Causes and management of stress at work.

Stress has been defined in different ways over the years. Originally, it was conceived of as pressure from the environment, then as strain within the person. The generally accepted definition today is one of interaction between the situation and the individual. It is the psychological and physical state that results when the resources of the individual are not sufficient to cope with the demands and pressures of the situation. Thus, stress is more likely in some situations than others and in some individuals than others. Stress can undermine the achievement of goals, both for individuals and for organisations (box 1). Signs of stress can be seen in people’s behaviour, especially in changes in behaviour. Acute responses to stress may be in the areas of feelings (for example, anxiety, depression, irritability, fatigue), behaviour (for example, being withdrawn, aggressive, tearful, unmotivated), thinking (for example, difficulties of concentration and problem solving) or physical symptoms (for example, palpitations, nausea, headaches). If stress persists, there are changes in neuroendocrine, cardiovascular, autonomic and immunological functioning, leading to mental and physical ill health (for example anxiety, depression, heart disease) (box 2, fig 1). Situations that are likely to cause stress are those that are unpredictable or uncontrollable, uncertain, ambiguous or unfamiliar, or involving conflict, loss or performance expectations. Stress may be caused by time limited events, such as the pressures of examinations or work deadlines, or by ongoing situations, such as family demands, job insecurity, or long commuting journeys. Resources that help meet the pressures and demands faced at work include personal characteristics such as coping skills (for example, problem solving, assertiveness, time management) and the work situation such as a good working environment and social support. These resources can be increased by investment in work infrastructure, training, good management and employment practices, and the way that work is organised. Historically, the typical response from employers to stress at work has been to blame the victim of stress, rather than its cause. Increasingly, it is being recognised that employers have a duty, in many cases in law, to ensure that employees do not become ill. It is also in their long term economic interests to prevent stress, as stress is likely to lead to high staff turnover, an increase in sickness absence and early retirement, increased stress in those staff still at work, reduced work performance and increased rate of accidents, and reduced client satisfaction. Good employment practice includes assessing the risk of stress amongst employees. This involves: c looking for pressures at work which could cause high and long lasting levels of stress c deciding who might be harmed by these c deciding whether you are doing enough to prevent that harm.