Risk factors for psychiatric morbidity among bank workers in a northern city of Nigeria

Objective. To determine the prevalence of psychiatric morbidi- ty in bank workers in Ilorin, Nigeria, and the sociodemo- graphic and work-related factors that may be associated with poor psychological health. Method. This cross-sectional two-staged study conducted between March and July 1999 involved screening using the 30-item General Health Questionnaire (GHQ-30), a socio- demographic questionnaire, the Present State Examination (PSE) schedule and diagnostic criteria from the 10th edition of the International Classification of Diseases (ICD-10). Data source. Bank workers in the three local government areas (west, east, and south) of Ilorin, a city in the middle belt of Nigeria. Data analysis. Data were analysed using EpiInfo version 6.0. Frequency distribution, cross tabulation, and chi-square analy- ses were obtained. The level of statistical significance was set at 5%. Result. Four hundred and thirty workers responded satisfactori- ly to the questionnaires (response rate 76%); 77 respondents (18%) were GHQ-positive and therefore had psychiatric mor- bidity. There was a significant association between psychiatric morbidity and age, gender, number of children, belonging to a social club, workload, promotion, and job status. Conclusion. The implications of these findings are discussed and possible medical and administrative interventions advo- cated.


Materials and methods
The study was conducted among bank workers in Ilorin, Nigeria, between March and July 1999.The town of Ilorin was upgraded from a provincial headquarter to the state capital following the creation of Kwara State in 1967. 35The town covers about 690 km 2 and comprises three local government areas (LGAs) (west, east, and south) peopled almost exclusively by the Yoruba tribe.
Banking is one of the major industries in the town and there are 13 commercial banks and one branch of the Apex (Central) bank.The staff complement of these banks ranges from 20 to 200, with the highest staff complement at the Central bank.An average bank worker works a minimum of 11 hours per day (from 7h30 to 18h30), and a minimum of 6 days per week (Monday to Saturday).Thus, an average bank worker works long hours, is likely to be overworked and emotionally stressed, and is at high risk for psychiatric morbidity.
Subjects for the study were invited to participate and were required to provide written, informed consent.The majority were willing to participate because they felt that it provided an opportunity to get medical advice on work-related and personal problems, and to express opinions on non-conducive work-related conditions.Confidentiality was assured.Five hundred and sixty-three bank employees consented to participate.Previous history of psychiatric illness was an excluding factor.
The study was conducted in two stages: the first stage involved screening for psychiatric morbidity using the 30-item General Health Questionnaire (GHQ-30). 37The GHQ-30 is a screening instrument to detect current, diagnosable psychiatric disorders and is intended for use in general practice and community settings. 379][40] Each questionnaire booklet was numbered serially (from 001 to 1 000), and the name/bank of every subject was written against the corresponding number on the questionnaire booklet on a 'tracer sheet'.This facilitated contact tracing of subjects for the second stage of the study.In the second stage subjects were interviewed using the Present State Examination (PSE) schedule 41 and diagnostic criteria from the 10th edition of the International Classification of Diseases (ICD-10), 42 as previously used in this environment. 15,40,43,45Psychiatric diagnoses were assigned.

Results
Results of the first stage of the study are presented.The response rate was 76% (430 of 563 subjects).Seventy-seven subjects (18%) had a score of 4 or more on the GHQ (median 5.0, range 4 -20) and were therefore assessed to have poor psychological health.

Age
The majority of respondents (N = 271, 67.4%) were between 30 and 44 years of age, with 70% of respondents with psychiatric morbidity falling into this age group.Age showed a significant

Marital and family status
The majority of respondents were married (N = 342, 80%) and had 3 children (N = 266, 65%

Educational status
Twenty-eight respondents (7%) had secondary education or equivalent, 292 (72%) had higher education, and 85 (21%) had an additional qualification.Among respondents with at least secondary education or equivalent, 2 (7%) had psychiatric morbidity compared with 55 (19%) of those with higher education, and 20 (24%) of those with additional qualifications (e.g.postgraduate diploma, masters degree in business administration (MBA), Fellow of the Chartered Institute of Nigeria (ICAN)).These differences were not statistically significant.

Religious and social factors
Three hundred and six respondents (80%) belonged to a religious group, while 77 (20%) did not.

Employment characteristics and morbidity (Table II)
One hundred and eighty-two respondents (44%) had worked 10 years or less, while 229 (56%) had worked more than 10 years.
Forty-one (23%) of those in the former category had poor psychological health compared with 32 (14%) in the latter category (15%) had morbidity, while 13 (32%) of those who reported a level of competence below their job requirement had morbidity (x 2 = 7.16, df = 2, p < 0.05).Two hundred and ninety-seven subjects (80%) had been promoted within the preceding 5 years.

Prevalence of psychiatric morbidity
This study found an 18% rate of psychiatric morbidity in bank employees.7][48] Extra-organisational factors might be responsible for these wide variations in prevalence observed across studies.For instance, the higher prevalence rates obtained in studies in Lagos 19,39

Sociodemographic factors
This study also found significantly higher morbidity among respondents with smaller families (i.e. two or fewer children).This is surprising because intuitively one would expect higher morbidity among those with three or more children, partly because of the increased demands that go hand in hand with a larger family.
Previous studies 17,49 have reported more career disruption and psychiatric disorders in women who have children.However, one explanation may be that respondents with fewer children may be in the early stages of marriage.These women may have little experience in coping with both household and work demands, resulting in a greater susceptibility to psychological ill health.
Having to combine care of children and family with work demands may be stressful to women especially in the event of home-work conflict. 11e finding of significantly higher morbidity among respondents in the under-30 and 30 -44-year age categories is partially consistent with previous studies. 50Respondents in the 30 -49 -year age group are in the middle stage of their careers, which may be in transition.This is also a time of marriage and raising children, which in themselves may be problem-laden.The study observed significantly higher morbidity in male respondents, a finding similar to that of previous studies. 47This finding arguably suggests that male workers are more prone to developing psychiatric disorders as they are likely to be more competitive in their work disposition.Another possible explanation is the African cultural tradition of bestowing certain responsibilities or social roles on males, for example the role of headship of the family.Thus, the impact of job loss as a result of continual restructuring that characterises the banking sector in recent times, may increase vulnerability to stress disorders among male workers.It has been reported that men in developing societies may be more exposed to stresses resulting from rapid social change than are women. 34wever, other studies have found higher morbidity in women than men. 11This may be attributed to the dual roles of women in society, namely coping with the burden of the household while at the same time dealing with work and office schedules.

Work-related factors
In this study respondents who reported light workloads had the highest morbidity in contrast to those who reported heavy workloads.The lowest rate of morbidity was found among those who reported acceptable workloads.One would have expected the opposite to be true but it may well be that those respondents who reported heavy workloads have adapted better to work conditions, resulting in less deleterious mental health effects.The contribution of excessive work to mental disturbance has been reported elsewhere. 39Quantitative work overload has been found to be positively associated with psychological and physical health problems 47,51,52 and researchers have suggested that qualitative and quantitative overload may produce different symptoms of psychological distress. 14reover, contrary to previous reports, significantly lower morbidity was observed among respondents who reported working overtime.The financial benefits accrued by those working overtime in the banking sector might be contributory.Low-ranking employees were observed to have the highest rate of morbidity, while the lowest rate of morbidity was observed among middleranking employees.This finding is in contrast to previous reports.
It may be hypothesised that junior employees adjust more easily to various organisational challenges and have fewer concerns relating to promotion and achievement.

Conclusion and recommendations
The study examined the general rate of psychiatric morbidity in a sample of bank employees, independent of specific psychiatric diagnosis.The 18% prevalence of psychiatric morbidity and the significant associations between psychiatric morbidity and sociodemographic (age, gender, number of children, membership of a social club), and work-related factors (job status, workload, work hours) suggests a need to mobilise efforts towards preventing or minimising the occurrence of psychological ill health in this sector.
Bank employees and management staff need to be trained properly in the identification of psychosocial factors that may be detrimental to the wellbeing of workers.
The establishment of organisational-based daycare facilities may help to mitigate the higher morbidity in respondents with children, especially women.This may alleviate some of worries associated with childcare and may reduce emotional tension and psychiatric illness.

articles Volume 11
No. 2 September 2005 SAJP Corporate health promotion programmes (to be funded and implemented jointly by corporations, communities, local, state, and federal governments as well as non-governmental organisations) with an emphasis on educational seminars and stress management workshops, may be useful.Modification of work intensity by adjusting work schedules, deter-mining appropriate break and rest periods, possibly in consultation with employees, may further reduce work tension, and reduce psychiatric morbidity.Periodic social gatherings or meetings between management and employees should also be encouraged to allow adequate and prompt dissemination of information on work processes, organisational policy, and technological changes, as well as direct ventilation of employees' problems.In the researcher's view these measures may reduce the morbidity associated with 'change' within the organisation.

Table II . Psychosocial factors at work of respondents (N (%))
articlesVolume 11No. 2 September 2005 SAJP rected x 2 = 18.31, df = 1, p < 0.001).Most (N = 262, 66%) felt their level of competence was appropriate to their job requirement.Among those who reported a level of competence above the job requirement, 18 (20%) had psychiatric morbidity, among those who reported an appropriate level of competence, 39