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There is a mental health epidemic going on in the construction industry. People working in construction are nearly 3.5 times more likely to die by suicide than the general population. Among working-age men, construction workers account for nearly 20% of all suicide deaths. As of 2020, construction workers were five times more likely to die from suicide than from a workplace injury or accident.

There are a multitude of factors that contribute to this epidemic. Construction workers face long working hours, hard physical labor and high injury rates. There are cultural norms and stigma in this male-dominated industry that often inhibit men from seeking help. The frequency and duration of construction work can be precarious, creating financial burden and stress during downturns.

Defining problematic conditions

Researchers and practitioners from Northeastern University and Washington University in Saint Louis (WashU) presented their research findings at a workshop titled, “Preventing Suicide and Protecting Mental Health in the Construction Industry” on October 13, 2022, at the 3^rd International Symposium Advancing Total Worker Health^® in Bethesda, MD.

Jack Dennerlein, PhD, professor and interim chair of the Department of Physical Therapy, Movement and Rehabilitation Sciences at Northeastern University, began his research with construction industry employees to better understand musculo-skeletal injuries (MSKs).

“Upon talking to them [construction workers], we quickly realized that mental health and substance misuse was a big issue for this population,” Dennerlein said. “There is a correlation between MSKs and mental health conditions including substance misuse.”

Dennerlein indicated that problematic conditions that lead to mental health conditions in the construction industry can be categorized in three ways:

• Job design, which includes workplace hazards, increased job demands and production pressure.
• Relational factors, such as supervisor support, discrimination, harassment, and stigma
• Job precarity, for example job security and tight labor markets

Dennerlein has interviewed several construction workers and consistently hears statements like, “when you don’t have any sense of [job] security, you can never really relax. You can never really be comfortable,” and “If you don’t work through sickness or injury, someone else will, and they will take your job.”

Access to mental health care

The field of occupational safety and health has made enormous strides over the past 50 years in making construction work safer. “It’s time to apply these same [risk management] principles to talk about mental health and reduce suicide in the construction industry,” Bradley Evanoff MD, MPH, of the Institute for Public Health at WashU, said.

“The complex nature of construction projects can create additional stress and strain,” Evanoff said. “Construction workers often have fragmented health care benefits because each employer and union offer different coverage.”

“Existing mental health resources such as employee assistance programs from employers and member assistance programs from unions are underutilized,” Anne Marie Dale, PhD, professor of occupational medicine and therapy at WashU, added. “Few construction companies offer accessible mental health care at the worksite to support worker’s mental health needs and well-being while at work.”

Employers offer and support programs

Over the course of the COVID-19 pandemic, Dale worked to implement a comprehensive mental health program within a large, multi-employer construction project in Des Moines, IA. The program was offered directly at the jobsite and at no cost to workers. It included wellness services such as coaching, counseling and medical care along with peer support, education and training, physical health challenges and financial education. Workers were allowed to participate in these services during work hours and field supervisors encouraged worker participation.

“Worksite mental health programs fill a much-needed gap,” Dale said. “Worker health benefits remain underutilized and access to services at the job site is important, especially to non-unionized construction workers.”

Written by David Shapiro, Colorado School of Public Health Certificate in Total Worker Health student, senior manager of programs and partnerships at CHWE, and lead advisor of CHWE’s signature public health outreach program, Health Links™.