CYPRUS: EWCO comparative analytical report on work-related stress

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This questionnaire analyses the work related stress in Cyprus concerning the stress factors and indicators in different sectors of economic activity. Even though employees and workers believe that they suffer from work related stress, according to studies there isn't a recent debate among social partners concerning this matter. However Trade unions and the Department of Labour Inspection are stressed out the need to develop a common action plan by all the interested groups in order to combat and eliminate the stress and its effects.

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 Cyprus the issue of work-related stress comes up more and more frequently in discussions on current affairs. The main tools for monitoring stress are national and sectoral surveys. Often such surveys focus on a single category of possible sources of work-related stress involving a specific area of employment. The main available sources of information on work-related stress are the following:

Department of Labour Inspection, Ministry of Labour and Social Insurance (2006), Assessment of the Situation in Cyprus regarding the Physical and Mental Disorders of Working People, Lefkosia. The main purpose of the survey was to study and identify job-related health problems faced by working people. The nationwide survey covered 1200 households where there were people aged 18-63 of either sex who either were in work or had been in work in the past. The data were collected by experienced researchers by means of personal interviews based on a structured questionnaire.

Dr. Constanti Panayiotis and Maria Kyriacou (2008), "The influence of hardiness on job stress". The study set out to identify workplace and individual factors, that increase or reduce stress in the lives of call centre operators at the Cyprus Telecommunications Authority, CYTA (Αρχή Τηλεπικοινωνιών Κύπρου, ΑΗΚ). Methodology was based on a quantitative primary data collection tool, a questionnaire which was distributed to employees of the Limassol-based department of which sixty-four returned the questionnaire completed. The data were analyzed utilizing multiple regression techniques. This survey analyses possible sources of work-related stress in the call centres and specifically deals with three factors: a) the worker’s personality, b) working conditions, and c) environmental conditions in the workplace.

Michailidis, Maria and Andreas Asimenos (2002), Occupational stress as it relates to higher education, individuals and organizations. Work, 19(2): 137-147. The study examines through the survey research methodology the degree to which, faculty, administrators and program coordinators working in higher education, experience stress at work. The study investigates among other the degree of occupational stress that individuals experience and the factors which influence the degree of the occupational stress.

Michailidis, Maria and Mouafak E-ali Elwkai (2003), Factors contributing to occupational stress experienced by individuals employed in the fast food industry. Work, 21: 125-140. The study examined through survey research methodology, the factors which appear to contribute to the experience of occupational stress of individuals working in the fast-food industry in Cyprus. A set of questionnaire was distributed to 100 employees of different fast-food restaurants in the two largest cities of Cyprus.

Michailidis, Maria and Yiota Georgiou (2005), Employee occupational stress in Banking. Work, 24: 123-137. The study examines the level of occupational stress in the Banking sector of Cyprus through the use of questionnaire distributed to 80 randomly selected full-time employees of different banks in the capital city of Cyprus, Nicosia. The study was meant to identify the degree of occupational stress for different groups of people as regards their educational level, their relaxation patterns and their smoking and drinking habits.

Andreou, Fani and Katerina Markidou (2006), Stress experienced by nurses in intensive care units and ways of dealing with it. Lefkosia: Cyprus School of Nursing. This survey studies the stress experienced by nursing staff in intensive care units (ICUs) in Cyprus, taking account of the causes of stress in relation to the work environment, the effects of stress on their health and ways of dealing with stress. Data were collected using a written questionnaire which was completed by all nursing staff working in ICUs, a total of 430 nursing officers in the whole of Cyprus. A qualitative survey was also carried out on the basis of semi-structured interviews with 20 nursing officers working in the ICU at Nicosia General Hospital.

Kokkinos M. Constantinos (2005), Job stressors, personality and burnout in primary school teachers. British journal of education psychology, 77: 229-243. The study investigates the association between burnout, personality characteristics and job stressors in primary school teachers from Cyprus. The sample of the study consisted of 447 primary school teachers from all regions of Cyprus, age varied from 21-59 through the completion of a questionnaire.

Billehøj Henrick, Report on the ETUCE Survey on Teacher's Work-related Stress (2007). The report aims to collect data on the identification of stress factors and stress indicators in teachers' work in primary, secondary and vocational educational sectors. The data were collected through a questionnaire sent to all ETUCE member organizations and associated member organizations in all the EU, EFTA and candidate countries in March 2007.

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 only available data on levels of work-related stress have emerged from a survey conducted by the Department of Labour Inspection (Τμήμα Επιθεώρησης Εργασίας) of the Ministry of Labour and Social Insurance (2006) (Υπουργείο Εργασίας και κοινωνικών Ασφαλίσεων); however, no data are available for the last five years.

According to this survey, 21% of the people who are working or have worked in the past face health problems that were caused or exacerbated by the jobs they do or did in the past. 23.2% of these people stated that they have stress-related problems, which are the third most important type of problem, after musculoskeletal disorders and general fatigue.

Source: Department of Labour Inspection, Ministry of Labour and Social Insurance (2006), Assessment of the Situation in Cyprus regarding the Physical and Mental Disorders of Working People, Lefkosia.

It is worth noting that 4.3% of the whole sample reported that they suffer from stress-related problems. As regards age, taking the whole sample into account, it would appear that stress-related problems are more severe among people aged 40-63 (5.4%) than among people aged 18-24 (1%). A gender analysis showed no important differences between men and women, apart from a slightly higher proportion of men (4.6%) than women (4.0%). Moreover, the survey showed that stress-related problems are associated with the length of time worked. Based on the whole sample, people who have worked for over 25 years report the greatest proportion of stress-related problems, whereas the figure for people who have worked for less than 5 years is much lower, at 1.1%. As far as jobs that cause health problems are concerned, stress appears to be the second most reported problem caused by various jobs, after musculoskeletal disorders, with the exception of teaching jobs, where stress is the number one problem faced by staff.

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.

According to the findings of the surveys cited in Q1, the quantitative factors affecting the creation of stress are seen to differ among workers depending on their occupations. In a survey by Billehøj Henrick (2007), primary, secondary and vocational training school teachers were asked to grade various stress factors on a scale of 1 (little effect) to 5 (major effect). The primary school teachers graded stress-related workload and working intensity factors at 2.5, whereas teachers in the other two educational levels graded them at 0. The problem of too many students in the classroom is among the four most stressful factors for vocational training teachers, who assessed it at 5, but the secondary education teachers assessed it at 0 because their classrooms usually have a well-balanced number of students.

In fast food industry, according to Michailidis, Maria and Mouafak E-ali Elwkai (2003), stress is becoming more and more common among the employees. The main emphasis of this industry is for the employee to satisfy the customer needs, but the employee's needs are most of the times neglected, hence increasing work stress. This neglect is often shown by long work hours, poor pay, lack of encouragement and minimal appreciation of worker initiative and creativity.

Workload and job routine are also job factors which influence job stress in the lives of call centre operators at the Cyprus Telecommunications Authority (CYTA) (Dr. Constanti Panayiotis and Maria Kyriacou, 2008). According to the study, in the environment of call centers, work can be standardized to create relatively uniform and repetitious activities, being organized in ways that weaken employee autonomy and creates work related stress. The findings of the study shown that workload and routine work influence job stress however workload is not consider as important stressed factor for the operators in the call centers unlike routine work.

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 report by Billehøj Henrick (2007), teachers both in primary education and in vocational education said that fear of a conflict is an important stress factor. The opposite was true for secondary education teachers, who believe that this factor causes them no stress, in contrast with the factor of unacceptable pupil behaviour. This finding is also strengthen by Kokkinos M. Constantinos (2005) study which stressed out that managing student misbehavior and time constraints are the two sources of stress that systematically predicted dimensions of burnout in primary school teachers.

Work life balance issues are considered to be one of the most important stress factors between the individuals working in higher education and fast food industry. Administrators, faculty and coordinators, employed at a major tertiary institution in Cyprus considered work and home interface between the top three major sources of pressure in their job (Michailidis, Maria and Andreas Asimenos, 2002). In the fast food industry the relationship that exist between the work and home environments is a relationship that breeds stress in the sense that the sources of pressure at work are affecting the home life, forming a two way relationship with sources of pressure at home affecting work and vice versa (Michailidis, Maria and Mouafak E-ali Elwkai, 2003).

According to Dr. Constanti Panayiotis and Maria Kyriacou, 2008, interaction with the customers in the call centres seems to have no influence in job stress on the contrary with Andreou, Fani and Katerina Markidou (2006), who maintain that nursing staff must deal on a daily basis with severely injured patients, many deaths and patients with acute psychological disturbances. In the case of nursing staff working in intensive care units, contact with patients is considered to be the more important risk factor for work-related stress.

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.

According to the teachers in primary education, bad school management, lack of school resources and bad social climate are the most important stress factors with an average score 4 (see Q2,1). Teachers in secondary education consider the above important however the lack of social support from colleagues has a greater impact in work related stress. Teachers in vocational education, report that bad social climate is between the four most important factors (score 5) with the greatest impact on work related stress followed by the lack of social support from colleagues (score 4), (Billehøj Henrick, 2007).

Dr. Constanti Panayiotis and Maria Kyriacou, 2008, study reveals that the supportive management style and the interpersonal and social support in the call centre CYTA can help the operators to keep stress levels low. It is also very clearly stated that in the fast food industry the organizational climate is experienced as a higher source of pressure resulting in increased levels of work stress by the female participants than their male colleagues.

Administrators, faculty and coordinators, employed at a major tertiary institution in Cyprus considered their relationships with other people both in and outside the organization between the top three major sources of pressure in their job (Michailidis, Maria and Andreas Asimenos, 2002).

According to Andreou, Fani and Katerina Markidou (2006), the lack of workplace support mechanisms is the most important factor likely to predict or indicate the existence of pressure and stress for the nursing staff in intensive care units.

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.

Teachers in primary secondary and vocational education consider the lack of career development as a stress factor with an average score 3 even though teachers in Cyprus are considered to have a permanent job with high wages and very good working conditions, (Billehøj Henrick, 2007).

The individuals in managerial positions in fast food industry appear to experience more negative stress than non-managers. Even though managers have the control over work it seems that they constantly running from sector to sector being involved in every particular aspect of the business in order to keep the workflow in the desired way. This study also reveals that female workers found the inability to delegate to be a higher source of pressure for them than their male counterparts, (Michailidis, Maria and Mouafak E-ali Elwkai, 2003).

Employees in call centre CYTA report low levels of control over work tasks and this was found to be strongly negative correlated to stress. Mean that low control over work increase the stress levels over employees. In addition the study shown that the high ability of the operators to perform the duties of the job, that can be enhanced by training and constant support, can be used as a shield to protect them from the negative consequences of stress, (Dr. Constanti Panayiotis and Maria Kyriacou, 2008).

Another very critical outcome in the study of Michailidis, Maria and Andreas Asimenos, 2002, is the general dissatisfaction and stress feeling of faculty employees regarding the amount of participation given to them in decision-making and with the amount of flexibility and freedom they have in the organization.

Michailidis, Maria and Yiota Georgiou (2005) deal with the issue of educational level of the employees in the bank sector, arguing that employees with higher degree level qualifications have more possibilities to develop their skills and this make them feel more satisfied with their jobs and less stressed.

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

None of the data sources identified in Q1 includes information regarding to individual and collective mechanisms for employees as a factor for work related stress.

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.

Teachers in secondary education report that role overload is one of the factors with a great impact on work related stress (score 5), followed by the teachers in primary and vocational education with an average score 3, (Billehøj Henrick, 2007).

Michailidis, Maria and Andreas Asimenos, 2002 in their study argue that faculty employees in higher education are not satisfied with the communication and the way information flows around the organization with the way changes and innovations are implemented, with the overall design or shape of the organization's structure and with the degree of motivation. This situation predisposes faculty employees to stress.

In call centers operators have high role demands which result to high levels of stress. Also the findings of Dr. Constanti Panayiotis and Maria Kyriacou 2008 study, indicate that low role ambiguity or role clarity has a stress impact on the operators in the call centre CYTA.

Conflicts of value and organisational justice.

In this content there is not much available data however the findings of Billehøj Henrick, 2007 study have shown that teachers in the secondary and vocational education consider self-defeating beliefs to have no significance towards stress (score 0) in the contrary with primary education teachers whereas they give a slightly attention to the impact of self-defeating beliefs on work related stress (score 2).

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

Job stability and career concerns are factors that employees in the call centres of CYTA regard as important for causing stress. More than half of the operators stated that they do not think that working for the company will lead them to the kind of future they want. This negative picture according to the authors can possibly be explained by the fact that call centre operators are employed on a part time basis and are paid by the hour, without any of the benefits enjoyed by their full-time co-workers in other departments (Dr. Constanti Panayiotis and Maria Kyriacou, 2008).

In the Billehøj Henrick, 2007 report teachers in secondary and vocational education consider the lack of job stability and security as a major factor for work related stress scoring 5 in contrary with the teachers in primary education that give no significance in this factor with a score 1.

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);

Individual outcomes seem to be the most frequent and important effect of work related stress stated in the above-mentioned studies. In Billehøj Henrick report teachers in primary, secondary and vocational education set the stress indicators in their workplace. According to the report the most important stress indicator for teachers in primary and secondary education is sleeping problems while teachers in vocational education find migraines and cardiovascular diseases more important. Important stress indicators for all three groups are depression hypertension, gastrointestinal disorders while addictions such as drinking smoking and drugs are not consider less important.

Physical and mental problems are also facing the individuals working in higher education according to Michailidis, Maria and Andreas Asimenos, 2002. Administrators, faculty and coordinators have symptoms of physical effects range from major illnesses such us coronary heart disease, hypertension, to complaints such as rashes, digestive and gastrointestinal problems.

According to Michailidis, Maria and Yiota Georgiou (2005), employees in the bank sector believe that the effects of stress can be physical (major illnesses), behavioural (drinking and smoking) mental or psychological (broad range of feelings). Due to difficult working conditions that bank employees face, like work load, narrow time limits, work intensity, high pace of work they usually compliant about musculoskeletal disorders and high levels of cardiovascular diseases. In addition high levels of stress can effect employees habits specially on drinking and smoking as a way to feel more relax.

Furthermore, greater levels of stress arising on primary school teachers from managing order and discipline in the classroom as well as lack of time were significantly predict emotional exhaustion and depersonalization (Kokkinos M. Constantinos, 2005). The fact that they daily face students' misbehaviour followed by discipline problems teachers believe that they daily feel stressed as students' attitude has an impact to their general appraisal.

In the fast food industry stress has significant impact on employees behaviours such as drinking (75% of the participants in the study drink alcohol) and smoking (67.5% smoke), therefore according to the authors Michailidis, Maria and Mouafak E-ali Elwkai, 2003 this can be an indicator of work stress.

According to Andreou, Fani and Katerina Markidou (2006), nursing staff in intensive care units are affected much more than other occupations by work-related stress. Nursing staff smoke and drink more, take sick leave more often, and see a deterioration in their overall health and well-being as a result of occupational stress. They suffer from frequent severe headaches, their job performance falls off and they are frequently involved in interpersonal conflicts due to misunderstandings they have with each other.

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

According to Michailidis, Maria and Mouafak E-ali Elwkai, 2003 employees in the fast food industry consider injuries on the job as a stress factor. Common injuries are slips, falls and burns. Another common stressful factor is the risk of robbery for workers who work early in the morning or late at night, though it is not that serious in Cyprus.

In the survey by Andreou, Fani and Katerina Markidou (2006), nursing staff report that stress may be due to personal factors, work environment or interpersonal relationships. Due to multiple role tasks that nurses sometimes have, lead them to frequently conflicts with their colleagues.

In both studies Kokkinos M. Constantinos, 2005 and Billehøj Henrick, 2007, teachers in primary education believe that appraisal of teachers' performance and managing student misbehaviour are important stressful factors. The fact that they daily face students' misbehaviour followed by discipline problems which has also an impact to their general appraisal, teachers believe that student misbehaviour is a very stressful factor

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);

Teachers in primary, secondary and vocational education have stressed out that they have frequently interpersonal conflicts as a symptom of being stressed. According to Billehøj Henrick, 2007 another important stress indicator for teachers in primary education is the incident of high absenteeism in contrary with teachers in secondary and vocational education.

In addition nursing stuff suffering from work related stress are often taking sick lives, increasing the rate of absenteeism in their occupation (Andreou, Fani and Katerina Marcidou 2006).

Regarding job satisfaction employees in higher education according to Michailidis, Maria and Andreas Asimenos, 2002, appear to be satisfied with achievement value and growth of their job apart from faculty employees that are dissatisfied with the organizational processes and structure of their job.

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.

There is no data regarding labour market or societal level outcomes in the sources identified in Q1. However it is generally accepted that stress has a serious effect on productivity and to social benefits system due to high rates of absence from work.

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 only action carried out in Cyprus to address work-related stress overall was the signing of the European Framework Agreement on work-related stress by the Ministry of Labour and Social Insurance and the social partners in June 2008. This agreement refers to an integrated framework for addressing and combating work-related stress; however, it excludes instances of violence, harassment and post-traumatic stress (CY0807019I). The signatory organisations committed to begin a dialogue immediately in their ranks and by extension to effectively implement the framework agreement.

The implementation of the provisions of the framework agreement is expected to bring about the following in all the organisations associated with the social partners: a better work environment, better labour relations, a better level of cooperation in the workplace, improved productivity, improved competitiveness of enterprises, savings in healthcare spending, fewer absences and increased job satisfaction for workers.

No effects of the implementation of the framework agreement have been reported to date.

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?

The main organisations promoting interventions regarding work-related stress at national level are the Ministry of Labour and Social Insurance (Υπουργείο Εργασίας και Κοινωνικών Ασφαλίσεων), with the Department of Labour Inspection (Τμήμα Επιθεώρησης Εργασίας) as the competent authority, the social partners, who signed the European Framework Agreement on Work-related Stress, the Employers and Industrialists Federation, OEB (Ομοσπονδία Εργοδοτών και Βιομηχάνων, OEB), the Cyprus Chamber of Commerce and Industry, KEBE ( Κυπριακό Εμποροβιομηχανικό Επιμελητήριο, ΚΕΒΕ), the Democratic Labour Federation of Cyprus, DEOK (Δημοκρατική Εργατική Ομοσπονδία Κύπρου, ΔΕΟΚ), the Pancyprian Federation of Labour, PEO (Παγκύπρια Εργατική Ομοσπονδία, ΠΕΟ) and the Cyprus Workers' Confederation, SEK (Συνομοσπονδία Εργαζομένων Κύπρου, ΣΕΚ).

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?

In accordance with the Framework Agreement on Work-related Stress, the interventions have been designed for the purpose of preventing, eliminating and/or reducing problems of work-related stress through the implementation of a variety of measures, such as training of staff and employees to make them aware of stress and avoid it, identification of stress-producing factors in the workplace by employers, and measures to support the individuals and groups affected by stress.

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 only common instrument in place to measure stress at organizational level is a study contacted by the Department of Labour Inspectorate entitled Assessment of the Situation in Cyprus regarding the Physical and Mental Disorders of Working People the results of which are above mentioned. This study identifies the major work related health problems (see Q1) as a mean to provide data that stress out the need to foster positive actions for the reduction of stress level. The study does not provide any positive actions.

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.

According to the Department of Labour Inspection, there were no examples of good practice in relation to work-related stress; however, the organisation of training seminars by large enterprises and banks in particular could be considered as such an example, since the banks are regarded as a sector with high levels of work-related stress. Specifically, in November 2009 Marfin Laiki Bank held, in the context of a campaign for Safety and Health Week, a seminar entitled “Psychosocial Risks in the Workplace” for the purpose of making employers and workers aware of issues relating to the risk factors for health hazards in the workplace. Their approach was focus on the effects of the work related stress in general rather than stress in Cyprus enterprises.

As concerns the organisation of information and training seminars, according to the Human Resource Development Authority, HRDA (Αρχή Ανάπτυξης Ανθρώπινου Δυναμικού, ΑΝΑΔ), 20 multi-enterprise programmes are held annually regarding management of work-related stress mostly focused on ways of stress prevention and stress management. This is quite a low number in relation to all the programmes ANAD offers.

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.

Apart from the Framework Agreement on Work-related stress, the social partners believe that the issue of work-related stress is not a priority issue in public discussions, particularly at a time when the renewal of the collective agreements is in question due to the financial crisis. However, the collective agreements highlight the avoidance, prevention and addressing of work-related stress as issues for discussion in a more general meaning rather than focusing in any specific labour aspect.

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.

In accordance with all the above-mentioned data, and from the interviews conducted with the social partners, it would appear that although most workers experience work-related stress every day, to date no policies to prevent and address it in the workplace have been taken forward. In addition, one important factor in the creation of work-related stress which we have not mentioned is the personality of each worker and its effect in relation to stress. In our opinion, the personality could also be investigated as a stressor, since low-profile, introverted and isolated people are more susceptible to stress. In parallel, women have not been mentioned as being the most susceptible to stress, when their multiple roles as mother, homemaker, wife and worker affect their mental health to a profound degree.

Polina Stavrou, Cyprus Labour Institute INEK/PEO