Bummed Out During the Holiday Season

Kenneth Nowack, Ph.D.


Any guess what medical condition or health risk is the most costly to employers? If you guessed stress, smoking, obesity, inactivity or diabetes you are way off the mark. In fact, the most costly is depression (Goetzl, R. et al. (1988). The relationship between modifiable health risk and health care expenditures: An analysis of the multi-employer HERO health risk and cost data base. JOEM, 40, 843-854).

Depression takes a pretty heavy toll on the U.S. workplace, affecting about 6 percent of employees each year and costing over $30 billion annually in lost productivity and absenteeism.

In a recent study in the Journal of American Medical Association, researchers reported on how a telephone treatment program had a substantial impact on cost savings, return to work and minimizing the length of the depressive symptoms compared toa a control group (Philip S. Wang, MD, DrPH, et al. Telephone Screening, Outreach, and Care Management for Depressed Workers and Impact on Clinical and Work Productivity Outcomes: A Randomized Controlled Trial. JAMA, 2007, 298(12), p. 1401-1411).

The study involved 604 workers at 16 large U.S. companies and included included pilots, lawyers, bankers, truckers and janitors. The study participants completed an online questionnaire that measured health risk factors including depression. Half of those identified were encouraged to seek a mental health specialist or contact their doctor. The other group received cognitive behavioral therapy over the phone.

Employees who received the telephone intervention worked, on average, about two weeks more during the yearlong study than those in the control group and more workers in the intervention group were still employed at the end of the study. Finally, the intervention employees were almost 40 percent more likely to recover from depression during the yearlong study.

Preliminary cost savings from more hours worked averaged about $1,800 per employee compared to the program’s initial $100 to $400 per worker cost.

It would appear that work/life balance benefits, including mental health insurance, would be something that employers would see value given just how prevalent and devastating depression can be in the workplace (Clinical depression affects about 7% – 18% of the population on at least one occasion in their lives, before the age of 40).

Furthermore, recent research with 24,324 employed workers, suggests that increased levels of job strain and a lack of social support at work are associated with higher risk of depression (Emma K. Robertson Blackmore, Stephen A. Stansfeld, Iris Weller, Sarah Munce, Brandon M. Zagorski, and Donna E. Stewart (2007). Major Depressive Episodes and Work Stress: Results From a National Population Survey. American Journal of Public Health, Sep 2007; doi:10.2105/AJPH.2006.104406). Here are some keys to identifying depression in bosses and co-workers:


One of the following major elements are typically observed for at least 2 weeks to suggest that an employee is experiencing depression. These include:

1. Depressed mood (feeling sad, helpless or hopeless etc.)


2. Loss of interest in normal daily activities (e.g., having little interest in activities you typically enjoy).

It is sufficient to have either of these symptoms in conjunction with five of a list of other symptoms over a two-week period. These include:

  1. A decrease in amount of pleasure or interest in almost all daily activities.
  2. Feelings of overwhelming sadness or inability to feel emotions.
  3. Intense feelings of guilt, nervousness, helplessness, hopelessness, worthlessness, loneliness and/or anxiety
  4. Disturbed sleep. Sleeping too much or having problems sleeping can be a sign you’re depressed. Waking in the middle of the night or early in the morning and not being able to get back to sleep are typical.
  5. Trouble concentrating, maintaining focus or making decisions and have problems with memory.
  6. Changes in appetite with weight loss or gain.
  7. Agitation. You may seem restless, agitated, irritable and easily annoyed.
  8. Fatigue (mental or physical) and loss of energy.
  9. Low self-esteem. You feel worthless and have excessive guilt.
  10. Less interest in sex. If you were sexually active before developing depression, you may notice a dramatic decrease in your level of interest in having sexual relations.
  11. Recurrent thoughts of death, dying or suicide.
  12. Feeling and/or fear of being abandoned by those close to you.

The good news is that depression is typically treatable and for employees, getting some help would appear to be a direct cost savings for employers…..Be well….

[tags] mental health, depression, worksite wellness, health promotion, leadership, engagement, productivity, kenneth nowack, ken nowack, nowack[/tags]


Sleep and Productivity

Kenneth Nowack, Ph.D.


I woke up tired this morning and know exactly why…I didn’t get both enough sleep and good quality sleep last night. Good thing I’m not making executive decisions, flying the space shuttle or doing delicate brain surgery not to mention being the third link in the security at one of our nuclear power plants.

It seems that just recently a federal inspector found an armed guard asleep at a gate inside the Indian Point nuclear power plant located about 35 miles north of New York City. A federal inspector actually found the 5 year veteran employee and tried for 2 minutes to wake the person before the guard “stood up and opened his eyes.” It must have been one of those dreams you really want to stay in! It seems the practice at this facility was to rotate guards during their 12-hour shifts to keep them alert (this guard had already worked two other posts before hitting NREM/REM land).

Well, maybe you won’t be surprised that in a recent study of US Workers, the prevalence of fatigue (lack of sleep being one of the major contributors) was 37.9%. Fatigue, when present, is associated with a threefold increase, on average, in the proportation of workers with condition-specific lost productive time (Ricci, J., Chee, Lorandeau, A. & Berger, J. (2007). Fatigue in the U.S. Workforce: Prevalence and Implications for Lost Productive Work Time. Journal of Occupational and Environmental Medicine. 49 (1), 1-10).

In fact the top three causes of lost work time by employees in the US based on research from Ron Kessler at the Harvard Medical School (due to both absence and presenteeism) include: Sleep disorders, depression and fatigue (these three each account for approximately 425-490 lost workdays per 100 full time employees).

Even the prestigious Harvard Business Review last year (October 2006) conducted an interview with sleep expert Dr. Charles Czeisler on the relationship between lack of sleep, poor performance and impaired decision making and judgment.

My colleague, friend and personal sleep expert Dr. Mark Rosekind founder of Alertness Solutions has found that even two hours less sleep than you need at night (that certainly can vary!) has the following results:

  1. Degrading critical judgment and decision making by 50%
  2. Diminishing memory by 20%
  3. Interfering with communication skills by 30%
  4. Affecting mood by 100% (good mood goes down and bad mood goes up)

Well, any new parent can attest to these findings….Well, if we look at some provocative new research maybe lack of sleep does indeed have an upside. According to data from the Cancer Prevention Study II, individuals who average seven hours of sleep each night have a lower mortality rate than do those who sleep eight hours or more (Kripke DF, Garfinkel L, Wingard DL, et al. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. 2002;59:131-136).

These findings were also consistent with earlier research suggesting that the lowest mortality was again at seven hours of total sleep, with some increase in mortality associated with short sleep and an even steeper increase with long sleep.  Good news indeed given that the average American on weekdays sleeps about six and one-half hours.

All obvious you say? Don’t blame me then when you wind up dreaming about this blog tonight.

zzzzzzzzzzzend….Be well….

[tags]insomnia, sleep, fatigue, depression, sleep disorders, fatigue countermeasures, REM, NREM, circadian rhythms, stress, dreams, dreaming, health, job burnout, kenneth nowack, ken nowack, nowack[/tags]


Corporate Wellness Makes Good Cents

Kenneth Nowack, Ph.D.


How Healthy Are Employees?

I recently did an analysis of a random sample of over 1,000 working professionals in diverse industries who have used our personal stress and health assessment called StressScan. Here are some of our findings:

Alcohol Use: 14.3% reported consuming more than 2 alcoholic beverages daily

Drug Use: 4.0% reported using non-prescription drugs for recreational purposes sometimes to always

Smoking: Only 10.0% reported smoking in our professional sample

Exercise: 41.1% reported “never” or “rarely” getting 20-30 minutes of exercise three times a week

Sleep: 26.8% “often” or “always” received less sleep then they need because they had difficulty falling or staying asleep

Time Pressured: 56.7% reported “often” or “always” feeling pressured and hurried for time (not having enough time to get enough done at work or him)

National Health Statistics

A recent 2008 Center for Disease Control Publication largely confirmed our StressScan findings ((Early Release of Selected Estimates Based on Data From the January–June 2008 National Health Interview Survey. Center for Disease Control)). Here are just a few highlights:

Obesity: Approximately two-thirds of the adult populations are either overweight or obese.

Overall Health: For the period January through June 2008, the percentage of persons who had excellent or very good health was 65.9% (95% confidence interval = 64.94–66.77%), which was not significantly different from the 2007 estimate of 66.0%.

High Blood Pressure: Percent of persons 20 years and over with hypertension: 31 (2001-2004)

Life Expectancy: Females: 80.4 years and for males: 75.2 years

Psychological Distress: For both sexes combined, persons aged 45–64 years (3.7%) were more likely to have experienced serious psychological distress during the past 30 days compared with persons aged 18–44 years (2.7%) and 65 years and over (2.4%).

Employee Wellness Makes Cents

A number of comprehensive reviews, or meta-analyses, have analyzed findings across large numbers of individual studies of worksite health promotion and disease prevention programs in the recent years. These programs provide health education to their employees to promote behaviors that will improve health or prevent disease, and typically include exercise programs, health-risk appraisal, weight control, nutrition information, stress management, disease screening, and smoking cessation.

The review found significant return on investment for the programs provided by these nine employers, with the range of benefit-to-cost ratios, ranging from $1.49 to $4.91 in benefits per dollar spent on the program, and a median of $3.14 (Nowack, K. (2008). Coaching for Stress: StressScan. Editor: Jonathan Passmore, Psychometrics in Coaching, Association for Coaching, UK, pp. 254-274).

Without a doubt, it makes great cents for companies to support and promote employee well-being and health…I think I will get out for my morning run now….Be well…..


[tags]stress, exercise, obesity, well-being, relaxation, immune system, health promotion programs, employee wellness, stress management, psychoneuroimmunology, resilience, hardiness, Kenneth Nowack, ken Nowack, Nowack[/tags]


Vacations May be Dangerous to Your Health

Kenneth Nowack, Ph.D.


I just got back from a short holiday in Yosemite and I ran into a professional couple who had just arrived and expressed how they were so looking forward to some taking in the natural  beauty there among other things. Unfortunately, one member of the family mentioned to me that they felt low energy and “something coming” on and was afraid he was going to get sick “as he so often did when they got away.” Gosh, and vacations were supposed to be a way to get away from our stresses, unwind and energize our battery.

America is the land of “relaxation deficit disorder” and even when we need a vacation we are often reluctant to take one. Even worse is when we do, we might even get sick because of it.

According to monster.com, 61% of workers in the United States take less than 15 days of vacation per year. US employees don’t clock the most hours at work — Korean workers are actually higher. Comparison studies shggest we do work 100 hours more than professional workers in Europe. The average workweek in the United States putsis a bit more than 44 hours.

A recent survey of 2,082 workers by Hudson suggested that more than half of the respondents said they do not use all of their vacation time and 30% indicated that they use less than half of their allotted personal time. Interestingly, 30% also reported feeling more comfortable taking sick time rather than vacation.

So, why do some people get sick in the heat of the battle, others after the battle and some are just plain resilient in the face of work and life stress (Nowack, K. (2007). Who is the Resilient Talent, and How Do You Develop It? . Talent Management, 3 (6) p. 12)?

It appears that all you Type A leaders who abruptly take a break might actually be at risk for getting sick! Yep, you are on that plane just ready to take a long deserved break and all of a sudden you begin to feel lousy. You think, “No, not now — I don’t need to get sick during my vacation!”

Of course, you were the same students who head home after finals week and after creating a huge sleep deficit (OK, partying will definitely add to that), eating more poorly then you typically do, and feeling some final exam pressure (surely at least once class got you fired up) you head home for that long awaited break only to basically find yourself in bed the entire time sicker than a dog (not really sure how this saying began).

Just when I thought vacations were advised, recommended and a stress reliever I had a chance to chat with a dear colleague and friend of mine who is on faculty at the UCLA School of Medicine — Marc Schoen, Ph.D. who has been researching and writing about this exact mind-body connection in his new book, “When Relaxation is Hazardous to Your Health.”

The Let Down Effect

When you’re straining and struggling under the burden of work or family pressures, your body releases a number of chemicals — including stress hormones — which mobilize your immune system against illness. But when the stressful period ends, your immune system pulls back its troops, and the body becomes less vigilant in weeding out invaders. At the same time, says Schoen, a reservoir of body chemicals called prostaglandins, left over from the stress response, tends to produce inflammation, and can trigger problems like arthritic pain and migraines.

Here are some options recommended by Schoen to minimize the Let Down Effect:

1. Schoen suggests techniques that activate the immune system just a little bit to keep it from slowing down too rapidly after a period of acute or chronic stress at work or home. Try physical activity/exercise — even 10-15 minutes in length — which can stimulate the immune-system in a positive manner. “Walk up and down the stairs in your office building,” says Schoen. “Or after a stressful day at work, instead of coming home and vegging-out in front of the TV, take a brisk walk for a few minutes.”

2. Try some challenging mental problem solving exercises to stimulate cognitive activity in the brain such as computer games, puzzles, under time constraints. “Several studies show that doing mathematical computations at a rapid pace actually increases immune-system activity,” says Schoen.

3. Practice mental and physical relaxation techniques such as meditation, yoga, or deep breathing, which can give your mind and body a rest stop from the day’s anxieties. Focus on breathing slower, inhaling deeply and exhaling naturally. Tune into the gentle rising and falling of your abdomen. This deep breathing can reduce your cardiac rate, stimulate relaxation centers in your brain and reduce your blood pressure. This type of relaxation is easy to apply particularly when you feel hurried, impatient or cognitively preoccupied.

By following his advice, I know I won’t be needing to take another vacation just to recover from my original vacation….Be well….
[tags]the let down effect, stress, well-being, vacations, relaxation, immune system, health promotion programs, employee wellness, stress management, psychoneuroimmunology, resilience, hardiness, meditation, yoga, breathing, kenneth nowack, ken nowack, nowack[/tags]


Taking the Stress out of Holiday Meals

Denise Nowack, RD

As we leave Thanksgiving behind, just the thought of another round of holiday entertaining seems overwhelming and exhausting.  Don’t despair.  Here are four simple strategies can help you relax more, stress less and enjoy good times with family and friends the next time around.


Plan ahead

  • Sketch out your holiday “game plan” in advance, including recipes, shopping lists, supplies…and who will help. 
  • Keep your menu simple.  Holiday meals are often times of overwork…and overeating.  Serve one appetizer, a salad and a side dish with the main entrée.  Your guests will thank you, too!
  • Delicious dishes don’t need to be complex or difficult to make.  Look for recipes that have 5 ingredients or less and keep preparation steps to a minimum.
  • Make out a shopping list.  Keep a piece of paper near the refrigerator and note the items you need.  This will save time at the market and ensure you won’t forget key ingredients

Pace yourself

  • You can lighten the load on the “big day” by including dishes you can prepare days, weeks in advance.  Use freezable dishes for part of your menu.  Some sauces or dips even taste better when the flavors get to blend for a few days in the refrigerator.
  • Recruit a partner.  All good chefs have assistants.  Find a family member or friend who will work beside you helping to gather the things you need, clear the clutter and clean as you go.   Enlist the kids to set and clear the table.
  • Collect your stuff.  Avoid running around the kitchen by gathering all your ingredients and equipment before you start meal preparation.  Then take a seat!  Once you collect everything you need, pull up a stool to the counter, or sit down at the table to assemble your ingredients.  This will help keep you from tiring before the meal is even served.
  • Be realistic and take on only what you can comfortably accomplish and ask others to help with the rest.  A potluck can be a great way to share the load and enjoy your time together rather than stressing over the stove.

Purchasing Power

  • Buy ready-to-use.  Purchasing pre-cut produce, shredded cheeses, jars of chopped garlic and other products of convenience can cut cooking time by 15 minutes…and save even more of your energy.
  • Know where you can opt out of cooking.  Instead of trying to make everything from scratch, relax and be merry with the help from your local market.   You can pick up party trays, side dishes—even a complete turkey dinner from the deli section of your grocery store.  Serve them in your own bowls or platters— no one needs to know.
  • Start your grocery shopping in advance.  By purchasing ingredients that can be stored in your freezer or cupboards you can make shopping more manageable and help minimize the time (and wait) in the crowed stores in the week before the holidays.
  • Go online shopping.  The task of grocery shopping can be exhausting.  Save your precious energy by calling on the help of your local supermarket.  Many offer low-cost delivery services and are as easy as a click of a button at your computer. 

Pack it Up

  • Enjoy the fruits of your labor in the days ahead.  Wrap up leftovers right after dinner in meal-sized portions.  Pop into your refrigerator or freezer for instant dinners that can be easily reheated.
  • Do a “Leftover Makeover.”  Have an idea on how to use the extra turkey and vegetables in tasty dishes the following day.  Here’s one that can come to life in just 15 minutes.

Easy Turkey Potpie

½, 15 oz. package refrigerator pie dough
Cooking spray
1/8 tsp kosher salt
2 cups cooked turkey, cubed
1 ¼ cup frozen mixed vegetables
1 cup frozen mushrooms (or fresh mushrooms quartered)
1, 10 oz. can of reduced-fat /reduced-sodium condensed cream of chicken soup
1 ¼ cup water

Cut 3, 4-inch circles out of dough.  Place on greased cookie sheet and spray tops lightly with cooking spray; sprinkle with salt.  Bake dough at 425 degrees for 8-10 minutes or until golden.

Combine remaining ingredients in a medium saucepan and bring to a boil.  Reduce heat and simmer for 8-10 minutes.  Spoon 1 cup of turkey mixture into a bowl.  Top each with a pie crust.  Serves 3 (serving size: 1 pie)


[tags]denise nowack, stress, holiday stress, eating, nutrition, healthy recipes[/tags]


Lifestyle Coaching as a Strategic Management Tool

Kenneth Nowack, Ph.D.



Please have a look at a recent article of mine at Talent Management magazine on coaching for lifestyle modification and behavior change (Nowack, K. (2007). Lifestyle coaching as a strategic management tool. Talent Management, 3 (7), 36-37).

It’s common in many coaching engagements to hear coachees share perceptions of work/family balance challenges and work stressors. Perceptions of stress are often quite high with 40% to 60% of all coachees reporting very high levels caused by both work and home pressures and challenges (Nowack, K M (2006) Optimising Employee Resilience: Coaching to Help Individuals Modify Lifestyle. Stress News, International Journal of Stress Management, 18, pp 9-12).

A conservative estimate of business benefits derived from the improvements in health status indicate a likely annual return on investment from such a program to be £3.73 for every £1 spent (vielife, 2005). Additionally, according to the Confederation of British Industry (CBI), the annual cost of sickness absence–which is directly influenced by lifestyle habits–was £11.6 billion, or £476 per employee per year in 2004.

In the United States, Aldana (2001) reviewed 13 studies that reported average benefit/cost ratios of $3.48 in reduced health care costs and $5.82 in lower employee absenteeism costs per each dollar invested. Finally, Pelletier (2001) reports on a total of 120 corporate health promotion studies that consistently show cost savings for the organization as well as productivity and health improvement.

Collectively, these reviews and others clearly indicate that stress and health management programms including coaching can be valuable for both the employee and the organisation. Although evidence suggests that a focus on individual interventions without addressing the root organisational causes are typically ineffective, individual health choices that employees make can impact fatigue, concentration, memory and productivity (Nowack, K M (2000) Occupational stress management: Effective or not? In P. Schnall, K. Belkie, P. Landensbergis, & D. Baker (Eds.), Occupational Medicine: State of the Art Reviews, Hanley and Belfus, Inc., Philadelphia, PA., 15 (1), pp 231-233).

So, today is really the first day of your lifestyle….Be well….

[tags]stress, coaching, wellness, health promotion, stress management, behavior change, health, psychological well-being, kenneth nowack, ken nowack, nowack[/tags]