Stressful work in primary health care and mental health: The role of gender inequities in Brazil.

ABSTRACT

BACKGROUND: This study aims to analyze the association between occupational stressors, evaluated by the Effort-Reward Imbalance Model (ERI), and the occurrence of common mental disorders (CMD) among healthcare workers (HCW), additionally considering mediation by over-commitment from work (OW) and mediation of gender effects by work stressors. METHODS: Cross-sectional study, including a random sample of 3343 HCWs, from six municipalities of Bahia, Brazil. The ERI scale measured the occupational stressors (main exposure), and the Self-Reporting Questionnaire (SRQ-20) was used to screen for CMD. Data analysis used Structural Equation Modeling techniques to understand the relationships between gender, occupational stressors, and the occurrence of CMD. RESULTS: ERI and OW were associated with CMD. OW mediated the negative effect of ERI on the mental health of HCW. Female workers had higher levels of ERI, OW, and CMD prevalence; the total gender effect on CMD prevalence was mediated by ERI and OW. CONCLUSIONS: The findings highlight the association of work psychosocial stressors and CMD among HCW, including partial mediation by OW. Gender inequalities persisted among HCW, with women most exposed to occupational stressors and CMD. ERI and OW partially mediated the effect of gender on CMD.