Influencia de la situación laboral y otros factores socioeconómicos sobre la salud mental de la población española

  1. Jorge Arias de la Torre
Supervised by:
  1. Antonio José Molina de la Torre Director
  2. Vicente Martín Sánchez Director

Defence university: Universidad de León

Fecha de defensa: 01 April 2019

  1. Aurora Bueno Cavanillas Chair
  2. Tania Fernández Villa Secretary
  3. Jordi Alonso Committee member

Type: Thesis


Background and aims Mental and behavioural disorders are a public health problem worldwide. Both the prevalence and the factors related to these disorders may vary depending on time and the specific geographical region. Due to this variability, a periodic and population-specific assessment of the prevalence could be appropriate. In addition, the prevalence of mental diseases could vary depending on the specific disease in which we put the focus on. With respect to the specific factors related to the prevalence, the importance of gender, employment status and socio-economic factors was previously pointed out from the social epidemiology. From this perspective and focusing on socio-economic factors, it could be highlighted the lack of knowledge about the relationship of family and household factors with the prevalence of mental health problems. Additionally, the prevalence could vary according to the specific disease considered, and one of the most frequent mental diseases is the Major Depressive Disorder (MDD). In this framework, the aims of this thesis are: to determine the general prevalence of mental health problems and MDD in the general population of Spain and to assess the influence on the prevalence of the employment status and other socio-economic factors. Methods To develop the proposed aims 3 cross-sectional studies were undertaken: one based on the Spanish National Health Survey of 2011/2012 (ENSE 2011/2012) (N=21,007) taking into account the whole population, one based on the same survey but taking into account only the working population, and a third one based on data from the European Health Interview Survey of 2015/2016 (EHIS 2015/2016) (N=22,842). In the studies based on ENSE 2011/2012, prevalence of mental health problems was assessed in general with the General Health Questionnaire (GHQ-12). In the study based on EESE 2015/2016, the presence of MDD was considered as dependent variable and was evaluated with Patient Health Questionnaire (PHQ-8). The employment status and other socio-economic factors (as gender, educational level or social class) were took as main independent variables. Prevalence of mental health problems and MDD were calculated and bivariable and multivariable logistic regression models were done. From these models, to assess the relationship between the dependent and independent variables, crude Odds Ratio (OR) and adjusted Odds Ratio (aOR) and their respective 95% Confidence Intervals (95% CI) were obtained. Results The results from the first of the studies show that the prevalence of mental health problems in Spain is between 15% and 25% depending on gender and social class. The highest prevalence in relation to the employment status was observed, independently of the gender and occupational social class, among unemployed people (men: most favored social classes 23.3% and less favored 26.1%; women: most favored social classes: 27.7% and less favored 32.7%). Among men that belong to most disadvantaged social classes, the main breadwinner role was associated with mental health problems (aOR=1.23; 95% CI: 1.04-1.45). Among women that belong to most favored social classes, to be widowed, separated or divorced (aOR=2.00; 95% CI: 1.22-3.29) and to do the domestic work alone (aOR=1.90; 95% CI: 1.23-2.95) was related to higher prevalence of mental health problems. Regarding the prevalence found when only was considered the working population (second study), it was higher among women (19.9%) than among men (13.9%) and the overall prevalence found was 16.8%. In both gender work stress and work satisfaction were related to the prevalence of mental health problems. Only among men the type of contract was related to the prevalence of mental problems (self-employment: aOR: 2.24 95% CI: 1.75-2.87; and temporary work or without contract: aOR: 1.46 95% CI: 1.07-1.99). Besides, only among women the age (aOR: 1.00 95% CI: 1.01-1.02) and to belong to the less favored social class (aOR: 1.45 95% CI:1.01-2.06) was related to the prevalence. Finally, taking into account the MDD prevalence found in the third study, this was of 8.0% (95% CI: 7.3-8.6) among women and of 4.1% (95% CI: 7.3-8.6) among men. In both genders, the prevalence of MDD was higher among unemployed people (women: aOR: 2.59, 95% CI: 1.92-3.51; and men aOR: 3.32, 95% CI: 2.35-4.69) and in those people that belong the most disadvantaged social classes. In both genders, a statistically significant (p<0.001) gradient of increase of the prevalence of MDD was found when the social class was lower. Conclusions According to the results obtained, currently in Spain mental health problems could affect approximately to 20% of the general population. Additionally, it becomes apparent that differences by gender and social class in mental health still exist, and that both family roles and employment status inside and outside household might constitute an important source of inequality in mental health. Regarding the working population, the prevalence of mental health problems was slightly lower than in the general population In addition, while among women this prevalence could be more related to the age and the occupational social class, among men might be more associated with employment related variables such as the type of contract. Lastly, focusing on MDD, it was estimated that between a 4% and 5% of men and between 7% and 9% among women could suffer this disease. Furthermore, in both genders MDD was related to the social disadvantage. Therefore, the obtained results could serve as baseline to stablish preventive measured focused on at-risk populations. Give a specific focus to the preventive interventions might improve their effectiveness and efficiency and, accordingly, the results found could help to reduce the prevalence of mental health problems and MDD in the population of Spain.