Dualized Labor Market and Polarized Health: A Longitudinal Perspective on the Association between Precarious Employment and Mental and Physical Health in Germany

How our longitudinal employment patterns might shape our health as we approach middle adulthood-US NLSY79 cohort

Recent labor market transformations brought on by digital and technological advances, together with the rise of the service economy since the 1980s, have subjected more workers to precarious conditions, such as irregular work hours and low or unpredictable wages, threatening their economic well-being and health. This study advances our understanding of the critical role employment plays in our health by examining how employment patterns throughout our working lives, based on work schedules, may shape our health at age 50, paying particular attention to the moderating role of social position. The National Longitudinal Survey of Youth-1979 (NLSY79), which has collected 30+ years of longitudinal information, was used to examine how employment patterns starting at ages 22 (n ≈ 7,336) might be associated with sleep hours and quality, physical and mental functions, and the likelihood of reporting poor health and depressive symptoms at age 50. Sequence analysis found five dominant employment patterns between ages 22 and 49: "mostly not working" (10%), "early standard hours before transitioning into mostly variable hours" (12%), "early standard hours before transitioning into volatile schedules" (early ST-volatile, 17%), "mostly standard hours with some variable hours" (35%), and "stable standard hours" (26%). The multiple regression analyses indicate that having the "early ST-volatile" schedule pattern between ages 22 and 49 was consistently, significantly associated with the poorest health, including the fewest hours of sleep per day, the lowest sleep quality, the lowest physical and mental functions, and the highest likelihood of reporting poor health and depressive symptoms at age 50. In addition, social position plays a significant role in these adverse health consequences. For example, whereas non-Hispanic White women reported the most hours of sleep and non-Hispanic Black men reported the fewest, the opposite was true for sleep quality. In addition, non-Hispanic Black men with less than a high school education had the highest likelihood of reporting poor health at age 50 if they engaged in an employment pattern of "early ST-volatile" between ages 22 and 49. In comparison, non-Hispanic White men with a college degree or above education had the lowest likelihood of reporting poor health if they engaged in an employment pattern of stable standard hours. This analysis underscores the critical role of employment patterns in shaping our daily routines, which matter to sleep and physical and mental health as we approach middle adulthood. Notably, the groups with relatively disadvantaged social positions are also likely to be subject to nonstandard work schedules, including non-Hispanic Blacks and people with low education; hence, they were more likely than others to shoulder the harmful links between nonstandard work schedules and sleep and health, worsening their probability of maintaining and nurturing their health as they approach middle adulthood.

The Covid-19 pandemic as an accelerator of economic worries and labor-related mental health polarization in Germany? A longitudinal interacted mediation analysis with a difference-in-difference comparison

Objectives

Labor-related mental health polarization refers to exposure to low-paid employment and unemployment decreasing mental health. Previous research identified economic worries as a key mediator. Against this background, the Covid-19 pandemic is often assumed to have accelerated already existing processes and affected vulnerable populations the most. Our study sought to investigate whether the Covid-19 pandemic accelerated the mediation by economic worries between employment type and mental health.

Method

Using the German Socioeconomic Panel (GSOEP) from 2016 onwards, we created a pre-Covid-19 sample (N = 8266) and a per-Covid-19 sample (N = 7294), with each having a t0 wave (2016/2018) and a t1 wave (2018/2020). We applied the mediational g-formula for longitudinal mediation with exposure-mediator (XM) interaction between employment type (X) and economic worries (M). We decomposed the total effect into a direct, indirect, and interacted effect of employment on mental health and provided a difference-in-difference comparison of the effects.

Results

During the Covid-19 pandemic, economic worries increased, and mental health decreased. However, the mediation by economic worries reduced by approx. 18.0% (e.g., from 35.0% to 28.9%). A decreased indirect effect caused the reduction in mediation, while the direct and interacted effect remained rather stable. We also found stark gender differences towards males having a higher total effect but a lower mediated effect during the Covid-19 pandemic.

Conclusion

Our results highlight that mediators competing to economic worries must have emerged during the Covid-19 pandemic. Such mediators could be the risk of infection at the workplace, the possibility of remote work, and gender-specific mediators. Our study is also the first to extend the mediational g-formula with the difference-in-difference approach. It can be used as a blueprint for researchers interested in evaluating the impact of events, such as the Covid-19 pandemic, on preexisting processes.

To what extent do job insecurity, income satisfaction, and self-rated health mediate the association between low income and presenteeism in Germany? A gendered analysis

PURPOSE

Low income is considered a possible determinant of presenteeism, explained by poor working and living conditions, increased levels of uncertainties and anxiety, and poor health status. We aimed to examine the association between low income and presenteeism by gender and to explain their association using different mediators.

METHODS

A total of 14,299 employees aged 18-65 from the 6th BIBB/BAuA Employment Survey 2012 were used, and mediation analyses with inverse odds weighting stratified by gender were conducted.

RESULTS

Low income was significantly associated with presenteeism for men at a significant level of α < .05 (β: 0.376; 95%-CI 0.148-0.604) and for women at a significant level of α < .10 (β: 0.120; 95%-CI - 0.015-0.255). The total effect (TE) was fully and significantly mediated for women when all mediator-weights were considered, whereas for men the consideration of single mediator-weights led to a full and significant mediation of the association between low income and presenteeism. Self-rated health status and income satisfaction contributed the most to the differences in presenteeism by low income with a proportion mediated of 96.3% (men) and 169.2% (women) for self-rated health and 101.6% (men) and 162.5% (women) for income satisfaction.

DISCUSSION

The results indicated a strong association between low income and presenteeism, in particular for men. Self-rated health and income satisfaction were the most important mediators of this association. The results underline not only the relevance of occupational health management and preventive measures, but also the need of a public debate about employment traditions, possibly resulting in role conflicts among men, and wage equality to prevent presenteeism of low-income earners.

[Working poverty and self-rated health during the COVID-19 pandemic: a comparative study over time using 1995-2021 Socioeconomic Panel data]

BACKGROUND

The working poor are considered a vulnerable group. This study examines whether health disparities between working-poor and non-working-poor workers have worsened in the wake of the COVID-19 pandemic by comparing them over time with earlier periods of economic crisis and social and labor market policy reform.

METHODS

The analyses are based on the Socioeconomic Panel (SOEP, 1995-2020) and the Special Survey on Socioeconomic Factors and Consequences of the Spread of Coronavirus in Germany (SOEP-CoV, 2020-2021). All employed persons aged 18-67 years were considered for the analyses to calculate the risks of poor subjective health due to working poverty using pooled logistic regression by sex.

RESULTS

Subjective health improved during the COVID-19 pandemic. Differences in health between the working poor and those who were not working poor remained relatively constant between 1995 and 2021. Individuals who were more likely to be in working poverty over time had the highest risk of inadequate health. The health disparities associated with the frequency of working poverty increased over time and peaked for both sexes in the pandemic. Significant sex differences were not identified.

DISCUSSION

This study illustrates the social embeddedness of working poverty as a determinant of poor health. In particular, those who were more likely to experience working poverty during their working lives are considered to be particularly vulnerable to inadequate health. Tendentially, the COVID-19 pandemic appears to reinforce this gradient in health.

The Emergence of Precarious Employment as a Determinant of Health in Europe and the Relevance of Contextual Factors: A Critical Research Synthesis

Precarious employment as a determinant of health remains on the rise in Europe, in contrast to the European Pillar of Social Rights. Research in epidemiology, public health, and occupational health research has debated the health impacts of precarious employment. A number of studies have concluded that precarious employment contributes to poor health. More recent research has focused on the contextual influences of the association between precarious employment and health. Accordingly, we argue that the welfare state and the specific institutional arrangements on the national level determine and mediate the extent of the association between precarious employment and health. This research synthesis: (a) debates explanations for the rise of precarious employment in Europe, (b) illustrates how precarious employment has risen in Europe since the 1980s, (c) indicates empirical findings of the association between precarious employment and health in Europe, (d) discusses how research explains between-country differences of the association between precarious employment and health, and (e) presents empirical findings on the contextual determinants of the association between precarious employment and health in Europe.

How Working Conditions, Socioeconomic Insecurity, and Behavior-Related Factors Mediate the Association Between Working Poverty and Health in Germany

Objectives: Aims of this study were to Schmitt (Advances in Life Course Research, 2021, 47: 100402) analyze the association of working poverty with mental and physical health-related quality of life and (Wang and Ford, J Organ Behav, 2020, 41 (9): 895–914) to explain these associations by behavior-related factors (heavy drinking, smoking status, body mass index), socioeconomic insecurity (deprivation in living standards, economic worries), and mental working conditions (effort-reward imbalance, job insecurity).

Methods: A total of 11,500 employees aged 17–67 from the German Socioeconomic Panel (2014, 2015, and 2016) were used, and mediation analyses with inverse odds weighting stratified by gender were conducted.

Results: Working poverty was significantly associated with both outcomes for both genders. Deprivation in living standards contributed the most to differences in mental health, with a mediated proportion of 60.3% (men) and 44.4% (women). Differences in physical health were significantly mediated by inadequate living standards in women, with a mediated proportion of 73.7%, whereas none of the mediators considered were significant in men.

Conclusion: Indicators of socioeconomic insecurity contributed most to the association of working poverty with mental and physical health. Results highlight the relevance of policy initiatives to strengthen the socioeconomic living conditions of the working poor.