Mental Ill-Health Risk Factors in the Construction Industry: Systematic Review

Workers in the construction industry must endure different weather conditions and engage in repetitive and strenuous jobs (Boatman et al. 2012). Many construction projects are nomadic and cyclical, resulting in high unemployment rates (European Agency for Safety and Health at Work 2007). Other characteristics of the industry include high job demand, long working hours, and unrealistic deadlines (Beswick et al. 2007). These characteristics can have major consequences on the physical and mental health of construction workers.

Considerable research shows that physical and mental health problems can arise from stress related to work and the workplace (Wang et al. 2017). It is essential to monitor the impact of psychosocial risk factors (RFs) on the health of workers, to better understand their effects on mental health and wellbeing, thereby helping to reduce workplace injuries, prevent disabilities, and increase productivity (Boschman et al. 2013). Poor mental health and risk of mental illness have taken a toll on the construction industry in several countries, as reflected by a high risk of depression, anxiety, suicidality, and eventual suicide (Burki 2018; Kamardeen and Loosemore 2016; Milner et al. 2015). For example, Jacobsen et al. (2013) surveyed workers at a construction site, where 9 of 10 survey respondents reported having mental health challenges and required medical follow-up.

According to the WHO (2001, p. 1), mental health is “a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” The definition signifies that good mental health is foundational for well-being and effective functioning (Herrman and Jané-Llopis 2005), while mental ill health (poor mental health) hinders an individual’s ability to realize their potential, work productively, and contribute to their community (Herrman and Jané-Llopis 2012). Common mental health problems in the working population include anxiety and depression (Battams et al. 2014; Grove 2006).

Mental ill health has substantial economic costs to nations, organizations, and individuals, which is prevalent in the heavy labor industries. In the United Kingdom (UK), approximately 400,000 workdays per year are reported lost to mental ill health and, specifically among construction workers, there were 1,419 suicides between 2011 and 2015, amounting to 3.7 times the UK national average (Burki 2018). In Australia, death resulting from suicide among construction workers is 2 times the Australian national average (Mates in Construction 2018; Gullestrup et al. 2011). Mental ill health or poor mental health is also a risk factor for workplace injuries and fatalities (Palmer et al. 2014; Siu et al. 2004). For instance, in the Australian construction industry, for every death lost to fatal workplace accident, six of such cases were intentional suicide (J. Gullestrup, “To study workplace and industry approaches to mental health and suicide prevention globally,” unpublished report, 2019).

Previous studies have revealed that mental ill health and occupational injury have a direct relationship. Park et al. (2001), through a prospective study, explained that workers with depressive symptoms are at three times the risk of workplace injury and fatalities. Park and colleagues found that, among farmers, depressive symptoms and amount of hours worked were associated with increased workplace injuries. Anxiety, depression, and psychological distress are found to cause sleep problems (Bowen et al. 2018; Taylor et al. 2005), which adversely affect well-being and safety. Similarly, in the construction industry, sleep problems are associated with fatigue, which in turn causes workplace injuries and accidents (Powell and Copping 2016, 2010). Additionally, depression is a significant correlate of fatigue (Sadeghniiat-Haghighi and Yazdi 2015).

Many studies have linked work stress to poor mental health and suicide; however, concerns have been raised about the scarcity of research addressing other factors that can interplay with work-related factors to cause mental health issues and suicide (Sunindijo and Kamardeen 2017). Mental health prevention programs have demonstrated effectiveness and reduction in costs for health management (Sandler et al. 2014; Knapp et al. 2011). However, successful prevention of mental health problems and its burden can only be realized after identifying the attributes and exposures, known as risk factors, that can threaten mental health (Furber et al. 2017). Increased insight into risk factors for mental ill health among the construction workforce is necessary to inform the selection of appropriate interventions (Boschman et al. 2013) for achieving a psychologically healthy and safe workplace.

Based on the preceding, the purpose of this study was to systematically review the body of knowledge regarding mental health in the construction industry and, specifically, to evaluate the different risk factors for mental ill health and how mental health has been assessed in the construction industry. Given that few studies to date have used validated scales for assessing mental health in the construction industry (Love et al. 2010), this review addressed the followings questions: (1) what validated mental health diagnosis tools have been used to identify or screen for the state of mental health among construction workers? and (2) what are the risk factors for mental ill health and protective factors for mental health among construction workers?

The overall objective of the study was to provide a guide on how best to evaluate the mental health of construction workers and identify the most appropriate mental health interventions for this population. Further, this review will help researchers focus on specific risk factors for adequate mental illness prevention in the construction industry, which can also inform prevention efforts in other heavy labor industries facing elevated risks of mental ill health and suicide.

A total of 32 stressors of mental health were reported in the included studies (Table 2). The stressors were categorized under eight headings following the studies of Okechukwu et al. (2014), Love et al. (2010), Campbell (2006), Michie (2002), and Sutherland and Davidson (1993). As presented in Table 2, the numbers 1–16 across the column headings correspond, respectively, to the articles listed in Table 1. The checkmark indicates the frequency of a risk factor identified in the articles. The most-identified risk factors were hours worked per day (excess of 60 h per week), work overload, low opportunity/ability to participate in decision making, and occupational climate (authority, tax autonomy, office politics). However, few studies considered work–life as a stressor.

It was deduced from the selected studies that most (97%) of the identified stressors for mental ill health in the construction industry constitute psychosocial factors. These risk factors can be grouped according to two principles: (1) previous studies that outlined some of these stressors (Love et al. 2010; Sutherland and Davidson 1993; Michie 2002); and (2) definitions of the stressors. The risk factors were grouped as pertaining to the following: job control, work support, job demand, coping strategy, work hazards, family, workplace injustice, welfare, and socioeconomic factors. Fig. 4 illustrates this as a conceptual framework.

From the studies considered, it was determined that construction workers use specific negative coping strategies to help relieve the day’s job stress (Lingard et al. 2007). These coping strategies impact negatively on mental health (Jacobsen et al. 2013). After classification, the mean scores for the risk factors’ variables were determined (Table 3). The mean score was determined by calculating the total number of studies that identified the different measures that form a variable and dividing the total by the number of measures in the variable. For instance, work hazard risk factor was calculated using

Based on the equation, the mean score of the risk factor was determined and ranked. The result showed that job demand risk factors pose a significant threat to mental health and as such, reforming job design for better quality health and well-being should be enforced.

Although risk factors in the construction industry are about 97% based on psychosocial working conditions, studies on protective factors for mental health in the industry are scarce. Protective factors elicited from the studies can be classified into 10 broad categories: marital status; increased job control; increased job support; reduced job demand; reduced workplace discrimination; family-friendly job opportunities; workplace justice; better welfare; positive socioeconomic measures; and positive (adaptive) coping strategies. A study by Lingard et al. (2007) considered compressed workweek intervention to improve work−family/life balance in the construction industry. The studies revealed some positive coping strategies adopted by construction workers, such as wishful thinking and emotion-focused coping strategies (Lim et al. 2018; Langdon and Sawang 2018), which are protective factors. Appropriate mental health promotion and interventions were highlighted by the studies and included adopting a compressed workweek, problem-solving; stress management; workplace feedback mechanism; caring, appreciation, encouraging building teamwork, and communication skills; job security; creating a sense of involvement among employees; improving workplace safety, good quality of environment; encouraging quality relationships among colleagues; and promotion as a reward mechanism. These interventions can enhance protective factors against mental ill health in the construction workplace.

Kamardeen and Sunindijo (2017) considered a combination of personal factors and psychosocial workplace factors. This study deduced that marital status acted as a risk factor and moderator. As a moderator, marital status provided a social support network that could be lacking in the workplace. Kamardeen and Sunindijo (2017) also proposed that interventions should be designed around scheduled casual gatherings such as coffee-break chats and ensuring a more comfortable workplace to cushion the effect of marital status, especially among professionals who are not married.

As illustrated in Fig. 4, the studies included in this systematic review identified several key risk factors for mental ill health in the construction industry. These risk factors included lack of job control, welfare concerns, workplace hazards, job demand, workplace injustice, family, and lack of support.

This systematic review revealed several important risk factors, highlighting many potential pathways to mental ill health among workers in the construction industry. With growing complexity in the workplace and rising daily demands placed on employees, the number of cases of mental ill health is increasing (Kuhn 2013). For instance, psychological distress was related to workplace injuries, and there was a high prevalence of injuries among workers with substantial psychological distress (Jacobsen et al. 2013). To address this serious public health concern, researchers should also examine factors beyond the workplace. For example, the construction industry should consider the effects of a range of psychosocial factors spanning both the workplace and the personal lives of construction workers. The goal is to better understand the interactions among all the risk factors for mental ill health that an employee can experience in his or her daily life, thereby informing the design of intelligent interventions.

The importance of maintaining mental health across all types of construction firms is high. For instance, one study found that employees of contractors are subjected to more mental ill-health risk factors than their counterparts working in consultant firms (Love et al. 2010). Also, many studies have emphasized the mental health of supervisors and people in supervisory positions, whereas fewer studies have mapped out risk factors for construction trades or laborer positions such as bricklaying (Boschman et al. 2013). There is limited research on risk factors and mental ill health by trade. Given the different responsibilities across trades, and the variation in treatment of and working conditions for employees, further investigation of these trends may help provide solutions across the various construction sector trades that can be stressors to mental health. Better understanding of the conditions across trades will inform interventions that will meet the specific needs of each trade.

The construction industry has focused mainly on the impact of work stress on mental health. As such, only psychosocial factors arising from working condition and workplace are considered. Less emphasis has been placed on other psychosocial factors such as marital status, family friction, loneliness, and bereavement. For instance, a study asserted that PTSD is high among construction frontline workers because of workplace hazards (Stocks et al. 2010). Another study demonstrated that other life events among construction workers could also result in PTSD (Boschman et al. 2013). Overall, there is a need for much more research within the industry into specific factors that can increase the risk of mental ill health, which could assist in building more robust interventions in the workplace. For instance, if experiences outside the workplace appear to be the primary source of stress, workplace interventions such as the Employee Assistance Program (Soeker et al. 2016; Nakao et al. 2007) could incorporate solutions such as making necessary counseling or therapy resources available to employees in need.

There is a need for intensified research on factors that promote health in addition to research on risk factors only. Research into specific protective factors for mental health in the industry is limited, with protective factors primarily informed by the reversal of risk factors. When protective factors are just a reversal of risk factors, interventions are likely to be shallow and ineffective (Franklin et al. 2017). According to Mrazek and Haggerty (1994), protective factors can be found within the individual, family, community, and other affiliations. Although the methodologies used in research into protective factors in the industry are weak, protective factors such as optimism, resilience, and self-esteem are given little attention. Studies need to consider a combination of protective factors to better inform on protective factors that best suit different construction workforces.

To effectively identify risk and protective factors, focus group approaches could be used. In conducting the focus group, mental health assessment tools can be used to separate the respondents into the control group (comprising those with no mental ill health) and the target group (those with mental ill health) (Rodgers 2011). Characteristics found more in people without mental ill health but absent in the target group may also constitute protective factors. The results can form the basis for classification of risk factors and protective factors, and for designing follow-up interventions for the construction industry.

Currently, it is unknown whether the rate of mental ill health reported in the construction industry of developed countries, where modern techniques of construction are employed, is consistent with that of lower-income countries. More research into risk factors in emerging and developing economies is essential to determine context and cultural factors that pose a risk for mental ill health. Such research will provide information on the impact of laws and policies for worker protection and safety within construction industries across different regions. This is especially important because expatriate companies execute many construction projects in lower-income countries under different procurement options.

Certainly, assessing risk factors is essential to evaluate the level of risk to health; however, it is important to note that risk factors do not emerge in isolation but, instead, are clustered together. Interventions aimed at promoting mental health should be directed toward clusters of risk factors. The goal is to focus research on protective factors for mental health. For example, to reduce the risk of job demand and fatigue, real-time monitoring technology could be adopted by construction organizations. Alternatively, primary job stress and mental health interventions are needed to ensure improved and sustainable job design policies across the construction sectors of various economies. Following the boom in technology, increased studies into flexible work arrangements (Rudolph and Baltes 2017) within the construction industry are needed. On the secondary intervention aspect, technological interventions to maintain mental fitness through building resilience and stress management should form policy making within the industry.

Furthermore, there is a need for studies on benchmarking job designs, mental health policies, and interventions in the construction workplace. This will help ensure that construction firms uphold psychological health management as a core duty to ensure the well-being of their employees. Studies in the construction industry should assess depression and anxiety at the same time, to determine which mental health problem is most prevalent in the industry and make it possible to identify specific stressors responsible for each.

Last, only two studies assessed suicidality, highlighting the need for more significant examination of the risk of suicide within the construction industry using reliable assessment measures. Greater knowledge of the prevalence of mental illness symptoms is needed, and can inform the selection and implementation of appropriate workplace interventions for mental health promotion and mental ill-health prevention, as well as specific treatment programs. This will, in turn, help to achieve a psychologically healthy and safe workplace.

There is growing urgency to address the prevalence of mental ill health facing the construction industry. This review contributes a greater understanding of risk factors for mental ill health and protective factors to assist occupational health researchers, construction regulatory bodies, and workforce organizations in developing better-tailored strategies to tackle specific risk factors.

This systematic review revealed that, although several studies have examined the stressors faced by construction workers for many years, only a few have employed reliable mental health assessment tools. Going forward, studies in the industry will need to use a full validated mental health assessment scale to affirm the impact of workplace stress on psychological health.

In total, 32 risk factors were identified from 16 studies spanning eight main categories as detailed in the conceptual framework. This framework and the checklist serve as a coordinated reference guide to risk factors for future use, although future studies are needed to expand on this framework by considering additional risk factors. Other factors could include poor health, lifestyle, poor relationship with family, custody issues, work–family/life balance, and many other psychosocial, contextual, and cultural factors. The workplaces of varied construction trades and professions need mental ill-health and suicidality interventions tailored to the various types of work.

There is a need for intensified research into factors that promote health rather than just those factors that deal with risk. There is a considerable need for the development of more specific, innovative protective factors and emerging intervention frameworks to mitigate the high incidence of mental ill health and suicidality presently plaguing the industry. The findings of this study are useful to policy makers, construction organizations, practitioners, and researchers to develop targeted and sustainable interventions in mitigating mental ill health and resulting impacts among construction personnel and other manual laborers.

Data generated or analyzed during the study are available from the corresponding author on request.

The authors are grateful to the Department of Building and Real Estate, Hong Kong Polytechnic University, for funding this study. This work is part of a more extensive Ph.D. study, under which studies sharing a similar background but different scope and content may be published. Dr. Naslund is supported by a grant from the National Institute of Mental Health (5U19MH113211).