Job strain — Attributable depression in a sample of working Australians: Assessing the contribution to health inequalities
Date
2008-05-27
Authors
LaMontagne, Anthony D
Keegel, Tessa
Vallance, Deborah
Ostry, Aleck
Wolfe, Rory
Journal Title
Journal ISSN
Volume Title
Publisher
Biomed Central
Abstract
Background: The broad aim of this study was to assess the contribution of job strain to mental health
inequalities by (a) estimating the proportion of depression attributable to job strain (low control and high demand
jobs), (b) assessing variation in attributable risk by occupational skill level, and (c) comparing numbers of job
strain–attributable depression cases to numbers of compensated 'mental stress' claims.
Methods: Standard population attributable risk (PAR) methods were used to estimate the proportion of
depression attributable to job strain. An adjusted Odds Ratio (OR) of 1.82 for job strain in relation to depression
was obtained from a recently published meta-analysis and combined with exposure prevalence data from the
Australian state of Victoria. Job strain exposure prevalence was determined from a 2003 population-based
telephone survey of working Victorians (n = 1101, 66% response rate) using validated measures of job control (9
items, Cronbach's alpha = 0.80) and psychological demands (3 items, Cronbach's alpha = 0.66). Estimates of
absolute numbers of prevalent cases of depression and successful stress-related workers' compensation claims
were obtained from publicly available Australian government sources.
Results: Overall job strain-population attributable risk (PAR) for depression was 13.2% for males [95% CI 1.1,
28.1] and 17.2% [95% CI 1.5, 34.9] for females. There was a clear gradient of increasing PAR with decreasing
occupational skill level. Estimation of job strain–attributable cases (21,437) versus "mental stress" compensation
claims (696) suggest that claims statistics underestimate job strain–attributable depression by roughly 30-fold.
Conclusion: Job strain and associated depression risks represent a substantial, preventable, and inequitably
distributed public health problem. The social patterning of job strain-attributable depression parallels the social
patterning of mental illness, suggesting that job strain is an important contributor to mental health inequalities.
The numbers of compensated 'mental stress' claims compared to job strain-attributable depression cases suggest
that there is substantial under-recognition and under-compensation of job strain-attributable depression. Primary,
secondary, and tertiary intervention efforts should be substantially expanded, with intervention priorities based
on hazard and associated health outcome data as an essential complement to claims statistics.
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Citation
LaMontagne et al. Job strain — Attributable depression in a sample of working Australians. BMC Public Health 2008, 8 :181