Abstract: Despite a global recent interest in this matter, researchers have not developed, or validated scales focused on workplace bullying or destructive leadership in Chile. There are antecedents of workplace violence in the country, and the relationship with psychological distress is worldwide documented. The present study aimed to provide evidence of validity based on the internal structure and relationship with other variables of the Negative Acts Questionnaire-Revised (NAQ-R) and the Destructive Leadership Scale (CDLS). A survey was applied to a multi occupational sample of 1995 civil servants of the main metropolitan areas of Chile: Santiago, Valparaiso, and Concepcion. Responses were analyzed through exploratory and descriptive statistics, Confirmatory Factor Analysis for internal structure, and Logistic Regression for bindings with psychological distress as a criterion, adjusting on confounding variables. The CDLS scale obtained acceptable fit indices once one item was deleted (WLSχ2 (64, N= 1847) = 642, p<.0,001; CMIN/df= 10.0; CFI= 0.966; GFI= 0.993; aGFI= 0.987; RMSEA = 0.070; 90% IC [0.065, 0.075] NNFI= 0.959), distinguishing between destructive (CR [composite reliability]= 0.81) and constructive leaderships (CR= 0.91). The NAQ-R showed properties that make it useful in the Chilean context as a unidimensional measure (WLSχ2 (206, N= 1927) = 648, p<.0.001; CMIN/df= 3.1; CFI= 0.969; GFI= 0.994; aGFI= 0.990; RMSEA = 0.033; 90% IC [0.030, 0.036] NNFI= 0.965; CR= 0.98). A higher prevalence of Distress in the presence of bullying (PR [Prevalence ratio]=1.03, 95%IC [confidence intervals] 1.02, 1.04) or destructive leadership was found (PR= 1.09, 95%IC 1.06, 1.13). Studies may obtain prevalence by empirical classification methods.

Resumen: La violencia laboral y los liderazgos destructivos acaparan un alto interés en el mundo, sin embargo, en Chile no existen procesos de validación para los instrumentos más utilizados globalmente. La evidencia muestra que la exposición a violencia laboral en Chile se asocia con distrés. El objetivo de este estudio fue proveer evidencia de validez del Cuestionario de Conductas Negativas (NAQ-R) y la Escala de Liderazgo Destructivo (CDLS), basada en la estructura interna y en relaciones con otras variables. Se aplicó una encuesta a una muestra multiocupacional de 1995 trabajadores(as) civiles asalariados(as) de las tres principales áreas metropolitanas de Chile: Gran Santiago, Valparaíso y Concepción. Se utilizó estadística descriptiva, análisis factorial confirmatorio para estructura interna y regresiones logísticas utilizando el distrés como criterio y ajustando por confusores. La prueba CDLS sólo obtuvo índices aceptables eliminado un ítem (WLSχ2 (64, N= 1847) = 642, p<.0,001; CMIN/gl= 10,0; CFI= 0,966; GFI= 0,993; aGFI= 0,987; RMSEA = 0,070; 90% IC [0,065, 0,075] NNFI= 0,959), diferenciando entre liderazgos destructivos (CR [fiabilidad compuesta]= 0,81) y constructivo (CR= 0,91). La prueba NAQ-R presenta evidencia que hace factible su aplicación como una prueba unidimensional (WLSχ2 (206, N= 1927) = 648, p<.0,001; CMIN/gl= 3,1; CFI= 0,969; GFI= 0,994; aGFI= 0,990; RMSEA = 0,033; 90% IC [0,030, 0,036] NNFI= 0,965; CR= 0,98). Se constató una mayor prevalencia de distrés en presencia de acoso (RP [Razón de Prevalencia]=1,03, 95%IC [intervalo de confianza] 1,02, 1,04) o liderazgos destructivos (RP= 1,09, 95%IC 1,06, 1,13). Se sugiere que estudios futuros utilicen métodos de clasificación empíricos de prevalencia.

Background: A work that dignifies, that is adequately rewarded and is carried out with social protection is considered decent by the International Labor Organization. Aim: To describe and understand the different dimensions of the dignity of medical work from the perspective of Chilean male and female doctors. Material and Methods: From a qualitative approach, the first stage of the study consisted in the application of an open response survey which was answered by doctors from all over the country. The second stage consisted in discussion instances about dignity of medical work. In the third stage, semi-structured in-depth interviews with doctors of both sexes and of different generations were conducted. The analysis of the data was carried out following the approaches of the Grounded Theory. Results: The concept of dignity of medical work arises from a historical process of social conquest and implies the recognition of the rights of professionals and patients. Optimal conditions are required to provide quality health care. However, even in unworthy conditions, doctors do everything possible to provide a decent care. The need to humanize the relationships that occur in the context of health care is proposed. Carrying out medical work with excellence and professionalism contributes to personal fulfillment. Associativity contributes to dignify medical work. Conclusions: The dignity of medical work is understood by doctors as a polysemic and relational concept.

Abstract It is relevant to study the emotional demands of health workers because they are inevitably linked to the nature of their tasks. Previous literature has linked workplace violence with emotional demands, since these demands imply an additional workload, which can become a source of conflict. A cross-sectional study was carried out by applying a self-report questionnaire to 1023 officials (302 men and 721 women) from three highly complex Chilean hospitals. When analyzing according to the simultaneous positive response to the four items applied, 63% of the women are exposed to high emotional demands versus 55% of men (p < 0.001). There were no significant differences between men and women in the other variables of the study, except the proportion belonging to the non-professional class (60% of women vs. 46% of men). High demands increase the chance of reporting Workplace Violence by more than four times in men and women (OR = 4.15 [IC: 2.55-6.76]). than those not exposed to high demands.

Resumen Es relevante estudiar las demandas emocionales del trabajo en salud porque se vinculan inevitablemente con la naturaleza del trabajo sanitario. La literatura previa ha vinculado la violencia laboral con las demandas emocionales, puesto que dichas demandas implican una carga de trabajo adicional pudiendo transformarse en una fuente de conflictos. Se realizó un estudio transversal mediante la aplicación de un cuestionario de autoreporte a 1023 funcionarios (302 hombres y 721 mujeres) de tres hospitales chilenos de alta complejidad. Los resultados muestran que el 63% de las mujeres están expuestas a altas demandas emocionales versus el 55% de los hombres (p < 0.001). No aparecen diferencias significativas entre hombres y mujeres en las demás variables del estudio, a excepción de la pertenencia al estamento no profesional (60% de mujeres versus 46% de hombres). Las altas demandas aumentan la chance de reportar violencia laboral en más de cuatro veces (OR = 4.15 [IC: 2.55-6.76]) al compararlos con los no expuestos a altas demandas.

Abstract: Exposure to psychosocial risks and workplace violence is associated with a higher prevalence of workers' mental health problems. The purpose of the present study was to examine the mediating role of workplace violence between psychosocial risks (ISOSTRAIN, effort-reward imbalance), organizational background (tyrannical leadership) and mental health problems (distress) among 1023 workers in three high complexity public hospitals in three regions of Chile. It was hypothesized that exposure to psychosocial risks and some organizational features (tyrannical leadership) is associated with lower levels of mental health and that part of this effect is mediated by exposure to workplace violence. A questionnaire was applied including the Negative Act Questionnaire Revised (NAQ-R), the Psychological Distress Screening, the Destructive Leadership Scale, the Effort-Reward Imbalance Questionnaire and the Job Content Questionnaire. Path analysis showed that exposure to psychosocial risks, tyrannical leadership and workplace violence increase levels of workers' distress. Part of the effect of psychosocial risks and tyrannical leadership on mental health is mediated by exposure to workplace violence. The article finishes by discussing the need to move forward in developing protocols and prevention of psychosocial risks and workplace violence, particularly in the context of public health work.

Resumen: La exposición a riesgos psicosociales y violencia laboral se asocia con una mayor presencia de problemas de salud mental en los/as trabajadores/as. El presente estudio tuvo como objetivo indagar el rol mediador de la violencia laboral entre los riesgos psicosociales (ISOSTRAIN, desbalance esfuerzo-recompensa), antecedentes organizacionales (liderazgo tiránico) y problemas de salud mental (distrés) en 1023 trabajadores/as de tres hospitales públicos chilenos de alta complejidad de tres regiones del país. Se hipotetizó que la exposición a riesgos psicosociales y algunas características organizacionales (liderazgo tiránico) se asocia a menores niveles de salud mental y que parte de este efecto se encuentra mediado por la exposición a violencia laboral. Se aplicó un cuestionario incluyendo el Negative Act Questionnaire Revised (NAQ-R), el Screening de Distrés Psicológico, la Escala de Liderazgo Destructivo, el Cuestionario de Desbalance Esfuerzo-Recompensa y el Job Content Questionnaire. Mediante análisis de senderos, se observó que la exposición a riesgos psicosociales, liderazgo tiránico y violencia laboral aumenta los niveles de distrés de los/as trabajadores/as. Parte del efecto de los riesgos psicosociales y el liderazgo tiránico en la salud mental se encuentra mediado por la exposición a violencia laboral. El artículo termina discutiendo la necesidad de avanzar en protocolos y prevención de riesgos psicosociales y violencia laboral, en particular en el contexto del trabajo en salud pública.

Mobbing, or bullying in the workplace, has gained relevance in recent decades due to its growing magnitude and negative effects on workers’ health. There are various approaches for studying the issue. However, thus far the evidence is scarce in Latin America and is focused on specific samples. This study aims to analyze workplace bullying and its association with mental health in the wage-earning population and to determine the extent to which this association is modified by gender. A survey was conducted with a sample of 1,995 male and female salaried workers in Chile’s three main metropolitan areas (Greater Santiago, Greater Valparaíso, and Greater Concepción) with three-stage random selection (blocks, households, and individuals). Prevalence rates for depressive symptoms, use of psychotropic medication, and stress were 10.9%, 12.8%, and 13%, respectively, and there was a strong relationship between mental health variables and workplace bullying, which persisted in the adjusted models. When comparing this association in the models stratified by gender, no significant differences were observed between men and women.

El acoso laboral ha adquirido relevancia en las últimas décadas, debido a su creciente magnitud y consecuencias negativas en la salud de los trabajadores, existiendo diversos enfoques para estudiarlo. Sin embargo, hasta la fecha en América Latina la evidencia es escasa y focalizada en muestras específicas. El objetivo de este estudio es describir el acoso laboral y su asociación con la salud mental en población asalariada y determinar en qué medida la asociación se modifica según el género. Se realizó una encuesta a una muestra de 1.995 trabajadores y trabajadoras asalariadas de las tres principales áreas metropolitanas de Chile (Gran Santiago, Gran Valparaíso y Gran Concepción) seleccionados al azar en tres etapas (manzanas, viviendas e individuos). La prevalencia de síntomas depresivos, consumo de psicotrópicos y distrés fue de 10,9%, 12,8% y 13% respectivamente en la muestra total, y existe una fuerte asociación entre variables de salud mental y acoso laboral, aún en los modelos ajustados. Al comparar esta asociación en los modelos estratificados por género, no se observaron diferencias significativas entre hombres y mujeres.

O assédio moral no trabalho ganhou relevância nas últimas décadas devido à sua crescente magnitude e às consequências negativas sobre a saúde dos trabalhadores, sendo que existem diversos enfoques para estudá-la. Entretanto, na América Latina, as evidências são raras e focalizadas em amostras específicas. O objetivo deste estudo é descrever o assédio no trabalho e a sua relação com a saúde mental nos funcionários, para determinar em que medida a relação se altera conforme o gênero. A pesquisa envolveu uma amostra de 1995 trabalhadores e trabalhadoras formais das três principais regiões metropolitanas do Chile (Grande Santiago, Grande Valparaíso e Grande Concepción) selecionados ao acaso, em três etapas (quarteirão, unidades habitacionais e indivíduos). A prevalência de sintomas depressivos, consumo de psicotrópicos e distresse foi de 10,9%, 12,8% e 13% respectivamente, na amostra total, e existe uma forte relação entre variáveis de saúde mental e assédio moral no trabalho, ainda nos modelos ajustados. A comparação desta relação nos modelos estratificados por gênero não mostrou diferenças significativas entre homens e mulheres.

O assédio moral no trabalho ganhou relevância nas últimas décadas devido à sua crescente magnitude e às consequências negativas sobre a saúde dos trabalhadores, sendo que existem diversos enfoques para estudá-la. Entretanto, na América Latina, as evidências são raras e focalizadas em amostras específicas. O objetivo deste estudo é descrever o assédio no trabalho e a sua relação com a saúde mental nos funcionários, para determinar em que medida a relação se altera conforme o gênero. A pesquisa envolveu uma amostra de 1995 trabalhadores e trabalhadoras formais das três principais regiões metropolitanas do Chile (Grande Santiago, Grande Valparaíso e Grande Concepción) selecionados ao acaso, em três etapas (quarteirão, unidades habitacionais e indivíduos). A prevalência de sintomas depressivos, consumo de psicotrópicos e distresse foi de 10,9%, 12,8% e 13% respectivamente, na amostra total, e existe uma forte relação entre variáveis de saúde mental e assédio moral no trabalho, ainda nos modelos ajustados. A comparação desta relação nos modelos estratificados por gênero não mostrou diferenças significativas entre homens e mulheres.

Mobbing, or bullying in the workplace, has gained relevance in recent decades due to its growing magnitude and negative effects on workers’ health. There are various approaches for studying the issue. However, thus far the evidence is scarce in Latin America and is focused on specific samples. This study aims to analyze workplace bullying and its association with mental health in the wage-earning population and to determine the extent to which this association is modified by gender. A survey was conducted with a sample of 1,995 male and female salaried workers in Chile’s three main metropolitan areas (Greater Santiago, Greater Valparaíso, and Greater Concepción) with three-stage random selection (blocks, households, and individuals). Prevalence rates for depressive symptoms, use of psychotropic medication, and stress were 10.9%, 12.8%, and 13%, respectively, and there was a strong relationship between mental health variables and workplace bullying, which persisted in the adjusted models. When comparing this association in the models stratified by gender, no significant differences were observed between men and women.

El acoso laboral ha adquirido relevancia en las últimas décadas, debido a su creciente magnitud y consecuencias negativas en la salud de los trabajadores, existiendo diversos enfoques para estudiarlo. Sin embargo, hasta la fecha en América Latina la evidencia es escasa y focalizada en muestras específicas. El objetivo de este estudio es describir el acoso laboral y su asociación con la salud mental en población asalariada y determinar en qué medida la asociación se modifica según el género. Se realizó una encuesta a una muestra de 1.995 trabajadores y trabajadoras asalariadas de las tres principales áreas metropolitanas de Chile (Gran Santiago, Gran Valparaíso y Gran Concepción) seleccionados al azar en tres etapas (manzanas, viviendas e individuos). La prevalencia de síntomas depresivos, consumo de psicotrópicos y distrés fue de 10,9%, 12,8% y 13% respectivamente en la muestra total, y existe una fuerte asociación entre variables de salud mental y acoso laboral, aún en los modelos ajustados. Al comparar esta asociación en los modelos estratificados por género, no se observaron diferencias significativas entre hombres y mujeres.

Resumo: O objetivo foi analisar a associação entre fatores de riscos psicossociais, dimensões organizacionais, violência no trabalho e indicadores de problemas de saúde mental em três hospitais chilenos. Mil e vinte e três trabalhadores responderam um questionário, foram realizadas análises descritivas, bivariadas (qui-quadrado) e multivariadas (regressão logística com odds ratio como medida de associação). Relataram violência no trabalho, 14,7% dos entrevistados. Os/as trabalhadores/as expostos/as a ISOSTRAIN (OR = 2,32, p = 0,001) têm maior chance de relatar violência no trabalho; desequilíbrio esforço-recompensa (OR = 5,52, p ≤ 0,001); liderança tirânica (OR = 3,02, p ≤ 0,001) e vulnerabilidade (OR = 1,97, p = 0,010), em relação aos não expostos. Os expostos a ISOSTRAIN (OR = 1,78, p = 0,024); desequilíbrio esforço-recompensa (OR = 2,49, p = 0,001); violência no trabalho (OR = 2,13, p = 0,003) e vulnerabilidade (OR = 2,29, p = 0,001) têm uma maior chance de reportar distresse elevado, em relação aos não expostos. Os expostos a desequilíbrio esforço-recompensa (OR = 2,84, p ≤ 0,001) e violência laboral (OR = 1,76, p = 0,041) têm maior chance de reportar sintomas depressivos do que os nãos expostos. Os expostos a desequilíbrio esforço-recompensa (OR = 2,07, p ≤ 0,001) e vulnerabilidade laboral (OR = 1,96, p = 0,001) têm maior chance de consumir psicotrópicos. Os contextos laborais com fatores de riscos psicossociais, dimensões organizacionais adversas e vulnerabilidade laboral foram associados a uma maior chance de violência no trabalho. Além disso, trabalhadores expostos à violência no trabalho, riscos psicossociais e vulnerabilidade têm maior chance de reportar problemas de saúde mental.

Abstract: The objective was to analyze the association between psychosocial risk factors, organizational dimensions, workplace violence, and indicators of mental health problems in three Chilean hospitals. A total of 1,023 workers answered a questionnaire, and descriptive, bivariate (chi-square), and multivariate (logistic regression with odds ratio as the measure of association) analyses were performed. Of all the interviewees, 14.7% reported workplace violence. Increased odds of workplace violence were associated with exposure to ISOSTRAIN (OR = 2.32, p = 0.001), effort-reward imbalance (OR = 5.52, p ≤ 0.001), tyrannical leadership (OR = 3.02, p ≤ 0.001), and vulnerability (OR = 1.97, p = 0.010). Workers exposed to ISOSTRAIN (OR = 1.78, p = 0.024), effort-reward imbalance (OR = 2.49, p = 0.001), workplace violence (OR = 2.13, p = 0.003), and vulnerability (OR = 2.29, p = 0.001) showed increased odds of high stress when compared to unexposed workers. Workers exposed to effort-reward imbalance (OR = 2.84, p ≤ 0.001) and workplace violence (OR = 1.76, p = 0.041) showed higher odds of reporting depressive symptoms. Those exposed to effort-reward imbalance (OR = 2.07, p ≤ 0.001) and work vulnerability (OR = 1.96, p = 0.001) showed higher odds of consuming psychoactive drugs. Work contexts with psychosocial risk factors, adverse organizational dimensions, and work vulnerability were associated with higher odds of workplace violence. Workers exposed to workplace violence, psychosocial risks, and vulnerability have higher odds of reporting mental health problems.

Resumen: El objetivo fue analizar la asociación entre factores de riesgos psicosociales, dimensiones organizacionales, violencia laboral e indicadores de problemas de salud mental en tres hospitales chilenos. Mil veintitrés trabajadores respondieron una encuesta, se realizó análisis descriptivos, bivariados (chi-cuadrado) y multivariados (regresión logística con odds ratio como medida de asociación). El 14,7% de los encuestados reporta violencia laboral. Tienen más oportunidad de reportar violencia laboral los/as trabajadores/as expuestos a ISOSTRAIN (OR = 2,32, p = 0,001); desequilibrio esfuerzo-recompensa (OR = 5,52, p ≤ 0,001); liderazgo tiránico (OR = 3,02, p ≤ 0,001) y vulnerabilidad (OR = 1,97, p = 0,010), respecto a los no expuestos. Los expuestos a ISOSTRAIN (OR = 1,78, p = 0,024); desequilibrio esfuerzo-recompensa (OR = 2,49, p = 0,001); violencia laboral (OR = 2,13, p = 0,003) y vulnerabilidad (OR = 2,29, p = 0,001) tienen más oportunidad de reportar distrés elevado, en relación a los no expuestos. Los expuestos a desequilibrio esfuerzo-recompensa (OR = 2,84, p ≤ 0,001) y violencia laboral (OR = 1,76, p = 0,041) tienen más oportunidad de reportar síntomas depresivos que los no expuestos. Los expuestos a desequilibrio esfuerzo-recompensa (OR = 2,07, p ≤ 0,001) y vulnerabilidad laboral (OR = 1,96, p = 0,001) tienen más oportunidad de consumir psicotrópicos. Los contextos laborales con factores de riesgos psicosociales, dimensiones organizacionales adversas y vulnerabilidad laboral se asocian a una mayor oportunidad de violencia laboral. Asimismo, trabajadores expuestos a violencia laboral, riesgos psicosociales y vulnerabilidad tienen mayor oportunidad de reportar problemas de salud mental.

Abstract: The objective was to analyze the association between psychosocial risk factors, organizational dimensions, workplace violence, and indicators of mental health problems in three Chilean hospitals. A total of 1,023 workers answered a questionnaire, and descriptive, bivariate (chi-square), and multivariate (logistic regression with odds ratio as the measure of association) analyses were performed. Of all the interviewees, 14.7% reported workplace violence. Increased odds of workplace violence were associated with exposure to ISOSTRAIN (OR = 2.32, p = 0.001), effort-reward imbalance (OR = 5.52, p ≤ 0.001), tyrannical leadership (OR = 3.02, p ≤ 0.001), and vulnerability (OR = 1.97, p = 0.010). Workers exposed to ISOSTRAIN (OR = 1.78, p = 0.024), effort-reward imbalance (OR = 2.49, p = 0.001), workplace violence (OR = 2.13, p = 0.003), and vulnerability (OR = 2.29, p = 0.001) showed increased odds of high stress when compared to unexposed workers. Workers exposed to effort-reward imbalance (OR = 2.84, p ≤ 0.001) and workplace violence (OR = 1.76, p = 0.041) showed higher odds of reporting depressive symptoms. Those exposed to effort-reward imbalance (OR = 2.07, p ≤ 0.001) and work vulnerability (OR = 1.96, p = 0.001) showed higher odds of consuming psychoactive drugs. Work contexts with psychosocial risk factors, adverse organizational dimensions, and work vulnerability were associated with higher odds of workplace violence. Workers exposed to workplace violence, psychosocial risks, and vulnerability have higher odds of reporting mental health problems.

Resumen: El objetivo fue analizar la asociación entre factores de riesgos psicosociales, dimensiones organizacionales, violencia laboral e indicadores de problemas de salud mental en tres hospitales chilenos. Mil veintitrés trabajadores respondieron una encuesta, se realizó análisis descriptivos, bivariados (chi-cuadrado) y multivariados (regresión logística con odds ratio como medida de asociación). El 14,7% de los encuestados reporta violencia laboral. Tienen más oportunidad de reportar violencia laboral los/as trabajadores/as expuestos a ISOSTRAIN (OR = 2,32, p = 0,001); desequilibrio esfuerzo-recompensa (OR = 5,52, p ≤ 0,001); liderazgo tiránico (OR = 3,02, p ≤ 0,001) y vulnerabilidad (OR = 1,97, p = 0,010), respecto a los no expuestos. Los expuestos a ISOSTRAIN (OR = 1,78, p = 0,024); desequilibrio esfuerzo-recompensa (OR = 2,49, p = 0,001); violencia laboral (OR = 2,13, p = 0,003) y vulnerabilidad (OR = 2,29, p = 0,001) tienen más oportunidad de reportar distrés elevado, en relación a los no expuestos. Los expuestos a desequilibrio esfuerzo-recompensa (OR = 2,84, p ≤ 0,001) y violencia laboral (OR = 1,76, p = 0,041) tienen más oportunidad de reportar síntomas depresivos que los no expuestos. Los expuestos a desequilibrio esfuerzo-recompensa (OR = 2,07, p ≤ 0,001) y vulnerabilidad laboral (OR = 1,96, p = 0,001) tienen más oportunidad de consumir psicotrópicos. Los contextos laborales con factores de riesgos psicosociales, dimensiones organizacionales adversas y vulnerabilidad laboral se asocian a una mayor oportunidad de violencia laboral. Asimismo, trabajadores expuestos a violencia laboral, riesgos psicosociales y vulnerabilidad tienen mayor oportunidad de reportar problemas de salud mental.

Resumo: O objetivo foi analisar a associação entre fatores de riscos psicossociais, dimensões organizacionais, violência no trabalho e indicadores de problemas de saúde mental em três hospitais chilenos. Mil e vinte e três trabalhadores responderam um questionário, foram realizadas análises descritivas, bivariadas (qui-quadrado) e multivariadas (regressão logística com odds ratio como medida de associação). Relataram violência no trabalho, 14,7% dos entrevistados. Os/as trabalhadores/as expostos/as a ISOSTRAIN (OR = 2,32, p = 0,001) têm maior chance de relatar violência no trabalho; desequilíbrio esforço-recompensa (OR = 5,52, p ≤ 0,001); liderança tirânica (OR = 3,02, p ≤ 0,001) e vulnerabilidade (OR = 1,97, p = 0,010), em relação aos não expostos. Os expostos a ISOSTRAIN (OR = 1,78, p = 0,024); desequilíbrio esforço-recompensa (OR = 2,49, p = 0,001); violência no trabalho (OR = 2,13, p = 0,003) e vulnerabilidade (OR = 2,29, p = 0,001) têm uma maior chance de reportar distresse elevado, em relação aos não expostos. Os expostos a desequilíbrio esforço-recompensa (OR = 2,84, p ≤ 0,001) e violência laboral (OR = 1,76, p = 0,041) têm maior chance de reportar sintomas depressivos do que os nãos expostos. Os expostos a desequilíbrio esforço-recompensa (OR = 2,07, p ≤ 0,001) e vulnerabilidade laboral (OR = 1,96, p = 0,001) têm maior chance de consumir psicotrópicos. Os contextos laborais com fatores de riscos psicossociais, dimensões organizacionais adversas e vulnerabilidade laboral foram associados a uma maior chance de violência no trabalho. Além disso, trabalhadores expostos à violência no trabalho, riscos psicossociais e vulnerabilidade têm maior chance de reportar problemas de saúde mental.

The aim of this review is to describe and to analyze scientific reports about occupational violence in the health area. A systematic review of the literature on Academic Search Complete (EBSCO Host), Medline, Pubmed, Scielo, Scopus and Web of Science was performed and 23 articles were selected for analysis. Most studies are quantitative, measuring workplace violence and its consequences, including multi-stratum samples. They mainly measure psychological and external violence and their subjects are hospital workers. Violence is conceived as coming from organizational dimensions. Facilitators of violence are related to the nature of the job and the most commonly studied consequences are related to mental health. The main consequences of the phenomenon are depressive symptoms, post-traumatic stress disorder (PTSD) and work stress. The nature of the job as a facilitator of violence relates primarily to the place of work and to the profession. Most of the studies are carried out with multi-stratum samples and combine workers from different services. However, studies in psychiatric services and with nursing staff are also common.

Resumo: O estudo estimou a prevalência de estresse no trabalho no Chile e suas associações com a exposição ocupacional ao risco psicossocial e qualidade do emprego, considerando as diferenças de gênero. Estudo transversal considerando uma amostra representativa nacional de 3.010 trabalhadores/as (1.486 mulheres e 1.524 homens). Dezoito por cento da amostra relataram estresse (23,8% mulheres vs. 14,8% de homens). Aqueles expostos a riscos psicossociais têm mais chances de sofrer estresse do que os não expostos, e as mulheres têm uma maior chance de sofrer estresse do que os homens. Homens e mulheres em empregos precários têm uma chance maior de estresse em comparação com aqueles com menos precariedade do emprego. No entanto, as mulheres em empregos precários têm uma maior chance de sofrer de estresse do que os homens em cargos semelhantes. Conclui-se que as mulheres têm uma maior proporção de empregos precários, estão mais expostas a riscos psicossociais e têm maior estresse, demonstrando a existência de uma dupla discriminação, social e de gênero, no mercado de trabalho no Chile.

Abstract: This study aimed to estimate the prevalence of work-related stress in Chile and its association with exposure to workplace psychosocial risks and quality of employment, considering gender differences. The cross-sectional study included a representative probabilistic national sample of 3,010 salaried workers (1,486 women and 1,524 men). Eighteen percent reported work-related stress (23.8% of women and 14.8% of men). People exposed to psychosocial risks had a higher probability of experiencing stress, and women were more likely to suffer stress than men. Women and men in precarious work showed increased likelihood of distress, compared to workers with less precarious jobs. However, women in precarious jobs were more likely to suffer stress than men in the same situation. The study concluded that women had more precarious jobs, experienced greater exposure to psychosocial risks, and suffered more stress than men. This is evidence of double discrimination (social and gender-based) in the Chilean labor market.

Resumen: El estudio estimó la prevalencia de distrés laboral en Chile y sus asociaciones con exposición a riesgo psicosocial laboral y calidad del empleo, considerando diferencias de género. El estudio transversal consideró una muestra probabilística representativa a nivel nacional de 3.010 asalariados/as en Chile (1.486 mujeres y 1.524 hombres). Un 18% reporta distrés (23,8% mujeres versus 14,8% hombres). Los expuestos a riesgos psicosociales tienen mayor chance de experimentar distrés que los no expuestos, y las mujeres presentan una chance de sufrir distrés mayor que los hombres. Hombres y mujeres en empleos precarios tienen una chance mayor de presentar distrés al compararse con quienes tienen menos precariedad laboral. No obstante, mujeres en empleos precarios tienen mayor chance de sufrir distrés que los hombres en empleos similares. Se concluye que las mujeres ocupan empleos precarios en mayor proporción, están más expuestas a riesgos psicosociales y presentan mayor distrés, evidenciando la existencia de una doble discriminación-social y de género-en el mercado laboral en Chile.

Resumo: O estudo estimou a prevalência de estresse no trabalho no Chile e suas associações com a exposição ocupacional ao risco psicossocial e qualidade do emprego, considerando as diferenças de gênero. Estudo transversal considerando uma amostra representativa nacional de 3.010 trabalhadores/as (1.486 mulheres e 1.524 homens). Dezoito por cento da amostra relataram estresse (23,8% mulheres vs. 14,8% de homens). Aqueles expostos a riscos psicossociais têm mais chances de sofrer estresse do que os não expostos, e as mulheres têm uma maior chance de sofrer estresse do que os homens. Homens e mulheres em empregos precários têm uma chance maior de estresse em comparação com aqueles com menos precariedade do emprego. No entanto, as mulheres em empregos precários têm uma maior chance de sofrer de estresse do que os homens em cargos semelhantes. Conclui-se que as mulheres têm uma maior proporção de empregos precários, estão mais expostas a riscos psicossociais e têm maior estresse, demonstrando a existência de uma dupla discriminação, social e de gênero, no mercado de trabalho no Chile.

Resumen: El estudio estimó la prevalencia de distrés laboral en Chile y sus asociaciones con exposición a riesgo psicosocial laboral y calidad del empleo, considerando diferencias de género. El estudio transversal consideró una muestra probabilística representativa a nivel nacional de 3.010 asalariados/as en Chile (1.486 mujeres y 1.524 hombres). Un 18% reporta distrés (23,8% mujeres versus 14,8% hombres). Los expuestos a riesgos psicosociales tienen mayor chance de experimentar distrés que los no expuestos, y las mujeres presentan una chance de sufrir distrés mayor que los hombres. Hombres y mujeres en empleos precarios tienen una chance mayor de presentar distrés al compararse con quienes tienen menos precariedad laboral. No obstante, mujeres en empleos precarios tienen mayor chance de sufrir distrés que los hombres en empleos similares. Se concluye que las mujeres ocupan empleos precarios en mayor proporción, están más expuestas a riesgos psicosociales y presentan mayor distrés, evidenciando la existencia de una doble discriminación-social y de género-en el mercado laboral en Chile.

Abstract: This study aimed to estimate the prevalence of work-related stress in Chile and its association with exposure to workplace psychosocial risks and quality of employment, considering gender differences. The cross-sectional study included a representative probabilistic national sample of 3,010 salaried workers (1,486 women and 1,524 men). Eighteen percent reported work-related stress (23.8% of women and 14.8% of men). People exposed to psychosocial risks had a higher probability of experiencing stress, and women were more likely to suffer stress than men. Women and men in precarious work showed increased likelihood of distress, compared to workers with less precarious jobs. However, women in precarious jobs were more likely to suffer stress than men in the same situation. The study concluded that women had more precarious jobs, experienced greater exposure to psychosocial risks, and suffered more stress than men. This is evidence of double discrimination (social and gender-based) in the Chilean labor market.

Background: Health care workers are exposed to high stress levels and psychosocial risks. The imbalance between the invested efforts and received rewards acquires special importance in this setting. Aim: To assess the psychosocial risk level and its relationship with depression, distress and psychotropic drug use among health care workers. Material and Methods: Seven hundred eighty two workers (602 females; 180 males) answered self-administered questionnaires to measure psychosocial risk and mental health. Results: Twenty five percent of respondents used psychotropic drugs, 34% had a high level of distress and 23% had depressive symptoms. They also reported a low level of decisional latitude (48%), high emotional demands (47%), low social support (41%) and a significant effort-reward imbalance (67%). Those exposed to job strain (high demands and low decisional latitude), iso-strain (job strain plus low social support), and effort-reward imbalance were twice as likely to suffer symptoms of depression and elevated distress compared to non-exposed subjects. Conclusions: There are high levels of psychosocial stress among health care workers.

Background: There is growing interest in the treatment and return-to-work of workers with labor related mental illnesses. Aim: To perform a systematic review of practices and interventions that improve return to work. Material and Methods: Systematic literature review. Thirty articles were selected for in- depth analysis. Results: Self efficacy perception, work motivation, a lower age and a better socioeconomic status were identified as worker-related return to work facilitators. Among work environment facilitators, good communication practices, supervisor support, a good assessment and modification of work load, adjustment of expectations, a good relationship between employers and employees and positive work experiences were identified. Treatment may improve return to work using a multidisciplinary approach, reducing stress and identifying psychosocial determinants of mental problems rather than symptoms and providing a timely health care. Conclusions: Return to work of workers with labor related mental illnesses requires a constant sharing of information between health care workers, employers and employees to identify common therapeutic objectives.

Background: In recent years there has been an increase in the prevalence of work-related mental problems, significantly increasing the average annual working days lost because of leave sick. With respect to the later return-to-work, the evidence is categorical in affirming the importance of the successful of this process for the relapse prevention. Furthermore, we note that throughout Latin America the literature and research on interventions to return-to-work is almost absent. Objective: To study the conditions of diagnosis, intervention and return to work that have shown effectiveness from the perspectives and experiences of professionals from a mutuality regarding the intervention to return to work in individuals with problems of mental health of occupational origin. Method: An exploratory-descriptive research was designed using qualitative methodology. Focus groups and interviews to six psychologists, three psychiatrists and four occupational therapists were used. Results: From a descriptive analysis using the procedure of open coding proposed by the Grounded Theory model, five core categories and two transverse phenomena emerged: The tripartite communication and the process oriented by the return to work. The two refer to the process of intervention to return to work as the actors involved in this, whether mutuality or the workers' immediate labor context.

Antecedentes: En los últimos años se ha observado un aumento en la prevalência de problemas mentales de origen laboral, incrementando significativamente el promedio anual de días de trabajo perdidos por reposo. Con respecto al posterior reintegro, la evidencia es categórica en afirmar la importancia de que este sea un proceso exitoso para la prevención de recaídas del trabajador. Asimismo, se constata que a nivel latinoamericano es casi inexistente la literatura e investigación en torno a intervenciones para el retorno laboral. Objetivo: Estudiar las condiciones de diagnóstico, intervención y retorno al trabajo que han mostrado efectividad desde la perspectiva y experiencias de tratantes de una mutualidad respecto de la intervención para el reintegro al trabajo en individuos con problemas de salud mental de origen laboral. Método: Se diseñó una investigación exploratoria-descriptiva, empleando metodología cualitativa. Se utilizaron grupos focales y entrevistas a seis psicólogos, tres psiquiatras y cuatro terapeutas ocupacionales que ejercen sus labores profesionales en una mutual en Chile. Resultados: A partir de un análisis descriptivo, empleando el procedimiento de codificación abierta propuesto por el modelo de Teoría Fundamentada, emergieron cinco categorías centrales y dos fenómenos transversales: La comunicación tripartita y el proceso orientado al reintegro laboral. Ambos hacen referencia tanto al proceso de intervención para el retorno al trabajo como a los actores involucrados en este, ya sea de la mutualidad como también del contexto laboral inmediato de los trabajadores.

This article assessed depressive symptoms associated with work-related psychosocial risk factors according to gender in Chile, using the demand-control model (Karasek) and effort-reward imbalance (Siegrist). A cross-sectional study was conducted in a random sample of 3,010 workers (35% female and 65% male) from the country. Data analysis determined prevalence and associations through various statistical techniques (χ 2 , logistic regression). Exposure to psychosocial risk factors at work and prevalence of depressive symptoms were higher in women than men (15% vs. 5%). The adjusted analysis highlighted that female workers exposed to Isostrain (OR = 2.34; 95%CI: 1.42-3.85) and low rewards (OR = 2.13; 95%CI: 1.41-3.21) and male workers exposed to psychological demands (OR = 3.04; 95%CI: 1.94-4.76) and effort-reward imbalance (OR = 2.19; 95%CI: 1.39-3.46) had increased risk of depressive symptoms. Exposure to work-related psychosocial risk factors was associated with depressive symptoms in Chilean workers. Effective prevention in key aspects of work organization is thus needed.

El objetivo fue evaluar sintomatología depresiva, asociada a factores de riesgo psicosocial laboral según sexo en Chile, mediante los modelos demanda-control (Karasek) y desequilibrio esfuerzo-recompensas (Siegrist). El estudio fue transversal con una muestra aleatoria de 3010 trabajadores asalariados (35% mujeres y 65% hombres) de todo el país. Se determinó prevalencias y asociaciones a través de diversas técnicas estadísticas (eg. χ 2 ; regresión logística). La exposición a factores de riesgo psicosocial laboral y la prevalencia de sintomatología depresiva es mayor en mujeres que en hombres (15% vs. 5%). En los análisis ajustados destaca que mujeres expuestas a Isostrain (OR = 2,34; IC95%: 1,42-3,85) y bajas recompensas (OR = 2,13; IC95%: 1,41-3,21), y hombres expuestos a demandas psicológicas (OR = 3,04; IC95%: 1,94-4,76) y desequilibrio esfuerzos-recompensas (OR = 2,19; IC95%: 1,39-3,46), tienen una chance aumentada de sintomatología depresiva al compararse con los no expuestos. La exposición a factores de riesgo psicosocial laboral se asoció con síntomas depresivos en trabajadores chilenos. Resulta clave generar prevención en aspectos de la organización del trabajo.

O objetivo foi avaliar os sintomas depressivos associados com fatores de risco ocupacionais psicossociais, por sexo, no Chile, por meio do modelo demanda-controle (Karasek) e desequilíbrio esforço-recompensa (Siegrist). O estudo foi transversal, com uma amostra aleatória de 3.010 empregados (35% mulheres e 65% homens) em todo o país. Prevalência e associações foram determinados por diversas técnicas estatísticas (eg. χ 2 ; regressão logística). A exposição ao fatores de risco ocupacionais psicossociais e prevalência de sintomas depressivos é maior em mulheres do que em homens (15% vs. 5%). Análise ajustada salienta que as mulheres expostas a Isostrain (OR = 2,34; IC95%: 1,42-3,85) e baixa recompensa (OR = 2,13; IC95%: 1,41-3,21) e homens expostos a demandas psicológicas (OR = 3,04; IC95%: 1,94-4,76) e desequilíbrio esforço-recompensa (OR = 2,19; IC95%: 1,39-3,46) têm chance maior de sintomas depressivos quando comparado com o não exposto. A exposição a fatores de risco ocupacionais psicossociais foi associada com sintomas depressivos em trabalhadores chilenos. A geração de cuidados preventivos em aspectos de organização do trabalho é fundamental.