The George Institute For Global Health
United Kingdom

Workplace Stress: A neglected aspect of mental health wellbeing

Workplace stress remains an often-neglected aspect across different industries and countries, including India. World Health Organization defines workplace stress as ‘the response people may have when presented with work demands and pressures that are not matched to their knowledge and abilities and which challenge their ability to cope’.

Some key factors that cause increased stress at workplace are workload (both excessive and insufficient work), lack of participation and control in the workplace, monotonous or unpleasant tasks, role ambiguity or conflict, lack of recognition at work, inequity, poor interpersonal relationships, poor working conditions, poor leadership and communication and conflicting home and work demands.

Depression or anxiety are not the only outcome of stress, physical disorders such as hypertension and diabetes can also be caused due to stress.

While research has established the two-way link between stress and these physical disorders, organizations need to realize this and encourage staff to maintain a good work-life balance and have guidelines about working hours based on good industrial practices and take measures to enforce these routinely.

Sexual harassment and bullying at workplace is another workplace-related stress that can happen at any organization. Both genders could be affected by these, but often women and those lower in the hierarchy are at increased risk.

Brouwers conducted a cross-sectional study across 35 countries including India and reported that about two-third of employees who had suffered from depression either faced discrimination at work or faced discrimination while applying for new jobs. Both perceived and anticipated discrimination are major causes for people suffering silently at the workplace and not seeking proper care.

In India, there are specific legal provisions to ensure safety at workplace and there are specific laws to prevent sexual harassment of women. Strict guidelines and processes need to be advocated, and every organization should have identified committees to handle any issues of discrimination, harassment and bullying.

Research & Interventions to reduce workplace stress

There has been previous research done on interventions to reduce workplace stress and International laws have been in force for many decades to protect human rights of employees at workplace, but the execution of policies is variable and often suboptimal.

Some interventions that were specifically found to be useful in reducing workplace stress were enhancing employee control, promoting physical activity, cognitive behaviour therapy for stress management and problem-focused return to work programmes.

On the contrary, counselling and debriefing following trauma were not effective and any exposure to trauma should be followed by provision of psychological first aid and formal psychological support by trained professionals.

Workplace screening for mental disorders followed by access to basic mental health services has been found to be effective, but could lead to a potential increase in anxiety levels in those who are screened as false positives, so routine screening at workplace is not recommended3.

While extant research has tended to focus on alleviation of symptoms and risk factors associated with workplace-related stress, less emphasis has been placed on gathering evidence on how mental disorders affect performance and absenteeism and how interventions have resulted in improvement of work performance and absenteeism.

Thus, more research is needed to gather evidence on the cost-effectiveness of interventions and the cost of mental disorder-related loss of productivity on the larger community. In low- and middle-income countries, there are additional needs to:

  1. Conduct basic epidemiological studies to understand the prevalence of workplace-related mental disorders and specific risk factors associated with different employment sectors,
  2. Understand what kind of systems are being put in place by different sectors to manage workplace stress, and
  3. To what degree are existing laws being followed and implemented, and what organizational restructuring is needed to improve the situation.

How to tackle workplace stress at organizational and National level

Some policy guidelines from WHO to tackle work stress and improve workplace culture are:

1) Analysing the mental health issues - As a first step, it is essential to have a clear understanding of not only the prevalence/incidence and risk factors associated with workplace stress, but also a better knowledge about the cost implications to an organization in terms of lost productivity. This is an exercise that can be done at individual organizations, at specific employment sector level in specific regions or across regions. This may need gathering new data through surveys or collating data available with the human resources or anonymized health records.

2) Developing the policy - A policy can be developed once the initial knowledge gained through the first step is available. The primary objective of such a policy should be to address concerns of all stakeholders and adhere to the organizations vision and mission. This should involve multiple meetings with different stakeholders to identify key components that need to be addressed. This engagement should be a continuous process throughout the development and execution of the policy.

3) Developing strategies to implement the policy - While implementing the policies, care should be taken to identify the key strategies that need to be implemented, the processes that need to be in place to implement such strategies, targets to be achieved and timelines that need to be adhered to while implementing the strategies. Finally, any additional budgetary allocations or training required to implement the policies, need to be made available.

4) Implementing and evaluating the policy - The implementation of any strategy will need collaboration and clear buy-in from all stakeholders. For some strategies, one might need to have a small demonstration project to start off, and based on the results tweak the strategies and then scale it up to a larger forum. Before implementing a policy, information should be disseminated widely either through a formal launch meeting or individual organizations’ dissemination network. For example, major government level policies that impact large number of employees or employers could have a launch meeting, whereas policies affecting only one organization with limited staff could be disseminated through office emails. This would enable everyone to be aware of the policies. One major drawback of many policies is that they lack a formal evaluation. This should be built into the system and appropriately funded from the outset. Specific guidelines about how to monitor and evaluate the policies should be in place at the time of the launch of the policies and conducted as per agreed timelines.

The government should play a key role in ensuring that policies are in place that address workplace stress. Not only should the government identify vulnerable populations such as women, children, persons with disability at different workplaces, but also ensure that every sector has appropriate safeguards to protect the rights of all employees including vulnerable populations. The government should also monitor how different sectors are performing with respect to workplace stress and have additional strategies in place to address issues related to sectors which have specifically higher level of physical or psychological stress such as mines, factories, health sector, among others.

Legal mechanisms should be in place to enforce laws and regulate them and penalize organizations which flout existing laws. The legal system should provide avenues that can be accessed both by employers and employees alike.

Our aim is that all workplaces in India are seen as a fair and non-discriminatory zone as far as stress, and mental ill-health are concerned.