Combined effects of gender, race, and occupational stressors on mental health

Sousa, Camila Carvalho de; Araújo, Tânia Maria de

doi:10.1590/2317-6369/15222en2024v49edepi12

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Revista Brasileira de Saúde Ocupacional

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Sumário

Research Article/Dossier Epidemiology, Health and Work • Rev. bras. saúde ocup. 49 • 2024 • https://doi.org/10.1590/2317-6369/15222en2024v49edepi12 copy

Combined effects of gender, race, and occupational stressors on mental health

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

analyze the isolated and combined effects of gender, race, and occupational stressors on the mental health of healthcare workers.

Methods:

cross-sectional study with a random sample of health workers in Bahia, Brazil. The primary exposure variables were gender, race, and occupational stressors, assessed using the Effort-Reward Imbalance (ERI) scale. The Self-Reporting Questionnaire (SRQ-20) measured common mental disorders (CMD), the outcome variable. The interaction measures were verified based on the additivity criterion by calculating the excess prevalence, excess prevalence ratio, and relative difference.

Results:

3,343 workers participated, 77.9% were female. CMD prevalence was 21.7% higher among women, Black people, and those exposed to work stressors. Among Black women in a situation of ERI, the prevalence of CMD was three times higher compared with white men in a situation of balance (reference group).

Discussion:

black women workers accumulate social disadvantages and are more susceptible to occupations that require more significant effort and less reward. CMD prevalence was higher at the intersection of exposures. Combined effect of the factors exceeded the sum of the isolated effects, demonstrating an interaction between gender, race, and occupational stressors.

Keywords:
gender; race; occupational stress; mental health; intersectionality; occupational health

*Characteristic*	n	%
Sex
Male	737	22.1
Female	2,597	77.9
Race/color
White	539	16.4
Black/brown	2,655	80.9
Asian	44	1.3
Indigenous	44	1.3
Age
Up to 40 years	1,925	58.0
Over 40 years	1,393	42.0
Education
With higher education	940	28.6
No higher education	2,352	71.4
Marital Status
With partner	1,413	42.5
Without a partner	1,915	57.5
Has children
Yes	2,311	69.6
No	1,011	30.4
Income
Up to 2 MW**	1,864	67.7
More than 2 MW.	905	32.7
Occupation
Physician	156	4.7
Nurse	227	6.8
Others with higher education	257	7.7
Nursing technicians	434	13.0
CHA/CEA***	1,035	31.1
Other for indirect assistance	1,223	36.7
Status
Effective	2,166	65.4
Temporary	1,144	34.6
Weekly Journey
Up to 40 hours	2,524	77.2
More than 40 hours	746	22.8
Satisfaction with work
Yes	2,497	74.9
No	835	25.1
Domestic Overload
Low	1,777	55.5
High	1,423	44.5
Occupational stress (Effort-reward balance)
Balance	1,981	61.4
Imbalance	1,245	38.6
Common mental disorder
No	2,537	78.3
Yes	702	21.7

*Characteristic*	*White Man*		*Black Man*		*White Woman*		*Black Woman*		p-value**
*Characteristic*	(n=146)*	%	(n=577)*	%	(n=392)*	%	(n=2,163)*	%	p-value**
Education
With higher education	90	63.4	138	24.2	192	49.9	503	23.5	< 0.001
No higher education	52	36.6	433	75.8	193	50.1	1,633	76.5	< 0.001
Age
Up to 40 years	82	56.2	343	59.7	223	57.5	1,241	57.7	< 0.812
Over 40 years	64	43.8	232	40.3	165	42.5	909	42.3	< 0.812
Marital Status
With partner	60	41.4	231	40.2	163	41.8	928	43.0	< 0.667
Without a partner	85	58.6	344	59.8	227	58.2	1,231	57.0	< 0.667
Children
No	64	43.8	186	32.3	133	34.0	609	28.3	< 0.001
Yes	82	56.2	389	67.7	258	66.0	1,542	71.7	< 0.001
Income
Up to 2 MW ***	47	37.7	303	62.1	174	53.4	1,312	73.6	< 0.001
More than 2 MW.	79	62.3	185	37.9	152	46.6	470	26.4	< 0.001
Occupation
Physician	34	23.6	47	8.2	42	10.8	31	1.4	< 0.001
Nurse	13	9.0	14	2.4	57	14.6	140	6.5
Others with higher education	26	18.1	38	6.6	59	15.1	125	5.9
Nursing technicians	4	2.8	22	3.8	58	14.9	346	16.0
CHA/CEA****	15	10.4	135	23.5	85	21.8	785	36.3
Other for indirect assistance	52	36.1	575	55.5	89	22.8	733	33.9
Weekly Journey
Up to 40 hours	85	58.6	404	70.9	292	76.0	1,688	80.5	< 0.001
More than 40 hours	60	41.4	166	29.1	92	24.0	412	19.5	< 0.001
Employment status
Effective	63	44.4	364	63.6	211	54.4	1,494	69.6	< 0.001
Temporary	79	55.6	208	36.4	177	45.6	653	30.4	< 0.001
Satisfaction with work
Satisfied	108	74.0	424	73.5	302	77.6	1,618	74.9	< 0.526
Dissatisfied	38	26.0	153	26.5	87	22.4	542	25.1	< 0.526
Domestic Overload
Low	123	87.9	421	79.7	247	65.0	906	45.1	< 0.001
High	17	12.1	107	20.3	133	35.0	1,104	54.9	< 0.001

*Exposure*	*CMD*		*Crude analysis*		Adjusted analysis**
*Exposure*	n	*P(%)*	PR	*95% CI*	PR**	95% CI**
Gender
Men	129	18.0	-	-	-
Women	575	22.8	1.26	1.06 ;1.50	1.11	0.90 ; 1.36
Race
White	92	17.7	-	-
Black/Brown	579	22.4	1.26	1.03 ; 1.54	1.13	0.89 ; 1.43
Asian	10	22.7	1.28	0.72 ; 2.28	1.51	0.84 ; 2.73
Indigenous	8	19.5	1.10	0.57 ; 2.11	1.35	0.70 ; 2.60
ERI
Balance	302	15.7	-	-
Imbalance	391	32.0	2.04	1.79 ; 2.33	1.89	1.61 ; 2.22

*Exposure*	*CMD*
	*Crude analysis*			Adjusted analysis**
	*P(%)*	PR	*95% CI*	PR**	95% CI**
Reference
Gender= 0, Race= 0, ERI= 0 (White men in E-R balance situation)	10.1	1.00	-	-	-
Intersectional categories
Gender= 1, Race= 0, ERI= 0 (White women in E-R balance situation)	11.7	1.15	0.56 ; 2.36	0.93	0.43 ; 2.02
Gender= 0, Race= 1, ERI= 0 (Black men in E-R balance situation)	13.5	1.33	0.67 ; 2.61	1.14	0.55 ; 2.34
Gender= 0, Race= 0, ERI= 1 (White men in E-R imbalance situation)	23.3	2.30	1.01 ; 5.24	1.65	0.62 ; 4.37
Combined intersectional categories
Gender= 1, Race= 1, ERI= 0 (Black women in E-R balance situation)	17.5	1.73	0.92 ; 3.26	1.26	0.64 ; 2.49
Gender= 0, Race= 1, ERI= 1 (Black men in E-R imbalance situation)	29.3	2.90	1.49 ; 5.59	2.16	1.05 ; 4.44
Gender= 1, Race= 0, ERI= 1 (White women in E-R imbalance situation)	32.4	3.20	1.65 ; 6.21	2.26	1.12 ; 4.69
Gender= 1, Race= 1, ERI= 1 (Black women in E-R imbalance situation)	33.1	3.27	1.74 ; 6.12	2.28	1.14 ; 4.45

*Exposure*	*P(%)*	*Excess prevalence* ^a	*Excess Prevalence Ratio (EPR = PR -1)*		*Relative Difference* ^d *((A/B) - 1) (%)*
*Exposure*	*P(%)*	*Excess prevalence* ^a	*Observed (EPRO) (A)* ^b	*Expected based on separate exposures (B)* ^c	*Relative Difference* ^d *((A/B) - 1) (%)*
Reference
Gender= 0, Race= 0, ERI= 0 (White men in E-R balance situation)	10.1	-	-	-	-
Intersectional categories
Gender= 1, Race= 0, ERI= 0 (White women in E-R balance situation)	11.7	1.6	0.15	-
Gender= 0, Race= 1, ERI= 0 (Black men in E-R balance situation)	13.5	3.4	0.33	-
Gender= 0, Race= 0, ERI= 1 (White men in E-R imbalance situation)	23.3	13.2	1.30	-
Combined intersectional categories
Gender= 1, Race= 1, ERI= 0 (Black women in E-R balance situation)	17.5	7.4	0.73	0.48	52
Gender= 0, Race= 1, ERI= 1 (Black men in E-R imbalance situation)	29.3	19.2	1.90	1.63	16
Gender= 1, Race= 0, ERI= 1 (White women in E-R imbalance situation)	32.4	22.3	2.20	1.45	51
Gender= 1, Race= 1, ERI= 1 (Black women in E-R imbalance situation)	33.1	23.0	2.27	1.78	27

Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho - FUNDACENTRO Rua Capote Valente, 710 , 05409 002 São Paulo/SP Brasil, Tel: (55 11) 3066-6076 - São Paulo - SP - Brazil
E-mail: rbso@fundacentro.gov.br

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[1] Contact: Camila Carvalho de Sousa E-mail: sousa.camila@ebserh.gov.br