Psychological health, self-reported physical health and health service use. Risk differential observed after one year of unemployment

A Comparison of Healthcare Use and Costs for Workers with Psychiatric Disabilities Employed in Social Enterprises Versus Those Who Are Not Employed and Seeking Work

Because of work's contribution to recovery, governments have moved to improve employment rates of people with severe mental disorders (SMDs). Social enterprises (SEs) have been identified as a means to achieve employment. In Ontario, Canada, the Ministry of Health and Long-Term Care (MOHLTC) have provided SEs government subsidies. Public funding arrangements create a potential trade-off for governments that must decide how to distribute constrained budgets to meet a variety of public needs. In Ontario, the government is potentially faced with choosing between supporting employment versus healthcare services. This study addresses the question, are there significant differences in service use and costs from the MOHLTC's perspective for people with SMDs working in SEs versus those who are not working and looking for work? Our results indicate there is a significant difference in healthcare use between the two groups suggesting there could be less healthcare use associated with SE employment.

Does employment alter the course and outcome of schizophrenia and other severe mental illnesses? A systematic review of longitudinal research

INTRODUCTION

This review synthesized prospective evidence to assess whether achieving employment alters the course of schizophrenia-spectrum disorder.

METHOD

Researchers identified relevant analyses for review via PubMed, expert referral, and reference review and systematically applied two levels of screening to 1484 citations using seven a priori criteria.

RESULTS

A total of 12 analyses representing eight cohorts, or 6844 participants, compared illness course over time by employment status in majority schizophrenia-spectrum samples. Employment was consistently associated with reductions in outpatient psychiatric treatment (2 of 2 studies) as well as improved self-esteem (2 of 2 studies). Employment was inconsistently associated with positive outcomes in several other areas, including symptom severity, psychiatric hospitalization, life satisfaction, and global wellbeing. Employment was consistently unrelated to worsening outcomes.

DISCUSSION

Achieving employment does not cause harm among people with schizophrenia-spectrum disorder and other severe mental illnesses. Further detailed mechanistic analyses of adequately powered long-term follow-up studies using granular descriptions of employment are needed to clarify the nature of associations between employment and hypothesized benefit.

The effects of depression and chronic diseases on the work outcomes of employees: a prospective study in Northwest China

A prospective cohort study was conducted to examine the impact of physical and mental health status on the job loss and job turnover rates in Northwestern China. There were 1778 employees included in the baseline survey at April 2006 and were followed-up in October 2006. They were classified into four groups: those with chronic diseases (n = 205), depression (n = 273), both chronic diseases and depression (n = 96), and a control group (n = 1204). Logistic regression was used to examine the impact of depression and chronic diseases on employment between the baseline and the 6-month follow-up interviews. The results of the analyses showed that participants suffering from depression were more likely to be unemployed (OR, 1.44; P < 0.05), recently changed jobs (OR, 3.28, P < 0.001) and earning a lower salary (B = -135.28RMB, P < 0.001). Depression accompanying chronic diseases had an increased risk of unemployment (OR, 2.05; P < 0.01). The participants with chronic diseases were more likely to change their jobs (OR, 2.53; P < 0.05), but this had no significant impact on unemployment and monthly salary. Overall, the findings suggest that people with depression were at a higher risk of unemployment and job turnover than people with chronic disease.

Financial strain, social capital, and perceived health during economic recession: a longitudinal survey in rural Canada

Although the health consequences of financial strain are well documented, less is understood about the health-protective role of social capital. Social capital refers to a sense of community embeddedness, which is in part reflected by group membership, civic participation, and perceptions of trust, cohesion, and engagement. We investigated whether perceptions of social capital moderate the relation between financial strain and health, both mental and physical. This longitudinal study surveyed adults in two communities in rural Ontario where significant job losses recently occurred. Data were collected on financial strain, social capital, perceived stress, symptoms of anxiety and depression, and physical health on three occasions over 18 months (N's = 355, 317, and 300). As expected, financial strain positively related to perceived stress, poor physical health and symptoms of anxiety and depression, whereas social capital related to less stress, better physical health, and fewer symptoms of anxiety and depression. Effects of financial strain on perceived stress and depressive symptoms were moderated by social capital such that financial strain related more closely to perceived stress and depressive symptoms when social capital was lower. The findings underscore the health-protective role of community associations among adults during difficult economic times.

Labour market status, insecurity and health

Workplace closure results in unselective unemployment. This unique feature has enabled studies of workplace closure to make a significant contribution to knowledge about the effect of unemployment on health. A review of recent longitudinal, controlled studies of workplace closure documents their contribution to this knowledge. It also identifies a number of methodological problems and the scarcity of data on white- collar workers and gender differences. Results are presented from a study of the health effects of job insecurity, change and loss among white- collar men and women which was able to address some of the methodological disadvantages of previous studies.

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.

The public health costs of job loss

We study the short-run effect of involuntary job loss on comprehensive measures of public health costs. We focus on job loss induced by plant closure, thereby addressing the reverse causality problem as job displacements due to plant closure are unlikely caused by workers' health status, but potentially have important effects on individual workers' health and associated public health costs. Our empirical analysis is based on a rich data set from Austria providing comprehensive information on various types of health care costs and day-by-day work history at the individual level. Our central findings are (i) overall expenditures on medical treatments are not strongly affected by job displacement; (ii) job loss significantly increases expenditures for antidepressants and related drugs, as well as for hospitalizations due to mental health problems for men (but not for women) although the effects are economically rather small; and (iii) sickness benefits strongly increase due to job loss.

Employment status and differences in the one-year coverage of physician visits: different needs or unequal access to services?

BACKGROUND

The dichotomy employed vs. unemployed is still a relevant, but rather crude measure of status in current labour markets. Also, studies concerning the association of employment status with health have to specify the type of the employment as well as the characteristics of the unemployment. This study aims to reveal differences and potential inequalities in physician visits among seven groups in the core-periphery structures of the labour markets.

METHODS

A total of 16,000 Finns responded to a postal survey in 2003. Their visits to physicians in public primary health care, occupational health care, private health services, hospital outpatient clinics and dental care services during previous year were measured as indicators of service utilisation. Participants were classified as employees having a permanent or fixed-term and full-time or part-time contract and as those experiencing short-term, prolonged or long-term unemployment. Differences in the one-year coverage of physician visits between these groups of employees were analysed using logistic regression analyses where differences in the need for services were controlled for by including demographics and self-rated health assessments in the models.

RESULTS

Permanently employed respondents had visited a physician most often, and the need-adjusted regression models showed significantly lower odds ratios for a visit among fixed-term employees (OR 0.65, 95% CI 0.53-0.81) and in particular among the long-term unemployed (OR 0.21, 95% CI 0.14-0.31). A stratified analysis according to health care sector showed the lowest odds ratios in occupational health care and private physicians (ORs between 0.05 and 0.73) and also low odds ratios for dentists (ORs between 0.45 and 0.91), whereas visits to public primary health care were more common among non-permanent employees and the unemployed (ORs between 1.46 and 2.39).

CONCLUSION

The use of physician services varies according to labour market status, being relatively low among the non-permanently employed and the unemployed. This underuse is emphasised when clinical need is taken into account. The main reasons for the variance evidently lie in the structures of the Finnish health service system. The result may indicate non-optimal health care of the population on the periphery of the labour market, but it may also reflect the importance of employment status as a context for need and the decision to visit a physician.

Health care utilization among persons who are unemployed or outside the labour force

BACKGROUND

In Sweden, equity in health is a central aim of public health policy. To this end, the health care system is obligated to offer equal access to health care according to need. However, unemployment may hinder the fulfillment of this goal. The aim of the present study was to assess self-reported health care needs and service utilization with respect to employment status.

METHODS

A questionnaire was sent to 4000 randomly chosen individuals 20-64 years of age living in different counties in Sweden (response rate 66.2%). Logistic regression analyses were carried out to estimate the influence of employment status, socio-demographic variables and health indicators on the need for and use of health care services.

RESULTS

In total, 42.2% (n=35) among the unemployed, 37.4% (n=55) among persons who were on long-term sick leave (LTSD), and 22.3% (n=467) of the employed persons, abstained from consulting a physician despite reporting a perceived need to do so. The results persisted after adjusting for socio-demographic variables, social support and personal finances (unemployed: OR=1.91; LTSD: OR=1.62). The risk of foregoing care remained higher among the unemployed, but not the LTSD-group, after adjusting for long-standing illness (OR=1.94). The unemployed were more likely than the employed to perceive a need to seek care for psychological problems. The risk of abstaining from consulting a physician was related to symptoms of depression.

CONCLUSIONS

Lack of employment may be related to unmet care needs, especially among unemployed who are experiencing psychological symptoms. To deal with the needs of the unemployed it may be useful to develop interventions within the health care system that focus more on psychological problems.

A comparison of the mental health of employed and unemployed women in the context of a massive layoff

The purpose of this study was to assess the impact of unemployment on the mental health of women in the context of massive unemployment. Comparisons were made between the level of mental distress experienced by unemployed and employed women, in two areas of Newfoundland, Canada that were affected by the northern cod moratorium. In addition, the relationships between women's mental distress and a number of variables were explored. Questionnaires were administered to 112 unemployed and 112 employed women three years after the moratorium began. The unemployed women reported significantly poorer mental well-being in the year prior to data collection. At the time of the study, however, both groups of women were experiencing high levels of distress. The moratorium, financial problems, and feelings of uncertainty were identified as key stressors for all the women, but especially for those without work. Among the working women, past experience with unemployment and level of education had significant correlations with their mental well-being.

The health effects of major organisational change and job insecurity

Since August 1988 an increasing proportion of the executive functions of government in the United Kingdom have been devolved to executive agencies. Transfer to an executive agency involves a period of uncertainty during which the options of elimination or transfer to the private sector are considered, followed by a marked change in management style and further periods of uncertainty when the agency's function is reconsidered for transfer to the private sector. This paper examines the effects of this major organisational change and consequent job insecurity on the health status of a cohort of 7419 white-collar civil servants by comparing groups either exposed to or anticipating exposure to this stressor, with controls experiencing no change. Compared with controls, men both already working in and anticipating transfer to an executive agency experienced significant increases in health self-rated as "average or worse", longstanding illness, adverse sleep patterns, mean number of symptoms in the fortnight before questionnaire completion, and minor psychiatric morbidity. Significant relative increases in body mass index were seen in both exposure groups while exposure to agency status was also associated with significant relative increases in blood pressure. Health-related behaviours, where they differed between exposure and control groups, tended to favour those in the exposure groups. Compared with controls, women in both exposure groups reported small increases in most self-reported morbidity measures and most clinical measurements, accompanied by slight beneficial changes in some health-related behaviours and small adverse changes in others. Significant relative increases were seen in mean number of symptoms, and ischaemia among women anticipating exposure and in body mass index among those exposed to agency status. Policy makers should be aware of the wider consequences of job insecurity when considering the efficiency of changes in employment policy.

Unemployment and health: a review

Unemployment has an adverse effect on health. This effect is still demonstrable when social class, poverty, age and pre-existing morbidity are adjusted for. Unemployed men and their families have increased mortality experience, particularly from suicide and lung cancer. Unemployed men also have a reduction in psychological well-being with a greater incidence of parasuicide, depression and anxiety. Unemployed men are more likely to use general practitioner and hospital services and receive more prescribed medicines. Smoking and alcohol consumption are often increased after the onset of unemployment. Women are less affected by enforced unemployment, but families are put at greater risk of physical illness, psychological stress and family breakdown. Maintaining financial security, providing proactive health care and retraining for re-employment can all reduce the impact of unemployment on health.

Effects of occupational status on the mental health of young Italian men and women. A cross-sectional study

The study was carried out on 548 subjects (307 women, 244 men) between the ages of 21 and 26, who had all obtained secondary school certificates. The survey was conducted in two contrasting areas, one showing a high rate of unemployment, the other a rate below the national average. The sample was divided into three groups according to occupational status: employed persons, students and persons seeking their first employment. The subjects were given five questionnaires: a demographic form, the General Health Questionnaire, the Beck Depression Inventory, the Beck Hopelessness Scale and the Rosenberg Self-Esteem Scale. Our findings revealed that unemployed women experience greater psychological distress while men are more subject to marked depressive states. There were no significant differences between the two areas surveyed.