Work organization, area labor-market characteristics, and depression among U.S. nursing home workers: a cross-classified multilevel analysis

Associations between forms of work organization that follow globalization and depression were examined in U.S. nursing home assistants. A cross-sectional study of 539 nurse assistants in 49 nursing homes in three states in 2000 assessed nursing home ownership type, managerial style, wage policy, nurse assistants' emotional stresses, and area labor-market characteristics (county income inequality, median household income, and social capital) in relation to the prevalence of depression among the nurse assistants. A cross-classified multilevel analysis was used. For-profit ownership, emotional strain, managerial pressure, and lack of seniority pay increases were associated with depression. Labor-market characteristics were not associated with depression once work organization was taken into account. The deregulation of the nursing home industry that accompanies globalization is likely to adversely affect the mental health of nursing home assistants.