2006, Number 5
Salud Mental 2006; 29 (5)
Depression among health workers: the role of social characteristics, work stress, and chronic diseases
Mudgal J, Guimaraes BGL, Díaz-Montiel JC, Flores Y, Salmerón J
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A substantial number of Mexican adults (9-13%) experience psychological distress and a significant minority suffers from severe mental impairment. Most people suffering from depression do not seek treatment, even though they can be helped and treated. In some families, depression may occur across generations, but it may also affect those without any family history. Low self-esteem, stressful life changes and chronic stress may provoke a depressive episode. In recent years, it has been demonstrated that medical conditions, such as cardio-vascular diseases, cancer, Parkinson’s disease and hormonal disorders, may lead to depression, making a sick individual apathetic, incapable of taking care of his/her physical needs. In turn, such apathy increases the recovery period. Most probably, a combination of genetic, psychological, and social factors work together in the development of a depressive disorder. However, very little is known about the principal causes of depression in Mexico. It is possible that, due to cultural and social differences, these factors and their impact are distributed differently on the Mexican population as compared to those from the US population.
The first objective from this study is to estimate the frequency and distribution of depression by social characteristics on a population of health workers in Mexico. The second objective is to study the effect of stress and chronic diseases on depression.
To study the effects of stress and chronic diseases on depression we used a cross-sectional data obtained from a total of 4048 workers. These workers participated in the “IMSS Health Worker Cohort Study in Morelos” through the years 1998 to 2000. Their age varied from 18 to 89 years. A self-reported questionnaire was administered to obtain information on life-style factors, social characteristics, work stress, and chronic diseases. Data were analyzed using politomic regressions to study the effects of social characteristics on moderate and high levels of depressive symptomatology and on risk factors, such as work stress and chronic diseases. The analysis is stratified by gender as it is expected that effects of such characteristics vary by gender.
Our results show that the workers’ socioeconomic characteristics are significantly associated with their depression level. Being female, being separated from the spouse, having lower education, and working in non-professional jobs with lower income is significantly and positively associated with depression. Similarly, having a less satisfying job and having more than one chronic disease is significantly and positively associated with depression. Workers from a lower socioeconomic status report higher levels of stress and suffer more chronic diseases compared to those from higher socioeconomic levels. Hence, some of the effects of social characteristics seem to be mediated by stress and chronic diseases.
Our results are consistent with previous research demonstrating systematic variations among groups of people who are at a higher risk for depression. In our study, we find that depression is higher among selected groups, such as women, young and old workers, those without a partner, and those with lower economic resources. We also find that stress and chronic diseases are among the reasons for which groups, which are socially and economically vulnerable, tend to become depressed. To be effective in the long run, any intervention directed to these groups of people must take into account associations highlighted in this paper.
ANDERSON RJ, LUSTMAN PJ, CLOUSE RE et al: Prevalence of depression in adults with diabetes: a systematic review. Diabetes, 49(suppl. 1):A64, 2000.
ANESHENSEL CS: Marital and employment role-strain, social support, and depression among adult women. In: Hobfoll SE (eds). Stress, Social Support, and Women. Hemisphere, New York, 1986.
ANESHENSEL CS, RUTTER CM, LACHENBRUCH PA: Social structure, stress, and mental health: Competing conceptual and analytic models. American Sociological Review, 56(12):166-178, 1991.
ANESHENSEL CS, PEARLIN LI: Structural contexts of sex differences in distress. In: Barnett RC, Biener L and Baruch GK (eds.). Gender and Stress. The Free Press, New York, 1987.
ANESHENSEL CS: Theory Based Data Analysis for Social Sciences. Sage Publications, Thousand Oaks, 2002.
AVISON WR: Roles and resources: The effects of family structure and the employment on women’s psychosocial resources and psychological distress. Research Community Mental Health, 8:233-156, 1995.
BARUCH GK, BIENER L, BARNETT RC: Women and gender in research on work and family stress. American Psychologist, 42(2):130-136, 1987.
BENJET C, WAGNER FA, BORGES GG, MEDINAMORA ME: The relationship of tobacco smoking with depressive symptomatology in the third Mexican National Addictions Survey. Psychological Medicine, 34:881-888, 2004.
ROSS CE, BIRD CE: Sex stratification and health lifestyle: consequences for men’s and women’s perceived health. J Health Social Behavior, 35(2):161-78, 1994.
CIECHANOWSKI PS, KATON WJ, RUSSO JE: Depression and Diabetes: Impact of depressive symptoms on adherence, function, and costs. Archives Internal Medicine, 160(21):3278-85, 2000.
FRASURE-SMITH N, LESPERANCE F, TALAJIC M: Depression and 18-month prognosis after myocardial infarction. Circulation, 91(4):999-1005, 1995.
FRERICHS RR, ANESHENSEL CS, CLARK VA: Prevalence of depression in Los Angeles County. American J Epidemiology, 113(6):691-699, 1981.
GARRISON CZ, SCHLUCHTER MD, SCHOENBACH VJ, KAPLAN BK: Epidemiology of depressive symptoms in young adolescents. J American Academy Child Adolescent Psychiatry, 28:343-351, 1989.
GORE S, MANGIONE TW: Social roles, sex roles and psychological distress: Additive and interactive models of sex differences. J Health Social Behavior, 24(4):300-312, 1983.
HIBBARD JH, POPE CR: Employment status, employment characteristics, and women’s health. Women Health, 10(1):59-77, 1985.
MARIÑO MC, MEDINA-MORA ME, CHAPARRO JJ, GONZALEZ-FORTEZA C: Confiabilidad y estructura factorial de CES-D en una muestra de adolescentes mexicanos. Revista Mexicana Psicología, 10(2):141-145, 1993.
MCLEOD JD, SHANAHAN MJ: Trajectories of poverty and children’s mental health. J Health Social Behaviour, 37:207-220, 1996.
MEDINA-MORA ME, RASCON ML, TAPIA R, MARIÑO MC, JUAREZ F et al.: Trastornos emocionales en población urbana mexicana: Resultados de un estudio nacional. Anales. Instituto Mexicano de Psiquiatría, 48-55, México, 1992.
MEDINA-MORA ME, BORGES G, MUÑOZ CL, BENJET C, JAIMES JB et al.: Prevalecía de trastornos mentales y uso de servicios: Resultados de la Encuesta Nacional de Epidemiología Psiquiátrica en México. Salud Mental, 26(4):1-20, 2003.
MONDRAGON L, BORGES G, GUTIERREZ R: La medición de la conducta suicida en México. Estimación y procedimientos. Salud Mental, 24:4-15, 2001.
MURRAY C, LOPEZ A: Alternative projections of mortality and disability by cause, 1990-2020: Global burden of disease study. Lancet, 349:1498-1504, 1997.
NEMEROFF CB, MUSSELMAN DL, EVANS DL: Depression and cardiac disease. Depression Anxiety, 8(suppl. 1):71-9, 1998.
OFFORD DR, BOYLE MH, SZATMARI P, RAE-GRANT NI, LINKS PS et al.: Ontario Child Health Study- II Six months prevalence of disorder and rates of service utilization. Archives General Psychiatry, 44(9):832-836, 1987.
PEARLIN LI: The Sociological Study of Stress. J Health Social Behavior, 30(3):241-256, 1989.
RADLOFF LS, LOCKE BZ: The community mental health assessment survey and the CES-D scale. In: Weissman MM, Myers JK, Ross CE (eds). Community Surveys of Psychiatric Disorders. Rutgers University Press, 177-189, New Brunswick, 1985.
RADLOFF SL: Center for Epidemiological Studies National Institute of Mental Health. Applied Psychological Measurement, 1(3):385-401, 1977.
ROBERTS RE, O’KEEFE SJ: Sex differences in depression re-examined. J Health Social Behaviour, 22(4):394-400, 1981.
ROBINS LN, HELZER JE, CROUGHAN J et al.: National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity. Archives General Psychiatry, 38:381-389, 1981.
ROSNER B: Fundamentals of Biostatistics. 4th. Edition. Wadsworth Publishing Company, 406-412, Belmont, 1995.
ROSS CE, MIROWSKY J: Households, employment, and the sense of control. Social Psychology Quarterly, 55(3):217-235, 1992.
SALGADO DE SNYDER VN, MALDONADO M: Características psicometrías de la escala de Depresión del Centro del Estudios Epidemiológicos en Mujeres Mexicanas Adultas de Areas Rurales. Salud Publica México, 36:200-209, 1994.
SALMERON CJ, ARILLO-SANTILLAN E, CAMPUZANO-RINCON JC, LOPEZ- ANTUNANO FJ, LAZCANOPONCE EC: Tabaquismo en profesionales de la salud del Instituto Mexicano del Seguro Social, Morelos. Salud Publica México, 44(Suppl. 1):S67-75, 2002.
TURNER RJ, WHEATON B, LLOYD DA: The epidemiology of social stress. American Sociological Review, 60:104-125, 1995.
USTUN TB, AYUSO-MATEOS JL, CHATTERJI S, MATHERS C, MURRAY CJL: Global burden of depressive disorders in the year 2000. British J Psychiatry, 184:386-392, 2004.
ZIEGELSTEIN RC, FAUERBACH JA, STEVENS SS et al.: Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infraction. Archives Internal Medicine, 160(12):1818-23, 2000.