Psychosocial Work Stress - A Primer

In our U.S. hustle culture, work stress is seen as an individual failure of someone who just can’t hack the pressure, as well as an individual responsibility to fix. So executives who have long proclaimed that overwhelmed, stressed out employees are one of their top concerns, offer “wellness” programs like lunchtime yoga, weight loss or smoking cessation programs or meditation apps to the burned out “talent” they seek to retain. And workers in low-wage or precarious work are often just supposed to be grateful they have a job at all.

But, in truth, the problem of work stress doesn’t rest with individual workers. Instead, work stress is the result of the way work itself is organized.

And it’s taking an enormous toll. Chronic work stress is actually so high and is associated with so much ill health - like cardiovascular disease, high blood pressure and diabetes, depression, anxiety, insomnia - that one meta-analysis of more than 200 work stress studies found that work can take years off one’s life and has become, technically, the fifth leading cause of death in the United States.

And that’s not because of industrial accidents like toiling in a coal mine or falling off a ladder; or being exposed to physical dangers like asbestos or toxic chemicals. Those are workplace hazards that the U.S. Occupational Health and Safety Administration regulates. It’s due to what U.S. OSHA doesn’t track or regulate, what researchers call the “psychosocial stress” that is ubiquitous in many workplaces: long work hours, work-family conflict, toxic bosses, uncertainty, unemployment, lack of health insurance. The higher the job demands and the less control the more that leads to job strain and work stress. That stress is compounded the more the effort at work doesn’t match the reward.

Researchers say acute psychosocial stress itself could be having a direct biochemical impact on the body, and lead to heart attack and stroke, for instance. And chronic stress over long periods of time may be what leads to changes in lifestyle that have a negative impact on health and wellbeing. “Chronic stress over time, when you have so many stress hormones circulating in your blood, is going to make you feel tired,” said Marnie Dobson, a medical sociologist who, along with epidemiologist Peter Schnall, directs the Healthy Work Campaign. “So if you’re fatigued, you may not feel like exercising, or eating properly, which can lead to illness in the long run.”

So here’s a primer on the 10 most common “psychosocial” stressors at work. Most workers experience more than one, sometimes all at once, and often over the course of a career:

1. Long Work Hours: People working long hours are two and a half times more likely to experience depression than those who work an 8-hour day, and have a 60 percent increased risk of coronary heart disease. A 2021 study by the World Health Organization and the International Labor Organization reported that working 55 hours or more per week is associated with a 35 percent higher risk of stroke and a 17 percent higher risk of dying from coronary heart disease, compared to those working a 35 to 40 hour week.

2. Work-Family Conflict: The struggle to combine work and care increases the odds of reporting poor physical health by 90 percent. The American Psychological Association reports that the stress of juggling work and family responsibilities is one of the top three work stressors. Caregivers often experience family to work conflict, and experience stress when family duties pull them away from work, particularly in unforgiving work environments. When work spills over into family life, stealing time from being home or available to loved ones or able to enjoy life, research shows it can lead to burnout and increase anxiety and depressive symptoms, Dobson said.

When workers with care responsibilities do feel supported at work, research on “work-family enrichment” shows workers sleep better, spend more quality time with family, and are more loyal and productive at work, among other benefits.

3. Low Job Control: Low job control increases mortality by almost 45%. This is all about worker power, having autonomy and agency to do your job, and the ability to organize to demand better job quality and work environments. Worker power has eroded in recent decades. Unlike in many other competitive advanced economies, where membership in trade unions is high, and workers often have a seat at the bargaining table, in the United States, just about 6 percent of the private sector workforce belongs to a union. Though recent victories by workers at Starbucks coffee shops and Amazon warehouses and other businesses may be emboldening workers to organize to demand better jobs, but union membership has been declining. Research shows that unionized workers enjoy better work schedules than non-unionized workers, and are happier, with greater job satisfaction and wellbeing.

“Job control is seen as a health protective mechanism. The more job control, the more you have ‘decision latitude’ – more choice in what projects and tasks you want to take on,” Dobson explained. “Low job control is more common in low-wage work. But as physicians, for instance, have more and more of their decision latitude whittled away by insurance companies, physician burnout has gone through the roof.

4. Shift Work: Rotating shifts, night shifts, unpredictable shifts, on call or just-in-time shifts have been most associated with sleep disruptions, which robs the body of recovery time. That can lead to an increase in cortisol, the stress hormone that can create inflammation and lead to chronic illness like cardiovascular issues, Dobson said. Nurses, for instance, are at high risk for sleep interruptions. Dobson and Schnall have studied work stress and firefighters, who work shifts. “Most people think firefighters die from fighting fires or exposure to fumes,” Dobson said. “But we found they were at much higher risk for hypertension, obesity and having a heart attack on the job. Part of it is they have 24-hour shifts and get constantly interrupted, and part is that they have to be constantly ‘on.’”

For workers with unpredictable schedules, Dobson said the uncertainty and low wages create intense stress. “It’s hard to manage or plan for childcare, or, if you’re in school, plan for classes,” she said. “And because these are also low-wage jobs – which in itself is a stressor – you may be more willing to take on-call shifts to get extra hours so you can pay the rent. Uncertainty is a major stressor for human beings in general, and can cause burnout and mental health problems.” Research has found that stable schedules improve subjective wellbeing, sleep quality and economic security.

5. High Job Demands: If you have a demanding job, but have some control over your workpace and workload, the research is mixed on whether that’s bad for your health. What is bad for your health, however, is high job demands and low job control. “When your job demands are high, to the point where it exceeds your ability to cope, that’s when job strain kicks in,” Dobson said. “And is related to burnout, higher blood pressure, heart disease and depressive symptoms.”

It’s not just knowledge workers, doctors, medical professionals, engineers, journalists and other white-collar workers who are likely to have high job demands, it’s any worker taking on more tasks or duties, often as a result of “lean staffing,” labor cuts or tight labor budgets. Or has high physical demands, like farm workers and construction workers.

Having an emotionally demanding job may not necessarily be negative, Dobson said, and some studies have found that emotionally demanding work can be beneficial to your health, “because there’s some value people get out of it, a sense of contribution and meaning,” she said. Where emotional labor does begin to harm health, she said, is when workers are constantly expected to display positive emotions on an ongoing basis, especially in the face of hostile customers or clients, like flight attendants, care workers or restaurant workers who must tamp down their own feelings and put on a good face at all times, particularly if they have to work for tips to make a living wage. Workers expected to “surface act,” like that experience emotional dissonance that’s linked to burnout and other mental health issues.

Working under tight or unrealistic deadlines that workers don’t have a say in can also lead to chronic stress, Dobson and Schnall said. As does an “always on” culture of late night emails or physical or virtual presence. The Healthy Work Campaign offers an anonymous survey for workers to measure their own work demands compared to a nationally representative sample.

6. Job Insecurity: Precarious work has been on the rise, with more contract, freelance and gig work, temp work, involuntary part-time work – think poorly paid temporary adjunct professors instead of tenure-track professors, for instance - as employers continue to focus on cutting labor costs to boost profits. High levels of job insecurity have been associated with higher incidence of mental health symptoms like depression and more cardiovascular disease and mortality, said Dobson.

Research done in organizations in the midst of restructuring have found that workers experienced high stress anticipating a job loss, awaiting firm decisions. “Anticipation of job loss is a major form of insecurity,” Dobson said. “But the people who survive layoffs often experience high levels of job insecurity and mental health issues as well. They’re left with the feeling that this might happen again.” And next time, it might be them.

7. Low organizational justice – Human dignity and the concept of “moral injury” lies behind this psychosocial stressor – that a worker can’t do the best job possible because of the way the organization or industry functions. Nurses assigned too many patients, for instance. Or warehouse workers, like Joe Liebman, a picker in St. Louis, who are asked to meet ever-higher quotas, and often must do so without explanation because of some algorithm that they can’t challenge, all while cameras watch and surveil their every move.

“The experience of unfairness and disrespect is a major stressor,” Dobson said. So toxic cultures and toxic bosses that allow bullying, microaggressions, gender and racial harassment and discrimination can lead to work stress and chronic ill health. Or cultures that don’t handle hiring, plumb assignments and promotions in a fair way. Low organizational justice is linked to burnout and poor mental health, as well as cardiovascular disease, Dobson said.

The emerging field of the study of “technostress” also fits here. When companies install “bossware” or “tattleware” software on digital workers to keep tabs on them, it signals a lack of trust. Madi Swenson, for instance, was so stressed about the constant digital monitoring that she began having panic attacks and quit her job. “Just last night, I had a nightmare that I had forgotten to press play on the time tracking app. And got fired as a result of it,” she said. Ashley Nixon, a professor of human resources and organizational behavior at Willamette University in Oregon who studies technostress, said such monitoring is a violation of trust. “What we know is that trust and justice within organizations is a huge predictor of … satisfaction, commitment and motivation,” Nixon said. “People stay in organizations that trust them, that they feel they are treated fairly in. But they leave organizations that they don’t.”

8. Low social support at work – Research shows low social support at work, combined with job strain, is the strongest risk factor for mental distress at work. This is all about relationships at work. “Social support is one of the primary ways in which we cope with stress – emotional support from family and friends, but also the information and resources we have access to,” Dobson explained. “So having a supportive supervisor, someone who cares about your welfare, who you are as a person, and provides you with the information and resources you need to get your job done, feeling accepted by coworkers, is critical. The presence of social support can buffer stressful job situations and job strain.” Without the buffer of social support, job strain is more likely to be associated with cardiovascular disease, she said.

Research on the pioneering approach of “family-supportive supervisor training” shows that worker health, wellbeing, job satisfaction and engagement improve when workers feel supported at work.

9. No health insurance – It should probably come as no surprise that a lack of health insurance, like low wages, can be a major stressor for people, and is linked to poorer health. Unlike other countries, where health care is seen as a universal right and many have universal health care systems, in the United States, individual employers can choose to provide health insurance – often at vastly different levels – and can set the conditions that can make it difficult to qualify for it. For instance, many employers keep worker hours below 30 hours per week in an effort to avoid offering workers insurance under the Affordable Care Act.

Yet without health insurance, people put off early treatment for illness, “which means people will potentially get seriously sick,” Dobson said. “If you have health insurance and can take care of your health conditions, you’re likely to live much longer. It also speaks to uncertainy, and whether workers feel they’re treated with respect and dignity. It all fits together.”

10. Unemployment: As lay-offs have become more common in recent decades, as organizations have adopted a business strategy to keep costs low and profits high by squeezing labor, a raft of research has found that being laid off more than doubles the risk of heart attack and stroke among older workers, can increase the chance of developing stress-related diabetes, arthritis or mental health issues by 83 percent, and even shorten life expectancy. Losing a job also often means losing access to health care in the U.S.

Unemployment is also linked to a higher risk of suicide.

But even anticipating being unemployed can be a major stressor, said Sarah Damaske, a sociologist at Penn State who’s most recent book, The Tolls of Uncertainty, explores the unemployment experience. “Just the thought of being unemployed stresses people out,” Damaske said. “And once you are unemployed, it really isn’t good for your health.” First, there’s the financial shock. Each state has developed its own unemployment insurance system. Some reimburse as much as 50 percent of what the unemployed worker had been making, in others it’s as little as 25 percent. Then comes the physical and mental health costs – feeling a loss of identity, or that what you do matters. Being unemployed can have a negative affect your health for years and years, and sometimes decades to come.”

For more on psychosocial work stress, listen to this episode of the Better Life Lab podcast on finding a better way to work. The podcast is a co-production of Slate and New America, sponsored by the Robert Wood Johnson Foundation.