Exploring Individual and Organizational Stress-reducing Interventions across Industries

Physical and mental job stress are critical drivers of individual health problems and organizational and societal costs. Health effects of stress lead to higher absenteeism, turnover, and loss of productivity for organizations, as well as higher healthcare expenditures. Long-term impact of stress on employees leads to chronic health conditions. Workplace interventions can help working adults reduce stress which in turn may reduce the impact of chronic health conditions. In May 2018, research on stress-reducing interventions was presented at the 2^nd International Symposium to Advance Total Worker Health^®. The purpose of this project was to describe stress interventions delivered in the workplace and report the health effects of implementation. A scoping review of more than ten thousand studies from 2007 through 2017 found 37 articles that met eligibility and reported outcomes; the summary of analysis results is below.

Results showed most studies on stress intervention in the workplace were conducted in the healthcare industry (40%), followed by education (11%), and in groups of general workers (11%), with 73% of the studies in white collar jobs. Most studies (33) involved individual-level strategies. The most common individual strategies were mindfulness, cognitive behavioral therapy, and coping strategies. Only two studies were delivered to the organization and two combined individual and organizational level strategies via a participatory program.

Studies with the largest effect used meditation, coping strategies, cognitive behavioral therapy, and multicomponent strategies, but use of these strategies did not consistently produce strong effects. Effect sizes varied by type of strategy and industry. Coping strategies produced a large effect in general workers but a small effect for healthcare. The health effect of physical activity strategies varied widely by the type of work and there was a tendency for high attrition of participants. Multi-component strategies had large effect in some studies, while others showed high attrition and low participation. Work organization interventions were multi-component. All of these studies were conducted in healthcare and results were limited by inadequate power and attrition from turnover; none showed a meaningful effect.

Most workplace stress reducing strategies in the published literature focused on increasing individual tolerance to stress rather than reducing the source of stress created by the job and organization. This is perhaps the most striking finding of this review, and reflects a widespread approach to job stress that runs counter to the approach taken to reduce health effects from all other occupational hazards, where the focus is on reducing worker exposures via the hierarchy of controls. Organizational interventions are more complex to deliver, and often require longer term assessment to determine effectiveness, but may be necessary to reduce stress and improve worker well-being at an organizational level.

Intervention studies should measure employee engagement and sustainability with the intervention as well as long-term health effects. Some interventions are more challenging to deliver at the workplace and some industries are more challenging to deliver interventions, particularly service oriented industries like healthcare. Multi-component strategies offer better health outcomes but also suffer from greater attrition and less engagement with employees.

The mixed results indicate that most workplaces may benefit from a tailored approach considering the needs of the particular work environment and worker population. Additionally, more research is needed on best practices within industries. With the growing concern for stress in the workplace, there is a need to know which stress reducing strategies are more likely to produce an effect. Preferred strategies appear to differ by industry. Offering multiple forms of strategies and targeting both individual and organizational levels may be needed to reduce stress in the workplace and help employees cope with their stress.

While research continues, there are many different strategies that organizations can begin implementing to reduce stressful working conditions and promote better mental health in the workplace. The NORA Healthy Work Design and Well-being Cross-sector Council works with partners to improve the design of work, work environments, and management practices in order to advance worker safety, health, and well-being. Additionally, the NIOSH Total Worker Health^® program integrates workplace interventions that protect safety and health with activities that advance the overall well-being of workers. For more information, check out resources below.

We would like to hear from you. How has your company taken steps to promote better mental health or implemented stress prevention programs? What challenges does your organization face in implementing programs that reduce stress and promote better mental health in the workplace? Please share them in the comment sections below.

Ann Marie Dale, PhD, OTR/L, is an Associate Professor of Medicine and Occupational Therapy at the Washington University School of Medicine.

Stephanie Kibby, OTD/S; Skye Buckner-Petty, MPH; Jaime R. Strickland, MA;  Bradley A. Evanoff, MD, MPH are all in the Division of General Medical Sciences, Washington University School of Medicine.

Sarah Mitchell, MPH, is an ORISE Fellow working in Research Translation and Communication in the NIOSH Office for Total Worker Health®.