Female workers more prone to psychological disorders

In 2006, the French Institute for Health Surveillance set up the Samotrace programme to assess the relations between mental health and work. The first findings show a high level of psychological distress among workers, mainly among women and in certain economic sectors, such as financial services and public administration. The study’s results also reveal high correlations with psychosocial factors at work, such as imbalance in terms of ‘effort-reward’ and over-commitment.

First epidemiological survey on mental health at work

The French Institute for Health Surveillance (Institut de Veille Sanitaire, InVS) launched the so-called Samotrace progamme in 2006, with the aim of setting up a national system for monitoring the relations between mental health and work on a long-term basis. The programme aims to estimate the prevalence of mental health disorders according to employment and its associated occupational exposures.

Survey methodology

The Samotrace programme is organised in three sections: a corporate section, a clinical section and an administrative data section (for more information on the programme, see the Annex on Survey methodologies in the EWCO report Rise in psychosocial risk factors at the workplace and FR0708019I). It has first been developed in two pilot geographic areas: France’s Centre region and surrounding areas, and the Rhône-Alpes region in southeast France.

Regarding the corporate section, the population sample was selected by random draw among workers, who were monitored by 110 occupational doctors in the Centre region and its surrounding areas. The 6,056 employees selected are representative of the population covered in terms of gender (57% of men), age (average age of 41 years), occupation and sectors of activity. Some 95% of the survey participants were employed on a permanent contract and 83% worked full time.

Assessing workers’ mental health and psychosocial work environment

The corporate section of the programme seeks to describe the relationship between mental health symptoms and the psychosocial environment at work. It therefore monitors workers’ health in companies in order to obtain mental health indicators according to occupation and sector of activity, as well as evaluations of exposure to risk factors by occupational doctors participating in a voluntary capacity.

Workers’ mental health was explored using the 28-item General Health Questionnaire (GHQ28) (34Kb MS Word), as well as the following indicators:

• use of psychotropic drugs;

• alcohol consumption (using the DETA (Diminuer Entourage Trop Alcool) questionnaire);

• use of tobacco;

• perceived health status.

The occupational psychosocial factors under scrutiny related to effort-reward imbalances and over-commitment in work, as well as to working in a way that goes against work ethics. More specifically, the workers were invited to describe psychosocial factors by assessing:

• the level of demand, control and support (based on Robert Karasek’s Job Content questionnaire);

• effort-reward imbalance (Johannes Siegrist’s Effort-Reward Imbalance model questionnaire);

• over-commitment;

• working in a way that harms professional integrity;

• violence and discrimination.

These data were completed with personal socio-demographic data, medical information such as work-related accidents, diseases and sleeping troubles, description of work tasks and employment.

Survey findings

The first results on the epidemiological monitoring in the workplace were published in early 2009. They cover France’s Centre region and surrounding areas; results from the second pilot area, the Rhône-Alpes region in southeast France, will complement these initial findings at a later stage.

More women prone to psychological distress

The psychological distress is assessed through the GHQ28. This questionnaire comprises four scales assessing the following psychosocial aspects: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. On the basis of the answers to the 28 questions, a score is calculated for each worker, ranging from 0 to 28. The score value of ‘4’ is usually chosen to define the psychological distress threshold.

The first results of the Samotrace programme reveal a higher prevalence of psychological distress among women – at 37.1% compared with 24.5% among men. More precisely, women recorded higher scores in relation to anxiety disorders than men – between 28% and 47% higher, depending on the occupation. Women also showed much higher levels for symptoms of depression – ranging from 53% to 75%, depending on the occupation, except for professionals and managers.

Men, on the other hand, show a much higher rate of alcohol overconsumption or dependence, (10.5% of men compared with 2.3% of women), while women use sleeping pills more regularly (5% of women compared with 2.2% of men).

The contrasted situation observed between men and women calls for further investigations and research to better understand the underlying psychosocial phenomena, and also the relation with psychosocial factors at work.

Work-related distress

A multivariate analysis on the first results of the Samotrace survey reveals a strong correlation between psychological distress and the psychosocial variables characterising the work environment. The relation is noticeably high for imbalance in terms of effort-reward at work: the prevalence of psychological distress is 71.8% for men who are exposed to effort-reward imbalance and 23.2% for those who are not; the respective figures for women are 81.2% and 35.5%. Other significant correlations between psychological distress and psychoscial factors at work include the following: over-commitment, working in a way that harms professional integrity, and exposure to threat or violence at work.

The survey findings also reveal noticeable differences in psychological distress according to the sector of activity: a significantly higher prevalence of distress is found in sectors such as financial services, public administration, and gas, electricity and water supply (see table below).

It is also the sectors of public administration, financial services, and community and personal services that show a higher proportion of men having problems with alcohol consumption. On the other hand, women working in public administration, financial services, and transport and communications are the most prone to use of psychotropic drugs.

Findings complement results of other study

These results are consistent with those of another monitoring programme conducted by InVS, focusing on declared occupational diseases (Maladies à caractère professionnel, MCP) that are currently not covered by occupational health insurance, and for which medical studies are underway seeking to prove a connection with employees’ working conditions. In this programme, a network of occupational doctors register twice a year, over a period of two weeks, all of the MCP that they declare along with the characteristics of all of the workers examined during this period. In 2007, some 6,220 workers of the 110,000 employees monitored presented an MCP, corresponding to a prevalence of 5.8% among the surveyed working population.

Psychological disorders were defined in line with the pathologies outlined in the chapter on mental and behavioural disorders of the International Classification of Diseases (ICD-10) of the World Health Organization (WHO), along with ‘mental disorders’ and ‘stress’ as defined in occupational health. The InVS monitoring programme indicated a prevalence of psychological disorders of 1.1% for men and 2.3% for women in France’s economically active population. A significantly higher prevalence of psychological disorders was recorded in certain sectors of the economy – that is, for 4.9% of women and 2.5% of men in financial services, and for 2.7% of women and 1.5% of men in public administration. In terms of occupational category, high-skilled, white-collar female workers are mostly affected (3.7%) by psychological disorders, while for men the prevalence of such disorders is higher for those with medium levels of qualification (1.8%).

Commentary

InVS underlines that these first results of the Samotrace programme need to be further complemented, confirmed and analysed to obtain a better understanding of the relation between psychosocial factors at work and psychosocial distress. Work-related psychosocial disorders are complex phenomena that are difficult to address properly with the existing investigation models. As for most ‘new’ occupational risks – such as carcinogens, mutagens and reprotoxic substances (CMRs), and work-related musculoskeletal disorders (MSD) – the underlying health or pathogenic dynamics do not respond to single factors or simple determinist processes. It thus appears increasingly complicated to determine thresholds for generally valid exposure values (see Lasfargue, 2008; Thébaud-Mony, 2008).

For this reason, the clinical section of the Samotrace programme should provide interesting findings complementing those of the corporate analysis. In the clinical part of this programme, occupational doctors collect clinical material on individual cases in order to develop a better understanding of the underlying phenomena that relate working conditions to psychological health. The clinical approach of the Samotrace programme relies in particular on workers’ own perception of their mental health, summarised in monographies by the participating occupational doctors. Most of the existing models consider workers’ perception of their mental health as a ‘black box’, since these models mainly describe statistical correlations between factors, as objectively as possible, and results in terms of psychosocial health.

References

Berson, C., Valenty, M., Homère, J., Le Naour, C., Mevel, M., Touranchet, A. and Imbernon, E., ‘Santé mentale dans le programme de surveillance des maladies à caractère professionnel’, Paper given at the 4th Scientific Meeting of the Health and Work Department (in French), 26 March 2009.

Cohindon, C. and Murcia, M., ‘Mal-être et travail, premier enseignements du programme Samotrace’, Paper given at the 4th Scientific Meeting of the Health and Work Department (in French), 26 March 2009.

Cohidon, C., Arnaudo, B., Murcia, M. et al, ‘Mal-être et environnement psychosocial au travail : premiers résultats du programme Samotrace, volet entreprise, France’, Bulletin Épidémiologique Hebdomadaire, InVs, No. 25–26, June 2009.

Lasfargues, G., ‘L’usure professionnelle entre pénibilité du travail et pénibilité au travail’, in Nicot, A. and Roux, C. (eds.), Pénibilité au travail, Lyon, ANACT, June 2008.

Thébaud-Mony, A., ‘Les cancers professionnels : à la croisée d’enjeux scientifiques, économiques, politiques et sociaux’, in Nicot, A. and Roux, C. (eds.), Pénibilité au travail, Lyon, ANACT, June 2008.

For more details on the GHQ28 and the French version of the Effort-Reward Imbalance model used in this programme, refer to:

Goldberg, D.P. and Hillier, V.F., ‘A scaled version of the General Health Questionnaire’, Psychological Medicine, Vol. 9, No. 1, 1979, pp. 139–145.

Niedhammer, I., Siegrist, J., Landre, M.F., Goldberg, M. and Leclerc, A., ‘Psychometric properties of the French version of the Effort-Reward Imbalance model’, Revue d’Épidemiologie et de Santé Publique, Vol. 48, No. 5, pp. 419–437.

Anne-Marie Nicot, National Agency for the Improvement of Working Conditions (Agence nationale pour l'amélioration des conditions du travail, ANACT)