A high level of work-related stress is associated with increased depression, anxiety, and decreased levels of healthy lifestyle behaviors. Professional occupation has been found to be related to lifestyle-related chronic diseases. Some health problems might arise from physical working conditions (e.g., exposure to heat or noise, work injuries) or work characteristics (e.g., high workload and lack of flexibility in working hours) [1].

Call center employees providing customer services via telephone are important for modern businesses. They experience high levels of occupational stress resulting from emotional abuse from unsatisfied customers [2], poor working conditions, low work-related social status, low pay, and a limited career path [3,4]. Difficulty in coping with these poor working environments can negatively affect their level of physical activity and psychological health status. Recently, the mental health of call center employees has become an issue of concern and a recent study reported high levels of depression, anxiety, and stress among them [3].

Health-promoting lifestyle behaviors (HPLB) are multidimensional patterns of perceptions and behaviors that sustain or increase an individual’s level of physical, social, and psychological well-being, and prevent further health problems [5,6]. Recent research showed that work-related stress was closely related to depression and lower levels of engagement in HPLB [6,7]. Although there is evidence of a positive effect of HPLB on maintenance and improvement of health, engaging in HPLB is probably challenging for workers [1,8,9]. Understanding health behaviors and the patterns of relationships with job characteristics and mental health among call center workers are important because a health-promoting lifestyle is a key factor in the improvement of health.

Mental health status, including depression and anxiety, has been found to be negatively related to HPLB among various populations [7,8,10,11]. Depression causes low energy levels, apathy, and loss of interest in pleasurable activities, all likely to make it difficult for one to engage in HPLB [8]. People under stress showed low levels of HPLB [12]. Stress has a negative impact on health status directly through physiological/psychological effects and can also indirectly alter health-related behaviors [13]. That is, employees experience stress and challenges in coping with, and have difficulty maintaining a healthy lifestyle, which can lead to smoking and physical inactivity.

There is scarce research on the mental health status of call center employees in South Korea and the relationship between their mental health and HPLB. This study aimed to examine and understand the mental health status of employees working at a credit card call center. The specific purpose of this study was to 1) examine call center employees’ HPLB, and 2) explore the relationships between their mental health status and HPLB.

Participants’ characteristics and related HPLP-II total scores are presented in Table 1. Most of the participants were women (91.4%), and 54.8% were married. The mean age was 36.11±8.16 years and approximately 65% had completed at least a college level of education. Approximately 25% of the participants reported a monthly household income of less than 2,000,000 KRW (approximately $1,701 USD). Those who were older and had a higher monthly household income reported more frequent and better practice of health-promoting behaviors.

Approximately 21% of the participants were smokers at the time of the survey. Only 27.4% reported that they had sufficient sleep, and approximately 12% felt that their health was good, 57.6% to be fair and 30.5% to be poor. Ex-smokers compared to current smokers, those with sufficient sleep, and a higher level of perceived health reported more frequent and better practice of health-promoting behaviors. Approximately 37% reported being satisfied with their current job.

The results on the mental health status and health-promoting behaviors of the participants are summarized in Table 2. The mean DASS total score was 23.87±13.98 out of a possible total score of 63. Among the subdomains, the mean score for stress was highest (9.22), followed by depression (7.49), and anxiety (7.16). Among the six HPLP-II subscales, interpersonal relations, spiritual growth, and stress management received high scores. Physical Activity had the lowest score.

When compared with normative scores, 68.5%, 70.2%, and 59.0% of the participants were classified as having moderate to severe levels of depression, anxiety, and stress, respectively. The mental health status inversely correlated with the HPLP-II. Those who were classified as normal based on the DASS (depression: F=22.49, P<0.001; anxiety: F=8.55, P<0.001; stress: F=9.06, P<0.001) were more likely to practice health-promoting behaviors.

There were differences found in the relationships between the mental health subdomains and subscales of the HPLP-II (Table 3). Depressive and stress symptoms had a profound impact on physical activity, spiritual growth, interpersonal relationships, and stress management. Anxiety symptoms were significantly related to physical activity, spiritual growth, and stress management.

The purpose of this study was to examine call center employees’ HPLB and explore the relationships between their mental health status and HPLB. The occupational vulnerability such as poor working conditions, low pay, and a limited career path, emotional labor, and high level of smoking among call center employees were reported [2-4]. Especially, their mental health issues have been concerned and a study reported high levels of depression, anxiety, and stress among them [3]. This study fills an important gap in the literature, as there are limited studies available that have explored the relationship between mental health status and HPLB among call center employees.

The mean age of the participants in this study was approximately 36 years, and most of the participants were women (91.4%). These demographic characteristics are similar to those of previous Korean studies on call center employees [2,18]. Individuals who were older, had a high household income, sufficient sleep, and good perceived health were more likely to have HPLB. Moreover, those who willingly engaged in health-promoting behaviors were more likely to have a healthier lifestyle.

The average HPLP-II score among the participants was 2.31, which is lower than the mean score of Korean nurses (2.66) [8], Korean middle-aged women (2.47), and Japanese university students (2.50) [19]. Health-promoting behaviors were related to sustaining or increasing the individual well-being, self- actualization, and personal fulfillment and decreasing the probability of illness [5,9]. It seems call center employees necessitate a attention of health care services to promote health-promoting intervention.

The average DASS score was 23.87±13.98, which is higher than various study samples implying Korean call center employees have mental health issues [3]. One study found that the psychological well-being of call center employees was poor [3], which suggests that they have serious mental health issues. Participants with moderate to severe levels of depression reported lower levels on the four HPLP-II subscales assessing physical activity, spiritual growth, interpersonal relationships, and stress management. These trends are consistent with the other mental health indicators (i.e., anxiety and stress). The other HPLP-II subscales that assessed health responsibility and nutrition also showed this tendency, but the results were not statistically significant. This finding suggests that call center employees who are mentally healthy may engage in self-care activities and have knowledge about health-promoting lifestyles. Work characteristics of call center employees, such as low job control, stress, and the emotionally demanding nature of the occupation, may be associated with poor mental health [11,20-22].

Few studies have reported on call center employees’ HPLB and mental health status. Consistent with a previous study [23], the current study showed that health-promoting lifestyles and mental health were negatively correlated for call center employees. A recent study reported the negative relationship between stress-related symptoms and HPLP for health care workers [11]. People in jobs with high psychological demands such as nurses and call center employees may experience high levels of stress-related symptoms, which may contribute to not engaging in behaviors that promote a healthy lifestyle.

Among the six health-promoting lifestyle domains, participants’ highest scores were in the domains of interpersonal relationships and spiritual growth, and their lowest scores were in the domains of health responsibility and physical activity. Our results are consistent with previous studies showing interpersonal relationships had higher scores, while health responsibility and physical activities had lower scores [8,13,24]. The participants’ highest score was in the interpersonal relationships domain, although it is lower compared to previous studies, which may be related to the job culture. Indeed, the hallmark of call center employees’ culture is their strong bonding and high support for each other [3]. This implies that call center employees may be encouraged to strengthen social support, facilitating their healthy behaviors. The spiritual growth domain received the second highest score, which is consistent with the results of previous studies [8,13,19]. Spiritual growth includes goals of individuals, their capacity to improve their health, and to what extent they know and are able to satisfy their needs [5]. This implies that call center employees have the potential for personal development such as wellness attainment.

This study also showed that participants scored lowest on the physical activity and health responsibility subscales. Health responsibility includes activities such as discussing health concerns, seeking health education, and receiving regular health check-ups. Low levels of health responsibility and physical activity have been shown in studies with diverse populations such as university students [19], Korean nurses [8], nursing students [13], and Chinese older adults [10]. Behaviors such as help-seeking and engaging in physical activities are important for health maintenance and improvement. The results of this study indicate that interventions related to knowledge and motivation enhancement aimed at increasing physical activity levels would benefit call center employees. Although a recent study showed that HPLPs with high levels of health responsibility and physical activity were not associated with actual physical activity [1], call center employees increased awareness of the importance of health-promoting lifestyles and physical activity may contribute to developing a more positive daily lifestyle. The low level of physical activity may be related to work characteristics, particularly a sedentary workplace environment. It is possible that call center employees’ physical inactivity is associated with a low level of physical activity at work, suggesting that a physically active environment or conducting programs at work that promote physical activities may have a positive effect on health promotion and disease prevention.

Several limitations must be considered when interpreting our findings. First, study participants were sampled using a convenience sampling technique using call center employees from a large credit card company through eight outsourced companies. Therefore, generalization of the results may be limited to similar populations. Second, 91.4% of the participants were women. Although women dominate the customer service industry in Korea, these findings cannot be generalized to call centers with male employees. Future studies should investigate mental health status and health-promoting behaviors among call center employees that include larger samples of men and with varying demographic and workplace characteristics. Third, response bias may have affected the results because managers were gatekeepers of the distribution of questionnaires. Some participants may have provided socially desirable responses as a result, especially with regard to the DASS.

There has been concerns about occupational and psychological vulnerability among call center employees. The findings of the present study confirm that call center employees who are mentally healthy tend to practice HPLB when compared to those with moderate to severe mental health issues. The study reveals concerning high level of depressive and stress symptoms, and its profound negative impact on physical activity, spiritual growth, interpersonal relationships, and stress management. As the call center service sector increases, so does the need to improve the physical and mental health of call center employees. There is an imperative need to resolve mental health issues of call center employees, who are at a high risk of health-related issues. Healthcare providers and organizations should closely and routinely monitor depression, anxiety, and stress in Korean call center employees and develop organizational and health-related policies for the Korean call center sector. Additionally, the development and implementation of health-related interventions to promote healthy lifestyle behaviors are critical for call center employees.