Work-related stress, also known as occupational stress or job stress, is a major alarming public health concern that has been increasing steadily over the past few decades among workers in all sectors. It is defined as “a pattern of reactions that occurs when workers are presented with demands or pressures (stressors) that are not matched to their knowledge, abilities and skills and which challenge their ability to cope” [1]. An estimated 19 to 30% of employees among the general working population are affected by workplace stress and burnout [2, 3]. Work-related stress contributes to 60% of workplace accidents, 40% of turnover, and 19% of absenteeism. Moreover, 10-13% of suicide deaths are due to working conditions. When job demands exceed a person’s resources, needs, or abilities, work stress occurs, resulting in negative psychological and cognitive effects. The most important components of these demands are the workload, physical work environment, difficulties balancing work and life, and emotional strain. The scientific community is giving more attention to job stress because it has an impact on job performance, physical and mental health [4–7].

In our era, a common problem that is experienced by workers in all professions is psychological distress at work, which results from several adverse health conditions related to workers’ health, safety, and wellbeing. Higher levels of psychological distress have been observed among employees in human service occupations like education, social work, and healthcare [2]. According to 2012 research, psychological distress was experienced by 1.4% of men and 3.1% of women in France [8]. A study showed that among a large French company, the prevalence of psychological distress among employees was 32.8% (95 % CI 31.8–33.9 %), higher among women (48.9 %, 95 % CI 46.5–51.7 %) than men (30.1 %, 95 % CI 29.0–31.2 %) [9]. Job strain, as defined by Karasek [10], is the combination of high psychological demands, including task quantity, complexity, and time pressure, and low decision latitude, including both decision authority and skill discretion. It also includes a dimension of social support at work [11]. This encompasses both instrumental and socio-economic support from interactions with managers and colleagues. Insufficient social support in the workplace is considered a potential risk factor for health. In France, a recent study conducted between November 2023 to January 2024 across 104 assisted reproductive technology (ART) centers, reported that among 464 participants including biologists (n = 124), gynecologists (n = 129), technicians (n = 107) secretaries (n = 51), midwives (n = 31), and other professions (n=22), 35.7% of professionals in French ART centers experienced job strain [12]. Another French study conducted in 2016 found that 23% of employees were exposed to job strain [13]. Moreover, data from the SUMER study that was conducted in France, revealed that women (28.2%) were more frequently exposed to job strain, based on the Karasek model, than men (19.6%) [11, 14].

Work-related stress is associated with multiple adverse health consequences and comorbidities, including mental disorders, depression, anxiety [15], sleep disorders [6, 16], and burnout [2]. Burnout is “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed”, and characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment in work. The literature has widely documented the association between job stress and negative mental health outcomes. Workers are more subjected to mental health problems such as depression and anxiety due to stressful work environments. Based on a study done in 2007, people with high psychological demands at work, including both heavy workloads and intense time pressure, were twice as likely to suffer from depression or generalized anxiety disorder than people who had lower job demands. Both women (1.90 [95% CI: 1.22–2.98]) and men (2.00 [95% CI: 1.13–3.56]) showed this association [17]. Another study showed that high job strain was associated with 3.8 (95% CI = 2.8-5.1) times higher odds of depressive symptoms, 1.7 (95% CI = 1.1-2.6) times higher odds of depressive disorders, and 7.4 (95% confidence interval [CI] = 5.6-9.7) times higher odds of burnout than low job strain among employees [18].

A study conducted among 1265 French pharmacists revealed that work-related stress was significantly associated with anxiety (29.16 ± 22.93 vs 52.56 ± 21.55 vs 71.39± 16.0, normal vs suggestive vs indicative scores of anxiety, respectively; p<0.001) and depression (42.77 ± 26.01 vs 68.56 ± 17.82 vs 76.44 ± 14.68, normal vs suggestive vs indicative scores of depression, respectively; p<0.001). The percentage of anxiety or depression indicative scores was higher for participants with a high level of work-related stress. Moreover, this study also revealed that the proportion of sleep disorders was significantly higher among participants suffering from high levels of work-related stress compared to those with low levels of work-related stress (37.6% vs 12.3%, p<0.001) [19]. A study done in America showed that the nature, quantity, mental demand, working hours, and associated stress of work played a fundamental role in insomnia, where approximately 60% of participants identified that either the development or prolongation of their insomnia was primarily caused by work [20]. Furthermore, a Chinese study done among 2116 oilfield workers showed that their sleep quality was poor, and as occupational stress increased, the prevalence of sleep disturbances increased as well [21].

Similarly, the issue of stress at work can be associated with the consumption of psychoactive substances and medications. Psychosocial job strain is associated with a higher risk of substance use disorders, mainly alcohol, tobacco, and cannabis [22]. Several studies have shown that job stress may be linked to increased psychoactive substance use as a coping mechanism to deal with work pressure and difficulties and to minimize the adverse effects of different sources of suffering, and this helps individuals to relax from job stress [7, 23]. For example, a study conducted using data from the French CONSTANCES cohort shows that men experiencing work-related stress were more likely to consume tobacco (OR=1.17, 95% CI=[1.06;1.29], p=0.002 for former smokers), use cannabis (OR=1.17, 95% CI=[1.06;1.29], p=0.001 for use more than a year ago), and have episodes of excessive alcohol consumption (OR=1.29, 95% CI=[1.10;1.51], p=0.002) compared to those who were not stressed. Exposure to work-related stress was associated with a higher level of tobacco use (OR=1.75, 95% CI=[1.34;2.30], p<0.001), alcohol consumption (chronic use: OR=1.59, 95% CI=[1.12;2.25], p=0.009; dependence: OR=2.30, 95% CI=[1.54;3.44], p<0.001), and cannabis use (OR=1.38, 95% CI=[1.10;1.75], p=0.006 for use more than once a month) compared to those not exposed among women [22].

A recent Brazilian study conducted among university professors revealed a significant association between occupational stress and consumption of psychoactive substances, where among professors experiencing stress at work, 85.7%, 28.6%, and 20% consume alcohol, tobacco, and cannabis, respectively [24]. According to a meta-analysis of European studies, smokers are more likely than non-smokers to report work-related stress (OR=1.11, 95% CI= [1.03;1.18]), and among smokers, those who reported work-related stress smoked on average more cigarettes per week than non-stressed smokers (an average of 3 extra cigarettes, i.e., 103.3 for stressed smokers versus 99.9 for non-stressed smokers) [25]. Moreover, a Canadian study showed that alcohol consumption tends to be higher when the perception of mental health and work-related or life stress is low. This study highlights the role that the work environment could play in preventing stressful factors and reducing alcohol consumption [26]. In Spain, researchers have reported a doubling of the risk of increased alcohol consumption based on exposure to a harmful work environment (OR=2.15, 95% CI=[1.51;3.06] for moderate exposure level, OR=2.23, 95% CI=[1.49;3.36] for high exposure level) [27]. Additionally, the study of Balayssac et al. (2017) demonstrated that among 421 French male pharmacists, 16.7% of those with a high level of stress at work had alcohol consumption above the WHO limit, compared to 4% of men whose consumption was below the World Health Organization (WHO) limit (p < 0.001) [19].

Furthermore, the study of CONSTANCES data highlights the effect of public contact on substance consumption: the consumption of tobacco and cannabis among professionals in contact with the public was higher than among professionals without public contact, for both men (OR=1.47, 95% CI=[1.22; 1.78], p<0.001 for high cigarette consumption; OR=1.38, 95% CI=[1.17; 1.63], p<0.001 for cannabis consumption, less than once a month) and women (OR=1.63, 95% CI=[1.18; 2.25], p=0.003 for high cigarette consumption; OR=1.31, 95% CI=[1.05; 1.63], p=0.017 for cannabis consumption, less than once a month). Alcohol consumption (chronic, at risk, or significant occasional) was higher among men in contact with the public compared with those who were not (OR=1.71, 95% CI=[1.43; 2.05], p<0.001 for moderate chronic consumption; OR=1.22, 95% CI=[1.12; 1.33], p<0.001 for at-risk consumption; OR=1.33, 95% CI=[1.18; 1.51], p<0.001 for significant occasional alcohol use more than once a month) [22].

Regarding the association between work-related stress and the consumption of psychoactive medications, a meta-analysis of 18 unique studies showed that high job demands were associated with a statistically significant increased risk of psychotropic medication use (RR 1.16, 95% CI 1.02 to 1.31). In studies reporting OR, high job demands were associated with an OR of 1.39 (95% CI 1.06 to 1.71) [28]. Another study conducted among French community pharmacies showed that anxiolytic and hypnotic drug use was significantly associated with work-related stress scores, where anxiolytic and hypnotic drug users were more stressed (score ≥70) than non-users (anxiolytics: 65.1% vs 34.9%, p < 0.001; hypnotics: 66.7% vs 33.3%, p < 0.001) and had higher stress scores (anxiolytics: 71.97 ± 17.34 vs 48.75 ± 27.19, p < 0.001; hypnotics: 73.35 ± 19.74 vs 51.15 ± 27.12, p < 0.001) [19].

In France, early childhood professionals, including “Agents Territoriaux Spécialisés des Écoles Maternelles (ATSEMs)”, “animateurs”, and “agents d’entretien”, play an important role in the well-being of children. “ATSEMs” are workers who help teachers in preschool classes; they are responsible for welcoming children, ensuring their hygiene, providing educational and technical support in the classroom, helping teachers with teaching staff during school hours, preparing materials, maintaining the class environment, as well as managing and assisting children throughout extracurricular time, such as breaks for lunch and care after school [29]. Early childhood “animateurs” are workers that play an important role in supporting the education, well-being, and development of children during extracurricular periods only outside regular school hours, such as the time before classes starts, during children’s meal and nap periods, and after school hours. They are implicated in organizing the children’s daily routine within the school, in the leisure centers, and during vacation. They also play with the children, supervise them in the playground, and organize and manage safe educational, artistic, and recreational (such as games and sports) workshops based on their needs, which aids in promoting the development, learning, and socialization of young children [30]. “Agents d’entretien” in charge of early childhood professionals are workers that maintain the safety and hygiene of children; they are responsible for cleaning and sanitizing areas such as floors, bathrooms, and play areas efficiently and effectively to ensure the health and safety of the children [31].

The working conditions of early childhood professionals expose them to high levels of psychosocial stress and burnout. Indeed, this profession face challenging working conditions, including material and human constraints, lack of recognition, paradoxical demands, exhaustion caused by children’s crying and screaming, and more. They often work long hours, manage large groups of young children, deal with the emotional needs of children, and interact with parents. Early childhood educators (ECEs) face many stressors through their work, such as high workload, stressful environment, limited chances of progress, and low pay, which cause low levels of job satisfaction and higher rates of turnover, as well as negative impacts on themselves, the field, and the children they work with [32]. A recent study conducted among 137 ECEs showed that 62% suffer from workload and 44% from job strain, compared to 35% and 36%, respectively, within the national sample [33].

In France, a recent study conducted in 340 nursery schools by the CNRACL National Prevention Fund among ATSEMs, which had a 67% response rate from 1,347 questionnaires distributed, showed that 62% think that their work negatively impacts their physical or psychological health, 82% stated that their daily activities induce more anxiety, and half of the respondents feel a deterioration in their sleep quality due to their work. Moreover, this study showed that this population suffers from a lack of support from the community and feelings of isolation [34]. Similarly, according to an in-depth study on childcare assistants, the average rate of long-term sick leave (90 days in the last 12 months) due to psychosocial risks in this population exceeds that of other territorial professions (30% compared to 25% for other professions) [35]. This could reflect dissatisfaction within this profession, despite its key role in preventing potential risky behaviors (addictions, dangerous behaviors, etc.) that children may develop later on. In fact, according to a study by the Rhône-Alpes Regional Health Observatory, early childhood professionals are “hidden actors” in this prevention. Therefore, their health status, especially mental health, at work is a major public health issue [36].

Early childhood professionals may also be affected by depressive disorders, with possible consequences on the behavior of children who are sensitive to the emotions of those around them [37]. The study of Farewell et al. (2022) demonstrated that among 136 Early Childhood Educators, the rates of depression were 2.3 times higher than nationally available normative data [33], which were consistent with the study of Linnan et al. (2017) showing that the rates of depression among this population are three times the national average (36% vs. 12% clinically depressed) [38].

Investigating the relationship between work-related stress and addictions among professionals outside the healthcare sector would be enriching, especially regarding early childhood professionals, whose role is crucial, and whose working conditions are challenging. This unique combination of stressors makes them an important population for studying the association between workplace stress and substance use. Despite their essential role, no studies have yet examined this association among early childhood professionals in France, particularly in Orléans Métropole, CCTVL, and Fleury-Les-Aubrais, making this the first investigation of its kind in these territories. We hypothesize that work-related stress is associated with the consumption of psychoactive substances and medications, as well as addiction, among early childhood professionals (“ATSEM”, “animateurs”, and “agents d’entretien”), and such consumption serves as a coping mechanism for occupational stress.

By focusing on early childhood professionals, this study has the potential to inform the development of targeted interventions and workplace policies aimed at reducing stress and preventing substance use in this vulnerable group, and to better target professionals at risk. This could have significant implications for their well-being and overall job satisfaction, as well as for the well-being of the children under their care.