title: Contribution of working conditions to occupational inequalities in depressive symptoms: results from the national French SUMER survey.
abstract: OBJECTIVE
  Social inequalities in mental health have been observed, but explanations are still lacking. The objectives were to evaluate the contribution of a large set of psychosocial work factors and other occupational exposures to social inequalities in mental health in a national representative sample of employees.
  
  
  METHODS
  The sample from the cross-sectional national French survey SUMER 2010 included 46,962 employees: 26,883 men and 20,079 women. Anxiety and depression symptoms were measured using the Hospital Anxiety and Depression scale. Occupation was used as a marker of social position. Psychosocial work factors included various variables related to the classical job strain model, psychological demands, decision latitude, social support, and other understudied variables related to reward, job insecurity, job promotion, esteem, working time/hours, and workplace violence. Other occupational exposures of chemical, biological, physical, and biomechanical nature were also studied. Weighted age-adjusted linear regression analyses were performed.
  
  
  RESULTS
  Occupational gradients were found in the exposure to most psychosocial work factors and other occupational exposures. Occupational inequalities were observed for depressive symptoms, but not for anxiety symptoms. The factors related to decision latitude (and its sub-dimensions, skill discretion, and decision authority), social support, and reward (and its sub-dimensions, job promotion, job insecurity, and esteem) contributed to explain occupational inequalities in depressive symptoms. Decision latitude played a major role in the explanation. Workplace violence variables contributed among men only. Other exposures of physical and biomechanical nature also displayed significant contributions.
  
  
  CONCLUSIONS
  Comprehensive prevention policies at the workplace may help to reduce social inequalities in mental health in the working population.
authors.affiliation: Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, INSERM, UMR_S 1136, 75013, Paris, France. isabelle.niedhammer@inserm.fr.|Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 75013, Paris, France. isabelle.niedhammer@inserm.fr.|Faculté de Médecine Pierre et Marie Curie - pôle Saint-Antoine, INSERM UMRS 1136, IPLESP, Team 7 (ERES), 27 rue de Chaligny, 75012, Paris, France. isabelle.niedhammer@inserm.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Niedhammer
authors.affiliation: Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, INSERM, UMR_S 1136, 75013, Paris, France.|Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 75013, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lesuffleur
authors.affiliation: Ministry of Labour, DARES, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Coutrot
authors.affiliation: Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, INSERM, UMR_S 1136, 75013, Paris, France.|Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 75013, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Chastang
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D005602:France; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000523:psychology*; D016273:Occupational Exposure / Q000009:adverse effects; D012201:Reward; D012307:Risk Factors; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology; D014937:Work / Q000523:psychology*; D017132:Workplace / Q000523:psychology*
keywords: Depressive symptoms; Mental health; Occupational exposures; Psychosocial work factors; Social inequalities in health; Working conditions