Intersec Occupational Health and Safety Conference

Dubai, January 2016

Anxiety and Depression amongst

workers in the O&G Sector –

Saipem’s survey

F. Mika¹ , N. Višnjić-Pichler¹, M. Nestsiarovich¹,

S. Pavičić-Žeželj², E. Croitoru¹, V. Nicosia¹

¹Saipem SpA

² School of Medicine, University of Rijeka

2mercoledì 3 febbraio 2016

Generalized Anxiety Disorder (GAD) and Depression

GENERALIZED ANXIETY

DISORDER

DEPRESSION

Prevalence

2.8% to 8.5% in GP

1.6% to 5.0%

in the general population

At least 5%

Manifestation

excessive and persistent

worrying that is hard to

control.

depressed mood

Symptoms

psychological symptoms

apprehensiveness and

irritability; physical increased

fatigue, palpitations, and

muscular tension

loss of interest or pleasure,

decreased energy, feelings of

guilt or low self-worth,

disturbed sleep or appetite,

and poor concentration

frequently co-occur

heterogeneity of results across countries

more frequent in high income countries compared with low

income countries

more frequent in females

different data about the incidence in age groups

causing among the highest number of days out of role

3mercoledì 3 febbraio 2016

Effects of GAD and Depression

•ability to make good decisions,

•cope with daily challenges,

•manage interpersonal relationships,

• realize individual potential, and

•make a productive and fruitful contribution to individual’s work team, family, and/or community.

Limiting :

•workplace performance (56%)

• relationship with coworkers and peers (51%)

•quality of work (50 %)

•relationships with superiors (43%)

Impact on work:

4mercoledì 3 febbraio 2016

Why anxiety and depression?

The prevalence of having any mental disorder in the prior year varies widely but is not lower than 35%;

WHO - 4th leading cause of disability worldwide (2nd in 2020) – Four in every ten workers experience

anxiety about their work;

Fewer than one in ten people have sought help from their GP to deal with anxiety;

Over 8 in 10 employers (84%) believe they have a responsibility to provide a work environment that

promotes mental well-being;

Tight-lipped workforce: Fewer than half (40%) employees whose mental condition interferes with work

have talked to their employer about it.

5mercoledì 3 febbraio 2016

Buck Surveys WORKING WELL (2014)

Employer objectives driving wellness strategy

Improving workforce morale/engagement 1

Reducing employee absences due to sickness or

disability2

Improving workplace safety 3

Improving worker productivity/reducing presenteeism 4

Maintaining work ability 5

Furthering organizational values/mission 6

Reducing health care or insurance premium costs 7

Promoting corporate image/brand 8

Fulfilling social/community responsibility 9

Attracting and retaining employees 10

Health issues driving wellness strategy

Stress 1

Physical activity/exercise 2

Nutrition /healthy eating 3

Workplace safety 4

Work-life issues 5

Depression/anxiety 6

High blood pressure 7

Chronic disease (e.g., heart disease, diabetes,..) 8

Personal safety 9

Psychosocial work environment 10

Sleep/fatigue 11

High Cholesterol 12

Obesity 13

6mercoledì 3 febbraio 2016

What the O&G Industry says?

OGP Report Number 343 (Revision 2011) Managing

health for field operations in oil and gas activities

OGP Report Number 470 (Revision 2011) Fitness

to work

o cover both physical and mental health;

o maintain employee confidentiality

o in risk assessment evaluate psycho-social risks

Moreover

”…. physical and mental capacities and the physical,

psychosocial and environmental demands of the job,……”

7mercoledì 3 febbraio 2016

Data from GIPSI

Total Records

Total

Employees

Total Records in GIPSI123735 81382

Group of Disease Disease DescriptionTotal

RecordsTotal

Employees

Mental and

behavioural diseases Anxiety disorders 43 33

Depressive episode 11 8

Dissociative (conversion) disorders 1 1

Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances 5 3

Mental and behavioural disorders due to use of alcohol 5 2

Mental and behavioural disorders due to use of cannabinoids 8 3

Mental and behavioural disorders due to use of cocaine 5 4

Mental and behavioural disorders due to use of tobacco 6 6

Nonorganic sleep disorders 191 136

Other neurotic disorders 1 1

Reaction to severe stress, and adjustment disorders 37 20

Schizophrenia 16 2

Unspecified mood (affective) disorders 6 4

Unspecified nonorganic psychosis 1 1

Unspecified organic or symptomatic mental disorders 4 3

Total Records 340 227

No. employees with MD

227 (0.28%)

Nº of contacts with medical

service due to MD

340 (0.27%)

8mercoledì 3 febbraio 2016

Scope and tools:

Assess the incidence of anxiety and depression among Saipem employees working in the Middle East

General Anxiety Disorder (GAD) 7 and Patients Health Questioner 9 ( PHQ9) - self-administered

instruments validated for screening, diagnosis, and assessment of the severity of GAD and depressive

symptoms, with good sensitivity and specificity

9mercoledì 3 febbraio 2016

GAD 7

GAD7

score

Severity

0-4 None

5-9 Mild

10-14 Moderate

>15 Sever

Cutpoint of ≥10 recommended

for further evaluation (i.e.,

drawing attention to a possible

clinically significant condition)

10mercoledì 3 febbraio 2016

PHQ 9

PHQ 9 score Severity

0-4 None None

5-9 Mild Watchful waiting; follow-up

10-14 Moderate Treatment plan, considering

counseling, and/or

pharmacotherapy

15-19 Moderately

Sever

Active treatment with

pharmacotherapy and/or

psychotherapy

>20 Sever Immediate initiation of

pharmacotherapy, referral to a

mental health specialist for

psychotherapy

Cutpoint of ≥10 recommended for further evaluation

(i.e., drawing attention to a possible clinically

significant condition)

Counts if present at all although a final decision about

the actual risk of self-harm requires a clinical interview.

11mercoledì 3 febbraio 2016

General data

12mercoledì 3 febbraio 2016

Data source

Saipem working sites in Middle East Area:

Iraq, Kuwait, UAE, KSA

Locations: offices, bases, drilling rigs (off

and onshore), vessels, camps.

Personnel: local and international

Employees’ origin: 50 nationalities (from 1

to 578 citizens), all 5 continents

Method : anonymous questionnaire

Participation: Voluntary

13mercoledì 3 febbraio 2016

Method Definition of the scope and tools

Presentation to management

Distribution of the questionnaires via email to operating sites

Local distribution of questionnaires by medical personnel

Within two weeks local collection of completed questionnaires and transmission to Head

Office for analysis

Elaboration of data, statistical analysis and drawing of conclusions

To perform all statistical methods (Student t-test, one – way ANOVA, Scheffe-test, multiple

linear regression analysis) we used STATISTICA, version 10.1 (StatSoft, Inc., Tulsa, OK, USA).

All analyzed data were considered statistically significant at p<0.05.

14mercoledì 3 febbraio 2016

Numbers

No. of Sites 41 1 Offshore

6 Onshore

31 Drilling Onshore

3 Drilling Offshore

Total No. of employees in the

area

8422 ( 1840 locals and 6582 expatriates

Total No. of questionnaires 1749 (1594 correctly completed all details of

questionnaires)

Participating employees Locals 263, Expatriates 1460 (26 missing nationalities)

Age from 18 to over 60

Years in the industry less than 1 – 48 years

15mercoledì 3 febbraio 2016

Grouping

Nationality

Locals vs expatriates

Onshore sites in Iraq vs KSA

Age

Years working in O&G Industry

Onshore Construction vs Onshore Drilling

16mercoledì 3 febbraio 2016

1490

187 45

27

GAD7

TOTAL

Total 1749

1408

235

76

22

8

PHQ9

Significant

anxiety Score ≥5

Should need

treatment Score ≥10

14,7% 4,12%

Significant

depressionScore ≥5

Should need

treatment Score ≥10

19,5% 6,06%

0 to 4

5 to 9

10 to 14

>15 (-19

for PHQ)

>20

“THOUGHTS THAT YOU WOULD

BE BETTER OFF DEAD OR OF

HURTING YOURSELF IN SOME

WAY”

98

53Have both GAD7 and PHQ9

≥10

17mercoledì 3 febbraio 2016

Results by Nationality

No.

GAD7

≥ 5GAD 7

≥ 10PHQ 9

≥ 5PHQ9

≥ 10 Q. 9

PositiveNo. % No. % No

.

% No. %

Total 1749 259 14.7 72 4.12 341 19.5 106 6.06 98

Europeans 218 48 22.01 14 6.42 55 25.3 20 9.63 7

Indian Subcont. 772 80 10.36 21 2.83 114 14.77 30 3.88 40

SE Asians 374 58 15.51 14 3.77 83 22.19 24 6.41 31

Midd. East/N.

Africa

319 71 20.37 25 5.32 78 24.45 28 8.78 12

Others 66 8 12.12 4 6.06 11 16.16 4 6.06 3

There are no significant differences among different groups of nationalities at p < 0,05

18mercoledì 3 febbraio 2016

210

3910

4

GAD7 locals

TOTAL LOCALS / EXPATS GAD7

Locals 263/Expats 1460

Significant

anxietyScore ≥5

Should need

treatmentScore ≥10

20.15% 5.32%

0 to 4

5 to 9

10 to 14

≥15 1260

146 31

23

GAD7 Expats

Significant

anxietyScore ≥5

Should need

treatment Score ≥10

13.7% 3.7%

For GAD incidence there is no significant difference between Locals and Expats at p < 0,05

19mercoledì 3 febbraio 2016

TOTAL LOCALS/EXPATS PHQ9

Locals 263/Expats 1460

1194

189

54

16

7

PHQ9

Significant

depressionScore ≥5

Should need

treatment Score ≥10

18.22% 5.27%

0 to 4

5 to 9

10 to 14

15 to 19

>20

196

42

19

5

1

PHQ9

Significant

depressionScore ≥5

Should need

treatmentScore ≥10

25.47% 9.51%

“THOUGHTS THAT YOU WOULD

BE BETTER OFF DEAD OR OF

HURTING YOURSELF IN SOME

WAY”

15 81

For Depression incidence there is significant difference between Locals and Expats at p < 0,05

20mercoledì 3 febbraio 2016

152

23

11

GAD7 Total

IRAQ

Total 177

Significant

anxietyScore ≥5

Should need

treatment Score ≥10

14.12% 1.3%

311

39 8

9

GAD7 Total

SAUDI Onshore Construction

Total 367

Significant anxietyScore ≥5

Should need

treatment Score ≥10

15.26% 4.63%

For GAD there is significant difference between employees in Iraq and KSA at p < 0,05

0 to 4

5 to 9

10 to 14

≥15

21mercoledì 3 febbraio 2016

151

22

4

0

0

PHQ9 Total

IRAQ

Total 177

Significant

depressionScore ≥5

Should need

treatment Score ≥10

14.12% 1.3%

277

57 22

6

5

PHQ9 Total

SAUDI Onshore Construction

Total 367

Significant

depressionScore ≥5

Should need

treatment Score ≥10

24.52% 8.99%

For Depression there is significant difference between employees in Iraq and KSA at p < 0,05

“THOUGHTS THAT YOU WOULD

BE BETTER OFF DEAD OR OF

HURTING YOURSELF IN SOME

WAY”

12 36

0 to 4

5 to 9

10 to 14

15 to 19

>20

22mercoledì 3 febbraio 2016

AGE CLASSIFICATION

26

86

48

22

2

10

25

6

3

0

4

12

10

0

0

21%

16%

12%11%

10%

7%

5%

3%

1%0% 0%

5%

10%

15%

20%

25%

18-25 26-35 36-45 46-60 over 60

0

20

40

60

80

100

120

140

>15

10 to 14

5 to 9

>5 points %

>10 points %

GAD7

18-25 26-35 36-45 46-60 Over

60

148 650 449 183 190-4

There is significant differences in GAD incidence

among different age groups at p < 0,05

23mercoledì 3 febbraio 2016

AGE CLASSIFICATION

11

47

125

0

7

10

4

0 0

0

4

3

1

0

23%22%

16%

11%

14%

10%

8%

3% 3%

0 0%

5%

10%

15%

20%

25%

18-25 26-35 36-45 46-60 over 60

0

20

40

60

80

100

>20

15 to 19

10 to 14

>5 points %

>10 points %

PHQ9

18-25 26-35 36-45 46-60 Over 60

144 600 423 193 18 0-4

There is significant differences in Depression

incidence among different age groups at p<0,05

24mercoledì 3 febbraio 2016

YEARS OF WORK WITHIN THE INDUSTRY

8452

39

31

7

4

18

3

5

19%

12% 12%

7%

2% 2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

<5 AND=5 YEARS >5 TO 10 YEARS >10 YEARS

0

20

40

60

80

100

120

140

160

180

200

>15

10 to 14

5 to 9

>5 points %

>10 points %

GAD7

<5 and=5 years >5-10 years >10 years

578 454 366 0-4

For GAD there is significant difference among

employees with different lengths of service in

the O&G industry at p < 0,05

25mercoledì 3 febbraio 2016

YEARS OF WORK WITHIN THE INDUSTRY

104 69

47

41

22

10

17

2

1

4

1

2

23%

18%

14%

9%

5%

1%

0%

5%

10%

15%

20%

25%

<5 AND=5 YEARS >5 TO 10 YEARS >10 YEARS

0

20

40

60

80

100

120

140

160

>20

15 to 19

10 to 14

5 to 9

>5 points %

> 10 points %

PHQ9

<5 and=5 years >5-10 years >10 years

545 422 354

For Depression there is significant difference

among employees with different lengths of service

in the O&G industry at p < 0,05

0-4

26mercoledì 3 febbraio 2016

642

10021

16

GAD7

ONSHORE CONSTRUCTION VERSUS ONSHORE DRILLING

Onshore Constr. 779 Onshore Drilling 676

Significant

anxiety

Should need

treatment

17.59% 4.75%

0 to 4

5 to 9

10 to 14

>15 1490

187 45

27

GAD7

Significant

anxiety

Should need

treatment

14.64% 4.88%

There is no significant difference related to GAD incidence among employees working onshore

on Construction and Drilling projects at p < 0,05

27mercoledì 3 febbraio 2016

605

12039

105

PHQ9

ONSHORE CONSTRUCTION VERSUS ONSHORE DRILLING

Onshore Constr. 779 Onshore Drilling 676

552

79

30

12

3

PHQ9

Significant

depression

Should need

treatment

18.34% 6.66%

0 to 4

5 to 9

10 to 14

15 to 19

>20

Significant

depression

Should need

treatment

22.34% 6.93%

“THOUGHTS THAT YOU WOULD

BE BETTER OFF DEAD OR OF

HURTING YOURSELF IN SOME

WAY”

53 27

There is no significant difference related to Depression incidence among employees working onshore on

Construction and Drilling projects at p < 0,05

28mercoledì 3 febbraio 2016

PQH 9 Question Nº 9

“THOUGHTS THAT YOU WOULD BE BETTER OFF DEAD OR OF HURTING

YOURSELF IN SOME WAY”

TOTAL 98

Thinking every day 13

Thinking more than

half the days20

Thinking several

days65

PHQ 9

range

PHQ9

score

0-4

PHQ9

score

5-9

PHQ9

score

10-14

PHQ9

score

15-19

PHQ9

score ≥20

Thinking every day 4-27 1 2 3 3 4

Thinking more than

half the days7-23 0 5 7 5 3

Thinking several days 2-20 12 37 12 3 1

25 Have both GAD7 and PHQ9 ≥10

29mercoledì 3 febbraio 2016

Previous mental disorders

14 declared previous mental disorders

no details available regarding the kind

of MD

Employment in the industry from 1 to

29 years

6 still on medication

9 have GAD 7 score 0-9

5 have GAD 7 score 10-21

11 have PHQ9 score 0-9

3 have PHQ9 score 10-27

2 Positive answers to the 9th question

of the PHQ9, both “thinking several days”

Limited number of cases does not allow

for any in-depth analysis

30mercoledì 3 febbraio 2016

Limitations of the survey:

Only GAD and Depression – does not take into account

other anxiety and Mental Disorders;

GAD 7 and PHQ 9 only probable diagnosis with diverse

sensitivity and specificity;

Totally anonymous, no possibility for follow-up, no

possibility for further information;

Limited number of those with already diagnosed

mental disorder under treatment which makes the

result of good control doubtful;

Lacking the clinical specificity that might be obtained

from direct review of clinical records

31mercoledì 3 febbraio 2016

Strengths of the survey:

Large number of participants

Participants from all over the

world;

Simple to administrate and carry

out in diverse primary care clinical

settings;

High specificity and sensitivity;

Discloses the problem;

Can be replicated in different

settings.

32mercoledì 3 febbraio 2016

Conclusions

Perhaps not the best time in the O&G Industry to carry out

such a survey;

Higher incidence of GAD and Depression in the industry than in

general population;

Both are under reported and under treated;

Usually not recognized at the beginning of the work

engagement/assignment;

Less frequent and severe with age and employment in the

industry;

Change is needed in the approach towards and in the system

for dealing with MD;

Brief and simple self-assessment techniques for MD should be

part of the Medical Fitness examination and kept confidential;

The survey needs to be developed further;

Should be extended to other areas;

Telepsychiatry??

33mercoledì 3 febbraio 2016