Human service work, gender and antidepressant use: a nationwide register-based 19-year follow-up of 752 683 women and men

Diagnoses of common mental disorders among social workers in Sweden: A register-based cohort study

BACKGROUND

Little is known about common mental disorders (CMD) diagnoses among social workers, i.e., depression, anxiety, or stress-related disorders. This study aims to examine the risk of CMD among social workers in comparison to other workers and to further investigate differences between men and women and specific occupational titles.

METHODS

This register-based cohort study consists of 3,034,304 persons, of which 26,610 were social workers (0.9 % of all workers), aged 30-64 years, living in Sweden in 2015. The risk of diagnosed CMDs was followed up until 2020. Cox regression models were used to calculate hazard ratios (HR) and 95 % confidence intervals (CI), adjusting for sex, birth country, education, and birth year.

RESULTS

The participants were followed up by a total of 16,833,742.9 person-years, with an average follow-up of 5.5 years. Social workers, compared to other workers, were at a higher risk of CMD (HR 1.3, 95 % CI 1.2-1.4) after adjustment. The HR was equal, 1.3, for depression (95 % CI 1.2-1.5) and anxiety or stress-related disorder (95 % CI 1.2-1.4). The association between social work and CMD was stronger among men (HR 1.7, 95 % CI 1.6-1.9) compared to women (HR 1.2, 95 % CI 1.1-1.3). Further, men working as assistance analysts had the highest risk among the occupational categories (HR 2.2, 95 % CI 1.2-3.9).

LIMITATIONS

CMD diagnoses only included cases treated in secondary care.

CONCLUSIONS

Social workers, especially male social workers, had a higher risk of CMD. This deserves attention for future research and interventions aimed at improving the mental health of social workers.

Prepandemic Mental Health and Well-being: Differences Within the Health Care Workforce and the Need for Targeted Resources

BACKGROUND

Occupational stress and diminished well-being among health care workers were concerning even before the coronavirus disease 2019 pandemic exacerbated existing stressors and created new challenges for this workforce. Research on the mental health of health care workers has focused on physicians and nurses, with less attention to other occupations.

METHODS

To assess pre-coronavirus disease mental health and well-being among workers in multiple health care occupations, we used 2017 to 2019 data from the Behavioral Risk Factor Surveillance System.

RESULTS

Across the health care workforce, insufficient sleep (41.0%) and diagnosed depression (18.9%) were the most common conditions reported. Counselors had the highest prevalence of diagnosed depression. Health care support workers had elevated prevalences for most adverse health conditions.

CONCLUSIONS

Ensuring a robust health care workforce necessitates identifying and implementing effective occupation-specific prevention, intervention, and mitigation strategies that address organizational and personal conditions adversely affecting mental health.

Use of outpatient and inpatient health care services by occupation-a register study of employees in Oulu, Finland

Background

The aim of this study was to examine how the use of outpatient and inpatient health services differs by occupational groups, and whether the differences are explained by sociodemographic factors and health status.

Methods

We used register-based data on 25–64-year-old employees living in the city of Oulu, Finland, in 2018 (N = 61,848). Use of outpatient health care services (public, private and occupational health care) among men and women was analysed with negative binomial regression models, and use of inpatient health care with logistic regression models, using two occupational classifications: occupational group (1-digit level) and more detailed occupation (2-digit level). Adjusted covariates were age, education, income, marital status, special reimbursement entitlements for medicines, and sickness absence.

Results

Examined at the level of larger occupational groups, the use of outpatient and inpatient health care was less common than average among managers, professionals and skilled agricultural, forestry and fishery workers; in women also among craft and related trades workers. Controlling for covariates explained only part of the differences, more among women than among men. Analysed at the level of more detailed occupations, the adjusted use of outpatient and inpatient care was more common among health associate professionals and stationary plant and machine operators, both among men and women. Furthermore, the use of outpatient care was common among male personal care workers, protective service workers and metal, machinery and related trades workers as well as among labourers in mining, construction, manufacturing and transport, and female customer services clerks and sales workers.

Conclusion

The use of health care services differs by occupation, and the differences are not fully explained by sociodemographic factors and health status. High occupational risks, attitudes and knowledge may explain the more frequent use of health services. Furthermore, explanations may be sought from lack of access to occupational health care or healthier working conditions and behavior.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07970-y.

Modern Aspects of Psychophysiological Selection of Employees for High-risk Work

In Ukraine, as in the rest of the world, the problem of the impact of occupational hazards and peculiarities of the labor process on higher nervous activity and general health of the working contingent remains relevant. The issue of fitness to work of employees, especially of dangerous, extreme professions is due to the extraordinary financial and economic, medical, social and psychological urgency of the problem. In the aspect of psychological and psychophysiological diagnosis, a large number of methodological approaches have been developed. Thorough psychophysiological diagnosis is the basis for predicting the effectiveness of employees and psychophysiological characteristics of the labor process. Thus, a wide variety of developed methodological approaches in modern conditions allows for effective psychophysiological examination of a particular field of activity of employees involved in high-risk work and opens further prospects for improving the psychophysiological support of professional activities of these persons. There is a need for theoretical substantiation and development of measures to improve the professional psychophysiological selection of industrial employees to perform high-risk work with further implementation and evaluation of medical, social and economic efficiency.

Workplace violence and health in human service industries: a systematic review of prospective and longitudinal studies

OBJECTIVES

To provide systematically evaluated evidence of prospective associations between exposure to physical, psychological and gender-based violence and health among healthcare, social care and education workers.

METHODS

The guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Medline, Cinahl, Web of Science and PsycInfo were searched for population: human service workers; exposure: workplace violence; and study type: prospective or longitudinal in articles published 1990-August 2019. Quality assessment was performed based on a modified version of the Cochrane's 'Tool to Assess Risk of Bias in Cohort Studies'.

RESULTS

After deduplication, 3566 studies remained, of which 132 articles were selected for full-text screening and 28 were included in the systematic review. A majority of the studies focused on healthcare personnel, were from the Nordic countries and were assessed to have medium quality. Nine of 11 associations between physical violence and poor mental health were statistically significant, and 3 of 4 associations between physical violence and sickness absence. Ten of 13 associations between psychological violence and poor mental health were statistically significant and 6 of 6 associations between psychological violence and sickness absence. The only study on gender-based violence and health reported a statistically non-significant association.

CONCLUSION

There is consistent evidence mainly in medium quality studies of prospective associations between psychological violence and poor mental health and sickness absence, and between physical violence and poor mental health in human service workers. More research using objective outcomes, improved exposure assessment and that focus on gender-based violence is needed.

Is combining human service work with family caregiving associated with additional odds of emotional exhaustion and sickness absence? A cross-sectional study based on a Swedish cohort

PURPOSE

The aim of the study is to examine to what extent human service work and family caregiving is associated with emotional exhaustion and sickness absence, and to what extent combining human service work and family caregiving is associated with additional odds.

METHODS

Data were derived from participants in paid work from the Swedish Longitudinal Occupational Survey of Health, year 2016 (n = 11 951). Logistic regression analyses were performed and odds ratios and 95% confidence intervals estimated for the association between human service work and family caregiving, respectively, as well as combinations of the two on one hand, and emotional exhaustion and self-reported sickness absence on the other hand. Interaction between human service work and family caregiving was assessed as departure from additivity with Rothman's synergy index.

RESULTS

Human service work was not associated with higher odds of emotional exhaustion, but with higher odds of sickness absence. Providing childcare was associated with higher odds of emotional exhaustion, but lower odds of sickness absence, and caring for a relative was associated with higher odds of both emotional exhaustion and sickness absence. There was no indication of an additive interaction between human service work and family caregiving in relation to neither emotional exhaustion nor sickness absence.

CONCLUSIONS

We did not find support for the common assumption that long hours providing service and care for others by combining human service work with family caregiving can explain the higher risk of sickness absence or emotional exhaustion among employees in human service occupations.

Occupational status and hospitalisation for mental disorders: findings from Friuli Venezia Giulia region, Italy, 2008-2017

Purpose: To investigate to which extent occupational status, and job titles, were associated with types of hospitalisations and psychiatric diagnoses among inpatients of Friuli Venezia Giulia Region, Italy.Methods: Cross-sectional study based on 10 years register data (2008-2017) on 2929 subjects hospitalised in General Hospital Psychiatric Units. Odds ratios (OR) of hospitalisations and psychiatric diagnoses for occupational status and job titles were calculated by logistic regression analysis.Results: Employed were at lower risk of urgent and involuntary hospitalisation. The risk of urgent hospitalisation was higher for affective, organic or other disorders, while all psychiatric diagnoses were at lower risk of involuntary hospitalisation than psychosis. Using white collars as reference category, army showed a higher risk for urgent hospitalisation (OR = 2.3) and affective disorders (OR = 1.9). A higher risk for affective disorders was found in managers (OR = 2.0). Blue collars were at higher risk for alcohol and substance abuse (OR = 1.7).Conclusions: Employment was protective for urgent and involuntary hospitalisations and severe diagnoses. Hospitalisation for affective disorders was more likely in managers, army, and for substances abuse in blue collars. More research is needed to assess the association between specific occupational groups and involuntary hospitalisation.KeypointsEmployment was shown to be a protective factor for both urgent and involuntary hospitalisations and diagnosis of severe mental disorder.Managers, police and military forces were at higher risk of being hospitalised for affective disorders, while blue collars were at higher risk of hospitalisation for alcohol and substances abuse.Future research would benefit from a better analysis on the association between more specific occupational groups and hospitalisation for psychiatric disorders, with a particular focus on involuntary treatment.Further research is needed to compare the risk of hospitalisation for mental disorders in temporary or permanent position, according to recent international changes in labour market and its impact on mental health.

Overall and work-related well-being of teachers in socially disadvantaged schools: a population-based study of French teachers

OBJECTIVES

As a human service profession, teaching presents specific risk factors that could be intensified in socially disadvantaged schools and, ultimately, impact the service quality. The aim of the present study was to evaluate the association between school socioeconomic status and teachers' well-being.

DESIGN

Population-based postal survey 'Teachers' Quality of Life' (MGEN Foundation for Public Health/French Ministry of Education; 2013). To categorise the school socioeconomic status, we used the 'Education Priority Area (EPA)' administrative classification, which is chiefly based on the proportion of underprivileged students and is available for primary and lower secondary state schools.

PARTICIPANTS

In-service French teachers randomly selected from among the teaching staff administrative list of the French Ministry of Education after stratification by sex, age and type of school.

OUTCOME MEASURES

Indicators of well-being at work included a question on job satisfaction, job difficulty evolution and the Maslach Burnout Inventory. The short version of the WHO Quality of Life questionnaire was used to evaluate overall well-being. Among primary and lower secondary school teachers, we evaluated cross-sectional associations between school EPA status and indicators of well-being, using logistic or linear regressions stratified by school level and adjusted for sociodemographic and work-related characteristics.

RESULTS

In the adjusted models, there was no significant difference in work-related well-being between teachers in EPA and non-EPA schools, both in primary school (n=154 vs n=788) and in lower secondary school (n=113 vs n=452). Regarding overall well-being, the only significant differences were seen among primary school teachers, with teachers in EPA schools reporting a worse perception of physical health and living environment than teachers in non-EPA schools.

CONCLUSION

Using a representative sample of French teachers, we did not observe substantial differences in work-related well-being between teachers in EPA and non-EPA schools.

Work-Related Psychological Distress and Its Management: The Perspective of Employees in the Financial Industry Compared With Those in Human Services

OBJECTIVE

Investigate psychological distress and its link to stress management interventions in the financial industry (FI) in comparison to the human services (HS) sector.

METHOD

Observational study across participating organizations in FI (66) and HS (81). Web-based version of depression anxiety stress scales (21 questions) and eight questions related to stress prevention interventions adopted by employers.

RESULTS

Indicated that FI workers are twice as likely as HS employees to present with stress and depression. Differences emerged on the availability of support at the workplace: FI workers reporting total lack of psychological support, although other forms of wellbeing promotion were more frequent. Close to 60% of individuals in the HS group reported no support (48% in the FI).

CONCLUSION

Workers in the FI industry have increased levels of workplace stress that could be possibly attributed to absence of prevention interventions at the workplace.

Antidepressant treatment among social workers, human service professionals, and non-human service professionals: A multi-cohort study in Finland, Sweden and Denmark

BACKGROUND

Social workers have an elevated risk for mental disorders, but little is known about their antidepressant treatment.

AIMS

To examine any and long-term antidepressant treatment among social workers in Finland, Sweden and Denmark.

METHODS

We linked records from drug prescription registers to three prospective cohorts: the Finnish Public Sector study, years 2006-2011, and nation-wide cohorts in Sweden and Denmark, years 2006-2014, including a total of 1.5 million employees in (1) social work, (2) other social and health care professions, (3) education and (4) office work. We used Cox proportional hazards models to estimate hazard ratios for any and long-term (>6 months) antidepressant treatment among social workers compared to the three reference occupational groups and carried out meta-analyses.

RESULTS

During follow-up, 25% of social workers had any prescriptions for antidepressants (19-24% reference occupations) and 20% for long-term treatment (14-19% reference occupations). The pooled effects for any and long-term treatment showed that probabilities were 10% higher in social workers compared to other health and social care professionals and 30% higher compared to education and non-human service professionals. Probabilities for any treatment in the three countries were relatively similar, but for long-term treatment social workers in Finland had a greater risk compared with other human service professions.

LIMITATIONS

There were differences between the cohorts in the availability of data. Specific diagnoses for the antidepressant treatment were not known neither adherence to treatment.

CONCLUSION

Social workers have a higher risk for any and long-term antidepressant treatment than other human and non-human service professionals.

The mental health impacts of health and human service work: Longitudinal evidence about differential exposure and susceptibility using 16 waves of cohort data

The health and human care workforce comprise a substantial and increasing proportion of the employed population in high income countries. This diverse workforce is comprised of high skilled workers, such as doctors and nurses, as well as lower skilled workers such as carers and support workers. This paper assessed psychosocial working conditions among health and human care workers compared to other workers. We also examined the effects of psychosocial working conditions on mental health. The data source was 16 waves of the Household Income Labour Dynamics in Australia survey. The exposure was a multidimensional, previously validated psychosocial job quality index. The outcome was changes in the Mental Health Inventory-5 (MHI-5). The effect modifier was a multicategory health and human care occupational variable. Random and fixed effects linear regression models were used to unpack between- versus within- person differences. Time varying confounders were controlled for. We found evidence of effect modification. Carers and support workers experienced a 4.90-point decline (95% CI −6.23 to 3.57) on the MHI-5 when reporting 3 or more job stressors compared to no stressors. These workers also reported lower levels of mental health than other occupational groups and had greater exposure to poor psychosocial working environments. Health workers also reported substantial declines on the MHI-5 when exposed to 3 or more job stressors (−3.50, 95% CI −5.05 to −1.94). Understanding the quality of employment in this workforce, and consequent impacts of this employment on mental health is critical to ensuring sustainable individual, organizational and client-related outcomes.

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The health and human service workforce is rapidly increasing in high-income countries.

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The diverse workforce includes both high-skilled and lower skilled workers.

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Lower skilled workers are differentially exposed to poor quality working conditions.

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All workers have a decline in mental health in response to poor quality work.

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This decline is particularly apparent in lower skilled workers.