Prevalence of depression and anxiety among working women in Saudi Arabia: psychosocial and perinatal correlates | BMC Women’s Health

To our knowledge, this current study is the first to assess depression and anxiety among working women in Saudi Arabia and its psychosocial and perinatal determinants. The prevalence of mild to moderate and moderately severe to severe depression was 50.2% and 20.3%, respectively. The prevalence of mild to moderate and severe anxiety was 49% and 15.5%, respectively. These results are similar to studies in Arab regions like Egypt and Jordan, which reported higher levels of depression and anxiety among working women [8, 27]. An explanation for the congruency of these findings with our results could be attributed to cultural similarities between the study subjects. Many understandable reasons could explain the vulnerable state of this group of women. Gender discrimination, pressure of multiple roles by women, and gender-based violence are all examples of these reasons. The greater housework and caregiving demand required from women compared to men, given their role as the primary caregiver at home in many cultures, can significantly jeopardize their mental health status. Work-related demands associated with full-time jobs, responsibilities at home, including housework, childcare, and social obligations to the family, and possible financial hardship could be sources of stress for this group of women. Women working for long hours could become subject to stressors as they work to meet their job obligations at the expense, sometimes, of their personal needs, children, and families.

In Spain, the prevalence of poor mental health was higher in working women than in men and was more related to socioeconomic rather than work-related variables [18]. In Germany, working women, especially those working in manual occupations, were found to be at a greater risk of poor mental health than men [28]. Furthermore, nightwork and overtime work were significantly correlated with anxiety [6]. As the majority of women in our study were in the healthcare sector, a gender gap of psychological disturbances with a higher prevalence of depression, anxiety, and stress among female healthcare workers than men were similarly documented [7, 29].

On the other hand, many research studies confirmed low levels of anxiety and depression with higher life satisfaction among employed women compared to housewife women [30,31,32,33,34]. In the Eastern province of Saudi Arabia, unemployed women were more likely to have depression than employed women. But employed women had a lower anxiety-trait score than unemployed women [5]. These findings can be explained by the assumption that employed women are usually more educated, financially independent, have more opportunities for making friends, socialize and enjoy leisure time, and have a better sense of how to lead a healthy lifestyle [30,31,32,33,34]. Possible reasons for these disparities include variations in access to mental health services, cultural factors, and socioeconomic differences. However, our study didn’t include a comparison group of unemployed women or housewives.

The present study revealed that the prevalence of moderately severe to severe depression was significantly higher among participants who had lower mean scores of total pregnancies. This result agrees with Holton et al., where mothers reported significantly better subjective well-being and greater life satisfaction than childless women [35]. Another study also found that women with children were less likely to be depressed than women without children [36]. This could be due to the functional impairment caused by the severe depression, which results in avoiding getting pregnant or any activity that might cause any additional burden that could be intolerable. Previous research has found that the severity of anxiety and depression may be one of the causes of human reproductive problems and that emotional disorders affect the secretion of sex cycle hormones and endometrial growth [37].

A positive correlation was found between depression and anxiety in this study, which is explained by the high comorbidity between them [24, 25]. Moreover, participants who were diagnosed previously with a psychiatric disorder had a significantly higher percentage of severe depression and anxiety in our analysis. A possible interpretation of this finding is having a previous history of medical problems might affect the subjects’ perception of their health as weak and feeling more vulnerable to contracting a new disease [38]. A strong association was evident in prior studies documenting a significantly higher prevalence of antenatal depression among those who reported depression diagnoses, needed medical consultations, and were treated for depression [39, 40].

Another finding in our study is the high percentage of severe anxiety among smoking participants. Smoking was associated with a higher degree of depression, anxiety, and stress [6, 41]. This finding is in concordance with what has been reported in another Saudi Arabian study [3, 4, 42, 43]. Recent research suggested that depression appears to be associated with smoking dependence and mediated by neuroticism [44]. The association between smoking and depression was examined in 60,814 study subjects, and it was reported that the strongest association was with comorbid anxiety depression, followed by anxiety, and only marginal depression [45].

Participants in our study drinking alcohol had a higher percentage of moderately severe to severe depression. Depression was the predictor variable of problematic alcohol consumption for women aged 18–34 years, and women aged 35–64 years used alcohol as the predominant coping style [46]. Employed females tended to drink more and exhibit higher ratios of problematic drinking, and the psychological attributes related to their drinking related to a state of anxiety and impulsiveness [47].

Half of the participants in the current study took maternity leave (49%), and most needed additional leave after it ended (65.2%). Taking leave from work provides time for mothers to rest, recover from pregnancy and childbirth, and attend to their child’s health and needs. The need to take additional leaves could indicate that the length of the maternity leave is perhaps insufficient. Although the length of maternity leave was not investigated in the scope of the study, a positive association was shown between the size of maternity leave and the mother’s mental health [48]. Women who took a short leave (6 weeks or less) and were high on marital concerns had the highest depression scores [49]. Full-time working women were interviewed at four months postpartum and showed elevated anxiety compared to their counterparts [49]. Short maternity leave can be conceptualized as a risk factor that, when combined with other factors, places women at greater risk for depression [49, 50]. The new policy in Switzerland extends maternity leave for many women to 14 weeks [48]. A more generous maternity leave during the birth of a first child was associated with reduced depressive symptoms [51]. Findings suggest employed women experience problems in well-being at approximately seven months postpartum and that with more than 15 weeks of leave, time off work positively affected maternal mental health [52].

This study has several limitations. The first is the study’s cross-sectional nature. Second, convenience sampling from one city (Riyadh) limits the generalizability of the results. Third, using an online questionnaire might have led to over and underestimation of certain groups (for example, those without internet access). The study did not include a comparison group or differentiate between types of employment, such as hard or simple work, nor did it assess the adequacy of salaries or specific employment contracts with insurance due to the initial study design focusing on broader employment and mental health outcomes. Additionally, while this study did not specifically categorize participants based on psychological or chronic physical disorders, acknowledging these factors as potential covariates in mental health outcomes is crucial for future research. Lastly, all the study data were self-reported, which may have introduced bias.

Despite these limitations, this study has important practical implications for employed women. Implanting flexible or remote working hours can be beneficial in addition to providing generous maternity leave. It is also important to increase workplace awareness about mental health and provide some resources or wellness programs with access to psychological services.

For future studies, it is recommended that a larger sample size of women with various characteristics recruited from different settings be studied. In addition, predisposing social factors like family and work need to be investigated further to determine whether they affect women’s mental health status in the workplace. Future research studies need to be conducted to comprehend the impact of mental distress on work productivity and to elucidate how gender differences may influence reproductive and other health outcomes related to mental distress. Other variables like employment types and employment contracts need to be considered in future studies to understand better how specific employment conditions affect mental health. Also, future studies should include other regions in Saudi Arabia and a comparison group of unemployed women.