Mental Health and Construction
Gonzalez-Guarda, R. M., Hayes, M., & Smith, L. (2026). Mental Health and Construction - Intervening to Prevent Collapse. JAMA Health Forum (Vol. 7, No. 8). American Medical Association.
Our opinion
This month, we highlight an article by an occupational medicine team from the prestigious Duke University in the United States that describes an unprecedented new landscape of mental health risks in the construction industry. The article was published in one of the world's leading medical journals, JAMA.
A must-read to understand the scale of the problem and the significant shift in focus from the traditional, unequivocal emphasis on physical injuries, at the heart of industrial safety, toward mental health issues, which are now addressed almost entirely outside the safety domain.
Our summary
Written using an AI system.
Mental Health in Construction: Safety’s Blind Spot
This article, published in “JAMA Health Forum”, draws attention to a reality that remains widely underestimated: the deterioration of mental health in the construction industry. The authors point out that construction workers are among the occupational groups most exposed to psychological disorders, substance use disorders, overdoses, and suicide, even though prevention policies in this sector have historically focused on physical safety and workplace injuries.
The construction industry employs approximately 8.3 million workers in the United States and plays a central role in the country’s economy. Yet its mental health indicators are particularly alarming. According to a national survey conducted in 2025, 64% of construction workers reported experiencing anxiety or depression during the previous twelve months, more than double the rate observed in the general U.S. population.
Data relating to substance use disorders are equally concerning. The sector has the highest overdose death rate of all major U.S. occupational groups: 162.6 deaths per 100,000 workers, approximately seven times the rate observed in the general population. The authors also note that male construction workers die by suicide at twice the rate of the overall population and that, within this profession, deaths by suicide now exceed deaths resulting from workplace injuries.
The article also highlights inadequate access to care. Each year, more than 470,000 construction workers reportedly need mental health services but are unable to access them for financial reasons.
The authors propose understanding this situation through several levels of analysis. The first concerns the social determinants of health. Economic hardship, family responsibilities, barriers to healthcare access, immigration-related challenges, and a lack of social support all represent vulnerability factors that can increase psychological distress even before workers arrive on a jobsite.
These individual factors are compounded by the constraints inherent to the profession. Construction sites frequently require long workdays, tight deadlines, physically demanding work, sometimes hazardous conditions, and seasonal or unstable employment. These constraints can lead to work-life imbalance, recurring economic insecurity, and insufficient recovery time. Over time, they contribute to chronic pain, workplace injuries, psychological disorders, and substance use.
One of the article’s most interesting contributions lies in its cultural analysis of the phenomenon. The authors note that the industry remains overwhelmingly male and has historically valued norms of toughness, endurance, and self-reliance. In many work environments, acknowledging psychological distress may be perceived as a sign of weakness or an inability to cope. This culture tends to delay recognition of difficulties and limits help-seeking behavior.
The authors interpret this situation as the result of a historical disconnect between two conceptions of safety. On the one hand, the prevention of physical injuries and accidents has become an essential component of safety management in construction. On the other hand, mental health has long received neither the same level of attention, nor the same investment, nor the same early-detection systems. As a result, many workers lack the resources needed to recognize the early signs of psychological distress or seek appropriate support.
In response to these findings, the article identifies several possible courses of action. The first is the development of a national prevention strategy integrating early identification, prevention, access to care, and worker support. The authors cite Australia as an example, often regarded as a pioneer in this field. The “MATES in Construction” program, developed across the industry, relies on peer-support approaches that are directly embedded in sector practices. This initiative forms part of a broader national strategy for suicide prevention and mental health promotion.
The article also describes several recent U.S. initiatives. These include the Construction Industry Alliance for Suicide Prevention, partnerships between specialized foundations and occupational safety organizations, and various resources developed by the Center for Construction Research and Training. What these initiatives have in common is an effort to integrate mental health into existing workplace safety programs rather than treating it as a separate issue.
Another important direction involves strengthening connections between companies and local health resources. The authors highlight the experience of a community organization in North Carolina that works with construction companies through informal meetings and awareness-raising discussions. The objective is to gradually build trust, encourage conversations about psychological distress, and promote earlier use of available support services.
Finally, the authors call for increased investment in research in this area. In their view, research efforts have contributed significantly to improving physical safety in construction, but far less to understanding and preventing psychological risks. They argue that rigorous evaluation programs should be developed, effective interventions identified, and successful approaches supported for large-scale dissemination.
The article concludes with a call to consider mental health as an integral dimension of safety in the construction industry. The authors argue that a strategy built on trust, close relationships, and the systematic use of data could provide more effective support to a workforce that is essential to the functioning of the economy.
Comments by René Amalberti, Foncsi’s director
This article is of particular interest to the research conducted over several years by Foncsi on the evolving boundaries of safety. It highlights a gradual shift in prevention priorities: after focusing for a long time on accidents causing material damage and physical injury, organizations are now discovering that the determinants of performance and safety also lie in more diffuse dimensions such as fatigue, mental workload, burnout, chronic stress, addictions, and social vulnerabilities.
The text also resonates with analyses conducted on production trade-offs, the sustainability of work, and the ability of organizations to preserve human resources that make long-term performance possible. From this perspective, mental health appears less like an isolated medical issue than as a revealing indicator of the overall functioning of sociotechnical systems.
Finally, the article raises a question that has become central in several high-risk industries: to what extent should organizations extend their responsibility for health determinants that sometimes originate outside the workplace, but whose consequences manifest themselves in the domains of work, safety, and operational reliability? This question could constitute a natural extension of the reflections already undertaken by the Foundation on the links between sustainable performance, system resilience, and the consideration of human and organizational factors.
