Home health aides, other welfare support workers could face elevated risk of suicide

May 8, 2021
People who give help to others for a living might need it themselves. (AP Photo/Andreea Alexandru)

People who give help to others for a living might need it themselves. (AP Photo/Andreea Alexandru)

Australian welfare support workers, a category including home health aides, nursing aides, and similar occupations that often involve caring for elderly patients and people with disabilities, are roughly 50% more likely to die by suicide than workers in other industries, in line with findings of elevated suicide rates in health care-related sectors such as social work and nursing.

The numbers were particularly pronounced among male welfare support workers, who faced a suicide rate of 23.8 for every 100,000 individuals compared with 15.7 for males in professions unrelated to health care, according to a paper by University of Melbourne researchers, published online in Occupational & Environmental Medicine on April 15. Welfare support workers are employed through both private and public institutions and are responsible for a wide variety of services, from caring for the elderly and those with physical or intellectual disabilities to providing support to vulnerable communities, including refugees, foster children and others who may have experienced severe trauma. And while social work jobs often require an advanced degree, many care-worker positions do not call for formal training as a prerequisite. 

"The significant takeaway from this work is recognition of the silent suffering of welfare support workers," Humaira Maheen, a lecturer at the University of Melbourne and the paper's lead and corresponding author, told The Academic Times. "The work is both emotionally and physically exhausting."

Since the data was gathered between 2001 and 2016, it's unclear how the COVID-19 pandemic could be affecting certain risk factors for suicide among welfare support workers, such as burnout and compassion fatigue — a feeling of being overwhelmed by others' trauma or an inability to empathize with patients. But preliminary research shows that among health care workers at least, rates of psychiatric disorders are soaring, with over a third of workers in the industry experiencing mild depression, and over 20% experiencing moderate depression.

Welfare support workers may encounter greater physical threats in the midst of the pandemic because of the necessity of being in close contact with their patients. "Due to the nature of their work, many of these workers are at elevated risk of contracting COVID-19 and have had to adjust and modify their work rapidly," Maheen said. "This has heightened stressors for this occupational group, particularly those working in aged care."

Welfare support workers may also be more likely to encounter long-term health challenges following employment in the industry, with one U.S. study showing a 5.5% chance of a care-related job ending in disability, a rate that was far higher than other fields. Additionally, roughly a third of U.S. direct-care workers entered the industry after a period of unemployment. 

And although studies indicate that citizens' mental health improves when they are provided more government welfare programs, fewer analyses have been conducted to assess the mental states of workers on the ground who help facilitate those services. People employed in the industry may experience higher levels of isolation and lower levels of control over their own work environment, two factors that have been shown to contribute to negative mental health outcomes, according to Maheen.

"Given the similarity of welfare workers' pre-employment profiles and job demands in different countries, we think the study findings can be relevant to other countries with similar population characteristics," she added. In the United States, care workers often receive lower wages compared with other employees in the health and social care sectors, earning an average of $13.36 per hour in 2019 and yearly earnings that amounted to around $23,263, according to the aging advocacy organization LeadingAge. High turnover rates — between 40% and 60%, according to another aging nonprofit — also plague the industry.

The researchers relied on a national database to compare suicide rates among welfare support workers with rates in other professions. They implemented a relatively standard methodology — developing rate ratios to identify those most at risk of suicide — but others have tried more experimental techniques to study the phenomenon, such as an algorithm that uses demographic data to predict suicide attempts among the general population.

Governments and nonprofit organizations that hire welfare workers might be able to help reduce suicide levels by "increasing awareness of suicide, reducing the stigma associated with mental health as well as facilitating and supporting help-seeking and help-offering," Maheen said. "There are also examples of suicide-prevention programs for nurses, which have shown a small to moderate impact on nurses' suicide literacy," or the degree of one's understanding of suicide warning signs and risk factors as well as available treatment options.

To build on their findings, the research team is interested in conducting personalized interviews with Australian care workers, which could reveal ideas for new interventions that could contribute to an improved work environment. "We think exploring lived experience of welfare support experience with suicide ideation could be an important future step for research in this area," Maheen said, "This will enable us to [identify] an underlying mechanism that causes the elevated suicide risk in this group."

The study "Suicide in welfare support workers: a retrospective mortality study in Australia 2001-2016," published April 15 in Occupational & Environmental Medicine, was authored by Humaira Maheen, Stefanie Dimov, Matthew J. Spittal and Tania L. King, University of Melbourne.

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