Gender, burnout and work-related stress
This chapter discusses gender, burnout and work–related stress. Specifically it looks at the role gender plays with regard to work–life balance, pay, career advancement, stress, mental health and physical health.
When we turn to the matter of gender and burnout, we encounter two specific problems. The first is that (as described in Chapter 2) researchers have turned up mixed results as to whether women suffer from burnout more readily or more often than men. In some studies, women appear to be more prone to burnout; in others it appears gender makes no difference.
The second problem, as discussed in Chapter 1, is that burnout is not a recognized mental health problem in countries which rely on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV). In these countries, burnout is likely to have been diagnosed as stress or depression. As a result, it is important to survey the literature on workplace stress and depression in these parts of the world since individuals suffering from burnout are likely to surface in these results but not to have been identified specifically.
Given this problem of identification and diagnosis, it is little wonder that the research is not clear on whether men or women are more burned out. It is also not clear on whether women or men typically experience more work–related stress. Some researchers, for example, claim that men are more acutely affected by work–related stress. At the 2008 British Psychological Society’s occupational psychology conference in Stratford–upon–Avon, business psychologist Lucy Watt explained that, based on her studies, men suffer from work–related stress more than women, but, remarkably, experience fewer health– related problems as a result. She explained that men seemed better able to buffer themselves from the harmful effects of stress (Jones, 2008).
In contrast, research presented in 2009 by Dr Brendan Burchell from the University of Cambridge’s Department of Sociology indicated that while men are indeed more stressed, depending on the circumstances, they are less able than women to buffer themselves from the effects of stress. Burchell’s studies revealed that men who feel insecure about their jobs are more likely than women to suffer from depression and anxiety. Burchell analyzed data from a survey of 300 UK employees along with the results from thousands of others through the British Household Panel Survey, funded by the Economic and Social Research Council (ESRC). He found that while men claim to be less worried about losing their jobs, they are, in fact, more stressed, worried and depressed than women (University of Cambridge, 2009).
For the most part, though, results like these showing that men suffer more work-related stress than women are not as common as studies which indicate that women are actually more stressed. A recent poll taken of 2,000 Britons by the Stroke Association, for example, found that twice as many women as men were experiencing high levels of stress. Approximately one-in-five women and one-in-ten men felt that their stress levels were out of control. The sources of stress were jobs, job insecurity and financial problems (Jones, 2011).
Along the same lines, a 2010 survey of 29,338 men and women in India, China, Brazil, Russia, America, Britain, Australia, Canada, Denmark, Finland, France, Germany, Italy, Japan, Mexico, the Netherlands, Spain, Sweden and Switzerland conducted by Kenexa Research Institute, found that women experienced more workplace stress than men. Stress levels were generally between 6 to 10 percent higher for women than they were for men depending on the type of job. Work–life balance, fair pay, supportive management, having a career path, and the type of work were all issues reported by the survey participants which directly contributed to their levels of stress (“Women suffer,” 2010).
This chapter looks at the research on gender and workplace stress. Several surprising and some alarming results have emerged over the last several decades which indicate that women not only experience workplace stress more acutely, but also suffer serious health problems, and sometimes even put their lives in danger because of their jobs.
Why are women more stressed? The explanation is that women, more than ever, are not only struggling with the stresses of the job but also with increasing demands at home including caring for elderly parents and raising children. As Paul Farmer, the chief executive of Mind, a mental health charity, said: “Undoubtedly, there is a combination of factors affecting women which mean they face greater challenges, maintaining work–life balance and caring responsibilities. Where there is increasing pressure at work and at home, it is often women who are expected to bear the brunt” (Laurance, 2009).
In single-parent households, the situation is particularly bleak. One study of single- and dual-parent households found the single mothers suffered from “role overload,” that is, they worked constantly either as a parent or a wage–earner with little or no downtime. As a result, they were “three times more likely to experience severe depression than the married women in the study. They were 80 per cent more likely to have chronic health problems and 40 per cent more likely to suffer from flu or colds” (Mironowicz, 1993). Frequent illness indicated a deep level of physical and mental exhaustion on the part of single mothers who were described as “worn out,” and they were 50 percent more likely than married mothers to use health services to deal with both depression and physical health problems.
This does not mean, however, that women who are married are stress free. Time pressure is a big problem for couples, and significant changes have occurred in the homes of married couples since the 1970s which have added to the stress. In 1970, for example, among two–thirds of married couples, one of those individuals – often the wife – stayed at home. The stay–at–home spouse had a full day to see to domestic responsibilities while the other spouse earned a salary. Today, however, that number has fallen to 40 percent which means that more spouses must tackle these domestic obligations after a full day at work (Parker-Pope, 2010). In addition, the average work week is longer for both spouses, having risen from 52.5 hours a week in 1970 to 63 hours in 2009 (Parker–Pope, 2010).
Women take on the lion’s share of domestic responsibilities. According to one US survey, women spend 28 hours a week on housework, while men claim to spend approximately 16 hours. There is also a vast difference in perception between the sexes as to how much time men spend on childcare. Close to half (49 percent) of men surveyed said they spent an equal amount of time or more on childcare than their spouse. In contrast, the women surveyed believed that only 31 percent of those men spent the amount of time they reported. More than half of all men also claimed to spend an equal amount of time or more on housework while 70 percent of their wives disagreed (Parker-Pope, 2010).
Even though women and men may not agree on the percentages, and even though men may not be shouldering half of the domestic responsibilities, it is clear that more men than ever before are troubled by the competing demands of work and family. Studies indicate that the number of men who experience this work–family conflict has risen noticeably since the 1970s. In 1977, for example, a US Department of Labor survey revealed that 34 percent of men experienced “some” or “a lot” of work–family conflict. In 2008, New York–based Work and Family Institute updated that study and found that 49 percent of working men with families were now reporting the same thing (Healy, 2011). The reasons for this include modern expectations that men will be more involved with their families. At the same time, wages are stagnating and hours of work, along with worries about job insecurity, have risen significantly.
So, while women in two-parent households still shoulder the burden of housework and child raising, men are not entirely stress free. Societal pressure for men to be more involved in family life than in previous decades means that work–home time pressures are increasingly becoming more of a problem for men as well as women.
Women are greater participants in the workforce than they have ever been in history and the traditional view of the husband as the primary breadwinner while the wife earns “pocket money” has been completely turned on its head. In the United States, for example, women hold half the jobs in the economy and were the “main or co–breadwinners in two– thirds of American families” (Cobble, 2010). In contrast, men represented “a majority of the jobless” (Cobble, 2010). Because men were hardest hit by the recession in the US, now 38 percent of women either make more money than their husbands or are the sole breadwinners in the household (Eichler, 2012).
The notion that women are less engaged in the workforce once they have children is also changing. In Canada, 70 percent of women with children who are still at home have jobs (Eichler, 2012).
Nonetheless, the expansion of women’s participation in the workforce has not led to corresponding significant improvements in the conditions of work. Instead, men still outpace women in terms of wages even for equal work. In the US, the gender pay gap is 23 percent (Cobble, 2010). In Canada, men earn on average 20 percent more than women. (“Canada gender pay gap,” 2010) while in the UK that figure is 19.5 percent (Jones, 2011).
Low pay has been and remains a women’s issue. A 2012 work–stress survey conducted by Harris Interactive on behalf of Everest College found that 73 percent of Americans felt stressed in the workplace, and low pay was the primary reason (11 percent). Close to double the amount of women (14 percent) ranked low pay as their top stressor compared with men (8 percent).
In addition, the female participants (11 percent) said that they were stressed because the job they were in was not their ideal career compared with men (5 percent) (Harris Interactive, 2012). Some of this has to do with the greater barriers women encounter in the job market, not only in securing certain jobs, but also in moving up the job ladder.
Both men and women are more likely to suffer from psychiatric disorders as a result of high pressure (long hours, time pressures) on the job. One study published in 2007 found that 45 percent of young adults in their early 30s with no pre–employment history of depression or anxiety could attribute the onset of psychiatric disorder to the excessive demands of their job. In other words, job stress was responsible for new psychiatric disorders in both men and women who had been mentally healthy up to that point (Melchior et al., 2007). Women in high pressure jobs were 75 percent more likely that women in low stress jobs and men were 80 percent more likely than men in low stress jobs to suffer from depression or anxiety.
Depression was also the focus of a recent British study which found that employees who spent excessive amounts of time at work were more likely to suffer from depression than those employees who worked a typical day. Individuals who worked 11-plus hour days (or 55-plus hours a week) were two and a half times more likely to report depression than those who worked a typical seven to eight hour day. In reaching this finding, researchers took into account the effect of the various socio–demographic factors of these employees and also the extent to which they lived a healthy or unhealthy lifestyle (Virtanen et al., 2012).
Women in these studies are generally more likely to suffer from depression than men. Researchers surveyed over 2000 British civil servants from 1991 to 1993 and followed up again six years later from 1997 to 1999. They found that women, younger workers, and low ranking employees with moderate alcohol use were most at risk for the onset of depression. Higher ranking men in the workplace did not seem particularly prone to depression; in contrast, higher ranking women were. Researchers surmised that the difference between men and women at this level of management had to do with the prevalence or absence of ongoing responsibilities at home (“A long work day,” 2012).
Work-related depression was also found to affect more women than men in a 2010 University of Melbourne and Victoria Health report. Researchers noted that 17 percent of women (compared with 13 percent of men) suffered from work-related depression as a result of stress on the job.
Finally, an extensive study of 30 European countries found that women between the ages of 25 and 40 are three to four times more likely than men to be depressed. Women in all age groups are two and a half times more likely to be more depressed than men. The reason, according to researchers, has to do with the stresses of balancing work and home commitments. Women not only suffer from depression earlier in life than they did in the 1970s but the rate has doubled since that time (Collins, 2011).
[m]arriage appears to reduce the risk of depression in males, for females it increases the risk. In females, you see these incredibly high rates of depressive episodes at times when they sometimes have their babies, where they raise children, where they have to cope with the double responsibility of job and family. (Collins, 2011)
The study also found that rates of depression in men had also risen since the 1970s (although not to the same extent) which Professor Wittchen attributed to an insecure job market, worries about job loss and higher divorce rates (Smyth, 2011).
Finally, research on how men cope with their job-related stress and depression and whether they seek help has been somewhat more alarming. One-third of all British males, for example, report they use alcohol to stop themselves from thinking about work (Tozer, 2006). Twenty-two percent of the males in this particular survey reported suffering from work-related depression while 35 percent said that work was responsible for problems sleeping. One in ten respondents saw work as responsible for a decreased interest in their family or significant other and 15 percent felt that work had disrupted their sex lives. Despite the impact on their family and health, however, men continue to be more reluctant than women to seek help (Tozer, 2006).
This is borne out by statistics in the UK which indicate that women are seeking help for stress in greater numbers than ever before and outpacing men. In 2009, for example, women made up 56 percent of all the referrals to National Health Service specialist psychiatric services for outpatient and inpatient treatment (Laurance, 2009).
The American Psychological Association has also reported that women are more likely to be stressed than men. Work was cited as being the second most significant source of stress (money was number one) and, once again, women reported higher average levels of stress than men. Of the women surveyed, 88 percent felt that stress was having an adverse impact on their health compared with 78 percent of men (American Psychological Association, 2012).
Work-related stress is not just a problem for women, it is also a serious problem for men. One study of job stress among young Finns (mean age 32) found that even though young women tended to report more work-related stress (35.6 percent versus 27.4 percent), it was young men who showed signs of early atherosclerosis (a build up of plaque inside the arteries) which placed them at risk for heart attacks and strokes. The young men were 29 percent more likely than women to have increased thickness in their arteries. This was true even when other unhealthy lifestyle factors (drinking, smoking, obesity, etc.) were taken into account (Hintsanen et al., 2005).
Men were also found to be at risk for certain health problems in a Danish study which in 2001 followed up with a group of healthy men first identified in 1970. Researchers found that high stress at work was a significant predictor of stroke, and that 10 percent of all strokes could be attributed to job stress, while 90 percent were attributable to other factors such as smoking and high blood pressure. This was true, however, only for men in higher social classes – i.e., those with higher education and job status. Little or no association between stroke and high job stress was found in men in the lowest social classes – i.e., those individuals with little education and low ranking jobs (Suadicani et al., 2011).
These studies tell us that job stress is clearly unhealthy for men. The same is true for women. Stress has consistently been linked with poorer health in women, and, for the most part its effects seem even more severe than they are for men. One study done in Sweden of male and female clerical workers and middle-managers, for example, found that both the male and female managers listed a “heavy workload, time pressure and responsibility for others” (Frankenhaeuser et al., 1989) as the main reasons for stress on the job. Women, however, felt additional sources of stress as compared to the men: one-third of the women felt that they had to perform better than the men merely to be considered equals. Also, while male managers showed the greatest job satisfaction and reported high levels of personal control, their counterparts – female managers – felt they had less control and less support from the managers above them.
The most significant difference between the men and women managers in this Swedish study was that blood pressure remained high for the women after work, while the blood pressure in the men decreased after 5 p.m. According to researchers, this indicates that women continue to experience stress after work as a result of the demands made of them at home. The study indicated that high demands at work, followed by more demands in their domestic life, left this group unable to unwind in the same way as their male counterparts. It also put the women at a greater risk for cardiovascular disease in the future.
Ten years after this study, in 1999, researchers at Laval University published a paper which showed similar results in their investigation of working women. Here, the link between high blood pressure in university-and non-university-educated women who were raising children was examined. University-educated women working in high-demand jobs had significantly higher blood pressure levels than their non-university-educated counterparts with similar domestic responsibilities. The blood pressure of the university-educated women remained high not only after the workday had ended, but throughout the evening and into the night, putting this group at risk for heart attacks and strokes (Brisson et al., 1999).
Shortly after the Laval Study was published, researchers from the Harvard School of Public Health published research which analyzed data collected from 21,290 nurses. The participant nurses had filled out surveys in both 1992 and 1996, and researchers looked at information about their jobs, along with changes in health (particularly any decline in health) over the four years between those two questionnaires.
They discovered that women in jobs with high demands (e.g., a relentless pace, not enough time to perform the work, too much work) but low ability to participate in decision making or to have some say in how the job was to be done had experienced the greatest decline in their physical and mental health. Low social support also contributed to poor mental and physical health (Cheng et al., 2000). “Some jobs are inherently stressful,” said Ichiro Kawachi, Associate Professor of Health and Social Behavior and one of the study’s authors. “What we found is that regardless of how healthy or resilient a person is, the job stress can affect her health” (“Major study,” 2000).
The researchers also noted that while previous research had linked job stress to heart disease and various other health problems, the current study revealed that health problems continue to get worse over time if job stress is unabated (“Major study,” 2000).
In addition to heart disease and risk of stroke, a study published in 2004 found a link between job stress and health matters which are specifically female such as premenstrual symptoms. Researchers surveyed over 6,000 active-duty women working across all branches of the US military. Sixty-nine percent of the women had experienced symptoms in the three months prior to the study, and job stress was found to be the strongest predictor of these symptoms (Hourani et al., 2004). Researchers explained that more than 40 percent of women in the military report experiencing “a great deal” or “a fairly large amount” of stress as part of their jobs.
Pregnancy and health of the child has also been found to be more problematic for women in jobs with long hours. Dutch researchers who focused on 7,000 pregnant women in Amsterdam found that women who worked in high stress jobs for more than 32 hours a week were at greater risk for a pregnancy condition called pre-eclampsia. Pre-eclampsia involves high blood pressure and damage to the maternal endothelium (the cells lining the blood and lymphatic vessels), liver and kidneys. The women reporting high stress on the job also gave birth to babies who were low birth-weight (a similar birth–weight, in fact, to that of women who smoked) and who cried excessively (“Women in high stress jobs,” 2006).
Like the Harvard School of Public Health study discussed above, a number of these studies have followed a population group over the course of several years to determine how stress is affecting their health. A Danish study which began in 1993, for example, collected data from 12,116 employed female nurses and followed this group for 15 years. The study found workload reported as being much too high could predict ischaemic heart disease (IHD) at a later date (Allesøe et al., 2010). Surprisingly, the results were even more pronounced among younger nurses.
A long term study in Britain (which followed 10,000 civil servants for 14 years) found that employees in high stress jobs had a better chance than those in low stress positions to be obese, and have higher cholesterol and blood pressure (known as metabolic syndrome) – all factors which put workers at risk for heart disease and diabetes (Chandola et al., 2006). While stressed men were twice as likely as their non-stressed male counterparts to develop the syndrome, women were five times more likely to have the syndrome when compared to men. According to experts, “one possible explanation is that prolonged exposure to work stress may affect the nervous system. Alternatively, chronic stress may reduce biological resilience and thus disturb the body’s physiological balance (homoeostasis)” (Boseley, 2006).
The results of another long term study were presented in 2010. Dr. Michelle Albert of Brigham and Women’s Hospital in Boston, speaking at the American Heart Association in Chicago, explained that her team of researchers had also discovered a link between job strain and cardiovascular disease. The study, sponsored by the US National Heart, Lung and Blood Institute, analyzed data gathered from over 17,000 women working in the health profession over a ten year period.
What the study found was that women who endured high demands but low control in their job had a much greater risk of heart attack (88 percent higher in women with high job stress), stroke, bypass surgery (43 percent higher) and death (Ubelacker, 2010). In total, women’s risk of suffering from some form of cardiovascular disease was 40 percent higher as a result of job stress.
Researchers in this same study noted that the fear of losing one’s job increased the factors which could lead to heart disease including high blood pressure and cholesterol and being overweight. Stress was also responsible for the release in the body of stress hormones such as cortisol which does damage by narrowing blood vessels, and affecting heart rate and blood pressure (Ubelacker, 2010).
What many of the foregoing studies have in common is that they have based a number of their assumptions on Karasek’s “job strain” model. This model posits that jobs with high demands and low autonomy or decision-making power result in the greatest health risks from stress. The US National Heart, Lung and Blood Institute study above, for example, found a link between high demand–low control jobs and poor health outcomes. One study in which data was compiled from 22,000 women over the course of ten years, however, indicated that this is not always the case.
In this study, researchers at Harvard and Yale found, much like the studies above, that women with stressful jobs were at much greater risk for serious physical health problems than their less stressed female counterparts. Results indicated that women suffering from job stress were 67 percent more likely than women with less stressful jobs to have a heart attack and 38 percent more likely to have a cardiovascular event such as a stroke (Slopen et al., 2012). Where this study differed from a number of the others which had come before it was that researchers discovered that high demand jobs, whether or not women had control over their work, resulted in greater health problems. In other words, high demands in the workplace were enough to lead to health problems. In contrast, men with jobs in which they had high demands and high control were found not to experience the same cardiovascular problems as women (Pearson, 2012).
Research is clear that job stress is mentally and physically unhealthy for men and women. Members of both sexes are more likely to develop psychiatric disorders when exposed to ongoing and high levels of stress in the workplace, and both sexes find themselves at greater risk for heart problems and strokes. Women, however, have been shown in most studies to suffer these effects more acutely than men particularly as they move up the ladder in an organization. As research suggests, women are more likely to suffer serious health problems when exposed to the stresses of the job, most likely because they are unable to unwind at home once their work day has come to a close.
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