Occupational risk factors for depression and anxiety symptoms: Insights from a large cohort study during and after the SARS-CoV-2 pandemic

Swaantje Casjens, Jan Hovanec, Nadine Glaser, Janka Massag, Laura Pfrommer, Nils Opel, André Karch, Saskia Muellmann, Irene Moor, Michael Gekle, Matthias Girndt, Simone Hettmer, Jessica I Höll, Michael Heuser, Thomas Frese, Rafael Mikolajczyk and Thomas Behrens

PLOS ONE, 2026, vol. 21, issue 4, 1-17

Abstract: Objectives: An increased risk for an occupation-related SARS-CoV-2 infection has been linked to higher psychological distress. This online survey investigates the prevalence of depressive and anxiety symptoms in a large sample of 34,303 participants from the German cohort for digital health research (DigiHero) after the pandemic (late 2023, t1) and retrospectively from the Omicron wave (early 2022, t0), emphasizing variations across occupational groups and work-related risk factors. Methods: Participants reported their employment status (currently working; seeking employment; not working). Workers provided their primary occupation to assess occupational SARS-CoV-2 infection risk. Symptoms of depression and anxiety (assessed via PHQ-4) and additional occupational risk factors were solicited for each time point. Associations between occupational exposure and stressors with the four-level PHQ-4 outcome were analyzed separately for t1 and t0 using ordinal regression and expressed as odds ratios (OR) with 95% confidence intervals (CI). Results: Over 60% of respondents were working at t1, and 1.4% classified themselves as seeking a job. Job seekers reported highest and non-working individuals lowest depressive and anxiety symptoms. Symptom severity varied by occupation with elevated odds in traffic/logistics professions exclusively at t1 (OR=1.24, 95% CI 1.04–1.48) and healthcare professions exclusively at t0 (OR=1.08, 95% CI 1.01–1.16). High occupational SARS-CoV-2 infection risk was linked to symptoms at t0. Overall, these associations were modest and partly attenuated after additional adjustment for individual work-related stressors (e.g., loneliness at work, chronic work-related stress, work-privacy conflicts). At both timepoints, individual stressors and sociodemographic factors showed stronger associations with severe symptoms than occupation (e.g., chronic work-related stress at t1 OR=2.87, 95% CI 2.70–3.04). Conclusions: Persistent post-pandemic depressive and anxiety symptoms among workers emphasize the importance of addressing individual psychosocial work-related stressors.

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0346871

DOI: 10.1371/journal.pone.0346871

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