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

How do labour market conditions explain the development of mental health over the life-course? a conceptual integration of the ecological model with life-course epidemiology in an integrative review of results from the Northern Swedish Cohort

BACKGROUND

The aim of this study was to contribute to the theoretical development within the field of labour market effects on mental health during life by integrating Bronfenbrenner's ecological model with mainly earlier theoretical work on life-course theory.

METHODS

An integrative review was performed of all 52 publications about labour market conditions in relation to mental health from the longitudinal Northern Swedish Cohort study. Inductive and deductive qualitative content analysis were performed in relation to Bronfenbrenner's ecological framework combined with life-course theories.

RESULTS

The following nine themes were identified: 1. Macroeconomic recession impairs mental health among young people. 2. The mental health effects on individuals of youth unemployment seem rather insensitive to recession. 3. Small but consistent negative effect of neighbourhood unemployment and other work-related disadvantaged on individuals' mental health over life. 4. Youth unemployment becomes embodied as scars of mental ill-health over life. 5. Weak labour market attachment impairs mental health over life. 6. Bidirectional relations between health and weak labour market attachment over life. 7. Macrolevel structures are of importance for how labour market position cause poor health. 8. Unequal gender relations at work impacts negatively on mental health. 9. The agency to improve health over life in dyadic relations. Unemployment in society permeates from the macrolevel into the exolevel, defined by Bronfenbrenner as for example the labour market of parents or partners or the neighbourhood into the settings closest to the individual (the micro- and mesolevel) and affects the relations between the work, family, and leisure spheres of the individual. Neighbourhood unemployment leads to poor health among those who live there, independent of their employment status. Individuals' exposure to unemployment and temporary employment leads to poorer mental health over the life-course. Temporal dimensions were identified and combined with Bronfenbrenner levels into a contextual life-course model CONCLUSION: Combining the ecosocial theory with life-course theories provides a framework for understanding the embodiment of work-related mental health over life. The labour market conditions surrounding the individual are of crucial importance for the embodiment of mental health over life, at the same time as individual agency can be health promoting. Mental health can be improved by societal efforts in regulations of the labour market.

Working life sequences over the life course among 9269 women and men in Sweden; a prospective cohort study

OBJECTIVES

To investigate working life courses in women and men and possible associations with socioeconomic, health-, and work-related factors.

METHODS

A 15-year prospective cohort study of individuals aged 18-50 in paid work at baseline and answering the Swedish Living Conditions Surveys (2000-2003, N = 9269) and their annual economic activity, using nationwide registers. We used sequence and cluster analyses to identify and group similar working life sequences. Multinomial logistic regression was used to examine associations of sex, socioeconomic, health-, and work-related factors with sequence cluster memberships.

RESULTS

We identified 1284 working life sequences, of which 65% represented continuous active (in paid work/studying) states. We then identified five sequence clusters, the largest one with individuals who were continuously active (n = 6034, 65% of the participants; 54% of women and 76% of men) and smaller ones with interruptions of the active state by long-term parental-leave, unemployment, and/or sickness absence/disability pension (SA/DP), or retirement. Women were more likely than men to belong to the "Parental-leave periods" (odds ratio [OR]: 33.2; 95% confidence intervals [CI]: 25.6, 43.1) and the "SA/DP periods" sequence clusters (OR: 1.8; 95% CI: 1.4, 2.1), also after adjustment for covariates. In both sexes, low education and poor health were the strongest predictors of belonging to the sequence cluster "Unemployment & SA/DP periods". Predictors of the "Parental-leave periods" sequence cluster differed between women and men.

CONCLUSIONS

In a cohort of individuals in paid work at baseline, the majority of women and men worked most of each year although women were more likely to have some interruptions characterized by long-term parental-leave or SA/DP periods than men, independently of socioeconomic, health-, and work-related factors.

Glucose Metabolism in Midlife Is Associated With Preceding 30-Year Employment Trajectories: A Northern Finland Birth Cohort 1966 Study

OBJECTIVE

The aim of the study is to evaluate how glucose metabolism in midlife is related to preceding 30-year-long employment trajectories.

METHODS

In the Northern Finland Birth Cohort 1966, we compared glucose metabolism at 46 to employment trajectories (previously defined for men and women and named as high-educated, traditional, self-employed, delayed, and floundering; n = 6399).

RESULTS

Compared with individuals in high-educated trajectories, odds ratios for type 2 diabetes (T2D, 95% confidence interval) in traditional and floundering trajectories in men were 1.65 (1.02-2.68) and 2.42 (1.38-4.23) and in women 1.89 (1.04-3.43) and 2.60 (1.46-4.62), respectively. In self-employed trajectory in women, odds ratios for prediabetes and T2D were 1.66 (1.09-2.51) and 2.47 (1.21-5.04).

CONCLUSIONS

The highest risks for T2D in midlife were associated after traditional and floundering trajectories in men and women and after self-employment trajectory in women.

Employment Pathways during Economic Recession and Recovery and Adult Health

Our study bridges literatures on the health effects of job loss and life course employment trajectories to evaluate the selection into employment pathways and their associations with health in the short and medium terms. We apply sequence analysis to monthly employment calendars from a population-based sample of working-age women and men observed from 2009 to 2013 (N = 737). We identify six distinct employment status clusters: stable full-time employment, stable part-time employment, stably being out of the labor force, long-term unemployment, transition out of the labor force, and unstable full-time employment. After adjustment for sociodemographic characteristics and health at baseline, those who transitioned out of the labor force showed significantly poorer self-rated health at follow-up, whereas steadily part-time employed respondents still showed a greater risk of meeting criteria for major or minor depression. The findings have important implications for how social scientists conceptualize and model the relationship between employment status and health.

Do workers accumulate resources during continuous employment and lose them during unemployment, and what does that mean for their subjective well-being?

Drawing on cumulative advantage/disadvantage and conservation of resources theories, I investigated changes in economic, social, and personal resources and in subjective well-being (SWB) of workers as they stayed continuously employed or continuously unemployed. I considered age, gender, and SES as potential amplifiers of inequality in resources and SWB. Using 28 yearly waves from the German Socio-Economic Panel (SOEP 1985–2012), I conducted multilevel analysis with observations nested within participants. A longer duration of continuous employment predicted slightly higher economic resources and thereby slightly higher SWB over time. A longer organizational tenure had mixed effects on resources and predicted slight reductions in SWB via lower mastery. A longer duration of continuous unemployment predicted marked reductions mainly in economic but also in social resources, which led to modest SWB decreases. Younger workers, women, and workers with higher SES benefited from longer continuous employment and organizational tenure more. At the between-person level, some evidence for self-selection of less resourceful individuals into long-term or repeated unemployment emerged. The highly regulated German labor market and social security system may both dampen the rewards of a strong labor force attachment and buffer against the losses of long-term unemployment.

Employment trajectories until midlife associate with early social role investments and current work-related well-being

Applying social investment theory (SIT), we examined whether employment trajectories until midlife, with differential investments in education and employment, are associated with social investments during early life and with work-related well-being in midlife, with a special reference to potential differences between self-employment and paid work. In the Northern Finland Birth Cohort 1966 (n = 6496; 2963 men, 3533 women), life-history calendars from age 16-45 were used to determine the respondents' yearly employment statuses (student, full-time employee, part-time employee, self-employed, unemployed, on parental leave, on sabbatical leave or otherwise not working). Latent class analysis was used to identify the employment trajectories. The associations of these trajectories with indicators of social investments in early life (mother's attitude to financial self-reliance, father's socioeconomic status, own success at school) and work-related well-being at age 46 (job satisfaction, life satisfaction, absence of retirement thoughts, work engagement, work favoring attitude and perceived job control) were studied using regression models and analyses of variance, adjusting for life situation at age 46. We identified five employment trajectories for both genders: 1) traditional full-time, 2) highly educated, 3) self-employed, 4) delayed full-time and 5) floundering employees. In early life, a mother emphasizing self-reliance in earning one's living was associated with both highly educated and self-employed trajectories. A white-collar father and own success at school preceded a highly educated trajectory. A farmer family background preceded self-employed trajectory. At age 46, highly educated and self-employed trajectories were associated with highest well-being at work, while those floundering perceived their work most negatively. Men in the delayed full-time employment trajectory reported better well-being at age 46 than those constantly floundering. Overall, the macroeconomic employment rates were unevenly reflected in the five trajectories. Our findings support SIT by showing that the employment trajectories most favorable for work-related well-being in midlife are long rooted in social investments during early life and characterized by further social investments in employment, such as higher education and self-employment.

Diverting blame to stay sane - young people's strategies for dealing with the mental health effects of precarious employment: a grounded theory study

BACKGROUND

Precarious employment is a risk factor for poor mental health, particularly among young adults. Knowledge about how young people maintain their mental health while in a precarious employment situation is scarce. The aim of the study was to explore the meaning of precarious employment for young adults in Sweden and their strategies for maintaining good mental health.

METHODS

In-depth interviews were conducted with 15 individuals (9 men and 6 women) aged 20-39 years in a precarious employment situation. Contact persons at union offices and at specific job-coaching organizations collaborating with the Swedish public employment agency in the city of Malmö were gate openers to reach informants. Analysis was based on constructivist grounded theory, implying an emergent design where data collection and analysis go hand in hand.

RESULTS

All informants had completed secondary school in Sweden, and one third had studied at the university level. A majority currently had jobs; however, they were mostly employed on an hourly basis and only a few had temporary full-time jobs. The analysis resulted in a core category "Diverting blame to stay sane," which summarized an emergent coping process involving individual resources and resources represented by the individuals' social capital. The developed theoretical model contained four main categories, "Facing reality," "Losing control," "Adapting," and "Fighting back," related to the core category.

CONCLUSIONS

The results implied a process where the challenges created by loss of employment-based rights required a coping process where the individual's social capital plays an important role. However, social capital is to a large extent determined by contextual factors, underlining the strong health equity aspect of precarious employment.

Is unemployment in young adulthood related to self-rated health later in life? Results from the Northern Swedish cohort

BACKGROUND

Many studies have reported that unemployment has a negative effect on health. However, little is known about the long-term effect for those who become unemployed when they are young adults. Our aim was to examine how unemployment is related to long-term self-rated health among 30 year olds, with an emphasis on how health differs in relation to education level, marital status, previous health, occupation, and gender.

METHODS

In the Northern Swedish Cohort, 1083 teenagers (~16 years old) were originally invited in 1981. Of these, 1001 participated in the follow-up surveys in 1995 and 2007. In our study, we included participants with either self-reported unemployment or activity in the labor force during the previous three years in the 1995 follow-up so long as they had no self-reported unemployment between the follow-up surveys. Labor market status was studied in relation to self-reported health in the 2007 follow-up. Information from the 1995 follow-up for education level, marital status, self-reported health, and occupation were part of the statistical analyses. Analyses were stratified for these variables and for gender. Analyses were performed with logistic regression, G-computation, and a method based on propensity scores.

RESULTS

Poor self-rated health in 2007 was reported among 43 of the 98 (44%) unemployed and 159 (30%) of the 522 employed subjects. Unemployment had a long-term negative effect on health (odds ratio with logistic regression 1.74 and absolute difference estimates of 0.11 (G-computation) and 0.10 (propensity score method)). At the group level, the most pronounced effects on health were seen in those with upper secondary school as their highest education level, those who were single, low-level white-collar workers, and women.

CONCLUSIONS

Even among those becoming unemployed during young adulthood, unemployment is related to a negative long-term health effect. However, the effect varies among different groups of individuals. Increased emphasis on understanding the groups for whom unemployment is most strongly related to ill health is important for future research so that efforts can be put towards those with the biggest need. Still, our results can be used as the basis for deciding which groups should be prioritized for labor-market interventions.

New Business Structures Creating Organizational Opportunities and Challenges for Work Disability Prevention

Purpose Flexible work arrangements are growing in order to develop resource-efficient production and because of advanced technologies, new societal values, changing demographics, and globalization. The article aims to illustrate the emerging challenges and opportunities for work disability prevention efforts among workers in alternate work arrangements. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability," held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a roundtable discussion with experts having direct employer experience. Results Both worker and employer perspectives were considered, and four common alternate work arrangements were identified: (a) temporary and contingent employment; (b) small workplaces; (c) virtual work/telework; and (d) lone workers. There was sparse available research of return-to-work (RTW) and workplace disability management strategies with regard to alternate work patterns. Limited research findings and a review of the grey literature suggested that regulations and guidelines concerning disabled workers are often ambiguous, leading to unsatisfactory protection. At the workplace level, there was a lack of research evidence on how flexible work arrangements could be handled or leveraged to support RTW and prevent disability. Potential negative consequences of this lack of organizational guidance and information are higher costs for employers and insurers and feelings of job insecurity, lack of social support and integration, or work intensification for disabled workers. Conclusions Future studies of RTW and workplace disability prevention strategies should be designed to reflect the multiple work patterns that currently exist across many working populations, and in particular, flexible work arrangements should be explored in more detail as a possible mechanism for preventing disability. Labor laws and policies need to be developed to fit flexible work arrangements.

Interaction Effects of Social Isolation and Peripheral Work Position on Risk of Disability Pension: A Prospective Study of Swedish Women and Men

Purpose

The study examines various combinations of levels of social isolation in private life and peripheral work position as predictors of disability pension (DP). A second aim was to test the potential interaction effects (above additivity) of social isolation and peripheral work position on the future risk of DP, and to provide results for men and women by age.

Method

The study was based on a sample of 45567 women and men from the Swedish population who had been interviewed between 1992 and 2007. Further information on DP and diagnoses was obtained from the Swedish Social Insurance Agency’s database (1993–2011). The studied predictors were related to DP using Cox’s proportional hazard regression. The analyses were stratified on sex and age (20–39 years, 40–64 years), with control for selected confounders.

Results

Increased risks of DP were found for most combinations of social isolation and peripheral work position in all strata. The hazard ratios (HRs) for joint exposure to high degree of social isolation and a peripheral work position were particularly strong among men aged 20–39 (HR 5.70; CI 95% 3.74–8.69) and women aged 20–39 (HR 4.07; CI 2.99–5.56). An interaction effect from combined exposure was found for women in both age groups as well as a tendency in the same direction among young men. However, after confounder control the effects did not reach significance.

Conclusions

Individuals who were socially isolated and in a peripheral work position had an increased risk of future DP. The fact that an interaction effect was found among women indicates that a combination of social isolation and peripheral work position may reinforce adverse health effects. There was no evidence that a peripheral work position can be compensated by a high degree of social intergration in private life.