Duchaine Caroline S, Ndjaboué Ruth, Levesque Manon, Vézina Michel, Trudel Xavier, Gilbert-Ouimet Mahée, Dionne Clermont E, Mâsse Benoît, Pearce Neil, Brisson Chantal
CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8, QC, Canada.
Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6, QC, Canada.
BMC Public Health. 2017 Jan 18;17(1):91. doi: 10.1186/s12889-017-4014-4.
Mental health problems (MHP) are the leading cause of disability worldwide. The inverse association between socioeconomic position (SEP) and MHP has been well documented. There is prospective evidence that factors from the work environment, including adverse psychosocial work factors, could contribute to the development of MHP including psychological distress. However, the contribution of psychosocial work factors to social inequalities in MHP remains unclear. This study evaluates the contribution of psychosocial work factors from two highly supported models, the Demand-Control-Support (DCS) and the Effort-Reward Imbalance (ERI) models to SEP inequalities of psychological distress in men and women from a population-based sample of Quebec workers.
Data were collected during a survey on working conditions, health and safety at work. SEP was evaluated using education, occupation and household income. Psychosocial work factors and psychological distress were assessed using validated instruments. Mean differences (MD) in the score of psychological distress were estimated separately for men and women.
Low education level and low household income were associated with psychological distress among men (MD, 0.56 (95% CI 0.06; 1.05) and 1.26 (95% CI 0.79; 1.73) respectively). In men, the contribution of psychosocial work factors from the DCS and the ERI models to the association between household income and psychological distress ranged from 9% to 24%. No clear inequalities were observed among women.
These results suggest that psychosocial work factors from the DCS and the ERI models contribute to explain a part of social inequalities in psychological distress among men. Psychosocial factors at work are frequent and modifiable. The present study supports the relevance of targeting these factors for the primary prevention of MHP and for health policies aiming to reduce social inequalities in mental health.
心理健康问题（MHP）是全球致残的主要原因。社会经济地位（SEP）与MHP之间的负相关关系已有充分记录。有前瞻性证据表明，工作环境中的因素，包括不良的心理社会工作因素，可能导致MHP的发生，包括心理困扰。然而，心理社会工作因素对MHP社会不平等的贡献仍不清楚。本研究从魁北克工人的人群样本中，评估了两种备受支持的模型——需求-控制-支持（DCS）模型和努力-回报失衡（ERI）模型中的心理社会工作因素对男性和女性心理困扰SEP不平等的贡献。
在一项关于工作条件、工作健康与安全的调查中收集数据。使用教育程度、职业和家庭收入评估SEP。使用经过验证的工具评估心理社会工作因素和心理困扰。分别估计男性和女性心理困扰得分的平均差异（MD）。
低教育水平和低家庭收入与男性的心理困扰相关（MD分别为0.56（95%CI 0.06；1.05）和1.26（95%CI 0.79；1.73））。在男性中，DCS模型和ERI模型中的心理社会工作因素对家庭收入与心理困扰之间关联的贡献范围为9%至24%。在女性中未观察到明显的不平等。
这些结果表明，DCS模型和ERI模型中的心理社会工作因素有助于解释男性心理困扰中社会不平等的一部分。工作中的心理社会因素很常见且可改变。本研究支持针对这些因素进行MHP一级预防以及旨在减少心理健康社会不平等的健康政策的相关性。
