Exploring the relationship between psychological distress and likelihood of help seeking in construction workers: The role of talking to workmates and knowing how to get help 1

Abstract

BACKGROUND:

Mental health problems are prevalent in male-dominated industries such as construction, where suicide rates are higher than the population average and help seeking is typically low.

OBJECTIVE:

To examine psychological distress in Australian construction workers and its relationship with help seeking via two hypothesised mediators: confidence in knowing how to get help and confidence in talking to workmates about mental health issues.

METHODS:

Workers (N = 511) completed a survey that assessed psychological distress, likelihood of help seeking, and confidence in knowing how to get help and talking to workmates. Bootstrapped multiple mediation analysis was performed using the PROCESS macro for SPSS.

RESULTS:

Psychological distress was higher than national estimates and most prevalent in men aged 25–44. Controlling for age and ability to recognise personal signs of mental health problems, psychological distress negatively predicted likelihood of help seeking. This relationship was partially mediated by knowing how to get help and confidence in talking to workmates.

CONCLUSIONS:

Results highlight the need to redress and mitigate mental health problems among high-risk groups of male workers. It provides useful guidance on multilevel workplace strategies to reduce stigma, enhance confidence and comfort in the process of seeking help and support in construction and other male-dominated industries.

Keywords

Mental health psychological distress construction industry occupational health men workplace

1 Introduction

Mental health problems are a leading cause of disability and contribute significantly to the global burden of disease [1]. The workplace bears a significant proportion of the social and economic burden associated with mental illness [2, 3], which is associated with an estimated 50–60 per cent of absenteeism [4]; costs related to lost productivity [5], and increased risk of physical health problems and involvement in accidents [6]. Workers employed in male-dominated industries, such as construction, report elevated levels of mental illness including anxiety and depression [3] and are particularly vulnerable to suicide, with data indicating suicide rates 80% higher in male low-skilled construction workers than the general population [7]. There is a clear need to address the mental health of these workers and the workplace provides an important but often overlooked setting to develop tailored strategies [8].

A key factor in the step towards recovery for a mental health problem is the ability and willingness to seek help. While evidence suggests that treatments for mental health problems can be effective, men typically have lower levels of health literacy than women [9] and are less likely to seek help and support for mental health concerns [10] or receive professional treatment [11, 12]. This pattern is particularly pervasive in the construction industry, which is characterised by physically demanding work with a high level of injury, disability and high absenteeism rates [13]. Furthermore, male construction workers are at far higher risk of mental health problems yet less likely to seek access to treatment than the general population [14 –16].

Numerous barriers to help seeking for mental health problems in construction workers have been proposed [17 –21], the first relating to a general lack of confidence in knowing how to seek help and access treatment [20]. Construction work is characterised by short term contracts, a fluctuating job market and a transient workforce, where workers frequently travel or are subcontracted to various locations and sites. The non-traditional organisational structure of the sector is recognised to pose significant challenges to effective communication [18], which are likely to affect personal health and wellbeing as well as safety. In the absence of a traditional work base, there is limited opportunity for workers to familiarise themselves with, share, or access, local mental health supports or work programs. Thus, workers are often unaware of pathways through which appropriate, confidential care may be available [19, 20]. Lack of confidence in knowing how to access help is further exacerbated by the social isolation experienced by many construction workers when working contractually and frequently adjusting to new working environments [19].

A second important barrier to male construction workers seeking help for mental health problems relates to stigma and beliefs around stoicism in the traditional masculine culture of the workplace [17, 21]. While positive working relationships and the ability to confide in work colleagues can act as a buffer to mental health problems [22], evidence suggests that these avenues of support are often not available for construction workers [23]. It is well established that men are less likely to discuss mental health issues than women [24], and the social connections that men have with other men tend to decline as they age [25]. Furthermore, the strong prevalence of traditional masculine norms in construction has been linked to negative and discriminatory attitudes towards mental illness and perceptions of unsupportive working relationships [14 , 20], which may further erode opportunities for open communication. Therefore, confidence in talking to workmates is likely to be a key factor in help seeking outcomes for those experiencing psychological distress, both as a means of social support and improved dissemination of information regarding other supports and services.

In light of the above, the first aim of the current study was to explore the prevalence of psychological distress in Australian construction workers and the relationship with likelihood of help seeking, which, despite growing anecdotal evidence, has rarely been studied empirically. The second aim of the study was to provide the first direct test of whether the relationship between psychological distress and help seeking can be explained by the extent to which workers are confident in knowing how to get help, and whether they are confident in talking to co-workers about mental health issues.

2 Method

2.1 Participants and procedure

A convenience sample of construction workers in NSW were obtained through collaboration with the NSW Building Trades Group (BTG). Subjects were recruited as part of a BTG professional development session. Workers were recruited onsite prior to undertaking drug and alcohol impairment training at their workplace and asked to voluntarily take part in a survey study, which was developed and administered by the National Centre for Education and Training on Addiction (NCETA). A pen- and paper-based questionnaire was administered to all participants. Confidentiality and anonymity were assured, and workers were free to withdraw from participation at any time. Ethics approval (#7932) was obtained from Flinders University Social and Behavioural Research Committee.

2.2 Measures

The predictor variable psychological distress was measured by the 10-item Kessler 10 (K10) [26], designed to quantify the frequency and severity of anxiety- and depression-related symptoms experienced in the previous four weeks (e.g., ‘in the past four weeks, how often did you feel hopeless?’). Each item is scored 1 (none of the time) to 5 (all of the time) and scores were summed to provide a total score ranging from 10–50, with higher scores indicating higher distress. The scale showed good reliability (α= 93).

The outcome variable ‘likelihood of help seeking’, and the two mediator variables ‘confidence in knowing how to get help’ and ‘confidence in talking to workmates about mental health issues’ were assessed by three items, measured on a scale of 1–4, where 1 = not at all confident, and 4 = very confident. The items were: “how likely is it that you would seek help if you were suffering from mental health problems?”; “how confident are you that you would know how to get help for poor mental health?” and “how confident are you that you could talk with your workmates about mental health issues?”, respectively.

Age in years and confidence in recognising the signs of mental health were used in the analyses as covariates, to control for differences in age and mental health literacy which are known to be associated with help-seeking behaviours [20]. The latter item was: “How confident are you that you could recognise the signs of poor mental health in yourself? (1) not at all confident, (4) very confident.

2.3 Statistical analysis

Descriptive statistics and correlational analyses were performed to determine mean values and associations between variables. For the main analyses, the Hayes PROCESS macro (v2.16) was used to perform multiple mediation based on the bootstrapping procedure recommended by Preacher and Hayes [27]. Direct and indirect effects of psychological distress on the likelihood of help seeking for mental health problems were estimated with both confidence in knowing how to get help, and confidence in talking to workmates as mediating variables, using 5000 bootstrapped bias corrected resamples. Age and confidence in recognising personal signs of mental health problems were included as covariates.

Figure 1 illustrates the path model applied to determine direct and indirect effects based on Preacher and Hayes [27]. The direct effect, path c^′, represents the strength of the direct influence of psychological distress on the likelihood of help seeking when the mediating variables are statistically controlled. The a paths (a1 and a2) represent the effect of psychological distress on the mediating variables, whereas the b paths (b1 and b2) show the effect of the mediator on the likelihood of help seeking, partialling out the effect of psychological distress. The indirect effect (i.e., the extent to which the effects of psychological distress on the likelihood of help seeking is mediated by confidence in knowing how to get help or talking to workmates) is found by multiplying a×b. The significance of the indirect effect is indicated when the 95% bias-corrected confidence interval (CI) values do not cross zero. A non-significant direct relationship between the predictor and the outcome variable would indicate full mediation, whereas partial mediation is determined if the direct relationship remained significant. The relative magnitude between the mediators were examined with pairwise contrasts of the specific indirect effects. Evidence for a difference in strength between two specific contrasts is found when the CIs do not cross zero.

Fig. 1

The path model for multiple mediation analyses.

3 Results

Of the 511 male respondents who completed the survey, n = 507 provided data for the outcome variable likelihood of help seeking for mental health problems. A further twenty-one participants selected the option ‘unsure’ for this question and were removed, leaving n = 486 for analyses. The average age of the sample was 35.11±11.76. To reduce the impact of outliers, extreme values (n = 8) on the K10 were truncated to 3.29 above the mean [28]. Mean scores and correlations for variables to be included in the model are shown in Table 1.

Table 1
Variable means (M), standard deviations (SD) Pearson’s bivariate correlations

Variable (range) M SD 1 2 3 4 5

1. Likelihood of help seeking (1–4) 2.72 0.89 -

2. Psychological distress (10–50) 15.93 6.41 –0.24^ -

3. Confidence in knowing how to get help (1–4) 2.69 0.90 0.49^ –0.15^ -

4. Confidence in talking to workmates (1–4) 2.56 0.94 0.40^ –0.14^ 0.59^ -

5. Age (15–68) 35.11 11.76 0.09 –0.17^ –0.04 0.02 -

6. Confidence in recognising mental health problems (1–4) 2.94 0.82 0.28^ –0.05 0.40^ 0.36^ –0.07

Variable (range)	M	SD	1	2	3	4	5
1. Likelihood of help seeking (1–4)	2.72	0.89	-
2. Psychological distress (10–50)	15.93	6.41	–0.24^**	-
3. Confidence in knowing how to get help (1–4)	2.69	0.90	0.49^**	–0.15^**	-
4. Confidence in talking to workmates (1–4)	2.56	0.94	0.40^**	–0.14^**	0.59^**	-
5. Age (15–68)	35.11	11.76	0.09	–0.17^**	–0.04	0.02	-
6. Confidence in recognising mental health problems (1–4)	2.94	0.82	0.28^**	–0.05	0.40^**	0.36^**	–0.07

^**p < 0.001.

The mean psychological distress score was 15.93±6.41 (Table 1). Scores of 15 or under on the K10 are considered low psychological risk, with previous national estimates of Australian males reporting a mean score of 13.9 [29]. Thus, psychological distress was higher than national estimates. Figure 2 shows a visual representation of the degree of psychological distress in different age categories of workers, categorised into low, moderate and high distress based on risk cut off points specified by the Australian Bureau of Statistics (ABS) [30]. Of the total sample, 61.0% were low risk (K10 score of 10–15), 22.9% were moderate risk (K10 score of 16–21), and 16.1% were high risk (K10 score of 22+). Moderate-high risk was greatest in the three younger groups (ages 15–24; 25–34; 45–54). High risk for psychological distress was most prevalent (approximately 20%) between ages 25–44 and decreased in older age groups (Fig. 2).

Fig. 2

Low, moderate and high psychological distress, by age group.

The mean score for likelihood of help seeking was 2.72±.89, indicating that most respondents fell approximately mid-range on the scale (Table 1). Of the total sample, 34.6% said they would be very unlikely-unlikely to seek help, 4.1% were unsure, and 61.3% said they would be likely or very likely to seek help for mental health problems. In general, a higher proportion (approximately 68%) of participants in the older age groups (ages 45–54 and 55+) said they would seek help (Fig. 3).

Fig. 3

Likelihood of seeking help for mental health problems, by age group.

Responses to confidence in knowing where to get help, and confidence in talking to workmates about mental health issues both indicated moderate scores on the 4-point scales, ranging between ‘somewhat confident –confident’. On average, respondents were moderately confident that they could recognise mental health problems in themselves (m = 2.94±.82) (Table 1).

Correlations between variables indicated a significant negative association between likelihood of help seeking and psychological distress, and significant positive associations between likelihood of help seeking and (1) confidence in knowing where to get help; (2) talking to workmates about mental health issues, and (3) recognising poor mental health in yourself, respectively (Table 1). Psychological distress was significantly and negatively associated with the latter three variables, and age in years. The highest correlation was between confidence in knowing how to get help and confidence in talking to workmates (r = .59). No sources of multicollinearity were identified.

3.1 Mediation analyses

Mediation was formally tested using the bootstrapped multiple mediation model described in Fig. 1. Figure 4 shows the direct and indirect effects of psychological distress on the likelihood of help seeking, through the mediators ‘confidence in knowing how to get help’ and ‘confidence in talking to workmates’, while holding the covariates constant. A significant negative direct effect of psychological distress was found on likelihood of help seeking, such that every point reduction in psychological distress was associated with a 0.02 increase on the 4-point likelihood of help seeking scale (Fig. 2). Significant indirect effects were found from psychological distress to likelihood of help seeking via the mediator ‘confidence in knowing how to get help’ (b = –.0064; CI, –.0126 to –.0015), and ‘confidence in talking to workmates’ (b = –.0019; CI, –.0051 to –.0003), showing partial mediation for both mediators (Fig. 2). Pairwise contrasts showed no difference in strength between the two mediators. The model explained 12% of the variance.

Fig. 4

Results of multiple mediation model.

4 Discussion

This study examined how psychological distress is related to help seeking among male construction workers, and tested two hypothesised mediators of the relationship. Addressing mental health issues in men is receiving increasing prominence given high rates of suicide and mental health problems. These problems are especially prominent among men working in male dominated industries such as construction where levels of psychological distress are known to be higher than the population average [21, 23].

Consistent with other studies [8], psychological distress was higher in this sample of construction workers than the general population, with nearly 40% of the sample reporting moderate to high levels of psychological distress. In general, high psychological distress was most prevalent in those aged 25–44. The latter accords with findings that psychological wellbeing and happiness often decreases toward mid-life and increases again as people get older [31, 32]. Similarly, research indicates that males tend to lose rather than enhance their social and emotional support systems during mid-age [25], further underscoring the importance of pro-active interventions that could include enhancement of workplace social support mechanisms.

As expected, there was a generally high level of reluctance to seek help. Approximately 35% of the sample indicated that they would be unlikely to do so, with the 35–44 age group most unlikely to seek help. However, controlling for age and the ability to recognise personal signs of mental health problems, construction workers with higher levels of psychological distress were less, rather than more, likely to report that they would seek help. In line with international reports [33], this finding supports the notion that mental illness continues to be stigmatised in the Australian construction industry [17, 19], and that expectations of discrimination from co-workers, and potentially employers in the form of perceived job insecurity, remains high. However, the negative association between psychological distress and help seeking was partially explained by the degree of confidence workers felt in both knowing how to get help and in talking to their workmates about mental health issues. These are novel findings that offer useful avenues for supporting improved mental health outcomes in this group of workers, suggesting that future efforts to redress and mitigate mental health problems could be enhanced by building confidence and comfort in the process of seeking help and facilitating conversation about mechanisms by which to do this.

At an organisational level, several things can be done. Workplaces can address social norms that may increase the acceptability of openly discussing mental health concerns and exploring options for supports. Simultaneously, workplace strategies to de-stigmatise the negative connotations associated with mental health are also required. Workplace policies that appropriately recognise and manage mental health problems have also been found to be effective early intervention strategies [34]. Of particular relevance are recent findings from Canada highlighting the role of the workplace supervisor in managing workplace mental health issues, whereby commitment to conveying support was found to conflict with concerns over breaching worker privacy [35]. Although workplace supervisors are key to improving conversations around mental health issues due to their influence on workplace culture, the difficulties in relation to overstepping boundaries are likely to be exacerbated in the traditional masculine norms of the construction industry context. To facilitate improvement in this regard, targeted education and skill-based programs designed to assist supervisors, in parallel with regular peer-to-peer and men’s support groups, are likely to increase connections and confidence in ‘speaking out’ about previously taboo topics. As also indicated in Kirsh et al [35], direct contact-based education sessions containing lived experience examples of recovery are also likely to transfer well to this environment, as a practical means of reducing prejudice via personal relevance [35, 36].

On a broader scale, work and employment conditions such as hazardous or dangerous work, poor industrial relations, low pay and workplace events such as accidents, industrial disputes and downsizing (phenomena common in the construction industry) can all contribute to psychological distress [37]. Furthermore, shift work and the irregular or long hours that are characteristic of the industry may hinder genuine desire to seek support or treatment. Of all work exposures, the presence of psychosocial work exposures, such as job insecurity, low perceived control, excessive job demands, poor working relationships or bullying may be particularly detrimental to the mental health of this working group [20 , 38]. Hence, systemic change to operational factors may be required to reduce mental health risks to workers more generally, as well as addressing related factors such as high alcohol and drug use within the industry [39]. Indeed, previous work has shown that a multi-level integration of individual, group and organisational focused interventions are effective in improving mental health outcomes at work [40].

4.1 Limitations

A number of limitations of the current study should be noted. First, the study findings are based on a cross-sectional, self-report survey, therefore it is not possible from this data to ascertain actual rates of help seeking for mental health problems in this sample. Furthermore, data were collected on a convenience sample of construction workers, therefore caution is warranted in relation to the generalisability of results. However, given that the higher level of psychological distress found in the current study was similar to that observed in comparable samples (e.g. [8]), cautious optimism can be assumed. Finally, the study highlighted a significant but small proportion of observed variance in explaining likelihood of help seeking in the current sample, and indicated partial rather than full mediation. Thus, it is likely that there are additional important mediators that could further contribute to understanding this relationship. Nonetheless, this is the first study to provide preliminary empirical support for the association between these variables and offers fruitful avenues to inform future intervention and research directions.

5 Conclusion

This study of a high-risk group of male construction workers confirmed high a prevalence of psychological distress and low propensity for help seeking that was partially explained by low levels of confidence in both talking about and knowing how to seek help in the workplace. While the construction industry has a duty of care toward their employees through occupational health and safety law and policy, the traditional focus has been on physical safety. In line with previous work, this study highlights the increasing need for a “psychologically safe” workplace climate [41] whereby co-workers are encouraged to reduce the social distancing of mental health topics between themselves in combination with targeted support strategies from employers and systems level change. The current study provides useful guidance on strategies that workplaces can implement to facilitate early intervention and effective prevention of mental health problems in the construction industry and other high-risk, male dominated sectors.

Conflict of interest

None to report.

Footnotes

Acknowledgments

This study was funded in part by New South Wales Health and the Australian Government Department of Health.

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