Evaluation of the level of psychological distress in construction workers during the COVID-19 pandemic in Southern Spain

Healthcare 2024, 12, 1224. https://doi.org/10.3390/healthcare12121224 www.mdpi.com/journal/healthcare Article Evaluation of the Level of Psychological Distress in Construction Workers during the COVID-19 Pandemic in Southern Spain Carlos Gómez-Salgado 1, Juan Carlos Camacho-Vega 2, Regina Allande-Cussó 3, Carlos Ruiz-Frutos 4,5, Mónica Ortega-Moreno 6, Jorge Martín-Pereira 1, Israel Macías-Toronjo 7, Blanca Prieto-Callejero 8, Juan Jesús García-Iglesias 4, Javier Fagundo-Rivera 9,* and Juan Gómez-Salgado 4,5,* 1 School of Doctorate, University of Huelva, 21007 Huelva, Spain 2 Department of Building Construction II, Higher Technical School of Building Engineering, University of Seville, 41012 Sevilla, Spain 3 Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Sevilla, Spain; [email protected] 4 Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain 5 Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil 092301, Ecuador 6 Department of Economy, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain 7 Department of Rehabilitation, Fremap Huelva, 21001 Huelva, Spain 8 Department of Nursing, University of Huelva, 21007 Huelva, Spain 9 Centro Universitario de Enfermería Cruz Roja, University of Seville, 41009 Sevilla, Spain * Correspondence: [email protected] (J.F.-R.); [email protected] (J.G.-S.); Tel.: +34-954350997 (J.F.-R.); +34-959219700 (J.G.-S.) Abstract: The COVID-19 pandemic posed a major challenge for construction companies, which were confronted with the need to prevent the enormous negative socio-psychological impact of the pandemic on their employees. The aim of this study was to evaluate the level of psychological distress among construction workers in an advanced phase of the COVID-19 pandemic in Andalusia, southern Spain. For this, a cross-sectional descriptive study was conducted using online questionnaires with data on sociodemographic variables and employment situation, COVID-19 pandemicrelated data, and Goldberg’s General Health Questionnaire (GHQ-12). A total of 860 questionnaires from all provinces of Andalusia, Spain, were collected between March and May 2022. Descriptive statistical analyses and non-parametric Mann–Whitney U and Chi-squared tests were performed, followed by logistic regression analysis. The incidence of psychological distress was higher among women, individuals under 43 years of age, those with a family income below EUR 1200, participants whose working conditions had been affected by the pandemic, those who had not received adequate means or specific training to protect themselves from infection, those who had experienced symptoms, those who had suffered side effects after vaccination, and those who had been hospitalised. The logistic regression analysis predicted the occurrence of psychological distress in this study by the effect of the pandemic on mental/emotional well-being, the working conditions affected during the pandemic, health-related variables, and the age of the worker. The correctly classified percentage was 75.1%. Assessing psychological distress in construction sectors may allow for the identification of vulnerable groups or even help to reduce the number of errors in daily practice and potential risks of occupational injury or illness. Keywords: COVID-19; construction industry; psychological distress; occupational safety and health; mental health; construction workers; workplace mental health Citation: Gómez-Salgado, C.; Camacho-Vega, J.C.; Allande-Cussó, R.; Ruiz-Frutos, C.; Ortega-Moreno, M.; Martín-Pereira, J.; Macías-Toronjo, I.; Prieto-Callejero, B.; García-Iglesias, J.J.; Fagundo-Rivera, J.; et al. Evaluation of the Level of Psychological Distress in Construction Workers during the COVID-19 Pandemic in Southern Spain. Healthcare 2024, 12, 1224. https:// doi.org/10.3390/healthcare12121224 Academic Editor: Vincenza Capone Received: 15 May 2024 Revised: 13 June 2024 Accepted: 17 June 2024 Published: 19 June 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/). Healthcare 2024, 12, 1224 2 of 14 1. Introduction The construction sector accounts for 13% of the world’s gross domestic product (GDP) and employs a low-skilled workforce compared to other productive sectors. Another feature that differentiates it from other jobs is that many activities are impossible to perform virtually [1,2]. In countries such as the UK, it accounts for 10% of employment [3], and it is a sector with high occupational accident rates worldwide [4]. In Spain, in 2023, workers in the construction sector represented 6.3% of the employed population and, specifically, 6.1% in Andalusia (204,100 workers) [5]. While research into mental health in the workplace in general and in the construction sector in particular is still in its early stages, it is known that suicide rates among lowskilled workers in the construction sector were considerably higher than the national rate in the UK [6], and other studies carried out before the COVID-19 pandemic revealed that two out of five construction workers suffer from depression and anxiety and, more seriously, three out of five workers have problems with alcohol consumption [7]. The most commonly used instruments to assess the mental health of workers in the construction industry are scales for depression, anxiety, and stress [8]. The mental health of construction workers has recently come to the forefront of occupational health and safety research, but the effectiveness of workplace interventions at an organisational level has been found to be limited [9]. Even before the COVID-19 pandemic, differences had been found between builders and supervisors in terms of psychosocial risks at work and their impact on mental health, with the former having a higher prevalence of the need to recover after work and more frequent distress, depression, or post-traumatic stress disorder [10]. For all the above said, this workforce faces a high-risk and mentally stressful work environment [11] and has one of the highest levels of workplace stressors, all of which has been exacerbated by the pandemic [12]. The role of work stress in favouring both unsafe behaviours and the level of safety participation has been shown to predispose to accidents yet not in terms of levels of safety compliance [13]. Workplace safety and health in construction is one of the seven challenges identified in the construction sector [14], which was affected by three types of safety-related stressors, role ambiguity, role conflict, and interpersonal safety conflict, where self-efficacy mediated between these three stressors and safety participation [15]. Workplace behaviours have been associated with job satisfaction and innovative behaviour at work, which is of particular interest at a time of increasing unemployment rates in this population group [16]. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as the cause of COVID-19, has led to a major health crisis that brought about economic recession and psychological insecurity worldwide [16]. Conveniently, the assessment of previous epidemics has made it possible to identify effects such as anxiety, depression, or increased psychiatric morbidity [17–19]. In 2022, Spain faced the seventh wave of the COVID-19 pandemic, marked by a peak in incidence on January 21st with 3418 cases per 100,000 inhabitants over fourteen days. This increase began in November 2021 and accelerated in December. However, starting on January 21st, the incidence started to decrease rapidly, falling by 33% in fifteen days. The severity of cases during this wave was significantly lower than in previous ones, with hospitalisation, ICU admission, and mortality rates between 10 and 22 times lower. The high vaccination coverage in Spain, with 90.8% of the population over 11 years of age vaccinated and 91% of those over 60 years of age with booster doses, was key in reducing the vulnerability and severity of cases [20]. Construction workers suffered the highest mortality rates during the COVID-19 pandemic [21]. This was despite the fact that in the US the collective adapted to perform some tasks by videoconferencing, like in other countries, in order to reduce the transmission of the disease [22], and specific guidelines were developed to manage and prevent the disease among workers [23]. Healthcare 2024, 12, 1224 3 of 14 Assuming that the impact on the sector may vary across countries, negative effects have been found, such as high unemployment rates in the US [24] and supply chain or material price increases, but also positive ones, such as the awareness of the need to incorporate digitalisation [25]. Therefore, a report from the Spanish Association of Major Construction Companies of Spain describes that the economic crisis caused by COVID-19 in Spain led to the collapse of up to 63% of public work contracts tendered and awarded; in this regard, the sector had to face a loss of nearly EUR 2.5 billion in tenders and close to EUR 3 billion in contracts [26]. The pandemic posed a major challenge for companies, as it required adapting working conditions, both technically and physically, to prevent the massive negative sociopsychological impact [27]. In this context, the present study represents the first assessment of the impact of the COVID-19 pandemic on the psychological distress of construction workers in Spain. Thus, the aim of this study was to assess the level of psychological distress (PD) among construction workers in an advanced phase of the COVID-19 pandemic in Andalusia, southern Spain. It also sought to identify personal and occupational variables determining this level of PD, which could be used to implement preventive measures in future health crises and other types of crises. 2. Materials and Methods 2.1. Design A cross-sectional observational study employing electronic survey instruments was carried out. 2.2. Population and Sample The research population comprised individuals employed in the Andalusian sector in 2023, totalling 204,100 workers, with women constituting 8.03% of the population [5]. A sample size of 383 participants was initially established, with a confidence level of 95%, a precision of 3.5%, and an adjustment for potential loss of 10%. However, the final sample size was 860 subjects. A non-probabilistic convenience sample was used. Questionnaires were received from all provinces of Andalusia, although a higher proportion was received from Seville and Huelva. The sample of workers analysed contained a higher proportion of men (81.7%), in line with the current sex distribution in the construction sector. Several companies were approached to participate in this study, and none refused to do so. Companies were asked to send the survey link to all their employees, regardless of their level of awareness of the prevalence of PD among their employees. Workers accessed the questionnaire mainly through their own mobile devices, although in some cases company-provided computers were used. The online questionnaire link was sent via email to companies based in Andalusia, trade union organisations, and workers’ associations in the sector who agreed to participate in this study and disseminate the questionnaire among their workers, between March and May of 2022. Information about the project, including a QR code and a printed poster to facilitate dissemination among workers, was attached to the emails. To access the questionnaire items, participants were required to first access the information sheet and provide informed consent. Without this consent, it was not possible to proceed with answering the items. 2.3. Instruments The previously validated Emotional Impact Questionnaire COVID-19 (EIQ COVID- 19) tool [28], which incorporates questions adapted from previous research [29], was used and expanded with industry-specific data tailored to the construction sector. This instrument encompassed sociodemographic characteristics such as age, sex, geographic Healthcare 2024, 12, 1224 4 of 14 location, employment status (self-employed, full-time, part-time, redundancies, unemployed), occupational classification (managerial, skilled, intermediate management, labourer, administrative, or custodial staff), nature of work, construction site type (residential, industrial, or civil), work environment (outdoor or indoor), income adequacy, household size, dwelling size in square meters, and usage of workplace dining facilities (yes, no, only in low attendance, non-existent, or closed during the pandemic). Furthermore, personal information pertinent to the COVID-19 pandemic was collected, encompassing aspects such as diagnosis, isolation experience, severity of illness, hospitalisation history, vaccination status and associated side effects, availability and utilisation of preventive measures, received training, perception of workplace safety, and the impact of the pandemic on work-related activities. The variable ‘Pandemic effect on mental/emotional well-being’ had ‘No’ as a reference, and the alternative options were ‘Yes’ or ‘Possibly’. As a strong predictor of morbidity [30] which has been included in previous epidemics [31] and COVID-19 studies [29], self-perceived health status was also measured. The variable ‘Overall health and physical condition’ took values between 1 and 10. To assess psychological distress, the Goldberg General Health Questionnaire, GHQ- 12, was used, comprising 12 items and offering 4 response options, with a total scoring range of 0 to 12 points [32]. The threshold applied was ≥3, aligning with the threshold used in Spanish national surveys [33]. The GHQ-12 has demonstrated strong reliability across various studies, with Cronbach’s alphas ranging from 0.82 to 0.86 [32]. The internal consistency index achieved was α = 0.905. 2.4. Data Analysis A univariate descriptive analysis was conducted, obtaining frequencies, means, and standard deviations based on the type of variable, as well as a bivariate analysis. Prior to the bivariate analysis, the result of the Kolmogorov–Smirnov test was obtained, which indicated the non-normality of the sample with a value of p < 0.05. For the bivariate analysis, contrast statistics such as the Mann–Whitney U test and the Chi-squared test were used to determine whether there were any statistically significant differences between the median scores and the classified score (GHQ < 3 or GHQ ≥ 3) for psychological distress and the other study variables, respectively. A binary logistic regression analysis was also performed to build a predictive model for the presence of psychological distress and the other variables. The model was built by introducing significant variables identified using the Wald method, with the objective of building a simple and robust model. To assess the model’s adequacy, various goodness- of-fit measures were used, including the Hosmer–Lemeshow test, percentage of correctly classified values, sensitivity, and specificity. Statistical significance tests were used to determine the inclusion of variables, so odds ratios were estimated and confidence intervals were provided for this measure of association. All analyses were carried out using SPSS 26.0 statistical software (IBM, Armonk, NY, USA). 2.5. Ethics Statement The 2013 Declaration of Helsinki (Fortaleza meeting, Brazil) was observed in this study. Written informed consent was obtained from the participants for the confidential use and treatment of the data in accordance with the Spanish Data Protection and Digital Rights Act of 2018. Participants were informed that their data would be duly safeguarded by the research team. A favourable opinion was obtained from the Regional Research Ethics Committee (PI_036-20). Healthcare 2024, 12, 1224 5 of 14 3. Results 3.1. Sociodemographic Characteristics of the Sample The group of construction workers surveyed was predominantly male (81.7%), with a mean age of 42.7 years and 61.2% of them living with a partner. In total, 75.5% of them reported a family income of more than EUR 1200 per month, and 43.5% stated that their income was sufficient to make ends meet. In terms of employment status, 78.6% of individuals had a full-time contract, 12.5% were self-employed, and 5.9% were part-time employees. To a lesser extent, there were workers who were unemployed at the time (2.8%) or who were still in the exceptional situation created during the pandemic to reduce redundancies through temporary redundancy procedures, which were partly subsidised by public funds (0.6%) (Table 1). Table 1. Sociodemographic characteristics. Cases (%) Sex Male 703 (81.7%) Female 154 (17.9%) Intersex 3 (0.3%) Age [mean (SD)] 42.7 (10.4) Marital status Married or cohabiting 526 (61.2%) Other situations 334 (38.8%) Approximately, how many square metres (m2) does your dwelling have? 0–50 m2 28 (3.3%) 51–75 m2 154 (17.9%) 76–100 m2 312 (36.3%) 101–125 m2 170 (19.8%) 126–150 m2 105 (12.2%) More than 150 m2 91 (10.6%) Do you consider that your income is sufficient to make ends meet? Yes 374 (43.5%) No or depending on the month 486 (56.5%) What is the total monthly family income? Between EUR 0 and 1200 211 (24.5%) More than EUR 1200 649 (75.5%) Employment situation Self-employed 104 (12.1%) Full-time employee 676 (78.6%) Part-time employee 51 (5.9%) Temporary redundancy procedure 5 (0.6%) Unemployed 24 (2.8%) Degree of responsibility Managers and skilled workers 209 (24.3%) Intermediate management 135 (15.7%) Manual workers 410 (47.7%) Others (administration staff, cleaning…) 106 (12.3%) Type of construction work Building work 491 (57.1%) Civil work 159 (18.5%) Industrial work 123 (14.3%) More than one type of work 86 (10.0%) Healthcare 2024, 12, 1224 6 of 14 Does not know/say 1 (0.1%) Construction site Outdoors 360 (41.9%) Indoors (of buildings, facilities…) 500 (58.1%) Use of staff canteen Yes 208 (24.2%) No 612 (71.2%) Other cases 40 (4.6%) In terms of the degree of responsibility at work, the highest percentage was found among labourers (47.7%), and 40.0% were managers and qualified staff or held middle management positions, while 12.3% were administrative or cleaning staff. According to the questionnaires, building works (57.1%) were the most frequently reported type of construction work, followed by civil works (18.5%) and industrial works (14.3%). Additionally, 41.9% of workers were engaged in outdoor work, and 24.2% used company canteens (Table 1). 3.2. Psychological Distress and Personal or Employment-Related Variables The prevalence of PD (GHQ < 3) among workers was 29.2%, with a higher incidence in women (37.7%) compared to men (27.3%) (p = 0.010). Participants with PD were younger (mean = 41.2; SD = 10.4) than those without PD (mean = 43.4; SD = 10.3) (p = 0.006). Subjects with PD had lower levels of health and a worse physical condition (p < 0.001). In terms of marital status, individuals who cohabited with a partner had a lower risk of developing PD (25.9%) than those who did not (34.4%) (p = 0.007). The presence of financial resources to make ends meet was associated with the development of PD, with those who reported having such resources being less likely to develop PD (24.3%) compared with those who did not (32.9%) (p = 0.006). It can be seen that respondents with a family income of less than EUR 1200 had a greater likelihood of experiencing PD (35.1%) compared to respondents with an income of more than EUR 1200 (27.3%), p = 0.030 (Table 2). For the variables size of dwelling, type of construction site, degree of responsibility, working outdoors–indoors, or the use of canteens, no differences were found regarding the development of PD. Table 2. Psychological distress and associated personal or employment data. NO GHQ < 3 YES GHQ ≥ 3 Cases % Cases % Statistical (Effect Size) p-Value Total 609 70.8% 251 29.2% Age [Median (IQR)] 43.4 (15) 41.2 (16) 66,022.5 (0.099) ** 0.006 Overall health and physical condition [Median (IQR)] * 8 (2) 8 (1) 61,608.50 (0.156) ** <0.001 Sex Male 511 72.7% 192 27.3% 6.551 (0.087) *** 0.010 Female 96 62.3% 58 37.7% Intersexual 2 66.7% 1 33.3% - - Marital status Married or cohabiting 390 74.1% 136 25.9% 7.269 (0.092) *** 0.007 Other situations 219 65.6% 115 34.4% Approximately, how many square metres (m2) does your dwelling have? 0–75 m2 122 67.0% 60 33.0% 1.597 0.206 Healthcare 2024, 12, 1224 7 of 14 More than 75 m2 487 71.8% 191 28.2% (0.043) *** Employment status Full-time employee/self-employed 558 71.5% 222 28.5% 4.010 (0.069) *** 0.045 Part-time employee/temporary redundancy procedure 33 58.9% 23 41.1% Unemployed 18 75.0% 6 25.0% - - Do you consider your income sufficient to make ends meet? Yes 283 75.7% 91 24.3% 7.546 (0.094) *** 0.006 No or depending on the month 326 67.1% 160 32.9% What is the total monthly family income? Between EUR 0 and 1200 137 64.9% 74 35.1% 4.685 (0.074) *** 0.030 More than EUR 1200 472 72.7% 177 27.3% Degree of responsibility Managers and qualified staff 139 66.5% 70 33.5% 4.802 (0.075) *** 0.187 Mid-level management 99 73.3% 36 26.7% Labourer 301 73.4% 109 26.6% Other (administrative staff, cleaning staff, …) 70 66.0% 36 34.0% Type of construction work Building work 348 70.9% 143 29.1% 6.950 (0.090) *** 0.073 Civil work 124 78.0% 35 22.0% Industrial work 82 66.7% 41 33.3% More than one type of work 55 64.0% 31 36% DK/DR 0 0% 1 100% Construction site Outdoors (open air) 254 70.6% 106 29.4% 0.020 (0.005) *** 0.888 Indoors (buildings, facilities, etc.) 355 71.0% 145 29.0% Use of staff canteen Yes 153 73.6% 55 26.4% 1.075 (0.036) *** 0.300 No 427 69.8% 185 30.2% Other cases 29 72.5% 11 27.5% - - DK/DR: Don’t know/respond; IQR: Interquartile Range; * Scoring from 1 to 10; ** Mann–Whitney U test; *** Chi-squared test. 3.3. Psychological Distress and Data Related to the COVID-19 Pandemic A higher percentage of PD (39.7%) was found among workers whose working conditions had been affected during the pandemic than among those whose working conditions had not been affected (17.4%), p < 0.001. In companies where protective measures such as masks, gloves, gels, and goggles had not been provided by the managing staff, 36.7% had PD, compared to 26.8% (p = 0.005) in companies where such measures had been provided. Additionally, workers who had not received specific training on COVID-19 were more likely to develop PD, with a prevalence of 33.1%, compared to 25.8% in those who had received such training (p = 0.020). The perception of safety and protection from infection while performing job duties was found to be associated with lower rates of PD. Specifically, 21.7% of those who felt completely safe had PD, compared to 35.1% of those who felt somewhat safe and 63.2% of those who felt not at all safe (p < 0.001). Having had side effects after COVID-19 vaccination was found to be associated with developing PD, with 34.4% of those who had had side effects and 25.2% of those who had not reporting PD (p = 0.003). The presence of COVID-19 symptoms was associated with a higher percentage of PD (33.0%) compared to those without symptoms (26.6%) (p = 0.042). Healthcare 2024, 12, 1224 8 of 14 It was found that 44.2% of workers who reported that the situation experienced during the COVID-19 pandemic had negatively affected their mental/emotional well-being had developed PD at a much higher rate than those who reported the opposite (9.7%) (p < 0.001) (Table 3). Table 3. Psychological distress and COVID-19-related data. NO GHQ < 3 YES GHQ ≥ 3 Chi-Squared Test Cases % Cases % Statistical p-Value Total 609 70.8% 251 29.2% Have you been diagnosed with COVID-19? Yes 247 68.4% 114 31.6% 1.724 (0.045) 0.189 No 362 72.5% 137 27.5% Has anyone in your circle been diagnosed with COVID-19? Yes 535 71.2% 216 28.8% .516 (0.025) 0.472 No 74 67.9% 35 32.1% Has anyone in your circle died from COVID-19? Yes 74 69.2% 33 30.8% 0.162 (0.014) 0.687 No 535 71.0% 218 29.0% Have you been isolated because you have had the disease or contact with a person tested positive? Yes 334 68.7% 152 31.3% 2.361 (0.052) 0.124 No 275 73.5% 99 26.5% Have you had mild symptoms? Yes 231 67.0% 114 33.0% 4.148 (0.069) 0.042 No 378 73.4% 137 26.6% Have your working conditions been affected by the pandemic? Yes 273 60.3% 180 39.7% 51.539 (0.245) <0.001 No 336 82.6% 71 17.4% Have your managers or your company provided and do they provide you with the necessary protective measures to avoid contagion (masks, gloves, gels, goggles)? Yes 457 73.2% 167 26.8% 7.932 (0.097) 0.005 No 143 63.3% 83 36.7% Other 9 90% 1 10% - - Did you receive or have you ever received specific training on COVID-19 disease (transmission routes, self-protec- tion measures, warning signs) organised by your managers or your company? Yes 343 74.2% 119 25.8% 5.417 (0.080) 0.020 No 255 66.9% 126 33.1% Other (self-employed, mid-level, …) 11 64.7% 6 35.3% - - In general, do you feel safe and protected from infection in the performance of your work duties? Yes, totally safe 360 78.3% 100 21.7% 39.653 (0.215) <0.001 Somewhat safe 235 64.9% 127 35.1% No, not at all safe 14 36.8% 24 63.2% Have you been vaccinated against COVID-19? Yes 600 71.0% 245 29.0% 0.864 (0.032) 0.353 No 9 60.0% 6 40.0% Have you had any side effects following vaccination? Yes 244 65.6% 128 34.4% 8.652 (0.10) 0.003 No 365 74.8% 123 25.2% Do you think that the situation experienced during the COVID-19 pandemic has negatively affected your mental/emotional well-being? Healthcare 2024, 12, 1224 9 of 14 Yes 272 55.85% 215 44.15% 121.616 (0.376) <0.001 No 337 90.35% 36 9.65% 3.4. Variables Determining the Development of Psychological Distress among Workers in the Construction Sector The variables that seem to be most predictive of the level of PD among construction workers are the following: ‘the effect of the pandemic on mental/emotional well-being’, OR = 6.182 (CI95%: 4.204, 9.089); ‘working conditions affected during the pandemic’, OR = 2.281 (CI95%: 1.628, 3.196); ‘variables related to health and physical condition’, OR = 0.797 (CI95%: 0.744, 0.854); and ‘age of the worker’, OR = 0.980 (CI95%: 0.969, 0.992). These variables predict 75.1% of the effect, an R2 = 0.428, a sensitivity of 44.2%, and a specificity of 87.9% (Table 4). Table 4. Variables determining the development of psychological distress among workers in the construction sector. Odds Ratio (Confidence Interval at the 95% Level) Effect of the pandemic on mental/emotional well-being (Ref. NO) 6.182 ** (4.204, 9.089) Working conditions affected by the pandemic (Ref. NO) 2.281 ** (1.628, 3.196) Health and physical condition 0.797 * (0.744, 0.854) Age 0.980 ** (0.969, 0.992) Sensitivity (%)/specificity (%) 44.2/87.9 Correctly classified percentage 75.1% R2 0.428 Hosmer–Lemeshow test χ2 = 5.138 (p = 0.743) Omnibus test χ2 = 329.678 (p < 0.001) * p < 0.005; ** p < 0.001. 4. Discussion Women in this study, a minority in the sector and in this sample, presented higher percentages of PD than men, something observed in most published studies both in the general population [34,35] and in the healthcare sector [36]. Consistent with previous studies, younger respondents, in this study those under 43 years of age, were the most likely to develop PD [35,37]. Individuals living alone, whose figures increased during the pandemic, were found to be more likely to develop PD [35]. This is consistent with the results in the present study in which a higher percentage of PD was found among workers living without a partner, with no statistically significant difference being observed based on the number of cohabitants. In other studies, a great heterogeneity and susceptibility towards developing PD was observed in different periods of the pandemic, where only those classified with a ‘chronic’ profile of living alone experienced a significant change, yet this variation was not found in the other groups [38]. PD in this study population (29.2%) was still very high but much lower than the levels found in non-healthcare workers during the first phase of the pandemic (67.3%) [39]. This discrepancy suggests that although there was a 33% reduction in the incidence of cases during the data collection period [20], psychological distress remained a significant condition among construction workers. Possible explanations for this sustained high level of PD despite the decrease in incidence could include lingering effects of the pandemic on mental health, such as increased stress and anxiety due to ongoing uncertainty, economic pressure, and changing working conditions [40]. Additionally, it is important to consider the unique challenges already faced by construction workers, such as the physical demands of the job, potential exposure to hazardous materials, and irregular employment