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High prevalence of depression among working people with occupational disease : a population-based study Carmen Otero Sierra 1 , Juan Miguel Macho- Fernandez 2 , Pedro R . Mondelo 3 , Nearkasen Chau 4 , Lorhandicap group 4.

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  1. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 High prevalence of depression among working people with occupational disease:a population-based studyCarmen Otero Sierra1, Juan Miguel Macho-Fernandez2, PedroR. Mondelo3,NearkasenChau4, Lorhandicap group4 1 Servicio de Prevención Hermanas Hospitalarias, Departamento de Organización de Empresas, UniversitatPolitècnica de Catalunya, Barcelona, Spain; 2 Servicio Angioradiología, Hospital Clinic, Barcelona, Spain; 3(CERpIE) Research Centre for Corporate Excellence & Innovation, UPC (Technical University of Catalonia), Barcelona, Spain; 4 INSERM, U669, University Paris-Sud, University Paris Descartes, UMR-S0669, Paris, France. Lorhandicap group: N Chau, F Guillemin, JF Ravaud, J Sanchez, S Guillaume, JP Michaely, C Otero Sierra, B Legras, A Dazord, M Choquet, L Méjean, N Tubiana-Rufi, JP Meyer, Y Schléret, JM Mur

  2. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Background Occupationaldiseases (OD) are common: ‒ The ODsare common. Theirprevalence have increased and was 9-fold higher in 2008 than in 1984(Institut de recherche et documentation en économie de la santé, 2012) ‒ Prevalence of ODs with permanent disability strongly increase, 7-fold higher than in 2006(Institut de recherche et documentation en économie de la santé, 2012) ‒ Most ODs are musculoskeletal disorders (MSDs) (Otero Sierra et al., Arch Mal Prof, 2000; Roquelaureet al., Arthritis & Rheumatism, 2006) ‒ A small proportion of occupational diseases have been recognized by the general compensation system (Otero Sierra et al., Arch Mal Prof, 2000).

  3. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Background Mental disorders are common: ‒ 450 millions people worldwide (Hosman et al., WHO report 2004) ‒ 83 millions adults (18-65 yr, 27%) in European Union (Wittchen & Jacob, EurNeuropharmacol2005) ‒ Depressive symptoms affect 23% of men and 31% of women (12-75 yr) in France (Beck et al., Paris: INPES, 2007) ‒ Theyrepresent 10% of total health care expediture, with direct & indirect costshigherthan cancer and diabetes(FondationFondamental2011) ‒ They relate to unhealthy behaviours and disability, and may become the most frequent cause of disability worldwide by 2030 (Penninxet al., ArchgenPsychiatry 1999; Harvey et al., Neuroimage, 2005; Khlatet al., Scand J Public Health 2010 ; WHO 2010; Chau et al., J OccupEnvion Med 2011). ‒ MSDs are associated with depression and cognitive disability, more strongly among manual workers, service workers, and clerks (Khlat et al., Scand J Public Health, 2010).

  4. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Background Hypotheses: ‒ Recognized ODs are relatively rare and recognition is rather late. ‒ Whenrecognized, physical/mental comorbidity and disabilities may be established. ‒ The issues maybehigheramong people atworkbecause of job demands and alteredhealth. ‒ Those issues mayexplain the steadyincrease of mortality of workers with OD in the last decade (Institut de recherche et documentation en économie de la santé, 2012). ‒ Appropriatepreventionshouldbesooner. Health monitoring maybe made by occupationaland generalphysicians as workerswithODs are confident on them(Otero Sierra et al., Arch Mal Prof, 2000).

  5. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Objectives To explore, using population-based studies, the depression risk for workers with recognized OD compared with the general population from the same geographical area for: ‒ Working subjects, ‒ Inactive subjects. Indeed, we postulate that occupational demands continue to play a role in depression among people at work, and less in inactive people. We further explored whether people with OD suffer from comorbidity (chronic diseases) and disability that may increase the depression risk.

  6. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Methods • Study sample: 727 subjects from the general compensation system (17 million workers in France) with recognized OD for a two-year period in north-eastern France (Lorraine). Participation rate: 79% (mails lost for 14 subjects). 560 subjects filled in a questionnaire. • Reference group: Subjects aged 15+ years living in 8,000 randomly selected households (with telephone) in north-eastern France (Lorraine, 1/100 of the population). 6,234 subjects filled in a questionnaire (participation rate 44.3%). 4,766 subjects retained for analysis (having worked at the time of survey).

  7. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Methods Study protocol • Study sample: 3 sending of self-administered questionnaires mailed at 1-month interval (with a covering letter and a pre-paid envelope for the reply). • Reference group: An application to participate and 3sendings of self-administered questionnaires at 1-month intervals (with a covering letter and a pre-paid envelope for the reply). The investigation was approved by the national review board (CNIL). Written informed consent from respondents.

  8. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Methods Questionnaire • Study sample: It covered socioeconomic characteristics, job characteristics, health, physician-diagnosed-diseases including depression, and disabilities. 5occupational categories were considered: professionals/managers; craftsmen/tradesmen/farmers/heads of firm; intermediate professionals; service workers/clerks; and manual workers (Because of small number of subjects, the 3first groups were grouped). • Reference group: The questionnaire covered sex, birth date, educational level, marital status, job characteristics,working conditions, health status, physician-diagnosed-diseases including depression, and disabilities.

  9. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Statisticalanalysis First, we compared the characteristics of the study sample with OD and the reference group using the Chi2 test. Then, we computed the depression risk for the study sample compared with reference group, for working and inactive people separately, using: ‒ Crude odds ratio, ‒ Sex-age-adjusted odds ratio (ORsa), ‒ Sex-age-occupation-adjusted odds ratio (ORsao). The contribution of occupation (%) to the depression risk was defined by (ORsa – ORsao)/(ORsao – 1). Finally, the associations between depression and subjects’ characteristics (including diseases) among working people with OD were assessed using the ORsa. STATA software (Stata, College Station, TX, USA) was used.

  10. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Results Table 1. Characteristics of the study sample with occupational diseases and the reference group: % “─”: not available.

  11. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Results Table 1. Characteristics of the study sample with occupational diseases and the reference group: % - continued “─”: not available.

  12. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Results Table 2. Prevalence and risk of depression among the subjects with occupational diseases and for the reference group: %, odds ratios and 95% CI *p<0.05, **p<0.01. a The contribution (%) of occupation to the depression risk was (1.94-1.54)/(1.94-1)=43%.

  13. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Results Table 3. Associations between depression and subjects’ characteristics among working people with occupational diseases (N=490): Sex-age-adjusted odds ratio and 95% CI *p<0.05, **p<0.01. N: number of subjects.

  14. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Results Table 3. Associations between depression and subjects’ characteristics among working people with occupational diseases (N=490) - Continued *p<0.05, **p<0.01. N: number of subjects.

  15. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Results Table 4. Associations between depression and diseases among working people with occupational diseases (N=490): Sex-age-adjusted odds ratio and 95% CI *p<0.05, **p<0.01.

  16. 3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Conclusion • Recognized occupational diseases were strongly associated with depression among workers remaining at work. • Most of these workers experienced a number of chronic diseases, difficulties for occupational, domestic and leisure activities, which were strongly related to depression. • Women were more affected by depression than men. • Occupational diseases were too tardily appropriately treated. • Prevention should be taken early to limit occupational exposures, occurring of diseases, and evolution to disabilities. • Health monitoring of working individuals with OD is needed. They are generally confident in general and occupational physicians (Otero Sierra et al., Arch Mal Prof, 2000).

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