Sa e y Science 133 (2021) 105033
A ailable online 7 Oc obe 2020
0925-7535/© 2020 Else ie L d. All igh s ese ed.
Sense o cohe ence, engagemen , and wo k en i onmen as p ecu so s o
psychological dis ess among non-heal h wo ke s du ing he COVID-19
pandemic in Spain
Ca los Ruiz-F u os
a
,
b
, M´
onica O ega-Mo eno
c
,
*
, Regina Allande-Cuss´
o
d
,
Diego Ayuso-Mu illo
e
, Sa a Domínguez-Salas
,
1
, Juan G´
omez-Salgado
a
,
b
,
*
,
1
a
Depa men o Sociology, Social Wo k and Public Heal h, Facul y o Labou Sciences, Uni e si y o Huel a, 21007 Huel a, Spain
b
Sa e y and Heal h Pos g adua e P og amme, Uni e sidad Espí i u San o, 092301 Guayaquil, Ecuado
c
Depa men o Economy, Uni e si y o Huel a, 21007 Huel a, Spain
d
Depa men o Nu sing, Facul y o Nu sing, Physio he apy, and Podia y. Uni e si y o Se ille, Se ille 41009, Spain
e
Gene al Council o Nu sing, Mad id 28023, Spain
Depa men o Psychology, Uni e sidad Loyola Andalucía, Dos He manas, 41704 Se illa, Spain
ARTICLE INFO
Keywo ds:
COVID-19
Psychological dis ess
Non-heal h wo ke s
Occupa ional heal h
Public heal h
ABSTRACT
Backg ound: The in e ela ionship be ween he sense o cohe ence, wo k en i onmen , wo k engagemen , and
psychological dis ess ha e pa icula in e es in non-heal h wo ke s who ca ied ou essen ial ac i i ies du ing
he COVID-19 pandemic.
Objec i e: To assess he e ec s o he COVID-19 on he physical and men al heal h o non-heal h wo ke s.
Design: Obse a ional desc ip i e c oss-sec ional s udy.
Da a sou ces: 1089 ques ionnai es ha e been analysed. Engagemen (UWES-9), sense o cohe ence (SOC-13),
men al heal h (Goldbe g GHQ-12), demog aphic da a, pe cep ion o heal h and s ess and wo k en i onmen
we e assessed.
Resul s: A low le els o engagemen , he pe cen age o dis ess is highe (77.9%). Low le els o sense o
cohe ence co espond o he highes pe cen ages o dis ess (86.3%). The 94.1% belie e i necessa y o p o-
essionals and olun ee s in ol ed in COVID-19 o ecei e psychological suppo . Low comp ehensibili y is
media ed by he pe cep ion o s ess; i he pe cep ion is low, comp ehensibili y is modula ed by he le el o
signi icance; i i is low, i gene a es 95.9% o dis ess.
Conclusion: The in e ela ionship be ween he sense o cohe ence, wo k en i onmen , wo k engagemen , and
psychological dis ess ha e pa icula in e es in non-heal h wo ke s who ca ied ou essen ial ac i i ies du ing
he COVID-19 pandemic. Almos all esponden s belie ed ha p o essionals and olun ee s in ol ed in COVID-
19 should ecei e psychological suppo . This may be an indica o o he e ec o he COVID-19 pandemic on
wo ke s’ men al heal h.
1. In oduc ion
The SARS-COV-2, COVID-19, began on 31 Decembe 2019 in Wuhan,
Hubei P o ince, China, and was con i med on 7 Janua y 2020, p eceded
in he las 20 yea s by SARS-COV-1 in 2003, and MERS-COV in 2012.
COVID-19 is becoming mo e i ulen , wi h a g ea e associa ion o ad-
missions in in ensi e ca e uni s and highe mo ali y (Huang e al.,
2020). In a e y sho ime, COVID-19 has ans o med and up oo ed
li es a ound he wo ld, and while he e a e clea di e ences wi h o he
pandemics such as HIV, om which i di e s in he o m o ansmission
and na u al his o y, hese also ha e poin s in common like he denial o
he associa ed dange s, o he ole ha public heal h may play (Edelman
e al., 2020). I should be eminded ha HIV con inues claiming mo e
han a million li es wo ldwide e e y yea (Collabo a o s GH, 2016). The
* Co esponding au ho s a : Campus El Ca men, Uni e sidad de Huel , A . de 3 de Ma zo, Huel a 21007, Spain.
E-mail add esses: [email p o ec ed] (C. Ruiz-F u os), [email p o ec ed] (M. O ega-Mo eno), [email p o ec ed] (R. Allande-Cuss´
o), d.ayuso@consejogene alen e me ia.
o g (D. Ayuso-Mu illo), [email p o ec ed] (S. Domínguez-Salas), [email p o ec ed] (J. G´
omez-Salgado).
1
Senio au ho s, hese au ho s con ibu ed equally o his wo k and should be ega ded as equal.
Con en s lis s a ailable a ScienceDi ec
Sa e y Science
jou nal homepage: www.else ie .com/loca e/sa e y
h ps://doi.o g/10.1016/j.ssci.2020.105033
Recei ed 21 Sep embe 2020; Accep ed 1 Oc obe 2020
Sa e y Science 133 (2021) 105033
2
COVID-19 pandemic has led o a global ecession, wi h g ea economic
ola ili y and psychological insecu i y, which has esul ed in companies
laying o many employees and empowe ing in o ma ion and commu-
nica ion echnologies o eplace wo ke s wi h in elligen machines and
a i icial in elligence (Ren e al., 2020).
The sense o cohe ence (SOC), p oposed by An ono sky wi hin he
salu ogenic model, explains why ce ain people do no lose hei heal h
when aced wi h s ess ul si ua ions, s eng hening pe sonal esou ces o
p e en bo h psychic and physical dis u bances (An ono sky, 1987).
The SOC is a sou ce o heal h p omo ion and a good p edic o o
bu nou , dep ession, and job sa is ac ion a es (Masano i e al., 2020).
Coping has been posi i ely ela ed o he SOC, and bo h SOC and
engagemen ha e been nega i ely ela ed o exhaus ion (Mi onga-
Monga and Maye , 2020). I is known ha he sense o cohe ence has a
nega i e co ela ion wi h de eloping pos - auma ic s ess, which could
be equalled o he s ess p oduced by he COVID-19 pandemic, hough
his co ela ion is posi i e wi h ega ds o ole ance o ex a e sion and
us a ion (F ommbe ge e al., 1999). The need o u he esea ch has
been aised o ind ou whe he he ela ionship be ween he SOC and
pos - auma ic s ess is o he causal ype, and wha ac o s may mod-
e a e i (Sch¨
a e e al., 2019). The e ec s o pos - auma ic s ess on
causing anxie y and dep ession ha e e idenced a highe pe cen age o
pos - auma ic s ess among women (Ca massi e al., 2018; Ch is iansen
and Elkli , 2008; Di le sen and Elkli , 2012) along wi h high cos s o he
public heal h se ices and o each indi idual (Lamou eux-Lama che
e al., 2016).
The sho ime since he s a o he pandemic by COVID-19 p e en s
us om ha ing eliable da a on he pos - auma ic s ess e ec s o his
pandemic. Howe e , expe ience om p e ious pandemics and i s
published esul s (Rajkuma , 2020) lead o he idea ha i has e ec s on
psychological ulne abili y such as esilience, among o he s (Con-
e sano e al., 2020).
The COVID-19 pandemic poses a huge challenge, a ec ing all com-
panies wo ldwide, bo h in echnical and physical aspec s, and wi h so-
ciopsychological epe cussions ne e seen be o e (Ca ne ale and Ha ak,
2020). In hese imes o c isis and unce ain y, he in luence ha Heal h
Au ho i ies ha e o p o ide adequa e in o ma ion h ough he media
and social ne wo ks is well-known, as his inc eases he commi men o
ci izens and os e s highe le els o compliance wi h p e en i e mea-
su es agains COVID-19. Fo mal aspec s a e also impo an , and i is
ad isable o include images o ideos when he in o ma ion gi en is
posi i e, and plain ex when i is nega i e (Chen e al., 2020).
I is known ha , when wo king condi ions p omo e us ed e-
la ionships and a coope a i e wo king en i onmen his helps p e en
men al illness (Gomez e al., 2019). In he s udy, hey assumed ha
“engagemen ” is cha ac e ised by ene gy, pa icipa ion, and e ec i e-
ness, which a e conside ed di ec opposi es o he h ee dimensions o
exhaus ion, cynicism, and lack o p o essional e iciency, espec i ely.
Commi ed employees ha e a sense o ene ge ic and e ec i e connec ion
o hei wo k ac i i ies and see hemsel es as able o ully handle he
demands o hei wo k. Wo k engagemen co esponds wi h low alues
o exhaus ion and cynicism, and high alues o e iciency (Schau eli
e al., 2002). I has been seen ha wo k engagemen (engagemen ) is
g ea ly in luenced by he deg ee o job sa is ac ion, whe e he sense o
cohe ence and, o a lesse ex en , esilience a e ac ing as a modula ing
ac o (De bis and Jasi´
nski, 2018). This esilience can be de ined as “ he
main enance o apid eco e y o men al heal h du ing o a e pe iods
o exposu e o s ess, as a esul o a po en ially auma ic e en , chal-
lenging li e ci cums ances, a c i ical phase o li e ansi ion, o a physical
illness”. The e is s ill unce ain e idence on he posi i e e ec s o
aining on such esilience (Kunzle e al., 2020). Coping skills ha e a
mode a ing e ec ega ding he SOC and engagemen a iables
(Mi onga-Monga and Maye , 2020). I has been p o en ha aking ac-
ion on he social capi al o companies gene a es well-being among hei
wo ke s and also bene i s he o ganisa ion, which gains e iciency and
lowe u no e a es (Ju eng en e al., 2020) and ha hose who engage
deeply in wo hwhile ac i i ies enjoy be e heal h and well-being, ha e
s onge and mo e abundan social ies, and e en g ea e esis ance o
s ess, some hing no so clea when he e is a g ea deal o en i on-
men al unce ain y (Bu ow and Hill, 2020).
Mos s udies ocus on he psychological e ec s o COVID-19 on
heal h wo ke s, o ge ing ha many o he wo ke s ha e had o wo k
away om home o pe o m he so-conside ed essen ial ac i i ies o
ha e had o adap hei wo k o elewo king and do i om home
(Bu do e al., 2020). The objec i e o his s udy has been o know he
in e ela ionship be ween he sense o cohe ence, wo k en i onmen ,
wo k engagemen , and psychological dis ess, in a collec i e o non-
heal h wo ke s du ing he pe iod o con inemen (qua an ine) in
Spain, di e en ia ing be ween hose who wo k away om home, as hey
belong o ac i i ies conside ed essen ial, and hose who had o wo k
om home.
2. Ma e ials and me hods
A c oss-sec ional obse a ional desc ip i e design s udy was ca ied
ou on a sample o 1038 non-heal h wo ke s, o which 461 wo ked away
om home, o belonging o he so-conside ed essen ial ac i i ies du ing
he pandemic pe iod, and 577 wo ke s who we e wo king om home.
As inclusion c i e ia, i was used: (i) being 18 yea s o age o olde ; (ii)
being a cu en ly ac i e wo ke ; and (iii) ha ing accep ed he in o med
consen . The exclusion c i e ia we e: (i) being unde he age o 18; (ii)
being a heal hca e wo ke ; and (iii) no li ing in Spain a he ime o
illing in he ques ionnai e.
2.1. Ins umen s
F om p e ious s udies, a numbe o ques ions we e adap ed o
include he necessa y in o ma ion o he s udy (Wang e al., 2020).
These included, in addi ion o sex and age, ques ions abou he wo king
en i onmen du ing he pandemic ega ding: e ec i eness, sa e y,
con lic , isk, accep ance, psychological help, bu den, s ess, and sa is-
ac ion. The ca ego isa ion o hose a iables ela ed o he wo k en i-
onmen , wi h sco es be ween 1 and 10, was ans o med in o nega i e
esponse o alues lowe han o equal o i e, and in o posi i e
esponse o he wise.
The le el o engagemen was e alua ed using he UWES-9 sho
scale, ansla ed and alida ed in many languages (Schau eli e al.,
2006). I con ains 9 i ems wi h a Like - ype esponse (1: ne e o 7:
always) and includes 3 dimensions: igou , dedica ion, and abso p ion.
A high sco e means ha he wo ke eels iden i ied wi h hei wo k. The
o al sco es ob ained in each o he dimensions we e ca ego ised in o:
low, in e media e, o high, whe e low g ouped non-heal h wo ke s wi h
sco es be ween he minimum and he 25 h pe cen ile, mean 50% o he
cases, and high be ween he 75 h pe cen ile and he maximum alue. In
ou s udy, he global ins umen ob ained a C onbach’s alpha o 0.942
and an in e nal consis ency o
α
=0.856 o he igou dimension, o
α
=0.905 o dedica ion, and
α
=0.847 o he abso p ion dimension.
The sense o cohe ence was assessed using An ono sky’s 13-i em
ques ionnai e (SOC-13) in i s Spanish e sion (Vi ues-O ega e al.,
2007). The o e all sco e anges om 13 o 91 poin s. I con ains h ee
dimensions: Meaning ulness, Comp ehensibili y, and Manageabili y.
These a e ca ego ised wi h c i e ia simila o hose desc ibed o he
UWES-9 ques ionnai e. In ou s udy, a C onbach’s alpha o 0.812 and
in e nal consis ency indexes o
α
=0.575 o Meaning ulness, o
α
=
0.666 o Comp ehensibili y, and o
α
=0.600 o Manageabili y we e
ob ained.
Goldbe g’s GHQ-12 Gene al Heal h Ques ionnai e (Goldbe g e al.,
1997) was used o assess men al heal h and psychological adjus men ,
which se es as a sc eening o non-psycho ic psychia ic diso de s and
has p e iously been used in o he epidemics, such as SARS (Tam e al.,
2004). I includes a scale o 12 i ems, wi h ou esponse and o e all
a ing op ions om 0 o 12. Ou s udy ob ained a C onbach’s alpha o
C. Ruiz-F u os e al.
Sa e y Science 133 (2021) 105033
3
0.869 and es ablished a cu -o poin o 3 o mo e poin s o de e mine
he p esence o psychological dis ess.
2.2. P ocedu e
A bibliog aphic e iew was conduc ed on s udies pe o med on
p e ious epidemics, ha helped de elop he ques ionnai e. A g oup o
p o essionals made up o 10 expe s: psychologis s, doc o s, and nu ses,
assessed he i s d a . Subsequen ly, 57 people pilo ed he ques ion-
nai e, 49.10% women wi h a mean age o 41.87 yea s, 57.90% wi h
pos g adua e s udies, and 56.10% o hem ma ied. None o hem ound
any unde s anding p oblems.
The su eys began 13 days a e he decla a ion o heal h ale s a us,
be ween 26 Ma ch and 26 Ap il 2020, and in ol ed con inemen a
home excep o wo k ac i i ies conside ed essen ial. E-mails we e sen
o di e en p o essional g oups who we e asked o acili a e hei
dissemina ion. Da a collec ion was ca ied ou h ough he online su ey
pla o m Qual ics®.
2.3. Da a analysis
A desc ip i e analysis was pe o med based on he absolu e e-
quencies and pe cen ages o a iables ha collec in o ma ion on sex,
age, engagemen , wo k en i onmen , and sense o cohe ence. In o de o
con as he exis ence o no o a ela ionship be ween hese a iables
and he p esence o psychological dis ess, he
χ
2 associa ion es was
used, dis inguishing he comple e sample o non-heal h wo ke s and
hose who wo ked away o om home.
The CHAID me hod was used o cons uc a classi ica ion ee o
de ec which cha ac e is ics ela ed o engagemen , wo k en i onmen ,
and sense o cohe ence played a ele an ole in he p esence o non-
psychological dis ess. To do his, using he
χ
2 es o independence,
hose wi h he lowes adjus ed p alue we e sea ched among he
p edic o s, as long as ha alue was less han o equal o he le el o
signi icance se in
α
=0.05.
The analyses we e ca ied ou wi h he s a is ical so wa e SPSS 26.0
(IBM, A monk, NY).
2.4. E hical p inciples
Th ough in o med consen , he pe mission was ob ained om he
pa icipan s who exp essed hei olun a y desi e o pa icipa e in he
s udy. The anonymi y and con iden iali y o he da a collec ed was
main ained and has he a ou able epo o he Resea ch E hics Com-
mi ee o Huel a, belonging o he Regional Minis y o Heal h o
Andalusia (PI 036/20), ha ing complied wi h all he e hical p inciples
con ained in he Helsinki Decla a ion.
3. Resul s
65.2% o non-heal h wo ke s ha e psychological dis ess. This ac is
signi ican ly associa ed wi h sex (p <0.001) and age (p =0.001), bu
no o hose who wo k away o om home (p =0.106). A high dis ess
le el (GHQ-12 ≥3) is highe among emales (71.8%) han among males
(52.5%). Di e ences wi h espec o sex a e main ained bo h in wo ke s
who ca y ou hei ac i i y away om home, p =0.001 and hose who
do so om home p <0.001. The le el o psychological dis ess is also
highe among wo ke s aged 43 yea s o younge (69.9%) han among
hose o e his age (60.2%). This associa ion is main ained among hose
who wo k om home (p =0.009) and is close o being s a is ically
signi ican among hose who wo k away om home (p =0.054).
3.1. Psychological dis ess depending on he le el o engagemen
In Table 1, he o e all le el o engagemen is associa ed wi h he
le el o psychological dis ess, p <0.001. A low le els o engagemen ,
Table 1
Associa ion be ween he UWES dimensions and psychological dis ess among ac i e non-heal h wo ke s.
Non-heal h wo ke s
(N =1038)
Non-heal h wo ke s
Wo king away om home (N =461)
Non-heal h wo ke s
Wo king om home (N =577)
GHQ GHQ GHQ
N (%) NO (N
=361)
YES (N
=677)
χ
2 P N
(%)
NO (N
=148)
YES (N
=313)
χ
2 p N
(%)
NO (N
=213)
YES (N
=364)
χ
2 p
VIGOUR
Low 287
(27.6)
20.2 79.8 126 19.0 81.0 161 21.1 78.9
In e media e 606
(58.4)
38.0 62.0 45.041 <0.001 271 33.2 66.8 22.980 <0.001 335 41.8 58.2 25.061 <0.001
High 145
(14.0)
50.3 49.7 64 53.1 46.9 81 48.1 51.9
DEDICATION
Low 299
(28,8)
24.4 75.6 125 23.2 76.8 174 25.3 74.7
In e media e 557
(53.7)
37.9 62.1 21.071 <0.001 258 34.1 65.9 7.111 0.029 299 41.1 58.9 14.781 0.001
High 182
(17.5)
42.3 57.7 78 39.7 60.3 104 44.2 55.8
ABSORPTION
Low 225
(21.7)
22.7 77.3 109 25.7 74.3 116 19.8 80.2
In e media e 578
(55.7)
37.7 62.3 18.729 <0.001 246 34.6 65.4 2.776 0.250 332 40.1 59.9 18.883 <0.001
High 235
(22.6)
39.1 60.9 106 33.0 67.0 129 44.2 55.8
UWES
Low 276
(26.6)
22.1 77.9 126 22.2 77.8 150 22.0 78.0
In e media e 529
(51.0)
37.2 62.8 30.097 <0.001 237 32.5 67.5 11.893 0.003 292 41.1 58.9 19.807 <0.001
High 233
(22.4)
44.2 55.8 98 43.9 56.1 135 44.4 55.6
C. Ruiz-F u os e al.
Sa e y Science 133 (2021) 105033
4
he e a e highe pe cen ages o dis ess (77.9%) han a in e media e
le els (62.8%) and high le els (55.8%). This same end is seen bo h in
he g oup o wo ke s wo king away om home and among hose who
wo k om home.
The e is also an associa ion be ween he h ee dimensions o
engagemen ( igou , dedica ion, and abso p ion) and he ac o p e-
sen ing o no psychological dis ess, wi h p <0.001 in he h ee di-
mensions. Wi h low le els o “ igou ”, he pe cen age o dis ess is
highe (79.8%) han wi h an in e media e (62.0%) o high le el
(49.7%). This g adual di e ence acco ding o he le el o igou is
main ained bo h in wo ke s who ca y ou hei ac i i y away om
home and among hose who wo k om home. The “dedica ion”
dimension also has a highe pe cen age o dis ess a low le els (75.6%)
han a in e media e (62.1%) and a i s highes le els (57.7%). This
g adual associa ion acco ding o he le el o “dedica ion” is main ained
bo h in wo ke s who pe o m hei ac i i y a home and away om i .
The “abso p ion” dimension also shows highe pe cen age o dis ess a
i s lowes le el (77.3%) han a i s in e media e (62.3%) and highes
le els (60.9%). The associa ion is s a is ically signi ican in hose who
wo k a home, bu i is no among hose who wo k away om home p =
0.250 (Table 1).
The segmen a ion ee o he le el o psychological dis ess based on
sex, age, wo kplace ( om home o away), and he UWES-9 es di-
mensions (Fig. 1), shows he igou dimension in i s i s node, being he
mos signi ican a iable. Fo each o he h ee o med g oups (low,
in e media e, and high), di e en c i e ia we e ob ained o he con-
s uc ion o he ee, no appea ing he a iables age and abso p ion.
Low igou gene a es a dis ess o 79.8%. An in e media e igou is
media ed by a second node by sex, and i i is emale, i gene a es 68.3%
o dis ess, while i i is male, i is media ed by a hi d node by he wo k
place, gene a ing 58.5% o dis ess among hose wo king away om
home, and 43.8% o dis ess in hose wo king om home. I he igou is
high, i is also media ed by a second node by sex. I i is emale, i is
media ed by a hi d node by age, and i i is young (43 yea s o younge ),
i is media ed by a ou h node by dedica ion. I dedica ion is high, i
gene a es 88.9% o dis ess while, i dedica ion is low o in e media e,
he dis ess is a 37.5%. Con e sely, i he emale is o e he age o 43,
he dis ess is se a 48.8%. I igou is high and i is male, he dis ess is
a 27.6%.
3.2. Wo k en i onmen and psychological dis ess
The pe cen age o non-heal h wo ke s who claim ha he company
has no p o ided hem wi h ma e ial and means o e ec i ely ca y ou
hei wo k is 35.5%, sligh ly highe among wo ke s who a e ac i e away
om home (42.3%), wi hou inding a s a is ically signi ican associa-
ion ega ding he p esence o psychological dis ess. The answe is e y
simila among hose who claim ha he company has no p o ided hem
wi h he necessa y ma e ial and means o sa ely ca y ou hei wo k.
The e is no independence ega ding he pe cep ion o no o
inc eased labou con lic in he wo kplace and he le el o dis ess, p <
0.001. The pe cen age o dis ess is highe among hose wi h his
conce n (79.76%) han among hose who do no pe cei e his labou
con lic (60.56%). This di e ence pe sis s bo h in hose who wo k away
om home and in hose who do so om home, albei wi h a highe
pe cen age o s ess ound among hose who pe cei e his con lic and
wo k away om home (83.06%).
The pe cep ion ha he p o ession o wo kplace pu s he pe son a
isk o being in ec ed is also associa ed wi h he le el o dis ess among
non-heal h wo ke s, p =0.013. I is no ed ha , among hose who
pe cei e his conce n, he pe cen age o dis ess is highe (69.38%) han
among hose who do no pe cei e i (61.99%). This di e ence is s a is-
ically signi ican among hose who wo k a home, bu no among hose
who do hei ac i i y away om home.
The pe cen age o hose who claim o accep he isk o ge ing
in ec ed (22.9%) sligh ly inc eases among wo ke s who do so away om
home (28.6%) and is smalle among hose who wo k om home
(18.4%). The e is no s a is ically signi ican associa ion wi h espec o
he pe cen age o psychological dis ess be ween hose who accep he
isk o becoming in ec ed as pa o hei wo k and hose who do no
(Table 2).
94.1% o esponden s belie e i necessa y ha p o essionals and
olun ee s in ol ed in COVID-19 should ecei e psychological suppo .
An associa ion is obse ed depending on whe he he e is p esence o
psychological dis ess, bu no in he sub-g oup ha wo ks away om
home. A simila pe cen age (95.7%) belie es ha psychological suppo
should ex end o he sick and hei amilies, dec easing o 85.7% o
hose who belie e ha psychological suppo should be gi en o he
gene al popula ion. A s a is ically signi ican associa ion can be seen
acco ding o he le el o dis ess bo h among wo ke s who pe o m hei
wo k om home and hose who do so away om home (Table 2).
The pe cen age o wo ke s wi h a high le el o dis ess is highe
among hose who “conside ha he e is an inc ease in hei wo kload
a e he s a o he heal h ale ” (69.89%) han among hose who do
no (59.57%). The non-independence o hese a iables, p <0.001, e-
mains s a is ically signi ican bo h among wo ke s wo king away om
home and among hose who do so om home.
When asked i “ hey eel mo e s essed a wo k”, he pe cen age o
Fig. 1. Segmen a ion ee displaying he le el o psychological dis ess on he basis o sex, age, wo kplace, and engagemen dimensions.
C. Ruiz-F u os e al.
Sa e y Science 133 (2021) 105033
5
Table 2
Associa ion be ween wo k en i onmen and psychological dis ess among ac i e non-heal h wo ke s.
Non-heal h wo ke s
(N =1038)
Non-heal h wo ke s
Wo king away om home (N =461)
Non-heal h wo ke s
Wo king om home (N =577)
GHQ GHQ GHQ
N (%) NO
(N =
361)
YES
(N =
677)
χ
2 p N (%) NO
(N =
148)
YES
(N =
313)
χ
2 P N (%) NO
(N =
213)
YES
(N =
364)
χ
2 p
EFFECTIVENESS
No 368
(35.5)
31.0 69.0 3.630 0.057 195
(42.3)
29.2 79.8 1.280 0.268 173
(30.0)
32.9 67.1 1.670 0.196
Yes 670
(64.5)
36.9 63.1 266
(57.7)
34.2 65.8 404
(70.0)
38.6 61.4
SAFETY
No 347
(33.4)
31.4 68.6 2.604 0.107 196
(42.5)
28.6 71.4 1.952 0.162 151
(26.2)
35.1 64.9 0.290 0.591
Yes 691
(66.6)
36.5 63.5 265
(57.5)
34.7 65.3 426
(73.8)
37.6 62.4
CONFLICT
No 786
(75.7)
39.44 60.56 31.019 <0.001 337
(73.1)
37.69 62.31 17.905 <0.001 449
(77.8)
40,76 59,24 12.830 <0.001
Yes 252
(24.3)
20.24 79.76 124
(26.9)
19.94 83.06 128
(22.2)
23,44 76,56
RISK
No 584
(56.3)
38.01 61.99 6.161 0.013 220
(47.7)
34.09 65.91 0.762 0.383 364
(63.1)
40.38 59.62 5.097 0.024
Yes 454
(43.7)
30.62 69.38 241
(52.3)
30.29 69.71 213
(36.9)
30.99 69.01
ACCEPTANCE
No 800
(77.1)
34,25 65,75 0.430 0.512 329
(71.4)
32,22 67,78 0.007 0.934 471
(81.6)
35.67 64.33 1.710 0.191
Yes 238
(22.9)
36,55 63,45 132
(28.6)
31,82 68,18 106
(18.4)
42.45 57.55
PSICO1
No 61
(5.9)
47.5 52.5 4.654 0.031 28
(6.1)
39.3 60.7 0.705 0.401 33
(5.7)
54.5 45.5 4.672 0.031
Yes 977
(94.1)
34.0 66.0 433
(93.9)
31.6 68.4 544
(94.3)
35.8 64.2
PSICO2
No 45
(4.3)
51.1 48.9 5.532 0.019 17
(3.7)
52.9 47.1 3.516 0.061 28
(4.9)
50.0 50.0 2.164 0.141
Yes 993
(95.7)
34.0 66.0 444
(96.3)
31.3 68.7 549
(95.1)
36.2 63.8
PSICO3
No 148
(14.3)
48.6 51.4 14.640 <0.001 64
(13.9)
45.3 54.7 5.948 0.015 84
(14.6)
51.2 48.8 8.603 0.003
Yes 890
(85.7)
32.5 67.5 397
(86.1)
30.0 70.0 493
(85.4)
34.5 65.5
BURDEN
No 470
(45.3)
40,43 59,57 12.075 0.001 238
(51.6)
38,66 61,34 9.688 0.002 232
(40.2)
42,24 57,76 4.727 0.030
Yes 568
(54.7)
30,11 69,89 223
(48.4)
25,11 74,89 345
(59.8)
33,33 66,67
STRESS
No 458
(44.1)
50,22 49,78 86.144 <0.001 207
(44.9)
47,83 52,17 42.604 <0.001 251
(43.5)
52,19 47,81 44.518 <0.001
Yes 580
(55.9)
22,59 77,41 254
(55.1)
19,29 80,71 326
(56.5)
25,15 74,85
SATISFATION
No 398
(38.3)
25,13 74,87 26.516 <0.001 201
(43.6)
27,86 72,14 2.944 0.086 197
(34.1)
22,34 77,66 27.305 <0.001
Yes 640
(61.7)
40,78 59,22 260
(56.4)
35,38 64,62 380
(65.9)
44,47 55,53
EFFECTIVENESS. Do you hink you depa men , se ice, uni o company has p o ided you wi h he necessa y means and ma e ial o EFFECTIVELY ca y ou you
job? SAFETY. Do you hink you depa men , se ice, uni o company has p o ided you wi h he necessa y means and ma e ial o SAFELY ca y ou you job?
CONFLICT. Ha e you obse ed any inc ease in labou con lic in you job? RISK. Do you hink you p o ession o wo kplace pu you a isk o ge ing in ec ed?
ACCEPTANCE. Do you accep he isk o ge ing in ec ed as pa o you job? PSICO1. Do you belie e i would be impo an o o e psychological suppo o p o-
essionals and olun ee s who a e ac i ely aking pa in he COVID-19 heal h c isis? PSICO2. Do you belie e i would be impo an o o e psychological suppo o
pe sons and hei amilies who a e di ec ly a ec ed by COVID-19 o deal wi h he di icul ies a isen om he heal h c isis? PSICO3. Do you belie e i would be
impo an o o e psychological suppo o he gene al popula ion o deal wi h he di icul ies a isen om he COVID-19 heal h c isis? BURDEN. Do you conside he e
has been an inc ease in he wo kload a e he onse o he heal h c isis? STRESS. Do you eel mo e s essed a wo k? SATISFATION. How would you sco e you job
sa is ac ion du ing he p esen COVID-19 si ua ion? DISTANCE. Do you conside app op ia e he dis ance main ained wi h you wo k ma es? CONTACT. A e you in
con ac wi h clien s/use s/pa ien s ha could be a sou ce o isk?
C. Ruiz-F u os e al.

Sa e y Science 133 (2021) 105033
6
hose who gi e a posi i e answe and p esen a le el o high dis ess is
77.41%, while o hose who gi e a nega i e answe , is 49.78%. This
associa ion is s a is ically signi ican , p <0.001, and main ained bo h
among wo ke s who ca y ou hei ac i i y a home and hose who do so
away, ob aining highe ela i e alues o dis ess hose who wo k away
om home.
I is seen ha he le el o psychological dis ess is highe among
hose who claim o ha e a lowe deg ee o sa is ac ion wi h hei wo k in
he cu en COVID-19 si ua ion (74.87%) han among hose who claim
o ha e a highe deg ee o sa is ac ion (59.22%). This associa ion is
s a is ically signi ican among hose who wo k om home, bu no
among hose who wo k away om home.
Fig. 2 shows how whe he o no eeling mo e s essed is he mos
signi ican a iable in he segmen a ion ee, inding i in he i s node.
Pe cei ed s ess is media ed by sex in a second node, and by emale in a
hi d node (age), in which younge women (43 yea s o younge )
gene a e 86.1% o dis ess, and hose o e ha age gene a e 75.8%,
while among males i is media ed by a hi d node, which is he deg ee o
pe cei ed labou con lic . Those who pe cei e his con lic show a pe -
cen age o dis ess o 82.0%, and hose wi hou his con lic show a
pe cen age o 62.4%.
3.3. Psychological dis ess and sense o cohe ence
F om he esul s shown in Table 3, we can say ha he o e all le el o
sense o cohe ence (SOC) is associa ed wi h he le el o psychological
dis ess, p <0.001. A lowe le el o SOC co esponds o he highes
pe cen ages o dis ess (86.3%), being he mean le el 62.3% and
e idencing a high le el o SOC (47.7%). The same end occu s o hose
who wo k om home and hose who do so away. The h ee dimensions
o he SOC ha e an associa ion wi h psychological dis ess, being p <
0.001 o he h ee dimensions, and equal end. Thus, in he “mean-
ing ulness” dimension, in i s lowes le els, he pe cen age o dis ess is
76.4%; a in e media e le els, i is 62.9%; and a he highes le el, i is
54.7%. This end is main ained bo h in hose who wo k away om
home and hose who do so om home, wi h highe ela i e alues
among hose who wo k away om home. The pe cen age o high le els
o dis ess among hose wi h a low alue in he “comp ehensibili y”
dimension is 86.8%; among hose wi h an in e media e le el, i is 61.9%;
and his pe cen age alls o 45.6% in hose wi h high le els o comp e-
hensibili y. This end is main ained bo h among hose who wo k away
om home and hose who do so om home. In he hi d o he
dimensions, “manageabili y”, a simila end occu s. The pe cen age o
hose wi h high le els o dis ess among hose wi h low le els o man-
ageabili y is 81.5%, dec easing o 63.1% among hose wi h in e media e
le els o manageabili y and o 51.6% among hose wi h high le els, p <
0.001. This end is main ained among hose who wo k away om home
and hose who do so om home.
In Fig. 3, node 1 o he segmen a ion ee s a s om Comp ehensi-
bili y, dis inguishing di e en c i e ia in he ee cons uc ion and no
appea ing he signi icance dimension. Low comp ehensibili y esul s in
le els o dis ess o 86.8%. In e media e comp ehensibili y is media ed
by a second node (sex), in which emales show le els o dis ess o
69.2%. Males a e media ed by a hi d node, ha deals wi h he wo k
place; i wo k is done om home, hey show 42.2% o dis ess, and i
wo k is done away om home, i is media ed by a ou h node (man-
ageabili y). He e, i manageabili y le els a e low o in e media e, a
dis ess o 68.1% is ob ained, and i manageabili y le els a e high, he
dis ess is o 36.0%, showing his b anch he minimum pe cen age o
psychological dis ess. I comp ehensibili y le els a e high, i is medi-
a ed by, as in he p e ious case, sex, p esen ing a pe cen age o dis ess
o 36.6% in he case males, o 43.2% in emales o e 43 yea s, and o
59.7% in emales aged 43 o younge .
3.4. Psychological dis ess, SOC, UWES and wo k en i onmen
Comp ehensibili y, one o he es dimensions on he sense o
cohe ence, is ound as he mos signi ican a iable wi h espec o he
le el o psychological dis ess, ollowed by eeling mo e o less s essed
a wo k.
Low comp ehensibili y and he p esence o s ess esul in he highes
pe cen ages o non-heal h wo ke s wi h psychological dis ess, 95.9% in
case o ha ing a low le el o signi icance, and 84.2% i he signi icance is
in e media e o high. The pe cen age o cases wi h psychological
dis ess is educed o 80.6% wi h low comp ehensibili y and no
pe cep ion o s ess.
I comp ehensibili y le els a e in e media e and non-heal h wo ke s
a e s essed, he pe cen age o cases wi h psychological dis ess was
80.2% among emales and was educed o 65.3% among males. Main-
aining comp ehensibili y a in e media e le els and wi hou p esence o
s ess (second le el node), he si ua ion o no job sa is ac ion du ing he
pandemic esul s in 64.8% o cases wi h psychological dis ess, while
his pe cen age dec eases i he e is job sa is ac ion. Job sa is ac ion was
media ed by a ou h node (sex), which showed 44.4% o psychological
Fig. 2. Segmen a ion ee displaying he le el o psychological dis ess on he basis o sex, age, wo kplace, and wo k en i onmen dimensions. CONFLICT. Ha e you
obse ed any inc ease in labou con lic in you job? STRESS. Do you eel mo e s essed a wo k? SATISFATION. How would you sco e you job sa is ac ion du ing
he p esen COVID-19 si ua ion?
C. Ruiz-F u os e al.
Sa e y Science 133 (2021) 105033
7
dis ess among emales and 17.5% among males wo king om home.
Those wo king away om home a e, in u n, media ed by he igou
dimension o he UWES-9 es : i igou le els we e low o in e media e,
he e we e 57.1% cases o dis ess, and hese we e null wi h high le els
o igou .
Wi h a high le el o comp ehensibili y and a highe pe cep ion o
s ess a wo k, as consequences o he pandemic, psychological dis ess
is media ed by a hi d node, he “Dedica ion” dimension o he UWES
es , which p esen s 94.1% wi h low le els o dedica ion and 57.7% wi h
in e media e o high le els. I he e is no high le el o pe cep ion o
s ess, i is media ed by sex, di e en ia ing 36.4% o psychological
dis ess among emales. In he case o males, i is media ed by a ou h
Table 3
Associa ion be ween he SOC dimensions and psychological dis ess among ac i e non-heal h wo ke s.
Non-heal h wo ke s
(N =1038)
Non-heal h wo ke s
Wo king away om home (N =461)
Non-heal h wo ke s
Wo king om home (N =577)
GHQ GHQ GHQ
N (%) NO
(N =
361)
YES
(N =
677)
χ
2 p N
(%)
NO
(N =
148)
YES
(N =
313)
χ
2 p N
(%)
NO
(N =
213)
YES
(N =
364)
χ
2 p
COMPREHENSIBILITY
(SOC_C)
Low 295
(28.4)
13.2 86.8 142 13.4 86.6 153 13.1 86.9
In e media e 504
(48.6)
38.1 61.9 103.425 <0.001 228 35.5 64.5 41.854 <0.001 276 40.2 59.8 60.371 <0.001
High 239
(23.0)
54.4 45.6 91 52.7 47.3 148 55.4 44.6
MANAGEABILITY
(SOC_M)
Low 281
(27.1)
18.5 81.5 142 18.3 81.7 139 18.7 81.3
In e media e 499
(48.1)
36.9 63.1 55.030 <0.001 208 31.2 68.8 31.331 <0.001 291 40.9 59.1 27.281 <0.001
High 258
(24.9)
48.4 51.6 111 51.4 48.6 147 46.3 53.7
MEANINGFULNESS
(SOC_S)
Low 309
(29.8)
23.6 76.4 147 19.0 81.0 162 27.8 72.2
In e media e 515
(49.6)
37.1 62.9 28.656 <0.001 220 36.8 63.2 17.538 <0.001 295 37.3 62.7 12.544 0.002
High 214
(20.6)
45.3 54.7 94 41.5 58.5 120 48.3 51.7
SOC
Low 270
(26.0)
13.7 86.3 136 13.2 86.8 134 14.2 85.8
In e media e 531
(51.2)
37.7 62.3 86.970 <0.001 224 35.3 64.7 38.914 <0.001 307 39.4 60.6 46.974 <0.001
High 237
(22.8)
52.3 47.7 101 50.5 49.5 136 53.7 46.3
Fig. 3. Segmen a ion ee displaying he le el o psychological dis ess on he basis o sex, age, wo kplace, and SOC es dimensions. SOC_C Comp ehensibili y
SOC_M Manageabili y.
C. Ruiz-F u os e al.
Sa e y Science 133 (2021) 105033
8
node, he Meaning ulness dimension o he SOC es , in which i
Meaning ulness le els a e low o in e media e, psychological dis ess is
ound in 29.0% o cases and, i Meaning ulness is high, psychological
dis ess is a 0.0% (Fig. 4).
4. Discussion
This s udy has allowed o analyse he impac on he psycho-
emo ional sphe e o he non-heal h wo ke s du ing he pe iod o
heal h ale by COVID-19 in Spain, di e en ia ing be ween he g oup o
wo ke s included in he ac i i ies conside ed essen ial who had o wo k
away om home, and hose who ca ied ou hei ac i i y om home,
h ough elewo k.
Simila esul s o p e ious s udies ha e been ound (Gomez e al.,
2019) ha associa e engagemen wi h men al heal h, p <0.001. We
ha e seen how a low le els o engagemen , he highes pe cen ages o
dis ess occu (77.9%), and his pe cen age p og essi ely dec eases wi h
in e media e le els (62.8%) and wi h he highes le els o engagemen
(55.8%). Some au ho s p opose u he esea ch on he associa ion be-
ween wo k engagemen and i s e ec s on men al heal h, ecommending
ha he possible modula ion ha managemen oles can o e should be
joined (Van Zyl e al., 2020). The e is a simila end in he h ee di-
mensions o engagemen : igou , dedica ion, and abso p ion, and his
happens bo h in he g oup o wo ke s who wo k away om home and
among hose who wo k om home. A la ge numbe o esponden s
s a ed ha , du ing he pandemic, he wo kload has inc eased. This can
be pa ly explained by ha ing o mee highe domes ic demands, by he
closu e o day-ca e se ices, o by ha ing o balance hei wo k-li e
while wo king om home, inding an associa ion be ween wo k
engagemen and domes ic demands (Chen and Fellenz, 2020).
In ou s udy, as in p e ious ones (F ommbe ge e al., 1999) low
le els o sense o cohe ence a e associa ed wi h he highes alues o
psychological dis ess, dec easing dis ess as he le el o he sense o
cohe ence inc eases, bo h in he o e all assessmen o SOC and in i s
h ee dimensions: comp ehensibili y, manageabili y, and meaning ul-
ness. Following he ecommenda ions o analyse in mo e de ail bo h
whe he his associa ion is o he causal ype and also he a iables ha
could in e e e as modula ing ones (Sch¨
a e e al., 2019), we ha e ound
ha mean comp ehensibili y le els a e media ed by sex, and among
males, by he wo kplace, depending on whe he i is away o om home,
and i wo k is done away, i is modula ed by he deg ee o
manageabili y. Ou s udy and p e ious ones (Ca massi e al., 2018;
Ch is iansen and Elkli , 2008; Di le sen and Elkli , 2012) ha e shown
ha emales ha e a highe pe cen age o dis ess a e a pos - auma ic
pe iod such as COVID-19. I is also conside ed logical ha he wo kplace
plays a ole in his due o he isk o con agion o hose who wo k away
om home, al hough his e ec would be pa ially o se by he e ec s o
con inemen a home and elewo k (Bu do e al., 2020). In he case o
high comp ehensibili y, he dis ess le el is condi ioned by sex, and in
he case o emales, by age. In ou s udy, younge ages (less han o equal
o 43 yea s) a e associa ed wi h highe le els o dis ess, as in p e ious
s udies, whe e i has been associa ed wi h you h (Losada-Bal a e al.,
2020)
Se e al a iables o he wo king en i onmen which appea o ha e
changed a e he es ablishmen o he heal h ale s a us by COVID-19
ha e ound an in luence on he le el o psychological dis ess. Le els
o pe cep ion o labou con lic ha e inc eased, and his is associa ed
wi h highe le els o dis ess when he pe cep ion is high (79.76%) han
when he pe cep ion o labou con lic is low (60.56%). Also, he e has
been g ea e dis ess among hose claiming o be in dange o becoming
in ec ed o in he high pe cen age o esponden s who epo ed hei
wo kload inc eased. Wo ke s wo king away om home and being in
con ac wi h cus ome s o use s who migh be in ec ed inc eases he
le el o psychological dis ess, a ac also obse ed in p e ious s udies.
On he o he hand, no main aining he ecommended social dis ance
wi h colleagues did no gene a e g ea e dis ess, as has been seen in
o he p e ious s udies (Leung e al., 2005), and which could be
explained by heal h au ho i ies ailing o o e clea in o ma ion (Chen
e al., 2020) o because he ques ion was no p ope ly unde s ood.
In ou s udy, we ha e seen ha psychological dis ess is associa ed
wi h he deg ee o pe cep ion o s ess, as was also obse ed in p e ious
s udies (Wang e al., 2020) and modula ed by he deg ee o job sa is-
ac ion. O he s udies ha e linked commi men o wo k (engagemen ) o
he deg ee o job sa is ac ion, whe e i seems ha he sense o cohe ence
can ac as a modula ing ac o (De bis and Jasi´
nski, 2018) and p oduce
g ea e s ess esilience (Bu ow and Hill, 2020).
Almos all esponden s (94.1%) belie ed ha p o essionals and
olun ee s in ol ed in COVID-19 should ecei e psychological suppo ,
a simila pe cen age conside ed i necessa y o he sick and hei am-
ilies, and a li le lowe pe cen age (85.7%) o he gene al popula ion.
This may be an indica o o wha mos esponden s hink ha he e ec
o he COVID-19 pandemic is p oducing on men al heal h and he need
Fig. 4. Segmen a ion ee displaying he le el o psychological dis ess on he basis o sex, age, wo kplace, and UWES-9 es dimensions, wo k en i onmen a iables
and SOC es dimensions. STRESS. Do you eel mo e s essed a wo k? SATISFATION. How would you sco e you job sa is ac ion du ing he p esen COVID-19
si ua ion? SOC_C Comp ehensibili y SOC_S Meaning ulness.
C. Ruiz-F u os e al.
Sa e y Science 133 (2021) 105033
9
o suppo .
5. Conclusions
35.5% o non-heal h wo ke s we e no p o ided wi h he means o
e ec i ely and sa ely ca y ou hei ac i i y, a pe cen age ha was
highe among hose wo king away om home (42.3%). 94.1% o hese
wo ke s belie e i necessa y ha p o essionals and olun ee s in ol ed
in COVID-19 should ecei e psychological suppo , and a simila pe -
cen age conside he same o he sick and hei amilies.
The highes pe cen ages o psychological dis ess a e ound wi h low
le els o global engagemen and in i s h ee dimensions: igou , dedi-
ca ion, and abso p ion. Also, high dis ess pe cen ages a e associa ed
wi h he lowes le els o sense o cohe ence and in i s h ee dimensions:
comp ehensibili y, manageabili y, and meaning ulness.
When analysing he associa ions o psychological dis ess wi h he
di e en dimensions o he UWES-9 es (sex, age, and wo kplace), i can
be said ha g ea e igou educes he pe cen age o cases wi h psy-
chological dis ess. Among he a iables ela ed o he wo k en i on-
men , a g ea e pe cep ion o s ess is associa ed wi h g ea e
psychological dis ess, and his is signi ican ly educed in he case o
being sa is ied a wo k, o ha ing no pe cei ed an inc ease in labou
con lic s du ing he pandemic.
Funding
This esea ch did no ecei e any speci ic g an om unding
agencies in he public, comme cial, o no - o -p o i sec o s.
Decla a ion o Compe ing In e es
The au ho s decla e ha hey ha e no known compe ing inancial
in e es s o pe sonal ela ionships ha could ha e appea ed o in luence
he wo k epo ed in his pape .
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