• Observatory: EurWORK
  • Topic:
  • Published on: 22 November 2010


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The work-related stress is still not high on the agenda of the Bulgarian institutions and social partners and is an underestimated issue at the workplace. The legislation and the National strategy on health and safety 2009-2012 contain some provisions for tackling the problems of work-related stress in the framework of more broad concepts of the wellbeing and psychosocial risks prevention. The research on stress is not systematic and the results are rarely publicly announced. There is also no comprehensive national policy on preventing and managing stress at work. More actively engaged with the stress issues is the Confederation of Independent Trade Unions in Bulgaria, which conducted few surveys and organised a National tripartite conference on stress in 2003.

Q1 Monitoring work-related stress at the national level

1. Are there any instruments in place to monitor work-related stress at the national level, for example, national surveys, sectoral studies, epidemiological studies, action research, or other research programmes? Please describe the main sources of information available on work-related stress in your country (coverage, methodology, definitions used, etc.).

There is no nationally representative surveys especially targeting stress. An epidemiological survey on mental health was carried out as part of an International survey (2002-2007) in 40 countries which partially touched the stress issues. In Bulgaria the sample included 5,318 persons and the survey was conducted in 2006. Due to technical problems the results are not yet published, but according to some preliminary data Bulgaria is at the top with very high levels of stress and depression.

However there is a significant amount of small studies on stress in different branches or professions, carried out mainly by researchers of the Institute of Psychology (Институт по психология, IP) and the National Centre for Public Health Protection (Национален център по опазване на общественото здраве, NCPHP).

Also active in the field is the Confederation of Independent Trade Unions in Bulgaria (CITUB). The Institute for Social and Trade Union Research at CITUB conducted few surveys of stress in the period between 2001 and 2005. In 2003, CITUB organised the first ever national tripartite conference which gathered more than 150 researchers, social partners and government representatives. The reports presented at the conference were published (see CITUB, 2003).

A. The pilot survey ‘Work stress in the context of transition. A case study of three public sectors in Bulgaria’ was carried out in 2002 by the Institute for Social and Trade Union Research (ISTUR) at CITUB. The survey was published by ILO. The study aimed at providing an in-depth analysis of the specific factors and sources of stress, and the extent to which they have been influenced by the process of transition. The study covers the three largest and most important public sectors – education, health and public administration at both the central and local government level. The survey is representative for these sectors.

Methodology: The random clustered sample of 1,026 respondents was distributed equally among the three sectors. The survey covered 45 cities nationwide. A face-to face interview containing 47 questions was conducted. The response rate was 97%, i.e. 995 persons were interviewed. The research team used a special methodology for assessing the level of stress based on grading of variables which is presented in the publication.

B. The survey of the Ministry of State Administration and State Reform (MDAAR), entitled Employee turnover, working conditions and motivation of civil servants was conducted in 2008 within the framework of the project ‘Improvement of human resource management policy within the state administration’ under the Operational Programme Administrative Capacity 2007–2013 . It examines civil servants’ perceptions about stress at work, factors causing stress, job satisfaction or dissatisfaction, and motivation.

Methodology: The quantitative study was conducted among a representative random sample of 4,000 civil servants chosen from three target groups: managers, professionals and auxiliary staff using structured face-to-face interviews.

C. Empirical psychological survey of judges in Bulgaria conducted in 2008 by the Union of psychologists in Bulgaria entitled ‘Stress and copying with the stress’ aims to define the level of stress and to propose coping measures.

Methodology: face to face structured interviews. The survey used proportional regional sample. The target population was 474 people representing 8.65% of all judges in the country.

Definition: Stress is defined as negative emotional state of the person due to lack of resources to handle certain situations.

D. General Labour Inspectorate (GLI –EA) - Survey on stress (2003)

Methodology: Questionnaire based survey with 196 employees in professions which are considered risky, including nurses, medical doctors, bus drivers, barmen and social workers. The questionnaire includes questions about the presence of stress at the workplace, main stress factors and subjective health problems.

2. Provide, if available, data on the overall level of work-related stress based on the identified sources. If possible, identify the main trends in this matter presenting data (e.g. for the last five years).

There are no data available for the overall level of work-related stress at country level. The existing studies were single, used different methodologies, small samples in some branches or of some professions, thus it is difficult to compare or to identify the trends over the years.

The identified levels of stress resulting from the surveys cited above are as follows:

According to the ISTUR survey, 59.7% of the respondents had experienced stress exposures in the 12 months prior to the survey.

According to the MDAAR survey in public administration almost three quarters of the respondents pointed out either very high (22.5% ) or high (50.7%) levels of work-related stress.

According to the results of the survey of judges about half of the respondents reported stress, including 24.4% - at low level and 22.0% - at medium level. No one of the respondents reported high level of stress.

80% of the respondents in the GLI survey consider their work stressful, while 45% of them said that the work-related stress is permanent.

Q2 Risk factors for work-related stress

Based on the main or most used monitoring instruments available (identified in Q1), please provide information on the following risk factors for stress.

Note: If available, please provide information on the main changes or trends in text. Any tables with figures illustrating those trends should be included in annex (if possible, breakdown the data by gender and/or other relevant variables).

Quantitative demands: workload, working hours, quantity and intensity of work.

Respondents to ISTUR survey indicated as stress factors: insufficient number of staff (84.0%), overtime (78.3%), about 70% mentioned also long working hours, night shifts, work at weekends, varying workload and work pace. Several components of work organization are assessed by an overwhelming majority of employees in the three sectors as considerable stressors: short deadlines that affect the quality of work and job satisfaction (92.5%); administrative formalities and paperwork (91.4%); contradictory assignments (89.1%); the need to do more work than required by the job description, or to do work that is not part of the job description (82.5%). More than 70% of the respondents define the following as stress factors: the absence of staff training programmes, especially when it comes to new equipment (76.9%); and growing demands with respect to the quality of work (73.2%).

About half of the respondents (51.3%) in the Survey of MDAAR indicated that their jobs had evolved to encompass a diverse range of responsibilities that had significantly increased their workload and stress levels. The time pressure was also cited as stress factor (48.1%).

Qualitative demands: these refer to emotional and cognitive demands at work and may include work-life balance issues, complexity of work, dealing with angry clients and suffering patients, feeling afraid, having to hide emotions, etc.

In the ISTUR survey, psychological abuse is quoted as a stressor by 88.8% of the respondents, the risk of physical abuse by 82.7%, while working with too many people causes stress for 74.9% of respondents.

Relations at work which may include social support from colleagues or supervisor, management style and relationships with colleagues/managers/the organisation; violence and harassment at work.

In the ISTUR survey, more than half of all respondents referred to some characteristics of the organisational climate as stressors: poor management of human resources that does not provide motivation for good performance (63.3%); the absence of personal data confidentiality (55.4%); the existence of “friendly circles” or cliques in the team (51.7%); the risk of suffering negative consequences due to information shared with colleagues (51.9%); and the impossibility for career advancement without acting in contradiction with one’s values (51.5%).

Some respondents in the MDAAR survey also mention poor relations with colleagues (16%) as a stress factor.

Autonomy, decision latitude and room for manoeuvre: control over work, including control over pace of work and over job content and decision-making power; predictability of work, use and possibility to develop skills.

A fifth of the respondents (22.8%) in the MDAAR survey pointed to too many tasks but low autonomy in decision making. Almost another fifth (17.3%) complained about the lack of clearly defined tasks to be performed. Other stress factors also mentioned are: doing monotonous work (12%); lack of clearly defined job descriptions (9.1%); and high complexity of tasks (6.2%).

Individual and collective mechanisms for employees’ involvement, particularly in relation to organisational change and change management, including communication of change.

There are no data available.

The perception of the role that the employee holds in the organisation and whether the employee is clear about what is expected of them in terms of their job; clarity of the management changes, i.e., how organisations manage and communicate change; motivation; over commitment and reward.

For 81.1% of the respondents of the ISTUR survey the absence of an adequate link between work performed and remuneration received is a stress factor, while for 59.4% the stress factor is the discrepancy between job performance and promotion. Meanwhile, the feeling that the improvement of professional skills is not encouraged or appreciated is a matter of concern and stress for 51.5%.

Low remuneration was the most frequently experienced work-related stress factor, reported by 66.7% of the respondents in the MDAAR survey, while 27.4% mentioned lack of performance assessment.

Conflicts of value and organisational justice.

There are no data available.

Precariousness of work (i.e. nature of the employment contract).

There are no data available.

If there are no surveys or large scale research programmes available, please provide information on how stress is measured/assessed in other sources: qualitative research data on stress risk assessment at company level or sectoral level, studies with a focus on specific occupations, etc.

Q3 Work-related stress outcomes

Please provide information (including references to the sources or studies) on stress-related outcomes:

Individual outcomes (e.g. mental health illnesses, including depression and anxiety, and physical illnesses, such as cardiovascular diseases, musculoskeletal disorders (MSDs), disabilities, fatigue and sleeping problems);

The ISTUR survey revealed high incidence of most chronic stress symptoms, indicating a high level of chronic stress with psychosomatic, emotional and behavioural effects. The incidence of sporadically manifested symptoms representing moderate stress levels or incidental stress reactions is even higher. The average for the study is 9.7 symptoms per person (3.4 chronic and 6.3 sporadic). Between the most frequently cited stress symptoms were: general fatigue – 56.5%; thinking about the job in the free time – 36.8%; headache – 31.5%; eyesight problems – 30.7%; easy fatigue– 25.5%; back pain – 22.9%; irritability – 19.8%; insomnia- 18.0%; morning fatigue- 14.4%; and muscle and joint pain- 13.7%. Among the ten most frequent symptoms are those suggesting nervous mental and negative emotional tension, as well as physical and emotional exhaustion, as part of the “burn-out” syndrome.

The survey of judges show that the respondents with low level of perceived stress reported 10 symptoms related to stress (strain and exhaustion, irritability, feeling trouble, continual tenseness and accumulation of fatigue, making more mistakes than usual, depression, strong exhaustion, desire to escape and to hide for a short time, feeling one-self stressed, frequent headaches), while those with medium level of stress added seven symptoms more, namely: health problems related to constant nervousness, feeling one-self in poor shape, feeling anxiety and fears about the future, being in horrible mood, ungrounded aggression, feeling the nervous system broken and feeling one-self unable to work.

According to 65% of the respondents in the GLI survey, stress leads to cardio-vascular diseases, psychological disorders and depression. The reported subjective symptoms of stress include: strain, anxiety disorders, worsen coordination and psycho-somatic disorders. In order to relieve stress, 30% of the respondents mentioned having increased the use of drugs, alcohol and cigarettes.

The social construction of stress by group of workers: can you provide references and main findings of research discussing this issue; factors acknowledged as stressful by some group of workers; groups which refer to stress or not to describe unsatisfactory situations

The ISTUR survey showed that certain characteristics of the workforce and jobs in public healthcare, education and public administration add to the risk of work stress. All these sectors –and especially the first two – are strongly feminised. In principle, the major professions in these sectors (teachers, doctors, nurses, servants in employment offices and social aids offices, etc.) are defined as high stress positions because of the specific nature of the jobs and their responsibilities which include care for patients, students, unemployed and socially disadvantaged persons. In addition, the people practising these professions work on a daily basis with specific social groups – people who are ill, students, the socially disadvantaged or the unemployed. In these sectors there is an increased exposure to stress also due to continuous reforms during recent years, including both amendments to the legal framework in line with the harmonisation with the European legislation and the transition to a market economy and substantial staff reductions. This has led to confusion and tension with respect to compliance with new requirements, an excessive workload for many of the staff, and a constant fear of job loss. In addition, in these sectors both the salaries and funding from the state budget are low. The combination of work-related stress and other types of stress has increased the frustration of the workers and their ability to cope with stress decreased.

Organisational outcomes (effects that individual stress outcomes have on organisations, e.g. absence from work, job satisfaction, morale, level of commitment, productivity, and the impact of these outcomes on organisations’ costs, performance, or innovation capacity);

According to the ISTUR survey, 22.4% of all respondents used different types of leave due to work-related stress: 7.7% went on sick leave, 13.6% on paid leave and 1.1% on unpaid leave. Some 37.4% of all respondents who went on leave because of stress obtained sick leave due to indications of clinical stress conditions. Meanwhile, 39.2% of respondents suffered stress but did not go on leave (‘presenteeism’). The survey also revealed that absence due to stress is causing serious disruption of the work organisation in health and education sectors.

The MDAAR survey in public administration showed high levels of turnover due to high overload and stress.

Labour Market or Societal level outcomes (the ‘costs’ to society of stress). This could include issues such as higher levels of unemployment and of recipients of incapacity benefits, costs to health and welfare systems, loss of productivity.

According to estimates from the ISTUR survey 7.7% of the workplace absences from work due to sickness are caused by occupational stress. Calculated on that basis the financial cost of stress is 0.03% of the GDP which is significantly lower than the estimates for many of the EU member-states. Some of the reasons for this are: low proportion of salaries in total GDP, and hence lower cost in terms of sickness, occupational accidents and diseases benefits; social security coverage based on the minimum wage; grey economy (representing according to expert estimates more than 30% of GDP); presenteeism, etc.

Q4 Interventions on work-related stress management

What relevant information is available about interventions on work-related stress management and their effectiveness?

Are any interventions in place to prevent or manage work-related stress? If so, what kind of interventions are they? Please describe them making reference to coverage, effectiveness, since when they are in place, etc.

The interventions to prevent or manage stress are rare, mainly in the framework of the general risk prevention and health promotion. This is due to the lack of commitment and capacity in the country to mobilise the organisations and institutions to elaborate and implement programmes and plans for stress monitoring and prevention.

In March 2009, the General Labour Inspectorate included in its inspections the examination of the level of stress in the companies inspected as required by the Law for healthy and safe working conditions. The inspector asks the employees whether they work to tight deadlines, experience pressure of time, bullying or harassment, lack autonomy, etc. The inspector also checks the existence of programmes for stress prevention. However, the evaluation is very subjective and perfunctory. In case of high level of stress (if more than half of employees reported stress) the fine to the employer is about 2,500€.

Which organisations are promoting these interventions? E.g. at national level (health and safety authority, labour inspectorate, social partners, government), at sectoral or at company level?

According to the legislation the issues of work-related stress are in the domain of many institutions at different levels (Ministry of Health, National Centre for Public Health Protection, Labour Inspectorate, company occupational medicine offices, general practitioners, employers), which hinders the coordination of such interventions and their effectiveness. The employer is obliged to provide a working environment with low level of stress, while the occupational medicine office, (all enterprises are obliged to have such office or to use the services of an independent occupational medicine office) must elaborate a programme for stress prevention.

Are the interventions devised to be implemented at the primary (action on causes) / secondary (action on individuals) or tertiary (action on the consequences of stress) stage?

As far as such interventions exist they target mainly the primary stage – action on causes.

Are any common instruments to measure stress at organisational level being used, developed, tested or assessed? Please describe them, indicating since when they are in place.

There are no common instruments.

Please identify and describe up to three examples of good practice and their effectiveness in terms of stress management, with a special focus on the lessons learned. These can be at national, sectoral or organisational level.

Programme for prevention and management of the work-related stress in the Ministry of Interior

Implemented in 2004, this programme aimed at reducing the impact of stress on policemen. Includes: psychological consultations in special offices and hot telephone line; debriefing; specialised training and dissemination of information on stress through printed materials and special web-site; regular surveys. The Programme includes also actions under the Peer-support project aimed at decreasing occupational stress and emotional strain through psychological support by colleagues. Although there is no official assessment of the programme it might be considered a good practice example as it is the first programme at ministerial level.

Programme “Working on Stress’ of the Non-ferrous Manufacture Company (KCM) – Plovdiv

KCM is a private company employing 1400 workers. The Programme ‘Working on stress” was introduced in 2005 and was in line with the company policy for health and safety and workplace health promotion.

The programme aimed at:

  • awareness rising of the employees on work-related stress and types of stress-related outcomes;

  • implementation of appropriate relaxing techniques for coping with stress-related outcomes;

  • increasing individual and team resistance towards psycho-emotional stressors at work.

There is no special assessment of the programme. However, due to well developed social dialogue and effective work of the working conditions council, regular monitoring of all programmes related to working environment is carried out. In the company there are no occupational accidents, the occupational morbidity and absence rates are low. All employees are entitled to 3 days more of paid leave provided in the collective agreement, while employees working at high risk workplaces according to the company risk assessment are entitled to seven days of rest in a sanatorium.

Are there any public discussions and/or interventions that address specifically the identification, prevention and management of stress due to organisational change and restructuring? If yes, please summarise them.

There are no public discussions addressing prevention or management of stress related to organisational change or restructuring processes.

Q5 Commentary

Please provide your own/your institution/centre view on work-related stress, referring to, for example, national debates about the topic or any other issue considered important from your national perspective which was not covered by this questionnaire.

The existing studies clearly show that the work-related stress is emerging as a growing problem in Bulgarian companies, with extensive costs to individuals, organisations and society. According to the present surveys, stressors at work tend to be much more virulent during the transition from a centralized to a market economy than they are in other societies, i.e. the problems of societies in transitions are a stress catalyst.

So far, stress at work has been a neglected area of policy intervention. Despite some legislative provisions the issues of work-related stress are underestimated at all levels of the industrial relations system.

In this regard, it is important for the social partners at national and organisational level to undertake joint actions to identify and prevent work-related stress in line with the European social partners’ Framework agreement on work-related stress (78Kb PDF), which has thus far been overlooked by Bulgarian social partners. There is a clear need for comprehensive rules, nationally representative research and dissemination of good practices for monitoring and prevention of the work stress.


  • Confederation of Independent Trade Unions in Bulgaria, Union of Scientist in Bulgaria, National Centre for Public Health. First National Tripartite Conference of the Bulgarian Society of Studying and Preventing Stress. (2003) Reports and summaries, S., CITUB, 478 pages

  • Hristov Zh., L.Tomev, N. Daskalova, D.Kircheva (2003). Work stress in the context of transition. A case study of three public sectors in Bulgaria, ILO - SRO- Budapest, Report No 26, available at: http://www.ilo.org/public/english/region/eurpro/budapest/download/work_stress.pdf

  • Dimitrov, D. (2003) General Labour Inspectorate. Survey on stress, Journal ‘Safety and Occupational Medicine’2003/6

  • MDAAR, (2008). ‘Employee turnover, working conditions and motivation of civil servants’, 2008 under the Operational Programme Administrative Capacity 2007–2013

Nadezhda Daskalova, ISTUR

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