Background The mental health problems of workers have become increasingly prominent and have attracted widespread attention. Studies have shown that occupational health literacy (OHL) is associated with the occurrence of occupational stress (OS), depressive symptoms, and anxiety, but relevant evidence is limited and needs to be further explored.

Objective To study the relationships of OHL with OS, depressive symptoms, and anxiety in front-line production workers in metal products industry, so as to provide scientific basis for mental health intervention in this industry, help improve the mental health status of workers, and enhance occupational health management.

Methods From August to October 2023, stratified cluster random sampling was used to select 1050 front-line production workers from 8 metal product enterprises in Jiaxing City as the respondents. A total of 1050 questionnaires were distributed and 950 were recovered, with a recovery rate of 90.5%. The OHL level of workers was evaluated using the National Key Population Occupational Health Literacy Monitoring Survey Personal Questionnaire (No.117), including the overall score and four dimensional scores, and qualified OHL was determined by the overall and each dimensional score rate≥80%; the Core Occupational Stress Scale (COSS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) were used to evaluate the OS, depressive symptoms, and anxiety of workers, respectively; the COSS score≥50, PHQ-9 score ≥10, and GAD-7 score>4 were used to determine positive case. Binary logistic regression was used to analyze the effects of OHL on OS, depressive symptoms, and anxiety.

Results The overall qualified OHL rate in this study was 54.84%. The qualified dimensional OHL rates of occupational health legal knowledge, basic knowledge of occupational health protection, basic skills of occupational health protection, and healthy work style and behaviors were 44.21%, 76.84%, 27.58%, and 59.26%, respectively. The positive rates of OS, depressive symptoms, and anxiety were 38.32% (364/950), 23.37% (222/950), and 29.58% (281/950), respectively. The binary logistic regression analysis showed that night shift significantly increased the risk of OS (OR=1.25, 95%CI: 1.13, 1.68) and anxiety (OR=1.39, 95%CI: 1.02, 1.88). Compared with the < 30 years old group, the risk of depressive symptoms (OR=0.55, 95%CI: 0.31, 0.99) and anxiety (OR=0.45, 95%CI: 0.27, 0.76) in the 40-< 50 years old group was lower. Men had a higher risk of depressive symptoms (OR=1.70, 95%CI: 1.14, 2.53). Compared with unmarried and < 1 year of service, married (OR=0.59, 95%CI: 0.35, 0.97) and 1-<3 years (OR=0.58, 95%CI: 0.35, 0.96) workers had a lower risk of depressive symptoms. Workers with occupational health protection knowledge had a lower risk of OS (OR=0.46, 95%CI: 0.32, 0.68). Workers with occupational health legal knowledge had a lower risk of anxiety (OR=0.56, 95%CI: 0.38, 0.83). The risk of depressive symptoms (OR=0.45, 95%CI: 0.31, 0.67) and anxiety (OR=0.64, 95%CI: 0.45, 0.92) was reduced in workers with healthy work style and behaviors.

Conclusion The average OHL level of workers in metal products industry in Jiaxing is low, and the prevalence of reporting mental health problems such as OS is high. Increasing the level of OHL in workers may help reduce the risk of OS, depressive symptoms, and anxiety.