Psychological distress and work engagement of construction workers during the COVID-19 pandemic: a differential study by sex

Citation: Gómez-Salgado, C.; Camacho-Vega, J.C.; Allande-Cussó, R.; Ruiz-Frutos, C.; Ortega-Moreno, M.; Linares-Manrique, M.; García-Iglesias, J.J.; Fagundo-Rivera, J.; Rodríguez-Díaz, L.; Vázquez-Lara, J.M.; et al. Psychological Distress and Work Engagement of Construction Workers during the COVID-19 Pandemic: A Differential Study by Sex. Buildings 2024,14, 773. https://doi.org/10.3390/ buildings14030773 Academic Editors: David Arditi and Mariusz Szóstak Received: 15 January 2024 Revised: 28 February 2024 Accepted: 8 March 2024 Published: 13 March 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). buildings Article Psychological Distress and Work Engagement of Construction Workers during the COVID-19 Pandemic: A Differential Study by Sex Carlos Gómez-Salgado 1, Juan Carlos Camacho-Vega 2, Regina Allande-Cussó3, Carlos Ruiz-Frutos 4,5 , Mónica Ortega-Moreno 6, Marta Linares-Manrique 7, Juan Jesús García-Iglesias 4, Javier Fagundo-Rivera 8,† , Luciano Rodríguez-Díaz 9, Juana María Vázquez-Lara 9and Juan Gómez-Salgado 4,5,*,† 1School of Doctorate, University of Huelva, 21007 Huelva, Spain 2Department of Building Construction II, Higher Technical School of Building Engineering, University of Seville, 41012 Sevilla, Spain 3Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Sevilla, Spain 4Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain 5Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil 092301, Ecuador 6Department of Economy, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain 7Department of Nursing, Faculty of Health Sciences of Melilla, University of Granada, 52005 Melilla, Spain 8Centro Universitario de Enfermería Cruz Roja, Universidad de Sevilla, 41009 Sevilla, Spain 9Department of Nursing, Faculty of Health Sciences of Ceuta, University of Granada, 51005 Ceuta, Spain *Correspondence: [email protected]; Tel.: +34-959-219-700 †These authors have contributed equally to this work and share senior authorship. Abstract: Since the beginning of the COVID-19 pandemic, a major impact on the mental health of the population has been observed, with women being one of the most affected groups. From the lockdown to “de-escalation” phases, sex differences have been recognised as significant determinants of mental health. Thus, equally ensuring physical and mental protection at work remains one of the challenges faced by industrial companies, especially in the construction sector, where the percentage of employed women has increased in recent years. This study aims to examine the impact of sex differences on psychological distress and work engagement in the productive construction sector, as well as related variables. For this, a cross-sectional descriptive study was performed. Descriptive statistical analyses were completed, and non-parametric Mann-Whitney U and Chi-squared tests were used to identify differences between men and women. This was followed by logistic regression analysis by sex. Psychological distress is more prevalent among women, even after controlling for most variables. Both sexes receive equal preventive measures and training from the companies, yet women still experience higher levels of psychological distress. At the beginning of the pandemic, women reported higher levels of anxiety and fear of COVID-19 and of perceived danger associated with the pandemic than men. However, these differences were not present by 2023. For men, work engagement appeared to be a determining factor for a stable mental health, while for women, health and physical status seemed to be more influential. In both sexes, psychological distress was found to be conditioned by mental and emotional well-being. In a sector where women are increasingly present, the differences observed in terms of how physical and mental health are affected across the two sexes justify the need to promote data analysis that acknowledges this reality. Keywords: mental health; construction workers; construction industry; sex; work conditions; anxiety; stress; fear; COVID-19; public health Buildings 2024,14, 773. https://doi.org/10.3390/buildings14030773 https://www.mdpi.com/journal/buildings Buildings 2024,14, 773 2 of 19 1. Introduction The COVID-19 health crisis has caused a severe global economic downturn, leading to psychological insecurity [ 1 ]. This has had a disproportionate impact on the most vulnerable groups [ 2 ], and has required significant technical and lifestyle adjustments [ 3 ]. Since its onset, the World Health Organization (WHO) has classified the COVID-19 pandemic as a public health concern due to its association with occupational exposure and close contact between co-workers [ 4 ]. Consequently, many governments authorised a gradual return to work in various sectors, including construction, as part of the ‘de-escalation’ process after lockdown restrictions [5]. The construction industry, known for its high number of health hazards and one of the highest occupational accident rates globally [ 6 , 7 ], faces occupational health and safety challenges [ 8 ]. Certain working conditions in the construction sector, such as stress, anxiety, and fear, have been linked to mental health issues among workers, leading to a higher incidence of workplace accidents [ 9 ]. Additionally, prolonged working hours have been associated with certain physical ailments, like musculoskeletal disorders [ 10 ]. Technical staff may experience pressure to expedite building projects, resulting in decreased productivity and increased absenteeism [ 11 , 12 ]. Moreover, small companies may perceive COVID-19 risk-reduction measures as less effective compared to their effect in larger companies [ 13 ]. Highly educated workers have shown greater satisfaction with their organisation’s response to the pandemic, yet they experienced heavier workloads and increased anxiety and depression, particularly among labourers [ 14 , 15 ]. Similarly, stress related to workplace safety measures can affect participation, with psychological factors acting as moderators [16]. The construction sector is predominantly male-dominated worldwide, although in Spain the percentage of women has increased since 2016 and reached 11.1% in 2022. Women are more likely to be found in administrative positions (46.8%) and professions requiring higher education, especially architecture, engineering, and urban planning (12.2%), as well as in cleaning activities. Women are predominantly employed in large and mediumsized companies, with the majority working in building construction (30.5%) and to a lesser extent in civil engineering (4.1%), with the majority aged between 30 and 54 and 74.3% working full-time [ 9 ]. In 2020, the percentage of women in building construction in Andalusia, southern Spain, was 11.75%, while the sector as a whole had a female share of 8.03% in 2022 [ 17 ], with a greater growth rate over the last 13 years (3.95%) than for men (2.43%) [18]. As stated before, from the onset of the COVID-19 pandemic, a major impact on the mental health of the population was observed [ 19 ], with women being one of the most affected groups [ 20 ]. Sex differences are recognised as significant determinants of mental health inequalities. However, recent studies indicate that public policies are still lacking, resources are scarce, bureaucratisation is high, and women’s participation in decision-making is still limited, thus showing that the implementation of sex-sensitive policies, which are essential for achieving sex equality in health, is poor [ 21 ]. These differences in mental health status by sex have been noted by WHO [ 22 ], with women having experienced higher levels of mental distress than men during the pandemic [ 23 ]. Additionally, variations exist throughout the different stages of the pandemic, particularly when preventive measures, social distancing, or isolation became commonplace among the workforce [ 24 , 25 ]. It has been already observed that psychological distress was significantly and negatively correlated with work engagement [ 26 ], and that work engagement moderated the direct and indirect effects of the stress related to job insatisfaction [27]. These facts, together with the increase in the percentage of female workers in the construction sector [ 28 ], led to the research question of this study, which was aimed to know what differences in the effects of COVID-19 on psychological distress and work engagement exist between male and female construction workers. In this context, this study aimed to investigate disparities in the impact that the COVID-19 pandemic has had on the psychological distress and work engagement of construction workers of both sexes in southern Spain and to correlate these impacts with Buildings 2024,14, 773 3 of 19 socio-demographic and health-related factors. These findings may help identify the risk factors that influence the mental well-being of women and men in the construction industry during pandemics. This will in turn facilitate the establishment of preventive measures, including safeguards for mental health, by establishing the respective pathways. 2. Materials and Methods 2.1. Study Procedure A cross-sectional descriptive study using online questionnaires was carried out. The study population comprised workers in the construction sector in the autonomous region of Andalusia, Spain. The government was interested in understanding the situation of the construction sector and any differences in its workers based on sex. Thus, the research team worked in collaboration with the Andalusian Observatory of Occupational Diseases of the Andalusian Institute for the Prevention of Occupational Risks [29]. Considering a population size, whatever their occupation within the sector, for the year 2023 of 204,100 subjects, of which 8.03% were women [ 17 ], a total sample of 384 individuals was estimated with a confidence level of 95%, precision of 3.5%, and adjustment for losses of 10%. However, using non-probability convenience sampling, the final sample size obtained was 857 participants, of whom 154 were women (17.9%). The study was conducted from March to May 2022. A pilot study was conducted on a sample of 50 participants to identify comprehension errors, test the data collection tool, and estimate the mean total completion time. Following the pilot study, no errors were identified, and the mean completion time was 9 min. The questionnaire was distributed online by sending emails to companies in the sector located in Andalusia (southern Spain), as well as to workers’ unions, sector associations, and construction material distribution companies. To this end, an application was made to the Spanish Government’s Register of Accredited Companies and Workers Associations [ 30 ], specifically for companies in the construction sector in Andalusia. After obtaining a list of 21,000 companies, the research team contacted all of them by e-mail presenting the project and the objectives of the study, and requesting their collaboration in disseminating the link to the data collection tool among their employees. Thus, the companies that accepted the collaboration disseminated by e-mail the objectives of the project and the link to the data collection tool among those employees who had agreed to be contacted for training and research purposes in their work affiliation with that company. A fact sheet outlining the research project, including its objectives, and a leaflet with the link to the data collection tool and a QR code were included. All participants were duly informed of the voluntary nature of their participation, the confidentiality of their data, and that they were free to withdraw from the project at any time. To participate, participants had to be 18 years or older, an active worker in the construction sector in Andalusia, and give their informed consent (Figure 1). 2.2. Instruments The Emotional Impact Questionnaire COVID-19 (EIQ COVID-19), previously validated by Gómez-Salgado J. and collaborators [ 28 ] and which includes questions adapted from previous studies [ 31 ], was used. This questionnaire had been previously used in numerous studies in Spain, and in Brazil to assess the emotional well-being of its population about COVID-19 [32]. This instrument was supplemented with other variables specific to the construction sector. Thus, the questionnaire included socio-demographic data such as age; sex; province; employment status (self-employed, full-time employee, part-time employee, temporary redundancy procedure, unemployed); professional category (manager, skilled worker, intermediate manager, manual worker, administrative or cleaning staff); type of work; type of construction project (building, industrial, or civil engineering); place of work (outdoors or indoors); economic income (sufficient to make ends meet or not, and euros earned per month in the household); persons living with them; the size of the dwelling in square Buildings 2024,14, 773 4 of 19 metres; and use of company canteens (yes, no, or only when there were few people, they did not exist, or they were closed during the pandemic). Buildings 2024, 14, x FOR PEER REVIEW 4 of 19 Figure 1. Research methodology flowchart. 2.2. Instruments The Emotional Impact Questionnaire COVID-19 (EIQ COVID-19), previously validated by Gómez-Salgado J. and collaborators [28] and which includes questions adapted from previous studies [31], was used. This questionnaire had been previously used in numerous studies in Spain, and in Brazil to assess the emotional well-being of its population about COVID-19 [32]. This instrument was supplemented with other variables specific to the construction sector. Thus, the questionnaire included socio-demographic data such as age; sex; province; employment status (self-employed, full-time employee, part-time employee, temporary redundancy procedure, unemployed); professional category (manager, skilled worker, intermediate manager, manual worker, administrative or cleaning staff); type of work; type of construction project (building, industrial, or civil engineering); place of work (outdoors or indoors); economic income (sufficient to make ends meet or not, and euros earned per month in the household); persons living with them; the size of the dwelling in square metres; and use of company canteens (yes, no, or only when there were few people, they did not exist, or they were closed during the pandemic). Data on COVID-19 disease were also included: diagnosis; isolation; severity; hospitalisation; vaccination and side effects; availability and use of preventive measures; and training received. Perceptions of being protected at work and whether their work had been affected by the pandemic were also included. As in the case of the EIQ COVID-19, two more questionnaires were selected and validated in Spain, which had already been used to assess psychological distress concerning COVID-19 in Spain in previous studies [23,33]. To measure psychological distress, the Goldberg General Health Questionnaire (GHQ-12) was used, which consists of 12 items with 4 response options and a total score ranging from 0 to 12 points [34]. This is a self-administered instrument that evaluates psychological well-being and identifies Figure 1. Research methodology flowchart. Data on COVID-19 disease were also included: diagnosis; isolation; severity; hospitalisation; vaccination and side effects; availability and use of preventive measures; and training received. Perceptions of being protected at work and whether their work had been affected by the pandemic were also included. As in the case of the EIQ COVID-19, two more questionnaires were selected and validated in Spain, which had already been used to assess psychological distress concerning COVID-19 in Spain in previous studies [ 23 , 33 ]. To measure psychological distress, the Goldberg General Health Questionnaire (GHQ-12) was used, which consists of 12 items with 4 response options and a total score ranging from 0 to 12 points [ 34 ]. This is a self-administered instrument that evaluates psychological well-being and identifies nonpsychotic disorders. The cut-off point used was >3, following the cut-off point used in national surveys in Spain and adhering to the authors Rocha et al. [ 35 ]. The GHQ-12 has shown good reliability in the different studies, with Cronbach’s alphas varying between 0.82 and 0.86 [ 34 ]. The internal consistency index obtained was α = 0.905, being higher than 0.7 and demonstrating good reliability. Work engagement (WE) was measured using the short version of the Utrecht Work Engagement Scale (UWES-9) [ 36 ]. The UWES-9 scale, based on the Job Demands-Resources model, has been empirically validated in various work contexts including industry, supporting its usefulness. It is an instrument designed to be self-administered and consists of nine items, with Likert-type response options ranging from 0 (Never) to 6 (Always). It consists of three dimensions, namely vigour, dedication, and absorption. The score for each of the different dimensions is obtained by adding the items of each dimension and dividing the result by the number of items that compose each dimension. The Spanish version of the instrument achieved the following Cronbach’s internal consistency indices: Buildings 2024,14, 773 5 of 19 vigour ( α = 0.82), dedication ( α = 0.86), and absorption ( α = 0.8), being higher than 0.7 and demonstrating good reliability concerning the construct measured by each scale [37]. To measure anxiety and fear of COVID-19, four ad hoc items were designed to assess perceived level of anxiety and fear and level of danger on a scale ranging from 0 to 10 points at the onset of the pandemic and at the time of data collection for the present study. In addition, the Anxiety and Fear of COVID-19 (AMICO) scale, designed and validated in previous studies by Gómez-Salgado et al. in 2021 [ 38 ], was also included. The scale obtained an internal consistency index of α = 0.92, and the established cut-off point was 6.4 points [ 34 ]. The response options of the AMICO scale range from 1 to 10 points, where 1 corresponds to strongly disagree and 10 to strongly agree. The total score of the scale is obtained by calculating the mean score of the self-reported responses. 2.3. Data Analysis The statistical analyses were carried out using SPSS version 27 [39]. A descriptive analysis of the variables used in the study was performed, providing frequencies, means, and standard deviations according to the type of variable. Subsequently, the normality of the data distribution was analysed using the Kolmogorov-Smirnov test, which showed the non-normality of the sample. To determine the existence or not of significant differences depending on the presence of distress and between men and women, non-parametric tests such as the Mann-Whitney U test or the Chi-squared test were used. Specifically, the chi-squared test has been used for categorical variables, while the Mann- Whitney U test was used to compare two independent groups of an ordinal variable [40]. A binary logistic regression analysis was also carried out to assess sex differences [ 41 ] on the presence or absence of psychological distress and to identify those variables among the ones studied that played a relevant role. The variables were included based on statistical significance tests. In this sense, UWES score, AMICO score, current level of anxiety and fear of COVID-19, effect of the pandemic on mental/emotional well-being, and the score for health and physical status were entered. ORs were estimated and confidence intervals were provided for this measure of association. To verify the adequacy of the model, different goodness-of-fit measures were used, such as the Hosmer-Lemeshow test, the percentage of correctly classified values, or the sensitivity and specificity. 2.4. Ethical Considerations The 2013 Declaration of Helsinki was considered [ 42 ]. Participants were required to explicitly provide informed consent before their participation, which was voluntary and confidential, and the data collected were processed following the current laws on personal data protection and digital rights of 2018 [ 43 ] and the Spanish Biomedical Research Act [ 44 ]. The project was approved by the Research Ethics Committee of Huelva, part of the Andalusian Ministry of Health (PI 036/20). 3. Results 3.1. Socio-Demographic Characteristics by Sex The percentage of women in the study (17.9%) was lower than that of men (81.7%), in line with the number of workers in the sector in Andalusia in 2023, which was 8.03%, according to data from the Andalusian Institute of Statistics and Cartography [17]. The mean age of women, 38.96 (SD = 9.98), was lower than that of men, 43.56 years (SD = 10.4), p< 0.001, as was the percentage of women with a partner (42.2%) lower than that of men (63.3%), p< 0.001. Regarding socio-economic level, the percentage of women who stated that their household income was over 1200 euros per month (63.6%) was lower than that of men (78.0%), p< 0.001. No statistically significant differences were found regarding the question of whether they considered that they had sufficient income to make ends meet nor regarding the size of the dwelling (Table 1). Buildings 2024,14, 773 6 of 19 Table 1. Socio-demographic characteristics by sex. Variable Total Men Women X2Test GFI n(%) n(%) n(%) p-Value Sex 857 703 (81.7%) 154 (17.9%) Age [mean (SD)] 42.7 (10.4) 43.56 (10.3) 38.96 (9.98) <0.001 * Marital status Married or cohabiting 524 (61.1%) 459 (63.3%) 65 (42.2) <0.001 0.967 Other situations 333 (38.9%) 244 (34.7%) 89 (57.8) 0–50 m228 (3.3%) 21 (3.0%) 7 (4.5%) 0.734 0.999 51–75 m2154 (18.0%) 123 (17.5%) 31 (20.1%) 76–100 m2310 (36.2%) 258 (36.7%) 52 (33.8%) 101–125 m2169 (19.7%) 143 (20.3%) 26 (16.9%) 126–150 m2105 (12.3%) 85 (12.1%) 20 (13.0%) More than 151 m291 (10.6%) 73 (10.4%) 18 (11.7%) Yes 373 (43.5%) 299 (42.5%) 74 (48.1%) 0.211 0.998 No or depending on the month 484 (56.5%) 404 (57.5%) 80 (51.9%) Between 0 and 1200 euros 211 (24.6%) 155 (22.0%) 56 (36.4%) <0.001 0.984 More than 1200 euros 646 (75.4%) 548 (78.0%) 98 (63.6%) Self-employed 104 (12.1%) 87 (12.4%) 17 (11.0%) <0.001 0.994 Full-time employee 673 (78.5%) 563 (80.1%) 110 (71.4%) Part-time employee 51 (6.0%) 30 (4.3%) 21 (13.6%) Temporary Redundancy Procedure 5 (0.6%) 4 (0.6%) 1 (0.6%) Unemployed 24 (2.8%) 19 (2.7%) 5 (3.2%) Degree of responsibility Managers and skilled workers 207 (24.2%) 147 (20.9%) 60 (40.0%) <0.001 0.939 Intermediate management 135 (15.8%) 114 (16.2%) 21 (13.6%) Manual workers 409 (47.7%) 392 (55.8%) 17 (11.0%) Others (administration staff, cleaning. . .) 106 (12.4%) 50 (7.1%) 56 (35.4%) Type of project Building work 489 (57.1%) 411 (58.5%) 78 (50.6%) 0.033 0.997 Civil Works 158 (18.4%) 117 (16.6%) 41 (26.6%) Industrial Works 123 (14.4%) 102 (14.5%) 21 (13.6%) More than one type of work 86 (10.0%) 73 (10.4%) 13 (8.4%) Place of work Outdoors 357 (41.7%) 319 (45.4%) 38 (24.7%) <0.001 0.974 Indoors (of buildings, facilities. . ..) 500 (58.3%) 384 (54.6%) 116 (75.3%) Use of canteens Yes 122 (14.2%) 111 (15.8%) 11 (7.1%) 0.003 0.996 Yes, only when there were not many workers 85 (9.9%) 74 (10.5%) 11 (7.1%) No, they have been closed during the pandemic 61 (7.1%) 42 (6.0%) 19 (12.3%) No, there are no canteens in the places I work in 184 (21.5%) 145 (20.6%) 39 (25.3%) No, I never use them 366 (42.7%) 302 (43.0%) 64 (41.6%) Other cases 39 (4.6%) 29 (4.1%) 10 (6.5%) *: Mann-Whitney U test; GFI: Goodness-of-Fit Index. In terms of employment status, there were significant differences between men and women (p< 0.001), with a higher percentage of part-time workers among women (13.6%) than among men (4.3%) and higher percentages of full-time workers among men (80.1%) than among women (70.4%). Similarly, there were differences concerning the degree of responsibility at work p< 0.001, with 40.0% of the women occupying managerial or skilled positions, compared to 20.9% of the men. On the other hand, while 55.8% of men held manual labour positions, the percentage was 11.0% for women. It should also be noted that women occupied 35.4% of the ‘Other’ section (administration, cleaning, etc.) and men, 7.1% (Table 1). Buildings 2024,14, 773 7 of 19 Regarding the type of work, differences were found between women and men p= 0.033, with a higher proportion of both sexes working in ‘Building works’, whereas a higher proportion of women were engaged in ‘Civil engineering’ (26.6%) than men (16.6%). Regarding the place of work, the proportion of women working outdoors (24.7%) was lower than that of men (45.4%). It was also observed that women were less likely to use canteens (p= 0.003) (Table 1). 3.2. Psychological Distress by Socio-Demographic Characteristics and Differentiated by Sex Overall, 29.2% of respondents had psychological distress (GHQ > 3), with statistically significant differences by sex, i.e., higher among women (37.7%) than among men (27.3%) (p= 0.37). In terms of marital status, among those without a partner, women (43.8%) were more likely to have psychological distress than men (31.1%) (p= 0.031) (Table 2). Table 2. Psychological distress by socio-demographic characteristics and differentiated by sex. Men Women No GHQ < 3 Yes GHQ > 3 No GHQ < 3 GFI χ2Test GFI Cases % Cases Cases % Cases % p-Value Total 511 72.7% 192 27.3% 62.3% 58 37.7% 0.037 * Marital status Married or cohabiting 343 74.7% 116 0.999 46 70.8% 19 29.2% 0.495 0.999 Other situations 168 68.9% 76 0.986 50 56.2% 39 43.8% 0.031 0.986 Approximately how many square metres (m2) does your dwelling have? 0–50 m211 52.4% 10 4 57.1% 3 42.9% N/A 51–75 m289 72.4% 34 0.984 18 58.1% 13 41.9% 0.122 0.984 76–100 m2198 76.7% 60 0.979 31 59.6% 21 40.4% 0.010 0.979 101–125 m297 67.8% 46 0.982 13 50.0% 13 50.0% 0.079 0.982 126–150 m266 77.6% 19 0.998 17 85.0% 3 15.0% 0.467 0.998 More than 151 m250 68.5% 23 0.999 13 72.2% 5 27.8% 0.759 0.999 Do you consider that your income is sufficient to make ends meet? Yes 232 77.6% 67 0.991 50 67.6% 24 32.4% 0.072 0.991 No, or depending on the month 279 69.1% 125 0.992 46 57.5% 34 42.5% 0.044 0.992 How much income do you receive in your household every month? Between 0 and 1200 euros 103 66.5% 52 0.997 34 60.7% 22 39.3% 0.441 0.997 More than 1200 euros 408 74.5% 140 0.992 62 63.3% 36 36.7% 0.022 0.992 Employment situation Self-employed 60 69.0% 27 0.996 13 76.5% 4 23.5% 0.536 0.996 Full-time employee 419 74.4% 144 0.982 64 58.2% 46 41.8% <0.001 0.982 Part-time employee 15 50.0% 15 0.929 16 76.2% 5 23.8% 0.059 0.929 Temporary Redundancy Procedure 2 50.0% 2 0.0% 1 100.0% N/A Unemployed 15 78.9% 4 3 60.0% 2 40.0% N/A Buildings 2024,14, 773 8 of 19 Table 2. Cont. Men Women No GHQ < 3 Yes GHQ > 3 No GHQ < 3 GFI χ2Test GFI Cases % Cases Cases % Cases % p-Value Degree of responsibility Managers and skilled workers 104 70.7% 43 0.982 34 56.7% 26 43.3% 0.051 0.982 Intermediate management 86 75.4% 28 1.000 13 61.9% 8 38.1% 0.197 1.000 Manual workers 287 73.2% 105 1.000 13 76.5% 4 23.5% 0.766 1.000 Others (administration staff, cleaning. . .) 34 68.0% 16 0.998 36 64.3% 20 35.7% 0.687 0.998 Type of project Building work 296 72.0% 115 0.997 51 65.4% 27 34.6% 0.237 0.997 Civil Works 98 83.8% 19 0.942 25 61.0% 16 39.0% 0.003 0.942 Industrial Works 70 68.6% 32 0.992 12 57.1% 9 42.9% 0.309 0.992 More than one type of work 47 64.4% 26 1.000 8 61.5% 5 38.5% 0.844 1.000 Place of work Outdoors 233 73.0% 86 0.976 19 50.0% 19 50.0% 0.003 0.976 Indoors (of buildings, facilities. . ..) 278 72.4% 106 0.997 77 66.4% 39 33.6% 0.211 0.997 Use of canteens Yes 139 75.1% 46 0.993 14 63.6% 8 36.4% 0.246 0.993 No 351 71.8% 138 0.992 75 61.5% 47 38.5% 0.027 0.992 *: Chi-squared test; GFI: Goodness-of-Fit Index; N/A: not available. At the socio-economic level, among the respondents who reported that their income was not enough to make ends meet, or was sometimes not enough to make ends meet, the percentage with psychological distress was higher among women (42.5%) than among men (30.1%) (p= 0.044). Similarly, among participants who reported a household income of more than 1200 euros per month, psychological distress was higher in women (36.7%) than among men (25.5%) (p= 0.022), with no statistically significant differences observed among those with an income below 1200 euros (Table 2). With regard to the work situation, the percentage of female full-time employees with psychological distress was higher (41.8%) than that of male employees under the same conditions (25.6%) (p< 0.001). There were no differences between men and women regarding the degree of responsibility. In the group of managers and skilled workers, the higher percentage of psychological distress among women was not found to be statistically significant (p= 0.051). The higher proportion of women reporting psychological distress in relation to the type of work they did was only statistically significant in the case of ‘civil work’, where it was 39.0% for women and 16.2% for men (p= 0.003). Women working outdoors were found to be more likely to experience psychological distress (50.0%) than men under the same conditions (27.0%) (p= 0.003). Women who did not use the canteen were more likely to have psychological distress (38.5%) than male workers who did not use it either (28.2%) (p= 0.027) (Table 2). Buildings 2024,14, 773 9 of 19 Psychological Distress, Working Conditions and COVID-19 Pandemic by Sex The higher percentage of overall psychological distress among women (37.7%) than among men (27.3%) (p= 0.037) was also observed when specifically analysing cases where it was stated that the companies provided means of protection to avoid infection: 39.4% among women versus 24.0% among men (p< 0.001); when they had received specific training from the company on ways of infection, routes of transmission, prevention measures, or warning signs of COVID-19: 40.1% among women and 23.1% among men (p= 0.001); and when they felt safe and protected from infection during the performance of their work duties: 33.3% of women with psychological distress and 19.3% of men (p= 0.006); also when they had been vaccinated against COVID-19: 37.3% of women with psychological distress and 27.2% of men (p= 0.013), as well as when they reported side effects after vaccination: 44.2% of women with psychological distress and 31.7% of men (p= 0.041) (Table 3). Table 3. Psychological distress, working conditions, and COVID-19 pandemic by sex. Men Women No GHQ < 3 Yes GFI Yes GHQ < 3 Yes GHQ > 3 χ2Test GFI Cases % Cases Cases % Cases % p-Value Total 511 72.7% 192 27.3% 62.3% 58 37.7% 0.037 * Have you been diagnosed with COVID-19? Yes 199 69.1% 89 0.999 47 66.2% 24 33.8% 0.637 0.999 No 312 75.2% 103 0.982 49 59.0% 34 41.0% 0.003 0.982 Has anyone in your circle been diagnosed with COVID-19? Yes 446 72.9% 166 0.995 88 64.2% 49 35.8% 0.043 0.995 No 65 71.4% 26 0.964 8 47.1% 9 52.9% 0.049 0.964 Has anyone in your circle died from COVID-19? Yes 57 69.5% 25 1.000 17 68.0% 8 32.0% 0.886 1.000 No 454 73.1% 167 0.980 79 61.2% 50 38.8% 0.007 0.980 Have you been isolated for having the disease or been in contact with a positive person? Yes 268 70.5% 112 0.977 65 62.5% 39 37.5% 0.117 0.977 No 243 75.2% 80 0.995 31 62.0% 19 38.0% 0.049 0.995 Have you been hospitalised for COVID-19? Yes 4 33.3% 8 1 100.0% 0.0% N/A No, but I had mild symptoms 180 69.2% 80 0.998 45 64.3% 25 35.7% 0.430 0.998 No 327 75.9% 104 0.983 50 60.2% 33 39.8% 0.003 0.983 Have your working conditions been affected by the pandemic? Yes 222 62.2% 135 0.995 50 53.2% 44 46.8% 0.113 0.995 No 289 83.5% 57 0.996 46 76.7% 14 23.3% 0.197 0.996 Have your managers or your company provided and do they provide you with the means of protection to avoid contagion (masks, gloves, gels, eye protection)? Yes 389 76.0% 123 0.982 66 60.6% 43 39.4% <0.001 0.982 No 117 63.2% 68 1.000 26 63.4% 15 36.6% 0.984 1.000 Other 5 83.3% 1 4 100.0% 0.0% N/A Buildings 2024,14, 773 16 of 19 have behaved in the same way. Likewise, they could also support the approximation of the results to the international population, given that the adoption of preventive measures by companies and the levels of fear and anxiety of COVID-19 in workers have been fairly homogeneous among the working population worldwide [ 9 ]. Yet, these data should be handled with caution due to the design of this study, as discussed below. Another limitation is the potential over-representation of women with higher educational level and younger age due to the methodology used to collect the information, which required access to the internet. Thirdly, this methodology (a cross-sectional study) does not establish causal associations and, thus, requires the application of other types of quantitative methods in future studies. However, the present study presents data from the construction sector in the south of Spain, analysed on the basis of the sex variable, showing for the first time in quantitative terms the differences between the two sexes. Author Contributions: Conceptualization, C.G.-S., J.C.C.-V., R.A.-C., C.R.-F., M.O.-M., M.L.-M., J.J.G.-I., J.F.-R., L.R.-D., J.M.V.-L. and J.G.-S.; Data curation, C.G.-S., J.C.C.-V., R.A.-C., C.R.-F., M.O.-M., M.L.-M., J.J.G.-I., J.F.-R. and J.G.-S.; Formal analysis, C.G.-S., J.C.C.-V., R.A.-C., C.R.-F., M.O.-M., M.L.-M., J.J.G.-I., J.F.-R., L.R.-D., J.M.V.-L. and J.G.-S.; Funding acquisition, J.G.-S.; Investigation, C.G.-S., J.C.C.-V., R.A.-C., C.R.-F., M.O.-M., M.L.-M., J.J.G.-I., J.F.-R., L.R.-D., J.M.V.-L. and J.G.-S.; Methodology, C.G.-S., J.C.C.-V., R.A.-C., C.R.-F., M.O.-M., M.L.-M., J.J.G.-I., J.F.-R., L.R.-D., J.M.V.-L. and J.G.-S.; Project administration, C.G.-S., J.C.C.-V., R.A.-C., J.F.-R. and J.G.-S.; Resources, C.G.-S., J.C.C.-V., R.A.-C., C.R.-F., M.O.-M., M.L.-M., J.J.G.-I., J.F.-R., L.R.-D., J.M.V.-L. and J.G.-S.; Software, C.G.-S., J.C.C.-V., R.A.-C., C.R.-F., M.O.-M. and J.G.-S.; Supervision, C.G.-S., J.C.C.-V., R.A.-C., C.R.-F., M.O.-M., M.L.-M., J.J.G.-I., J.F.-R., L.R.-D., J.M.V.-L. and J.G.-S.; Validation, C.G.-S., J.C.C.-V., R.A.-C., C.R.-F., M.O.-M., M.L.-M., J.J.G.-I., J.F.-R., L.R.-D., J.M.V.-L. and J.G.-S.; Visualization, C.G.-S., J.C.C.-V., R.A.-C., C.R.-F., M.O.-M., M.L.-M., J.J.G.-I., J.F.-R., L.R.-D., J.M.V.-L. and J.G.-S.; Writing—original draft, C.G.-S., J.C.C.-V., R.A.-C., C.R.-F., M.O.-M., M.L.-M., J.J.G.-I., J.F.-R., L.R.-D., J.M.V.-L. and J.G.-S.; Writing—review & editing, C.G.-S., J.C.C.-V., R.A.-C., C.R.-F., M.O.-M., M.L.-M., J.J.G.-I., J.F.-R., L.R.-D., J.M.V.-L. and J.G.-S. All authors have read and agreed to the published version of the manuscript. Funding: This research is part of the project “Impact of the COVID-19 pandemic on the emotional and occupational health of construction workers: Evaluation and intervention proposals” which was funded by the Andalusian Institute for the Prevention of Occupational Hazards (IAPRL), part of the Ministry of Employment, Training and Self-Employment of Andalusia (CTC-2022142721). Data Availability Statement: Data available within reasonable request to the corresponding author. Acknowledgments: All authorizations for the use of the scales in this study, especially the GHQ-12, were obtained by the authors. Conflicts of Interest: The authors declare no conflicts of interest. References 1. Ren, T.; Cao, L.; Chin, T. Crafting Jobs for Occupational Satisfaction and Innovation among Manufacturing Workers Facing the COVID-19 Crisis. Int. J. Environ. Res. Public Health 2020,17, 3953. [CrossRef] [PubMed] 2. 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