Relationships of demandingwork conditions with fatigueand psychotropic drug use:A community-based study

Lorhandicap group:N Chau, JF Ravaud, E Bourgkard, J Sanchez, M Choquet,JP Meyer, C Otero Sierra,JP Michaely, B Legras, F Guillemin,A Bhattacherjee, S Guillaume, A Dazord,L Méjean, N Tubiana-Rufi, Y Schléret, JM MurINRS, Département Epidémiologie en Entreprises, Vandoeuvre-lès-Nancy, Inserm U420, INRS, Inserm U472, Inserm U502-CERMES, IFR25-RFRH, Script-Inserm, EA 3444, LIM, Hôpital Robert Debré APHP, CTNERHI, ORSAS (France), and Indian Institute of Technology (India)

Investigation supported by the European Pole for Health

Epicoh 2004 – Melbourne, 13-15 October 2004

Objective

Demanding work conditions with multiple hazards can increase psychotropic drug use

Assessment of the relationships of demanding work conditions with regular psychotropic drug use among employed people

Epicoh 2004 – Melbourne, 13-15 October 2004

Materials and methodsThe sample: All subjects aged 15 or more from 8,000 households randomly selected from the Lorraine (north-eastern France)

Mailed self-administrated questionnaire: • socio-demographical characteristics, smoking habit, alcohol use • highly demanding occupational hazards • regular psychotropic drug use (fatigue, headache, sleeplessness, nervousness or anguish)

Epicoh 2004 – Melbourne, 13-15 October 2004

Study protocol

(a) A request of participation by means of a questionnaire to ascertain the number of people in the household

(b) Sending out standardized auto-questionnaires with a covering letter and a pre-paid envelope for reply

(c) Sending a reminding letter without questionnaire

(d) Sending questionnaires with a covering letter and a pre-paid envelope

Communications addressed to the households at one month intervals

The results were expressed in terms of adjusted odds ratios

Epicoh 2004 – Melbourne, 13-15 October 2004

Results

7,807 households contacted (193 communications lost, 2%)

3,460 households participated (44.3%) Every member participated for 86% of these

households

6,214 participants

The present study concerned the 2,826 employed people

Epicoh 2004 – Melbourne, 13-15 October 2004

Fig. 1. Distribution of the sample (n=6,214) and the Lorraine population (n=1,848,579 – Insee census) according to age (%)

0

2

4

6

8

10

12

14

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70 o

r over

Sample Lorraine population

Epicoh 2004 – Melbourne, 13-15 October 2004

Men 56.6Age (yr) : mean (SD) 38.5 (10.2)Current smokers 34.4Excess alcohol use 8.9

Job category Executives, intellectual professionals, teachers18.2 Workmen 21.6 Foremen 4.8 Employees 35.5 Farmers, craftsmen, tradesmen 5.1 Technicians 6.0 Others 8.8

Table 1. Characteristics of the subjects (n = 2826): %

Epicoh 2004 – Melbourne, 13-15 October 2004

Table 2. Demanding occupational hazards: %

Noise 28.0Mental workload 26.3Artificial light 20.8Heat 18.7Standing about and

walking 18.5Pace 18.2Cold 16.0Wrong work posture 14.3Handling objects 13.2Physical workload 10.0Working in adverse

climates 6.2Hand tools with vibration5.1Workplace with vibration

3.9

Working on production line3.4Tasks at high level 3.3Shocks 2.3Machine tools 2.2Heat radiation 1.6Hammer 1.6Screwdriver 0.9

Number of hazards 0 40.1 1-2 40.2 3-4 12.2 5 or over 7.5

Epicoh 2004 – Melbourne, 13-15 October 2004

Fig. 2. Prevalence of psychotropic drug use (%)

3,84,37,1

21,5

30

0

5

10

15

20

25

30

35

All drugs

combined

Headache Nervousness

or anguish

Sleeplessness Fatigue

Epicoh 2004 – Melbourne, 13-15 October 2004

Table 3. Prevalence of psychotropic drug use according to age, sex, smoking habit and alcohol use: %

Age (yr) 15-29 33.9 30-39 27.1 40-49 30.3 NS (p = 0.064) 50-59 31.1 60 or over 28.6Sex Men 23.5 p < 0.001 Women 38.5Smoking habit Current smokers 32.0 NS Others 28.9Excess alcohol use Yes 30.0 NS No 30.0

Epicoh 2004 – Melbourne, 13-15 October 2004

Table 4. Psychotropic drug use for various job categories compared to executives, intellectual professionals, and teachers: OR adjusted on age

and sex and 95% CI

Executives, intellectual professionals, teachers 1.00

Workmen 1.98‡ (1.49-2.65)

Foremen 1.76† (1.12-2.76)

Employees 1.64‡ (1.27-2.13)

Farmers, craftsmen, tradesmen 1.68* (1.09-2.60)

Technicians 1.76† (1.12-2.76)

Others 1.21 (0.82-1.79)

*p < 0.05, †p<0.01, ‡p<0.001

Epicoh 2004 – Melbourne, 13-15 October 2004

Table 5. Relationship between the number of hazards NH and psychotropic drug use : 0R adjusted on age, sex and job and 95% CI

Number Fatigue Headache Sleeplessness Nervousness of subjects or anguish

NH=0 1134 1.0 1.0 1.0 1.0

NH=1 or over 1792 1.66* 1.39† 2.46‡ 2.00‡ (1.02-2.69) (1.12-1.73) (1.46-4.13) (1.36-2.91)

1-2 1137 1.48 1.25* 2.14† 1.67* (0.88-2.47) (1.00-1.57) (1.25-3.68) (1.12-2.51)

3-4 344 1.61 1.52† 3.43‡ 2.67‡ (0.85-3.07) (1.11-2.07) (1.74-6.75) (1.61-4.41)

5 or over 211 1.74 2.08‡ 2.65 5.98‡ (0.73-4.12) (1.36-3.17) (0.95-7.40) (2.71-13.17) *p < 0.05, †p<0.01, ‡p<0.001

Epicoh 2004 – Melbourne, 13-15 October 2004

Fig. 3. Relationship between the number of hazards NH and psychotropic drug use : 0R adjusted on age, sex and job and 95% CI

1.44(1.15-1.75)

1.66(1.26-2.20)

2.74(1.83-4.09)

0

0,5

1

1,5

2

2,5

3

NH 0 NH 1-2 NH 3-4 NH 5 orover

Epicoh 2004 – Melbourne, 13-15 October 2004

Conclusions

• Demanding work conditions may cause psychotropic drug use

• Prevention should reduce occupational hazards, particularly when their number is high