Mental health problems and suicidal behaviors in person-related work: a Swedish register-based cohort study

OBJECTIVES: Person-related work requires workers to interact with individuals who are not employed at the workplace, eg, clients or patients. Besides (i) the general demands of interpersonal contact, this can entail (ii) emotional demands and (iii) conflicts/quarrels. These three potential stressors may negatively affect workers' mental health. We examined the associations of these three dimensions of person-related work with the risk of mental health problems, including diagnoses of depressive, anxiety/stress-related and alcohol-/drug-use disorders, pharmacotherapy for such disorders, and suicidal behaviors, including deaths and suicide attempts. METHODS: Around 3.6 million workers aged 20-60 years in Sweden in 2006 were included in the study. Dimensions of person-related work were assessed respectively using a job exposure matrix. Mental health and suicide outcomes in 2007-2020 were determined based on patient, drug, and death registers. Multi-variable Cox regression models were used. RESULTS: Of the study participants, 1 481 900 individuals experienced at least one of the studied outcomes. Among women, high exposure to each dimension of person-related work was respectively associated with increased risks of the outcomes [hazard ratios (HR) of 1.04-1.27 for general contact with people, 1.16-1.41 for emotional demands, and 1.11-1.19 for conflicts/quarrels], after adjusting for potential confounders. Among men, a high exposure to each dimension was respectively associated with increased risks (HR of 1.11-1.16 for general contact with people, 1.10-1.23 for emotional demands, and 1.08-1.16 for conflicts/quarrels) of mental health diagnoses and pharmacotherapy. The associations with suicide deaths and attempts were not observed after adjusting for income and previous mental health problems and suicide attempts. CONCLUSIONS: Person-related work is associated with a slightly increased risk of mental health problems and suicidal behaviors among women and with mental health problems among men. Estimates seem to be strongest for emotional demands.