Sense of coherence, engagement, and work environment as precursors of psychological distress among non-health workers during the COVID-19 pandemic in Spain

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 . Re e ences An ono sky, A., 1987. Un a elling he mys e y o heal h: How people manage s ess and s ay well. Jossey-Bass, San F ancisco. Bu do , A., Po u, F., Rugulies, R., 2020. The COVID-19 (Co ona i us) pandemic: consequences o 103 occupa ional heal h. Scand. J. Wo k En i on. Heal h 46 (3), 229–230. h ps://doi.o g/10.5271/sjweh.3893. Bu ow, A.L., Hill, P.L., 2020. 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