January 8, 2018
Columbia University's Mailman School of Public Health
People who travel for business two weeks or more a month report more symptoms of anxiety and depression and are more likely to smoke, be sedentary and report trouble sleeping than those who travel one to six nights a month. Among those who consume alcohol, extensive business travel is associated with symptoms of alcohol dependence. Poor behavioral and mental health outcomes significantly increased as the number of nights away from home for business travel rose.
The Global Business Travel Association Foundation estimates there were nearly 503 million person-business trips in 2016 in the U.S. compared to 488 million in the prior year. "Although business travel can be seen as a job benefit and can lead to occupational advancement, there is a growing literature showing that extensive business travel is associated with risk of chronic diseases associated with lifestyle factors," said Andrew Rundle, DrPH, associate professor of Epidemiology at the Mailman School of Public Health. "The field of occupational travel medicine needs to expand beyond its current focus on infectious disease, cardiovascular disease risks, violence and injury to bring more focus to the behavioral and mental health consequences of business travel."
The study was based on the de-identified health records of 18,328 employees who underwent a health assessment in 2015 through their corporate wellness work benefits program provided by EHE International, Inc. The EHE International health exam measured depressive symptoms with the Patient Health Questionnaire (PHQ-9), anxiety symptoms with the Generalized Anxiety Scale (GAD-7) and alcohol dependence with the CAGE scale.
A score above 4 on the Generalized Anxiety Scale (GAD-7) was reported by 24 percent of employees, and 15 percent scored above a 4 on the Patient Health Questionnaire (PHQ-9), indicating that mild or worse anxiety or depressive symptoms were common in this employee population. Among those who consume alcohol, a CAGE score of 2 or higher indicates the presence of alcohol dependence and was found in 6 percent of employees who drank. GAD-7 and PHQ-9 scores and CAGE scores of 2 or higher increased with increasing nights away from home for business travel. These data are consistent with analyses of medical claims data from World Bank employees which found that the largest increase in claims among their business travelers was for psychological disorders related to stress.
Employers and employees should consider new approaches to improve employee health during business trips that go beyond the typical travel health practice of providing immunizations and medical evacuation services, according to Rundle, whose earlier research found that extensive business travel was associated with higher body mass index, obesity, and higher blood pressure.
"At the individual-level, employees who travel extensively need to take responsibility for the decisions they make around diet, exercise, alcohol consumption, and sleep. However, to do this, employees will likely need support in the form of education, training, and a corporate culture that emphasizes healthy business travel. Employers should provide employees who travel for business with accommodations that have access to physical activity facilities and healthy food options."