Mental Health Illnesses among Mortuary Workers, A neglected Occupational Group

Introduction

The funeral and mortuary sector, including funeral homes, cemeteries and crematoria, is a largely neglected sector with regard to the study of occupational factors that can affect quality of working life and mental health [1]. Mortuary services form an integral part of services provided by a tertiary healthcare centre [2]. These services include receipt, storage and release of the deceased. Managing this process safely, securely, efficiently, effectively and appropriately is the core business of mortuary services teams. These include among others, mortuary assistants who handle and wash bodies, embalmers sanitize bodies to slow down the decay process as well as restore a life-like appearance to the corpse and funeral directors who arrange for the disposal of the corpse [2].

The work of mortuary workers presents high physical demands and significant psychosocial stressors [3] that may affect health and wellbeing. Above the most common job characteristics, such as the workload, the degree of autonomy and control, this occupational group has to confront work-related aspects such as counselling bereaved families, working with human remains and work-related social stereotypes [4-6]. Mortuary workers are at high risk of developing depression and other psychiatric disorders owing to the nature of their work and exposure to deceased victims of violent deaths [7]. Repeated occupational exposure to death and dead bodies is a significant risk factor for the development of mental health problems [7]. Mental health issues such as depression, death anxiety and post- and secondary-traumatic stress disorder, compassion fatigue and burnout have been found to affect funeral and mortuary workers [1].

Despite these there is paucity of studies that have been conducted on mental health illnesses among mortuary workers. The few that have been conducted have revealed that for example, posttraumatic stress disorder (PTSD) appears to be common among mortuary workers with prevalence rates ranging between 4.4% and 28.5% reported in studies conducted in South Africa [7], Belgium [8] and United States of America (USA) [9]. Anxiety and depression have been reported by 32% and 29% of Canadian Funeral Service Workers, respectively [10] with anxiety also reported by 13% of South African mortuary workers [7]. Burnout is common among mortuaries. In China, funeral workers in Anhui Province experienced severe job burnout [11]. About 19.2% and 44.9% of funeral directors in Belgium reported burnout during and after the first wave of COVID-19, respectively [8]. Furthermore, burnout scores of 72.9 %, 51.9%, and 75.9% in the emotional exhaustion, depersonalization, and personal accomplishment subscales have been reported among forensic physicians in Egypt [12]. In Turkey, burnout was also common with 14% of mortuary workers emotionally highly exhausted, 32.4% highly depersonalized and 76.1% had a low sense of personal achievement [13].

These mental health illnesses among mortuary workers have been associated with various factors. In Egypt, for example, male forensic physicians were 4 and 5.6 times more likely to report burnout (emotional exhaustion scale) [crude odds ratio (COR): 4.2, 95% Confidence Interval (CI): 1.7–10.6] and depersonalization [COR: 5.6, 95% CI: 2.6–12.0] more than their female counterparts. Females on the other hand were three times more likely to report diminished personal accomplishment than the males (COR: 3.0, 95% CI: 1.3–6.8] [12]. In a study of Canadian funeral service workers, females were more likely to report anxiety compared to the males (78.9% vs 39.1, p=0.003) [10]. Conflicting findings have been reported with age. Some studies for example, in Egypt, reported that younger (aged 39 years or younger) forensic physicians were twice more likely to report depersonalization compared to older ones (>39 years) (AOR: 2.1: 95%CI: 1.1–4.3) [12]. In contrast, elderly funeral directors in USA experienced lower levels of death anxiety compared to the younger ones [14].

The working duration in the mortuary was positively correlated with the diminished personal achievement among forensic doctors and staff in a mortuary (p = 0.007) [13]. Furthermore, workers with 0–5 years of experience were less likely to experience burnout compared to those who had worked for more than 5 years (p = 0.008) [8]. In South Africa, inexperienced mortuary workers had significantly higher levels of depression compared with experienced mortuary workers (p = 0.032) [7].

Perceived stress has also been associated with depression among South African mortuary workers [7]. Harassment has been associated with depression among female funeral directors. They face discrimination since the funeral care industry is predominately male which contributed to them developing depression. Harassment has also been strongly associated with causing anxiety (p< 0.01) [4]. Traumatic stress events, the number of funerals, the high demands of the job and overexposure to death during their work can all lead to a negative impact on funeral directors’ mental health [15].

To cope with these mental health illnesses, funeral directors resorted to their internal defense mechanisms such as compartmentalizing their emotions to ensure that they focus on doing their job rather than sympathizing and to avoid being triggered, or they used some external de-stressor such as engaging in physical activities to refresh the mind. Some turn to family, coworkers, and friends to help cope with work stress [16]. Other mortuary workers resort to training, seeking professional help, writing down and working out to cope with these conditions [17]. In Gauteng, South Africa, some mortuary workers turned to their religious groups, consulted private doctors, and resorted to smoking and alcohol while some preferred to discuss their matters with colleagues as coping mechanisms [18].

Mortuary workers play a critical role in health care therefore their mental state should be protected. Future research should be conducted in developing countries to investigate the prevalence and risk factors in their context as there is scarcity of such studies in low- and middle-income countries. Moreover, future qualitative research should be conducted to explore reasons for mental health illnesses in this occupational group to tailor make prevention and/ or coping strategies to lessen prevalence and severity of these illnesses among this important group.

Acknowledgements

None.

Conflicts of Interest

None.

References

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