Work-family trajectories and health: A systematic review

Investigating sustainability in work after participating in a welfare-to-work initiative using a 2-year cohort study of Work Programme participants in Scotland

OBJECTIVES

This study investigated sustainability and multimorbidity alongside barriers to employment including health and policy to demonstrate intersectional impact on return-to-work success within a UK welfare-to-work programme.

DESIGN

Cohort study design: The study calculated the proportion of time spent employed after experiencing a job start and the proportion retaining work over 6 months. Employment/unemployment periods were calculated, sequence-index plots were produced and visualisations were explored by benefit type and age.

SETTING

This study used confidential access to deidentified data from unemployed Work Programme clients operated by Ingeus on behalf of the UK Government in Scotland between 1 April 2013 and 31 July 2014.

PARTICIPANTS

13 318 unemployed clients aged 18-64 years were randomly allocated to a Work Programme provider and monitored over 2 years.

RESULTS

This study has two distinct groupings. 'Employment and Support Allowance (ESA)' corresponding to those with work-limiting disability in receipt of related state financial support, and 'Jobseeker's Allowance (JSA)' corresponding to unemployment claimants. Despite fewer and later job starts for ESA clients, those that gained employment spend relatively more subsequent time in employment when compared with individuals without work-limiting conditions (ESA clients under 50, 0.73; ESA clients over 50, 0.79; JSA clients under 50, 0.67 and JSA clients over 50, 0.68). Proportion in permanent jobs was higher among ESA than JSA clients (JSA under 50, 92%; JSA over 50, 92%; ESA under 50, 95% and ESA over 50, 97%).

CONCLUSION

The research demonstrated that returning to paid employment after a reliance on welfare benefits is challenging for people aged over 50 and those with disability. The study found that although fewer older ESA claimants entered employment, they typically remained in employment more than JSA clients who did not leave the Work Programme early. This indicates the importance of identifying risk factors for job loss in ageing workers and the development of interventions for extension of working lives.

Work-family trajectories across Europe: differences between social groups and welfare regimes

Introduction

Work and family trajectories develop and interact over the life course in complex ways. Previous studies drew a fragmented picture of these trajectories and had limited scope. We provide the most comprehensive study of early-to-midlife work-family trajectories to date.

Methods

Using retrospective data from waves 3 and 7 of the Survey of Health, Aging and Retirement in Europe (SHARE), we reconstructed work-family trajectories from age 15 to 49 among almost 80,000 individuals born between 1908 and 1967 across 28 countries. We applied multichannel sequence and cluster analysis to identify typical trajectories and multinomial logistic regression models to uncover their social composition.

Results

The results revealed six common trajectories. The dominant and therefore standard trajectory represents continuous full-time employment with having a partner and children. Women, the lower educated and persons from conservative and liberal welfare regimes are underrepresented in this trajectory, whereas men, higher educated people and those from social-democratic, Eastern European and Baltic welfare regimes are overrepresented. The other trajectories denote a deviation from the standard one, integrating a non-standard form of work with standard family formation or vice versa. Mothers in a stable relationship generally work part-time or not at all. When mostly in full-time employment, women are more likely to be divorced. Lower educated persons are less likely to have work-family trajectories characterized by full-time work and a non-standard family, yet more likely to be non-employed for large parts of their life with standard family formation. Younger cohorts are underrepresented in non-employment trajectories, but overrepresented in part-time employment trajectories along with a partner and children as well as full-time employment trajectories with divorce. Individuals from Southern European and liberal regimes are more likely to be non-working and self-employed partnered parents and those from social-democratic regimes are more likely to be full-time employed divorced parents. We also found pronounced gender differences in how educational level, birth cohort and welfare regime are associated with work-family trajectories from early to midlife.

Discussion

Our findings highlight the socially stratified nature of earlier-life work-family trajectories in Europe. Potential implications for inequalities in later life are discussed.

Risk Factors and Short-Term Prognosis of Lymphocele After Kidney Transplant

OBJECTIVES

Lymphocele is a frequent complication after kidney transplant and needs attention. This study was undertaken to analyze perioperative risk factors and short-term outcomes associated with lymphocele after kidney transplant.

MATERIALS AND METHODS

Our single-center study retrospectively analyzed 264 recipients of kidney allografts from January 2018 to October 2021. Patients were classified into 2 groups according to the occurrence of lymphocele. Perioperative clinical data and follow-up indicators were compared between groups.

RESULTS

The incidence of lymphocele after kidney transplant was 19.7%. Univariate analysis showed that percentage of male patients, hypothermic machine perfusion proportion, and postoperative hemoglobin and albumin were lower and flow velocity of renal artery was higher in the lymphocele group compared with the control group. Multivariate logistic regression revealed that postoperative hemoglobin <95 g/L (odds ratio = 2.01; 95% confidence interval, 1.01-4.05; P = .03) was an independent risk factor and hypothermic machine perfusion (odds ratio = 0.27; 95% confidence interval, 0.08-0.96; P = .04) was a protective factor for the determination of lymphocele. Comparisons of related complications indicated that drainage tube and urinary catheter removal times were longer and urinary tract infection and moderate to severe anemia proportions were higher in the lymphocele group. Follow-up data showed that postoperative 1-month serum creatinine was higher and 1-month estimated glomerular filtration rate was lower in lymphocele group compared with the control group, but no significant differences were shown at 12 months.

CONCLUSIONS

Postoperative hemoglobin may be a risk factor and hypothermic machine perfusion may be a protective factor for lymphocele after kidney transplant. Lymphocele only temporarily affects short-term kidney function, especially during hospitalization.

Are migrants diagnosed with a trauma-related disorder at risk of premature mortality? A register-based cohort study in Denmark

Background

Mental illness is common among refugees displaced by conflict and war. While evidence points to the relatively good health in terms of longevity of migrants resettled in the destination country, less is known about the mortality of the most vulnerable migrants with a trauma-related diagnosis alone and those with an additional comorbid psychotic disorder. This study aimed to provide an overview of the number and mortality of foreign-born individuals diagnosed with Post-Traumatic Stress Disorder or Enduring Personality Change after a Catastrophic Event (PTSD/EPCACE), a psychotic disorder or both.

Methods

A nationwide register-based cohort study, including residents in Denmark, followed from 1 January 1995 to 31 December 2016. The exposure was PTSD/EPCACE and psychotic disorders as well as region of origin. Relative all-cause mortality was estimated using Cox proportional hazards regression models and calculated for migrants with one or both groups of disorders compared to those from the same region without the disorder.

Results

During the study period, 6,580,000 individuals (50.4% women) were included in the cohort. Of these 1,249,654 (50.5% women) died during follow-up. For men and women from the former Yugoslavia, the Middle East and Northern Africa, a PTSD/EPCACE diagnosis alone or with comorbid psychotic disorder was not associated with increased mortality after adjusting for region of origin. A psychotic disorder alone, however, was associated with an increased mortality rate.

Conclusion

Despite the severity of many refugees' traumatic experiences, a diagnosis of a trauma-related psychiatric disorder did not appear to increase the mortality rates.

Partnership trajectories and their consequences over the life course. Evidence from the German LifE Study

OBJECTIVE

Following a life course perspective, this study examines the link between partnership trajectories and three dimensions of psychological well-being: psychological health, overall sense of self-worth and quality of life.

BACKGROUND

Assuming that life outcomes are the result of prior decisions, experiences and events, partnership histories can be seen as a resource for psychological well-being. Furthermore, advantages or disadvantages from living with or without a partner should accumulate over time. While previous cross-sectional research has mainly focused on the influence of partnership status or a status change on well-being, prior longitudinal studies could not control for reverse causality of well-being and partnership trajectories. This research addresses the question of how different patterns of partnership biographies are related to a person's well-being in middle adulthood. Selection effects of pre-trajectory well-being as well as current life conditions are also taken into account.

METHOD

Using data from the German LifE Study, the partnership trajectories between ages of 16 and 45 are classified by sequence and cluster analysis. OLS regression is then used to examine the link between types of partnership trajectories and depression, self-esteem and overall life satisfaction at age 45.

RESULTS

For women, well-being declined when experiencing unstable non-cohabitational union trajectories or divorce followed by unpartnered post-marital trajectories. Men suffered most from being long-term single. The results could not be explained by selection effects of pre-trajectory well-being.

CONCLUSION

While women seem to 'recover' from most of the negative effects of unstable partnership trajectories through a new partnership, for men it was shown that being mainly unpartnered has long-lasting effects on their psychological well-being.

Work-family trajectories in young adulthood: Associations with mental health problems in adolescence

During young adulthood, several transitions in work and family lives occur, but knowledge of the work-family trajectories of the current generation of young adults, i.e. people born in the 1990s, is lacking. Moreover, little is known about whether the mental health status before the start of the working life may shape work-family trajectories. We used 18-year follow-up data from the TRAILS cohort study of individuals born between 1989 and 1991 (n = 992; 63.2% women). Internalising and externalising problems were measured with the Youth Self-Report at ages 11, 13 and 16 years. Monthly employment, education and parenthood states were recorded between 18 and 28 years. Applying sequence analysis, we identified six work-family trajectories in women and men. The first five trajectories were labelled: long education, continuous education and work, education and work to work, early work, and inactive. The main difference between trajectories of women and men was in the timing of parenthood, thus the remaining trajectory of women was labelled active with children, and the remaining trajectory of men active. Women who experienced externalising problems in adolescence were more likely to belong to the trajectory characterised by parenthood. Men who experienced internalising problems in adolescence were more likely to belong to the trajectory characterised by a long time spent in education. The TRAILS data allowed us to consider timing, duration and ordering of the work and family states in young adulthood, and to use multiple assessments of mental health in adolescence. Further research needs to examine the mechanisms through which early mental health affects later work and family outcomes.

Gendered work-family life courses and late-life physical functioning: A comparative analysis from 28 European countries

Combining work and family roles can have beneficial consequences on health but could also result in chronic stress and adverse health outcomes at older ages. This study aimed to examine combined employment, parenthood, and partnership histories of men and women during the childbearing period (ages 15-49), and to investigate the links of these work and family roles with physical functioning later in life. We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with retrospective information on employment, parenthood, and partnership histories for 18,057 men and 20,072 women (n = 38,129) living in 28 different countries belonging to six European welfare clusters. We applied multichannel sequence analysis (MCSQA) and hierarchical clustering to group work-family trajectories into 12 clusters for men and 15 clusters for women. We assessed the association between work-family life courses and grip strength by estimating multivariable linear regression models. Delayed work and family transitions, unstable employment, and the absence of combinations of work and family roles between age 15 and 49 were associated with weaker grip strength in later life for both men and women. Results differed by gender and were framed by the welfare context in which gendered work and family responsibilities unfold across individual life courses. The findings make an important contribution to the domain of gender and health in later life and stress the need to engage more with issues related to the mechanisms linking work and family trajectories to poor health in later life.