U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Centers for Disease Control and Prevention
National Institute for Occupational Safety and Health
The National Institute for Occupational Safety and Health (NIOSH) is
the Federal agency responsible for conducting research and making
recommendations for the prevention of work-related illness and injury.
NIOSH is part of the U.S. Department of Health and Human Services; it is
distinct from the Occupational Safety and Health Administration (OSHA),
which is a regulatory agency located in the U.S. Department of Labor.
As part of its mandate, NIOSH is directed by Congress to study the
psychological aspects of occupational safety and health, including stress at
work. NIOSH works in collaboration with industry, labor, and universities
to better understand the stress of modern work, the effects of stress on
worker safety and health, and ways to reduce stress in the workplace.
Steven Sauter - Lawrence Murphy
Michael Colligan - Naomi Swanson - Joseph Hurrell, Jr. - Frederick Scharf, Jr. - Raymond Sinclair
Paula Grubb - Linda Goldenhar - Toni Alterman - Janet Johnston - Anne Hamilton - Julie Tisdale
Mention of any company name or product does not constitute endorsement by the
National Institute for Occupational Safety and Health.
This document is in the public domain and may be freely copied or reprinted.
Copies of this and other NIOSH documents are available from
Publications Dissemination, EID
4676 Columbia Parkway
Cincinnati, OH 45226–1998
Fax number: (513) 533–8573
Telephone number: 1–800–35–NIOSH (1–800–356–4674)
To receive other information about occupational safety and health problems, call
1–800–35–NIOSH (1–800–356–4674), or visit the NIOSH Homepage on the
World Wide Web at
The longer he waited, the more David worried. For weeks he had been plagued
by aching muscles, loss of appetite, restless sleep, and a complete sense of
exhaustion. At first he tried to ignore these problems, but eventually he became
so short-tempered and irritable that his wife insisted he get a checkup. Now,
sitting in the doctor’s office and wondering what the verdict would be, he didn’t
even notice when Theresa took the seat beside him. They had been good friends
when she worked in the front office at the plant, but he hadn’t seen her since she
left three years ago to take a job as a customer service representative. Her gentle
poke in the ribs brought him around, and within minutes they were talking and
gossiping as if she had never left.
“You got out just in time,”
he told her. “Since the
feels safe. It used to be
that as long as you did
your work, you had a job.
That’s not for sure
anymore. They expect the
same production rates even
though two guys are now doing the work of three. We’re so backed up
I’m working twelve-hour shifts six days a week. I swear I hear those
machines humming in my sleep. Guys are calling in sick just to get a
break. Morale is so bad they’re talking about bringing in some
consultants to figure out a better way to get the job done.”
said. “I’m afraid I jumped from the
frying pan into the fire. In my new
job, the computer routes the calls and
they never stop. I even have to
schedule my bathroom breaks. All I
hear the whole day are complaints
from unhappy customers. I try to be
helpful and sympathetic, but I can’t
promise anything without getting my boss’s approval. Most of the time
I’m caught between what the customer wants and company policy. I’m
not sure who I’m supposed to keep happy. The other reps are so uptight
and tense they don’t even talk to one another. We all go to our own little
cubicles and stay there until quitting time. To make matters worse, my
mother’s health is deteriorating. If only I could use some of my sick time
to look after her. No wonder I’m in here with migraine headaches and
high blood pressure. A lot of the reps are seeing the employee assistance
counselor and taking stress management classes, which seems to help.
But sooner or later, someone will have to make some changes in the way
the place is run.”
Percentage of workers who
report they feel “quite a bit or
extremely stressed at work.”
report they are “often or very
often burned out or stressed
by their work.”
report their job is “very or
David’s and Theresa’s stories are unfortunate but not unusual. Job stress has
become a common and costly problem in the American workplace, leaving few
workers untouched. For example, studies report the following:
• One-fourth of employees view their jobs as the number
one stressor in their lives.
Northwestern National Life
• Three-fourths of employees believe the worker has more
on-the-job stress than a generation ago.
Princeton Survey Research Associates
• Problems at work are more strongly associated with health
complaints than are any other life stressor—more so than
even financial problems or family problems.
St. Paul Fire and Marine Insurance Co.
Fortunately, research on job stress has greatly expanded in recent years. But in
spite of this attention, confusion remains about the causes, effects, and prevention
of job stress. This booklet summarizes what is known about job stress and what
can be done about it.
Job stress can be defined as the harmful physical and emotional responses that
occur when the requirements of the job do not match the capabilities, resources,
or needs of the worker. Job stress can lead to poor health and even injury.
The concept of job stress is often confused with challenge, but these concepts are
not the same. Challenge energizes us psychologically and physically, and it
motivates us to learn new skills and master our jobs. When a challenge is met, we
feel relaxed and satisfied. Thus, challenge is an important ingredient for healthy
and productive work. The importance of challenge in our work lives is probably
what people are referring to when they say “a little bit of stress is good for you.”
But for David and Theresa, the situation is different—the challenge has turned
into job demands that cannot be met, relaxation has turned to exhaustion, and a
sense of satisfaction has turned into feelings of stress. In short, the stage is set for
illness, injury, and job failure.
Nearly everyone agrees that job stress results from the interaction of the worker
and the conditions of work. Views differ, however, on the importance of worker
characteristics versus working conditions as the primary cause of job stress.
These differing viewpoints are important because they suggest different ways to
prevent stress at work.
According to one school of thought, differences in individual characteristics such
as personality and coping style are most important in predicting whether certain
job conditions will result in stress—in other words, what is stressful for one
person may not be a problem for someone else. This viewpoint leads to
prevention strategies that focus on workers and ways to help them cope with
demanding job conditions.
Although the importance of individual differences cannot be ignored, scientific
evidence suggests that certain working conditions are stressful to most people.
The excessive workload demands and conflicting expectations described in
David’s and Theresa’s stories are good examples. Such evidence argues for a
greater emphasis on working conditions as the key source of job stress, and for
job redesign as a primary prevention strategy.
In 1960, a Michigan court upheld a compensation claim by an automotive assembly-
line worker who had difficulty keeping up with the pressures of the production line.
To avoid falling behind, he tried to work on several assemblies at the same time and
often got parts mixed up. As a result, he was subjected to repeated criticism from the
foreman. Eventually he suffered a psychological breakdown.
By 1995, nearly one-half of the States allowed worker compensation claims for
emotional disorders and disability due to stress on the job [note, however, that courts
are reluctant to uphold claims for what can be considered ordinary working
conditions or just hard work].
1995 Workers Compensation Yearbook
On the basis of experience and research, NIOSH favors the view that working
conditions play a primary role in causing job stress. However, the role of
individual factors is not ignored. According to the NIOSH view, exposure to
stressful working conditions (called job stressors) can have a direct influence on
worker safety and health. But as shown below, individual and other situational
factors can intervene to strengthen or weaken this influence. Theresa’s need to
care for her ill mother is an increasingly common example of an individual or
situational factor that may intensify the effects of stressful working conditions.
Examples of individual and situational factors that can help to reduce the effects
of stressful working conditions include the following:
• Balance between work and family or personal life
• A support network of friends and coworkers
• A relaxed and positive outlook
long work hours and shiftwork; hectic and routine tasks that have little
inherent meaning, do not utilize workers’ skills, and provide little sense
to the computer, allowing little room for flexibility, self-initiative,
Management Style. Lack of participation by workers in decision-
making, poor communication in the organization, lack of family-
Example: Theresa needs to get the boss’s approval for everything,
and the company is insensitive to her family needs.
of support or help from coworkers and supervisors.
interact with other workers or receive help from them.
responsibility, too many “hats to wear.”
satisfy both the customer’s needs and the company’s expectations.
growth, advancement, or promotion; rapid changes for which workers
Example: Since the reorganization at David’s plant, everyone is
worried about their future with the company and what will happen
Environmental Conditions. Unpleasant or dangerous physical
conditions such as crowding, noise, air pollution, or ergonomic
Example: David is exposed to constant noise at work.
Stress sets off an alarm in the brain, which responds by preparing the body
for defensive action. The nervous system is aroused and hormones are
released to sharpen the senses, quicken the pulse, deepen respiration, and
tense the muscles. This response (sometimes called the fight or flight
response) is important because it helps us defend against threatening
situations. The response is preprogrammed biologically. Everyone responds
in much the same way, regardless of whether the stressful situation is at
work or home.
Short-lived or infrequent episodes of stress pose little risk. But when
stressful situations go unresolved, the body is kept in a constant state of
activation, which increases the rate of wear and tear to biological systems.
Ultimately, fatigue or damage results, and the ability of the body to repair
and defend itself can become seriously compromised. As a result, the risk
of injury or disease escalates.
In the past 20 years, many studies have looked at the relationship between
job stress and a variety of ailments. Mood and sleep disturbances, upset
stomach and headache, and disturbed relationships with family and friends
are examples of stress-related problems that are quick to develop and are
commonly seen in these studies. These early signs of job stress are usually
easy to recognize. But the effects of job stress on chronic diseases are more
difficult to see because chronic diseases take a long time to develop and can
be influenced by many factors other than stress. Nonetheless, evidence is
rapidly accumulating to suggest that stress plays an important role in
several types of chronic health problems—especially cardiovascular
disease, musculoskeletal disorders, and psychological disorders.
Health care expenditures are nearly 50% greater for workers who
report high levels of stress.
Journal of Occupational and Environmental Medicine
Many studies suggest that psychologically demanding jobs that allow employees
little control over the work process increase the risk of cardiovascular disease.
On the basis of research by NIOSH and many other organizations, it is widely
believed that job stress increases the risk for development of back and upper-
extremity musculoskeletal disorders.
Several studies suggest that differences in rates of mental health problems (such as
depression and burnout) for various occupations are due partly to differences in job
stress levels. (Economic and lifestyle differences between occupations may also
contribute to some of these problems.)
Although more study is needed, there is a growing concern that stressful working
conditions interfere with safe work practices and set the stage for injuries at work.
Suicide, Cancer, Ulcers, and Impaired Immune Function
Some studies suggest a relationship between stressful working conditions and these
health problems. However, more research is needed before firm conclusions can be
Some employers assume that stressful working conditions are a necessary evil—
that companies must turn up the pressure on workers and set aside health
concerns to remain productive and profitable in today’s economy. But research
findings challenge this belief. Studies show that stressful working conditions are
actually associated with increased absenteeism, tardiness, and intentions by
workers to quit their jobs—all of which have a negative effect on the bottom line.
Recent studies of so-called healthy organizations suggest that policies benefiting
worker health also benefit the bottom line. A healthy organization is defined as
one that has low rates of illness, injury, and disability in its workforce and is also
competitive in the marketplace. NIOSH research has identified organizational
characteristics associated with both healthy, low-stress work and high levels of
productivity. Examples of these characteristics include the following:
• Recognition of employees for good work performance
• Opportunities for career development
• An organizational culture that values the individual worker
• Management actions that are consistent with organizational values
Stress Prevention and Job Performance
The St. Paul Fire and Marine Insurance Company conducted several studies
on the effects of stress prevention programs in hospital settings. Program
activities included (1) employee and management education on job stress,
(2) changes in hospital policies and procedures to reduce organizational
sources of stress, and (3) establishment of employee assistance programs.
In one study, the frequency of medication errors declined by 50% after
prevention activities were implemented in a 700-bed hospital. In a second
study, there was a 70% reduction in malpractice claims in 22 hospitals that
implemented stress prevention activities. In contrast, there was no reduction
in claims in a matched group of 22 hospitals that did not implement stress
—Journal of Applied Psychology
must take time off work because of stress, anxiety, or a related disorder
will be off the job for about 20 days.
Bureau of Labor Statistics
The examples of Theresa and David illustrate two different approaches for
dealing with stress at work.
Stress Management. Theresa’s company is providing stress management
training and an employee assistance program (EAP) to improve the ability of
workers to cope with difficult work situations. Nearly one-half of large companies
in the United States provide some type of stress management training for their
workforces. Stress management programs teach workers about the nature and
sources of stress, the effects of stress on health, and personal skills to reduce
stress—for example, time management or relaxation exercises. (EAPs provide
individual counseling for employees with both work and personal problems.)
Stress management training may rapidly reduce stress symptoms such as anxiety
and sleep disturbances; it also has the advantage of being inexpensive and easy to
implement. However, stress management programs have two major
• The beneficial effects on stress symptoms are often short-lived.
• They often ignore important root causes of stress because they focus on the
worker and not the environment.
Organizational Change. In contrast to stress management training and
EAP programs, David’s company is trying to reduce job stress by bringing in a
consultant to recommend ways to improve working conditions. This approach is
the most direct way to reduce stress at work. It involves the identification of
stressful aspects of work (e.g., excessive workload, conflicting expectations) and
the design of strategies to reduce or eliminate the identified stressors. The
advantage of this approach is that it deals directly with the root causes of stress at
work. However, managers are sometimes uncomfortable with this approach
because it can involve changes in work routines or production schedules, or
changes in the organizational structure.
Reduced stress disorders
Satisfied and productive workers
Profitable and competitive organizations
• Ensure that the workload is in line with workers’ capabilities and resources.
• Design jobs to provide meaning, stimulation, and opportunities for workers
to use their skills.
• Clearly define workers’ roles and responsibilities.
• Give workers opportunities to participate in decisions and actions affecting
• Improve communications—reduce uncertainty about career development
and future employment prospects.
• Provide opportunities for social interaction among workers.
• Establish work schedules that are compatible with demands and
responsibilities outside the job.
No standardized approaches or simple “how to”
manuals exist for developing a stress prevention
program. Program design and appropriate
solutions will be influenced by several factors—
the size and complexity of the organization,
available resources, and especially the unique
types of stress problems faced by the
organization. In David’s company, for example,
the main problem is work overload. Theresa, on
the other hand, is bothered by difficult
interactions with the public and an inflexible work schedule.
Although it is not possible to give a universal prescription for preventing stress
at work, it is possible to offer guidelines on the process of stress prevention in
organizations. In all situations, the process for stress prevention programs
involves three distinct steps: problem identification, intervention, and
succeed, organizations need to be adequately prepared. At a minimum,
preparation for a stress prevention program should include the following:
• Building general awareness about job stress (causes, costs, and control)
• Securing top management commitment and support for the program
• Incorporating employee input and involvement in all phases of the
• Establishing the technical capacity to conduct the program (e.g.,
Bringing workers or workers and managers together in a committee or
problem-solving group may be an especially useful approach for developing a
stress prevention program. Research has shown these participatory efforts to
be effective in dealing with ergonomic problems in the workplace, partly
because they capitalize on workers’ firsthand knowledge of hazards
encountered in their jobs. However, when forming such working groups, care
must be taken to be sure that they are in compliance with current labor laws.
The National Labor Relations Act may limit the form and structure of employee
assistance if they are unsure of their responsibilities or obligations under the National
Labor Relations Act.
Low morale, health and job complaints, and employee turnover often provide the
first signs of job stress. But sometimes there are no clues, especially if employees
are fearful of losing their jobs. Lack of obvious or widespread signs is not a good
reason to dismiss concerns about job stress or minimize the importance of a
source of a suspected stress problem in an organization depends partly on the size
of the organization and the available resources. Group discussions among manag-
ers, labor representatives, and employees can provide rich sources of information.
Such discussions may be all that is needed to track down and remedy stress
problems in a small company. In a larger organization, such discussions can be
used to help design formal surveys for gathering input about stressful job condi-
tions from large numbers of employees.
Regardless of the method used to collect data, information should be obtained
about employee perceptions of their job conditions and perceived levels of stress,
health, and satisfaction. The list of job conditions that may lead to stress (page 9)
and the warning signs and effects of stress (page 11) provide good starting points
for deciding what information to collect.
Objective measures such as absentee-
ism, illness and turnover rates, or
performance problems can also be
examined to gauge the presence and
scope of job stress. However, these
measures are only rough indicators of
job stress—at best.
Data from discussions, surveys, and
other sources should be summarized
and analyzed to answer questions about
the location of a stress problem and job
conditions that may be responsible—
for example, are problems present
throughout the organization or confined
to single departments or specific jobs?
stress at work have been identified and the scope of the problem is understood,
the stage is set for design and implementation of an intervention strategy.
In small organizations, the informal discussions that helped identify stress
problems may also produce fruitful ideas for prevention. In large organizations, a
more formal process may be needed. Frequently, a team is asked to develop
recommendations based on analysis of data from Step 1 and consultation with
Certain problems, such as a hostile work environment, may be pervasive in the
organization and require company-wide interventions. Other problems such as
excessive workload may exist only in some departments and thus require more
narrow solutions such as redesign of the way a job is performed. Still other
problems may be specific to certain employees and resistant to any kind of
organizational change, calling instead for stress management or employee
assistance interventions. Some interventions might be implemented rapidly (e.g.,
improved communication, stress management training), but others may require
additional time to put into place (e.g., redesign of a manufacturing process).
Before any intervention occurs,
employees should be informed about
actions that will be taken and when they
will occur. A kick-off event, such as an
all-hands meeting, is often useful for
• Target source of stress
• Propose and prioritize
• Communicate planned
• Implement interventions.
the intervention process. Evaluation is necessary to determine whether the inter-
vention is producing desired effects and whether changes in direction are needed.
Time frames for evaluating interventions should be established. Interventions
involving organizational change should receive both short- and long-term
scrutiny. Short-term evaluations might be done quarterly to provide an early
indication of program effectiveness or possible need for redirection. Many
interventions produce initial effects that do not persist. Long-term evaluations are
often conducted annually and are necessary to determine whether interventions
produce lasting effects.
Evaluations should focus on the same
types of information collected during
the problem identification phase of the
intervention, including information
from employees about working
conditions, levels of perceived stress,
health problems, and satisfaction.
Employee perceptions are usually the
most sensitive measure of stressful
working conditions and often provide
the first indication of intervention
effectiveness. Adding objective
measures such as absenteeism and
health care costs may also be useful.
However, the effects of job stress
interventions on such measures tend to
be less clear-cut and can take a long
time to appear.
The following pages provide examples of actions some organizations have taken
to help prevent stress in their workplaces.
• Conduct both short-
• Measure employee
perceptions of job
health, and satisfaction.
• Include objective
• Refine the intervention
strategy and return to
organization sensed an escalating level of
tension and deteriorating morale among her
staff. Job dissatisfaction and health symptoms
such as headaches also seemed to be on the rise.
Suspecting that stress was a developing problem
in the department, she decided to hold a series of
all-hands meetings with employees in the
different work units of the department to explore
this concern further. These meetings could be
best described as brainstorming sessions where
individual employees freely expressed their
views about the scope and sources of stress in
their units and the measures that might be
implemented to bring the problem under control.
Using the information collected in these meetings and in meetings with middle
managers, she concluded that a serious problem probably existed and that quick
action was needed. Because she was relatively unfamiliar with the job stress field,
she decided to seek help from a faculty member at a local university who taught
courses on job stress and organizational behavior.
After reviewing the information collected at the brainstorming sessions, they
decided it would be useful for the faculty member to conduct informal classes to
raise awareness about job stress—its causes, effects, and prevention—for all
workers and managers in the department. It was also decided that a survey would
be useful to obtain a more reliable picture of problematic job conditions and
stress-related health complaints in the department. The faculty member used
information from the meetings with workers and managers to design the survey.
The faculty member was also involved in the distribution and collection of the
anonymous survey to ensure that workers felt free to respond honestly and openly
about what was bothering them. He then helped the department head analyze and
interpret the data.
Analysis of the survey data suggested that three types of job conditions were
linked to stress complaints among workers:
• Unrealistic deadlines
• Low levels of support from supervisors
• Lack of worker involvement in decision-making.
Having pinpointed these problems, the department head developed and prioritized
a list of corrective measures for implementation. Examples of these actions
included (1) greater participation of employees in work scheduling to reduce
unrealistic deadlines and (2) more frequent meetings between workers and
managers to keep supervisors and workers updated on developing problems.
A Large Manufacturing Company.
Although no widespread signs of stress were
evident at work, the corporate medical director
of a large manufacturing company thought it
would be useful to establish a stress prevention
program as a proactive measure. As a first step
he discussed this concept with senior
management and with union leaders. Together,
they decided to organize a labor-management
team to develop the program. The team
comprised representatives from labor, the
medical/employee assistance department, the
human resources department, and an outside
human resources consulting firm. The
consulting firm provided technical advice
about program design, implementation, and
evaluation. Financial resources for the team
and program came from senior management, who made it clear that they
supported this activity. The team designed a two-part program. One part focused
on management practices and working conditions that could lead to stress. The
second part focused on individual health and well-being.
conditions, the team worked with the consulting firm to add new questions about
job stress to the company’s existing employee opinion survey. The survey data
were used by the team to identify stressful working conditions and to suggest
changes at the work group and/or organizational level. The employee health and
well-being part of the program consisted of 12 weekly training sessions. During
these sessions, workers and managers learned about common sources and effects
of stress at work, and about self-protection strategies such as relaxation methods
and improved health behaviors. The training sessions were offered during both
work and nonwork hours.
The team followed up with quarterly surveys of working conditions and stress
symptoms to closely monitor the effectiveness of this two-part program.
These examples are based on adaptations of actual situations. For other examples of job stress
interventions, see the Conditions of Work Digest, Vol. 11/2, pp. 139–275. This publication
may be obtained by contacting the ILO Publications Center at P.O. Box 753, Waldorf, MD
20604 (Telephone: 301–638–3152). Or call NIOSH at 1–800–35–NIOSH.
National Institute for Occupational Safety and Health (NIOSH)
Outside the U.S.: 1–513–533–8328
Cincinnati, Ohio 45226–1998
NIOSH provides information and publications about a wide range of occupational hazards,
including job stress. NIOSH information about job stress can be found on the NIOSH job
stress internet page (http://www.cdc.gov/niosh/jobstres.html), or call 1–800–35–NIOSH
• More Information about Job Stress
The Encyclopaedia of Occupational Health and Safety, 4th Edition (ISBN 92–2–109203–8)
contains a comprehensive summary of the latest scientific information about the causes and
effects of job stress (see Vol. 1, Chapter 5, Mental Health; Vol. 2, Chapter 34, Psychosocial
and Organizational Factors).
International Labour Office (ILO) Publications Center
P.O. Box 753
Waldorf, MD 20604
• Other Publications about Job Stress
Go to the NIOSH job stress internet site (http://www.cdc.gov/niosh/jobstres.html), or call
the NIOSH 800 number (1–800–35–NIOSH).
• Location of a Psychologist or Consultant in Your Area
American Psychological Association (APA 1-800-964-2000
750 First St., N.E.
Washington, DC 20002–4242
State psychological associations maintain a listing of licensed psychologists who may be able
to help with stress-related issues. Call the APA or your State psychological association for
more information, or refer to the APA internet site with this information
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