Relationship between Occupational Stress, Mental Health and COVID-19: History
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Giulia Foti
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Giorgia Bondanini
,
Georgia Libera Finstad
,
Federico Alessio
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Gabriele Giorgi

The COVID-19 pandemic led to serious psychological consequences that negatively affect workers’ mental health, leading to post-traumatic symptoms. In this scenario, employees may be exposed to multiple stressors that ultimately drain their resources. 

  • COVID-19
  • mental health
  • post-traumatic stress

1. COVID-19 Pandemic and Its Impact on Psychological Distress

The COVID-19 pandemic led to serious psychological consequences that negatively affected the mental health of individuals. Indeed, research shows that COVID-19 is associated with negative outcomes, such as psychological distress. For example, a survey carried out in China on a sample of 600 workers showed that 6.33% experienced anxious states (women had a higher prevalence), while 17.17% experienced depressive symptoms (Wang et al. 2020). Serious mental health consequences were reported especially for healthcare workers. In fact, an Italian study conducted on a sample of 1379 workers showed that 49.38% of the respondents reported post-traumatic symptoms, 24.73% exhibited symptoms of depression, 19.80% reported anxiety symptoms, 8.27% exhibited problems of insomnia, and finally, 21.90% reported high perceived stress (Rossi et al. 2020). A cross-sectional survey conducted in China also showed that 40.2% of the sample had significant symptoms related to post-traumatic stress disorder. The percentages of depression, anxiety, and stress states were 13.6, 13.9, and 8.6, respectively (Si et al. 2020). While healthcare workers are the population most affected by the psychosocial consequences of the pandemic, negative outcomes were also observed for other professional groups. For example, a study conducted on a sample of bankers showed that during the pandemic, almost all employees were experiencing anxiety, depression, and stress, and that 11.1% of the sample ranged from severely stressed to extremely stressed (Yasmin et al. 2022). In addition, other research highlighted that education and social work professionals, public administrative employees, bank employees, and employees in other jobs at high or potential risk of COVID-19 infection were found to be at higher risk of depressive and anxiety symptoms. Furthermore, factors contributing to mental distress may be inadequate protective equipment, reduced relationship with coworkers, and work-privacy conflicts (Casjens et al. 2022).

2. COVID-19 as a Traumatic Event: COVID-19-Related Stress

The association between COVID-19 and post-traumatic stress disorder is becoming a topic to which researchers around the world are turning their attention. Post-traumatic stress disorder can generally occur after exposure to a traumatic event. According to Cramer and colleagues, post-traumatic stress reaction develops following five phases: (1) objective exposure from which subjective reactions arise; (2) the formation of a memory network and thus the subjective processing of the traumatic event and the interpretation of the stimuli associated with it; (3) intrusion, i.e., the memories of the traumatic event which activate the fear network, causing hyperarousal and avoidance mechanisms; (4) avoidance, i.e., coping strategies implemented in order to reduce the discomfort caused by the intrusive phase; and (5) the outcomes, i.e., the resolution of the network that manifests itself with high symptomatology (Creamer et al. 1992). Then, there are three nosographic criteria for understanding trauma-related psychopathology, which will have unique characteristics within the pandemic framework: objectively defined trauma, objectively defined exposure, and subjectively reported reactions (North et al. 2021). Regarding the novel coronavirus and objectively defined trauma, it is recognized that COVID-19 is a disease that occurs ‘naturally’, and as such, is not mentioned among the traumatic events in the DSM-5, but, as we shall see, it produces clearly visible traumatic effects and generates important secondary stressors such as financial and social losses, reduced opportunities to socialize with friends and loved ones, and the interruption of important activities of daily life (North et al. 2021). Thus, exposure to the virus is a highly stressogenic factor for both workers and the general population. Finally, with regard to subjective emotional reactions, distressing emotional states could lead to psychopathological outcomes (North et al. 2021). As for the hypothesis that COVID-19 can be considered a traumatic factor, the research by Bridgland and colleagues found that 13.2% of the participants probably had post-traumatic symptoms even if the types of exposure to COVID-19 did not fall within the diagnostic criteria. In addition, the emotional impact of the events experienced/predicted as worse was found to be a predictor of PTSD (Bridgland et al. 2021). Furthermore, the results of the study by Sanchez-Gomez and colleagues, conducted on a general sample of workers, found a statistically significant correlation between fear of COVID-19 and the three dimensions of PTSD: intrusion, hyperarousal, and avoidance. In addition, the results showed that hyperarousal plays a mediating role in the relationship between intrusive thoughts and individual outcomes, such as fear of COVID-19 and mental health (Sanchez-Gomez et al. 2021).

3. Work-Related Stress: The Five Dimensions and Their Impact on Psychological Distress

The National Institute for Occupational and Safety and Health (NIOSH) (Schill and Chosewood 2013) defines work-related stress as a series of “harmful physical and emotional reactions that occur when job demands are not commensurate with the worker’s capabilities, resources or needs of the workers”. The type of occupation and the organizational conditions are important factors that can generate serious psychosocial consequences (Bonde 2008). There are several factors that contribute to occupational stress. The dimension termed as “job demands (JD)” is linked to the effort required operationalized as workload, both physical and psychological; rhythms of work; consistency of requests (Bakker and Demerouti 2007). JD includes high pressure in the workplace, an unfavorable working environment, and onerous emotional effort in interactions with customers (Karasek 1979). The decision latitude or job control dimension is understood as the freedom perceived by the worker in responding to work tasks. It therefore refers to mastery and discretion within the work environment. A third dimension to be considered, which is also included in the Job Demand Control Support (JDCS) model, is social support, that is, social support from supervisors and colleagues. Job control can act as a moderator, being able to mitigate the devastating effects of stress (Karasek and Theorell 1990) and protect from job strain (Haines et al. 1991).
Therefore, psychological distress and adverse health-related consequences arise when there is an imbalance between job demands and workers’ resources, for example, in terms of lack of job control and lack of social support (Marchand and Durand 2011). Another factor to consider is role ambiguity, defined by Kahn, Wolfe, Quinn, Snoek, and Rosenthal as the ambiguity experienced by workers regarding the parts of their role which are not clearly defined in terms of behavior, tasks, priorities, and/or criteria to be met (Kahn et al. 1964).
In summary, occupational stress can by analyzed through the following dimensions: supervisor support, colleague support, job demands, job control, and role ambiguity. These factors are closely associated with the employee’s psychological health. In fact, colleague and supervisor support proved to be important protective factors in the workplace (Marchand and Blanc 2010). Indeed, both low social support and lack of supervisor support are associated with increased psychological distress (Inoue et al. 2022) (Dennerlein et al. 2021). This is especially true for teleworkers, since insufficient supervisor support is associated with a high risk of psychological distress in this population (Kikunaga et al. 2023). Therefore, actions by leaders as supervisors are important in increasing positive employee attitudes and behaviors in the organization (Cahyadi et al. 2022a, 2022b). Moreover, low job control in the workplace can generate significative psychological distress (Elovainio et al. 2007; Elliott et al. 2017) as well as role ambiguity (Choi et al. 2011). Finally, in line with what Karasek supposes (Karasek 1979), research carried out in various organizational contexts has shown that a high level of job demands coupled with low levels of job control is associated with increased psychological distress (Karasek and Theorell 1990; Xie et al. 2021), while emotion-focused coping strategies act as a mediator in this relationship (Oshio et al. 2021).

4. Work-Related Stress as a Facilitator of the Onset of COVID-19 Stress Symptoms

The presence of work-related stress may promote the development of COVID-19-related post-traumatic symptoms. Work-related stress has a significant impact on the well-being of the worker (Ben-Ezra and Hamama-Raz 2021), as does COVID-19-related stress (Bridgland et al. 2021), as anticipated above. The individual may perceive exposure to a given stressful event as challenging or threatening, as evidenced by Hofboll’s Conservation of Resources (COR) theory. COR theory, proposed as motivational theory, asserts that personal and social resources moderate the potential negative impact of stressful situations in the individual’s life and focuses on the use of resources in these circumstances. The basic tenet of the theory states that individuals are motivated to acquire and protect their resources. In this perspective, stress is the result of the subjective perception of events as exceeding one’s resources and of environmental and objective situations that threaten or may induce resource depletion (Lazarus and Folkman 1984; Giorgi et al. 2020; Hobfoll 1998). Following the first corollary, individuals with more resources are more likely to acquire new ones and are less vulnerable to resource loss, while the opposite trend can be observed in the case of individuals with a depleted resource pool (Hobfoll 1988). Furthermore, since loss is more valued than gain and stress occurs when resources are lost, organizations and individuals can experience loss spirals where with each loss there is an increase in the magnitude of the effect (second corollary) (Hobfoll 1998, 2001; Halbesleben et al. 2014). In addition, another possible explanation lies in the physiological perspective: exposure to high levels of glucocorticoids, a class of hormones that are activated after exposure to stressful situations, could have an impact on the onset of psychopathologies.
In this regard, it can be assumed that an individual already suffering from work-related stress and thus with reduced personal resources may experience a further loss of resources when faced with a stressful event such as COVID-19, thus developing post-traumatic symptoms. Additionally, workers in the early stages of work-related stress coping with a traumatic event, such as COVID-19, may have elevated levels of stress hormones that facilitate the development of post-traumatic stress symptoms (Marin et al. 2011). In line with this perspective, research by Marin and colleagues (Marin et al. 2011) demonstrated that work-related stress, acting on individual vulnerability, triggers the onset of various pathologies, including post-traumatic stress disorder. It is therefore hypothesized that the vulnerability induced by the presence of work-related stress makes the individual more vulnerable to traumatic experiences, in this case related to COVID-19.

This entry is adapted from the peer-reviewed paper 10.3390/admsci13040116

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