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Occupational Medicine Advance Access originally published online on August 23, 2006
Occupational Medicine 2007 57(1):18-24; doi:10.1093/occmed/kql088
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© The Author 2006. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Racial discrimination, ethnicity and work stress

Emma Wadsworth1, Kamaldeep Dhillon2, Christine Shaw1, Kamaldeep Bhui2, Stephen Stansfeld2 and Andrew Smith1

1 Centre for Occupational and Health Psychology, Cardiff University, 63 Park Place, Cardiff CF10 3AS, UK
2 Centre for Psychiatry, Queen Mary, University of London, Charterhouse Square, London E1M 6BQ, UK

Correspondence to: E. Wadsworth, Centre for Occupational and Health Psychology, Cardiff University, 63 Park Place, Cardiff CF10 3AS, UK. Tel: +44 29 2087 6599; fax: +44 29 2087 6399; e-mail: wadsworthej{at}cardiff.ac.uk


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Background Previous research has suggested higher work stress among minority ethnic workers.

Aims To determine levels of work stress in three ethnic groups, consider the contribution of racial discrimination to the groups' profiles of occupational and demographic associations with stress, and assess the association between work stress and well-being.

Methods A household quota sample design was used, and 204 black African–Caribbean, 206 Bangladeshi and 216 white (UK born) working people took part in structured interviews.

Results More black African–Caribbean respondents reported high work stress than either Bangladeshi or white respondents. Reported racial discrimination among black African–Caribbean female respondents was strongly associated with perceived work stress. Among the black African–Caribbean respondents, women who reported experiencing racial discrimination at work had higher levels of psychological distress.

Conclusions Perceived work stress may be underpinned by exposure to racial discrimination at work among black African–Caribbean women, and this may affect their psychological well-being.

Keywords      Ethnicity; racial discrimination; work stress


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Work stress can be defined in several ways. First, it is often viewed as a characteristic of the work environment similar to other environmental hazards, such as noise. In this case, it is measured by considering the relationship between exposure and health. Second, it is seen as a physiological response to a threatening or difficult aspect of work, and may be measured directly (e.g. an adverse reaction to work stress can be measured using cortisol). Third, it may be seen in terms of an interactional framework, as in the effort–reward imbalance model [1], where the imbalance between effort and reward at work interacts to influence health. Finally, transactional theories [2] focus on the cognitive processes and emotional reactions individuals have with their work environment. In this case, perceptions of stress are primarily used. In the work described here, the impact of work characteristics, including both environmental stressors (such as noise and working hours) and organizational stressors (such as effort–reward imbalance and job demand), on perceived work stress was considered.

In earlier work [3], 30% of non-white respondents reported very or extremely high stress compared to 18% of white workers. However, no further investigation was possible because of the small proportion of minority ethnic respondents.

Ethnic minority groups make up ~8% of the UK population. This represents an increase over the last four decades. Minority ethnic groups also have a younger age structure than the white (UK born) population, reflecting past immigration and fertility patterns. They will therefore continue to rise as a proportion of the working population well into the 21st century [4].

There is considerable evidence that perceived stress at work is widespread [3] and is associated with ill-health [5,6]. Recent figures showed that >2 million people in the UK reported suffering from work-related ill-health [7]. It has also been suggested that ethnic minorities experience particular negative work environments which can lead to stress [8], and that the pattern of long-term illness among those of working age varies with ethnicity [9,10]. Furthermore, there is a large literature on ethnicity and mental health [11]. However, there is very little UK information about work stress and health in different ethnic groups. A recent review of ethnic minorities' occupational health and safety identified the lack of evidence on ethnicity and work-related health issues as a research priority [4].

It has been suggested that social and economic inequalities, underpinned by racial discrimination, are fundamental causes of ethnic inequalities in health [12]. Several studies have shown associations between racial discrimination and both physical illness [13,14] and psychological distress [15,16], and discrimination has recently been recognized as a psychological stressor and possible risk factor for physical illness [17]. The dearth of UK research on ethnicity, occupational stress and health is, therefore, further compounded by failure to consider the potentially powerful influential role of discrimination in these relationships.

This study aimed to establish rates of perceived work stress in three ethnic groups. In addition, it focused on the contribution of the reported experience of racial discrimination to the groups' profiles of occupational and demographic associations with perceived stress, and assessed the association between perceived work stress and well-being.


   Methods
Top
 Abstract
 Introduction
 Methods
Results
 Discussion
 Conflicts of interest
 References
 
The quota sampling method was based on that used in the EMPIRIC (Ethnic Minority Psychiatric Illness Rates in the Community) Survey [18] and aimed to achieve interviews with 200 respondents from each of the three ethnic groups. Altogether, 3181 households were selected on a 1:15 ratio from a database drawn from the Electoral Registers and Post Office Address Files for five council wards in Hackney and Tower Hamlets, East London. The total population of the five wards was 47 722, of which 4708 (10%) were black African–Caribbean, 8998 (19%) Bangladeshi and 26 456 (55%) white [9]. Interviews were attempted at 3176 households. Up to four recruitment attempts were made at each household. If the interview was refused, or the resident did not fit the research criteria, interviewers tried up to six households on either side of the identified one until a participant was recruited. This occurred 2769 times. Inclusion criteria were being in paid work, aged between 18 and 65 years, self-reported ethnicity of black African–Caribbean, Bangladeshi or white (UK born). The team of 25 interviewers comprised men and women from each of the ethnic groups being investigated. Interviewer and interviewee ethnicity and gender were matched as often as possible [19].

The structured interview included demographics, health (psychological well-being), lifestyle, occupational factors and discrimination. The demographic, health and lifestyle factors are summarized in Table 1 (available as Supplementary data at Occupational Medicine Online), and the nine occupational and two discrimination factors are described in more detail below.

  1. Work stress: measured using a single item asking ‘In general, how do you find your job?’ with responses on a five-point Likert scale (not at all stressful, mildly stressful, moderately stressful, very stressful, extremely stressful). Those responding very or extremely stressful were compared with those responding not at all, mildly or moderately stressful. This measure and cut-point have been validated [3] and used elsewhere [3,22].
  2. Working hours: respondents were asked how many hours a week they worked on average, and those working ≥30 h were compared with those working less.
  3. Contract: respondents were asked whether their job was permanent, temporary/casual or fixed contract, and those with permanent jobs were compared with the others.
  4. Position: respondents were asked which of seven items best described their current position at work [self-employed (25+ employees in company), self-employed (<25 employees), self-employed (no employees), manager (25+ employees), manager (<25 employees), supervisor, employee]. Employees were compared with those who were self-employed, managers or supervisors.
  5. Type: socio-economic class was determined from job title using Computer Assisted Standard Occupational Coding [23]. Those with non-manual jobs were compared with those with manual jobs.
  6. Treatment: respondents were asked ‘Do you feel that you have been treated unfairly at your present place of work, e.g. when applying for promotion?’. Those who answered yes were compared with those who said no.
  7. Ethnic mix: respondents were asked ‘In general, what is the predominant ethnic or cultural origin of the people you work with?’, and responses recorded on a five-point scale. Comparisons were made between those who answered all or mostly different from you, and those who answered all or mostly the same as you or mixed—half and half.
  8. Effort–reward imbalance [24]: two dimensions were computed—effort–reward imbalance [ratio of effort (situational factors which make work more demanding) and reward (pay, status and opportunities for advancement)] and intrinsic effort (personal factors, such as motivation and commitment to work). For each dimension, respondents above and below the median were compared.
  9. Job strain [25]: three dimensions were computed—job demand (pace and intensity of work), control (amount of control the worker has over work and the skill and variety involved) and support (support from colleagues and superiors). For each dimension, respondents above and below the median were compared.

Respondents were asked ‘Have you had any experience of discrimination at work (e.g. being treated unfairly) in your present job on the basis of the following: age, caste, class, culture, disability, ethnicity, gender, language, race, religion, sexuality, village kinship?’. Responses were yes or no. Two discrimination variables were derived:

  1. Racial discrimination: those who answered yes to discrimination on the basis of race, culture or ethnicity were compared with those who said no.
  2. Other discrimination: those who answered yes to discrimination on the basis of age, class, disability, gender or sexuality were compared with those who said no.

The study was approved by the East London and City Health Authority Local Research Ethics Committee.

Associations between the dependent variable (work stress) and each of the independent variables were first assessed using chi-square tests and analysis of variance. These analyses were carried out for each ethnic group separately, and for the sample as a whole. Any variables significantly associated with work stress (for any ethnic group or the whole sample) were included in backward stepwise logistic regression models used to determine associations with work stress for each ethnic group separately and for the whole sample. In these models, P < 0.05 was used as the entry criterion and P > 0.10 as the removal criterion. The Hosmer and Lemeshow Goodness-of-Fit statistic was fixed at P > 0.05 [26]. The association between racial discrimination and psychological distress was considered using analysis of variance. The analyses were carried out using the Statistical Package for Social Sciences (SPSS for Windows, Release 12.0.2).


   Results
Top
 Abstract
 Introduction
 Methods
 Results
Discussion
 Conflicts of interest
 References
 
In total, 626 people took part in the survey. After exclusions (those who were ineligible, non-contacts, etc.), the response rate was 55% (see Appendix 1, available as Supplementary data at Occupational Medicine Online). Two hundred and four (33%) respondents were black African–Caribbean, 206 (33%) Bangladeshi and 216 (34%) white (UK born).

There were some significant differences between the groups in terms of gender [more black African–Caribbean respondents were female: 119 (58%) compared to 96 (44%) among white and 61 (30%) among Bangladeshi respondents, P < 0.001], marital status [more Bangladeshi respondents were married: 145 (71%) compared to 102 (47%) and 91 (45%) white and black African–Caribbean respondents, P < 0.001], education [more whites had a further education qualification: 132 (61%) compared to 105 (52%) and 73 (36%) among black African–Caribbean and Bangladeshi respondents, P < 0.001], income [more whites earned ≥£20 000: 113 (54%) compared to 64 (33%) and 36 (19%) among black African–Caribbean and Bangladeshi respondents, P < 0.001], work hours [more Bangladeshi respondents worked part-time: 67 (33%) compared to 49 (24%) and 40 (19%) of black African–Caribbean and white respondents, P = 0.0004], positions [more whites were managers, supervisors or self-employed: 89 (41%) compared to 50 (25%) and 47 (23%) among Bangladeshi and black African–Caribbean respondents], contract [fewer Bangladeshi respondents had permanent contracts: 148 (73%) compared to 186 (87%) and 167 (83%) of white and black African–Caribbean respondents, P = 0.002] and manual work [more whites had non-manual jobs: 148 (69%) compared to 116 (57%) and 105 (51%) of black African–Caribbean and Bangladeshi respondents, P = 0.001].

Overall, 13% of respondents reported experiencing high work stress: 18% (n = 37) of black African–Caribbean, 11% (n = 24) of white and 8% (n = 17) of Bangladeshi respondents (P = 0.01).

Eight per cent reported experiencing discrimination at work: 12% (n = 24) of black African–Caribbean, 7% (n = 14) of Bangladeshi and 6% (n = 14) of white respondents (P = 0.09). The overall level is similar to the 7% who reported experiencing discrimination in an earlier study [3].

Initial analyses between perceived work stress and occupational and demographic characteristics were carried out for the sample as a whole, and for each ethnic group separately (Table 2). These suggested an association between work stress and ethnicity: more black African–Caribbean respondents reported high work stress. Both gender and reported racial discrimination were associated with perceived work stress for the whole sample. For gender, this reflected an association among black African–Caribbean respondents only, while for racial discrimination, the association was apparent among black African–Caribbean and white (UK born) but not Bangladeshi respondents.


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  		Table 2 Associations between work stress and each of the independent variables by ethnicity

 
Logistic regression analyses were then carried out for the whole sample and each ethnic group separately. Reporting experiencing racial discrimination at work, gender, negative affect, contract, background noise and the work characteristics, effort–reward imbalance and job demand, were all associated with perceived work stress for the whole sample (Table 3). Among the white respondents, effort–reward imbalance and unfair treatment at work were associated with perceived work stress. Position and intrinsic effort were associated with perceived work stress among the Bangladeshi respondents. For the black African–Caribbean group, both reported exposure to racial discrimination and gender were associated with perceived work stress, together with negative affect and background noise.


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  		Table 3 Multivariable associations with work stress (only the last step of the analyses is shown)

 
Among the black African–Caribbean group, 69% of the 13 women who reported experiencing racial discrimination at work reported high work stress. This is considerably higher than the 20% among the 105 women who did not report experiencing racial discrimination. A similar effect was suggested among the men (30% of the 10 who reported experiencing racial discrimination reported high stress compared to 5% of the 74 who did not). These differences were also apparent when mean work stress scores were considered (negative affect and background noise were included as covariates). Women who reported experiencing discrimination had the highest perceived stress level [3.48 (SE = 0.26)]. This was significantly higher than women who did not report experiencing discrimination [2.65 (0.09), P = 0.003]. Similarly, men who reported experiencing racial discrimination at work had higher perceived stress levels than men who did not [2.91 (0.30) compared to 2.23 (0.11), P = 0.03]. Among those who did not report experiencing racial discrimination, women reported higher perceived stress than men (P = 0.006).

Psychological distress was determined using the GHQ-28 [20] and defined at the clinical cut-point of ≥5. Overall, 23% (n = 139) met this criterion: 24% (n = 47) of Bangladeshi, 23% (n = 48) of white and 22% (n = 44) of black African–Caribbean respondents. Analyses suggested no association between psychological distress and ethnicity, but a clear association with work stress and racial discrimination. Fifty per cent (n = 36) of those who reported high work stress were also experiencing psychological distress compared to 19% who reported low work stress (n = 102) (P < 0.001). Similarly, 43% (n = 22) of those who reported experiencing racial discrimination at work also had psychological distress compared to 21% of those who did not report experiencing racial discrimination (n = 117) (P = 0.001).

Focusing on the black African–Caribbean group, which had the highest proportion of respondents with high perceived work stress, showed that women who reported experiencing racial discrimination had the highest mean GHQ scores (Table 4).


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  		Table 4 Mean GHQ score by gender and racial discrimination among black African–Caribbean respondents

 

   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
Conflicts of interest
 References
 
A higher proportion of black African–Caribbean respondents reported high work stress compared to Bangladeshi and white respondents. Reported racial discrimination among black African–Caribbean females was strongly associated with high perceived work stress. These findings were strongly supported by data from a follow-up interview phase [19]. Previous work has also identified racial discrimination as a contributory factor to stress among minority ethnic workers [27].

The analyses also showed that, among the black African–Caribbean respondents, women who reported experiencing racial discrimination at work had higher GHQ scores. This suggests an association between the reported experience of racial discrimination and psychological distress among these respondents. It was not clear why this was not reflected in overall differences in psychological distress between the ethnic groups. However, the groups perceived work, work stress and racial discrimination in different ways [19], suggesting different expectations as well as possible differences in attributional and response styles.

Several studies have recognized the important role of racial discrimination in health [11,13–16,27]. Recent UK research suggests that minority ethnic teachers experienced discrimination on a weekly or even daily basis, and almost half of them described their workplace as displaying signs of institutional racism [27]. This social and economic inequality, which is one of the fundamental causes of ethnic inequalities in health, may well be underpinned by racism [12]. Findings from the US also indicate that racial bias, in terms of both institutional and interpersonal prejudice at work, was a more important predictor of job satisfaction among African–American women than other occupational stressors, such as low decision authority and heavy workload [28], and that racial discrimination affects job stress among black women [29].

The implication that black African–Caribbean women may be particularly at risk of work stress and its consequences because of the potential for gender and/or racial bias has, therefore, been apparent for sometime. However, there has been very little UK research in this area; occupational stress research has almost always been carried out among predominantly white groups.

It was not possible to establish causation from the study's cross-sectional data. However, it is possible that these complex relationships are at least in part what lie behind previous work indicating lower levels of psychological well-being among black women compared with white women [30].

Compared with black African–Caribbean respondents, fewer Bangladeshi respondents in this study reported experiencing racial discrimination at work. This was also supported by the follow-up data, and may in part reflect differences in their experience and perception of discrimination [19]. It may also be explained by a response bias (Bangladeshi respondents may have been less willing to discuss racial discrimination with an interviewer), an attributional bias (such as denial) or a difference between the groups, such as that more Bangladeshis work with others of the same or similar ethnic group. Some white (UK born) respondents also reported racial discrimination at work. None reported discrimination at the second interview (despite being selected for follow-up on this basis), so the study has no data about the nature of this discrimination. However, this does suggest the possibility of wider race relations' problems.

The cross-sectional design was a limitation, and the geographically localized nature of the sample means that the generalizability of the findings is unclear. However, it is likely to be typical of these ethnic groups in UK inner cities. Replicating the analyses as far as possible in existing datasets from elsewhere in the UK [3,22] supported the main findings (data not shown). This emphasizes the importance of ethnicity in work practices and policy suggested by the findings reported here and the follow-up data [19].

Both non-response and response bias may also have affected the study. It is possible that some groups were less willing to take part, or that some respondents were less comfortable with certain aspects of the interview. The study was also limited to three ethnic groups. Further research is necessary to establish whether these associations are apparent in a wider range of ethnic groups and in more geographically dispersed populations.

Nevertheless, the study showed that more black African–Caribbean respondents reported high work stress than either Bangladeshi or white respondents. Among black African–Caribbean females, the reported experience of racial discrimination at work was strongly associated with both perceived work stress and psychological distress. This suggests that perceived work stress may be underpinned by reported exposure to racial discrimination at work among black African–Caribbean women, and that this may affect their psychological well-being.


Key point
  • The experience of racial discrimination reported by black African–Caribbean female respondents is associated with perceived work stress.

 


   Conflicts of interest
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
References
 
None declared.


   Acknowledgements
 
This work was funded by the Health & Safety Executive.


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 

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