Job stress among humanitarian aid workers

Objective: This thesis examined the prevalence of burnout, alcohol consumption, and psychological distress and their association with stress-related working conditions – defined either in terms of the Effort-Reward Imbalance (ERI) model, or the ERI model combined with the Job Demand-Control-Support (job strain) model (DCS) – in two large-scale international samples of humanitarian aid workers. The studies herein were the first in the extant literature to examine organisational stressors using job stress models in this occupational group. Furthermore, given the paucity of previous research on the subjective stress-related experiences of humanitarian aid workers, this thesis also contains an interview-based study that explored how humanitarian aid workers perceived the transactional stress process. One key characteristic of this thesis was that both quantitative and qualitative approaches were utilised to provide a deep and ecologically valid understanding of the stressor-strain relationship. Identifying the links between stressful aspects of work and both psychological and behavioural health outcomes may help inform the design of sector-specific health interventions. Methods: A mixed-methods approach was adopted to allow for a thorough examination of the prevalence of health and health-related behavioural outcomes, their relationship to stress-related working conditions (psychosocial stressors), and the concept of work-related stress in the population under study. Survey designs were used for Study 1 and 2 and involved the administration of a structured questionnaire. For the first study (Parts 1-2, Organisation A), logistic regression analyses were run based on a cross-sectional survey (N = 1,980) conducted separately for men and women to investigate the relations between ERI and both burnout (Part 1) and heavy alcohol consumption (Part 2) while controlling for demographic and occupational characteristics. In Study 2 (Organisation B), logistic regression analyses were based on a cross-sectional survey (N = 283) conducted separately for men and women to investigate the independent and combined relations between the ERI and DCS models and psychological distress while controlling for demographic and occupational characteristics. The final study was interview-based (Study 3, Organisation B) and it explored how humanitarian aid workers (N = 58) employed by a United Nations-aligned organisation perceived the transactional stress process. Results: The prevalence rates for the burnout components were as follows: high emotional exhaustion—36% for women and 27% for men; high depersonalisation—9% and 10%; and low personal achievement—47% and 31% for women and men, respectively. Intermediate and high ERI scores were associated with a significantly increased risk of high emotional exhaustion, with mixed findings for depersonalisation and personal achievement. The prevalence of heavy alcohol consumption among women (18%) was higher than the corresponding rate for men (10%), lending support for the effort-reward perspective only among women. Intermediate and high ERI scores in women was associated with a three-fold risk of heavy alcohol consumption. The results broadly suggest that occupational stressors from the ERI and DCS models, both individually and in combination, are significantly associated with psychological distress. A thematic analysis undertaken within the qualitative study revealed several main themes. An emergency culture was found where most employees felt compelled to offer an immediate response to humanitarian needs. The rewards of humanitarian work were perceived as motivating and meaningful, and employees experienced a strong identification with humanitarian goals and reported high engagement. Constant change and urgent demands were reported by the participants to result in work overload. Finally, managing work-life boundaries, and receiving positive support from colleagues and managers, helped buffer perceived stress, work overload, and negative health outcomes. Conclusions: The results of the present thesis convincingly demonstrate the usefulness of the ERI model as a framework for investigating burnout and heavy alcohol consumption among humanitarian aid workers. Furthermore, the findings demonstrate the independent and combined predictive effects of components of two alternative job stress models (ERI and DCS) on psychological distress. Taken together, the findings underscore the deleterious associations between work-related psychosocial hazards and mental and behavioural health outcomes. Specifically, unique insights were obtained about the work-related stress process in relation to humanitarian aid workers – for example, the emergency culture shaping organisational norms. The results suggest that interventions based on these two influential theories, and supplemented by knowledge on role-specific stressors evident in the sector, hold promise for reducing health outcomes. The practical implications of the results are discussed and suggestions are made in the light of the present research and stress theory.