People who travel for business two weeks or more per 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, according to a study conducted by researchers at Columbia University’s Mailman School of Public Health and City University of New York. Among those who consume alcohol, extensive business travel is also 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 results are published online in the Journal of Occupational and Environmental Medicine.



The Global Business Travel Association Foundation estimates there were nearly 503 million business trips taken in 2016 in the United States, up from 488 million the previous 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, one of the first studies to report the effects of business travel on non-infectious disease health risks, 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 group. Among those who consume alcohol, a CAGE score of 2 or higher was found in 6 percent of employees who drank, indicating alcohol dependence. GAD-7 and PHQ-9 scores and CAGE scores of 2 or higher rose in relation to the duration of business travel. These findings are consistent with analyses of medical claims data from World Bank employees which found that the largest increase in claims from 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 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,” he says. “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.”



Co-authors are Tracey Revenson, The Graduate Center, City University of New York; and Michael Friedman, EHE International, Inc. Medical Advisory Board.