Association between workplace and mental health and its mechanisms during COVID-19 pandemic: A cross-sectional, population-based, multi-country study

Background: The COVID-19 pandemic worsens populations' mental health. However, little is known about the COVID-19-related mental health among remote workers. Methods: We retrieved data from survey of Health, Ageing and Retirement in Europe, covering 27 countries. Eligible people were those employed. The main outcome is the mental disorder, covering four aspects: depression, anxiety, sleep disorder, and loneliness. Country-specific weighted mixed models were fitted to estimate the association of workplaces with mental health, controlled for age, gender, education level, living alone, making ends meets, working hours, closing to suspected or confirmed COVID-19 cases, received anti-virus protection, social contact, disability, and chronic disease. Moderate analyses were conducted to explore possible mechanisms. Results: 11,197 participants were included, among them 29.3% suffered at least one worse mental disorder. After controlling for covariates, compared with those who worked at the usual workplace, those who worked at home only or part of the time did not associate with worse mental disorders (p-value >= 0.1395), and those who worked at neither the usual workplace nor home had a 55% higher likelihood of suffering from worse mental disorders (OR = 1.55, 95%CI 1.03-2.36). The mediation analyses identified three indirect pathways by which workplaces influence mental health, including making ends meets, social contact, and receiving anti-virus protection. Detailed results on subtypes of mental disorders were also provided. Limitations: All assessments were self-reported, resulting in a risk of method bias. Conclusions: During the COVID-19 pandemic, working at other places, neither at the usual workplace nor home, worsened mental health. Evidence provided in this study will contribute to more nuanced and practical public health policy strategy making.