Epidemiological Surveillance of Mental Distress and Burnout

Work-related illnesses and disorders, such as psychological distress and burnout, have a significant impact on public health in France. While they represent a significant burden, exposure to occupational risk factors and the associated disorders and illnesses are preventable through appropriate preventive measures, which must be adapted over time in response to changes in the characteristics of the working population and working conditions (longer working lives, aging, job insecurity, etc.). High-quality epidemiological surveillance is necessary to identify priorities, quantify and monitor occupational exposures, work-related illnesses, and their consequences on employment and the under-recognition of occupational diseases. In particular, it helps to better tailor prevention efforts to the sectors, occupations, and groups of workers most at risk. The goal is to better understand and identify occupational exposures, and to reduce the occupational (illness, disability, impairment, social exclusion, etc.), socio-familial, psychological, and economic consequences of work-related health problems. To address these challenges, Santé publique France monitors and tracks psychological distress and burnout (depressive symptoms, depressive disorders, anxiety disorders, suicides and suicide attempts, and burnout) using several approaches:

• Describe the prevalence of mental health disorders among employed workers by occupation and sector of activity.

• Describing the associations between psychosocial occupational exposures and mental health disorders.

• Describe the prevalence of work-related psychological distress.

Santé publique France contributes in particular to the 2016–2020 Occupational Health Plan (PST3), whose two main pillars are prevention and job retention.

The Samotrace Program

Santé publique France has established the Samotrace program (Mental Health Observatory for Work in Rhône-Alpes and Centre) in partnership with the Institute of Occupational Medicine and François Rabelais University in Tours. The Samotrace program enables the description of the prevalence of various mental health disorders and the analysis of the links between these disorders and occupational exposures across a wide range of professions and economic sectors. This initiative was implemented in two pilot geographic areas: in 2006, in the Centre, Poitou-Charentes, and Pays de la Loire regions; and then, in 2007, in the Rhône-Alpes region (departments of Rhône and Isère).

Suicide Mortality Among Agricultural Workers

Santé publique France and the Caisse centrale de la mutualité sociale agricole (CCMSA) have partnered to produce regular indicators of suicide mortality among farm owners and agricultural workers and to provide insights to guide prevention efforts. This partnership is part of the Suicide Prevention Plans for the agricultural sector.

The study initially focused on farm owners and was subsequently extended to include agricultural workers.

The Cosmop program

Santé publique France drew on data from INSEE’s Permanent Demographic Sample (EDP) and the DADS (Annual Declaration of Social Data) panel, combined with the CÉPIDC’s medical causes of death database, to establish the Cosmop program (Cohort for Monitoring Mortality by Occupation). The objective of this initiative was to systematically and regularly describe causes of death by occupation and their trends over time across the French population. In particular, analyses of suicide mortality before age 65, by socio-professional category and economic sector, were conducted.

The Coset Program

Established by Santé publique France, the Coset program (Cohorts for Work-Related Epidemiological Surveillance) aims to describe the health and occupational exposures of the entire working population in France, regardless of socio-professional category, sector of activity, or status (employee or self-employed, private or public sector).

Coset draws on data from prospective cohorts comprising workers enrolled in various health insurance schemes, initially focusing on workers in metropolitan France covered by one of the three main schemes: the general scheme, the agricultural scheme (MSA—Mutualité sociale agricole), and the self-employed scheme, which together cover 95% of the working population in France. These cohorts provide insights into the prevalence of depressive symptoms among the working population.

Epidemiological Surveillance in the Workplace

One of the main objectives of this project is to establish, at the level of companies or institutions, surveillance of workers’ health based on detailed occupational characteristics. Initially, cause-specific mortality studies were conducted; within this framework, an analysis of suicide mortality is available for large companies or institutions—such as the prison system, the RATP, Air France, EDF-GDF, and the fire department—that agreed to participate in the program.

The MCP Program

The MCP program relies on a network of volunteer occupational physicians who commit to reporting, during two two-week campaigns held throughout the year—known as “MCP Fortnights”—any illnesses they believe, based on their knowledge of the workplace, to be work-related. These illnesses have either not been reported or have not been recognized by an occupational disease compensation program at the time of reporting. It is possible to monitor the prevalence of work-related mental health issues through the MCP Program.

Feasibility Study on the Implementation of a Suicide Surveillance System Based on Data from Medical Examiners' Offices (MEOs)

Since 2015, a working group led by Santé publique France, bringing together IMLs and CépiDc-Inserm, has been working on a pilot study aimed at testing the feasibility of developing a suicide surveillance system—and in particular, a system for suicides potentially related to work—based on data from IMLs. This study follows a recommendation from the National Suicide Observatory.

Preventing mental distress and burnout

Through various epidemiological surveillance systems, Santé publique France helps provide the necessary information for implementing measures to prevent psychosocial risks.