Healthy people--healthy business: a critical review of stress management programs in the workplace

Occupational Mental Health Promotion: A Prevention Agenda Based on Education and Treatment

Purpose of the Review.

Psychological disorders are one of the 10 leading work-related diseases and injuries in the United States according to the National Institute for Occupational Safety and Health. This article addresses occupational mental health and preventive stress management in the workplace. The individual and organizational costs are briefly considered with concern for reducing the burden of suffering associated with these problems.

Search Method.

As an American Psychological Association interdisciplinary panel, we searched the psychological, medical, public health, and organizational literature. We selected articles relevant to the problem of psychological disorders in the workplace and to enhancing occupational mental health and preventive stress management.

Important Findings.

The panel proposed a national agenda of education and treatment, combined with a program of evaluation research, for addressing these issues. Target populations are identified, and the need for collaboration among a variety of national constituencies is considered. Advancing occupational mental health and promoting skills in preventive stress management is considered in the context of comprehensive health promotion.

Major Conclusions.

The panel concluded that there is a pressing need to: 1) set a ‘gold’ standard concerning the current state of knowledge in the domains of occupational mental health and stress management; 2) identify Diagnostically Related Groups (DRGs) which are stress-related; 3) establish assessment standards for stress and mental health; 4) set guidelines for reasonable interventions; and 5) establish acceptable post-outcome criteria.

Stress Reduction at the Worksite: An Evaluation of Two Methods

Stress is estimated to cost industry between 75 and 100 billion dollars annually as a result of absenteeism, medical claims and diminished productivity. Two types of stress management programs were studied to evaluate their effectiveness at the worksite. The Time-Life Stress Management Program and a Myers-Briggs Personality Type approach were used. The Time-Life program was given to 113 participants, and 35 participated in the Myers-Briggs program. Baseline stress (strain) scores were obtained using a standardized strain survey instrument. Follow-up strain scores were obtained six to eight months after baseline for 62 percent of the individuals. Both groups showed significant reductions in follow-up strain scores when compared to baseline. Reductions in strain were greater in the group with higher baseline strain scores (Time-Life). Worksite stress management programs have the potential to reduce strain among employees for at least six to eight months.

Goal Setting, Social Support, and Financial Incentives in Stress Management Programs: A Pilot Study of Their Impact on Adherence

A stress management program was implemented at two worksites to answer the following questions: 1) Is it feasible to design a stress management program that is of sufficient duration to change old habits, is tailored to the specific needs of the individual, and yet is administratively manageable? 2) To what degree does the use of powerful, reliable, independent variables make it possible for program participants to adhere to a stress management goal of their choosing? A program of six months duration that included personal stress management projects attracted a total of 21 participants at the two worksites. They met their weekly personal project commitments more than 80 percent of the time, and significant changes occurred on a measure of social anxiety.

Crisis management: the psychological dimension

Doepel, D.G., 1991. Crisis management: the psychological dimension. Industrial Crisis Quar terly, 5 : 177-188.

In the last decade an enormous amount of research has been conducted on the psychological aspects of the human response to traumatic events. During the same period managers and management consultants have developed sophisti cated procedures for responding to traumatic events that occur in the work place. This paper combines a number of key aspects of both and proposes strat egies for enhancing the overall effectiveness of crisis management by focusing upon the stress experienced by management and employees in the aftermath of traumatic events.

Economic impact of corporate wellness programs in Europe: A literature review

OBJECTIVES

The purpose of this review is to summarize the current evidence on the economic impact of corporate wellness programs (CWPs) in Europe from the results of randomized controlled trials (RCTs) published up to 2013.

METHODS

A review was undertaken by searching for RCTs with key words in the following databases: PubMed, SPORT-Discus, and Business Source Premier. Only RCTs that evaluated the economic impact of CWPs, and included analyses performed in Europe with results converted into monetary values, were eligible for inclusion. An approach to economic analyses from both an employer's perspective and a societal perspective was also undertaken.

RESULTS

Eleven RCTs were identified, and review of these studies determined that the economic impact of the majority of CWPs analyzed was mostly negative. We discuss a possible explanation for these discrepancies with regard to prior reviews in this area. Despite the fact that the RCT is the "gold standard" for investigating without bias, several limitations to the methodology may have influenced the results of the studies in this review and suggested the use of caution in the interpretation of the results.

CONCLUSIONS

The findings of this review could be a "wake up call" for companies regarding the high probability of bias from non-RCT studies, the majority of which report a positive economic impact of these programs, and the risk of taking inappropriate decisions based on the results of such studies.

Employee stress claims: increasing implications for health promotion programming

Abstract Characterized as "the Nation's fastest growing occupational disease" by the National Council on Compensation Insurance, stress has become a major issue for corporate leaders today. With the recent rise in high cost stress claims, organizations have become interested in preventing potential stress problems. This article discusses types of stress claims, individual and occupational risks, reasons given for filing claims, efforts aimed at prevention, and future outlooks. Finally, the implications for health promotion programming in providing a multi-dimensional approach to preventing the physical, psychological and economic impact of stress, are discussed.

A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention

Stress has been associated with a variety of chronic and acute conditions and with higher use of health care services. This research reports on 18-month outcomes of a randomized clinical trial of a stress-management program based on the transtheoretical model (TTM; J. O. Prochaska & C. C. DiClemente, 1986). A national sample of 1,085 individuals participated (age range = 18-91 years, M = 55.33; 68.9% female, 31.1% male; 84.8% Caucasian; 15.2% non-Caucasian). Both the treatment and control groups received assessments at 0, 6, 12, and 18 months. In addition to the assessments, the treatment group received 3 individualized reports (0, 3, 6 months) and a manual. The 18-month assessment was completed by 778 individuals (72%). A random effects model indicated that participants completing the study in the treatment group had significantly more individuals reporting effective stress management at follow-up time points than did completers in the control group. Results also indicate that the intervention had significant effects on stress, depression, and specific stress-management behaviors. Results provide evidence for the effectiveness of this TTM population-based stress-management intervention.

Differences in health care costs and utilization among adults with selected lifestyle-related risk factors

PURPOSE

This study examined the relationship between lifestyle-related health risks and health care costs and utilization in adults.

DESIGN

A 2-year prospective study with no intervention was used to compare health care utilization and costs in employees with different levels of health risks.

SETTING

Data were collected at a primarily white-collar worksite during 1994 and 1995.

SUBJECTS

Subjects included 982 employees and spouses, mean age 32.1 +/- 10.1 years.

MEASURES

Employee medical claims obtained from a third-party administrator were analyzed with respect to health care expenses and utilization. Exercise habits, stress, and overall wellness were assessed by self-report and obesity by the body mass index (BMI). Regression, regression with outliers removed, and odds ratios were used to analyze the associations.

RESULTS

Employees who were at high risk for overall wellness (2.4 times), stress (1.9 times), and obesity (1.7 times) were more likely to have high health care costs (> $5,000) than subjects not at high risk. Mean total medical costs also were greater for high-risk subjects compared to lower risk subjects for overall wellness (difference = $1,973; F = 10.65, p = .001), stress (difference = $1,137; F = 7.35, p = .007), and obesity (difference = $1,092; F = 9.09, p = .003). The exercise habits measure was not significantly associated with health care costs or utilization.

CONCLUSIONS

Results indicate that health risks, particularly obesity, stress, and general lifestyle, are significant predictors of health care costs and utilization in employed young adults.

Sind die Effekte eines primärpräventiven Streßbewältigungstrainings von Dauer? Eine randomisierte, kontrollierte Follow-up-Studie 1Gefördert mit Mitteln des Bundesminsteriums für Gesundheit

Zusammenfassung. In einer randomisierten Kontrollgruppenstudie wurden die längerfristigen Effekte eines kognitiv-behavioralen Stressbewältigungstrainings in der primären Prävention auf das psychophysische (Wohl-)Befinden und das selbstberichtete Bewältigungsverhalten ein halbes Jahr nach Interventionsende untersucht. 47 Trainingsteilnehmer und 33 Kontrollpersonen nahmen an der Follow-up-Untersuchung teil. Die Drop-out-Rate betrug 19 %. Die Intervention bestand aus einem Training in Progressiver Muskelrelaxation, einem strukturierten Problemlösetraining und einem Genußtraining. Folgende Erhebungsinstrumente wurden eingesetzt: die Eigenschaftswörterliste (EWL) von Janke und Debus (1978) , der Gießener Beschwerdebogen (GBB) von Brähler und Scheer (1983) , der Streßverarbeitungsfragebogen (SVF) von Janke, Erdmann und Kallus (1985) sowie Ratingskalen zur Erfassung des Medikamentenkonsums. Die Daten wurden mit den jeweiligen Ausgangswerten als Kovariaten varianzanalytisch ausgewertet. Signifikante Trainingseffekte zeigten sich bei vier von fünf Bewältigungsfaktoren sowie bei zwei von vier Befindenskriterien. Sechs Monate nach Trainingsende wiesen die Trainingsteilnehmer stärker ausgeprägte aktive Kontrollversuche und relativierende kognitive Bewältigungsformen, mehr kompensatorische Bewältigungsmöglichkeiten sowie weniger resignativ-vermeidende Tendenzen und ein besseres psychisches Befinden als die Kontrollpersonen auf.

Analysis of a worksite health promotion program's impact on job satisfaction

This study assessed the impact of participation in a health promotion program and engagement in healthy behaviors on job satisfaction. A survey response rate of 70% (n = 1,283) was obtained at a northern state university with an established worksite health promotion program. Significant differences in job satisfaction were obtained by education level, job classification, marital status, dependents, and regular exercise behaviors. No differences in job satisfaction were obtained by health promotion program involvement or any other health behavior other than regular exercise. Results suggest that health promotion programs do not significantly impact job satisfaction. Rather, job design and the psychosocial aspects of the work environment may be more influential in improving job satisfaction. Based on the results of this study, organizations attempting to improve employee health should provide health promotion programs and address the job itself. To improve job satisfaction, attention to the job itself is required.

The ecology of work and health: research and policy directions for the promotion of employee health

This article identifies new research and policy directions for the field of worksite health in the context of the changing American workplace. These directions are viewed from an ecological perspective on worksite health and are organized around three major themes: (1) the joint influence of physical and social environmental factors on occupational health, (2) the effects of nonoccupational settings (e.g., households, the health care system) on employee well-being and the implications of recent changes in these settings for worksite health programs, and (3) methodological issues in the design and evaluation of worksite health programs. Developments in these areas suggest that the field of worksite health may be undergoing a fundamental paradigm shift away from individually oriented wellness programs (provided at the worksite and aimed primarily at changing employees' health behavior) and toward broader formulations emphasizing the joint impact of the physical and social environment at work, job-person fit, and work policies on employee well-being.

Mind-body medicine in primary care. Implications and applications

A growing body of research in basic and clinical science confirms that psychological states and interventions affect physiologic and pathophysiologic processes and the outcome of clinical illness. This evidence is reviewed in detail, with special attention paid to those findings that have particular relevance for primary care physicians. Specific guidelines are offered for incorporating mind-body principles and techniques into primary care practice.

Stress and coping in the context of psychoneuroimmunology: a holistic framework for nursing practice and research

Nurses who specialize in mental health routinely deal with stress and coping as priority issues. Yet there has been no consensus on an overriding framework for organizing and interpreting knowledge concerning the influences of stress on health and well-being. In addition, stress-management interventions have often been piecemeal. This article surveys traditional and emerging conceptualizations of stress and stress management, with a special focus on the transactional model and psychoneuroimmunology as complementary integrative frameworks. The authors recommend a comprehensive approach for stress management that includes behavioral, cognitive, and combination strategies for active coping as well as cognitive-behavioral techniques for relaxation.

Policies and procedures in the workplace: how health care organizations compare

Many organizations are implementing programs and services to manage the human and economic costs of stress. A mail survey was conducted of 500 randomly selected Canadian organizations having at least 500 employees. The survey tapped four major areas: organizational policies and procedures for managing stress; programs and services offered; perceived benefits and constraints for the organization; and projected future directions in this area. Analyses of returns from 210 organizations-43 health and 167 non-health-revealed various findings. For example, over half of health care organizations have policies and procedures as opposed to less than half of non-health care organizations. Also, health care organizations place greater emphasis on smoking cessation, weight control programs and on stress management training. Although some Canadian organizations are addressing stress, much more could and should be done, especially by organizations that do not yet recognize the impact of stress on employees and their work performance.

Mind-body health: research, clinical, and policy applications

PURPOSE OF THE REVIEW. This critical review presents an overview of the development in the field of mind-body medicine over the last 10 years and has taken tentative steps toward suggesting the components of a new model of health based on psychoneuroimmunology. While documenting the major shortcomings of present research design, methodology, data analysis, and subsequent hypotheses, this article points out areas of sufficient promise for practical and responsible clinical applications of the research. SEARCH METHOD USED. A thorough review of the clinical and experimental medical literature related to the interaction between mind and body is presented, and the new and complex research in the field of psychoneuroimmunology is analyzed. SUMMARY OF IMPORTANT FINDINGS. Despite the mixed and sometimes conflicting findings in current research, there is an increasingly compelling body of scientific evidence indicating that mind-body interactions are at the root of both health and disease. Research demonstrates that psychological factors seem to play a causal role in the onset and course of many chronic disorders and that psychological, emotional, psychosocial, and behavioral interventions have at least as much proof of effectiveness as many purely medical treatments. MAJOR CONCLUSIONS. There is a substantial growing body of scientific and clinical knowledge which demonstrates an inextricable interaction between mind and body. Such an approach empowers individuals and organizations to assume greater responsibility for health as a basis for the development of a true health care system.