Risk factors for psychological stress among international business travellers

Travelers' perceptions of jetlag and travel fatigue: A scoping review

Effective management strategies for jetlag have largely been studied and evaluated through the lens of circadian science and biological rhythms. Jetlag is mostly self-managed by the individual. The most effective strategies require individuals to make behavioral changes to carefully alter sleep-wake schedules and time light exposure. However, travelers' perceptions, including their experiences, beliefs about jetlag/travel fatigue, and management expectations remain unclear. Therefore, the aim of this scoping review was to systematically synthesize the literature to understand what is currently known about travelers' perceptions of jetlag and travel fatigue. A literature search was conducted through EMBASE, PsycINFO, PubMed and Scopus generating 1164 results (2 articles known to authors), which were screened against our inclusion criteria. Twenty-two studies including data from 3952 participants were evaluated for its study design and traveler-centered outcome measures across the domains of: 1) Traveler Health Beliefs and Knowledge about Jetlag and Travel Fatigue; 2) Experience of Jetlag and Travel Fatigue 3) Traveler Priorities; 4) Self-reported Management Strategies for Jetlag and Travel Fatigue; and 5) User Experiences of Management Strategies. Synthesis of results suggests a potential mismatch between researchers' focus on circadian misalignment and travelers' focus on air travel comfort. A better understanding of the beliefs, attitudes, knowledge, satisfaction, experiences, and expectations about jetlag and travel fatigue will better enable the development of interventions that align with traveler priorities.

Flexible global working arrangements: An integrative review and future research agenda

The topography of global mobility within multinational enterprises (MNEs) is evolving where we now have a portfolio of flexible global working arrangements (FGWAs) including: international business travellers, flexpatriates, short-term international assignees, international commuters, and rotational assignees. The need for more agile structures and more efficient mechanisms to transfer globally dispersed knowledge are two key enablers in this evolution. With increased interest, this paper offers the first systematic, integrative review of 100 articles on FGWAs. The review indicates that these forms of global work appear to be a somewhat overlooked double-edged sword in that they may confer significant but unrealised value for MNEs alongside hidden, adverse consequences for individuals. Notable was the lack of insight into the HR function's input or oversight at either a strategic or operational level. We find that there is a distinct lack of strategic linkages to global mobility and/or HR functions. We propose a research agenda that centres on better understanding the international HR function's role and responsibility in providing a more strategic and sustainable perspective of these increasingly common FGWAs alongside virtual work. The COVID-19 pandemic may offer a critical juncture point in which there is greater strategic consideration on the utilisation and support of such arrangements.

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This is the first systematic review on flexible global working arrangements

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There is a clear imbalance in representation of the work arrangements in the literature

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Value creation and destruction highlight the doubled-edged nature of such work

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There is a lack of research into the HR function's input or oversight

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Research on strategic IHRM integration and sustainable management is proposed

Ill-being or well-being? Energising international business travellers

Purpose

The purpose of this qualitative study is to explore well-being experiences of international business travellers (IBTs) and contribute to our understanding of personal and job characteristics as antecedents of ill- or well-being.

Design/methodology/approach

The authors’ insights are based on semi-structured in-depth interviews with 32 IBTs assigned to various destinations ranging from single-country travel to global operation. Participants in this study represent a range of traveller personas (regarding demographics, type of work, travel patterns). Thematic analysis is used to reveal new insights.

Findings

The authors’ analysis revealed trip-load (i.e. workload, control, organisational support) and intensity of travel (i.e. frequency, duration and quality) as job characteristics that sit on an energy stimulation continuum, driving work-related outcomes such as stress and burnout or health and well-being. Energy draining and boosting processes are moderated by cognitive flexibility and behavioural characteristics.

Practical implications

Findings represent a framework for managing IBT well-being via adjustments in job and travel characteristics, plus guidance for training and development to help IBTs self-manage.

Originality/value

The insights within this paper contribute to the conversation around how to enhance well-being for IBTs and frequent flyers. The study intends to offer direction as to which specific job, psychological and behavioural characteristics to focus on, introducing a novel framework for understanding and avoiding serious consequences associated with international mobility such as increased stress, burnout and ill-health.

Psychological well-being of Portuguese expatriates in Sub-Saharan Africa: a cross-sectional study

BACKGROUND

Psychological health problems are highlighted among the most relevant disease patterns in expatriates. The purpose of this study was to determine the psychological well-being in Portuguese expatriates in Angola and Mozambique, considering the increasing expatriation wave.

METHODS

A cross-sectional self-administered web survey was conducted in a sample of 352 Portuguese civil expatriates in Angola and Mozambique. Clinically significant psychological distress was determined using General Health Questionnaire (GHQ)-12 and associated factors were studied using multiple logistic regression analysis.

RESULTS

GHQ-12 items showed good internal consistency as reflected by the Cronbach's alpha. One-third of the screened expatriates corresponded to cases of clinically significant psychological distress. Age, country of birth, self-reported psychological symptoms and self-perception of general health in the previous 3 months were identified as independent variables associated with psychological distress.

CONCLUSIONS

Increasing awareness and monitoring expatriates mental health should be in the health agenda, furthermore considering them a risk group in need of evidence-based mental health expatriate preparedness. The use of user-friendly validated tools, such as GHQ-12, allowing objective assessment and surveillance of these hard to reach populations should be reinforced.

Portuguese expatriates' health in Angola and Mozambique-a cross-sectional study: increasing awareness and need for more surveillance

BACKGROUND

Increasing numbers of expatriates are working in sub-Saharan Africa. There is little published data on the complex population and this survey aimed at understanding expatriate morbidity by accessing self-reported health problems and malaria preventive practices.

METHODS

A cross-sectional web-based survey was conducted targeting Portuguese expatriates in Angola and Mozambique. Logistic regression analysis explored factors associated with self-reported health problems and psychological symptoms in the previous 3 months.

RESULTS

A total sample of 352 adult Portuguese urban civil occupational expatriates was obtained. Median length of expatriation was 3 years. Considering a 3-month timeframe, one in five expatriates reported new health problems and need of medical assistance, 5% were hospitalized and 64% reported general psychological symptoms. Less than 2% of subjects were on malaria chemoprophylaxis. Having chronic health conditions doubled the reporting of new health problems. Increasing length of expatriation was associated with decreasing reporting of general psychological symptoms. Directors and executive managers and expatriates living alone tended to report more general psychological symptoms.

CONCLUSION

Expatriate communities deserve enhanced surveillance for the health issues that affect them. This will improve evidence-based preparation and intervention by public and travel health practitioners.

“Keeping the family side ticking along”

Purpose

– The purpose of this paper is to explore the work-family interface of two non-traditional forms of expatriation. The paper contributes to existing research by comparing and contrasting the experiences of international business travellers and rotational assignees, pointing out the similarities in their experiences but also showing considerable differences in how the work-family interface plays out in these two groups.

Design/methodology/approach

– In line with the exploratory nature of the research, the authors carried out a qualitative case study drawing on interview data with rotators and international business travellers (n=20). In order to get more in-depth insights into the experiences of these two groups of assignees, the authors also used the photo-elicitation technique, which corresponds with the recent recognition that the evolving nature of international assignments requires alternative methods of inquiry to enhance the understanding of the challenges faced by them.

Findings

– The study points to four major factors affecting the work-family interface: time spent away, unpredictability of work schedules, limited ability to exercise control over it as well as limited availability of organisational support. The findings illustrate that while these factors impact international business travellers and rotators alike, their intensity varies considerably in the experiences of these two groups.

Research limitations/implications

– The research is based on a single case study and a small sample which needs to be considered when discussing the implications of the findings. Future research can valuably extend and build on the here reported observations.

Practical implications

– A number of practical implications are discussed, notably pertaining to the ways in which organisations can mitigate the challenges encountered by international business travellers and rotators.

Originality/value

– The papers focuses on two groups of assignees that are underrepresented in the expatriate literature despite their increasing empirical significance in international business.

Work-family conflict faced by international business travellers

Purpose

– The purpose of this paper is to examine the direct and moderating effect of gender and parental status on the relationship between international business travel days and work-to-family conflict (WFC) among international business travellers (IBTs) on the basis of the conservation of resources theory.

Design/methodology/approach

– The study was conducted among 1,366 Finnish people in jobs demanding international business travel and a moderated hierarchical regression was utilised in data analysis.

Findings

– An increase in the number of international business travel days and being a parent is positively related to WFC. Women with dependent children experience a lower level of WFC than do men with dependent children. However, a significant interaction effect between international business travel days, parental status and gender was found that indicates that the volume of travel days increases the level of WFC for those women who have children more than it does for women who do not have children. For men, increased numbers of travel days raises levels of WFC, as does having children, but there is no interaction between travel days and parental status among men. An increased number of travel days was least critical for WFC among women without dependent children and most critical for WFC among women with dependent children However, women with dependent children were able to travel to a considerable extent before their levels of WFC overtook those of men with dependent children.

Practical implications

– The findings indicate that organisations should pay particular attention to developing policies and practices that take account of the family status of the traveller. In addition, to assist IBTs to cope with their WFC, attention should be paid to the intensity of work-related travel. However, gender seemed not to play a particularly important role in WFC, indicating that organisations need not be wary of recruiting both men and women into roles involving international business travel.

Originality/value

– This is the first study focusing on IBTs WFC that simultaneously takes account of how the intensity of business travel and both gender and parenthood are related to it.

Business travelers: vaccination considerations for this population

Illness in business travelers is associated with reduced productivity on the part of the employee as well as the employer. Immunizations offer a reliable method of preventing infectious diseases for international business travelers. The authors review the travel patterns of business travelers, available data on illnesses they encounter, their potential travel-associated risks for vaccine-preventable diseases and recommendations on immunizations for this population. Routine vaccines (e.g., measles, tetanus and influenza) should be reviewed to assure that they provide current coverage. The combined hepatitis A and hepatitis B vaccine with a rapid schedule offers options for those with time constraints. Other vaccine recommendations for business travelers need to focus on their destinations and activities and underlying health, taking into account the concept of cumulative risk for those with frequent travel, multiple trips or long stays.

The Development of the Job Stressor Appraisal Scale as Part of the Job Stress Battery

This study introduces the psychometric qualities of the Job Stressor Appraisal Scale (JSAS), a part of the Job Stress Battery, which comprehensively measures job stress in terms of job stressors, moderators, and strains. The JSAS measures employees’ appraisals of job stressors by considering both their frequency and intensity. To test its psychometric qualities, we administered the JSAS to a sample of 1,069 employees in Turkey. Factor analysis revealed a 5-factor structure, with 43 items explaining 46.1% of the variance. Cronbach’s α coefficients of the factors and the total scale varied between .66 and .93. In terms of construct and convergent validities, results generally showed significant correlations in the expected directions. These findings obtained on the validity and reliability of the scale imply good psychometric qualities.

Travel-related change of residence leads to a transitory stress reaction in humans

OBJECTIVE

It is well known that animals show a stress response when confronted with a novel environment. The aim of the this study was to investigate whether humans show a similar response by studying the reaction to a travel-related transitory change of residence.

METHOD

Forty-eight individuals (32 women, 16 men, age 40-83 years) traveling to a health resort approximately 120 km from their home town participated in the study. Individuals monitored their blood pressure (BP) twice a day 3 weeks before (baseline) and during the stay and filled out a diary stating their mood and sleep. The change of the variables relative to baseline on the day before departure, the travel day, and the day after arrival as well as 5 days after arrival were determined.

RESULTS

Systolic and diastolic BPs were increased on the day before travel and diastolic BP remained increased on the travel day and the day after arrival. Sleep was poorer during the first night at the new residence. All three variables had returned to baseline level 5 days into the stay. Mood was not affected by the change of residence.

CONCLUSION

The results indicate that not only the change of residence but also its anticipation affects individuals in a transient way. The findings are relevant not only for the basic understanding of the reaction to novel environments but also to travel, tourism as well as rehabilitation, and spa-research.

A web-based approach to address cardiovascular risks in managers: results of a randomized trial

OBJECTIVES

To examine whether a Web-based health and leadership development program--designed specifically for managers--was associated with changes in self-reported and biometric indicators of cardiovascular disease within the context of a randomized control trial.

METHODS

A total of 145 managers from 8 organizations participated in a 6-month Internet-based program or a control condition. They completed pre- and posttest assessments that included both self-reported attitudes (on diet, exercise, and mental health) and biometric measures (eg, body weight, waist circumference).

RESULTS

The intervention was associated with improvements in dietary attitudes, dietary self-efficacy, and exercise, and reductions in distress symptoms. Women in the program reduced their waist circumference significantly more than controls.

CONCLUSIONS

The program showed promise for reducing cardiovascular disease risk factors. Similar results across diverse organizations suggest the program may be useful across industry types.

Health and well-being factors associated with international business travel

BACKGROUND

International travel by US business travelers is continuing to increase with the globalization of the economy. The objective of this study was to determine if the frequency and duration of international business travel is associated with differences in travelers' health and well-being. This study expands our limited knowledge of the impact of long-haul travel on healthy lifestyle choices and traveler's perceptions of their health and well-being.

METHODS

12,942 unique health risk appraisal (HRA) records of US employees of a multinational corporation were analyzed according to self-reported (objective and subjective) travel history and lifestyle habits.

RESULTS

Comparing 2,962 international travelers and 9,980 non-travelers, international business travel was significantly associated with a lower body mass index, lower blood pressure, excess alcohol consumption, sleep deprivation, and diminished confidence to keep up with the pace of work.

CONCLUSIONS

This study demonstrated both positive and negative associations on the health risks and well-being of a large sample of US-based international business travelers from an US multinational company. This study identifies targeted areas for pretrip screening and counseling to proactively address potential negative effects of travel and may assist in the design of corporate travel health and employee assistance programs.

Morbidity in expatriates--a prospective cohort study

BACKGROUND

Expatriates comprise an important, but rarely studied subset of international travellers. This study was performed to assess the incidence of health events in an expatriate group and to evaluate factors affecting this incidence.

METHODS

A cohort of 2020 Foreign and Commonwealth Office (FCO) staff and partners living abroad were followed-up over 1 year. The main outcome measure was incidence of illness or injury serious enough to require consultation with a doctor. Data collection was by means of a self-administered questionnaire. Poisson regression was used to estimate the rates of health events and to test for association between health events and a number of independent variables.

RESULTS

The incidence of health events was 21%. Trauma (incidence 5%), musculoskeletal disorders (incidence 4%) and infectious disease (incidence 3%) were the principal causes of morbidity. The incidence of psychological disorders was low (1%). Of significance, employees were at increased risk of morbidity when compared to partners, with a higher incidence of health events [incidence rate ratio (IRR) 1.4, 95% CI 1.1-1.9] and psychological disorders (IRR 5.9, 95% CI 1.0-34.1). Moreover, unaccompanied employees were at increased risk of health events (IRR 1.3, 95% CI 1.0-1.7), and of traumatic injury (IRR 2.3, 95% CI 1.3-4.3) when compared to accompanied employees.

CONCLUSION

While the morbidity in FCO personnel is low in comparison to other expatriate groups, the higher risk of morbidity in employees and unaccompanied individuals merits further research, particularly to ascertain whether work demands, isolation or risk-taking behaviour are contributory factors.

Long-term influence of working abroad on returnees' mental health

Although international business travel is increasing, there is a lack of research on its repercussions for mental health. This study analysed the long-term influence of international business travel on the mental health status by comparing depression, anxiety and job stress between workers with and without international assignment experience. The subjects were divided into an 'experienced group' composed of 70 male workers who had experienced an overseas assignment of at least six months, and a 'non-experienced group' consisting of 2,163 male workers who had not. To assess the mental health status, Zung's Self-Rating Depression Scale (SDS) and Sheehan's Patient Rated Anxiety Scale (Sheehan) were employed. The Job Content Questionnaire (JCQ) was used to examine job stress. In addition, information about the characteristics of the overseas assignments was collected. The experienced group had significantly higher scores for job control, supervisor support and co-worker support in the JCQ, while no differences were observed for the SDS and Sheehan. Whether or not the subjects travelled abroad with their families, whether or not they went against their will, and whether or not they enjoyed their stay had no effects on their mental health. Job demand had a significantly positive correlation with the duration of the assignment.

Travel and health status: a survey follow-up study

BACKGROUND

To date there is little sound knowledge on the relationship between travel and health status as perceived by the traveller. Our aim was to investigate the frequency and risk factors of travel-associated illnesses and injuries and identify potential protective factors.

METHODS

All adults enrolled in a health insurance scheme who planned to travel in 2002 were eligible for participation in a baseline survey. Pre-travel written questionnaires and post-travel telephone interviews were conducted with responders. We analysed travel-associated health problems using descriptive methods and multivariate logistic regression.

RESULTS

From 8316 persons who returned a pre-travel questionnaire, a sample of 2384 were chosen, of whom 1471 completed post-travel interviews. 10.1% of all travellers reported travel-associated illnesses, and 1.8% suffered from injuries during travel. Among travellers to European destinations, 6.0% reported an illness as opposed to 16.2% of travellers to overseas destinations. Predictors for travel-associated illness were age <30 years (OR 1.48), duration of travel >4 weeks (OR 3.35) and travel destination. Perceived health status as scored by the travellers improved after travel. The frequency of medical consultations and personal health-related expenses decreased significantly shortly after travel.

CONCLUSIONS

In this study, travel had a positive effect on the perceived health status of the traveller. The positive effects of travel seemed to outweigh the impact of health problems. Travel did not lead to increased health-related costs, neither in individual health expenses nor indirectly through increased medical consultation rates.

Medical Assessment of the Health Effects of Short Leisure Trips

Using responses to questionnaires and results of saliva samples from 40 women, the authors assessed the effects on health of participation in a short leisure trip (2 nights, 3 d) to Kyushu Island in Japan. They addressed transportation, sightseeing, and group activities during the tour, which might differ from participants' usual activities. Levels of the salivary endocrinological stress markers cortisol and chromogranin A (CgA) were determined by enzyme-linked immunosorbent assay (ELISA). In each of the groups with characteristics considered healthy and related to lifestyle, patterns of behavior, perceived stressors, and stress reactions, a decrease in the cortisol levels and an increase in the CgA levels were apparent during the tour. The baseline for stress hormone changes was the levels on awakening on Day 1 (i.e., immediately before the tour). These findings suggest that even short periods of travel can bring about a reduction in di-stress and acquisition of eu-stress, experienced as feeling uplifted or fulfilled.

International business travel: impact on families and travellers

OBJECTIVES

Spouses and staff of the World Bank Group (WBG) were questioned about the impact of international business travel on families and travellers. Dependent variables were self reported stress, concern about the health of the traveller, and negative impact on the family. We hypothesised that several travel factors (independent variables) would be associated with these impacts. These travel factors had to do with the frequency, duration, and predictability of travel and its interference with family activities.

METHODS

Survey forms were developed and distributed to all spouses of travelling staff as well as a small sample of operational staff. Kendall's tau b correlation coefficients of response frequencies were computed with the data from scaled items. Written responses to open ended questions were categorised.

RESULTS

Response rates for spouses and staff were 24% and 36%, respectively. Half the spouse sample (n=533) and almost 75% of the staff sample (n=102) reported high or very high stress due to business travel. Self reported spouse stress was associated with six out of eight travel factors. Female spouses, those with children, and younger spouses reported greater stress. Self reported staff stress was significantly associated with four out of nine travel factors. Further insight into how business travel affects families and staff (including children's behavioural changes) and how families cope was gained through responses to written questions.

CONCLUSIONS

The findings support the notion that lengthy and frequent travel and frequent changes in travel dates which affect family plans, all characteristic of WBG missions, negatively affects many spouses and children (particularly young children) and that the strain on families contributes significantly to the stress staff feel about their travel. Policies or management practices that take into consideration family activities and give staff greater leeway in controlling and refusing travel may help relieve stress.

Mental health insurance claims among spouses of frequent business travellers

OBJECTIVES

Following up on two earlier publications showing increased psychological stress and psychosocial effects of travel on the business travellers this study investigated the health of spouses of business travellers.

METHODS

Medical claims of spouses of Washington DC World Bank staff participating in the medical insurance programme in 1997-8 were reviewed. Only the first of each diagnosis with the ninth revision of the international classification of diseases (ICD-9) recorded for each person was included in this analysis. The claims were grouped into 28 diagnostic categories and subcategories.

RESULTS

There were almost twice as many women as men among the 4630 identified spouses. Overall, male and female spouses of travellers filed claims for medical treatment at about a 16% higher rate than spouses of non-travellers. As hypothesised, a higher rate for psychological treatment was found in the spouses of international business travellers compared with non-travellers (men standardised rate ratios (RR)=1.55; women RR=1.37). For stress related psychological disorders the rates tripled for both female and male spouses of frequent travellers (>or= four missions/year) compared with those of non-travelling employees. An increased rate of claims among spouses of travellers versus non-travellers was also found for treatment for certain other diagnostic groups. Of these, diseases of the skin (men RR=2.93; women RR=1.41) and intestinal diseases (men RR=1.31; women RR=1.47) may have some association with the spouses' travel, whereas others, such as malignant neoplasms (men RR=1.97; women RR=0.79) are less likely to have such a relation.

CONCLUSION

The previously identified pattern of increased psychological disorders among business travellers is mirrored among their spouses. This finding underscores the permeable boundary between family relations and working life which earlier studies suggested, and it emphasises the need for concern within institutions and strategies for prevention.

Perceived stress and health-related outcomes in a Swiss population sample 1This research was supported by grants from the Swiss Federal Office of Public Health, the Swiss Foundation of Health Promotion and the Swiss Federal Office of Sports

This cross-sectional study aimed at analysing the perception of stress and its relation to health-related outcomes in the Swiss population. A sample drawn from this population included 992 participants aged 15 to 64 years. The interview covered socio-demographic data, perceived stress, psychological and somatic symptoms as well as perceived general health status. Patterns of stress were grouped into three categories. “Stressed” included persons who reported that they felt overwhelmed by stressful situations during the previous month. “Challenged” included those who reported that they experienced stressful situations but could manage those well. “Not stressed” consisted of respondents who did not experience stress. Results indicated that 38.6% of the sample reported being stressed, 33.3% challenged and 28.1% not stressed. Analysis of the distribution of perceived stress showed that, in particular, women, younger people, single parents, students and the self-employed felt stressed relatively often. In a logistic regression analysis, age and gender remained the factors most strongly associated with self-perceived stress. Perception of stress was not related to subjective ratings of general health. However, respondents in the stressed category were more likely than their counterparts to indicate various clinically relevant symptoms. 2 The authors are grateful to Julie Page and Jen Wang for their critical reading of the manuscript.