Una aproximación a la dignidad del trabajo médico / The dignity of medical work. A qualitative approach

BACKGROUND: A work that dignifies, that is adequately rewarded and is carried out with social protection is considered decent by the International Labor Organization. AIM: To describe and understand the different dimensions of the dignity of medical work from the perspective of Chilean male and female doctors. MATERIAL AND METHODS: From a qualitative approach, the first stage of the study consisted in the application of an open response survey which was answered by doctors from all over the country. The second stage consisted in discussion instances about dignity of medical work. In the third stage, semi-structured in-depth interviews with doctors of both sexes and of different generations were conducted. The analysis of the data was carried out following the approaches of the Grounded Theory. RESULTS: The concept of dignity of medical work arises from a historical process of social conquest and implies the recognition of the rights of professionals and patients. Optimal conditions are required to provide quality health care. However, even in unworthy conditions, doctors do everything possible to provide a decent care. The need to humanize the relationships that occur in the context of health care is proposed. Carrying out medical work with excellence and professionalism contributes to personal fulfillment. Associativity contributes to dignify medical work. CONCLUSIONS: The dignity of medical work is understood by doctors as a polysemic and relational concept.

Acoso laboral y salud mental en trabajadores chilenos: el papel del género / Workplace bullying and mental health in Chilean workers: the role of gender / Assédio moral no trabalho e saúde mental em trabalhadores chilenos: o papel do gênero

El acoso laboral ha adquirido relevancia en las últimas décadas, debido a su creciente magnitud y consecuencias negativas en la salud de los trabajadores, existiendo diversos enfoques para estudiarlo. Sin embargo, hasta la fecha en América Latina la evidencia es escasa y focalizada en muestras específicas. El objetivo de este estudio es describir el acoso laboral y su asociación con la salud mental en población asalariada y determinar en qué medida la asociación se modifica según el género. Se realizó una encuesta a una muestra de 1.995 trabajadores y trabajadoras asalariadas de las tres principales áreas metropolitanas de Chile (Gran Santiago, Gran Valparaíso y Gran Concepción) seleccionados al azar en tres etapas (manzanas, viviendas e individuos). La prevalencia de síntomas depresivos, consumo de psicotrópicos y distrés fue de 10,9%, 12,8% y 13% respectivamente en la muestra total, y existe una fuerte asociación entre variables de salud mental y acoso laboral, aún en los modelos ajustados. Al comparar esta asociación en los modelos estratificados por género, no se observaron diferencias significativas entre hombres y mujeres.

Mobbing, or bullying in the workplace, has gained relevance in recent decades due to its growing magnitude and negative effects on workers' health. There are various approaches for studying the issue. However, thus far the evidence is scarce in Latin America and is focused on specific samples. This study aims to analyze workplace bullying and its association with mental health in the wage-earning population and to determine the extent to which this association is modified by gender. A survey was conducted with a sample of 1,995 male and female salaried workers in Chile's three main metropolitan areas (Greater Santiago, Greater Valparaíso, and Greater Concepción) with three-stage random selection (blocks, households, and individuals). Prevalence rates for depressive symptoms, use of psychotropic medication, and stress were 10.9%, 12.8%, and 13%, respectively, and there was a strong relationship between mental health variables and workplace bullying, which persisted in the adjusted models. When comparing this association in the models stratified by gender, no significant differences were observed between men and women.

O assédio moral no trabalho ganhou relevância nas últimas décadas devido à sua crescente magnitude e às consequências negativas sobre a saúde dos trabalhadores, sendo que existem diversos enfoques para estudá-la. Entretanto, na América Latina, as evidências são raras e focalizadas em amostras específicas. O objetivo deste estudo é descrever o assédio no trabalho e a sua relação com a saúde mental nos funcionários, para determinar em que medida a relação se altera conforme o gênero. A pesquisa envolveu uma amostra de 1995 trabalhadores e trabalhadoras formais das três principais regiões metropolitanas do Chile (Grande Santiago, Grande Valparaíso e Grande Concepción) selecionados ao acaso, em três etapas (quarteirão, unidades habitacionais e indivíduos). A prevalência de sintomas depressivos, consumo de psicotrópicos e distresse foi de 10,9%, 12,8% e 13% respectivamente, na amostra total, e existe uma forte relação entre variáveis de saúde mental e assédio moral no trabalho, ainda nos modelos ajustados. A comparação desta relação nos modelos estratificados por gênero não mostrou diferenças significativas entre homens e mulheres.

Asociaciones entre factores de riesgos psicosociales, dimensiones organizacionales y problemas de salud mental, relacionados con la violencia laboral, en trabajadores de tres hospitales chilenos de alta complejidad / Associations between psychosocial risk factors, organizational dimensions, and mental health problems related to workplace violence among workers of three Chilean hospitals of high complexity / Associação entre fatores de riscos psicossociais, dimensões organizacionais e problemas de saúde mental relacionados com a violência no trabalho em trabalhadores de três hospitais chilenos de alta complexidade

Resumen: El objetivo fue analizar la asociación entre factores de riesgos psicosociales, dimensiones organizacionales, violencia laboral e indicadores de problemas de salud mental en tres hospitales chilenos. Mil veintitrés trabajadores respondieron una encuesta, se realizó análisis descriptivos, bivariados (chi-cuadrado) y multivariados (regresión logística con odds ratio como medida de asociación). El 14,7% de los encuestados reporta violencia laboral. Tienen más oportunidad de reportar violencia laboral los/as trabajadores/as expuestos a ISOSTRAIN (OR = 2,32, p = 0,001); desequilibrio esfuerzo-recompensa (OR = 5,52, p ≤ 0,001); liderazgo tiránico (OR = 3,02, p ≤ 0,001) y vulnerabilidad (OR = 1,97, p = 0,010), respecto a los no expuestos. Los expuestos a ISOSTRAIN (OR = 1,78, p = 0,024); desequilibrio esfuerzo-recompensa (OR = 2,49, p = 0,001); violencia laboral (OR = 2,13, p = 0,003) y vulnerabilidad (OR = 2,29, p = 0,001) tienen más oportunidad de reportar distrés elevado, en relación a los no expuestos. Los expuestos a desequilibrio esfuerzo-recompensa (OR = 2,84, p ≤ 0,001) y violencia laboral (OR = 1,76, p = 0,041) tienen más oportunidad de reportar síntomas depresivos que los no expuestos. Los expuestos a desequilibrio esfuerzo-recompensa (OR = 2,07, p ≤ 0,001) y vulnerabilidad laboral (OR = 1,96, p = 0,001) tienen más oportunidad de consumir psicotrópicos. Los contextos laborales con factores de riesgos psicosociales, dimensiones organizacionales adversas y vulnerabilidad laboral se asocian a una mayor oportunidad de violencia laboral. Asimismo, trabajadores expuestos a violencia laboral, riesgos psicosociales y vulnerabilidad tienen mayor oportunidad de reportar problemas de salud mental.

Abstract: The objective was to analyze the association between psychosocial risk factors, organizational dimensions, workplace violence, and indicators of mental health problems in three Chilean hospitals. A total of 1,023 workers answered a questionnaire, and descriptive, bivariate (chi-square), and multivariate (logistic regression with odds ratio as the measure of association) analyses were performed. Of all the interviewees, 14.7% reported workplace violence. Increased odds of workplace violence were associated with exposure to ISOSTRAIN (OR = 2.32, p = 0.001), effort-reward imbalance (OR = 5.52, p ≤ 0.001), tyrannical leadership (OR = 3.02, p ≤ 0.001), and vulnerability (OR = 1.97, p = 0.010). Workers exposed to ISOSTRAIN (OR = 1.78, p = 0.024), effort-reward imbalance (OR = 2.49, p = 0.001), workplace violence (OR = 2.13, p = 0.003), and vulnerability (OR = 2.29, p = 0.001) showed increased odds of high stress when compared to unexposed workers. Workers exposed to effort-reward imbalance (OR = 2.84, p ≤ 0.001) and workplace violence (OR = 1.76, p = 0.041) showed higher odds of reporting depressive symptoms. Those exposed to effort-reward imbalance (OR = 2.07, p ≤ 0.001) and work vulnerability (OR = 1.96, p = 0.001) showed higher odds of consuming psychoactive drugs. Work contexts with psychosocial risk factors, adverse organizational dimensions, and work vulnerability were associated with higher odds of workplace violence. Workers exposed to workplace violence, psychosocial risks, and vulnerability have higher odds of reporting mental health problems.

Resumo: O objetivo foi analisar a associação entre fatores de riscos psicossociais, dimensões organizacionais, violência no trabalho e indicadores de problemas de saúde mental em três hospitais chilenos. Mil e vinte e três trabalhadores responderam um questionário, foram realizadas análises descritivas, bivariadas (qui-quadrado) e multivariadas (regressão logística com odds ratio como medida de associação). Relataram violência no trabalho, 14,7% dos entrevistados. Os/as trabalhadores/as expostos/as a ISOSTRAIN (OR = 2,32, p = 0,001) têm maior chance de relatar violência no trabalho; desequilíbrio esforço-recompensa (OR = 5,52, p ≤ 0,001); liderança tirânica (OR = 3,02, p ≤ 0,001) e vulnerabilidade (OR = 1,97, p = 0,010), em relação aos não expostos. Os expostos a ISOSTRAIN (OR = 1,78, p = 0,024); desequilíbrio esforço-recompensa (OR = 2,49, p = 0,001); violência no trabalho (OR = 2,13, p = 0,003) e vulnerabilidade (OR = 2,29, p = 0,001) têm uma maior chance de reportar distresse elevado, em relação aos não expostos. Os expostos a desequilíbrio esforço-recompensa (OR = 2,84, p ≤ 0,001) e violência laboral (OR = 1,76, p = 0,041) têm maior chance de reportar sintomas depressivos do que os nãos expostos. Os expostos a desequilíbrio esforço-recompensa (OR = 2,07, p ≤ 0,001) e vulnerabilidade laboral (OR = 1,96, p = 0,001) têm maior chance de consumir psicotrópicos. Os contextos laborais com fatores de riscos psicossociais, dimensões organizacionais adversas e vulnerabilidade laboral foram associados a uma maior chance de violência no trabalho. Além disso, trabalhadores expostos à violência no trabalho, riscos psicossociais e vulnerabilidade têm maior chance de reportar problemas de saúde mental.

Violencia laboral en trabajadores del sector salud: revisión sistemática / Workplace violence among health care workers

The aim of this review is to describe and to analyze scientific reports about occupational violence in the health area. A systematic review of the literature on Academic Search Complete (EBSCO Host), Medline, Pubmed, Scielo, Scopus and Web of Science was performed and 23 articles were selected for analysis. Most studies are quantitative, measuring workplace violence and its consequences, including multi-stratum samples. They mainly measure psychological and external violence and their subjects are hospital workers. Violence is conceived as coming from organizational dimensions. Facilitators of violence are related to the nature of the job and the most commonly studied consequences are related to mental health. The main consequences of the phenomenon are depressive symptoms, post-traumatic stress disorder (PTSD) and work stress. The nature of the job as a facilitator of violence relates primarily to the place of work and to the profession. Most of the studies are carried out with multi-stratum samples and combine workers from different services. However, studies in psychiatric services and with nursing staff are also common.

Associação entre estresse, riscos psicossociais e qualidade do emprego de trabalhadores assalariados chilenos: uma perspectiva de gênero / Asociaciones entre distrés, riesgos psicosociales y calidad del empleo en trabajadores/as asalariados/as en Chile: una perspectiva de género / Psychosocial risks, quality of employment, and workplace stress in Chilean wage-earning workers: a gender perspective

Resumo: O estudo estimou a prevalência de estresse no trabalho no Chile e suas associações com a exposição ocupacional ao risco psicossocial e qualidade do emprego, considerando as diferenças de gênero. Estudo transversal considerando uma amostra representativa nacional de 3.010 trabalhadores/as (1.486 mulheres e 1.524 homens). Dezoito por cento da amostra relataram estresse (23,8% mulheres vs. 14,8% de homens). Aqueles expostos a riscos psicossociais têm mais chances de sofrer estresse do que os não expostos, e as mulheres têm uma maior chance de sofrer estresse do que os homens. Homens e mulheres em empregos precários têm uma chance maior de estresse em comparação com aqueles com menos precariedade do emprego. No entanto, as mulheres em empregos precários têm uma maior chance de sofrer de estresse do que os homens em cargos semelhantes. Conclui-se que as mulheres têm uma maior proporção de empregos precários, estão mais expostas a riscos psicossociais e têm maior estresse, demonstrando a existência de uma dupla discriminação, social e de gênero, no mercado de trabalho no Chile.

Resumen: El estudio estimó la prevalencia de distrés laboral en Chile y sus asociaciones con exposición a riesgo psicosocial laboral y calidad del empleo, considerando diferencias de género. El estudio transversal consideró una muestra probabilística representativa a nivel nacional de 3.010 asalariados/as en Chile (1.486 mujeres y 1.524 hombres). Un 18% reporta distrés (23,8% mujeres versus 14,8% hombres). Los expuestos a riesgos psicosociales tienen mayor chance de experimentar distrés que los no expuestos, y las mujeres presentan una chance de sufrir distrés mayor que los hombres. Hombres y mujeres en empleos precarios tienen una chance mayor de presentar distrés al compararse con quienes tienen menos precariedad laboral. No obstante, mujeres en empleos precarios tienen mayor chance de sufrir distrés que los hombres en empleos similares. Se concluye que las mujeres ocupan empleos precarios en mayor proporción, están más expuestas a riesgos psicosociales y presentan mayor distrés, evidenciando la existencia de una doble discriminación-social y de género-en el mercado laboral en Chile.

Abstract: This study aimed to estimate the prevalence of work-related stress in Chile and its association with exposure to workplace psychosocial risks and quality of employment, considering gender differences. The cross-sectional study included a representative probabilistic national sample of 3,010 salaried workers (1,486 women and 1,524 men). Eighteen percent reported work-related stress (23.8% of women and 14.8% of men). People exposed to psychosocial risks had a higher probability of experiencing stress, and women were more likely to suffer stress than men. Women and men in precarious work showed increased likelihood of distress, compared to workers with less precarious jobs. However, women in precarious jobs were more likely to suffer stress than men in the same situation. The study concluded that women had more precarious jobs, experienced greater exposure to psychosocial risks, and suffered more stress than men. This is evidence of double discrimination (social and gender-based) in the Chilean labor market.

Indicadores de salud mental asociados a riesgo psicosocial laboral en un hospital público / Psychosocial stress among health care workers

Background: Health care workers are exposed to high stress levels and psychosocial risks. The imbalance between the invested efforts and received rewards acquires special importance in this setting. Aim: To assess the psychosocial risk level and its relationship with depression, distress and psychotropic drug use among health care workers. Material and Methods: Seven hundred eighty two workers (602 females; 180 males) answered self-administered questionnaires to measure psychosocial risk and mental health. Results: Twenty five percent of respondents used psychotropic drugs, 34% had a high level of distress and 23% had depressive symptoms. They also reported a low level of decisional latitude (48%), high emotional demands (47%), low social support (41%) and a significant effort-reward imbalance (67%). Those exposed to job strain (high demands and low decisional latitude), iso-strain (job strain plus low social support), and effort-reward imbalance were twice as likely to suffer symptoms of depression and elevated distress compared to non-exposed subjects. Conclusions: There are high levels of psychosocial stress among health care workers.

Facilitadores del reintegro laboral en trabajadores con patología mental de origen laboral: una revisión sistemática / Return to work enablers for workers with work-related mental illness

Background: There is growing interest in the treatment and return-to-work of workers with labor related mental illnesses. Aim: To perform a systematic review of practices and interventions that improve return to work. Material and Methods: Systematic literature review. Thirty articles were selected for in- depth analysis. Results: Self efficacy perception, work motivation, a lower age and a better socioeconomic status were identified as worker-related return to work facilitators. Among work environment facilitators, good communication practices, supervisor support, a good assessment and modification of work load, adjustment of expectations, a good relationship between employers and employees and positive work experiences were identified. Treatment may improve return to work using a multidisciplinary approach, reducing stress and identifying psychosocial determinants of mental problems rather than symptoms and providing a timely health care. Conclusions: Return to work of workers with labor related mental illnesses requires a constant sharing of information between health care workers, employers and employees to identify common therapeutic objectives.

Reintegro laboral en trabajadores con problemas de salud mental: la perspectiva de los tratantes / Return to work in workers with mental health problems: attendants perspective

ANTECEDENTES: En los últimos años se ha observado un aumento en la prevalência de problemas mentales de origen laboral, incrementando significativamente el promedio anual de días de trabajo perdidos por reposo. Con respecto al posterior reintegro, la evidencia es categórica en afirmar la importancia de que este sea un proceso exitoso para la prevención de recaídas del trabajador. Asimismo, se constata que a nivel latinoamericano es casi inexistente la literatura e investigación en torno a intervenciones para el retorno laboral. OBJETIVO: Estudiar las condiciones de diagnóstico, intervención y retorno al trabajo que han mostrado efectividad desde la perspectiva y experiencias de tratantes de una mutualidad respecto de la intervención para el reintegro al trabajo en individuos con problemas de salud mental de origen laboral. MÉTODO: Se diseñó una investigación exploratoria-descriptiva, empleando metodología cualitativa. Se utilizaron grupos focales y entrevistas a seis psicólogos, tres psiquiatras y cuatro terapeutas ocupacionales que ejercen sus labores profesionales en una mutual en Chile. RESULTADOS: A partir de un análisis descriptivo, empleando el procedimiento de codificación abierta propuesto por el modelo de Teoría Fundamentada, emergieron cinco categorías centrales y dos fenómenos transversales: La comunicación tripartita y el proceso orientado al reintegro laboral. Ambos hacen referencia tanto al proceso de intervención para el retorno al trabajo como a los actores involucrados en este, ya sea de la mutualidad como también del contexto laboral inmediato de los trabajadores.

BACKGROUND: In recent years there has been an increase in the prevalence of work-related mental problems, significantly increasing the average annual working days lost because of leave sick. With respect to the later return-to-work, the evidence is categorical in affirming the importance of the successful of this process for the relapse prevention. Furthermore, we note that throughout Latin America the literature and research on interventions to return-to-work is almost absent. OBJECTIVE: To study the conditions of diagnosis, intervention and return to work that have shown effectiveness from the perspectives and experiences of professionals from a mutuality regarding the intervention to return to work in individuals with problems of mental health of occupational origin. METHOD: An exploratory-descriptive research was designed using qualitative methodology. Focus groups and interviews to six psychologists, three psychiatrists and four occupational therapists were used. RESULTS: From a descriptive analysis using the procedure of open coding proposed by the Grounded Theory model, five core categories and two transverse phenomena emerged: The tripartite communication and the process oriented by the return to work. The two refer to the process of intervention to return to work as the actors involved in this, whether mutuality or the workers' immediate labor context.

Salud mental y naturaleza del trabajo: cuando las demandas emocionales resultan inevitables / Mental health and nature of work: when the emotional demands becomes inevitable

ANTECEDENTES: el trabajo en servicios y particularmente el trabajo que involucra asistencia a personas se caracteriza por altas demandas emocionales. OBJETIVO: describir las demandas emocionales y efectos en la salud mental de trabajadores de una institución pública en Chile cuyo trabajo es particularmente demandante en el uso de las emociones. MÉTODO: con un diseño transversal, se aplicó una encuesta al 77% de los funcionarios para analizar las demandas emocionales del trabajo y un screening de distrés y síntomas depresivos. Se describen las prevalencias y las diferencias de éstas en función de algunas dimensiones sociodemográficas y laborales. Posteriormente se analiza la asociación entre la exposición a las demandas emocionales y la chance de presentar síntomas depresivos o distrés elevado. RESULTADOS: las prevalencias encontradas son mayores a las de la población general tanto en el reporte de demandas emocionales del trabajo como en los resultados de salud mental. CONCLUSIÓN: se comprueba la hipótesis de que la índole de la tarea que expone a altas demandas emocionales tiene efectos negativos en la salud mental. Dado lo anterior, la preocupación por la salud mental de personas que se desempeñan en trabajos de esta naturaleza debe ser un tema prioritario y, en consecuencia, se requieren medidas diligentes para prevenir la aparición de problemas de salud mental...

BACKGROUND: work in services and particularly work that involves assisting persons is characterized by high emotional demands. OBJECTIVE: To describe the emotional demands and effects on the mental health of workers at a public institution in Chile whose work is particularly demanding in the use of emotions. METHOD: In a cross-sectional design, a survey was applied to 77% of the institution's staff. The survey included an emotional demands scale and a screening of distress and depressive symptoms. Prevalences and differences based on several demographic and work-related dimensions were described. The association between exposure to emotional demands and the likelihood of having depressive symptoms or high distress were reported. RESULTS: Higher prevalences were found than those reported in the general population for both the emotional demands of the work and the mental health outcomes reported. CONCLUSION: the hypothesis that the nature of the work that presents high emotional demands has negative effects on mental health. Hence, concerns about the mental health of people who work in these types of jobs should be a priority, and therefore, diligent measures are necessary to prevent the onset of mental health problems in these settings...

ANTECEDENTES: o trabalho em serviços e especialmente o trabalho que envolve assistência a pessoas caracteriza-se pelas altas demandas emocionais. OBJETIVO: descrever as demandas emocionais e seus efeitos na saúde mental de trabalhadores de uma instituição pública no Chile, cujo trabalho é particularmente intenso no que diz respeito ao emprego das emoções. MÉTODO: com desenho de corte transversal, aplicou-se um questionário a 77% dos funcionários da empresa, visando analisar as demandas emocionais do trabalho, assim como um screening de distress e sintomas depressivos. Descrevem-se as prevalências e as diferenças observadas em função de algumas dimensões sociodemográficas e funcionais. Posteriormente, se analisa a associação entre a exposição às demandas emocionais e a possibilidade de apresentar sintomas depressivos ou distress elevado. RESULTADOS: as prevalências encontradas são mais acentuadas que na população em geral, tanto no que diz respeito às demandas emocionais do trabalho como nos resultados relativos a saúde mental. CONCLUSÃO: corrobora-se a hipótese de que a natureza da tarefa que expõe a elevadas demandas emocionais tem efeitos negativos na saúde mental. Assim, a preocupação pela saúde mental de pessoas que desenvolvem trabalhos dessa natureza deve ser um tema prioritário e, como consequência, requerem-se medidas urgentes para prevenir o surgimento de problemas de saúde mental...

Sintomas depresivos y distres laboral en trabajadores chilenos: condiciones diferenciales para hombres y mujeres / Depressive symptoms and work-related stress in Chilean workers: differential conditions for males and females / Sintomas depressivos e estresse em trabalhadores chilenos: condicoes diferenciais para homens e mulheres

El objetivo fue evaluar sintomatología depresiva, asociada a factores de riesgo psicosocial laboral según sexo en Chile, mediante los modelos demanda-control (Karasek) y desequilibrio esfuerzo-recompensas (Siegrist). El estudio fue transversal con una muestra aleatoria de 3010 trabajadores asalariados (35% mujeres y 65% hombres) de todo el país. Se determinó prevalencias y asociaciones a través de diversas técnicas estadísticas (eg. χ 2 ; regresión logística). La exposición a factores de riesgo psicosocial laboral y la prevalencia de sintomatología depresiva es mayor en mujeres que en hombres (15% vs. 5%). En los análisis ajustados destaca que mujeres expuestas a Isostrain (OR = 2,34; IC95%: 1,42-3,85) y bajas recompensas (OR = 2,13; IC95%: 1,41-3,21), y hombres expuestos a demandas psicológicas (OR = 3,04; IC95%: 1,94-4,76) y desequilibrio esfuerzos-recompensas (OR = 2,19; IC95%: 1,39-3,46), tienen una chance aumentada de sintomatología depresiva al compararse con los no expuestos. La exposición a factores de riesgo psicosocial laboral se asoció con síntomas depresivos en trabajadores chilenos. Resulta clave generar prevención en aspectos de la organización del trabajo.

This article assessed depressive symptoms associated with work-related psychosocial risk factors according to gender in Chile, using the demand-control model (Karasek) and effort-reward imbalance (Siegrist). A cross-sectional study was conducted in a random sample of 3,010 workers (35% female and 65% male) from the country. Data analysis determined prevalence and associations through various statistical techniques (χ 2 , logistic regression). Exposure to psychosocial risk factors at work and prevalence of depressive symptoms were higher in women than men (15% vs. 5%). The adjusted analysis highlighted that female workers exposed to Isostrain (OR = 2.34; 95%CI: 1.42-3.85) and low rewards (OR = 2.13; 95%CI: 1.41-3.21) and male workers exposed to psychological demands (OR = 3.04; 95%CI: 1.94-4.76) and effort-reward imbalance (OR = 2.19; 95%CI: 1.39-3.46) had increased risk of depressive symptoms. Exposure to work-related psychosocial risk factors was associated with depressive symptoms in Chilean workers. Effective prevention in key aspects of work organization is thus needed.

O objetivo foi avaliar os sintomas depressivos associados com fatores de risco ocupacionais psicossociais, por sexo, no Chile, por meio do modelo demanda-controle (Karasek) e desequilíbrio esforço-recompensa (Siegrist). O estudo foi transversal, com uma amostra aleatória de 3.010 empregados (35% mulheres e 65% homens) em todo o país. Prevalência e associações foram determinados por diversas técnicas estatísticas (eg. χ 2 ; regressão logística). A exposição ao fatores de risco ocupacionais psicossociais e prevalência de sintomas depressivos é maior em mulheres do que em homens (15% vs. 5%). Análise ajustada salienta que as mulheres expostas a Isostrain (OR = 2,34; IC95%: 1,42-3,85) e baixa recompensa (OR = 2,13; IC95%: 1,41-3,21) e homens expostos a demandas psicológicas (OR = 3,04; IC95%: 1,94-4,76) e desequilíbrio esforço-recompensa (OR = 2,19; IC95%: 1,39-3,46) têm chance maior de sintomas depressivos quando comparado com o não exposto. A exposição a fatores de risco ocupacionais psicossociais foi associada com sintomas depressivos em trabalhadores chilenos. A geração de cuidados preventivos em aspectos de organização do trabalho é fundamental.

Riesgo psicosocial laboral y patología mental en trabajadores de hospital / Psychosocial risk at work and mental illness in hospital workers

Existe crecinte evidencia en torno a las asociaciones entre la exposición a riesgo psicosocial laboral y analizar la presencia de riesgo psicosocial laboral y sintomatología de salud mental en trabajadores no clínicos de un hospital público. Metodología: estudio transversal descriptivo asociativo en trabajadores no clínicos de un hospital público de Santiago (Chile). Se aplicó un cuestionario autoadministrado para evaluar exposición al riesgo psicosocial (modelos demanda-control y desbalance esfuerzo-recompensas). Las varibales resultado fueron sintomatología depresiva, ansiosa, y consumo de psicotrópicos. El análisis fue descriptivo y asociativo (prueba exacta de Fisher). Resultados: 47% de los trabajadores presentan alta demanda psicológica, 46% baja autonomía, 61% bajo apoyo social y 75% desbalance entre el esfuerzo invertido y las recompensas percibidas. La prevalencia de sintomatología depresiva y ansiosa en la muestra total fue de 10% y 30% respectivamente, mientras que el 25% declara haber consumido psicotrópicos. El consumo de psicotrópicos fue significativamente más alto (p-0,05) entre las personas con bajo apoyo social y con desbalance esfuerzo-recompensa. Discusión: el consumo de psicotrópicos se asoció con bajo apoyo social y con un desbalance entre los esfuerzos invertidos en el trabajo y las recompensas percibidas. Esto pudiera tener implicancias en la salud y el desempeño de los trabajadores, por lo que se requiere de nuevos estudios, especialmente en esta población, para comprender esta relación y generar programas de prevención en esta materia.

There is growing evidence on the association between exposure to psychosocial risk at work and adverse health outcomes. Objetive: to describe and analyze the presence of spycholosocial risk at work and mental health symptoms in non-clinical workers from a public hospital. Methods: a cross-sectional study was conducted at a public hospital in Santiago (Chile). A self-administered questionnaire was applied to assess exposure to psychosocial risk ( demand-control and effort-reward imbalance models). The outcome variables were depression symptoms, and psychotropic drug consumption. The analysis was descriptive and associative (Fisher´s exact test). Results: 47% of the workers showed high psychological demands, 46% low autonomy, 61% low social support and 75% imbalance between effort expended and rewards received. The prevalence of depressive and anxious symptoms in the total sample was 10% and 30% respectively, while 25% reported having used psychotropic drugs. The consumption of psychotropic drugs was significantly higher (p < 0.05) among those with low social support and effort-reward imbalance. Discussion: the consumption of psychotropic drugs was associated with low social support and imbalance between efforts expended and rewards received. This might have implications in the workers’ health and performance; therefore, further research is required, particularly on this kind of population, to understand this relationship and thus develop prevention programs in this regard.

Malestar psicofisiológico en profesionales de la salud pública de la Región Metropolitana / Psychophysiological distress among health care professionals working in Chilean public hospitals

Background: The public health reform in Chile resulted in changes in working conditions and organization of health centers. Aim: To examine the presence of psychophysiological symptoms in professionals of public hospitals in the Metropolitan Region and their association with current working conditions. Material and Methods: A questionnaire of quality of working life was applied to a sample of 80 physicians and 110 nurses. The questionnaire considers scales and open questions. Results: Nurses had a higher level of discomfort than physicians (p < 0.01) and had significantly higher scores for emotional distress, physical fatigue, digestive disorders, headache, insomnia, back pain and muscle tension (p < 0.01). There were statistically significant negative correlations between psychophysiological distress and working conditions (r = -0.418), social climate (r = -0.395), satisfaction with the organization (r = -0.337) and psychosocial well-being (r = -0.267). A regression model showed that 21 percent of the variance in psychophysiological distress was explained by working conditions, psychosocial well-being and adaptation to the organization. Conclusions: There is a relationship between the high prevalence of psychophysiological symptoms and bad working conditions of public health professionals.