Niedhammer Isabelle, Lesuffleur Thomas, Coutrot Thomas, Chastang Jean-François
Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, INSERM, UMR_S 1136, 75013, Paris, France.
Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 75013, Paris, France.
Int Arch Occup Environ Health. 2016 Aug;89(6):1025-37. doi: 10.1007/s00420-016-1142-6. Epub 2016 May 19.
Social inequalities in mental health have been observed, but explanations are still lacking. The objectives were to evaluate the contribution of a large set of psychosocial work factors and other occupational exposures to social inequalities in mental health in a national representative sample of employees.
The sample from the cross-sectional national French survey SUMER 2010 included 46,962 employees: 26,883 men and 20,079 women. Anxiety and depression symptoms were measured using the Hospital Anxiety and Depression scale. Occupation was used as a marker of social position. Psychosocial work factors included various variables related to the classical job strain model, psychological demands, decision latitude, social support, and other understudied variables related to reward, job insecurity, job promotion, esteem, working time/hours, and workplace violence. Other occupational exposures of chemical, biological, physical, and biomechanical nature were also studied. Weighted age-adjusted linear regression analyses were performed.
Occupational gradients were found in the exposure to most psychosocial work factors and other occupational exposures. Occupational inequalities were observed for depressive symptoms, but not for anxiety symptoms. The factors related to decision latitude (and its sub-dimensions, skill discretion, and decision authority), social support, and reward (and its sub-dimensions, job promotion, job insecurity, and esteem) contributed to explain occupational inequalities in depressive symptoms. Decision latitude played a major role in the explanation. Workplace violence variables contributed among men only. Other exposures of physical and biomechanical nature also displayed significant contributions.
Comprehensive prevention policies at the workplace may help to reduce social inequalities in mental health in the working population.
心理健康方面的社会不平等现象已被观察到，但仍缺乏相关解释。本研究旨在评估一系列心理社会工作因素及其他职业暴露因素对全国具有代表性的员工样本中心理健康社会不平等现象的影响。
2010年法国全国性横断面调查SUMER的样本涵盖46,962名员工，其中男性26,883名，女性20,079名。使用医院焦虑抑郁量表测量焦虑和抑郁症状。职业被用作社会地位的标志。心理社会工作因素包括与经典工作压力模型相关的各种变量、心理需求、决策自由度、社会支持，以及其他与奖励、工作不安全感、工作晋升、自尊、工作时间/时长和工作场所暴力等研究较少的变量。还研究了化学、生物、物理和生物力学性质的其他职业暴露因素。进行了加权年龄调整线性回归分析。
在大多数心理社会工作因素和其他职业暴露因素的暴露情况中发现了职业梯度。观察到抑郁症状存在职业不平等，但焦虑症状不存在。与决策自由度（及其子维度，技能裁量权和决策权）、社会支持和奖励（及其子维度，工作晋升、工作不安全感和自尊）相关的因素有助于解释抑郁症状的职业不平等。决策自由度在解释中起主要作用。工作场所暴力变量仅在男性中起作用。物理和生物力学性质的其他暴露因素也显示出显著影响。
工作场所的综合预防政策可能有助于减少劳动人口心理健康方面的社会不平等。
