Job loss and health in the U.S. labor market

Mid-career work patterns and physical and mental functioning at age 60-64: evidence from the 1946 British birth cohort

BACKGROUND

Previous studies of the associations between unemployment and health have primarily focused on mental health and long-term associations have not often been explored. This study investigated if discontinuous employment in mid-career was related to self-reported physical and mental functioning at age 60-64 years.

METHODS

Data come from the Medical Research Council National Survey of Health and Development, a British cohort that has been followed-up since birth in 1946. A total of 2061 study members had data available on mid-career employment patterns and physical and mental functioning assessed using the Short Form 36 questionnaire at age 60-64. Employment patterns in mid-career were categorized into: (i) continuous employment; and discontinuous employment during; (ii) early period (ages 36-43); (iii) late period (ages 43-53); and 4) both periods.

RESULTS

Continuous employment was reported by 63.3% of men and 38.7% of women, while 8.7% of men and 23.4% of women reported being in discontinuous employment during both early and late mid-career. When compared with those in continuous employment those in discontinuous employment during both early and late mid-career had poorer physical functioning, men adjusted β (difference in mean physical functioning T score) -3.84, 95% CI - 6.06 to - 1.63, P = 0.001 and women -3.62, 95% CI - 5.17 to - 2.08, P < 0.001. Findings were parallel but weaker for those in discontinuous employment during late mid-career. Discontinuous employment during both periods and particularly during late mid-career was associated with poorer mental functioning in early old age.

CONCLUSIONS

Discontinuous employment during mid-career was associated with poorer self-reported physical and mental functioning around the age of retirement.

Poor quality in the reporting and use of statistical methods in public health - the case of unemployment and health

BACKGROUND

It has previously been reported that many research articles fail to fulfill important criteria for statistical analyses, but, to date, these reports have not focused on public health problems. The aim of this study was to investigate the quality of reporting and use of statistical methods in articles analyzing the effect of unemployment on health.

METHODS

Forty-one articles were identified and evaluated in terms of how they addressed 12 specified criteria.

RESULTS

For most of these criteria, the majority of articles were inadequate. These criteria were conformity with a linear gradient (100 % of the articles), validation of the statistical model (100 %), collinearity of independent variables (97 %), fitting procedure (93 %), goodness of fit test (78 %), selection of variables (68 % for the candidate model; 88 % for the final model), and interactions between independent variables (66 %). Fewer, but still alarmingly many articles, failed to fulfill the criteria coefficients presented in statistical models (48 %), coding of variables (34 %) and discussion of methodological concerns (24 %). There was a lack of explicit reporting of statistical significance/confidence intervals; 34 % of the articles only presented p-values as being above or below the significance level, and 42 % did not present confidence intervals. Events per variable was the only criterion met at an undoubtedly acceptable level (2.5 %).

CONCLUSIONS

There were critical methodological shortcomings in the reviewed studies. It is difficult to obtain unbiased estimates, but there clearly needs to be some improvement in the quality of documentation on the use and performance of statistical methods. A suggestion here is that journals not only demand that articles fulfill the criteria within the STROBE statement, but that they include additional criteria to decrease the risk of incorrect conclusions being drawn.

Who suffers during recessions? Economic downturns, job loss, and cardiovascular disease in older Americans

Job loss in the years before retirement has been found to increase risk of cardiovascular disease (CVD), but some studies suggest that CVD mortality among older workers declines during recessions. We hypothesized that recessionary labor market conditions were associated with reduced CVD risk among persons who did not experience job loss and increased CVD risk among persons who lost their jobs. In our analyses, we used longitudinal, nationally representative data from Americans 50 years of age or older who were enrolled in the Health and Retirement Study and surveyed every 2 years from 1992 to 2010 about their employment status and whether they had experienced a stroke or myocardial infarction. To measure local labor market conditions, Health and Retirement Study data were linked to county unemployment rates. Among workers who experienced job loss, recessionary labor market conditions at the time of job loss were associated with a significantly higher CVD risk (hazard ratio = 2.54, 95% confidence interval: 1.39, 4.65). In contrast, among workers who did not experience job loss, recessionary labor market conditions were associated with a lower CVD risk (hazard ratio = 0.50, 95% confidence interval: 0.31, 0.78). These results suggest that recessions might be protective in the absence of job loss but hazardous in the presence of job loss.

The great recession and behavior problems in 9-year old children

This article examines associations between the Great Recession and 4 aspects of 9-year olds' behavior-aggression (externalizing), anxiety/depression (internalizing), alcohol and drug use, and vandalism-using the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort drawn from 20 U.S. cities (21%, White, 50% Black, 26% Hispanic, and 3% other race/ethnicity). The study was in the field for the 9-year follow-up right before and during the Great Recession (2007-2010; N = 3,311). Interview dates (month) were linked to the national Consumer Sentiment Index (CSI), calculated from a national probability sample drawn monthly to assess consumer confidence and uncertainty about the economy, as well as to data on local unemployment rates. Controlling for city-fixed effects and extensive controls (including prior child behavior at age 5), we find that greater uncertainty as measured by the CSI was associated with higher rates of all 4 behavior problems for boys (in both maternal and child reports). Such associations were not found for girls (all gender differences were significant). Links between the CSI and boys' behavior problems were concentrated in single-parent families and were partially explained by parenting behaviors. Local unemployment rates, in contrast, had fewer associations with children's behavior, suggesting that in the Great Recession, what was most meaningful for child behavior problems was the uncertainty about the national economy, rather than local labor markets.

Short-run effects of job loss on health conditions, health insurance, and health care utilization

Job loss in the United States is associated with reductions in income and long-term increases in mortality rates. This paper examines the short-run changes in health, health care access, and health care utilization after job loss that lead to these long-term effects. Using a sample with more than 10,000 individual job losses and longitudinal data on a wide variety of health-related outcomes, we show that job loss results in worse self-reported health, activity limitations, and worse mental health, but is not associated with statistically significant increases in a variety of specific chronic conditions. Among the full sample of workers, we see reductions in insurance coverage, but little evidence of reductions in health care utilization after job loss. Among the subset of displaced workers with chronic conditions and those for whom the lost job was their primary source of insurance we do see reductions in doctor's visits and prescription drug usage.

Unemployment, disability and life expectancy in the United States: A life course study

BACKGROUND

Unemployment may be associated with health through factors including stress, depression, unhealthy behaviors, reduced health care, and loss of social networks. Little is known about associations of total lifetime unemployment with disability and life expectancy.

HYPOTHESIS

People with high unemployment (≥the median) will live shorter lives with more disability than those with less unemployment.

METHODS

Data were nationally representative of African Americans and non-Hispanic whites, from the Panel Study of Income Dynamics (37 waves 1968-2011, n = 7,970, mean work years = 24.7). Seven waves (1999-2011, 58,268 person-years) measured disability in activities of daily living. We estimated monthly probabilities of disability and death associated with unemployment using multinomial logistic Markov models adjusted for age, sex, race/ethnicity, education, health status at baseline and throughout work life, and social support. We used the probabilities to create large populations with microsimulation, each individual having known monthly disability status, age 40 to death. We analyzed the populations to measure outcomes.

RESULTS

Respectively for African American and white women and African American and white men, life expectancies (with 95% confidence intervals) from age 40 with low unemployment were ages: 77.1 (75.0-78.3), 80.6 (78.4-81.4), 71.4 (69.6-72.5), and 76.9 (74.9-77.9). Corresponding high unemployment results were: 73.7 (71.7-75.0), 77.5 (75.1-78.0), 68.4 (66.8-69.0), and 73.7 (71.5-74.3). The percentage of life disabled from age 40 was greater with high unemployment for the same groups, by 23.9%, 21.0%, 21.3%, and 21.1% (all p < 0.01).

CONCLUSIONS

High lifetime unemployment may be associated with a larger proportion of later life with disability and lower life expectancy.

The Far-Reaching Impact of Job Loss and Unemployment

Job loss is an involuntary disruptive life event with a far-reaching impact on workers' life trajectories. Its incidence among growing segments of the workforce, alongside the recent era of severe economic upheaval, has increased attention to the effects of job loss and unemployment. As a relatively exogenous labor market shock, the study of displacement enables robust estimates of associations between socioeconomic circumstances and life outcomes. Research suggests that displacement is associated with subsequent unemployment, long-term earnings losses, and lower job quality; declines in psychological and physical well-being; loss of psychosocial assets; social withdrawal; family disruption; and lower levels of children's attainment and well-being. While reemployment mitigates some of the negative effects of job loss, it does not eliminate them. Contexts of widespread unemployment, although associated with larger economic losses, lessen the social-psychological impact of job loss. Future research should attend more fully to how the economic and social-psychological effects of displacement intersect and extend beyond displaced workers themselves.

The consequences of job displacement for health: moderating influences of economic conditions and educational attainment

This paper examines the impact of worker displacement on health in the United States from 1975-2004, especially the extent to which the impact of displacement on health varies according to the economic conditions in the year of displacement and the education level of the displaced worker. Findings from ordered probit and fixed effects models suggest that the negative impact of displacement on health is exacerbated by a higher unemployment rate at the time of displacement and for displaced workers with a college degree.

The impacts of job loss and job recovery on self-rated health: testing the mediating role of financial strain and income

BACKGROUND

Is regaining a job sufficient to reverse the harmful impacts on health of job loss during the Great Recession? We tested whether unemployed persons who found work within 1 year of job loss experienced a full recovery of their health. Additionally, we tested the mediating role of financial strain and household income.

METHODS

Linear regression models were used to assess the effects of job loss and recovery on self-rated health using the longitudinal EU-SILC, covering individuals from 27 European countries. We constructed a baseline of employed persons (n = 70 611) in year 2007. We evaluated income and financial strain as potential mediating factors.

RESULTS

Job loss was associated with worse self-rated health in both men (β = 0.12, 95%CI: 0.09-0.15) and women (β = 0.13, 95%CI: 0.10-0.16). Financial strain explains about one-third of the association between job loss and health, but income did not mediate this relation. Women who regained employment within 1 year after job loss were found to be similarly healthy to those who did not lose jobs. In contrast, men whose employment recovered had an enduring health disadvantage compared with those who had not lost jobs (β = 0.11, 95%CI: 0.05-0.16). Unemployment cash benefits mitigated financial strain but were too low to substantially reduce perceived financial strain among men.

CONCLUSIONS

Men and women's health appears to suffer equally from job loss but differs in recovery. For men, employment recovery was insufficient to alleviate financial strain and associated health consequences, whereas in women regaining employment leads to health recovery.

Health effects of unemployment benefit program generosity

OBJECTIVES

We assessed the impact of unemployment benefit programs on the health of the unemployed.

METHODS

We linked US state law data on maximum allowable unemployment benefit levels between 1985 and 2008 to individual self-rated health for heads of households in the Panel Study of Income Dynamics and implemented state and year fixed-effect models.

RESULTS

Unemployment was associated with increased risk of reporting poor health among men in both linear probability (b=0.0794; 95% confidence interval [CI]=0.0623, 0.0965) and logistic models (odds ratio=2.777; 95% CI=2.294, 3.362), but this effect is lower when the generosity of state unemployment benefits is high (b for interaction between unemployment and benefits=-0.124; 95% CI=-0.197, -0.0523). A 63% increase in benefits completely offsets the impact of unemployment on self-reported health.

CONCLUSIONS

Results suggest that unemployment benefits may significantly alleviate the adverse health effects of unemployment among men.

Cumulative structural disadvantage and racial health disparities: the pathways of childhood socioeconomic influence

Cumulative structural disadvantage theory posits two major sources of endogenous selection in shaping racial health disparities: a race-based version of the theory anticipates a racially distinct selection process, whereas a social class-based version anticipates a racially similar process. To operationalize cumulative structural disadvantage, this study uses data from the 1979 National Longitudinal Survey of Youth in a Latent Class Analysis that demographically profiles health impairment trajectories. This analysis is used to examine the nature of selection as it relates to racial differences in the development of health impairments that are significant enough to hinder one's ability to work. The results provide no direct support for the race-based version of cumulative structural disadvantage theory. Instead, two key findings support the social class-based version of cumulative disadvantage theory. First, the functional form of the different health trajectories are invariant for whites and blacks, suggesting more racial similarly in the developmental process than anticipated by the race-based version of the theory. The extent of the racial disparity in the prevalences across the health impairment trajectories is, however, significant and noteworthy: nearly one-third of blacks (28 %) in the United States experience some form of impairment during their prime working years compared with 18.8 % of whites. Second, racial differences in childhood background mediate this racial health disparity through the indirect pathway of occupational attainment and through the direct pathway of early-life exposure to health-adverse environments. Thus, the selection of individuals into different health trajectories, based largely on childhood socioeconomic background, helps explain racial disparities in the development of health impairments.

(Dis)placing trust: the long-term effects of job displacement on generalised trust over the adult lifecourse

Increasing rates of job displacement (i.e. involuntary job loss from redundancy, downsizing, restructuring) have been suggested to be a key driver of declining macro-levels of generalised trust. This article undertakes the first test of how job displacement affects individuals' tendencies to (dis)trust over the adult lifecourse, using two-waves of the Great Britain National Child Development Study cohort data, on a sample of n=6840 individuals. Applying both lagged dependent variable logistic regression and two-wave change-score models, experiencing job displacement between the ages of 33 and 50 appears to significantly scar individuals' generalised trust, with depressed trust observable at least nine years after the event occurred. However, this effect is dependent on the value an individual places on work: the greater the attachment to employment the stronger the negative effect of displacement. A range of mediators, such as physical health, mental well-being, and personal efficacy, do not appear to account for the effect.

Is there a Link Between Foreclosure and Health?

We investigate the relationship between foreclosures and hospital visits using data on all foreclosures and all hospital and emergency room visits from four states that were among the hardest hit by the foreclosure crisis. We find that living in a neighborhood with a spike in foreclosures is associated with significant increases in urgent unscheduled visits, including increases in visits for preventable conditions. The estimated relationships cannot be accounted for by increasing unemployment, declines in housing prices, migration, or by people switching from out-patient providers to hospitals.

How does unemployment affect self-assessed health? A systematic review focusing on subgroup effects

BACKGROUND

Almost all studies on the effect on health from unemployment have concluded that unemployment is bad for your health. However, only a few review articles have dealt with this relation in recent years, and none of them have focused on the analysis of subgroups such as age, gender, and marital status. The objective of our article is to review how unemployment relates to self-assessed health with a focus on its effect on subgroups.

METHODS

A search was performed in Web of Science to find articles that measured the effect on health from unemployment. The selection of articles was limited to those written in English, consisting of original data, and published in 2003 or later. Our definition of health was restricted to self-assessed health. Mortality- and morbidity-related measurements were therefore not included in our analysis. For the 41 articles included, information about health measurements, employment status definitions, other factors included in the statistical analysis, study design (including study population), and statistical method were collected with the aim of analysing the results on both the population and factor level.

RESULTS

Most of the studies in our review showed a negative effect on health from unemployment on a population basis. Results at the factor levels were most common for gender (25 articles), age (11 articles), geographic location (8 articles), and education level (5 articles). The analysis showed that there was a health effect for gender, age, education level, household income, and geographic location. However, this effect differed between studies and no clear pattern on who benefits or suffers more among these groups could be determined. The result instead seemed to depend on the study context. The only clear patterns of association found were for socioeconomic status (manual workers suffer more), reason for unemployment (being unemployed due to health reasons is worse), and social network (a strong network is beneficial).

CONCLUSIONS

Unemployment affects groups of individuals differently. We believe that a greater effort should be spent on specific groups of individuals, such as men or women, instead of the population as a whole when analysing the effect of unemployment on health.

Addressing the unemployment-mortality conundrum: non-linearity is the answer

The effect of unemployment on mortality is the object of a lively literature. However, this literature is characterized by sharply conflicting results. We revisit this issue and suggest that the relationship might be non-linear. We use data for 265 territorial units (regions) within 23 European countries over the period 2000-2012 to estimate a multivariate regression of mortality. The estimating equation allows for a quadratic relationship between unemployment and mortality. We control for various other determinants of mortality at regional and national level and we include region-specific and time-specific fixed effects. The model is also extended to account for the dynamic adjustment of mortality and possible lagged effects of unemployment. We find that the relationship between mortality and unemployment is U shaped. In the benchmark regression, when the unemployment rate is low, at 3%, an increase by one percentage point decreases average mortality by 0.7%. As unemployment increases, the effect decays: when the unemployment rate is 8% (sample average) a further increase by one percentage point decreases average mortality by 0.4%. The effect changes sign, turning from negative to positive, when unemployment is around 17%. When the unemployment rate is 25%, a further increase by one percentage point raises average mortality by 0.4%. Results hold for different causes of death and across different specifications of the estimating equation. We argue that the non-linearity arises because the level of unemployment affects the psychological and behavioural response of individuals to worsening economic conditions.

Recessions, job loss, and mortality among older US adults

OBJECTIVES

We analyzed how recessions and job loss jointly shape mortality risks among older US adults.

METHODS

We used data for 50 states from the Health and Retirement Study and selected individuals who were employed at ages 45 to 66 years during 1992 to 2011. We assessed whether job loss affects mortality risks, whether recessions moderate the effect of job loss on mortality, and whether individuals who do and do not experience job loss are differentially affected by recessions.

RESULTS

Compared with individuals not experiencing job loss, mortality risks among individuals losing their job in a recession were strongly elevated (hazard ratio = 1.6; 95% confidence interval = 1.1, 2.3). Job loss during normal times or booms is not associated with mortality. For employed workers, we found a reduction in mortality risks if local labor market conditions were depressed, but this result was not consistent across different model specifications.

CONCLUSIONS

Recessions increase mortality risks among older US adults who experience job loss. Health professionals and policymakers should target resources to this group during recessions. Future research should clarify which health conditions are affected by job loss during recessions and whether access to health care following job loss moderates this relation.

Personality, well-being, and health

A lifespan perspective on personality and health uncovers new causal pathways and provides a deeper, more nuanced approach to interventions. It is unproven that happiness is a direct cause of good health or that negative emotion, worry, and depression are significant direct causes of disease. Instead, depression-related characteristics are likely often reflective of an already-deteriorating trajectory. It is also unproven that challenging work in a demanding environment usually brings long-term health risks; on the contrary, individual strivings for accomplishment and persistent dedication to one's career or community often are associated with sizeable health benefits. Overall, a substantial body of recent research reveals that conscientiousness plays a very significant role in health, with implications across the lifespan. Much more caution is warranted before policy makers offer narrow health recommendations based on short-term or correlational findings. Attention should be shifted to individual trajectories and pathways to health and well-being.

Individual joblessness, contextual unemployment, and mortality risk

Longitudinal studies at the level of individuals find that employees who lose their jobs are at increased risk of death. However, analyses of aggregate data find that as unemployment rates increase during recessions, population mortality actually declines. We addressed this paradox by using data from the US Department of Labor and annual survey data (1979-1997) from a nationally representative longitudinal study of individuals-the Panel Study of Income Dynamics. Using proportional hazards (Cox) regression, we analyzed how the hazard of death depended on 1) individual joblessness and 2) state unemployment rates, as indicators of contextual economic conditions. We found that 1) compared with the employed, for the unemployed the hazard of death was increased by an amount equivalent to 10 extra years of age, and 2) each percentage-point increase in the state unemployment rate reduced the mortality hazard in all individuals by an amount equivalent to a reduction of 1 year of age. Our results provide evidence that 1) joblessness strongly and significantly raises the risk of death among those suffering it, and 2) periods of higher unemployment rates, that is, recessions, are associated with a moderate but significant reduction in the risk of death among the entire population.

The recent economic recession and self-rated health in Estonia, Lithuania and Finland: a comparative cross-sectional study in 2004-2010

BACKGROUND

The late-2000s financial crisis had a severe impact on the national economies on a global scale. In Europe, the Baltic countries were among those most affected with more than a 20% decrease in per capita gross domestic product in 2008-2009. In this study, we explored the effects of economic recession on self-rated health in Estonia and Lithuania using Finland, a neighbouring Nordic welfare state, as a point of reference.

METHODS

Nationally representative cross-sectional data for Estonia (n=10 966), Lithuania (n=7249) and Finland (n=11 602) for 2004-2010 were analysed for changes in age-standardised prevalence rates of less-than-good self-rated health and changes in health inequalities using logistic regression analysis.

RESULTS

The prevalence of less-than-good self-rated health increased slightly (albeit not statistically significantly) in all countries during 2008-2010. This was in sharp contrast to the statistically significant decline in the prevalence of less-than-good health in 2004-2008 in Estonia and Lithuania. Health disparities were larger in Estonia and Lithuania when compared to Finland, but decreased in 2008-2010 (in men only). In Finland, both the prevalence of less-than-good health and health disparities remained fairly stable throughout the period.

CONCLUSIONS

Despite the rapid economic downturn, the short-term health effects in Estonia and Lithuania did not differ from those in Finland, although the recession years marked the end of the previous positive trend in self-rated health. The reduction in health disparities during the recession indicates that different socioeconomic groups were affected disproportionately; however, the reasons for this require further research.

Job loss, wealth and depression during the Great Recession in the USA and Europe

AIM

To examine whether late-career job loss increased depression among older workers approaching retirement in the USA and Europe.

METHODS

Longitudinal data came from the Health and Retirement Survey and the Survey of Health, Ageing, and Retirement in Europe. Workers aged 50 to 64 years in 13 European countries and the USA were assessed biennially from 2006 to 2010. Individual fixed effects models were used to test the effect of job loss on depressive symptoms, controlling for age, sex, physical health, initial wealth and socio-demographic factors.

RESULTS

Job loss was associated with a 4.78% [95% confidence interval (CI): 0.823% to 8.74%] increase in depressive symptoms in the USA compared with a 3.35% (95% CI: 0.486% to 6.22%) increase in Europe. Job loss due to a worker's unexpected firm closure increased depression scores in both the USA (beta=28.2%, 95% CI: 8.55% to 47.8%) and Europe (beta=7.50%, 95% CI: 1.25% to 13.70%), but pooled models suggested significantly stronger effects for US workers (P<0.001). American workers who were poorer before the recession experienced significantly larger increases in depressive symptoms compared with wealthier US workers (beta for interaction=-0.054, 95% CI: -0.082 to -0.025), whereas pre-existing wealth did not moderate the impact of job loss among European workers.

CONCLUSIONS

Job loss is associated with increased depressive symptoms in the USA and Europe, but effects of job loss due to plant closure are stronger for American workers. Wealth mitigates the impact of job loss on depression in the USA more than in Europe.

Strategies for the Resolution of Identity Ambiguity Following Situations of Subtractive Change

This article applies the concept of identity ambiguity to the individual level of analysis, suggesting that identity ambiguity will likely follow certain scenarios of change in which an essential target of one’s identification is abruptly lost. This temporary absence of identification has thus far been understudied, and it is proposed that individuals perceive it as a negative experience, in which opportunities for reidentification are uncertain and unclear. It is further proposed that they will be driven to overcome this identity ambiguity through one of four distinct strategies. The choice of which strategy to adopt is moreover said to be influenced by the interaction between opposing factors: the strength of one’s organizational identification prior to the change and the degree to which the new setting is perceived as prestigious, distinct, and with values that are congruent to one’s personal values. Finally, a discussion of theoretical and managerial implications is provided.

The impact of employment transitions on health in Germany. A difference-in-differences propensity score matching approach

This article investigates the effects of transitions between employment and unemployment on health. It also addresses the question of whether or not the widespread use of temporary employment has altered the positive health effects of employment. Drawing on data from the German Socio-Economic Panel for the period 1995-2010, we apply difference-in-differences propensity score matching to identify the direct causal effects of unemployment and reemployment on psychological and physical health. This combination of two approaches towards causal inference controls for both unobserved fixed effects and observable differences in a flexible semi-parametric specification. Our sample includes persons between the ages of 16-54 who have at least experienced one respective employment transition (treatment groups) or are continuously employed or unemployed (control groups). The results show that only psychological but not physical health is causally affected by the respective employment transitions. Specifically, the effects of unemployment and reemployment are of similar size, highlighting the importance of reemployment in compensating unemployment's negative impact on psychological health. In contrast, health selection and confounding seem to be important determinants of the cross-sectional association between unemployment and physical health. Carrying out separate analyses for permanent and temporary workers, we shed new light on the health effects of temporary employment. It has been argued that the rise of temporary employment has introduced a new inequality in the world of work, blurring the line between employment and unemployment. However, contrary to our expectations we find that both employment transitions have effects of a similar size for permanent and temporary workers. In sum, our results highlight two points. First, longitudinal research is needed to properly evaluate the health effects of unemployment, reemployment, and temporary employment. Second, compared to temporary employment, unemployment is still the greater threat to individuals' psychological health.

History of labour market attachment as a determinant of health status: a 12-year follow-up of the Northern Swedish Cohort

OBJECTIVE

The present study aims at using trajectory analysis to measure labour market attachment (LMA) over 12 years and at examining whether labour market tracks relate to perceived health status.

DESIGN

Data were retrieved from a 26-year prospective cohort study, the Northern Swedish Cohort.

SETTING AND PARTICIPANTS

All ninth grade students (n=1083) within the municipality of Luleå in northern Sweden were included in the baseline investigation in 1981. The vast majority (94%) of the original cohort participated at the fourth follow-up. In this study, 969 participants were included.

MEASURES

Perceived health status (psychological distress and non-optimal self-rated health) at age 42 and the data obtained from questionnaires.

RESULTS

We have identified four tracks in relation to LMA across the 12-year period: 'permanent', 'high level', 'strengthening' and 'poor level' of attachment. LMA history relates to psychological distress. High level (OR 1.55 (95% CI 1.06 to 2.27)), strengthening (OR 1.95 (95% CI 1.29 to 2.93)) and poor attachment (OR 3.14 (95% CI 2.10 to 4.70) involve higher OR for psychological distress compared with permanent attachment. The overall p value remained significant in the final model (p=0.001). Analyses regarding non-optimal self-rated health displayed a similar pattern but this was not significant in the final model.

CONCLUSIONS

Our results suggest that health status in mid-life, particularly psychological distress, is related to patterns of LMA history, to a large part independently of other social risk factors and previous health. Consideration of heterogeneity and time in LMA might be important when analysing associations with perceived health.

Credit Card Blues: The Middle Class and the Hidden Costs of Easy Credit

In an era of increased access to credit, it becomes increasingly important to understand the consequences of taking on unsecured consumer debt. We argue that credit can have both positive and negative consequences resulting from its ability to smooth life transitions and difficulties but that this occurs simultaneously with increased financial risks and stress resulting from carrying unsecured debt. We find that those in the middle of the income distribution suffer the greatest disruptions to mental health from carrying debt. Affluent borrowers are relatively unmoved by debt, suggesting the use of short-term debt as a convenience strategy for the financially well-heeled. The least advantaged borrowers are also suffer emotionally less from debt, possibly because securing spendable funds for necessities remains their most pressing concern. The onset of the Great Recession, however, produced increased emotional distress for all classes.

Job displacement among single mothers: effects on children's outcomes in young adulthood

Given the recent era of economic upheaval, studying the effects of job displacement has seldom been so timely and consequential. Despite a large literature associating displacement with worker well-being, relatively few studies focus on the effects of parental displacement on child well-being, and fewer still focus on implications for children of single-parent households. Moreover, notwithstanding a large literature on the relationship between single motherhood and children's outcomes, research on intergenerational effects of involuntary employment separations among single mothers is limited. Using 30 years of nationally representative panel data and propensity score matching methods, the authors find significant negative effects of job displacement among single mothers on children's educational attainment and social-psychological well-being in young adulthood. Effects are concentrated among older children and children whose mothers had a low likelihood of displacement, suggesting an important role for social stigma and relative deprivation in the effects of socioeconomic shocks on child well-being.

The effects of earlier income variation on mortality: an analysis of Norwegian register data

Several studies have shown a positive relationship between mortality and episodes of income decline, unemployment, or poverty shortly before death or in the more distant past. Our objective was to analyse the mortality effects of earlier income changes more generally, net of the overall level. We used Norwegian register data that included individual histories of annual labour income and focused on mortality among men aged 50-69 in 1990-2002. Men in this age group who, during the preceding 15 years, had experienced at least two substantial falls in income as well as at least one substantial increase, or vice versa, experienced an excess mortality of 17 per cent. For men who experienced fewer changes, there were only weak indications of excess mortality. Variation dominated by falls in income did not have a more adverse effect than variation dominated by rises.

The health effects of leaving school in a bad economy

This study investigates the lasting health effects of leaving school in a bad economy. Three empirical patterns motivate this study: Leaving school in a bad economy has persistent and negative career effects, career and health outcomes are correlated, and fluctuations in contemporaneous economic conditions affect health in the short-run. I draw data from the National Longitudinal Survey of Youth 1979 Age 40 Health Supplement. Members of my sample left school between 1976 and 1992. I find that men who left school when the school-leaving state unemployment rate was high have worse health at age 40 than otherwise similar men, while leaving school in a bad economy lowers depressive symptoms at age 40 among women. A 1 percentage point increase in the school-leaving state unemployment rate leads to a 0.5% to 18% reduction in the measured health outcomes among men and a 6% improvement in depressive symptoms among women.

Bad Jobs, Bad Health? How Work and Working Conditions Contribute to Health Disparities

In this review, we touch on a broad array of ways that work is linked to health and health disparities for individuals and societies. First focusing on the health of individuals, we discuss the health differences between those who do and do not work for pay, and review key positive and negative exposures that can generate health disparities among the employed. These include both psychosocial factors like the benefits of a high status job or the burden of perceived job insecurity, as well as physical exposures to dangerous working conditions like asbestos or rotating shift work. We also provide a discussion of the ways differential exposure to these aspects of work contributes to social disparities in health within and across generations. Analytic complexities in assessing the link between work and health for individuals, such as health selection, are also discussed. We then touch on several contextual level associations between work and the health of populations, discussing the importance of the occupational structure in a given society, the policy environment that prevails there, and the oscillations of the macroeconomy for generating societal disparities in health. We close with a discussion of four areas and associated recommendations that draw on this corpus of knowledge but would push the research on work, health and inequality toward even greater scholarly and policy relevance.

Jobless now, sick later? Investigating the long-term consequences of involuntary job loss on health

In the light of the current economic crises which in many countries lead to business closures and mass lay-offs, the consequences of job loss are important on various dimensions. They have to be investigated not only in consideration of a few years, but with a long-term perspective as well, because early life course events may prove important for later life outcomes. This paper uses data from SHARELIFE to shed light on the long-term consequences of involuntary job loss on health. The paper distinguishes between two different reasons for involuntary job loss: plant closures, which in the literature are considered to be exogenous to the individual, and lay-offs, where the causal direction of health and unemployment is ambiguous. These groups are separately compared to those who never experienced a job loss. The paper uses eleven different measures of health to assess long-term health consequences of job loss, which has to have occurred at least 25 years before the current interview. As panel data cannot be employed, a large body of variables, including childhood health and socio-economic conditions, is used to control for the initial conditions. The findings suggest that individuals with an exogenous job loss suffer in the long run: men are significantly more likely to be depressed and they have more trouble knowing the current date. Women report poorer general health and more chronic conditions and are also affected in their physical health: they are more likely to be obese or overweight, and to have any limitations in their (instrumental) activities of daily living. In the comparison group of laid-off individuals, controlling for the initial conditions reduces the effects of job loss on health - proving that controlling for childhood conditions is important.

Perceived stress and self-rated health of Haitian and African Americans with and without Type 2 diabetes

BACKGROUND

Blacks have a higher incidence of diabetes and its related complications. Self-rated health (SRH) and perceived stress indicators are associated with chronic diseases. The aim of this study was to examine the associations between SRH, perceived stress and diabetes status among two Black ethnicities.

MATERIALS AND METHODS

The cross-sectional study included 258 Haitian Americans and 249 African Americans with (n = 240) and without type 2 diabetes (n = 267) (n = 507). Recruitment was performed by community outreach.

RESULTS

Haitian-Americans were less likely to report 'fair to poor' health as compared to African Americans [OR = 0.58 (95% CI: 0.35, 0.95), P = 0.032]; yet, Haitian Americans had greater perceived stress than African Americans (P = 0.002). Having diabetes was associated with 'fair to poor' SRH [OR = 3.14 (95% CI: 2.09, 4.72), P < 0.001] but not perceived stress (P = 0.072). Haitian-Americans (P = 0.023), females (P = 0.003) and those participants having 'poor or fair' SRH (P < 0.001) were positively associated with perceived stress (Nagelkerke R(2) = 0.151).

CONCLUSION

Perceived stress associated with 'poor or fair' SRH suggests that screening for perceived stress should be considered part of routine medical care; albeit, further studies are required to confirm our results. The findings support the need for treatment plans that are patient-centered and culturally relevant and that address psychosocial issues.

Public broadcasting, media engagement, and 2-1-1: using mass communication to increase the use of social services

BACKGROUND

The 2008-2009 subprime mortgage crisis was catastrophic, not only for the global economy but for families across the social spectrum. The resultant economic upheaval threatened the livelihoods, well-being, and health of many citizens, who were often unsure where to turn for help. At this critical juncture, public broadcasting stations worked to connect viewers to support resources through 2-1-1.

PURPOSE

This study was designed to evaluate the ability of public broadcasting to increase the use of information and referral services.

METHODS

Autoregressive integrated moving average (ARIMA) modeling and regression analysis document the relationship between public broadcasting initiatives and 2-1-1 call volume in 35 highly affected U.S. markets. Time-series data from St. Louis MO were collected and analyzed in 2008. Station-level data from across the nation were collected during 2009-2010 and analyzed in 2010.

RESULTS

ARIMA results show a distinct linkage between the timing and duration of Channel 9 in St. Louis MO (KETC) programming and a subsequent (approximately 400%) increase in 2-1-1 calls regarding financial services and assistance. Regression path analysis not only found evidence of this same effect nationally but also showed that differences in the broadcaster's orientation and approach mediated effects. Specifically, stations' orientations toward engagement were mediated through strong outreach strategies to increase 2-1-1 use.

CONCLUSIONS

This study documents the ability of public broadcasting to help citizens in need connect with social resources through 2-1-1 services. By focusing attention on the mortgage crisis and its attendant consequences, and by publicizing 2-1-1 services as a gateway to supportive resources, public broadcasters fostered linkages between those in need and social resources. Moreover, the level of a station's commitment to engaging citizens had a strong bearing on the success of its programming initiatives and community partnerships with organizations such as 2-1-1.

Labor force participation and health-related quality of life in HIV-positive men who have sex with men: the Multicenter AIDS Cohort Study

Too many people with HIV have left the job market permanently and those with reduced work capacity have been unable to keep their jobs. There is a need to examine the health effects of labor force participation in people with HIV. This study presents longitudinal data from 1,415 HIV-positive men who have sex with men taking part in the Multicenter AIDS Cohort Study. Generalized Estimating Equations show that employment is associated with better physical and mental health quality of life and suggests that there may be an adaptation process to the experience of unemployment. Post hoc analyses also suggest that people who are more physically vulnerable may undergo steeper health declines due to job loss than those who are generally healthier. However, this may also be the result of a selection effect whereby poor physical health contributes to unemployment. Policies that promote labor force participation may not only increase employment rates but also improve the health of people living with HIV.

Influence of employment and job security on physical and mental health in adults living with HIV: cross-sectional analysis

BACKGROUND

In the general population, job insecurity may be as harmful to health as unemployment. Some evidence suggests that employment is associated with better health outcomes among people with HIV, but it is not known whether job security offers additional quality-of-life benefits beyond the benefits of employment alone.

METHODS

We used baseline data for 1660 men and 270 women who participated in the Ontario HIV Treatment Network Cohort Study, an ongoing observational cohort study that collects clinical and socio-behavioural data from people with HIV in the province of Ontario, Canada. We performed multivariable regression analyses to determine the contribution of employment and job security to health-related quality of life after controlling for potential confounders.

RESULTS

Employed men with secure jobs reported significantly higher mental health-related quality of life than those who were non-employed (β = 5.27, 95% confidence interval [CI] 4.07 to 6.48), but insecure employment was not associated with higher mental health scores relative to non-employment (β = 0.18, 95% CI -1.53 to 1.90). Thus, job security was associated with a 5.09-point increase on a 100-point mental health quality-of-life score (95% CI 3.32 to 6.86). Among women, being employed was significantly associated with both physical and mental health quality of life, but job security was not associated with additional health benefits.

INTERPRETATION

Participation in employment was associated with better quality of life for both men and women with HIV. Among men, job security was associated with better mental health, which suggests that employment may offer a mental health benefit only if the job is perceived to be secure. Employment policies that promote job security may offer not only income stability but also mental health benefits, although this additional benefit was observed only for men.

A narrative review on the effect of economic downturns on the nursing labour market: implications for policy and planning

Economic downturns and recession lead to budget cuts and service reductions in the healthcare sector which often precipitate layoffs and hiring freezes. Nurses, being the largest professional group in healthcare, are strongly affected by cost reductions. Economic downturns destabilize the nursing labour market with potential negative outcomes, including serious shortages, extending beyond the recessionary period. The objectives of this manuscript are to provide an overview of the potential short- and long-run impact of economic downturns on the supply and demand of nurses, and present healthcare decision makers with a framework to enhance their ability to strategically manage their human resources through economic cycles.A narrative review of the literature on the effects of economic downturns on the nursing labour market in developed countries was carried out with a special focus on studies offering a longitudinal examination of labour force trends. Analysis indicates that economic downturns limit the ability of public payers and institutions to finance their existing health workforce. As salaried healthcare workers, nurses are especially susceptible to institutional budget cuts. In the short run, economic downturns may temporarily reduce the demand for and increase the supply of nurses, thereby influencing nursing wages and turnover rates. These effects may destabilise the nursing labour market in the long run. After economic downturns, the market would quickly display the pre-recessionary trends and there may be serious demand-supply imbalances resulting in severe shortages. Potential long-term effects of recession on the nursing labour market may include a downsized active workforce, difficulty in retaining younger nurses, a decreased supply of nurses and workforce casualisation.Lack of understanding of labour market dynamics and trends might mislead policy makers into making misinformed workforce downsizing decisions that are often difficult and expensive to reverse. In the aftermath of an economic downturn, the costs of attracting nurses back often outweigh the short term cost savings. Effective management should support the nursing workforce by creating attractive and stable work environments to retain nurses at a manageable cost.

The length of unemployment predicts mortality, differently in men and women, and by cause of death: a six year mortality follow-up of the Swedish 1992-1996 recession

This study examines the relationship between the total amount of accumulated unemployment during the deep Swedish recession of 1992-1996 and mortality in the following 6 years. Nearly 3.4 million Swedish men and women, born between 1931 and 1965 who were gainfully employed at the time of the 1990 census were included. Almost 23% of these individuals were unemployed at some point during the recession. We conduct a prospective cohort study utilizing Cox proportional hazard regression with a mortality follow-up from January 1997 to December 2002. We adjust for health status (1982-1991), baseline (1991) social, family, and employer characteristics of individuals before the recession. The findings suggest that long-term unemployment is related to elevated all-cause mortality for men and women. The excess mortality effects were small for women and attributable to a positive, linear increase in the hazard of alcohol disease-related mortality and external causes-of-death not classified as suicides or transport accidents. For men, the excess hazard of all-cause mortality was best represented by a cubic, non-linear shape. The predicted hazard increases rapidly with the shortest and longest accumulated levels of unemployment. However, the underlying pattern differed by cause-of-death. The cancer, circulatory, and alcohol disease-related analyses suggest that mortality peaks with mid-levels of accumulated unemployment and then declines with longer duration unemployment. For men, we observed a positive, linear increase in the hazard ratios associated with transport and suicide mortality, and a very steep non-linear increase in the excess hazard ratio associated with other external causes of death that were not classified as suicide or transport accidents. In conclusion, mortality risk increases with the duration of unemployment among men and women. This was best described by a cubic function for men and a linear function for women. Behind this pattern, different causes-of-death varied in their relation to the accumulation of unemployment.

Association of returning to work with better health in working-aged adults: a systematic review

OBJECTIVES

We systematically reviewed the literature on the impact of returning to work on health among working-aged adults.

METHODS

We searched 6 electronic databases in 2005. We selected longitudinal studies that documented a transition from unemployment to employment and included a comparison group. Two reviewers independently appraised the retrieved literature for potential relevance and methodological quality.

RESULTS

Eighteen studies met our inclusion criteria, including 1 randomized controlled trial. Fifteen studies revealed a beneficial effect of returning to work on health, either demonstrating a significant improvement in health after reemployment or a significant decline in health attributed to continued unemployment. We also found evidence for health selection, suggesting that poor health interferes with people's ability to go back to work. Some evidence suggested that earlier reemployment may be associated with better health.

CONCLUSIONS

Beneficial health effects of returning to work have been documented in a variety of populations, times, and settings. Return-to-work programs may improve not only financial situations but also health.

Is work beneficial to good health?

Unemployment and insecurity at work are a source of stress and may create a threat to individual physical and psychological health. The purpose of this study was to examine the connection between personal, functional, and professional variables and reports of how the health of hospital patients is impacted by financial status in Israel. One hundred and forty three hospitalized patients completed demographic, health-functional, and financial status questionnaires. Of the respondents, 32.9% reported a correlation between financial status and health. Significant connections were found between family status, lack of work, a change in partner's employment status, job insecurity, and financial commitments and reports of a correlation between financial status and health. The multivariate model predicting reports of a correlation between financial status and health was statistically significant. Discussion and implications focus on the need to create special preparation among health care professionals, in the community and in hospitals, to identify and treat people suffering from financial stress.

The Economic Burden Shouldered by Public and Private Entities as a Consequence of Health Disparities Between Men and Women

On average, American men live shorter, less healthy lives than women. They are more likely to be the victim of a violent crime, die in a car crash, commit suicide, and be injured at work. In addition, men have higher death rates in 9 of the top 10 causes of death, and are less likely to receive routine preventative care, leaving men with a life span that is significantly shorter than women’s. Recently, policy makers and researchers have been paying more attention to health disparities including race, sex, and ethnicity. However, men are still noticeably absent from these discussions despite being significantly harmed by disparities in preventive care, quality of life, and overall health outcomes. Ignoring these disparities is costly in terms of lost productivity, lives lost, and financial costs incurred by the government and employers each year. Premature death and morbidity in men costs federal, state, and local governments in excess of $142 billion annually. It also costs U.S.employers and society as a whole in excess of $156 billion annually in direct medical payments and lost productivity and an additional $181 billion annually in decreased quality of life. As federal and state governments and the private sector struggle with increasing health entitlement burdens—including escalating health care costs—eliminating male health inequities emerges as an important source of savings. This analysis will examine the economic and intangible costs associated with the health disparities that exist between genders and the benefits reaped if these disparities are reduced or eliminated.

The individual experience of unemployment

This review describes advances over the past decade in what is known about the individual experience of unemployment, predictors of reemployment, and interventions to speed employment. Research on the impact of unemployment has increased in sophistication, strengthening the causal conclusion that unemployment leads to declines in psychological and physical health and an increased incidence of suicide. This work has elucidated the risk factors and mechanisms associated with experiencing poor psychological health during unemployment; less so for physical health and suicide. Psychologists have begun to contribute to the study of factors associated with reemployment speed and quality. The past decade has especially illuminated the role of social networks and job search intensity in facilitating reemployment. Evidence suggests some individuals, especially members of minority groups, may face discrimination during their job search. Although more work in this arena is needed, several intervention-based programs have been shown to help individuals get back to work sooner.

The protective effects of social/contextual factors on psychiatric morbidity in LGB populations

BACKGROUND

Lesbian, gay and bisexual (LGB) populations evidence higher rates of psychiatric disorders than heterosexuals, but most LGB individuals do not have mental-health problems. The present study examined risk modifiers at the social/contextual level that may protect LGB individuals from the development of psychiatric disorders.

METHODS

Data are drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N = 34,653), a nationally representative study of non-institutionalized US adults. Risk variables included social isolation and economic adversity. High state-level concentration of same-sex couples, obtained from the US Census, was examined as a protective factor.

RESULTS

The past-year prevalence of major depression and generalized anxiety disorder was lower among LGB respondents living in states with higher concentrations of same-sex couples, compared with LGB respondents in states with lower concentrations. Additionally, the increased risk for mood and anxiety disorders among LGB individuals exposed to economic adversity and social isolation was evident only in states with low concentrations of same-sex couples. These interactions between the risk and protective factors were not found among heterosexuals, suggesting specificity of the effects to LGB individuals. Results were not attenuated after controlling for socio-demographic factors, state-level income inequality, state-level policies targeting LGBs and state-level attitudes towards LGB-relevant issues.

CONCLUSIONS

These results provide evidence for the protective effect of social/contextual influences on the prevalence of psychiatric disorders in LGB individuals. Measures of the social environment should be incorporated into future research on the mental health of LGB populations.

Precarious employment, bad jobs, labor unions, and early retirement

OBJECTIVES

We examined the extent to which involuntary job loss, exposure to "bad jobs," and labor union membership across the life course are associated with the risk of early retirement.

METHODS

Using data from the Wisconsin Longitudinal Study, a large (N=8,609) sample of men and women who graduated from high school in 1957, we estimated discrete-time event history models for the transition to first retirement through age 65. We estimated models separately for men and women.

RESULTS

We found that experience of involuntary job loss and exposure to bad jobs are associated with a lower risk of retiring before age 65, whereas labor union membership is associated with a higher likelihood of early retirement. These relationships are stronger for men than for women and are mediated to some extent by pre-retirement differences in pension eligibility, wealth, job characteristics, and health.

DISCUSSION

Results provide some support for hypotheses derived from theories of cumulative stratification, suggesting that earlier employment experiences should influence retirement outcomes indirectly through later-life characteristics. However, midlife employment experiences remain associated with earlier retirement, net of more temporally proximate correlates, highlighting the need for further theorization and empirical evaluation of the mechanisms through which increasingly common employment experiences influence the age at which older Americans retire.