Work-related stress and psychosomatic complaints : A quantitative study done among working adults in Sweden

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School of Health, Care and Social Welfare

WORK-RELATED STRESS AND

PSYCHOSOMATIC COMPLAINTS

A quantitative study done among working adults in Sweden

LOI GRAHN JESPER

Main Area: Public Health Level: Second cycle Credits: 15

Programme: Master’s program in Health, Care and Social Welfare

Course Name: Thesis in Public Health

Supervisor: Fabrizia Giannotta Examiner: Susanna Lehtinen-Jacks Seminar date: 2020-06-03

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ABSTRACT

The workplace is an arena that most individuals spend time at. Work-related stress and psychosomatic complaints are problems for the society. Work-related stress has increased in Sweden over the past decades.

The aim was to investigate the difference between men and womenin work-related stress and psychosomatic complaints among working adults in the Swedish population, and to see if there is a relationship between work-related stress and psychosomatic complaints. The author posted an online survey on Facebook and Discord and 95 adults answered the survey. The result showed that there is a relationship between work-related stress and psychosomatic complaints. Psychosomatic complaints are more common among those who experience more work-related stress. There were no differences between men and women when it comes to work-related stress and psychosomatic complaints.

The model Job demand control support model was used in this study. The model is measured with scales such as workload, time pressure and role conflicts. It can be used to see the

relationship between job decision latitude and stress indicators.

Psychosomatic complaints are more common among those who experience more stress. There are no differences between men and women when it comes to psychosomatic complaints and work-related stress.

Keywords: job demand-control-support model, psychosomatic complaints, work-related stress, working adults

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1 INTRODUCTION

Workers represent half of the world’s population (World Health Organization, 2007). They have a major role in the contribution of the societies economic and social growth. There are different factors to determine the individual workers health, where the health is not only determined by factors like workplace danger but also other factors like social and individual factors and if the individuals have access to health care (World health organisation, 2007). Even if there are existing interventions that are proven to be effective against occupational hazards, there are still gaps in some countries that lack access to occupational health services. The workplace is a place where individuals spend most of their awake time, which proves that this is an arena where public health workers can contribute to a healthier workplace. Even if there are interventions that may work to prevent occupational hazards, there is still a risk that it could be less effective on the less advantaged groups. These groups could be the ones that have a lower social capital (WHO, 2007). Further, WHO (2007) explains that

employment and individuals working conditions have powerful effects on health equity. Good working conditions can provide different types of protection such as; social status, personal development opportunities and being protected from physical and psychosocial danger. Working under certain conditions with a good social climate could improve the individual’s social relations and even increase the self-esteem of the individuals, which in turn could lead to positive health effects (WHO, 2007).

As the individuals spend most of their time at their workplace, they provide economic stability for their household and families, which could strengthen the social welfare for each individual. Maintaining a healthy working capacity is therefore of importance for the public health. Other health risks exist within the workplace, where the employees can face different health hazards for example noise, unsafe machines, which can lead to psychosocial stress. This could in turn cause occupational diseases and provoke other health difficulties. Work position or working conditions can also be factors that affects the individual health. Working under stress proves that individuals are more likely to smoke more and that their diets often are unhealthy and have exercise less (WHO, 2020). Therefore, it is important that everyone has access to health care, where everyone could reduce their exposure to occupational risks. Also, the health care could help prevent future work-related diseases and injuries (WHO, 2020).

This topic about work-related stress and psychosomatic complaints came as an idea from a previous course of the master program, where the author wrote about leadership and the related stress that they face every day. Further, the author found articles about work-related stress that increased the curiosity of this topic. Thereafter, the author decided to write about psychosomatic complaints and work-related stress among the Swedish population, which is a relevant topic when it comes to public health.

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2 BACKGROUND

General stress has increased in Sweden over the years, and 16 per cent of the Swedish population between the age of 16-84 years stated that they are stressed, the proportion of women who were stressed were more compared to men (Folkhälsomyndigheten, 2020). The rate of sick leave increased dramatically during the 1990’s in Sweden but has since then decreased. Women has been the majority that often go on sick-leave or go on early retirement pension. In Sweden men and women are often working in different sectors, which means that they could be exposed to different types of work-related stress due to the differences in workplace (Holmgren, Dahlin-Ivanoff, Björkelund & Hensin, 2009).

Stress often occurs at workplaces when the employees faced high demands and have little too no control over their own work process. Other factors that causes stress are that the little support employees get from their superiors and colleagues (WHO, 2020). Further, employees can become stressed when the pressure of performing at a higher degree at the workplace continues for a longer period. Pressure can be positive if it is kept on a motivating level where the employed can manage the work level and if they keep learning. Being exposed to negative pressure from the workplace could turn into a stress factor for the employees. This could end up in hurting the employee’s health and damage the employees work performance (WHO, 2020).

Work-related stress has over the years become a factor that Swedish people die from, as stress kills around 500 people yearly (Arbetsmiljöverket, 2019). It is shown that work-related diseases are more likely to be the death outcome for employees rather than accidents at the workplace. Other factors that also may come with a deadly outcome are shift work, heavy physical work and different types of noises. The death rate of these factors is expected to decrease by each year, while work-related stress mortality is expected to be increase in the future (Arbetsmiljöverket, 2019).

The work-related stress has over the years increased in Sweden since the 1980s, and it is expected to continue this path in the future as well. Research from 1981 to 2000 showed an increased percentage in negative stress levels, where the largest increase was among trade workers, hotel and restaurants workers and health workers (Arbetsmiljöverket, 2019).

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2.1 Psychosomatic complaints

Psychosomatic disorders are a type of somatic illness, that is often caused by mental stress and distress. However, the list of different conditions that are considered to have a

psychosomatic basis has decreased, as a result from the progress of scientific research. Further, it is explained that psychosomatic symptoms can contribute to different diseases, such as heart disease, nervous stomach and skeletal muscle guarding. The conditions of these diseases can worsen if the individual is faced with stress and distress (Bransfield & Friedman, 2019). If an individual is stressed in combination of being more emotionally and

physiologically active could increase the risk of allostatic load. Allostatic load is explained as the wear and tear of the body caused by stress. Some of the physiological changes that happens to an individual during stress is that the blood pressure, heart rate and breathing is affected. Further, if the body is in a continued state of stress it will decrease the chance of recovery that could cause damage the individual both physically and mentally. Two examples of psychosomatic illnesses that are caused by stress are psychosomatic cardiovascular

diseases and irritable bowel disease. Acute stress can be good for a shorter period, but if it continues it could have damaging effects on the body. Individuals that are more susceptible of stress are more prone to get psychosomatic symptoms and disorders as an outcome of stress. Bransfield & Friedman (2019) explains that all individuals have different

vulnerabilities, which makes them prone to different types of psychosomatic symptoms. Psychosomatic symptoms are said to be the primary outcome of stress. A study by Chueh, Yen, Lu & Yang (2010) explains that perceived stress has a positive association to

psychosomatic symptoms. Lack of social support from supervisors and friends may be the factor that increases stress and psychosomatic symptoms among employees. Whereas, Cohen & Willis (1985) explains that social support can act as a protective barrier against stressful events. Further, Folkhälsomyndigheten (2017) explains some of the different psychosomatic complaints that an individual can feel. These are; sleep problems, depression, nervousness, headache, stomach ache, backpain and dizziness.

2.2 Stress

Stress is usually called strain or pressure. Individuals can experience different kinds of stress like physical (e.g., disease) emotional (e.g., grief or psychological (e.g., fear). There is a wide variety of how individuals cope with stress. It depends on how individuals see each situation and how their general physical health state are in order to respond or handle a stressful situation (McEwen, & Sapolsky, 2006). Furthermore, individuals can experience negative stress in their youth and even while in the womb, this can in turn result in how the individual handles stressful events. This could also increase the risk of the individual to over-react over stressful situations (McEwan & Sapolsky, 2006). Most individuals tend to smoke, drink and exercise less while under stress. When an individual feel threatened, he or she can experience some type of stressful situation called “fight or flight”. This will start a reaction in the body where different hormones will spread through the bloodstream, these hormones are called cortisol and adrenalin. These hormones will help the body to be prepared for the situation

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that occurs, which increases concentration, the ability to react and strength. The immune system and memory will be sharper during the stressful situation. After the stressful event has passed the body will go back to normal, which only happens during a short-term event. If that event would persist the body will have no time to recover which could lead to damage on the organs (McEwan & Sapolsky, 2006).

Stress can be defined in different ways. One of them is defined as a response-based one and consists of three different stages of stress response. The first stage of this response is when the body is alerted with an alarm, preparing the body. The second stage is when an

autonomic activity is activated in the body, which starts the whole process of when the body prepares to handle the stress. The third and last stage of this process is when the body is exposed to a degree of stress that is too much for the body to handle it might cause

exhaustion for the individual. This could in turn damage the body and bring the individual to a collapse. During the second stage of the stress effect is when the body is adapting and coping with the stressful situation. But if the individual continues to be exposed to stress and does not get a break from it, could result with exhaustion and being dangerous for the

individual (Baxter, 1993).

Stress can also be a dynamic process, as Baxter (1993) explains, and depends on the

individuals perceived demands and the resources that the individual possesses to cope with the stress at hand. Different aspects of stress have also shown to be factors in human behaviour, where an individual can get increased concentration whilst having a decreased attention span. The individuals short- and long-term memory can also be affected by stress. Other results of persisting stress can be that the individual has a harder time to plan and organize, whereas individuals that live with chronic stress tend to always look-out for possible stress generating situations

2.3 Effects of stress on cognitive functioning

During stimulus of different stressors, a biological response is created, which causes what is called stress. If an individual is exposed to a stressful work workplace or any other

environment that causes stress, this experience could in turn cause different types of

diseases. Chronic stress could even lead to complications of the brain mass and even alter its weight, the result of this could cause damage to the individuals’ response to stress, cognition and memory (Yaribeygi, Panahi, Sahraei, Johnston & Sahebkar, 2017). Yaribeygi et al, (2017) Explain that stress has a negative impact on memory, however stress does not always have a negative effect on the memory. Stress sometimes can be positive as it can improve memory. If the individual is exposed to a condition that is e.g. of non-familiarity, could in fact improve the brain function and thereafter improve the memory. An example of this is taking a written exam where the memory has shown to be improved for a short period of time (Scwabe, Wolf & Oitzl, 2010). Stress also affects the cognition and learning of individuals depending on the duration and origin of the stressor (Sandi, 2013). Scholey et al, (2014) explains that

individual change in behaviour could lower stress, which has proven to increase their cognitive ability. Further, it has shown that if the individual is exposed to a shorter time of stress it could improve cognitive functions such as verbal and virtual memory, and if the

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stress is of a longer duration it could have a negative impact and cause cognitive disorders and harm the memory and judgment of an individual. Other factors that influences the cognitive aspect of stress, is the age and gender, that could make a difference when it comes to stress (Sandi, 2013).

2.4 Effects of stress on health

During a stressful event, the body will produce hormones that helps the body to prepare for the event. These hormones are good for a shorter period, but if the body still produce the stress hormones, they could end up doing more harm than good (Yaribeygi et al, (2017). Some health problems that could occur are that the digestive system could be damaged which could result in stomach ache. Moreover, obesity may occur as the appetite increases which could lead to weight gain. Furthermore, Yaribeygi et al. (2017) explain that stress can affect the appetite and that there is an interaction between nutrition and stress. The immune system will be weakened which makes the individual more receptive of colds or other infections. Also, the nervous system can be damaged which could cause anxiety, depression, loss of sleep and making the individual less interested in physical activity. It might even affect the memory and decision making (McEwan & Sapolsky, 2006).

The cardiovascular system is also affected during stressful events, as the blood pressure and heart rate is affected by the hormones. Blood fats and sugar levels are increased over the duration of stress, which increases the risk for heart disease (McEwan & Sapolsky, 2006). One relationship that has been discussed for decades is the one between stress and the immune system. Individuals that are exposed to stress are more likely to have an impaired immune system. As a consequence, the individual will suffer from more frequent illnesses (Khansari, Murgo & Faith, 1990; Dantzer & Kelley, 1989). Further, severe stress could lead to cancer. Indeed, growth of malignant cells and tumour expansion are two of the results of suppression of the immune system (Reiche, Nunes & Morimoto, 2004). Stress also have an effect on the cardiovascular system, this depends if the stress is acute or chronic. This could be both stimulating and inhibitory for the cardiovascular system (Rozanski, Blumenthal & Kaplan, 1999; Engler & Engler, 1995). Stress works as an activator for the autonomic nervous system and that in turn affect the cardiovascular system. This could result in an increased heart rate, strength of contraction and narrowing of the veins to name a few examples (Vrijkotte, van Doomen & de Geus, 2000; Herd, 1991). Further studies show that

psychological stress can cause a reaction called alpha-adrenergic stimulation, this causes an increased heart rate and that the body needs more oxygen, which can increase the risk of myocardical infarction (Rozanski et al., 1998; Jiang et al., 1996 & Dakak et al., 1995). Further, Hornstein (2004) explain that mental stress can lead to risky behaviours for the heart such as smoking that leads to an increase of stimulation of the autonomic nervous system, and

Pignalberi, Ricci & Santini (2002) explain that severe mental health and risky behaviour can cause sudden death.

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2.5 Work-related stress

Work-related stress has been identified as a challenge when it comes to workers’ health and how healthy the workers organizations are. Stress can cause unhealthy individuals, this could result in less motivation, productiveness and the workers being less safe at their workplace. Work can be stressful for different reasons. When stress is not necessarily related to work, this is nothing that the employer can control. However, the employer can create a healthy work environment where the employees feel safe and where they get the support that is needed to lower work-related stress factors. A working management with fair demands and a healthy work organization can create a safer environment where the employees feel protected from stress (Leka, Griffiths & Cox, 2003).

Work-related stress can occur when people are faced with demands and pressure that are not fitting for the employee’s ability to handle work tasks that are asked from them. This could create a challenge for the employee. The stress often come from poor leadership, which creates a condition where the employee feels less support from their employer and even from their colleagues. Where the most common reason for stress is the loss of control, and not being able to cope with the high pressure and demands that are asked by the supervisor (Leka et al, 2003). Heavy workload, time pressure and conflicts with colleagues are other factors that can cause work-related stress. Work-related stress can affect not only the individuals themselves but also the organization, as it can result in dissatisfaction, lowered productivity and being absent from work (Harzer & Ruch, 2015).

Further, research shows that stressful types of work arise when employees face demands and pressure and where there is little to no support from others like the employer and colleagues. Also, that the employees do not feel like they have a choice or control over the situation. Moreover, a study by Hessels, Rietveld & van der Zwan (2017) explains that work-related stress could affect the employee’s health and work performance.

According to a research study by Rivera-Torres, Araque-Padilla & Montero-Simó (2013) occupational stress can exceed to the workplace and endanger the well-being of the workers. Moreover, the study shows that men and women often experience different working

environments and demands, even if they work with the same profession. However, women are more likely to work with monotonous jobs than men that could cause occupational stress among the women. Furthermore, it is explained that work-related stress often causes mental disorders among women than men, but where men are more prone to experience heart diseases. (Rivera-torres et al, 2013).

Further, Hessels et al, (2017) explain that work-related stress can affect the well-being and health status of the employee. Thus, affecting their social status with health-care costs and affecting their productivity at work. Another study by Ose (2005) explains that if an

individual is experiencing stress at the workplace could result in the feeling of loss of control. This can result in absence of work and an increased use of health-care services. A study by Holmgren et al, (2009) explains that having higher demands and a lower control in

combination with lower social support has been proven to be factors for increased sick leave and musculoskeletal and psychiatric disorders. A higher degree of workload with high psychological and physical demands was associated with symptoms of illness and sick leave,

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and this was particularly true for women than men (Holmgren et al, 2009). Factors that have been proven to cause burnout and emotional exhaustion are for example; higher workload, lack of social support and low participation when it comes to decision making at the

workplace (Magnusson Hanson, Theorell, Oxenstierna, Hyde & Westerlund, 2008).

2.6 Theoretical framework

2.6.1 Job demand-control-support model

For this thesis the chosen theory is the job demand-control-support model by Robert Karasek and Theorell, which has been proven to be one of the leading work stress models. The model consists of components such as; psychosocial demands, job decision latitude and social support. However, these were not measured in the study. The demand component is often measured by using scales of such as workload, time pressure and role conflicts (Anderson-Snyder, Krauss, Chen, Finlinson & Huang, 2008). Further, the model can be used to see if there is a relationship between job decision latitude and strain indicators, some of these indicators are depression, exhaustion or sick days. It is shown that greater decision latitude was associated with less work-related stress. This model can provide additional help as a tool to explain the psychological and physical well-being of employees. (Anderson-Snyder, et al, 2008). The model was introduced in 1979 by Karasek and this model would outline the impact different work characteristics had on stress, health and individuals’ occupational well-being. The central principle of the model explains that jobs with higher demands and where individuals have a lower degree of decision making can result in a decreased well-being and increased strain. Furthermore, Karasek (1979) explains that if individuals faced high

demands from their work but with a higher level of control can instead be positive, as the individual will feel more motivated, this is called an active job. Low control and demand are called passive jobs that can cause boredom and increased risk of strain among workers as they have little to no control over their work. Lastly, Karasek (1979) described jobs with low demands and high control as low strain jobs. A few years later social support was added as the third aspect and predictor of this model. Karasek & Theorell (1990) explain that if an individual is exposed to high strains at work would be amplified if the social support was low. Lack of social support was a predictor for increased job strain. But social support at the workplace can bring positive effects

The different aspects of the model will be shortly summarized here;

Job demands:

Includes the physical, social or organizational aspects of the work that requires physical or mental exercise. It consists of work pace or time pressure and workload demands (De Jonge & Dormann, 2006). According to the theory, a certain level of work demand could be

beneficial for the psychological well-being. This also bring other beneficial factors such as learning, motivation and work performance, and may increase their job satisfaction. Stressful situations where employed have higher demands could have negative effects. This usually

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comes from how much stress the individual experiences or how frequently the stress occurs. An example of it could be if the individual is met with constant interruptions during their workday (Fila, 2016).

Job control:

This aspect includes how an individual sees its’ own belief to affect their own change on their work environment, and how much control they possess an individual has over its’ own autonomy and decision making when it comes to work tasks (Karasek, 1979).

Workplace social support:

Workplace support refers to the helpful workplace relationships regarding job-related matters. This could be the social relationship a worker has with their supervisor and co-workers. With an increased social support, the workers can gain an increase in their social capital, that could help them with acquiring information or getting help with a work task from their colleagues. This does not mean that everyone can intervene in every situation that may occur when someone needs help at the workplace. But Lin (1999) explain that social capital can be beneficial in reducing the workers other personal resources (e.g. physical and mental strain). To conclude this aspect is that high levels of social support is seen as to be associated with an individuals’ well-being, whereas if the individual experiences less social support could in turn be a stimulant for stress.

Furthermore, Magnusson Hanson (2008) explain that the model has been strongly associated with cardiovascular diseases (CVD) and mental disorders, whereas Kristensen, Bjorner, Christensen & Borg (2004) also explain with help from the model that if individuals are exposed with high demands, low decision latitude and have a lower social support they will have a higher risk of poor psychological well-being and CVDs.

2.7 Problem formulation

Stress has over the last decades increased among the Swedish population, where work-related stress kills 500 workers every year, (Arbetsmiljöverket, 2019). As stress is a

continuous problem in the society and work-related stress can become a big problem for not just organisations but the general population as well. Previous research has shown that psychosomatic complaints is an outcome of work-related stress. However, to the authors knowledge, research in this field is not recent and updated. This proves that this field still needs further research. This will produce updated knowledge, to be used for public health practitioners to work preventively to lower the work-related stress.

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3 AIM

The aim of this study is to study is to see if there are differences between men and women in psychosomatic complaints and work-related stress among working adults in the Swedish population, and if there is a relationship between work-related stress and psychosomatic complaints.

3.1 Research questions

• Is there a relationship between work-related stress and psychosomatic complaints? • Is there a difference between men and women in psychosomatic complaints?

• Is there a difference between men and women in the experienced work-related stress?

4 METHOD AND MATERIAL

4.1 Methodological approach

In order to answer the aim and research questions of this thesis, a quantitative method was chosen. The quantitative method was deemed to be appropriate, as the aim was to see if there was connection between work-related stress and psychosomatic complains among adults. In this case a cross sectional design would be appropriate as this design is used when the

researcher describes and measures the degree or association between two or more variables.

4.2 Study design

A cross-sectional design was used in this study, which means that the researcher conducts observing measures of several variables that are taken from a single point of time (Field, 2018). This method can be used to see if there are differences between different variables that are of interest for the researcher (Bryman, 2012). This method was used because the study hade a time frame of 10 weeks, and the author made the choice that this was most suitable for the time frame.

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4.3 Sample, Population and Sampling

The population that this study aimed to investigate were working adults in Sweden. The purpose of the study was to see the occurrence of work-related stress among working males and females in Sweden. The chosen sampling for this study is called snowball sampling, which is a type of convenience sampling. This means that the researcher contacts a group of people that are relevant to the research that is being done. Further, the researcher uses this group of people to establish a contact with other people that are suitable for the research, and the initial group shares the survey with other individuals that are relevant for the study. There is also a problem with using this method, that is that the researcher does not have a sample that will be representative of the population (Bryman, 2012). Before handing out the survey or posting it online, the researcher can make a pilot study, which means that the researcher tests the survey on respondents that will not be in the actual study. This could help the researcher to see if there are questions that may be harmful for any of the

respondents that will answer the actual survey or if the questions are confusing in some way. This could also prevent loss of data for the researcher (Bryman, 2012). The questionnaire was tested with two individuals in order to understand whether the questions were non harmful and clear. The test did not lead to any changes in the questionnaire.

Because of the current situation of the covid-19 pandemic, the author posted a google survey on the authors Facebook page, where anyone that could see the survey was able to answer it. The participants that answered and saw the survey could also share the survey. As this survey was posted on Facebook the sample was still a convenient choice as they were the ones that were available for the author. The final sample number of the survey after being posted for over a week was finalized at 73 respondents. After the sample numbers had stopped, the author chose to use another platform called Discord where the author asked some individuals if they were interested in answering the survey and if they could share it to others that were relevant to the study. This resulted in 22 more respondents and the final sample size became 95.

4.4 Data collection

The data collection was conducted through an online survey made with the Google survey tool. It was thereafter posted on a social media platform called Facebook. The survey was first intended to be given to participants in a physical form. But, because of the covid-19 situation the author made a digital form of survey that could be answered on a computer or

smartphone. This was done in order to make it as simple as possible for potential participants to be able to answer the survey. It was then decided that the survey was going to be posted on Facebook in order to get in touch with participants that were available for the author. There was no time limit on the survey. This means that the survey did not have to be answered during a certain time limit. However, the survey needed to be completed during one occasion, as it was impossible to close the survey and continuing to answer it later. This was decided in order to make the survey as approachable as possible so that the participants could answer the survey when they had the time or was available to answer it.

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4.5 Survey and variables

In order to answer the study’s aim and research questions, questions from two different types of surveys was used. The first from was the “Health on equal terms?” that comes from

Folkhälsomyndigheten (2020) and the second survey is Prevents’ work environment survey called “Psychosocial work environment” (Prevent 2016). These surveys contained questions that could help answer the aim and research questions and questions from each survey was picked out in order to fit in to the theme of the study.

In the survey some background variables where used, these were; gender, self-evaluated health. To investigate the self-evaluated health a question called How do you assess your general state of health? from “Health on equal terms?”, this question was answered by alternatives called very good, good, somewhat, very bad and bad (Appendix A). A stress question was added to the questionnaire, that was named “Do you currently feel stressed?” but was rewritten as “Are you currently stressed by your work?” in order to be more relevant to the aim of the study. The question was answered with alternatives called Not at all,

Somewhat, Pretty much and Very much. The question was then dichotomized in order to be used in the analysis. The stress question was used throughout the whole analysis process, in order to answer the aim and research question. Other questions from the questionnaire was also used in order to explain the characteristics of the sample of the study. The questions used were “Gender”, “Age”, “What is your main job?” and “Educational level” (question 1, 2, 5 & 7, appendix A)

Psychosomatic complaints were examined through a sample of different symptoms that were taken from “Health on equal terms?” (Folkhälsomyndigheten, 2020), where the questions asked if the participants had experienced these symptoms for the last 3 months. The following symptoms that was asked in the question were, Headache, Migraine, Stomach ache, Ache in shoulders/neck, Ache in back or hips, Ache in hands/knees/legs/feet, Tinnitus, Sleeping difficulties, restless sleep. These symptoms were answered with Never, Rarely, Sometimes, Often and Always. The psychosomatic questions presented above were also used throughout the whole analysis process, as the psychosomatic complaints are the outcomes of work-related stress.

Other questions that were used in the questionnaire and to answer the psychosocial work environment factors were taken from Prevents survey for Psychosocial work environment (Prevent, 2016). In total 19 questions were added to the questionnaire as they were deemed to be relevant for the questionnaire. However, these questions were not used during the analysis. The questions that were taken from this survey were (1) My workload is acceptable, (2) My work is varied, (3) I know what is required of me at work, (4) Others’ demands on me (Customers, users, patients etc.), (5) I have enough time to do my job, (6) I can do my work during my normal working hours, (7) I have the resources required for me to do my job, (8) I can influence decisions related to my work-related duties, (9) I can affect my work rate myself, (10) If necessary, I get help from my superior to prioritize my tasks, (11) My superior helps me if I have to much work to do, (12) I know who to turn to in order to get support and help to do the work, (13) I enjoy the working with my colleagues, (14) My colleagues show me respect, (15) We can openly discuss difficulties at my workplace, (16) I

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have work hours that suit me, (17) I can use breaks to relax from work, (18) I have the energy to do other things after work, (19) My work is free from strong mentally stressful work tasks and work situations. These questions where made with different statements that

the participants could answer with different alternatives ranging from one to six, where one was not correct at all and six was correct. The following questions in the survey were picked in a thematic order from the Prevent survey. The themes for each question were related to workload, job decision latitude, leadership, organization, support and recovery.

4.6 Method of analysis

In order to analyse the gathered data from the surveys, the author used a program called IBM Statistical Package for the Social Sciences 22 (SPSS). This program is used in order to create statistical analyses of data, this could for example be done in order to see if there is a

relationship between work-related stress and psychosomatic complains.

In order to create the dataset on SPSS the author had to transfer the data from the Google survey to an excel document. After the survey answers had been transferred to an excel document, and thereafter the excel dataset was transferred to SPSS. The first step of the analysis was to create a frequency table that show the different jobs of each participant. In order to create this table, the author used the question “What is your main job?” (Question 7, appendix A). A descriptive analysis was done in order to create the frequency table that is presented in quantity (n=) and per cent (%). During the analysis the author used some questions in order to further explain the sample and some of the characteristics. The chosen characteristics that are shown are age, gender and educational level of the participants. These are shown with figures and tables, presented with (n=) and (%).

Before the analysis of the data started, a Cronbach’s alpha test was done in order to measure the internal reliability of the indicators (Field, 2018). Field (2018) explains that a Cronbach’s alpha test is the most common way to measure the internal reliability. The measure value of a Cronbach’s alpha test goes from 0-1 where 0.7 and 0,8 is deemed as an acceptable value. The Cronbach’s alpha test for the psychosomatic complaints index resulted in a 0.754 value, which is considered as an acceptable value. Thereafter, an index was created from the question “How often during the past three months have you had the following problems” (question 12, appendix A). This question contained nine different indicators that targeted to measure psychosomatic complains. An index was created by adding up all nine questions concerning psychosomatic complaints. The range of the score each participant could get were 9 to 45.

The first research question “Is there a relationship between work-related stress and

psychosomatic complaints?” was answered with the questions “Are you currently stressed by your work” and “How often during the past three months have you had the following

problems” (question 11 & 12, appendix A). The author then dichotomized the question “Are you currently stressed by your work. Further, an independent t-test was done to see if there is a relation between work-related stress and psychosomatic complains. This type of test can be done in order to see if there are differences between two groups, in this case those who are

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little stressed and those who experience much stress. The result is shown with the mean (M) and standard deviation (sd) (Field, 2018).

The second research question “Is there a difference between women and men in experienced stress?” was answered with question one and 10 (appendix A). In order to answer the

research, question a chi squared test (²). This type of test can be used in order to see if there are differences between two categorical variables in the population. To achieve statistical significance, it depends on two factors these are the magnitude and the number of categories of the two variables that are tested (Bryman, 2012).

The third research question “Is there a difference between men and women in psychosomatic complaints” was also answered with an independent t-test and the author used the question “Are you currently stressed by work and “How often during the past three months have you had the following problems” (Question 11 & 12, appendix A). The work-related question was categorical, and the psychosomatic complaints index was continuous, which made it possible to do a independent t-test. The result was presented in (m) and (sd).

4.7 Quality criteria

When a quantitative study is used within research, increases the value of three important components that important to consider throughout the research process. These are the validity, reliability and generalizability. Validity means that if the indicators that are chosen for the survey measures what they are supposed to measure. There are a few different types of validity and they are called face validity, concurrent validity, construct validity and convergent validity. Face validity is often talked about when a researcher creates a new measure, where the researcher should establish a face validity, this means that the measure should reflect the content of the concept in question. In order to establish the face validity, the researcher could ask for help from other experts in the field. That could help the researcher to see if the measure reflects what it is supposed to measure (Bryman, 2012). While this study has used inspiration by other survey questions that have been used several times before, could increase the study’s validity. While using questions from each survey that intends to measure what it is supposed to measure. Further, the face validity of this study could increase as questions from Folkhälsomyndigheten (2020) has been used before and that the questions have been made by experts in the field. When it comes to the Prevent survey (2016) questions it cannot be said that they are experts by any means but that they work within the field of work environment and that may increase the face validity.

The study’s reliability means the consistency of a measure of a concept, and how well the study has been done in order to be replicated at different time. There are three different types if reliability, these are test-retest reliability, Internal reliability and Inter-observer

consistency. In this study the author has not taken test-retest or inter- observer consistency into consideration as it does not suit the chosen study design and because of the time aspect. However, the internal reliability was taken into consideration for the study. A Cronbach’s alpha test was used to assess the internal reliability of the psychosomatic symptoms measure.

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A Cronbach’s alpha tests are done with indicator measures, where problem can be that they do not measure the same thing, which could mean that they lack coherence. Where the value of this test goes from 0-1 and where 0.8 is an accepted value of internal reliability (Bryman, 2012).

Generalizability seeks to what extent the result of a study is generalizable to the other population that has not been in the study. Because the author used a snowball sample it is unlikely that the sample of this study is representative of the Swedish population (Bryman, 2012).

4.8 Considerations of questions related to research ethics

It is important to consider the four ethical aspects when conducting a research study. The four ethical aspects are Harm to participants, Lack of informed consent, Invasion of privacy and Deception. In order to determine that the future participants of the study are not harmed or offended. This was considered throughout the whole process of the development of the survey. The participants of the study got read the missive letter that was posted at the first page of the survey (appendix B). The missive letter contained information that was important for the respondents of the survey as it gave them the information that the survey is

anonymous and voluntary. The harm of participants principal means that no participant that is involved with the study is to be harmed, and that questions in the survey should be created in a way that the participants are not harmed in any way. Lack of informed consent means that the participants must receive all possible information of the study. Moreover, this is done for the participants to give their consent to participate in the study. The third principle is called invasion of privacy, this means that the gathered data is supposed to be protected from other people than the researcher and his or her colleagues. This is done in order to protect the anonymity, and that the data is handled with confidentiality. Also, that no one that has not participated in the study will be able to get a hold of the participants

information. The last principal is called deception, which means that the gathered data is only used for the research study that the participants have given consent for (Bryman, 2012).

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5 RESULTS

The following figures and tables will show some of the basic characteristics of the study population.

5.1 Distribution of different jobs

Figure 1. Frequency of the different jobs of the sample

Figure 1 shows categories for different types of jobs for the respondents. Specifically, sales & warehouse category included different jobs, i.e. working in a store or a warehouse, and consisted of 12 respondents (12,6%). The school category consisted of 33 respondents (34,7%) and this category contained jobs like teachers and childcare. Health care and Social work include of 7 respondents (7,4%) and consisted of jobs like nursing and medical

personnel. Hotel & Restaurant had 7 respondents (7,4%) and consisted of jobs like working at restaurants and chefs. Industrial work & Construction consisted of 10 respondents (10,5%) the category consisted of jobs like carpenters and industrial service. Manager consisted of 3 respondents (3,2%) and consisted of work like team-leading and manager. IT consisted of 6 respondents (6,3%) and consisted of jobs like software specialist & IT consultant. Office work consisted of 8 respondents (8,4%) and the category consisted of working at an office and the Engineer job consisted of 6 respondents (6%) and this category consisted of different jobs within engineering. 0 5 10 15 20 25 30 35

N=93

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5.2 Age and gender

Table 1. Genders distribution of the participants

Gender Frequency (n=) Per cent (%)

Man 38 40

Woman 55 57.9

I don’t know 1 1.1

Other 1 1.1

Most of the sample were women (n=55) compared to men (n=38). With two participants choosing “I don’t know” and “Other”.

Figure 2. Age of the participants

Figure 2 shows the age range of the sample. Most of the participants were 28 years old (n= 17), and the age range of the participants were from 22 to 63 years old.

0 2 4 6 8 10 12 14 16 18 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 42 43 44 47 48 49 50 51 52 53 54 56 58 59 60 63

Age

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5.3 Education level

Table 2. Highest educational level of the study population

Education Total (n=) Per cent (%)

College/University 65 68.4 High school 27 28.4 Primary education 1 1.1 Other (Community Collage etc.) 2 2.1

Most of the participants had graduated from college or university (n= 65), whereas some of the participants had graduated from high school (n=27). Rest of the participants had either a primary education (n= 1) or had graduated from “Other (community college etc.)” (n= 2).

5.4 Relationship between work-related stress and psychosomatic

complaints

The analysis shows that there is a relationship between work-related stress and

psychosomatic complains (t= -3.817, df= 45.8, p= 0.01). It is more common to experience psychosomatic complains among the respondents that experience more work-related stress (M= 23.7097, sd= 6.92913) than among the participants that experience little work-related stress (M= 18.3871, sd= 4.95341).

5.5 Differences between men and women in psychosomatic complaints

The analysis showed no significant mean difference between men scores on psychosomatic complaints (M= 19.8158, sd= 6,83337) and women (M= 20.5556, sd= 5.68901; t= -.547, df= 70.231, p= .586).

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5.6 Differences between men and women in experienced work-related

stress

The analysis shows that there is no difference between men and women that answered that they experience little stress (see table 3, ²= 1,080, df= 3, p= ,782).

Table 3. Gender differences in work-related stress. Shown in percentage (%) and total (N=93)

Gender Little stress More stress Women 65,5% (n=36) 34,5% (n=19)

Men 68,4% (n=26) 31.6% (n=12)

6 DISCUSSION

6.1 Method discussion

6.1.1 Choice of method & study design

In this thesis the author chose to use the quantitative method, in order to research the occurrence and distribution of gender on work-related stress and if there was a relation between work-related stress and psychosomatic complaints in the Swedish population. This method was deemed to be the most useful one in order to research the occurrence and relation. A quantitative method aims to examine the relation between a theory and research. The quantitative method also aims to collect numerical data (Bryman, 2012).

A cross-sectional design was used in this study. This design collects data from a single point of time that, which suited the time frame of the study. As the author had a time limit of 10 weeks, essentially made the choice easier as this design is more suited for a shorter time frame (Field, 2018). Factors that are beneficial with this design is that does not need much resources and is less time consuming, these factors also played a big role when choosing the study design. A disadvantage with this choice of design is that the researcher only can analyse the relation between the variables. The variable’s relation has been taken from a single point of time. Another disadvantage with this type of design is that the researcher cannot find causality between the variables. This means that the researcher will not be able to see what causes what, that is if work-related causes psychosomatic complaints or vice versa (Bryman, 2012).

Further, if the author would have a longer time frame a longitudinal study design would have been something to reconsider. This design intends to gather data from two different points of

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time at least, makes it possible to see causalities. However, it was not chosen because of the time and resources this type of design needs (Bryman, 2012).

Because of the time limitation the cross-sectional design was more suited for the time plan of the study. Also, that the study was conducted to see the occurrence of different

phenomenon’s in this case work-related stress and psychosomatic complains, and to measure different variables strengthened the choice of picking this design. Further, this design does not need that much resources as it is less time consuming (Merril, 2013). In this case was appropriate because of the time limit. Further, there is a disadvantage when this type of study design is chosen, as the design can’t explain causality, which mean that the researcher can’t explain which variable causes what (Field, 2018). For example, if work-related stress causes psychosomatic complains or vice versa.

6.1.2 Sample & study population

The aim of this study was to examine the working adults of the Swedish population, when it comes to work-related stress and psychosomatic complaints. The sample of this study was chosen by posting the survey the authors Facebook page, and then not randomly. The author chose to use a snowball sampling method. One disadvantage that comes with this chosen sample method is that it is not likely that the result will be representative to the population (Bryman, 2012). This makes it harder for the author see if the result is representative for the working adults in the Swedish population.

Before posting the survey, the researcher can do a pilot study that could provide good information, if for example some questions are written in a way that could hurt the

participants. The author did not do a pilot study but tested the survey on two individuals that would not participate in the study. A strength from testing the questionnaire before posting it could be that the questions are well formulated and not harmful to the future respondents. Another strength could be that it could lower the chance of missing data in the questionnaire. Because of the current covid-19 pandemic the author chose to use an online survey to gather the data where the only option was to use the snowball sampling method, this means that the sample is not randomly chosen. Further, the sample size of this study was only 95. This could have influenced the result as the sample. This also influences the generalizability of the study. Using Facebook as a platform could also prove to have had an effect on the sample size, as there could be people that did not feel like answering the survey. Moreover, posting the survey at the wrong time could also have been a disadvantage for the author. This means that if the author posted the survey at a certain time when fewer individuals would see the post on Facebook. That could result in fewer people answering or sharing the survey. If the author would have the opportunity to provide the survey in physical form to the individuals in person without the covid-19 situation, could have changed the sample method, this could have had another effect on the sample size. Because of the small sample the power of the data is affected, and this can make it hard to find significant results from the analysis. This could therefore be a consequence of the small sample size.

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6.1.3 Posting the survey & data collection

During the start of the thesis the author, decided to create an online survey that would be sent out to the participants instead of handing it out in physical form. This choice was made because of the current covid-19 pandemic. A strength that could come from using an online questionnaire is that a snowball method would make it easier for people to share it. Using a physical survey could be harder to share and would also be time and resource costly for the author. Where the online questionnaire brings another aspect that people can share it through different platforms that could have an effect on the sample size. A possible consequence from using the online questionnaire is that it could be hard gather a larger sample if the first sample does not share the questionnaire, that could start the snowball effect. This could also influence the statistical power of the sample. Posting the questionnaire on other Facebook groups was on the agenda for the author but was cancelled, because the author thought that this could gather a sample that was not fitted for the population of the study. However, the author chose to use another platform called Discord in order to get more respondents. This choice gave the author 22 more respondents for the study. This could be seen strength, the sample became larger and the study got more men, before using Discord the already gathered sample had more women than men so this could provide more of a mix between men and women to the study sample. The author does not know if the participants answered the questionnaire alone or if anyone else was present during the time the survey was answered as well. This could result in that they answered the survey differently. Another aspect is that the author chose to use another platform than Facebook. The other platform that was used is called Discord, that is a type of online communication program, where people can chat. The author used this platform to send out

6.1.4 Creating the questionnaire

The chosen method for this study was to use a questionnaire survey, this is a fast and effective tool that can be used when a large sample is needed for a study. A strength while using a survey is that it can gather a large amount of data at a single point of time. Another strength is that using an online survey is free and time efficient. Another factor for using the survey as a data collecting method was that they were more suited for the aim of the study and because of the covid-19 situation. This could be both a strength and limitation. The limitation of this could be that the author does not reach the intended respondents for the sample. Furthermore, it is not clear if each respondent answers the questions truthfully as the questions from the questionnaire. The questions might be written in a way that makes the respondents feel like they must answer just to answer the question. This could in turn be negative for the result of the study. The respondents might feel that they are forced to answer each question even if that it might not have an alternative that suits them. Therefore, the author chose to focus on questions that was better suited for the targeted population.

6.1.5 The study’s analysis method & data processing

The first analysis was done in order to create a table to explain the different jobs from each study participant. A strength of this was that the author showed the result in both (n) and (%). Bryman (2012) explains that when presenting a table with the total number of

participants and the percentage will make the result easier to read and understand. Although the author thought that the result was presented with a larger text that could be hard to

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understand from a reading point of view. That could be a limitation of presenting a table. But a strength of this was that it was done in order to protect the anonymity of the participants in the study.

As the author used web-based tool in order to create the survey, proved to be time saving. The gathered data could be transferred to a excel document. This helped the with the transferring to SPSS. However, a limitation that surfaced while using this method was that each variable was not in order. A strength with using this method was that the author easily could recode the different variables as some of the survey questions (appendix A) already were coded with numbers. Which made it the recoding of variables easier for the author. This could be a limitation because the author used a new method to collect data and to transfer the data to SPSS. A strength of using this method is that it could take away the human factor, that some numbers would have been added incorrectly when creating the data set.

The research questions were answered with a chi-squared test and independent t-tests, both tests can see differences. The chi-squared test can be used in order to see differences between two groups, but a limitation using this test is that it cannot show the strength of association (Bryman, 2012). Both tests were deemed relevant for the analysis and would help the author to answer the aim and research question. These aimed to see if there is a relation between both work-related stress and psychosomatic complaints, and differences between men and women and work-related stress.

6.1.6 The study’s quality criteria’s

When conducting research, it is important to consider the different aspects of quality. One aspect to take in consideration is the validity criteria. It is important that the survey that is used measures what it is supposed to measure. Therefore, it is important that the questions in the survey used are validated. In this study the author chose to use Folkhälsomyndighetens (2020) survey called “Health on equal terms”. This is a questionnaire that they use yearly for the Swedish population and this could be a strength in study as the chosen questions are created and used by experts in the field of public health. But it is rather extensive so only few of their questions were collected to be used in the survey. However, the author reframed a question from this survey in order to fit the purpose of the study. Because the author chose to reformulate a question might question the face validity of that question. Where a limitation is that the author did not ask any experts of the field if the question would be validated or not. The author also incorporated questions from another survey that is called “Psychosocial work environment” by Prevent (2016) that create work environment questionnaires for different business that helps them create a better work environment. Although these questions were not used in the final analysis, they were still added in order to fit the purpose of the study and fill out the questionnaire with relevant questions to the subject. However, as these questions were not used in the analysis the author could have done a questionnaire with questions that only were relevant for the analysis. It is unclear if the questions from their survey are

validated but they are created by experts from the field. Furthermore, the next quality criteria are the reliability aspect. Reliability is the consistency of a measure of a concept. Also, how the author describes the whole process the study so another researcher can replicate the same study. As study is not a longitudinal study, the stability aspect of reliability has not been taken into consideration. But one thing that has been done and can be checked is the internal

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reliability of the study is the Cronbach’s alpha test. This test was done in order to see the internal reliability of the created index from question 11 (appendix A).

The third aspect is the generalizability aspect that is important when a quantitative study is done, because what the researcher wants is to see if the result is generalizable to the

population. However, because the author chose the snowball sampling method which cannot show a result that is representative for the Swedish population (Bryman, 2012). The chances of the result being generalizable to the Swedish population are very low. Another factor that could decrease the chance of generalizability is that the smaller sample size, and that there were more women than men. To summarize, the generalizability of the results is not warranted to the rest of the working adults in Sweden.

6.1.7 Ethical considerations

Ethical considerations have been considered throughout the whole process of the study, where the author has followed each aspect of ethics in order to strengthen the quality of the study. The first step was to create a missive letter that would provide the most important information for the participants. The letter contained information that the survey is

anonymous and voluntary, that the participants can decline their participation if they do not want to continue. It is important that the ethical considerations are followed all the way through a research study, in order to not causing harm to the participant. A strength in this study is that the following questions in the survey (appendix A) were chosen in order to not ask harmful questions. However, the author cannot be sure that everyone that answered the survey took the time to read the missive letter before answering the questions. This could therefore lower the ethics of this study. A thought came up about this issue, were if the author could have used another type of platform to create the survey. That an option existed that the participants had to press a checkbox in order to continue to the survey questions. This

method could have been proven to increase the ethics. Nevertheless, increase the chance that the participants took the time to read the missive letter.

Another aspect of this could be that the if the author were present while giving out physical surveys, this could ensure that each participant got the chance to have the missive letter read to them or that the author was giving out that information verbally. This method could have strengthened the ethics of the study. Unfortunately, this was impossible because of the covid-19 situation. Further thoughts that came up was that when the author used another platform to gather samples. Was that it could be considered unethical to ask people that the author knew. But a strength with this is that the gathered samples were handled with the highest confidentiality and anonymity because the author chose to categorize the different jobs (appendix A) in order to make it more anonymous. Also, to secure that no participant could be identified through the answers they gave. Further, some steps were taken into

considerations such as the storing and handling the data, as the author had all the stored data on an USB memory which would secure that the data could not be used by any other person. The gathered data was only handled by the author but were seen by the authors supervisor. The data was also stored on the authors private google account, that could be a limitation of the security of the data. But since it was a private account it could also be a strength as the author was the only one that had access to the data. Further, the gathered data was set to be

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deleted as soon as the thesis was done. This was done in order to not cause any harm or deception to the participants.

6.2 Result discussion

The result show that there is a relation between work-related stress and psychosomatic complaints. Participants that experience more work-related stress are experience more psychosomatic complaints. Furthermore, the result show that there are no differences between women and men when it comes to work-related stress and psychosomatic complaints.

6.2.1 The relation between work-related stress and psychosomatic complaints.

The result shows that a relationship between work-related stress and psychosomatic complaints exists. Experiencing psychosomatic complaints was more common among the participants that experienced more stress at work than among the participants that experienced little stress. This is in line a study by Holmgren et al. (2008) that explain that burnout and emotional exhaustion can be caused by work-related stress. Further, Holmgren et al. (2008) points out that psychosomatic complaints have a strong connection to work-related stress. If the individual experiences higher demands in combination with lacking social support can increase the risk of psychosomatic complaints such as musculoskeletal and psychiatric disorders. Furthermore, Ose (2005) explain that if the individual experience an increased amount of stress at work could result in sick leave. This could also result in that an increased amount of health care service would be needed.

Those who experience more work-related stress tend to feel like they lack control over their situation. Poor leadership and high demands are often the factors that increase the risk of ill-health among the employed. Hessels et al. (2017) explain that work-related stress has a clear effect on the employee’s health, that ultimately lowers the work performance. The result of the study is also consistent with the demand control support model by Karasek & Theorell (1990). Furthermore, stress and high demands are factors that can result in lack of

motivation and the employee’s cognitive learning. Another study by Scholey et al. (2014) explain that if an individual experiences stress for longer periods of time, this could have a negative effect on the individual’s health. As a result, cognitive disorders may happen because of long term stress. This could affect the individual’s memory and judgement during stressful moments. Further thoughts that came up during the analysis of the result. The workplace is an arena where most individuals spend their time, this strengthens the hypothesis that the workplace is a place that should work preventively in order to maintain the mental and physical wellness of every employee.

It is an important job for every organization to have employees that are healthy and come to their workplace. The positive climate could have a positive effect on motivation and

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social support from the workplace influenced higher levels of stress. This could be one of the reasons that the result shows that people experience work-related stress.

Further, a study done by Leka et al. (2003) that a study showed that fair work demands, and healthy working environment could provide safety for the employees and would result in a less stressful workplace. As the result shows that the individuals that experience more psychosomatic complaints, a thought is that work-related stress is an occurring problem at their workplace. This could be why they experience more psychosomatic complaints than the ones that are experiencing less stress at work. It could also depend on how often the stressful situations occur at their workplace. However, this factor was not analysed in this study but could have been something to consider. Fila (2016) explaines that individuals facing

concurring interruptions during their work time would often experience negative effects from stress.

6.2.2 Gender differences with experienced stress from work

The result shows that there were no differences between men and women in experienced stress. Women that experience little work-related stress were more than the ones that answered that they experienced more stress, this was also seen among the men. This result could be related to the research study by Holmgren et al. (2009) that further explain that experiencing high demands with a low to no social support can result with several factors that increases the risk of sick leave. This was more common among women. Another research done by Magnusson et al. (2008) also explain that the earlier mentioned factors are related to burnout. Where they also explain that having no control over decision making at the

workplace, is the result of work-related stress.

Furthermore, the result is in contrast with the article by Rivera-Torres et al. (2013) that explains that women and men are often exposed to different types of work environments. However, previous research showed that occupational stress among women and men does not differ for all types of work-related stress (Rivera et al, 2013). But in some cases, women experience more psychosomatic symptoms like depression and anxiety, and men experience heart diseases when stress at work is involved. The demands and tensions from the

workplace can be different for women and men even if they would work with the same profession. It is also explained that women often stay at their workplace longer than men. This proves that women can ultimately be exposed to stressors in a longer spectrum if they are faced with low social support and high demands. A thought that came up during the analysis is that the sample size could have had an impact on the result. If a larger sample size would have been collected the study could have had an entirely different result. The small sample resulted in a lack of power which lead to difficulties in getting significant results. Another aspect is that a low sample size decreases the chance of the results being

representative for the population.

The model by Karasek & Theorell (1990) and the article by Rivera-Torres et al. (2013) has a strong connection when they explain that increased social support was shown to have an important impact on women’s’ health as more social support from the workplace showed to be a positive factor to prevent work-related stress. Further, work-related stress among

Work-related stress and psychosomatic complaints : A quantitative study done among working adults in Sweden