Association between occupational stress and subclinical depression in Chinese primary healthcare workers

Jiao Zhang; Lingzhong Xu; Wenzhe Qin; Aijun Xu

doi:10.3389/fpsyt.2023.1238603

Association between occupational stress and subclinical depression in Chinese primary healthcare workers

Front Psychiatry. 2023 Nov 7:14:1238603. doi: 10.3389/fpsyt.2023.1238603. eCollection 2023.

Authors

Jiao Zhang^{1

2}, Lingzhong Xu^#³, Wenzhe Qin³, Aijun Xu^#^{2

4}

Affiliations

¹ School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China.
² Jiangsu Research Center for Major Health Risk Management and TCM Control Policy, Nanjing University of Chinese Medicine, Nanjing, China.
³ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
⁴ School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.

^# Contributed equally.

Abstract

Background: Wellbeing of healthcare workers is crucial for the effective functioning of primary health systems. This study aimed to examine the association between occupational stress and subclinical depression among primary healthcare workers, and to establish the foundation for future preventive strategies.

Methods: A cross-sectional study was conducted in Tai'an City, Shandong Province, China. Data were collected from 832 medical staff in primary health institutions using a structured self-administered questionnaire. The participants completed the Challenge and Hindrance-Related Self-Reported Stress (C-HSS) Scale and Patient Health Questionnaire-9. Multivariable logistic regression analysis was conducted to explore the relationship between occupational stress and subclinical depression among primary healthcare workers.

Results: The prevalence of subclinical depression among primary healthcare workers was 11.66%. Participants with subclinical depression have a significant higher level of occupational stress (including challenge-stress and hindrance-stress). Regression analysis result indicated that higher level of occupational stress was significantly associated with more severe subclinical depression, and the risk of subclinical depression remained after adjusting other covariates (OR = 4.57, 95%CI, 3.14-6.63). The association between challenge-stress and subclinical depression was not statistically significant when controlling for hindrance-stress. Subgroup analysis showed that male healthcare workers who perceived higher level of challenge stress were more likely to develop subclinical depression than female healthcare workers.

Conclusion: The level of subclinical depression among Chinese primary healthcare workers was high, and occupational stress especially hindrance stress may contribute to subclinical depression. Findings were also robust in subgroup analysis after adjusting for other covariates. These findings emphasize the importance of occupational stress psychosocial interventions to decrease the risk of developing depression among the primary healthcare workers.

Keywords: challenge & hindrance stressors; gender difference; occupational stress; primary healthcare worker; subclinical depression.

Grants and funding

This study was supported by the National Natural Science Foundation of China (No. 71974118) and the Humanities and Social Science Fund of Ministry of Education of China (No. 22YJCZH236). These funders had no further role in research design, data collection and analysis, writing of the report, and deciding whether to submit the paper for publication.