
with job characteristics.
Carvalho and Journal of Career Quantitative, 218 city council Burnout – Maslach To test the relationship
Chambel (2016a) Development Cross-sectional, employees Burnout Inventory between High-
(Psychology) Structural -General Version; Performance Work
Equation Model Engagement – Utrecht System and workers'
Work Engagement general well-being –
Scale; Health tested the mediation by
Perceptions; job characteristics and
Satisfaction with Life workplace well-being.
Carvalho, & Spanish Journal of Quantitative, 1,885 bank Burnout – Maslach To analyze work-to-family
Chambel (2016b) Psychology Cross-sectional, employees Burnout Inventory conflict (WFC) and
(Psychology) Latent Profile -General Version; enrichment (WFE)
Analysis Engagement – Utrecht profiles related to job
Work Engagement characteristics and well-
Scale; Health being at work and general
Perceptions; well-being.
Satisfaction with Life
Carvalho and Armed Forces and Quantitative, 175 marine Burnout – Maslach To test the mediated effect
Chambel (2017) Society (Social Cross-sectional, military Burnout Inventory of work-family conflict
Sciences) Structural workers -General Version; and the enrichment on the
Equation Model Engagement – Utrecht relationship between job
Work Engagement characteristics and
Occupational Stress, Health 227

(Continued)
Table 11.1 (Continued)
228

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Scale; Health well-being at work (i.e.,

Perception burnout, engagement).
Carvalho, Chambel, Frontiers in Quantitative, 254 services Mental health – GHQ 28 To examine the role of WFC
Neto, and Psychology Cross-sectional, company as a mechanism that
Lopes 2018) (Psychology) Structural workers explains the relationship
Equation Model between job
characteristics (i.e., those
established by the Job
Demands-Control-
Maria José Chambel et al.

Support Model) and

workers’ mental health
and, moreover, based on
gender inequalities in
work and non-work roles,
to analyze gender as a
moderator of this
mediation.
Chambel, Carvalho, Career Quantitative, 736 contact Burnout – Maslach To compare part-time and
Cesário, and Development Cross-sectional, center workers Burnout Inventory full-time employees by
Lopes (2017) International Structural -General Version; analyzing the relationship
(Psychology) Equation Model Engagement – Utrecht between job
Work Engagement characteristics and
Scale; Health workplace well-being
Perception (i.e., burnout and
engagement) and by the
(Continued)
Table 11.1 (Continued)

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

mediating role of the

work-to-life conflict.
Chambel, Lorente, Journal of Quantitative, 2,867 workers Engagement – Utrecht To identify Psychological
Carvalho, and Managerial Cross-sectional, Work Engagement Contract profiles,
Martinez (2016) Psychology Latent Profile Scale differentiating between
(Psychology) Analysis permanent and temporary
agency workers (TAW),
and, moreover, to analyze
whether different profiles
presented different levels
of work engagement.
Coelho Tavares International Quantitative, 32 field workers Psychosocial Risks- To investigate the effect of
Lima, and Journal of Longitudinal The Copenhagen different kinds of work on
Lourenco (2018) Occupational (two waves), Psychosocial the psychosocial
Safety and Regression Questionnaire- assessment of workers
Ergonomics CoPsoQ (short under the same
(Medicine; version) management and
Social Sciences) organizational
environment.
Coelho Tavares Work (Medicine) Quantitative, 32 private Psychosocial Risks- To assess the association
Lourenco, and Cross-sectional, administrative The Copenhagen between environmental,
Lima (2015) Descriptive workers Psychosocial physical, and
Questionnaire- organizational working
CoPsoQ (short conditions and the
version) physical and psychosocial
Occupational Stress, Health 229

(Continued)
Table 11.1 (Continued)
230

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

well-being of a sample
of private-sector office
workers.
Correia de Sousa Journal of Quantitative, 1,107 employees Engagement – Utrecht To aim mainly at further
and van Organizational Cross-sectional, Work Engagement understanding how
Dierendonck Change Structural Scale servant leadership can
(2014) Management Equation Model affect engagement during
(Management) a merger with high levels
of uncertainty through
Maria José Chambel et al.

the mediating role of

organizational
identification and
psychological
empowerment.
Coutinho Queirós Work (Medicine) Quantitative, 399 employees Psychosocial Risks – To assess the main work-
Henriques Norton, Cross-sectional, in a public The Copenhagen related determinants of
and Alves (2019) Regression hospital Psychosocial high exposure to
Questionnaire – psychosocial risk factors
CoPsoQ (medium among workers in the
version) hospital setting.
Cruz-Mendes, La Medicina Quantitative, 95 nurses Burnout – Maslach To measure the levels of
Claro, & Cruz- del Lavoro Cross-sectional, working in Burnout Inventory – burnout among nurses
Robazzi (2014) (Medicine) Descriptive central prisons General Survey working in prisons and
their relationship to the
socio-demographic
(Continued)
Table 11.1 (Continued)

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

variables and type of

employment contract.
Cumbe et al. (2017) Revista de Quantitative, 46 health care Burnout – Maslach To assess the association
Psiquiatria Cross-sectional, professional – Burnout Inventory – between burnout,
Clínica Regression oncology Human Services functional coping
(Medicine) service Survey strategies, and
occupational factors in
a sample of oncology
providers – mostly nurses.
David and Acta Médica Quantitative, 404 teachers Positive and Negative To relate burnout,
Quintão (2012) Portuguesa Cross-sectional, Affective Schedule personality, affectivity,
(Medicine) Regression (PANAS); Bunout – coping strategies, and life
Maslach Burnout satisfaction.
Inventory; Satisfaction
with Life Scale (SWLS)
Duarte, and Pinto- International Quantitative, 94 oncology Quality of Life – The To explore the effectiveness
Gouveia (2016) Journal of Intervention nurses professional quality of an on-site, abbreviated,
Nursing Studies (nonrando­ of life scale, version and mindfulness-based
(Nursing) mized, wait-list 5 (ProQOL-5); intervention for nurses.
comparison Depression, Anxiety,
design) Stress Scale (DASS-
21); Satisfaction with
Life Scale (SWLS)
Duarte and Pinto- European Journal Quality of Life – The To clarify the relationships
Gouveia (2017) of Oncology Professional Quality between several
Occupational Stress, Health 231

(Continued)
Table 11.1 (Continued)
232

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Nursing Quantitative, 221 hospital of Life Scale, Version dimensions of empathy,

(Nursing) Cross-sectional, oncology 5 (ProQOL-5) self- compassion, and
Regression nurses psychological
inflexibility, and positive
(compassion satisfaction),
and the professional
quality of life.
Duarte and Pinto- Applied Nursing Quantitative, 298 hospital Quality of Life – The To explore the relationships
Gouveia (2017) Research Cross-sectional, nurses Professional Quality between empathy,
(Nursing) Regression of Life Scale, Version empathy-based
Maria José Chambel et al.

5 (ProQOL-5) pathogenic guilt, and

professional quality
of life.
Gama, Barbosa, and European Journal Quantitative, 360 nurses Burnout – Maslach To identify socio-
Vieira (2014) of Oncology Cross-sectional, Burnout Inventory demographic,
Nursing Regression professional, proximity to
(Nursing) death, training and
educational, and personal
factors relevant to
burnout dimensions in
nurses coping with death
issues.
Garrosa Rainho International Quantitative, 98 nurses Burnout – Maslach To assess temporal and
Moreno-Jiménez, Journal of Longitudinal Burnout Inventory; – cross-sectional
and Nursing Studies (two waves), Human Services relationships between
Monteiro (2010) (Nursing) Regression Survey job stressors, hardy
personalities, and coping
(Continued)
Table 11.1 (Continued)

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

resources on burnout
dimensions among
nurses.
Geraldes Madeira Personnel Review Quantitative, 2,055 contact Burnout – Maslach To analyze the moderating
Carvalho, and (Psychology) Cross-sectional, center workers Burnout Inventory- role of affective
Chambel (2019) Regression General Version; commitment in the
relationship between
work-personal life
conflict (WPLC) and
burnout.
Gomes (2014) Interamerican Quantitative, 318 health Stress – Stress To analyze stress of nurses
Journal of Cross-sectional, professionals Questionnaire for and physicians.
Psychology Descriptive (physicians and Health Professionals
(Psychology) nurses) (SQHP); Burnout –
Maslach Burnout
Inventory– Human
Services Survey
Gomes and Stress & Health Quantitative, 2,310 nurses Stress -Stress To analyze the psychometric
Teixeira, (2016) (Psychology, Cross-sectional, Questionnaire for properties of three
Medicine) Confirmatory Health Professionals instruments that focus
Factor Analysis (SQHP); Psychological on the professional
Well-being – GHQ 12 experiences of nurses in
aspects related to
occupational stress,
(Continued)
Occupational Stress, Health 233
Table 11.1 (Continued)
234

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

cognitive appraisal, and

mental health issues.
Gomes, Cruz, and Psicologia:Teoria e Quantitative, 286 nurses from Stress – Stress To analyze occupational
Cabanelas (2009) Pesquisa Cross-sectional, hospitals and Questionnaire for stress in nurses from
(Psychology) Regression healthcare Health Professionals hospitals and healthcare
centers (SQHP); Burnout – centers.
Maslach Burnout
Inventory – Human
Services Survey;
Maria José Chambel et al.

Health -Physical
Health Scale
Gomes, Faria, and Work and Stress Quantitative, 333 academic Burnout – Maslach To analyze the mediating
Gonçalves (2013) (Psychology) Cross-sectional, teaching staff Burnout inventory role of the cognitive
Structural –Educators survey appraisal on the
Equation Model relationship between
occupational stress and
burnout.
Gomes, Faria, and Western Journal of Quantitative, 2,302 nurses Psychological Well- To test the mediating role of
Lopes (2016) Nursing Cross-sectional, Being- GHQ 12 primary (e.g., threat and
Research Structural challenge perceptions)
(Nursing) Equation Model and secondary
(e.g., coping potential and
control perception)
cognitive appraisal in the
relationship between
(Continued)
Table 11.1 (Continued)

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

occupational stress and

psychological health.
Hernández-Marrero American Journal Mix, Cross- 9 palliative care Burnout – Maslach To identify the most
Pereira, and of Hospice and sectional, teams Burnout Inventory – common ethical decisions
Carvalho (2016) Palliative Descriptive Human Services made by Portuguese
Medicine Survey; Interviews palliative care teams and
(Medicine) understand how the
making of such decisions
relates to burnout.
da Silva João and Journal of Quantitative, 3,227 nurses Well-being – To assess the existence,
Saldanha Interpersonal Cross-sectional, Interpersonal frequency, and intensity
Portelada (2016) Violence Descriptive Relations at Work of mobbing within the
(Psychology) Scale (IRWS). Portuguese nurse
population, as well as its
impact on their well-being
and interpersonal
relationships
Joaquim et al. (2017) Psychology, Health Quantitative, 118 medical Stress Questionnaire for To calculate the prevalence
& Medicine Cross-sectional, residents of Health Professionals of burnout and stress on
(Psychology, Regression Oncology, (SQHP); Maslach’s medical residents of
Medicine) Hematology, Burnout Inventory – Oncology, Haematology,
and Human Services and Radiotherapy in
Radiotherapy Survey Portugal, as well as to
determine predictors of
burnout and stress.
Occupational Stress, Health 235

(Continued)
Table 11.1 (Continued)
236

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Lapa, Carvalho, European Journal Quantitative, 710 anesthesia Stress Questionnaire in To study the validation of
Viana, Ferreira, of Cross-sectional, specialists Anaesthesiologists the Stress Questionnaire
and Pinto- Anaesthesiology Exploratory and (SQA) in
Gouveia (2016) (Medicine) Confirmatory Anaesthesiologists (SQA).
Factor Analyses
Laranjeira (2012a) Applied Nursing Quantitative, 424 nurses Fatigue Severity To translate and test the
Research Cross-sectional, Scale (FSS) reliability and validity of
(Nursing) Descriptive and the Portuguese version
Exploratory of the FSS.
Maria José Chambel et al.

Factorial
Analysis
Laranjeira (2012b) Journal of Clinical Quantitative, 102 nurses Stress-Perceived Stress To clarify the association
Nursing Cross-sectional, Scale between perceived stress
(Nursing) Descriptive. in work and the types of
coping strategies used by
Portuguese nurses.
Lourenço Carnide Plos One Quantitative, 1,761 young Widespread Pain To estimate the associations
Benavides, and (Medicine) Cross-sectional, adults Syndrome between psychosocial
Lucas (2015), Regression (Fibromyalgia Survey work environment and
Questionnaire); musculoskeletal outcomes
Musculoskeletal pain (widespread pain
(Nordic syndrome features and
Musculoskeletal regional pain) in a
Questionnaire) population-based sample
of young workers.
(Continued)
Table 11.1 (Continued)

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Maia and European Journal Quantitative, 59 nurses and Posttraumatic Stress To determine the
Ribeiro (2010) of Emergency Cross-sectional, medical Disorder Scale (PTSD); psychological impact of
Medicine Regression doctors of the Psychological Well- exposure to current death
(Medicine) National Being – GHQ 12 and physical injury events
Institute of in the context of motor
Medical vehicle accidents among
Emergency emergency personnel and
to identify which
variables better predict
posttraumatic stress
disorder.
Maroco, Maroco, Ata Médica Quantitative, 1,262 nurses and Burnout – Maslach To report the incidence of
Sacadura-Leite, Portuguesa Cross- 466 physicians Burnout Inventory – burnout in healthcare
Bastos, Vazão, & (Medicine) sectional,Descri­ Human Services professionals.
Campos (2016) ptive Survey
Marques-Pinto, Jesus, Spanish Journal of Quantitative, 2,235 hospital Burnout – Maslach To examine the predictive
Mendes, Fronteira, Psychology Cross-sectional, nurses Burnout Inventory – value of job demands and
and (Psychology) Structural Human Services resources in the
Roberto (2018) Equation Model Survey); Engagement – explanations of nurses’
The Utrecht Work intention to leave the
Engagement Scale organization, and to test
the mediating roles of
professional burnout and
engagement in these
relationships.
Occupational Stress, Health 237

(Continued)
Table 11.1 (Continued)
238

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Marques Alves Occupational Quantitative, 368 hospital Burnout – Maslach To assess the prevalence of
Queiros Norton, Medicine Cross-sectional, workers Burnout Inventory— burnout in different
and (Medicine) Regression Human Services professional groups of
Henriques (2018) Survey. hospital staff, and to
examine how the
professional category is
associated with levels of
burnout.
Martinez and Stress and Health Quantitative, 296 nurses at Presenteeism Scale To analyze the predictors
Maria José Chambel et al.

Ferreira (2012) (Psychology, Cross-sectional, public hospitals (SPS-6) Health of presenteeism.

Medicine) Descriptive Condition Index
Martins-Pereira PLoS One Quantitative, 355 professionals Maslach Burnout To identify and compare
Teixeira Carvalho, (Medicine) Cross-sectional, from 10 Inventory – Human burnout levels between
and Hernández- Regression intensive care Services Survey professionals working in
Marrero (2016) units and intensive and palliative
9 palliative care care units, and to assess
units which workplace
experiences are associated
with burnout.
Martins, Sales- International Quantitative, 62 university Ability to Work – To identify psychosocial
Oliveira, Journal of Cross-sectional, workers ́
WorkAbility Index indicators within the
Loureiro (2016) Working Descriptive organizational context
Conditions and to analyze mobbing
(Social Science) and capacity to work in a
sample of administrative
(Continued)
Table 11.1 (Continued)

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

employees of a
Portuguese public
university.
Martins, Andrade, Turkish Online Quantitative, 90 special Burnout – Stress and To assess stress and burnout
Albuquerque, & Journal of Cross-sectional, education Burnout Scale (CPB-R) in special education
Cunha. (2015) Educational Descriptive teachers teachers and find out to
Technology what extent socio-
(Education) demographic and
psychosocial variables
have a significant effect
on those levels.
Mesquita, Ribeiro, Applied Research Quantitative, 229 male Health – Short Form To evaluate the effect of
and Quality Life Intervention warehouse Health Survey – SF-36 following a 21-month
Moreira (2011) (Social Science) workers from exercise program on the
a food quality of life of
distribution warehouse workers.
company
Monteiro and Spanish Journal of Qualitative, 25 journalists Distress and Eustress To characterize and
Marques- Psychology Content Emotional Reactions – compare occupational
Pinto (2017) (Psychology) Analysis Interviews stress variables perceived
by journalists in their
daily work and in critical
scenarios.
European Journal Burnout – Maslach
of Burnout Inventory;
Occupational Stress, Health 239

(Continued)
Table 11.1 (Continued)
240

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Morais Maia Anaesthesiology Quantitative, 263 Human Services To assess stress and burnout
Azevedo Amaral, (Medicine) Cross-sectional, anesthesiolo­ Survey among Portuguese
and Tavares (2006) Regression gists anaesthesiologists.
Alves de Moura La Medicina del Quantitative, 19 psychiatry Psychosocial Risks – To assess psychiatry and
Serranheira, and Lavoro Cross-sectional, and 20 The Copenhagen anesthesiology residents
Sacadura- (Medicine) Regression anaesthesiology Psychosocial in a central and university
Leite (2016) medical Questionnaire – hospital for the presence
doctors Medium Version of psychosocial risks
(CoPsoQ) at work.
Maria José Chambel et al.

Neto, Chambel, and Occupational Quantitative, 819 sales workers Psychological health – To determine the effects of
Carvalho, (2018) Medicine Cross-sectional, and 1,016 GHQ 12 work-family life conflict
(Medicine) Regression contact center on employee well-being,
workers after controlling the effect
of job demands, control,
and support.
Neto, Ferreira, Annals of Work Quantitative, 353 workers Burnout – Maslach To examine the intervening
Martinez, and Exposures and Cross-sectional, from a service Burnout Inventory; variables of emotional
Ferreira. (2017) Health Structural company Psychological Well- exhaustion and
(Medicine) Equation Model Being- GHQ 28 psychological well-being
in the direct and indirect
relationships between
workplace bullying and
indicators of productivity
loss due to presenteeism.
(Continued)
Table 11.1 (Continued)

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Neto Carvalho Journal of Quantitative, 713 workers Mental health – To test the reciprocal effect
Chambel Manuel Occupational Longitudinal, of a service GHQ 28 between work-family
Pereira Miguel, and and (three waves), company conflict and employee
Reis (2016) Environmental Structural well-being using cross-
Medicine Equation Model lagged analyses on the
(Medicine) basis of three waves.
́
Orgambidez-Ramos, Ciência & Saúde Quantitative, 297 hospital Burnout – Maslach To examine to what extent
Borrego-Alés & Coletiva Cross-sectional, nurses Burnout Inventory structural empowerment
Ruiz-Frutos (2018) (Medicine) Regression and vulnerability to stress
can play a predictive role
in the burnout.
Rodrigues, & Revista Latino Quantitative, 235 nurses Well-being – To identify stressors for
Ferreira (2011) Americana de Cross-sectional, Interpersonal nurses working in
Enfermagem Descriptive Relations at Work intensive care units.
(Nursing) Scale (IRWS)
Pereira, Fonseca & International Mixed, Cross- 73 (quantitive) Burnout – Maslach To identify burnout levels,
Carvalho (2012) Journal of sectional, 11 (qualitative) Burnout Inventory – risk and protective
Palliative Regression nurses from Human Services factors, prevention
Nursing palliative teams Survey strategies, and the
(Nursing) emotional impact of
working in palliative care
among nurses in Portugal.
Pocinho and Educação e Quantitative, 54 teachers Stress – Teacher Stress To determine teachers'
Capelo. (2009) Pesquisa (Social Cross-sectional, Questionnaire QSP vulnerability to stress, to
Sciences) Descriptive identify the main sources
of stress, to recognize
Occupational Stress, Health 241

(Continued)
Table 11.1 (Continued)
242

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

teachers' main coping

strategies, to analyze
whether such strategies
condition the presence of
stress at work, and to
establish whether the self-
efficiency perceived can
be used to predict work
stress.
Maria José Chambel et al.

Queiros Carlotto Psicothema Quantitative, 1,157 hospital Burnout – Maslach To identify predictors of
Kaiseler Dias, and (Psychology) Cross-sectional, nurses Burnout Inventory – burnout among nurses
Pereira (2013) Regression. Human Services working in hospitals.
Survey
Ramos, Serranheira, Revista Brasileira Quantitative, 131 cash-in- Perceived health – To establish the health and
and Sousa- de Medicina do Cross-sectional, transit Age Questionaire safety at work (HSW)
Uva (2018) Trabalho Descriptive employees conditions for employees,
(Medicina) to characterize their
working conditions and
tasks, and to identify the
aspects of their activities
that influence their health
and safety, as well as self-
reported health problems.
Occupational 374 occupational Psychosocial Risks – To evaluate burnout levels
Therapy in therapists The Copenhagen and prevalence among
(Continued)
Table 11.1 (Continued)

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Reis, Vale, Camacho, Health Care Quantitative, Psychosocial occupational therapists,

Estrela, and (Medicine) Cross-sectional, Questionnaire – as well as to relate those
Dixe (2018) Descriptive Medium Version levels to practitioner age,
(CoPsoQ) gender, client age, years
of professional activity,
and area of practice.
Rodrigues, Paiva, International Quantitative, 11 air traffic Linear Heart Rate To understand the effect of
Dias, Aleixo, Journal of Ambulatory controllers Variability (HRV) stress on cognitive
Filipe, and Environmental Study features were performance, and to
Cunha (2018) Research and extracted from ATCs identify whether this
Public Health Electrocardiogram effect is related to an
(Medicine) (ECG) – medical autonomic response to
clinically certified stress.
equipment
(VitalJacket®).
Rodrigues, Kaiseler, International Quantitative, 14 emergency Description of the Most To investigate stress and
Queirós, Basto- Journal of Diary response Stressful Situation of coping among Emergency
Pereira (2017) Emergency officers the Working Day; Response
services (Social Stress Intensity Lickert Officers (EROs).
Sciences) Scale; Open Question:
What did you do to
cope with the stressful
situation?
PeerJ — Life and 17 firefighters Continuous
Environment Electrocardiogram
Occupational Stress, Health 243

(Continued)
Table 11.1 (Continued)
244

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Rodrigues, Paiva, Journal Quantitative, (ECG) and actigraphy To study the effects of stress
Dias, and (Medicine) Ambulatory measurement – events on physiological
Cunha (2018) Study medical clinically stress.
certified equipment
(VitalJacket®).
Roque, Veloso, Silva, Ciência & Saúde Quantitative, 305 health Stress – Stress To examine the experience
and Costa (2015) Coletiva Cross-sectional, professionals Questionnaire for of stress in health
(Medicine) Regression and 392 users Health professionals (physicians,
Professionals (QSPS) nurses, and clinical
Maria José Chambel et al.

secretaries), and to study

satisfaction with the
services provided by them
from users.
Sá and Issues on Mental Quantitative, 107 nurses Burnout – Maslach To investigate both the
Fleming. (2008) Health Nursing Cross-sectional, Burnout Inventory – prevalence of bullying in
(Nursing) Descriptive Human Services Portuguese nurses and the
Survey; General health relationship between the
– General Health symptoms of burnout and
Questionnaire mental health in nurses
(GHQ-28); Mental who report being bullied.
health – Mental
Health Inventory
(MHI-5)
(Continued)
Table 11.1 (Continued)

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Santos, Barros, and Physiotherapy Quantitative, 55 hospital Stress – The To identify occupational
Carolino (2010) (Health Cross-sectional, physiothera­ Occupational Stressors stressors and coping
Professionals) Descriptive pists Inventory resources in a group of
physiotherapists, and to
analyze interactions
between subjective levels
of stress, efficacy in stress
resolution, and coping
resources used by these
professionals.
Satuf, Monteiro, International Quantitative, 971 workers from Physical and Mental To study the effects of job
Pereira, Esgalhado, Journal of Cross-sectional, different Health – MOS SF-36; satisfaction on mental
Marina Afonso, Occupational Regression organizations Happiness – Covilhã and physical health,
and Safety and Happiness happiness, subjective
Loureiro (2016) Ergonomics Questionnaire (CHQ); well-being, and self-
(Medicine; Subjective well-being – esteem.
Social Sciences) PANAS
Silva, et al. (2017) BMC Medical Quantitative, 238 medical Depression – Beck To determine the prevalence
Education Longitudinal students Depression Inventory of depression in medical
(Medicine; (four waves), (BDI); Anxiety – State students, its developments
Social Science) K-means cluster Trait Anxiety during the course, its
analyses. Inventory; Burnout – persistence for affected
ANOVA Maslach Burnout students, and to study the
Inventory – Student factors associated with
Version
Occupational Stress, Health 245

(Continued)
Table 11.1 (Continued)
246

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

depression and how these

factors change over time.
da Fonte Sousa Revista Latino Quantitative, 96 nurses of Stress – Occupational To identify sources of stress
Gomes, dos Americana de Cross-sectional, Surgery Stress Inventory; and coping strategies in
Santos, & da Mata Enfermagem Descriptive Oncology Psychological Well- nurses who work in three
Almeida (Nursing) Services being (GHQ 12) Head and Neck Surgery
Carolino (2013) Oncology Services.
Sousa, Pereira- Medical Problem Qualitative, Cross- 112 professional Interviews To describe the prevalence
Machado, Greten of Performing sectional, orchestra of the most common
Maria José Chambel et al.

& Coimbra, (2016) Artists Descriptive musicians complaints affecting

(Medicine) musicians in the three
professional orchestras.
Teixeira, Ribeiro & BMC Quantitative, 82 physicians and Burnout – Maslach To study the incidence and
Carvalho (2013) Anesthesiology Cross-sectional, 218 nurses Burnout Inventory – risk factors of burnout
(Medicine) Descriptive Human Services in ICUs.
Survey
Teixeira, Ribeiro, Journal of Medical Quantitative, 300 nurses and Burnout – Maslach To explore the ethical
Fonseca, & Ethics Cross-sectional, physicians Burnout Inventory – problems that may
Carvalho, (2014) (Medicine) Regression Human Services increase burnout levels
Survey; among physicians and
nurses working in
intensive care
units (ICUs).
39 management Interviews To analyze management
consultants consultants’ self-
(Continued)
Table 11.1 (Continued)

Authors (Year of Journal (Area) Study Design Participants Well-being indicator Aim of the Study
Publication) and measure used

Von Humboldt, Leal, Stress & Health Qualitative, perceptions of

Laneiro, and (Pychology, Content occupational stress
Tavares (2013) Medicine) Analysis (SPoOS), sources of stress
(SoS), and stress
management strategies
(SMS), and to find latent
constructs that can work
as major determinants in
consultants’
conceptualization of
SPoOS, SoS, and SMS.
Occupational Stress, Health 247
248 Maria José Chambel et al.
study design, cross-sectional/longitudinal study design, data collection
mode, work context, and well-being measure, but are different from the
other studies. A two-step cluster analysis identifies group segmentation
by first running pre-clustering and then by means of hierarchical
methods (Garson, 2014). As such, it combines both approaches. This
technique can detect latent relationships within and between studies with
multiple distinct characteristics. The optimal cluster solution was de­
termined using Akaike’s information criterion. The quality of fit of the
resulting modeled clusters was measured using the silhouette measure of
cohesion and separation (Dimitriadou, Dolničar, & Weingessel, 2002).
The silhouette measure contrasts the average distance among elements in
the same cluster (within-cluster cohesion) with the average distance to
elements in other clusters (between-cluster separation).

Results

When, Where, and What is Investigated?

The review of the articles (marked with * in the references; see also
Table 11.1) revealed that publications began in 2006 but were scarce
(i.e., zero, one, or three studies per year) up to 2012, while in 2016 and
2018 more published studies were observed – 16 for both years.
Regarding the choice of journal publications, this review found that the
vast majority (n = 70) were international had published only one paper,
and the detachment occurred in Occupational Medicine (n = 3), in the
Spanish Journal of Psychology (n = 3), and in Stress & Health (n = 4). As
for the scientific area of these publications, the review revealed that more
than one third (n = 30) had been published in Psychology and Social
Sciences, more than one third (n = 29) in Medicine, Health, Mental
Health, and 16% (n = 12) in Nursing and 4 in other publications1. The
majority focused on the negative side of occupational well-being. Over
half of the analyzed articles (n = 36) studied burnout; stress was analyzed
in seven, anxiety and depression in nine, work engagement was in­
vestigated in only nine, and satisfaction with life in four studies.

Who was Investigated, How, and For What Purpose?

The sample size used varied from 11 to 3,227, although a significant
number used samples consisting of between 51 and 300 participants (n =
34, 45.3%) or more than 300 participants (n = 32, 42.6%). Indeed, it was
common to find samples with hundreds of workers (e.g., Baylina, Barros,
Fonte, Alves, & Rocha, 2018; Satuf, Monteiro, Pereira, Esgalhado,
Marina Afonso, and Loureiro 2016) to analyze the relationship between
work-related factors and workers’ well-being, to analyze the prevalence of
stress – namely burnout (e.g., Marques, Alves, Queiros, Norton, and
 Occupational Stress, Health 249
Henriques 2018), and to validate a scale for specific professionals (e.g.,
Lapa, Carvalho, Viana, Ferreira, Pinto-Gouveia, 2016). However, there
were also studies that presented smaller samples – focusing on the effects
of stress events on physiological stress (e.g., Rodrigues, Paiva, Dias, &
Cunha, 2018) or on the effects of a specific intervention (Duarte & Pinto-
Gouveia, 2016). The majority (n = 40, 53.3%) of the analyzed articles
used samples with healthcare professionals (only nurses: n = 22, 55%,
only doctors: n = 4, 10%, both nurses and doctors: n = 5, 12.5%, and
diverse professionals: n = 9, 22.5%); whereas, samples with other pro­
fessionals (firefighters, police, army, or security forces: n = 6, 8%, teachers:
n = 4, 5.3%, contact center or temporary workers: n = 4, 5, 3%, bank,
administrative, or financial workers: n = 5, 6.7%, students: n = 2, 2.7%,
and others: n = 5, 6.7%) were less frequent. Heterogeneous samples – that
is, samples comprising professionals with various occupations – were used
only in nine (12%) of the studies.
As far as other organizational context characteristics are concerned –
namely, size and public versus private – we observed that the analyzed
articles did not always contain information about the size of the organi­
zation (n = 30, 40%) or whether it was a private or public company
(n = 27, 36%). However, among those that identified these characteristics,
the following was observed: 22 (29.3%), 12 (16%), and 11 (14.7%) had
collected data respectively from large, small to medium, and diverse or­
ganizations; while 26 (33.3%), 18 (24%), and 5 (6.7%) had collected data
respectively from public, private, and diverse organizations.
The vast majority of studies were quantitative (n = 69, 92%), cross-
sectional (n = 64, 85,3%), and reliant on the use of self-reported data
(n = 71, 94.7%). Only three were qualitative. Six had a longitudinal
design – four with two waves, one with three waves, and one with four
waves. Four studies reported interventions, and four used objective or
hetero-reported data.
Regarding the measures used, the vast majority of quantitative studies
(65 out of 72, 90.3%) used validated international scales (e.g., burnout:
Maslach Burnout Inventory (n = 36), work engagement: The Utrecht
Work Engagement Scale (n = 9), health: Health Perception (n = 4), mental
health: SF-36 (n = 2), well-being: Satisfaction with Life (n = 4) and GHQ
12 or GHQ 28 (n = 9), and affects and emotions: PANAS (n = 2).
However, some studies used measures developed in Portugal to analyze
the stress of healthcare professionals (one used in three studies and an­
other used in one study) and the stress of teachers and general stress and
happiness (each used only in one study).
As for the aim of the studies reviewed, we observed that more than
half analyzed health or well-being predictors (n = 48, 64%); four
examined health or well-being indicators as mediators; four studied
the consequences of health and well-being; 12 described the prevalence
of stress among workgroups; three reported the validation of a health
250 Maria José Chambel et al.
or well-being measure; and four analyzed the effects of an intervention
on health or well-being. Of the studies that researched antecedents,
half (n = 24) analyzed situational variables; 10 analyzed individual
variables; and 14 had a mixture of situational and individual variables.

Two Main Groups of Studies Found

The cluster analysis revealed two distinct clusters. The four conditions
(i.e., sample size, type of study, sample dimension, and work popu­
lation) retained in the final TSC analysis had a silhouette coefficient
of 0.50 – indicative of good data partitioning. The other variables
(i.e., data collection mode, work context, and well-being measure) did
not play an important role in clustering. The two clusters were of
different sizes – with 57 studies (76%) and 18 studies (24%) respec­
tively – and the type of study (e.g., cross-sectional, etc) was the main
cluster predictor.
Cluster 1 is characterized by cross-sectional studies, smaller samples
(i.e., fewer than 300 participants), exclusively quantitative approaches,
and several populations of healthcare workers. Cluster 2 consists of
longitudinal and mixed designs, qualitative and mixed approaches, lar­
gest sample sizes, and more diversified work population (cf., Table 11.2).
Approximately 78% (n = 14) of Cluster 2 studies had been published
in the last 5 years against 56% of the studies in Cluster 1 (n = 32), and

Table 11.2 Two-Step Cluster Analysis

Cluster 1 Cluster 2
(n=57) Cross- (n=18) Longitudinal
Sectional n (%) and Mixed n (%)

Type of study
Cross-sectional 57 (100) 5 (28)
Longitudinal and mixed 0 (0) 13 (72)
Qualitative versus quantitative
Qualitative 0 (0) 3 (17)
Quantitative 57 (100) 12 (66)
Mixed 0 (0) 3 (17)
Sample size*
>300 23 (40) 16 (89)
<=300 34 (60) 2 (11)
Work population main categories
Healthcare workers 34 (60) 5 (28)
Service employees 8 (14) 1 (6)
Teachers 4 (7) 0 (0)
Others 11 (19) 12 (67)

Note
*
The variable entered the TSA as continuous.
 Occupational Stress, Health 251
the computer-assisted web interview data collection mode had similar
proportions (28%) in both clusters. The paper-and-pencil mode re­
corded a higher level of use in Cluster 1 studies (67%) compared to
Cluster 2 (44%).

Discussion
The aim of this chapter was to review, summarize, and evaluate the
research on occupational stress, health, and well-being developed in
Portugal. Along with several inclusion criteria, our review focused on 75
studies. Our qualitative systematic literature review revealed that:
healthcare professionals were the most researched; quantitative and
cross-sectional studies were predominant; the majority of studies sought
to ascertain the causes of workers’ stress, health, and/or well-being,
while others pinpointed the level of stress or well-being in specific pro­
fessionals; and the majority focused on the negative side of occupational
stress, health, and well-being, and burnout took priority.

Professionals Studied
Health professionals, and nurses, in particular, have been recognized as
professions with job and work conditions that influence their stress,
health, and well-being (e.g., McVicar, 2005; Mark & Smith, 2012;
O’Connor, Muller Neff, and Pitman 2018; Riahi, 2011). Our systematic
review revealed that these were the most studied professionals in
Portugal; thus, supporting the idea that this population is vulnerable to
stress as a result of their occupational activity. However, other profes­
sionals, for example, teachers (e.g., Chambel & Ernesto, 2013), military
personnel (e.g., Chambel, Castanheira, Oliveira-Cruz, & Lopes, 2015),
policemen (e.g., Gomes & Afonso, 2016), airline pilots (Reis, Mestre, &
Canhão, 2013), and salespeople (Castanheira & Chambel, 2010) have
different work and job conditions that significantly affect their stress,
health, and well-being. Therefore, future studies should be developed
using samples of workers with other occupations.

The Studies’ Design

Our systematic review reveals that research on occupational stress, health,
and well-being in Portugal has been dominated by cross-sectional studies –
with a minority representing longitudinal studies. Moreover, if we use the
criteria of Kelloway and Francis (2013) that consider a longitudinal study
to be one that employs three or more waves, this review will only identify
two studies. Silva et al. (2017) sampled medical students and analyzed the
evolution of their depression, anxiety, and burnout over time. Neto
Carvalho Chambel Manuel Pereira Miguel and Reis (2016) used a sample
252 Maria José Chambel et al.
of workers of a service company to show the reciprocal effect between
work-family conflict and employee well-being for 18 months. Although
this predominance of cross-sectional studies has been identified as a
characteristic in occupational health literature (e.g., Häusser, Mojzisch,
Niesel, & Schulz-Hardt 2010; Luchman & González-Morales, 2013;
Taris & Schaufeli, 2016), it has a significant limitation. Cross-sectional
studies only enable an understanding of whether the relationship between
variables is significant but do not permit the establishment of unidirec­
tional causation (e.g., De Lange, Taris, Kompier, Houtman, & Bongers,
2003; Zapf, Dormann, & Frese, 1996). Thus, a cross-sectional approach
is inappropriate to show, for example, that specific personal, job-related,
or organizational characteristics influence workers’ stress, health, or well-
being. With this design, it is also possible that reverse causation may exist,
and workers’ stress, health, or well-being influence their occupational si­
tuation perceptions. Of the articles included in this revision, Ângelo and
Chambel (2015) sampled firefighters with a two-wave study and found
that the causal direction of the relationship between job demands and
burnout was reciprocal.
Future research with longitudinal designs that can address such pat­
terns of causation (e.g., cross-lagged panel designs) would be valuable to
identify the underlying processes associated with workers’ stress, health,
and well-being change and development. Mäkikangas, Kinnunen, Feldt,
and Schaufeli’s (2016) systematic review showed that changes in
workers’ well-being are more frequent than stability. We need more
evidence on the specific features of the job and organizational context
(i.e., training, human resource management practices, job insecurity,
organizational change) that may influence a change in workers’ stress,
health, and well-being.
This systemic review also shows that intervention studies are rare
in the available literature on workers’ stress, health, and well-being in
Portugal (Barbosa, Nolan, Sousa, Marques, & Figueiredo, 2014,
2016; Duarte & Pinto-Gouveia, 2016; Mesquita, Ribeiro, &
Moreira, 2011). The intervention studies not only provide valuable
information on the causal relationships, but also enable a systematic
examination of the organizational actions (e.g., training, actions, and
practices) and their efficacy to promote workers’ health and well-
being. Thus, researchers should be encouraged to employ more in­
tervention studies in order to increase the ecological validity of or­
ganizational actions and practices and consequently increase their
evidence-based nature.

Antecedents of Workers’ Stress, Health, and Well-Being

Our systematic review also reveals that the majority of studies analyze
the antecedents of occupational stress, health, and well-being and among
 Occupational Stress, Health 253
these, situational factors have been underlined. This observation is in line
with literature reviews (e.g., Babatunde, 2013; Nielsen, Nielsen,
Ogbonnaya, Känsälä, Saari, & Isaksson 2017) that also demonstrate the
relevance of job, work, and organizational factors in explaining work
stress and well-being. However, in regard to situational stress, health,
and well-being antecedents, this review makes it possible to distinguish
different study groups. The first group includes studies that analyze
different situational factors acknowledged by literature as having an
influence on occupational stress, health, and well-being, without con­
sidering the specific nature of sampled professionals. The studies that
used the CopSoq instrument to analyze the psychosocial risks are an
example: Alves de Moura Serranheira and Sacadura-Leite (2016) sam­
pled psychiatrists and anesthetists; Coelho Tavares Lourenco and Lima
(2015) sampled private administrative workers; Coelho Tavares Lima
and Lourenco (2018) sampled field workers; Coutinho Queirós
Henriques Norton and Alves (2019) sampled employees in a public
hospital; and Reis, Vale, Camacho, Estrela, and Dixe (2018) sampled
occupational therapists. In the same group, this systematic review ob­
served some studies that analyzed stressors underlined in literature as
situational factors with detrimental effects on occupational health and
well-being. As an example, da Silva João and Saldanha Portelada (2016)
sampled nurses to analyze the effect of mobbing, and Neto Chambel and
Carvalho (2018) sampled sales and contact center workers to analyze the
effect of the work-family – life – conflict. Finally, and also included in
this group, some studies performed an empirical test of a theoretical
model. For example, Gomes, Faria, and Lopes (2016) conducted a study
based on Lazarus and Folkman’s Model (Lazarus & Folkman, 1984) and
confirmed the importance of cognitive appraisal in the relationship be­
tween occupational stress and the psychological health of nurses. Ângelo
and Chambel (2014) sampled firefighters by expanding the Job
Demands-Resources (JD-R) model to include proactive coping in both
health impairment and motivational processes and observed that
proactive coping partially mediated the relationship between job de­
mands and burnout – as well as the relationship between job resources
and engagement.
The second group identified by this systematic review includes studies
that analyzed some of the specific characteristics of the professional
sample being studied. The assumption is that this occupation implies
high stressors that contribute to the emergence of stress or illness. For
example, Martins-Pereira Teixeira Carvalho, and Hernández-Marrero
(2016) analyzed professionals (i.e., nurses and physicians) working in
intensive and palliative care units – considering that they were at risk of
developing burnout due to their provision of end-of-life care for pa­
tients – and observed that conflicts (e.g., with patients and/or families
and intra and/or inter-teams) were the most significant determinant of
254 Maria José Chambel et al.
burnout. In the same vein, Maia and Ribeiro (2010) sampled emer­
gency personnel, considering that exposure to current death and events
of physical injury in the context of motor vehicle accidents, was a high
predictor of posttraumatic stress disorder (PTSD). However, the au­
thors found that peritraumatic dissociation and distress were the only
predictors of PTSD symptoms, but direct coping explained PTSD var­
iance beyond their contribution.
This systematic review also identifies a third group which seeks to
describe the participants’ stress – namely, their burnout level. The
assumption is that the sampled professionals are confronted with high
stressors and consequently have high levels of burnout. For example,
Maroco, Sacadura-Leite, Bastos, Vazão, and Campos (2016) reported
the incidence of burnout in healthcare professionals (i.e., nurses
and physicians); Cruz-Mendes, Claro, and Cruz-Robazzi (2014) re­
ported the levels of burnout among nurses working in prisons; and
Teixeira, Ribeiro, Fonseca and Carvalho (2013) reported levels of
burnout of physicians and nurses working in intensive care units. In
the same vein, the study of Marques, et al. (2018) described the levels
of burnout in health professionals, comparing different professional
groups of hospital staff and analyzing how the professional category is
associated with levels of burnout. These studies support the idea that
these professionals are vulnerable to burnout but do not contribute to
explaining why and how the development of this chronic stress in­
dicator occurs. They do not analyze the professional experiences of
these workers nor bring to light the levels of stressors they en­
countered, or explain whether the stressors they may have en­
countered were related to the fact that they had these occupations.
Furthermore, the studies identified in the third group of this systematic
review did not use a theoretical model to ascertain the occurrence of
burnout. For example, the assumptions of the Conservation of
Resources Model (COR, Hobfoll, 1989) should be used. These defend
that burnout occurs when a professional perceives high demands that
threaten something of value to him/her, and that threat or loss taxes or
exhausts the resources they have available to confront the situation. In
fact, these assumptions have been supported by the meta-analysis of
Lee and Ashforth (1996) - which showed that job demands were im­
portant predictors of burnout, by the meta-analysis conducted by
Alarcon (2011) – which observed that higher demands and lower re­
sources were associated with burnout, and by the systematic review of
Seidler et al. (2014) which indicated that high job demands, the low
possibility of exerting control, and non-supportive workplaces are
important to explain the development of burnout. Thus, we suggest
that future studies must analyze different situations with high de­
mands and low resources to explain the development of burnout in
Portuguese professionals.
 Occupational Stress, Health 255
The Consequences of Work Stress and Well-Being
There is evidence demonstrating that healthy workers perform better
than non-healthy workers (Motyka, 2019) or that burnout negatively
affects workers’ performance (Swider & Zimmerman, 2010; Taris,
2006). Despite the fact that our literature review shows that the con­
sequences of stress, health, and well-being are understudied, studies
analyzing their effect on workers’ performance support this relationship.
Indeed, Martinez and Ferreira (2012) sampled nurses from a public
hospital and observed that stress and health conditions predict pre­
senteeism. Neto, Ferreira, Martinez, and Ferreira (2017) sampled
workers from a service company and showed that bullying was related to
well-being and exhaustion, which in turn was related to presenteeism.
Lastly, Rodrigues, Paiva, Dias, Aleixo, Filipe, and Cunha (2018) showed
in an ambulatory study with air traffic controllers that stress had a ne­
gative effect on cognitive performance. Furthermore, this review also
reveals a study (Marques-Pinto et al., 2018) that analyzed the attitudinal
consequences of workers’ well-being, namely turnover intentions.
Moreover, and also in line with previous studies demonstrating that
burnout and engagement have consequences for health and job attitudes
(Maslach, Schaufeli, & Leiter, 2001; Taris, 2006; Taris & Schaufeli,
2016), Marques-Pinto et al. (2018) sampled nurses from hospitals and
showed that their decisional involvement was positively related to work
engagement and negatively to burnout which, in turn, predicted their
intentions to leave the hospital where they worked.
Future studies should analyze the effects of stress, health, and well-
being on professionals’ attitudes and behaviors and consequently help
organizations to develop preventive interventions and early identification
of this health condition in the work environment – contributing not only
to workers’ health, but also to the efficiency and effectiveness of these
organizations (Salvagioni, Melanda, Mesas, González, Gabani, and De
Andrade 2017).

The More Frequently Studied Negative Side

Another trend that is salient when revisiting literature on occupational
stress, health, and well-being in Portugal is a prevailing negative bias of
studies addressing illness rather than wellness. This is illustrated by the
fact that more than half of the publications had analyzed burnout. This is
not exclusive to the studies in Portugal. Indeed, Schaufeli and Salanova
(2007) listed the papers published on workplace well-being in the
Journal of Occupational Health Psychology between 1996 and 2005 and
found that, out of 233 manuscripts, only 14 referred exclusively to po­
sitive indicators. The authors found a ratio of 14:1 in favor of papers
focusing on mental illness. In the same vein, Macik-Frey, Quick, and
256 Maria José Chambel et al.
Nelson (2007) analyzed the literature on occupational health from 1990
to 2005 and confirmed that stress and burnout were the predominant
trends. It is important to create a shift in this tendency towards illness, as
failing to capture the positive aspects of work and inherent resources is
inappropriate and incomplete. As argued by Turner, Barling, and
Zacharatos (2002, p. 715), “… it is time to extend our research focus
and explore more fully the positive sides, so as to gain a full under­
standing of the meaning and effects of working”. Indeed, most organi­
zations expect their workers to take responsibility and initiative, to be
committed to the organization and the team, and to be involved with the
job and to feel accountable for high-quality performance.
Hence, we need more studies that address the positive sides of work
and the effective functioning of Portuguese professionals. Literature on
stress and health has demonstrated that illness and health can be ex­
plained by different variables – the threat of loss or availability of re­
sources; Hobfoll, 2002 - and we now have extensive evidence showing
how the loss of resources is associated with feelings of illness, while the
availability of resources is associated with health and well-being
(Nielsen, Nielsen, Ogbonnaya, Känsälä, Saari, & Isaksson, 2017). In
line with the assumption that the loss of resources explains stress and
illness, for example, Joaquim et al. (2017) sampled medical residents of
oncology, hematology, and radiotherapy and found that “dealing with
patients” and “overwork” were important predictors of stress, and
overwork was directly related to burnout. Showing that resources should
prevent stress and illness in a resources loss situation, Martins-Pereira,
Teixeira, Carvalho, and Hernández-Marrero (2016) sampled profes­
sionals from intensive and palliative care units and observed that higher
burnout levels were significantly and positively associated with experi­
encing conflicts in the workplace, but having post-graduate education in
intensive/palliative care was significantly but inversely associated with
higher burnout levels. Confirming the role of resources in the promotion
of well-being, Correia de Sousa and van Dierendonck (2014) sampled
workers from two merging companies and showed that servant leader­
ship was positively related to organizational identification and psycho­
logical empowerment which, in turn, was positively related to work
engagement.
Having argued the need to increase focus on well-being and good
functioning, we also believe that it is important to continue to study
stress and illness. Hence, research on occupational stress, health, and
well-being would benefit from more studies that are simultaneously ac­
counting for positive and negative indicators. The very few Portuguese
studies that examine both positive and negative indicators (Ângelo &
Chambel, 2014, 2015; Carvalho & Chambel, 2015, 2017; Chambel,
Carvalho, Cesário, & Lopes, 2017; Marques-Pinto, et al., 2018) focused
on the antecedents of burnout and engagement and treated them as two
 Occupational Stress, Health 257
independent parallel indicators. Therefore, there is still much to explore
on the potential interaction effects between these two workplace well-
being indicators. In line with Schaufeli and Taris (2014), the develop­
ment process of engagement and the development process of burnout
should not be independent. Thus, future research should deepen this
research line and analyze both processes jointly – namely, the role of
engagement in burnout development and vice-versa.

Conclusions
By means of the present systematic review, it was possible to elaborate
on several theoretical and practical considerations. From a theoretical
point of view, we noted that, to date, there is a remarkable prevalence of
studies focusing on antecedents rather than the consequences of stress
and these underline mental illness rather than mental wellness.
From a practical perspective, we are also able to elaborate on some
final considerations. For instance, within a methodological scope, this
systematic literature review has clearly highlighted a number of the
limitations of previous studies that should be overcome in future re­
search. Firstly, the predominant cross-sectional design of previous stu­
dies – which does not enable inference of the causal relationships among
the variables and does not present a picture of the occupational stress,
health, and well-being evolution – levels across time. Secondly, the
majority of studies analyzed healthcare professionals, while other pro­
fessionals that are also characterized by high stressors have either not
been studied or are only studied occasionally. Finally, and still from a
practical point of view, the present systematic review has allowed us to
ascertain that occupational stress, health, and well-being consequences,
compared to the analysis of antecedents, have received less interest from
researchers. Thus, we suggest that future studies should observe the ef­
fects of occupational stress, health, and well-being. Smaller studies and
cross-sectional designs may be associated with an online data collection
mode and, therefore, they are easier and less expensive to perform, and
are useful for academic proposals. Longitudinal designs are time-
consuming, yet more robust designs are needed, along with a more di­
versified work population, in order to understand the specific context of
Portugal. Notwithstanding, the two clusters obtained showed that an
increased tendency to perform studies with large samples, and a long­
itudinal design has been observed in recent years – as shown in Cluster 2.
These findings are of interest to national authorities that need quality
information in order to plan prevention and health promotion programs,
and, therefore, these types of studies should be encouraged and
supported.
In short, the current work has contributed to summarize all the em­
pirical evidence obtained to date on Portuguese workers’ stress, health,
258 Maria José Chambel et al.
and well-being, and, by doing so, it has highlighted future pathways for
the research of occupational stress, health, and well-being in this
country.

Note
1 When the Journal was classified with more than one area, we chose the area of
work of the first author.

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12 Organizational Stress in Russia
Natalia Ermasova, Natalia Rekhter,
and Sergey Ermasov

Introduction
Work-related stress is an issue of growing concern in developing coun-
tries due to globalization and the changing nature of work. The impact
of stress can be seen in many aspects of human life. It is evident in the
feelings and perceptions of people when they do not have enough time,
skills, or resources to effectively handle personal or professional de-
mands (Hyde & Allen, 1996; Nichols, 2008; Selye 1956, 1974).
Research has indicated that work-related stress is considered a disease or
a cause of disease (Selye, 1956, 1974; Doublet, 2000; Kinman & Jones,
2005; Nguyen, Kass, Mujtaba, & Tran, 2014). Stress in the workplace
not only impacts individual performance, but also the organization’s
effectiveness as a whole. Work-related stress may affect the organiza-
tion’s effectiveness due to the costs associated with increased ab-
senteeism and staff turnover, replacement of absent workers, increased
unsafe working practices, accident rates, complaints from clients/custo-
mers, and reduced productivity, performance, and profitability of
organization (Nguyen et al., 2014).
The purpose of this study is to examine the level of stress in Russia. We
chose Russia for several reasons. Russia is the eighth largest economy in
the world by nominal value – with an estimated GDP of $2,117.8 billion
in 2016 (Australian Government-Department of Foreign Affairs and
Trade, 2014). According to the Russian Federation Federal State
Statistical Service, Russia had a population of about 143.3 million in 2016
and is considered the largest country in the world in terms of geographic
territory. Russia’s labor force consists of 75.24 million workers or 52.8%
of the total population.
Russia has emerged as one of the key players in the world – both
politically and economically. Since the collapse of the Soviet Union,
Russia has made remarkable improvements to become more open in
terms of its market and global integration. With its membership in the
World Trade Organization (WTO) in 2012, Russia has strengthened its
position in the world economy and has opened more opportunities for its

DOI: 10.4324/9780429292538-12
 Organizational Stress in Russia 269
international trade. However, recently, the political and economic en-
vironment in Russia has shifted to more restricted norms. These fluc-
tuations made Russia uniquely positioned in terms of changes in cultural
norms and behaviors, peoples’ motivation, and entrepreneurship
(Nguyen et al., 2014). The above observations make it important to
analyze the current developments in Russia. According to the Russian
employment agency Unity, about 35% of managers’ willful termination
of employment declared that one of the main reasons for this dismissal is
stress at work. In addition, there has been limited number of research
examining work-related stress in Russia. This paper expands the body of
knowledge of stress management and provides practical implications for
managers who work with this specific population. In addition, by using
a widely accepted questionnaire survey created in the United States on a
Russian sample, this study further fulfills the need to validate such
instrument for cross-cultural comparison purposes later on.

Literature Review

Work-Related Stress
According to Ellis (2006), stress is “a sequence of events with the pre-
sence of a concern about successful performance and fear of negative
consequences resulting from performance failure, which evokes powerful
negative emotions of anxiety, anger, and irritation”. The more encom-
passing definition is provided by Nguyen, Mujtaba, and Boehmer (2012)
who states that “stress can be all those feelings and perceptions in
lack of time, ability, skill, or resources to effectively deal with personal
or professional demands in a given time” (p.13). Stress describes the
individual’s perception of the psychological situation – which becomes
a critical factor (Fell, Wayne, & Wallace, 1980; Folkman & Lazarus,
2015; Finn, 1997; Goldbaum, 2012; Gorelova, 2013; Halder &
Mahato, 2013).
Research related to different aspects of stress is typically viewed as a
subspecialization within medical sociology – a perspective that obscures
commonalities with more traditional sociological areas of inquiry –
especially social stratification. (Aneshensel, 1992). Pearlin (1989) sug-
gested that stress research tends to be concerned less with the
consequences of stressful life experience than with outcomes of illness –
especially psychological disorders.
Various research associates stress with the multiple roles each in-
dividual plays in life. For instance, Bolino and Turnley (2005) found that
the higher levels of individual initiative are associated with higher levels
of employee role overload, job stress, and work-family conflict. They
asserted that the relationship between individual initiative and work-
family conflict is moderated by gender. Their findings suggested that the
270 Natalia Ermasova et al.
relationship between individual initiative and work-family conflict is
stronger among women than among men.
There are authors who analyze occupational stress across diverse
occupations. Johnson et al. (2005) compared the experience of occupa-
tional stress across a large and diverse set of occupations and found that
six occupations (i.e., prison officers and the police, ambulance workers,
teachers, social services, and customer services – call centers) in the
United Kingdom are reporting worse than average scores on each of the
factors – physical health, psychological well-being, and job satisfaction.
Some authors analyzed the differences in work overload stress per-
ceptions of working adults in different countries. In a series of cross-
cultural studies, Vietnamese working adults appeared to experience
more work overload stress than their German, Dutch, Russian, and
Japanese counterparts (Nguyen et al. 2012; Nguyen, Lee, Mujtaba, &
Ruijs, 2013; Nguyen, Ermasova, Pham, & Mujtaba, 2013; Nguyen,
Mujtaba, & Pham, 2013; Nguyen et al., 2014). Nguyen et al. (2012)
found that German working adults appear to experience more work
overload stress than Dutch working adults. However, no significant
difference in stress scores was found between German and Japanese
working adults (Nguyen et al., 2014).
A study by Ivanova (2014) analyzed the effect of having full-time or part-
time jobs on the stress level of full-time undergraduate students in Russia.
The survey conducted among 2,804 such students from eight regions of
Russia revealed that, among the students who had full-time or part-time
jobs (54.3% of participants), 31.4% of men and 43.5% of women reported
feeling stressed at work; and the same percentage of students reported
feeling severely fatigued due to pressure and exhaustion of combining work
with studying. An additional 10.2% of men and 15.4% of women reported
feeling severely fatigued and stressed at the same time.
Shevchuk, Strebkov, and Davis (2018) suggest that “working time
adversely influences satisfaction with work-life balance. The presence of
extrinsic values reduces satisfaction with work-life balance, while the
presence of intrinsic values improves satisfaction with work-life balance”
(p. 747). It could be explained that the same job is associated “with more
positive psychosocial outcomes for people who value the work itself as
opposed to people who value material rewards and conditions. They are
able to secure emotional rewards from the work process itself”
(Shevchuk et al. (2018, p. 739).
Beehr, Walsh, and Taber (1976) analyzed work-related stress of
79 male and 64 female members of a white-collar union employed in
drafting, mechanical, and technical-clerical jobs in a Midwestern man-
ufacturing company. They found that some effects of role stresses on
individually valued states were incompatible with their effects on three
organizationally valued motivational states: involvement, an effort
toward quantity, and an effort toward quality.
 Organizational Stress in Russia 271
Stress can be positive and motivating when it is short. For example,
when one needs to urgently submit reports, sometimes, the work is done
more efficiently under the pressure of a deadline. Moreover, work in
conditions of constant scarce resources – including time – is a mid-level
stressor. Similar tension occurs when a person has: (1) difficulty in
dealing with employers, (2) worries about career development, and
(3) contradictory tasks. The risk of serious and chronic stress increases
when there are sudden changes in working conditions or when a person
is deprived of the support of colleagues, family, and leadership. Stress is
formed from a combination of these factors and the inability to relax.
The results of constant work-related stress are complex somatic pa-
thology, reduced adaptive abilities of the organism, and chronic fatigue
syndrome. The symptoms of work-related stress are fatigue, weakness in
the morning, frequent headaches, insomnia, conflicts, or susceptibility
to loneliness.
Many scholars prove a connection between chronic job stress and a
host of negative outcomes among police officers (Ermasova, Cross, &
Ermasova, 2020; Keinan & Malach-Pines, 2007; Kerley, 2005; Larned,
2010; Lazarus & Folkman, 1984; Lindsay, 2008). Stress can lead to
depression, and depression can lead to negative coping techniques such
as violence, alcohol, and substance abuse (Larned, 2010; Lazarus &
Folkman, 1984; Violanti, 2001; Violanti et al, 2011). There is a long-
itudinal study by Gafarov, Gromova, and Panov (2019) on the impact
of work-related stress on the risk of cardiovascular diseases. The study
that was conducted over a 16-year period among 1,346 men and
women in Siberia, Russia revealed that the risk of having cardiovascular
diseases among people who are experiencing work-related stress is
3.6 times higher for men and 3.2 times higher for women, compared to
individuals with no or low work-related stress. Similar results were
found by Kivimäki and Kawachi (2015) in their research consisting of
232,767 respondents who demonstrated that the risk of cardiovascular
diseases among people with the reported high-stress jobs was 1.26 times
higher than the risk among people with low or no risk jobs.

Economic and Social Stress in Russia and Its Impact on

Work-Related Stress
Yiu, Bruton, and Lu (2005) argued that the early Russian transition
experience provided uniquely important insights into the historic char-
acteristics of business groups, because it represented a case in which
market failures were important; the institutional transition was in place;
and business groups were young and newly formed. Since the beginning
of Perestroika or “openness” in 1987, the business environment in
Russia has been turbulent and unpredictable (Holt, Ralston, & Terpstra,
1994; Puffer, 1996). Ermasova (2013) highlighted a high level of
272 Natalia Ermasova et al.
uncertainty in economic, investment, and social aspects of life and
business in Russia. In the case of Russia, Carr (2006–2007) showed that
the effect of the unstable and uncertain economic environment in the
country had an impact on the strategic decisions of the Russian people.
Alexander Moskvin, the Scientific Director of the clinic Infoecology
Social Stress Clinic, said in his interview in Gorelova (2013) that
“Negative social factors have much more influence on the stress level of
managers in Russia than their foreign counterparts”. He highlighted the
following reasons of the high-stress level of managers in Russia: (1) the
general situation in the country, (2) the uncertainty, which increases
negative expectations, (3) distrust of people, (4) the lack of uniform rules
in business, and (5) the constant changes in accounting and legislature
that do not allow managers to develop a sequence of actions.
According to Gupta, Shipp, Nash, Herrera, and Healey (2013), Russia
has been a diverse and socially volatile country. Although the country is
considered politically Russian, 20% of its population is comprised of
ethnically non-Russian minorities. There are over 100 minority lan-
guages in various regions. A considerable body of research suggested that
ethnic or racial hostility and their behavioral expressions were likely to
be relatively more intense in areas where minorities comprise a smaller
segment of the population than in other areas (Kleinpenning &
Hagendoorn, 1993; Levin & McDevitt, 1993; Dekker, Malová, &
Hoogendoorn, 2003; Gudkov, 2003).
Russia experienced economic crises in 1992, 1998, 2008, and 2016 to
2017 that led to the dramatic impoverishment of the population, social
anxiety, and high levels of stress. These crises brought a lot of financial
and social problems to Russia – including a high level of inflation and
unemployment. Russia experienced two serious economic crises in 1992
and 1998 that were accompanied by a drop in personal income and rapid
impoverishment. The start of the transition period – a “shock therapy” –
occurred in 1992 after a political decision to accomplish a rapid tran-
sition to a market economy. In 1992, consumer prices grew 3.5 times
faster than wages and exploded by 2,500% (Goskomstat, 1993;
Klugman& Braithwaite, 1998). As a result of these dramatic changes in
the economic and financial situation, the life expectancy of Russian
males dropped from 63.8 to 57.7 years from 1992 to 1994. Female life
expectancy dropped from 74.4 years to 71.2 years (Gavrilova,
Evdokushkina, Semyonova, & Gavrilov, 2001). Gavrilova and Gavrilov
(2011) suggest that “each economic crisis was associated with a rapid
increase in stress-related violent mortality. On the other hand, new
factors (hazards) related to the unsafety of social environment and young
age mortality are becoming more and more significant” (p.18).
In addition to the decrease in the life expectancy, the economic “shock
therapy” led to the increase in the so-called “social” diseases – such as
depression, alcoholism, drug abuse, and suicidal attempts – which are
 Organizational Stress in Russia 273
caused by a chronic and acute state of stress and are currently afflicting
the majority of the population in Russia (Shtemberg, 2014).
The 2008 economic and financial crisis in the United States of America
was contingent for the Russian economy. Grima and Caruana (2017)
found that “the dependency on the United States is more persistent in
countries which depend on commodity prices, such as Brazil and Russia,
rather than for countries whose economic growth is dependent on
finished products, such as China and India” (p.729).
The World Trade Organization 2007 Report (2007, p. 1) highlighted
the problem of work-related stress in Russia. Working adults in Russia
are “subjected to rapid and drastic economical and social changes –
where there is an increased demand for the adaptation of workers, the
overriding of traditional values, the reorientation of the occupational
health system, and generally poor working conditions”. Psychosocial
stress has increased as a result of the unprecedented changes in Russia’s
economic condition and the reduction of “safety net” services. During
the time of transition, the population of the Russian Federation had to
deal with: (1) the increased demands of learning new skills, (2) the need
to adopt new ways of working, (3) the pressure of the demand for higher
productivity and higher technical and computer skills, (4) the demands
for increased quality of work and time pressure, (5) higher job compe-
tition, (6) increased job insecurity and fewer benefits, and (7) less time
for co-workers and socializing. Moreover, the majority of people lost
their life savings, were deprived of their social benefits, and experienced a
higher level of corruption and criminal activities. All these changes
caused an increase in the stress level among the Russian population –
resulting in psychotic, stress-related disorders (Shtemberg, 2014). For
instance, the number of psychotic, stress-related disorders for 1,000
adults in Russia has increased from 16.5 in 1950 to 1970 to 31.1 in 1971
to 1995 (Schepin, 1998). The number of psychotic, stress-related dis-
orders among children from newborn to 14 -year-olds was 6.3 cases for
every 100,000 children in 1990 and 13.3 cases in 2000 (Gurovich,
Voloshin, & Golland, 2002). According to Dmitrieva, a Director of the
State Research Center of the Social and Criminal Psychiatry and also a
Minister of Health of Russian Federation in 1997, 61,5% of the popu-
lation of the Russian Federation requires some type of the psy-
chotherapy, and 40% of the population suffers from the various
psychological disorders – a majority of which are caused by stress (in
Shtemberg, 2014).
Based on the report from the World Health Organization (WHO)
(2011), the number of suicides in Russia is between 26 to 39 suicides per
100,000 of the population, depending on the source of the report. In
some regions – Volgo-Vyatski, East and West Siberia, the Far East, and
Ural – the number of suicides reaches 81 cases per 100,000 of the
population, and in the Republics of Komi and Udmurtia, it reaches
274 Natalia Ermasova et al.
150–180 cases per 100,000 of the population. These numbers are at least
three times as high as the average rate of suicide in all other developed
world countries. Half of the people who committed suicide in Russia are
30 years old or younger. Meanwhile, according to the WHO, if the
number of suicides in a country exceeds 20 or more cases per 100,000 of
the population, then this is a reflection of the country’s deep psycholo-
gical and social crises. Shtemberg (2014) asserts that the dynamic of
the suicide rate in Russia from 1990 to 2000 is reflective of the Stress
Theory – which describes three levels of stress and stress-related beha-
vior. During the first phase, the increase in stress levels leads to a rapid
increase in suicide rates. This phase is followed by the adaptation and the
decrease in the suicide rate in the environment where stress level remains
high. The third phase – exhaustion – results in another spike in the
suicide rates. All three phases of the Stress Theory have presented
themselves in Russia during the last three decades.
Declining health status was also closely connected to stress-induced
illnesses. In a study conducted in 2018 among 1,500 respondents in the
two Russian cities of Vologda and Cherepovetc, it was revealed that
among respondents who reported experiencing stress often or very often,
18% reported having regular headaches, 35% had regular illnesses, 9%
had a stress-related short-term disability, 7% had a stress-related long-
term disability, and 34% experienced stressed-induced various chronic
conditions. This is in comparison to the corresponding 9%, 16%, 2%,
2%, and 26% of the same conditions among respondents who reported
seldomly experiencing stress. Among respondents who reported having
regular stress, 12.7% evaluated their health as poor compared to 6.1%
of respondents who reported having no or low stress in their lives
(Korolenko, 2019).
Besides this, various global and local changes led to increasing de-
mands on a growing number of workers. When workers are unable to
deal with these demands, work-related stress may result. When stress
persists or occurs repeatedly, it can have various negative effects on
workers and the companies they work for. Psychosocial stress may
manifest itself as depression, anxiety, domestic violence, an increase in
smoking, work injures, an increase in alcohol consumption, and divorce.
In Russia, managers have to spend a lot of effort on defending
themselves in response to pressure from top managers; this can cause
stress. Another feature of Russian corporate stress is the habit of
bringing personal problems to work. Russian leaders traditionally
broadcast their emotions on subordinates (Matveev, 2002).
Bokhan et al. (2018) found that the “lack of mutual understanding in
the family may lead to depression, estrangement, a decline in psycho-
logical and physical health, and a decrease in the partners’ ability to
work” (p. 52). According to the World Population Review (2019),
Russia has a significantly high level of divorces (4.7 per 1,000 of the
 Organizational Stress in Russia 275
population). Russia also has the highest rate of divorce in the world since
2011. According to the United Nations data from 2011, Russia’s divorce
rate was 4.8 divorces for every 1,000 residents.
Additionally and recently, Russians became one of the top users of
social network sites (SNS). There is an estimated number of 73.1 million
SNS users in Russia or approximately 51.9% of the entire population
(comScore, 2013, The Statistical Portal, 2019). Russians also rank third
in the world in terms of the number of minutes each user spends on
SNSs. On average, users devote approximately 58 minutes a day inter-
acting with various pages, groups, and events (The Statistics Portal,
2019). According to different research sources, social media can play the
role of both a stressor and a stress reliever in various circumstances –
including work-related stress (Harzer & Rush, 2015; Powell, 2019).
There are a plethora of positive aspects associated with the use of
social media, such as, for instance, instant connectivity with like-minded
people, enhanced access to a large spectrum of informational sources,
rapid knowledge sharing, possibilities of crowdfunding, and the like
(Brufonski, 2012; Amedie, 2015; Deen and Hendricks, 2012). However,
there are also social media-associated concerns and problems. Several
studies have identified a phenomenon called “Facebook depression”.
The phenomenon, that received its name from the most popular social
media platform, describes stress caused by the pressure of staying en-
gaged and seeking acceptance and approval of virtual friends. This type
of stress is particularly persistent among teenagers, who feel the need to
be perpetually engaged in texting, instant messaging, posting, liking,
sharing, replying to posts, and seeking reassurance of their actions,
opinions, and appearances from their peers. Often, this type of social
media behavior causes anxieties, which can lead to depression and oc-
casionally even suicidal behavior (O’Keeffe & Clarke-Pearson, 2011;
Amedie, 2015).
Recently, studies have brought into discussion another stressor caused
by the presence of SNS. The cause of stress is a sense of apprehension or
even fear that other people might be having rewarding experiences from
which one is absent. The stressor received an unofficial title of “Fear of
Missing Out” (FoMO) and is associated with the feeling of fear, worries,
anxieties, depression, and stress (Przybylski, Murayama, DeHaan, &
Gladwell, 2013, Beyens, Frison, & Eggermont, 2016). The type of stress
that can be linked to FoMO, such as, seeing Instagram, Snapchat, or
Facebook pictures of events in which teenagers were not invited, re-
ceiving no likes on their posts, and other similar instances (Fox &
Moreland, 2015, Beyens, et al., 2016). Studies by Chion, Lee, and Liao
(2015) and Rekhter and Hossler (2019) reported that many SNS users
exhibit distress when, for some reason, certain SNS were not available
for them or when their smartphones went missing because of the FoMO
of being socially excluded.
276 Natalia Ermasova et al.
Social media sites – such as Instagram, Pinterest, Facebook, and
blogging – provide opportunities for enhanced image perception which,
consequently, leads to creating an environment of unrealistic and un-
achievable images of perfection (e.g., perfect surroundings, perfect food,
perfect careers, perfect bodies, perfect lives, etc.). Several studies have
demonstrated that this superficial imagery and struggle for virtual ex-
cellence and flawlessness can cause depressive anxiety as well as long-
term emotional and psychological problems (Amedie, 2015; Fardouly,
Diedrichs, Vartanian, & Hallwell, 2015).
Another problem with work-related stress is that drinking is one of the
major coping mechanisms for Russians. Some researchers consider social
stress as a major determinant of the sharp increase of drinking in Russia
(Pridemore, 2002; Shapiro, 1997; Vlassov, 1999). Pridemore (2002)
highlights that rates of alcohol consumption and homicide in Russia are
among the highest in the world, and already-high levels have increased
dramatically after the collapse of the Soviet Union. Russian culture is
more tolerant of those who drink in excess and are more accustomed to
personal and social problems that follow drinking (Pridemore, 2002).
Cockerham, Hinote, & Abbott (2006) found that “females carried a
much heavier burden of psychological distress than males, but this dis-
tress did not translate into greater alcohol consumption and smoking for
these women or for men” (p.2381).
A specific problem of work-related stress is the presence of two work-
forces in many Russian firms. The first consists of older workers who have
a traditional Russian mindset and resist change. The second workforce is
made up of young, aggressive “New Russians” who are generally eager
to adapt. Members of this group are driven by career ambitions and often
have some training in business and English or a few years’ experience
working for a foreign firm in sales or marketing. It also appears to be a
common pattern to place younger workers in charge of older ones early
in their careers, thereby adding to the tension in the workplace. This
indicates that Russians with different age groups may have different
perceptions of work-related stress.
The study by Ermasova, Nguyen, and Bruce (2017) found that
Russian working adults in this sample perceived moderate work
overload stress. They did not find any significant difference in the
overload of stress scores of Russian working adults based on age,
gender, level of education, work experience, and management ex-
perience. Ermasova et al. (2017) found a significant difference in the
overload stress scores of Russian working adults based on religion.
Muslim practitioners had the highest scores compared to Christian
and non-practicing groups. Religious minorities may feel more
stressed because of how they feel about ethnic or racial hostility and
their behavioral expressions.
 Organizational Stress in Russia 277
Conclusions and Recommendations
Russian citizens lived through a unique political and economic transition
in the 1990s; there were many financial and economic crises. These
changes not only created new challenges, but also resulted in a high level
of stress in the country – including a high level of work overload stress.
It is important to be aware of the role played by Russian history and
culture, as well as the unique social, political, and economic circum-
stances that the nation faced. According to Pietilä and Rytkönen (2008),
“stress, as a concept, has emerged in a wide range of different institu-
tional sites – such as the media and public health policy – and has be-
come a discursive entity of contemporary social life in Russia” (p. 327).
The high level of stress is combined with unhealthy coping methods in
Russia. “Many people turn to unhealthy coping methods when it comes
to handling stress – such as overeating, drug or alcohol abuse, procras-
tinating, or sleeping too much – and, while these will offer temporary
relief, in the long run, they can do more harm than good” (Jones, 2011).
Russia has the highest level of alcohol consumption and divorce rate in
the world.
Future studies should look into different types of work-related stress
in addition to overload stress. Finally, this study only focused on Russian
respondents. Future studies should examine the stress perception of
people from different countries for comparative purposes, since the
workforce has become more globalized and diverse now more than ever.

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13 Occupational Stress in South
Africa
From the Past to the Fourth
Industrial Revolution
Claude-Hélène Mayer and
Rudolf M. Oosthuizen
Introduction
The stress level in South African workplaces was already described in the
1990s as one of the highest in the world (Van Zyl, 2002). According to
Nevid, Rathus, and Greene (2017), stress refers to “the strain or pressure
placed on an organism to adapt or adjust”. Stress is regularly described
as a feeling of being overwhelmed, worried, or run-down; it can affect
human beings for a long time and is frequently accompanied by an un-
comfortable “emotional journey” – which triggers biochemical, phy-
siological, and behavioral adjustments. Stress, in addition, can be
described as a physiological and intellectual response to any undertaking
or stimulus – which creates a disturbance or imbalance of the mind-body
system (Plessis & Smith, 2013).
Almost 20 years after Van Zyl’s (2002) stress research, South African
organizations are still described as highly stressful contexts affecting the
drastic growth of stress-related illnesses and psychological issues in and
beyond workplaces (Bismilla & Gantley, 2018). This is particularly due
to not only the aspects relating to the transition into the Fourth
Industrial Revolution (4IR), technological adjustments, higher risk fac-
tors, and lifestyle changes in a globalized work environment, but is also
due to the intrasocietal changes within the South African society, de-
creasing economic stability, political challenges – such as corruption and
crime, and financial as well as educational downhills. South African
scholars Cilliers and Flotman (2016), stated that the 21st Century world
of work is known for its growing sources of stress, brought about with
the aid of the demands of the Fourth Industrial Revolution, new
economy, non-stop change, transformation, globalization, complexity,
uncertainty, and alienation. Not being able to cope with these needs
results in negative stress – or distress – manifesting among personnel as
negativity, poor decision-making, emotional alienation, ineffective
system and people management, and an increase in autocratic and
bureaucratic leadership.

DOI: 10.4324/9780429292538-13
 Occupational Stress in South Africa 285
Various organizations, such as workplace health organizations and
insurance companies, warn of increasing disability claims due to psy-
chological, psychiatric, and mental disorders (Old Mutual Corporate,
2017). At the same time, selected organizations have put interventions
and strategies in place to decrease stress in organizational contexts – such
as applying stress evaluations to identity stressors (Ngope, 2019), in-
creasing salutogenic functioning and sense coherence as coping me-
chanisms (Oosthuizen and Van Lill, 2008), and developing integrated
organizational health frameworks (Hart & Cooper, 2001) and organi-
zational strategies to combat stress at work (Adams, 2007). Stress levels
have been measured in regard to their causes within and outside South
African organizations over several decades to determine the causes of
stress and to intervene with the appropriate interventions and tools (Van
Zyl, 2002; Oosthuizen and Van Lill, 2008; Oosthuizen, 2019).
The aim of this chapter is to present an insight into selected facets
of stress and its management in theory and practice within the South
African occupational and organizational work context. It provides con-
textual information on the South African society in the past, the present,
and the fourth Industrial Revolution work contexts. Conclusions and
recommendations for future theory and practice are given.

Stress in South African Occupations: General Findings

As highlighted in the introduction, stress experiences and stress research
have a long tradition in South African occupations and organizations
(Van Zyl, 2002; Barnard, 2013; Van den Berg & Van Zyl, 2008; Van der
Colff & Rothmann, 2009; De Beer, Pienaar, & Rothmann, 2016).
Within the occupational and organizational stress research, South
African research shows that stress experienced in the organization and at
work strongly interlinks with the experience of burnout and often leads
to the ill-health of employees (Van der Colff & Rothmann, 2009).
Most often, psychosocial stress at work is skilled because of challenges
stemming from a challenging environment and tasks that are difficult to
meet. Thus, due to the chance of failure, this evokes severe negative
emotions alerting physiological responses. As indicated before, most
employees in the 21st Century are threatened by psychological stress,
particularly in the workplace, which has detrimental effects on the
economic system of any country. An investigation was conducted in
South Africa which indicated that occupational stress creates an emo-
tional environment that can be transmitted to the home and affects the
dynamics of household life. Work stress no longer affects only the em-
ployee, but also spills over and influences different human beings with
whom the person interacts – such as their spouse and children. High
stress levels in South Africa have further been related to various different
factors – such as high divorce rates, high numbers of accidents, high drug
286 Claude-Hélène Mayer and Rudolf M. Oosthuizen
consumption (Van Zyl, 2002) – but also to interracial conflicts and
unhealthy competition at work. Nevid et al. (2017) note that a stressor is
a supply of strain which includes mental elements – for example, ex-
aminations at university and problems in social relationships, existence
adjustments such as the death of a cherished one, divorce, or career
termination. Prolonged or excessive stress can overtax the coping ca-
pacity of people and cause states of emotional distress – inclusive of
anxiety or despair – and bodily harm, which includes fatigue and other
complications.
Work stress has been associated with out-of-workplace contexts –
such as marital relationships, parenting, and psychological adjustment
(Van Zyl, 2002). Oosthuizen and Koortzen (2007), indicate that the
causes of stressors arising outside the work situation are characterized by
marital dysfunction and divorce, limited time with family, problems with
children, and lifestyle factors such as the abuse of alcohol, excessive
smoking, and lack of exercise. In addition, the causes of stressors ori-
ginating within the work situation manifest in terms of task character-
istics, organizational functioning, physical working conditions and job
equipment, career and social matters, remuneration, fringe benefits, and
personnel policy. The degree of shift work, overloading, underloading,
and traumatic incidents are identified as main task characteristic stres-
sors (Oosthuizen & Koortzen, 2007). In addition, Van Zyl (2002)
mentions that it appears that stress and associated health problems result
in high losses within organizational contexts. Each year corporations
are forced to allocate a large share of their running expenditure just to
supply employee well-being benefits – resulting in greater customer costs,
decreasing profits, or both (Ngope, 2019).
Coetzer and Rothmann (2007) have pointed out that high incidents of
competition and rivalry between organizations, particularly in the in-
surance industry, lead to high-stress levels, ill-health, and decreased em-
ployee well-being. Other research contributes to the findings by
highlighting that workplace incivility causes stress and, related to that,
other physical illnesses – such as heart disease and migraines (Smidt, De
Beer, Brink, & Leiter, 2016). Furthermore, stress in the South African
workplace is caused by shame, shameful experiences, and failure experi-
enced in the workplace (Mayer, Viviers, & Tonelli, 2017). Within the
context of research on health and well-being, Barnard (2013), as well as
Van den Berg and Van Zyl (2008), have highlighted that a low sense of
coherence might be related to high-stress levels within the South African
society. Mayer and Barnard (2015) have further pointed out that stress
levels are particularly high in South African society and among women in
the workplace. It can thus be assumed that members of minority groups
within South African workplaces or organizations ̶ particularly those with
a low sense of coherence – might experience even higher levels of stress
than members of other groups and of individuals with a high sense of
 Occupational Stress in South Africa 287
coherence. Some South African researchers have highlighted that 10% of
the total burden of diseases in South Africa are neuropsychiatric disorders
(Lopez, Mathers, Ezzati, Jamison, & Murray, 2006), and according to
Tomlinson, Grimsrud, Stein, Williams, and Myer (2009), these psycho-
logical and neuropsychiatric disorders are strongly interlinked with stress.
Other research in South Africa points out that occupational stress
occurs particularly due to inadequate workplaces, which, for example,
have inadequate sanitary facilities or extremely high temperatures
(Venugopal et al., 2016). Nunfam, Adusei-Asante, Van Etten, Oosthuizen,
and Frimpong (2018) also emphasize that employees’ experiences are
stressful because of heat due to climate change and a change in workers’
health and safety conditions. With heat stress, employees experience social
impacts, as well as heat illnesses, injuries, productive losses, inadequate
social well-being, and deaths. These new work stresses need to be ad-
dressed by individual adaptation strategies, as well as by policy decisions.
Other researchers, such as Chetty, Coetzee, and Ferreira (2016), have also
pointed out that changes in the workplace can cause stress in South Africa.
They have studied particular psychological reactions and characteristics to
understand reactions to change and have highlighted that stress perception
increases when job embeddedness is low and when employees are not well
prepared for changes.
Van Wyk, de Beer, Pienaar, and Schaufeli (2016) look at occupational
stress from a completely different point of view. They highlight that
workplace boredom within the South African workplace context can also
be interlinked with experienced stress. Sieberhagen, Rothmann, and Pienaar
(2009) support the findings and highlight that work-related boredom and
depressed moods in South African workplaces might cause stress in em-
ployees. In this context, workplace boredom is linked to experiencing a lack
of job resources, which interlinks with a higher need frustration and lower
motivation that must be counteracted through increased self-fulfillment,
self-esteem, confidence, and lower levels of emotional exhaustion (Erasmus,
2018). In the following, and anchored in general perspectives on workplace
stress, the authors will focus on stress in specific workplaces and occupa-
tional and organizational sectors to present selected findings on stress in
specific societal and organizational contexts – which appear outstanding.
The presentation of recent research can only provide an idea of the foci of
stress research in South Africa and does not attempt to present a complete
overview of the research landscape on the topic, but rather presents
directions of contemporary stress research.

Stress in the South African Health Sector

According to Conradieet al. (2017), stress strongly impacts nurses across
cultures and strongly influences health, well-being, and work perfor-
mance in the health sector. In their research, Van der Colff and
288 Claude-Hélène Mayer and Rudolf M. Oosthuizen
Rothmann (2009) found that nurses in South Africa experience high
levels of stress when experiencing depletion of emotional resources,
feelings of depersonalization, high job demands, a lack of organizational
support, and a weak sense of coherence. Stress research among nurses
has gained particular interest in the past years, and research has shown
that stress predicts burnout and compromises productivity and perfor-
mance as well as the quality of care afforded to patients (Khamiza 2015).
Khamisa, Peltzer, Ilic, and Oldenburg (2017) have, in a follow-up study,
highlighted that research – particularly among nurses – needs to differ-
entiate clearly between work stress and personal stress, since work stress
relates strongly to job satisfaction and personal stress to burnout and
general health.
Other research (Conradie et al., 2017) conducted in the Free State – a
province in South Africa – highlighted that nurses (over 90% of which are
black and female) mostly experience stress due to having to provide finan-
cially for their children and dependent minors (over 70%), caring for them
(almost 40%), and fearing that they may move away (ca. 26%). However,
in regard to occupational stressors, the nurses mentioned the following: high
workload (66.3%), lack of decision-making by superiors (58.1%), under-
payment (53.5%), endangerment of physical health (52.3%) and safety
(50.0%), working hours (51.2%), pressure due to expectations from su-
periors (48.8%), the uncertainty of employment (48.8%), and work re-
sponsibilities (47.7%). They experienced stress regarding health issues such
as hyper- and hypotension (35.3%). Because of stress, 34.5% of participants
took leaves, 34.5% developed depression, and 14.3% had panic attacks.
Stern et al. (2017) emphasize that healthcare workers are often
stressed when dealing with patients, and they struggle to balance
maintaining their distance from patients while being professional and
supportive. Their behavior might therefore express stress (e.g., shouting
at patients). At the same time, the authors emphasize that patients also
experience stress, anger, and helplessness. Moreover, they experience
stress for certain ailments – for example, there is a stigma associated with
HIV. Various studies on HIV/AIDS and stress have been conducted in
the South African health context because the number of people living
with HIV is relatively high, compared to the rest of the world. Research
within the health context has further shown that relationship conflict in
couples living with HIV increases stress and forgetfulness and that the
support of the partner through caring, joking, and talking can help in a
big way in reducing stress (Conroy et al., 2017).

Stress in the South African Construction, Mining, and Security

Industries
In the past, stress research in the construction industry hardly focused on
African contexts, and studies have only recently paid greater attention to
 Occupational Stress in South Africa 289
South Africa (Cattell, Bowen, & Edwards, 2016). The authors highlight
that the experience and perception of stress relate to critical time con-
straints, the volume of work, and adequate compensation, as well as
negatively affected work-life balance. De Beer, Rothmann, and Pienaar
(2016) focus on aspects of employment, equity experiences, and affir-
mative action drivers in post-apartheid South Africa and point out that
stress is vibrant in the construction industry.
One of the most important occupational stress factors of workers in
South African mines relates to money and debt (James & Rajak, 2014).
According to Jacobs and Pienaar (2016), different stressors are at play.
They researched a multinational gold mining company in South Africa
and found that most of the stress relates to role conflict, role ambi-
guity, quantitative job insecurity, coping, and safety compliance at
work. The strategy used to manage stress at work is coping avoidance.
Nzonzo (2016) has explored drivers of employee well-being in South
Africa and has found that, particularly in the South African police
force, high levels of stress occur. The author does not only ascribe
these high stress levels to the apartheid history and ongoing influences
of that history in the workplace, but also to contemporary trends,
identity insecurities, social conditions, lifestyle, and low confidence
and skills.

Stress in South African Education

The educational sector has been studied in regard to occupational stress,
and findings show that teachers who suffer from workplace bullying in
the South African educational system feel tired and stressed (52%)
(Jacobs & de Wet, 2015). Smit and Du Plessis (2016) have supported
these findings by highlighting that bullying is often an underestimated
topic in workplaces – which leads to huge amounts of stress and even
suicide. Vos and Kirsten’s (2015) research emphasizes that workplace
bullying in the educational sector and of teachers impacts strongly on the
teachers’ health and stress levels and is interlinked with other psychiatric
conditions – such as depression, posttraumatic stress disorder, panic
attacks, and a negative influence on the teaching-learning process.
Within higher education institutions, Barkhuizen and Rothmann (2008)
have found that occupational stressors predict ill-health and a lack of
organizational commitment by academics. Stress in this occupational
field relates to compensation and benefits, work overload, and work-life
balance (Barkhuizen & Rothmann, 2008).
Mayer, Oosthuizen, and Surtee (2017) have pointed out that in the
South African higher educational context, women leaders feel stressed by
the multiple challenges they have to face daily, and the authors suggest
that stress tolerance and mental health-related concepts need to be
strengthened – such as salutogenesis in organizations while increasing a
290 Claude-Hélène Mayer and Rudolf M. Oosthuizen
sense of coherence through specific interventions and tools. Parallel
to studies – which focus on teachers and professionals in educational
institutions – Case (2017) describes that, at the college level, young
engineers-in-training are also stressed when aiming at practicing “self-
authorship”. Self-authorship is defined as “a synthesis of intellectual,
intrapersonal, and interpersonal development” which is one goal of
education and which, at the same time, can be experienced as stressful
due to its complexity. Furthermore, the available research indicates that
the prevalence of stress is increasing among students studying in higher
education. Issues such as student retention and student progression are
becoming increasingly important for all universities (Robotham & Julian
2006; Robotham, 2008).
Transformation in higher education remains slow due to low access
for previously disadvantaged groups. The poor socioeconomic back-
ground of the majority of tertiary learners who come from the previously
disadvantaged group is a stressor and barrier for accessing tertiary
education. “Without appropriate and adequate financial funding, stu-
dents who come from financially challenged households in South Africa
might never be able to achieve academic success, change the negative
cycle of poverty, or contribute towards changing the race and gender
profile of South African academe” (Machika & Johnson, 2014).
Evidence shows that, on average, 70% of the families of the higher
education dropouts in South Africa were in the category of “low eco-
nomic status” – the majority of which come from previously dis-
advantaged groups (Letseka & Maile, 2008). The Fees Must Fall
movement during 2015 and 2016 – a student protest for free education –
resulted in massive disruptions at universities, with students vowing to
shut down universities until the government heeded their call. Despite
commitments by the government to fund disadvantaged students, there is
concern that free education is not sustainable in the current economic
environment (Manda and Dhaou, 2019; South Africa, 2017). The entire
movement seems to be accompanied by high stress levels for all parties
involved.

Stress from Different Cultural Perspectives in South Africa

International research has highlighted that culture moderates the relation
between perceived stress, social support, and mental and physical health
(Shavitt et al., 2016). Although there seems to be various research on
culture, race, and stress in the US-American context (Hunter, Case,
Joseph, Mekaawi, & Bokhari, 2017), there seems to be a void in the
South African context of research on culture, race, and stress. In the
1990s, Van Zyl (2002) started with research on stress levels in different
South African sociocultural and racial groups. The research found that
stress levels in different groups are extremely high: coloreds at 34,7%,
 Occupational Stress in South Africa 291
whites at 38,1%, and 35% among black South Africans. In comparison,
stress levels in the United States and Europe were between 10 and 22%
(Van Zyl, 2002).
Mayer (2005) has highlighted that distress can easily occur in South
Africa due to belonging to a certain cultural, ethnic, or racial community.
In her study, for example, one colored interviewee emphasized that he is
distressed about being part of and belonging to the colored community is
stressed about “having to share the ‘low self-esteem’ of the ‘Colored
Community’” (Mayer, 2005, p. 323). A more recent study from 2017
(Jaga, Arabandi, Bagraim, & Mdlongwa, 2018), points out that the ne-
gotiation of racial affiliation, gender, race, work, and family is extremely
stressful for black South African women. Based on the intersectionality
theories, the authors explore how difficult it is for black women to ad-
vance at work and how stressed they feel about the expectations for them
to manage the different areas in their lives. Another recent study by
Marteleto, Cavanagh, Prickett, and Clark (2016) has emphasized that
instability in parent-child co-residence can cause stress for children –
particularly in colored and black communities. While these racial groups
have historically often been exposed to a fluid household environment due
to labor migration, child-fostering concepts, and non-marital fertility,
HIV/AIDS adds a source of instability in these groups particularly.
Stress can occur due to racial affiliation, educational status, socio-
cultural background, a sense of religious-ideological obligation, threats
to personal safety, feelings of inferiority and lack of self-esteem, au-
thoritarian decision-making, as well as identity conflicts (Mayer, 2005).
A white priest emphasizes that he believes that affirmative action pro-
cedures cause particular stress for whites. Additionally, interracial re-
lationships can cause stress for the partners, as reported in a research
study in 2005 – 11 years after the end of apartheid, since they fear that
these kinds of relationships are still not accepted in broader society
(Mayer, 2005). After having presented stress research in selected societal
and organizational contexts, we will continue by focusing on the
characteristics of occupational stress in South Africa.

Characteristics of Occupational Stress

South African researchers, such as Robbins, Judge, Odendaal, and Roodt
(2009) and Oosthuizen (2019) distinguish between individual and orga-
nizational stress characteristics, as explained in the following section.

Individual Stress Characteristics in the Fourth Industrial

Revolution in South Africa
The average employee works about 40 to 50 hours per week, but the
experiences and problems with which employees are confronted with
292 Claude-Hélène Mayer and Rudolf M. Oosthuizen
when not at work can spill over to their work. This encompasses ele-
ments in the employee’s private life – primarily family issues, personal
financial problems, and inherent personality characteristics. Stress signs
expressed at work may additionally simply stem from the person’s
persona (Robbins et al., 2009).
Furthermore, employees experience the pressures of the Fourth
Industrial Revolution personally in terms of the following demands
(Oosthuizen, 2019):

• Flexibility: Escalating virtual work makes employees time and place-

independent. Work-task rotation further necessitates employees to
be flexible in their job responsibilities.
• Uncertainty tolerance: This involves enduring change, especially
work-related changes due to work-task rotation or reconfigurations.
• Continuous learning: Frequent work-related transformation makes
it compulsory for employees to be willing to continue to learn.
• Ability to work under pressure: Employees involved in innovation
processes must be able to cope with increased pressure due to shorter
product life cycles and reduced marketing time.
• Sustainable mindset: As representatives of their organizations,
employees need to support sustainability initiatives.
• Compliance: This involves stricter rules regarding information
technology security, working with machines, or working hours
(Hecklaua et al., 2016).
• Resilience: This involves the capacity of the employee to cope in spite
of Smart Technology, Artificial Intelligence, Robotics, and Algorithms
(STARA), barriers, or limited resources. Resilient employees are
willing and able to overcome the fears and stress of STARA by
tapping into their emotional strength.

Besides personal stress characteristics, employees are impacted by

organizational stress characteristics, as presented in the following section.

Organizational Stress Characteristics in the Fourth Industrial

Revolution in South Africa
According to Robbins et al. (2009) and Oosthuizen (2019), organizational
stress characteristics primarily include six different types of demands,
which are explained in the following: task, role, STARA knowledge, and
methodological, interpersonal, and societal competency demands.
Task demands encompass the format of the employees’ job (e.g., au-
tonomy, assignment variety, degree of automation), working pre-
requisites, and physical work layout. For example, working in an
overcrowded room or in an open office where interruptions are constant
can increase anxiety levels and stress. Furthermore, employees must be
 Occupational Stress in South Africa 293
able to deal efficiently with a large amount of data (i.e., big data)
(Huber & Kaiser, 2015). In addition, they have to acquire the necessary
skills to be equipped for the increase in virtual work (Hecklaua et al.,
2016; Stock-Homburg, 2013).
Role demands relate to pressures placed on an individual as a feature
of the particular position they play in an organization. Role conflicts
create expectations that may also be tough to reconcile or satisfy. Role
overload is experienced when the worker is expected to perform more
functions than time permits. Role ambiguity is created when function
expectations are no longer honestly understood, and employees are no
longer sure what they are supposed to do (Ngope, 2019).
STARA knowledge demands are becoming increasingly significant
owing to cumulative task accountability. Employees may experience high
stress levels due to the demands presented by the Fourth Industrial
Revolution:

• Specialized competencies: All-inclusive and specialized competencies

are required to change from operational to more strategic functions.
• Process comprehension: Advanced process intricacy demands a
wider and deeper process comprehension.
• Media abilities: Accumulative virtual work requires that employees be
able to use smart technology and media – for example: smart glasses.
• Programming abilities: The intensification of algorithms and
digitized processes initiates an advanced demand for employees
with programming abilities.
• Understanding information technology security: Virtual functions
on servers or platforms compel employees to be aware of
cybersecurity (Hecklaua et al., 2016; Oosthuizen, 2019).

Methodological demands in the landscape of the Fourth Industrial

Revolution could also contribute to the high stress levels of employees in
terms of the following (Hecklaua et al., 2016):

• Creativity: The need for more smart technology and innovative

products, as well as for internal enhancements, calls for creativity.
• Innovative thinking: Every employee with more accountable and
strategic functions has to act as an innovator.
• Problem-solving: Employees must be able to identify the sources of
mistakes and be able to improve processes and procedures.
• Conflict-solving: An advanced service emphasis increases customer
associations; conflicts need to be resolved.
• Decision-making: Since employees will have higher process
accountability, they will have to make their own decisions.
• Diagnostic abilities: Constructing and scrutinizing significant amounts
of information and multifaceted processes becomes compulsory.
294 Claude-Hélène Mayer and Rudolf M. Oosthuizen
• Research competencies: Employees have to be able to use reliable
sources for continuous learning in fluctuating environments of
Artificial Intelligence.
• Proficiency assimilation: Multifarious quandaries need to be elucidated
more proficiently – for example: examining increasing quantities of
algorithmic data (Hecklaua et al., 2016; Oosthuizen, 2019).

Interpersonal demands are pressures created by other employees. Lack

of social support from colleagues and negative interpersonal re-
lationships can cause extensive stress, especially among employees
with excessive social needs. The nature and variety of social desires
differ among people. The organizational structure defines the degree
of differentiation in the organization, the degree of policies and reg-
ulations, as well as the point where decisions are made. Excessive
guidelines and lack of participation in decisions that affect employees
are examples of structural variables that could possibly cause stress.
Organizational leadership refers to the managerial style of the orga-
nization’s senior executives; some executives might also create a sub-
culture characterized by tension, concern, and anxiety. In addition,
some may even set up unrealistic pressures to perform in a short space
of time, impose excessively tight controls, and automatically dismiss
employees who cannot meet requirements. Just as environmental un-
certainty influences the design of an organization’s structure, it also
influences stress levels among employees in any organization. Changes
in the organization cycle create economic uncertainties. Political un-
certainties may also have an effect on market stability, which will
affect not only personnel directly involved, but also their families
(Ngope, 2019).
The Fourth Industrial Revolution also demands societal competencies
from employees, which could contribute to stress, namely:

• Intercultural abilities: Employees are required to have an

understanding of different cultures – especially different work
practices – when working internationally.
• Language abilities: Employees must be able to understand and
converse with international associates and customers.
• Communication abilities: Service inclination demands good listening
and presentation abilities from employees; whereas, increasing
virtual work requires sufficient virtual communication abilities.
• Networking abilities: Working in a highly globalized and
interconnected value chain requires knowledge networks from
employees.
• Teamwork abilities: Increasing teamwork and collective work on
platforms demand an ability from employees to respect team rules
(Oosthuizen, 2019).
 Occupational Stress in South Africa 295
The Fourth Industrial Revolution requires developing countries such as
South Africa to rise to the challenges brought by their sociohistoric,
socioeconomic, and economic contexts. Developing countries need to
develop models or strategies that are responsive and relevant to their
context instead of blindly adopting so-called “exemplary models” that
have worked in contexts that are different from the developing country
adopting them. There is also a greater need to develop strategies that
bring social benefits instead of focusing primarily on economic prospects
brought by the Fourth Industrial Revolution. Strategies should also look
into innovative ways of addressing socioeconomic stressors such as
potential job losses, widening wage gaps, and skills redundancy. In de-
monstrating the benefits of the Fourth Industrial Revolution, the gov-
ernment should also explain how social innovations in Industry 4.0
could address some of society’s stressors and improve the quality of life
and social well-being of citizens (Manda and Ben Dhaou, 2019).

Managing Stress in South African Occupations and

Organizations
After having presented the causes and impacts of stress on South African
workplaces and organizations, the question arises how stress can be
managed in this specific context and which interventions and tools can
be used to reduce occupational stress to improve health and well-being
(Sieberhagen, Pienaar, & Els, 2011; Sieberhagen et al. 2009). It is sug-
gested that stress management needs to take place on different levels,
namely on the individual (micro) level, on the organizational (meso)
level, and on the societal (macro) level. In the following section, the
authors refer to these different levels and corresponding possible stress
management options.

The Micro-Level of Stress Management in South Africa

Researchers (e.g., Nunfam et al., 2018; Chetty et al. 2016) have pointed
out that, on the individual level, employees need to develop adaptation
strategies to workplaces – in particular, to workplace changes due to
global, societal, organizational, or individual changes. The empowering
and strengthening of individual strategies and focusing on concepts such
as a sense of coherence (Mayer, 2005), self-fulfillment, confidence, and
other positive psychology constructs (Erasmus, 2018) can support the
reduction of stress.

The Meso-Level of Stress Management in South Africa

On the organizational level, stress needs to be reduced through organi-
zational strategies and impact. Coetzee and Rothmann (2005) have
296 Claude-Hélène Mayer and Rudolf M. Oosthuizen
emphasized that organizational commitment moderates the effect of work
stress in organizations – impacting positively on well-being, organizational
growth, stability, and the decrease of stress. This means that South African
organizations need to increase organizational commitment through, for
example, care for employees, specific benefits, influential training, and
support of employees’ professional and personal development. In this
context, organizations should focus on the high embeddedness of em-
ployees at work to reduce work stress, adjust policies, and prepare their
employees for (potential) changes and implement those changes through
programs (Chetty et al. 2016). It has further been pointed out (Stern et al.,
2017) that organizations should engage more in community work to
cooperate with the South African healthcare system and thereby aim at
reducing stress of healthcare professionals and their patients.
Previous research has also suggested that, in order to reduce stress levels
in organizations, trained mental health professionals and counselors must
be employed in organizations to foster the well-being of employees and
to reduce the experience of workplace stress (Cooper & Bevan, 2014;
Katushabe, et al., 2015; Salanova, Del Líbano, Llorens, & Schaufeli,
2014). As for international contexts (Khoury, Sharma, Rush, & Fournier,
2015), mindfulness-based training to reduce stress in individuals has been
suggested for South African contexts (Mayer & Walach, 2018) to increase
health and well-being and decrease stress.

The Macro-Level of Stress Management in South Africa

On the macro level and in regard to the entire South African society, the
government needs to address the burning issues within the society – such
as crime and safety, unemployment, Black Economic Empowerment and
Affirmative Action strategies, poverty, access to education, and healthcare.
However, racial tensions and the late effects of the apartheid and the
historical separation of race groups also need to be addressed to deal with
stress that occurs in workplaces and across society. If the burning issues
of society were to be addressed by the government, the stress levels in
organizations and workplaces would decrease as well. In regard to the
Fourth Industrial Revolution, the South African government needs to
develop a vision and proper strategies to deal appropriately with the up-
coming challenges and to develop the well-being of South African society.
The government and industries must cooperate to address the fears of the
Fourth Industrial Revolution in the future by implementing strategies on
how to address and professionally cope with the rapid global challenges.

Conclusions and Recommendations

Stress is rife in South African society. It seems to be anchored on the
historical struggles of the country and the newly anticipated stressors of
 Occupational Stress in South Africa 297
the rapidly occurring Fourth Industrial Revolution. The success of the
Fourth Industrial Revolution will depend on leadership from all sectors
working together to leverage the opportunities and address the stressors
associated with the Fourth Industrial Revolution. Political leadership, for
example, is responsible for developing and implementing an enabling
environment for digital transformation and innovation. Business lea-
dership is responsible for leading think tanks and the much-needed in-
novation in the Fourth Industrial Revolution (Manda and Ben Dhaou,
2019). Social leadership also plays an important role in preparing society
for the changes and stressors brought by the Fourth Industrial
Revolution. Political leadership in South Africa has recognized the
Fourth Industrial Revolution and its potential to address the country’s
triple challenges and stressors of poverty, unemployment, and inequality.
The development of policies and strategies addressing digital transfor-
mation is a sign of commitment from leadership. However, the im-
plementation of reforms remains a stressor – as witnessed by poor policy
implementation.
Manda and Dhaou (2019) stated that collaboration is critical during
transformation and they associated stress with change. Collaboration
between the various role-players in the Fourth Industrial Revolution is
critical in ensuring the success of the Fourth Industrial Revolution that
will disrupt and cause stress not only for organizations, but also the
government and society. The development of policies and strategies that
are responsive to the priorities of South Africa will require that the
government work with business and social partners in addressing some
of the stressors and in leveraging the opportunities brought by the Fourth
Industrial Revolution.

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14 Organizational Stress in the
United States of America
Research and Practice
James Campbell Quick

Introduction
Stress as a construct in the United States was framed in 1915 by Cannon
(1929) and elaborated on his notions of stress and strain in homeostasis
(Cannon, 1935). Kahn et al. (1964) at the University of Michigan were
the first research group that studied organizational stress. In this chapter
addressing organizational stress in the United States of America, I pro-
vided an abbreviated historical backdrop before exploring the current
cultural context that is being defined by several major national issues.
The third major section of the chapter provides a view of the most salient
concepts and measures relevant to organizational stress. This section
relies on both psychological science and public health practice - the latter
founded on the science of epidemiology. The fourth major section of the
chapter explores the influence of the cultural context on organizational
stress. The boundary between work life and non-work life is neither
always sharply defined nor clear. Rather, the organizational boundary is
a permeable one, through which there are impacts and spillovers be-
tween the organization and the elements in its larger environment
(Nelson & Quick, 2019).

Historical Backdrop
The stress concept in America originated in medicine and physiology
with the research of Walter B. Cannon, who first called it “the emergency
response” (Benison, Barger, & Wolfe, 1987). Cannon (1935) and later
distinguished stress from strain. The second half of the 20th century saw
the proliferation of theories of organizational stress by a wide range of
social psychologists, industrial engineers, sociologists, and organiza-
tional behaviorists, starting with Kahn et al. (1964). By the end of the
20th century, Cooper (1998) presents ten leading theories - several of
which are American in origin. For example, the person-environment fit
theory is based on Kahn’s social psychological research, the burnout
theory (Maslach, 1982), and the theory of preventive stress management

DOI: 10.4324/9780429292538-14
304 James Campbell Quick
resulted from the translation of the public health notions of prevention
into an organizational stress context (Hargrove, Quick, Nelson, &
Quick, 2011; Quick & Quick, 1984).
Contrary to the 1988 Business Week headline, “Stress: The Test
Americans Are Failing”, Americans passed the stress test when life ex-
pectancy is the operational measure throughout the 20th century.
American men and women extended their average life expectancy at
birth by over 50% in less than a century - from less than 50 years in 1900
to over 75 years before the mid-1980s (Vital Statistics of the United
States, 1988). Further, some stress is good, and not all stress is bad. In
spite of the normalcy of the stress response, stress can be the kiss of death
as well as the spice of life (Levi, 2000). Stress is a direct contributing
cause or an indirectly implicated one in over 50% of all human mor-
bidity and mortality (Quick & Cooper, 2003). In the United States, the
ten leading causes of death account for about 80% of all deaths. Stress is
directly implicated in four causes (i.e. heart disease, strokes, injuries, and
suicide and homicide) and indirectly implicated in another three (i.e.
cancer, chronic liver disease, and emphysema and chronic bronchitis).
These broader health statistics provide a backdrop to the current state of
cultural affairs in America as related to organizational stress.

Current Cultural Context in the United States

A review of the Centers for Disease Control and Prevention’s National
Center for Health Statistics shows that life expectancy in the United
States since the year 2000 has advanced in most years yet also shows
years of decline - as in 2017 when life expectancy for the United States
population declined to 78.6 years. In this section I examine the long
working hours in America, ten workplace stressors resulting from
business policies and practices that contribute to mortality and incre-
mental health expenditures, health insurance and healthcare, gun vio-
lence, and the opioid epidemic of the past decade. These cultural forces
have direct and indirect impacts on organizational stress and risk ex-
posures for employees.

Long Working Hours

Worrall & Cooper (2001) found the global competition in the 1990s was
pushing working hours up, especially in the United States and the United
Kingdom. Interestingly at that time, the British had very long working
hours as compared to their European partners. Americans appear to
trump the British and other developed working cultures. Gallup’s 2017
State of American Well-Being found that Americans do work hard, an
average of 34.4 hours per week, which is longer than their counterparts
in the world’s largest economies. However, many Americans well exceed
 Organizational Stress in the United States 305
that average. Gallup found that American adults employed full-time
report working an average of 47 hours per week - equating to roughly
six workdays per week. Executives and senior managers can expect to
work in the 50 or 60-hour range. Goh, Pfeffer, and Zenios (2016)
identify long working hours as one of ten leading workplace stressors.
There is no question that work carries a host of social, psychological,
and economic benefits. However, work in excess becomes a harmful
burden. Research has not established the optimum working hours above
which the range of costs and harm exceeds the benefits accrued for the
employee and for the organization.

Workplace Stressors, Mortality, and Health Expenditures

Goh et al. (2016) built a model to estimate the excess mortality and
incremental health expenditures associated with exposure to 10 work-
place stressors: unemployment, lack of health insurance, exposure to
shift work, long working hours, job insecurity, work-family conflict, low
job control, high job demands, low social support at work, and low
organizational justice. At the core of their concern is how American
business policies, practices, and workforce management practices are
contributing to organizational stress and employee strain. Their epide-
miological evidence links specific workplace stressors to health out-
comes. However, they conclude that the aggregate contribution of these
factors to overall mortality and health spending is simply unknown.
They did find over 120,000 deaths per year and approximately 5–8%
of annual healthcare costs associated with, and therefore for attributable
to, management practices within United States companies and the ways
in which they manage their workforces. The estimates generated by their
model showed that 50,000 of these excess deaths per year resulted from
not having insurance. They indicate that Wilper et al. (2009) reported a
number quite close (45,000), thus giving the authors confidence in their
model estimates. Their research found that unemployment followed the
absence of insurance closely in contributing to excess mortality. In ad-
dition, low job control was an important factor as well, contributing an
estimated 31,000 excess deaths annually.
In addition to the absence of health insurance, their research found
that high-demand jobs and work-family conflict were major exposures
that contributed to healthcare expenditures - if not to mortality. While
they found that each of the exposures contributed to healthcare ex-
penditures, not all of them contributed to incremental deaths, at least
within their model. This may be, in part, due to some of the data lim-
itations which the authors discuss. What is especially significant about
the research of Goh et al. (2016) is that it brings epidemiology and public
health to bear the risks associated with organizational stress in the
workplace.
306 James Campbell Quick
Health Insurance and Healthcare in America
A third cultural factor, included in the Goh et al. (2016) research, is that
of health insurance and its associated factor of healthcare in America.
The United States funds its healthcare system significantly differently
than virtually every other industrialized nation (Macik-Frey, Quick, &
Nelson, 2007). While the United States has the best medical system in the
world that can treat the sick, it does not have the best health system with
an emphasis on prevention. Macik-Frey et al. (2007) provide two al-
ternative models for national healthcare. One model is a national health
insurance model, as used in Switzerland, where private providers are
reimbursed 100% by the government for services. A second model is a
National Health Service model, as used in the United Kingdom, where
healthcare providers are effectively government employees. The United
States follows neither model and has struggled through the Obama and
Trump administrations in attempting to help tens of millions of unin-
sured Americans. This is a critical consequential issue in the United
States, in part, due to the relationship between health insurance and
mortality among adults (Wilper et al., 2009). America has the most
expensive system in the world with some of the worst outcomes.
The American Psychological Association (2018) has been conducting
Stress in America surveys for over a decade, and the 2018 results showed
a marked relationship between health insurance and stress level.
Specifically, on a ten-point scale, the uninsured reported nearly 25%
more stress than those who had insurance (5.6 versus 4.7). APA reported
that healthcare-related stress was higher in urban areas and that higher
household income did not appear to mitigate the high healthcare stress
related to the cost of insurance, changes in national healthcare policy,
cost of medications, and medical bills.

Gun Violence in America

Workplace violence has been a concern in America dating back to the
20th century. One FBI estimate indicated that 85% or more of work-
place violence is preventable because stress often serves as the triggering
event for the violence (Mack, Shannon, Quick, & Quick, 1998).
However, the surge in cultural gun violence - some of which is spilling
over into working environments - has reached epidemic levels in the past
decades. The mass shooting in an El Paso Walmart during 2019 is one of
the more dramatic and tragic examples of how gun violence in America
is seriously impacting organizational stress. The cultural escalation and
spread of gun violence are causing many small business owners to re-
think workplace safety in order to divert the work environment from
being a target (Simon & Cutter, 2019). They are using a combination of
workplace changes such as security cameras and door buzzers, as well as
 Organizational Stress in the United States 307
training employees in active shooter drills that prepare them to better
respond to violent and dangerous employees. While high-risk employees
who can become dangerous may be a small number, likely just 1–3% of
a work population, these individuals can create havoc, lead to significant
loss of life, and leave traumatic aftermath that haunts the organization
over an extended period of time - even years (Quick, McFadyen and
Nelson, 2014).
While gun violence typically focuses on harm to others, as previously
discussed, the problem also encompasses suicide by guns. This problem
is less typical within most organizations but has become an escalating,
even epidemic, problem within the United States military forces over the
past two decades. The United States is now in the longest war, even if
undeclared by the United States Congress, in its national history. The five
armed services (the United States Army, the United States Navy, the
United States Marine Corps, the United States Air Force, and the United
States Coast Guard) are among the largest organizations in the culture.
By 2008, the rising suicide rates across services, especially within the
United States Army and Marine Corps, are most of those in direct
contact with enemy forces in Afghanistan and Iraq, as well as the ac-
companying rise in post-traumatic stress disorder (PTSD) and traumatic
brain injury (TBI), led then-Secretary of Defense Robert Gates to appoint
13 experts on psychological health to the Defense Board for three-year
terms in 2008 to 2011. General Casey (2011) launched a comprehensive
soldier fitness program aimed at raising psychological resilience in the
United States Army, which, in retrospect, appears well-intended but fails
to isolate and help those in the greatest need. The suicide rates in the
United States military and among veterans are now well above their age-
comparable civilian counterparts, while in the 1990s the case was the
reverse.

The Opioid Epidemic

Suicide may be considered an act of despair - one resulting from the loss
of hope. This is also true for the drug addiction problem in America.
Between 2007 and 2017, “drug-use disorders” jumped from #13 to the
#3 cause of premature deaths in the United States. This dramatic jump
can be largely attributed to the pervasive and endemic opioid epidemic
that has swept America and triggered a national response from attorney
generals in many states. The State of Oklahoma won a $500 million
judgment against Johnson & Johnson for their role in fueling the opioid
epidemic within the state. More telling is the bankruptcy filing by Purdue
Pharma, maker of OxyContin, with their proposed $10 billion settle-
ment proposal. The scale of the opioid epidemic is daunting as are the
organizational and individual effects of the epidemic - both economically
and financially, as well as from a humanitarian perspective. This
308 James Campbell Quick
epidemic, as with the long war, is likely to have a long tail that will
impact American culture for years to come.

Salient Concepts and Measures

What is the range of concepts and measures used in America for orga-
nizational stress research? There is no universally agreed-upon set of
concepts and measures in the domain of organizational stress. Quick,
Quick, Nelson, & Hurrell, (1997: p. 126) provide a comprehensive
overview of 17 organizational measures and indicators, five to seven
measures of modifiers of the stress response, and seven measures of in-
dividual distress or strain. In a subsequent review, Quick, Cooper,
Nelson, Quick, and Gavin (2003) offer five conceptual frameworks for
the study of organizational stress along with four more specific, if mul-
tifaceted, measures - for examples developed in the United States, the Job
Stress Survey and the Occupational Stress Inventory - for use in orga-
nizational stress research. These are not all equally relevant nor salient in
the United States culture today nor has any single organizational stress
measure become the gold standard over the past 20 years. The question
now is what are the most salient concepts and measures for organiza-
tional stress research and practice in contemporary America? The gap
between science and practice that is noted by Goh et al. (2016) is the
same gap in America noted by Quick and Quick (1984). What has
changed in the intervening thirty years is the greater appreciation for the
key roles that epidemiology and public health can play in addressing
organizational stress in America (cf., Goh et al., 2016).
Epidemiology and public health are less concerned with concepts and
theories than they are with causal factors and surveillance systems.
Preventive intervention is keyed to diagnostic information and surveil-
lance indicators in the organization. Valid and reliable stress measure-
ment requires multiple psychological, environmental, and medical
considerations (Quick, Quick, & Gavin, 2000). Stress instruments fall
into four construct categories. These are measures of (1) environmental
demands and sources of stress, (2) healthy and normal stress response,
(3) modifiers of the stress response, and (4) psychological, behavioral,
and medical distress and strain. Goh et al. (2016) have isolated ten
salient workplace stressors that have consequences for mortality and
healthcare costs - all focusing on organization environment demands
(e.g. long working hours) or modifiers of stress response (e.g. social
support at work). These top ten can be used for the purpose of work-
place surveillance and assessment. In addition to environmental condi-
tions, organizational stress assessment should focus on individual
responses and indicators. For the purposes of organizational stress
measurement in 2019 America, we should focus on the most salient
measure related to the cultural data.
 Organizational Stress in the United States 309
Organizational surveillance and screening should include considera-
tion of three individual strain indicators - which are anxiety, depression,
and burnout. Anxiety disorders, one of the two most common presenting
complaints about stress with the other being depression, affect one in
every six people in the United States (Quick & Cooper, 2003). As early
as 1980, NIOSH identified stress and psychological disorders in the
workplace as one of the top ten occupational health hazards in America
(Sauter, Murphy, & Hurrell, 1990). There is no evidence that this has
changed appreciably during the intervening decades, while NIOSH and
the American Psychological Association have taken constructive and
cooperative actions to address the needs. Burnout is a continuing orga-
nizational stress concern within American organizations and occupa-
tions. Maslach’s (2006) continuing work in educating those who need to
know about this problem has been ongoing as well. One research project
within the American Orthopaedic Association using the Maslach
Burnout Inventory found an emergent concern with burnout among the
academic leaders within the profession and offered stress management
skills for mitigating the problem (Quick et al., 2006).
Individual-level measures are insufficient for organizational stress
assessments when considering both research and practice. The direct
costs of organizational distress and strain can be significant, running
well into billions of dollars (Quick, Wright, Adkins, Nelson, & Quick,
2013). Cascio and Boudreau (2011) have done systematic research to
costing employee attitudes and behaviors with organizational con-
sequences in mind. Two key organizational indicators that they focused
on are turnout and absenteeism. Turnover rates can be easily tracked
and monitored by an organization as one key indicator of stress while
benchmarking with industry and national averages. Cascio and
Boudreau (2011) note that there are both separation costs and re-
placement costs associated with turnover in an organization. They
suggest that the voluntary, in distinction from involuntary, turnover is
what the organization should be most concerned with monitoring and
managing. In fact, some turnover, and especially involuntary turnover,
can be healthy for the organization - removing underperforming em-
ployees and refreshing the workplace with vital and energetic new-
comers.
Absenteeism, including sick leaves, is the second key organizational
indicator that Cascio and Boudreau (2011) encourage management to
monitor. They estimate that 16% of absenteeism can be directly attri-
butable to organizational stress and another 26% to family-related is-
sues. The remaining nearly 60% may be caused by personal illness (sick
leaves), personal needs, and a sense of entitlement. Accordingly, there
may be hidden costs and hidden issues embedded within the absenteeism
rates that management may need to explore more deeply below the in-
dicator numbers themselves.
310 James Campbell Quick
In addition to these two organizational indicators, which can be used
both for research and for management practice, organizations might
consider monitoring the workplace for high-risk employees - which are
employees with the potential for acting out in damaging and destructive
ways (Quick & McFadyen, 2014). Good managers, leaders, and ex-
ecutives throughout any organization know who these individuals are.
The purpose of identifying these employees is to refer them to an orga-
nizational clinical psychologist who can triage their situation to de-
termine if there is a need for psychological, financial, family counseling,
or other stress-related needs (Klunder, 2008). The early identification
and early intervention with high-risk employees in need of such services
are to prevent problems and outbreaks before they occur. With the levels
of gun violence and drug addiction problems in the larger culture, this
category of surveillance and monitoring is well warranted.
In summary, the most salient concepts and measures for organiza-
tional stress research and practice would be:
Organizational-Level and Workplace

Absenteeism and voluntary turnover (Cascio & Boudreau, 2011);

Unemployment, lack of health insurance, exposure to shift work,
long working
hours, job insecurity, work–family conflict, low job control, high job
demands,
low social support at work, and low organizational justice (Goh
et al., 2016);

Individual-Level Screening and Assessment

The Trait-State Anxiety Inventory (American Psychological

Association, 2019a);
Beck Depression Inventory (BDI) (American Psychological
Association, 2019b);
Maslach Burnout Inventory (MBI) (cf. Maslach, 2006).

Cultural Influences in the United States Leading to

Emergent Practices
Historical and current American cultural influences lead to some of the
specific practices for organizational stress management and coping me-
chanisms. One of the more distinctive cultural values is that of in-
dividualism - that is, respect for the autonomy and integrity of the
individual. One consequence of this is that the burden of adjustment and
coping with organizational stress is placed on the individual (Quick &
Quick, 1984) - which stands in contrast to the more environmentally
 Organizational Stress in the United States 311
focused workplace redesign strategies prevalent in Sweden, throughout
Europe, and the United Kingdom (Levi, 2000). As a result, three stress
management and coping mechanisms evolved within the American cul-
ture and are primarily individually focused. These are physical fitness,
positive stress, and organizational clinical psychology. In addition to
these, there is an organizationally focused NIOSH-APA strategy for
healthy work organizations.

Physical Fitness
A central element of the corporate wellness programs that emerged in
response to the increased attention to stress in the mid-20th century in
the United States was physical fitness training. Kenneth Cooper, MD was
a national advocate for this movement with his research and practice in
preventive medicine. Having started as a flight surgeon in the United
States Air Force, Cooper put a strong emphasis on aerobic fitness and
later on also emphasized flexibility and strength training (Nelson &
Quick, 2019). The emphasis is on strengthening the cardiovascular
system - a key system implicated in the stress response. Aerobic discipline
aims to improve health and well-being, yet a key side effect of such
discipline is as a stress management skill that became central to corpo-
rate wellness and fitness programs across the United States (Nelson &
Quick, 2019). In addition to the cardiovascular benefit achieved in
aerobic fitness, there are two other key benefits - greater longevity (i.e. fit
individuals on average have five additional years of life) and improved
mental health and less depression (i.e. one of the two key presenting
complaints about stress) (Cooper & Cooper, 2007). Gallup’s 2008–2017
national trends data show an increase in exercise from 51% to 55% - a
positive and welcomed trend.

Positive Stress: Positive Organizational Behavior, Positivity,

and Eustress
The primary focus in 20th-century stress and organizational stress re-
search focused on how stress could harm, compromise, impair, cause
disease and dysfunction, and/or kill (Quick et al., 1997). In the late
1990s, there was a recognition that the positive aspects of stress had been
downplayed and/or overlooked. The subsequent two decades have seen
an emergence of sound research and practice in positive stress: positive
organizational behavior (POB), positivity, and eustress. Luthans (2002)
pioneered the domain of POB with an emphasis on psychological capital.
His construct of psychological capital emphasizes hope, optimism, resi-
lience, and efficacy. Evaluations of the positive impact of psychological
capital on employee well-being show positive effects over time (Arvy,
Luthans, Smith, & Palmer, 2010).
312 James Campbell Quick
Fredrickson’s (2009) psychological research on positivity focused on
thoughts and emotions with their impact on physiology and behavior. A
key aspect of her approach is the balance between the positive and the
negative. Individuals who experience a roughly 1-to-1 ratio of positive to
negative thoughts and emotions are difficult to spend time with due to the
heavy dose of negativity; these people drain energy from others. Those
individuals who have a ratio closer to 3-to-1, or maybe even 5-to-1, of
positive to negative thoughts and emotions are much less stressful to be
around but they are realistic about the difficulties and challenges of life.
The positive extreme is comprised of individuals who experience ratios of
something like 11-to-1 of positive to negative thoughts and emotions.
These hyper-positive people are very difficult to engage with and have a
real challenge in engaging with life’s real difficulties and demands.
Positivity can be contagious in a good way, just as infectious diseases can
be contagious in a bad way. This aspect of positivity leads to thriving
which is the flip side of harmful organizational stress. Gallup’s 2008–2017
national trends data on thriving show an increase from 49% to 56% -
another positive and welcomed trend greater than that of exercise.
Eustress is literally normal stress and hence, can be subsumed under
positive stress. Eustress has appeared infrequently in the organizational and
workplace stress literature, although that gap has begun to close over the
past two decades (Nelson & Simmons, 2011). Eustress reflects the extent
to which individuals appraise a situation or event as beneficial or as a
potential enhancement of their well-being. Work situations elicit a mixture
of both positive and negative responses from individuals. The indicators of
eustress should be positive psychological states - such as attitudes or
emotions that reflect an active engagement with the work environment.
Eustressed workers are actively engaged, meaning they are immersed
in and pleasurably occupied by the demands of the work at hand.
Workers can be engaged and perceive positive benefits even when con-
fronted with extremely demanding stressors. Some, in fact, may wish to
proactively call up this response and to prolong the experience of eus-
tress. Nelson and Simmons (2011) refer to this process as “savoring” and
offer it as a complement to what is called “coping” in response to dis-
tress. They further suggest that individuals who are likely engaged in
savoring are those who are optimistic, hardy, and self-reliant, and who
possess an internal locus of control and a sense of coherence. As a
complement to distress prevention, we need to study eustress generation,
which consists of ways that managers can help employees engender and
savor the eustress response at work.

Organizational Clinical Psychology

Organizational clinical psychology is an individually focused practice
that evolved within the United States. Air Force. Adkins (1999), as an
 Organizational Stress in the United States 313
organizational clinical psychologist, designed and implemented the
concept of an Organizational Health Center (OHC) - a structural me-
chanism for enhancing health and managing stress. An OHC is one
mechanism for applying behavioral science, psychology, and public
health in the workplace - with an emphasis on individual prevention and
intervention. Adkins’ clinical psychological approach aimed to reduce
stress and psychological disorders at work as proposed by NIOSH
(Sauter et al., 1990). The precipitating events for Adkins to evolve this
new systemic, yet individually focused, approach to organizational
clinical psychology were a series of suicides in the industrial logistics
depot where she was assigned. She conducted a one-year evaluation of
her innovative approach and found:

1 Workers’ compensation rates declined by 3.9%, following a 4.6%

increase in the previous year, exceeding the management-established
goal of a 3% reduction and saving over $289,000 in workers'
compensation costs;
2 Healthcare utilization rates declined by 12%, yielding savings of
over $150,000 in recaptured productivity alone; and
3 Deaths resulting from behavioral problems - including suicides -
declined by 41%, resulting in cost savings of over $4 million.

Drawing on Adkins’ (1999) innovation, Quick and Klunder (2000) ap-

plied organizational clinical psychology in the realignment and closure of
the United States Air Force’s largest industrial maintenance deport at
Kelly Air Force Base (AFB), Texas. Triggered by the Base Realignment
and Closure Commission (BRAC) recommendation in July 1995 to
United States President Clinton, Kelly AFB joined the list of realigned
and/or closed domestic military installations. Specifically, the San
Antonio Air Logistics Center was one of the military installations on the
realignment and/or closure list. The industrial restructuring process af-
fected the largest number of federal employees in United States history.
The Center at Kelly AFB was the largest industrial employer in South
Texas with over 13,000 personnel (about 85% federally employed ci-
vilians and 15% military service members) and one of the largest in-
dustrial facilities in the Department of Defense. The commanding
general chose to appoint an organizational clinical psychologist re-
commended by the United States Air Force Surgeon General’s chief
clinician. As an organizational clinical psychologist, one of Klunder’s
(2000) first actions was to identify the 1–3% of the workforce at high-
risk. Over 300 individuals were identified through the screening process
and triaged for the support or help that each required, being referred to
professionals.
A five-year evaluation of the program ended on July 13, 2001, when
the organization closed. The results were the following:
314 James Campbell Quick
1 No fatalities: there was not a single closure-related fatality in the
organization during the closure. While there was a significant decline
in suicide rates throughout the Air Force, as reported by the Centers
for Disease Control and Prevention for the period of 1995 to 1999,
the experience at Kelly AFB is still noteworthy in this regard.
2 No incidences of workplace violence:
3 Significant cost avoidance: there were over $33,000,000 in cost
savings during the six-year period based on human resource
estimates of complaints that did not happen. The Air Force
estimates each employee complaint at a cost of about $80,000, all
costs considered. Human resources found the number of official
complaints to be approximately 25% below their estimate, resulting
in the significant total estimated cost savings.

Concerned organizational leadership from the commanding general all

the way down was instrumental in this organizational clinical psycho-
logical intervention for organizational stress, health, and well-being.
More importantly, this success did not come at the expense of organi-
zational performance.

Healthy Work Organization: Research and Practice

Abraham Maslow called for healthy work environments as early as the
1960s. In 1998, the Workplace Health Group (WHG) was established to
conduct multidisciplinary research in worker health, safety, and orga-
nizational effectiveness (Haynes et al., 2019). Their agenda aligns with
the United States Centers for Disease Control and Prevention’s NIOSH
Total Worker Health (TWH) initiative (Hudson et al., 2019). The TWH
approach integrates health protection and health promotion with a focus
on changing work stressors - that is, placing some of the burdens of
coping with organizational stress on the work environment rather than
on the workers (Quick et al., 2013). The healthy work organization
approach does draw heavily on the public health notions of risk ex-
posure, surveillance, and prevention. Within this domain, Hammer et al.
(2011) bring our attention to the importance of monitoring the work-
family boundary and encouraging the development of family-supportive
supervisory behaviors that benefit all concerned parties.

Concluding Note: Start at the Top

Organizational stress can start at the top and have a negative cascading
effect throughout the entire organization. Toxic emotions can have
harmful, destructive, and contagious (Frost & Robinson, 1999)
throughout an entire workplace. By the same token, good clinical in-
tervention with a senior executive who has mastered positive stress
 Organizational Stress in the United States 315
management skills can be primary prevention and a benefit for tens,
hundreds, and even thousands of workers throughout an organization.
Quick and Quick (2013) identify five key threats and challenges that
executives face - which are stress, burnout, social isolation, toxic effects
of emotions, and traumatic events and tragedies. The American strate-
gies of exercise, positivity, and organizational clinical psychology can
enable senior leaders to confront and overcome these threats and chal-
lenges for their own benefit and for the benefit of many others in their
organizations.

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15 Key Issues and Future Research
Kajal A. Sharma, Cary L. Cooper, and
D.M. Pestonjee

This volume reflects the current status of work stress research in various
countries that are economically, socially, politically, and technologically
different. Moreover, organizations in these countries have different
workforce demographics, regulatory compliance, legal demands, culture
and climate. However, different chapters reflect that stress is still iden-
tified and acknowledged as a significant issue in all countries. In our
concluding discussion, we reflect on some of the key takeaway points
arising from the discussion in different chapters and suggest future work
areas.
We notice that there is consensus about some of the major sources of
work stress across different countries. Stressors like work overload,
work hours, lack of control, role conflict, role ambiguity, work re-
lationships, career advancement opportunities, salary, job insecurity,
organizational factors like culture and policies, and work-life balance
issues are common in various national stress literature. This is not an
exhaustive list, but it identifies some of the most critical stressors faced
by the global workforce. However, the quality and quantity of in-
vestigations on the stress-strain relationship vary in different countries.
For instance, there is extensive literature covering organizational stress
issues from the United States, United Kingdom, and other European
countries compared to countries like Russia, Brazil, South Africa, and
many Arab and African countries. Recently, there has been an increase in
research studies from India and China, as they have emerged as the
hottest centers of economic growth; however, more work needs to
be done.
We observe that there is considerably less research undertaken in ex-
amining the individual-difference variables - such as personality char-
acteristics, demographic factors (i.e. age, gender, education, marital status,
socioeconomic status, and ethnic or racial group), and organizational
context dimensions (i.e. management styles, organizational culture, lack of
communication, mutual decision-making and organization politics) -
which should be investigated further and included as potential causes and/
or moderators of the work stress process. Another noticeable trend is that
DOI: 10.4324/9780429292538-15
 Key Issues and Future Research 319
researchers in many developing countries have shown keen interest in
analyzing the antecedents of stress as compared to examining the different
consequences of stress on health. Further, moderating factors influencing
the relationship between stress and ill-health - such as locus of control,
gender differences, personality predispositions, and socioeconomic status -
have been studied in developed countries, but such themes have not re-
ceived much exposure in the literature of developing countries. More
studies need to focus on the multiple consequences of stress on human
health. Cooper and Quick (2017) point out that stress is directly or in-
directly linked to seven of the ten leading causes of death in all developed
nations, including the United States of America and the United Kingdom.
These seven causes are heart disease, cancer, stroke, injuries, suicide/ho-
micide, chronic liver disease, emphysema, and chronic bronchitis. On the
other hand, according to the World Health Organization (WHO,
2007), about 75% of the world’s labor force - which accounts for about
2,400 million people - lives and works in developing countries, and
20–50% of workers in industrialized countries may be subjected to ha-
zardous exposure at work, and this rate is expected to be higher in de-
veloping and newly industrialized countries. In light of such facts, it
becomes more significant for researchers to examine the link between
stress and health-related outcomes and behaviors for the benefit of the
global workforce.
Countries face unique climate and cultural stressors - such as heat
stress, the role of the state, the role of national culture, the proportion
and state of workers in the non-regulatory sector, weak legislation to
protect worker rights, power harassment (i.e. managerial abuse of
power), the presence of social media, and the role of religion. The in-
fluence of such factors on work and work organizations in different
countries has been discussed in this book. Further research needs to be
undertaken on these unique stressors, as they are responsible for the
changing nature and forms of jobs as well as new and different work
settings. Further research on such aspects will benefit organizations to
understand the internal and external environment of their businesses,
their unique challenges, effectively plan work for the workforce, and
devise all-inclusive stress interventions accordingly. Cultural aspects
especially may need significant attention when dealing with work-related
stress in developing countries. Features such as spirituality, religion,
tradition, the collectivist approach, and societal expectations and dy-
namics are integral to the cultural fabric of these countries. These
characteristics make them different from most of the developed countries
that have individualistic cultural traits. Thus, researchers need to in-
vestigate the environment in which stress occurs and focus on context-
based research - which is also suggested by Cooper, Dewe, and
O’Driscoll (2001), as the environment can influence the nature of strain
being experienced by the individual.
320 Kajal A. Sharma et al.
Research presented in different chapters acknowledges the contribu-
tion made by present models, theories and measures developed to study
stress. However, the discussion highlights the need for developing more
culture-specific models and theories. This issue is critical for developing a
context-based understanding of organizational stress. Most stress models
and frameworks have their roots in Western cultures where they seem to
fit in the internal and external environments of organizations.
Nonetheless, researchers from various countries like India, China, Brazil,
South Africa, Nigeria, Russia, and Japan have been using the same
models to examine stress phenomena in their cultures. Considering the
uniqueness of different local and national cultures, these models might
not be fit for purpose and need to be customized or modified. There
should also be attempts to develop new models considering the changing
work and work environment in such countries. The issue of the effec-
tiveness of psychological instruments designed based on Western the-
ories and models used for research in other cultures is also been debated.
Researchers like Laungani (2007); Spector et al. (2004); Burke (2010);
Bhagat et al. (2010) have raised the issue of Western imitation in the
context of cross-cultural research on stress and discussed problems as-
sociated with the use of such models, theories, and measures. Cooper
et al. (2001) suggest that, in light of social and economic changes over
the past two decades, the existing measures used for capturing data on
stress and coping should be evaluated in terms of (a) the content of items,
(b) the scoring of responses, and (c) the process of establishing internal
reliability.
International research collaborations can play a critical role in helping
researchers develop new models. However, for such initiatives to be
successful, researchers must respect the traditions, beliefs, and values of
different cultures and learn from them while developing theories and
models to explain phenomena like stress-strain-coping (Palsane, Bhavsar,
Goswami, & Evans, 1999). The development of indigenous models and
measures might offer further clarity on how the work and work en-
vironment might be perceived differently by employees with different
cultural backgrounds. Considering that the contemporary work orga-
nizations have a diversified workforce, this knowledge can be useful for
organizations to understand the cultural values endorsed by their em-
ployees and how they influence employees’ work attitudes and beha-
viors.
A prominent view found across national literature is that stress is
harmful, so there has been an extensive examination of the negative side
of stress compared to the positive effects of stress on the workforce. As
there is a bias towards identifying the negative effects of stress, research
has focused on finding the causes for it and developing coping me-
chanisms to deal with stress (Nelson & Simmons, 2003). Illness rather
than wellness is associated as a by-product of stress and there is extensive
 Key Issues and Future Research 321
literature to support this. Myers (2000) highlighted that the number of
publications on negative states exceeds that of positive states by a ratio
of 14:1, which was also supported by Avey, Luthans, and Jensen (2009).
Schaufeli and Salanova (2007) suggested that failing to capture the po-
sitive effects of stress offers an inappropriate and incomplete description
of this phenomenon. In his book, Selye (1956) spoke about two types of
stresses - eustress and distress - found in the workplace - a concept that
has been supported by much research in the following years. However,
there has been extensive focus on distress compared to eustress - which
highlights that researchers have focused more on treating stress symp-
toms rather than examining factors that can prevent distress at work. It
has also been observed (Le Fevre, Matheny, & Kolt 2003) that some
popular theories in the field - like control theory (Spector, 1998), P-E fit
theory (Edwards, Caplan, & Van Harrison, 1998), and the Cybernetic
theory (Cummings & Cooper, 1998) do not differentiate between both
kinds of stresses. Most of the stress theories and models on stress have
discussed how stress is generated and have supported the identification
and weakening of stress-generating factors in the work environment to
manage stress effectively. However, these models have failed to discuss
the identification of factors that could act as buffers against stress.
Nonetheless, researchers like Quick and Quick (1979) have investigated
the ways to combat stress at work with their theory on preventive stress
management. There has been a surge in studies focusing on positive
psychology and its influence on work recently, but, before that, very few
studies focussed on these aspects (e.g. Pestonjee, 1992; Lazarus, 1993;
Luthans, 2002; Peterson, 2006; Avey et al., 2009; Seligman, 2012;
Rahimnia, Mazidi, & Mohammadzadeh,2013; De Sousa & van
Dierendonck, 2014; Abbas & Raja, 2015; Chambel, Carvalho, Cesário,
& Lopes, 2017; Marques-Pinto, Jesus, Mendes, Fronteira, & Roberto,
2018; Celik, 2018). Although, more remains to be explored on the
factors and mechanisms preventing stress at work. Hence, it is important
to focus on positive psychology and offer a thorough examination of the
positive influence of stress on work - which is also endorsed by other
researchers. As suggested by Turner, Barling, and Zacharatos (2002), it
is time to expand our research and focus on exploring the positive effects
of stress on work fully so that we can develop a complete understanding
of the meaning and effects of working.
We witness that there is a dominance of cross-sectional research in
stress literature and a need for more longitudinal studies. Many re-
searchers suggest that longitudinal research designs offer stronger con-
clusions on the causal relationship of different independent and
dependent variables as compared to cross-sectional research designs
(Fried, Rolland, & Ferris, 1984; Cooper et al., 2001; Skakon, Nielsen,
Borg, & Guzman, 2010; Kelloway and Francis, 2013; Mäkikangas,
Kinnunen, Feldt, & Schaufeli, 2016). They also provide an opportunity
322 Kajal A. Sharma et al.
to study the influence of time factors on the dynamics of the stress-
strain-coping process. Thus, such studies can help provide us with a
better understanding of the causal processes. This approach can provide
greater opportunity for generalization of research findings but also
demands a longer-term commitment to generate effective longitudinal
research. Researchers also need to be aware of the challenges of under-
taking longitudinal studies - like time lag, sample size, changes during the
study, and the stability of measures and a need to work around these
(Ter Doest & De Jonge, 2006). Laungani (1999) also highlighted that
researchers especially from developing countries face constraints like the
lack of funding, the lack of informational and technological support,
poor industry and academic interaction, and the lack of international
collaborations - which, to our understanding, not only influence but also
limit the quality and quantity of research output. The popularity of
longitudinal designs has grown over the last couple of decades, yet there
is still a lot of ground to cover - an observation which is echoed by other
researchers like Taris and Kompier (2003); Cooper et al. (2001);
Skakon et al. (2010); Pandey, Gaur, and Pestonjee (2013) and
Mäkikangas et al. (2016).
We also spot that quantitative methodologies are more popular
compared to qualitative methodologies in studying stress. This has also
been reflected in different reviews (e.g. Jex & Beehr, 1991; Kristensen,
1996; Cooper et al., 2001; Lin, 2003; Mazzola, Schonfeld, & Spector,
2011). Quantitative studies are important in exploring the stress-strain-
coping relationship and considered more time and cost-effective from the
researcher’s point of view. However, this method has limitations that can
be overcome by examining the stress-strain-coping dynamics through a
qualitative lens. Qualitative research does not limit the stressors, strains,
and coping methods used by employees (Schonfeld & Farrell, 2010).
Hence, as these studies do not follow any preconceived notions, they are
found to be very useful in exploring and providing insights on the latent
factors related to stress in different groups in different situations. This
kind of research is person and organization-focused offering valuable
insights on current issues and assisting the discovery of new person and
situation-centric stress characteristics that can help design specific and
effective interventions. Many researchers have endorsed qualitative
methodologies and their importance in stress research (O’Driscoll and
Cooper, 1996; Richards, Oman, Hedberg, Thoresen, & Bowden, 2006;
Randall, Cox, & Griffiths, 2007; Schonfeld & Farrell, 2010; Schonfeld
& Mazzola, 2013). However, researchers should also consider the lim-
itations of the qualitative approach. Given there are limitations in both
quantitative and qualitative designs, some researchers have suggested the
application of a more “balanced approach”. This balanced approach
endorses adopting a “mixed method” design wherein the strengths of
both qualitative and quantitative methods are capitalized on. We observe
 Key Issues and Future Research 323
this as a growing trend in most of the developed countries, and studies
undertaken in cross-cultural context have been especially and extensively
employing triangulation methodology (Narayanan, Menon, & Spector,
1999; Cooper et al., 2001; Östlund, Kidd, Wengström, & Rowa-Dewar,
2011; Liu, Spector, & Shi, 2008; Tummala-Narra, Inman, & Ettigi,
2011; Singh, Cross, Munro, & Jackson, 2020). We suggest that more
studies should adopt triangulation methodology, as it supports re-
searchers in integrating qualitative and quantitative research outcomes
and helps them clarify their theoretical propositions, as well as the
foundations of their results. This method also offers an opportunity by
which researchers can establish more clear links between theory and
empirical findings, challenge theoretical assumptions, and develop new
and perhaps culture-inclusive stress theories and models.
Another important reflection is that there is a dearth of organization-
based intervention studies in stress literature. Hence, knowledge of the
effectiveness of different proposed stress management interventions in
practice is limited. Different researchers across countries have identified
similar trends (Havermans et al., 2016; Giga, Cooper, & Faragher,
2003; Duarte & Pinto-Gouveia, 2016, Li et al., 2017; Ugwoke et al.,
2018). Generally, across literature, interventions are of two kinds:
person-centric and organizations-centric. Some researchers (Montano,
Hoven, & Siegrist, 2014) have suggested that organization-wide inter-
ventions yield beneficial results for the organizations, as they generally
lead to systemic changes to organizational practices that target all em-
ployees or a particular group of employees. On the other hand, it has
been argued that in practice, organization-wise interventions to manage
stress are less frequent as they incur costs and are complex in application
and measurement. Hence, researchers have also been examining in-
dividual interventions that help employees to develop skills to manage,
cope, and reduce their work stress. They are considered a more cost and
time-effective way of countering stress, and, therefore, have also received
attention from employers and employees (Tetrick & Winslow, 2015).
However, evidence shows that their duration is short; hence, their ef-
fectiveness may be limited (Bhui et al., 2016). Chapters from different
countries have offered some insights into popular intervention practices
prevalent in those countries. We can conclude that there is an increasing
trend of organization-wide interventions in developed countries; how-
ever, organizations in developing countries expect employees to take
ownership of managing and coping with work stress. To create healthy
organizations, it is essential to strike a balance between different kinds of
interventions. Depending on the work, workgroup, and work setting,
different interventions - like primary interventions (aiming to prevent
exposure to known risk factors and to increase the resilience of the
workforce), secondary interventions (aimed at reversing a progression),
and tertiary interventions (aimed at reducing severity) - can benefit
324 Kajal A. Sharma et al.
organizations (Leka & Jain, 2017). Hence researchers like Robertson
and Cooper (2011) and Weinberg and Cooper (2012) have suggested
that all kinds of organizations should consider a range of all such in-
terventions to deal which work stress. Intervention-based studies not
only expand understanding of causal relationships, but they also enable
systematic assessment of the organization’s various stress prevention
management and treatment strategies and the effects of such strategies in
maintaining and promoting employee’s overall health and well-being at
work. Therefore, more researchers should undertake intervention studies
based on organizational evidence validating the organization’s actions
and practices and developing further knowledge on the implementation
and effectiveness of various kinds of interventions. An understanding
developed through such studies can also help improve general manage-
ment practices in various kinds of organizations.
Today we see different types of organizations around us from big
and global corporate businesses to small and medium-sized businesses
who employ formal and/or informal workforces, operate in different
cultures, and face exceptional challenges - like the current global
pandemic caused by Covid-19. Covid-19 has once again put the cri-
tical issue of work stress management and employee health to the
forefront. The role of the state, work organizations, and other stake-
holders in identifying the causes of stress, taking proactive measures,
analyzing the impact of stress on different groups, identifying suitable
interventions, implementing identified interventions in the necessary
time frame, and evaluating the helpfulness of applied interventions is
seen to be critical in dealing with stress effectively within organizations
and community at large during this pandemic. We have discussed
stress as a global phenomenon in our first chapter, however, con-
sidering our observations from literature, we endorse that the strate-
gies devised to eliminate stress and create healthy organizations have
to include local, national flavors to be successful. Important stake-
holders like governments, social partners, unions, private and public
organizations, employees, and researchers together need to devise ef-
fective strategies to prevent, manage, and treat stress in the organi-
zational space. This can be done most effectively by sharing
information, resources, expertise, and experience to develop best
management practices at workplaces. Researchers can also play a
significant role by expanding knowledge on the best practices by un-
dertaking more cross-cultural and interdisciplinary research. Our un-
derstanding is that implementing such quality management practices
will make organizations and the workforce thrive in most cultures
around the globe and help them persevere during extraordinary cir-
cumstances, like the current Covid-19 crisis. However, more research
should be undertaken globally to gain a comprehensive insight on the
full impact of the current pandemic on workforce and organizations to
 Key Issues and Future Research 325
identify and to rapidly adapt to new, integrated, and sustainable in-
terventions that make contemporary work organizations more re-
sistant to any similar situation in the future.

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Index

Note: Italicized page numbers refer to figures, bold page numbers refer to tables.

abbaya 196 Al-Sinawi, H. 210

absenteeism: in Australia 7; in India Altman, J. 198
81, 92; in Japan 92, 138; in Alves, E. 253
Malaysia 2; in Oman 209; in Russia Alves de Moura, P. 253
209; in United States 309 amal-salih 210
Abu-Hilal, M. 201 American Orthopaedic
Act of Promoting Measures to Prevent Association 309
Death and Injury from Overwork American Psychological
(Japan) 129 Association 306
Adesola, A.O. 145 American Sociological
Adkins, J.A. 312–13 Association 202
Adusei-Asante, K. 287 An Organizational Stress Screening
Afsharian, A. 12 Tool (ASSET) 51
ageism 194 Anagnostopoulos, A. 74
Aguiar, O.B. 33 Anene, O.P. 147
Ahmed, N. 93 Ângelo, R.P. 253
Akintayo, I. 153 Anil Kumar, V. 90
Akinyele, F.E. 145 animal professionals 16
Akinyele, S.T. 145 Anosike, N.M. 147
Al Busaidy, N.S.M. 199 Antoniou, A.S. 67, 71
Al-Adawi, S. 194, 210 anxiety disorders 309
Al-Alawi, M. 200 Apostolopoulou 69
Alarcon, G.M. 254 artificial intelligence (AI) 292–3
Albania 192, 193 arubaito (fringe workers). 132
alcohol use 276 Asano, Hirokatsu 133
Aleixo, M. 255 Ashforth, B.E. 254
Alfrey, K.L. 14 Ashy, M.A. 210
algorithms 292–3 Asia Pacific Academy for Psychosocial
Al-Hashemi, T. 200 Factors at Work 16
Allah 210 assa 195
Al-Lawati, S. 201 aursia 196
Al-Maniri, A. 199 Australia 2; causes of occupational
Almazroui, A. 201 stress 8; GDP 7, 15; landmass 7;
Al-Nabhani, A.M. 198, 200 occupational stress in 7–17;
Al-Rubaee, F.R. 199, 200 population 7
Al-Sinawi, H. 194 Australia, occupational stress in 8–13;
 Index 331
bullying 12–13; dangerous wildlife blogs 276
15–16; distance 13–14; heat 14–15; Boase, A. 10
incivility 12–13; job demands 9–11; Boehmer, T. 269
job resources 9–11; occupations Bokhan, T.G. 274
with highest stress levels 8; Bolino, M.C. 269
psychosocial safety climate 11–12; Bond, S.A. 12
stressor appraisals 9–11 Borg, V. 94
Austria 192 Borthwick, A. 199
Auton, J.C. 11 Boudreau, J.W. 309
Avey, J.B. 321 Braganza, D. 89
Azuh, D.E. 147 Brazil, work stress in 23–36; coding
scheme 24–5; Demand-Control-
Babajide, E.O. 153 Social Support Model 26; Effort-
Balochs 195 Reward Imbalance model 26;
BAME employees 3 geographical characteristics 26–8;
Banerjee, S. 90 inclusions 24, 25; methodological
banking sector, Nigerian 151–2 characteristics 26–8; partial
Barbour, J. 8 distribution by knowledge area 27;
Barkhuizen, N. 289 reactions to work stress 28–9;
Barley, S.R. 94 stressors 28–9; surveys 24, 25;
Barling, J. 256, 321 temporal characteristics 26–8, 27;
Barnard, A. 286 worker characterizations 28
Baron, R.A. 145 Brazilian Burnout Inventory 33
Bartlett’s Test 203 Brief Job Stress Questionnaire
Base Realignment and Closure (BJSQ) 137
Commission (BRAC) 313 Brough, Paula 8, 8–9, 9–10
Bastos, C. 254 Bruce, M. 276
Baynes-Rock, M. 16 Bruton, G. 271
Beck Depression Inventory (BDI) 310 Bulgaria 192
Beehr, T.A. 270 bullying 12–13
Beijing 46–51 Burke, R.J. 43, 94, 320
Belgian Safe Work Information Burman, R. 94
Center 185–6 burnout 3, 89, 168–9, 169, 177,
Belgium 192 199–201, 254, 255, 309
Belgium, work-related stress in Burnout Inventory 86
167–88; acknowledgement of risks
178–81; burnout 168–9, 169, 177, Calais, S.L. 33
178; colleague help and support Camacho, C. 253
173; handbooks for 182; job Campos, J. 254
autonomy 172, 175–6; job demands Cannon, Walter B. 303
170–4; manager help and support cardiovascular diseases, work-
173; negative social interactions related 271
171; opportunities for control 171, Cardoso, H.F. 33
175; overview 167–8; participation Carlotto, M.S. 33
174; prevalence of 168–9; Carr, C. 272
psychosocial risks 169–77; Cartwright, S. 3
quantitative job demands 170, 175; Caruana, L. 273
risk management 181, 181–7; skill Carvalho, A.S. 253, 254, 256
discretion 172; trend data 179 Carvalho, V.S. 251, 253
Bhagat, R. 320 Cascio, W.F. 309
Bhatt, S. 89 Case, J.M. 290
Bi, P. 15 Casey, G. 307
Biggs, A. 8, 10 Cavanagh, S. 291
332 Index
Certified Health and Productivity Cronbach’s Alpha 202
Management Organization cross-cultural studies 44–5, 270
Recognition Program (Japan) 138 cross-sectional studies 251–2
Chambel, M.J. 251, 253 Cruz-Mendes, A.M. 254
Chand, P. 91 Cruz-Robazzi, M. 254
Chandramouleeswaran, S. 89 culture 44; and coping 198–9; and
Chaturvedi, S.K. 93 work-related stress 201
Chen, P.Y. 12 Cunha, J.P.S. 255
Chetty, P.J.J. 287 cybernetic theory 321
China (Mainland) 44, 56 Cyprus 64, 192
Chitra, T. 91 Czech Republic 64, 192
Chrisopoulos, S. 12
Cilliers, F. 284 da Silva João, A.L. 253
Clark, S. 291 daily workers 132
Claro, M. 254 Dalcin, L. 33
climate change 15 Damásio, B.F. 33
Clinton, Bill 313 Daudt, H.M.I. 222
Coelho, D.A. 253 Davey, A. 90
Coetzee, M. 287 David, A. 153
Coetzee, S.E. 295 De Beer, L.T. 289
Coetzer, W.J. 286 De Beer, L.T. 287
Cohen, R. 69 deaths 313, 319
Cohen, S. 202–3 decision-making 293
collectivism: versus individualism 208; Demand-Control-Social Support
and occupational stress 209–10 Model 26, 31, 34
communicaiton abilities 294 Demerouti, E. 74
Compas, B.E. 198 DemografieFondsDemographie 186
compliance 292 Denmark 192
conflict-solving 293 Denyer, D. 82
Connor-Smith, J.K. 198 Department of Defense 313
Conradie, Maria 287 depression 194, 274, 309
Conservation of Resources (COR) descriptive analysis 83–6
model 254 Deshmukh, M. 91
Considine, R. 14 Dewe, P.J. 33, 94, 319
construction industry 154, 288–9 Dhaou, S.B. 297
continuous learning 292 dhow culture 213
control theory 321 diagnostic abilities 293
Cooper, C.L. 3, 33, 43, 67, 68, 70, 94, Dias, D. 255
148, 308, 319, 322, 324 disability claims 285
Cooper, Kenneth 311 dishdasha 195
coping mechanisms 154–5, 162–6, dispersion modeling 12
209; and culture 198–9; emotion- distance 13–14
focused 198; problem-focused 198 distress 195, 208
coping methods/styles 89–90 divorce 274–5
Coping Strategies Scale 84 Dixe, M.A. 253
Copper, C.L. 305 Doble, N. 93
correctional officers 10 Dollard, M.F. 12
counterproductive work behaviors Doraiswamy, I.R. 91
(CWBs) 150 Dormann, C. 12
Coutinho, H. 253 downsizing 67
Covid-19 3–4, 323 Drosos, N. 71
creativity 293 drought 15
Croatia 192 Du Plessis, J.V.D. 289
 Index 333
dual-earner families 56 Fanaras, D.L. 69
Faria, S. 253
EBSCO 82 Fees Must Fall Movement 290
economic stress 271–6 femininity 210–11
Edge, K. 198 Ferreira, A.I. 255
education sector: Nigeria 149–50; Ferreira, N. 287
South Africa 289–90 Filipe, R.M. 255
Edwin, N. 89 Finland 192
effort-reward imbalance 214 firefighters 10–11
Effort-Reward Imbalance model 26, Flemish Institute for Healthy Living
32, 34, 86 (VIGO) 186
Effort-Reward Imbalance flexibility 292
Questionnaire (ERIQ) 29 Flotman, A.P. 284
El Paso Walmart mass shooting fly-in fly-out (FIFO) workers 14
(2019) 306–7 Folkman, S. 196–7, 198
Eliot, R.S. 197 Fonseca, A.M. 254
Elsevier 82 Fonseca, M.J.M. 33
Elsheshtawy, E. 201 Fotinatos-Ventouratos, R.S.J. 68, 70
Emam, M. 201 Fourth Industrial Revolution
Emerald 82 284, 291–5
emergency workers 132 France 62, 192
emotional intelligence 90 Francis, L. 251
emotional resources 10–11 Frank, J. 86, 90
emotion-focused coping 198 Freitas, C.P.P. 33
Employee’s Compensation Act of Freitas, G.R. 33
2010 (Nigeria) 156 Frimpong, K. 287
entrusted workers 132 Fujimura, Masanori 131
e-payment 152 Fujioka, Yosei 132
Epetimehin, S. 145 Fukazawa, Kenji 132
epidemiology 308 Fukui, Satoe 132
Ermasova, N.B. 276
Estonia 192 Gafarov, V.V. 271
Estrela, C. 253 Gandhi, S. 93
European Foundation for the Gandi, J.C. 150
Improvement of Living and Gardner, B. 14
Working Conditions 63–4 Garg, N. 91
European Survey of Enterprises on Gates, Robert 307
New and Emerging Risks (ESENER) Gaur, S.P. 93, 322
168–9, 169, 175, 178–9, 179–81, Gavrilov, I. 272
181, 192, 193 Gavrilova, N. 272
European Union 62 GDP 1; Australia 7; Nigeria 147;
European Union (EU-28) 180–2 Russia 268
European Working Conditions Survey gender bias 194
(EWCS) 168, 191, 192 gender inequality 211–12
Eurozone 62 General Health Questionnaire 85–6
eustress 195, 208, 311–12 generic job resources 10
evil eye 214 Germany 62, 192; work-related stress
expatriate workers 214 in 64
External Services for Prevention and Goh, J. 305, 306
Protection at Work (Belgium) 186 Gomes, A.R. 253
Ezenwaji, I.O. 151 Google Scholar 82
Gorelova, E. 272
Facebook 275, 276 Goswami, T.G. 90
334 Index
Gowardman, J. 16 Guoswami, T.G. 94
Greater China job stressors 43–57; Gupta, N. 272
descriptive statistics 49; dual-earner Guzman, J. 94
families 56; fit statistics 51; guanxi
(relationship) 56; intercorrelation of Habigzang, L.F. 33
Chinese stressors 50; haken workers (dispatch workers) 132
intercorrelation of main variables Hans, A. 201
53; interpersonal conflict 55; job Hansen, A. 15
insecurity 56; job satisfaction 51; Haratani, Takashi 132
measures of 51–2; open-ended Hart, Peter 9, 9–11
interviews 47; open-ended hasad 214
qualitative methodology 46; Hashimoto, Hideki 134
organizational politics 55; Hayward, R. 10
paternalistic leadership 55; power Healey, D. 272
distance 55; regression analysis 54; health expenditures 305
samples and procedures 46–51; Health Perception 249
strains 51–2; work-family healthcare sector: India 287–8; Nigeria
conflict 56 150–1; South Africa 287–8
Greece: economic crisis 64–6; exports healthcare utilization ratges 313
69; female labor participation in 70, healthy work organizations 314
71; financial aid package to 65; GDP heat 14–15
69; gender employment gap 71; heat stress 15, 89
Kallikratis Reform 66; labor laws Hellas see Greece
73–4; physical and mental health in Hellas Employee Assistance Programs
68–9; population 62; stress, work- (Hellas EAP) 73
related in 63–4; unemployment Hellenic Republic see Greece
rate 70 Henriques, A. 253
Greece, organizational stress in 62–79; Hernández-Marrero, P. 253, 256
attitudes toward women managers herpetologists 16
71–2; causes of 64–76; coping Herrera, J. 272
mechanisms 72–4; downsizing 67; Higher Council for Prevention and
and economic crisis 64–6; GDP 65; Protection at Work 185
health effects on employees 67; Hirst, G. 45
intervention strategies 72–4; job HIV/AIDS 288
autonomy 70; job crafting for 74–5; Hofstede, G. 208, 210, 211
and lack of transparency 67–8; and Hong Kong 44, 46–51, 56
level of justice in organizations Humphrey, J.H. 197
67–8; nonstandard/atypical work Hungary 192
arrangements 67–8; primary Hurrell 30–8
interventions 75; and restructuring hypertension 153
of organizations 66–7; secondary
interventions 75; skills mismatch 70; Ibem, E.O. 147
specific stressors 69–72; tertiary Iceland 193
interventions 75; unemployment Ilic, D. 288
rate 65, 70 incivility 12–13
Greenberg, J. 145 India, work stress in: in academic
Greene, B. 284 sector 88–9; in banking 88; burnout
Grima, S. 273 89; consequences 92–3; coping
Grimsrud, A.T. 287 methods/styles 89–90; cross-
Grodal, S. 94 sectional studies 85–6; cultural
Gromova, F.A. 271 influence 95; descriptive analysis
guanxi (relationship) 56 83–6; descriptive features of studies
gun violence 306–7 109–27; emotional intelligence 90;
 Index 335
in healthcare 87–8; heat stress 89; Jathanna, P.N.R. 89
international literature 93–4; Jegede, O.J. 148
intervention-based studies 91–2; job Jeitinho Brasileiro 34
performance 90; job satisfaction Jensen, S.M. 321
90–1; in law enforcement 88; jinn 214
organization types 84; overview Joaquim, A. 256
81–2; research methods 84–5, 85, Job Content Questionnaire (JCQ) 137
86; stressors 44, 86–9, 87; job crafting 74–5
systematic review 82; unorganized job demands 9–11
sector 80; variables 89–92; work Job Demands-Control model 168
sectors 84, 85; workforce Job Demands-Resources (JD-R)
characteristics 80; workplace model 253
spirituality 91 Job Demands-Resources model 86
individualism 200; versus job insecurity 56
collectivism 208 job performance 90
Industrial Revolution 221 job resources 9–11
information technology security 293 job satisfaction 90–1
innovative thinking 293 job stressors: appraisals 9–11; in Brazil
Inoue, Akiomi 134 28–9, 29; categories 43; cross-
Instagram 275, 276 cultural studies 44–5; cultural
insurance companies 285 factors 44; cultural factors in 44; in
intercultural abilities 294 Greater China 43–57; in India 44,
International Labour Organization 1 86–9, 87; in Japan 133; in Nigeria
International Monetary Fund 147–8, 162–6; in Oman 213–15; in
(IMF) 80 United States 44; Western
interpersonal conflict 55 models 43–4
intervention studies 252, 323 Job-Content Questionnaire (JCQ) 29
Ireland 192 Johnson, S. 270
“iron rice bowl” era 56 Johnson & Johnson 307
ISI Web of Science 222 Joshi, K. 201
Islam 195, 210 JSTOR 82
Italy 192 Judge, T. 291
Ito, Takahiro 133 Junior, P.L.D. 147
Ivanova, L.I. 270
Kahn, R.I/ 303
Jackson, S.E. 168–9 kahwa 196
Jacob, D.K. 91 Kaiser-Meyer-Olkin (CMO)
Jacobs, M. 289 202–3, 203
Jahan, F. 200 Kallikratis Reform 66
Jain, N. 93 Kamarck, T. 202
Japan, organizational stress in 128–39; Kane, P.P. 93
government policies on 136–8; karo-jisatsu (work-related suicide) 2,
health and productivity 129–30; causes of 129–30; future
management 138; karo-jisatsu research 138; incidence of 129;
129–30; karoshi 129–30; long work versus karoshi 129
hours 130–2, 131; mental health karoshi (death-from-overwork)
implications 133–4; non-regular 129–30; causes of 129–30; future
employment 132–4; overview 128; research 138; incidence of 129;
power harassment 134–5; sexual versus karo-jisatsu 129
harassment 135; Stress Check Karunanidhi, S. 91
Program for 137; stressors 133; Kawachi, I. 271
work style reforms 136; workplace Kawaguchi, Daiji 133
harassment 134–5 Kawakami, Norito 131, 134
336 Index
Keenan, A. 45, 46 Lopes, H. 253
Kelloway, E.K. 251 Lourenco, M.L. 253
Kelly Air Force Base 313 Lu, Y. 271
Khamisa, N. 288 Lunde-Jensen, P. 197
Khan, S. 91 Luthans, F. 321
khanjar 195 Luxembourg 192
Kirsten, G.J. 289
Kitayama, S. 198 Ma, J. 44
Kivimaki, M. 271 Macedo, V.A. 147
Klunder, C. 313 Macedonia 192, 193
Koller, S.H. 33 Macik-Frey 306
Komorida, Tatsuo 130 Macik-Frey, M. 255
Kompier, M. 322 magic 214
Koortzen, P. 286 Maia, A.C. 254
Koshy, R.C. 91 Mäkikangas, A. 322
Koukiadaki, A. 74 Malaysia, absenteeism/presenteeism
Koukoulaki, T. 66 costs in 2
Koul, H. 91 Malta 192
Kretsos. L. 74 Manda, M. 297
Kumar, S.P. 91 Manuel, S. 251
Kumar, Suneel 201 manufacturing sector, Nigerian 152–3
Kumar, V.K. 91 maqbous 196
Markus, H.R. 198
Labor Inspectorate Authorities Maroco, J. 254
(Greece) 68 Marques, M.M. 254
Lagos State, Nigeria 152, 156 Marteleto, L.J. 291
Lahad, M. 69 Martin, Angela 9
Lambert, C.E. 94 Martinez, L.G. 255
Lambert, E.G. 86 Martins-Pereira, S. 253, 256
Lambert, V.A. 94 masculinity 210–11
language abilities 294 Maslach 169
Latha, K.S. 89 Maslach, C. 33, 168
Latvia 64, 192 Maslach Burnout Inventory 29, 249, 309
Laungani, P. 320, 322 Maslach Burnout Inventory (MBI) 310
Lawati, Hasan al 212 Maslow, Abraham 314
Lawler, J. 45 Mayer, C.-H. 286, 289, 291
lawyers, stress management 10 McEwen, B.S. 197
Lazarus 198 McLinton, S.S. 12
Lazarus, R.S. 44, 196–7 ME 68
Lazarus and Folkman’s Model 253 medical residents 256
Lee, R.L. 254 medical sociology 269
Leiter, M.P. 167–9, 168–9 medical students 201
Levi, L. 197 Mediterranean syndrome 73
LGBT employees 3 Mehta, P. 90
Li, Y. 12 Mendelson, S. 197
Liang, B. 199 Menon, S. 44
Lipp’s Inventory of Symptoms of mental health: Australia 7; Belgium
Stress for Adults 29 168–9; Brazil 23; Greece 68–9;
Lithuania 192 Japan 133–4; Netherlands 133–4
Liu, C. 45, 55, 94 Mermelstein, R. 202
Living Situation Survey Meyerson, D.E. 94
(Netherlands) 177 Michigan Organizational Assessment
longitudinal studies 251–2, 322 Questionnaire 51
 Index 337
micro and small enterprises Nielsen, K. 94
(MSEs) 193 Nigeria, organizational stress in
mining industry 289 145–57; in banking sector 151–2; in
Mirtschin, P. 16 construction sector 153–4; coping
Montenegro 192, 193 mechanisms 154–5, 162–6; cultural
Montibeler, J. 33 factors in 156–7; in education sector
mortality rates 305 149–50; government as culprit in
Mosaku, T.O. 147 156–7; in healthcare sector 150–1;
Moskvin, Alexander 272 versus other countries 146–7;
Mouza, A.M. 67 overview 145–6; in police force 154;
Mujtaba, B.G. 269 socioeconomic factors 148; stressors
mussar 195 and strains 147–8, 162–6; and weak
Myer, L. 287 enforcement of labor laws 156;
Myers, D.G. 321 work content 147–8; work
context 147–8
Najarian, B. 197 NIOSH Generic Job Stress
Nakata, Akinori 132 Questionnaire 137
Narayanan, L. 44 non-regular employment, in Japan
Nash, S. 272 132–4; arubaito (fringe workers)
National Institute for Occupational 132; daily workers 132; emergency
Safety and Health (NIOSH) workers 132; entrusted workers
309, 313 132; fair treatment of 136; haken
National Labour Council 185 workers (dispatch workers) 132;
National Strategy for Well-Being at increasing 132–3; mental health
Work 186 implications 133–4; and
negative affectivity 150 organizational stress 133; paato
Nelson, D.L. 256, 308, 312 (part-time workers) 132; seasonal
Netherlands, work-related stress in workers 132; statistics 132–3;
167–88; acknowledgement of risks stressors 133; types of 132
178–81; burnout 168–9, 169, 177; Norton, P. 253
colleague help and support 173; Norway 192, 193
handbooks for 182; job autonomy Nunfam, V.F. 287
172, 175–6; job demands 170–4; nurses 150–1, 200, 254
manager help and support 173; Nurses’ Stress Inventory 29
negative social interactions 171; Nwokeoma, B.N. 145, 154
opportunities for control 171, 175;
overview 167–8; participation 174; Obama, Barack 306
prevalence of 168–9; psychosocial Obasi, N.J. 147
risks 176, 180; quantitative job occupational stress, definition of 197
demands 169, 170, 175; risk factors Occupational Stress Index 84
180; risk management 181, 181–7; Occupational Stress Indicator (OSI) 44
skill discretion 172; trend occupational stress research: Australia
data 177–8 7–17; Belgium 167–88; Brazil
Netherlands Working Conditions 23–36; Greater China 43–57;
Survey (NWCS) 177 Greece 62–79; India 80–95; Japan
Neto, M. 251, 253 128–39; Netherlands 167–88;
networking abilities 294 Nigeria 145–57; Oman 194–216;
neuropsychiatric disorders 287 Portugal 221–58; Russia 268–77;
neuroticism 201 South Africa 284–97; United States
Nevid, J.S. 284, 286 303–15
Newton, T.J. 45, 46 occupational therapy 200
Nguyen, L.D. 269, 270, 276 Odendaal, A. 291
Nicholas, A.L. 147 O’Driscoll, M.P. 33
338 Index
O’Driscoll, M.P. 94 Organizational Role Stress Scale 84
O’Driscoll, M.P. 319 organizational stress: across diverse
Ogbari, M. 145 occupations 270; in banking sector
Ogbuanya 150 151–2; and cardiovascular diseases
Ohya,Yukihiro 131 271; causes of 64–76; in
oil fields, stress in 200 construction sector 153–4; coping
Okebukola, P.A. 148 mechanisms 72–4, 154–5, 162–6;
Okeke, M.N. 145, 152 cross-cultural studies 270; cultural
OlaOlorun, A.D. 151 factors in 156–7, 304–8, 310–15;
Olatona, F.A. 152, 154 and drinking 276; economic factors
Olawoyim, O. 148 64–6, 271–6; in education sector
Oldenburg 288 149–50; eustress 311–12;
Olofin, A. 151 government as culprit in 156–7;
Olusegun, A.J. 148, 151 government policies on 136–8;
Oluwasayo, A.J. 148 health effects 67, 271; in healthcare
Oman: cultural dress 195–6; sector 150–1; intervention strategies
dependence on expatriates 215; 72–4; mental health implications
dhow culture 213; dishes 196; 133–4; mortality rates 305;
expatriate workers 214; gender overload stress 276; physical fitness
inequality 211–12; gender myths 311; positive effects 271; positive
212; geographic location 195; stress 311–12; power harassment
income 214; land area 195, 215; 134–5; primary interventions 75;
limited socializing in 215; and religion 276; and restructuring
Omanization policy 215; population of organizations 66–7; and roles in
195; religion 195; social norms 211; work 270; secondary interventions
social order 215; stressors in 75; sexual harassment 135; and
213–15; topography and scattered social stress 271–6; socioeconomic
inhabitation 215; unemployment factors 148; stressors 133, 147–8,
rate 214; women's rights in 211–12; 305; tertiary interventions 75; and
women's roles in 211–12 use of social network sites 275–6;
Oman, occupational stress in work style reforms 136; working
194–216, 199–201; behavioral conditions 271; working hours
changes 208; burnout 199–201; and 130–2, 304–5; work-life balance
collectivism 209–10; coping 270; workplace harassment 134–5;
strategies 196–7, 198–9, 209; and see also work stress
culture 201; data analysis 202–3; organizational stress research: Greece
definition of 196, 197; demographic 62–79; Japan 128–39; Nigeria
data of respondents 203–8; distress 145–57; Russia 268–77; United
in society 213–15; effects of 196; States 303–15
empirical studies on perceived stress Osibanjo, O.A. 149
202–8; methodology 202; overview Osmany, M. 93
196–7; and power distance 210–13; Owolabi, A.O. 151
studies on 199–201 Owolabi, M.O. 151
Onyishi, I.E. 149
Oosthuizen, J. 287 paato (part-time workers) 132
Oosthuizen, R.M. 286, 289, 291 Paiva, J.S. 255
open-ended method 45 Pandey, S. 94, 322
opioid epidemic 307–8 Panov, D.O. 271
organizational clinical psychology park rangers 16
312–13 paternalistic leadership 55
Organizational Health Center Pathak, P. 89
(OHC) 313 Pearlin, L.I. 269
organizational politics 55 Peltzer, K. 288
 Index 339
Perceived Stress Scale (PSS) 84, 202 Prasad, K.D. 90
Pereira Miguel, J. 251 Preferred Reporting Items for
perestroika 271 Systematic Reviews and Meta-
“person of confidence” 187 Analyses (PRISMA) 222
personality traits 201 presenteeism: in Australia 2; in
person-environment fit theory Malaysia 2; in Portugal 255
303, 321 Prickett, K. 291
Pestonjee, D.M. 322 primary interventions 323
Petrou, P. 74 primary prevention stage 3
physical fitness 311 private universities, Nigerian 149
physical working conditions 153 problem-focused coping 198
Pienaar, J. 287, 289 problem-solving 293
Pinterest 276 Probst, T.M. 45
Piraeus Bank Group 73 process comprehension 293
Pisaniello, D. 15 proficiency assimilation 293
Poland 192 programming abilities 293
police force, Nigerian 154 PSC-12 11–12
Porath, C. 3 psychosocial safety climate
Portugal, occupational stress research (PSCs) 11–12
in 221–58; aim of study 224–47; psychosocial stress 274
analysis 223, 248; antecedents of public health 308
work stress 252–4; area of study public universities, Nigerian 149
224–47, 248; authors 224–47; PubMed 222
consequences of work stress 255; Purde Pharma 307
cross-sectional studies 251–2; flow
diagram of systematic selection of qualitative research 322
studies 223; healthcare professionals quantitative studies 322
256; inclusion/exclusion criteria Queirós, C. 253
223; intervention studies 252; Quick, J.C. 255, 308, 313, 321
journals 224–47, 248; longitudinal Quick, J.D. 308, 321
studies 251–2; methodology 222; Qureshi, H. 86
negative bias 255–6; organizational
size 249; participants 224–47; Raaidan, Amira al 194
private vs. public organizations 249; Ramesh, B. 91
professionals studies 251; reviewed Ranta, R.S. 89, 91
studies 224–47; sample sizes 248–9; Raper, M.J. 10
study design 224–47, 248–9, 251–2; Rathus, S.A. 284
two-step cluster analysis 250; well- rational emotive behavior coaching
being indicator and measures (REBC) 155
224–47, 249; year of publication Rebar, A.L. 14
224–47, 248 Reis, C. 251, 253
positive organizational behavior religion 276
311–12 religous apparel, and religion 276
positive stress 311–12 remote area nurses (RANs) 13–14
positivity 311–12 research competencies 293
posttraumatic stress disorder (PTSD) resilience 292
254, 307 Ribeiro, E. 254
power distance 55, 210–13; femininity Ribeiro, O. 254
211; masculinity 210; uncertainty Ritzmann, R.F. 197
avoidance 212–13 road rage 213
power harassment 134–5 Robbins, S. 291
Prabhu, S. 89 Robertson, I. 324
Prakash, C. 91 robotics 292–3
340 Index
Rocco, P. 194 seasonal workers 132
Rodrigues, S. 255 secondary interventions 323
Roger, D. 197 secondary prevention stage 3
Romania 192 secondary schools 150
Roodt, G. 291 security industry 289
Rothmann, S. 286, 287, 289, 295 Self Reporting Questionnaire 29
Russia: alcohol use in 276; divorce in self-authorship 290
274–5; economic crises 272; self-disclosure, avoidance of 213–14
economic stress in 271; GDP 268; Selye, Hans 197
life expectancy 272; perestroika Semmer, N.K. 183
271; population 268; psychotic, Serbia 192, 193
stress-related disorders in 273; Serranheira, F. 253
safety net 273; social diseases sexual harassment 135
272–3; social network sites 275–6; Sharia law 212
social stress in 271; suicides 273–4; Sherwood, H. 198
transition to market economy 272; Shevchuk, A. 270
worforce 268; workforce 276 Shi, L. 45, 94
Russia, organizational stress in Shipp, S. 272
268–77, 270; across diverse shuva 196
occupations 270; and sick leaves 309
cardiovascular diseases 271; cross- sickness absence 2
cultural studies 270; and drinking Sieberhagen, C. 287
276; and economic stress 271–6; Siebert, W. 74
health effects 271, 274; of managers Simmons, B.L. 312
272, 274; medical sociology 269; Singh, M. 90
overload stress 276; positive effects Sinha, B. 199
271; and religion 276; and roles in Siu, O. 44
work 270; scarce resources 271; and Sivaramakrishnan, A. 91
social stress 271–6; symptoms 271; Skakon, J. 94, 322
two workforces 276; and use of Skinner, E.A. 198
social network sites 275–6; working Skinner, J.E. 197
conditions 271; work-life balance Sloan, S.J. 43
270; work-related stress 269–70 Slovakia 192
Slovenia 64, 192
Sacadura-Leite, F. 253, 254 small to medium-sized enterprise
Sakurai, Keiko 134 (SMEs) 9
Salami 150 Smart, P. 82
Salanova, M. 255–6, 321 smart technology 292–3
Saldanha Portelada, A.F. 253 Smit, D.M.D. 289
Salgado, J. 44 Snapchat 275
Saltzman, H. 198 social network sites 275–6
San Antonio Air Logistics Center 313 social stratification 269
Sanchez 44 social stress 271–6
Sangeetha, G. 93 Socio-Economic Council for Flanders
Sant`Anna, A.D. 147 (SERV) 186
Satisfaction with Life 249 Souchamvali, D. 67
Schaufeli 257 South Africa: colored community 291;
Schaufeli, W.B. 168, 255, 287, 321 Fourth Industrial Revolution 291–5;
Science Direct 82 HIV/AIDS 288
Scopus 82, 222 South Africa, occupational stress in
Scott, S.J. 222 284–97; black women 291;
seal handlers 16 characteristics of 291–5;
Searle, B.J. 11 competition and rivalry 286;
 Index 341
construction industry 288–9; from Stylianidis, S. 68
different cultural perspectives suicides: Australia 2; Japan 2, 129–30;
290–1; in education sector 289–90; Russia 273–4; United States 313; in
effects of 285–6; health effects 286; United States armed services 307
health sector 287–8; high level of Supriya, M.V. 93
285–6; mining industry 289; in Surtee, S. 289
minority groups 286; Survey of Enterprises on New and
neuropsychiatric disorders from Emerging Risks – Psychosocial Risks
286; overview 284–5; in police force (Portugal) 221
289; security industry 289; in sustainability 292
sociocultural and racial groups Swahilis 195
290–1; stress management 295–6; Sweden 64, 192
stressors 286; in women 286; Switzerland 192, 193; national health
workplace boredom 287 insurance in 306
South Korea, work hours in 131
Spain 192 Taber, T.D. 270
special education teachers 149–50 Taha, H. 201
specialized competencies 293 Taipe 46–51
specific job resources 10 Taiwan 56
Spector, P.E. 45, 94, 320 Takahashi, Masaya 132
Spector. P.E. 44 Tamayo, M.R. 33
Spreitzer, G. 3 Taris, T.W. 183, 257, 322
State of American Well-Being survey Tavares, C.S. 253
(2017) 304–5 Taylor and Francis 82
Stein, A.J. 287 teamwork abilities 294
Steinberg, A. 197 Teixeira, C.M. 253, 254, 256
Stern, E. 288 tertiary interventions 324
Stevenson, S. 16 tertiary prevention stage 3
strategic alignment 10 Theofanidis. D. 69
Strebkov, D. 270 Thompson, G.G. 16
stress: defined 284; definition of 63, Thompson, S.A. 16
269; health effects 304 Thomsen, A.H. 198
stress, work-related 1–4; causes of Times Oman 194
1–2; definition of 63; effects of 2 Tomlinson, M. 287
Stress Check Program (Japan) 137 Total Worker Health (TWH)
Stress Incident Record 46 initiative 314
stress management 295–6; macro-level Tozer, S. 16
295–6; meso-level 295–6; micro- Trait-State Anxiety Inventory 310
level 295 Tranfield, D. 82, 83
stress management interventions Transparent Reporting of Systematic
(SMIs) 8–9 Reviews and Meta-Analysis
Stress Management (Tummers/ (PRISMA) 24
Rocco) 195 triangulation method 323
stress test 304 Tróccoli, B.T. 33
stressors 1–2, 319; appraisals 9–11; in Trump, Donald 306
Brazil 28–9, 29; categories 43; cross- Tsuchiya, Masao 134
cultural studies 44–5; cultural Tsutsumi, Akizumi 131
factors 44; in Greater China 43–57; Tuckey, M.R. 10–11, 12
in India 44, 86–9, 87; in Japan 133; Tummers, L. 194
in Nigeria 147–8, 162–6; in Oman Turkey 192, 193
213–15; in United States 44; Turner, N. 256, 321
Western models 43–4 Turnley, W.H. 269
study design 224–47, 251–2 turnover rates 309
342 Index
Ugwoke 150 wasta 214
Ugwu, F.O. 149 Watson, D.C. 199
Umege, D.C. 153 Webster, V. 12
Umehara, Katsura 131 Weinberg, A. 324
uncertainty: avoidance 212–13; wildlife 15–16
tolerance 292 Williams, D.R. 287
unemployment rate 214 Williams, J. 10
United Kingdom 192; national health Williams, S. 43
service 306; work stress in 146–7; Willson, L.R. 199
working hours 305 Wilper, A.P. 305
United States: economic and financial women: black 286; employees 3;
crises of 2008 273; gun violence in managers 71–2; rights 211–12; roles
306–7; health care in 306; health 211–12; work stress in 286
expenditures 305; health insurance Woods, M. 16
in 306; opioid epidemic 307–8; Work Health and Safety Act 2011
stressors in 44; suicides in armed (Australia) 7
services 307; work hours in 131; work hours: in developed countries
work stress in 146 131; in Japan 130–2, 131; in South
United States Air Force Surgeon Korea 131; United Kingdom 305; in
General 313 United States 305
United States Centers for Disease work stress 1–4; in academic sector
Control and Prevention 314 88–9; antecedents 252–4; in
United States, organizational stress in banking 88; bullying 12–13;
303–15, 307; cultural context burnout 89; causes of 1–2;
304–8; cultural influences 310–15; characteristics of 291–5;
eustress 311–12; healthy work competition and rivalry 286;
organizations 314; historical consequences 92–3, 255;
backdrop 303–4; mortality rates construction industry 288–9; coping
305; organizational clinical mechanisms 89–90; cross-sectional
psychology 312–13; physical fitness studies 85–6; cultural influence 95;
311; positive organizational dangerous wildlife 15–16; definition
behavior 311–12; positive stress of 63; from different cultural
311–12; positivity 311–12; working perspectives 290–1; distance 13–14;
hours 304–5; workplace in education sector 289–90; effects
stressors 305 of 2, 285–6; health effects 286, 319;
Unity (Russian employment in healthcare 87–8, 287–8; heat
agency) 269 14–15; heat stress 89; high level of
Utrecht Work Engagement Scale 249 285–6; incivility 12–13; inclusions
24; job demands 9–11; job
Vahtera, J. 67 performance 90; job resources 9–11;
Vaidya, R. 90 job satisfaction 90–1; in law
Valente, J.G. 33 enforcement 88; mining industry
Van den Berg, H.S. 286 289; in minority groups 286;
Van Etten, E.J. 287 neuropsychiatric disorders from
Van Mossel, C. 222 286; occupations with highest stress
Van Wyk, S. 287 levels 8; organization types 84; in
Van Zyl, E. 284, 286, 290 police force 289; psychosocial safety
Vandelanotte, C. 14 climate 11–12; security industry
Vazão, M.J. 254 289; in sociocultural and racial
Vos, J.D. 289 groups 290–1; stress management
295–6; stressor appraisals 9–11;
Wadsworth, M.E. 198 stressors 28–9, 86–9, 87, 286;
Walsh, J.T. 270 surveys 24, 25; temporal
 Index 343
characteristics 26–8, 27; in women prevention of 136–7; sexual
286; work sectors 84, 85; worker harassment 135
characterizations 28; workplace workplace health organizations 285
boredom 287; workplace workplace spirituality 91
spirituality 91; see also work-related stress: in Belgium
organizational stress 167–88; cross-cultural studies 270;
work stress research: Australia 7–17; in Netherlands 167–88
Belgium 167–88; Brazil 23–36; World Health Organisation (WHO) 1
Greater China 43–57; Greece World Health Organization
62–79; India 80–95; Japan 128–39; (WHO) 319
Netherlands 167–88; Nigeria World Trade Organization (WTO) 43,
145–57; Oman 194–216; Portugal 268, 273
221–58; Russia 268–77; South Worrall, L. 304
Africa 284–97; United States worship 210
303–15
Work Stress Scale 29 Xanthopoulou, D. 74
worker’s compensation: claims 7; Xiang, J. 15
rates 313
work-family conflict 56 Y Magazine 194, 212
Working Conditions Act Yiu, D. 271
(Netherlands) 183–4
working environment 2–3 Zacharatos, A. 256, 321
work-life balance 270 Zadow, A. 12
workplace harassment: in Japan Ziaian, T. 12
134–6; power harassment 134–5;