Occupational stress and health-related quality of life among public sector bank employees: A cross-sectional study in Mysore, Karnataka, India.

BACKGROUND: Occupational morbidities have been estimated to cause an economic loss up to 10-20% of the gross national product of a country. It is an important cause of occupational morbidity and decreased quality of life (QOL) for the workers. AIM: The aim of the present study is to assess the level of occupational stress and its association with the QOL among the public sector bank employees.
MATERIALS AND METHODS: The present study was conducted among employees of public sector banks in Mysore district, Karnataka, India. A cross-sectional study design was used for the study. Job stress was measured by using occupational stress index (OSI) scale questionnaire and health-related QOL was measured using the short form 12 (SF-12) questionnaire. The sample size estimated for the study was 526 and cluster random sampling technique was used. Chi-square test was used to find the association between the study variables and level of stress. Multiple linear regression model was used to find the determinants of health-related QOL among the study subjects.
RESULTS: The total number of the study subjects was 546 out of which 57% were males and 43% were females. The proportion of study subjects reporting to be current smokers was 4.2% and almost all study subjects reported occasional alcohol consumption. The mean physical component summary (PCS) score and mental component summary (MCS) using the original United States standardization were 47.90 and 48.30, respectively. The individuals with mild stress scored higher in both PCS and MCS than the individuals who had moderate to severe stress levels. There was significant association of health related quality of life with the age of the respondent,presence of at least one morbidity and level of stress with health-related QOL.
CONCLUSION: This study has shown an association of occupational stress with the QOL. There is a need for interventions aimed at mitigating the occupational stress among employees of the banking sector.

INTRODUCTION

As “health is not merely the absence of disease but a positive state of physical, mental and social well-being” {World Health Organization (WHO), 1986} a healthy working environment is one in which there is not only the absence of harmful conditions but also the presence of health-promoting actions.[1] Occupational stress is the interaction of the worker and the conditions at work.[2] Stress is an unavoidable consequence of modern living but it is an undesirable outcome.[3] Occupational stress leads to physical disorders because the internal body system changes to try to cope with the stress. Some physical disorders are short-ranged such as an upset stomach while others are long-ranged such as a stomach ulcer.[3] The body responds to physical, mental, or emotional pressure by releasing stress hormones such as epinephrine and norepinephrine that increase blood pressure (BP), heart rate, and blood sugar levels. Therefore, persons experiencing chronic stress can have digestive problems, fertility problems, urinary problems, and a weakened immune system. Also, people with chronic stress are more prone to viral infections such as the flu or common cold and to have headaches, sleep trouble, depression, and anxiety.[4]

Three sets of factors can act as potential sources of occupational stress including environmental, organizational, and individual.[5] Lifestyle behaviors are influenced by strategies people use to cope with stress.[6]

A high level of occupational stress not only detrimentally influences the quality, productivity, and creativity of the employees but also the employee's health, well-being, and morale.[7] Good mental health is needed to maintain a healthy lifestyle and depression plays a central role in influencing the quality of life (QOL).[8] The postliberalization era has witnessed various environmental changes in the banking industry.[9] Lifestyle-related factors such as obesity, drinking habits, diet, and physical inactivity are well-established determinants of hypertension.[10] In contrast, the role of chronic workplace stress on long-term BP regulation and the predisposition to hypertension remain unclear.[11] Although, various facets of psychosocial job stress have been studied, the findings have been inconsistent[121314151617] although Wright and Sweeney have identified an association between coping strategy and higher diastolic BP.[18] Previous studies have not considered whether the relationship between work stress and BP could be mediated by lifestyle factors such as alcohol consumption and regular physical activity.[10] Workplace health and wellness are about early identification of chronic disease and lifestyle-related preventable risks.[19] Thus, the present study was conducted to examine the contribution of key demographic, occupational stress and lifestyle factors affecting the QOL among bank employees.

MATERIALS AND METHODS

The study was conducted at Mysore district, Karnataka, India among the employees of selected public sector banks. All employees with a minimum of 3 complete years of service were included for participation in the study except pregnant women. A two-stage cluster random sampling method was used for the study. In the first stage, all the branches of the banks were listed out and then the employees were selected from the branches randomly. The sample size was calculated considering the prevalence of stress (p) to be 35% and relative precision (e) of 10% with a 95% confidence interval using the formula Z2 P(1-p)/e2. Considering a design effect of 1.5, the final sample size calculated was 546. Institutional ethical committee approval was obtained from a tertiary hospital. A written informed consent was obtained from the participants. The job stress was assessed using the occupational stress index (OSI) scale and the score base classification of stress was performed. A standardized questionnaire for measuring health-related QOL questionnaire, short form 12 (SF-12) was used in the present study. Data analysis was performed with the help of the statistical software, Statistical Package for the Social Sciences (SPSS) version 15.0 (Chicago, IL, USA). Multiple linear regression was performed to know the association between stress and QOL after adjusting for potential confounders.

RESULTS

Of the 546 study participants, the demographic characteristics showed that about 57% were males [Table 1]. Majority of the study subjects belonged to the age group of more than 50 years (48.4%) followed by the age group of 40–49 years (18.1%) [Table 1]. Most of the study subjects were graduates (67%) followed by those with postgraduate degree (28.8%). Almost half of the study subjects' current designation of work was clerk (51.6%) followed by the designation officer, which was 25.6% [Table 1]. The proportion of officers experiencing severe stress(12.1%) was higher as compared to managers (5.6%) and clerks (6.7%) [Table 2]. Moderate stress was experienced more by clerks (68.4 %) as compared to officers or managers [Table 2]. The proportion of respondents experiencing mild stress was higher among Managers (34.70%) as compared to officers and clerks [Table 2].

Table 1

Distribution of study subjects according to sociodemographic characteristics

Table 2

Distribution of level of stress among the employees according to current workplace designation

The mean physical component summary (PCS) and mental component summary (MCS) scores using the original United States standardization was 47.90 and 48.30, respectively. Overall, the men scored significantly higher than women in PCS (P = 0.01). There was a significant relationship between PCS and MCS scores with sleep reduced due to work pressure (P < 0.001). The people who reported having ever consumed alcohol scored lower score on PCS scale as compared to those people who never consumed alcohol but the difference was not statistically significant (P = 0.530) [Table 3]. The PCS showed significant association with at least one related morbidity (P < 0.001) [Table 4]. A score difference of 5.6 in MCS was found between respondents with at least one morbid condition and those without any morbidity. The multiple linear regression analysis showed that with a unit increase in the age in years, the physical component summary score of QOL decreased by an average of 0.07 [Table 4]. There is a significant difference in the MCS (P < 0.001) among individuals with mild stress versus moderate stress. There was a difference of 7 points in the MCS score between those subjects who were mildly stressed and those who were severely stressed. Variables such as age, presence of morbidity, and level of stress showed a significant association with MCS [Table 5]. The independent variables in the multiple linear regression model showed no correlation with each other.

Table 3

Distribution of study variables according to PCS and MCS

Table 4

Multiple linear regression model to predict health-related quality of life from PCS

Table 5

Multiple linear regression model to predict health-related quality of life from MCS

DISCUSSION

This study found that the mean PCS score and MCS score using the original United States standardization were 47.90 and 48.30, respectively. The individuals with mild stress scored higher in both PCS score and MCS score than the individuals who showed moderate and severe stress levels. There was a significant association between age, presence of at least one morbidity, and level of stress with health-related QOL.

In the current study, about 19.6% of the employees suffered from back pain. The findings were consistent with a study conducted in Brazil by Marilda et al.,[20] which reported about 48% of the respondents with muscle tension. The study conducted by Debra et al.[21] showed that two-thirds of the participants reported one or more chronic conditions that were almost similar to the findings of the present study where the majority of the individuals showed at least one or more morbidity.

About 12.10% of officers reported severe stress as compared to the managers (5.60%) and clerical grade employees (6.70%). As specified by Raj and Debashish,[22] bank officers form a delicate link between the management and the clerical staff, which may be instrumental in the difference in the levels of stress demonstrated between the clerical and managerial staff.[22] The study conducted by Bhatia et al.[23] showed a similar finding that people working below the supervisors such as officers or clerks experienced more stress.

There was significant relation of PCS and MCS with chronic morbid conditions like heart disease diabetes and hypertension. A study by Tuchsen[24] points to the psychologically demanding work with unsatisfactory decision authority as a possible cause of this increased risk of developing morbidities. There was no association between PCS and MCS scores and smoking. The people who had ever consumed alcohol scored lower on both PCS and MCS than those who never consumed alcohol.

Similar finding was reported by Xu J et al.[25] in their study among civil servants in China.

The presence of chronic morbid condition and physical activity has a significant association with PCS. MCS score does not show an association with any of study variables. A study by Luiz et al.[26] among financial service employees in Brazil reported that job strain had its largest impact on mental health.

CONCLUSION

In conclusion, the present study has shown that there is a high level of stress among the officers. There is an association between the level of stress and the health-related QOL among the public bank employees. The individuals with mild stress scored higher in both physical and mental QOLs than the individuals in the moderate and severe stress levels. This study calls for initiatives to improve the QOL of employees in the banking sector. Further, the study was conducted among the public sector bank employees and the private banks may have different work environments; hence, the study findings should be generalized to among private sector bank employees.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.