Causes and effects of stress in project management
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=== For your team members === | === For your team members === | ||
− | * '''Encourage getting enough, good quality sleep.''' | + | * '''Encourage getting enough, good quality sleep.''' Because of the fundamental mechanisms of how stress works, the number one way of alleviating stress is allowing the stressed person to rest and relax. The most accessible way of doing this, is to simply get the proper amount of sleep. For most adults this ranges between 7-9 hours, although a few can function fine with 6 hours, while some others need upwards of 10. Whatever the stressor may be, having a robust sleep schedule is highly important for processing and overcoming it. The quality of sleep can be improved by reducing interruptions, lowering the amount of blue light in the evening (e.g., reducing screen-time before bedtime is highly effective), and by having a consistent schedule (waking up and going to bed at the same time every day). |
− | * '''Ensure proper distribution of workload.''' Taking care to make sure that employees are only given tasks they can realistically handle is key. If | + | * '''Ensure proper distribution of workload.''' While sleeping more can help in the recovery part of stress management, it is also necessary to reduce the amount of stress endured to begin with. Taking care to make sure that employees are only given tasks they can realistically handle is key. If a stressed team member is noticed, reducing their workload temporarily can help them immensely in overcoming stress. This can also be done through delegation to other employees and cutting away low priority tasks. |
− | * '''Provide resources for managing stress.''' | + | * '''Provide resources for managing stress.''' In general, knowledge on how to manage stress may not be general knowledge. In this case, resources or education should be provided, such that employees are able to begin handling their stress in a productive manner. Examples of resources could be: |
** Training in prioritisation, delegation, and time-management. | ** Training in prioritisation, delegation, and time-management. | ||
− | ** Access to personal stress management (meditation techniques, self-help | + | ** Access to personal stress management (meditation techniques, self-help books etc.). |
** In more extreme cases, help them to get in contact with a mental health professional. | ** In more extreme cases, help them to get in contact with a mental health professional. | ||
=== For yourself === | === For yourself === | ||
− | * '''Getting enough, good quality sleep.''' | + | * '''Getting enough, good quality sleep.''' Same reasons apply as stated in the above section. |
* '''Relaxation, meditation, and mindfulness exercises.''' Taking the time to process any external stress, either through meditation, reflective relaxation, or mindfulness exercises can help manage personal stress.<ref>[''National Alliance on Mental Illness (NAMI)''. Managing Stress.] https://www.nami.org/Your-Journey/Individuals-with-Mental-Illness/Taking-Care-of-Your-Body/Managing-Stress</ref> | * '''Relaxation, meditation, and mindfulness exercises.''' Taking the time to process any external stress, either through meditation, reflective relaxation, or mindfulness exercises can help manage personal stress.<ref>[''National Alliance on Mental Illness (NAMI)''. Managing Stress.] https://www.nami.org/Your-Journey/Individuals-with-Mental-Illness/Taking-Care-of-Your-Body/Managing-Stress</ref> | ||
− | * '''Social safety net.''' | + | * '''Social safety net.''' Consider putting effort into establishing a casual social network or relying on close family for emotional support and collaborative relaxation. This will provide a robust safety net which can be used for venting about workplace stressors or making relaxation time more relaxing or simply, more fun. |
− | * '''Physical activity.''' | + | * '''Physical activity.''' Improving the circulation in the body will make sure the chemical processes that get started by stress can be done efficiently, and that the exhaustion it causes can be recovered from quickly. The simplest way to achieve this is going for a walk in a pleasant location, but for a combination with the above-mentioned points, consider joining a team sport (e.g., football, baseball, hockey, etc.) or a group session for exercise (e.g., yoga, cycling, running etc.). |
− | * '''Avoid alcohol and drugs''' | + | * '''Avoid alcohol and drugs.''' Again, because of the mechanisms of stress, adding more toxins for your body to handle while it is already dealing with stress will cause it to take longer to recover from the stressors. Necessary medications are an exception here. |
[https://www.cdc.gov/niosh/docs/99-101/default.html] | [https://www.cdc.gov/niosh/docs/99-101/default.html] | ||
[https://www.elevatecorporatetraining.com.au/2019/11/05/15-ways-great-leaders-manage-team-stress/] | [https://www.elevatecorporatetraining.com.au/2019/11/05/15-ways-great-leaders-manage-team-stress/] | ||
+ | [https://www.apa.org/topics/stress/chronic] | ||
== The physiological processes of stress == | == The physiological processes of stress == | ||
The physiological processes behind stress are key to understanding the causes and effects. Here, the overall response is covered including topics such as, fight-or-flight, alarm, resistance, and exhaustion/rest. To make this matter easier to understand, an example is provided. | The physiological processes behind stress are key to understanding the causes and effects. Here, the overall response is covered including topics such as, fight-or-flight, alarm, resistance, and exhaustion/rest. To make this matter easier to understand, an example is provided. | ||
=== The General Adaption Syndrome (GAS) === | === The General Adaption Syndrome (GAS) === | ||
− | The General Adaption Syndrome, developed by Hans Selye in the 1950s<ref>[The General-Adaptation-Syndrome.] ''Selye, Hans. (1951)''. Annual review of medicine. 2. 327-42.10.1146/annurev.me.02.020151.001551.</ref> is the medical term for what a living organism, such as | + | The General Adaption Syndrome, developed by Hans Selye in the 1950s<ref>[The General-Adaptation-Syndrome.] ''Selye, Hans. (1951)''. Annual review of medicine. 2. 327-42.10.1146/annurev.me.02.020151.001551.</ref> is the medical term for what a living organism, such as a human, does when exposed to any kind of stress, positive or negative. This syndrome explains the changes in the body’s chemistry that happen over the process of responding to the stress. |
GAS has three distinct phases, an initial phase where the sympathetic nervous system (Fight-or-flight system) activates, a following phase where the organism makes efforts to cope with the stress, and a third and final stage of either exhaustion or recovery which happens when the organism fails or succeeds in overcoming the stressor and either depletes its physiological resources or recovers the spent energy over a resting period. | GAS has three distinct phases, an initial phase where the sympathetic nervous system (Fight-or-flight system) activates, a following phase where the organism makes efforts to cope with the stress, and a third and final stage of either exhaustion or recovery which happens when the organism fails or succeeds in overcoming the stressor and either depletes its physiological resources or recovers the spent energy over a resting period. | ||
==== Alarm phase ==== | ==== Alarm phase ==== | ||
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=== Internal (Personal (affects select individuals)) === | === Internal (Personal (affects select individuals)) === | ||
These factors tend to be more personal and should therefore be handled with utmost care for the individual experiencing them. While some of these are beyond the control of a PM (major life events), most of them can be worked on through workplace action. The internal factors include, but are not limited to: | These factors tend to be more personal and should therefore be handled with utmost care for the individual experiencing them. While some of these are beyond the control of a PM (major life events), most of them can be worked on through workplace action. The internal factors include, but are not limited to: | ||
− | * '''Status | + | * '''Status (Individual and occupational).''' The status or social standing may be important factors for an individual in determining their self-worth. If the individual ties their self-worth to their job, then a sudden drop in perceived social standing may be a significant stressor for the individual |
− | * '''Workplace bullying.''' | + | * '''Workplace bullying.''' Being defined as repeated instances of mistreatment of an individual by either other employees or managers, involving a power-imbalance of some sort, where the target has less power than the bullies. Bullying can be covert or overt, being either missed by superiors, or known by many, but not acted upon. Bullying may be as direct as verbal harassment, physical abuse, humiliation, and so on, but may also take the form of overbearing supervision, constant criticism, or blocking promotions. |
− | * '''Narcissism and psychopathy.''' | + | * '''Narcissism and psychopathy.''' Interacting with people who may be classified as narcissists or psychopaths is likely to lead to a higher level of stress. [Thomas, David (2010). Narcissism: Behind the Mask. Book Guild.] [Boddy, Clive (2011). Corporate Psychopaths: Organizational Destroyers. Palgrave Macmillan.] This in turn also leads to a higher turnover rate, and absenteeism. |
− | * '''Sexual harassment.''' | + | * '''Sexual harassment.''' Defined as the unwelcome use of overt or implicit sexual overtones in an interaction, including but not limited to sexual assault (nonconsensual contact, rape, forcing the victim to perform sexual acts, etc.), indecent exposure, sharing of explicit photos, videos or images, and verbal harassment. Sexual harassment can happen to anyone in any company position, of any gender and can come from any place; co-workers, people from different departments, or people from outside the company. Being subjected to sexual harassment results in decreased performance as a consequence of lowered trust in the work environment. This is difficult for a PM to handle, and professional, and possibly legal help should be used and provided for the victim. |
− | * '''Work-life balance.''' | + | * '''Work-life balance.''' Having poor work-life balance refers to the balance between time and energy spent on work versus the employee’s personal life. Here, the PM should be aware of the important events of the employee’s personal life and should be prepared to delegate or redistribute should it be necessary. |
− | * '''Major life events.''' | + | * '''Major life events.''' Defined as high impact events such as the death of a loved one, the birth of a child, major injury, getting married and many more. This is usually beyond the control of the PM and can create a large amount of stress in a short period of time for the employee. Some of these major life events are temporary, and the stress caused by them may only be present for a short time, while others may require an adaption period where the employee adapts to the new circumstances. |
Revision as of 17:34, 19 March 2022
Developed by Casper Stenbæk – Work In Progress
Notes for the reviewer: Figures and formatting will be done later, as the initial article is written in Word for the word counter and backup reasons.
Todo:
- Methods for managing your own stress.
- Internal/personal Stressors
- Rework Intro/Abstract
- Fix references
Introduction/Abstract
This article will describe the causes and effects of stress in project management. The hope is that this article will be a starting point to understanding both how to manage the stress of team members, and how to prevent the stress from forming in the first place. The article will not be considering communication strategies although communication is a critical part of stress management. To frontload the information, tangible tools are first described, providing quick access for urgent situations. The starting point will be a short description of stress as a physiological process, what the mechanisms are, and how it affects the persons experiencing it. The article will also cover some of the important models around stress in workplaces. After a thorough description of the mechanics of stress, the article will list the common causes of stress. It is currently uncertain whether it is feasible to write a management strategy for each cause, or if a general management technique should be provided instead, this will be clearer after more research. In any case, the article will then provide techniques and strategies for managing this stress. The techniques will mainly be from the managers perspective, but methods should also be relevant for general workers.
Contents |
What you can do as a manager
This section contains the fundamental, solution-oriented actions you can take to help your team manage stress. This part is mainly for managing existing stress, for a more extensive description of preventative and interventive measures, see section 5: “Preventative measures and intervention”.
For your team members
- Encourage getting enough, good quality sleep. Because of the fundamental mechanisms of how stress works, the number one way of alleviating stress is allowing the stressed person to rest and relax. The most accessible way of doing this, is to simply get the proper amount of sleep. For most adults this ranges between 7-9 hours, although a few can function fine with 6 hours, while some others need upwards of 10. Whatever the stressor may be, having a robust sleep schedule is highly important for processing and overcoming it. The quality of sleep can be improved by reducing interruptions, lowering the amount of blue light in the evening (e.g., reducing screen-time before bedtime is highly effective), and by having a consistent schedule (waking up and going to bed at the same time every day).
- Ensure proper distribution of workload. While sleeping more can help in the recovery part of stress management, it is also necessary to reduce the amount of stress endured to begin with. Taking care to make sure that employees are only given tasks they can realistically handle is key. If a stressed team member is noticed, reducing their workload temporarily can help them immensely in overcoming stress. This can also be done through delegation to other employees and cutting away low priority tasks.
- Provide resources for managing stress. In general, knowledge on how to manage stress may not be general knowledge. In this case, resources or education should be provided, such that employees are able to begin handling their stress in a productive manner. Examples of resources could be:
- Training in prioritisation, delegation, and time-management.
- Access to personal stress management (meditation techniques, self-help books etc.).
- In more extreme cases, help them to get in contact with a mental health professional.
For yourself
- Getting enough, good quality sleep. Same reasons apply as stated in the above section.
- Relaxation, meditation, and mindfulness exercises. Taking the time to process any external stress, either through meditation, reflective relaxation, or mindfulness exercises can help manage personal stress.[1]
- Social safety net. Consider putting effort into establishing a casual social network or relying on close family for emotional support and collaborative relaxation. This will provide a robust safety net which can be used for venting about workplace stressors or making relaxation time more relaxing or simply, more fun.
- Physical activity. Improving the circulation in the body will make sure the chemical processes that get started by stress can be done efficiently, and that the exhaustion it causes can be recovered from quickly. The simplest way to achieve this is going for a walk in a pleasant location, but for a combination with the above-mentioned points, consider joining a team sport (e.g., football, baseball, hockey, etc.) or a group session for exercise (e.g., yoga, cycling, running etc.).
- Avoid alcohol and drugs. Again, because of the mechanisms of stress, adding more toxins for your body to handle while it is already dealing with stress will cause it to take longer to recover from the stressors. Necessary medications are an exception here.
The physiological processes of stress
The physiological processes behind stress are key to understanding the causes and effects. Here, the overall response is covered including topics such as, fight-or-flight, alarm, resistance, and exhaustion/rest. To make this matter easier to understand, an example is provided.
The General Adaption Syndrome (GAS)
The General Adaption Syndrome, developed by Hans Selye in the 1950s[2] is the medical term for what a living organism, such as a human, does when exposed to any kind of stress, positive or negative. This syndrome explains the changes in the body’s chemistry that happen over the process of responding to the stress. GAS has three distinct phases, an initial phase where the sympathetic nervous system (Fight-or-flight system) activates, a following phase where the organism makes efforts to cope with the stress, and a third and final stage of either exhaustion or recovery which happens when the organism fails or succeeds in overcoming the stressor and either depletes its physiological resources or recovers the spent energy over a resting period.
Alarm phase
The first phase when encountering stress is the alarm phase. This phase consists of two parts, a shock part where the body endures/becomes aware of the stressor, and a second, anti-shock part in which the body responds by producing chemicals that heighten awareness and response time, adrenaline, and numbs pain, cortisol (aka the stress-hormone). The second part is what is more commonly known as the fight-or-flight response.
EXAMPLE: An employee learns that they are falling behind in terms of productivity, and if they don’t increase their productivity they will be fired. Although the body is not in any physical danger, it reacts in the same way, as if a dangerous animal was just sighted in close proximity to a campsite. This activates the alarm phase, where the fight-or-flight response shuts down digestion, increases heart rate and generally makes the body ready for action.
Resistance Phase
Body attempts to cope in productive (solving the problem) or non-productive (avoiding the problem) ways. In addition to the adrenaline produced in the Alarm phase, another chemical is produced, noradrenaline, which has similar, but less intense effects, and focuses more on the blood vessels where adrenaline focuses on the heart. [4]
EXAMPLE: The employee now begins to feel normal again, the noradrenaline helping them to stay focused on their work and dealing with the immediate problem. Here, the body is burning some of its limited chemical resources to help deal with the stressor.
Exhaustion/Recovery Phase
Prolonged exposure to stress eventually drains the body’s chemical arsenal, and the person experiencing the stress will then enter the last phase, exhaustion. Here, the body is unable to maintain normal function and symptoms that appeared in the first stage may reappear (sweating, heart rate increase, etc.). As such the body is now no longer equipped to fight stress and may begin to experience tiredness, depression, anxiety, and feelings of hopelessness. If the stressor is overcome during the resistance phase, then the body uses the third phase to rebuild the chemical resources that were used. This requires a safe and comfortable environment where the natural counterpoint to fight-or-flight: the rest-and-digest process, can begin. Here, the body uses the nutrients gained through eating and drinking to synthesise the chemicals needed for the next time a stressor presents itself. This is why eating healthy and nourishing food is so vital in handling and recovering from stress.
EXAMPLE (Exhaustion): Even though the employee has been hard at work for a prolonged time now, he is still nowhere close to finishing the work (or the workload has been repeatedly increased), with the cost of failure still being the loss of the job. Now the chemical resources of the body are used up, causing the employee to have low amounts of energy, as well as a weakened immune system. In this example, this manifests in a sense of hopelessness, and depression.
EXAMPLE (Recovery): If the employee manages to finish his work, or the stressor is otherwise removed (completed by someone else, no longer necessary to avoid loss of job, etc.) then the employee can begin the recovery process, where the body replenishes the resources spent in handling the stress. This is done in periods where there are no active stressors for the body to handle, and the normal processes of digesting food and conserving energy are possible (e.g., going to a comfortable and safe environment such as home).
Physical and psychological effects of prolonged stress
When the exhaustion phase of the GAS is reached and experienced for longer periods of time, it may have the following effects on the body:
Physical effects
Due to having its chemical balance disturbed through repeated activation of the alarm phase, the body is no longer able to cope with the stressor. As explained earlier, this manifests physically as tiredness and low energy levels, but also in a weakened immune system. Due to this weakened immune system, it is common for prolonged stress to be accompanied by increased frequency of illness and disease.
Psychological effects
Since adrenaline and noradrenaline are neurotransmitters, having an imbalance of them will cause changes in the brains ability to function normally. Because of this, prolonged stress is also linked with memory loss, and increased susceptibility to depressive episodes and mental illness. In extreme cases, workplace stress may lead to long-term depression, and the effects thereof.
Effects on workplace performance
According to a study by the American Center for Disease Control (CDC), prolonged experience of workplace stress can have a direct impact on the bottom line of the company. This prolonged stress may manifest in employees as follows[3]:
- Reduced creativity, collaboration, sense of team cohesion, and engagement in the work
- Deterioration in internal (workplace) or external (stakeholder) relationships
- Deterioration in work-life balance, affecting home-life or outside relations.
- Serious losses in productivity and quality control
- Increased healthcare costs of employee
- High absenteeism
- Excessive turnover
- Negative brand reputation
Causes of stress
The causes of stress are numerous, and many different models have been proposed to try to explain the occurrence of workplace stress. One of the most influential models is the Demand-Control-Support model [4], in which stress is caused by high demands, low control and/or lack of support from the environment (team, management etc.). To get an overview, it would be helpful to classify the stressors, and thereby see which are actionable, and which are out of your control as a PM. According to the paper by Cooper and Marshall, 1976[5], there are multiple different classes of stressor. They are generally classified into two overall classes: the workplace related stressors (workload, job security, physical environment etc.), and the non-workplace related stressors (family problems, life crises, etc.). In addition to this, the stressors are also divided into two classes depending on whether they come from the workplace environment (physical environment, workload, working hours etc.) or if they come from the persons in the workplace (bullying, sexual harassment, status etc.). By dividing this way, it is possible to distinguish between factors that might be affecting the entire team, such as the general working conditions of the workplace, and more individual focused factors, such as workplace bullying or sexual harassment. In this article, the causes will be presented in the latter classification (), as this is assumed to be more useful to a project manager.
External (General (affects whole team))
These are the factors that you, as a PM, might be able to tangibly change, either through planning or redelegation. The external factors are many, including, but not limited to:
- Working conditions. If the workplace is not generally comfortable for your employees, or even outright unsafe, then the employees will be stressed by a constant worrying about their safety. Additionally, annoyances and disturbances such as high or low temperature, noise, or unpleasant smells will put additional stress on the employees through constantly having to adapt to these circumstances, often activating the GAS described above. Providing a safe and comfortable working environment will therefore reduce the amount of stress faced by an employee.
- Workload. As seen in the example used in the GAS explanation section, having an unrealistic workload will cause the employee stress. An increased workload can be the result of an increase in demands, or a decrease in available resources. Whatever the reason, managing the stress coming from this stressor requires an evaluation of the employee’s current tasks, in which unnecessary tasks are cut away, some tasks are delegated, and the must-do tasks are decided upon. Keeping tabs on your employees’ workload and evaluating the available resources before assigning new tasks, are the prime preventative measures from the PM’s point of view.
- Long hours. As also explained in the section on the GAS, the body needs time to replenish the chemical reserves between handling of stressors. This both applies to days with long hours, as well as weeks with reasonable working hours, but no rest days. Both of these will result in the same problem, namely the employee not being able to spend enough time in the recovery stage of the GAS. Ensure your employees are getting enough, regular relaxation time.
- Salary. Although the financial or economic stress is a topic that requires a lot more study, it is well known that socioeconomic status is inversely related to health and well-being. Additionally, higher job autonomy (being allowed to choose for yourself) is related to lower stress. And it has been found that jobs that allow workers greater autonomy, on average, pay more. [6] As such, it is only through common sense that it is advised to help a struggling employee through realistic wages and increased stability.
Internal (Personal (affects select individuals))
These factors tend to be more personal and should therefore be handled with utmost care for the individual experiencing them. While some of these are beyond the control of a PM (major life events), most of them can be worked on through workplace action. The internal factors include, but are not limited to:
- Status (Individual and occupational). The status or social standing may be important factors for an individual in determining their self-worth. If the individual ties their self-worth to their job, then a sudden drop in perceived social standing may be a significant stressor for the individual
- Workplace bullying. Being defined as repeated instances of mistreatment of an individual by either other employees or managers, involving a power-imbalance of some sort, where the target has less power than the bullies. Bullying can be covert or overt, being either missed by superiors, or known by many, but not acted upon. Bullying may be as direct as verbal harassment, physical abuse, humiliation, and so on, but may also take the form of overbearing supervision, constant criticism, or blocking promotions.
- Narcissism and psychopathy. Interacting with people who may be classified as narcissists or psychopaths is likely to lead to a higher level of stress. [Thomas, David (2010). Narcissism: Behind the Mask. Book Guild.] [Boddy, Clive (2011). Corporate Psychopaths: Organizational Destroyers. Palgrave Macmillan.] This in turn also leads to a higher turnover rate, and absenteeism.
- Sexual harassment. Defined as the unwelcome use of overt or implicit sexual overtones in an interaction, including but not limited to sexual assault (nonconsensual contact, rape, forcing the victim to perform sexual acts, etc.), indecent exposure, sharing of explicit photos, videos or images, and verbal harassment. Sexual harassment can happen to anyone in any company position, of any gender and can come from any place; co-workers, people from different departments, or people from outside the company. Being subjected to sexual harassment results in decreased performance as a consequence of lowered trust in the work environment. This is difficult for a PM to handle, and professional, and possibly legal help should be used and provided for the victim.
- Work-life balance. Having poor work-life balance refers to the balance between time and energy spent on work versus the employee’s personal life. Here, the PM should be aware of the important events of the employee’s personal life and should be prepared to delegate or redistribute should it be necessary.
- Major life events. Defined as high impact events such as the death of a loved one, the birth of a child, major injury, getting married and many more. This is usually beyond the control of the PM and can create a large amount of stress in a short period of time for the employee. Some of these major life events are temporary, and the stress caused by them may only be present for a short time, while others may require an adaption period where the employee adapts to the new circumstances.
Personal differences (limitations)
A lot of the things mentioned here are general concepts that don’t necessarily apply to everyone equally. As a PM, this can be frustrating, as some of the measures taken to prevent or intervene during stressful situations may not have the desired effect. To get the full effect of the measures mentioned below, it is therefore critical that the PM understands and cares about the members of their team. Understanding and caring helps the PM to select and use the tools provided in this article more accurately.
Preventative measures and intervention
General information about handling and
What to look for
To deduce whether an individual is experiencing stress, the following factors could be indicators of excessive stress.
- Anxiety
- Depressed mood
- Irritability
- Apathy, loss of interest in work
- Complaints of lack of sleep (sleeping problems)
- Fatigue
- Trouble concentrating
- Muscle tension (complaints or anxious body language)
- Headaches (complaints or body language)
- Stomach problems (complaints or sudden increase in bathroom breaks)
- Social withdrawal
- Excessive use of drugs or alcohol
Most of these indicators will be observable through body language or general behaviour, but most can be deduced through a quick question such as “Are you getting enough sleep?” or “Are you feeling ok?”. In general, being observant and noticing behavioural changes will help you as a PM notice an overly stressed team member.
Annotated Bibliography
The National Institute for Occupational Safety and Health (NIOSH), CDC. ”STRESS… At Work”. [7] This article/paper by the American NIOSH provides a good overview of occupational stress as well as providing case studies from select companies and their strategies for managing stress.
I. S. Schonfeld et al. “Occupational Health Psychology: Work, Stress, and Health”. [8] Comprehensive book explaining occupational stress in great detail. This book explains the history of stress, as well as the research methodologies used, but what is most useful for the average PM is probably going to be chapters 3 and 10, which explain the impact of working condition on mental health, and the interventions for improved mental health respectively. Additionally, chapters 5, 6, 8, and 9 are recommended for greater insight into specific parts of occupational stress.
References
- ↑ [National Alliance on Mental Illness (NAMI). Managing Stress.] https://www.nami.org/Your-Journey/Individuals-with-Mental-Illness/Taking-Care-of-Your-Body/Managing-Stress
- ↑ [The General-Adaptation-Syndrome.] Selye, Hans. (1951). Annual review of medicine. 2. 327-42.10.1146/annurev.me.02.020151.001551.
- ↑ [Here's why workplace stress is costing employers $300 billion a year.] Business Insider, https://www.businessinsider.com/how-stress-at-work-is-costing-employers-300-billion-a-year-2016-6?r=US&IR=T
- ↑ [Chapter 3.3: The Demand-Control-(Support) Model] Occupational Health Psychology: Work, Stress, and Health. I. S. Schonfeld et al., 2017, Springer
- ↑ [Cooper, C.L. & Marshall, L. (1976). Occupational sources of stress: A review of the literature relating to coronary heart disease and mental ill health.] Journal of occupational psychology, 49, 11-28.
- ↑ [Chapter 11.1.1: Money] Occupational Health Psychology: Work, Stress, and Health. I. S. Schonfeld et al., 2017, Springer
- ↑ [STRESS… At Work] The National Institute for Occupational Safety and Health (NIOSH), CDC. https://www.cdc.gov/niosh/docs/99-101/default.html
- ↑ [Occupational Health Psychology: Work, Stress, and Health] Irvin S. Schonfeld, PhD and Chu-Hsiang Chang, PhD, 2017, Springer Publishing Company