Practice 10-Minute Consultation

Stress at work

BMJ 2017; 357 doi: (Published 15 June 2017) Cite this as: BMJ 2017;357:j2489
  1. Thomas Despréaux, chief resident1 2 3,
  2. Olivier Saint-Lary, general practitioner, senior lecturer4 5,
  3. Florence Danzin, psychiatrist1 6,
  4. Alexis Descatha, occupational/emergency practitioner, professor1 2 3
  1. 1Occupational health unit, University hospital of Poincaré site, Garches, France
  2. 2Versailles St-Quentin University, Versailles, France
  3. 3CESP, U 1018 Inserm, Villejuif, France
  4. 4Versailles Saint-Quentin en Yvelines, Faculty of Health sciences Simone Veil, Department of Family Medicine, Montigny le Bretonneux, France
  5. 5Université Paris-Saclay, University Paris-Sud, Villejuif, France
  6. 6Charcot Psychiatric Hospital, France
  1. Correspondence to O Saint-Lary olivier.saint-lary{at}

What you need to know

  • Long working hours and strain at work contribute to stress, ill health, and increased risk of cardiovascular diseases, diabetes, and mental illnesses

  • Explore occupational factors such as an imbalance between effort and reward, work overload, bullying, and job insecurity

  • Workplace interventions, a short period of leave from work, and psychological treatment can be considered, alongside regular follow-up to assess how the patient is coping

A 55 year old senior executive presents with low back pain. He appears anxious. A reorganisation within his company has increased his workload and he has been working more hours but receiving no recognition from management. Last week he felt humiliated by a colleague. Since then he has not been able to sleep for more than a couple of hours each day.

Stress accounts for more than a third of all cases of work related ill health and almost half of all working days lost due to illness.1 Internationally, systematic reviews and meta-analysis of observational data suggest that job strain and poorly functioning work environments are associated with the development of depressive symptoms.234 A longitudinal cohort study from Norway found workplace bullying to be associated with subsequent suicidal ideation.5 Long working hours are also associated with increased risk of stroke, heart disease,6 and diabetes,7 and poor lifestyle including inactivity,7 smoking,7 and risky alcohol use.8

Patients might present with unexplained somatic symptoms, such as odd aches and pains, palpitations, loss of appetite, and loss of sleep.910 Explore their symptoms and discuss any contributing factors in their work and personal life. The consultation can be long and difficult, as the patient might not volunteer all the information or draw …

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