[The association between psychosocial work demands and mental health problems in Quebec: a gender-based analysis]

Poverty, social exclusion, and mental health: the role of the family context in children aged 7-11 years INMA mother-and-child cohort study

Mental health problems are common in childhood and tend to be more frequent in populations at risk of poverty or social exclusion (AROPE). The family environment can play a role in reducing the impact of economic hardship on these problems. The aim of this study was to assess the effect of multidimensional poverty on the mental health of children aged 7-11 years and the role of the family environment in two areas of Spain. Participants were 395 and 382 children aged 7 and 11 from Gipuzkoa and Valencia, respectively. Internalizing and externalizing problem scales of the child behaviour checklist (CBCL) were used. AROPE indicators were obtained by questionnaire, and three dimensions of the family context (Organization of the Physical Environment and Social Context, Parental Stress and Conflict, and Parental Profile Fostering Development) were measured through subscales 3, 4 and 5 of the Haezi-Etxadi family assessment scale (7-11) (HEFAS 7-11), respectively. Data were analysed using negative binomial regression and Structural Equation Modelling. AROPE prevalence was 7.1 and 34.5% in Gipuzkoa and Valencia, respectively. In both cohorts, there was a significant increase in internalizing and externalizing problems among participants with a higher AROPE score. However, AROPE did not affect internalizing problems in children from families living in a better physical environment and with social support (Subscale 3). The AROPE effect was jointly mediated by subscales 4 and 5 in 42 and 62% of internalizing and externalizing problems, respectively. Preventing economic inequities by economic compensation policies, improving the neighbourhood and immediate environment around the school, and promoting positive parenting programmes can improve mental health in childhood.

Psychosocial stressors at work and inflammatory biomarkers: PROspective Quebec Study on Work and Health

BACKGROUND

Chronic low-grade inflammation has been associated with high risk of several chronic diseases such as cardiovascular diseases, diabetes, depression, and dementia. As low-grade inflammation could be present long before the apparition of the disease, identifying modifiable risk factors could allow to act upstream. Psychosocial stressors at work have been suggested as modifiable risk factors of low-grade inflammation, but few longitudinal studies have evaluated the association between these stressors and inflammatory biomarkers, such as C-reactive protein (CRP) and interleukin-6 (IL-6).

OBJECTIVE

This longitudinal study evaluate the associations between exposure to psychosocial stressors at work and CRP and IL-6, separately and combined into an inflammatory index.

METHODS

Data came from a cohort of 9188 white-collar workers recruited in 1991-1993 (T1) and followed-up after 8 (T2, 1999-2000) and 24 (T3, 2015-2018) years. Participants included in this study were randomly selected at T3 for serum biomarkers studies (n = 2557). CRP and IL-6 were measured using standardized protocols. Psychosocial stressors at work were assessed at T2 according to recognized models: Karasek's Demand-Control-Support model and Siegrist's Effort-Reward Imbalance (ERI) model, using validated questionnaires. High job strain was defined by an exposure to high psychological demand combined with low job control, and iso-strain was defined by an exposure to high job strain combined with low social support at work. ERI was defined by an imbalance between psychological demand and social, economic, and organizational reward. Several covariates were considered including sociodemographic, anthropometric, and lifestyle characteristics, and comorbidities. Prevalence ratios (PRs) and 95% confidence interval (CI) for the highest quartile of CRP, IL-6 and inflammatory index at T3 according to psychosocial stressors at work measured at T2 were calculated using generalized estimating equations. Multiple imputation and inverse probability of censoring weighting were done.

RESULTS

In men, an association was observed between exposure to iso-strain and the inflammatory index (PR of 1.42 (95% CI: 1.06;1.90)), mainly among men aged less than 65 years (PR of 2.00 (95% CI: 1.37;2.92)). In this same age group, associations with inflammatory biomarkers were also observed among men with exposure to ERI, and among women with exposure to low reward at work or moderate social support at work.

CONCLUSION

These results suggest that psychosocial stressors at work may increase low-grade inflammation. However, further studies are needed to corroborate these results and to clarify the potential differences between men and women. As these stressors are frequent and modifiable, their reduction is important for public health and could play a role in the primary prevention of chronic diseases.

Cumulative exposure to psychosocial stressors at work and global cognitive function: the PROspective Quebec Study on Work and Health

OBJECTIVES

Psychosocial stressors at work have been proposed as modifiable risk factors for mild cognitive impairment (MCI). This study aimed to evaluate the effect of cumulative exposure to psychosocial stressors at work on cognitive function.

METHODS

This study was conducted among 9188 white-collar workers recruited in 1991-1993 (T1), with follow-ups 8 (T2) and 24 years later (T3). After excluding death, losses to follow-up and retirees at T2, 5728 participants were included. Psychosocial stressors at work were measured according to the Karasek's questionnaire. Global cognitive function was measured with the Montreal Cognitive Assessment. Cumulative exposures to low psychological demand, low job control, passive job and high strain job were evaluated using marginal structural models including multiple imputation and inverse probability of censoring weighting.

RESULTS

In men, cumulative exposures (T1 and T2) to low psychological demand, low job control or passive job were associated with higher prevalences of more severe presentation of MCI (MSMCI) at T3 (Prevalence ratios (PRs) and 95% CIs of 1.50 (1.16 to 1.94); 1.38 (1.07 to 1.79) and 1.55 (1.20 to 2.00), respectively), but not with milder presentation of MCI. In women, only exposure to low psychological demand or passive job at T2 was associated with higher prevalences of MSMCI at T3 (PRs and 95% CI of 1.39 (0.97 to 1.99) and 1.29 (0.94 to 1.76), respectively).

CONCLUSIONS

These results support the deleterious effect of a low stimulating job on cognitive function and the cognitive reserve theory. Psychosocial stressors at work could be part of the effort for the primary prevention of cognitive decline.

Psychosocial work stressors, high family responsibilities, and psychological distress among women: A 5-year prospective study

BACKGROUND

Psychological distress is a strong and independent predictor of major depression. Assuming multiple roles (such as being both a mother and an employee) under stressful conditions may lead to psychological distress. This study evaluated, for the first time, the longitudinal effect of the simultaneous exposure to psychosocial work stressors and high family responsibilities on women's psychological distress.

METHODS

Women were assessed at baseline (N = 1307) and at 3- and 5-year follow-ups. Psychosocial work stressors of the demand-control and effort-reward imbalance models were measured with validated questionnaires. Family responsibilities were also self-reported and referred to the number of children and their age(s) as well as housework and childcare. Psychological distress was measured with the validated Psychiatric Symptoms Index questionnaire. Prevalence ratios (PR) of psychological distress were modeled with log-binomial regressions.

RESULTS

Having high family responsibilities did not increase women's prevalence of psychological distress. However, being exposed to either job strain or effort-reward imbalance led to a higher prevalence of psychological distress at the 3- and 5-year follow-ups (PR of 1.25-1.62). Being simultaneous exposed to these psychosocial work stressors and high family responsibilities also increased the prevalence of psychological distress (PR of 1.44-1.87), but no interactions were observed between stressors and responsibilities.

CONCLUSIONS

In this 5-year prospective study, simultaneous exposure to psychosocial work stressors and high family responsibilities increased the prevalence of psychological distress among women. Work stressors were, however, driving most of the effect, which reinforces their importance as modifiable risk factors of women's mental health problems.

Work, family, work-family conflict and psychological distress: A revisited look at the gendered vulnerability pathways

This paper revisited the vulnerability hypothesis to explain the greater level of psychological distress among working women compared to working men. A comprehensive vulnerability model was tested in which work and family stressors and psychosocial resources are directly related to psychological distress and indirectly through work-to-family (WFC) and family-to-work (FWC) conflicts. Data came from a random sample of 989 women and 1,037 men working in 63 Canadian establishments. Multilevel path analyses were performed separately for men and for women. The results show that many work/family stressors and resources are linked to men's or women's psychological distress directly and indirectly through WFC and FWC. However, the z-test used to assess whether the relationships differed significantly between women and men indicated that only two relationships differ significantly between the two groups: experimenting problems with children and a low self-esteem are associated positively to psychological distress through FWC only for women. In addition to showing the specific involvement of work-family conflict in the psychological distress inequality, this study contributes to revealing that testing the differences in the magnitude of the relation offer a more suitable appraisal of the vulnerability mechanism involved in the psychological distress inequality between men and women.