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Sleep Patterns and Their Impact on Lifestyle, Anxiety and Depression in BPO workers

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Introduction: Business process outsourcing (BPO) is the contracting of a specific business task, such as payroll, to a third party service-provider. It involves work schedules pertaining to extreme forms of shift-work. Circadian rhythm sleep disorders (CRSD) are not infrequently seen amongst shift workers who, in turn, comprise a large segment of the population employed in the BPO industry. The pattern of sleep, prevalence of anxiety and depression and the overall impact of the nature of their employment on their lifestyle were studied in a segment of BPO workers employed in the call centers around New Delhi. Material & Method: One hundred and eighty-one individuals employed in the BPO industry (call centers) around New Delhi, and a similar number of age and gender matched subjects not thus employed, serving as controls, were included in this study. A questionnaire was submitted to each of them. It included a set of 42 questions, responses to which would yield information pertaining to items related to sleep, lifestyle, anxiety, depression and personal particulars. Appropriate statistical methods were applied to analyze the data. Results: The sleep pattern of BPO workers was found to be markedly different from normal. They were sleepier (ESS of 10-14 was found in 51.4% in the BPO group as against 20.5% in the control group) (p value <0.001); Total sleep time values were found to be in the similar range amongst the BPO workers as well as in the control group population They were more depressed (imperative depression was observed in 62.9% as against only 4.6% in the control group)(p value< 0.001); they were also seen to suffer more from anxiety disorder (an imperative anxiety disorder was found in 33.9% of BPO workers as against 1.4% of the control group) and the use of stimulants (tea, coffee, and cola), other substances (alcohol, narcotics) was also commoner in this group than in controls(p value<0.002). Significant correlation was observed between sleep score and depression (p value <0.001), sleep score and stress at work (p value <0.001), sleep score and abuse of alcohol (p<0.060), sleep score and abuse of narcotics (p value<0.016), Sleep score was also found to correlate with lack of exercise (p value<0.049). Conclusions: The present study has highlighted some of the redeeming features associated with sleep patterns, depression, anxiety and lifestyle that are noted in the BPO workers.
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64
ORIGINAL ARTICLE
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Indian J Sleep Med 2007; 2.2, 64-70
Address for Correspondence
Dr. J. C. Suri
Senior Chest Physician & Head, Department of
Pulmonary, Critical Care & Sleep Medicine, Vardhman
Mahavir Medical College & Safdarjang Hospital,
New Delhi
E-mails: jcsurijc@del3.vsnl.net.in; jcsuri@rediffmail.com
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Sleep Patterns and Their Impact on Lifestyle, Anxiety
and Depression in BPO workers
J. C. Suri, M. K. Sen, Padam Singh*, Rohit Kumar, Puneet Aggarwal
Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College &
Safdarjang Hospital, New Delhi
* Formerly AdditionalDirector General, Indian Council of Medical Research& Director, ICMR Institute
for Research in Medical Statistics, New Delhi
Introduction
Business process outsourcing (BPO) is the
contracting of a specific business task, such as
payroll, to a third party service-provider.1 The
most common examples of BPO are call centers, human
Abstract
Introduction: Business process outsourcing (BPO) is the contracting of a specific business task,
such as payroll, to a third party service-provider. It involves work schedules pertaining to extreme
forms of shift-work. Circadian rhythm sleep disorders (CRSD) are not infrequently seen amongst
shift workers who, in turn, comprise a large segment of the population employed in the BPO industry.
The pattern of sleep, prevalence of anxiety and depression and the overall impact of the nature of
their employment on their lifestyle were studied in a segment of BPO workers employed in the call
centers around New Delhi.
Material & Method: One hundred and eighty-one individuals employed in the BPO industry (call
centers) around New Delhi, and a similar number of age and gender matched subjects not thus
employed, serving as controls, were included in this study. A questionnaire was submitted to each
of them. It included a set of 42 questions, responses to which would yield information pertaining to
items related to sleep, lifestyle, anxiety, depression and personal particulars. Appropriate statistical
methods were applied to analyze the data.
Results: The sleep pattern of BPO workers was found to be markedly different from normal. They
were sleepier (ESS of 10-14 was found in 51.4% in the BPO group as against 20.5% in the control
group) (p value <0.001); Total sleep time values were found to be in the similar range amongst the
BPO workers as well as in the control group population They were more depressed (imperative
depression was observed in 62.9% as against only 4.6% in the control group)(p value< 0.001);
they were also seen to suffer more from anxiety disorder (an imperative anxiety disorder was found
in 33.9% of BPO workers as against 1.4% of the control group) and the use of stimulants (tea,
coffee, and cola), other substances (alcohol, narcotics) was also commoner in this group than in
controls(p value<0.002). Significant correlation was observed between sleep score and depression
(p value <0.001), sleep score and stress at work (p value <0.001), sleep score and abuse of
alcohol (p<0.060), sleep score and abuse of narcotics (p value<0.016), Sleep score was also
found to correlate with lack of exercise (p value<0.049).
Conclusions: The present study has highlighted some of the redeeming features associated with
sleep patterns, depression, anxiety and lifestyle that are noted in the BPO workers.
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Indian Journal of Sleep Medicine (IJSM), Vol. 2, No. 2, 2007
65
resources, accounting and payroll outsourcing. India
has one of the largest pools of low-cost English speaking
scientific & technical talent, thus making it an obvious
choice to outsource to multinational companies. The
total revenue from BPO market is projected to increase
from $110,167 in the year 2002 to 173,070 in 2007. 1
Concern has been expressed over the health problems
of the largely young population employed in this industry.
The various health issues in the call-center industry
include those related to stress, sleep disorders, digestive
system, depression, eyesight problems, ear problems,
personal habits, discipline & behavioral issues and inter-
personal relationships etc.2
Circadian rhythms are physiological or behavioral
cycles with a period of approximately 24 hours produced
by an endogenous pacemaker, evidently the supra-
chiasmatic nucleus (located in the hypothalamus) being
the master circadian clock of the body 3,4. Circadian
rhythm sleep disorders (CRSD) are not infrequently seen
amongst shift workers who, in turn, comprise a large
segment of the population employed in the BPO industry.
The individual’s circadian rhythm is normal but
challenged because the sleep-wake internal clock setting
is at odds with the sleep wake cycle of the shift work
schedule.
Insomnia, excessive sleepiness, impairment of
occupation, academic or social, psychological and
psychiatric functioning may be the presenting symptoms
of a CRSD. There are six primary CRSDs according to
the International classification of Sleep Disorers5. They
include delayed sleep phase syndrome, advanced sleep
phase syndrome, non-24-hour sleep-wake syndrome (also
termed as “non-entrained type” or “free-running type”),
irregular sleep-wake syndrome, shift work sleep disorder
and jet lag syndrome6.
Majority of individuals who perform night duties or
shift work are unable to sleep adequately during daytime
and hence develop cumulative sleep debt leading to
significant sleep deprivation. Features characterizing
sleep deprivation include fatigue, mood changes
(depression, erratic behavior, irritability), decreased
cognitive functioning (attention, focus, memory,
concentration), poor executive functioning (decision
making, fading of judgment, decreased productivity),
impaired vigilance and a predisposition to infections.
Sleep disorders in the chosen segment of population
in this study (namely BPO workers), may be associated
with features of anxiety, depression and an impairment
in the lifestyle. It is with a view to decipher
comprehensively the pattern of sleep in this population,
the prevalence of anxiety and depression and the overall
impact of the nature of their employment on their lifestyle,
that this study was conducted. The principal instrument
used in this study was a questionnaire. It may be added
that the BPO industry is peculiar to this part of the
developing world and not may studies have looked into
the sleep-related aspects of morbidity in this population.
Material and Method
One hundred and eighty individuals employed in the
BPO industry (call centers) around New Delhi, and a
similar number of age and gender matched subjects not
thus employed, serving as controls, were included in this
study. A written informed consent was obtained from
each participant. A questionnaire was submitted to each
of them. The subjects and their employers were
informed of the objectives and methodology used during
the survey. Complete confidentiality was guaranteed.
The telephone number and email ID of the principal
investigator were provided for help in completing the
questionnaire. The subjects were also intimated that
they were free to consult the Department of Pulmonary,
Critical Care & Sleep Medicine, VMMC & Safdarjang
Hospital, New Delhi in order to investigate the sleep
disorders they reported.
The questionnaire recorded the following information:
Age, gender, marital status.
Working conditions particularly related to shift work,
which included whether they have to often work more
than 10 hrs a day or more than 6 days a week,
number of years and months working rotating shifts.
Sleep habits and problems related to sleep and
sleepiness (including Epworth Sleepiness Score)
A validated anxiety questionnaire7
A validated depression questionnaire 7
A validated stress and lifestyle questionnaire 7
Consumption of tea, coffee, colas, cocktails, narcotics
& substance abuse.
History of having accidents because of sleepiness
The total number of questions was forty-two. Groups
of items aimed to detect various sleep parameters were
bunched together. They included sleep (10 questions
J. C. Suri, M. K. Sen, Padam Singh, Rohit Kumar, Puneet Aggarwal
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66
and the Epworth sleepiness score), depression (15
questions), anxiety (8 questions), stress at work and
lifestyle (9 questions). Sleepiness was scored by the
Epworth Sleepiness Scale (ESS)8. The values of ESS score
greater than 10 were considered as indicative of excessive
sleepiness (1-6 = normal, 7-9 = average, >18 = very
sleepy). The anxiety questionnaire comprised eight
questions; an answer in the affirmative to >3 of the 8
questions was taken as “probable” anxiety and that to >5
as presence of “imperative” anxiety where the individual
would benefit by a seeking psychiatric consultation. As
regards the depression questionnaire, which comprised
15 questions, affirmative answers in >4 and >6 questions
were taken as “possible” and “imperative” depression
respectively. Imperative depression was taken as situation
where the individual would probably derive benefit by
seeking professional help.
Sleep deprivation was determined in every subject
by calculating an “index of sleep deprivation”. This index
was derived by the following formula: “average sleep debt
as reported” multiplied by “ number of months reported
as spent in the shift duty”. (Table 3) To cite the example
of an individual who has been in the profession for two
years (24 months) and has reported to be sleeping for an
average of 6 hours on any weekday, the “average sleep
debt” would be 2 hours (8 minus 6 hours); the “index
of sleep deprivation” would be 48 (2 multiplied by 24).
Appropriate statistical methods were applied.
Results
There were one hundred and eighty one individuals
included in the test group of population, namely those
employed in the BPO industry. There were 149 (82.3%)
males and 32 (17.7%) females. The age ranged from 19
years to 37 years. A similar number of individuals with
matching age and gender distribution, who were not BPO
employees, served as the control group.
The sleepiness score (measured by the ESS) of 10-14
was found in 51.4% in the BPO group as against 20.5%
in the control group. A score of 15-19 was observed in
14.5% in the test group compared to 2.1% in the control
group. Normal sleepiness score (0-9) was found in only
30.7% of the individuals in the test group as against
77.4% in the control group. An extremely high sleepiness
score (>20) was found in 3.4% of the BPO employees
but none of the individuals in the control group. These
differences were all statistically very significant (p value
Table 1: Depression, anxiety, sleep-score, sleep-time in
BPO workers and control group (p value <0.05)
Table 2: Lifestyle parameters in BPO workers
Sleep Patterns and Their Impact on Lifestyle, Anxiety and Depression in BPO workers
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67
< 0.001) (Table 1 & Figure 3)
Total sleep time values were found to be in the similar
range amongst the BPO workers as well as in the control
group population.
Based on the questionnaire for depression, majority
of individuals in the control group (85.4%) were found
to be free of any depressive symptoms as against only
18.9% of the BPO workers. Amongst the test group,
imperative depression (i.e.>six questions answered as
“yes”) was observed in 62.9% as against only 4.6% in
the control group. A possible depression (i.e. >four
question answered as “yes”) was noticed in 18.3% of the
BPO workers as against 10% in the control group (Table-
1). These observations were statistically very significant
(p value <0.001).
The anxiety questionnaire also revealed interesting
data. A majority of the control group population (92.3%)
was free of any anxiety symptoms as against only 27.2%
of the test group. An imperative anxiety disorder (answer
of “yes” to > 5 questions) was found in 33.9% of BPO
workers as against 1.4% of the control group. A possible
anxiety disorder (answer of “yes” to > 3 question) was
noticed in 38.9% of BPO workers compared to only
6.3% of the control population (Table-1). These
observations were statistically very significant (p value
<0.001).
Cigarette smoking was reported in 40.6% and coffee/
tea/cola beverage use in 65.7% of BPO workers as against
7.5% and 49.7% respectively in the general population
(p value <0.001). Abuse of narcotic drugs was reported
by 27.6% of BPO workers compared to 4.1% of the
normal population (p value <0.001). Among BPO
workers, 35.9% of drank more than 2 cocktails per week
as against only 2.1% of the normal population (p value
<0.001). About 35.4% of the BPO workers exercised
less than twice a week compared to 17.4% of the control
group population (p value <0.001) (Table-2).
About 50.8% of the BPO workers often worked more
than 10 hrs/day or 6 days in a week compared to 31.7%
of the control group (p value<0.001). About 58.3% of
the test population reported stress at work compared to
19.3% of control group (p<0.001). When faced with a
no-win situation, 48.1% of the BPO workers reported
dissatisfaction compared to 22.1% of the control group
(Table-2) (p<0.001).
Relationships amongst sleep score and other
parameters (anxiety, depression & lifestyle) were also
analyzed by Pearson Chi-Square method, likelihood ratio
was obtained and linear-by-linear associations were
studied (Table 3, figures 1 & 2). Significant correlation
was observed between sleep score and depression (p value
<0.001), sleep score and stress at work (p value <0.001),
sleep score and abuse of alcohol (p<0.060), sleep score
and abuse of narcotics (p value<0.016), Sleep score was
also found to correlate with lack of exercise (p
value<0.049).
Discussion
Sleep patterns
Analysis of data from a large and heterogeneous group
of French workers has revealed the increase of sleep
disorders in relation to age, female gender and shift
working 9,10 . The prevalence of excessive sleepiness (ESS
Table 3: Value of different parameters(%) according to
sleep score and p-value for significance of difference
Fig 1: Correlation of severity of sleepiness score with depression,
anxiety and various lifestyle parameters within the BPO worker
group. (1=ESS<5, 2=ESS 6-9, 3=ESS>10)
J. C. Suri, M. K. Sen, Padam Singh, Rohit Kumar, Puneet Aggarwal
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68
normal. They were sleepier as assessed by ESS (a
sleepiness score (measured by the ESS) of 10-14 was
found in 51.4% in the BPO group as against 20.5% in
the control group; a score of 15-19 was observed in 14.5%
in the test group compared to 2.1% in the control group.
The highly significant difference in sleepiness scores
between BPO workers and control population can be
attributed to the nature of their vocation which involves
long stretches of night duties.
Despite a highly significant difference in sleepiness
scores between the BPO workers and control population,
sleep time values were, however, found to be in the
similar range amongst the two groups. It may be
concluded that “total sleep time” as reported by the
respondent in the questionnaire is actually synonymous
with “time in bed”, during most part of which the BPO
worker has either not been sleeping or had a very poor
quality of sleep. This has probably not been capable of
restoring the sleep debt faced after a night-shift and
resulted into excessive sleepiness.
A study on a group of Italian police officers has found
that shift-work conditions and seniority may enhance
sleep disorders and may favor sleep-related accidents11.
The effects of shift work on sleepiness, performance and
safety are profound. Examples include greater incidence
of truck accidents at night, errors in meter-readings in
gas works during night shift, telephone operators
connecting calls more slowly at night, speed of spinning
threads in a textile mill going down during the night,
poorer mental arithmetic and reduced reaction time
during a night shift, nuclear disaster at Chernobyl, the
Three Mile Island reactor accident and reduced medical
mistakes in interns following improvement in rest
conditions19. In the BPO group of the present study
subjects, 32% reported of having had an accident or
near-accident because of sleepiness compared to only
4.8% of the controls. This is very serious observation
and may have disastrous consequences.
Shift-work sleep disorder typically manifests as
insomnia or excessive sleepiness that occurs with the
work schedule12. A majority of shift workers experience
difficulties after a night shift and quite a few may have
problems with early morning start-times, sleep being
typically curtailed by 1 to 4 hours12. Various animal
and human models of sleep deprivation have
demonstrated that clinical disorders that cause either
sleep curtailment or fragmented sleep resulting in
functional sleep deprivation result in excessive daytime
Fig 2: Correlation of sleepiness score with depression, anxiety and
various lifestyle parameters amongst BPO workers and control
group.
Fig 3: Proportion of subjects in various categories of sleepiness
scores among BPO workers (top panel) and control group (bottom
panel); inset showing shade-coding of various categories of sleepiness
scores (ESS).
> 10) has been shown to be 44.8% in night workers,
35.8% in rotating workers and 32.7% in day shift
workers17. The present study has revealed that the sleep
pattern of BPO workers is markedly different from
Sleep Patterns and Their Impact on Lifestyle, Anxiety and Depression in BPO workers
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69
sleepiness13. Variations have been observed in the ability
of an individual to cope with shift work, which is
influenced by several factors that include age, domestic
responsibilities, commute times, diurnal preference and
other sleep disorders14. Treatment of shift work sleep
disorders have traditionally centered on good sleep
hygiene, bright light, melatonin and short-term use of
sleep medication14-16
Shift rotation and sleep schedule
Several studies have reported high degree of sleepiness
during night shift with no sleepiness at all during the day
shifts19. In one study involving 60 paper-industry workers
in an extremely rapidly rotating shift system with very
short rest in between shifts (night shift 8 hrs off
afternoon shift 8 hrs off morning shift 56 hrs
off), it was seen that sleepiness rose to high levels during
the first night shift, fell to intermediate levels during the
afternoon shift and reached high levels again during the
morning shift. Sleepiness was back to normal on the
first recovery day18. Adjustment to night shifts does not
normally occur because of the exposure to daylight while
returning home from the night shift which counteracts
the expected delay of the circadian clock, when light is
not interfering, however (e.g. when night shift workers
are provide with strong sunglasses for the morning
commute home) adjustment occurs20. Amongst BPO
workers included in this study, 57.8% individuals
maintained a regular sleep schedule as compared to
71.2% amongst controls. Sixty percent of the BPO
workers and 29% among controls felt exhausted during
the day. Among BPO workers 61.9% felt that excessive
sleepiness interfered with their work and social life as
against only 17.8% of the controls. About 43% of the
BPO workers napped during working hours compared
to only 10.1% of the controls, the mean duration of the
nap being 15 minutes in the former and 12 minutes in
the latter. Rotation of shifts was reported by 56.7%.
Similar findings, perhaps on a smaller scale, are also
found in most other shift-workers like police personnel
and factory-workers. BPO work may therefore be
considered as an extreme form of shift work.
Anxiety & depression
A higher prevalence of ulcers, depressive, sleepiness-
related accidents, missed workdays and missed family
or social events was observed in those shift workers
suffering from insomnia or excessive sleepiness17. The
BPO workers in this study were also observed to be
more depressed (imperative depression was observed in
62.9% as against only 4.6% in the control group). They
were also seen to suffer more from anxiety disorder
(imperative anxiety disorder was found in 33.9% of BPO
workers as against 1.4% of the control group).(Table 1)
Lifestyle parameters
Peculiar practices adopted by BPO employees may
predispose them to various health problems. Heavy foods
during night, skipping breakfast, eating lunch in the
evening are some of them21. Frequent headaches,
fatigue, sleepiness, diminution in reflexes and work
efficiency may occur. The individuals also become
irritable and unsociable. In the present study, use of
stimulants (tea, coffee, and cola), other substances
(alcohol, narcotics) was also commoner in the BPO
workers’ group than in controls. Longer working hours,
stress at work, lack of physical exercise and dissatisfaction
was also observed in a larger proportion of this population
than in controls. Another study that included 400 shift
workers found that the proportion with a very negative
attitude to work hours constituted 8% and were mainly
characterized by marked sleepiness and sleep
complaints18.
Insomnia has been defined as difficulty falling asleep,
staying asleep, or non-restorative sleep for at least one
month and it must be associated with a work period
that occurs during the habitual sleep phase and excessive
sleepiness 19 . Working in a BPO is an extreme form of
shift-work. It is often associated with long working hours
during night (occasionally at a stretch), awkward working
hours (e.g. “UK-USA shift”, “graveyard shift”) and
frequent unpleasant interactions with clientele (that may
not always be particularly friendly to talk to over the
telephone).
Correlations between various parameters
Significant correlation was observed between sleep score
and depression (p value <0.001), sleep score and stress
at work (p value <0.001), sleep score and abuse of alcohol
(p<0.060), sleep score and abuse of narcotics (p
value<0.016), Sleep score was also found to correlate
with lack of exercise (p value<0.049). (Table 3, Figures
1&2) Depression may be precipitated in a predisposed
individual who is excessively sleepy as well as exposed to
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70
stressors at work that may be peculiar to the nature of
BPO work (occasional unpleasant interactions with a
client over telephone). The other lifestyle parameters like
abuse of alcohol & narcotics, lack of exercise and stress
at work might also be directly impacted by excessive
sleepiness as evident from these observations.
The quality of sleep may be abnormal even if the
total sleep time is somehow compensated (e.g. increase
in arousals, decrease in slow-wave and REM sleep etc.).
In such individuals in whom total sleep time is not
significantly different from normal, a qualitative variation
in sleep (like deficient slow-wave and REM sleep) may
impact on the lifestyle parameters mentioned above.
Conclusions
The present study has only highlighted some of the
redeeming features associated with sleep patterns,
depression, anxiety and lifestyle that are noted in the
BPO workers. This segment of the workforce is
undergoing tremendous increase in magnitude. The
healthcare issues in this sector are of prime importance.
The BPO industry in the developing world in general,
and in India in particular, is destined to witness a
phenomenal growth. A healthcare policy aimed at finding
remedial measures to issues pertaining to the health status
of this category of workers would invariably result into
healthy growth and prosperity of this industry. More
studies involving a larger number of subjects that are
aimed to look into these and other morbidities, followed
by interventional measures to mitigate these problems
as mentioned earlier, in this section of shift-workers in
greater detail are therefore recommended.
Acknowledgements
The authors are thankful to Dr. Tulsi Adhikari, Senior
Research Officer, ICMR Institute for Research in
Medical Statistics, New Delhi for the help rendered in
the statistical analysis of this data.
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BPO
Sleep Patterns and Their Impact on Lifestyle, Anxiety and Depression in BPO workers
... A high level of emotional intelligence (EI) scores predict a more stable mental state and a better performance at work ( Bar-On, et al. 2006). However, a low level of EI scores suggest that mental state is at risk, specifically in terms of depression, anxiety, and stress (Suri, et al. 2007;Jeyapal, et al. 2015). ...
... This study aims to bring to light the hidden life of online content guardians-the CMs-with the hope of preventing psychological disturbance in their lives. The research specifically focuses on identifying relationship between the levels of emotional intelligence as suggested by Goleman's EI model (2001) and the levels of depression, anxiety, and stress as the identified dimension among content moderators' mental state (Suri, et al. 2007;Jeyapal, et al. 2015;Raja and Bhasin 2014). In measuring the recognized variables, the identification and the prevention of substantial symptoms affecting mental state are possible. ...
... Among the mental state domains, anxiety has the highest classification under normal description on both sexes which could be influenced by the nature of its working hours in the graveyard shifts (Suri, et al. 2007). Comparing those with changes in work schedule and no changes at all, the study shows that stress and anxiety are more dominant. ...
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This research sought to find predictive correlation in identifying the level of emotional intelligence including its domains namely: self-emotional appraisal, other's emotional appraisal, use of emotion and regulation of emotion toward the level of mental state specifically in stress, anxiety, and depression among content moderators (CM). The study utilized a predictive-correlational design and employed complete enumeration. Wong and Law's Emotional Intelligence Scale (WLEIS) was used to measure the level of emotional intelligence while the Depression, Anxiety and Stress 21 Scale (DASS-21) was used to measure the level of mental state. The results showed that the overall level of mental state's relationship towards the overall level of emotional intelligence is negatively significant. This means that the higher the level of emotional intelligence, the lower the level of stress, anxiety, and depression. The result of the research recommends to isolate the possible affected employees, assess if the level of exposure caused severe disturbance on CM's mental state, investigate for secondary traumatic stress and professional burnout, and establish a mental health program that caters different roles in organization. Therefore, these initiatives can protect both the CM's overall welfare and the organization's interest. Moreover, the results of the study could prove to be beneficial and influential to the international guidelines and best practice on occupational health policies and programs.
... The present study has highlighted some redeeming features associated with sleep patterns, depression, anxiety, and lifestyle noted in BPO workers (Suri C. et al., 2007). Most call center workers work at times when they would typically be sleeping. ...
... They were sleepier. The present study has highlighted some of the redeeming features associated with sleep patterns, depression, anxiety, and lifestyle noted in BPO workers (Suri C. et al., 2007). Additionally, long hours of work, permanent night shifts, incredibly high work targets, and loss of identity are the dark clouds threatening to mar the 'sunshine' call center industry. ...
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This study aimed to investigate the lived experiences of BPO on-site employed students at the University of Cebu- Main Campus, including the challenges they encounter, how they manage pressure and stress, and the coping mechanisms they employ to balance their academic responsibilities with their work commitments. The qualitative research method was employed to achieve this, with sixteen (16) participants selected through purposive sampling. Data collection involved conducting semi-structured interviews with open-ended questions, and the qualitative data was analyzed using Braun and Clarke's (2006) thematic analysis approach. The analysis revealed fourteen (14) emergent themes, categorized under four (4) overarching themes, which addressed the sub-problems. The overarching themes included the reasons for working while studying, categorized as "Reasons of Participants on Working While Studying" with four (4) emergent themes: Good Work Compensation, Competency, Interpersonal Skill, and Provider. The lived experiences of BPO on-site employed students fell under the theme "Lived Experiences as a BPO on-site Employed Student," with four (4) emergent themes: On Physiological Needs, Overwhelming Workload, Patience, and Night Life. The challenges faced by the participants were grouped under "Challenges Met by the Participants," with three (3) emergent themes: Time Management, Sleep Deprivation, and Irate Customers. Lastly, the coping mechanisms employed by the participants were classified under the theme "Coping Mechanisms of the Participants on the Challenges Met," with three (3) emergent themes: Me Time, Not Giving Care, and Positivity. The study's findings and recommendations addressed the challenges experienced by on-site employed students working in the BPO industry, providing valuable insights into their unique experiences.
... Besides emotional work mentioned above, intensive and stressful, and repetitive work in call centers weakening employee autonomy and loss of control results in impaired sleep. [32][33] In our study, 17.9% of the workers reported impaired sleep. The impaired sleep group had significantly poor HRQOL scores than the unimpaired group. ...
... Previous studies supporting the findings of this study showed that impaired or inadequate sleep was associated with health related morbidity and decreased HRQOL. 17,[32][33][34] Finally, in our study, an important number of participants reported concentration difficulty (65%), listening difficulty (50.7%), understanding difficulty (44.3%), and lower work productivity (33.8%). Those problems were related to poor HRQOL. ...
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Objective: The purpose of this study was to investigate health related quality of life (HRQOL) and related factors among bank call center employees. Material and Method: The sample consisted of 201 employees. We evaluated HRQOL by using SF-36. The Pearson's correlation coefficients, independent groups t-test and one-way ANOVA test were used for data analyses. Results: Overall, 47.8% of the subjects stated that their workplace was mostly stressful. Almost all (95.5%) workers reported that their workplaces were noisy; 56.2% of them described themselves as "mildly noise annoyed", and 43.8% as "severely annoyed". Perceived job stress, noise annoyance and job dissatisfaction were associated with poor HRQOL. Musculoskeletal discomfort, headache, concentration difficulty, nervousness and fatigue were the most prevalent complaints. All health problems were associated with poor HRQOL. Conclusion: In conclusion, clarification of effecting factors on HRQOL of bank call center workers will drive the call center sector for the implementation of interventions towards preventing deleterious effects on health and HRQOL of their workers and towards creating a happy and healthy work environment. Keywords: Call center, health complaints, health-related quality of life, job satisfaction, perceived job stress, perceived noise annoyance, quality of life. Nobel Med 2016; 12(1): 79-86 BANKA ÇAĞRI MERKEZİ ÇALIŞANLARINDA SAĞLIKLA İLİŞKİLİ YAŞAM KALİTESİ VE İLİŞKİLİ FAKTÖRLER ÖZET Amaç: Bu çalışmanın amacı banka çağrı merkezinde çalışanların sağlıkla ilişkili yaşam kaliteleri (SİYK) ve ilişkili faktörleri incelemektir. Materyal ve Metot: Çalışmanın örneklemini bir ban-kanın çağrı merkezinde çalışan 201 kişi oluşturmuş-tur. SİYK SF-36 ile değerlendirilmiş; verilerin anali-zinde Pearson's korelasyon katsayısı, bağımsız gruplar için t-testi ve tek yönlü ANOVA testi kullanılmıştır. Bulgular: Olguların %47,8'i işyerinin çoğu zaman stresli, hemen tamamı (%95,5) gürültülü olduğunu ifade etmiş; %56,2'si gürültüden hafif, %43,8'i ise ciddi derecede rahatsız olduklarını belirtmişlerdir. Algılanan iş stresi, gürültü rahatsızlığı ve iş memnu-niyetsizliği daha kötü SİYK kalitesi ile ilişkili bulun-muştur. Olguların en belirgin sağlık şikayetleri kas iskelet rahatsızlıkları, baş ağrısı, konsantrasyon güç-lüğü, sinirlilik ve yorgunluk idi; sağlık sorunlarının tümü daha kötü SİYK kalitesi ile ilişkili idi. Sonuç: Banka çağrı merkezi çalışanlarının SİYK'si-ni etkileyen faktörlerin ortaya konması, sağlığı ve SİYK'sini bozan faktörlerin önlenmesine yönelik girişimlerin uygulanması mutlu ve sağlıklı çalışma ortamı yaratılmasında çağrı merkezi sektörü için yol gösterici olacaktır. Anahtar kelimeler: Çağrı merkezi, sağlık şikayetleri, sağlıkla ilişkili yaşam kalitesi, iş doyumu, algılanan iş stresi, algılanan gürültü rahatsızlığı, yaşam kalitesi. Nobel Med 2016; 12(1): 79-86
... Due to the difference in time zones between India and such countries, most work is performed during night hours corresponding to a time suitable to their international customers. Such erratic work timings are often called "graveyard shift" or "UK-USA shift" by few researchers [4]. They deal with the pressure to meet certain metrics and daily quotas, along with managing an unnatural night-shift biological time-frame. ...
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Introduction: Business Process Outsourcing (BPO) industry has been rapidly expanding in India over the last 10 years. While em
... Previous studies on TZD work have researched its impact on health, proving that working at non-standard work hours-which stretch beyond the typical daylight periods and include night work-negatively affect TZD workers' medical and social well-being (Carmel & Kojola, 2012). These workers experience a high level of stress, anxiety, depression, sleeping problems and an increasing risk of suffering from cardiovascular disease (Bharat & Paul, 2016;Suri et al., 2007). Despite the increasing practice of offshoring with consequent TZD work, the study of social consequences of the organization of work and non-work lives is an area which has been relatively under-researched (Albertsen et al., 2008). ...
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Offshoring business processes to low-cost locations around the globe has made temporal flexibility a pervasive feature in the work lives of young workers in global South countries like Sri Lanka as it requires them to work on a time zone dependent (TZD) basis. In an environment where great resignation has broadened the discourse on flexibility and work-life balance while pandemic-induced economic crisis urging the Asian businesses to return to purely physical pre–Covid-19 legacy processes, this article explores the under-researched social consequences of the organization of work and non-work lives around non-standard work schedules, and how Sri Lankan TZD workers experience and manage those consequences. Data was gathered from in-depth interviews with TZD workers in Sri Lanka. The findings reveal that TZD work reflects a temporal colonization of global South countries by the capital of Western countries. Though unexpected, interposed transitions are inevitable in TZD work, male and female TZD workers experience them differently due to the reinforcement of prevailing gender and cultural stereotypes in Sri Lanka. Despite significant social de-synchronization resulting from temporal colonization, TZD workers have rearticulated the way they produce their social life with a more ‘inward’ approach—facilitated by the homelike environment created at the workplace.
... [11][12][13][14][15][16] There are not sufficient studies documenting sleep trends specifically in India, even though current employment profiles may be related with reduced or irregular sleep. 17 In view of major role of sleep in human functioning, and also in the recent scenario, where India is witnessing growing instances of assaults against resident doctors, we undertook the following cross-sectional study at our institution. We evaluated the subjective sleep quality, day time sleepiness, satisfaction with quality of life, stress, anxiety, depression and their association with subjective sleep quality of the resident doctors on their off-duty days and also compared the findings amongst various departments of our institution. ...
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p class="abstract"> Background: Medical residency programs are traditionally supposed to be having long working hours, which can be associated with a poor quality of sleep and resultant daytime sleepiness. This poses threat to both physician and patient. This study has an alarming importance in recent scenario, where India is witnessing growing incidents of assaults against resident doctors. We evaluated the subjective sleep quality, day time sleepiness, satisfaction with life, stress, anxiety and depression and their association with subjective sleep quality amongst the residents on their off-duty days and also compared these findings amongst various departments of our institution. Methods: This cross-sectional study was conducted among 77 first year resident doctors of Government Medical College, Amritsar during the period from May 2018 to March 2019. The tools used for assessment were Pittsburgh sleep quality index, Epworth sleepiness scale, the satisfaction with life scale (SWLS) and depression, anxiety and stress scale-21 questionnaire. Results: Our results indicated that 71.43% residents were poor sleepers. 53.24% residents had day time sleepiness of which 46.75% had excessive day time sleepiness. 40.26% residents had mild to moderate stress, 44.16% had mild to moderate anxiety, 31.16% residents suffered from depression of which 18.18% residents suffered moderate to severe depression. 90.91% residents were satisfied with their life on applying SWLS. Poor sleep quality was perceived greatly by the resident doctors in our public hospital. Conclusions: Understanding the potential impacts of fatigue on resident physicians performance /safety and using this knowledge to optimize shift-duty schedule may reduce the risks to both doctors and patients.</p
... Most call center agents work at times when they would usually be sleeping. According to Suri et al. (2007), this could challenge the individual's circadian rhythm because the sleep-wake internal clock setting is at odds with sleep-wake cycle of the shift schedule ultimately resulting in circadian rhythm sleep disorders. A majority of workers in night duties is unable to sleep adequately during daytime and hence may develop cumulative sleep debt leading to significant sleep deprivation. ...
... Sleep disruptions could challenge a person's circadian rhythm. The internal clock environment is at odds with the shift schedule sleep-wake cycle, resulting in circadian sleep rhythm disorders (Suri et al., 2007). Sleep deprivation in rotating shifts is an evident health issue that has already been reported in earlier studies (Tune, 1968 andWright, 2009). ...
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The majority of the International BPOs in India function at night. Working on the night shift ends up in serious health issues like sleep disorder, musculoskeletal discomforts, eye strain etc. The job stressors also significantly impact social life, and the COVID-19 lockdown in India had an adverse effect on all the sectors. This study aimed to identify the health risks and job stressors during the post lockdown period and give insights into the overall health and stress levels of the BPO employees. The study includes 400 employees from five BPO companies of Udyog Vihar Gurugram, India. Responses were collected through an online questionnaire categorised into four parts viz, demographic parameters, health parameters, social parameters and job stressors during post lockdown. Descriptive statistics were calculated; frequency and percentage values had also been described. Primary health-related issues in BPO job are: Sleep deprivation (76%), Eye problems and headache due to prolonged computer use (88%), Musculoskeletal discomforts (80%), Acidity, constipation etc. (76%) and considerable weight gain (62%). Major social issues include not getting leaves during festivals (68%), disruptions in family and personal life because of the job (80%). The job stressors during post lockdown are, facing demanding customers (70%), Erratic/graveyard shifts (88%), high target (90%), difficulties maintaining physical distancing, handwashing and facemask wearing (95%), fearing getting infected with COVID-19 (86%). Periodic health assessments at the workplace, adding sufficient breaks, and setting up recreational areas may help curb these reported issues.
... Due to the difference in time zones between India and such countries, most work is performed during night hours corresponding to a time suitable to their international customers. Such erratic work timings are often called "graveyard shift" or "UK-USA shift" by few researchers [4]. They deal with the pressure to meet certain metrics and daily quotas, along with managing an unnatural night-shift biological time-frame. ...
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Before the use of melatonin can be recommended based on solid scientific evidence, further studies, conducted with adequate methods, are needed. A specific melatonin receptor agonist, ramelteon, has recently been approved as hypnotic. Although positive effects have been reported, extensive use in clinical practice would be necessary to confirm whether the statistically significant improvements are clinically meaningful, since the changes sometimes were relatively small, and the samples studied were large or very large.
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The development and use of a new scale, the Epworth sleepiness scale (ESS), is described. This is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness. One hundred and eighty adults answered the ESS, including 30 normal men and women as controls and 150 patients with a range of sleep disorders. They rated the chances that they would doze off or fall asleep when in eight different situations commonly encountered in daily life. Total ESS scores significantly distinguished normal subjects from patients in various diagnostic groups including obstructive sleep apnea syndrome, narcolepsy and idiopathic hypersomnia. ESS scores were significantly correlated with sleep latency measured during the multiple sleep latency test and during overnight polysomnography. In patients with obstructive sleep apnea syndrome ESS scores were significantly correlated with the respiratory disturbance index and the minimum SaO2 recorded overnight. ESS scores of patients who simply snored did not differ from controls.
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We compared the contributions of bright light during the night shift and dark goggles during daylight for phase shifting the circadian rhythm of temperature to realign with a 12-hour shift of sleep. After 10 baseline days there were 8 night-work/day-sleep days. Temperature was continuously recorded from 50 subjects. There were four groups in a 2 x 2 design: light (bright, dim), goggles (yes, no). Subjects were exposed to bright light (about 5,000 lux) for 6 hours on the first 2 night shifts. Dim light was < 500 lux. Both bright light and goggles were significant factors for producing circadian rhythm phase shifts. The combination of bright light plus goggles was the most effective, whereas the combination of dim light and no goggles was the least effective. The temperature rhythm either phase advanced or phase delayed when it aligned with daytime sleep. However, when subjects did not have goggles only phase advances occurred. Goggles were necessary for producing phase delays. The most likely explanation is that daylight during the travel-home window after a night shift inhibits phase-delay shifts, and goggles can prevent this inhibition. Larger temperature-rhythm phase shifts were associated with better subjective daytime sleep, less subjective fatigue and better mood.
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Sleep is a fundamental biological process involved in multiple homeostatic processes. Yet in critically ill patients, perhaps those in most need of a good night’s rest, sleep is fragmented and of poor quality. This sleep deprivation likely contributes to the significant burden of delirium and immune dysfunction that is evident in the critically ill. While most sedatives appear to produce a state akin to “pharmacologically induced sleep,” there are important differences to natural sleep. One exception appears to be alpha-2 agonists that produce a state of sedation that is closer to natural sleep than drugs that target the GABAA receptor (that includes the benzodiazepines and propofol). Here we review the function and neurobiology of natural sleep, comparing and contrasting it with different types of sedation, and discuss the potential consequences thereof. We also cover a major impediment to the research into sleep in the intensive care unit (ICU): the difficulty in identifying it. Finally we cover the implications of sleep-disordered breathing (encompassing obstructive sleep apnea and obesity hypoventilation syndrome) in the ICU. Brain dysfunction, epitomized by the acute confusional state of delirium, is common in critically ill patients and is associated with significant morbidity and mortality (see Chapter 1, this volume). Sleep disruption is emerging as an important risk factor for developing critical care delirium. Most sedatives appear to produce a state akin to “pharmacologically induced sleep;” but in fact produce a state with important differences to natural sleep. An important exception are alpha-2 agonist drugs that produce a state of sedation that appears closer to natural sleep.
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Endogenous circadian rhythms in physiology and behavior are ubiquitous among mammals and are regulated by a master circadian clock, the suprachiasmatic nucleus of the hypothalamus. These intrinsic circadian rhythms are synchronized by light, melatonin, and social or physical activity to the 24-hour external light and dark cycles. Circadian rhythm sleep disorders (CRSD) occur when there is an alteration of the internal circadian timing mechanisms or a misalignment between the timing of sleep and the 24-hour social and physical environments. CRSDs, such as delayed sleep phase, advanced sleep phase and shift work sleep disorder, are often under-recognized, yet should be considered in the differential of patients presenting with symptoms of insomnia and/or hypersomnia. Because behavioral and environmental factors often are involved in the development and maintenance of these disorders, a multimodal treatment approach that combines behavioral and/or pharmacologic approaches is usually required. In addition to good sleep habits, timed exposure to bright light and melatonin can be used for the treatment of CRSD. Rapid advances in understanding the physiologic, cellular, and molecular basis of circadian rhythm and sleep regulation will likely lead to improved diagnostic tools and treatments for CRSDs.
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This article describes the circadian and homeostatic processes involved in the modulation of sleep and wakefulness. It defines the six currently identified primary circadian rhythm sleep disorders and the process for diagnosing each entity. It then focuses on the use of chronotherapy, phototherapy, and melatonin to treat delayed sleep phase syndrome, the circadian rhythm sleep disorder most commonly seen in children and adolescents.
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Circadian rhythm sleep disorders are caused by a mismatch between the sleep-wake pattern and circadian phase. Sleep at the circadian high is impaired, while alertness is reduced during wakefulness. This article explores the various circadian rhythm sleep disorders, including shift work sleep disorder, jet lag sleep disorder, delayed sleep phase syndrome, advanced sleep phase syndrome, non-24-hour sleep syndrome, and irregular sleep syndrome.
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Sleep deprivation and sleep loss are pervasive in modern society, largely stemming from societal demands of increased productivity. This increased productivity does not come without a cost to basic physiologic processes that have been explored by animal and human sleep deprivation research over the last century. These studies have provided some understanding of the molecular and neurochemical ramifications of sleep loss, and the circadian and homeostatic processes involved with sleep-wake mechanisms. Clinicians have several tools to assess daytime sleepiness as a consequence of sleep loss, and often this sleep loss is related to sleep and medical conditions. A better understanding of the causes and consequences of sleep loss can lead to recognition and curtailment of voluntary sleep deprivation and management of disorders that result in sleep loss.
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Circadian rhythm sleep disorders are characterized by a misalignment between the timing of sleep-wake and the external environment that results in insomnia, excessive daytime sleepiness, and impaired waking function. This chapter covers sleep disorders thought to be result of alterations in the endogenous circadian clock, such as delayed sleep phase type, advanced sleep phase type, free-running type, and irregular sleep-wake type, and those that result in circadian misalignment as a result of alterations in the external environment, such as shiftwork type and jetlag type. The clinical presentation, prevalence, pathophysiology, and treatment options are discussed. Comprehensive treatment should take into account behavioral and environmental factors that influence sleep-wake and is aimed at realignment of the sleep-wake cycle with desired times using circadian synchronizing agents such as light and melatonin in combination with good sleep hygiene.
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Circadian rhythm sleep disorders occur when individuals attempt to sleep at the wrong circadian time. The misalignment between the internal circadian timing system and the external environment is typically due to either an alteration in the functioning of the circadian timing system (e.g., delayed or advanced sleep phase disorder) or to changes in the external environment (e.g., jet lag). However, the clinical presentation of most of the circadian rhythm sleep disorders is influenced by a combination of physiologic, behavioral, and environmental factors. These disorders lead to complaints of insomnia and excessive daytime sleepiness, with impairment in important areas of functioning and quality of life. Current treatments, such as timed exposure to bright light and exogenous melatonin, primarily serve to align the timing of circadian rhythms or increase the strength of the circadian signal. Although these treatments are effective, their use in clinical practice has been limited by the availability of adequate diagnostic tools and large-scale randomized controlled clinical trials. The rapid advances in our understanding of the molecular, cellular, and physiologic basis of circadian regulation and the pathophysiology of these disorders will lead to more targeted and effective treatments.