Women's work roles and their impact on health, well-being, and career: comparisons between the United States, Sweden, and The Netherlands

Depressed mood in the working population: associations with work schedules and working hours

The impact of working time arrangements (WTA) on health has been studied extensively. Still, little is known about the interrelation between work schedules, working hours, and depressed mood. For work schedules, the underlying assumptions regarding depressed mood refer to a disturbance of social and biological rhythms, whereas for working hours, the assumptions relate to workload and work capacity. Conversely, depressed mood may urge an employee to adjust his/her work schedule and/or number of working hours/week (h/wk). The aim of this study was to assess the association between work schedule and working hours with depressed mood. Using baseline data from the Maastricht Cohort Study, depressed mood in day work was compared with depressed mood in different shiftwork schedules (n = 8843). Within day work, several categories of working h/wk were studied in association with depressed mood (n = 7217). The association between depressed mood and several aspects of overtime was assessed separately. Depressed mood was measured with a dichotomous item: "Did you feel down every day over the last two weeks?" Separate logistic regression analyses were conducted for men and women, with adjustments for potential confounders. The odds ratio (OR) for depressed mood was greater for men involved in shiftwork than for men only involved in day work (three-shift OR = 2.05 [95% confidence interval, CI 1.52-2.77]; five-shift OR = 1.34 [95% CI 1.00-1.80]; irregular-shift OR = 1.79 [95% CI 1.27-2.53]). In female employees, five-shift work was associated with a higher prevalence of depressed mood (OR = 5.96 [95% CI 2.83-12.56]). Regarding the number of working h/wk, men working <26 h/wk had a higher prevalence of depressed mood than men working 36-40 h/wk (OR = 2.73 [95% CI 1.35-5.52]). After conducting trend analyses, a significant decreasing trend was found in men, whereas an increasing trend was found in women working a high number of hours. Furthermore, a dose-response relationship was present in men regarding the number of overtime h/wk. This study showed that different work schedules and working hours are associated with depressed mood. Shiftwork was related to a higher prevalence of depressed mood than day work. The association was more pronounced for male employees. Regarding the number of working h/wk, male and female employees showed an opposite trend in depressed mood. Because of the possibility of a healthy worker effect and the possibility of a reciprocal relationship between WTA and depressed mood, the reported relation might be underestimated. This study has illustrated that occupational physicians, who deal with depressed mood among workers, should carefully consider the impact of WTA.

Prevalência de transtornos mentais comuns entre residentes em áreas urbanas de Feira de Santana, Bahia

OBJETIVO: Descrever a prevalência de transtornos mentais comuns segundo características sociodemográficas, hábitos de vida e presença de doenças crônicas entre residentes em áreas urbanas de Feira de Santana, Bahia. MÉTODOS: Trata-se de um estudo epidemiológico de corte transversal com amostra da população de 15 anos ou mais de idade de Feira de Santana, aleatoriamente selecionada. Foi utilizado um formulário, contendo informações sociodemográficas, de hábitos de vida e doenças referidas. O SRQ-20 foi utilizado para mensuração de Transtornos Mentais Comuns (TMC). A análise estatística foi realizada com nível de significância p < 0,05, cálculo da razão de prevalência e intervalos de confiança de 95%. RESULTADOS: Foram estudados 3.597 indivíduos, 71,4% do sexo feminino. A prevalência global de TMC foi de 29,9%. A análise dos dados revelou que as características sociodemográficas (sexo, renda e escolaridade), os hábitos de vida e as condições clínicas estavam associados à maior prevalência de TMC. CONCLUSÕES: O estudo permitiu estimar a prevalência de TMC na população urbana de um município localizado no nordeste do Brasil e identificar características associadas aos TMC que podem interferir na saúde mental da população estudada. Nesse sentido, as políticas de atenção a saúde mental do município devem contemplar ações direcionadas ao incentivo a participação em atividades de lazer além de campanhas de controle do uso de tabaco e doenças crônicas.

Factors associated with body dissatisfaction and disordered eating in women in midlife

OBJECTIVE

In this study, we examined developmentally appropriate factors that may be associated with body dissatisfaction and disordered eating in women in midlife.

METHOD

Participants were a community sample of 200 women aged 35-65. Outcome measures were the weight concern, shape concern, eating concern, and restraint subscales of the Eating Disorder Examination-Questionnaire (EDE-Q). Independent variables were importance of appearance, importance of function, cognitive reappraisal (of aging changes to appearance), and body-related self-care.

RESULTS

Importance of appearance, self-care, and body mass index (BMI) accounted for variance in regression modeling for all EDE-Q variables. In addition, cognitive reappraisal was related to shape concern and restraint, and importance of function and age were also associated with restraint. Participants identified as probable eating disorder cases had significantly higher BMI, importance of appearance and function, and significantly lower cognitive reappraisal and self-care scores than participants identified as noncases.

DISCUSSION

This study provides support for the role of developmentally relevant factors in body dissatisfaction and disordered eating in midlife women.

Individual and contextual covariates of burnout: a cross-sectional nationwide study of French teachers

BACKGROUND

Limited information on the covariates of burnout syndrome in French teachers is available. The aim of this study was to evaluate the relative contributions of individual and contextual factors on the three burnout dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment.

METHODS

The source data come from an epidemiological postal survey on physical and mental health conducted in 2005 among 20,099 education workers (in activity or retired) selected at random from the health plan records of the national education system. The response rate was 52.4%. Teachers in activity currently giving classes to students who participated in the survey (n = 3,940) were invited to complete a self-administered questionnaire including the Maslach Burnout Inventory. 2,558 teachers provided complete data (64.9%). Variables associated with high emotional exhaustion (highest quartile of score), high depersonalization (highest quartile), and reduced personal accomplishment (lowest quartile) were evaluated using multivariate logistic regression. Studied variables referred to demographic characteristics, socio-professional environment, job dissatisfaction, experienced difficulties at work, and teaching motivations.

RESULTS

Different variables were associated with each burnout dimension. Female teachers were more susceptible to high emotional exhaustion and reduced personal accomplishment, whereas male teachers were more susceptible to high depersonalization. Elementary school teachers were more susceptible to high emotional exhaustion, but less susceptible to high depersonalization and reduced personal accomplishment than their higher school level counterparts. Experienced difficulties with pupils were associated with all three dimensions. A socio-economically underprivileged school neighbourhood was also related to high emotional exhaustion and high depersonalization.

CONCLUSION

Programs to enhance teaching environment might be an interesting approach to try to prevent burnout. It would be useful to take the different dimensions into account in planning the intervention.

Engagement in patterns of daily occupations and perceived health among women of working age

The aim of the present cross-sectional study was to examine how subjective experiences of engagement in patterns of daily occupations (gainful employment, domestic work, enjoyable and recreational occupations) were associated with perceived health among women of working age. The sample (n=488) was drawn from a longitudinal cohort study of women of working age in Gothenburg, Sweden. Participants were women 38 (n=202) and 50 (n=286) years of age. They completed a questionnaire including questions about occupational experiences in relation to their patterns of daily occupations, perceived health, and socioeconomic factors. The results of the present study showed that a combination of different experience dimensions of patterns of daily occupations was associated with perceived health among women of working age, even when adjusted for socioeconomic factors and age. The results provided occupational pattern-related health indicators, i.e. manageability, personally meaningful occupations, and occupational balance. To combine these health indicators can be a way for occupational therapists to enable women to develop strategies to promote health and to prevent stress and sick leave.

Women on sickness absence—views of possibilities and obstacles for returning to work. A focus group study

PURPOSE

The aim was to learn how women on sickness absence due to work related strain perceive and describe their possibilities and obstacles for returning to work.

METHOD

The focus group method was used. Five groups were conducted and each group met at one occasion. Twenty women participated in total.

RESULTS

Three different themes were found. In 'The process of losing control' the participants describe the process from controlling every day living, to total loss of control of private and working life. The second theme, 'Not finding alternatives', deals with the difficulties of finding an alternative way back to work. 'Mastering life as a whole' contains strategies for regaining control over daily activities and life as a whole. The results show that personal as well as environmental factors have an impact for returning to work.

CONCLUSIONS

In this study we have received an understanding of the complex situation of being on sickness absence due to work related strain. We have learned the importance of recognizing the context of the individual and understanding the interplay between the person and the environment. As professionals in rehabilitation we can use this knowledge to create a rehabilitation programme supporting people back to work.

Social-cognitive theories for predicting physical activity behaviours of employed women with and without young children

Chronic disease interventions for women have been understudied in the workplace domain. Understanding the role of cognitions in individual behaviour can help motivate change and suggest directions for achieving improvements in health. The purpose of this study was to identify psychosocial constructs and social-cognitive theories [e.g. Transtheoretical model (TTM), Theory of Planned Behaviour (TPB), Protection Motivation Theory (PMT) and Social Cognitive Theory (SCT)] that are most salient for explaining physical activity behaviour among employed women (n = 1183). Demographic information, and social-cognitive measures related to physical activity, intention and behaviours (e.g. stage of change, energy expenditure) were assessed. A series of multiple regression analyses predicting intention, energy expenditure and stage of change were conducted separately for: (1) women with young children (n = 302), and (2) women without young children (n = 881) for each of the respective social-cognitive theories. Although taken as a whole the results were relatively similar between the two sub-groups of women for each of the socio-cognitive theories examined in this study, differences were observed in the relative contributions of the theoretical constructs between the two sub-groups. Results also indicate that self-efficacy and intention were the strongest predictors of behaviour among both women with and without young children. The explained variances (R(2)) for the theories examined in this study for different sub-groups ranged from 16 to 60%, generally reflecting what has been reported in other studies within the physical activity domain. The results of this study could be useful in guiding future research and in designing physical activity intervention programs for these specific population groups. Integrating approaches of individual lifestyle change while addressing issues related to creating supportive environments for women in various life stages is a suggested strategy for future work in this area.

The prevalence of work-related stress, and its association with self-perceived health and sick-leave, in a population of employed Swedish women

BACKGROUND

Women report more occupational ill-health and are more sick-listed than men. Exploration of women's working conditions would therefore seem to be valuable. In this study we investigated the prevalence of work-related stress and its association with self-perceived health and sick-leave in a population of employed, working Swedish women.

METHODS

This cross-sectional population study comprised 424 employed, working women who answered questionnaires on work-related stress, self-perceived health and sick-leave. The odds ratio (OR) with 95% confidence interval (CI) was calculated in order to analyse the association between the exposure variables of work-related stress and outcome variables of ill-health symptoms, self-rated health and sick-leave.

RESULTS

Ten percent of the group reported high perceived stress owing to indistinct organisation and conflicts, and 25% high perceived stress owing to individual demands and commitment. Twenty-two percent reported low influence at work and 33% reported work interference with leisure time. All categories of overall work-related stress were significantly associated with increased odds of high level of illness symptoms, with the highest OR for high perceived stress owing to indistinct organisation and conflicts and high perceived stress owing to individual demands and commitment with an OR of 3.17 (CI = 1.51-6.62) and 4.53 (CI = 2.71-7.56) respectively. High perceived stress owing to indistinct organisation and conflicts and low influence at work were significantly associated with sick-leave with an OR of 3.85 (CI = 1.59-9.30) and 2.54 (CI = 1.17-5.48) respectively.

CONCLUSION

This study showed an association between, on the one hand, work-related stress, and on the other hand, illness symptoms and sick-leave. Distinguishing between the occurrence of negative work characteristics, and the immediate perception of stress because of these, resulted in a broad view of women's working conditions and expanded knowledge of work-related stress in women.

The Relationships of Hassles and Uplifts to Experience of Health in Working Women

Swedish women are more ill than men are, often explained by women's heavier total workload. A balanced pattern of daily occupations is believed to promote health. The aim of this study was to investigate the relationship of aspects of the pattern of daily occupations and lifestyle factors to working mothers' health and well-being, and whether control influenced any relationships. One hundred working, cohabiting mothers took part in semi-structured interviews targeting health and well-being, control, lifestyle variables, and hassles and uplifts in the pattern of daily occupations. All variables were dichotomised according to a median cut and subjected to logistic regression analyses. Working more and having a university diploma were found to be risk factors for experiencing more hassles. Risk factors for fewer uplifts were having more than two children and fewer leisure occupations. Experiencing less control constituted a risk of low self-rated health and with an additional high level of hassles impacted on the experience of well-being.

Gender differences in work-home interplay and symptom perception among Swedish white-collar employees

OBJECTIVE

To analyse gender differences in paid and unpaid workload and symptoms in matched groups of Swedish white-collar workers with children.

DESIGN AND SETTING

Paid and unpaid workload and perceived stress from paid work, conflict between demands and control over household work were measured by a total workload (TWL) questionnaire. Some symptoms were rated with regard to frequency and severity as a measure of health. Cross-sectional analyses were performed.

PARTICIPANTS

Matched groups of male (n = 440) and female (n = 529) well-educated white-collar workers in full-time employment, aged 32-58 years and living with children in the home.

RESULTS

Women in higher positions in Sweden are healthier than the average population of women, but report more symptoms than men in the same position as well as more stress from paid work, more conflict between demands and a greater TWL. However, women also reported more control over household duties and TWL was not associated with more symptoms. The men were mainly focused on their paid work role and perhaps even more so than men in the general population as they were fairly resistant to feelings of conflicting demands.

CONCLUSION

Even among matched groups of full-time employed, well-educated men and women, traditional gender differences in division of responsibilities and time allocation were found. Even though the women were healthy at this stage, they might risk future ill health, owing to high workload, stress and feelings of conflicting demands.

Recovery after shift work: Relation to coronary risk factors in women

Shift work increases the risk for developing cardiovascular disease. There is, however, little knowledge of what aspects of shift scheduling that are detrimental and what characteristics promote good health. The aim of the present study was to evaluate whether coronary risk factors deteriorate after a hard work period and whether recovery, in the form of a week off, was sufficient to improve them. A total of 19 women worked an extremely rapidly rotating and clockwise shift schedule at a paper and pulp factory. They underwent two health examinations, one at the end of the work period and one after the week off. In addition, the women were divided into a tolerant and a vulnerable group, depending on their satisfaction with their work hours. Most risk factors did not change, but total cholesterol and low-density lipoprotein (LDL)-cholesterol were lower after the working period than after the week-off. In addition, vulnerable women had higher levels of total cholesterol and a higher ratio of total cholesterol/high-density lipoprotein (HDL) than tolerant ones. In conclusion, the finding that a week-off worsens cholesterol levels was against our hypothesis and suggests further studies on how activities/responsibilities outside the workplace affect shift-working women. It was also shown that susceptible shift workers had worse lipid profiles.

Total workload as related to psychological well-being and symptoms in full-time employed female and male white-collar workers

Most research on the combined effects of paid and unpaid workload has related these factors to stress, depression, and physical symptoms. Thus, comparative knowledge concerning positive aspects of human functioning, such as health and well-being and how they relate to total workload of employed women and men, is limited. Our aim in this study was to investigate how total workload including paid and unpaid work is related to psychological well-being and symptoms in full-time employed women and men. We obtained data on workload, general symptoms, and the Ryff scales covering self-acceptance, environmental mastery, positive relations, personal growth, purpose in life, and autonomy from questionnaires mailed to a stratified sample of highly educated white-collar workers aged between 32 and 58 years. Data from women (n = 430) and men (n = 400) living in partner relationships with at least one child showed that increasing hours of unpaid work was associated with decreasing levels of self-acceptance and environmental mastery in women, whereas paid work was associated with increasing levels of personal growth and decreasing levels of purpose in life. For men, paid work was associated with increasing levels of personal growth and more symptoms. We discuss factors underlying the gender-specific relationships between paid and unpaid work, psychological well-being, and symptoms.

Prenatal influences on brain dopamine and their relevance to the rising incidence of autism

The incidence of autism has risen 10-fold since the early 1980s, with most of this rise not explainable by changing diagnostic criteria. The rise in autism is paradoxical in that autism is considered to be one of the most genetically determined of the major neurodevelopmental disorders and should accordingly either be stable or even declining. Because a variety of epigenetic influences, particularly those occurring during the prenatal period, can override or masquerade as genetic influences, these should be considered as prime contributors to the recent increase of autism. Prenatal influences on dopamine activity are especially well-documented, including the effects of maternal psychosocial stress, maternal fever, maternal genetic and hormonal status, use of certain medications, urban birth, and fetal hypoxia. All of these factors have been implicated in the genesis of autism, which is characterized by a "hyperdopaminergic" state based on evidence from monkey and human behavioral studies, pharmacological studies in humans, and a left-hemispheric predominance of both dopamine and autistic-like symptoms. Chronically high maternal levels of dopamine caused by the pressures of increasingly urbanized societies and by changing maternal demographics such as increased workforce participation, educational achievement level, and age at first birth, may be especially significant epigenetic contributors to the recent autism rise.

Sources of Social Support as Predictors of Health, Psychological Well-Being and Life Satisfaction Among Dutch Male and Female Dual-Earners

We examined whether gender differences in health, psychological well-being, and life satisfaction, can be explained by effects of work-related and nonwork-related sources of social support. The sample consisted of 459 men and women from dual earner families. Men report better health and psychological well-being than women, whereas women report higher life satisfaction than men. Contrary to our expectations, women receive more social support from colleagues than men, while men and women equally receive support from their supervisor. As for the nonwork-related sources of social support, men receive more social support from their spouse, while women receive more social support from relatives and friends. No gender differences exist in the effects of social support. Although men and women differ with respect to the social support they receive from different sources, these differences cannot explain gender differences in health, psychological well-being and life satisfaction.

Engendering health disparities

How is gender implicated in our exploration of health disparities in Canada? Set against the backdrop of federal government policy, this review paper examines the ways in which gender intersects with other health determinants to produce disparate health outcomes. An overview of salient issues including the impact of gender roles, environmental exposures, gender violence, workplace hazards, economic disparities, the costs of poverty, social marginalization and racism, aging, health conditions, interactions with health services, and health behaviours are considered. This review suggests health is detrimentally affected by gender roles and statuses as they intersect with economic disparities, cultural, sexual, physical and historical marginalization as well as the strains of domestic and paid labour. These conditions result in an unfair health burden borne in particular by women whose access to health determinants is--in various degrees--limited. While progress has certainly been made on some fronts, the persistence of health disparities among diverse populations of women and men suggests a postponement of the vision of a just society with health for all that was articulated in the Federal Plan on Gender Equality. Commitment, creativity and collaboration from stakeholders ranging from various levels of government, communities, academics, non-governmental agencies and health professionals will be required to reduce and eliminate health disparities between and among all members of our society.

Social class and self-reported health status among men and women: what is the role of work organisation, household material standards and household labour?

Social class understood as social relations of ownership and control over productive assets taps into parts of the social variation in health that are not captured by conventional measures of social stratification. The objectives of this study are to analyse the association between self-reported health status and social class and to examine the role of work organisation, material standards and household labour as potential mediating factors in explaining this association. We used the Barcelona Health Interview Survey, a cross-sectional survey of 10,000 residents of the city's non-institutionalised population in 2000. This was a stratified sample, strata being the 10 districts of the city. The present study was conducted on the working population, aged 16-64 years (2345 men and 1874 women). Social class position was measured with Erik Olin Wright's indicators according to ownership and control over productive assets. The dependent variable was self-reported health status. The independent variables were social class, age, psychosocial and physical working conditions, job insecurity, type of labour contract, number of hours worked per week, possession of appliances at home, as well as household labour (number of hours per week, doing the housework alone and having children, elderly or disabled at home). Several hierarchical logistic regression models were performed by adding different blocks of independent variables. Among men the prevalence of poor reported health was higher among small employers and petit bourgeois, supervisors, semi-skilled (adjusted odds ratio-aOR: 4.92; 95% CI: 1.88-12.88) and unskilled workers (aOR: 7.69; 95%CI: 3.01-19.64). Work organisation and household material standards were associated with poor health status with the exception of number of hours worked per week. Work organisation variables were the main explanatory variables of social class inequalities in health, although material standards also contributed. Among women, only unskilled workers had poorer health status than the referent category of manager and skilled supervisors (aOR: 3.25; 95%CI: 1.37-7.74). All indicators of work organisation and household material standards reached statistical significance, excepting the number of hours worked per week. In contrast to men, among women the number of hours per week of household labour was associated with poor health status (aOR: 1.02; 95% CI: 1.01-1.03). Showing a different pattern from men in the full model, household material deprivation and hours of household labour per week were associated with poor health status among women. Our findings suggest that among men, part of the association between social class positions and poor health can be accounted for psychosocial and physical working conditions and job insecurity. Among women, the association between the worker (non-owner, non-managerial, and un-credentiated) class positions and health is substantially explained by working conditions, material well being at home and amount of household labour.

Integrating qualitative methods into occupational health research: a study of women flight attendants

AIMS

To identify possible work related sources of psychosocial stress in order to develop pertinent questionnaire items for a cross-sectional health survey of 3000 Italian women flight attendants, and to solicit suggestions on improving survey participation.

METHODS

Qualitative study in which 26 current and former women flight attendants participated: three focus groups of 6-7 participants each and six in-depth individual interviews. The session themes included positive and negative aspects of the job; relationships with colleagues, superiors, and passengers; perception of occupational risk for serious diseases; compatibility of work and family; and experiences of work related sources of stress and their effect on health. A transcript based analysis of the focus groups and interviews was used to identify emerging themes related to risk factors for mental health problems.

RESULTS

The participants indicated that mental health was a major concern. Several work related risk factors possibly related to adverse outcomes, such as depression and anxiety, were highlighted. These included isolation and solitude, fears of being inadequate partners and mothers due to job demands, passenger relationships, and lack of protection by employers with respect to workplace exposures and violent passengers. The information gained was used to develop a mental health module for inclusion in the health survey questionnaire which included questions on history of severe depression or anxiety, suicidal ideation or attempt, substance abuse, workplace sexual harassment, social support, leisure time activities, relationship with a partner, and role as mother.

CONCLUSIONS

Employing qualitative methods to identify work related sources of psychosocial stress enabled development of pertinent questionnaire items for a cross-sectional epidemiological study of women flight attendants. Follow up qualitative research may be necessary in order to put the cross-sectional study findings into context and to explore actions or strategies for preventing work related health problems evidenced from the survey.

The relationship between job stress, burnout and clinical depression

The definition and phenomenological features of 'burnout' and its eventual relationship with depression and other clinical conditions are reviewed. Work is an indispensable way to make a decent and meaningful way of living, but can also be a source of stress for a variety of reasons. Feelings of inadequate control over one's work, frustrated hopes and expectations and the feeling of losing of life's meaning, seem to be independent causes of burnout, a term that describes a condition of professional exhaustion. It is not synonymous with 'job stress', 'fatigue', 'alienation' or 'depression'. Burnout is more common than generally believed and may affect every aspect of the individual's functioning, have a deleterious effect on interpersonal and family relationships and lead to a negative attitude towards life in general. Empirical research suggests that burnout and depression are separate entities, although they may share several 'qualitative' characteristics, especially in the more severe forms of burnout, and in vulnerable individuals, low levels of satisfaction derived from their everyday work. These final issues need further clarification and should be the focus of future clinical research.

Psychophysiology of work: stress, gender, endocrine response, and work-related upper extremity disorders

BACKGROUND

Mental stress may induce muscle tension and has been proposed to contribute to the development of work related upper extremity disorders (WRUEDs) by driving low threshold motor units into degenerative processes by overload.

METHODS AND RESULTS

Measurements of perceived stress, catecholamines, blood pressure, and heart rate are associated with stress induced elevation of trapezius electromyographic activity. In repetitive tasks, where WRUEDs are common, psychophysiological arousal is generally high both during and after work. A possible explanation of the high prevalence of WRUEDs among women could be that women often are performing repetitive tasks and are exposed to additional stress from unpaid work.

CONCLUSIONS

It is concluded that both physical and psychosocial work conditions may contribute to WRUEDs by inducing physiological stress and muscle tension.