3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 High prevalence of depression among working people with occupational disease: a population-based study Carmen Otero Sierra1, Juan Miguel Macho-Fernandez2, Pedro R. Mondelo3, Nearkasen Chau4, Lorhandicap group4 1 Servicio de Prevención Hermanas Hospitalarias, Departamento de Organización de Empresas, Universitat Politècnica 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

3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Background Occupational diseases (OD) are common: ‒ The ODs are common. Their prevalence 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; Roquelaure et 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).

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, Eur Neuropharmacol 2005) ‒ Depressive symptoms affect 23% of men and 31% of women (12-75 yr) in France (Beck et al., Paris: INPES, 2007) ‒ They represent 10% of total health care expediture, with direct & indirect costs higher than cancer and diabetes (Fondation Fondamental 2011) ‒ They relate to unhealthy behaviours and disability, and may become the most frequent cause of disability worldwide by 2030 (Penninx et al., Arch gen Psychiatry 1999; Harvey et al., Neuroimage, 2005; Khlat et al., Scand J Public Health 2010 ; WHO 2010; Chau et al., J Occup Envion 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).

3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Background Hypotheses: ‒ Recognized ODs are relatively rare and recognition is rather late. ‒ When recognized, physical/mental comorbidity and disabilities may be established. ‒ The issues may be higher among people at work because of job demands and altered health. ‒ Those issues may explain the steady increase of mortality of workers with OD in the last decade (Institut de recherche et documentation en économie de la santé, 2012). ‒ Appropriate prevention should be sooner. Health monitoring may be made by occupational and general physicians as workers with ODs are confident on them (Otero Sierra et al., Arch Mal Prof, 2000).

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.

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).

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 3 sendings 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.

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. 5 occupational 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 3 first 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.

3rd Conference on Occupational Risk Prevention, Bilbao, 23-25 May 2012 Statistical analysis 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.

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: %   Study sample (N=560) Reference group (N=4,766) p-value Men 49.0 51.0 0.078 Age (yr) <0.001 <45 25.7 51.4 45-54 33.6 16.3 55-64 27.1 13.7 65 or over 13.6 18.5 Occupation Manual workers 73.7 23.8 Service workers/clerks 18.4 36.5 Others 7.9 39.7 Occupational status Working 87.5 56.8 Inactive 12.5 43.2 Bad health status 70.9 42.8 Chronic diseases Depression 4.8 3.6 0.137 Infectious disease 13.4 ─ Cancer 2.1 2.4 0.714 Nervous-system disease 1.8 5.2 Deafness 14.8 Cardio-vascular disease 16.8 20.3 0.051 “─”: not available.

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   Study sample (N=560) Reference groupa (N=4,766) p-value Respiratory disease 16.4 9.6 <0.001 Asbestos 4.5 ─ Others 13.4 Genitourinary disease 1.4 3.2 0.021 Musculoskeletal disorders 71.2 52.0 Osteoarthritis 30.4 Carpal tunnel 33.0 3.0 Scoliosis and cyphosis 6.4 10.5 0.002 Tendinitis, tenosynovitis, and epicondylitis 46.6 8.4 Other diseases 15.0 19.2 0.015 Number of diseases 0-1 37.9 58.6 2-4 48.4 32.6 5 or over 13.7 8.8 Disabilities 69.1 Occupational activity 59.5 Domestic activity 51.1 26.4 Leisure activity 46.4 “─”: not available.

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   Reference groupa Study sample p-value Working people Number of subjects 2,709 490 Frequency of depression (%) 2.6 4.9 0.006 Crude odds ratio 1.00 1.94** 1.21-3.12 Sex-age-adjusted odds ratio 1.94* 1.11-2.38 Sex-age-occupation-adjusted odds ratio 1.54a 0.82-2.88 Inactive people 2,057 70 4.3 0.825 0.88 0.27-2.83 0.99 0.30-3.25 0.92 0.27-3.09 *p<0.05, **p<0.01. a The contribution (%) of occupation to the depression risk was (1.94-1.54)/(1.94-1)=43%.

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   N % OR 95% CI Sex Men 238 2.5 1.00 Women 251 7.2 3.40* 1.29-8.86 Bad health status No 147 1.4 Yes 343 6.4 4.93* 1.09-22.32 Number of diseases 1 179 1.1 2-4 245 6.5 5.33* 1.18-24.02 5 or over 66 9.1 8.27* 1.53-44.64 Disability for occupational activity 186 3.2 304 5.9 1.73 0.65-4.57 Disability for domestic/leisure activity 219 2.3 271 7.0 2.88* 1.02-8.17 *p<0.05, **p<0.01. N: number of subjects.

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   N % OR 95% CI Job adjusted because of diseases No 284 2.8 1.00 Yes 206 7.8 2.71* 1.10-6.72 Time-schedule adjusted because of diseases 326 3.7 164 7.3 1.95 0.81-4.67 Aid of colleagues for demanding tasks 244 4.5 246 5.3 1.10 0.47-2.58 Diploma Higher than primary school 253 Primary school 237 7.2 2.09 0.79-5.50 Opinion for occupational disease declaration procedure Acceptable, convenient, no opinion 323 4.3 Complicated 167 6.0 1.38 0.59-3.20 *p<0.05, **p<0.01. N: number of subjects.

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   Odds ratio 95% CI Infectious disease 1.03 0.29-3.69 Cancer Indeterminate Nervous-system disease 7.98* 1.38-46.04 Deafness 1.74 0.52-5.80 Cardio-vascular disease 1.60 0.60-4.25 Respiratory disease Asbestos 13.64** 2.27-82.09 Others 1.21 0.34-4.34 Genitourinary disease 9.09* 1.42-58.25 Musculoskeletal disorders Osteoarthritis 2.57* 1.03-6.39 Carpal tunnel 3.56** 1.36-9.29 Scoliosis and cyphosis 2.42 0.66-8.90 Tendinitis, tenosynovitis, epicondylitis 1.11 0.46-2.68 0.76 0.16-3.49 1.63 0.57-4.62 *p<0.05, **p<0.01.

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).