Mental Health in the Association of Working Environment Stress and Work Performance among Aviation Crew Members: A Nationwide Cross-sectional Study

Abstract Introduction: Aviation crew members often face high work stress, which is under-researched. This study investigates the association between working environment stress and work performance among aviation crew members while examining the mediating role of mental health. Methods: A total of 19,137 aviation crew members (61.6% male), with a mean age of 32.2 ± 6.2 years, were included in the analysis. Working environment stress, anxiety, and depression were measured by the Nordic Work Psychiatry and Social Factors Questionnaire (QPS-Nordic), 7-item Generalized Anxiety Disorder Scale, and 9-item Patient Health Questionnaire, respectively. Use the single item in the Health and Work Performance Questionnaire to evaluate work performance. Unordered logistic regression analyzed the relationship between working environment stress and work performance, whereas mediation analysis examined the role of anxiety and depression. Results: Results showed that 51.6% of aviation crew members reported medium to high levels of working environment stress, with 7.3% showing anxiety and 11.7% experiencing depression. Compared to low stress, moderate stress increased the odds of poor work performance by 2.38 times (odds ratio [OR] =2.38, 95% confidence interval [CI]: 2.17–2.61), and high stress by 2.48 times (OR = 2.48, 95% CI: 2.17–2.83). Higher working environment stress was linked to increased risks of anxiety and depression, which mediated 68.2% and 71.8% of the relationship between working environment stress and work performance, respectively. Conclusion: High working environment stress among aviation crew can lower work performance, mediated by anxiety and depression. Prioritizing mental health and stress management is crucial to prevent negative impacts.