Lyndall Strazdins

Women, work and musculoskeletal health.

Why are employed women at increased risk for upper limb musculoskeletal disorders and what can this tell us about the way work and family life shape health? Despite increases in womens labour force participation, gender differences in work-related health conditions have received little research attention. This appears be the first study to examine why employed women are much more likely than men to experience upper body musculoskeletal disorders. A mailed self-report survey gathered data from 737 Australian Public Service employees (73% women). The majority of respondents were clerical workers (73%). Eighty one per cent reported some upper body symptoms; of these, 20% reported severe and continuous upper body pain. Upper body musculoskeletal symptoms were more prevalent and more severe among women. The gender difference in symptom severity was explained by risk factors at work (repetitive work, poor ergonomic equipment), and at home (having less opportunity to relax and exercise outside of work). Parenthood exacerbated this gender difference, with mothers reporting the least time to relax or exercise. There was no suggestion that women were more vulnerable than men to pain, nor was there evidence of systematic confounding between perceptions of work conditions and reported health status. Changes in the nature of work mean that more and more employees, especially women, use computers for significant parts of their workday. The sex-segregation of women into sedentary, repetitive and routine work, and the persisting gender imbalance in domestic work are interlinking factors that explain gender differences in musculoskeletal disorders.

Work and health in a contemporary society: demands, control, and insecurity

Objective: To examine independent associations of job strain (high demands and low control) and job insecurity with mental and physical health outcomes. Design: Cross sectional general population study conducted in 2000 using a self completed questionnaire. Setting: Two adjoining cities in south east Australia. Subjects: 1188 employed professionals, aged 40–44 years, 55% (n = 655) male. Main outcome measures: Depression, anxiety, physical, and self rated health (SRH). Results: Adverse job conditions were relatively prevalent as 23% of the sample reported high job strain, while 7.3% and 23% reported high and moderate job insecurity respectively. Associations between job conditions and health persisted after adjustment for gender, education, marital status, employment status, major life events, and negative affectivity (personality). When adjusted for job strain, high job insecurity was independently associated with a greater than threefold increase in odds for poor SRH, depression and anxiety (OR (95% confidence intervals) poor SRH: 3.72 (1.97 to 7.04) depression: 3.49 (1.90 to 6.41), anxiety: 3.29 (1.71 to 6.33)), and a twofold increase for physical health 2.19 (1.21 to 3.95). High job strain also showed significant independent associations with depression: 2.54 (1.34 to.4.75) and anxiety: 3.15 (1.48 to 6.70). Conclusion: In this relatively privileged socioeconomic group, insecure employment and high job strain showed independent, consistent, and strong associations with physical and mental health. These adverse job conditions are on the increase, particularly insecure employment, and the influence of these two work conditions are an important focus for future public health research and their prevalence and impact should be examined in other occupations.

The psychosocial quality of work determines whether employment has benefits for mental health: results from a longitudinal national household panel survey

Objectives Although employment is associated with health benefits over unemployment, the psychosocial characteristics of work also influence health. We used longitudinal data to investigate whether the benefits of having a job depend on its psychosocial quality (levels of control, demands and complexity, job insecurity, and unfair pay), and whether poor quality jobs are associated with better mental health than unemployment. Method Analysis of seven waves of data from 7,155 respondents of working age (44,019 observations) from a national household panel survey. Longitudinal regression models evaluated the concurrent and prospective association between employment circumstances (unemployment and employment in jobs varying in psychosocial job quality) and mental health, assessed by the MHI-5. Results Overall, unemployed respondents had poorer mental health than those who were employed. However the mental health of those who were unemployed was comparable or superior to those in jobs of the poorest psychosocial quality. This pattern was evident in prospective models: those in the poorest quality jobs showed greater decline in mental health than those who were unemployed (B = 3.03, p<0.05). The health benefits of becoming employed were dependent on the quality of the job. Moving from unemployment into a high quality job led to improved mental health (mean change score of +3.3), however the transition from unemployment to a poor quality job was more detrimental to mental health than remaining unemployed (−5.6 vs −1.0). Conclusions Work of poor psychosocial quality does not bestow the same mental health benefits as employment in jobs with high psychosocial quality.

Job Strain, Job Insecurity, and Health: Rethinking the Relationship

Job strain (high demands and low control) is a widely used measure of work stress. The authors introduce a new way of looking at work stress by combining job strain with job insecurity, a combination increasingly prevalent in contemporary economies, using data from a cross-sectional survey (N = 1,188) of mid-aged Australian managers and professionals. Those reporting both strain and insecurity showed markedly higher odds for mental and physical health problems (depression: odds ratio [OR] 13.88, 95% confidence interval [CI] 5.67-34.01; anxiety: OR 12.88, CI 5.12-32.39; physical health problems: OR 3.97, CI 1.72-9.16; and poor self-rated health: OR 7.12, CI 2.81-18.01). Job strain and insecurity showed synergistic associations with health, and employees experiencing both could be at heightened health risk.

Acts of Love (and Work): Gender Imbalance in Emotional Work and Women’s Psychological Distress

Family members do work to meet people’s emotional needs, improve their well-being, and maintain harmony. When emotional work is shared equally, both men and women have access to emotional resources in the family. However, like housework and child care, the distribution of emotional work is gendered. This study examines the psychological health consequences of gender divisions in emotional work. Quantitative and qualitative data from a sample of 102 couples with young children show that the gender imbalance affected women’s, but not men’s, experience of love and conflict in their marriage. Through this erosion of the marriage, the gender imbalance posed a health risk to women and helped explain gender differences in psychological distress. Couples preserved a sense of mutuality by accounting for the gender imbalance as something beyond men’s choice or control, or in terms of women’s excess emotional needs, thus entrenching gender differences in the performance and consequences of emotional work.

The associations between work stress and mental health: A comparison of organizationally employed and self-employed workers

This study examined the associations between work stressors and mental health in organizationally employed and self-employed workers, and with the numbers of general practitioner (GP) services used by these two employment groups. The participants were selected from those already taking part in the PATH Through Life Project, in Australia. A total of 2275 men and women aged from 40 to 44 years participated in a community survey and were in the labour force at the time of the interview. Those who participated entered responses into a hand-held computer under the supervision of an interviewer. A total of 14.2% of the group identified themselves as self-employed. Respondents also provided details of their occupation and the extent to which they experienced work stressors. Some 72.6% of these participants gave consent for information on their use of GP services over a 12-month period to be obtained from national insurance records. We found that self-employed men and women reported more decision authority than the organizationally employed, while self-employed women also had more manageable job demands. Self-employment offered men no health benefit. However, women who were self-employed reported worse physical health than their organizationally employed counterparts. While work stress factors were most likely to be associated with the use of GP services by self-employed men, the use of those services by women was more strongly associated with their experiences of stress in organizational employment. Overall, self-employment was found to be associated with relatively few mental health benefits.

Work demands, job insecurity and sickness absence from work. How productive is the new, flexible labour force?

Background: We investigate one aspect of productivity – sickness absence – and ask whether job insecurity and high work demands are associated with increased sickness absence and, if so, whether mental or physical health mediates this association. We further investigate if having control at work modifies these associations.

Parents’ Nonstandard Work Schedules and Child Well-Being: A Critical Review of the Literature

This paper provides a comprehensive review of empirical evidence linking parental nonstandard work schedules to four main child developmental outcomes: internalizing and externalizing problems, cognitive development, and body mass index. We evaluated the studies based on theory and methodological rigor (longitudinal data, representative samples, consideration of selection and information bias, confounders, moderators, and mediators). Of 23 studies published between 1980 and 2012 that met the selection criteria, 21 reported significant associations between nonstandard work schedules and an adverse child developmental outcome. The associations were partially mediated through parental depressive symptoms, low quality parenting, reduced parent–child interaction and closeness, and a less supportive home environment. These associations were more pronounced in disadvantaged families and when parents worked such schedules full time. We discuss the nuance, strengths, and limitations of the existing studies, and propose recommendations for future research.

The limitations of employment as a tool for social inclusion

BackgroundOne important component of social inclusion is the improvement of well-being through encouraging participation in employment and work life. However, the ways that employment contributes to wellbeing are complex. This study investigates how poor health status might act as a barrier to gaining good quality work, and how good quality work is an important pre-requisite for positive health outcomes.MethodsThis study uses data from the PATH Through Life Project, analysing baseline and follow-up data on employment status, psychosocial job quality, and mental and physical health status from 4261 people in the Canberra and Queanbeyan region of south-eastern Australia. Longitudinal analyses conducted across the two time points investigated patterns of change in employment circumstances and associated changes in physical and mental health status.ResultsThose who were unemployed and those in poor quality jobs (characterised by insecurity, low marketability and job strain) were more likely to remain in these circumstances than to move to better working conditions. Poor quality jobs were associated with poorer physical and mental health status than better quality work, with the health of those in the poorest quality jobs comparable to that of the unemployed. For those who were unemployed at baseline, pre-existing health status predicted employment transition. Those respondents who moved from unemployment into poor quality work experienced an increase in depressive symptoms compared to those who moved into good quality work.ConclusionsThis evidence underlines the difficulty of moving from unemployment into good quality work and highlights the need for social inclusion policies to consider peoples pre-existing health conditions and promote job quality.

The health effects of jobs : Status, working conditions, or both?

Background: This study investigates whether the association of job strain and insecurity with health differs by status.