Minor psychiatric disorders among nurses university faculties

This cross-sectional study addresses 130 nursing faculty members in federal universities from Rio Grande do Sul, Brazil. It investigated the psychological demands and decision latitude (the Demand-Control Model by Karasek) and their association with Minor Psychological Disorders (MPDs). The Brazilian versions of the Self-Report-Questionnaire-20 and the Job Stress Scale were used. MPDs were prevalent in 20% of the studied individuals. After adjusting for potential confounders, the chances of participants presenting mental disorders were higher in the quadrant ‘active strain jobs’ (OR=14.23, 95% CI 1.55 to 130.73), followed by the ‘high strain jobs’ quadrant (OR=10.05, 95% CI 1.23 to 82.44), compared to nursing professors classified in the ‘low strain jobs’ quadrant. We conclude that high psychological demands and low control over work can cause disorders in nursing professors, among them, MPDs.


Introduction
In addition to teaching, the work of nursing professors involves research, assisting students, and interpersonal relationships with their colleagues and other professionals, students, superiors and other elements existing in the work place (1) .The teaching profession has been identified as the profession most exposed to conflictive environments with highly demanding work tasks, including extra-class tasks, meetings, problems with students, schedules, and routines that may expose workers to stressful situations (2) .Job strain may result from a mismatch between demands from the professional practice and the worker's ability to cope with such demands, once demands are established in the locus of work and workers experience different degrees of control over the tasks they perform (3)(4) .
Among the models that investigate occupational stress, the Demand-Control Model (DC Model) or Job Strain, proposed in the late 1970s (3) by Robert Karasek,   stands out.This model investigates two psychosocial dimensions in the workplace, 'psychological demands' and 'decision latitude', and the risk of workers becoming sick (3,5) .'Psychological demands' refer to pressure such as the time/speed demanded in the performance of tasks and conflicts among contradictory demands.
'Decision latitude' is related to the possibility of workers using their intellectual skills to perform their work and have sufficient decision-making authority on how and when to perform tasks (3,5) .
The DC Model assesses the psychosocial environment of the workplace through the combination of high and low levels of the two dimensions, which are divided into four specific kinds of jobs that suggest different risks are posed to health.They are: high strain jobs (a combination of high psychological demand and low decision latitude -greatest risk to health); active strain jobs (high demand and high decision latitude); low strain jobs (low demand and high decision latitude -lowest risk) and passive jobs (low demand and low decision latitude) (3) .The DC Model has been used in recent decades in various countries to assess the association between high strain jobs and some outcomes, such as cardiovascular disorders (5) , musculoskeletal disorders (6) , minor psychiatric disorders (7) , diseases of the digestive system (3) , and absenteeism (8) , among others.
Among the mentioned disorders, Minor Psychiatric Disorders (MPDs) occur in the presence of significant organic disorders arising from the individual's response to a stimulus considered to be a stressor (9) .According to estimates of the World Health Organization (WHO), MPDs affect about 30% of workers and severe mental disorders affect from 5% to 10% of workers (10) .
MPDs refer to clinical conditions of individuals with symptoms such as anxiety, sadness, fatigue, diminished concentration, irritability, insomnia, depression or somatization and which do not satisfy all the criteria defining mental disease according to the International Classification of Diseases (ICD-10) (11)(12) .
The workplace in the health field imposes physical and mental demands on workers.Consequently, MPDs are increasingly more prevalent among professionals within this field, especially nursing workers (4,13) .Some studies (2,14) report that professionals in the field of education have been also affected by these disorders, such as teachers in the municipal teaching system.
Therefore, evaluating the stressors present in the workplace of nurses teaching in federal educational institutions is relevant, as well as the repercussions of job strain on these workers' mental health.
Data organization and analysis: the Epi-info ® program, version 6.4, was used to store data through double data entry.After checking for errors and inconsistencies (validated), data were analyzed through the PASW Statistics ® (Predictive Analytics Software, da SPSS Inc., Chicago -USA), version 18.0 for Windows.
The JSS (5) , considered to be an independent variable, includes 17 questions: five refer to psychological demand, six to decision latitude, six to social support.
'decision latitude'.The levels of demand and control were dichotomized into high and low and the following groups were created to compose the DC Model's quadrants: low strain jobs, active strain jobs, passive strain jobs, and high strain jobs.
MPDs, considered to be dependent variables, were assessed according to the scores obtained in the SRQ-20, which was validated in Brazil at the end of the 1980s (16) .The cut-off point indicating an MPD was seven positive answers, for both women and men, based on previous studies conducted with nursing workers and teaching professionals (2,(13)(14) .
The following co-variables were considered: a)

Results
The When the percentage of MPDs was evaluated according to the model's quadrants, we observed that the prevalence of MDPs was the highest in the 'active strain jobs' (36.8%), followed by the quadrants 'high strain jobs' (30.6%), 'passive strain jobs' (8.8%), and 'low strain jobs' (3.6%).The differences found were statistically significant (p<0.05),which confirms that the groups are independent.
Then main results obtained in the analyses of raw and adjusted associations among the DC Model's quadrants and MPDs are described in Table 1.
given construct.The JSS's general Cronbach's alpha was 0.54, which demonstrates satisfactory internal consistency (17) , even though the value is below that obtained for the quadrants in the validation of the scale for Portuguese (5) .It is worth noting that the use of translated and cross-culturally adapted instruments may be a factor limiting understanding of questions on the part of the interviewees, as may be the case with the question "Do you have to do the same thing over and over again?"The participants may have not recognize some repetitive activities such as advising students.In this study, the nursing professors advised five or more students.Sequential advising is a repetitive activity, however, as it occurs with different students addressing diverse subjects, the repetitive nature of the task may go unnoticed.Factors of this nature may have interfered in the scale's alpha value.
When 'psychological demand' and 'decision latitude' were combined to compose the DC Model's quadrants, we observed that the highest frequency of nursing professors were classified in the quadrant 'high strain jobs' followed by 'passive strain jobs', 'low strain jobs' and 'active strain jobs'.Different data were found in the study conducted with teachers from the primary school.
There, the highest percentage of teachers was allocated in the quadrants 'low strain jobs' and 'active strain jobs' (1/3 each) (14) .In another study, the distribution of nursing workers in the four quadrants was the following: 20.4% 'low strain jobs'; 21.2% 'high strain jobs'; 28.5% 'active strain jobs' and 29.9% 'passive strain jobs' (7) .
This imposed an increasing demand of a cognitive nature on professors as they become responsible for the decisionmaking that controls the work processes and also solving problems that result from them (18) , as well as experiencing external pressure accruing from different controlling and evaluating agencies.
Scores above seven were obtained by the nursing professors (20.1%) on the SRQ-20.This result is above that found in studies addressing nursing workers (7) and professors from higher education (19) intuitions and below the results of studies addressing primary school teachers (2,14) , physicians (20) , medical students (21) , South African students from the health field (22) , and dentists.
The DC Model's (3) main hypothesis that high strain jobs predict health risks was confirmed in this study.
Nursing professors classified in the quadrant 'high strain jobs' do have a greater chance of being classified as potentially having an MPD than those who are located in the 'low strain jobs' quadrant (OR=10.05;CI 95%=1.23-82.44).
However, nursing professors determined to be in the quadrant 'active strain jobs' also presented a greater likelihood of presenting an MPD when compared to those in the 'low strain jobs' (OR=14.23;CI 95%=1.55-130.73).A study (19) whose objective was to present the theoretical and methodological foundations of the DC Model and discuss its ability to identify different job situations in the Brazilian context reported that the model's two dimensions appear as independent attributes, though in the case of 'active strain jobs', high demands could block reinforcements coming from high decision latitude, which indicates that 'active strain jobs' may also be harmful to the psychological health of nursing professors.
Results similar to those found in this study were also identified in other studies, which verified that workers in 'high strain jobs' were more likely to be classified as potentially leading to an MPD than those in 'low strain jobs' even after adjusting for potential confounding variables (7,13,(19)(20) .
It is worth noting that the context of teaching is more complex than the results found in this study reveal.Though it is apparent that an imbalance arising from job demands and decision latitude can cause mental suffering.
Among the limitations of this study we note the large magnitude of confidence intervals, possibly due to the population's size and the prevalence of the outcome (MPD), which may overestimate the odds ratio.
Additionally, it is not possible to confirm the presence of causal relationships with certainty since cross-sectional Tavares JP, Beck CLC, Magnago TSBS, Zanini RR, Lautert L.
studies simultaneously view the subject's exposure and their health condition (23) ; therefore, reverse causality cannot be disregarded.Also, even though the DC Model is intended for generalized use, it does not necessarily take into account the peculiarities of the nature of the work involving the relationship among people, since it was originally built to be applied to industry workers (24) .
It is important to note that there are few published studies addressing higher education professors.This gap hindered comparison of results.Nevertheless, this deficiency was remedied through comparison of data found in this study with those originating in studies conducted with nurses from the hospital field and primary school teachers.

Conclusion
The conclusion is that nursing professors developing activities within 'high strain jobs' have a greater chance of developing an MPD when compared to those performing activities within 'low strain jobs'.It is also apparent that those classified in the quadrant 'active strain jobs' also present a greater likelihood of being affected by mental disease than those classified in 'low strain jobs'.Such a fact is in agreement with the model's assumptions, suggesting that a high psychological demand negatively affects nursing professors, even when these workers have a high level of control over their work.
Nursing professionals should intensify research and establish strategies to promote health within the work routine to contribute to the autonomy of workers as well as to identify new means to promote wellbeing in the workplace.Moreover, it is essential that nursing professors rethink their nursing education and seek to implement to curricula focusing on promoting the health of workers.
Finally, the complexity of the work conditions of nursing professors is a reason for further studies addressing other occupational disorders, as well as the use of other scales to evaluate psychosocial aspects.
difference in the classification of workers in the DC Model's quadrants may be explained by the work dynamics experienced by the studied professionals (nursing workers, secondary school teachers, and nursing professors).In relation to the work of nursing professors (at a college level), prolonged activities may be more frequent because in addition to preparing classes and tests, they advise undergraduate, undergraduate research and graduate students, conduct research projects, extension activities, and administer practical classes in the hospital environment and in primary health care units.It seems that the work of nursing professors combines the effects of their activity as nurses and as professors, resulting in greater psychological demands, which can affect their psychological health.Additionally, Brazilian federal universities are experiencing a restructuring process due to the downsizing of the support services staff and the implementation of new technologies.This change has Tavares JP, Beck CLC, Magnago TSBS, Zanini RR, Lautert L.
* T.N.The Brazilian Institute of Geography and Statistics (IBGE) uses a color classification: White, Black, Pardo (Mixed origin), Yellow (East Asian) and Indígena (Ameridian).† T.N.Brazilian Federal Universities have four hierarchical levels in academic career.Professor Adjunto refers to the second level.The SRQ-20's Cronbach's alpha was 0.82.The overall prevalence of suspected MPDs among the participants was 20.1%.No statistically significant difference (p>0.05) was found when the socio-demographic covariables and the percentage of MPDs were analyzed.

Table 1 -
Raw and adjusted associations among the DC