Abstract
BACKGROUND: The increasing workload faced by general practitioners (GPs) and practice assistants (PrAs) contributes to chronic stress and heightens the risk of depression. Various work-related factors, including work-privacy conflict (WPC), may further exacerbate this risk. This study explores the role of work-related factors, focusing on WPC, as mediators in the association between perceived chronic stress and the risk of incident depression among German GP practice personnel. METHODS: This study included 366 German GPs and PrAs using baseline and follow-up data from the IMPROVEjob trial. We assessed the risk of incident depression (Cut-off = 50) through changes in the World Health Organization Well-being Index (WHO-5) and measured perceived chronic stress using the Trier Inventory for the Assessment of Chronic Stress Screening Scale (TICS-SSCS). Work-related factors were evaluated, with a specific focus on WPC, using the corresponding scale from the Copenhagen Psychosocial Questionnaire (COPSOQ III). A causal mediation analysis was performed to examine how work-related factors mediate the effect of perceived chronic stress on depression risk. RESULTS: Increased perceived chronic stress was observed in 43.64% of participants, while 56.36% reported stable or decreased stress levels from baseline to follow-up. This increase in perceived chronic stress was associated with heightened reported work-privacy conflict (β = 8.99, p = 0.01), though higher baseline levels of work-privacy conflict appeared to mitigate this effect (β = -0.35, p < 0.001). Reported Work-privacy conflict increased for 43.22% of participants, remained stable for 28.39%, and decreased for another 28.39%. Moreover, heightened reported work-privacy conflict correlated with a greater risk of incident depression (logit β = 0.20, p = 0.015; OR = 1.02 per point, 1.22 per 10-point increase), with baseline conflict levels showing smaller subsequent increases (β = -0.35, p < 0.001), likely reflecting regression to the mean/ceiling effect. The risk of incident depression was identified in 19.49% of participants, while 80.51% did not develop depressive symptoms. Causal mediation analysis further revealed that work-privacy conflict partially mediate the relationship between chronic stress and the risk of incident depression, with both a direct effect ([Formula: see text] = 0.17, p = 0.002) and a mediation effect ([Formula: see text] = 0.03, p = 0.020) contributing to this association. Additionally, no significant associations were found between personal or work-related factors (e.g., age, gender, work time) and incident depression. CONCLUSION: This study emphasizes the need to address work-privacy conflict as a key factor in reducing the mental health burden associated by chronic stress among general practice personnel.