Work-related stress and depressive disorders

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Abstract

The 1980s and 1990s has seen a considerable change in the workforce structure in industrialised economies. Employees are commonly faced with greater demands and less job security, both of which are likely to be stressful, thus psychological disorders especially depression may increasingly be caused by work-related stressors. An issue of this journal in 1997 (Vol. 43, No. 1) was indeed devoted to stress in the workplace and since then, these workplace changes have progressed and a review seems timely. Because interpreting results of cross-sectional studies is limited by a potential reciprocal relation between work stressors and depression (since “effort after meaning” can influence how “distressed” individuals report stressors at work), this review largely focuses on prospective or predictive studies to minimise this bias. Not surprisingly, the findings from occupational stress research is consistent with the more general life event stress literature showing that specific acute work-related stressful experiences contribute to “depression” and, more importantly perhaps, that enduring “structural” occupational factors, which may differ according to occupation, can also contribute to psychological disorders. There are significant implications for employees, their families, employers and indeed the wider community.

Introduction

Work and family are the two domains from which most adults derive satisfaction in life; equally they are the common sources of stressful experiences. The working environment continues to change with globalisation of the world economy and economic rationalisation driving job restructuring, greater part-time and contract work, and greater workload demands that commonly occur in a context of higher job insecurity. There is thus not an unreasonable perception in the community that work is increasingly the source of much of our stress and distress.

The implications of work-related stress include the effects on worker satisfaction and productivity, their mental and physical health, absenteeism and its economic cost, the wider impact on family function and finally, the potential for employer liability. While depression is the most likely adverse psychological outcome, the range of other possible “psychological” problems include “burnout,” alcohol abuse, unexplained physical symptoms, “absenteeism,” chronic fatigue and accidents, sick building syndrome and repetitive strain injury [1]. This review focuses largely on prospective or “predictive” studies both of “depression” and “burnout,” and it is based on literature searches using Medline, Psych INFO and EMBASE from 1966 to 2000 (keywords: occupational stress, work, occupations, workload, occupational health, depression, anxiety). The review assesses the stressor findings by different occupational groups because they may embrace different qualities of stress which furthermore may be a major factor contributing to psychological morbidity in these groups.

Section snippets

Morbidity in different occupational groups

In the studies reviewed it is usual for depression to be diagnosed by a range of questionnaires including the Beck Depression Inventory, Zung scale, the General Health Questionnaire (GHQ), the Centre for Epidemiological Studies Depression Scale (CESD) or similar clinically validated questionnaires. Burnout is also a construct often used and embraces three clusters of symptoms; “emotional exhaustion,” “depersonalisation” (negative, insensitive attributes to clients) and a sense of reduced

“Moderating variables”

Covariates are often presumed to influence the “work stress and depression” relationship; these include specific acute stressful events, “hours worked,” job involvement, job controllability, personality variables and social supports. Whether these variables are independent predictors of depression or moderate the relation of work stress to depression is not always clear.

Findings from intervention studies

Intervention studies can provide the most robust evidence of a causal relationship but they are few in this area. Briner [77] and Cooper and Cartwright [78] have reviewed stress interventions in the workplace and emphasise the need to distinguish primary interventions (organisation/structural change), secondary interventions (stress management/coping strategies) and tertiary interventions (interventions targeted for those actually stressed).

Secondary and tertiary interventions appear to have

Discussion

There are methodological limitations to many of these studies. Firstly, measures of psychological morbidity most commonly employed are self-report measures; rarely do the studies assess “psychiatric caseness” as diagnosed by a clinician, for obvious logistical reasons given the large sample sizes. Furthermore, other studies use “burnout” as an outcome measure which is not well validated as a construct, even though it does have some significant relationship to psychological health status,

Conclusions

Occupational stress is of increasing importance due to continuing structural changes in the workplace, with both increasing demands and job insecurity imposed on employees. A range of adverse health outcomes have been identified but psychological disorders are significant because they occur frequently, are often unrecognised and can be accompanied by significant social morbidity; there are important implications for the lifestyle and health of employees and their families and there are

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