Tag Archives: Stress

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

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. 

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.

 

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.

Does caring for others damage your mental health?

This blog is dedicated to the memory of the paper’s lead author, the luminary Allison Milner, whose recent death has left the world a poorer place.

Health work and caring make up a significant proportion of jobs in high-income countries – but how does the mental health of people in those jobs compare with others? And how does the mental health of those in higher-status medical jobs compare with that of those in lower-skilled and lower-paid caring jobs? Tania King and colleagues* at the University of Melbourne turned to a major Australian longitudinal study for answers.

The health and social care workforce is very diverse, encompassing both those with the highest levels of skill and salary and those with some of the lowest. Yet all those workers have one thing in common: they work primarily in jobs which involve caring for others.

This means the emotional demands of the job are high: these workers often experience threats of or actual violence, for instance, and tend to have low levels of control over their work. This has been shown to lead to burnout, high levels of sickness absence and high job turnover.

We used the Household, Income and Labour Dynamics in Australia (HILDA) survey, a nationally representative study which has collected information from more than 13,000 people each year since 2001, to look at three questions:

  • Are job conditions in health and care more stressful than those in other sectors?
  • Do job stressors affect the health of health and care workers more than they affect others?
  • If health and care workers do suffer more than others, is that linked to the type of people who tend to go into that type of work and how they react to stress?

On the first question, we found that overall the working conditions of those in caring and support work jobs – the lower-paid, lower-skilled end of the sector – were worse than those in higher-status medical jobs, with care workers reporting a higher number of stress factors such as high demands, lack of control, job insecurity and perceived unfairness of pay.

Then we looked at workers’ mental health, using a widely recognised scale which assesses respondents’ symptoms of depression and anxiety in the past four weeks, along with more positive feelings such as calmness and happiness.

We found carers and support workers had poorer mental health scores than health workers. They also scored worse when compared to other workers who were not in health, care or other people-facing roles.

Other human service workers, such as hospitality workers, sales staff and personal assistants had worse mental health than those in roles which involved less personal contact. Of the four groups – carers, health workers, human service workers and others – carers had the worst mental health and health workers had the best.

Mental health effects

What were the biggest stress factors for the different groups? We found job insecurity had the greatest effect on all of them. But there were differences, too: In human service jobs, fairness of pay was the second-biggest factor, while in health care professions low control was associated with the second largest decline in mental health.

But we also found differences in the ways in which different groups reacted to stress: When carers and support workers reported three or more different stress factors, that resulted in a three-point decline on the mental health scale when compared to those reporting none. But when health care workers reported three or more stress factors that was associated with a lower, 2.65 point, decline in mental health.

Low-skilled is high-stress?

Our results suggest – perhaps surprisingly, given popular narratives about the stress suffered by senior executives – that lower skilled carers and support workers are more likely to be exposed to stress at work than higher skilled health workers such as doctors and nurses. They also have poorer mental health and a greater adverse reaction to stress.

There is other evidence to show low-income, less-educated workers suffer more from work stress. But our analysis adds another factor – the care workforce we looked at are mainly women with lower incomes and less education than either health workers or our reference group of other workers.

And even when this largely-female, low-status group of carers reports no stress factors at work, its mental health is worse than that of other workers – we found a three-point difference on the mental health scale between carers and either health staff or our reference category of non-health, non-people-facing staff.

Hence, people with lower levels of mental health face an accumulation of health hazards. They are likely to find themselves in stressful jobs which propel them into even worse mental health.

And so to our final question – is the poor mental health of care workers somehow intrinsic to them as people? Our methods enabled us to control for stable (time-invariant) characteristics such as gender, personality or country of birth (called within person effects), as well as things which might change over time, such as age, income and type of employment. The results showed that even after controlling for within person effects, as well as these other factors such as age and income, being exposed to these stress factors had a negative effect on the mental health of care workers.

We concluded that – while it’s important to note that health workers, too, experienced stress and poor mental health – low-quality working environments has a clear effect on the poorer outcomes of carers and support workers.

The impact of these environments does not stop with those who work in them:  this may also have knock-on effects on the quality of care provided. Earlier studieshave shown factors such as anxiety, stress and burnout  among healthcare workers are linked with poorer patient safety, too.

There is a dire need for more investigation into working conditions among health and human service workers. Such research could be critical in informing workplace design, particularly as the number of people employed as health and human service continues to grow. For that workforce to be sustainable, jobs need to be structured to promote health and productivity as well as a high quality of care.

The mental health impacts of health and human service work: Longitudinal evidence about differential exposure and susceptibility using 16 waves of cohort data, by Allison Milner, Tania L. King and Anne Kavanagh, was published in Preventive Medicine Reports, vol 14, June 2019.

Is working flexibly good for your health?

Flexible working is considered good practice – and in England, most workers have the right to apply to work flexibly after they’ve been in their job six months. But what do we know about the benefits? A new study by Tarani Chandola and colleagues used biological measures to look at differences in stress markers among workers with reduced hours and those without.

In recent years many employees have been able to alter their work patterns to fit in with childcare and other responsibilities. Typically, this can mean working part-time, job-sharing, only working during school term-times or working from home some of the time.

It’s assumed this should help to relieve stress. But until now, we didn’t know whether this was necessarily the case. After all, there could be down-sides – for example working at home can mean a blurring of the boundaries between work and family time, part-time working can be a barrier to promotion and job-sharing can bring its own tensions.

Until recently we had to rely on workers’ own reports of how they felt in order to judge this interplay between work, family life and stress. But now a number of social surveys have begun collecting samples which allow us to measure biological changes which can indicate stress, too.

This is known as ‘allostatic load’ – when we’re repeatedly subjected to stress or trauma, this can lead to chronically heightened levels of stress hormones. And that is associated with all sorts of long-term health problems, such as heart disease, type-2 diabetes and depression.

We were able to use data from participants in the Understanding Society study, which began in 2009 and which follows more than 60,000 adults in 40,000 households. As well as responding to detailed questionnaires, many of them have been visited by nurses who have taken physical measurements and blood samples.

Blood-based markers

As well as blood-based markers such as insulin growth factor 1 and cholesterol, their pulse rate, blood pressure and waist-to height ratio were also measured.

After taking out those who weren’t employed, who didn’t have the nurse visits or for whom some measurements were missing, we had a sample of a little over 6,000 people.

All those people had been asked whether flexible working arrangements were available at their workplace, how many hours they worked and whether they were the primary carer for their children.

We categorised working hours into three groups, with different levels for men and women because they tend to have very different working patterns. So women were grouped into those working less than 24 hours per week, more than 25 hours and more than 37 hours; while men were grouped into those working less than 37 hours, 37-40 hours and more than 40 hours.

Unsurprisingly, we found more women than men had made use of flexible working  arrangements – almost no men in our sample were the main carers for two or more children.

Chronic stress

There were particularly high levels of biological chronic stress markers among women with childcare responsibilities who worked more than 37 hours per week. Those with similar childcare responsibilities but working fewer than 25 hours per week didn’t have any measurable effect on their stress levels.

Both men and women who had access to, and made use of, reduced-hours flexible working had lower levels of biological stress markers than those who didn’t have flexible working.

We found these types of reduced-hours arrangement were more common among those in lower-paid occupations, especially among men, and among older workers of both genders.

Other types of flexible working arrangements, such as working from home, were more common among those from more advantaged social groups. But we didn’t find any association between these types of working and lowered levels of stress.

So, what has our study told us? We’ve learned a good deal about the complex relationships between social and biological factors in our lives. And, crucially for policymakers, we can see that it’s particularly important for women with childcare responsibilities to be able to access shorter working hours when they need to. For employers, this isn’t just a matter of logistics and of ensuring a stable and happy workforce – it’s also a major factor in ensuring that workers live longer and healthier lives.

Are Flexible Work Arrangements Associated with Lower Levels of Chronic Stress-Related Biomarkers? A Study of 6025 Employees in the UK Household Longitudinal Study, is research by Tarani Chandola (University of Manchester and UCL), Cara Booker, Meena Kumari and Michaela Benzeval (University of Essex) and is published in Sociology.

Woman worker

Anti-social working hours: Are they making women depressed?

The rise of globalisation and the 24/7 economy are fuelling demands for people to work long hours and weekends.  But what’s the evidence about how these ways of working link with depression? Gill Weston and colleagues from the International Centre for Lifecourse Studies in Society and Health at UCL and Queen Mary University of London found such working conditions are linked to poorer mental health in women. 

Across the globe, the effects of overwork are becoming apparent.  In eastern Asian countries the risk of death due to overwork has increased.  In the UK, work-related stress accounts for millions of lost working days every year.  

Within the EU, a significant proportion of people have to work unsociable hours – with nearly a quarter working most Saturdays and a third working at least one Sunday a month.  But despite this, there isn’t much clear evidence about the links between work patterns and mental health. 

Some studies have found a connection between unsociable work patterns and depression.  But many of the studies only focused on men, some only looked at specific types of worker or workplaces and few took account of work conditions such as whether workers had any control over how fast they worked.  

To address these gaps, we set out to look for links between long or irregular hours and depression using a large nationally representative sample of working men and women in the UK.  We particularly wanted to look at whether there were differences between men and women because research has shown that work is organised, experienced and rewarded differently for men and women, and because men and women react differently to overwork and time pressure. 

We used data from Understanding Society, which surveys people living in 40,000 households across the UK.  In particular we focused on information about working hours, weekend working and working conditions collected from 11,215 working men and 12,188 working women between 2010 and 2012.  They had completed a questionnaire designed to study levels of psychological distress.

Who works the most? 

We found men tended to work longer hours in paid work than women, and having children affected men’s and women’s work patterns in different ways: while mothers tended to work fewer hours than women without children, fathers tended to work more hours than men without children.  

Two thirds of all men worked weekends, compared with half of all women.  Those who worked all or most weekends were more likely to be in low skilled work and to be less satisfied with their job and their earnings than those who only worked Monday to Friday or some weekends 

Which workers have the most depressive symptoms? 

Women in general are more likely to be depressed than men, and this was no different in our study. 

Independent of their working patterns, we also found that workers with the most depressive symptoms were older, smokers, on lower incomes, in physically demanding jobs, and who were dissatisfied at work. 

Are long and irregular hours linked to depression? 

Taking these findings and other factors into account, when we looked at the mental health effects of work patterns on men and on women, the results were striking: while there was little or no difference in depressive symptoms between men who worked long hours and those who did not, this was not the case for women.   

Those women who worked 55 hours or more per week had a higher risk of depression than women working a standard 35-40 hour week.   

Similarly weekend working showed differences for men and women.  Compared to workers who only worked on weekdays, men who worked weekends also had a greater number of depressive symptoms, but only if they had little control at work or were dissatisfied with work.  Whereas for women,  regardless of their control or satisfaction, working most or all weekends was linked to more depressive symptoms. 

Why might women suffer more than men while working these antisocial hours?  

There might be a number of reasons why women might be more affected than men: 

  • Women who work long hours are in a minority – just four per cent of them in our sample worked 55 hours or more per week. This may place them under additional pressure. 
  • Women working longer hours tend to be in male-dominated occupations, and this may also contribute to stress. 
  • Women working weekends tend to be concentrated in low-paid service sector jobs, which have been linked to higher levels of depression. 
  • Many women face the additional burden of doing a larger share of domestic labour than men, leading to extensive total work hours, added time pressures or overwhelming responsibilities.  

What should be done about these risks? 

Our findings should encourage employers and policy-makers to think about how to reduce the burdens and increase support for women who work long or irregular hours – without restricting their ability to work when they wish to.  More sympathetic working practices could bring benefits both for workers and for employers – of both sexes. 

Long work hours, weekend working and depressive symptoms in men and women: Findings from a UK population-based study by Gill Weston, Afshin Zilanawala, Elizabeth Webb, Livia Carvalho, and Anne McMunn is published in the  Journal of Epidemiology and Community Health, which is published by the BMJ. 

Working with a long-term illness – does employment status make a difference?

Across the developed world, a growing share of the population suffers from chronic disease such as diabetes, arthritis or heart problems – in the EU, around 45 per cent of those aged 55-64 had such a disease in 2015. And that affects their ability to work: just half of those with chronic illnesses are employed, compared to three quarters of those without. But how do the self-employed cope with such conditions, when compared with those in employment? Maria Fleischmann and colleagues from the RenEWL project find these differences in work status can make a major difference.

We know that when people become chronically ill, changes in their working conditions can help them to continue working. And we also know that good working conditions – being able to control how you use your time and how you do your job, whether you make the decisions and whether you feel valued, for instance – can help all of us to stay in paid work for longer.

And of course, if you become ill you’re more likely to feel the need to take time off or maybe to give up work altogether. We wanted to compare how the employed and the self-employed adjust their working conditions when facing a diagnosis of chronic disease.

Existing research tells us that many older people work for employers, and have to ask for their approval when it comes to making adjustments to their working conditions. The self-employed, meanwhile, are much more able to make their own decisions and tend to feel they have more control over their working lives.

We looked at people’s ability to control their work: physical demands, working hours, psychological demands such as how fast they had to work, and social aspects such as whether they felt valued.

And we had a great source of data for this – the English Longitudinal Study of Ageing (ELSA), which has followed a total of almost 9,000 over-50s since 2002.

From that group we were able to find and study 1389 participants who reported no chronic diseases when they were interviewed in 2004-5 – the second wave of interviews – and who were in work.  We were then able to look at what happened to them before the seventh wave of interviews, in 2013-14.

A little over 40 per cent of our sample were in managerial or professional occupations, a quarter in intermediate occupations, and almost 30 per cent in routine and manual occupations.

After diagnosis

At each interview, respondents were asked whether they had been diagnosed by a doctor with lung disease, asthma, arthritis, cancer, high blood pressure, diabetes or high blood sugar, stroke or heart problems.

During the study period 510 of the 1389 sample members were newly diagnosed with one of those conditions. We were able to look at how they fared at work for four years after that, and we found some striking differences between how the employed and the self-employed seemed to have been treated.

The physical demands of our participants’ jobs were pretty similar before their diagnosis, for instance. But afterwards significant numbers of those who were employed said that those demands had actually increased when they were diagnosed. The self-employed, meanwhile, told us the opposite had happened to them – they reported significantly lower physical demands at work immediately after diagnosis. This effect continued for some time, though it grew less pronounced.

How could that be? We think maybe the increase in physical demands among the employed could be due to perception – similar demands might be perceived as more strenuous by the chronically ill. The self-employed, meanwhile, have more freedom to adjust those demands when they feel they need to.

The self-employed reported that their working hours dropped by an average of 2.8 hours per week on diagnosis, while those who were employed did not see a change. This effect was not statistically significant, though.

Employees found that their level of autonomy at work also dropped marginally, while for the self-employed there was no significant change. We did not find any major changes in psychological or social conditions in either group.

So, what did we learn? Essentially, that improvements in working conditions after diagnosis of chronic illness were restricted to the self-employed. So employers may need to ask themselves some hard questions – do they want to hold on to workers who become unwell? If they do, then they should consider the levels of flexibility they offer, and they should think about making adjustments for those workers if they don’t want to lose them.

In an ageing society, older people are expected to work ever longer and therefore to remain at work even when they begin to suffer from health problems. Our findings should also encourage policy-makers and governments to think about how chronically ill older adults are treated at work.

Changes in autonomy, job demands and working hours after diagnosis of chronic disease: a comparison of employed and self-employed older persons using the English Longitudinal Study of Ageing (ELSA)by Maria Fleischmann, Ewan Carr, Baowen Xue, Paola Zaninotto, Stephen A Stansfeld, Mai Stafford and Jenny Head, is published in the Journal of Epidemiology and Community Health.