Occupational Medicine 2005 55(7):568-571; doi:10.1093/occmed/kqi122
© The Author 2005. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Psychosocial work conditions, unemployment and self-reported psychological health: a population-based study
Martin Lindström
Department of Community Medicine, Malmö University Hospital, Lund University, S-205 02 Malmö, Sweden
Correspondence to: Martin Lindström, Department of Community Medicine, Malmö University Hospital, Lund University, S-205 02 Malmö, Sweden. Tel: +46 040 333003; fax: +46 040 336215; e-mail: martin.lindstrom{at}smi.mas.lu.se
 |
Abstract
|
|---|
Aim To investigate the association between psychosocial conditions
at work, unemployment and self-reported psychological health.
Methods A cross-sectional postal questionnaire for the 2000 public health survey in Scania was administered to both working and unemployed people aged 18–64 years. Logistic regression models were used to investigate the association between psychosocial factors at work/unemployment and self-reported psychological health (General Health Questionnaire 12). Psychosocial conditions at work were classified according to the Karasek–Theorell demand–control/decision latitudes into relaxed, active, passive and job strain. The multivariate analyses included age, country of origin, education, economic stress and social participation.
Results A total of 5180 people returned their questionnaire, giving a participation rate of 59%. Fifteen per cent of men and 20% of women reported poor psychological health. Those with high demands and high control (active category), those with high demands and low control (job strain category) and the unemployed had significantly higher odds ratios of poor psychological health compared to those with low demands and high control (relaxed category). Those with low demands and low control (passive category) did not differ significantly from the relaxed category. The associations remained in the multivariate analyses.
Conclusions The study found that certain psychosocial work factors are associated with higher levels of self-reported psychological ill-health and illustrates the great importance of psychosocial conditions in determining psychological health at the population level. As found elsewhere, being unemployed was an even stronger predictor of psychological ill-health.
Keywords Economic stress; psychosocial conditions at work; self-reported psychological health; social participation
|
Introduction
|
|---|
Psychological ill-health is a common and important cause of
chronic health problems in Western societies. Only musculoskeletal
problems have a comparable effect in terms of disability-adjusted
life years. Mental health is a very complex concept and can
be defined in many ways. One strategy is to measure components
such as the presence of anguish, anxiety, headache, persistent
fatigue and sleep disorder. In Sweden, the prevalence of these
symptoms increased among young and middle-aged men and women
between 1988–89 and 1998–99. No corresponding increase
was observed among people aged 65 years. The prevalence of mental
health problems is higher in the unemployed and homeless, and
in those who live in poor neighbourhoods, have financial problems
or were born abroad [
1]. In a study from southern Sweden, mental
health as measured by the General Health Questionnaire (GHQ)
was shown to be significantly associated with age, sex, country
of birth, education and social participation [
2]. There is strong
support for the relationship between unemployment and poor mental
health [
3].
Psychosocial work conditions may affect general mental health at the population level. More than 20 years ago, the demand–control model for the characterization of psychosocial work conditions was introduced by Karasek and Theorell. The original model contains two dimensions. One dimension concerns the worker's control/decision latitude over the work situation in terms of creativity, repetitivity as well as freedom and responsibility to decide what to do and when to do it. The other dimension concerns demands on the worker in terms of work pace, intensity, skills required to be able to do the work and the ability to keep up with colleagues. Four categories can be derived from this model: ‘relaxed’ if control is high and demands are low; ‘active’ if control is high and demands are high; ‘passive’ if control is low and demands are low; and ‘job strain’ if control is low and demands are high [4]. Job strain is positively associated with cardiovascular diseases [5] and low back pain [6]. Psychiatric conditions such as depression and exhaustion have also been reported to be more common among workers with job strain [7,8]. However, the relationship between psychosocial work conditions and mental health has been less investigated at the population level. The aim of this study was to investigate the impact of psychosocial work conditions and unemployment on self-reported psychological health.
|
Methods
|
|---|
The details of the study population from the public health questionnaire
Scania 2000 have been described elsewhere [
9]. The variables
have been defined in previous studies [
2]. The GHQ12 was used
to measure poor psychological health.
Prevalences (%) and odds ratios (ORs) with 95% confidence intervals (CIs) of poor psychological health in the four psychosocial work categories and among the unemployed were calculated according to age, sex, country of origin, education, financial problems and social participation. Crude and adjusted ORs with 95% CI of poor self-reported psychological health were calculated for the psychosocial work categories and unemployment. Statistical analysis was performed using SPSS software (version 11.5).
|
Results
|
|---|
A total of 5180 people returned their questionnaires, giving
a participation rate of 59%. The prevalence of poor psychological
health was 15.2% among men and 19.8% among women.
Table 1 shows
the univariate distributions of the GHQ12 according to psychosocial
work categories and unemployment. The prevalence of poor psychological
health was significantly raised in all categories except the
passive group when compared to the relaxed group, being highest
in the unemployed group and also in those born outside Sweden,
those with financial problems or those with low social participation.
The oldest age group had significantly lower levels of poor
psychological health.
View this table:
[in this window]
[in a new window]
|
Table 1. Prevalences and OR with 95% CI of poor psychological health (GHQ12) according to psychosocial work conditions, unemployment, age, country of origin, education, financial problems and social participation
|
|
Table 2 shows multivariate analysis with adjustment for age,
country of origin, education, financial problems and social
participation. The active and job strain categories and the
unemployed have significantly higher ORs of poor psychological
health compared to the relaxed category even after multivariate
adjustments.
View this table:
[in this window]
[in a new window]
|
Table 2. Crude and adjusted OR with 95% CI of poor psychological health (GHQ12) according to psychosocial work conditions and unemployment
|
|
|
Discussion
|
|---|
Our study found that certain psychosocial work factors are associated
with higher levels of self-reported psychological ill-health
and illustrates the great importance of psychosocial conditions
in determining psychological health at the population level.
As found elsewhere, being unemployed was an even stronger predictor
of psychological ill-health.
Because the GHQ12 measures relative changes in an individual during the past 14 days rather than the absolute level of psychological problems, it could be argued that this is only a relative indication of psychological health. However, even without any absolute point of reference, this argument does not hold at the population level and it seems that a larger proportion of those in the active, job strain and unemployed categories have reported poorer psychological health during the past 14 days than those in the relaxed reference category. The risks of selection bias, misclassification and remaining confounding are relatively small [2].
Psychosocial work conditions may causally affect psychological health [4]. The relaxed category is theoretically the ideal one and is used as the reference. The accumulated psychosocial strain in the job strain situation, i.e. low decision latitude/low control and high demands, may lead to accumulated anxiety which inhibits active learning and social contacts and produces poor psychological health [10], which is supported by this study. The passivity and lack of opportunities to acquire new skills or uphold already acquired skills in the unemployed category most plausibly lead to poor psychological health, a notion also supported by this study. The observation that the passive category does not significantly differ from the relaxed category while the active category has a significantly higher prevalence of poor health suggests that the demands dimension of the model may be more important than the control dimension in determining poor psychological health at the population level.
The findings have implications for prevention because it would appear that measures to improve psychosocial work conditions might affect the psychological health at the population level and the prevalence of poor psychological health.
|
Conflicts of interest
|
|---|
None declared.
|
Acknowledgements
|
|---|
This study was supported by grants from the Avtal om Läkares
Forskning Government Grant Dnr M:B 19 1003/2004, Sweden. The
author wishes to thank Professor Robert Karasek for interesting
and fruitful discussions on several occasions during the summer
of 1999.
|
References
|
|---|
- The National Board on Health and Welfare. Nationella Folkhälsorapporten (The National Public Health Report). Stockholm, Sweden: The National Board on Health and Welfare, 2001;118–136.
- Lindström M. Social capital, the miniaturisation of community and self-reported global and psychological health. Soc Sci Med 2004;59:595–607.
- Kasl SV, Jones BA. The impact of job loss and retirement on health. In: Berkman L, Kawachi I, eds. Social Epidemiology. Oxford: Oxford University Press, 2000; 118–136.
- Karasek R, Theorell T. Healthy Work. Stress, Productivity and the Reconstruction of Working Life. New York: Basic Books, 1990.
- Siegrist J, Peter R, Junge A, Cremer P, Seidel D. Low status control, high effort at work and ischemic heart disease: prospective evidence from blue-collar men. Soc Sci Med 1990;31:1127–1134.
- Kilbom Å, Armstrong T, Buckle P et al. Musculoskeletal disorders: work-related risk factors and prevention. Int J Occup Environ Health 1996;2:239–246.[Medline]
- Kawakami N, Haratani T, Araki S. Effects of perceived job stress on depressive symptoms in blue-collar workers of an electrical factory in Japan. Scand J Work Environ Health 1992;18:195–200.[Web of Science][Medline]
- Stansfeld SA, North FM, White I, Marmot Mg. Work characteristics and psychiatric disorder in civil servants in London. J Epidemiol Community Health 1995;49:48–53.[Abstract/Free Full Text]
- Lindström M. Psychosocial work conditions, social capital and daily smoking: a population-based study. Tob Control 2004;13:289–295.[Abstract/Free Full Text]
- Theorell T. Working conditions and health. In: Berkman L, Kawachi I, eds. Social Epidemiology. Oxford: Oxford University Press, 2000;95–117.
CiteULike 
Connotea 
Del.icio.us What's this?
Top
Abstract
Introduction