# The effects of perceived chronic stress and work-related factors on the risk of incident depression among German general practice personnel: a causal pathway approach using IMPROVEjob study data

## TL;DR

This study finds that work-privacy conflict partially explains how chronic stress increases depression risk among German general practice staff.

## Contribution

The novel contribution is identifying work-privacy conflict as a mediator linking chronic stress to depression risk in healthcare workers.

## Key findings

- Work-privacy conflict partially mediates the relationship between chronic stress and depression risk.
- Higher baseline work-privacy conflict reduced the effect of increased chronic stress on depression.
- Personal and work-related factors like age and gender were not significantly associated with depression risk.

## Abstract

The increasing workload faced by general practitioners (GPs) and practice assistants (PrAs) contributes to chronic stress and heightens the risk of depression. Various work-related factors, including work-privacy conflict (WPC), may further exacerbate this risk. This study explores the role of work-related factors, focusing on WPC, as mediators in the association between perceived chronic stress and the risk of incident depression among German GP practice personnel.

This study included 366 German GPs and PrAs using baseline and follow-up data from the IMPROVEjob trial. We assessed the risk of incident depression (Cut-off = 50) through changes in the World Health Organization Well-being Index (WHO-5) and measured perceived chronic stress using the Trier Inventory for the Assessment of Chronic Stress Screening Scale (TICS-SSCS). Work-related factors were evaluated, with a specific focus on WPC, using the corresponding scale from the Copenhagen Psychosocial Questionnaire (COPSOQ III). A causal mediation analysis was performed to examine how work-related factors mediate the effect of perceived chronic stress on depression risk.

Increased perceived chronic stress was observed in 43.64% of participants, while 56.36% reported stable or decreased stress levels from baseline to follow-up. This increase in perceived chronic stress was associated with heightened reported work-privacy conflict (β = 8.99, p = 0.01), though higher baseline levels of work-privacy conflict appeared to mitigate this effect (β = -0.35, p < 0.001). Reported Work-privacy conflict increased for 43.22% of participants, remained stable for 28.39%, and decreased for another 28.39%. Moreover, heightened reported work-privacy conflict correlated with a greater risk of incident depression (logit β = 0.20, p = 0.015; OR = 1.02 per point, 1.22 per 10-point increase), with baseline conflict levels showing smaller subsequent increases (β = -0.35, p < 0.001), likely reflecting regression to the mean/ceiling effect. The risk of incident depression was identified in 19.49% of participants, while 80.51% did not develop depressive symptoms. Causal mediation analysis further revealed that work-privacy conflict partially mediate the relationship between chronic stress and the risk of incident depression, with both a direct effect (\documentclass[12pt]{minimal}
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This study emphasizes the need to address work-privacy conflict as a key factor in reducing the mental health burden associated by chronic stress among general practice personnel.