Gender career divide and women's disadvantage in depressive symptoms and physical limitations in France

Mind the glass ceiling: The gender gap in how depressive symptoms after age 55 relate to earlier career mobility in CONSTANCES

A substantial body of research has shown an association between career mobility and mental health in later life through health selection and causal processes, with favourable health outcomes associated with upward mobility. However, gender differences in these associations have been largely overlooked, despite evidence of gender inequalities in career opportunities. We use data on individuals aged 55-69 from the CONSTANCES cohort. We examine their current mental health and career trajectories between ages 20-55, reconstructed through a retrospective questionnaire. Using sequence analysis, we identify 11 types of past occupational mobility (upward, downward, stagnant) across a gradient from unskilled to high-skilled occupations. We use nested logistic regression to assess their association with depressive symptoms (CES-D) in men and women separately, controlling for socio-demographic variables and occupational hazards. For both men and women, depressive symptoms are strongly associated with careers involving unskilled jobs, with no difference between directions of mobility. For men, upward mobility into skilled or high-skilled jobs is associated with fewer depressive symptoms compared to a stagnant career. This is not the case for women, for whom upward career mobility to high-skilled jobs is associated with more depressive symptoms compared to stagnation at origin. Our findings show a gendered relationship between mental health in later life and past career mobility and highlight the mental health issues faced by women who break through the glass ceiling. They call for further research into the circumstances of women's careers that challenge their mental health in later life.

Mental health of social media influencers

There is a wide body of research on the effects of social media use on mental health, particularly focusing on young people. However, very little is known about the mental health of social media influencers (SMIs), who also tend to be quite young. This is of growing significance as more of our daily lives is conducted online, and in the context of poor population mental health globally, which declined further as a result of the COVID-19 pandemic. We therefore set out to review the mental health of SMIs and, in the absence of literature on SMIs, drew on other similar but more traditional occupational groups, such as the self-employed, to draw conclusions and identify directions for future research.

Uncertainty in Medical and Dental Students of Pakistan Regarding Their Future Career and Its Major Causes: A Cross-Sectional Study

OBJECTIVES

This study aimed to evaluate the extent of confidence in medical and dental students regarding their careers after being enrolled in their germane institutes and to identify the magnitude of uncertainty in medical and dental students about their careers and the important causes of this uncertainty.

METHODS

This study was conducted among enrolled students in different medical and dental colleges and universities of Pakistan, including the public and private sectors, from March 1 to March 15, 2023. The level of confidence in their career was evaluated using a close-ended questionnaire of a three-point Likert scale developed and tested by the investigators and approved by the Ethical Review Board (ERB) along with the synopsis. Data were managed and analyzed using Microsoft Excel 19 (Microsoft Corporation, USA) and IBM SPSS Statistics for Windows, version 27 (released 2020; IBM Corp., Armonk, New York, United States).

RESULTS

This study included 1,126 students from public and private medical and dental institutes. The majority of participants 965(85.7%) were satisfied with their chosen profession, and 1,042 (92.5%) students believed they could make a positive contribution to society. Out of the total participants, 246 (21.8%) students showed their intention of changing careers if provided with a comparable/alternative opportunity. A very small proportion, 154 (13.7%), were dissatisfied with their current clinical training and studies. The study also revealed that extra and unjustified academic pressure from institutions is the leading cause of uncertainty among students. Moreover, the lack of psychological support and counseling provided during the academic years adds to the magnitude of uncertainty.

CONCLUSION

In Pakistan, a staggering number of medical and dental students are unsure of their future careers and career prospects. The main causes of this uncertainty are the extra, unwarranted academic pressure that institutions place on students and the dearth of psychological support and counseling offered during the course of studies. This study not only highlights the prevailing uncertainty among medical students but also identifies the causes behind it. Addressing these causes can alleviate the prevailing uncertainty and bring about satisfactory and productive academic achievements without suffering from worries about the future.

Comparing the occurrence of chronic physical disorders in self-employed individuals with that of employees: A systematic review

BACKGROUND

A stringent systematic review of population-based observational studies focusing on the physical health of self-employed individuals as a basis for the development of targeted prevention strategies is lacking.

OBJECTIVE

We aimed to systematically evaluate all the studies of good quality that compared the occurrence of chronic physical disorders in self-employed individuals with that of employees.

METHODS

We searched three major medical databases (MEDLINE, Web of Science, Embase) following the Cochrane guidelines. The quality of the studies was rated based on the slightly modified validated assessment tool that was developed by Hoy et al.RESULTS:We included 16 population-based studies of good quality, with data from 15,369,964 participants in total. The two longitudinal evaluations of Swedish national registers with the longest follow-up periods showed increased cardiovascular mortality and incidence estimates of cardiovascular disease in self-employed individuals compared with those of white-collar (i.e., nonmanual) employees but decreased risk estimates compared with those of blue-collar (i.e., manual) workers. The results of the shorter cohort studies were heterogeneous. In cross-sectional studies, prevalence estimates for musculoskeletal, respiratory and malignant diseases were higher among self-employed individuals than among employees.

CONCLUSION

The long-term cardiovascular disease risk and mortality of self-employed individuals seemed to be higher than those of white-collar employees but lower than those of blue-collar employees. As a basis for targeted prevention strategies, further longitudinal studies in different settings are required to better understand the development of physical health disorders for specific self-employment categories such as sole proprietors, small entrepreneurs, family businesses and others.

Can Sex Differences in Old Age Disabilities be Attributed to Socioeconomic Conditions? Evidence from a Mapping Review of the Literature

Old age disabilities are more common among women than men, and adverse socioeconomic conditions are associated with a higher prevalence of disabilities among older adults. The goal of this study was to complete a mapping review of the available evidence assessing the extent to which the observed sex differences in older adults’ disabilities can be attributed to sex differences in socioeconomic status. We searched three databases for articles published between 2009 and 2019, and after screening and looking at eligibility criteria, 6 articles were included in the review. For those studies that did not directly analyse the contribution of socioeconomic conditions, we used the ‘difference method’ to estimate the proportion of the sex gap in disabilities among older adults that could be attributed to socioeconomic conditions. Our review demonstrated that women generally have a higher prevalence of disabilities than men. In several studies, these differences could be partly attributed to sex differences in the distribution of socioeconomic conditions. We also find great elasticity in the magnitude of both the sex gap in disabilities and in the proportion that could be attributed to differences in socioeconomic conditions.

Gender heterogeneity in self-reported hypertension

We investigate the gender gap in hypertension misreporting using the French Constances cohort. We show that false negative reporting of hypertension is more frequent among men than among women, even after conditioning on a series of individual characteristics. As a second step, we investigate the causes of the gender gap in hypertension misreporting. We show that women go to the doctor more often than men do and that they have better knowledge of their family medical history. Once these differences are taken into account, the gender gap in false negative reporting of hypertension is reversed. This suggests that information acquisition and healthcare utilisation are crucial ingredients in fighting undiagnosed male hypertension.

Occupation-Based Life Expectancy: Actuarial Fairness in Determining Statutory Retirement Age

This study examines occupation-based differences in life expectancy and the extent to which health accounts for these differences. Twentyseven-year survival follow-up data were used from the Dutch population-based Longitudinal Aging Study Amsterdam (n = 2,531), initial ages 55-85 years. Occupation was based on longest-held job. Results show that the non-skilled general, technical and transport domains had an up to 3.5-year shorter life expectancy than the academic professions, accounting for the compositional characteristics age and gender. Statutory retirement age could be made to vary accordingly, by allowing a proportionally greater pension build-up in the shorter-lived domains. Health accounted for a substantial portion of the longevity difference, ranging from 20 to 66%, depending on the health indicator. Thus, health differences between occupational domains today can be used as a means to tailor retirement ages to individuals' risks of longevity. These data provide a proof of principle for the development of an actuarially fair method to determine statutory retirement ages.

Occurrence of Mental Illness and Mental Health Risks among the Self-Employed: A Systematic Review

We aimed to systematically identify and evaluate all studies of good quality that compared the occurrence of mental disorders in the self-employed versus employees. Adhering to the Cochrane guidelines, we conducted a systematic review and searched three major medical databases (MEDLINE, Web of Science, Embase), complemented by hand search. We included 26 (three longitudinal and 23 cross-sectional) population-based studies of good quality (using a validated quality assessment tool), with data from 3,128,877 participants in total. The longest of these studies, a Swedish national register evaluation with 25 years follow-up, showed a higher incidence of mental illness among the self-employed compared to white-collar workers, but a lower incidence compared to blue-collar workers. In the second longitudinal study from Sweden the self-employed had a lower incidence of mental illness compared to both blue- and white-collar workers over 15 years, whereas the third longitudinal study (South Korea) did not find a difference regarding the incidence of depressive symptoms over 6 years. Results from the cross-sectional studies showed associations between self-employment and poor general mental health and stress, but were inconsistent regarding other mental outcomes. Most studies from South Korea found a higher prevalence of mental disorders among the self-employed compared to employees, whereas the results of cross-sectional studies from outside Asia were less consistent. In conclusion, we found evidence from population-based studies for a link between self-employment and increased risk of mental illness. Further longitudinal studies are needed examining the potential risk for the development of mental disorders in specific subtypes of the self-employed.

Conditions of existence and subjective perceptions of retirement: quantitative evidence from France

This article explores subjective perceptions of retirement in France, using original quantitative data on the customers of a not-for-profit insurance company. The sample contains individuals aged 40–84, who are either in the labour force (N = 923) or retired (N = 705). Perceptions of retirement are measured using closed questions on views of the retirement transition (these views can be positive, negative or neutral) and definitions of retirement (retirement can be interpreted as a period of freedom, boredom, greater risk of precariousness, etc.). Using a number of different social indicators, we examine whether differences in social conditions translate into heterogeneous perceptions. We also investigate whether social differences in perceptions fade away with increasing age. Both working-age individuals and retirees generally have a positive view of the retirement transition and often define retirement as a period of freedom. Perceptions of retirement are shaped by social conditions: a higher level of education and income, greater wealth, better health and stronger social involvement go hand in hand with rosier perceptions. Moreover, we uncover a strengthening of this social gradient with increasing age. Finally, perceptions are positively correlated with satisfaction in various domains, for retirees.

Gender Differences in Disability and Economic Hardship in Older Europeans

European women live longer, but they experience more old age-related disability than men. Disability is related to social factors, among which is poverty, through various pathways. While women's poverty has been pointed up as a challenge for Europe, our study investigates to what extent and in which countries a greater exposure to economic hardship is associated with older women's disability disadvantage. We used the 2014 EU-SILC data in 30 European countries for men and women aged 50-79 years (N = [1179-17,474]). Disability was measured by self-reported activity limitation and economic hardship by difficulties in "making both ends meet" and "facing unexpected expenses". Country-specific nested logistic regressions measured the women's disability disadvantage and its association with economic hardship. We found that activity limitations and economic hardship varied substantially across Europe, being the lowest in Sweden and Norway. We found gender gaps in activity limitations in 23 countries, always to women's disadvantage. After adjusting for age, this disadvantage was significant in 19 countries. In 11 of these countries, women's excess disability is associated with excess economic hardship in women, especially in Iceland, France, Sweden, and Austria. Women's excess disability and social factors such as economic hardship are linked, even in protective countries. These situations of double disadvantage for women deserve attention when designing policies to reduce health inequalities and to promote healthy ageing.