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Assessing the Economic Impact of Stress—The Modern Day Hidden Epidemic
Madhu Kalia
This article examines the economic effects of all forms of stress—work-related stress, home stress, and post-traumatic stress
disorder (PTSD)—as health hazards. Such an approach inherently broadens the analysis from a few well-defined, quantitative
variables, such as those most commonly studied by economistswho traditionally examine job stress alone. It also enables
us to draw conclusions regarding the socioeconomic factors and the psychology of stress and helps in understanding the
larger question of the economic cost of stress in today’s global environment. Stress and its related comorbid diseases are
responsible for a large proportion of disability worldwide. The World Health Organization (WHO)Global Burden of Disease
Survey estimates that mental disease, including stress-related disorders, will be the second leading cause of disabilities by
the year 2020. Although the term “stress” is used in a wide variety of contexts, it has consistently been demonstrated that
individuals with stress and related disorders experience impaired physical and mental functioning, more work days lost,increased impairment at work, and a high use of health care services. The disability caused by stress is just as great as the
disability caused by workplace accidents or other common medical conditions such as hypertension, diabetes, and arthritis.
We present evidence that calls for early recognition of workplace stress and for businesses to allocate more resources to
stress management in theworkplace.
Copyright 2002, Elsevier Science (USA). All rights reserved.
THE GLOBAL ECONOMIC burden of stress-related mental
illness is expected to rise in the coming decade.1 The
World Health Organization (WHO) Global Burden of Disease
Survey2 estimates that by the year 2020, depression and anxiety
disorders, including stress-related mental health conditions,
will be highly prevalent and willbe second only to ischemic
heart disease in the scope of disabilities experienced by sufferers.
The WHO Collaborative Study of Psychological Problems
in General Health Care screened nearly 26,000 individuals
attending primary care facilities in 14 countries and found that
10.4% of patients had current depression or stress-related anxiety.
1,3 The Depression Research in European Society(DEPRES)
survey,1,4 involving 78,463 adults, found a 6-month prevalence
rate of 17% for depressive disorders. Similarly, the US National
Co-morbidity Survey (NCS) found that 17.3% of the
general population had experienced an episode of major depression
and 24.5% had suffered from an anxiety disorder at
some time during their lives.1,5 A higher mortality rate is
observed in myocardial infarctionpatients who are depressed
than in myocardial infarction patients without depression.6
Stress, social isolation, lower income, and lower educational
levels are all related to a poor cardiac outcome.7
In order to analyze the price or the cost of stress, it has been
thought reasonable to use work-related stress alone to arrive at
conclusions related to the monetary equivalent of stress. Grootand Maassen van den Brink8 have used this economic approach
to make monetary inferences and also to test some of the
psychological theories of stress such as the demand/control
theory. In doing so, these authors assume that the “good stress”
or “arousal stress” of Selye’s general adaptation syndrome
theory9 has little economic value and that all work-related
stress is an undesirablecharacteristic of the job and, therefore,
the worker needs to receive extra monetary compensation for
doing a job involving stress. Is work stress the only form of
stress that has an impact on the economy? Does home stress
impact job performance and therefore productivity in economic
terms? Does post-traumatic stress disorder (PTSD) impact employee
productivity, for example, after the September...