Defining Stress among Corrections Professionals

Corrections professionals experience high levels of acute and chronic work-related stress. This stress leads to increased mental and physical illness, early disability and mortality, and increased healthcare costs. Reducing stress requires identifying and prioritizing factors that contribute to it. Corrections professionals (n = 296) working at six different Oregon Department of Corrections facilities completed a cross-sectional survey, including demographics, work history and validated stress and occupational constructs. The outcome of perceived stress was measured using the Perceived Stress Scale (PSS-4 Short Form). Using a linear mixed effects regression model, we found that perceived stress increases with increased work-related stress (p = 0.02), work hours (p = 0.03), operational stressors (p = 0.002), and lack of procedural injustice (p = 0.03) and decreases with more time employed at current facility (p = 0.06), improved job satisfaction (p < 0.001), and among married or partnered individuals (p = 0.05). Identifying these predictors of stress can inform the development of policy changes to mitigate the stress of this challenged work force.


Introduction
The World Health Organization has declared work-related stress as one of the greatest challenges of the twenty-first century [1]. Previous research has identi-livered surveys directly at each post for those who were interested in participating. Site liaisons and staff coverage allowed staff to complete surveys during their work shift. Written informed consent was obtained prior to participation. These paper surveys were scanned and cleaned by researchers using Tele Form software system.

Demographics and Work History
Demographics collected included age (years), gender, race (Asian, Black/African American, Native American/Native Alaskan, Native Hawaiian/Other Pacific Islander, Hispanic/Latino, more than one race, and Non-Hispanic white), education (high school/General Educational Development GED/some college, two-year Associates degree, or four-year Bachelor's degree/more), current relationship status (married/partnered or not married/partnered), and military service (ever active duty in U.S. armed services or never served). Work history variables included time employed at current facility (years), security level of AIC's primarily worked with in the past month (minim, medium, or maximum security), post primarily worked in the past month (non-housing, general population, or special housing/segregation units), shift primarily worked in the past month (day, swing, night), and average hours worked per week in the past month.

Perceived Stress
The Perceived Stress Scale (PSS-4 Short Form) [15] was used to measure perceived stress among participants. For this construct, participants rated on a five-point Likert scale (1 = None of the time, 5 = All of the time) how often they felt in the past month about the following: that they were able to control important things in their life, confident about their ability to handle personal problems, that things were going their way, and that difficulties were piling up so high that you could not overcome them. A total stress score was created by adding the responses from the four questions together after reverse coding for the first three questions.
Occupational constructs also include Likert scale responses. Resource insufficiency, possibility of AIC conflict, organizational stressors, operational stressors include ratings for how much of the following as contributed to stress experienced in the past month (1 = not at all, 5 = very much) in respect to corrections professionals' resources (management support, guidelines), AIC relations (possibility of violence and incidents), administration (staff shortages, leadership styles), and work life balance (shift work, over-time demands, social life limitations) respectively. Experienced and witnessed violence constructs included how often have threat, assaults without a weapon, and assaults with a weapon have occurred during the last six months (0 = rarely, less than once a month, 4 = more than a week), which was later reclassified to rarely (less than once a month) and once a month or more due to limited distribution of responses.
The remaining constructs included ratings about overall agreement (1 = Strong disagree, 5 = strongly agree). Work-related stress rates negative feelings towards (fatigue, worry, anger), while work overload assesses difficulty and complexity of job demands. For the environmental safety and dangerousness constructs participants rate perceived risk among AICs. Supervisor, co-worker, and organizational support assesses negative feelings towards supervisors, co-workers, and the current institution's ability to assist with job demands. Procedural justice refers to inconsistent and unclear policies and organizational decision-making. Public image refers to participants' attitudes towards negative media coverage in the portrayal of corrections professionals' role. Job satisfaction includes questions related to positive attitudes towards current work (enjoyment, pride) and intentions to quit reflect attitudes towards leaving corrections work or current facility.

Statistical Analyses
Perceived stress was analyzed using a linear mixed effects regression model, with a random effect for the six different correctional facilities to account for the correlation among corrections professionals within each facility. A purposeful selection approach [26] was used to build the model considering the occupational constructs, demographics, and work history variables as possible predictors of perceived stress. Lastly, model diagnostics confirmed the final model by checking model assumptions. The statistical software R version 3.6.2 was used to conduct all statistical analyses.

Results
Participation varied across the six facilities and averaged 34%, with a total of 330 surveys collected. Thirty-four participants were excluded from analysis due to missing information for perceived stress, occupational constructs, demographics, or work history (n = 296). However, no more than 1.5% were missing for any one variable.
Demographic, work history characteristics, and perceived stress among the final sample (n = 296) are described in Table 1. Participants were mostly middle Open Journal of Preventive Medicine Short Form) (15) was 9.33 ± 2.71, ranging from a minimum score of four to a maximum score of 18, and slightly skewed to the right ( Figure 1). Prior to use in the regression model, the consistency of the occupational constructs was determined using Cronbach's alpha (α) to ensure inter-reliability (α > 0.70) using IBM SPSS Statistics 25. Each of these occupational constructs maintained inter-reliability among the sample (Cronbach's α > 0.74).
Unadjusted regressions with perceived stress as the outcome (Table 2) found insignificant associations with gender (p = 0.84), AIC's security level (p = 0.39), shift (p = 0.36), years employed at current facility (p = 0.31). Measures significantly associated with perceived stress (using α = 0.25) were work-related stress, work overload, environmental safety/dangerousness, possibility of AIC conflict, organizational stressors, operational stressors, resource insufficiency, procedural justice, organizational support, supervisor support, co-worker support, job satisfaction, intentions to quit, public image, age (all p < 0.001), experience violence (p = 0.01), relationship status (p = 0.02), work hours (p = 0.02), witnessed   All associations between demographic, work history, and occupational constructs were assessed before the model building process to eliminate multi-collinearity. Possibility of conflict, organizational stressors, supervisor support, and education were excluded in the rest of the model building progress due to their strong relationship with other variables in the model. More specifically, organizational stressors is significantly related to resource insufficiency (r = 0.84), work-related stress (r = 0.66), and supervisor support (r = 0.65); possibility of conflict related with environmental safety/dangerousness (r = 0.57); supervisor support related with procedural justice (r = 0.66) and co-worker support (r = 0.51) (all p's < 0.001); and education related to post (χ 2 = 13.12, p = 0.01).
After purposeful selection with the included variables significantly associated with perceived stress, the variables remaining in the perceived stress model were work-related stress, operational stressors, procedural justice, job satisfaction, relationship status, work hours, and time employed at current facility. Model Open Journal of Preventive Medicine  diagnostics indicated the final model was a good fit (Variance Inflation Factor > 5, residual plots showed no major deviations from model assumptions, and overall model p < 0.001), and no additional transformations were necessary.
Results from the final model (Table 3) found that perceived stress increases with increased work-related stress (p = 0.02), work hours (p = 0.03), operational stressors (p = 0.002), and lack of procedural injustice (p = 0.03), and decreases with more time employed at current facility (p = 0.06), improved job satisfaction (p < 0.001), and among married or partnered individuals (p = 0.05).
Standardized estimates of the final model were also created for each participant based on the difference of each score from the mean divided by the standard deviation. Based on these standardized estimates, operational stressors accounted for the greatest increase in perceived stress (β = 0.57), while job satisfaction accounted for the greatest decrease (β = −0.58). Average hours worked per week (β = 0.31) and lack of procedural justice (β = 0.32) accounted for the smallest increase in perceived stress, while time employed at current facility (β = −0.25) was associated with the smallest decrease in perceived stress.

Discussion
This study found significant associations between perceived stress among corrections professionals and age, relationship status, and various occupational conditions, such as job specific stress (work-related stress, work overload), environmental (environmental safety and dangerousness, possibility of conflict, experienced violence), organizational (organizational and operational stressors, resource insufficiency, procedural justice, organizational support), work relationships (supervisor and co-worker support), job contentment (job satisfaction and intentions to quit), and outside of work (public image). When considering all possible demographic, work history, and occupational constructs included in this study using a purposeful selection approach, results indicate that corrections professionals' perceived stress increases with work-related stress, longer work hours, increased operational stressors, and lack of procedural justice. Factors reducing perceived stress included increased job satisfaction, longer tenure at a facility, and being partnered or married. Results also suggest that corrections work-related stress is most influenced by operational stressors and job satisfaction.
Certain of these factors align with prior findings among occupational groups.
Work-related stress [16] [17] refers to negative overall feelings towards work such as tension, fatigue, pressure, frustration, anger and worry. It is known that increases in stress at work contributes to overall perceptions of stress. In fact, a 2019 American Psychological Association report found that 64% of adults in the United States cited work as a significant source of stress [27]. Therefore, further exploring the occupational factors that remained in the stress model are also important to address in terms of mitigating stress among high stress occupations.
Operational stressors were constructs found to be significantly associated with perceived stress among corrections professionals. In this study, operational stressors [13] [22] [23] refer to occupational issues that contributed most to stress in the past month, such as shift work, mandatory overtime, and difficulty with work-life balance, such as managing social life outside of work, limited availability to spend with family and friends, and feeling like always on the job. This means when considering work-specific stressors, negative feelings towards these operational type factors are associated with increases in overall stress.
In addition, increases in work hours also contributed to stress, suggesting more hours spent at work also increases stress. The economic returns on the additional hours did not seem to mitigate the negative impact of long hours. These findings are consistent with previous research suggesting increases in occupational health issues [28] and work-family conflict [29] among those who work longer hours. This is especially apparent in an occupation such as corrections, which can require mandatory overtime to maintain operations.
Procedural justice [16] [17] [24] in this study refers to fairness of work-related procedures, such as inconsistencies with polices, rules and regulations in regard to disciplinary actions and promotions. A systematic review including the occupational constructs considered in this study, found that organizational structure and climate of correctional facilities have the most consistent relationship with work-related stress and burnout among staff [13]. These factors include unclear goals and policies, lack of procedural justice, lack of decision-making ability, and lack of organizational support. These findings are similar to the results of this study that procedural justice was most associated with increases in perceived stress.
Results also found that increases in job satisfaction, which included enjoyment and pride in their job, were a protective factor for stress among corrections professionals. Other research also finds that job satisfaction is negatively associated with work-related stress, whereas positively associated with hope and self-efficacy [30]. In addition, current research suggests increasing social support at work in order to significantly reduce the impact of job demands and improve job satisfaction [20].
There are limitations of this study limiting the generalizability or results, including small sample size, low participation rate (34% across facilities), and reduced geographical sampling distribution. Despite these limitations, our sample represented of the Oregon Department of Corrections' demographics. Further, controlling for the random effect of facility accounted for within facility differences to account for generalizing results to other correctional facilities in Oregon.

Conclusion
This study has identified possible predictors of stress among Oregon corrections professionals. These findings can inform the development of policy changes that improve working conditions among this high stress occupation. Further, interventions addressing these factors determined as the greatest predictors of stress can improve corrections professionals' mental well-being, physical health, job performance, and other economic outcomes. Open Journal of Preventive Medicine corrections professionals' stress levels.
• Results indicate work related factors such as work-specific stressors, work hours, operational stressors and lack of procedural justice significantly contribute to increase in overall stress levels. These differences can also be attributed to differences in job satisfaction, time currently employed at current correctional facility, and marital status.
• These findings can inform the development of work place health promotion interventions and policy changes to improve working conditions among this high stress occupation.