Tag Archives: Mental health

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. 

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.

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.

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. 

Work stress and ill health – what’s the link?

Lots of studies have suggested stress can be a cause of ill health – and that leads to people ceasing to work before they reach retirement age. But most have offered only a snapshot on the issue. Now a new analysis of data from a major panel study by José Ignacio CuitúnCoronado and Tarani Chandola from the University of Manchester has shed new light on how work stress can affect an employee’s health over a longer period.

Many animals have the ability to adapt to environmental changes and pressures so that they’re better prepared the next time they happen. Bears can put on fat as winter approaches, for instance, to help them stave off hunger and stay warm.

And human beings can do this too. Stressful situations trigger chemical responses which can help to give us extra resources when things are tough. Our neuroendocrine systems, for instance, trigger hormonal responses which enhance our physical performance when we need it most.

But these valuable systems can have a downside. In our research, we wanted to look at how repeated exposure to stressful situations might contribute to health problems, particularly in people nearing the end of their working lives. We call this stress-induced effect ‘Allostatic Load’ – the wear and tear” on the body that accumulates as an individual is exposed to repeated or chronic stress because of fluctuating hormonal responses.

Given that many governments are looking for ways to extend working lives, there’s particular interest in finding out how stress can affect the health of older workers.We were able to tap into a rich source of information – the English Longitudinal Study of Ageing (ELSA), which has followed a representative sample of almost 10,000 over50s since 2002.

These participants have been interviewed regularly and one of the things they’ve been asked to report is whether they’ve experienced a sense of imbalance between the effort they put into their jobs and the rewards they get out.

Health testing

This gave us a sample of 2663 older adults, all over 50 and living in England, who’d reported these feelings at least once and who’d been assessed as having had an adverse reaction to them. We wanted to know whether repeated episodes had a bigger effect than just one, and whether the effect would be just as strong for past episodes as it was for more recent ones.

Between 2004-5 and 2014-16 the group were asked about stress at work, but they also underwent physical tests to see how the various systems in their bodies were bearing up.

They were visited by nurses who carried out a battery of tests including taking hair samples to assess levels of the stress-related hormone cortisol, carrying out blood pressure checks to provide information on their cardio-vascular systems, white blood cell counts to assess their immune systems and cholesterol checks on their metabolic systems. Participants also had measurements taken of their waist to height ratios – a good indicator of coronary heart disease risk factors.

Overall, we found the more occasions of work-stress a participant had reported, the greater their ‘Allostatic Load’ index – that is, the greater the amount of biological wear and tear. Moreover, the evidence suggests that employees who had experienced stress more recently (towards the end of their working career)had higher levels of health risk when compared to those who had experienced it earlier in their careers.

This suggests there is an association between repeated reports of stress at work and biological stress mechanisms, which in turn could lead to stress-related disorders such as coronary heart disease, type-2 diabetes or depression. This also suggests that previous cross-sectional studies which reported small or inconsistent associations may have suffered because they were only measuring one effect at one time.

Work-related stress is one of the reasons for labour market exit – and our findings would suggest that earlier, snapshot studies may have underestimated the true effect of work-related stress on health over a lifetime.

As this is an observational study, it is not possible tomake any causal claims. Also, there may be other factors that we have not taken into account that may explain the association between stress and disease risk. For example, sleep problems may be relevant – though they may also be part of the journey from stress to ill-health.

But equally it is possible that cumulative exposure to work stress is resulting in damage to employees’ physical health, which is then leading to disability and an early exit from the world of work. So, if we want to extend working lives then reducing work-related stress could be one of the keys to achieving that goal.

Allostatic Load and Effort-Reward Imbalance: Associations over the Working-Career, by José Ignacio Cuitún Coronado, Tarani Chandola and Andrew Steptoe, is published in the International Journal of
Environmental Reasearch and Public Health
.

Working after retirement age: who benefits?

Recent reforms have made it unlawful for employers to force their workers to retire. So what are the reasons why some people stay on after state pension age while others choose to leave? How do those decisions affect quality of life for those who stay, and for those who go? A study by Giorgio Di Gessa and colleagues at King’s College London and the University of Manchester sheds new light on the issue.

We know that more of us are working after we reach retirement age – but until now we haven’t known much about how people make that decision, or about what effect it has on their sense of wellbeing afterwards.

In our research, we used English data from a panel study of older people to find out more about who chooses to stay on in work and why. We then went on to ask whether those who chose to work felt differently about their lives when compared with those who felt they had to work.

We took a representative sample of 2,500 men aged 65 to 74 and women aged 60 to 69 who had previously been in work, and we found one fifth of them still had paid jobs. Of those, two thirds had chosen to continue to work because they enjoyed their jobs or because they wanted to keep fit and active. The other third said they worked for financial reasons: either they couldn’t afford to retire or they wanted to improve their pension provision for later.

We placed the retired respondents into three groups: Those who had had a ‘normal’ retirement when they became eligible for a state pension (28 per cent), those who felt they had to retire because of ill-health or redundancy (2 per cent); and those who retired voluntarily – because they could afford to do so or because they wanted to spend more time with their family, for instance (28 per cent).

Quality of life

On average, those who had retired experienced a lower quality of life, when measured on the CASP-19 scale for older people. The highest quality of life was reported by those who had stayed in work voluntarily, while the lowest was reported by those who had retired involuntarily. The gap in quality of life between these two groups is similar to the one observed between respondents who said they had a long-standing illness and those who did not. As expected, respondents who were financially better off also had higher quality of life scores.

When we considered changes in these CASP-19 scores over time, we found that on average people experienced a drop in their quality of life over a six-year period between two ‘waves’ of the study: about a quarter experienced a decrease of 5 points or more whereas just over 16% experienced an improvement of 5 or more points. Those working voluntarily experienced a slight increase in their quality of life when they eventually retired. On the other hand, the wellbeing of those who were working out of necessity did not improve after retirement.

Health benefits

As one might expect, the scores improved among those whose health got better after retirement, and worsened among those whose health deteriorated.

It’s worth noting that our study sample is skewed towards the more advantaged – the proportion with no qualifications is significantly lower than in the census. It is therefore likely that our study underestimates the percentage of people who work out of financial necessity.

What does our study tell us about working after retirement age? In particular, it reminds us how important it is for people to feel they have control over these key decisions about their lives. Those who continue working because they have to have lower quality of life than those who continue working because they want to – and even once those people have retired, this wellbeing gap is likely to persist.

We know that people who experience a higher quality of life tend to be healthier and to live longer.

Government initiatives aimed at helping workers maintain control over their decisions are worthwhile – but policymakers should also consider how people might be given more support throughout their lives to protect their financial and personal wellbeing if they do have to work for longer.

Further information

The decision to work after State Pension Age and how it affects Quality of Life: Evidence from a 6-year English panel study is a research paper by Giorgio Di Gessa of King’s College London, Laurie Corna of King’s College London, Debora Price of the University of Manchester and Karen Glaser of King’s College London. It is published in the journal Age & Ageing.

Never too early to intervene to get us working longer

Working for longer is something we are all having to get our heads around. It’s certainly a priority for the Government, which wants to encourage more older people into satisfying jobs that will help them stay happy and healthy as they age. For older people already in good jobs that they enjoy, who have been fit and active for most or all their life, this could be a great opportunity for them and their families. Of course that’s not the case for everyone. Dr Charlotte Clark has been looking at what having poor mental health as a child could mean for our working life in our mid fifties. Here she explains why policy makers and businesses need to pay close attention to the mental wellbeing of the nation if they want to extend people’s working lives successfully.

Working beyond traditional retirement age has been the focus of much attention in recent years as policy makers, businesses and working people across the UK get used to the idea that more of us need to work for longer to take account of the fact that more and more of us are living longer and that this reality comes at a cost.

As things stand, by their mid fifties, many people are not in work because of early retirement, long-term sickness or disability, being or becoming unemployed or because they are long term homemakers. So the onus for working longer tends to fall on those who stay employed through all or most of their lives. But could more be done to encourage and support those most likely not to be working at 55 to do so and then to continue to do so?

Looking right across people’s lives to track what may have influenced a person to leave or not be working at 55 provides us with a much clearer and more nuanced picture than a simple snapshot in time. We wanted to see whether having poor mental health as a child or as an adult might be an important part of that picture and give us some ideas for interventions that could extend the working lives of this group of people in a way that would benefit them and society more widely.

Increasing psychological support

It’s fair to say that the Government’s ambitions to get more people working for longer have been laid out quite clearly already, as has their commitment to putting people’s physical and mental health on an equal footing. Saying that, their commitment has been called into question recently in a report from The King’s Fund, which says parity is a long way off.

When it comes to specific groups not working, the Department for Work and Pensions has tended to focus its attention on benefit claimants rather than other groups who, for one reason or another may choose not to work – housewives and husbands for example.

Government initiatives to try to help people with mental health problems find work have included the ‘Improving Access to Psychosocial Therapies’ (IAPT) programme, which has increased provision of therapies for benefit claimants with depressive and anxiety disorders.

Evaluations of IAPT suggest that ‘Nationally, of [adult] people that finished a course of treatment in IAPT, 45% recover. . . and a further 16% show reliable improvement’. Encouraging results that have led to modest increases in employment, and it’s hoped there will be more positive news on this front.

However, things don’t look quite so encouraging when it comes to younger people with mental health problems and that’s what our research is shining a spotlight on. It’s also an area we believe should be a focus for policy makers and those working with young people including parents and schools. After all, successfully extending people’s working lives can only be done once they successfully enter and then remain in employment. This is less likely for youngsters with poor mental health.

55-year survey

We used information from the National Child Development Study which has followed the lives of thousands of people born in 1958, and collected detailed information about their lives and circumstances.

This included their employment situation and, first and foremost, we were able to see that, at age 55, nearly 19 per cent of the 9,000 participants in the study were not working: 2.8 per cent were unemployed, 5.2 per cent were permanently sick, 3.3 per cent were retired and 7.5 per cent were homemaker/other.

From a very young age, the study also collected information on whether the individuals in the study exhibited signs of depression or worry, whether they were hostile, disobedient or aggressive.

Even when we took account of a wide range of other things such as whether they suffered poor mental health as young or older adults, numbers of other children in the household, whether their partner was employed, qualifications etc. the association with problems as a child were still really strong.

Drilling down into whether those mental health issues were ‘internalized’ or ‘externalized’, we were able to see that those who were depressed or anxious as children were about one and a half times more likely to be unemployed or permanently sick as their peers without problems.

It was a similar story for those who had shown externalised signs such as aggression. They were more than twice as likely to be unemployed or permanently sick, and also more likely to fall into the homemakers/other category too.

Interestingly there was no strong link between poor mental health in childhood and taking early retirement or being employed part-time.

Children’s mental health

Of course there is a lot more at play in children’s lives than we have taken account of in this study. Nevertheless, it is clear from our research that addressing the mental health problems of the very youngest in society could and should be an area for focus and schools, together with parents and those with a responsibility for the wellbeing of young children have key roles to play here.

It seems it is never too early to intervene proactively to try to help young people get and stay on a healthy happy path that will lead to them a productive and satisfying working life that extends well beyond the age of 55. Equally, given that people identifying themselves as ‘homemakers’ rather than unemployed are the largest group not working at age 55, policy makers could consider ways to get this economically inactive group into the workplace, in tandem with its efforts to support the mental health of those people on benefits.

There is also a message here for policy makers about just how important it is to make those promises about parity of esteem between mental and physical health a reality sooner rather than later.

Impact of childhood and adulthood psychological health on labour force participation and exit in later life is research by Charlotte Clark and colleagues and is published in Psychological Medicine. The research is part of the ESRC funded Research on Extended Working Lives (RenEWL) programme at UCL.