Sweden: EWCO comparative analytical report on Work-related Stress

  • Observatory: EurWORK
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  • Published on: 22 November 2010


Disclaimer: This information is made available as a service to the public but has not been edited by the European Foundation for the Improvement of Living and Working Conditions. The content is the responsibility of the authors.

Work related stress in Sweden is addressed as a part of the overall health among employees, with employers and the civil services taking responsibility for the employees’ health. The beginning of the millennium saw a small peak in work-related stress in Sweden, but since then it seems to have decreased somewhat. Among women 10.6% reported in 2008 that work had caused disorders because of stress or mental strain, and the corresponding proportion for men was 6.1%. However, stress does not have to lead to disorders in order to affect a person, and a higher percentage reports problems sleeping or relaxing after work.

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.).

In Sweden work related stress and health has been investigated for a long period of time, which means that there are several sources which investigates stress and health issues on the Swedish labour market. In particular there are three surveys with national coverage which provide information on work related stress.

The first study is the Swedish Work Environment Survey (SWES), which has been carried out by Statistics Sweden (Statistiska Centralbyrån, SCB) every other year since 1989. The 2007 survey was commissioned by the Swedish Work Environment Authority (Arbetsmiljöverket, AV) and aims to describe the work environment of the population in employment between the ages of 16 and 64. SWES was conducted using a set of supplementary questions in connection with SCB’s regular Labour Force Survey (Arbetskraftundersökningen, AKU). AKU is done via a telephone interview and has a sample size of 12,500, of whom 10,500 responded. The 10,500 who participated in AKU then received a supplementary questionnaire, which 8,000 persons responded to.

SLOSH (Swedish Longitudinal Occupational Survey of Health) is a longitudinal cohort study which follows up on the SWES of 2003. The aim of the study is to examine the relationship between work organizations, work environment and health. The study has additional questions compared to SWES, and also has the advantage that it studies the same participants over a longer period of time. The survey was commissioned by the Stress Research Institute (Stressforskningsinstitutet) and was carried out by SCB from March to May 2006.

Work Related Disorders is a survey commissioned by AV which measures new and old work related disorder as reported by the respondents during one year. Studies on work related disorders have been conducted since 1991 on the whole population, and from 2003 on the gainfully employed. The current study is from 2008, and is conducted by asking supplementary questions to the AKU.

Work related stress in all three surveys is defined according to the respondents own perception of stress, i.e. in the questions themselves. All three surveys try to look at the underlying factors of stress instead of stress itself, which means that there are few questions specifically on work related stress. Instead there are questions about difficulty in sleeping, influence at work, relaxation after work etc. The definition of work related stress is therefore a subjective opinion by the respondent.

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).

The Work Related Disorders survey found that stress and mental strain is the most common cause of work related disorders among women in Sweden, and the second most common cause among men, with the first cause being physical load.

Figure 1: ‘Work has caused disorders because of stress or mental strain’, by gender, 1998-2008 (%)


Source: Work Related Disorders, 2008

The percentage of women who answered that the “work has caused disorders because of stress or mental strain” was 10.6% in 2008, and the corresponding percentage for men was 6.1%. There has been a statistically significant increase in the number of men and women who answered the question affirmatively from 1998 to 2008.

Regarding work-related stress, 39.0% of the total population in SWES (34.0% among men and 46.0% among women) stated that “work is so stressful that you do not have time to talk or think about anything other than work (at least half the time)”. In 2005, 40.0% of the respondents stated this (35.5% among men and 44.9% among women). The figure below shows the trend in this question, which seems to be upwards sloping among women since 2003, but the trend among men seems to be fairly constant.

Figure 2: ‘Work is so stressful that you do not have time to talk or think about anything other than work (at least half the time) ‘, by gender, 1999-2007, %


Source: SWES, 1999, 2001, 2003, 2005, 2007

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.

Table 1: Quantitative demands by gender, 2005 and 2007 (%)











High Workload, too much to do (agrees to a high extent)







Worked overtime during survey week







Worked more than 10 hours overtime







Source: SWES 2005, 2007

According to the SWES, the quantitative demands at work seem to be relatively unchanged since 2005.

In SLOSH about one fifth of the participants (20.0% of the women and 21.4% of the men) stated that they were dissatisfied with their contracted working hours and would have liked to work fewer hours per week. Between 2003 and 2006 there was an increase in the proportion of participants that stated that they had to skip lunch, work late or take work home. In 2003, 33.2% stated that they had to do this at least once a week, compared to 41.1% in 2006.

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.

SLOSH reports that a considerably larger percentage of women than men stated that their job put them in emotionally disturbing situations. Of the female participants, 60.9% stated that they experienced this situation sometimes or more often, compared to 38.0% of their male counterparts. More women experienced that the demands at work interfered with their home- and family life. The proportion of women who experienced this was 9.9%, compared to 8.1% of the men.

Figure 3: Can not get mind off work during my free time (every week), 1999-2007, %


Source: SWES, 2007

The percentage of those having difficulty relaxing after work has remained relatively steady over the years.

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,

Social support and relations with co-workers and managers is an important part of the social environment and lack of it can be a contributing factor to stress. SWES has questions regarding these issues, and as is shown in the diagram below the situation according to the respondents appears to be that there has been a decrease in the amount of support given to men by managers, but the situation for women appears to be relatively unchanged. Even so, men receive a higher level of perceived support from their managers.

Figure 4: Seldom/never gets support and encouragement from managers, by gender, 1997 -2007 (%)


Source: SWES, 2007

With regard to support from co-workers the percentages appears to be relatively unchanged over time for women. Men have experienced more swings in the amount of support according to the data, but the overall levels appear to be relatively unchanged as well.

Figure 5: Seldom/never gets support and encouragement from co-workers, by gender, 1999-2007 (%)


Source: SWES, 2007

According to SWES data, about one in every 8 women (13.0%) and one in five male respondents (21.0%) report that they rarely or never receive support and encouragement from their colleagues when the work becomes troublesome. This percentage is relatively unchanged over a 10-year period.

SLOSH reports similar results, but finds that the possibility to get support when work is hard has decreased over time. In 2003, 35.4% in total responded that they always had the possibility to receive support, a number that decreased to 27.0% in 2006. Regarding the general relationships with colleagues and supervisors in Sweden, 83.6% agreed with the statement that there is a good spirit of unity at their workplace, and 89.8% considered that the collaboration with colleagues worked quite or very well. 70.4% also agreed to a high or very high extent to the question “Does your manager listen to you and pay attention to what you say?”

When investigating violence and harassment at work the SLOSH-survey found that, in 2006, 2.3% of the surveyed individuals stated that they had been subject to personal persecution in the form of unkind words or behaviour from their colleagues a couple of days a month or more. This percentage is somewhat higher than the percentage for 2003, where 1.6% stated this. However, a lower percentage in 2006 (85.7%) than in 2003 (92.1%) stated that they had not been exposed at all during the last twelve months.

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.

SWES investigates factors related to autonomy and control at work, and there does not seem to be any significant changes from 2005 to 2007.

Table 2: Autonomy, control, influence and education, by gender, 2005 and 2007, %










Cannot determine when different tasks are to be done







Can control the pace of work







Has too little influence at work







Has too much influence at work







Has an opportunity to learn new things and develop in his/her profession every week







Have received education at work during the last 12 months







Source: SWES, 2005, 2007.

SLOSH has information about the development over time regarding autonomy at work. The data shows a somewhat lower proportion of individuals that experience that they are able to determine the hours they work in 2006 (63.3%) compared to 2003 (66.7%). For women autonomy at work also seems to have decreased over time. In 2003, 49.7% of the women stated that they could take short breaks at any time in order to talk, a number which decreased to 37.2% in 2006.

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

When asked if they were informed well in advance about important decisions 35.2% of the participants in SLOSH stated that they strongly disagreed, and 11.8% stated that they strongly agreed. In a question about employee involvement 68.0% stated that they were entitled to give their opinion in matters of personal interest, and concerning the statement “Does your manager listen to you and pay attention to what you say?” 70.4% agreed that this was the case. The percentage of employees who feel that their work is meaningful is 76.0% for women and 68.0% for men.

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.

Significant stress can often result from when an employee experiences an imbalance between working efforts and rewards according to new research. SLOSH investigates the effect of over commitment and of the employees’ subjective assessment of their own work effort in relationship to the rewards they receive. Among the total population 13.5% stated that they agreed and felt distressed or very distressed by the statement “Considering all my efforts and achievements, I do not receive the acknowledgement I deserve at work”. In 2006, 11.2% strongly agreed that their closest ones claimed that they sacrificed too much for their job. These questions are new additions to SLOSH, and thus there are no possibilities for comparisons over time.

Conflicts of value and organisational justice.

SLOSH has a section about organisational factors with specific questions regarding organisational justice. These questions are about organisational justice, and not specifically about the conflict between values and organisational justice.

Over half of the participants in the study from 2006 agreed or strongly agreed with the statement that decisions taken are consistent (53.1% for men and 48.0% for women) and that the same rules apply to everyone.

One question which might provide some insight into the conflict between values and organisational justice is how prone the employees are to present criticism, and 80.5% answered in the study from 2006 that they mostly not or never hesitated to present criticism of the working conditions. The percentage for 2003 was 80.6%, so no significant change has been observed.

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

Regarding the nature of the employment contract, 93.5% reported in AKU that they worked full-time, 6.5% part-time and a majority of the gainfully employed had an employment with conditional tenure or permanent job. The percentages were 85.3% of the men and 89.7% of the women. Additionally, 9.2% of the men and 3.0% of the women were self-employed.

When comparing SLOSH from 2006 with the 2003 edition, a higher percentage of both men and women experienced that there was a risk of being involuntarily transferred to new duties. In 2006, 21.8% reported that this was a risk, compared to 13.2% in 2003. The perceived risk among employees of temporary or permanent dismissal also rose during this time period, from 10.1% in 2003 to 15.3% in 2006. There were also a slightly higher percentage of men compared to women 2006 who felt threatened; 17.6% of the men compared to 13.3% of the women.

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 studies and statistics in Sweden in most cases relate to overall health, and not specifically to stress. We will present data on mental and physical illness that does not exclusively focus on stress, but on other health aspects as well. However, stress is the most cited reasons for sick-leave among women and men in Sweden and research has shown that it has a major impact on health. Some questions are new additions to SLOSH 2006 and are therefore not comparable to the numbers for 2003.

Figure 6: Work has lead to problems with… (percentage of individuals who reported this problem every day)


Source: Work Related Disorders 2008

This figure shows the physical disorders in Sweden, which seems to have decreased over time. Although this is not exclusively related to stress, research by the National Board of Health and Welfare (Socialstyrelsen) has shown that long-term stress leads to physical problems such as back or neck pain.

SLOSH also examines individual outcomes with regard to adequate sleep and exhaustion, and finds that a small part of the population suffers from these problems. However, only 62.6% reported that they definitely/mostly had adequate time for resting and relaxation, which means that a large part does have these problems occasionally. There was no significant change from 2003 to 2006 on this question.

Table 3: Individual outcomes on sleep and recuperation




Have you been troubled by the following in the last 3 months? (Always/5 times a week or more)







…difficulties falling asleep?






…difficulties awakening?







During the last 3 months, have you had a hard time sleeping because thoughts about work have kept you awake? (Every day)







Besides sleep, do you think you get adequate time for resting and relaxation between working days? (Answer: No, far from sufficient)







Source: SLOSH 2006

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.

Socialstyrelsen states in a study from 2003 that three factors appear to be acknowledged as stressful in research and in surveys: low control over work, lack of social support and high demands. These factors are more common among those with high levels of stress, and that has also been found to be a contributing factor to burnouts among employees. Läkartidningen (free translation: The Medical Journal) has found that these factors often work together and reinforce each others to create a stressful environment. The stressful effects of low control over work and high demands can be negated somewhat if there is a high level of social support from co-workers and managers, for example.

In a study by the Institute for Labour Market Policy Evaluation (IFAU) it is also shown co-workers work absence has an important influence on other employee’s behaviour and absence. Social interaction in the work place is an important factor with regards to work absence. In case of stress this would mean that a stressful situation could reinforce itself and further increase the stress level at a work place (SE0901049I).

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);

Socialstyrelsen reports on estimated costs for work related stress in range of 5-10% of GDP, €20 billion for EU. These costs are based on loss of productivity and sick leave. Efforts to reduce work related stress has lead to good results in terms of reduced sick leave and greater productivity, which suggests that the effects on organisations in Sweden are large. One particular case was Gevalia Coffee (Gevalia Kaffe) and their project which aimed to reduce work related stress and long-term sick leave. Calculations on the costs and benefits of this project found that investments were paid back four times, and at the same time sick leave was cut in half. More information on this is presented below, in the good practice example.

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.

Psychological problems (of which stress is a major contributing factor) were the most common diagnose in 2007 and has increased dramatically since 1990. In 2007 it stood for close to 40% of all newly granted sickness and activity compensations for both men and women.

Figure 7: Percentage of newly-granted sickness and activity compensation due to mental illness, 1990 – 2007


Source: Social Insurance in figures, 2008

The Swedish Social Insurance Agency reports that 20,098 persons were on sick leave due to stress-related diseases in 2006, a number that decreased to 8,482 in 2009. This decrease however is probably due to a reformation of the rules for sick leave begun by the current government, and clearer guidelines for doctors.

According to the annual report by Försäkringskassan, the total costs of absence from work for the social security system were close to SEK 108 billion in 2008 (approximately €10 billion). These figures include sick benefits and costs of rehabilitation, and correspond to approximately 4% of GDP. See SE0911039Q for more information.

There are no specific numbers for how much stress related diseases costs, but according to Försäkringskassans numbers, 11% of sick leave in Sweden is due to stress, and a corresponding number may provide an approximate estimation. If that is the case, work related stress costs nearly SEK 12 billion in 2008 (approximately €1.1 billion). However other diseases may well be associated with stress, such as depression or anxiety. One conclusion in a study from Socialstyrelsen in 2003 is that the work related mental illness and stress often are results of a long term process, and that the symptoms can be similar to depressions. In that case the diagnosis by a doctor can be depression, when the underlying reason actually is stress or exhaustion.

Some of the cases diagnosed with depression could therefore possible be attributed to stress, which means that up to 31% of all sick leaves concerns work related stress. This is the percentage of those on sick leave who are diagnosed with depression, severe stress reactions or anxiety, which all could be attributed to stress. Women are more affected by these conditions, and 34% of the sick leave diagnoses for women are attributed to these factors. The corresponding number for men is 26%.

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.

Interventions on work related stress in the Swedish labour market fall under health and safety, and there seems to be few interventions aimed solely at work related stress. However, this is a major and growing problem; mental illness is now the most common diagnose for those with newly-granted sickness or activity compensation.

The responsibilities of the employer on issues regarding the working environment and work related stress are stipulated in the Work Environment Act (Arbetsmiljölagen, AML) from 1977. It states that every company shall see health and safety as a natural part of their daily work. In relation to this all companies in Sweden shall conduct a systematic working environment routine (systematiskt arbetsmiljöarbete, SAM) which is also regulated by law.

SAM states that employers shall actively work with all physical, psychological and social relationship concerning the employees’ health. The employer’s responsibility concerns prevention of illness and the effects of stress in the workplace. Employers shall carry out regular assessments on the risk that an employee falls ill and for companies with more than 9 employees this shall be documented in writing.

All work places in Sweden with more than 5 employees shall also have a safety representative who works with issues relating to health and safety among the employees. The safety representative is part of the planning and implementation of SAM, and for example investigates the working conditions, plans interventions and works on the annual reviews.

SAM also states that employers shall take preventive action to protect the employees’ health and that this shall be done as soon as possible in order to prevent illness or accidents. The employees shall also have an opportunity to review the SAM and provide feedback, which means that they have a responsibility for improving working conditions. About half of the men (54%) and women (53%) state that SAM is being done in their workplace in SWES.

Most of the preventive efforts regarding work related stress are done in a framework defined by SAM and AML. For example, Satsafriskt (free translation: Effort for Health ) was a constellation of employers and trade unions who gave economic support and expert help to different projects within public authorities that aimed to improve the working conditions and decrease short-term and long-term sick leave by preventing illness. The project aimed at improving SAM-procedures and improving employer’s daily work with SAM.

In case an employee goes on sick leave the employers also have responsibility for rehabilitation in the workplace, and such measures include adapting the workplace, changing work tasks, redeployment, education and changing working hours. The public health care sector has responsibility for the medical treatment, and the municipality has responsibility for social actions. The overall responsibility lies with Socialstyrelsen.

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?

AV is the government organisation in charge of the working environment and their role is to provide a basis for SAM in all companies.

The Swedish Work Environment Authority’s Statute Book (Arbetsmiljöverkets författningssamling, AFS) provides provisions for how Swedish companies should satisfy their responsibility for the working environment, and how they should work with these issues on a daily basis. Their role is to lead, coordinate, support and develop the work on rules and regulations regarding the working environment, and they also provide advice and education on these issues.

The companies have a large roll in promoting interventions, since they are responsible for their own working environment. Their role is to ensure that SAM is being done in the work place, and to assess the employees’ health and security. In this work they can get assistance from trade unions and employers’ organisations, which can provide help with working conditions and health issues for the employees.

An important such organisation in Sweden is Prevent (Prevent), which is a co-operation between The Confederation of Swedish Enterprise (Svenskt Näringsliv), the Swedish Trade Union Confederation (Landsorganisationen, LO) and the Council for Negotiation and Co-operation (Förhandlings- och samverkansrådet, PTK). Prevent aims to provide knowledge and education regarding the daily working environment, with work related stress being one of their main areas. They also work with developing methods and support for improving the working environment. Prevent is financed by AFA Insurance (AFA Försäkring) in most part, which in turn is owned by LO and Svenskt Näringsliv (for more information about Prevent, see SE0911029Q).

Another such organisation is Healthy Life (Sunt Liv), which provides support, education and inspiration for provincial council employees and local government employees in order to improve their health and working conditions. Healthy Life has been developed by AFA Försäkring on commission by Swedish Association of Local Authorities and Regions, SALAR (Sveriges Kommuner och Landsting, SKL), the Swedish Municipal Workers’ Union (Kommunal), The Public Employees’ Negotiation Council (OFR) and the Swedish Confederation of Professional Associations (SACO).

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?

According to SAM, companies should provide a good working environment for the employees, i.e. to work in a preventive way on causes for illness and stress. The employers have the responsibility to assess risk factors in the work place and to investigate working conditions. In SAM there is also a provision that states that there should be an action plan addressing the risk factors, and that employers should implement it as soon as possible. According to SAM the employers should take action for the individual employees, and aim to improve employee health by offering a good working environment. They should also follow up on their employees’ health should they fall ill.

Therefore, the interventions are implemented at the primary stage (creating a good work environment) and secondary stage (following up on individual causes).

If an individual should become sick the employers shall also provide assistance and support for that individual, for example by changing work tasks or time, or by redeployment. In this case they can get help from public authorities, trade unions or employers’ organisations, or other organisations such as Prevent or Sunt Liv. This would be the tertiary stage, where the consequences of stress (in this case) are addressed.

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.

The Institute for Stress Medicine (Institutet för stressmedicin, ISM) has an overview of 25 common instruments used to measure the psychosocial working environment. These are all survey-based and generally used in order to provide an evidence based start for working with the psychosocial environment and stress. Summarized below is a description of the most common instruments used to measure stress and the psychosocial working environment.

The Work and Health-survey (Arbete och hälsa-enkäten) has been developed by Karolinska Institutet (Karolinska Institutet) and originally examined health, lifestyle and psychosocial working environment among 4,000 employees in the engineering industry. It is now being used by AFA Försäkring and Sunt Liv. AFA Försäkring provides the surveys to companies who wish to assess the stress levels and the overall health levels of their employees. This can then be used to identify risk factors or in the companies working with SAM. Sunt Liv used the survey as part of their basic methodology. The survey also contains support functions such as feedback at individual and group level.

LO, SACO, the Swedish Confederation of Professional Employees (TCO) and Svenskt Näringsliv have developed a survey in order to assist in the work in implementing the European framework on work related stress. The survey contains 35 questions concerning work related stress. The survey is administered by Prevent.

QPS Nordic has been developed by researchers from four different Nordic countries as part of a project for the Nordic Council of Ministers (Nordiska Ministerrådet). It was developed to measure psychological, social and organisational working conditions in the Nordic countries and consists of two different versions, a long version with 129 questions and a short version with 34 questions. The short version is can be used to measure stress at an organisational level. Both versions can be used for organisational development and interventions, and for studies on the relationship between work and health. This survey has a scientific basis and can thus be difficult to use without help. However, with expert help it can provide insight into the psychosocial, social and working conditions aspects within an organisation.

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.

The Stress Research Clinic (Stressmottagningen ) conducted a study from 2002 to 2003 that examined the effects of an extensive intervention by Kraft Foods (Kraft Foods) in Sweden to decrease sick leave among the personal at Gevalia Kaffe, one of their subsidiaries. The result was compared to other subsidiaries, one which received a limited intervention (control unit A) and one who did not receive any intervention (control unit B).

The employees at Gevalia Kaffe and control unit A were given surveys that measured their stress levels which were followed by individual advice on how to manage stress. Those employees who had a high level of stress were offered medical and psychological help and participation in a stress-management program. Other interventions such as lectures and educations were also instigated at Gevalia Kaffe, and on a lesser scale in control unit A.

Table 4: Sick leave among white collar workers (long-term and short-term)









Control Unit A




Control Unit B




Source: The Stress Research Clinic, 2003

The results show that an intervention to manage stress levels among employees is profitable, and that it leads to a lower percentage of sick leave. The conclusion of the study is that an intervention has a larger effect if it is more comprehensive.

Sunt Liv reports on two pre-schools that began a project in 2001 to reduce work related stress and to decrease long-term sick leave. Before the project, around 40% of the employees were on long-term sick leave at both pre-schools, but that rate fell to almost 0% afterwards. The work focused on reducing stress factors by clarifying the employees’ responsibilities and increasing continuity at work. Each employee is now responsible for one specific task for two weeks, whereas before the project every employee tried to do everything. All personnel also received massage training.

The lessons learned were that clearer definitions of what each employee was supposed to do and knowing who was responsible for what part of the work reduced stress and stability and lead to increased efficiency. It also increased continuity for the children, since they had a better sense for what each teacher did and whom they could turn to. Increased continuity for the children in turn lead to positive effects for the personnel.

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.

In case of organisational change or restructuring employers shall make a risk assessment for ill health. This is dictated by AV, and it also states that the risk assessment shall lead to a plan for how the restructuring shall take place. The plan shall specifically include who is responsible for what part of the restructuring and a program for the employees who are noticed and an offer for them to participate. The program shall include different actions to enable the employees who are let go to find a new job, and support in other ways.

This means that employers in Sweden shall by law manage and prevent stress due to organisational changes and restructuring, but they can get help from different organisations such as Prevent or the trade unions.

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 issue of work-related stress in Sweden is mostly concerned with long-term sick leave due to burnout or exhaustion syndromes. Stress in itself is mostly discussed in terms of overall health, but is considered a big problem in particular for those on long-term sick leave.

There has been much debate in Sweden about the rising presence of long-term sick leave during the late 1990’s and onwards. The number of persons on sick leave has decreased from 2006 to 2009, in part due a reformation of the social insurance by the current government, with stricter regulations and clearer guidelines for doctors. The reform aimed to bring back those on sick leave onto the labour market quicker, by forcing them to seek work more actively.

The reform has been much criticized by the opposition party’s, especially the Swedish Social Democrat Party (Socialdemokraterna) because it forces people to seek work and decreases their social security. The Swedish Trade Union Confederation (Landsorganisationen, LO) is also highly critical, stating that this reform throws people out on the labour market without any concern for their safety or well-being. LO instead wants to focus on more and better rehabilitation for those on long-term sick leave, and creating a more fair and safe insurance for sick leave.

Work-related stress is not addressed in the debate per se, but as stated above it is part of the overall debate about sick leave and health on the Swedish labour market.


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  • Försäkringskassan, The Swedish Social Insurance Agency, Annual Report, ”Socialförsäkringen i siffror 2008”. 2008. http://www.forsakringskassan.se/irj/go/km/docs/fk_publishing/Dokument/Publikationer/Socialf%C3%B6rs%C3%A4kingen%20i%20siffror/Socialf%C3%B6rs%C3%A4kingen%20i%20siffror%202008.pdf

  • Socialstyrelsen, The National Board of Health and Welfare, “Utmattningssyndrom. Stressrelaterad psykisk ohälsa.” 2003. http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/10723/2003-123-18_200312319.pdf

  • Läkartidningen, The Medical Journal, ”Emotionell utmattning vanlig bland kvinnor i offentlig sektor”, 2002. http://www.stressmottagningen.nu/rapporter/files/Lakartid_em_utmattning.pdf

  • IFAU- Institutet för Arbetsmarknadspolitisk Utvärdering, Institute for Labour Market Policy Evaluation, Working paper 2009:2”Sick of your colleagues’ absence?” 2009 http://www.ifau.se/upload/pdf/se/2009/wp09-02.pdf

  • Stressmottagning, The Stress Research Clinic, ”En helhjärtad satsning på stressprevention – Ibland krävs det krafttag”2004 http://www.stressmottagningen.nu/dokument/kraftprojekt.pdf

  • AFA Försäkring, AFA Insurance ”Allvarliga arbetsskador och långvarig sjukfrånvaro” 2009 http://www.afaforsakring.se/upload/rapport%202009/AFA_rapport_2009_FINAL.pdf

  • Institutet för Stressmedicin, The Institute for Stress Medicin, ”Instrument för att mäta den psykosociala arbetsmiljön” 2008. http://www.stressmedicin.com/dokument/Publikationer/IMS-hafte%20nr%201%20web.pdf

  • Arbetsmiljöverket, The Swedish Work Environment Authority, “Systematiskt Arbetsmiljöarbete” 2001. http://www.av.se/dokument/afs/ursprungs/ursprungsAFS2001_01.pdf

09 Claes Bäckman and Mats Kullander, Oxford Research

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