Psychosocial Work Stress and Mental Health: Results from ELSA-Brasil Study

INTRODUCTION: Increasing importance has been given to the psychosocial environment at work in the occupational health literature. It might cause behavioral changes, physical and mental health damages, resulting in absenteeism and representing an obstacle to returning to work. In Brazil, mental disorders are among the top three groups of diseases associated with disability pensions and sickness benefits. The aim is to investigate the association between psychosocial stress at work and Common Mental Disorders (CMD).

METHODS: A cross-sectional analysis with baseline data from ELSA-Brazil.  Active civil servants from 6 research centers (n=11570 comprised the sample). They answered a questionnaire about mental health (Clinical Interview Schedule- Revised) and psychosocial factors at work  (Job Stress Scale). Statistical analysis was performed using Poisson regression model adjusted for potential confounders (demographic and work-related characteristics, lifestyle habits, stressful life events and self-rated general health). Results were stratified by educational level and the Karasek model (low strain, high strain, active job and passive job).

RESULTS: Servants with high strain (high demand and low control) at work had higher prevalence of CMD (41,8%), followed by those who performed active job (high demands and high control)(31,6%) and passive jobs (low demands and low control)(28,2%). After adjustments, prevalence ratios (PR) of the association between psychosocial stress at work and CMD were:  PR=1.95 (1.72-2.21) for servants with high strain and college degree;  PR=1.27 (1.11-1.46) for those with high school degree, and  PR=1.23 (0.91-1.66) among those with elementary school education. Servants with college degree and who performed active and passive jobs reported a higher prevalence of CMD [PR=1.70 (1.50-1.92) and PR=1.22 (1.07- 1.39), respectively].

CONCLUSIONS: The present study corroborates previous findings regarding the relevant association between mental health and work-related stress. These results may be even underestimated since the servants enrolled in this study work in public institutions that provide job security. The cross sectional design does not allow a causal effect analysis. The present findings may foster the development of prevention of illness work programs in the research participating institutions.