For your traveler clients. . .
Stress and the Frequent International Business Traveler

Karl Neumann, MD

Comfortable lounges at airports. Cushiony seats in the front of the plane. Limousines waiting at curbside. Jetting here and there and seeing the world - and having someone else pay the bill. Great work if you can get it?

Maybe not.

A majority of people who are frequent international business travelers experience stress-related symptoms which adversely affect their health, their work performance, and their professional relationships with their coworkers. Moreover, business travelers' frequent absences from home cause parallel but different psychosocial symptoms in their spouses and children which, in turn, further impact negatively on the business traveler, creating a downward spiral with increasing stresses on family cohesiveness and professional work performance.

In various studies of frequent business travelers, about a third report a "high" degree of stress, and another third report a "moderate" degree. "Being away from home" was easily the most frequently mentioned cause of the stress. Other common reasons cited included, "jetlag", "visiting developing countries', "length of trip." Conversely, fewer than ten percent of the business travelers and their spouses believe that business travel is a positive experience. And the ultimate affront, many international business travelers fly economy class and though there are no statistics, class of travel does not appear to have an appreciable effect on feelings of stress.

These were some of the findings at a Symposia, "Stress, the Business Traveler, and Corporate Health," organized by the World Bank and held in Washington D.C. The meeting drew almost a hundred experts - mostly from corporate medical departments but also from travel clinics and government agencies - to discuss the causes of stress in business travel and explore ways to minimize it.

International business travel is big business. The employees of some of the larger corporations log tens of thousands of international missions per year - "mission" is corporate parlance for business trip - making travel stress an important economic and human resource problem. The World Bank, for example, based in Washington, sends its employees on more than 18,000 overseas missions a year, the largest number of business travelers from one organization. (Their travel budget is a staggering $120,000,000 per year.) Moreover, it is reasonable to assume that the countless business travelers who work for small companies or who work for themselves experience similar stress-related problems.

And the number of international business travelers continues to increase rapidly, perhaps doubling every decade or so, an increase that is likely to continue. To date, the predicted large-scale replacement of business travel with ever more sophisticated telecommunications, including teleconferencing has not materialized, and may never do so.

The impetus for the World Bank to organize the Symposia were several finding among the Bank's employees, findings reported in two published studies. One study reports that employees who travel frequently see physicians and other health care providers about three times as often as a matched group of employees who do not travel, and that stress-related complaints are strikingly more frequent in the travel group. (Occup Environ Med 1997;54:499-503.). The other report found that employees on missions tend to feel a strong sense of social and emotional concern for their families and a sense of isolation. The traveling employees also believe that there is a strong association between the stresses of business travel and their physical and emotional health.

Other findings in these studies include: stress-related complaints per mission per year tend to remain static for up to three missions but then complaints increase per mission; complaints are far more common in males than in females; age, parts of the world visited, and number of times zones crossed are not important determinants; feelings of isolation and mood changes are also common in spouses left at home; having children under the age of eighteen at home is only a small contributor to stress; and, in spite of the frequent complaints raised by business travelers, few missions end in total failure. It is very rare for business travelers having to return home prematurely because of stress-related problems. But stress does seem to cause many hard-to-quantify, less-than-optimum work performances.

(Mission failures are far more common among employees posted overseas. "Posting" means away for more than 6 months, usually with ones, family. And in most cases such failures are due to coping problems experienced overseas by accompanying dependents rather than in employees. In financial terms, each such mission failure costs employers tens of thousands of dollars in actual costs - employee training and relocation expenses, for example, and additional losses from the disruption of business. However, the problems of employees posted overseas were not the focus of this Symposia.)

Causes of Stress

Surveys of frequent, long distance business travelers show that they experience two types of stress:

• The routine discomforts and annoyances that all long distance travelers encounter such as altered eating and sleeping patterns, changes in climate, and concerns about health and safety issues.
• Challenges unique to long distance business travelers. These fall into three general categories:
  • Concerns about the effects of frequent and extended travel on ones' personal physical and psychological well being;
  • The effects of being away from home on ones' family;
  • The workload that business travelers are expected to accomplish on each mission and the amount of work awaiting them upon their return to the office, workloads frequently perceived as "unreasonable." During the mission, work-related stressful activities include having to make decisions away from the office without the usual office support system, communicating in foreign languages, operating in an unfamiliar business culture, and spending long hours in negotiations, for example.

Strategies for Dealing with Stress

Here are some recommendations that came out of this Symposia:

• Better selection of employees for travel. Since about a third of business travelers do not complain of travel-related stress there are clearly differences in people regarding this issue, but little is known about these differences. Perhaps psychological tests could be developed to better screen job applicants for positions that involve extensive travel.
• Employers should be more candid with job applicants about how much travel a position requires, which is not always the case. But job descriptions change and non-travel positions can rapidly become travel intensive. Promotions within the organization can also change travel necessity. Job applicants should be apprised of the fact that in many organizations experience gained in missions is a consideration in promotions. Moreover, overseas travel is often appealing to a young job seeker but becomes tedious and stressful after time.
• Flexibility regarding travel schedules to allow more time at home. Corporate travel budgets are often "penny wise and pound foolish." Cost considerations sometimes force travelers to be away on a Saturday night or to use an airline with limited schedule flexibility. Ideally, business travelers should be able to return home before weekends, and leave home after weekends. When possible, employees should be consulted about the timing of their missions. And there should be realistic limits to the amount of time spent away from home per year. In fact many organizations have such limits but they are rarely followed. And in spite of the official policy allowing employees to refuse travel assignments, refusing is looked down upon by immediate supervisors.
• Travel schedules and work assignments should be overviewed by senior staff members who have "been there, done that." Realistic scheduling from a human resource point of view may require days off from work before a mission and again on return in order to take care of both family chores and office matters. Family chores may involve seemingly mundane chores such as bill paying, servicing the car, and other task that, ideally, should not be left for the stay-at-home spouse. Female business travelers seem to have a tougher time preparing for their absences than males. Females area generally being more involved with baby sitters and carpool arrangements, and freezing food for future meals, for example.
• Less workload immediately before and after trips. Office workload tends to increase just before a mission - routine work plus preparing for the mission - and immediately on return. Optimum office scheduling may require that several days before the trip are devoted to the mission with no other work assignments, and a day or two of "debriefing" upon return, and another day or so to handle work that has piled up on the desk and in the computer.
• Minimizing trip cancellations and date changing. Extremely disruptive to frequent business travelers' personal lives is repeated changes is travel schedules, something that happens quite frequently, albeit, many of the changes are unavoidable. Rescheduling missions often requires rescheduling family obligations that have already been changed. Employees should be given the option to declines missions if this happens often.
• Counselors to help with the "nuts and bolts" of overseas travel. Experts can help travelers cope with many of the basic travel issues, the health and safety concerns, for example. In fact, many corporations already have in-house medical departments, sometimes even travel clinics, and some organizations have extensive web sites to help business travelers better plan trips - but often, the travelers do not make use of them.
• Minimizing the impact on the family of being away. The effects of a parents' frequent absence from home on children are not well understood, but the absences appear to have a negative affect on the children. (According to one boy who was interviewed, "My father being away on a trip makes little difference. When he is home he spends so much time at the office, that he is never home anyway.") The impact can, perhaps, be minimized by scheduling special family events prior to departure - a day in the park, a day trip, or a visit to a favorite restaurant, for example. Also beneficial may be for children to accompany the departing parent to the airport, discussing the itinerary and looking at maps, and providing children with books and videotapes about the countries the parent is visiting.

Coping overseas and staying in touch with home

Travelers should stay in close touch with spouses and children back home, using the mail, the telephone, and E-mail, regardless of cost to themselves. Some organizations cover the cost of daily E-mail and telephone; the ones that do not, should. Children like to receive mail even if the parent calls or E-mails them everyday. E-mail appears to be a very effective way for a parent to stay in touch with a child old enough to use a computer. Sending audiocassettes and videos from overseas may help smaller children.

Children appear to require more personal attention while one parent is away. They appear more comfortable with the routines that they are accustomed to and do not take well to additional changes, a new baby sitter or staying with a relative, for example. Some children seem to find comfort in marking off the days on the calendar until the parent returns home.

Support groups consisting of other families of business travelers working for the same corporation and living in the same neighborhood appear to be very helpful for spouses at home.

Close to a 100% of spouses describe their returning mate as being irritable and withdrawn when they return home, probably the effects of fatigue and stress. Awareness of such behavior helps dealing with it. Coming home celebrations, if any, are best postponed for a few days. Travelers should try to come back home before a weekend, if possible.

Karl is editor of NewsShare and webmaster for ISTM. He is Associate Clinical Professor of Pediatrics at the Weill/Cornell Medical College and Associate Clinical Attending Pediatrician at the New York- Presbyterian Hospital. This article is reprinted from the newsletter, Traveling Healthy, with permission.