An Urgent Call to Address Work-related Psychosocial Hazards and Improve Worker Well-being

Posted on by Paul Schulte, PhD; Steven Sauter, PhD; Hope Tiesman, PhD; Sudha Pandalai, MD; L. Casey Chosewood, MD, Rene Pana-Cryan, PhD; Chia-Chia Chang, MPH; Tapas Ray, PhD; John Howard, MD; Thomas Cunningham, PhD; Naomi Swanson, PhD; Jeannie Nigam, MS; Steven Wurzelbacher, PhD; and Dori Reissman, MD


Work-related psychosocial hazards are factors in the work environment that can cause stress, strain, or interpersonal problems for the worker. This has the potential to cause physical and psychological harm. Work-related psychosocial hazards are on the verge of surpassing many other occupational hazards in terms of their contribution to poor health, injury, disability, and costs.[1][2][3][4] The extensive and cumulative impacts of these exposures represent an alarming public health problem that merits immediate, increased attention. A new report from the National Institute for Occupational Safety and Health examines the link between work-related psychosocial hazards and adverse effects and provides six crucial societal actions needed to address this pressing problem.

The link between work-related psychosocial hazards and adverse health effects

Work-related psychosocial hazards have been shown to cause physical injuries, burnout, cardiovascular disease, depression, high blood pressure, sleep disturbance, and suicidal ideation (see the full list in Table 2 of the report). Beyond their effects on health, psychosocial hazards can also impair workers’ ability to participate effectively in the work environment and with other people in and outside of work.[5] Research has shown:

  • Associations between moderate level of mental health conditions such as depression, anxiety and work organization variables such as such as low job control and effort-reward imbalance[6]
  • Job insecurity and long working hours are significantly associated with coronary heart disease, stroke, and depression[7]
  • Job strain (the adverse outcome that results from exposure to job stressors such as the combination of work with high demands and low control) is associated with a 23% increase in coronary heart disease[8] and a 30% increase in the risk of stroke[9]
  • Workers reporting job stressors such as job strain had an increased incidence of coronary artery disease[10]
  • Workers who experienced workplace violence also experienced depression, anxiety, post-traumatic stress disorder (PTSD), burnout, sleep problems, increased use of antidepressants, and decreased job satisfaction and quality of life[11]
  • Workers who reported high job demands, high job strain, and effort/reward-imbalance had an increased risk for workplace musculoskeletal disorders[12]

Burden of work-related psychosocial hazards and adverse physical and mental health effects

Most workers have the potential to be exposed to some degree of work-related psychosocial hazards due to meeting expectations and deadlines, working or interacting with others, balancing work with life responsibilities, and coping with difficult work organization processes. [13][1]

The General Social Survey (GSS), 2018 – NIOSH Quality of work life (QWL) supplement revealed that in 2018:

  • Close to 30% of workers responded that they, either always or often, found their work stressful.
  • Almost 70% agreed that they had to work very fast, and 43% perceived that demand at their job interferes with their family life.
  • Approximately 25% of workers believe they don’t have any decision-making power at work, and a similar percentage reported an inability to take time off work when needed.

Another study showed that between 2015 and 2019 non-fatal workplace violence events among workers increase by 25%.[4]

In terms of economic burden, a 2016 study assessed direct U.S. medical costs of exposure to 10 work-related psychosocial hazards at $187 billion (in 2014 dollars). [14]  Although the frequency of mental health workers compensation claims is low, it is increasing in the United States. This is possibly due to an increase in state workers’ compensation laws to cover these claims and increasing awareness of mental health conditions among workers and the connection to working conditions.[15]

What can employers do to address work-related psychosocial hazards?

In occupational safety and health, the hierarchy of controls has been used to prioritize effective, and sustainable control solutions. NIOSH adapted the hierarchy of controls to reflect Total Worker Health® principles (eliminate, substitute, redesign, educate, encourage). This adapted version can serve as a framework for addressing work-related psychosocial hazards.[16]

There are multiple approaches employers can take to mitigate work-related psychosocial hazards, based on the hierarchy of controls. These approaches can target the organization (e. g., work redesign ) or the individual (e. g., health promotion and stress management programs) and can be delivered at primary, secondary, or tertiary prevention levels.[17] In general, efforts should start with applying primary prevention approaches at the broadest levels. In the case of psychosocial hazards, this means interventions that alter the working conditions, rather than individually-focused psychosocial supports.[18] Organizational-level solutions approaches are likely to be more effective, have broader impact, and be more sustainable. It is suggested that comprehensive approaches, which include both organizational and individual-level interventions, may be the most impactful and sustainable. [19][20][21]

Preventive Actions

While we continue to see an increase in worker exposure, we also see the growing impact on communities, companies, and our nation to work-related psychosocial hazards. The study authors provide six societal actions that may help address work-related psychosocial hazards below.

1) Increase awareness of this critical issue through a comprehensive public campaign

2) Increase etiologic, intervention, and implementation research

3) Initiate or augment surveillance efforts

4) Increase translation of research findings into guidance for employers and workers

5) Increase the number and diversity of professionals skilled in preventing and addressing these psychosocial hazards

6) Develop a national regulatory or consensus standard to control work-related psychosocial hazards

When done comprehensively, preventing and addressing work-related psychosocial hazards will help promote work as a means to achieving greater health and well-being for workers.

Share with us in the comment section below how your workplace is addressing psychosocial hazards in the workplace.


Paul A. Schulte, PhD; and Steven L. Sauter, PhD are NIOSH contractors with Advanced Technologies and Laboratories International, Inc. 

Hope M. Tiesman, PhD, is with the NIOSH Division of Safety Research.

Sudha P. Pandalai, MD; L. Casey Chosewood, MD, Rene Pana-Cryan, PhD; Chia-Chia Chang, MPH; Tapas K. Ray, PhD; and John Howard, MD; are with the NIOSH Office of the Director.

Thomas R. Cunningham, PhD; Naomi G. Swanson, PhD; and Jeannie A.S. Nigam, MS; are with the NIOSH Division of Science Integration.

Steven J. Wurzelbacher, PhD, is with the NIOSH Division of Field Studies and Engineering.

Dori B. Reissman, MD, is the former Director of the World Trade Center Health Program.



[1] Way K. Psychosocial hazards. The Core Body of Knowledge for Generalist OHS Professionals. 2nd ed. 2020.

[2] Daly M. Prevalence of psychological distress among working-age adults in the United States, 1999–2018. Am J Public Health. 2022;112(7):1045-1049.

[3] Hassard J, Teoh KR, Visockaite G, Dewe P, Cox T. The cost of work-related stress to society: a systematic review. J Occup Health Psychol. 2018;23(1):1.

[4] Harrell E, Langton L, Petosa J, et al. Indicators of workplace violence, 2019. US Dept of Justice, US Dept of Labor, US Dept of Health and Human Services. 2022. NCJ 250748; NIOSH 2022-14.

[5] Chen B, Wang L, Li B, Liu W. Work stress, mental health, and employee performance. Front Psychol. 2022;13:1006580.

[6] Harvey SB, Modini M, Joyce S, et al. Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems. Occup Environ Med. 2017;

[7] Niedhammer I, Bertrais S, Witt K. Psychosocial work exposures and health outcomes: a meta-review of 72 literature reviews with meta-analysis. Scand J Work Environ Health. 2021;47(7):489.

[8] Kivimäki M, Nyberg ST, Batty GD, et al. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. The Lancet. 2012;380(9852):1491-1497.

[9] Huang Y, Xu S, Hua J, et al. Association between job strain and risk of incident stroke: A meta-analysis. Neurology. 2015;85(19):1648-1654.

[10] Theorell T, Jood K, Järvholm LS, Vingård E, Perk J, Östergren PO, Hall C. A systematic review of studies in the contributions of the work environment to ischaemic heart disease development. Eur J Public Health. 2016;26(3):470-477

[11] Rudkjoebing LA, Bungum AB, Flachs EM, et al. Work-related exposure to violence or threats and risk of mental disorders and symptoms: a systematic review and meta-analysis. Scand J Work Environ Health. 2020;46(4):339.

[12] Taibi Y, Metzler YA, Bellingrath S, Müller A. A systematic overview on the risk effects of psychosocial work characteristics on musculoskeletal disorders, absenteeism, and workplace accidents. Appl Ergon. 2021;95:103434.

[13] WHO. Mental Health at Work: Policy Brief. World Health Organization. 2022.

[14] Goh J, Pfeffer J, Zenios SA. The relationship between workplace stressors and mortality and health costs in the United States. Management Science. 2016;62(2):608-628.

[15] Thumula V, Negrusa S. A primer on behavioral care in workers’ compensation. Workers’ Compensation Research Institute. 2022;

[16] NIOSH. Fundamentals of Total Worker Health approaches: Essential elements for advancing worker safety, health, and well-being. US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. 2016. DHHS (NIOSH) Publication No. 2017-112.

[17] Dinos S, Citrin, R., Bhui, K. Stress management in the workplace. In: O’Donnell MP, ed. Health Promotion in the Workplace. 5th ed. Art & Science Health Promotion Institute; 2017:491-506.

[18] Parker S, Van Den Broeck A, Holman D. Work design influences: A synthesis of multilevel factors that affect the design of jobs. The Academy of Management Annals. 2014;11(1):267–308.

[19] Hudson HL, Nigam JA, Sauter SL, Chosewood L, Schill AL, Howard JE. Total Worker Health. American Psychological Association; 2019.

[20] Lamontagne AD, Keegel T, Louie AM, Ostry A, Landsbergis PA. A systematic review of the job-stress intervention evaluation literature, 1990–2005. Int J Occup Environ Health. 2007;13(3):268-280.

[21] Nielsen K, De Angelis M, Innstrand ST, Mazzetti G. Quantitative process measures in interventions to improve employees’ mental health: a systematic literature review and the IPEF framework. Work Stress. 2023;37(1):1-26.

Posted on by Paul Schulte, PhD; Steven Sauter, PhD; Hope Tiesman, PhD; Sudha Pandalai, MD; L. Casey Chosewood, MD, Rene Pana-Cryan, PhD; Chia-Chia Chang, MPH; Tapas Ray, PhD; John Howard, MD; Thomas Cunningham, PhD; Naomi Swanson, PhD; Jeannie Nigam, MS; Steven Wurzelbacher, PhD; and Dori Reissman, MD

3 comments on “An Urgent Call to Address Work-related Psychosocial Hazards and Improve Worker Well-being”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    An additional adverse health effect not noted in the report is the elevated risk of functional gastrointestinal disorders associated with psychosocial hazards in the workplace. This has a considerable effect on QoL for those diagnosed and significantly impacts work.

    For example:
    Huerta, P. A., Cifuentes, M., Levenstein, C., & Kriebel, D. (2019). The Association of Occupational Psychosocial Factors with the Prevalence of Irritable Bowel Syndrome in the Chilean Working Population. Ann Work Expo Health, 63(4), 426-436.

    Lim, S. K., Yoo, S. J., Koo, D. L., Park, C. A., Ryu, H. J., Jung, Y. J., . . . Koh, S. J. (2017). Stress and sleep quality in doctors working on-call shifts are associated with functional gastrointestinal disorders. World J Gastroenterol, 23(18), 3330-3337.

    Jang, S. H., Ryu, H. S., Choi, S. C., & Lee, S. Y. (2017). Psychological Factors Influence the Irritable Bowel Syndrome and Their Effect on Quality of Life among Firefighters in South Korea. Psychiatry Investig, 14(4), 434-440. doi:10.4306/pi.2017.14.4.434

    Westerberg, L., & Theorell, T. (1997). Working conditions and family situation in relation to functional gastrointestinal disorders. The Swedish Dyspepsia Project. Scand J Prim Health Care, 15(2), 76-81.

    Thank you for this timely and important article. Psychosocial hazards (high job demands, workplace bullying, long hours, work-family conflict, low job control, effort-reward imbalance etc.) are a major source of burnout and poor worker-well-being in health care and many other industries. There are over 40 years of research showing the evidence between poor working conditions that cause chronic stress leading to poor mental health, but also cardiovascular disease and death. Its time we learn and teach others how to address the organization of work to improve worker health and safety. Thanks to our colleagues at NIOSH and Total Worker Health for their leadership and the many great resources for industry, employers, unions and workers. We at the Healthy Work Campaign can also offer science-based psychosocial hazard identification and solutions/interventions

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Page last reviewed: April 18, 2024
Page last updated: April 18, 2024