Work-related stress is associated with poor mental health, such as depressive disorders or burnout [1–5]. The specific aspects of work that induce stress and stress-related diseases have been the subject of intense research for decades, and a large number of major work-stressors have been identified [6,7]. They can roughly be grouped into factors associated with either work tasks; social relations with customers, colleagues or supervisors; the organization of work including working time arrangements, or employment relations.
In contrast, technology as a source of stress was not the focus of work stress research for a long time. This has changed with the digital transformation. Digital technologies have become omnipresent in almost all branches and jobs, and their diffusion has a fundamental impact on organizational structures, communication, business models, work organization and employment relations. It is almost inevitable that such changes will have consequences for the individual workers. From an occupational health and safety perspective, it is important to identify specific aspects of the digitalization processes that lead to work stress, and therefore have the potential to impair mental health .
This article summarizes research on the associations between digital technologies used at work, stress and mental health. We will first describe what digitalization of work is and what its main consequences are. Next, we will discuss how technology-related stress or ‘technostress’ is defined and distinguish specific dimensions of technostress. The empirical part provides an overview of relevant study results. They suggest that certain aspects of work with digital technologies not only negatively affect worker's mental health but also indicate that digitalization can have positive effects for mental well being. Conclusions, however, must be drawn with caution as the evidence base is still small.
DIGITALIZATION OF WORK AND THE PSYCHOSOCIAL WORK ENVIRONMENT
Digitalization is a fundamental technology-driven transformation process. It has its origins in the rapid progress of digital technologies and their increasing diffusion into all domains of live . Work is a major field of digitalization. In Europe, for example, the proportion of workers who reported a frequent use of digital technologies increased from 36 to 57% between 2005 and 2015 . Examples for predominant digital technologies in the world of work are information and communication technologies -- ICT (e.g. mail, social media, smart phones), software based work-environments and processes (e.g. enterprise resource planning software), wearables (e.g. smart glasses), smart factories in industry or robotics. These innovations turned out to be powerful motors of change affecting almost any part of a business: social relations within an institution, communication (with customers, partners, suppliers, authorities, the public), the way single tasks are performed (e.g. messaging instead of personal meetings), the work organization (e.g. where and how to work), employment relations (e.g. precarious employment in gig-economy), and the goods or services produced or provided [11–13]. Labour markets also change as new qualifications are required while other occupations are replaced by technology . This digital transformation has consequences on workers’ psychosocial work environments. These can either be negative in terms of technology-related stress or positive in terms of a reduction of stress by useful digital tools or by better work organization supported by technology.
TECHNOSTRESS AT WORK: THE CONCEPT
The American psychologist Craig Broad was one of the first scholars who suggested that computer technology can be a cause of stress among its users . He introduced the term ‘technostress’ to label psychological responses to negative experiences with computers. Mainly based on observations of clinical cases, he treated as a psychotherapist, he defined technostress as a ‘modern disease of adaption caused by an inability to cope with the new computer technologies in a healthy manner’ . Since then the interest in this ‘modern disease’ has constantly grown [16▪▪]. As the original definition is rather broad, efforts were made to identify relevant subdimensions of the construct. Albeit no commonly accepted definition exists, many researchers (including the recent reviews [16▪▪,17]) refer to a list of single categories or ‘technostress creators’ compiled by Tarafdar et al.. They divided technostress into techno-overload, techno-complexity, techno-insecurity, techno-uncertainty and techno-invasion. Table 1 provides a description of their characteristics. The table also contains three additional categories that are not included in the list of Tarafdar et al.  but turned out to be additional technostress-creators in empirical studies: techno-unreliability [19–21], technological workplace surveillance [22–25] and stress in human-machine interaction [26–29]. With regard to measures, most studies use self-reported measures and only a few rely on qualitative or experimental methods .
This list is preliminary and likely to be incomplete because of different reasons. As no consensus about the concept of technostress exists, a variety of terms and measures are used in research .
Moreover, because of the rapid change in technology, there is a delay between the implementation of new technologies and attempts to systematically research their impact on health [31▪]. Thus, the effect of very recent phenomena like the gig-economy or artificial intelligence is not yet evaluated. It can also be criticized that the categories shown in Table 1 overlap. They also mix up different concepts of the technology--stress association. In some of them, technology is simply an antecedent of other well established work-related stressors like job insecurity or high psychological demands whereas in other categories, technology is the primary stressor (e.g. unreliability).
TECHNOSTRESS AND MENTAL HEALTH: MECHANISMS
The psychobiological stress reaction is the central mediator between technology and mental health. Technostress in its stricter sense (technology as a stressor) is closely related to transactional stress theory established in psychological stress research. Tarafdar et al.[31▪] define technostress as ‘a process that includes (1) the presence of technology environmental conditions; which are appraised as (2) demands or techno-stressors that are taxing on the individual and require a change; which set into motion (3) coping responses; that lead to (4) psychological, physical, and behavioural outcomes for the individual’. A resulting chronic activation of the human stress system is the proximal risk factor for several diseases including mental diseases [32–34]. A number of biomarker studies have shown that the technostress-creators described above are indeed associated with increased activation of the stress system, establishing the proposed biological link (see below).
Two other aspects are relevant. First, a number of factors have been identified, which modify if work with technology is perceived as stressful, and whether or not a stress response is triggered. Established factors are attitudes of the workers towards digital technologies, digital literacy, coping styles, involvement in implementation of technologies, and organizational technical support [16▪▪,17,31▪,35,36]. Second, technostress has an inherent negative notion but technology can also be designed and used in a way that reduces workload. Flexibility, for example, does not necessarily cause work-life conflicts but can help to organize the requirements from different life domains better. We will, therefore, include a paragraph on possible positive effects in the following results section.
TECHNOSTRESS AND MENTAL HEALTH: EMPIRICAL FINDINGS
Two systematic reviews on technostress have been published recently [16▪▪,17]. They provide an overview on current findings about the emergence of technostress at work and its consequences for health, well being and productivity. We will summarize the main results of these systematic reviews with a focus on mental health research. We will also add newer studies from the technostress literature. We will structure the results along three dimensions of the stress process: the role of digitalization in the perception of stress; the relation between technostress creators and biological stress reactions and the association between technostress and mental health outcomes.
DIGITALIZATION AND THE PERCEPTION OF STRESS
It is the core assumption of technostress literature that digital technologies may be perceived as stressful. The recent reviews largely include studies based on cross-sectional designs and use the categories of techno-overload or techno-complexity as indicators of technostress. Most of them revealed a correlation between work with digital technologies, mainly defined by ICT use, and an increase in self-reported work stress. Chesley , for example, found that ICT use at work was related to techno-overload (higher speed rate, more interruptions) and to techno-complexity (multitasking). A few studies also tested more specific ICT topics (e.g. e-mail use) and work stress. Stich et al.  showed that e-mail use is appraised as stressful both when it exceeds or fails to meet the user's expectation and preference.
Additionally, a study by Stadin et al. showed that ICT use is associated with increased work stress (e.g. job strain).
A qualitative study showed that new forms of human--machine interactions can lead to the experience of stress . Stressors linked to human--machine interaction are technical problems, poor usability, low situation awareness, and new skills that are required. Technical problems, such as breakdowns were described as a main stressor when employees were not qualified to handle these problems on their own, thus decelerating workflow and causing additional time pressure.
Another potential outcome of the digitalization processes is techno-invasion, which often leads to work-life conflicts. Studies show that work-overload and flexibility because of technology use increases work-life conflicts . Furthermore, using ICTs to perform work tasks at home makes employees perceive their work/family borders permeably and work-to-family conflicts became more likely under these conditions . Several studies investigated if work-related internet and smartphone use blurs the distinction between work and private life [42–46] and found that the intrusion of work into private life can causes conflicts with family members [47,48].
TECHNOSTRESS AND PSYCHOBIOLOGICAL STRESS REACTIONS
The dominant indicators for a stress reaction in general stress research are glucocorticoids including the hormone cortisol, heart rate and heart rate variability, as well as blood pressure . Some studies investigate specifically the biological stress reactions related to technostress . Riedl et al.  showed in a laboratory experiment that the cortisol levels and the skin conductance of individuals increased after a computer system breakdown. This supports the hypothesis that technostress creators activate stress reactions. In another experimental study, Mark et al.  showed that workers have less stress reactions (measured by heart rate variability) when access to mails was interrupted temporarily, in comparison to those who had continuous access to their emails. A study by Galluch et al.  investigated if ICT-related frequent interruptions cause stress reactions. The authors used salivary alpha-amylase (a marker of the sympathetic nervous system) as an outcome measure. The result of the experiment was an increase in alpha-amylase scores when ICT-related interruptions increased.
TECHNOSTRESS AND MENTAL HEALTH OUTCOMES
Studies that directly tested an association between technostressors and mental health are scarce. Among the few studies, the majority focused on the association of ICT use with burnout. Most of them used the Maslach Burnout Inventory to define Burnout . Those cross-sectional studies and also one intervention study found positive associations between technostress and burnout [54–57]. A recent study by Park et al.[58▪], for instance, showed that work-related smartphone use after work is associated with burnout. The authors conclude that this should be minimized and they emphasize the ‘right to disconnect’ after work to prevent burnout.
There are also few other studies on mental health related symptoms. A study by Abeliansky and Beulmann , for example, investigated if an increase in industrial robots affects the mental health of workers. They showed that an increase in the so-called robot intensity (ratio of industrial robots over employment) is associated with a decrease in mental health. To measure mental health, they used several mental health symptoms combined into a mental health index.
There are also some studies that test specific mental health symptoms, such as cognitive complaints or depressive symptoms [59–62]. A longitudinal study tested if ICT demands predicted cognitive complaints in a 2-year follow-up . ICT demands were assessed by self-assessment of high demands because of new technologies (e.g. too many emails or constantly being interrupted by e-mail) or more flexible working conditions. They predicted cognitive complaints even after adjustment for potential confounders like education or somatic disease. Using the same study, a newer longitudinal analysis revealed that repeated exposure to high ICT demands at work lead to the development of poor self-rated health over time for men but not for women [63▪]. To sum up, a few studies with mostly cross-sectional designs exist that provide preliminary evidence that technostress can impair the mental health of workers. More studies are needed that test the assumptions in a longitudinal design, strictly control for confounders and use clinical outcomes (e.g. major depression).
POSITIVE EFFECTS OF DIGITAL TECHNOLOGIES AT WORK
It is important to highlight some contradictory findings as they suggest that digital technologies can have positive effects on occupational health and well being. An observational study, for example, revealed that better work organization by ICT was associated with better well being for employees . The same was found in an observation of the effects of automation in a pharmacy where stress was reduced by technology . In addition, Kushlev and Dunn  demonstrated in an experiment that an explicit e-mail policy (checking mails only at defined times) decreases stress and promotes mental well being. Some of the already mentioned studies on techno-invasion also provide nuanced findings. On the one side, ICTs blur the distinction between work and private life with the risk of work--family conflicts, on the other side, they also allow a greater flexibility in handling job demands and organising private life demands in the work time [41,42]. Comparable findings exist for workplace surveillance. Close monitoring can be perceived as stressful when it is used to promote unrealistic levels of productivity or challenges a worker's need for autonomy [22,66]. In contrast, in the case that employees felt the purpose of monitoring was to optimize the workflow, health was not affected [22,66,67]. These, and a few other examples, point to the importance of a differentiated view on the effects of digital technologies [31▪]. Further research is deserved to study whether well designed digital technologies and a supportive organizational structure promote mental health among workers who frequently use digital technologies.
Research on technostress as a risk factor for mental disorders is a work-in-progress. Empirical studies are limited and often rely on small samples with a cross-sectional design and restricted measures of psychological strain. A major limitation is the striking lack of longitudinal studies, which makes it difficult to disentangle causal mechanisms and to account for potential confounding by strong predisposing factors like personality or qualification . Another difficulty is the missing consensus on what exactly technostress is and a resulting vast heterogeneity in concepts, terms and measures . This is not surprising, as researchers from very different professional backgrounds, such as engineering, computer science, psychology, sociology, management and epidemiology are involved.
Keeping these limitations in mind, we conclude that research suggests certain types of technostress at work are related to poor mental health. Findings on biological outcomes establish a link between technology and stress and first findings suggest a correlation between technology-induced stress and mental health (in particular burnout). Stronger designs of future studies are necessary in order to allow for a proper risk assessment of the ubiquitous digital technologies at work and other life domains.
Financial support and sponsorship
This work is based on reviews conducted for a series of research projects on psychological risk assessment in digital work funded by the German Federal Ministry of Education and Research (BMBF) (Grant/Award Numbers: FKZ 02L14A170; 02L16D020; 02L18B020).
Conflicts of interest
There are no conflicts of interest.
REFERENCES AND RECOMMENDED READING
Papers of particular interest, published within the annual period of review, have been highlighted as:
▪ of special interest
▪▪ of outstanding interest
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