Tag Archives: Well-being

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

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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. 

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Retirement: is it good for your mental health?

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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.

 

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

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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.

Retirement: good or bad for your heart?

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Across the globe, more people are spending more time in retirement than ever before. So staying healthy in later life is critical. Yet political debates on ageing tend to ignore a growing body of research on how retirement can affect our health. Baowen Xue and colleagues from the Department of Epidemiology and Public Health at UCL looked at links between retirement and cardio-vascular disease – and found unexplained differences between Europe and the US.

Is retirement good for your heart, or bad for it? The question is an important one because cardio-vascular disease (CVD) is the biggest cause of death globally and costs health services a huge amount of money.

Some studies have shown retired people have a higher risk of being diagnosed with CVD than those who are still working. But until now the evidence has been unclear.

We set out to review evidence from across the world, so that we could help to build a more accurate picture of whether, and how, retirement might affect our cardio-vascular health. As CVD is linked to our lifestyle, diet and other behaviour, there are lots of ways in which changes that take place in retirement might have an effect – both negative or positive.

Longitudinal studies

We looked for longitudinal studies that could help answer our questions, and found 82 which measured risk factors for CVD and 14 which looked at actual incidence of CVD. The second set of 14 papers provided the answer to our first question – does retirement affect our cardio-vascular health?

The answer revealed a major difference between the USA and Europe. Studies conducted in the US showed no significant effect, good or bad, on retirees’ cardio-vascular health. In Europe, meanwhile – with the exception of France – studies consistently showed a link between retirement and an increase in CVD.

Data from the British Regional Heart Study, for instance, showed that healthy men who retired before the age of 60 were more likely than others to die from circulatory disease within five and a half years. Fatal and non-fatal CVD was also more common among retirees in Denmark, Greece, Italy and the Netherlands.

Why might this be? Could there be cultural or lifestyle differences between Europe and the US which might cause this difference? We took a systematic look at the risk factors.

Weight gain

First, we looked at weight gain. If Americans were less likely to put on weight after retirement compared to Europeans, that might help to explain the difference. But when we looked at this, we found that body mass index (BMI) actually increased after retirement in the USA – and also Japan -but did not change in England, Denmark, France, Germany, Switzerland or Korea. While those who do physically demanding jobs are likely to put on weight after they retire, most people aren’t.

Could it be that retired people generally do less exercise – another risk factor – in Europe? The studies suggest that’s not the reason. While many retirees did more physical activities, they also spent more time sitting still – so the effect was a balanced one. For instance, a retiree might play more golf, but also watch more television.

Do retired people perhaps smoke more, we asked? Again, there were contradictory results but 12 out of 14 studies either showed no effect or showed retirement led to people smoking less.

Perhaps retired people in Europe drink more, then? Again, this couldn’t be identified as the reason. Studies in Australia, the UK, Japan and the USA suggested there was no association between retirement and alcohol consumption.

Diet is another possible cause of CVD, but again, there was no clear pattern of between retirement and diet emerged from reviewed studies.

No benefits

So the picture isn’t straightforward, and we don’t have answers as to why retirement might put Europeans at risk but not Americans. What we can say, though, is that none of the studies we looked at found any beneficial effects of retirement on CVD.

Apart from a decrease in smoking, there wasn’t evidence of any general ‘relief’ effect of retirement on people’s cardio-vascular health – so the supposition that working could be bad for our health and therefore retirement better for it doesn’t necessarily hold true.

However, studies that showed retirement brought negative health effects should be interpreted with caution. Many assessed the health effects of retirement by comparing retired people with employed people – and we know people who stay in the labour market are generally healthier than retirees. We do know people who have CVD, diabetes or hypertension are more likely to retire.

What our review has done is to reveal the complex nature of the underlying mechanism through which retirement might impact on the risk factors for CVD. Different people react differently to retirement, depending on their life experiences and the cultural and policy environments in which they live. So there isn’t one global solution to any of this – each country needs to plan its citizens’ retirement according to their individual needs.

The impact of retirement on cardiovascular disease and its risk factors: A systematic review of longitudinal studies, by Baowen Xue, Jenny Head and Anne McMunn, is published by The Gerontologist.

Is working flexibly good for your health?

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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.

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

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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.

 

Being a carer: a sizeable problem

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Millions of people combine work with caring responsibilities – looking after an older relative, a disabled child or a partner, for example. But what are the effects on the health of those who do this? Rebecca Lacey and colleagues from the ESRC International Centre for Lifecourse Studies at UCL have found that younger women and those who juggle working and caring are at higher risk of being obese.

The number of people who care for others without pay is huge – and it’s growing. In the United Kingdom there are more than seven million such carers – around one in five adults. About six in 10 of them are women.

We know from existing studies that becoming a carer can mean having to stop work – but an ageing society, extended working lives and cuts in social care funding mean those doing this unpaid caring are also increasingly often juggling their caring responsibilities and paid work.

Caring is linked to behaviour which leads to health risks, as well as to poorer health. Carers can suffer from the deterioration of their relationships with those they care for – particularly when the person needing to be cared for has dementia. They have to juggle caring and other responsibilities, resulting in little time for themselves: this means they may have less time to exercise and to eat healthily. They can also suffer additional financial burdens. All this can lead to measurably higher levels of stress – for example, research has shown that carers have higher levels of cortisol, which can cause the body to lay down fat. We wanted to know more about whether particular groups of carers were at increased risk of being obese.

We were able to use a major study, Understanding Society, which has followed a representative sample of 40,000 UK households since 2009 and which is also linked to another study, the British Household Panel Survey, which first started in 1991.

This enabled us, for the first time, to look at obesity amongst UK carers from the age of 16 onwards: previous studies had only looked at older carers or carers of those with specific conditions such as dementia.

We had information on 9,421 participants who had also been visited by nurses for health checks between 2009 and 2012, of whom 1,282 were carers. We were able to look at factors such as Body Mass Index (BMI) alongside whether participants had an illness or disability, their education, occupation, household income, socioeconomic position, partnership status and whether they were parents. We looked at how many people they cared for, and for how many hours in the week. And we also looked at whether they were also doing paid work, and if this was full or part-time.

Nurse visits were used to measure participants’ weight, percentage of body fat and BMI.

Women as carers

Roughly in line with national figures, we found women were more likely to be carers and to put in more hours of care each week. Female carers were more likely than their male counterparts to have children at home and also to be working outside the home – this may be because male carers tend to be older.

When we looked at whether men’s caring was linked to obesity, we did find an association – men who were carers had higher BMIs and larger waists. However, once we had taken differences in age into account we didn’t find this statistically significant.

But when we looked at women, the story was rather different. In contrast to men, women who were carers were significantly more likely to have larger waists or a higher percentage of body fat. And there was a particularly strong effect when it came to women who combined caring with full-time work: amongst young women aged 16-44 who were in full time work, those who were carers had waists 4cm larger, on average, than those who were not carers. Those who were caring and working beyond the age of 65 were also larger, with higher proportions of body fat and bigger waists.

Why is this? Why would women’s health potentially suffer a greater adverse effect than men’s from being a carer? It seems the strains on them may be greater – younger women may be working outside the home and may also be caring for children, for instance. They may lose touch with friends who have more freedom to enjoy leisure time. Carers are likely to have less time to spend exercising or to prepare healthy and nutritious meals – and those combining several caring roles with working life are likely to be particularly hard-hit.

This matters, not least because the scale of the issue is so great – and because the UK relies so heavily on its citizens to look after their own – carers have been estimated to save the UK economy £132 billion per year. We need to make this largely hidden army of unpaid carers a public health priority.

Informal caregiving and markers of adiposity in the UK Household Longitudinal Study is research by Rebecca Lacey, Anne McMunn and Elizabeth Webb of the ESRC International Centre for Lifecourse Studies, University College London.

Use it or lose it: fact or fiction?

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We’ve probably all heard the phrase: “Use it or lose it” –  the belief that if we don’t keep our brains active, particularly as we grow older, our mental abilities will fade. Or that, conversely, if we stay mentally active we can hold back the inevitable decline that comes with ageing. But is that really true, and how might we differ from one another in this respect? A new study by Baowen Xue and colleagues from the RenEWL project at UCL tests the hypothesis.

If, as the theory goes, a lack of mentally challenging activity can lead to a loss of ability, then retirement might increase that risk. And previous studies suggest that may be the case – we know that those who retire later have better cognitive function and a lower risk of dementia.

In our study we set out to learn whether the sorts of activities we all do at work could benefit older peoples’ memories, and whether certain factors could help to preserve their abilities.  There’s a theory that some of us build up ‘reserves’ which can provide us with a buffer against later decline: if we have lots of mental stimulation as children, for instance, or if we have mentally demanding jobs as adults.

We wanted to test the ‘use it or lose it’ theory, and also to find out whether those who work in high-grade jobs might be at lower risk of cognitive decline after retirement.

The subjects for our research were 3433 people who participated in the Whitehall II Study, which followed a cohort of civil servants for more than 30 years, beginning when they were aged between 35 and 55.

Cognitive ability tests

We were able to look at measurements of the participants’ cognitive abilities from up to 14 years before they retired and for up to 14 years afterwards.

The participants were tested on four different measures. Their verbal memory was assessed through a test in which they listened to a list of words and were then given two minutes to write down as many as possible. Verbal fluency was judged in two ways – participants were asked to write as many words beginning with ‘S’ as they could within one minute – ‘phonemic’ fluency – and also to recall as many animal names as possible within the same time – ‘semantic’ fluency. Finally, abstract reasoning – the ability to identify patterns and rules in data and to use them to solve problems – was measured through a four-part test known as AH4.

We found that participants’ abilities decreased over time on all four measures.  But the decline in verbal memory scores was 38 per cent faster after retirement than it was before, even after taking account of that age-related deterioration. Those who worked in higher-grade jobs also had some protection while they were still working, but this effect was lost when they retired.

Trajectories of verbal memory by employment grade

However, while retirement had a significant impact on verbal memory, particularly for those in more senior jobs, it did not make a difference when it came to the other tests we looked at – verbal fluency and abstract reasoning. Nor were there any significant differences in verbal memory decline between men and women in our sample.

Our findings are consistent with the theory of ‘mental retirement’ – suggesting that the work environment can be more mentally stimulating than the leisure environment as a retiree. As well as losing the direct stimulation they get from work, retirees may also suffer from indirect effects – from losing the need for self-discipline and organisation, for example, as well as from having fewer opportunities to communicate and collaborate with others. For instance, social networks could be more extensive during employment than they are later in life.

The finding that employees in high grade jobs suffer smaller declines before retirement also points to a wider significance – all of us can benefit, in terms of memory, from mentally stimulating activities.

So, do our findings support the ‘use it or lose it’ theory? Yes, they do. They suggest that failing to keep mentally active may lead to faster cognitive decline after retirement.

Effect of retirement on cognitive function: the Whitehall II cohort study, by Baowen Xue, Dorina Cadar, Maria Fleischmann, Stephen Stansfeld, Ewan Carr,Mika Kivimäki, Anne McMunn and Jenny Head, is published in the European Journal of Epidemiology.

Working after retirement age: who benefits?

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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

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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.