Occupational stressors and common mental disorders: generational and gender differences in the ELSA-Brasil cohort

Abstract

Objective  To analyze the association between occupational stressors and common mental disorders, by sex and birth cohort.

Methods  A cross-sectional study of currently employed workers participating in the baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Common mental disorders (CMD) were assessed using the Clinical Interview Schedule – Revised (CIS-R), and occupational stressors using the Swedish Demand-Control-Support Questionnaire (DCSQ). Binary logistic regression was employed, stratified by sex and birth cohort.

Results  A total of 11,601 workers participated, 52.1% of whom were female. The overall prevalence of CMD was 26.8%, 35.9% among women, and 19.3% among men. Occupational stressors and CMD were associated after adjustment only among working women of the Baby Boomer generation (OR = 1.32; 95% CI = 1.13, 1.54) and those in high-demand jobs (OR = 1.41; 95% CI = 1.14, 1.73), and among Generation X women who were currently employed (OR = 1.39; 95% CI = 1.09, 1.78).

Conclusion  It is necessary to investigate long-term effects associated with the occurrence of life events that generate stressors and factors that may potentially modify their impact. Interventions targeting the most affected groups, in the workplace and/or health care settings, are recommended for the promotion and protection of health.

Keywords:
Common Mental Disorders; Gender and Health; Generational Differences; Occupational Stress; Mental Health; Occupational Health

Resumo

Objetivo  Analisar a associação entre estressores ocupacionais e transtornos mentais comuns, segundo sexo e geração de nascimento.

Métodos  Estudo transversal com trabalhadores ativos participantes da linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Transtorno mental comum (TMC) foi mensurado com o Clinical Interview Schedule – Revised (CIS-R) e estressores ocupacionais com o Questionário Sueco de Demanda-Controle-Apoio Social (DCSQ). Empregou-se regressão logística binária, com estratificação por sexo e geração de nascimento.

Resultados  Participaram 11.601 trabalhadores, 52,1% do sexo feminino. A prevalência global de TMC foi 26,8%, 35,9% entre as mulheres e 19,3% entre os homens. Houve associação entre estressores ocupacionais e TMC após ajuste apenas entre mulheres da Geração Baby Boomer com trabalho ativo (OR = 1,32; IC95% = 1,13; 1,54) e de alta exigência (OR = 1,41; IC95% = 1,14; 1,73) e entre mulheres da Geração X com trabalho ativo (OR = 1,39; IC95% = 1,09; 1,78).

Conclusão  Evidenciou-se a necessidade de se investigar efeitos de longo prazo associados à ocorrência de eventos de vida produtores de estressores e fatores que potencialmente modifiquem seu impacto. Ações voltadas a grupos mais afetados, no ambiente de trabalho e/ou nos serviços de saúde, são recomendadas para a promoção e proteção da saúde.

Palavras-chave:
Transtornos Mentais Comuns; Gênero e Saúde; Diferenças Geracionais; Estresse Ocupacional; Saúde Mental; Saúde do Trabalhador

Introduction

Mental disorders have become one of the most significant psychosocial phenomena of our time, with high prevalence in low-, middle-, and high-income countries worldwide and accounting for approximately one-third of all mental illnesses¹,². Common mental disorders (CMDs) refer to symptoms such as insomnia, anxiety, depression, irritability, difficulty concentrating, forgetfulness, fatigue, and somatic complaints, affecting more women than men². Among these, depression and anxiety are the leading causes of disability worldwide, accounting for approximately 40 million disability-adjusted life years (DALYs) in the 20–29 age group³. According to the Pan American Health Organization, in Latin America, Brazil has the highest prevalence of depression, with 5.8% of the population suffering from depression and 9.3% experiencing anxiety-related symptoms¹-³.

In the workplace, CMDs have imposed economic and social burdens on society as a whole, serving as the primary factors driving up the cost of the disease burden in industrialized Western countries due to absenteeism and disability³. In a study examining the association between CMDs and occupational stress among French public-sector workers, the prevalence of the problem among women was nearly twice that of men⁴. Also in the French context, the 2010 SUMER National Survey, conducted every seven years by the French Ministry of Labor among approximately 50,000 workers to examine associations between psychosocial factors at work and sick leave, showed that periods of absence and depression related to work-related stress were significantly higher among women⁵,⁶.

The stress experienced in many workplace situations compounds the trend toward precariousness in the world of work and is associated with the intensification of production rhythms, long workdays, and the demand for versatile and multifaceted workers. In this context, work processes at universities have also undergone a series of changes and uncertainties, the demands of which can create stressful conditions for their workforce⁷. Characteristics such as low control, high demands, and low social support in the workplace have been reported as risk factors for mental health problems in epidemiological studies¹,⁵.

Given the multiple causes of stress and the amount of time spent on work during adulthood, it is important to identify possible mechanisms through which the work environment affects workers’ health. The psychosocial aspects of work are sources of occupational stress, with impacts on mental health⁸-¹⁰. Among these possible mechanisms, gender and generation of birth are considered social constructs that strongly influence the health-illness process¹¹.

Gender is a recognized social marker. Analyzing the role of these differences is essential for better understanding the inequalities and health problems that occur in workplace contexts¹²-¹⁴. Studies examining the relationship between gender and workers’ mental health have been conducted in various countries⁹,¹⁰,¹⁵ and indicate that women and men from different populations have varying risks of work-related stress-induced illness.

Just as gender stems from social construction, birth cohorts are also socially influenced. The historical context of birth and of each life stage determines behaviors and reflects different risks of illness among generational groups¹⁶. Discussions about generations have gained relevance, especially due to the need to understand how individuals from different generational groups respond to situations experienced at work, considering their cultural contexts, their relationships in work environments, and the strategies they develop to cope with work pressures and demands.

Occupational stress encompasses dimensions of the psychological demands involved in work and the degree of control workers have over their own work. It is suggested that most adverse reactions to psychological demands are centrally related to these dimensions of work, since, when combined, they generate different work situations with varying impacts on workers’ mental health¹⁷.

It is well known that individuals behave in distinct ways depending on the context in which they live and the influences they have received and/or continue to receive throughout their lives. They may have different attitudes toward the pressures generated in these settings, given how they deal with the organization and work processes; these categories of analysis influence workers’ autonomy and competitiveness, which are key determinants for the emergence of CMDs, which, in turn, can make a particular generation more susceptible to work-related illnesses. Thus, this study aims to analyze the association between occupational stress and CMDs, according to sex and birth generation.

Methods

Study Design and Context

This cross-sectional study used baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). This is a Brazilian, multicenter cohort study involving 15,105 participants from six educational and research institutions in the Northeast, Southeast, and South regions of the country (Federal University of Bahia – UFBA, University of São Paulo – USP, Federal University of Espírito Santo – UFES, Federal University of Minas Gerais – UFMG, Federal University of Rio Grande do Sul – UFRGS, and the Oswaldo Cruz Foundation – Fiocruz)¹⁸ with the primary objectives of investigating the incidence and progression of diabetes and cardiovascular diseases and their biological, behavioral, environmental, occupational, psychological, and social determinants¹⁸. Data was collected through a questionnaire administered by trained interviewers who were supervised at all stages by the coordination team¹⁸. The cohort’s methodological procedures are detailed in other publications¹⁸,¹⁹.

Participants

All participants who took part in the ELSA-Brasil baseline survey at the six institutions (2008–2010) were eligible for the study, except for retirees (n = 3,009). Participants of Indigenous or Asian race/ethnicity were excluded from the statistical modeling analysis, as they accounted for 3.47% of the total, as were participants who did not answer all questions regarding occupational stress or the CMD assessment, totaling 11,601 workers, 6,046 of whom were female and 5,555 male.

Variables

Outcome: Common Mental Disorders (CMD)

To assess CMDs, the Clinical Interview Schedule - Revised (CIS-R) questionnaire²⁰ was used – an instrument translated into Brazilian Portuguese and adapted to the cultural context through translation and cross-cultural adaptation processes, to ensure its more reliable use in this cohort of workers ²⁰. The CIS-R is a structured interview designed to measure neurotic symptoms over the past 30 days and the 7 days preceding the interview, through 14 sections: somatic symptoms, fatigue, concentration and forgetfulness, sleep problems, irritability, concern about physical health, depression, depressive ideas, worries, anxiety, phobias, panic, compulsions, and obsessions²⁰. A CIS-R score of 12 or higher indicates the presence of CMDs (the instrument’s score ranges from 0 to 57)²⁰,²¹.

Main Exposure: Occupational Stressors

The assessment of occupational stressors was limited to participants who were employed at the time of the interview, since the instruments used measure characteristics of current work, such as psychological demands, control over work, and social support. These models were developed to assess psychosocial exposures during work activities; their application to retired, unemployed, or on-leave individuals is not recommended, as this could compromise the validity of the measure and introduce exposure classification error²¹-²³.

To assess occupational stressors in this study, alongside the CIS-R, the Brazilian version of the Swedish Demand-Control-Support Questionnaire (DCSQ), the Job Stress Scale, developed by Theorell in 1988 and adapted into Portuguese by Alves et al.²², was used. The DCSQ covers three dimensions: psychological demands (five items); job control (six items); and social support at work (six items), with Likert-scale responses. Each dimension was scored as the sum of all corresponding items and then categorized as high or low using the median of the study population as the cutoff point (14 points for psychological demands of work and 18 points for job control)²³.

Based on the combination of demand and control levels, the four quadrants predicted by the Karasek model were established, characterizing the work situation as low-demand (high control and low demand), which represents the reference group classified as unexposed; passive work (low demand and low control) and active work (high demand and high control) were considered intermediate exposure groups; high-demand work (high demand and low control) was considered the group with the highest exposure. Social support at work was dichotomized into high or low using the median value in the study sample as the cutoff point (18 points)²¹,²⁴.

The Brazilian version of the DCSQ demonstrated internal consistency with intraclass correlation coefficients of 0.88, 0.87, and 0.86 and Cronbach’s alpha of 0.72, 0.63, and 0.86 for the dimensions of psychological demands of work, job control, and social support at work, respectively²². The dimensional structure of this instrument was evaluated in studies conducted with different occupational groups²³.

Covariates

To construct the “birth generation” variable, the “year of birth” variable was used to categorize three generational cohorts: i - Traditionalists or the Vargas Era (the generation born between 1934 and 1945, aged 63 to 74 at the start of the study); ii - Baby Boomers or Pre-Dictatorship Generation (those born between 1946 and 1964, aged 44 to 62 at the start of the study); and iii - Generation X or Dictatorship Generation (those born between 1965 and 1975, aged 35 to 43 at the start of the study). In this study, the generations were referred to as Traditionalists, Baby Boomers, and Generation X, to align with the terminology used in other studies.

The variable “sex” was used in this study as a proxy for gender, given the growing body of evidence in the literature²⁵ pointing to differences between women and men regarding social roles. The participants’ generation and sex were treated as effect-modifying variables in this study.

The confounding covariates analyzed were selected based on the literature and derived from questionnaires that included questions on sociodemographic aspects (self-reported race/skin color, educational attainment, and marital status); health behaviors (leisure-time physical activity, considering weekly engagement in minutes of light activity [walking] and moderate- and vigorous-intensity activities; alcohol consumption, smoking, and medication use); and work-related variables (weekly work hours, time in current job [years], psychological demand, control over work, and social support).

Weekly working hours were categorized as less than 40 hours/week, exactly 40 hours/week, and more than 40 hours/week, since a 40-hour workweek is common in the university setting.

Statistical Analysis

Descriptive statistics were applied to obtain the frequency distributions of the variables of interest and the primary exposure. The prevalence of the outcome variable (CMD) was analyzed according to population characteristics by sex and across exposure groups, with differences assessed using tests based on Pearson’s chi-square distribution. The exposure, occupational stress, was analyzed by quadrants (low-demand work, passive work, active work, and high-demand work) and by individual dimensions (psychological demand of work, degree of control over work, and social support at work). For the quadrant models, the “low-demand work” quadrant was used as the reference category.

The presence of potential confounders and effect modifiers in the association between occupational stress and CMDs was assessed for the following covariates, selected based on the literature: self-reported race/skin color, marital status, educational level, physical activity during leisure time, use of antidepressants and benzodiazepines, alcohol consumption, smoking status, length of time in current occupation, and weekly work hours.

Interactions were identified using the Likelihood Ratio Test after defining the saturated and reduced logistic regression models for each of the possible effect-modifying variables and their corresponding product terms. No effect-modifying variables were identified for the associations studied, according to this test at the 5% level²⁶. The backward method was used to include variables in the logistic regression model and to assess potential confounders. The analysis began with a full model including potential confounders. Variables were considered potential confounders if their percentage change was 10 or more when comparing the crude association with the adjusted association. All analyses to assess potential confounders and effect modifiers were performed separately by gender and birth cohort. Cohort and sex were treated as a priori effect modifiers.

To examine the association under study, the odds ratio (OR) with a 95% confidence interval (CI) was calculated for both the crude and adjusted associations. Logistic regression analyses included only participants with no missing data for the variables included in the models.

Analyses of the association between occupational stress and CMDs, by generation and sex, were adjusted for the following confounding variables: educational level, weekly working hours, length of time in the current job, and social support. The final binary logistic regression model, conducted for both sexes, included only the Baby Boomer and Generation X cohorts, as there was no positive and statistically significant association for any variable in the Traditionalist Generation. No interaction effects were found. All analyses were performed using Statistics Data Analysis (Stata), version 14.

Ethical Considerations

The ELSA-Brasil study was approved by the Research Ethics Committee of the Institute of Collective Health (CEP/ISC No. 027-06) on May 26, 2006, and by the Research Ethics Committees of the six research centers. All participants signed an informed consent form.

Results

Of the 11,601 active participants, 52.1% were female. Among the women, 70.31% belonged to the Baby Boomer generation, the majority of whom had completed higher education (55.35%), self-identified as white (52.36%), and were in a stable relationship (55.04%). Most of the male sociodemographic characteristics were similar to those of the women, except for marital status (married). In this category, 81.09% of men were married, representing a 47% higher proportion (relative difference) compared to women (Table 1)

Table 1
General characteristics of the working-age participants by sex. ELSA-Brasil, 2008–2010 (n = 11,601)

Sociodemographic characteristics	Men (n = 5,555)		Women (n = 6,046)		p-value
	n	%	n	%
Birth cohort					0.131
Traditionalist	172	3.10	152	2.51
Baby Boomers	3,912	70.42	4,252	70.31
Generation X	1,471	26.48	1,642	27.18
Education Level					<0.001
Up to complete elementary school	815	14.67	440	7.27
Complete high school graduate	1,980	35.64	2,261	37.38
Complete Higher education	2,760	49.69	3,348	55.35
Race/Skin Color*					<0.001
White	2,907	53.03	3,138	52.36
Brown	1,767	32.23	1,716	28.63
Black	808	14.74	1,139	19.01
Marital status					<0.001
Married/In a relationship	4,505	81.09	3,328	55.04
Separated/Divorced	563	10.14	1,315	21.75
Single	309	5.56	847	14.01
Widower	52	0.94	284	4.70
Other (previously married)	126	2.27	272	4.50
Physical activity**					<0.001
Light	4,088	74.76	4,872	81.82
Moderate	870	15.91	766	12.86
Strong	510	9.33	317	5.32
Smoking Habits					<0.001
Never smoked	2,920	52.57	3,814	63.08
Former smoker	1,821	32.78	1,463	24.20
Smoker	814	14.65	769	12.72
Alcohol consumption***					<0.001
Currently drinks	4,244	76.41	3,960	65.53
Does not currently drink	1,074	19.34	1,187	19.64
Has never drunk	236	4.25	896	14.83
Antidepressant Use					<0.001
No	5,389	97.01	5,555	91.88
Yes****	166	2.99	491	8.12
Benzodiazepine use					<0.001
No	5,445	98.02	5,803	95.98
Yes	110	1.98	243	4.02
Areas of Work
Weekly Work Hours					<0.001
<40 hours	714	12.85	1,349	22.31
40 hours	2,722	49.00	2,999	49.60
>40 hours	2,119	38.15	1,698	28.09
Time in current job (years)					<0.001
0–9	2,017	36.31	2,450	40.52
10–19	1,683	30.30	1,987	32.87
20 or more	1,855	33.39	1,609	26.61
Psychological demand					0.016
Low/Medium	3,038	54.69	3,170	52.43
High	2,517	45.31	2,876	47.57
Control over work					0.182
High	4,011	72.21	4,299	71.10
Low/Medium	1,544	27.79	1,747	28.90
Social Assistance					0.061
High	5,185	93.34	5,589	92.44
Low/Medium	370	6.66	457	7.56
Occupational Stress (DCM)*****					0.008
Low requirement	2,155	38.79	2,264	37.45
Active employment	1,856	33.41	2,035	33.66
Passive work	883	15.90	906	14.98
High demands	661	11.90	841	13.91

• n = 11,601. Small differences in the total “n” for each variable are due to missing values. Missing values: * 73 (male) and 53 (female); ** 87 (male) and 91 (female); *** 1 (male) and 3 (female);
• ^**** Use of antidepressants (tricyclics, selective serotonin reuptake inhibitors, others, more than one class).
• ^***** Demand-Control Model: low-demand work (low demand and high control); active work (high demand and high control); passive work (low demand and low control); and high-demand work (high demand and low control).

Regarding health behaviors, most working women reported engaging in light recreational physical activity (82.12%), having never smoked (63.08%), and currently consuming alcoholic beverages (65.53%). As for medication use, 91.88% of the women did not take antidepressants, and 95.98% did not take benzodiazepines; statistically significant differences between the sexes were observed for these selected characteristics (p < 0.05) (Table 1).

Regarding work-related aspects, it was observed that most participants reported workweeks of 40 hours or fewer. The length of time in their current job differed between periods for both genders, with men reporting longer tenure. Regarding psychological demands, that is, time spent on work, task demands, and the pace of task completion, as well as the conflict between different demands, there were slight differences in low demand between men (54.69%) and women (52.43%). High control over work was similar among women (71.10%) and men (72.21%) (Table 1).

Regarding the dimension of social support, which reflects aspects related to relationships with coworkers and supervisors, both men (93.34%) and women (92.44%) reported working in a more pleasant environment and having less conflict-ridden interpersonal relationships. Occupational stress, measured using the demand-control- y model, showed that 37.45% of women and 38.79% of men were engaged in low-demand work, while 33.66% of women and 33.41% of men reported performing high-demand work. It is important to note that the variables “control over work” and “social support” did not show a statistically significant positive association with gender (Table 1).

Among the 11,601 active participants in the study, 26.8% had CMDs. However, a significant difference by sex was observed: the prevalence among females was 35.9%, and 19.3% among males, with a 86% higher odds ratio for CMDs among women compared to men (OR = 1.86; 95% CI 1.75; 1.98) (Table 2).

Table 2
Prevalence of common mental disorders (CMD), by selected variables and sex. ELSA-Brasil, 2008–2010 (n = 11,601)

Selected Variables	Male (n = 5,555)					Female (n = 6,046)
	n*	CMD (n)	Prevalence (%)	OR	95% CI	n*	CMD (n)	Prevalence (%)	OR	95% CI
Crude Prevalence	-	1,072	19.3	1.00		-	2,173	35.9	1.86	1.75; 1.98
Sociodemographic
Birth Cohort
Traditionalist	172	25	14.5	1.00		152	36	23.7	1.00
Baby Boomers	3,912	737	18.8	1.35	0.91; 2.09	4,252	1,506	35.4	1.51	1.08; 2.16
Generation X	1,471	310	21.1	1.55	1.03; 2.44	1,642	631	38.4	1.64	1.17; 2.36
Race/Skin Color
White	2,907	503	17.3	1.00		3,135	990	31.6	1.00
Black	808	162	20.0	1.16	0.96; 1.39	1,139	468	41.1	1.30	1.16; 1.46
Brown	1,767	393	22.2	1.29	1.12; 1.47	1,716	698	40.7	1.29	1.17; 1.42
Education
Up to complete elementary school	815	184	22.6	1.00		440	193	43.9	1.00
Complete high school graduate	1,980	456	23.0	1.02	0.86; 1.22	2,259	933	41.3	0.94	0.80; 1.10
Complete Higher education	2,760	432	15.7	0.69	0,58; 0,82	3,347	1,047	31.3	0.71	0.61; 0.84
Marital status
Single/Separated/Divorced/Widowed	1,050	261	24.9	1.00		2,718	970	35.7	1.00
Married/In a Relationship	4,505	811	18.0	0.72	0.63; 0.84	3,327	1,203	36.2	1.01	0.92; 1.10
Health behaviors
Physical activity
Moderate/Vigorous	1,380	207	15.0	1.00		1,083	282	26.0	1.00
Light	4,088	849	20.8	1.38	1.19; 1.62	4,871	1,860	38.2	1.47	1.29; 1.67
Smoking status
Never smoked/Former smoker	4,741	860	18.1	1.00		5,279	1,838	38.2	1.00
Smoker	814	212	26.0	1.43	1.23; 1.67	769	335	43.6	1.25	1.11; 1.41
Alcohol consumption
Has never drunk	236	47	19.9	1.00		896	321	35.8	1.00
Does not currently drink	1,074	252	23.5	1.18	0.86; 1.64	1,186	530	44.7	1.24	1.08; 1.44
Currently drinks	4,244	773	18.2	0.91	0.68; 1.26	3,958	1,321	33.4	0.93	0.82; 1.06
Antidepressant use
No	5,389	1,010	18.7	1.00		5,555	1,903	34.3	1.00
Yes **	166	62	37.3	1.99	1.52; 2.58	491	270	55.0	1.60	1.41; 1.82
Benzodiazepine use
No	5,445	1,021	18.8	1.00		5,803	2,020	34.8	1.00
Yes	110	51	46.4	2.46	1.82; 3.26	243	153	63.0	1.79	1.51; 2.12
Areas of Work
Weekly Work Hours
Up to 40 hours	3,436	656	19.1	1.00		4,350	1,518	34.9	1.00
More than 40 hours	2,119	416	19.6	1.02	0.90; 1.16	1,698	655	38.6	1.10	1.01; 1.21
Time in current occupation (years)
20 or more	1,855	327	17.6	1.00		1,609	529	32.9	1.00
0–9	2,017	421	20.9	1.20	1.03; 1.39	2,450	920	37.6	1.15	1.03; 1.28
10–19	1,683	324	19.3	1.11	0.95; 1.30	1,987	724	36.4	1.11	0.99; 1.24
Psychological demand
Low/Medium	3,038	552	18.2	1.00		3,170	1,040	32.8	1.00
High	2,517	520	20.7	1.13	1.01; 1.28	2,876	1,033	39.4	1.10	1.004; 1.20
Control over work
High	4,011	743	18.5	1.00		4,299	1,465	34.1	1.00
Low/Medium	1,544	329	21.3	1.15		1,747	708	40.5	1.19	1.08; 1.30
Social Assistance
High	5,185	935	18.0	1.00		5,589	1,922	34.4	1.00
Low/Medium	370	137	37.0	2.05	1.70; 2.46	457	251	54.9	1.60	1.40; 1.82
Occupational Stress (DCM)***
Low demands	2,155	381	17.7	1.00		2,264	689	30.4	1.00
Active workforce	1,856	362	19.5	1.10	0.95; 1.28	2,035	776	38.1	1.25	1.13; 1.39
Passive work	883	171	19.4	1.10	0.91; 1.32	906	351	38.7	1.27	1.11; 1.45
High demand	661	158	23.9	1.35	1.11; 1.63	841	357	42.4	1.40	1.22; 1.59

• Note: *Small differences in the total “n” for each variable are due to missing values. OR: Odds ratio; 95% CI: 95% confidence interval.
• ** Use of antidepressants (tricyclics, selective serotonin reuptake inhibitors, others, more than one class).
• *** Demand-Control Model: low-demand work (low demand and high control); active work (high demand and high control); passive work (low demand and low control); and high-demand work (high demand and low control).

Some results obtained from the group of women indicated a positive and statistically significant association with the presence of CMDs, such as: belonging to the Baby Boomer or Generation X birth cohorts, self-identifying as Black or Brown, engaging in light physical activity, being a smoker, not currently consuming alcohol, using antidepressants and benzodiazepines, having a weekly work schedule of more than 40 hours, having a shorter duration in the job (0 to 9 years), experiencing high psychological demand, low/moderate control over work, and low social support. Having completed higher education was a protective factor (OR = 0.71; 95% CI 0.61; 0.84) for the occurrence of CMDs among women (Table 2).

Among men of Generation X, a statistically significant positive association was observed between CMDs and self-reported brown race/skin color, engaging in light physical activity, being a smoker, using antidepressants and benzodiazepines, having less time in the occupation, experiencing high psychological demands, low control over work, low social support, and high job demands. Having completed a college degree was a protective factor against the occurrence of CMD (OR = 0.69; 95% CI 0.58; 0.82), as was having a stable marital status (OR = 0.72; 95% CI 0.63; 0.84) (Table 3).

Table 3
Prevalence of common mental disorders (CMDs) by selected variables, generation, and male gender. ELSA-Brasil, 2008–2010 (n = 5,555)

Characteristics	Generation/Male
	Traditionalist					Baby Boomers					Generation X
	Total* (n = 172)	CMD (n = 25)	P** (%)	OR***	95% CI	Total* (n = 3,912)	CMD (n = 737)	P** (%)	OR***	95% CI	Total* (n=1,471)	CMD (n=310)	P** (%)	OR***	95% CI
Sociodemographic
Race/Skin Color
White	114	12	10.5	1.00		2,031	341	16.8	1.00		762	150	19.7	1.00
Brown	31	7	22.6	2.15	0.72; 5.91	1,242	273	22.0	1.31	1.11; 1.54	494	113	22.9	1.16	0.90; 1.49
Black	22	6	27.3	2.59	0.80; 7.46	586	113	19.3	1.15	0.92; 1.42	200	43	21.5	1.09	0.75; 1.54
Education
Up to complete elementary school	34	7	20.6	1.00		688	154	22.4	1.00		93	23	24.7	1.00
Complete high school graduate	27	7	25.9	1.26	0.38; 4.21	1,403	324	23.1	1.03	0.84; 1.26	550	125	22.7	0.91	0.59; 1.50
Complete Higher education	111	11	9.9	0.48	1.17; 1.46	1,821	259	14.2	0.64	0.51; 0.78	200	162	19.6	0.79	0.51; 1.28
Marital status
Single/Divorced/Widowed/Other	33	6	18.2	1.00		689	171	24.8	1.00		328	84	25.6	1.00
Married/In a relationship	139	19	13.7	0.75	0.29; 2.30	3,223	566	17.6	0.71	0.60; 0.84	1,143	226	19.8	0.77	0.60; 1.00
Health behaviors
Physical activity
Moderate/Vigorous	42	4	9.5	1.00		943	141	15.0	1.00		395	62	15.7	1.00
Lightweight	128	21	16.4	1.72	0.58; 6.90	2,919	587	20.1	1.34	1.12; 1.63	1,041	241	23.2	1.47	1.11; 1.98
Smoking status
Never smoked/Former smoker	155	19	12.3	1.00		3,285	584	17.8	1.00		1,301	257	19.8	1.00
Smoker	17	6	35.3	2.89	0.94; 7.50	627	153	24.4	1.37	1.14; 1.64	170	53	31.2	1.58	1.15; 2.13
Alcohol consumption
Has never drunk	7	3	42.9	1.00		170	30	17.6	1.00		59	14	23.7	1.00
Does not currently drink	31	7	22.6	0.52	0.12; 3.16	786	183	23.3	1.31	0.89; 2.01	257	62	24.1	1.01	0.56;1.97
Currently drinks	134	15	11.2	0.26	0.74; 1.41	2,955	524	17.7	1.00	0.69; 1.50	1,155	234	20.3	0.85	0.49; 1.59
Antidepressant use
No	168	24	14.3	1.00		3,784	691	18.3	1.00		1,437	295	20.5	1.00
Yes****	4	1	25.0	1.75	0.04; 10.73	128	46	35.9	1.96	1.43; 2.65	34	15	44.1	2.14	1.18; 3.60
Benzodiazepine use
No	165	22	13.3	1.00		3,822	696	18.2	1.00		1,458	303	20.8	1.00
Yes	7	3	42.9	3.21	0.61; 10.70	90	41	45.6	2.50	1.77; 3.43	13	7	53.8	2.59	1.03; 5.40
Areas of Work
Weekly Work Hours
Up to 40 hours	105	17	16.2	1.00		2,464	466	18.9	1.00		867	173	20.0	1.00
More than 40 hours	67	8	11.9	0.74	0.26; 1.80	1,448	271	18.7	0.99	0.85; 1.15	604	137	22.7	1.14	0.90; 1.43
Time in current occupation (years)
20 or more	113	16	14.2	1.00		1,631	283	17.4	1.00		111	28	25.2	1.00
0–9	27	5	18.5	1.31	0.37; 3.74	1,131	242	21.4	1.23	1.03; 1.47	859	174	20.3	0.80	0.54; 1.24
10–19	32	4	12.5	0.88	0.21; 2.74	1,150	212	18.4	1.06	0.88; 1.27	501	108	21.6	0.85	0.56; 1.35
Psychological demand
Low/Medium	106	14	13.2	1.00		2,145	388	18.1	1.00		787	150	19.1	1.00
High	66	11	16.7	1.26	0.52; 2.99	1,767	349	19.8	1.09	0.94; 1.26	684	160	23.4	1.22	0.97; 1.54
Control over work
High	128	16	12.5	1.00		2,789	501	18.0	1.00		1,094	226	20.7	1.00
Low/Medium	44	9	20.5	1.64	0.64; 3.93	1,123	236	21.0	1.17	0.99; 1.37	377	84	22.3	1.08	0.83; 1.39
Social Assistance
High	162	24	14.8	1.00		3,676	661	18.0	1.00		1,327	250	18.6	1.00
Low/Medium	10	1	10.0	0.68	0.02; 4.14	236	76	32.2	1.79	1.39; 2.27	124	60	48.4	2.61	1.93; 3.47
Occupational Stress (DCM)*****
Low demands	80	10	12.5	1.00		1,507	263	17.5	1.00		568	108	19.0	1.00
Active work	48	6	12.5	1.00	0.30; 3.03	1,282	238	18.6	1.06	0.89; 1.27	526	118	22.4	1.17	0.90; 1.55
Passive work	26	4	15.4	1.23	0.28; 4.27	638	125	19.6	1.12	0.90; 1.39	219	42	19.2	1.01	0.69; 1.45
High demands	18	5	27.8	2.22	0.60; 7.14	485	111	22.9	1.31	1.04; 1.64	158	42	26.6	1.40	0.95; 2.01

• Note: *Total male working-age population by generation. Minor differences in the total “n” for each variable are due to missing values. **P = Prevalence; ***OR: Odds ratio; 95% CI – 95% Confidence Interval; ****Use of antidepressants (tricyclics, selective serotonin reuptake inhibitors, others, more than one class); ***** Demand-Control Model: low-demand work (low demand and high control); active work (high demand and high control); passive work (low demand and low control); and high-demand work (high demand and low control).

Regarding the prevalence of CMDs by generation and sex, it was observed that, in the Traditionalist Generation, for both sexes, there was no association between CMDs and any of the variables analyzed (Tables 3 and 4).

Table 4
Prevalence of common mental disorders (CMDs) by selected variables, generation, and female gender. ELSA-Brasil, 2008–2010 (n = 6,046)

Characteristics	Generation / Female
	Traditionalist					Baby Boomers					Generation X
	Total* (n = 152)	CMD (n = 36)	P** (%)	OR***	95% CI	Total* (n = 4.252)	CMD (n = 1.506)	P** (%)	OR***	95% CI	Total* (n = 1.642)	CMD (n = 631)	P** (%)	OR***	95% CI
Sociodemographic
Race/Skin Color
White	68	11	16.2	1.00		2.176	673	30.9	1.00		891	306	34.3	1.00
Brown	42	13	31.0	1.91	0.79; 4.72	1.232	486	39.4	1.27	1.13; 1.44	442	199	45.0	1.31	1.09; 1.58
Black	37	11	29.7	1.83	0.72; 4.67	802	335	41.8	1.35	1.18; 1.54	300	122	40.7	0.80	0.65; 0.99
Education
Up to complete elementary school	39	11	28.2	1.00		369	165	44.7	1.00		32	17	53.1	1.00
Complete high school graduate	37	10	27.0	0.95	0.36; 2.48	1.624	660	40.6	0.91	0.76; 1.08	598	263	44.0	0.82	0.51; 1.44
Complete Higher education	76	15	19.7	0.70	0.30; 1.68	2.259	681	30.1	0.67	0.57; 0.80	1.012	351	34.7	0.65	0.40; 1.13
Marital status
Single/Divorced/Widowed/Other	99	23	23.2	1.00		2.037	721	35.4	1.00		582	226	38.8	1.00
Married/In a relationship	53	13	24.5	1.10	0.49; 2.17	2.214	785	35.5	1.00	0.90; 1.11	1.060	405	38.2	0.98	0.83; 1.16
Health behaviors
Physical activity
Moderate/Vigorous	24	8	33.3	1.00		766	193	25.2	1.00		293	81	27.6	1.00
Light	127	28	22.0	0.66	0.29; 1.68	3.424	1.295	37.8	1.50	1.28; 1.75	1.320	537	40.7	0.98	0.83; 1.16
Smoking status
Never smoked/Former smoker	143	33	23.1	1.00		3.638	1.236	34.0	1.00		1.498	569	38.0	1.00
Smoker	9	3	33.3	1.44	0.28; 4.60	614	270	44.0	1.29	1.13; 1.48	146	62	42.5	1.11	0.84; 1.45
Alcohol consumption
Has never drunk	36	10	27.8	1.00		643	234	36.4	1.00		217	77	35.5	1.00
Does not currently drink	28	12	42.9	1.58	0.61; 3.99	842	363	43.1	1.18	1.00; 1.40	316	155	49.1	1.38	1.05; 1.84
Currently drinks	88	14	15.9	0.57	0.23; 1.44	2.762	908	32.9	0.90	0.78; 1.05	1.108	399	36.0	1.01	0.79; 1.31
Antidepressant use
No	146	33	22.6	1.00		3.879	1.314	33.9	1.00		1.530	556	36.3	1.00
Yes****	6	3	50.0	2.21	0.43; 7.05	373	192	51.5	1.52	1.30; 1.77	112	75	67.0	1.84	1.43; 2.35
Benzodiazepine use
No	147	34	23.1	1.00		4.056	1.383	34.1	1.00		1.600	603	37.7	1.00
Yes	5	2	40.0	1.72	0.20; 6.75	196	123	62.8	1.84	1.52; 2.22	42	28	66.7	1.77	1.16; 2.59
Areas of Work
Weekly Work Hours
Up to 40 hours	132	34	25.8	1.00		3.050	1055	34.6	1.00		1.168	429	36.7	1.00
More than 40 hours	20	2	10.0	0.39	0.04; 1.51	1.202	451	37.5	1.08	0.97; 1.21	476	202	42.4	1.16	0.97; 1.37
Time in current occupation (years)
20 or more	81	17	21.0	1.00		1.387	455	32.8	1.00		141	57	40.4	1.00
0–9	29	11	37.9	1.81	0.77; 4.09	1.465	533	36.4	1.11	0.97; 1.26	956	376	39.3	0.98	0.74; 1.32
10–19	42	8	19.0	0.91	0.34; 2.22	1.400	518	37.0	1.23	0.99; 1.28	545	198	36.3	0.90	0.67; 1.24
Psychological demand
Low/Medium	75	12	16.0	1.00		2.230	720	32.3	1.00		865	308	35.6	1.00
High	77	24	31.2	1.95	0.94; 4.28	2.022	786	38.9	1.20	1.09; 1.33	777	323	41.6	1.17	0.99; 1.37
Control over work
High	102	22	21.6	1.00		3.040	1.018	33.5	1.00		1.157	425	36.7	1.00
Low/Medium	50	14	28.0	1.30	0.61; 2.65	1.212	488	40.3	1.20	1.08; 1.34	485	206	42.5	1.15	0.97; 1.37
Social Assistance
High	149	34	22.8	1.00		3.929	1.335	34.0	1.00		1511	553	36.6	1.00
Low/Medium	3	2	66.7	2.92	0.34; 11.40	323	171	52.9	1.56	1.32; 1.83	131	78	59.5	1.63	1.27; 2.07
Occupational Stress (DCM)*****
Low demands	52	8	15.4	1.00		1.594	479	30.1	1.00		618	202	32.7	1.00
Active employment	50	14	28.0	1.82	0.71; 5.00	1.446	539	37.3	1.24	1.09; 1.41	539	223	41.4	1.27	1.04; 1.54
Passive work	23	4	17.4	1.13	0.25; 4.22	636	241	37.9	1.26	1.07; 1.47	247	106	42.9	1.31	1.03; 1.66
High demands	27	10	37.0	2.41	0.85; 7.02	576	247	42.9	1.43	1.22; 1.67	238	100	42.0	1.29	1.00; 1.64

• Note: *Total female working-age population by generation. Minor differences in the total “n” for each variable are due to missing values. ^** P = Prevalence; ^*** OR = Odds ratio; 95% CI = 95% Confidence Interval; ^**** Use of antidepressants (tricyclics, selective serotonin reuptake inhibitors, others, more than one class); ^***** Demand-Control Model: low-demand work (low demand and high control); active work (high demand and high control); passive work (low demand and low control); and high-demand work (high demand and low control).

Positive associations between CMD and the following characteristics were found among men in the Baby Boomer Generation: being of mixed-race, engaging in light physical activity, being a smoker, using antidepressants and benzodiazepines, having spent less time in their current job, having low/moderate social support, and facing high job demands. Factors negatively associated with CMDs included having a completed college degree (OR = 0.64; 95% CI 0.51; 0.78) and being in a stable marital relationship (OR = 0.71; 95% CI 0.60; 0.84) (Table 3).

The factors positively associated with CMD among women of the Baby Boomer generation were: being of mixed-race or Black, engaging in light physical activity, being a smoker, not currently consuming alcohol, using antidepressants and benzodiazepines, experiencing high psychological demand at work, having low control over work, having low social support, and being engaged in active work, passive work, or high-demand work (Table 4).

For Generation X women, positive associations were found with the following characteristics: being of mixed-race or Black, engaging in light physical activity, being a smoker, not currently consuming alcohol, using antidepressants and benzodiazepines, having low social support, and engaging in active work, passive work, or high-demand work (Table 4). For men, positive associations were found with the following characteristics: engaging in light physical activity, using antidepressants and benzodiazepines, and having low social support (Table 3).

When analyzing the association between occupational stress and CMDs in the crude model for women of the Baby Boomer generation, compared to low-demand work (low psychological demand and high control), a higher prevalence ratio was observed among active jobs (OR = 1.38; 95% CI 1.19; 1.61); passive work (OR = 1.42; 95% CI 1.17; 1.72), and high-demand work (OR = 1.75; 95% CI 1.44; 2.13). When exposure to high-demand work (low control and high demand) was analyzed, women were more likely to develop CMD (OR = 1.75; 95% CI 1.44; 2.13) than men in this generation (OR = 1.40; 95% CI 1.09; 1.80) (Table 5).

Table 5
Crude and adjusted associations between occupational stress and CMD, by generation and sex. ELSA-Brasil, 2008–2010

Models	Baby Boomers				Generation X
	Men (n = 737)		Women (n = 1,506)		Men (n = 310)		Women (n = 631)
Occupational Stress (DCM)*	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Crude Model **
Low requirement	1.00		1.00		1.00		1.00
Active work	1.08	0.89; 1.31	1.38	1.19; 1.61	1.23	0.92; 1.65	1.45	1.14; 1.85
Passive work	1.15	0.91; 1.46	1.42	1.17; 1.72	1.01	0.68; 1.50	1.55	1.14; 2.10
High demand	1.40	1.09; 1.80	1.75	1.44; 2.13	1.54	1.02; 2.32	1.49	1.10; 2.03
Adjusted Model ***
Low requirement	1.00		1.00		1.00		1.00
Active work	1.03	0.84; 1.23	1.32	1.13; 1.54	1.15	0.85; 1.55	1.39	1.09; 1.78
Passive work	0.90	0.70; 1.16	1.19	0.97; 1.46	0.94	0.62; 1.42	1.35	0.98; 1.84
High demand	1.05	0.81; 1.37	1.41	1.14; 1.73	1.20	0.77; 1.87	1.18	0.86; 1.63

• OR: Odds ratio; 95% CI: 95% confidence interval
• *Demand-Control Model: low-demand work (low psychological demand and high control); active work (high psychological demand and high control); passive work (low psychological demand and low control); and high-demand work (high psychological demand and low control); ^** Raw Model; ^*** Adjusted Model: raw model + adjusted for education level, work hours, length of employment, and social support.

Among Generation X women, a positive association was also observed between CMD and the categories of active work (OR = 1.45; 95% CI 1.14; 1.85), passive work (OR = 1.55; 95% CI 1.14; 2.10), or high-demand work (OR = 1.49; 95% CI 1.10; 2.03). Among Generation X men, a higher incidence of CMD was associated with high-demand work (OR = 1.54; 95% CI 1.02; 2.32) (Table 5).

After adjusting the model for potential confounders, the positive and statistically significant association between occupational stressors and CMDs persisted only among women of the Baby Boomer generation who were actively employed (OR = 1.32; 95% CI 1.13; 1.54) and had high-demand jobs (OR = 1.41; 95% CI 1.14; 1.73) and among Generation X women who were currently employed (OR = 1.39; 95% CI 1.09; 1.78) (Table 5).

Discussion

The results showed that the prevalence of CMDs among Generation X individuals, compared to older generations, was 55% higher among men and 64% higher among women. They also revealed that occupational stressors were associated with a higher prevalence of CMDs among Baby Boomer women in high-demand jobs and among Generation X women in active employment, compared to those in low-demand jobs, after adjustment.

Other studies in the field of occupational health have also observed that younger workers and women had a higher incidence of CMDs²⁷,²⁸.

The discussion regarding the higher risk of mental illness among women has been highlighted in the literature¹⁰,²⁹. Aspects related to the gender division of labor highlight not only the inequalities between women and men in the labor market but also the unequal distribution of domestic tasks between the sexes, exacerbating conflicts that can strain relationships at work and within the family, as well as contributing to the development of health problems¹³,²⁹.

Both brown and Black women of the Baby Boomer generation had higher prevalences of CMD than white women. These findings corroborate other studies that have identified similar trends in the prevalence of CMD by race/skin color¹⁰,¹²,³⁰, even though in the field of mental health, race/skin color has been little explored as a central focus of analysis, despite robust evidence of the effects of racism on mental health. Race can influence exposure to stress, as it is a determinant of social status, as well as due to experiences of discrimination and racism³⁰.

Socioeconomic and individual factors, as well as lifestyle habits, can influence the onset of illness in the workplace, exacerbating or causing various health problems, such as mental disorders. In this study, smoking among men of Generation X and among women of the Baby Boomer generation was a factor associated with the prevalence of mental disorders among these participants. Studies indicate an increase in the prevalence and severity of CMDs and depressive symptoms associated with smoking³¹,³². However, the cross-sectional nature of the analyses limits interpretations regarding the directionality of the observed associations, and reverse causality cannot be ruled out.

Contrary to what is expected in most studies, in this study, abstaining from alcohol was positively associated with the presence of CMDs among women from the Baby Boomer and Generation X cohorts. Most studies point to an association between CMD and excessive alcohol consumption, as well as suggesting that episodes of anxiety and depression are related to excessive alcohol consumption ³³. The finding of a higher prevalence of CMD among women who reported not consuming alcohol should be interpreted with caution, as cross-sectional studies do not allow for establishing the temporality of the association. Studies have shown that this association may reflect the phenomenon known as the “sick quitter effect³⁴, in which individuals stop drinking alcohol due to health problems, resulting in an apparent association between abstinence and poorer mental health. Another hypothesis is that abstinence indicates less participation in social activities, serving as an indirect marker of social isolation.

The use of antidepressants and benzodiazepines showed a positive and statistically significant association with the presence of CMDs for both sexes across all generations, except for the Traditionalist Generation. Benzodiazepines and antidepressants are among the most used psychotropic medications in various countries around the world. A study conducted at a mental health clinic in the state of São Paulo revealed the inappropriate use of benzodiazepines among adults and the elderly. It was observed that only a small proportion of prescriptions were considered appropriate, both in terms of indication and recommended duration of treatment³⁵.

A study on the prevalence and factors associated with antidepressant use among adults in the urban area of Pelotas revealed a trend toward increased antidepressant consumption, serving as a warning to healthcare professionals to be more discerning in their prescribing practices and to avoid indiscriminate prescribing of these drugs³⁵. The studies also indicated that antidepressants were the psychotropic drugs most combined with benzodiazepines³⁵.

Regarding the relationship between occupational stress and CMDs at the baseline of the ELSA-Brasil study, a consistent association was observed in this study. Several studies corroborate our findings regarding the association between work-related psychosocial factors and mental illness³⁶,³⁷, while also offering insights through the combined analysis of participants’ birth cohort and gender.

Occupational stress was a construct assessed in the work domain, showing stronger associations among women. Working in high-demand situations - that is, with high demands and low control – was detrimental to the mental health of female workers at these universities. This association between gender and stress has been shown to be significant in several studies¹⁰,¹⁶, possibly demonstrating gender inequalities and discrimination in the workplace.

When analyzing the association between occupational stress and CMDs in the crude model of this study, both Baby Boomer and Generation X women showed a high prevalence of CMDs in active, passive, and high-demand jobs compared to low-demand jobs (low psychological demand and high control). Among men, a positive and significant association was observed only with high-demand work. Activities involving high psychological demands and low control contribute to workplace burnout and, consequently, to physical and psychological illness³⁸.

According to Griep et al.³⁹, the analysis of psychosocial factors at work can be considered a relevant measure for assessing health conditions; it can help improve working conditions, reduce absenteeism and sick leave due to illness and occupational stress, and contribute to promoting workers’ health as well as preventing risks and health complications in work environments and processes.

Studies indicate that psychosocial stress at work is clearly associated with CMDs⁸,³⁶,³⁷. In a study aimed at investigating the relationship between psychosocial occupational stress and mental illness, it was found that the risk of depression was approximately twice as high among workers exposed to high job demands, defined as high work demands combined with low job control (effect estimate [EE] = 1.99, 95% CI 1.68; 2.35)³⁶. In a systematic review with a meta-analysis on the associations between psychosocial work factors and health outcomes, psychosocial stress emerged as an important risk factor for outcomes such as depressive and anxiety symptoms ⁹.

The inclusion of educational attainment, social support, working hours, and time in the occupation weakened the strength of the association between the analyzed outcome and active employment for women of the Baby Boomer and Generation X cohorts, and between high demand work and the outcome for women of the Baby Boomer cohort. Among men, the inclusion of these variables in the model rendered the association between occupational stress and CMDs non-significant. In this study, the data indicated that having completed higher education constituted a protective factor accounting for 31% of the occurrence of CMDs among men and 29% among women.

In a study conducted with civil servants at a public university, it was observed that these workers’ higher level of education may be related to the fact that they have job security and are eligible for a percentage of tuition-free spots in courses at these institutions. These factors, in turn, encourage their participation in training programs and the development of additional skills, which positively impacts their quality of life at work⁴⁰.

The association between social support and CMD was identified in another study³⁹. Support from colleagues and supervisors can modify the effect of work-related stress or even act as a protective factor against the adverse health effects of work-related burnout³⁹.

The main limitation of this study stems from the use of cross-sectional data, which does not allow for an investigation of the possibility of reverse causality. The fact that the sample in this study consists of a population of civil servants, that is, an employed population with job security, distinguishes it from the general population, placing it under different conditions. In populations subject to job instability, or even those who are unemployed and thus more exposed to certain psychosocial stressors, the factors analyzed here could have a negative impact, increasing the incidence CMDs. Nevertheless, the study presents important findings that reinforce its contribution to occupational health, particularly for workers exposed to high demand work and low social support. Of note is the use of a large worker population, which confers high statistical power and greater precision to the prevalence estimates and measures of association. Another important aspect is the incorporation of a generational perspective when analyzing CMDs, an approach that remains under-explored in national studies. The use of the Demand-Control-Support Model, which has been widely validated in international literature, strengthens the study’s theoretical consistency, while analyses adjusted for potential confounding factors lend greater robustness to the results and reduce the possibility of spurious associations.

Conclusion

This study revealed a high prevalence of CMDs among active ELSA-Brasil workers, with a significantly higher prevalence among women than among men. In both sexes, mental health disorders were associated with factors related to health behaviors and psychosocial characteristics of work, particularly low social support at work and high-demand work, confirming the relevance of occupational factors to workers’ mental health.

It was observed, however, that these associations differed according to sex and birth cohort. Women had a higher prevalence of CMDs, and a greater number of associated factors compared to men. Furthermore, stratified analyses showed that the Baby Boomer and Generation X cohorts, particularly among women, exhibited greater vulnerability to CMDs, suggesting that generational experiences and gender inequalities may influence how occupational factors and health behaviors affect mental health. Among men, although some associations were observed, they proved less consistent after stratification by generation.

The findings of this study point to the need to investigate long-term effects associated with the occurrence of stressful life events, as well as factors that may potentially modify their impact (e.g., social support). Individuals belonging to Generation X, especially women, and those with lower levels of education are more exposed to the effects of work-related stress and a lack of social support. Measures aimed at addressing the needs of these groups, whether in the workplace and/or in health care settings, are recommended to promote and protect the health of these individuals.

References

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  » https://doi.org/10.3389/phrs.2021.1604234
• ² World Health Organization. Depression and other common mental disorders: global health estimates [Internet]. Geneva: WHO; 2017 [citado 14 jun 2023]. Disponível em: https://www.who.int/publications/i/item/depression-global-health-estimates
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Information on academic work:

Article derived from the doctoral dissertation titled “Diferenças geracionais e transtornos mentais comuns em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) [Generational differences and common mental disorders among participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)],” defended by the author Adryanna Cardim in 2023 in the Graduate Program in Public Health at the Federal University of Bahia.

Data Availability:

The dataset used and/or analyzed during this study is available from the corresponding author upon submission of a justified request and review by the Publications Evaluation Committee of the Steering Committee of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Statement on the use of Artificial Intelligence:

The authors declare that no artificial intelligence tools were used in the preparation of this article.

Presentation at a scientific event:

The authors report that the study was presented at the 12th Brazilian Congress of Epidemiology, held in Rio de Janeiro, Brazil, from November 24 to 27, 2024.

Funding:

The study received funding from the Ministry of Health (Secretariat of Science and Technology) and the Ministry of Science, Technology and Innovation (FINEP, Agency for the Financing of Studies and Projects, and CNPq), Grant Nos. 01 06 0010.00, 01 06 0212.00, 01 06 0300.00, 01 06 0278.00, 01 06 0115.00, and 01 06 0071.00.

Contact:

Adryanna Cardim. E-mail: [e-mail]

Competing interests:

The authors declare that there are no competing interests.

Responsible Editors:

Fernando Ribas Feijó. https://orcid.org/0000-0002-8505-9567 Universidade Federal da Bahia – UFBA

Leila Posenato Garcia. https://orcid.org/0000-0003-1146-2641. Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho – FUNDACENTRO

Lúcia Rotenberg. https://orcid.org/0000-0002-4132-2167 Fundação Oswaldo Cruz – FIOCRUZ

Tânia Maria de Araújo. https://orcid.org/0000-0003-2766-7799. Universidade Estadual de Feira de Santana – UEFS

Publication Dates

• Publication in this collection
  30 Oct 2026
• Date of issue
  2026

History

• Received
  23 July 2025
• Reviewed
  03 July 2026
• Accepted
  22 July 2026