J. Soc. Occup. Med. (1976) 26, 13-20
Stress at Work: a Comparison of Attitudes between Psychiatric and Non-psychiatric Short-stay Patients MILAN ARDIS Department of Psychology, University of Hull
Fifty million working days a year are lost in industry because of mental illness. This is greater than the loss from strikes or from many common physical ailments. Since the early 1960s the number of days lost has been increasing rapidly. No simple explanation of this trend can be offered. Changes in diagnostic practices, however, especially in the acceptability of diagnoses, may have a marked effect. The increase in incapacity due to 'psychoneuroses' and 'psychoses' may reflect a more knowledgeable attitude to mental illness, not only on the part of the doctors, but also patients and employees, for whom much of the stigma of mental illness has receded. The increased notification of mental illness may be associated with the reduced incapacity from ulcers and other psychosomatic illness whose development may be prevented by the early recognition, acceptance and treatment of anxiety states (Office of Health Economics, 1971). There is no fixed criterion for mental health or mental ill health. The cut-off point between the two extremes varies considerably. All organized work
involves a certain degree of personal stress, and it is recognized that individuals vary in their ability to cope with stress factors (Selye, 1950). The rubric of stress responses covers a multitude of related factors such as neurotic anxiety, depression and psychosomatic disorders. This article, which is greatly abridged from an unpublished thesis, summarizes an investigation into attitudes to work as portrayed by stressed and non-stressed workers. Instead of conducting the research at factory medical centres, the focus moved to the hospitals. There two apparent advantages were envisaged. First, groups defined as psychiatric cases (assumed to be under neurotic stress) and non-psychiatric cases (relatively free from neurotic stress) were available for comparison. Secondly, the occupations found within these groups would be community-wide, not restricted to a small number of factories. It was decided, therefore, to select a psychiatric group and a non-psychiatric group of men from hospitals in Hull. Comparison of their attitudes towards their everyday work would be ascertained by use of a postal questionnaire. The responses to the questions would depict either positive, neutral or negative attitudes. The latter represented the main focus of interest. The hypothesis was put forward that the psychiatric patients would express significantly greater negative attitudes towards their work than the nonpsychiatric patients. If the hypothesis was upheld, it was expected that these negatively viewed factors would represent stressors in the work environment. For the purposes of this investigation, it was assumed that positive attitudes were related to job satisfaction; negative attitudes were related to job dissatisfaction; and that these attitudes were unidimensional. It is recognized that such an assumption is controversial (Jahoda and Warren, 1960). 13
Downloaded from http://occmed.oxfordjournals.org/ at Monash University on June 23, 2015
Summary In the last decade there has been a disturbing increase in days lost due to mental illness. Since the 1950s psychological research in this area has been sporadic and limited, mainly due to methodological difficulties. One particular problem has been the inability to identify and diagnose stressed workers at the factory. In an attempt to circumvent this issue, two groups of working men who had been short-stay patients were obtained from hospital records. The stressed group comprised psychiatric patients, the control group were patients from the ear, nose and throat department. The results of a questionnaire completed by 182 men revealed that the psychiatric group did not differ significantly from the ENT group in their atttitude towards work. However, highly anxious psychiatric men compared with low-anxiety ENT men reported a frustrating job that lacked variety. The former showed more uncertainty about their role in the organization but less sensitivity to lack of praise for good work.
14
OCCUPATIONAL MEDICINE
Construction of the Questionnaire As this study was conducted by one investigator with limited time and no grant facilities, the questionnaire had to be carefully devised so that the maximum amount of pertinent information could be elicited from the subjects, with the minimum of time and analysis. A postal questionnaire was essential in these circumstances. It had to be selfexplanatory; interesting and acceptable to the subjects; quick and easy to complete; flexible enough to apply to many degrees of literacy and most occupations. The questionnaire was not applicable to self-employed respondents who were excluded from data analysis. An important feature
of the questionnaire was that subjects were not required to name their firm or employer, nor to give an indication of how much they earned. The Questions In conjunction with the psychiatrist, who suggested likely stress factors, a list of fifty possible questions was drawn up. These were selected from several sources concerned with measuring attitudes to work. The main sources were the books by the following authors: Hyman, 1955; Edwards, 1957; Oppenheim, 1966; Shaw and Wright, 1967. The final twenty questions, chosen from the original list of fifty, sampled several components of job satisfaction such as the intrinsic nature of the work, working conditions, autonomy, security and promotion prospects. The Scale of Measurement An eleven-point ordinal scale was adopted, and placed under each question. This scale enabled respondents to allocate intensity of feeling in relation to 'between questions' and 'within questions'. The scale also provided clear discrimination between the positive and negative poles, which was necessary for the statistical test of the hypothesis. On all questions except 5, 8, 18 and 20 (where the scores were reversed) a high figure denoted positive feelings, a low figure, negative feelings and the central point (6) represented a neutral attitude. Response to the Questionnaire Of the 150 forms posted to the psychiatric group, 79 replies were suitable for analysis. The response rate was 60 per cent. There were 271 forms posted to the ENT group of which 103 were suitable for analysis. The response rate was 46 per cent for this group. Analysis of the Samples The distribution of the final two samples, categorized in terms of method of payment, marital status, age group and so on, showed no significant difference between the two groups, except in a category labelled 'length of service' (yv2 = 12-28, d.f. = 3, />
Stress at Work: a Comparison of Attitudes between Psychiatric and Non-psychiatric Short-stay Patients MILAN ARDIS Department of Psychology, University of Hull
Fifty million working days a year are lost in industry because of mental illness. This is greater than the loss from strikes or from many common physical ailments. Since the early 1960s the number of days lost has been increasing rapidly. No simple explanation of this trend can be offered. Changes in diagnostic practices, however, especially in the acceptability of diagnoses, may have a marked effect. The increase in incapacity due to 'psychoneuroses' and 'psychoses' may reflect a more knowledgeable attitude to mental illness, not only on the part of the doctors, but also patients and employees, for whom much of the stigma of mental illness has receded. The increased notification of mental illness may be associated with the reduced incapacity from ulcers and other psychosomatic illness whose development may be prevented by the early recognition, acceptance and treatment of anxiety states (Office of Health Economics, 1971). There is no fixed criterion for mental health or mental ill health. The cut-off point between the two extremes varies considerably. All organized work
involves a certain degree of personal stress, and it is recognized that individuals vary in their ability to cope with stress factors (Selye, 1950). The rubric of stress responses covers a multitude of related factors such as neurotic anxiety, depression and psychosomatic disorders. This article, which is greatly abridged from an unpublished thesis, summarizes an investigation into attitudes to work as portrayed by stressed and non-stressed workers. Instead of conducting the research at factory medical centres, the focus moved to the hospitals. There two apparent advantages were envisaged. First, groups defined as psychiatric cases (assumed to be under neurotic stress) and non-psychiatric cases (relatively free from neurotic stress) were available for comparison. Secondly, the occupations found within these groups would be community-wide, not restricted to a small number of factories. It was decided, therefore, to select a psychiatric group and a non-psychiatric group of men from hospitals in Hull. Comparison of their attitudes towards their everyday work would be ascertained by use of a postal questionnaire. The responses to the questions would depict either positive, neutral or negative attitudes. The latter represented the main focus of interest. The hypothesis was put forward that the psychiatric patients would express significantly greater negative attitudes towards their work than the nonpsychiatric patients. If the hypothesis was upheld, it was expected that these negatively viewed factors would represent stressors in the work environment. For the purposes of this investigation, it was assumed that positive attitudes were related to job satisfaction; negative attitudes were related to job dissatisfaction; and that these attitudes were unidimensional. It is recognized that such an assumption is controversial (Jahoda and Warren, 1960). 13
Downloaded from http://occmed.oxfordjournals.org/ at Monash University on June 23, 2015
Summary In the last decade there has been a disturbing increase in days lost due to mental illness. Since the 1950s psychological research in this area has been sporadic and limited, mainly due to methodological difficulties. One particular problem has been the inability to identify and diagnose stressed workers at the factory. In an attempt to circumvent this issue, two groups of working men who had been short-stay patients were obtained from hospital records. The stressed group comprised psychiatric patients, the control group were patients from the ear, nose and throat department. The results of a questionnaire completed by 182 men revealed that the psychiatric group did not differ significantly from the ENT group in their atttitude towards work. However, highly anxious psychiatric men compared with low-anxiety ENT men reported a frustrating job that lacked variety. The former showed more uncertainty about their role in the organization but less sensitivity to lack of praise for good work.
14
OCCUPATIONAL MEDICINE
Construction of the Questionnaire As this study was conducted by one investigator with limited time and no grant facilities, the questionnaire had to be carefully devised so that the maximum amount of pertinent information could be elicited from the subjects, with the minimum of time and analysis. A postal questionnaire was essential in these circumstances. It had to be selfexplanatory; interesting and acceptable to the subjects; quick and easy to complete; flexible enough to apply to many degrees of literacy and most occupations. The questionnaire was not applicable to self-employed respondents who were excluded from data analysis. An important feature
of the questionnaire was that subjects were not required to name their firm or employer, nor to give an indication of how much they earned. The Questions In conjunction with the psychiatrist, who suggested likely stress factors, a list of fifty possible questions was drawn up. These were selected from several sources concerned with measuring attitudes to work. The main sources were the books by the following authors: Hyman, 1955; Edwards, 1957; Oppenheim, 1966; Shaw and Wright, 1967. The final twenty questions, chosen from the original list of fifty, sampled several components of job satisfaction such as the intrinsic nature of the work, working conditions, autonomy, security and promotion prospects. The Scale of Measurement An eleven-point ordinal scale was adopted, and placed under each question. This scale enabled respondents to allocate intensity of feeling in relation to 'between questions' and 'within questions'. The scale also provided clear discrimination between the positive and negative poles, which was necessary for the statistical test of the hypothesis. On all questions except 5, 8, 18 and 20 (where the scores were reversed) a high figure denoted positive feelings, a low figure, negative feelings and the central point (6) represented a neutral attitude. Response to the Questionnaire Of the 150 forms posted to the psychiatric group, 79 replies were suitable for analysis. The response rate was 60 per cent. There were 271 forms posted to the ENT group of which 103 were suitable for analysis. The response rate was 46 per cent for this group. Analysis of the Samples The distribution of the final two samples, categorized in terms of method of payment, marital status, age group and so on, showed no significant difference between the two groups, except in a category labelled 'length of service' (yv2 = 12-28, d.f. = 3, />
