SITUATIONS OF IMBALANCING BETWEEN STRESS-REWARDS AND COMMON MENTAL DISORDERS IN BASIC HEALTH CARE WORKERS

Abstract This study focused the association between common mental disorders and situations of imbalance between efforts and rewards in primary health care workers held in sanitary district, municipality of Salvador, Bahia, Brazil. The study included workers who were active in the district’s health in 2012. A cross-sectional study, with 400 out of 509 workers, was conducted. Effort-Reward Imbalance was used to evaluate effort and reward at work and the Self-Reporting Questionnaire measured common mental disorders. The prevalence of common mental disorders was 21%, 46.2% of studied workers experienced situations of work-reward imbalance at work. The highest prevalence of common mental disorders was observed in the effort-reward imbalance (26.9%) and in the operational workers group (33.8%). Correspondence analysis indicated a relationship between effort and reward imbalance and common mental disorders in the first dimension. The log-binomial logistic regression model showed a positive association between effort and reward imbalance and common mental disorders (adjusted prevalence ratio=1.91). Workers exposed to situations of effort-reward imbalance at work showed a higher frequency of mental illness. It is necessary to intervene in the management and organization of the work regarding the demands of the services, precarious work conditions and forms of reward or recognition.

摘要 本研究聚焦巴西巴伊亚州萨尔瓦多市卫生区基层医疗卫生工作者常见精神障碍与工作付出-回报失衡（Effort-Reward Imbalance）状况之间的关联。研究对象为2012年该卫生区在岗的医疗卫生工作者。本研究为横断面研究，共纳入509名工作者中的400名作为研究样本。采用付出-回报失衡（Effort-Reward Imbalance）量表评估工作中的付出与回报水平，采用自评问卷（Self-Reporting Questionnaire）测评常见精神障碍情况。研究对象中常见精神障碍的患病率为21%，46.2%的被调查工作者存在工作付出-回报失衡状况。在存在付出-回报失衡的群体（26.9%）以及操作类工作者群体（33.8%）中，常见精神障碍的患病率最高。对应分析结果显示，在第一维度上，工作付出-回报失衡与常见精神障碍之间存在关联。对数二项式logistic回归模型分析结果显示，工作付出-回报失衡与常见精神障碍之间存在正向关联（调整后患病率比=1.91）。工作中存在付出-回报失衡的工作者，罹患精神疾病的比例更高。有必要针对服务需求、不稳定的工作环境以及薪酬或认可形式等方面，对工作管理与组织模式进行干预。