Effets des facteurs psychosociaux au travail sur la santé mentale. Une revue de littérature des études prospectives portant sur trois modèles émergents

Les études mesurant les effets des facteurs psychosociaux au travail sur la santé mentale utilisent de préférence les modèles largement documentés de demande-latitude-support (DLS) de Karasek et al. et de déséquilibre-effort-reconnaissance (DER) de Siegrist. Or il existe d’autres modèles théoriques encore peu documentés, exploités et / ou analysés. Par une revue de littérature d’études prospectives réalisées dans les pays industrialisés de 1990 à 2010, notre article a pour objectif de présenter les modèles DLS et DER et de préciser leurs limites, d’exposer l’état des connaissances concernant l’effet sur la santé mentale des facteurs psychosociaux de trois modèles émergents (la justice organisationnelle, le leadership, et la prévisibilité – ou prédictabilité – au travail), et de déterminer si ces effets sont indépendants des modèles DLS et DER. Les résultats des études démontrent que les facteurs psychosociaux mesurés par le modèle de la justice organisationnelle ont des effets délétères sur la santé mentale, indépendamment des modèles DLS et DER. Des effets négatifs du leadership et de la prévisibilité sur la santé mentale ont également été observés dans une majorité des études, mais le nombre limité d’études prospectives ne permet pas de conclure de façon aussi assurée au statut explicatif de ces modèles. Quoi qu’il en soit, les modèles émergents permettent de mesurer certains facteurs psychosociaux non pris en compte par les modèles DLS et DER et nous semblent mériter d’être intégrés dans de futures études prospectives sur la santé au travail.Studies evaluating the effects of psychosocial factors at work on health usually use Karasek’s job demand-control-support (DCS) and Siegrist’s effort-reward imbalance (ERI) models which are both largely documented. There are other models that have been little documented, exploited or analysed yet. Using a literature review of prospective studies carried out in industrialised countries from 1990 to 2010, our paper aims to present the main features of the DCS and ERI models and to explain what their limits are. It also sets out to present a state of knowledge concerning the effect of psychosocial factors of three emerging models (“organisational justice”, leadership and “work predictability”) on mental health and determine whether psychosocial factors measured by these three models have an effect on mental health, regardless of the DCS and ERI models. The results of these studies show that the psychosocial factors measured by the organisational justice model have deleterious effects on mental health, independently from the DCS and ERI models. Negative effects of leadership and predictability on mental health have also been observed in most studies. However, because of the limited number of prospective studies, we cannot establish the explanatory status of these models. Be that as it may, emerging models allow to measure some psychosocial factors that are not taken into account by the DCS and ERI models and are thus worth being integrated into future prospective studies on occupational health

Psychosocial work factors and social inequalities in psychological distress: a population-based study.

BACKGROUND: Mental health problems (MHP) are the leading cause of disability worldwide. The inverse association between socioeconomic position (SEP) and MHP has been well documented. There is prospective evidence that factors from the work environment, including adverse psychosocial work factors, could contribute to the development of MHP including psychological distress. However, the contribution of psychosocial work factors to social inequalities in MHP remains unclear. This study evaluates the contribution of psychosocial work factors from two highly supported models, the Demand-Control-Support (DCS) and the Effort-Reward Imbalance (ERI) models to SEP inequalities of psychological distress in men and women from a population-based sample of Quebec workers. METHODS: Data were collected during a survey on working conditions, health and safety at work. SEP was evaluated using education, occupation and household income. Psychosocial work factors and psychological distress were assessed using validated instruments. Mean differences (MD) in the score of psychological distress were estimated separately for men and women. RESULTS: Low education level and low household income were associated with psychological distress among men (MD, 0.56 (95% CI 0.06; 1.05) and 1.26 (95% CI 0.79; 1.73) respectively). In men, the contribution of psychosocial work factors from the DCS and the ERI models to the association between household income and psychological distress ranged from 9% to 24%. No clear inequalities were observed among women. CONCLUSIONS: These results suggest that psychosocial work factors from the DCS and the ERI models contribute to explain a part of social inequalities in psychological distress among men. Psychosocial factors at work are frequent and modifiable. The present study supports the relevance of targeting these factors for the primary prevention of MHP and for health policies aiming to reduce social inequalities in mental health

The Influence of Age, Sex, and Socioeconomic Status on Glycemic Control Among People With Type 1 and Type 2 Diabetes in Canada: Patient-Led Longitudinal Retrospective Cross-sectional Study With Multiple Time Points of Measurement

BackgroundClinical guidelines for most adults with diabetes recommend maintaining hemoglobin A1c (HbA1c) levels ≤7% (≤53 mmol/mol) to avoid microvascular and macrovascular complications. People with diabetes of different ages, sexes, and socioeconomic statuses may differ in their ease of attaining this goal. ObjectiveAs a team of people with diabetes, researchers, and health professionals, we aimed to explore patterns in HbA1c results among people with type 1 or type 2 diabetes in Canada. Our research question was identified by people living with diabetes. MethodsIn this patient-led retrospective cross-sectional study with multiple time points of measurement, we used generalized estimating equations to analyze the associations of age, sex, and socioeconomic status with 947,543 HbA1c results collected from 2010 to 2019 among 90,770 people living with type 1 or type 2 diabetes in Canada and housed in the Canadian National Diabetes Repository. People living with diabetes reviewed and interpreted the results. ResultsHbA1c results ≤7.0% represented 30.5% (male people living with type 1 diabetes), 21% (female people living with type 1 diabetes), 55% (male people living with type 2 diabetes) and 59% (female people living with type 2 diabetes) of results in each subcategory. We observed higher HbA1c values during adolescence, and for people living with type 2 diabetes, among people living in lower income areas. Among those with type 1 diabetes, female people tended to have lower HbA1c levels than male people during childbearing years but higher HbA1c levels than male people during menopausal years. Team members living with diabetes confirmed that the patterns we observed reflected their own life courses and suggested that these results be communicated to health professionals and other stakeholders to improve the treatment for people living with diabetes. ConclusionsA substantial proportion of people with diabetes in Canada may need additional support to reach or maintain the guideline-recommended glycemic control goals. Blood sugar management goals may be particularly challenging for people going through adolescence or menopause or those living with fewer financial resources. Health professionals should be aware of the challenging nature of glycemic management, and policy makers in Canada should provide more support for people with diabetes to live healthy lives