Temporary employment and antidepressant medication: a register linkage study

Trends in the use of benzodiazepine receptor agonists among working-age adults in Belgium from 2004 to 2018

Introduction

The use of psychotropics, such as benzodiazepine receptor agonists (BzRAs), among working-age adults in Belgium has shown educational differences. However, it is unclear how work status plays a role in this relationship. Therefore, this research aims to investigate whether work status explains observed educational differences in BzRA use. In addition, considering medicalisation processes, where non-medical factors, such as work status, are increasingly associated with medical mental health care-seeking behavior, this research also aims to investigate whether work status explains observed educational differences in BzRA use, regardless of mental health status.

Methods

Data are obtained from the Belgian Health Interview Survey (BHIS). Four successive waves are covered: 2004, 2008, 2013, and 2018. The weighted data represent a sample of 18,547 Belgian respondents aged 18 to 65 years old. Poisson regression models are used to analyze the research aims. Time evolutions are plotted using marginal means postestimation.

Results

The average use of BzRAs shows a slight decline over the waves studied (2004 = 5.99, 2008 = 5.88, 2013 = 5.33, 2018 = 4.31). Educational and work status differences in BzRA use are observed, regardless of mental health status. Individuals with longer education report lower use compared to individuals with shorter education, and individuals who are unemployed, (pre-)retired, or sick or disabled report higher use compared to employed individuals. Furthermore, work status acts as a mediator, partially explaining educational differences in BzRA use, regardless of mental health status.

Discussion

Work-related uncertainty leads to increased prescribing and medication use, regardless of mental health. Medicalisation and pharmaceuticalisation processes detach social problems from their social roots and treat them as personal failures. The marginalization of the social roots of unemployment, sick leave and involuntary (pre-)retirement has led to a personalization of responsibility. Negative feelings arising from such work statuses may cause isolated, non-specific symptoms for which medical treatment is sought.

Gender Gap in Mental Health during the COVID-19 Pandemic in South Korea: A Decomposition Analysis

The economic and social effects of the COVID-19 pandemic have been widespread but unevenly distributed among genders. The pandemic may have also affected men's and women's mental health differently. This study examined whether the pandemic had stronger adverse effects on women's mental health than on that of men given that the decline of the labor market was greater for women than for men. Using data from South Korea (June/September/December 2020, N = 3000), we investigated the gender gap in mental health during the first year of the COVID-19 pandemic and its association with gender differences in labor market experiences. We employ the Blinder-Oaxaca decomposition method for this analysis. Although depression and anxiety increased among employed women and men during COVID-19, women showed lower levels of mental health than men. A significant portion of this gender gap is explained by women experiencing greater job loss, income reduction, and prohibition of remote work than men. We also find that women in their 30s experienced greater mental health problems than men of the same age even after controlling for other conditions. Overall, our findings show that a greater proportion of employed women than men experienced poor labor market conditions and increased family burdens during the COVID-19 pandemic, which contributed to women reporting worse mental health than men.

Mental illness rates among employees with fixed-term versus permanent employment contracts: a Danish cohort study

PURPOSE

It has been hypothesized that employment in a fixed-term instead of permanent contract position is associated with an increased risk of development of mental health problems. The present study aimed at estimating rate ratios between fixed-term and permanent employees in the Danish labor force, for use of psychotropic drugs and psychiatric hospital treatment due to mood, anxiety or stress-related disorders, respectively.

METHODS

Employment data were drawn from the Danish Labor Force Survey of 2001-2013, which is a part of the European Labor Force Survey. Full-time employed survey participants without mental illness at the baseline interview (N = 106,501) were followed in national health registers for up to 5 years. Poisson regressions were used to estimate rate ratios for redeemed prescriptions of psychotropic drugs and psychiatric hospital treatments due to mood, anxiety or stress-related disease. The analyses were controlled for age, gender, industrial sector, nighttime work, level of education, calendar year, disposable family income and social transfer payments within 1 year prior to the baseline interview.

RESULTS

The rate ratio for hospital diagnosed mood, anxiety or stress-related disorders among employees with fixed-term vs. permanent employment contracts was estimated at 1.39 (99.5% CI 1.04-1.86), while the corresponding rate ratio for redeemed prescriptions of psychotropic drugs was estimated at 1.12 (99.5% CI 1.01-1.24).

CONCLUSION

The present study supports the hypothesis that employment in a fixed-term rather than permanent contract position is associated with an increased risk of developing mental health problems.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR2-10.2196/24392.

Does persistent precarious employment affect health outcomes among working age adults? A systematic review and meta-analysis

OBJECTIVE

To evaluate the impact of persistent precarious employment (lasting 12+ months) on the health of working age adults, compared with more stable employment. Persistent precarity reflects a shift towards less secure forms of employment and may be particularly important for health.

METHODS

Nine databases were systematically searched to identify quantitative studies that assessed the relationship between persistent precarious employment and health outcomes. Risk of bias (RoB) was assessed using an adaptation of the Effective Public Health Practice Project tool. Narrative synthesis and random effects meta-analysis were conducted. Certainty of evidence was assessed using the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Of 12 940 records screened, 50 studies met the inclusion criteria and 29 were included in meta-analyses. RoB was generally high (n=18). The most reported outcome domain was mental health; with evidence also reported relating to general health, physical health,and health behaviours. Of GRADE assessed outcomes, persistent precarious employment was associated with increased risk of poor self-rated health (OR 1.53, 95% CI 1.09 to 2.14, I2=80%) and mental health symptoms (OR 1.44, 95% CI 1.23 to 1.70, I2=65%). The association with all-cause mortality was imprecisely estimated (OR 1.10, 5% CI 0.91 to 1.33, I2=73%). There was very low GRADE certainty across all outcomes.

CONCLUSIONS

Persistent precarious employment is associated with poorer health, particularly for outcomes with short time lags, though associations are small and causality is highly uncertain. Further research using more robust methods is needed but given potential health harms of persistent precarious employment, exploration of precautionary labour regulations and employment policies is warranted.

Fixed-term contract positions, unemployment and mental ill health: a Danish cohort study

Background

Both perceived job insecurity and unemployment has been associated with an increased risk of developing mental ill health. It has, moreover, been proposed that an insecure employment may be as detrimental as unemployment itself.

Objective

To estimate incidence rate ratios (RRs) of (i) redeemed prescriptions for psychotropic drugs and (ii) psychiatric hospital treatment due to mood, anxiety, or stress-related disease, among fixed-term contract workers (as an operationalization of insecure job) vs. unemployed, in the general population of Denmark.

Methods

Data on baseline employment status were drawn from the Danish Labor Force Surveys in the years 2001–2013. Participants (10,265 fixed-term contract workers and 7926 unemployed) were followed for up to 5 years in national registers (2439 cases of psychotropic drug use, 71,516 person years; 311 cases of psychiatric hospital treatment, 86,790 person years). Adjusted RRs were obtained by Poisson regression. We aspired to minimize health selection effects by (i) exclusion of survey participants who received sickness benefits, social security cash benefits, psychiatric hospital treatment or a prescription for psychotropic drugs, within 1-year prior to baseline (n = 11,693), (ii) adjustment for age, gender, level of education, calendar year, disposable family income and maternity/paternity benefits within 1-year prior to baseline.

Results

The adjusted RR for fixed-term contract workers vs. unemployed was 0.98 (99.5% CI: 0.87—1.11) for psychotropic drugs and 0.93 (99.5% CI: 0.67—1.30) for psychiatric hospital treatment.

Conclusion

The present study did not find significant differences in the risk of developing mental ill health between fixed-term contract workers and unemployed, and thus suggests that fixed-term contracts may be as detrimental as unemployment.

Trial registration

International Registered Report Identifier (IRRID): DERR2-10.2196/24392.

Prospective Associations Between Fixed-Term Contract Positions and Mental Illness Rates in Denmark's General Workforce: Protocol for a Cohort Study

BACKGROUND

In 2018, 14% of employees in the European Union had fixed-term contracts. Fixed-term contract positions are often less secure than permanent contract positions. Perceived job insecurity has been associated with increased rates of mental ill health. However, the association between fixed-term contract positions and mental ill health is uncertain. A recent review concluded that the quality of most existing studies is low and that the results of the few studies with high quality are contradictory.

OBJECTIVE

This study aims to estimate the incidence rate ratios (RRs) of psychotropic drug use and psychiatric hospital treatment. These ratios will be considered, first, in relation to the contrast fixed-term versus permanent contract and, second, to fixed-term contract versus unemployment.

METHODS

Interview data with baseline information on employment status from the Danish Labor Force Surveys in the years 2001-2013 will be linked to data from national registers. Participants will be followed up for up to 5 years after the interview. Poisson regression will be used to estimate incidence RRs for psychiatric hospital treatment for mood, anxiety, or stress-related disorders and redeemed prescriptions for psychotropic drugs, as a function of employment status at baseline. The following contrasts will be considered: full-time temporary employment versus full-time permanent employment and temporary employment (regardless of weekly working hours) versus unemployment. The analyses will be controlled for a series of possible confounders. People who have received sickness benefits, have received social security cash benefits, have redeemed a prescription for psychotropic drugs, or have received psychiatric hospital treatment for a mental disorder sometime during a 1-year period preceding baseline will be excluded from the study. The study will include approximately 134,000 participants (13,000 unemployed, 106,000 with permanent contracts, and 15,000 with fixed-term contracts). We expect to find approximately 16,400 incident cases of redeemed prescriptions of psychotropic drugs and 2150 incident cases of psychiatric hospital treatment for mood, anxiety, or stress-related disorders.

RESULTS

We expect the analyses to be completed by the end of 2021 and the results to be published in mid-2022.

CONCLUSIONS

The statistical power of the study will be large enough to test the hypothesis of a prospective association between fixed-term contract positions and mental illness in the general workforce of Denmark.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/24392.

Employment Status Change and New-Onset Depressive Symptoms in Permanent Waged Workers

Background

This study aimed to investigate the relationship between changes in employment status and new-onset depressive symptoms through a one-year follow-up of permanent waged workers.

Methods

We analyzed the open-source data from the Korea Welfare Panel Study. Using the 2017 data, we selected 2,314 permanent waged workers aged 19 to 59 years without depressive symptoms as a base group. The final analysis targeted 2,073 workers who were followed up in 2018. In 2018, there were five categories of employment status for workers who were followed up: permanent, precarious, unemployed, self-employed, and economically inactive. Multiple logistic regression was used to determine the association between employment status change and new-onset depressive symptoms.

Results

Adjusted multiple logistic regression analysis showed that among male workers, workers who went from permanent status to being unemployed (odds ratio: 4.50, 95% confidence interval: 1.19 to 17.06) and from permanent status to being precarious workers (odds ratio: 3.15, 95% confidence interval: 1.30 to 7.65) had significantly high levels of new-onset depressive symptoms compared with those who retained their permanent employment status. There were no significant increases in new-onset depressive symptoms of male workers who went from permanent status to being self-employed or economically inactive. On the other hand, no significant differences were found among female workers.

Conclusion

Our study suggests that the change of employment status to precarious workers or unemployment can cause new-onset depressive symptoms in male permanent waged workers.

Chronic diseases and multimorbidity among unemployed and employed persons in the Netherlands: a register-based cross-sectional study

OBJECTIVES

The first objective of this study was to describe the age-specific prevalence of chronic diseases and multimorbidity among unemployed and employed persons. The second objective was to examine associations of employment status and sociodemographic characteristics with chronic diseases and multimorbidity.

DESIGN

Data linkage of cross-sectional nationwide registries on employment status, medication use and sociodemographic characteristics in 2016 was applied.

SETTING

Register-based data covering residents in the Netherlands.

PARTICIPANTS

5 074 227 persons aged 18-65 years were selected with information on employment status, medication use and sociodemographic characteristics.

OUTCOME MEASURES

Multiple logistic regression analysis and descriptive statistics were performed to examine associations of employment and sociodemographic characteristics with the prevalence of chronic diseases and multimorbidity. The age-specific prevalence of six common chronic diseases was described, and Venn diagrams were applied for multimorbidity among unemployed and employed persons.

RESULTS

Unemployed persons had a higher prevalence of psychological disorders (18.3% vs 5.4%), cardiovascular diseases (20.1% vs 8.9%), inflammatory diseases (24.5% vs 15.8%) and respiratory diseases (11.7% vs 6.5%) than employed persons. Unemployed persons were more likely to have one (OR 1.30 (1.29-1.31)), two (OR 1.74 (1.73-1.76)) and at least three chronic diseases (OR 2.59 (2.56-2.61)) than employed persons. Among unemployed persons, psychological disorders and inflammatory conditions increased with age but declined from middle age onwards, whereas a slight increase was observed among employed persons. Older persons, women, lower educated persons and migrants were more likely to have chronic diseases.

CONCLUSION

Large differences exist in the prevalence of chronic diseases and multimorbidity among unemployed and employed persons. The age-specific prevalence follows a different pattern among employed and unemployed persons, with a relatively high prevalence of psychological disorders and inflammatory conditions among middle-aged unemployed persons. Policy measures should focus more on promoting employment among unemployed persons with chronic diseases.

Construction trade and extraction workers: A population at high risk for drug use in the United States, 2005-2014

OBJECTIVE

To estimate prevalence of past-month marijuana, cocaine, and nonmedical prescription opioid (NPO) use and determine employment-related correlates of drug use among construction trade/extraction workers (CTEW).

METHODS

We analyzed ten years of data (2005-2014) from 293,492 adults (age≥18) in the National Survey on Drug Use and Health, comparing CTEW and non-CTEW.

RESULTS

CTEW were 5.6% (n = 16,610) of the sample. Compared to non-CTEW, CTEW were significantly more likely to report past-month marijuana (12.3% vs. 7.5%), cocaine (1.8% vs. 0.8%), and/or NPO use (3.4% vs. 2.0%; Ps<.001). Among CTEW, past-week unemployment and working for >3 employers was associated with increased odds of marijuana and NPO use. Missing 1-2 days in the past month because the participant did not want to go into work was associated with increased odds for use of marijuana, cocaine, and NPO use. Missing 3-5 days of work in the past month because sick or injured was associated with double the odds (aOR = 2.00 [95% CI: 1.33-3.02]) of using NPO. Having written drug policies was associated with reduced odds for cocaine use, and workplace tests for drug use during hiring and random drug testing were also associated with lower odds of marijuana use.

CONCLUSIONS

CTEW are a high-risk population for drug use. Precarious employment is associated with higher prevalence of drug use while some workplace drug policies were associated with lower prevalence. Coupled with reports of high overdose mortality among CTEW, these findings suggest that prevention and harm reduction programming is needed to prevent drug-related morbidity and mortality among CTEW.

Exposure to work stress and use of psychotropic medications: a systematic review and meta-analysis

BACKGROUND

There is good evidence that job stressors are prospectively related to mental health problems, particularly depressive symptoms. This review aimed to examine whether job stressors were also related to use of psychotropic medications.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach, we examined seven electronic databases that indexed literature from a wide range of disciplines. Inclusion criteria were (1) the study included a job stressor or psychosocial working condition as an exposure, and (2) psychotropic medication was an outcome. All effect-size estimates were considered but needed to present either a SE or 95% CIs to be included in meta-analyses. Data were pooled between studies using the relative risk (RR) or odds ratio (OR) and 95% CIs.

RESULTS

There were 18 unique studies with non-overlapping exposures eligible for inclusion in the quantitative meta-analysis. High job demands were associated with a statistically significant increased risk of psychotropic medication use (RR 1.16, 95% CI 1.02 to 1.31). There was also an elevated RR in relation to work-family conflict (RR 1.26, 95% CI 1.03 to 1.48). In studies reporting OR, high job demands were associated with an OR of 1.39 (95% CI 1.06 to 1.71).

CONCLUSIONS

The findings of this review highlight the need for policy and programme attention to reduce harmful exposure to psychosocial job stressors. Health-service use measures should be considered as outcomes and may represent more severe mental health conditions.

Effect of work schedule on prospective antidepressant prescriptions in Sweden: a 2-year sex-stratified analysis using national drug registry data

INTRODUCTION

Depression-related mood disorders affect millions of people worldwide and contribute to substantial morbidity and disability, yet little is known about the effects of work scheduling on depression. This study used a large Swedish survey to prospectively examine the effects of work schedule on registry-based antidepressant prescriptions in females and males over a 2-year period.

METHODS

The study was based on an approximately representative sample (n=3980 males, 4663 females) of gainfully employed participants in the Swedish Longitudinal Occupational Survey of Health. Sex-stratified analyses were conducted using logistic regression. For exposure, eight categories described work schedule in 2008: 'regular days' (three categories of night work history: none, ≤3 years, 4+ years), 'night shift work', 'regular shift work (no nights)', 'rostered work (no nights)', 'flexible/non-regulated hours' and 'other'. For the primary outcome measure, all prescriptions coded N06A according to the Anatomical Therapeutic Chemical System were obtained from the Swedish National Prescribed Drug Register and dichotomised into 'any' or 'no' prescriptions between 2008 and 2010. Estimates were adjusted for potential sociodemographic, health and work confounders, and for prior depressive symptoms.

RESULTS

In 2008, 22% of females versus 19% of males worked outside of regular daytime schedule. Registered antidepressant prescription rates in the postsurvey period were 11.4% for females versus 5.8% for males. In fully adjusted models, females in 'flexible/non-regulated' schedules showed an increased OR for prospective antidepressant prescriptions (OR=2.01, 95% CI=1.08 to 3.76). In males, odds ratios were most increased in those working 'other' schedules (OR=1.72, 95% CI=0.75 to 3.94) and 'Regular days with four or more years' history of night work' (OR=1.54, 95% CI=0.93 to 2.56).

CONCLUSIONS

This study's findings support a relationship between work schedule and prospective antidepressant prescriptions in the Swedish workforce. Future research should continue to assess sex-stratified relationships, using detailed shift work exposure categories and objective registry data where possible.

Temporary work and depressive symptoms in South Korean workers

Background

In many countries, including South Korea, labour market changes have led to an increase in unstable, temporary jobs. There is evidence that workers in such jobs may experience poorer mental health than those in more stable employment.

Aims

To investigate the association between temporary employment and depressive symptoms in South Korean workers.

Methods

We analysed data from the 2010-2014 Korean Welfare Panel Study (KOWEPS). Employment type was categorized into workers paid per day of labour (day labourers), those on short-term contracts (fixed-term workers) and permanent workers. The association between employment type and depressive symptoms, measured using the Center for Epidemiological Studies Depression scale (CES-D 11), was examined using the generalized estimating equation model.

Results

A total of 3756 workers aged 20-59 were included in the 2010 baseline population. Day labourers had the highest mean CES-D 11 score, followed by fixed-term workers and permanent workers. With the day labourer group as reference, fixed-term workers (β: -1.5027, P < 0.001) and permanent workers (β: -2.1848, P < 0.001) showed statistically significant decreases in depression scores.

Conclusions

Compared with day labourers, fixed-term workers and permanent workers had progressively lower depression scores. The findings of this study suggest that mental health inequalities based on employment type exist in South Korea.

The Institutional Foundations of Medicalization: A Cross-national Analysis of Mental Health and Unemployment

In this study, we question (1) whether the relationship between unemployment and mental healthcare use, controlling for mental health status, varies across European countries and (2) whether these differences are patterned by a combination of unemployment and healthcare generosity. We hypothesize that medicalization of unemployment is stronger in countries where a low level of unemployment generosity is combined with a high level of healthcare generosity. A subsample of 36,306 working-age respondents from rounds 64.4 (2005-2006) and 73.2 (2010) of the cross-national survey Eurobarometer was used. Country-specific logistic regression and multilevel analyses, controlling for public disability spending, changes in government spending, economic capacity, and unemployment rate, were performed. We find that unemployment is medicalized, at least to some degree, in the majority of the 24 nations surveyed. Moreover, the medicalization of unemployment varies substantially across countries, corresponding to the combination of the level of unemployment and of healthcare generosity.

Working conditions and psychotropic drug use: cross-sectional and prospective results from the French national SIP study

Prospective studies exploring the associations between a large range of occupational factors and psychotropic drug use among national samples of workers are seldom. This study investigates the cross-sectional and prospective associations between occupational factors, including a large set of psychosocial work factors, and psychotropic drug use in the national French working population. The study sample comprised 7542 workers for the cross-sectional analysis and 4213 workers followed up for a 4-year period for the prospective analysis. Psychotropic drug use was measured within the last 12 months and defined by the use of antidepressants, anxiolytics or hypnotics. Three groups of occupational factors were explored: classical and emergent psychosocial work factors, working time/hours and physical work exposures. Weighted Poisson regression analyses were performed to adjust for covariates. In the cross-sectional analysis, psychological demands, low social support and hiding emotions were associated with psychotropic drug use. Job insecurity for men and night work for women were associated with psychotropic drug use. In the prospective analysis, hiding emotions and physical exposure were predictive of psychotropic drug use. Dose-response associations were observed for the frequency/intensity of exposure and repeated exposure to occupational factors. This study underlines the role of psychosocial work factors, including emergent factors, in psychotropic drug use. Prevention policies oriented toward psychosocial work factors comprehensively may be useful to reduce this use.

Employment status and mental health care use in times of economic contraction: a repeated cross-sectional study in Europe, using a three-level model

INTRODUCTION

Framed within the recent economic crisis, in this study we investigate the medical mental health care use of the unemployed compared with that of the employed in Europe, and whether the relationship between employment status and mental health care use varies across macro-economic conditions. We examine whether the macro-economic context and changes therein are related to mental health care use, via their impact on mental health, or more directly, irrespective of mental health.

METHODS

We use data from three waves of the Eurobarometer (2002, 2005/2006, and 2010), which has a repeated cross-sectional and cross-national design. Linear and logistic multilevel regression analyses are performed with mental health, contacting a general practitioner, and contacting a psychiatrist for mental health problems as dependent variables. The multilevel design has three levels (the individual, the period-country, and the country), which allows us to estimate both longitudinal and cross-sectional macro-effects. The macro-economic context and changes therein are assessed using national unemployment rates and growth rates in Gross Domestic Product (GDP).

RESULTS

The mean unemployment rate is negatively related to mental health, although for women, this effect only applies to the employed. Among women, no relationship is found between changes in the macro-economic context and mental health. The unemployment rate, and changes in both the unemployment rate and the real GDP growth rate, are associated with men's care use, regardless of their mental health, whereas this does not hold for women. In countries with an increase in the unemployment rate, both unemployed and employed men tend to medicalize their problems more by contacting a general practitioner, irrespective of their mental health, while the likelihood of contacting a psychiatrist is lower among employed men.

CONCLUSIONS

Our findings stress the importance of taking the macro-economic context and changes therein into account when studying the mental health care use of unemployed people compared with the employed, in particular among men. Moreover, it is important to make the distinction between primary and specialized medical care use, as the impact of macro-economic conditions is dependent on the type of care, which also applies when controlling for mental health.

Psychological distress in the workforce: a multilevel and longitudinal analysis of the case of regulated occupations in Canada

Background

This study uses a multidimensional theoretical model to evaluate the role of regulated occupations and working conditions in explaining psychological distress.

Methods

Various multilevel regression analyses were conducted on longitudinal data for which measures repeated over time (n₁ = 36,166) were nested in individuals (n₂ = 7007).

Results

Results showed that when we controlled for working conditions, family situation, the social network outside the workplace, and personal characteristics, the level of psychological distress was significantly lower among professional workers in regulated occupations than among professionals not in regulated occupations. Among the working conditions studied, skill utilisation, psychological demands, and job insecurity were positively associated with psychological distress levels, whereas social support in the workplace was inversely related to distress. Finally, our results suggest that self-esteem reduced the effect of social support in the workplace on psychological distress levels in the workforce.

Conclusions

These results support our hypothesis that working in regulated occupations exerts a direct effect on mental health. These results also make clear the importance of developing new tools for measuring psychological distress among upper-level professional workers. Such tools will be much better suited to the realities characterising today's knowledge-based economies.

Body mass index, blood pressure, and glucose and lipid metabolism among permanent and fixed-term workers in the manufacturing industry: a cross-sectional study

BACKGROUND

Temporary employment, a precarious form of employment, is recognized as social determinant of poor health. However, evidence supporting precarious employment as a risk factor for health is mainly obtained from subjective data. Studies using objective clinical measurement data in the assessment of health status are limited. This study compared body mass index (BMI), lipid and glucose metabolism, and health-related lifestyle factors between permanent workers and fixed-term workers employed in the manufacturing industry.

METHODS

Data of 1,701 male manufacturing industry workers <50 years old in Japan were collected and analyzed. Anthropometric data were BMI, calculated using measured height and weight of study participants, and blood pressure. For lipid metabolism, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels were determined. For glucose metabolism, fasting plasma glucose and hemoglobin A1c (HbA1c) levels were measured. Multiple regression analysis adjusted for age and lifestyle factors was performed.

RESULTS

BMI was significantly higher in permanent workers (22.9 kg/m2) compared with fixed-term workers (22.4 kg/m2). The leaner population (BMI < 18.5) was greater among fixed-term workers (8.3%) compared with permanent workers (4.0%), whereas the overweight population (BMI ≥ 25.0) was greater among permanent workers (21.4%) compared with fixed-term workers (18.1%). Although fixed-term workers tended not to be overweight, regression analysis adjusted for age and lifestyle factors suggested that fixed-term employment was significantly associated with higher blood pressure (systolic β = 2.120, diastolic β = 2.793), triglyceride (β = 11.147), fasting blood glucose (β = 2.218), and HbA1c (β = 0.107) compared with permanent workers (all p < 0.01).

CONCLUSIONS

Fixed-term workers showed more health risks, such as poorer blood pressure and lipid and glucose metabolism, even when adjusted for age and lifestyle variables, although BMI of fixed-term workers were lower than permanent workers. Precarious work might contribute to a deteriorating health status even among less overweight populations.

Antidepressant use and associations with psychosocial work characteristics. A comparative study of Swedish and Danish gainfully employed

BACKGROUND

Although depression is common, prevalence estimates of antidepressant use among the workforce and undisputed evidence relating psychosocial work characteristics to depression is scarce. This study cross-sectionally assesses the prevalence of antidepressant use among employed in Sweden and Denmark and prospectively examines associations between work characteristics and antidepressant use.

METHODS

Data on work demands, influence and learning possibilities was collected 2005-2006 from two representative samples of employed aged 20-59 years from Sweden (n=4351) and Denmark (n=8064) and linked to purchases of antidepressants through national prescription drug registries. Standardized 12-month prevalences were calculated. Cox regressions on work characteristics and incident use were performed separately and estimates pooled.

RESULTS

Employed Swedish residents had higher standardized prevalence than Danish, 6.0% compared to 5.0%. Working fast and conflicting demands were associated with incident use when estimates were pooled, but adjustment for baseline health attenuated these estimates. Emotionally disturbing situations were related to any incident use, and more strongly to use >179 defined daily dosages/year, even after adjustment for various covariates.

LIMITATIONS

Statistics based on national prescription drug registries are influenced by, e.g., treatment seeking behaviours and other reasons for prescription than depression. Selective drop-out may also affect prevalence estimates.

CONCLUSIONS

The study indicates that use of antidepressants among the workforce is relatively high and that employed Swedish residents had higher prevalence of antidepressant use than Danish. Relationships between work characteristics and antidepressant use were, however, similar with emotional demands showing the strongest association, indicating that particular groups of employees may be at increased risk.

Exploring the association between social capital and depressive symptoms: results of a survey in German information and communication technology companies

OBJECTIVE

This study examines the association between social capital at work and depressive symptoms in employees.

METHODS

Data for this cross-sectional study were collected through an online survey with the full population of employees from six companies in the German information and communication technology sector (response rate: 58.4%). A multivariate logistic regression analysis was performed.

RESULTS

Results of data from a total of 328 employees suggest that, after controlling for sociodemographic factors, health awareness, and job strain, lower levels of perceived social capital at work are associated with the experience of depressive symptoms (OR = 0.76; 95% CI: 0.64-0.90).

CONCLUSIONS

Our findings suggest that characteristics of high social capital at work, such as an established environment of trust and a sense of common values and convictions, could be an essential resource for preventing depressive disorders.

Working conditions and psychotropic medication: a prospective cohort study

PURPOSE

To examine whether work arrangements, physical working conditions and psychosocial working conditions are associated with subsequent mental health problems, measured by prescribed psychotropic drugs.

METHODS

Data on working conditions collected among 40-60-year-old employees of the City of Helsinki, Finland (N = 6,498) were linked with the register of prescribed medication. Purchases of antidepressants (ATC class N06A), sleeping pills and sedatives (N05B and N05C), and any psychotropic drugs during a 5-year follow-up were examined. Current users and those with regular use of psychotropic drugs during the past 3 years were excluded, leaving 5,786 respondents for analysis.

RESULTS

Working overtime was associated with purchases of sleeping pills among men but otherwise the associations between work arrangements and psychotropic medication were negligible. Desktop work was associated with purchases of sleeping pills among women. Among psychosocial working conditions, high self-assessed mental strenuousness and job dissatisfaction were consistently associated with purchases of antidepressants, sleeping pills and any psychotropic drugs. The strongest association was found for job dissatisfaction, which increased the risk of antidepressant purchases by 24% per one standard deviation increase in job dissatisfaction. The results for men were largely similar, with high mental strenuousness and job dissatisfaction, and poor workplace climate showing the strongest associations, particularly with antidepressant purchases.

CONCLUSIONS

Adjustment of work environments by reducing mental strenuousness and improving job satisfaction might help in prevention of mental health problems that account for a major part of the disease burden among employees.

Gender and age disparities in the associations of occupational factors with alcohol abuse and smoking in the French working population

BACKGROUND

This study assessed the associations of short-term employment, physical and psychological occupational demands, and job dissatisfaction with alcohol abuse (using the Audit-C test) and daily smoking among working French men and women in different age groups.

METHODS

The sample included 13,241 working people, 18-29, 30-39, and 40-59-years-old, randomly selected in France and interviewed by phone. Occupation, type of employment, physical demands, psychological demands, job dissatisfaction, gender, age, educational level, and income were considered. Data were analyzed with logistic models.

RESULTS

Alcohol abuse affected 20.4% of men and 7.5% of women; smoking 32.1% and 24.2%, respectively. Their patterns of association with the occupational factors varied with gender and age. Job dissatisfaction was the leading factor among young men (adjusted odds ratio for alcohol abuse and smoking: 1.71 and 2.02), whereas short-term employment was the leading factor among young women (1.69 and 1.58), this pattern being reversed in older generations. The pattern of associations of physical and psychological demands with outcomes is more complex, but overall psychological demands were more important for women (especially the younger ones) than men, especially for smoking (OR>1.6). Smoking within 5 min after waking was much more common among male and female smokers with these occupational factors, suggesting a potential dependency.

CONCLUSIONS

Workers with short-term employment and occupational demands are subject to a higher risk for alcohol abuse and smoking with high gender and age disparities. Gender and age should be considered when designing measures to prevent substance abuse related to occupation.

Job stress and mental health of permanent and fixed-term workers measured by effort-reward imbalance model, depressive complaints, and clinic utilization

OBJECTIVES

The number of workers with precarious employment has increased globally; however, few studies have used validated measures to investigate the relationship of job status to stress and mental health. Thus, we conducted a study to compare differential job stress experienced by permanent and fixed-term workers using an effort-reward imbalance (ERI) model questionnaire, and by evaluating depressive complaints and clinic utilization.

METHODS

Subjects were permanent or fixed-term male workers at a Japanese research institute (n=756). Baseline data on job stress and depressive complaints were collected in 2007. We followed up with the same population over a 1-year period to assess their utilization of the company clinic for mental health concerns.

RESULTS

The ERI ratio was higher among permanent workers than among fixed-term workers. More permanent workers presented with more than two depressive complaints, which is the standard used for the diagnosis of depression. ERI scores indicated that the effort component of permanent work was associated with distress, whereas distress in fixed-term work was related to job promotion and job insecurity. Moreover, over the one-year follow-up period, fixed-term workers visited the on-site clinic for mental concerns 4.04 times more often than permanent workers even after adjusting for age, lifestyle, ERI, and depressive complaints.

CONCLUSIONS

These contrasting findings reflect the differential workloads and working conditions encountered by permanent and fixed-term workers. The occupational setting where employment status was intermingled, may have contributed to the high numbers of mental health-related issues experienced by workers with different employment status.

Effort-reward imbalance and its association with health among permanent and fixed-term workers

Background

In the past decade, the changing labor market seems to have rejected the traditional standards employment and has begun to support a variety of non-standard forms of work in their place. The purpose of our study was to compare the degree of job stress, sources of job stress, and association of high job stress with health among permanent and fixed-term workers.

Methods

Our study subjects were 709 male workers aged 30 to 49 years in a suburb of Tokyo, Japan. In 2008, we conducted a cross-sectional study to compare job stress using an effort-reward imbalance (ERI) model questionnaire. Lifestyles, subjective symptoms, and body mass index were also observed from the 2008 health check-up data.

Results

The rate of job stress of the high-risk group measured by ERI questionnaire was not different between permanent and fixed-term workers. However, the content of the ERI components differed. Permanent workers were distressed more by effort, overwork, or job demand, while fixed-term workers were distressed more by their job insecurity. Moreover, higher ERI was associated with existence of subjective symptoms (OR = 2.07, 95% CI: 1.42-3.03) and obesity (OR = 2.84, 95% CI:1.78-4.53) in fixed-term workers while this tendency was not found in permanent workers.

Conclusions

Our study showed that workers with different employment types, permanent and fixed-term, have dissimilar sources of job stress even though their degree of job stress seems to be the same. High ERI was associated with existing subjective symptoms and obesity in fixed-term workers. Therefore, understanding different sources of job stress and their association with health among permanent and fixed-term workers should be considered to prevent further health problems.

[The contribution of work and other social determinants to the onset of psychotropic drug use among workers in Canada]

OBJECTIVES

This study aims to examine the contribution of work and other social determinants to the onset of psychotropic drug use among workers over an 8-year period.

METHODS

The study is based on a secondary analysis of the longitudinal data of the National Population Health Survey (NPHS) of Statistics Canada carried out between 1994-1995 and 2002-2003. A panel of 7,338 people aged 15 to 55 and employed at cycle 1 was selected. To establish the incidence rate, we included those participants identified at cycle 1 as not using psychotropic drugs. Overall, 7,020 people in 1,347 local communities did not use psychotropic drugs at cycle 1 and constituted the group at risk in the study. Discrete time survival multilevel regression models were used.

RESULTS

The onset of psychotropic drug use was estimated at 3.5% over the 8-year period studied. With the exception of the number of hours worked, occupations and other work characteristics measured in the NPHS do not show a significant contribution. Being a woman, age, physical health, smoking and stressful childhood events support an increased risk of psychotropic drug use, whereas certain personality traits decreased the risk of psychotropic drug use.

CONCLUSIONS

The work factors measured in the NPHS seem to play a limited role in the incidence of psychotropic drug use. More research is needed to better capture patterns of workers' psychotropic drug use over time.

Work-related stress and psychosomatic medicine

This article introduces key concepts of work-related stress relevant to the clinical and research fields of psychosomatic medicine. Stress is a term used to describe the body's physiological and/or psychological reaction to circumstances that require behavioral adjustment. According to the Japanese National Survey of Health, the most frequent stressors are work-related problems, followed by health-related and then financial problems. Conceptually, work-related stress includes a variety of conditions, such as overwork, unemployment or job insecurity, and lack of work-family balance. Job stress has been linked to a range of adverse physical and mental health outcomes, such as cardiovascular disease, insomnia, depression, and anxiety. Stressful working conditions can also impact employee well-being indirectly by directly contributing to negative health behaviors or by limiting an individual's ability to make positive changes to lifestyle behaviors, such as smoking and sedentary behavior. Over the past two decades, two major job stress models have dominated the occupational health literature: the job demand-control-support model and the effort-reward imbalance model. In both models, standardized questionnaires have been developed and frequently used to assess job stress. Unemployment has also been reported to be associated with increased mortality and morbidity, such as by cardiovascular disease, stroke, and suicide. During the past two decades, a trend toward more flexible labor markets has emerged in the private and public sectors of developed countries, and temporary employment arrangements have increased. Temporary workers often complain that they are more productive but receive less compensation than permanent workers. A significant body of research reveals that temporary workers have reported chronic work-related stress for years. The Japanese government has urged all employers to implement four approaches to comprehensive mind/body health care for stress management in the workplace: focusing on individuals, utilizing supervisory lines, enlisting company health care staff, and referring to medical resources outside the company. Good communications between occupational health practitioners and physicians in charge in hospitals/clinics help employees with psychosomatic distress to return to work, and it is critical for psychosomatic practitioners and researchers to understand the basic ideas of work-related stress from the viewpoint of occupational health.

[Chronic psychotropic drugs use in the Canadian labor force: what are the contributions of occupation and work organization conditions?]

BACKGROUND

This study aims to better understand the contributions of occupation and work organization conditions to the development of chronic psychotropic drugs use among workers in Canada.

METHODS

The study is based on a secondary analysis of the longitudinal data of the National Population Health Survey (NPHS) of Statistics Canada which includes five cycles from 1994-1995 to 2002-2003. A panel of 6585 people from 15 to 55 years old and employed at cycle 1 and nested in 1413 neighbourhoods was selected. Multilevel models of regression were estimated on three levels: repeated measures (level 1=24,785 observations) were nested in the individuals (level 2=6585 individuals) and the individuals nested in the local communities (level 3=1413 neighborhoods).

RESULTS

The prevalence of multiple episodes (two episodes and more between cycle 1 and cycle 5) of psychotropic drugs use was 6.7% (95%CI=6.0-7.4%). Only occupation and the number of working hours showed a significant contribution. Family and individual variables like marital status and personality traits (locus of control and sense of coherence) had a significant contribution, in addition to time, gender, age, physical health, number of cigarettes and stressful childhood events.

CONCLUSION

Work contributes weakly to the risk of chronic psychotropic drugs use, whereas individual characteristics make a much more important contribution to the phenomenon.

Misclassification and the use of register-based indicators for depression

OBJECTIVE

To study the degree to which depression indicators based on register data on hospital and antidepressant treatment suffer from differential misclassification with respect to gender, age and social group.

METHOD

Data on 7378 persons were obtained by linking a cross-sectional survey of Danish adults aged 40 and 50 years with population-based registers. Misclassification was analysed by comparing survey data to register data on major depression using the method proposed by Rothman and Greenland.

RESULTS

Differential misclassification was found. Adjustment for misclassification reduced women's odds ratios from 2.18 to 1.00 for hospital treatment and from 1.70 to 1.10 for antidepressants. For the lower social group, the corresponding odds ratios increased from 1.18 to 3.52, and from 1.35 to 2.32 respectively, whereas odds ratios with respect to age remained almost unchanged.

CONCLUSION

Differential misclassification should be considered when register-based information about hospital and antidepressant treatment are used as depression indicators.

[Health status of precarious workers in "Toshikoshi Haken Mura (Dispatch Workers' New Year Village)"]

In Japan, the liquidity of employment is progressing rapidly. Due to the global recession which started in 2008, large-scale unemployment of precarious workers, including dispatch workers, is expected in 2009. In recent studies, it has been suggested that the unstable employment status itself may affect the health conditions of such workers. At the end of 2008, "Toshikoshi Haken Mura" (Dispatch Workers' New Year Village) was established in central Tokyo as a shelter for about 500 workers who had lost their jobs and accommodation. We participated in health consultations and medical checkups conducted by the Tokyo Metropolitan Government on January 8-10, 2009 to investigate the health conditions of the "villagers". Eighty-nine people attended health consultations and medical checkups (mean age, 48 yr). Physical complaints in the order of prevalence were as follows: respiratory (cough, 43%; sputum, 36%), low-grade fever (16.9%), musculoskeletal (13.5%), dermal (5.6%), digestive (3.4%), neurological (3.4%) and others including mental complaint (10.1%) such as anxiety, insomnia, and depression. During individual consultations, we found many cases who had had difficulty in getting medical consultations and whose treatment had been discontinued. Moreover, the rate of getting periodic medical examination remained low at 23.8% (among 84 people). Health problems of precarious workers have not been sufficiently recognized; however, there were cases whose poor health was indeed related to unstable employment. Studies on the health effects of temporary work should have higher prioritizes in the occupational health field.