STRESS ...AT WORK

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health
recommendations for the prevention of work-related illness and injury.

NIOSH is part of the U.S. Department of Health and Human Services; it is

distinct from the Occupational Safety and Health Administration (OSHA),

which is a regulatory agency located in the U.S. Department of Labor.

As part of its mandate, NIOSH is directed by Congress to study the

psychological aspects of occupational safety and health, including stress at

work. NIOSH works in collaboration with industry, labor, and universities

to better understand the stress of modern work, the effects of stress on

worker safety and health, and ways to reduce stress in the workplace.

OCCUPATIONAL SAFETY AND

HEALTH ACT OF 1970

OSHA

(Enforcement)

NIOSH

(Research)

PROTECT WORKER SAFETY AND HEALTH
Prepared by a NIOSH working group

Steven Sauter - Lawrence Murphy

Michael Colligan - Naomi Swanson - Joseph Hurrell, Jr. - Frederick Scharf, Jr. - Raymond Sinclair

Paula Grubb - Linda Goldenhar - Toni Alterman - Janet Johnston - Anne Hamilton - Julie Tisdale

STRESS

...AT WORK
This document is in the public domain and may be freely copied or reprinte

Copies of this and other NIOSH documents are available from

Publications Dissemination, EID

National Institute for Occupational Safety and Health

4676 Columbia Parkway

Cincinnati, OH 45226–1998

Fax number: (513) 533–8573

Telephone number: 1–800–35–NIOSH (1–800–356–4674)

E-mail: pubstaft@cdc.gov

To receive other information about occupational safety and health problems, c

1–800–35–NIOSH (1–800–356–4674), or visit the NIOSH Homepage on th

World Wide Web at

http://www.cdc.gov/niosh

DHHS (NIOSH) Publication No. 99–101
The nature of work is changing at whirlwind speed.

Perhaps now more than ever before, job stress poses a

threat to the health of workers and, in turn, to the health

of organizations. Through its research program in job

stress and through educational materials such as this

booklet, NIOSH is committed to providing organizations

with knowledge to reduce this threat.

This booklet highlights knowledge about the causes of

stress at work and outlines steps that can be taken to

prevent job stress.

STRESS...AT WORK
exhaustion. At first he tried to ignore these problems, but eventually he becam

so short-tempered and irritable that his wife insisted he get a checkup. Now,

sitting in the doctor’s office and wondering what the verdict would be, he did

even notice when Theresa took the seat beside him. They had been good frien

when she worked in the front office at the plant, but he hadn’t seen her since 

left three years ago to take a job as a customer service representative. Her gen

poke in the ribs brought him around, and within minutes they were talking an

gossiping as if she had never left.

“You got out just in time,”

he told her. “Since the

reorganization, nobody

feels safe. It used to be

that as long as you did

your work, you had a job.

That’s not for sure

anymore. They expect the

same production rates even

though two guys are now doing the work of three. We’re so backed up

I’m working twelve-hour shifts six days a week. I swear I hear those

machines humming in my sleep. Guys are calling in sick just to get a

break. Morale is so bad they’re talking about bringing in some

consultants to figure out a better way to get the job done.”

2
frying pan into the fire. In my new

job, the computer routes the calls and

they never stop. I even have to

schedule my bathroom breaks. All I

hear the whole day are complaints

from unhappy customers. I try to be

helpful and sympathetic, but I can’t

promise anything without getting my boss’s approval. Most of the time

I’m caught between what the customer wants and company policy. I’m

not sure who I’m supposed to keep happy. The other reps are so uptight

and tense they don’t even talk to one another. We all go to our own little

cubicles and stay there until quitting time. To make matters worse, my

mother’s health is deteriorating. If only I could use some of my sick time

to look after her. No wonder I’m in here with migraine headaches and

high blood pressure. A lot of the reps are seeing the employee assistance

counselor and taking stress management classes, which seems to help.

But sooner or later, someone will have to make some changes in the way

the place is run.”
4

Percentage of workers who

report they feel “quite a bit or

extremely stressed at work.”

25% 50%

Survey by Yale University

29%

Percentage of workers who

report they are “often or very

often burned out or stressed

by their work.”

25% 50%

Survey by the Families and Work Institute

26%

Percentage of workers who

report their job is “very or

extremely stressful.”

25% 50%

y y 

40%
workers untouched. For example, studies report the following:

• One-fourth of employees view their jobs as the number

one stressor in their lives.

—Northwestern National Life

• Three-fourths of employees believe the worker has more

on-the-job stress than a generation ago.

—Princeton Survey Research Associates

• Problems at work are more strongly associated with health

complaints than are any other life stressor—more so than

even financial problems or family problems.

—St. Paul Fire and Marine Insurance Co.

Fortunately, research on job stress has greatly expanded in recent years. But in

spite of this attention, confusion remains about the causes, effects, and prevention

of job stress. This booklet summarizes what is known about job stress and what

can be done about it.
or needs of the worker. Job stress can lead to poor health and even injury.

The concept of job stress is often confused with challenge, but these concepts 

not the same. Challenge energizes us psychologically and physically, and it

motivates us to learn new skills and master our jobs. When a challenge is met

feel relaxed and satisfied. Thus, challenge is an important ingredient for health

and productive work. The importance of challenge in our work lives is probab

what people are referring to when they say “a little bit of stress is good for you

But for David and Theresa, the situation is different—the challenge has turned

into job demands that cannot be met, relaxation has turned to exhaustion, and a

sense of satisfaction has turned into feelings of stress. In short, the stage is set 

illness, injury, and job failure.

Job stress

results when the requirements

of the job do not match the

capabilities, resources,

or needs of the worker.

6
characteristics versus working conditions as the primary cause of job stress.

These differing viewpoints are important because they suggest different ways to

prevent stress at work.

According to one school of thought, differences in individual characteristics such

as personality and coping style are most important in predicting whether certain

job conditions will result in stress—in other words, what is stressful for one

person may not be a problem for someone else. This viewpoint leads to

prevention strategies that focus on workers and ways to help them cope with

demanding job conditions.

Although the importance of individual differences cannot be ignored, scientific

evidence suggests that certain working conditions are stressful to most people.

The excessive workload demands and conflicting expectations described in

David’s and Theresa’s stories are good examples. Such evidence argues for a

greater emphasis on working conditions as the key source of job stress, and for

job redesign as a primary prevention strategy.

In 1960, a Michigan court upheld a compensation claim by an automotive assemblyline worker who had difficulty keeping up with the pressures of the production line.

To avoid falling behind, he tried to work on several assemblies at the same time and

often got parts mixed up. As a result, he was subjected to repeated criticism from the

foreman. Eventually he suffered a psychological breakdown.

By 1995, nearly one-half of the States allowed worker compensation claims for

emotional disorders and disability due to stress on the job [note, however, that courts

are reluctant to uphold claims for what can be considered ordinary working

conditions or just hard work].

—1995 Workers Compensation Yearbook
py py g j, 

individual factors is not ignored. According to the NIOSH view, exposure to

stressful working conditions (called job stressors) can have a direct influence o

worker safety and health. But as shown below, individual and other situationa

factors can intervene to strengthen or weaken this influence. Theresa’s need to

care for her ill mother is an increasingly common example of an individual or

situational factor that may intensify the effects of stressful working conditions

Examples of individual and situational factors that can help to reduce the effec

of stressful working conditions include the following:

• Balance between work and family or personal life

• A support network of friends and coworkers

• A relaxed and positive outlook

NIOSH Model of Job Stress

8

Risk 

Injur

and

Illnes

Stressful

Job

Conditions

Individual and

Situational Factors
The Design of Tasks. Heavy workload, infrequent rest breaks,

long work hours and shiftwork; hectic and routine tasks that have little

inherent meaning, do not utilize workers’ skills, and provide little sense

of control.

Example: David works to the point of exhaustion. Theresa is tied

to the computer, allowing little room for flexibility, self-initiative,

or rest.

Management Style. Lack of participation by workers in decisionmaking, poor communication in the organization, lack of familyfriendly policies.

Example: Theresa needs to get the boss’s approval for everything,

and the company is insensitive to her family needs.

Interpersonal Relationships. Poor social environment and lack

of support or help from coworkers and supervisors.

Example: Theresa’s physical isolation reduces her opportunities to

interact with other workers or receive help from them.

Work Roles. Conflicting or uncertain job expectations, too much

responsibility, too many “hats to wear.”

Example: Theresa is often caught in a difficult situation trying to

satisfy both the customer’s needs and the company’s expectations.

Career Concerns. Job insecurity and lack of opportunity for

growth, advancement, or promotion; rapid changes for which workers

are unprepared.

Example: Since the reorganization at David’s plant, everyone is

worried about their future with the company and what will happen

next.

Environmental Conditions. Unpleasant or dangerous physical

conditions such as crowding, noise, air pollution, or ergonomic

problems.

Example: David is exposed to constant noise at work.
released to sharpen the senses, quicken the pulse, deepen respiration, and

tense the muscles. This response (sometimes called the fight or flight

response) is important because it helps us defend against threatening

situations. The response is preprogrammed biologically. Everyone responds

in much the same way, regardless of whether the stressful situation is at

work or home.

Short-lived or infrequent episodes of stress pose little risk. But when

stressful situations go unresolved, the body is kept in a constant state of

activation, which increases the rate of wear and tear to biological systems.

Ultimately, fatigue or damage results, and the ability of the body to repair

and defend itself can become seriously compromised. As a result, the risk

of injury or disease escalates.

In the past 20 years, many studies have looked at the relationship between

job stress and a variety of ailments. Mood and sleep disturbances, upset

stomach and headache, and disturbed relationships with family and friends

are examples of stress-related problems that are quick to develop and are

commonly seen in these studies. These early signs of job stress are usually

easy to recognize. But the effects of job stress on chronic diseases are more

difficult to see because chronic diseases take a long time to develop and can

be influenced by many factors other than stress. Nonetheless, evidence is

rapidly accumulating to suggest that stress plays an important role in

several types of chronic health problems—especially cardiovascular

disease, musculoskeletal disorders, and psychological disorders.

10

Health care expenditures are nearly 50% greater for workers who

report high levels of stress.

—Journal of Occupational and Environmental Medicine
Job Stress and Health:

What the Research Tells Us

Cardiovascular Disease

Many studies suggest that psychologically demanding jobs that allow employees

little control over the work process increase the risk of cardiovascular disease.

Musculoskeletal Disorders

On the basis of research by NIOSH and many other organizations, it is widely

believed that job stress increases the risk for development of back and upperextremity musculoskeletal disorders.

Psychological Disorders

Several studies suggest that differences in rates of mental health problems (such as

depression and burnout) for various occupations are due partly to differences in job

stress levels. (Economic and lifestyle differences between occupations may also

contribute to some of these problems.)

Workplace Injury

Although more study is needed, there is a growing concern that stressful working

conditions interfere with safe work practices and set the stage for injuries at work.

Suicide, Cancer, Ulcers, and Impaired Immune Function

Some studies suggest a relationship between stressful working conditions and these

health problems. However, more research is needed before firm conclusions can be

drawn.

—Encyclopaedia of Occupational Safety and Health

Difficulty in concentrating

Short temper

Upset stomach

Job dissatisfaction

Low morale
concerns to remain productive and profitable in today’s economy. But research

findings challenge this belief. Studies show that stressful working conditions a

actually associated with increased absenteeism, tardiness, and intentions by

workers to quit their jobs—all of which have a negative effect on the bottom li

Recent studies of so-called healthy organizations suggest that policies benefitin

worker health also benefit the bottom line. A healthy organization is defined as

one that has low rates of illness, injury, and disability in its workforce and is al

competitive in the marketplace. NIOSH research has identified organizational

characteristics associated with both healthy, low-stress work and high levels of

productivity. Examples of these characteristics include the following:

• Recognition of employees for good work performance

• Opportunities for career development

• An organizational culture that values the individual worker

• Management actions that are consistent with organizational values

Stress Prevention and Job Performance

The St. Paul Fire and Marine Insurance Company conducted several studies

on the effects of stress prevention programs in hospital settings. Program

activities included (1) employee and management education on job stress,

(2) changes in hospital policies and procedures to reduce organizational

sources of stress, and (3) establishment of employee assistance programs.

In one study, the frequency of medication errors declined by 50% after

prevention activities were implemented in a 700-bed hospital. In a second

study, there was a 70% reduction in malpractice claims in 22 hospitals that

implemented stress prevention activities. In contrast, there was no reduction

in claims in a matched group of 22 hospitals that did not implement stress

prevention activities.

—Journal of Applied Psychology

12
—Bureau of Labor Statistics
Stress Management. Theresa’s company is providing stress managemen

training and an employee assistance program (EAP) to improve the ability of

workers to cope with difficult work situations. Nearly one-half of large compa

in the United States provide some type of stress management training for their

workforces. Stress management programs teach workers about the nature and

sources of stress, the effects of stress on health, and personal skills to reduce

stress—for example, time management or relaxation exercises. (EAPs provide

individual counseling for employees with both work and personal problems.)

Stress management training may rapidly reduce stress symptoms such as anxie

and sleep disturbances; it also has the advantage of being inexpensive and easy 

implement. However, stress management programs have two major

disadvantages:

• The beneficial effects on stress symptoms are often short-lived.

• They often ignore important root causes of stress because they focus on t

worker and not the environment.

Organizational Change. In contrast to stress management training and

EAP programs, David’s company is trying to reduce job stress by bringing in a

consultant to recommend ways to improve working conditions. This approach 

the most direct way to reduce stress at work. It involves the identification of

stressful aspects of work (e.g., excessive workload, conflicting expectations) a

the design of strategies to reduce or eliminate the identified stressors. The

advantage of this approach is that it deals directly with the root causes of stres

work. However, managers are sometimes uncomfortable with this approach

because it can involve changes in work routines or production schedules, or

changes in the organizational structure.

As a general rule, actions to reduce job stress should give top priority to

organizational change to improve working conditions. But even the most

conscientious efforts to improve working conditions are unlikely to elimin

stress completely for all workers. For this reason, a combination of

organizational change and stress management is often the most useful

approach for preventing stress at work.

14
ORGANIZATIONAL CHANGE

A HEALTHY WORKPLACE

Reduced stress disorders

Satisfied and productive workers

Profitable and competitive organizations

+

=

STRESS MANAGEMENT

How to Change the Organization

to Prevent Job Stress

• Ensure that the workload is in line with workers’ capabilities and resources.

• Design jobs to provide meaning, stimulation, and opportunities for workers

to use their skills.

• Clearly define workers’ roles and responsibilities.

• Give workers opportunities to participate in decisions and actions affecting

their jobs.

• Improve communications—reduce uncertainty about career development

and future employment prospects.

• Provide opportunities for social interaction among workers.

• Establish work schedules that are compatible with demands and

responsibilities outside the job.

—American Psychologist
pg p

program. Program design and appropriate

solutions will be influenced by several factors—

the size and complexity of the organization,

available resources, and especially the unique

types of stress problems faced by the

organization. In David’s company, for example,

the main problem is work overload. Theresa, on

the other hand, is bothered by difficult

interactions with the public and an inflexible work schedule.

Although it is not possible to give a universal prescription for preventing stress

at work, it is possible to offer guidelines on the process of stress prevention in

organizations. In all situations, the process for stress prevention programs

involves three distinct steps: problem identification, intervention, and

evaluation. These steps are outlined beginning on page 17. For this process to

succeed, organizations need to be adequately prepared. At a minimum,

preparation for a stress prevention program should include the following:

• Building general awareness about job stress (causes, costs, and control)

• Securing top management commitment and support for the program

• Incorporating employee input and involvement in all phases of the

program

• Establishing the technical capacity to conduct the program (e.g.,

specialized training for in-house staff or use of job stress consultants)

Bringing workers or workers and managers together in a committee or

problem-solving group may be an especially useful approach for developing a

stress prevention program. Research has shown these participatory efforts to

be effective in dealing with ergonomic problems in the workplace, partly

because they capitalize on workers’ firsthand knowledge of hazards

encountered in their jobs. However, when forming such working groups, care

must be taken to be sure that they are in compliance with current labor laws.*

*

The National Labor Relations Act may limit the form and structure of employee

involvement in worker-management teams or groups. Employers should seek legal

assistance if they are unsure of their responsibilities or obligations under the National

16 Labor Relations Act.
are fearful of losing their jobs. Lack of obvious or widespread signs is not a good

reason to dismiss concerns about job stress or minimize the importance of a

prevention program.

Step 1 – Identify the Problem. The best method to explore the scope and

source of a suspected stress problem in an organization depends partly on the size

of the organization and the available resources. Group discussions among managers, labor representatives, and employees can provide rich sources of information.

Such discussions may be all that is needed to track down and remedy stress

problems in a small company. In a larger organization, such discussions can be

used to help design formal surveys for gathering input about stressful job conditions from large numbers of employees.

Regardless of the method used to collect data, information should be obtained

about employee perceptions of their job conditions and perceived levels of stress,

health, and satisfaction. The list of job conditions that may lead to stress (page 9)

and the warning signs and effects of stress (page 11) provide good starting points

for deciding what information to collect.

Objective measures such as absenteeism, illness and turnover rates, or

performance problems can also be

examined to gauge the presence and

scope of job stress. However, these

measures are only rough indicators of

job stress—at best.

Data from discussions, surveys, and

other sources should be summarized

and analyzed to answer questions about

the location of a stress problem and job

conditions that may be responsible—

for example, are problems present

throughout the organization or confined

to single departments or specific jobs?

• Hold group discussions

with employees.

• Design an employee

survey.

• Measure employee

perceptions of job

conditions, stress,

health, and satisfaction.

• Collect objective data.

• Analyze data to

identify problem

locations and stressful

job conditions.
18

Step 2 – Design and Implement Interventions. Once the sources 

stress at work have been identified and the scope of the problem is understood

the stage is set for design and implementation of an intervention strategy.

In small organizations, the informal discussions that helped identify stress

problems may also produce fruitful ideas for prevention. In large organizations

more formal process may be needed. Frequently, a team is asked to develop

recommendations based on analysis of data from Step 1 and consultation with

outside experts.

Certain problems, such as a hostile work environment, may be pervasive in the

organization and require company-wide interventions. Other problems such as

excessive workload may exist only in some departments and thus require more

narrow solutions such as redesign of the way a job is performed. Still other

problems may be specific to certain employees and resistant to any kind of

organizational change, calling instead for stress management or employee

assistance interventions. Some interventions might be implemented rapidly (e.

improved communication, stress management training), but others may require

additional time to put into place (e.g., redesign of a manufacturing process).

Before any intervention occurs,

employees should be informed about

actions that will be taken and when they

will occur. A kick-off event, such as an

all-hands meeting, is often useful for

this purpose.

• Target source of stress

for change.

• Propose and prioritize

intervention strategies

• Communicate planned

interventions to

employees.

• Implement intervention
Time frames for evaluating interventions should be established. Interventions

involving organizational change should receive both short- and long-term

scrutiny. Short-term evaluations might be done quarterly to provide an early

indication of program effectiveness or possible need for redirection. Many

interventions produce initial effects that do not persist. Long-term evaluations are

often conducted annually and are necessary to determine whether interventions

produce lasting effects.

Evaluations should focus on the same

types of information collected during

the problem identification phase of the

intervention, including information

from employees about working

conditions, levels of perceived stress,

health problems, and satisfaction.

Employee perceptions are usually the

most sensitive measure of stressful

working conditions and often provide

the first indication of intervention

effectiveness. Adding objective

measures such as absenteeism and

health care costs may also be useful.

However, the effects of job stress

interventions on such measures tend to

be less clear-cut and can take a long

time to appear.

The job stress prevention process does not end with evaluation.

Rather, job stress prevention should be seen as a continuous process

that uses evaluation data to refine or redirect the intervention strategy.

The following pages provide examples of actions some organizations have taken

to help prevent stress in their workplaces.

• Conduct both shortand long-term

evaluations.

• Measure employee

perceptions of job

conditions, stress,

health, and satisfaction.

• Include objective

measures.

• Refine the intervention

strategy and return to

Step 1.
20

Example 1

A Small Service Organization. A

department head in a small public service

organization sensed an escalating level of

tension and deteriorating morale among her

staff. Job dissatisfaction and health symptoms

such as headaches also seemed to be on the rise.

Suspecting that stress was a developing problem

in the department, she decided to hold a series of

all-hands meetings with employees in the

different work units of the department to explore

this concern further. These meetings could be

best described as brainstorming sessions where

individual employees freely expressed their

views about the scope and sources of stress in

their units and the measures that might be

implemented to bring the problem under control.

Using the information collected in these meetings and in meetings with middle

managers, she concluded that a serious problem probably existed and that quic

action was needed. Because she was relatively unfamiliar with the job stress fi

she decided to seek help from a faculty member at a local university who taugh

courses on job stress and organizational behavior.

After reviewing the information collected at the brainstorming sessions, they

decided it would be useful for the faculty member to conduct informal classes 

raise awareness about job stress—its causes, effects, and prevention—for all

workers and managers in the department. It was also decided that a survey wou

be useful to obtain a more reliable picture of problematic job conditions and

stress-related health complaints in the department. The faculty member used

information from the meetings with workers and managers to design the surve

The faculty member was also involved in the distribution and collection of the

anonymous survey to ensure that workers felt free to respond honestly and ope

about what was bothering them. He then helped the department head analyze a

interpret the data.
• Low levels of support from supervisors

• Lack of worker involvement in decision-making.

Having pinpointed these problems, the department head developed and prioritized

a list of corrective measures for implementation. Examples of these actions

included (1) greater participation of employees in work scheduling to reduce

unrealistic deadlines and (2) more frequent meetings between workers and

managers to keep supervisors and workers updated on developing problems.

Example 2

A Large Manufacturing Company.

Although no widespread signs of stress were

evident at work, the corporate medical director

of a large manufacturing company thought it

would be useful to establish a stress prevention

program as a proactive measure. As a first step

he discussed this concept with senior

management and with union leaders. Together,

they decided to organize a labor-management

team to develop the program. The team

comprised representatives from labor, the

medical/employee assistance department, the

human resources department, and an outside

human resources consulting firm. The

consulting firm provided technical advice

about program design, implementation, and

evaluation. Financial resources for the team

and program came from senior management, who made it clear that they

supported this activity. The team designed a two-part program. One part focused

on management practices and working conditions that could lead to stress. The

second part focused on individual health and well-being.
were used by the team to identify stressful working conditions and to suggest

changes at the work group and/or organizational level. The employee health a

well-being part of the program consisted of 12 weekly training sessions. Durin

these sessions, workers and managers learned about common sources and effe

of stress at work, and about self-protection strategies such as relaxation metho

and improved health behaviors. The training sessions were offered during both

work and nonwork hours.

The team followed up with quarterly surveys of working conditions and stress

symptoms to closely monitor the effectiveness of this two-part program.

These examples are based on adaptations of actual situations. For other examples of job st

interventions, see the Conditions of Work Digest, Vol. 11/2, pp. 139–275. This publication

may be obtained by contacting the ILO Publications Center at P.O. Box 753, Waldorf, MD

20604 (Telephone: 301–638–3152). Or call NIOSH at 1–800–35–NIOSH.

22
4676 Columbia Parkway Outside the U.S.: 1–513–533–8328

Cincinnati, Ohio 45226–1998

http://www.cdc.gov/niosh

NIOSH provides information and publications about a wide range of occupational hazards,

including job stress. NIOSH information about job stress can be found on the NIOSH job

stress internet page (http://www.cdc.gov/niosh/jobstres.html), or call 1–800–35–NIOSH

(1–800–356–4674)

• More Information about Job Stress

The Encyclopaedia of Occupational Health and Safety, 4th Edition (ISBN 92–2–109203–8)

contains a comprehensive summary of the latest scientific information about the causes and

effects of job stress (see Vol. 1, Chapter 5, Mental Health; Vol. 2, Chapter 34, Psychosocial

and Organizational Factors).

International Labour Office (ILO) Publications Center 301–638–3152

P.O. Box 753

Waldorf, MD 20604

• Other Publications about Job Stress

Go to the NIOSH job stress internet site (http://www.cdc.gov/niosh/jobstres.html), or call

the NIOSH 800 number (1–800–35–NIOSH).

• Location of a Psychologist or Consultant in Your Area

American Psychological Association (APA 1-800-964-2000

750 First St., N.E. fax: 202–336–5723

Washington, DC 20002–4242

State psychological associations maintain a listing of licensed psychologists who may be able

to help with stress-related issues. Call the APA or your State psychological association for

more information, or refer to the APA internet site with this information

(http://helping.apa.org/find.html).
and violence. In: Burton JF, ed. 1995 Workers’ Compensation Year Book.

Horsham, PA: LRP Publications, pp. I-217–I-222.

American Psychologist

Sauter SL, Murphy LR, Hurrell JJ, Jr. [1990]. Prevention of work-related

psychological disorders. American Psychologist 45(10):1146–1158.

Bureau of Labor Statistics

BLS [1996]. Bureau of Labor Statistics Homepage [http://stats.bls.gov/]. Tabu

data, 1992–96: Number and percentage distribution of nonfatal occupational

injuries and illnesses involving days away from work, by nature of injury or

illness and number of days away from work. Date accessed: 1998.

Encyclopaedia of Occupational Health and Safety

Sauter S, Hurrell J, Murphy L, Levi L [1997]. Psychosocial and organizational

factors. In: Stellman J, ed. Encyclopaedia of Occupational Health and Safety.

Vol. 1. Geneva, Switzerland: International Labour Office, pp. 34.1–34.77.

Families and Work Institute

Bond JT, Galinsky E, Swanberg JE [1998]. The 1997 national study of the

changing workforce. New York, NY: Families and Work Institute.

Journal of Applied Psychology

Jones JW, Barge BN, Steffy BD, Fay LM, Kuntz LK, Wuebker LJ [1988]. Stre

and medical malpractice: organizational risk assessment and intervention. Jour

of Applied Psychology 73(4):727–735.

Journal of Occupational and Environmental Medicine

Goetzel RZ, Anderson DR, Whitmer RW, Ozminkowski RJ, Dunn RL,

Wasserman J, Health Enhancement Research Organization (HERO) Research

Committee [1998]. The relationship between modifiable health risks and healt

care expenditures: an analysis of the multi-employer HERO health risk and co

database. Journal of Occupational and Environmental Medicine 40(10).

24
page 5.)

Northwestern National Life Insurance Company [1992]. Employee burnout:

causes and cures. Minneapolis, MN: Northwestern National Life Insurance

Company. (Note: This reference is the source for the information presented in the

graph on page 4.)

Princeton Survey Research Associates

Princeton Survey Research Associates [1997]. Labor day survey: state of workers.

Princeton, NJ: Princeton Survey Research Associates.

St. Paul Fire and Marine Insurance Company

St. Paul Fire and Marine Insurance Company [1992]. American workers under

pressure technical report. St. Paul, MN: St. Paul Fire and Marine Insurance

Company.

Yale University

Barsade S, Wiesenfeld B, The Marlin Company [1997]. Attitudes in the

American workplace III. New Haven, CT: Yale University School of

Management.
26

Call NIOSH at

1–800–35–NIOSH (1–800–356–4674)

Fax number: (513) 533–8573

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Delivering on the Nation’s promise:

Safety and health at work

for all people

through research and prevention

DHHS (NIOSH) Publication No. 99–101