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ISSN : 1598-7248 (Print)
ISSN : 2234-6473 (Online)
Industrial Engineering & Management Systems Vol.21 No.2 pp.192-205

Stress at the Workplace and Its Impacts on Productivity: A Systematic Review from Industrial Engineering, Management, and Medical Perspective

Elkana Timotius*, Gilbert Sterling Octavius
Department of Industrial Engineering, Universitas Kristen Krida Wacana, Jakarta, Indonesia
Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
*Corresponding Author, E-mail:
January 4, 2021 ; January 26, 2021 ; January 24, 2022


In every fast-paced surrounding, stress is present in every life aspect, including at the workplace. It is a deeply personal experience, with various stressors affecting every individual differently. This study assessed the past and present workplace stress-related information and analyzed its impact on productivity. It primarily concentrates on the field's philosophical principles, while providing a collection of directions for future study as well. This study was formed in the statement of PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis). The impact of stress at the workplace on the employee’s productivity was observed in the cohort and cross-sectional studies from the perspective of industrial engineering, management, and medicine. Four eligible studies were qualitatively assessed from 2,642 identified literature through four databases (Cochrane, Science Direct, Scielo, and PubMed) using keywords stress, impact, productivity, industrial engineering, management, and medicine. The study was convinced that stress at the workplace contributes to worsening relationships at home, worsening relationships between superiors and subordinates as well as contracting diseases. It has a potential negative impact on productivity. Furthermore, the work environment plays a significant contribution in inducing workplace stress because of human physiologic response. Noxious stress is detrimental to the human body, especially if maintained in the long run. Therefore, stress management is imperative before it is too late.



    Humans are living beings who have physical and spiritual aspects. These two aspects are interrelated and influence each other. Physical aspects are not only measured by body health but also the body’s ability to carry out productive activities. Likewise, the spiritual aspect of humans is not only in the form of feelings, emotions, and thoughts but also psychological comfort to live life and be able to enjoy it. The occurrence of disturbances in the physical aspect will result in instability in the spiritual aspect, and vice versa. In carrying out life activities, espe- cially for an employee when carrying out his work, the physical and spiritual aspects must always be controlled and in prime condition to produce optimal performance. However, in practice, these prime conditions are difficult to achieve by workers due to the large responsibilities they have, the high demands of work, and the intense competition in the world of work.

    Since the first productivity has been an interesting topic of discussion in the industrial world. Many studies have been conducted to find the right strategy to increase productivity, as well as industry practitioners who continue to strive to design productive work methods. Unfortunately, very few people realize that productivity is not only built through work strategies and methods. Productivity is related to the human element as an actor in the industry, meaning that productivity is also determined by the spiritual and physical aspects of humans. The nonprime conditions experienced by workers will affect the productivity they produce.

    It is a well-established understanding that stress in many industrial countries has become more complex, especially in the working environment. There is a substantial cash loss in stress-related issues, and millions of employees are severely impacted individually (Hassard et al., 2017). Martin and Matiaske (2017) believed that the consequences of stress in workplaces were absenteeism, psychological and health problems, loss of interest, and other unproductive manners. Stress at the workplace is not restricted to a specific job or region, it has had influence everywhere since decades ago. While working stress is inevitable, the workplace should also be capable of encouraging individuals to perform at their best, particularly in creative tasks, as stated by Samani et al. (2014).

    The world has become a fast-paced, dynamic, highly stimulating environment in which stress is inevitable. A multitude of variables in the workplace can increase stress levels, especially for those who work under pressure constantly. Stults-Kolehmainen and Sinha (2014) argued that while stress has its positive side in raising performance when in excess it can lead to negative health and productivity consequences. There are many workplace stressors in play, which can be seen from three approaches, which are: an engineering approach, psychological approach, and physiological/health approach.

    Symptoms that arise due to stress include sleep disturbances, high blood pressure, and dizziness, which are leading to missed attendance, employee turnover, high tension, poor working-home relationships, and low quality of work (ILO, 2016). A strategy to manage stress at work is highly essential for the overall company’s well-being. According to the importance of this issue, the study must be conducted across disciplines. Stress at the workplace is not only related to a medical aspect but also it must be managed properly to be transformed into something more productive as the principles of industrial engineering.


    2.1 Stress

    The definition of stress varies widely depending on the different points of view under different conditions. The commonly used definition of stress is one that was proposed by Selye (1946), in which stress is perceived as the unspecific response of the body to any demand. In his opinion, stress is not the same as emotion or anxiety because it may arise under or even in responding to anesthesia. Stress may also take place in plants and bacteria that do not even have a nervous system. Stress is not something that needs to be avoided or prevented, since just keeping alive generates a requirement for sustaining energy.

    Selye (1946) categorized stress as “positive stress” and “negative stress”. Positive stress, also recognized as eustress or good stress, is inherently confronted over a short period and is useful for motivation, better focus, improved employees coping skills, excitement, and improved performance. Meanwhile, negative stress, which is also known as distress or bad stress, can lead to anxiety, feeling uselessness, and mental or physical problems then decrease performance in the short-term or long-term (Bowen et al., 2014;Leung et al., 2005). Among these two, negative stress has the potential to bring health problems and thus actions must be taken to manage its causative factors. It is recognized as occupational stress when stress is the outcome of occupational factors including the misalignment between the job requirements and employee’s skills, needs, or resources. Ng et al. (2005), however, concluded that stress in the workplace is not limited to any specific profession or occupation.

    Cox and Griffiths (2005) define three approaches to stress: engineering, physiological, and psychological. Stress in the engineering approach is used as an individual attribute as a standard requirement for the ecosystem; it is an independent variable that results in negative health outcomes. Stress and health effects are separate but interrelated. The physiological approach considers stress based on biological changes that occur as a result of individual stress. Selye (1946) indicated that in the short term, stress is flexible in which someone able to keep safe and avoid accidents. In the current period when everything is fast-paced, increasing job demands cause unavoidable stress that affects health negatively. Stress is a psychological approach that is considered to be an active response to an individual's social environment (Cox et al., 2000).

    A stressor is a significant factor of stress and can trigger a stress response (Enshassi and Swaity, 2015). Stressors are typically classified into four classifications, including personal stressors, organizational stressors, physical stressors, and job stressors as well (Leung et al., 2008;Leung et al., 2010;Senaratne and Rasagopalasin gam, 2017). Besides, stress was categorized by Leung et al. (2008) as burnout, objective stress, and physical stress. They also found that individual stress has a negative relationship with performance. While an increase in occupational accidents has been reported, alcoholism, drug abuse, and high absenteeism, also become crucial social issues due to stress at the workplace.

    There were physical, psychological, behavioral manifestations of the stress at the workplace (Amankwah et al., 2015;Ekundayo, 2014). Physical stress disorders include hair loss, eating disorders, weight loss due to irregular sleeping and under-healthy meals, high blood pressure, cardio-bronchial pain, palpitations, headaches, sweaty palms, muscle aches, breathlessness, hyperventilation, dry throat and mouth, stomach ulcers, indigestion, diarrhea, etc. Stress manifestations in psychological are lack of focus, the feeling of being worthless and depressed, depression, tenseness, insomnia, skepticism, social phobia, etc. Behavioral stress manifestations are becoming easily distracted, excessive or inadequate eating, impulsive behavior, aggressive, irritability, burnout, speech problems, under or over-sleeping, personality changes, teeth grinding, increased smoking indulgence, leisure drugs and alcohol, nervousness, increased error rate, loss of concentration, absenteeism, etc. According to Leung et al. (2010), stress may express nervousness or frustration and could affect performance and mental health as well. Bowen et al. (2013) also found similar results in their research.

    2.2 Stress at the Workplace

    Work stress is dependent on the work itself. Different work needs different characteristics with unique sets of skills needed. Because of the inherent nature of the job, Statt (1994) noted that, besides mining and police work, construction work is another very stressful profession. Construction workers experienced so much pressure on their working environment, and it has had unpleasant impacts on health and work productivity. In contrast, Enshassi et al. (2015) found that the safety performance of the construction industry was not affected by work stress and job burnout. Moreover, different work gives a different level of stress, either a desk job or a field job. Swaminathan and Rajkumar (2010) analyzed that a field job has a higher level of stress than a desk job. Since stress is a subjective matter, stress at the workplace is manifested at a different level according to the character of the individual. It plays an important part in coping with stress, for instance, habits of working close to the deadline or sociability.

    Other stress categories are associated with the job nature including inadequate remuneration, working environment, organizational stress, employee conflicts, poor organizational communication, job demand, job role, unspecified employment requirements, lack of authority, and lack of adequate facilities (Chen et al., 2006;Ibem et al., 2011;Leung et al., 2010;Raitano and Kleiner, 2004). As organizational related stressors, Ng et al. (2005) listed unsatisfactory remuneration, insufficient space for creativity, and uncertainty of job requirements. Haynes and Love (2004) indicated that work overload, long-hour shifts, and work-family conflicts as the employment stressor. Enshassi et al. (2015) also pointed out inadequate safety training, lack of job stability, lack of proper safety performance management, low wages, unfair rewards and punishment system, the management concern on productivity without safety and well communication, are the major stressors in the organization. Likewise, work stress and organizational performance are negatively correlated (Cotton and Hart, 2003;Elovainio et al., 2002). According to Cooper et al. (1985), the causative stressors have been more broadly categorized by incorporating several tiers including environmental and individual differences. In essence, work stress may develop when there is an imbalance between the employee’s requirements, skills, and abilities to achieve a specific work objective (Blaug et al., 2007).

    2.3 Stress at the Workplace for Productivity

    In the field of human factors and ergonomics, Samani et al. (2014) found that the workplace can be a trigger to have a positive mood. Unfortunately, the workplace often makes employees stressed, particularly in the industrial sectors. It is among the most vital health hazards for employees working (Rengamani et al., 2017). It affects physical and psychological disorders and may result in adverse outcomes, including productivity. This productivity issue is becoming more serious and more complex, especially in developing countries where the health of employees has never been valued. Stress at the workplace can impair one’s well-being through physical, psychological, emotional, and behavioral then can be related to heart attacks, hypertension, and other diseases (Blaug et al., 2007). Work stress is a normal condition and sometimes necessary, consider the suitability of employees in the work environment rather than their job characteristics. High stress, however, can affect one’s work performance, physical and emotional health for a long period. If the employees take care of their stress levels themselves, it will greatly reduce health issues and have a positive contribution to the success of the organization (Bakker et al., 2012). Severe work stress contributes to anxiety, poor performance, illness, and absenteeism in productivity problems (Crandall and Perrewe, 2020). Noxious stress differs from normal stress, remains and continually increases. This causes harmful negative effects both physically, mentally, and work performance.

    Physiologically, stress alerts the nervous system to protect the body as a reaction, awakens the human brain, and endorphins raise awareness. The nervous system becomes alert and releases hormones to increase awareness; there are some manifestations of an increase in pulse rate and tense muscles. This is referred to as a fight or flight reaction; helping the body prepare against alarming situations is essential. Whether stress is created because of work or other circumstances, this response is the same. A lesser impact on the body will be temporary or acute stress. However, if a stressful situation is not resolved, the body will become tenser over a longer period due to an increased depreciation. Psychosocial stressors are the key elements that lead to a wide range of employee’s healthrelated stress. They result in restlessness, cardiac diseases, gastrointestinal disorders, absenteeism, unhappiness, exhaustion, musculoskeletal disease, accidents, work-family issues, and many other problems. They may result in low productivity, errors at work, work accidents, less accountability, low morale, and labor lawsuits leading to additional costs and losses for the company.

    Stress at the workplace commonly occurs chronically, that is until the employee is assigned to another job or went on vacation. Chronic stress has been found to affect our body through a multitude of processes. Macroscopic and physical changes in neural networks are associated with certain brain areas (Mariotti, 2015). Scientists reported that employees with work stress have significantly more leukocytes circulated than they did not work. The acute phase reaction, usually triggered by a destructive factor, initially involves a disease behavior that involves symptoms of depression, such as decreased physical activity, social withdrawal, mood, somnolence, fatigue, and cognitive changes.


    The systematic review is formed as the statement of PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) as shown in Figure 1. To develop literature search strategies by asking focused clinical questions, the study applied the PICO framework as follows: P (Population) is for all employees who are working; I (Intervention) is the stress that is being burdened towards the employees; C (Comparison) is reviewing the stress from the perspectives of industrial engineering, management, and medicine; O (Outcome) is reviewing the impact or effect of stress on the employee.

    The study included cohort studies and crosssectional studies that observed the effect of stress on employees from the perspective of industrial engineering, management, and medicine. Exclusion criteria included studies that included animal studies, non-research papers such as a book chapter or encyclopedia, and studies without the English language.

    Four different databases such as Cochrane, Science Direct, Scielo, and PubMed were used to conduct a systematic literature search. The keywords used in the search engines are listed in Appendix 1. There was no year limit imposed on the study filtered. The identification of records by using the keywords found 2,642 kinds of literature. While the study searched four databases but only Science Direct provided all identified literature. Having screened on each title and abstract, there are only 96 kinds of literature that proper to be considered. Unfortunately, there are 6 duplicated pieces of literature so only 90 kinds of literature for the further selection process. The study finally selected 4 kinds of literature because 80 of them are not a research paper, 3 articles are not written in the English language, and the others 3 kinds of literature have a scope which out of the research topic.

    Data were extracted from selected literature in a standardized form by compiling citations, subjects, and research findings. The citations included the author's name, publication year, and the title of the research. The analysis process in this systematic review is related to the methodology, location, objects of each research to obtain the synthesis as the objective of the study.


    The summary of eligible studies to be assessed qualitatively in the systematic review is shown in Table 1. There were 4 studies out of the 2,642 studies that appropriate for this study refers to used keywords. The studies included are from Smoktunowicz et al. (2017), Livitckaia et al. (2019), Lundgren et al. (2014), and Uzoigwe et al. (2016).

    The Newcastle Ottawa Scale (NOS) assessment is applied to assess the quality of nonrandomized studies that interpret meta-analytical results as recommended by Luchini et al. (2017). By using the NOS, each study is categorized into three groups: the selection of the study groups; the comparability of the groups; and the ascertainment of either the exposure or outcome of interest for case-control or cohort studies respectively. Stars awarded for each quality item serve as a quick visual assessment. Stars are awarded such that the highest quality studies are awarded up to nine stars. The method was developed as a collaboration between the University of Newcastle, Australia, and the University of Ottawa, Canada, using a Delphi process to define variables for data extraction. The scale was then tested on systematic reviews and further refined.

    The four studies selected in this systematic review were assessed for their quality by a NOS rating for further analysis. As indicated in Table 2, all selected studies had NOS above 7 where the study of Uzoigwe et al. (2016) obtained the highest NOS score. Their obtained NOS convince that the quality of the studies is good. Prospective cohort studies were carried out by Smoktunowicz et al. (2017), Livitckaia et al. (2019), and Lundgren et al. (2014), while Uzoigwe et al. (2016) were cross-sectional studies.

    Smoktunowicz et al. (2017) found that demands for perceived stress were influenced, either directly or indirectly, by self-efficacy and inter-role conflict to manage work and family. Their further study three months later showed that inter-role conflict did not mediate perceived stress, but did mediate self-efficacy. There was an association between demands and inter-role conflict which in turn led to decreased self-efficacy and thus leading to elevated perceived stress at work significantly.

    The purpose of the Livitckaia et al. (2019) study was to examine the possible correlations between sleep and stress in the daily activity of moderate-intensity in cardiovascular disease patients. Eleven cardiac patients were observed and found that night sleep duration was associated with the daily activity of moderate intensity, but the stress was not associated with daily physical activity of moderate intensity. Although this study has the lowest number of participants, this is a preliminary study and hence the sample size should not be a major problem.

    Lundgren et al. (2014) studied several workers from industrial, service, and agricultural sectors by quantitative measurements on the heat stress, clothing testing, workload estimations, as well as qualitative information on health impacts and loss of productivity. They found that in a very dry season all workplaces had a very high exposure to heat and most workers had a moderate to high workload. Problems were also found in terms of clothing as there is high insulation with the clothing in regards to the weather. Females were especially vulnerable in terms of this aspect as they wear more clothing as protective clothing on top of their traditional clothing. This is the only study to assess the impact of quantitative measurements in the setting of various sectors of workplaces.

    Lastly, Uzoigwe et al. (2016) observed 173 professional women working in the engineering area, information technology firms, and hospitals. Their study did not find a significant difference between different sectors in work-family role conflicts, but job demand, job role overload, hours of work, and family responsibilities were significantly associated with work-family role conflicts. This study is the best study included with a NOS score of 8 as well as having the largest number of participants.

    Table 3 provides a summary of the findings of the four studies. If considered each source of stress at the workplace that impacts work productivity, three main groups can be analyzed further, namely: gender issues and work-family conflict, workload and work environment, and the relationship between employees and supervisors.


    5.1 How do Gender Issues and Work-Family Conflict Cause Stress in the Workplace?

    Channar et al. (2011) investigated the issue of workplace gender discrimination and its impact on the level of employee stress. Their results indicate that in private institutions, female employees are more discriminated against than male employees, but not in public institutions. Gender discrimination is a factor leading to decreased em- ployee satisfaction, motivation, dedication, and enthusiasm levels and increasing employee stress levels. Furthermore, women are more likely to experience stress than at work, particularly married women (Kavitha et al., 2012).

    Smith et al. (2018) stated that work-family conflict is predicted to affect work stress and reduce work productivity. It is reflected in a process that reduces job outcomes. Time, mood, and energy may be depleted by daily work-home systems are likely to impair work concentration, which hinders long-term work outcomes (Brummelhuis and Bakker, 2012).

    In a study conducted by Enshassi and Swaity (2015), work-family conflict is the most prevalent personal stressors for employees. They do not care about their personal lives, except for their work; regretfully, this dedication conflicts with their concern for their family. Huge job responsibilities also caused stress for these individuals. Besides, lack of teamwork among employees becomes another factor of stress. The result of this study may be true where employees are committed to their work, working individually, and have to stay at work for a long period.

    5.2 How do Workload and Work Environment Cause Stress in the Workplace?

    The workload is the amount of work to be done by an employee in a certain period. Qureshi et al. (2012) found a positive relationship between workload and stress. Although the high workload often causes stress subjectively, compensatory responses can be obtained that maintain behavioral and physiological adaptation (Selye, 1946). Furthermore, Qureshi et al. (2012) believed stress at the workplace, which is caused by a high workload, is positively related to turnover intentions. Turnover intentions can be used as a reflection of the inability of the employees to adjust to the stressor in form of the workload given. As the main reasons for causing job stress in employees, the worst, workload, role conflict, and insufficient monitoring reward lead to reduced productivity of employees (Warraich et al., 2014).

    According to Thayer et al. (2010), work environments, such as ventilation and lighting, affect one’s response to stress at the workplace by circadian heart rate variability and cortisol levels. Air quality and poor lighting were both associated with high cortisol in the morning, higher heart rate, and decreased heart rate variations throughout the day. On the other hand, light levels and views of nature may help with better health and lower depressive symptomatology. Another environment variable that may affect stress at the workplace is temperature. The physiological reaction of the worker to heat is to reduce physical activity, which reduces the internal heat production of the body. The result of this natural preventive mechanism is slower work, resulting in reduced work capacity and ultimately lower productivity. In global, Dunne et al. (2013) estimated that environmental heat stress significantly reduced labor capacity in peak months, and projected a further reduction in productivity of 80% by 2050 at this rate. These environmental factors were also linked to job satisfaction in employees.

    5.3 How does the Relationship between Employees and Supervisors Cause Stress in the Workplace?

    Mackey et al. (2017), Tepper (2007), and Zhang and Liao (2015) have shown that abusive supervisors are highly influencing employee behaviors. Convergent proof of negative impacts on Organizational Citizenship Behavior (OCB) and Counterproductive Work Behavior (CWB) has been identified. OCB is a voluntary behavior that leads to organizational effectiveness (Organ, 1997), but on the other hand, CWB is an immoral behavior that leads to a detrimental effect on other employees and the organization (Bennett and Robinson, 2000).

    Work stress is related to lower OCB and greater CWB. Regarding OCB, Zhang et al. (2019) argued that abusive supervised employees are deterred from contributing more. As CWB is concerned, Forgas (2002) and Krischer et al. (2010) indicated unethical supervision reduces the proactive actions usually used to follow the rule. Therefore, employees lost control of their behaviors when they experience heavy stress due to abusive supervision and are prefer to commit CWB rather than OCB (Lian et al., 2012).

    Restubog et al. (2011) discovered from the resource perspective that abusive supervision can be a chronic stressor, such as undermining, ridiculing, and criticizing employees. As a result, employees must take substantial action to resolve the stressful cases of abuse (Lee and Ashforth, 1990). Psychosomatic complaints and negative emotions are symptoms of work stress (Lazarus, 1991).

    5.4 How Does Stress at the Workplace Cause an Illness?

    Stress has been linked to several diseases. However, it is complex and affected by many other factors as well. These factors include genetic vulnerability, coping style, personality type, and social support. For human health, not all stress is bad. Short-term stress, for example, coupled with a good coping mechanism, can boost the immune system. On the other hand, chronic stress has a deleterious effect on health. Chronic stress increases the T-cells suppressor and catecholamine levels, which in turn suppress the immune system. Aside from adaptive immunity, stress also affects the histamine level. Histamine is the main mediator of many allergic diseases such as asthma and since stress can raise its level, asthmatic patient with chronic stress is more prone to having an asthma attack (Salleh, 2008).

    Cancer is another life-threatening disease that has a potential link with stress. Stress could suppress the function of Natural Killer (NK) cells. These cells destroy precancer cells before they mature into full-blown cancer. Outside the immune system, stress also affects many body functions. Stress has been found to alter the body’s insulin demand and therefore, could increase the risk of having diabetes mellitus in high-risk individuals. When combined with a high-fat diet and sedentary lifestyle, stress at the workplace could also accelerate plaque buildup in the arteries and cause atherosclerotic plaque. This condition has many devastating effects such as coronary heart disease and ischemic stroke. Stress also has an effect on acid production in the stomach. Raised acid concentration could cause a peptic ulcer, stress ulcers, or ulcerative colitis. Naturally, stress could also cause or trigger a psychiatric illness, even with a stronger cause-andeffect relationship than physical illness. According to Salleh (2008), stress is strongly correlated with neuroses, depression, and even schizophrenia.

    5.5 How Does Stress at the Workplace Relate to Productivity?

    Donald et al. (2005) found the psychological wellbeing is related to employee productivity. They believed in the relationship between stress at the workplace and work productivity. However, it is inevitable to disregard that productivity also depends on job types which bring about varying levels of stress. According to Enshassi and Swaity (2015), the complexity of the construction project with a strict target of achievement has long been considered an industry with stressful job demands. Excessive stress affects job performance and productivity in its quality, output, and cost efficiency (Amankwah et al., 2015;Ng et al., 2005). In the meantime, Ibem et al. (2011) emphasized that negative stresses were experienced by construction workers, and they had unpleasant effects on health as well as productivity at work. Another example would be those who work in the healthcare industry such as doctors and nurses. They prone to stress because not only affected by the common variables but also the character of their work and society expectations. The British Medical Association (BMA) reported that there were a significant proportion of stress effects in both junior and senior doctors, and they were harmful to the nature of health and service of doctors to patients (Maslach et al., 2001). Sauter and Murphy (1995) found stress at the workplace in the healthcare industry is about 70% higher than in other industries, and sadly, female doctors have a stress risk almost 4 times than male doctors.

    Workers in the health industry are more likely to have a higher level of stress compared to other professions in other sectors as mentioned by Puteri and Syaebani (2018). They argue that it does not only impact fatigue, absenteeism, turnover, customer dissatisfaction, but for health professionals, in particular, it will lead to incorrect diagnosis and curative action. The stress in the medical environment is more dominant caused by job pressure and lack of organizational support (Puteri and Syaebani, 2018). Similar to other industries, Arbabisarjou et al. (2013) proved that job stress has a negative correlation with performance in health industries. These findings were also supported by Bjaalid et al. (2020) that stress was negatively related to job performance for hospital employees, it is related to the motivational resources autonomy. The focus on productivity and top management’s wish to improve hospital performance have unintended consequences to stress levels increased. However, Arbabisarjou et al. (2013) believed that stress at a certain level is sometimes necessary to boost the performance of employees. Employees do their job regularly but due to workloads and time constraints, their performance reduces. Niks et al. (2018) advised intervention the stress for health workers by managing the work breaks, crafting the job, creating the lean management, and preparing the coaching trajectories. Their research indicated those ways able to maintain health, well-being, and performance outcomes for health workers.

    In the occupational health and safety aspect from industrial engineering perspective, there is sufficient evidence that stress may result in increased burnout and manifest as emotional exhaustion, depersonalization syndrome, and a sense of low personal achievement (Bowman et al., 2003;Tamini and Kord, 2011). In the management perspective, stress may also harm the effectiveness of work, as it reduces concentration (Bower and Segerstrom, 2004), decreases attention (Emmett, 2013;Robertson, 2012), weakens the capacity for making a decision (Linden et al., 2001), and decreases the ability to maintain strong interactions with stakeholders (McGonagle and Kessler, 1990). In the medical perspective, stress also may lead to increase depression (Freudenberger, 1980), disrupt personal relationships (Kristensen et al., 2005), psychological distress (Shirom and Melamed, 2005), decrease job satisfaction (Sanders, 2013), and even suicide (Maslach et al., 2001). In short, as also mentioned by Shahraki and Bakar (2019), fatigue caused by rest problems contributes to productivity losses and leads to a high cost to businesses. Table 4 shows the manifestation of stress at workplace and its impact to productivity.

    5.6 Implementing Stress Management at the Workplace

    Stress management is an essential action to decrease the negative impacts of work stress. Its approach is for improving workers’ overall well-being and productivity (Sutarto et al., 2020). Quick and Tetrick (2011) catego rized stress interventions into three levels as shown in Table 5. They suggested the company implement the programs to refer to employees’ stress intervention levels. They believed that a different treatment program can more be effective to anticipate the negative impacts of stress at the workplace.

    The intervention program in stress management proposed by Bourbonnais et al. (2011) targeted improvement in several factors of psychosocial work including psychological demands, limited authority, unsupported management, imbalance in the reward system, psychological distress, and employee burnout. They can be conceived as personal resources (e.g., emotional stability), employment resources (e.g., management support), and job resources (e.g., job authority, remuneration system). In many of the variables targeted by the intervention, they found substantial improvements. A thorough risk evaluation that guided the implementation of the intervention is likely to be due, in part, to the effectiveness of this intervention.

    Hülsheger et al. (2013) proposed mindfulness to reduce employee stress as a part of stress management among employees. It promotes an adaptive response to stress in an appropriate, non-judgmental manner (Michel et al., 2014). Madsen (2003) is convinced that the program of mindfulness promotes the physical, emotional, spiritual, and social well-being of oneself to function at the highest possible level. They could even concentrate on communication and comprehension, such as instructional design, communication skills training, and personal coaching. Also, assessment and evaluation services, such as heart rate screening, nutrition reviews, wellness assessment, and vision test, may be used.


    Stress is a physiologic response that is imperative in humans to maintain survival by eliciting “fight or flight” responses. However, noxious stress is detrimental to the human body, especially if maintained in the long run. In the workplace, stress is found to be strongly related and may contribute to work-family conflicts, drifting relationship between the supervisor and the employee, and contracting diseases which can be costly. Therefore, stress management, for everyone’s interest, should be applied as early as possible to manage stress better and utilize it to increase productivity in workplace harmony.

    There are several limitations to the studies. First, the studies chosen are heterogeneous in samples. Thus, discussing stress in terms of industrial engineering, management field, as well as medical could not be evenly discussed as some studies put more emphasis on certain fields. Second, there is a lack of randomized control trials that look at the effects of stress on employee productivity. Last, the study does not explore grey literature and literature not presented in English, thus there are possibilities that the study did not include other studies that should be included in this study.

    This study emphasizes a few points on how stress could negatively affect employees. Stress has a directimpact on work productivity as it puts a heavy strain on the mind and body by activating hormonal pathways which include the “fight or flight” system. Indirectly, stress could affect productivity by disrupting the relationship between employee, spouse, as well as with superiors. The work environment also had a moderating effect between stress and work productivity. Therefore, the study suggests that the workplace should be adjusted so that noxious stress is removed while the “good stress” is maintained. This could be done by implementing a workplace wellness policy, removing variables that might affect stress in the workplace, as well as providing counselors in the workplace to help employees talk about their stress more positively.

    Future studies should look into a few things such as which type of intervention is the most successful in remedying stress. Also, there should be randomized controlled trials that study the impacts of each variable that are hypothesized to cause stress, as well as which ones are the most important. Lastly, studies should also include a longterm follow-up to delve further into whether stress has implications in mortality rate in the workplace, endocrine diseases such as diabetes mellitus, cardiovascular diseases such as heart attack and stroke, as well as mental health disorders such as depression.



    PRISMA flowchart of the study selection.


    Keywords used in each search engine

    Summary of eligible studies to be assessed qualitatively in the systematic review

    Quality assessment of the studies using the Newcastle Ottawa Scale

    Sources of stress at work related to productivity

    Manifestation of stress at workplace

    Types of stress interventions and programs (Quick and Tetrick, 2011)


    1. Amankwah, O. , Boakye-Agyemang, N. A. , and Martin, L. (2015), The effect of stress on the job satisfaction and productivity of construction professionals in the Ghanaian construction industry, Information and Knowledge Management, 5(5), 42-49.
    2. Arbabisarjou, A. , Ajdari, Z. , Omeidi, K. , and Jalalinejad, R. (2013), The relationship between job stress and performance among the hospital nurses, World of Sciences Journal,2, 181-188.
    3. Bakker, J. , Holenderski, L. , Kocielnik, R. , Pechenizkiy, M. , and Sidorova, N. (2012), Stess@ work: From measuring stress to its understanding, prediction and handling with personalized coaching, Proceedings of the 2nd ACM SIGHIT Symposium on International Health Informatics, 673-678.
    4. Bennett, R. J. and Robinson, S. L. (2000), Development of a measure of workplace deviance, Journal of Applied Psychology, 85(3), 349-360.
    5. Bjaalid, G. , Olsen, E. , Melberg, K. , and Mikkelsen, A. (2020), Institutional stress and job performance among hospital employees, International Journal of Organizational Analysis, 28(2), 365-382.
    6. Blaug, R. , Kenyon, A. , and Lekhi, R. (2007), Stress at work: A report prepared for the work foundation’s principal partners, Project Report, The Work Foundation, London, cited 2020 December 13, Available from: publication/report/69_69_stress_at_work.pdf.
    7. Bourbonnais, R. , Brisson, C. , and Vézina, M. (2011), Long-term effects of an intervention on psychosocial work factors among healthcare professionals in a hospital setting, Occupational and Environmental Medicine, 68(7), 479-486.
    8. Bowen, P. , Edwards, P. , and Lingard, H. (2013), Workplace stress experienced by construction professionals in South Africa, Journal of Construction Engineering and Management, 139(4), 393-403.
    9. Bowen, P. , Edwards, P. , Lingard, H. , and Cattell, K. (2014), Workplace stress among construction professionals in South Africa: The role of harassment and discrimination, Engineering, Construction and Architectural Management, 20(6), 620-635.
    10. Bower, J. E. and Segerstrom, S. C. (2004), Stress management, finding benefit, and immune function: Positive mechanisms for intervention effects on physiology, Journal of Psychosomatic Research,56(1), 9-11.
    11. Bowman, R. E. , Beck, K. D. , and Luine, V. N. (2003), Chronic stress effects on memory: Sex differences in performance and monoaminergic activity, Hormones and Behavior, 43(1), 48-59.
    12. Brummelhuis, L. L. and Bakker, A. B. (2012), A resource perspective on the work-home interface: The work-home resources model, American Psychologist, 67(7), 545-556.
    13. Channar, Z. A. , Abbassi, Z. , and Ujan, I. A. (2011), Gender discrimination in workforce and its impact on the employees, Pakistan Journal of Commerce and Social Sciences, 5(1), 177-191.
    14. Chen, J. C. , Silverthorne, C. , and Hung, J. (2006), Organization communication, job stress, organizational commitment, and job performance of accounting professionals in Taiwan and America, Leadership & Organization Development Journal, 27(4), 242-249.
    15. Cooper, C. L. , Cooper, R. D. , and Eaker, L. H. (1985), Living with Stress, Penguin Books, Harmondsworth, NY.
    16. Cotton, P. and Hart, P. M. (2003), Occupational wellbeing and performance: A review of organizational health research, Australian Psychologist, 38(2), 118-127.
    17. Cox, T. and Griffiths, A. (2005), The nature and measurement of work-related stress: Theory and practice. In: J. R. Wilson and N. Corlett (eds.), Evaluation of Human Work (3rd ed.), Abingdon, UK: Routledge.
    18. Cox, T. , Griffiths, A. , and Rial-González, E. (2000), Research on Work-related Stress, Office for Official Publications of the European Communities, Luxembourg.
    19. Crandall, R. and Perrewe, P. L. (Ed.) (2020), Occupational Stress: A Handbook, CRC Press.
    20. Donald, I. , Taylor, P. , Johnson, S. , Cooper, C. , Cartwright, S. , and Robertson, S. (2005), Work environments, stress, and productivity: An examination using ASSET, International Journal of Stress Management, 12(4), 409-423.
    21. Dunne, J. P. , Stouffer, R. J. , and John, J. G. (2013), Reductions in labour capacity from heat stress under climate warming, Nature Climate Change, 3(6), 563-566.
    22. Ekundayo, J. A. (2014), Occupational stress and employees productivity in the workplace, International Journal of Scientific Research in Education, 7(2), 157-165.
    23. Elovainio, M. , Kivimäki, M. , and Vahtera, J. (2002), Organizational justice: Evidence of a new psychosocial predictor of health, American Journal of Public Health, 92(1), 105-108.
    24. Emmett, S. (2013), Why lawyers need resilience, Bulletin (Law Society of South Australia), 35(3), 31.
    25. Enshassi, A. and Swaity, E. A. (2015), Key stressors leading to construction professionals’ stress in the Gaza Strip, Palestine, Journal of Construction in Developing Countries, 20(2), 53-79.
    26. Enshassi, A. , El-Rayyes, Y. , and Alkilani, S. (2015), Job stress, job burnout and safety performance in the Palestinian construction industry, Journal of Financial Management of Property and Construction, 20(2), 170-187.
    27. Forgas, J. P. (2002), Feeling and doing: Affective influences on interpersonal behavior, Psychological Inquiry, 13(1), 1-28.
    28. Freudenberger, H. J. (1980), Burn-Out: The High Cost of High Achievement, Anchor Press, New York.
    29. Hassard, J. , Teoh, K. R. H. , Visockaite, G. , Dewe, P. , and Cox, T. (2017), The cost of work-related stress to society: A systematic review, Journal of Occupational Health Psychology, 23(1), 1-17.
    30. Haynes, N. S. and Love, P. E. D. (2004), Psychological adjustment and coping among construction project managers, Construction Management and Economics, 22(2), 129-140.
    31. Hülsheger, U. R. , Alberts, H. J. E. M. , Feinholdt, A. , and Lang, J. W. B. (2013), Benefits of mindfulness at work: The role of mindfulness in emotion regulation, emotional exhaustion, and job satisfaction, Journal of Applied Psychology, 98(2), 310-325.
    32. Ibem, E. O. , Anosike, M. N. , Azuh, D. E. , and Mosaku, T. O. (2011), Work stress among professionals in the building construction industry in Nigeria, Australasian Journal of Construction Economics and Building, 11(3), 45-57.
    33. ILO (2016), Workplace Stress: A Collective Challenge, ILO Publications, Geneva.
    34. Kavitha, P. , Kavitha, V. , and Arulmurugan, P. Kavitha, P. (2012), Role of stress among women employees forming majority workforce at IT sector in Chennai and Coimbatore, Tier-I & Tier-II centers, SONA Global Management Review, 6(3), 1-11.
    35. Krischer, M. M. , Penney, L. M. , and Hunter, E. M. (2010), Can counterproductive work behaviors be productive? CWB as emotion-focused coping, Journal of Occupational Health Psychology, 15(2), 154-166.
    36. Kristensen, T. S. , Borritz, M. , Villadsen, E. , and Christensen, K. B. (2005), The Copenhagen burnout inventory: A new tool for the assessment of burnout, Work & Stress, 19(3), 192-207.
    37. Lazarus, R. S. (1991), Psychological stress in the workplace, Journal of Social Behavior and Personality, 6(7), 1-13.
    38. Lee, R. T. and Ashforth, B. E. (1990), On the meaning of Maslach’s three dimensions of burnout, Journal of Applied Psychology, 75(6), 743-747.
    39. Leung, M. , Chan, Y. , and Yuen, K. W. (2010), Impacts of stressors and stress on the injury incidents of construction workers in Hong Kong, Journal of Construction Engineering and Management, 136(10), 1093-1103.
    40. Leung, M. , Ng, S. T. , Skitmore, R. M. , and Cheung, S. (2005), Stressors of construction cost estimation in Hong Kong, Construction Management and Economics, 23(1), 33-44.
    41. Leung, M. , Zhang, H. , and Skitmore, M. (2008), Effects of organizational supports on the stress of construction estimation participants, Journal of Construction Engineering and Management, 134(2), 84-108.
    42. Lian, H. , Brown, D. J. , Ferris, D. L. , Liang, L. H. , Keeping, L. M. , and Morrison, R. (2012), Abusive supervision and retaliation: A self-control framework, Academy of Management Journal, 57(1), 116-139.
    43. Linden, W. , Lenz, J. W. , and Con, A. H. (2001), Individualized stress management for primary hypertension: A randomized trial, Archives of Internal Medicine, 161(8), 1071-1080.
    44. Livitckaia, K. , Kouidi, E. , Blom, P. M. , Maglaveras, N. , van Gils, M. , and Chouvarda, I. (2019), Exploring the impact of sleep and stress on daily physical activity of cardiac patients: A preliminary study, Hippokratia, 23(1), 15-20.
    45. Luchini, C. , Stubbs, B. , Solmi, M. , and Veronese, N. (2017), Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale, World Journal of Meta-Analysis, 5(4), 80-84.
    46. Lundgren, K. , Kuklane, K. , and Venugopal, V. (2014), Occupational heat stress and associated productivity loss estimation using the PHS model (ISO 7933): A case study from workplaces in Chennai, India, Global Health Action, 7(1), 25283.
    47. Mackey, J. D. , Frieder, R. E. , Brees, J. R. , and Martinko, M. J. (2017), Abusive supervision: A meta-analysis and empirical review, Journal of Management, 43(6), 1940-1965.
    48. Madsen, S. R. (2003), Wellness in the workplace: Preparing employees for change, Organizational Development Journal, 21(1), 46-55
    49. Mariotti, A. (2015), The effects of chronic stress on health: New insights into the molecular mechanisms of brain–body communication, Future Science, 1(3).
    50. Martin, A. and Matiaske, W. (2017), Absenteeism as a reaction to harmful behavior in the workplace from a stress theory point of view, Management Revue, 28(2), 227-254.
    51. Maslach, C. , Schaufeli, W. B. , and Leiter, M. P. (2001), Job burnout, Annual Review of Psychology, 52(1), 397-422.
    52. McGonagle, K. A. and Kessler, R. C. (1990), Chronic stress, acute stress, and depressive symptoms, American Journal of Community Psychology, 18(5), 681-706.
    53. Michel, A. , Bosch, C. , and Rexroth, M. (2014), Mindfulness as a cognitive-emotional segmentation strategy: An intervention promoting work-life balance, Journal of Occupational and Organizational Psychology, 87(4), 733-754.
    54. Ng, S. T. , Skitmore, R. M. , and Leung, T. K. C. (2005), Manageability of stress among construction project participants, Engineering, Construction & Architectural Management, 12(3), 264-282.
    55. Niks, I. , Jonge J. , Gevers, J. , and Houtman, I. (2018), Work stress interventions in hospital care: Effectiveness of the DISCovery method, International Journal of Environmental Research and Public Health, 15(2), 332-352.
    56. Organ, D. W. (1997), Organizational citizenship behaviour: It’S construct clean-up time, Human Performance, 10(2), 85-97.
    57. Puteri, L. A. and Syaebani, M. I. (2018), Employees work stress level in the hospital, International Research Journal of Business Studies, 11(3), 231-243.
    58. Quick, J. C. and Tetrick, L. E. (Ed.) (2011), Handbook of Occupational Health Psychology, American Psychological Association, Washington, D.C.
    59. Qureshi, M. I. , Jamil, R. A. , Iftikhar, M. , Arif, S. , Lodhi, S. , Naseem, I. , and Zaman, K. (2012), Job stress, workload, environment and employees turnover intentions: Destiny or choice, Archives Des Sciences, 65(8), 230-241.
    60. Raitano, R. E. and Kleiner, B. H. (2004), Stress management: Stressors, diagnosis, and preventative measures, Management Research News, 27(4/5), 32-38.
    61. Rengamani, J. , Poongavanam, S. , and Shameem, A. (2017), Assessing the job stress of Indian seafarers’ based on job demand control model, International Journal of Mechanical Engineering and Technology, 8(12), 150-159.
    62. Restubog, S. L. D. , Scott, K. L. , and Zagenczyk, T. J. (2011), When distress hits home: The role of contextual factors and psychological distress in predicting employees’ responses to abusive supervision, Journal of Applied Psychology, 96(4), 713-729.
    63. Robertson, D. (2012), Build Your Resilience: How to Survive and Thrive in Any Situation, Hodder Education, London.
    64. Salleh, M. R. (2008), Life event, stress and illness, Malaysian Journal of Medical Sciences, 15(4), 9-18.
    65. Samani, S. A. , Rasid, S. Z. B. A. , and Sofian, S. (2014), A workplace to support creativity, Industrial Engineering & Management Systems, 13(4), 414-420.
    66. Sanders, M. (2013), Existential Depression: How to Recognize and Cure Life-related Sadness in Gifted People, CreateSpace Independent Publishing Platform.
    67. Sauter, S. L. and Murphy, L. R. (1995), Organizational Risk Factors for Job Stress, American Psychological Association, Washington, D.C.
    68. Selye, H. (1946), The general adaptation syndrome and the diseases of adaptation, The Journal of Clinical Endocrinology & Metabolism, 6(2), 117-230.
    69. Senaratne, S. and Rasagopalasingam, V. (2017), The causes and effects of work stress in construction project managers: The case in Sri Lanka, International Journal of Construction Management, 7(1), 65-75.
    70. Shahraki, S. and Bakar, N. B. A. (2019), The effects of rest problems on workforce fatigue and productivity, Industrial Engineering & Management Systems, 18(4), 845-858.
    71. Shirom, A. and Melamed, S. (2005), Does burnout affect physical health? A review of the evidence, Research Companion to Organizational Health Psychology, 599-622.
    72. Smith, T. D. , Hughes, K. , DeJoy, D. , and Dyal, M. (2018), Assessment of relationships between work stress, work-family conflict, burnout and firefighter safety behavior outcomes, Safety Science, 103, 287-292.
    73. Smoktunowicz, E. , Cieslak, R. , and Demerouti, E. (2017), Interrole conflict and self-efficacy to manage work and family demands mediate the relationships of job and family demands with stress in the job and family domains, Anxiety, Stress, & Coping, 30(5), 485-497.
    74. Statt, D. A. (1994), Psychology and the World of Work, Macmillan, Basingstoke.
    75. Stults-Kolehmainen, M. A. and Sinha, R. (2014), The effects of stress on physical activity and exercise, Sports Medicine, 44, 81-121.
    76. Sutarto, A. P. , Khairai, K. M. , and Wahab, M. N. A. (2020), Multimodal stress-management intervention improves physiological, psychological, and productivity of assembly-line workers, Industrial Engineering & Management Systems, 19(4), 812-824.
    77. Swaminathan, P. S. and Rajkumar, S. (2010), Study on stress levels in organizations and their impact on employees’ behavior, Management and Labour Studies, 35(1), 59-71.
    78. Tamini, B. K. and Kord, B. (2011), Burnout components as predictors of job & life satisfaction of university employees, Indian Journal of Industrial Relations, 47(1), 126-137.
    79. Tepper, B. J. (2007), Abusive supervision in work organizations: Review, synthesis, and research agenda, Journal of Management, 33(3), 261-289.
    80. Thayer, J. F. , Verkuil, B. , Brosschotj, J. F. , Kevin, K. , West, A. , Sterling, C. , Christie, I. C. , Abernethy, D. R. , Sollers, J. J. , Cizza, G. , Marques, A. H. , and Sternberg, E. M. (2010), Effects of the physical work environment on physiological measures of stress, European Journal of Cardiovascular Prevention and Rehabilitation, 17, 431-439.
    81. Uzoigwe, A. G. , Low, W. Y. , and Noor, S. N. M. (2016), Predictors of work-family role conflict and its impact on professional women in medicine, engineering, and information technology in Nigeria, Asia Pacific Journal of Public Health, 28(7), 629-637.
    82. Warraich, U. A. , Ahmed, R. , Ahmad, N. , and Khoso, I. (2014), Impact of stress on job performance: An empirical study of the employees of private sector universities of Karachi, Pakistan, Research Journal of Management Sciences, 3(7), 14-17.
    83. Zhang, Y. and Liao, Z. (2015), Consequences of abusive supervision: A meta-analytic review, Asia Pacific Journal of Management, 32(4), 959-987.
    84. Zhang, Y. , Liu, X. , Xu, S. , Yang, L. , and Bednall, T. C. (2019), Why abusive supervision impacts employee OCB and CWB: A meta-analytic review of competing mediating mechanisms, Journal of Management, 45(6), 2474-2497.
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