Being accommodating in the workplace: could it help close the disability employment gap? 

In 2020, 8.4 million people of working age (16-64) reported that they were disabled which is 20% of the working age population. 52 percent of disabled people aged 16-64 were in work compared with  81 percent of non-disabled people. It’s a gap the Department for Work and Pensions wants to tackle, but good research for evidence-based policy solutions in this area is thin on the ground. New research from Tarani Chandola and Patrick Rouxel suggests that ‘workplace accommodations’ such as flexible or part-time working, mentorship and training and support could help the Government achieve its 10 year ambition to halve the disability employment gap.

In its 2017 policy paper Improving lives: the future of work, health and disability, the DWP committed to seeing the number of  disabled work in work rise by 1 million from 3.5 to 4.5 million over the subsequent 10 years. 

When we talk about the disability employment gap we mean the difference between the number of people with a disability who are in work compared with those without a disability. The gap comes about through people having to leave work through ill-health or the onset of physical or mental health problems whilst working, together with the fact that if you’re disabled, you have considerably lower chances of getting a job in the first place. The large majority (83 percent) become disabled whilst they are in work and once they do the likelihood of them being in work a year later is much reduced.

There has been little research in this area, particularly when it comes to looking at all this in the round in order to get the bigger picture as it relates to all workers who use some sort of work place accommodation or adjustment to how, where and when they carry out the role. In order to make sound policy recommendations that work for disabled people and employers, the Government has been looking to develop a more comprehensive evidence base. 

Rather than starting with a person’s medical condition, we thought it could be useful to examine which workers (no matter the state of their health) are able to access e.g. a technical solution that means they can fulfil a role they otherwise wouldn’t be able to, as well as a range of flexible arrangements such as working hours, modified duties, being based at home, having access to a mentor. 

We wanted to try to establish who and how these arrangements and adaptations help to remain in work.

Barriers faced

We made use of information on more than 6,000 participants from the Life Opportunities Survey , which looks specifically at the barriers disabled people face in participating in various aspects of life including work. 

Around a third of the people we looked at who were in work reported some sort of impairment – a problem with their sight, hearing, mobility, pain, breathing, learning mental health or with a range of other conditions and disability-related issues. They were more likely to be out of work a year later than peers with no impairment, particularly if their impairments were to do with mobility or dexterity in which case they were three times more likely to be unemployed.

Workers with some sort of impairment or disability who had modified work duties or hours were more likely to remain economically active (in work or looking for work) than those who reported no such accommodations.

Modifications

A modified work area or equipment led to workers being twice as likely to stay in work. Indeed the more modifications reported, the more likely workers with an impairment were to be in work one year later.

Particularly noteworthy was how true this was for workers with mental impairments. Those who had no workplace accommodations were over 2/3rds (or 70 percent) less likely to remain in work than workers with no mental impairment.

This stark gap closed where two or more accommodations were reported. Also interesting was the fact that people with mental impairments were considerably less likely than those who reported physical pain to report an increase in their workplace accommodations. 

Looking at the wider picture of who accesses work accommodations and why, the main reason was not actually related to disability at all, but with having caring responsibilities.

The key things we learn from all this are that despite the evidence that workers with mental impairments could benefit considerably from workplace accommodations, they are less likely to have their workplace adjusted to take account of it.

This is something that could be a focus for policymakers and employers looking to close the disability employment gap. It should be especially helpful in informing managers and supervisors who have a crucial role in creating healthy and inclusive workplaces where all can thrive and progress. 

The role of workplace accommodations in explaining the disability employment gap in the UK is research by Tarani Chandola and Patrick Rouxel and is published in Social Science & Medicine.

Youth unemployment and later mental ill-health: who is at risk?

The pandemic has brought links between unemployment and mental health to the fore. With joblessness having risen across the globe, new research looking at the longer-term effects is particularly timely. Liam Wright and colleagues from UCL’s Department of Epidemiology and Public health describe new research which could motivate efforts to target vulnerable groups and use resources efficiently.

We have known for some time that unemployment has a detrimental effect on mental health. And we know, too, that these effects can last for many years. A large body of research tells us those who have a spell out of work when young are more likely to suffer from poor wellbeing, depression and anxiety even decades later. 

It’s particularly useful to study these effects through the lens of youth unemployment, for two main reasons. First, unemployment rates are higher for those under 25 and recessions have a disproportionate effect on them. Second, unemployment at this formative stage of life may have a greater impact than unemployment later on: it can affect the way young people see themselves and can set off ‘chains of risk.’

Negative experiences during youth can have a measurable impact on our responses to stress, and that this can have a lifelong effect on our physical and mental health.

But until now we don’t know much about the reasons behind these links, or about whether these impacts were experienced differently by different groups of people. By learning more about these things, we should be able to direct resources more effectively to those who are likely to need extra help.

We decided to look at whether unemployment had a stronger association with later mental health for some individuals than others using a statistical technique called quantile regression. We also looked at whether the association was stronger for those with longer unemployment spells, was larger in men or women, and whether later employment success (which is thought to explain the association) was associated with relatively better mental health.

Mental health

We used data from Next Steps, formerly the Longitudinal Study of Young People in England, which followed a cohort of English school children who were aged 13 and 14 in 2003-4. The group were followed up to the age of 25– by that stage, there were 7,700 in our sample.

The mental health of the participants was measured at age 25 using the General Health Questionnaire or GHQ-12, a screening tool which can pick up mood and anxiety disorders and which scores them on a 36-point scale of seriousness – with 36 the most serious. We also took account of whether the respondents had a disability, their mental health during adolescence, as well as how they saw their general physical health.

We were able to compare these health scores with the employment status of the young people, focusing on those who had been unemployed for six months or more around the ages of 18 to 20 – this took place between 2008-10 and coincided with the global financial crisis, after which youth unemployment rose significantly.

We took account of a range of other factors such as gender, ethnicity, neighbourhood deprivation, educational attainment at age 25 and risk-taking behaviours such as drug-taking, alcohol, smoking and anti-social behaviour.

The results supported our key hypothesis that the association between youth unemployment and later mental health was driven by a relatively small proportion of formerly unemployed individuals who had very poor levels of mental health. Our model suggested that among a set of hypothetical individuals with average characteristics, more than 30 per cent of those who had been unemployed more than six months would have GHQ scores over 15 on the 36-point GHQ scale; 10 percentage points more than those who had not.

These effects could be seen even among those who were employed by age 25, and there was some evidence that the association was greater for men than for women.

Who’s at risk?

Our findings support and extend our existing knowledge, and they also pose questions: who are the individuals most at risk? We know men are more vulnerable in this respect than women, though this may be in part due to the greater likelihood that they are seeking work as opposed to looking after children, for example. But do men suffer more in economic, as opposed to mental health, terms?

We might also look at whether certain personality traits can help or hinder the wellbeing of those who find themselves unemployed while young. For example, does it help to feel that one has control over one’s own destiny, rather than taking a more fatalistic approach?

And we might look, too, at the mechanisms through which scarring takes place. Could unemployment while young affect people’s neuro-behavioural development? Or should we focus more on the ways in which an early spell of unemployment can cause problems later in the jobs market?

The answers to these questions could help us to identify vulnerable groups more accurately, and to point towards policy solutions which could potentially reduce these scarring effects in the future.

Heterogeneity in the Association Between Youth Unemployment and Mental Health Later in Life: A Quantile Regression Analysis of Longitudinal Data from English Schoolchildren, is research by  Liam Wright, Jenny Head and Stephen Jivraj of the Department of Epidemiology and Public Health, University College London, and is published in BMJ Open (http://dx.doi.org/10.1136/bmjopen-2020-047997).

Could having a psychologically demanding job actually be good for you?

Recent research has highlighted that those in psychologically demanding jobs which don’t offer possibility of control are more likely to become ill or to leave the labour market early. But a new study carried out in Sweden suggests the picture may be more complex than previously thought – for some workers, having a demanding job can be associated with good outcomes. Kristin Farrants from the Karolinska Institutet outlines what she and colleagues found and what it might mean for extending people’s working lives.

Governments across the developed world are interested in exploring how people can be enabled to extend their working lives. And a key part of that discussion has focused on how working conditions affect the likelihood that workers will stay on longer.

We know from earlier research that the working environment can affect how people feel about working into later life – if they are in jobs which are demanding but which don’t give them much control, they tend to want to leave. But until now we didn’t know much about what actually happened – do those intentions turn into reality? And what is the relationship between the demands of the job and the amount of control the worker has, when it comes to working after the usual retirement age?

We used nationwide register data from Statistics Sweden, to study all the 55-64 year-olds living and working in Sweden in December 2001. We followed up the same individuals 11 years later, in 2012, to see whether they were still working.

As predicted, we found that those who were in jobs with low levels of control in 2001 were less likely to be in paid work in 2012, while the reverse was true for those with a high level of control over their work tasks.

But when it came to how demanding the job was, the picture was more nuanced. Overall, those with more demanding jobs were less likely to have old-age pension, sick-leave benefits, or social assistance, 11 years on, than those with less demanding jobs, while those with low-demand, low-control jobs were less likely than others to carry on working.

Women and men

But there were significant differences between women and men. We found that when it came to control at work, women who had a high level of control over their work tasks were more likely to stay on in paid work, even if their jobs were not very demanding. For men, this was only the case if their jobs were both high-demand and high-control.

A possible explanation for these gender differences is that the jobs market in Sweden is highly gendered: perhaps the difference is in the type of jobs men and women do, rather than in the level of control or stress they have. It could also be due to differences in other factors, such as family needs, income or health.

Our findings support the underlying theory, which was first proposed in the 1970s by Robert Karasek. His Job Demand Control Model suggests it is high demands in combination with low control that leads to stress which can be bad for our health. Karasek’s model suggests that it is not stress, per se, which makes us ill – it is the mismatch between being asked to do a lot and yet not feeling in control of how we do it. So if our jobs are very demanding yet we feel we are in the driving seat, that makes a big difference to us.

Staying in paid work

Why does this matter? Across the developed world we have falling birth rates and increasing life expectancy – so it’s important to governments that people stay in jobs rather than retiring early. And if workers can stay healthy, this will be easier to achieve.

We already know that low levels of control are associated with high levels of disease, disability and sick leave. But the evidence about the role of job demands has been more equivocal.

Our research adds new depth to the picture. High-stress jobs are not necessarily bad; in fact a demanding job can be a positive factor in older people’s lives. Jobs which stretch and challenge us can keep us moving on in the labour market – and as well help us stay healthy.

Associations between combinations of job demands and job control among 616,818 people aged 55-64 in paid work with their labour market status 11 years later: a prospective cohort study, by Kristin Farrants, Jenny Head, Elisabeth Framke, Reiner Rugulies and Kristina Alexanderson, is published in International Archives of Occupational and Environmental Health .

Lockdown – just how stressful has it been?

2020 is a year many will be happy to see the back of. It has been a stressful time for sure with periods of lockdown creating major challenges for our day to day work and family lives. But have the stresses and strains associated with lockdown affected the mental health of the UK population as a whole? Tarani Chandola and colleagues have been using specially collected COVID19 data to investigate.

On March 23, the UK found itself in its first lockdown, a direct result of rising infection rates and deaths caused by the pandemic. The new normal for many was working from home whilst trying to homeschool children. The weekly shop involved queues and masks and social distancing. Getting a doctor or dentist appointment or scheduled medical treatment took on a whole new dimension. Trips to the pub, cinema and theatre were things people could no longer look forward to and looking out for elderly relatives and friends became more important and challenging in equal measure.

Gradually through the Summer months, many of these restrictions were eased and the majority of children returned to school. Businesses including pubs, gyms and hairdressers were able to re-open albeit with strict social distancing and hygiene measures in place.

The severity of the restrictions combined with the direct effects of the disease itself created what might be described as a perfect storm of increased potential stresses likely to adversely affect the mental health of people everywhere. Most of us will have felt fearful about catching the disease, and many will have experienced additional worries for already vulnerable family and friends. The realities of working at home brought its own challenges while for others being furloughed or losing their job brought additional anxiety. 

Although there have been widespread reports of worsening mental health and wellbeing through the first UK lockdown, there have also been some reports that this eased somewhat through April and May although not back to pre-pandemic levels.

COVID-19 data

In our research, which made use of data from Understanding Society including its specially-collected COVID-19 study, we were able to look across a slightly longer period of time at the experiences of between 13,000 and 17,000 people in the UK. These were people who had been involved in the survey for many years, so there was a great deal of background information available as a backdrop for our research. 

We wanted to see whether more people were reporting struggling with mental health problems and to what extent the prevalence of problems was directly related to the stresses and strains of lockdown and the pandemic specifically. We also wanted to see if, after the initial ‘shock’ of events in April eased in subsequent months as people began to adapt and ‘get used to’ their new circumstances.

Between April and July study participants were asked a range of questions directly related to the disease itself including whether they had had it, been tested for it or experienced symptoms. There were also questions about any other health treatment, their families, work and money- related concerns such as struggling to pay the bills.

Every month people were asked about their work status so we could see for example  who was employed, self-employed, working reduced hours, furloughed or been made redundant. They were also asked about hours spent on childcare and homeschooling or whether they felt lonely.

Common mental disorder

Before lockdown just under 25 per cent of people in the UK had experienced mental health issues and this rose to just over 37 per cent in April, so more than a third of the population. There was a gradual dropping off of cases through to July (just under 26 per cent) taking things almost back to pre-lockdown levels. 

The percentage of new cases of mental health problems among participants in April was double (around 28 percent) what it was in the preceding 12 months.

And recovery rates from a mental health issue dropped from pre-lockdown months through April to June but picked up again in July, by which time social restrictions had been eased considerably and, our research shows, potential stressors around COVID itself, juggling work and family responsibilities and health, business and money concerns had decreased for most.

The number of people who reported having some sort of health limiting condition and having to cancel or postpone medical treatment halved from April to July. Over the same period, the number of self-employed people who said their business had been adversely affected also went down from 3.6 percent to 0.6 percent. Employees who reported being made unemployed or being on reduced hours also more than halved and there was only a small increase in the proportion of people describing themselves as ‘economically inactive’. 

Rates of reporting ‘often feeling lonely’ went down from 8.8 to 6.7 percent and fewer people reported having to spend more than 16 hours a week on childcare or homeschooling although there was a small increase in the proportion of people spending 1-15 hours on those tasks.

For some people, problems with paying bills remained an issue throughout the period,  although the percentage of people who said they found things very difficult financially or who said the future looked bleaker financially reduced somewhat from April onwards. 

Which stresses affected people most?

The strongest link between lockdown related stress was loneliness. People in the survey who reported ‘often feeling lonely’ were 11 to 16 times more likely to have mental health problems from the April to July compared to those who never felt lonely. Other important stressors were having COVID-19 symptoms and always working from home. 

Self-employed people whose businesses were negatively impacted by COVID-19 were more likely to develop a mental health problem compared to their peers whose businesses were not. And by July, employees who became unemployed, or were made redundant or whose work hours were reduced were over two times as likely to develop a problem compared with those who were unaffected. 

Adults doing16 hours or more a week on childcare or home schooling were about 1.4 times more likely to develop a problem compared to those who had no children or did not spend any time on childcare. 

Adults who were finding it quite or very difficult financially were 2.4 times more likely to develop a mental health issue compared to those who were living comfortably. Similarly, adults who expected their future finances to be worse off than now were 1.6 times more likely.

Longitudinal analysis

Our findings from looking at this group of people across April to July are in line with other surveys undertaken by the Office of National Statistics and the UCL COVID-19 study of 90,000 adults. We add to that picture by looking more closely at which stressful circumstances are most likely to drive up incidences of poor mental health during a pandemic of this nature. 

We conclude that despite the lifting of many lockdown conditions by July and a decrease in the levels of many of the psychological and social stressors, these stressors continued to drive poor mental health among people who were lonely and those who were made unemployed or redundant, had financial problems or had childcare or home schooling duties.

As unemployment and redundancy increase in the labour market, an inevitable result of recent events, it will be important to keep monitoring the mental health consequences of unemployment. It is Interesting also to note that employees who were furloughed had about the same levels of mental health problems as employees whose job hours were not affected. This suggests that the government measures to protect jobs also had positive mental health benefits for those employees who were able to keep their jobs albeit in a “furloughed” state.

The mental health impact of COVID-19 and lockdown-related stressors among adults in the UK is research by Tarani Chandola, Cara Booker, Meena Kumari and Michaela Benzeval and  is published in Psychological Medicine

Leaving school: how do work and family transitions affect women’s wealth and wellbeing later on?

How have the early adult lives of a generation of young women who grew up after the war impacted on their lives now? Baowen Xue and Anne McMunn from the ESRC International Centre for Lifecourse Studies at UCL discuss two new papers which look at life satisfaction, mental health and economic wealth among older women. Their findings suggest early marriage and domestic labour are linked to worse outcomes later in life. 

The move out of education into work, marriage and parenthood is a sensitive time for young people and can set the course for their later lives. So which circumstances have turned out to be beneficial, and which have been less so?

We used data from the English Longitudinal Study of Ageing, ELSA, to look for answers to these questions. Our study followed a sample of over-50s who have been interviewed every two years since 2002. A Life history interview was conducted additionally to collect information about their  education, work and family lives.

We identified a group of almost 4,000 women born before 1956 who answered questions on life satisfaction and mental health, and in our second paper a smaller group of just under 1800 for whom income data was also available.

Our hypothesis as we set out on the research was that those who married and had children later, and who therefore tended to have stronger ties to work early on, would have better mental health in later life. This largely proved to be true, though remaining single was not the answer: this group tended to suffer from isolation and loneliness later in life.

We identified six types of transition from education into work and family life: Early marriage and domestic labour, later marriage and domestic labour, later marriage and later work entry, later marriage and early work entry, early work entry and remaining single, and a group whose experiences were mixed and included lone parenthood, marriage with or without children and a mixture of employment types.

Early motherhood and domestic labour

The key finding in our study was that women who took on motherhood and domestic labour at an early stage were more likely to suffer from depression and lower life satisfaction in later life than those who went to work early and married late. Those with mixed histories and those who stayed single and childless were also more vulnerable to poor mental health and low life satisfaction. But those who started work late – often through staying in education – and also married late had the highest life satisfaction and the lowest level of mental illness.

We found that these effects could by and large be linked to socioeconomic status: those from more privileged backgrounds tended to gain higher educational qualifications, to enter work later and to marry later, and that set them on a path to a better quality of life later on. Conversely, those from less privileged backgrounds tended to gain fewer qualifications, to marry earlier and to have a poorer quality of life later.

A second paper, also using ELSA data asked a linked question: how does leaving full-time education and becoming a home-maker at an early stage affect women’s economic wealth later in life?

We took the life histories of just under 1800 women born between 1939 and 1952, and looked at when they left education as well as how their entry into work affected their financial situation in later life. 

We found those who left education early and went straight into domestic roles were four times less likely than their more educated peers to be in the highest household wealth bracket in later life.

Women who started work between the ages of 21 and 24 were 40 per cent more likely to be in professional or managerial jobs than those who left school by age 16 and started work early. They were 53 per cent more likely to be in the top earnings bracket for women of their age and were almost four times more likely to be in the top bracket for total household wealth.

We concluded that the age at which women leave education plays a pivotal role in their later economic, personal and mental wellbeing. For the generation of women who are now pensioners, an early entry into domestic rather than paid labour cast a long shadow, while higher education conferred particular advantages. 

As higher education and later partnership have become the norm for today’s young women, these studies will form a baseline which will one day enable us to see whether their experiences compare or contrast with those of their grandmothers’ generation.

The Long Shadow of Youth: Girls’ Transition From Full-Time Education and Later-Life Subjective Well-Being in the English Longitudinal Study of Ageing is research by Baowen Xue, Penny Tinkler and Anne McMunn and is published in the Journals of Gerontology: Social Sciences

Girls’ transition to adulthood and their later life socio-economic attainment: Findings from the English Longitudinal Study of Ageing is research by BaoWen Xue, Penny Tinkler, Paola Zaninotto and Anne Mc Munn and is published in Advances in Life Course Research.

Anne McMunn and BaoWen Xue are based at the ESRC International Centre for Lifecourse Studies in Society and Health at UCL. Paola Zaninotto works with the English Longitudinal Study of Ageing at UCL and Penny Tinkler is based at the Manchester Institute for Collaborative Research on Ageing.

Working and caring: the mental health toll of combining paid work and childcare during lockdown

Baowen Xue and Anne McMunn from the ESRC International Centre for Lifecourse Studies  at University College London discuss new research showing  that women spent considerably more time than men undertaking housework and childcare during lockdown and the knock on for working parents’ mental health, particularly that of lone mothers. They explain how the analysis adds further weight to the Women’s Budget Group’s calls for a care-led approach to the recovery and say years of progress towards a more gender equal society will be derailed if nothing is done.  

There can rarely have been a more talked about start of the school year than that of 2020. Much has been said about the setbacks to children’s learning and the challenges that have faced parents juggling homeschooling, childcare, housework and working from home during lockdown. The indications from early research into this were that women were tending to bear the brunt of these extra caring responsibilities and that this was likely to have a detrimental effect on their mental health. Now new analysis of specially collected data from the early months of COVID-19 adds further evidence of this.

Lockdown during the COVID-19 pandemic brought with it a host of challenges for us all, not least an almost immediate increase in unpaid care work such as childcare and housework, particularly for families with young children. Research by a team at the Institute for Fiscal Studies confirmed that women continued to spend more time than men doing unpaid care work during lockdown

These early findings prompted major concern from a host of gender equality lobby groups and organisations, not least the Women’s Budget Group, who have called on the Government to prioritise and invest more in care provision to help address these inequalities.

Our research using data collected during the early months of lockdown confirms that women spent much more time on housework and childcare than men. Mental health was worse for the man/woman in a couple where he/she was the only one to adapt or reduce work hours for childcare. This suggests that fairness really matters in this context. 

For single mothers, having to change work patterns to juggle their job responsibilities  with childcare and homeschooling, things were even tougher. They exhibited considerably more symptoms of poor mental health and this finding stayed strong even when we accounted for their mental health pre-lockdown. 

COVID19 data

During April and May, a number of participants from the 40,000 household study Understanding Society took part in a special ongoing COVID19 study. As part of that they were asked a range of questions about how much time they spent each week doing housework and childcare/homeschooling. They were also asked whether they had had to adapt working patterns or reduce working hours due to childcare/homeschooling. On top of this they were asked a range of questions to gauge the state of their mental health.

On average, the women in the study spent about 15 hours per week in April and May doing housework compared with men who spent 10 hours. When it came to caring for the children and doing homeschooling, women spent nearly twice as much time on this as men – 20.5 hours per week in April increasing to 22.5 hours in May. For men the figure was 12 hours per week for each month.

Only 12 percent of working fathers reduced work hours due to caring responsibilities compared with 17 percent of working mothers.

Between couples, women undertook 64 percent of housework and 63 percent of childcare. Where parents were in a couple they tended not to reduce their working hours, although where this did occur it was more likely to be the woman than the man who made the adjustment (21 percent compared with 11 percent).

Continued gender inequality

Although this research is still under peer-review, we don’t anticipate the essential figures changing. The essential message from this research about how badly lockdown is affecting working parents, particularly single mothers, will also stay the same. 

Looking after children all day who would ordinarily be at school, with the additional responsibilities of homeschooling and extra cooking, cleaning and juggling the demands of a job in circumstances that are challenging have, for many, likely led to sleepless nights, lack of exercise, loneliness and feelings of being overwhelmed. It will undoubtedly have put a strain on relationships between couples and within families.

With children back at school, the load will have eased for some, but the stresses and worries of lockdown are by no means over. There are numerous reports of schools sending home whole classes of children to quarantine because of reports of or concerns over COVID cases among teachers and pupils alike. As we write this, cases of COVID19 are rising at an alarming rate, the Government has announced further tightening of restrictions and the coming Autumn and Winter months look challenging for everyone.

Even before the pandemic, our research showed that very little progress was being made towards a fairer division of housework and childcare and that women were still doing the lion’s share of cleaning, cooking and caring for the kids. 

Care-led recovery

The Women’s Budget Group, together with a number of other important voices in the gender equality debate, say a care-led recovery is what’s required in order to redistribute unpaid work between men and women more equally. 

At the launch of their recent report on the issue, the Group’s Dirtector, Dr Mary- Ann Stephenson, commented that a care- led recover will ‘ensure we all have time to care, and time free from care. It will allow men to spend more time with their loved ones and remove the burden of unpaid work from women so that it is shared equally amongst a household. Coronavirus has shown us that the economy is not working but for women the economy has never really worked and this pandemic has highlighted the stark impact it is having on women’s mental health. We can no longer continue this way and expect that women will just bear the brunt. We are the economy and it’s time the economy worked for us.’

At a global level, many concerns are being expressed that progress towards a more gender equal world is being hampered by COVID19. Governments everywhere must recognise that the pandemic is derailing hard fought for improvements and that lone mothers, yet again, are suffering most. Action is needed now to to help people get their lives back on track and keep the gender equality train moving forward. 

Gender differences in the impact of unpaid care work on psychological distress during the Covid- 19 lockdown in the UK is a Pre-Print in SOCARXIV by Dr Baowen Xue and Professor Anne McMunn from the ESRC International Lifecourse Centre in the Department of Epidemiology and Health at UCL. 

Who cares? Looking after mum and dad and links with work and relationships

Who are the ‘sandwich generation’ of people caring for parents while in mid-life? Anne McMunn and colleagues from the UCL Department of Epidemiology and Public Health, along with Age UK, asked whether our working lives and our relationships affect the likelihood that we will take on these roles. Their findings suggest the pool of available caregivers is likely to dwindle as work and relationships change.

Informal caring is a crucial component of social care in the UK – around seven million people care for someone in this way, and as the population ages this is expected to increase to more than 10 million by 2030. It’s been estimated that in a little more than a decade there could be a shortfall of around 160,000 such carers.

There’s been a major increase in the numbers of carers who are aged 50-64 and who are therefore likely to be working at the same time.

So we need to know what factors may make people more likely to become carers. Are those who have often been in part-time work in pole position to step in when the need arises? Are those people more likely to be in stable relationships or not? And to what extent does gender have an influence?

Are you caring for a parent?

We used data from the National Child Development Study, which follows more than 17,400 babies born in a single week in 1958 in Great Britain. They have been questioned throughout their lives on their economic, medical and social circumstances. At age 55 the participants were asked if they were caring for a parent or parent-in-law, providing shopping or transport, housework, financial support or personal care.

The responses were analysed alongside information on the participants’ work lives and relationship status.

We found significant differences between men and women when it came to the ways in which work patterns influenced their likelihood of becoming a carer. For men, those who had entered full-time work early and who had been in work for longer were the most likely group to become carers for the older generation of their family.

For women, longer periods spent in part-time employment were associated with a greater likelihood of caring for a parent at age 55.

But among both men and women, those in long marriages were more likely to be caring for parents or in-laws than those who had remained single or whose relationships had been less stable.

Family-oriented lives

It’s perhaps not surprising that women who spend fewer hours in paid work  are more likely to become carers for older relatives. But why would those who are married be more likely to take on the role than their single siblings? Perhaps those with stable relationships are seen as being more family-minded, or perhaps those who aren’t married tend to be in less family-friendly jobs?

We might also speculate that women who have spent long periods combining paid work with childcare find it ‘makes sense’ for them to look after other relatives. 

We were also surprised to find men with longer-term employment were more likely to provide care compared with men who’d spent fewer years in employment: perhaps these men are perceived within their families as successful and competent providers. And maybe those with long-term, full-time contracts are more able to get flexible working and leave entitlements which allow them to combine work and care. 

We know that women are spending more time in the labour market and in full-time work at the same time as the need for family caring is increasing. We also know that fewer people are in long-term marriages as partnerships become increasingly diverse and varied. 

What are the implications, then, for subsequent generations among whom family forms are more diverse and men’s and women’s working lives are more similar? 

Double-burden

This continued ‘double burden’ has potential implications for the longer-term health and well-being of family caregivers: evidence suggests combining full-time work and adult care is linked with worse health and earlier labour-market exits for women in particular.

Our results suggest the pool of informal caregivers is likely to shrink, just as the pool of potential care recipients is set to increase. And this has important implications for the provision of adult social care in the UK.

Demand for care services is already outstripping supply. This is an important area that should be considered as social care reforms announced in 2017 are rolled out.

Life course partnership and employment trajectories and parental caregiving at age 55: prospective findings from a British Birth Cohort Study, by Anne McMunn, Rebecca Lacey and Elizabeth Webb, is published in Longitudinal and Life Course Studies

Anne McMunn and Rebecca Lacey are at the ESRC International Centre for Lifecourse Studies at UCL’s Department of Epidemiology & Public Health, and Elizabeth Webb works for Age UK.

Older man

Retirement: is it good for your mental health?

Retirement has traditionally been seen as a stressful time, with disruption to routines bringing potential health hazards. Recently this assumption has been challenged – maybe retirement could actually be a relief to many people.  But the evidence so far has been mixed. Now a new study by Maria Fleischmann and colleagues from the renEWL project at UCL suggests there are mental health benefits to retirement – with the biggest gains for those retiring from stressful, unrewarding jobs.  

As working lives get longer and retirement ages rise, policymakers and employers are waking up to financial implications: if employees are less productive or often absent due to ill health as they near retirement, that costs money.

The debate about retirement has centred on whether it’s experienced with a sense of loss or of relief. But could the answer be in the types of jobs people do before they retire? Could that post-retirement dip or boost be dependent on whether those jobs were good, rewarding ones?

Does workers’ mental health in the run-up to retirement, and in the years afterwards, depend to some extent on the type of work they do, and the amount of stress they experience while at work? Surely those who do not enjoy their jobs will benefit more, in mental health terms, from retirement.

Whitehall II Study

We used data from the Whitehall II cohort study, which started in 1985–1988 and which followed more than 10,000 London-based civil servants who were then aged 35-55. They were questioned every two or three years about their working and personal lives, and at some points also had clinical examinations. This long follow-up period allowed us to observe changes in mental health over an exceptionally long period of time.

We looked at a sample of 4,700 people who had retired but who had not been forced to do so for health reasons; who had given information on their work status and who had answered multiple questions on mental health. Two thirds were men.

The participants had been scored on the General Health Questionnaire  mental health scale, which has 30 questions covering depression, anxiety, sleep disturbance and social functioning. They had also answered questions on the psychological and social demands of their jobs, their levels of skill and decision-making authority and how well they felt they were supported by colleagues and superiors.

Positive effects of retirement

For most, retirement brought improvements in mental health, especially in the first three years. Our findings showed a pattern in which there was a steep improvement immediately after retirement, with individuals then settling into a more stable phase.

But these improvements were more pronounced in those who retired from jobs with poorer working conditions. This was particularly the case for those who had stressful or alienating jobs. This was also true for those who lacked support from colleagues and who lacked control over decision-making in their working lives.

The mental health benefits of retirement were not strongly affected by the levels of authority people had at work, or by the breadth of skills they used in their jobs – though those with lower-skill jobs generally had worse mental health.

In our analysis we took into account other factors such as social and economic status, general health, health-related behaviour such as drinking and smoking, age at retirement, relationship status and occupational grade.

The average age of retirement was 60.5 years, and more than three quarters of our sample were married or cohabiting. Four out of 10 worked in the highest – administrative – grade and a similar proportion in the middle – professional or executive – grade. One third had left the civil service before retirement.

In general, these were healthy people – just two per cent took depression medication and 83 per cent had no chronic illness. Almost half had never smoked and less than 10 per cent were dependent on alcohol. Just under half had a normal or low body weight, and their psychological and social working conditions were generally good.

Good jobs are key

So, our study once again confirms that workers in “good jobs” have better mental health. Even though those in less good jobs benefit more from retirement with respect to mental health, this does not close the gap between the two groups.

We believe, on the basis of these results, that employers and policymakers can reduce health care costs through changes in the workplace. In short, if workers have good working conditions early in their careers,  they will reap the rewards later on.

Mental Health Before and After Retirement—Assessing the Relevance of Psychosocial Working Conditions: The Whitehall II Prospective Study of British Civil Servants, is research by Maria Fleischmann, Baowen Xue and Jenny Head, and is published in the Journals of Gerontology: Social Sciences; B Psychol Sci Soc Sci, 2019, Vol. XX, No. XX, 1–11, doi:10.1093/geronb/gbz042

Maria Fleischmann is at the Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1105, The Netherlands.

 

Constriction worker

Is temporary employment bad for your health?

How is the health of those in insecure jobs affected by their working lives? Rachel Sumner and colleagues* have discovered some types of work may be just as strongly linked with poor health as unemployment is.

It’s long been acknowledged that there’s a link between unemployment and poor health. A recent Government Green Paper put it starkly:

“People who are unemployed have higher rates of mortality and a lower quality of life. This is an injustice that we must address.”

But is any job really better than no job? Or could some types of employment actually be linked just as strongly to poor health?

We looked at the issue using data from the Understanding Society study, which took blood samples from more than 4500 people aged between 16 and 64 who were either working or unemployed in 2010 and 2011– we excluded those who were retired, homemaking, not working due to incapacity or in education.

Overall, 7.6 per cent of our sample were unemployed. Amongst the employed, 81.8 per cent were permanently employed, 5.3 per cent were temporarily employed and 12.9 per cent were self-employed.

Health indicators

These samples were used to show whether the study participants had raised levels of fibrinogen or C-reactive protein (CRP), both of which are inflammatory markers and are associated with increased risk of heart disease. Healthy lifestyles decrease CRP levels, while obesity, physical inactivity and smoking increase them.

We compared the levels of these markers in those who were unemployed, permanently employed, temporarily employed and self-employed. We took into account a range of individual, social and health factors which might also influence the levels of these markers.

We didn’t find links between employment status and levels of CRP – but we did find links with fibrinogen.

We looked at how the levels of fibrinogen in different types of employee compared with those who were unemployed. And while those in permanent jobs or self-employed had lower levels of this marker, those in temporary work had similar levels to the unemployed.

So, not all types of work are equally beneficial in health terms – and in particular, temporary work would seem to be linked with worse health than other types. Indeed, in health terms we may actually be just as well off being unemployed as we are in an insecure job.

Why does this matter? It matters because less stable types of employment have grown in recent decades, with many workers employed on fixed-term contracts and experiencing uncertain job conditions. This has already been shown to have negative psychological consequences.

And since the recent global recession, which happened just before our data was collected, both unemployment and temporary employment have expanded. The European Union has a higher temporary employment rate than the OECD average  – 14.2 per cent compared with 11.2 per cent in 2016.

Levels of temporary employment in the UK are lower than the EU average – just six per cent in 2017 and four per cent in 2019  – but temporary employment has become more common since the financial crisis, particularly among young people. The rate of young people in the UK going into precarious employment has already resulted in poorer mental health.

Lessons for policymakers

If temporary employment is associated with an increased risk of mortality then earlier research which has simply compared unemployment with employment has not captured the complexities of the situation.

In conclusion, our findings would suggest there is little difference between the health effects of temporary employment and unemployment, using these particular indicators.  And given the continuing rise of precarious modes of employment across developed countries, this has significant implications for public health. Policymakers should encourage employers to expand the use of permanent contracts.

Unemployment, employment precarity, and inflammation, by Rachel C. Sumner, Rachel Bennett, Ann-Marie Creaven and Stephen Gallagher, is published in Brain, Behavior and Immunity.

Rachel Sumner and Rachel Bennett are based at the School of Natural & Social Sciences, University of Gloucestershire, United Kingdom; Ann-Marie Creaven and Stephen Gallagher are at the Health Research Institute, Department of Psychology, University of Limerick, Ireland.

Young woman sat by window

Are some types of job bad for your mental health? And how can employers ensure poor mental health does not lead to early retirement?

Mental illness is a major cause of early retirement – but do those who are forced to leave work early for this reason get better afterwards? What is the relationship between work stress and mental health? A new study of public sector workers in Finland suggests there is a link – and there are important lessons for employers. Tarani Chandola from the ESRC International Centre for Lifecourse Studies was among the authors of the study.

One way in which we can track the prevalence and level of mental illness is by looking at the use of psychotropic medication – that is, medication which can alter one’s mental state. This group of drugs includes common antidepressants, anti-anxiety drugs and antipsychotic medication. 

If there is a link between work stress and mental illness, then we should expect those forced to leave work for this reason to get better after retirement. So by tracking the levels of psychotropic medication among a group of workers before and after retirement, we could find out the extent to which there was such a link.

We were able to use data from a long-term study of Finnish public sector workers to examine the issue more closely. 

It matters because previous studies have shown an increase in the use of this group of drugs among all those who take disability retirement, particularly those whose retirement was due to mental ill health. Those from higher social classes saw the biggest drop in medication use after retirement, suggesting there are social factors at play here, too.

Global issues

The effect does seem to vary around the globe, though – some studies from Asia found an increase, rather than a decrease, in mental health problems after leaving work. But in Europe, retirement has often been found to be followed by an improvement in both mental and physical health. Retirees have reported sleeping better, feeling less tired and generally feeling a greater sense of wellbeing. 

We were able to use data from the Finnish Public Sector study cohort study, which followed all employees working in one of 10 towns and six hospital districts between 1991 and 2005. The study included participants from a wide range of occupations including administrative staff, cleaners, cleaners and doctors, and they were followed up at four-year intervals regardless of whether they were still in the same jobs. Their survey responses were linked to a register of medication purchases for at least two years before retirement and two years after.

We had information on 2,766 participants who took retirement because of disability. Uniquely, the data included both participants’ use of medication and their perceived levels of work stress. So we were able to ask whether there were differences in this pre and post-retirement effect between those in low and high-stress jobs.

Specifically, we looked at something called effort-reward imbalance – that is, when workers put in too much effort at work but get few rewards in compensation: according to a recent review, this carries an increased risk of depressive illness. 

If our theories were correct, we would see a decline in the use of psychotropic medication after disability retirement, and it would be greatest among those with high levels of effort-reward imbalance. Along with mental illness the other major cause of disability retirement in Finland is musculoskeletal disease, so we categorised our sample in three groups – mental illness, musculoskeletal disease and ‘other.’ Eight out of 10 in the sample were women, and three out of 10 reported high effort-reward imbalance before retirement.

Unsurprisingly, those who retired due to a mental disorder had the greatest increase in psychotropic drug use before retirement. And those who were in high-stress, low-reward jobs had higher levels of medication use than those who were not. But after retirement, there was no difference in psychotropic drug use between those with high vs low effort-reward imbalance. It looked as though stopping work in high stress jobs reduced the need for higher psychotropic medication use among those workers who exited the labour market for mental health reasons.  

Retirement because of musculoskeletal disease or other causes was not associated with any similar link between stress level and psychotropic medication.

Lessons for employers

Our study showed that among people retiring due to mental disorders, those in high-stress, low-reward jobs benefited most from retirement. So it’s likely that they could benefit from the alleviation of work-related stress before retirement, too.

In conclusion, if employers could find ways of reducing the levels of stress suffered by employees suffering from mental ill-health, their early exit from paid employment might be prevented and their working lives might be extended. 

Psychotropic medication before and after disability retirement by pre-retirement perceived work-related stress was published in the European Journal of Public Health, Vol. 0, No. 0, 1–6. 

The other authors were Jaana Halonen, Taina Leinonen, Ville Aalto, Tuula Oksanen, Mika Kivimäki and Tea Lallukka of the Finnish Institute of Occupational Health; Hugo Westerlund and Marianna Virtanen of the Stress Research Institute, Stockholm University; Martin Hyde of the Centre for Innovative Ageing, Swansea University; Jaana Pentti, Sari Stenholm and Jussi Vahtera of the Department of Public Health, University of Turku; Minna Mänty of the Department of Public Health, University of Helsinki; Mikko Laaksonen of the Research Department, Finnish Center for Pension.

These authors also have the following additional affiliations: Jaana Halonen; Stress Research Institute, Stockholm University; Jaana Pentti; Department of Public Health, University of Turku; Minna Mänty; Statistics and Research, City of Vantaa, Finland; Mika Kivimäki, Department of Public Health, University of Helsinki and Department of Epidemiology and Public Health, University College London; Marianna Virtanen, School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu; Tea Lallukka, Department of Public Health, University of Helsinki.