Dyspnoea may elevate stress in artificial stone benchtop industry workers

Dyspnoea is associated with higher perceived stress in silica-exposed workers from the artificial stone benchtop industry at risk of silicosis, a permanent but preventable lung disease, suggests a study.

Other factors, such as leaving the industry, early attendance, and a history of anxiety or depression, may also help identify those at risk of poorer mental health outcomes.

“[Dyspnoea] can therefore be used as a simple way of identifying those who may require additional support through the assessment, follow-up, and compensation pathways,” the researchers said.

“Interventions that are aimed at reducing dyspnoea may also lower perceived stress, [but] this requires further research,” they added.

A total of 547 workers aged <45 years from the artificial stone benchtop industry who were undergoing assessment for silica-related disease were included in the analysis.

The researchers collected data on demographics; occupational, medical, and smoking history; modified Medical Research Council (mMRC) dyspnoea scale; Perceived Stress Scale (PSS-10) questionnaire; spirometry; and chest x-ray. They also conducted univariate and multivariate regression analyses.

Most of the participants were men in the industry for <10 years. PSS-10 scores increased with each increase in dyspnoea score. Higher PSS-10 scores were also seen in those who are no longer in the industry, with a history of anxiety or depression, attending assessment early in the program, and a medium exposure duration. [Respirology 2022;27:455-461]

Workers who used an interpreter reported lower stress. Multivariate analysis revealed no significant difference across job title, age, sex, smoking, spirometry, or chest x-ray categories.

“With each worsening category of dyspnoea, stress increased,” the researchers said. “We hypothesize that it is the distressing experience of dyspnoea that increases stress as this is something which the worker is aware of, whereas they may not be aware of abnormal clinical markers.”

Moreover, the association between dyspnoea and stress persisted even after adjusting for anxiety and depression history.

“While exercise training is beneficial at improving 6-min walk test distance and health-related quality of life measurements, it does not reduce mMRC dyspnoea scores in asbestosis and silicosis and other dust-related respiratory diseases or interstitial lung disease,” the researchers said. [Cochrane Database Syst Rev 2015;CD009385; Thorax 2008;63:549-554]

In univariate analysis, no significant difference was observed between never and current smokers, but the researchers believed that the increased PSS-10 score seen in smokers was because smoking relieves stress rather than cause it. However, smoking causes dyspnoea, which then increases stress.

No significant difference in stress was also noted between men and women. This contrasted the trend in both English and non-English speaking populations with the PSS instrument. [J Appl Soc Psychol 2012;42:1320-1234; BMC Public Health 2010;10:513; Int J Environ Res Public Health 2011; 8:3287-3298; Span J Psychol 2006;9:86-93]

The present finding could be explained by the small sample of women in the analysis but might also indicate a difference in roles within the stone benchtop industry.

“Artificial stone benchtops are a popular kitchen product, but dust from their preparation and installation contains respirable crystalline silica, which causes silicosis,” the researchers said.