[Inequalities in mental health in the working population]

Diagnosis and Treatment of Depression in Spain: Are There Gender Inequalities?

It is well known that women are more likely than men to be diagnosed with depression and to consume antidepressants. The factors related to the medicalisation of depression and their social distribution remain unclear. The aim of this study was to analyse gender inequalities in the medicalisation of depression from an intersectional perspective. This was a cross-sectional study based on data from the European Health Survey relating to Spain. Gender inequalities were calculated using prevalence ratios of women compared to men with a diagnosis of depression and antidepressant use, adjusted for age, depressive symptoms, primary care visits and diagnosis of depression in the case of antidepressant use. After adjustments, the diagnosis of depression and the use of antidepressants were more prevalent in women, especially of lower socioeconomic levels. Gender inequalities in the diagnosis of depression also increased with decreasing level of education. Regarding the use of antidepressants, gender inequalities were not significant in university graduates and people of higher social. The gender inequalities found in the diagnosis and treatment of depression cannot be completely attributed to a higher level of depressive symptoms in women or their greater frequency of visits to primary care. Inequalities are greater in more vulnerable social groups.

Environmental, Health and Sociodemographic Determinants Related to Common Mental Disorders in Adults: A Spanish Country-Wide Population-Based Study (2006-2017)

Common mental disorders (CMD) represent a serious, growing public health concern, especially in women. The aims of this study were to report the prevalence of CMD among the adult population in Spain, to analyze the time trends from 2006 to 2017 and to explore the associations between CMD and gender, in relation to the perceived environmental and sociodemographic problems and clinical factors. A nationwide cross-sectional study was conducted including 48,505 participants aged 16 to 64 years old who had participated in the Spanish National Health Surveys in 2006, 2011/2012 and 2017. A logistic regression analysis was performed to identify the variables associated with CMD by gender. The prevalence of CMD was 20.4% in 2006, 20.8% in 2011/2012 and 16.9% in 2017 (p = 0.36). In women, the probability of having a CMD was higher in widowed or separated/divorced compared with single individuals and as the perception of distressing noise levels from outside the home increased. The probability of CMD was lower as the level of education increased in men. Foreigners and those with limitations due to health problems, chronic conditions and worse perceived health were more likely to suffer from a CMD in both women and men.

[Social class, psychosocial occupational risk factors, and the association with self-rated health and mental health in Chile]

The objective of this study was to analyze the association between social class and psychosocial occupational risk factors and self-rated health and mental health in a Chilean population. A cross-sectional study analyzed data from the First National Survey on Employment, Work, Quality of Life, and Male and Female Workers in Chile (N = 9,503). The dependent variables were self-rated health status and mental health. The independent variables were social class (neo-Marxist), psychosocial occupational risk factors, and material deprivation. Descriptive and logistic regression analyses were performed. There were inequalities in the distribution of psychosocial occupational risk factors by social class and sex. Furthermore, social class and psychosocial occupational risk factors were associated with unequal distribution of self-rated health and mental health among the working population in Chile. Occupational health interventions should consider workers' exposure to socioeconomic and psychosocial risk factors.

Gender inequalities in occupational health related to the unequal distribution of working and employment conditions: a systematic review

Introduction

Gender inequalities exist in work life, but little is known about their presence in relation to factors examined in occupation health settings. The aim of this study was to identify and summarize the working and employment conditions described as determinants of gender inequalities in occupational health in studies related to occupational health published between 1999 and 2010.

Methods

A systematic literature review was undertaken of studies available in MEDLINE, EMBASE, Sociological Abstracts, LILACS, EconLit and CINAHL between 1999 and 2010. Epidemiologic studies were selected by applying a set of inclusion criteria to the title, abstract, and complete text. The quality of the studies was also assessed. Selected studies were qualitatively analysed, resulting in a compilation of all differences between women and men in the prevalence of exposure to working and employment conditions and work-related health problems as outcomes.

Results

Most of the 30 studies included were conducted in Europe (n=19) and had a cross-sectional design (n=24). The most common topic analysed was related to the exposure to work-related psychosocial hazards (n=8). Employed women had more job insecurity, lower control, worse contractual working conditions and poorer self-perceived physical and mental health than men did. Conversely, employed men had a higher degree of physically demanding work, lower support, higher levels of effort-reward imbalance, higher job status, were more exposed to noise and worked longer hours than women did.

Conclusions

This systematic review has identified a set of working and employment conditions as determinants of gender inequalities in occupational health from the occupational health literature. These results may be useful to policy makers seeking to reduce gender inequalities in occupational health, and to researchers wishing to analyse these determinants in greater depth.

[Gender inequalities in occupational health in Spain]

OBJECTIVES

To analyze gender inequalities in employment and working conditions, the work-life balance, and work-related health problems in a sample of the employed population in Spain in 2007, taking into account social class and the economic sector.

METHODS

Gender inequalities were analyzed by applying 25 indicators to the 11,054 workers interviewed for the VI edition of the National Working Conditions Survey. Multivariate logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (95% CI), stratifying by occupational social class and economic sector.

RESULTS

More women than men worked without a contract (OR=1.83; 95% CI: 1.51-2.21) and under high-effort/low-reward conditions (1.14:1.05-1.25). Women also experienced more sexual harassment (2.85:1.75-4.62), discrimination (1.60:1.26-2.03) and musculoskeletal pain (1.38:1.19-1.59). More men than women carried out shift work (0.86:0.79-0.94), with high noise levels (0.34:0.30-0.40), and high physical demands (0.58:0.54-0.63). Men also suffered more injuries due to occupational accidents (0.67:0.59-0.76). Women white-collar-workers were more likely than their male counterparts to have a temporary contract (1.34:1.09-1.63), be exposed to psychosocial hazards and discrimination (2.47:1.49-4.09) and have occupational diseases (1.91:1.28-2.83). Gender inequalities were higher in the industry sector.

CONCLUSIONS

There are substantial gender inequalities in employment, working conditions, and work-related health problems in Spain. These gender inequalities are influenced by social class and the economic sector, and should be considered in the design of public policies in occupational health.

The incorporation of gender perspective into Spanish health surveys

BACKGROUND

Most studies into social determinants of health conducted in Spain based on data from health surveys have focused on social class inequalities. This paper aims to review the progressive incorporation of gender perspective and sex differences into health surveys in Spain, and to suggest design, data collection and analytical proposals as well as to make policy proposals.

METHODS

Changes introduced into health surveys in Spain since 1995 to incorporate gender perspective are examined, and proposals for the future are made, which would permit the analysis of differences in health between women and men as a result of biology or because of gender inequalities.

RESULTS

The introduction of gender perspective in health surveys requires the incorporation of questions related to family setting and reproductive work, workplace and society in general to detect gender differences and inequalities (for example, domestic work, intimate partner violence, discrimination, contract type or working hours). Health indicators reflecting differential morbidity and taking into account the different life cycle stages must also be incorporated. Analyses ought to be disaggregated by sex and interpretation of results must consider the complex theoretical frameworks explaining the differences in health between men and women based on sex differences and those related to gender.

CONCLUSIONS

Analysis of survey data ought to consider the impact of social, political and cultural constructs of each society. Any significant modification in procedures for collection of data relevant to the study of gender will require systematic coordination between institutions generating the data and researchers who are trained in and sensitive to the topic.