Tag: Stress

Causes of Anxiety Disorders (Physical Disorder or Drug)

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Anxiety can also be caused by a general medical disorder or the use or discontinuation (withdrawal) of a drug.

General medical disorders that can cause anxiety include the following:

  • Heart disorders, such as:
    • Heart failure; and
    • Abnormal heart rhythms (arrhythmias)
  • Hormonal (endocrine) disorders, such as:
    • An overactive adrenal gland (hyperadrenocorticism); or
    • Thyroid gland (hyperthyroidism); or
    • A hormone-secreting tumour called a pheochromocytoma.
  • Lung (respiratory) disorders, such as:
    • Asthma; and
    • Chronic obstructive pulmonary disease (COPD).

Even fever can cause anxiety.

Anxiety may occur in dying people as a result of fear of death, pain, and difficulty breathing.

Drugs that can trigger anxiety include the following:

  • Alcohol;
  • Stimulants (such as amphetamines);
  • Caffeine;
  • Cocaine;
  • Many prescription drugs, such as corticosteroids; and
  • Some over-the-counter weight-loss products, such as those containing:
    • The herbal product guarana;
    • Caffeine; or
    • Both.

Withdrawal from alcohol or sedatives, such as benzodiazepines (used to treat anxiety disorders), can cause anxiety and other symptoms, such as insomnia and restlessness.

Causes of Anxiety Disorders

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The causes of anxiety disorders are not fully known, but the following may be involved:

  • Genetic factors (including a family history of an anxiety disorder);
  • Environment (such as experiencing a traumatic event or stress);
  • Psychologic makeup; and/or
  • A physical condition.

An anxiety disorder can be triggered by environmental stresses, such as the breakup of a significant relationship or exposure to a life-threatening disaster.

When an individual’s response to stresses is inappropriate or an individual is overwhelmed by events, an anxiety disorder can arise. For example, some individuals find speaking before a group exhilarating. But others dread it, becoming anxious with symptoms such as sweating, fear, a rapid heart rate, and tremor. Such individuals may avoid speaking even in a small group.

Anxiety tends to run in families. Doctors think some of this tendency may be inherited, but some is probably learned by living with anxious individuals.

Did You Know?

  • Anxiety disorders are the most common type of mental health disorder.
  • Individuals with an anxiety disorder are more likely than other individuals to have depression.

Identifying Mental Illness

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Mental illness cannot always be clearly differentiated from normal behaviour.

For example, distinguishing normal bereavement from depression may be difficult in people who have had a significant loss, such as the death of a spouse or child, because both involve sadness and a depressed mood.

In the same manner, deciding whether a diagnosis of anxiety disorder applies to people who are worried and stressed about work can be challenging because most people experience these feelings at some time.

The line between having certain personality traits and having a personality disorder can be blurry.

Thus, mental illness and mental health are best thought of as being on a continuum.

Any dividing line is usually based on the following:

  • How severe the symptoms are;
  • How long symptoms last; and
  • How much symptoms affect the ability to function in daily life.

Mental Health & the HSE

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Introduction

In their Annual Report and Accounts 2017/2018, the Health and Safety Executive (HSE) stated that there were “0.5 million work-related stress, depression or anxiety cases (new or long-standing) in 2016/17” (HSE, 2018, p.9).

What is the HSE?

“HSE is the independent regulator for work-related health and safety in Great Britain. We are committed to playing our part in the wider health and safety system to ensure that others play theirs in creating healthier, safer workplaces. We also deliver wider functions such as regulatory schemes intended to protect the health of people and the environment, balancing the economic and social benefits that chemicals offer to society.” (HSE, 2018, p.10).

HSE and Stress

HSE states that where (work-related) stress is prolonged it can lead to both physical and psychological damage, including anxiety and depression, and that work can also aggravate pre-existing conditions, and problems at work can bring on symptoms or make their effects worse.

They go on to state that whether work is causing the health issue or aggravating it, employers have a legal responsibility to help their employees. Work-related mental health issues must to be assessed to measure the levels of risk to staff. Where a risk is identified, steps must be taken to remove it or reduce it as far as reasonably practicable.
Some employees will have a pre-existing physical or mental health condition when recruited or may develop one caused by factors that are not work-related factors.

Employers may have further legal requirements, to make reasonable adjustments under equality legislation.

Information about employing people with a disability can be found on GOV.UK or from the Equality and Human Rights Commission in England, Scotland, and Wales.

There is advice for line managers to help them support their employees with mental health conditions.

What is the Stevenson Farmer ‘Thriving at Work’ Review?

In 2017, the UK government commissioned Lord Stevenson and Paul Farmer (Chief Executive of Mind) to independently review the role employers can play to better support individuals with mental health conditions in the workplace.

The ‘Thriving at Work’ report sets out a framework of actions – called ‘Core Standards’ – that the reviewers recommend employers of all sizes can and should put in place.

The core standards were designed to help employers improve the mental health of their workplace and enable individuals with mental health conditions to thrive.

By taking action on work-related stress, either through using the HSE Management Standards or an equivalent approach, employers would be able to meet parts of the core standards framework, as they would:

  • Form part of a mental health at work plan;
  • Promote communications and open conversations, by raising awareness and reducing stigma; and
  • Provide a mechanism for monitoring actions and outcomes.

Can Mental Health and Work-related Stress be Interlinked?

Work-related stress and mental health problems often go together and the symptoms can be very similar. For example, work-related stress can aggravate an existing mental health problem, making it more difficult to control. And, if work-related stress reaches a point where it has triggered an existing mental health problem, it becomes hard to separate one from the other.

Common mental health problems and stress can exist independently. For example, an individual can experience work-related stress and physical changes such as high blood pressure, without having anxiety, depression or other mental health problems. They can also have anxiety and depression without experiencing stress.

The key differences between them are their cause(s) and the way(s) they are treated.

  • Stress is a reaction to events or experiences in someone’s home life, work life or a combination of both.
  • Common mental health problems can have a single cause outside work, for example bereavement, divorce, postnatal depression, a medical condition or a family history of the problem.

However, an individual can have these sorts of problems with no obvious causes. Employers can help manage and prevent stress by improving conditions at work. But they also have a role in making adjustments and helping the individual manage a mental health problem at work.

Linking HSE’s Management Standards, and Mental Ill Health and Stress

Although stress can lead to physical and mental health conditions, and can aggravate existing conditions, the good news is that it can be tackled.

By taking action to remove or reduce stressors, an employer can:

  • Prevent an individual becoming ill; and
  • Avoid those with an existing condition becoming less able to control their illness.

HSE’s Management Standards approach to tackling work-related stress establishes a framework to help employers tackle work-related stress and, as a result, also reduce the:

  • Incidence of mental ill health; and
  • Negative impact of mental ill health.

The Management Standards approach can help employers put processes in place for properly managing work-related stress. By covering six key areas of work design employers will be taking steps that will:

  • Minimise pressure;
  • Manage potential stressors; and
  • Limit the negative impact that the work could have on their employees.

References

HSE (Health & Safety Executive). (2018) Annual Report and Accounts 2017/18. Available from World Wide Web: http://www.hse.gov.uk/aboutus/reports/ara-2017-18.pdf. [Accessed: 18 November, 2019].

HSE (Health & Safety Executive). (2019) Mental Health. Available from World Wide Web: https://www.hse.gov.uk/stress/mental-health.htm. [Accessed: 18 November, 2019].

The Workplace & Common Mental Health Problems

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1.0 Pre-2010

Common mental health problems are widespread and debilitating. Surveys carried out in Great Britain and internationally indicate that at any one time about one adult in six in the general population has a condition such as anxiety or depression. Incidence is higher among women and in people aged 45-54 years and there appears to be an upward trend in their rates over the last 15 years (Deverill & King, 2009). About three-quarters of adults with a common mental health problem are not in receipt of medication or counselling, including two thirds of those assessed as having a level of symptoms sufficient to warrant treatment (Deverill & King, 2009).

These levels of prevalence are mirrored among working age adults. At any one time nearly one worker in six will be experiencing depression, anxiety or problems related to stress. This increases to one in five when drug or alcohol dependence are included (Sainsbury Centre, 2007).

Although most of these mental health problems are unrelated to issues at work (HSE, 2007), there may be associations with workplace conditions such as long work hours, work overload, lack of control over work, lack of participation in decision making, poor social support and unclear management and work role, with some correlation with poor management style (Michie & Williams, 2003; Stansfeld, 2002; Berkels et al., 2004; Sanderson & Andrews, 2006). High demands and low support at work have been shown to be predictive of depressive symptoms worsening, independent of individual personality traits (Paterniti et al., 2002). Women are at risk of increased depression and anxiety if the management style at their workplace is not inclusive or considerate; and male employees are more at risk if they feel excluded from decision making (Kivimaki et al., 2003a; Ylippaavalniemi et al., 2005; Kivimaki et al., 2003b).

Against the backdrop of an economic recession and a labour market under pressure, people may increasingly be underemployed – that is involuntarily working part-time or for a wage at or below the poverty level because they have lost their former employment. Underemployment is an independent risk factor for worsening mental health and such suboptimal jobs may contribute to depression (Dooly et al., 2000; Friedland & Price, 2003).

The changing nature of work itself adds another layer of risk to mental health. For example atypical work, such as seasonal or casual work or fixed-term or subsidised jobs for people moving off benefits linked to unemployment support, is associated with significantly worse mental health (Sanderson & Andrews; 2006).

In summary, common mental health problems are the dominant health problem in the working age population (HWWB, 2009). Despite high rates of mental ill health, there are indications that almost half of employers think between none and one in twenty of their employees will ever experience a mental health problem during their working lives (Shaw Trust, 2006).

Low awareness among employers about the extent mental ill health, coupled with inadequate levels of treatment for those with these conditions and pervasive stigmatising public attitudes towards mental health problems (TNS Social, 2009), result in the perpetuation of a set of circumstances that are personally and financially costly to individuals, their families and their workplaces. An effective approach to the management of common mental health problems in the workplace could minimise or avert many of the related problems and costs associated with staff turnover, absenteeism and presenteeism (Sainsbury Centre, 2007; Sanderson & Andrews, 2006; Hilton, 2007).

2.0 Post-2010

Moving past 2010, the last decade has witnessed progress from employers regarding mental health. For example, many large employers now offer mental health-related services as part of their employee assistance programmes (EAP).

There are also many more opportunities outside of the workplace – such as charities and NHS services – that both employers and employees can turn to; many just need to be aware of them and be signposted.

Although there have been improvements, there is still much to be done.

3.0 References

Berkels, H., Henderson, J., Henke, N., Kuhn, K., Lavikainen, J., Lehtinen, V., Ozamiz, A., van den Heede, P. & Zenzinger, K. (2004) Mental Health Promotion and Prevention Strategies for Coping with Anxiety, Depression and Stress-Related Disorders in Europe. Final Report 2001-2003. Dortmund/Dresden/Berlin: WHO.

Deverill, C. & King, M. (2009) Common Mental Disorders. In: McManus, S., Meltzer, H., Brugha, T., Bebbington, P. & Jenkins, R. (eds) Adult Psychiatric Morbidity in England: Results of a household survey. The NHS Information Centre. (www.ic.nhs.uk/pubs/psychiatricmorbidity07).

Dooley, D., Prause, J. & Ham-Rowbottom, K.A. (2000) Underemployment and depression: longitudinal relationships. Journal of Health and Social Behaviour. 41, pp.421-436.

Friedland, D.S. & Price, R.H. (2003) Underemployment consequences for the health and wellbeing of workers. American Journal of Community Psychology. 32, pp.33-45.

Hilton, M. (2007) Getting upstream of psychological disability in the workforce – who are we not seeing and at what cost? Presentation available from: http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC003869.

HSE (Health and Safety Executive). (2007) Self-Reported Work-Related Illness 2005/06. Available from World Wide Web: http://hse.gov.uk/statistics/tables/0506/swit1.htm. [Accessed: 20 November, 2019].

HWWB (Health, Work and Wellbeing). (2009) Working our Way to Better Mental Health: A framework for action. Available from World Wide Web: http://www.workingforhealth.gov.uk/Initiatives/Mental-health-and-employmentstrategy/Default.aspx. [Accessed: 20 November, 2019].

Kivimaki , M., Vahtera, E.J., Virtanen, M. & Stansfeld, S.A. (2003b) Association between organizational inequity and incidence of psychiatric disorders in female employees. Psychological Medicine. 33, pp.319-326.

Kivimaki, M., Elovainio, M., Vahtera, J. & Ferrie, J.E. (2003a) Organisational justice and health of employees: prospective cohort study. Occupational Environmental Medicine. 60, pp.27-34.

Michie, S. & Williams, S. (2003) Reducing workrelated psychological ill health and sickness
absence: a systematic literature review. Occupational and Environmental Medicine. 60, pp.3-9.

Paterniti, S., Niedhammer, I., Lang, T., & Consoli, S.M. (2002) Psychosocial factors at work, personality traits and depressive symptoms: Longitudinal results from the GAZEL study. British Journal of Psychiatry. 181(2), pp.111-117.

Sainsbury Centre. (2007) Mental Health at Work: Developing the Business Case. London: Sainsbury Centre for Mental Health.

Sanderson, K. & Andrews, G. (2006) Common mental disorders in the workforce: Recent findings from descriptive and social epidemiology. Canadian Journal of Psychiatry. 51(2), pp.63-75.

Shaw Trust (2006) The Last Workplace Taboo. Available from World Wide Web: http://www.tacklementalhealth.org.uk. [Accessed: 20 November, 2019].

Stansfeld, S. (2002) Work, personality and mental health. British Journal of Psychiatry. 181, pp.96-98.

TNS Social (2009) Attitudes to Mental Illness 2009. Research Report. JN189997. Available from World Wide Web: http://www.library.nhs.uk/mentalHealth/ViewResource.aspx?resID=319335. [Accessed: 20 November, 2019].

Ylippaavalniemi, J., Kivimaki, M., Elovainio, M., Virtanen, M., Keltikangas-Jarvinen, L. & Vahtera, J. (2005) Psychosocial work characteristics and incidence of newly diagnosed depression: a prospective cohort study of three different models. Social Science Medicine. 61, pp.111-112.