More than 21 per cent of student nurses manifest stress indicators equivalent to disorders found in outpatient psychiatric clinics, according to a 1987 study, while an earlier study showed that 19 per cent of British teachers "were depressed beyond the level of psychiatric outpatients".

Meanwhile, studies have estimated that stress can cost a company with 1,000 employees more than £1.5 million a year in diminished efficiency, absenteeism and high staff turnover.

Work-related stress affects 28 per cent of people in the EU according to a recent survey by the European Foundation for the Improvement of Living and Working Conditions. Some 27 per cent of women, 28 per cent of men, 33 per cent of self-employed and 27 per cent of employed workers admit to work-related stress.

These figures are probably an underestimate. Studies have shown that higher status workers are more likely to admit to stress, while unskilled manual workers - who actually suffer from it more - tend not to disclose it, but cope by increased smoking or drinking.

Stress figures were highest in Greece (50 per cent), Italy (41 per cent), Sweden (38 per cent), Luxembourg (38 per cent) and Finland (34 per cent).

They were lowest in Ireland at 12 per cent.

The EU survey found that the pace of work is ever increasing; that many workers continue to lack autonomy over their job; that people frequently work irregular or unsocial hours and the increase in casual and temporary work is characterised by poor working conditions.

Almost a third of employees are exposed to stresses like intense noise while some 40 per cent have to work in painful or tiring positions. More than 50 per cent have no personal control over the light, ventilation or temperature. A recent CBI survey found that workrelated stress increases significantly in bigger companies and "jumps markedly in organisations with over 1,000 employees". Stress at work was rated as a "medium to strong" cause of sickness absence. Employees with permanent exposure to painful or tiring working positions lost an average of 8.2 days in 1996 (compared to only 2.6 days for those with no such exposure).

Workers with permanent exposure to repetitive movements lost an average of 5.8 days (in contrast to those who avoided such movements who missed only 2.8 days).

Mr Ben Fletcher, Prof of Psychology at the University of Hertfordshire, has written that at any one time 8-10 per cent of the workforce is likely to be suffering from some major psychological problem such as "clinically relevant levels of depression or free-floating anxiety".

Many attribute this strain to their job. Indeed in Britain in 1994 a social worker successfully proved that a county council had not shown sufficient care in preventing his work-related mental illness. Often the first you know that you're under excessive stress is when you end up in the cardiology unit of a hospital having had a heart attack.

The smart way to notice beforehand and take preventive action is to be attentive to disturbed sleep and fatigue; poor concentration; irritability; anxiety; impaired judgment; increased drinking or smoking; indecisiveness; a decline in creativity; a vulnerability to infections; digestive problems; an inability to relax, or a diminished sex drive.

Self-critical Type A personalities, who typically constitute over half a workforce, are more prone to workrelated stress. Characterised by drive, ambition, aggression, competitiveness, alertness, impatience and pessimism, they are the most likely candidates for promotion - and a heart attack. Often they prefer to feel helpless and resentful rather than adopt a healthy stress-reducing strategy.

Companies should be alerted to excessive organisational stress by: increased staff turnover; bad vibes and poor morale; workers avoiding one another; reduced motivation and productivity; rising absenteeism; declining punctuality; an increase in accidents or customer complaints.

Dr Fionnuala O'Loughlin, consultant psychiatrist at the Bon Secours hospital in Glasnevin, says companies need to realise that when it comes to stress "we're not talking about a crowd of namby-pambies".

Middle managers suffer more stress than most because they get flack from above and below, she explains. Underpromotion and over-promotion also produce stress. Casual workers are "certainly a ringer for stress" given the uncertainty of their situations and their need to perform "very well" all the time. She believes solutions to work-related stress lie at both the organisational and individual levels.

The Health and Safety Authority says that controlling workplace stress "is no more optional than the control of any other hazards" and that any stress-reduction programme "which concentrates solely on the worker is likely to be ineffective".

Prof Fletcher says that "a stressful job can be made less stressful by increasing supports rather than by reducing demands".