Employee stress management: An examination of adaptive and maladaptive coping strategies on employee health

Abstract

BACKGROUND:

Employees commonly report feeling stressed at work.

OBJECTIVE:

Examine how employees cope with work and personal stress, whether their coping strategies are adaptive (protective to health) or maladaptive (detrimental to health), and if the manner in which employees cope with stress influences perceived stress management.

METHODS:

In this cross-sectional study, a random sample of 2,500 full-time university non-student employees (i.e. faculty, salaried professionals, and hourly non-professionals) were surveyed on health related behaviors including stress and coping. Approximately 1,277 completed the survey (51% ). Hierarchical logistic regression was used to assess the ability of adaptive and maladaptive coping strategies to predict self-reported stress management, while controlling for multiple demographic variables.

RESULTS:

Over half of employees surveyed reported effective stress management. Most frequently used adaptive coping strategies were communication with friend/family member and exercise, while most frequently used maladaptive coping strategies were drinking alcohol and eating more than usual. Both adaptive and maladaptive coping strategies made significant (p < 0.05) contributions to predicting employee’s perceived stress management. Only adaptive coping strategies (B = 0.265) predicted whether someone would self-identify as effectively managing stress. Use of maladaptive coping strategies decreased likelihood of self-reporting effective stress management.

CONCLUSIONS:

Actual coping strategies employed may influence employees’ perceived stress management. Adaptive coping strategies may be more influential than maladaptive coping strategies on perceived stress management. Results illustrate themes for effective workplace stress management programs. Stress management programs focused on increasing use of adaptive coping may have a greater impact on employee stress management than those focused on decreasing use of maladaptive coping. Coping is not only a reaction to stressful experiences but also a consequence of coping resources. Thereby increasing the availability of resources in the workplace to facilitate the use of adaptive coping strategies is necessary for successful stress management and, ultimately, healthier employees.

Keywords

Coping behavior health promotion employee health stress management

1 Introduction

Employees commonly report feeling stressed or tense at work [1, 2]. Specifically, 35% say that their job is harming their physical or emotional well-being, 42% say job pressures are interfering with their family or personal lives, 50% report more demanding workloads than they had a year ago, and 51% report some amount of lost productivity due to stress while at work [1, 2]. When accounting for both acute and chronic stressors, stress levels can have marked impacts on both physical and mental health [3]. For instance, sustained stress has been shown to increase the risk of heart disease, lower immune response, negatively affect sleep, and decrease mental health [4]. Simply stated, stress is negatively associated with health.

Meta-analyses document the negative association between work performance and health, particularly psychological health [5]. Mental health risks resulting from stress, such as poor emotional health, anxiety, and/or depression, exhibit a consistent and significant association with decreased productivity and increased rates of presenteeism (i.e., the act of going to work despite not feeling well) [6 –9]. The estimated percentage of total costs of common health conditions attributed to presenteeism range from 14–73% , depending upon the health condition [10]. Additionally, distressed employees experience higher rates of absenteeism and health care consumption as compared to their less stressed co-workers [9 , 12].

As a result of the negative impact of stress on the well-being and work productivity of employees, organizations have begun to implement workplace stress management programs. Many of these programs demonstrate effectiveness in decreasing stress and improving employee health [13 –15]. These workplace health promotion programs offer tangible economic benefits to employers, such as decreased health care costs and increased employee productivity [16, 17]. Such benefits to employees are becoming increasingly important as health care costs rise, chronic disease prevalence increases, and the workforce ages during difficult economic times. Chenoweth asserts that employers seeking to help employees “identify the origin of stress and understand the relationship between daily stress and the development of illness and pain.”[18(p.92)]

1.1 Coping with stress

Folkman and Lazarus [19] originally defined two general types of coping efforts, problem- or emotion-focused. Since this original classification of coping efforts, the number of categories for coping has continued to grow, with no clear consensus in terms of defining these categories [20]. What is agreed upon, however, is that coping strategies are multidimensional and multifunctional. Thus, coping efforts must be considered within the context of their use to accurately understand their value [21].

From a health promotion paradigm, the evaluation of a coping strategy is inherently tied to its adaptive (protective) or maladaptive (detrimental) effect on one’s health. Adaptive coping strategies include behaviors such as exercise, meditation, and seeking social support, while maladaptive behaviors encompass activities like avoidance, overeating, and drug use. Classification of coping strategies as adaptive and maladaptive behavior is commonly used in research of coping strategies and illness-related stress [22, 23]. Moreover, maladaptive coping is associated with higher levels of stress as well as decreased physical and mental well-being [24 –26]. For instance, Koopman et al. [27] found poorer mental health status among employees who participate in hazardous or harmful drinking, have greater stress at work or home, practice more avoidance coping, or regularly use antidepressants.

1.2 Current investigation

The purpose of this paper is threefold: (1) to examine how employees at a large southeastern university cope with stress; (2) determine whether the coping strategies are adaptive (protective to health) or maladaptive (detrimental to health); and (3) determine if the manner in which individuals cope with stress (i.e. adaptive or maladaptive) influences perceived stress management.

2 Methods

In the fall of 2009, the Health Promotion Coalition of a large public 4-year university in the Southeast surveyed a random sample (n = 2500) of full time, non-student or other personnel services university employees (possible pool of 10,156) on a number of health related behaviors including stress and coping. Items included in the Coalition’s employee health risk behavior survey were either adapted or adopted from the National College Health Assessment [28] and the Behavioral Risk Factor Surveillance System [29]. Prior to the final administration of the questionnaire, the survey was piloted with a small number of employees in order to determine appropriateness of language, survey length and ease of understanding of each item. Minor modifications to the wording of some survey items were made as a result of the pilot study. No attempt was made to exclude pilot participants from the random sample. All procedures were vetted and approved by the university’s Institutional Research Board.

2.1 Participant recruitment

In an effort to increase the response rate, we employed a mixed mode methodology to recruit participants. More specifically, Human Resources provided the investigators with both e-mail and campus mail address in order to notify and recruit potential participants. Using the list of employees and campus addresses obtained from Human Resources, we sent all potential participants a formal letter that (a) described the purpose of the investigation, (b) notified of a coming email invitation containing a link to the web-based survey, and (c) included an incentive (small lapel pin). Using a small incentive with the initial participation request has been highly effective at increasing response rates with previous investigations [30]. Participants were also advised that they could request a hard copy of the survey if preferred.

2.2 Sample

Of the 2,500 pre-notification/invitation letters mailed, 127 were returned for incorrect and/or inactive addresses, leaving an initial sample of 2,373. Of those successfully contacted, 92 respondents requested a paper-based survey. Upon receipt, all paper-based surveys were manually entered into the online survey program. Two reminder emails were sent to all participants, either indicating appreciation if the survey was completed or requesting completion if not previously completed. Approximately 1,256 respondents completed the web based survey and 21 returned paper-based surveys, resulting in a response rate of 54% .

2.3 Measures

Perceived Stress Self-Management was indexed via a single item [“Overall, do you effectively manage your stress (include work and personal stress)?”]. Responses were dichotomously classified as “yes” or “no”.

Adaptive (healthy) Coping Strategies were indexed via a number of different strategies. Specifically, respondents were asked to identify whether they had employed any of the following strategies (mark if yes) within the last 30 days specifically for the purpose of decreasing stress: Exercise or physical activity; Yoga; Received a massage; Deep breathing; Guided imagery; Progressive muscle relaxation; Meditation; Participated in spiritual/religious activities; Communicated with a friend or family member (phone, e-mail or in person); and Communicated with a counsel, psychologist or health professional (phone, e-mail or in person). Responses were aggregated into a single continuous variable, ranging from 0 (did not employ any of the above coping strategies within the last month to decrease stress) to 10 (employed all of the above coping strategies in the last month to decrease stress). Higher values indicated a greater number of positive stress reducing strategies.

Maladaptive (unhealthy) Coping Strategies were also indexed with several items. Specifically, respondents were asked to indicate (check if yes) whether the following strategies had been used within the past 30 days specifically for the purpose of decreasing stress: Ate more than usual; Drank alcohol; Smoked Cigarettes; Used illegal drugs; and Gambled. Reponses were aggregated into a single continuous variable ranging from 0 (did not employ any of the above coping strategies within the last month to decrease stress) to 5 (employed all of the above coping strategies in the last month to decrease stress).

Several demographic Covariates were included in the analyses in order to control for confounding effects on any observed relationships between perceived stress self-management and the use of adaptive or maladaptive coping strategies. These control variables were specifically chosen because previous literature has indicated an influential relationship to stress levels and/or management. Specifically, research shows men and women experience and cope with stress differently [31 –33] and that changes in coping occur over the lifespan [34 –36]. Ethnicity has been shown to affect appraisal and coping behaviors [37, 38] as does educational attainment [39, 40]. Being married has also been identified as an influencing factor on types of coping strategies used [40, 41]. Thus, sex, ethnicity (Black, Hispanic, and White), age, education, and marital status were all employed as controls in our analyses.

2.4 Analysis

Utilizing the Predictive Analytics SoftWare (PASW) (version 18.0), basic descriptive statistics were generated. In order to meet the primary objective of this analysis, hierarchical (i.e., block) logistic regression was employed to then assess the ability of adaptive and maladaptive coping strategies to predict self-reported stress management, above and beyond the influence of the aforementioned confounding variables.

3 Results

Table 1 summarizes the demographic characteristics of the current sample. Most of the university employee respondents were female (56% ) and of Caucasian decent (83% ). Approximately 63% of the sample indicated they effectively managed their personal and work-related stress. Table 2 outlines the prevalence of the adaptive and maladaptive coping strategies employed. The most common forms of coping were exercise (54% ), communication with friends or family members (56% ), deep breathing (23% ), drinking to excess (16% ), and eating more (16% ).

For the first block of the hierarchal logistics regression, both adaptive and maladaptive coping were entered simultaneously. The covariate model (Model 1, displayed in Table 3) outlines the unique contributions of each independent variable in predicting one’s self-reported ability to effectively manage their stress. As a whole, the model (χ2 = 11.001, df = 2, p < 0.004) was statistically significant, and correctly classified approximately 59% of the cases. For the second block of the hierarchal logistic regression, covariates were entered. Overall, the -2 x log-likelihood and associated chi-square statistics (χ2 = 26.462, df = 10, p < 0.003) were statistically significant, indicating the model was able to distinguish between those who were, and were not, able to effectively manage stress. The non-significant Hosmer-Lemeshow goodness of fit test (χ2 with 8 df = 4.768, p = 0.782) provided further support for the model’s overall reliability and fit.

As seen in Table 3, both predictor variables made a unique, statistically significant (p < 0.05) contribution to predicting employee’s perceived ability to effectively manage their stress. However, only adaptive coping strategies (B = 0.265) predicted whether someone would self-identify as effectively managing their stress, above and beyond that of the covariates. Adaptive coping strategies recorded an odds ratio of 1.304 (CI = 1.094, 1.554; p < 0.003), indicating that using more adaptive coping strategies would increase the probability that someone will self-report effectively managing their stress. The use of maladaptive coping strategies (B = –0.424) was not a significant predictor of self-reported stress management (p < 0.076), recording an odds ratio of 0.654 (CI = 0.410, 1.045). However, it is of practical importance to note the negative relationship, indicating that as one increases the use of maladaptive coping strategies (e.g., alcohol, tobacco and drug use), the likelihood of self-reporting effectively managing stress is reduced.

4 Discussion

This study examined how non-student employees at a large public southeastern 4-year university cope with stress, whether their coping strategies are adaptive (protective to health) or maladaptive (detrimental to health), and determined if the manner in which individuals cope with stress (i.e. adaptive or maladaptive) influenced perceived stress management. Overall, more than half of employees surveyed (63.2% ) reported effective management of personal and work stress. This finding echoes previous investigations documenting a majority (74% ) of university employees reporting being able to handle work stress “well” or “fairly well” [42]. The most frequently used adaptive coping strategies were communication with a friend or family member (56.3% ) and exercise (53.7% ). Other studies have also found seeking social support to be the most frequently used coping strategy among employee populations [43, 44], and physical activity has been repeatedly correlated with stress reduction [45].

Findings from this investigation mirror Hu and Cheng [46], who documented that actual coping strategies employed may influence employees’ perceived stress management abilities. More specifically, adaptive coping strategies were found to be more influential than maladaptive coping strategies on perceived stress management. Furthermore, as the quantity of adaptive coping strategies used increased, the probability that an individual would self-report effectively managing his or her stress also increased. These findings suggest stress management programs focused on increasing use of adaptive coping may have a greater impact on employee stress management than those focused on decreasing use of maladaptive coping.

That said, simply teaching and/or promoting adaptive coping skills is not enough. Coping is not only a reaction to stressful experiences but also a consequence of coping resources [47, 48]. Thereby increasing the availability of resources in the workplace to facilitate the use of adaptive coping strategies is necessary for successful stress management. Research shows the most effective stress management programs utilize a range of strategies [49 –51] and are tailored to the organization and participants [15 , 53]. For example, depressive symptoms and somatization in employees most at risk for leaving their jobs were decreased by enhancing workplace coping resources of social support and positive work team functioning [54].

While a focus on adaptive coping is recommended, practitioners should not ignore the maladaptive coping strategies of employees. This study found a negative influence of maladaptive coping strategies on one’s perceived ability to manage stress and identified the most frequently used maladaptive coping strategies as drinking alcohol (16.4% ) and eating more than usual (15.5% ). Reliance on such coping behaviors could increase an individual’s health risks, as maladaptive coping strategies are often associated with negative impacts on one’s health [24 –26].

4.1 Limitations

This study has several limitations that should be considered in unison with the result. First and foremost, due to its cross-sectional nature we are unable to speak to the causal relationship between perceived stress management and coping behaviors. Additionally, this investigation reports on only one workplace and the response rate was low (54% ), thus limiting the ability to generalize these findings to other employee populations. This study also is limited by the use of a single item to measure perceived stress management and potential social desirability, response, and recall biases associated with self-report data. Moreover, it is possible that respondents who reported using alcohol to cope with stress were underrepresented as some may be unaware that they were drinking in order to cope. Finally, coping efforts must be considered within the context of their use to accurately understand their value [21]. Future research should therefore seek to better understand why individuals use different coping strategies, how those coping strategies are perceived, as well as one’s perceived competency in performing these behaviors.

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