Sarah C. Olesen

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.

Mental health affects future employment as job loss affects mental health: findings from a longitudinal population study

BackgroundWorkforce participation is a key feature of public mental health and social inclusion policies across the globe, and often a therapeutic goal in treatment settings. Understanding the reciprocal relationship between participation and mental health has been limited by inadequate research methods. This is the first study to simultaneously examine and contrast the relative effects of unemployment on mental health and mental health on employment status in a single general population sample.MethodData were from working-age respondents (20 to 55 years at baseline) who completed nine waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey (N=7176). Cross-lagged path analyses were used to test the lagged and concurrent associations between unemployment and mental health over time, adjusting for sociodemographic characteristics.ResultsMental health was shown to be both a consequence of and risk factor for unemployment. Thus, the poorer mental health observed amongst people who are not working is attributable to both the impact of unemployment and existing mental health problems. While the strength of these two effects was similar for women, the results for men suggested that the effect of unemployment on subsequent mental health was weaker than the effect of mental health on subsequent risk of unemployment.ConclusionDisentangling the reciprocal links between mental health and workforce participation is central to the development and success of clinical goals and health and social policies that aim to promote either aspect. This study demonstrates that both effects are important and supports concurrent responses to prevent a cycle of disadvantage and entrenched social exclusion.

The role of hardship in the association between socio-economic position and depression.

Objective: It is well established that socio-economic position is associated with depression. The experience of financial hardship, having to go without the essentials of daily living due to limited financial resources, may explain the effect. However, there are few studies examining the link between financial hardship and diagnosable depression at a population level. The current paper addresses this gap and also evaluates the moderating effect of age. Method: Data were from 8841 participants aged 16–85 years in Australia’s 2007 National Survey of Mental Health and Wellbeing. The 12-month prevalence of depressive episode was assessed using the Composite International Diagnostic Interview. Measures of socio-economic position included: financial hardship, education, labour-force status, occupational skill, household income, main source of income, and area-level disadvantage. Results: Financial hardship was more strongly associated with depression than other socio-economic variables. Hardship was more strongly associated with current depression than with prior history of depression. The relative effect of hardship was strongest in late adulthood but the absolute effect of hardship was greatest in middle age. Conclusions: The results demonstrate the critical role of financial hardship in the association between socio-economic disadvantage and 12-month depressive episode, and suggest that social and economic policies that address inequalities in living standards may be an appropriate way to reduce the burden attributable to depression.

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.

Personal factors influence use of cervical cancer screening services: epidemiological survey and linked administrative data address the limitations of previous research

BackgroundNational screening programs have reduced cervical cancer mortality; however participation in these programs varies according to womens personal and social characteristics. Research into these inequalities has been limited by reliance on self-reported service use data that is potentially biased, or administrative data that lacks personal detail. We address these limitations and extend existing research by examining rates and correlates of cervical screening in a large epidemiological survey with linked administrative data.MethodsThe cross-sectional sample included 1685 women aged 44-48 and 64-68 years from the Australian Capital Territory and Queanbeyan, Australia. Relative risk was assessed by logistic regression models and summary Population Attributable Risk (PAR) was used to quantify the effect of inequalities on rates of cervical cancer screening.ResultsOverall, 60.5% of women participated in screening over the two-year period recommended by Australian guidelines. Screening participation was associated with having children, moderate or high use of health services, employment, reported lifetime history of drug use, and better physical functioning. Conversely, rates of cervical screening were lower amongst women who were older, reliant on welfare, obese, current smokers, reported childhood sexual abuse, and those with anxiety symptoms. A summary PAR showed that effective targeting of women with readily observable risk-factors (no children, no partner, receiving income support payments, not working, obese, current smoker, anxiety, poor physical health, and low overall health service use) could potentially reduce overall non-participation in screening by 74%.ConclusionsThis study illustrates a valuable method for investigating the personal determinants of health service use by combining representative survey data with linked administrative records. Reliable knowledge about the characteristics that predict uptake of cervical cancer screening services will inform targeted health promotion efforts.

Prevalence of Self-Management Versus Formal Service Use for Common Mental Disorders in Australia: Findings from the 2007 National Survey of Mental Health and Wellbeing

Objective: To determine the proportion of Australian adults who use non-practitioner led support services and self-management strategies for common mental disorders. Method: Data were drawn from the 2007 National Survey of Mental Health and Wellbeing, a representative survey of 8841 Australian adults aged 16 to 85 years. This survey included the Composite International Diagnostic Instrument to obtain diagnosis of International Classification of Diseases (Version 10; ICD-10) mental disorders. Information about consultations with health professionals for mental health problems and the use of support services and self-management strategies was also collected. Results: Half of all adults who met the criteria for an affective or anxiety disorder in the last 12 months reported using non-practitioner led support services and/or self-management strategies for their mental health problems. Six per cent used support services, including Internet and non-online support groups and telephone counselling, and 51.9% used self-management strategies such as doing ‘more of the things you enjoy’ to ‘help deal with’ their mental health problems. Of people with a 12-month common mental disorder, 24% used support services and/or self-management strategies without additional formal services; 29.3% used both. Of adults with a 12-month affective or anxiety disorder, 37% used neither formal services nor self-management strategies. A substantial proportion of people who reported using self-management strategies for their mental health did not have a diagnosable affective or anxiety disorder. Conclusions: The use of non-practitioner led support services and self-management strategies for mental health problems, with and without adjunct use of formal health services, is widespread in Australia. Future research is needed to investigate why people may select these strategies over formal services, or whether self-management reflects the presence of barriers to use of formal services.

Psychosocial job adversity and health in Australia: analysis of data from the HILDA Survey

Objective: This study examines measures of psychosocial job quality developed from the Household Income and Labour Dynamics in Australia (HILDA) Survey, and reports on associations with physical and mental health.

Socioeconomic differences in antidepressant use in the PATH through life study: Evidence of health inequalities, prescribing bias, or an effective social safety net?

BACKGROUND Depression is more common amongst those who are economically disadvantaged. However there is inconsistent evidence concerning the relationship between socioeconomic position and antidepressant use. Moreover, evidence of greater antidepressant use amongst those of lower socioeconomic position may reflect their greater psychiatric morbidity, a prescribing bias towards pharmacological treatments, or provide evidence of an effective social safety net. This study investigates these issues whilst addressing methodological limitations of earlier studies. METHOD Data were from a large, random community survey of Australian adults (N=4493) with linked administrative data for primary-care service use. Depression was measured using the Patient Health Questionnaire, with other measures of current mental health and history of depression included in analysis. Multiple personal indicators and a combined measure of social disadvantage were considered. A series of analyses systematically examined competing explanations for socioeconomic differences in depression and antidepressant treatment. RESULTS Markers of socioeconomic disadvantage were associated with a greater likelihood of antidepressant use. This finding was not attributable to the higher rates of depression amongst the disadvantaged. A similar pattern of results was evident for non-pharmaceutical treatments (primary care consultations). Socioeconomic position was not associated with use of complementary medications for depression, not covered by Australias social safety net. LIMITATIONS Analysis did not consider specialist mental health services. CONCLUSIONS Socially disadvantaged respondents reported greater antidepressant use and service use after controlling for current depression symptoms. This pattern of findings suggests Australias universal health-care system and social safety net may help address potential inequalities in health care.